Assessment of Water, Sanitation and Hygiene (WASH) of living surroundings and school environment among adolescent high school students in Northwest Ethiopia: mixed method study

Abstract

BACKGROUND: School-based WASH programs in low- and middle-income countries showed significant impacts on health, nutrition and education. Poor WASH practices contributed to malnutrition, anemia, infections, and gender inequities, particularly among adolescents. Inadequate facilities, sociocultural and economic disparities are key challenges. This study aimed to assess the availability, quality, accessibility and practice of WASH in the living surroundings and school environments among adolescent high school students in the study area. METHODOLOGY: This study employed a convergent explanatory mixed-method design across four high schools in Machakel district among high school students during the 2022/2023 academic year. Purposive sampling technique was applied for qualitative data collection including thirty-three key informants and six focus group discussions. Using proportional random sampling technique, 410 students were sampled and surveyed. Data collection utilized surveys, interviews, focus groups, and school WASH observations. WASH was categorized as "good" or "poor" based on mean scores of adolescent WASH. Quantitative data were analyzed using descriptive statistics and logistic regression. Qualitative findings were triangulated for a comprehensive understanding of adolescent WASH. Determinant factors were identified through multi-variable binary logistic regression (p < 0.05). RESULT: Adolescent high school students in the district faced poor water access (70.2%) and inadequate sanitation (74.9%). Nearly 90% rely on untreated water sources, whereas 21.2% of students rely on passive water treatment techniques. Most handwashing stations were dysfunctional and lacked soap, undermining hygiene practices. Poor WASH, experienced by over 70% of students, was compounded by water shortages, inadequate infrastructure, and cultural norms limiting hygiene practices. School location and living arrangements are determinants of WASH of adolescent students. Students from Shelel high school had higher odds of having a favorable WASH compared with those from Amanuel high school. The adjusted odds ratio (AOR) was 2.15 (95% CI: 1.03-4.48, p = 0.041). Living arrangement was also independently associated with adolescent WASH. Students living with their family had significantly higher odds of favorable WASH compared with those living alone, with an AOR of 2.58 (95% CI: 1.30-5.11, p = 0.006). CONCLUSION: The study in the district revealed critical gaps in WASH among high school students, posing serious health and educational challenges. Water accessibility is inadequate with poor treatment practice. Female students faced gender-specific issues, including poor menstrual hygiene facilities. Socioeconomic disparities amplify these problems, particularly for those students living alone away from family. Integrated and contextualized WASH improvements are needed to address these issues and enhance students' health and overall well-being.