Handwashing education and promotion is a proven strategy to reduce diarrhea and respiratory illness globally.

Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention.

Hygiene interventions consisted of an initial teacher training session followed by the installation of soap or sanitizer wall dispensers at the four intervention schools

One strategy that addresses the challenges of limited water supplies, as well as, the time and effort requirements  for hand hygiene is the use of waterless alcohol-based hand sanitizer.

The United Nations Children Fund (UNICEF) estimates that only 51% of primary schools in 60 low-income countries have access to adequate water supplies.

Respiratory infections are major contributors to global child mortality, causing 1.7 million child deaths annually. Transmission of pathogens causing these syndromes is particularly prevalent in schools, where students are in close contact with each other.

Handwashing is difficult in locations with limited resources and water access. 

Access to sanitizer resulted in significantly higher hand cleaning rates after using the toilet and before eating lunch, times during which hands could easily become contaminated or pathogens could be transferred from hands to mouth. 

Sanitizer was well accepted by teachers and students alike.