Water, sanitation, and hygiene service conditions in primary schools in Dhaka: A school-based cross-sectional study

BACKGROUND: School water, sanitation, and hygiene services (WASH) are crucial for child health and education. In Bangladesh, WASH coverage is generally high, yet challenges remain in cleanliness, inclusiveness, and menstrual hygiene management in primary schools. This study evaluated WASH service levels and operational performance in government primary schools in Dhaka District. METHODS: In 2025, we conducted a cross-sectional survey involving 100 randomly selected government primary schools. Data were gathered through interviews and observations, and WASH service levels were classified using WHO/UNICEF criteria. We created domain-specific performance scores for water, sanitation, and handwashing based on functionality, accessibility, availability, quality, and cleanliness, combining these into an overall WASH performance score. Ordinary least squares regression with robust standard errors was used to analyze associations with school characteristics. RESULTS: Most schools met basic drinking-water standards (92/100) and had high water performance scores (mean 93/100, SD 15). In contrast, sanitation services were weaker, with only 39% meeting basic standards and a mean sanitation score of 71/100 (SD 15). Hygiene was the weakest operational domain, with 58% meeting basic standards and a mean handwashing score of 43/100 (SD 42), largely due to non-availability of soap. In multivariable regression analyses, more frequent WASH teaching was associated with higher handwashing and overall WASH performance scores. CONCLUSION: Drinking-water access was generally good, but sanitation quality, sanitation-related inclusiveness, and handwashing remained inadequate. Strengthening maintenance, ensuring soap availability, improving accessibility and menstrual hygiene facilities, and integrating WASH into school teaching may help improve school WASH conditions.