Rural-Urban Disparities in Water, Sanitation, and Hygiene (WASH) Infrastructure in Primary and Secondary Schools: A Case of Iringa Region, Tanzania

INTRODUCTION

Water, Sanitation, and Hygiene (WASH) infrastructure in primary and secondary schools is critical for promoting health and educational outcomes among students [1]. Access to safe water, sanitation, and hygiene services is a fundamental human right for school children [2-5]. The Sustainable Development Goal 6 (SDG 6) calls for universal access to safe water, sanitation, and hygiene services for all by 2030 [2]. The provision of essential Water, Sanitation, and Hygiene (WASH) services in schools is crucial for creating a safe, healthy, and clean learning environment. Furthermore, these services promote the development of positive hygiene practices that students can uphold throughout their lifetime [2-5].

According to the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) 2020, approximately 50% of schools in low-income countries lack basic water services, and 50% also lack adequate sanitation facilities [6,7]. These deficiencies are particularly pronounced in rural areas, where infrastructure is often underdeveloped [7]. The lack of adequate WASH facilities can lead to increased absenteeism, the spreading of infectious diseases, and hindered academic performance [8,9]. The progress report on WASH services in schools by the WHO/UNICEF joint monitoring program (JMP) in 2022 revealed that numerous schools globally, including those in low-income countries such as Tanzania, lack access to basic WASH facilities. The JMP report reported that only 71% of schools have access to basic drinking water services, 72% have access to basic sanitation facilities, and 58% have access to basic hygiene services [5].

The WASH study, conducted in rural educational institutions across six Sub-Saharan African countries, revealed that the availability of improved water sources on-site, enhanced sanitation facilities, and access to water and soap for handwashing varied significantly, ranging from 1% in Ethiopia and Mozambique to 23% in Rwanda. Additionally, fewer than 23% of rural schools fulfilled the World Health Organization's recommended student-to-latrine ratios for both boys and girls [10].

In Tanzania, access to safe water and sanitation facilities in schools remains a challenge. The importance of WASH infrastructure in schools cannot be overstated, as it directly influences student attendance, health, and overall learning experiences. A study by Jacob and Kazaura highlights that while there have been improvements in access to safe drinking water and sanitation, significant disparities exist between urban and rural areas, particularly affecting schools in low socio-economic regions [11]. This is corroborated by findings from the National Sanitation Campaign, which reported that only 50% of schools met the guidelines for sanitation facilities, with many lacking reliable water supplies and functional handwashing stations [12]. Such deficiencies not only hinder the ability of students to maintain proper hygiene but also contribute to the spread of waterborne diseases, which are particularly detrimental to children’s health [13].

Moreover, the impact of WASH on educational outcomes is profound. Research indicates that schools with inadequate sanitation facilities often see higher rates of absenteeism, particularly among girls who may lack access to menstrual hygiene management resources [14]. A study conducted in various Tanzanian schools found that cultural programs promoting hygiene and sanitation were effective in raising awareness, yet only a fraction of schools implemented these initiatives consistently [15]. The lack of proper facilities can lead to increased health risks, with studies showing that poor hygiene practices are associated with higher incidences of diarrhea and other illnesses among school children [16].

Additionally, the role of hygiene education in schools is crucial. Educational interventions that incorporate hygiene practices can significantly improve health outcomes. For instance, the Participatory Hygiene and Sanitation Transformation (PHAST) model has been successfully implemented in Tanzanian schools to engage students in learning about hygiene and sanitation [14]. Such programs educate students about the importance of WASH and empower them to take action within their communities, fostering a culture of hygiene that extends beyond the school environment [14].

However, the success of such interventions often depends on community engagement and the availability of resources, which can be limited in rural settings [17]. A comprehensive approach that includes community involvement, adequate funding, and training for school staff is essential for the sustainability of WASH programs in Tanzanian schools [12].

In light of the limited and unequal distribution of resources to enhance Water, Sanitation, and Hygiene (WASH) reported in various studies, this research aimed to investigate the disparities in WASH infrastructure between rural and urban primary and secondary schools in the Iringa Region of Tanzania. The findings of this study, along with the conclusions drawn and recommended actions, will contribute to improving WASH conditions in Tanzanian schools, ultimately benefiting students' health and well-being.

METHODS

Area of study

This study was conducted in the Iringa, Kilolo, and Mufindi districts located within the Iringa region. The Iringa Region is situated in the Southern Highlands zone of mainland Tanzania, positioned below the Equator. It is delineated by latitudes 6° 55’ and 9° 00’ south, as well as longitudes 33° 45’ and 36° 55’ east of Greenwich. To the north, Iringa shares its borders with the Singida and Dodoma regions. The Morogoro region lies to the east, while the Mbeya region is to the west. Additionally, the Njombe region is situated to the south of Iringa [18]. Three districts were selected in this study due to their different economic, geographical, and population sizes. Iringa municipality from the Iringa district was selected to represent schools from urban areas as it is predominantly urban. Kilolo and Mufindi districts were selected to present schools from rural areas as they are predominantly rural. Iringa district has 151 primary and 42 secondary schools, of which 50 primary and 30 secondary schools are from Iringa municipality, Kilolo district has 133 primary and 44 secondary schools, and Mufindi district has 162 primary and 48 secondary schools [19-22].

Study design

This study used a quantitative cross-sectional descriptive design to assess water, sanitation, and hygiene infrastructure in primary and secondary schools in all three districts. It was conducted from July 4 to July 25, 2024, and provided an overview of the state of infrastructure during data collection.

Study population

This study involved schools from rural and urban areas of the Iringa region, including public and private schools, day, boarding, mixed schools, and primary and secondary schools. In secondary schools, the study included both ordinary and high-level schools.

