Assessing the Impact of Teacher-Led School-based Hygiene Intervention on Children's Handwashing Practices for Childhood Disease Prevention in Lagos, Nigeria: A Cluster Randomised Control Trial

Assessing the Impact of Teacher-Led School-based Hygiene Intervention on Children's Handwashing Practices for Childhood Disease Prevention in Lagos, Nigeria: A Cluster Randomised Control Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing the Impact of Teacher-Led School-based Hygiene Intervention on Children's Handwashing Practices for Childhood Disease Prevention in Lagos, Nigeria: A Cluster Randomised Control Trial Cassandra Akinde, Adepeju Adeniran, Osaruese Egharevba, Daniel Rattner, and 21 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8340366/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Poor hand hygiene contributes significantly to preventable childhood diseases in Nigeria. Teacher-led school-based interventions offer a promising approach to improve childhood hygiene behaviours. This study assesses the impact of such an intervention on handwashing practices among schoolchildren in Lagos, Nigeria. Methods A cluster randomised controlled trial was conducted from January to October 2024 among 3,458 pupils (primaries 1–6) in 50 schools across four LGAs in Lagos State. 25 schools received the teacher-led WASHED-UP hygiene intervention, while 25 served as controls. Data on handwashing knowledge, practices, and absenteeism were collected at baseline and endline using structured questionnaires and observational checklists. Intervention effects were analysed using multilevel mixed-effects linear and logistic regression models, adjusting for clustering and baseline covariates (p < 0.05). Results Although 50 schools were initially enrolled as planned, 5 withdrew after baseline, resulting in 45 schools with 2,300 pupils included in the analysis. Therefore, of the eligible schools, 45 participated (25 intervention, 20 control), enrolling 2,300 pupils at baseline (mean age = 8.4 ± 1.8 years). Baseline knowledge scores were slightly higher in the control group (20.26 ± 3.29) than in the intervention group (19.81 ± 3.31; p = 0.001). At endline, knowledge scores were comparable (control: 19.91 ± 3.54; intervention: 20.08 ± 2.99; p = 0.246). Handwashing practice scores improved in both groups but were significantly higher in the intervention group at both baseline (16.26 ± 3.28 vs 14.22 ± 2.93; p < 0.001) and endline (16.81 ± 3.81 vs 14.94 ± 4.55; p < 0.001). The proportion of pupils with good handwashing practice increased from 32.0% to 40.7% in the intervention group, compared to 8.4% to 26.5% in the control group (χ² = 63.1; p < 0.001). Correlation between knowledge and practice strengthened post-intervention (r = 0.51; p < 0.001), indicating positive behavioural change. Conclusions The study showed that school-based interventions have a significant impact on shaping health behaviours and promoting child well-being. It unravels the importance of integrating structured WASH education into Nigeria’s primary school curriculum as a scalable strategy to improve hygiene practices and reduce the burden of preventable diseases among school-aged children. Health Hand hygiene Schools WASH Childhood Illness Prevention Children School Absenteeism Full Text Additional Declarations No competing interests reported. Supplementary Files drivedownload20251210T184737Z3001.zip SupplementaryMaterial2RespondentsDemographicsTable1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8340366","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":559915317,"identity":"7acb101e-254f-47d4-a0f6-a1ff2122658f","order_by":0,"name":"Cassandra 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Trial","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health, Hand hygiene, Schools, WASH, Childhood Illness Prevention, Children, School Absenteeism","lastPublishedDoi":"10.21203/rs.3.rs-8340366/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8340366/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePoor hand hygiene contributes significantly to preventable childhood diseases in Nigeria. Teacher-led school-based interventions offer a promising approach to improve childhood hygiene behaviours. This study assesses the impact of such an intervention on handwashing practices among schoolchildren in Lagos, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cluster randomised controlled trial was conducted from January to October 2024 among 3,458 pupils (primaries 1\u0026ndash;6) in 50 schools across four LGAs in Lagos State. 25 schools received the teacher-led WASHED-UP hygiene intervention, while 25 served as controls. Data on handwashing knowledge, practices, and absenteeism were collected at baseline and endline using structured questionnaires and observational checklists. Intervention effects were analysed using multilevel mixed-effects linear and logistic regression models, adjusting for clustering and baseline covariates (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAlthough 50 schools were initially enrolled as planned, 5 withdrew after baseline, resulting in 45 schools with 2,300 pupils included in the analysis. Therefore, of the eligible schools, 45 participated (25 intervention, 20 control), enrolling 2,300 pupils at baseline (mean age\u0026thinsp;=\u0026thinsp;8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 years). Baseline knowledge scores were slightly higher in the control group (20.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29) than in the intervention group (19.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31; p\u0026thinsp;=\u0026thinsp;0.001). At endline, knowledge scores were comparable (control: 19.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54; intervention: 20.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99; p\u0026thinsp;=\u0026thinsp;0.246). Handwashing practice scores improved in both groups but were significantly higher in the intervention group at both baseline (16.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28 vs 14.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and endline (16.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81 vs 14.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The proportion of pupils with good handwashing practice increased from 32.0% to 40.7% in the intervention group, compared to 8.4% to 26.5% in the control group (χ\u0026sup2; = 63.1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Correlation between knowledge and practice strengthened post-intervention (r\u0026thinsp;=\u0026thinsp;0.51; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating positive behavioural change.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe study showed that school-based interventions have a significant impact on shaping health behaviours and promoting child well-being. It unravels the importance of integrating structured WASH education into Nigeria\u0026rsquo;s primary school curriculum as a scalable strategy to improve hygiene practices and reduce the burden of preventable diseases among school-aged children.\u003c/p\u003e","manuscriptTitle":"Assessing the Impact of Teacher-Led School-based Hygiene Intervention on Children's Handwashing Practices for Childhood Disease Prevention in Lagos, Nigeria: A Cluster Randomised Control Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-15 13:03:28","doi":"10.21203/rs.3.rs-8340366/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"241319c4-06dd-4de2-975f-ec0c74227952","owner":[],"postedDate":"December 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-06T06:41:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-15 13:03:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8340366","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8340366","identity":"rs-8340366","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}