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PLOS BLOGS Speaking of Medicine and Health

How many toilets?

In his blog below Gavin Yamey, currently undertaking a Kaiser Family Foundation-funded project in global health reporting in Sudan and East Africa, writes from Nairobi about how the number of toilets is crucial in creating “worm free schools”.

Read Gavin’s previous posts about his fellowship and rural communities far from the reach of global health programs. For more about the cost-effectiveness of mass de-worming programs, see this article in PLoS Neglected Tropical Diseases.


One of the stories I’m working on, as part of my global health reporting fellowship, is about the benefits of deworming schoolchildren.  So I’ve been visiting primary schools across Kenya, in a Nairobi slum and along the northern and southern coastal districts, interviewing teachers and parents.

School health and education experts have taught me some of the crucial things to look for when sizing up a school.

So, what are some of the markers of a good (and healthy) educational experience?

Some are pretty obvious.  Its going to be hard to learn much if you are in a class of a hundred students and there’s a high rate of teacher absenteeism. On the other hand, you’re more likely to have a stimulating experience in a small classroom with walls covered in interesting teaching materials.

There’s also one crucial question to ask when visiting a school: “How many toilets are there?”

At one school in Nairobi, there weren’t nearly enough.  And they were blocked on the day that I visited.  The stench of feces was overwhelming.

Poor sanitation makes it easier for intestinal worms to spread between schoolchildren. Although deworming drugs have an important role to play in creating “worm free schools,” if there are too few toilets, there’s a good chance that the dewormed children will get re-infected.

It’s an illustration, I think, of one of the central dilemmas of global health.  How do you balance the “quick wins” (the rapid impact interventions, like deworming and vitamin A) with the longer-term investments that will ultimately bring lasting change?

Gavin Yamey


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