Publications & Reports

Water, Sanitation, and Hygiene Facilities and Hygiene Practices Associated with Diarrhea and Vomiting in Monastic Schools, Myanmar.

Weaver ER, Agius PA, Veale H, Dorning K, Hlang TT, Aung PP, Fowkes FJ, Hellard ME
Centre for Population Health, Burnet Institute, Melbourne, Australia.


Gastrointestinal diseases are one of the leading causes of mortality among children globally, causing one in 10 child deaths. Although the majority of deaths are in children aged </= 5 years, the burden of disease in school-aged children is still considerable and contributes to high rates in school absenteeism. This study investigates behavioral and structural risk factors associated with diarrhea and/or vomiting among school-based children in Myanmar. Cross-sectional data from a school-based multistage cluster sample of grade 4 and 5 students were analyzed to explore water, sanitation, and hygiene (WASH) facilities and hygiene-related practices of students in monastic schools in Myanmar. The outcome of interest was student self-reported diarrhea and/or vomiting in the past week. Random effects multinomial logistic regression models were used to explore correlates at the student and school level. A total of 2,082 students from 116 schools across eight states/regions were included. Of these, 11% (223) self-reported at least one episode of diarrhea only, 12% (253) at least one episode of vomiting only, and 12% (244) diarrhea and vomiting in the past week. Independent risk factors associated with the outcome included poor availability of handwash stations, no access to a septic tank toilet, inconsistent toilet use, and lower student grade. These findings highlight the importance of having an adequate number of handwash stations for students, the provision of septic tank toilets, and consistent toilet use. Future WASH programs need to target not only the provision of these WASH facilities but also their utilization, particularly among younger school-aged children.

Link to publisher’s web site

Freya J. I. Fowkes is supported by a future fellowship from the Australian Research Council, and Margaret E. Hellard is supported by a fellowship from the National Health and Medical Research Council of Australia. We would like to acknowledge and thank the Myanmar Education Consortium who funded the Burnet Institute Myanmar (BIMM) in partnership with the Monastic Education Development Group (MEDG) to build the capacity of the Monastic School system to provide quality education in these targeted schools. We also gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program.


  • Journal: The American Journal of Tropical Medicine and Hygiene
  • Published: 20/06/2016
  • Volume: 95
  • Issue: 2
  • Pagination: 278-287