Assessing and comparing Knowledge, Attitude, and Practices related to Water, Sanitation and Hygiene Among Government and Non-government School students in Gujarat: A Mixed-Method Study

Abstract

Abstract Background: Water, sanitation, and hygiene (WASH) practices are vital for health, especially among school students who can propagate messages. Comparing WASH knowledge, attitudes and practices between government and non-government schools can guide tailored interventions. This mixed methods study aimed to assess and compare WASH-related knowledge, attitudes, and practices among adolescents in government versus non-government schools in Gujarat, India. Materials and Methods: A cross-sectional survey was conducted among 566 students from 17 government and 17 non-government schools. Interviews using a standardized questionnaire provided quantitative data on WASH-related knowledge, attitudes, and practices. Qualitative data was gathered through focus group discussions exploring influences on student WASH behaviors. Analyses included descriptive statistics, group comparisons, multivariate regression, and thematic analysis. A-value of P <0.05 was considered significant. Results: In total, 566 students participated, with 257 (45%) from government and 309 (55%) from non-government schools. Non-government students showed significantly better knowledge of handwashing (AOR 1.9, 95% CI 1.3-2.7), fecal-oral transmission (AOR 1.8, 95% CI 1.3-2.5), open defecation (AOR 1.7, 95% CI 1.2-2.4), and menstrual hygiene (AOR 3.2, 95% CI 1.1-9.2). More non-government students had positive attitudes about safe drinking water (AOR 4.1, 95% CI 1.8-9.6), conserving water (AOR 2.0, 95% CI 1.4-2.9), cleanliness (AOR 1.8, 95% CI 1.1-2.9), investing in hygiene (AOR 5.3, 95% CI 3.1-9.2), and menstrual management (AOR 2.1, 95% CI 1.2-3.6). In practices, non-government students showed higher use of soap (AOR 1.9, 95% CI 1.3-2.8), better menstrual hygiene (AOR 5.9, 95% CI 3.2-10.9), and more sanitary defecation (AOR 2.7, 95% CI 1.8-4.0). Superior WASH outcomes were associated with older age (AOR 1.8, 95% CI 1.1-3.0), urban locality (AOR 2.3, 95% CI 1.5-3.5), higher parental education (AOR 2.1, 95% CI 1.3-3.4), and affluence (AOR 3.1, 95% CI 1.8-5.2). Qualitative data highlighted knowledge gaps, inadequate facilities, detrimental cultural beliefs, poverty, and the need for government support. Conclusions: Disparities exist in WASH behaviors between school types, suggesting the need for tailored interventions addressing specific gaps. Schools play a critical role in cultivating proper hygiene through infrastructure provision and targeted education. Government schools may require extra support to overcome challenges related to WASH access and quality.