SCHOOL HEALTH CASE STUDY
Proving that water
changes everything
In this study we wanted to collect data on the percentage of children living with water-borne diseases and then examine the impact that a project by Water Underground has on the health of those children.
Background
In 2018, in coordination with the Provincial Health Department, Water Underground conducted a school-wide study in the community of Manhenje — a soon-to-be site of a new Water Underground project.
While 94 percent of children in Mozambique enroll in primary school, 51% drop out by the fifth grade. Even among children who finish primary school, nearly two-thirds leave the system without basic reading, writing, and math skills. The illness and impacts of lacking access to clean water is responsible for extended absences and eventual dropout from school, poor physical growth and stunted mental development, severe illness and death in children (especially those under 5 years of age).
In this study we wanted to collect data on the percentage of children living with these diseases and then examine the impact that a project by Water Underground has on the health of those children.
Objective
The purpose of the study was to examine a health trend in parallel time with the interventions of a Water Underground project in that community. The study measured the health of school age children in the Primary School of Manhenje, specifically the most common communicable diseases in the developing world that are attributed contact & consumption of contaminated water, poor sanitation and absence of hygiene habits.
The end objective of the study was to see if there was a direct correlation able to be drawn between the health in school-age children and the impact of our intervention program. Given that no other intervention had been done in the community that may influence the figures during the study’s timeframe — any positive, negative, or neutral change in statistics can be seen to measure the effective impact of the Water Underground intervention.
Method
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The study first needed to collect baseline data (pre-project) that was also indicative of the broader health snapshot in this region. By coordinating logistics between the Director of the School, teachers, parents, District Health Department and the Provincial Laboratory — stool samples we collected from all 532 students at the Primary School over a period of 5 days. The total age-range of the students was 6 - 16 years old, with a median age of 10, and average age 11. 4 additional nurses were also on site each day to examine each child for the presence of skin diseases, specifically Ringworm (tinea), which is an infectious disease of the skin, scalp or nails (pictured left).
Each days samples needed to stay chilled and delivered to the Lab by end of day to maintain integrity of the results. This made logistics difficult given the rural, remote location of the community. There was great cooperation and we were very pleased to work in unison with all departments, especially with the District Health Department. Beyond the purposes of our internal study, the funding and collection of this data greatly helped the District and Provincial Health Departments by providing unfiltered statistics that may have never otherwise been able to be collected given their constraints — and will be used to prioritize their strategies and resources.
At the laboratory, all of the stool samples were tested for the presence of worms, parasites and pathogens. We also tested specifically for the pathogens causing the disease schistosomiasis*. We conducted this study before water was made available in the school and before any training had been done. We then treated everyone in the school for worms with Praziquantel.
Pre-Project Baseline Results
March 2018
82%
PARASITES
test positive for parasites, or indications of parasite growth.
38%
BILHARZIA
38 % were positive for Schistosomiasis / bilharzia.
8%
TINEA
8 % (42 children) had Tinea
Impact Analysis and Re-test
After 6 months, we conducted a follow up study with a re-testing of stool samples in an identical methodology as the primary samples. At this stage, water had become available in the school and the whole Water Underground training program had concluded.
We chose to wait 6 months because all children were treated for the parasites after the first samples were collected, and by this 6 month period, the parasites / pathogens would have returned despite initial treatment because of re-exposure. 2 years later, we again conducted the same survey to measure the sustained impact.
Post-Project Results
6 MONTHS POST PROJECT
2%
PARASITES
​had evidence parasites, or indications of parasite growth.
97 % REDUCTION IN CASES
0%
BILHARZIA
were positive for Schistosomiasis
​
100 % REDUCTION IN CASES
2%
TINEA
6 children children had Tinea. (All newly Enrolled)
​
​
85 % REDUCTION IN CASES
Final Results Analysis
Pre-Project results showed an overwhelming 82% of students had evidence of parasites, worms or pathogens. These numbers are consistent (if not worse) with the broader statistics of the water crisis and justify the gravity of the issue.
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However, within 6 months of completion of the Water Underground model that included a clean water source, elimination of Open-Defecation in the community, and intense training to influence a behavior change in personal & community hygiene — we observed a 97% reduction of cases and a complete elimination of cases of Schistosomiasis.
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These extraordinary results draw a direct correlation between the improvement in health in school children and the effectiveness of the Water Underground Model and are proven sustainable given that the results were maintained (even slightly lowered) after 2 years.
Sustainability Results
2 YEARS POST PROJECT
1%
PARASITES
​had evidence parasites, or indications of parasite growth.
50% FURTHER REDUCTION
98.5% TOTAL REDUCTION
0%
BILHARZIA
were positive for Schistosomiasis
​
ZERO CASES MAINTAINED
2%
TINEA
2 children children had Tinea. (All newly Enrolled)
​
​
75 % FURTHER REDUCTION
95% TOTAL REDUCTION
