Diseases related to inadequate water, sanitation and hygiene are a huge burden in developing countries. It is estimated that 88% of diarrhoeal disease is caused by unsafe water supply, and inadequate sanitation and hygiene (WHO, 2004c). Many schools serve communities that have a high prevalence of diseases related to inadequate water supply, sanitation and hygiene (particularly lack of hand-washing), and where child malnutrition and other underlying health problems are common. If everyone in the world had access to a regulated piped water supply and sewage connection in their houses, 1863 million days of school attendance would be gained due to less diarrhoeal illness (WHO, 2004c).
Schools, particularly those in rural areas, often completely lack drinking-water and sanitation facilities, or have facilities that are inadequate in both quality and quantity. Schools with poor water, sanitation and hygiene conditions, and intense levels of person-to-person contact are high-risk environments for children and staff, and exacerbate children’s particular susceptibility to environmental health hazards.
These guidelines are designed to help strengthen water supply, sanitation and hygiene measures in particular, while recognizing the importance of, and links with, other areas of environmental health, such as air quality and physical safety.
Children’s ability to learn may be affected in several ways. Firstly, helminth infections, which affect hundreds of millions of school-age children, can impair children’s physical development and reduce their cognitive development, through pain and discomfort, competition for nutrients, anaemia, and damage to tissues and organs. Long-term exposure to chemical contaminants in water (e.g. lead and arsenic) may impair learning ability. Diarrhoeal diseases, malaria and helminth infections force many schoolchildren to be absent from school.
Poor environmental conditions in the classroom can also make both teaching and learning very difficult. The effect of disease in teachers — impairing performance and increasing absenteeism — also has a direct impact on learning, and teachers’ work is made harder by the learning difficulties faced by schoolchildren.
Gender and disability
Girls and boys, including those with disabilities, are likely to be affected in different ways by inadequate water, sanitation and hygiene conditions in schools, and this may contribute to unequal learning opportunities. For example, lack of adequate, separate private and secure toilets and washing facilities may discourage parents from sending girls to school. In addition, lack of adequate facilities for menstrual hygiene can contribute to girls missing days at school; this can even lead girls to drop out of education altogether at puberty. Toilets that are inaccessible often mean that a disabled child does not eat or drink all day to avoid needing the toilet, leading to health problems and eventually to their dropping out of school altogether.
The wider community
Children who have adequate water, sanitation and hygiene conditions at school are more able to integrate hygiene education into their daily lives, and can be effective messengers and agents for change in their families and the wider community. Conversely, communities in which schoolchildren are exposed to disease risk because of inadequate water supply, sanitation and hygiene at school are themselves more at risk. Families bear the burden of their children’s illness due to bad conditions at school.
The hygiene behaviours that children learn at school — made possible through a combination of hygiene education and suitable water, sanitation and hygiene-enabling facilities — are skills that they are likely to maintain as adults and pass on to their own children.