Children are considered as the most vulnerable group of individuals affected by lack of water, sanitation and hygiene facilities which predisposes them to a wide range of enteric diseases particularly diarrhoeal and parasitic infections. School-based WASH interventions typically aim to reduce the incidence of hygiene related diseases, improve school outcomes for pupils and influence hygiene practices of families and the wider community. This study intends to investigate the impact and effectiveness of the teacher-led school- based hygiene intervention on handwashing practices and prevention of diarrhoea, undernutrition, and pneumonia among school children in primary schools in Lagos, Nigeria.

This research project will be conducted as a school cluster-randomized study with 50 randomly selected low-cost private primary schools in the Lagos region. The expected number of schools included is 25 intervention and 25 control schools (schools that have not received the intervention but that are similar enough to the intervention schools to facilitate comparison). Quantitative data will be collected on the implementation and impact of the intervention, and qualitative data will be collected to explore teacher perceptions of best WASH practices. The intervention WASHED-UP (Water, Sanitation and Hygiene Education Against Diarrhoea, Undernutrition and Pneumonia) will be implemented as a 2-week health awareness campaign that will train children and teachers to deliver the program on hygiene promotion in schools. Intervention components include the presentation of interactive stories, games and songs, nutrition education, participatory food demonstration classes using food models, the use of animated characters representing occasions for handwashing with soap, practical and visual demonstrations to communicate the presence of germs and handwashing with soap removes them in comparison to only water, the use of daily diaries by students to record their handwashing behaviour and making a public commitment to handwashing with soap as a club. Digital surveys and implementation checklists will be used to collect the impact (survey) and implementation data, respectively and audio recordings of focus groups will be used to collect data related to stakeholder perceptions of the WASHED-UP program. For school absence, data are planned to be obtained from paper-based school records, including registers and sick-bay records. Approximately 3500 children will be recruited for data collection which will involve administering questions on socio-demographics, illness, reasons for school absence, disease history, sanitation behaviour at home and school and attendance at WASH clubs. At the end of the study all control schools will receive the intervention subsequently.

Data will be collected in three phases:

• Phase 1: February to March 2024 and will consist of a baseline survey.
• Phase 2: May to June 2024 and will consist of an implementation phase in the form of the intervention in the randomly selected 25 primary schools in Lagos.
• Phase 3: September to November 2024 and will consist of three months of follow-up post-implementation and comparison to control schools. Data will be collated using the Kobo Toolbox survey tool and analyzed with Statistical Package for Social Sciences (SPSS).

Inclusion Criteria:

• Schools are located in Lagos state
• Schools must have functional WASH facilities:
• Schools must have access to a water source
• Schools have school registers

Exclusion Criteria:

• School authorities refuse to participate
• Schools which have received WASH intervention

Essential Study protocol and data collection tools will be shared with other researchers

June to December 2024

The intervention is WASHED-UP (Water, Sanitation and Hygiene Education Against Diarrhoea, Undernutrition and Pneumonia), a 2-week health awareness campaign that will train children and teachers to deliver the program on hygiene promotion in schools.