Sampling and sample size

An equal number of rural and urban schools were selected based on a proportionate distribution of private and public schools, primary and secondary schools, and boarding and day schools. Thus, rural and urban school strata were separated. Then, 32 schools were selected from rural schools in Kilolo and Mufindi districts, 16 schools from each, and 32 schools from Iringa Municipality, representing schools from urban areas, making a total of 64 schools. Further strata were formed based on private and public schools, primary and secondary schools, and day, boarding, and mixed schools. A simple random selection technique was used to select schools from each stratum.

Data collection

Data were collected using a structured checklist designed to assess WASH infrastructure in primary and secondary schools, based on WHO and UNICEF guidelines. The list included two main parts: water facilities, which assessed the availability and reliability of clean drinking water, and sanitation and hygiene facilities, which assessed the availability, functionality, and condition of toilets, hand washing facilities, and menstrual hygiene management facilities.

Statistics

Data analysis was done using Statistical Package for Social Science (SPSS) version 26, where descriptive and comparative analysis summarized and interpreted the results. Frequencies and percentages regarding the availability and status of WASH facilities were summarized using descriptive statistics. Mean and standard deviation values were calculated for continuous variables, such as number of toilets. Based on a scoring system, schools were classified as having adequate or inadequate WASH infrastructures. Schools that achieved 60% or more of the WASH indicators were classified as adequate, while those that achieved less than 60% were classified as inadequate. Rural-urban WASH facilities in schools were compared using cross-tabulations. Also, Chi-square tests were used to assess the relationship between rural and urban schools' adequacy of WASH facilities.

RESULTS

Demographic characteristics of schools

This study included 64 schools, evenly divided between rural and urban locations, with 32 schools (50%) from each area. Regarding educational level, primary schools comprised the majority, with 32 (50%) schools. Ordinary-level secondary schools accounted for 24 (37.5%), while high-level secondary schools comprised the smallest group, contributing only 8 (12.5%).

Public schools predominated, with 42 (65.6%) schools, compared to 22 (34.4%) private schools. The Iringa district had the highest representation, contributing 32 (50%) schools, while Kilolo and Mufindi each contributed 16 schools (25%). Additionally, there were more day schools, with 40 (62.5%) schools, whereas boarding schools were fewer, numbering only 6 (9.4%), as described in Table 1.

Availability and status of WASH facilities in schools

The highest availability of WASH indicators are functional toilets for students at 62 (96.9%) and separate toilets for boys and girls at 61 (95.3%). Additionally, 58 (90.6%) schools have educational programs for students on the importance of water conservation, and the same number, 58 (90.6%), provide education on hygiene and sanitation practices.

On the other hand, the indicators with the lowest availability are water filters or purification systems, which were only found in 15 (23.4%) schools. The sufficient number of toilets to accommodate female students, as recommended by WHO (20 girls per toilet), is met in only 16 schools (25%). Furthermore, only 20 schools (31.3%) conduct regular water quality testing, and hand sanitizers are available in addition to handwashing stations in 24 (37.5%) schools, as detailed in Table 2.

Rural-urban comparison of availability and status of WASH facilities in schools

Significant differences were observed between rural and urban schools regarding the availability and maintenance of WASH infrastructure based on 23 indicators. Many (21) indicators showed higher availability in urban schools, while only 2 indicators were higher in rural schools. The only indicators observed as slightly more adequate in rural than urban schools include the sufficient number of toilets for female students, following WHO recommendations of 20 girls per toilet, which had 9 (28.1%) in rural schools compared to 7 (21.9%) in urban schools. Additionally, a designated staff member responsible for sanitation management was reported in 28 (87.5%) rural and 27 (84.4%) urban schools. Four WASH indicators exhibited substantial differences, exceeding 40% between rural and urban schools. Urban schools reported significantly better results in the following indicators: availability of designated drinking water stations for students (11 or 34.4% in rural vs. 26 or 81.3% in urban), sufficient water supply to meet the needs of all students and staff (17 or 53.1% in rural vs. 30 or 93.8% in urban), reliable sources of clean drinking water (18 or 56.3% in rural vs. 31 or 96.9% in urban), and regular maintenance of drinking water facilities (14 or 43.8% in rural vs. 27 or 84.4% in urban), as detailed in Table 3.

The findings in Table 4 further highlight disparities in toilet status between rural and urban schools. The average number of female students per toilet was 34.4 ± 21.1 in rural schools and 35.3 ± 18.3 in urban schools. Additionally, the average number of male students per toilet was 60.5 ± 106.2 in rural schools compared to 34.2 ± 21.6 in urban schools.

The results described in Figure 1 show descriptive statistics of the adequacy scores for WASH elements in rural and urban schools. Rural schools had a maximum score of 91.3% and a mean of 54.6%, which is inadequate compared to urban schools, which had a maximum score of 100% and a mean of 74.5%.

Also, this study revealed that 64% of all assessed schools had adequate WASH infrastructure, while 36% had inadequate infrastructure. In comparison, only 40.6% of rural schools had adequate infrastructure compared to 87.5% of urban schools, as described in Figure 2.

Bivariate analysis of factors associated with adequacy status in schools

This study analyzed a significant association between demographic variables and school adequacy using bivariate analysis. Among the independent variables examined, only two (school location and school district) displayed a significant association with adequacy, all with a P-value (P< 0.05). In contrast, the rest of the independent variables showed no significant association, all with a P-value (P> 0.05), as illustrated in Table 5.

Table (5). Bivariate analysis of factors associated with adequacy status in schools (N = 64)

* P

DISCUSSION