Anal Cleansingin Rural Kenyan Schools Anal cleansing is a taboo subject that is often overlooked by researchers and program staff. The SWASH+ Project conducted focus groups with male and female 12- to 15- year-old students in rural Kenya and collected data from teachers and parents to understand students’ anal cleansing practices and beliefs.
Students reported using several materialsfor anal cleansing: schoolbook paper and [leaves were cited as the most frequentlyused while in school.All students in the focus groups felt guiltyabout tearing up schoolbooks because theywere forced to lie to teachers about whypages were missing and they were ruininglearning material. Students agreed thattoilet paper was the best material to use,however, it is rarely purchased or madeavailable for use. Of the 114 head teachersinterviewed, 111 (97%) reported neverproviding materials for anal cleansing(McMahon, 2011).
The SWASH+ study revealedgenerational differences inanal cleansing practices.Focus group participantsreported the elderly, adultsand some young childrenhad no shame about usingleaves to wipe butadolescents found thisembarrassing.Students reported askingtheir parents to buy toiletpaper however, parentsoften refused because theyquestioned theeffectiveness and utility oftoilet paper, which theynever or rarely used andthey consider expensive andprone to tearing.
Students reported never discussing latrine use or defecationwith friends or family. Parents stated that they had neverbeen trained on how to use a latrine and many had no homelatrine.Because they engaged in open defecation – and almostalways used leaves that were an arm’s reach away – therewas never an opportunity to train their children on latrineuse or how to use materials other than natural materials.
Focus groups also confirmed many students were confused abouthow to wipe. Students reported that younger children did notknow how to properly wipe or use the latrine, creating unsanitarylatrine conditions. If school latrines are unsanitary and are notproperly maintained students are much less likely to use latrines.The practice of wiping feces on walls is so common that studentsrefer to it as ‘writing on the wall.’ Younger children were reportedlyunashamed of using leaves or hands to wipe, or scooting on grassto clean their bottoms.
Adding new and clean latrinesat school increases student’suse of latrines for defecation.However, students’ risk ofbacterial contamination andsickness increases ifconcurrent improvement tohand hygiene and provision ofanal cleansing material is notprovided.
A recent SWASH+ study foundthe addition of new sanitationfacilities to the hygienepromotion and water treatmentintervention greatly increasedchildren’s risk of having any E.coli and high levels of E. coli ontheir hands.The percent of students withE.coli on their hands increasedfrom 37% at baseline to 90% atfollow up in schools thatreceived new latrines. Analcleansing materials, educationand handwashing with soap arenecessary components to schoolWASH (Freeman, 2012).
Social responsibility played asignificant role in the olderstudents’ desire to wipe andto wash their hands afterusing the latrine. Studentsoften were concerned thatthey may spread illness ormake friends ill. Emotionalfactors motivated students towipe, including a desire toavoid shame because ofsoiled clothing or smelliness.
After analyzing the research, theSWASH+ team recommendedmaking anal cleansing materialsavailable and teaching children howto use them, providing water andsoap near latrines, encouragingschool officials to ensure adequatematerials are available, and workingto educate parents about theimportance of anal cleansing.
ReferencesMcMahon, S., Caruso, B., Obure, A., Okumu, F., & Rheingans, R. (2011). ‘Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya.’ Tropical Medicine and International Health. 16(12), 1536- 1540.Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans R. (2012) ‘Impact of school-based hygiene promotion and sanitation interventions on pupil hand contamination in western Kenya: a cluster-randomized trial.’Photography by CARE/Brendan Bannon. Photo essay by Julie Straw; edited by Malaika Cheney-Coker.SWASH+ is a five-year applied research project to identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya. The partners that form the SWASH+ consortium are CARE, Emory University, the Great Lakes University of Kisumu, the government of Kenya, and the former Kenya Water for Health Organisation (KWAHO), and Water.org. SWASH+ is funded by the Bill & Melinda Gates Foundation and the Global Water Challenge. For more information, visit www.swashplus.org.