Impact of the Provision of Safe Drinking Water on School Absence Rates in Cambodia: A Quasi-Experimental Study

BACKGROUND Education is one of the most important drivers for helping people in developing countries lift themselves out of poverty. However, even when schooling is available absenteeism rates can be high. Recently, focus is being given on whether or not WASH interventions can help reduce absenteeism in developing countries. However, none has focused exclusively on the role of drinking water provision. We report a study on the association between absenteeism and provision of treated water in containers maintained in schools. METHODS AND FINDINGS We undertook a quasi-experimental longitudinal study of absenteeism rates in 8 schools, 4 of which received one 20 l container of treated drinking water per day. The water had been treated by filtration and ultraviolet disinfection. Weekly absenteeism rates were compared across all schools using the negative binomial model in generalized estimating equations. There was a strong association between the provision of free water and reduced absenteeism (Incidence rate ratio = 0.39 (95% confidence intervals 0.27-0.56)). However, there was also a strong association with season (wet versus dry) and a significant interaction between receiving free water and season. In one of the intervention schools, it was discovered that the water supplier was not fulfilling his contract and was not delivering sufficient water each week. In this school, we showed a significant association between the number of water containers delivered each week and absenteeism (IRR = 0.98 95% CI 0.96-1.00). CONCLUSION There appears to be a strong association between providing free and safe drinking water and reduced absenteeism, although only in the dry season. The mechanism for this association is not clear but may be in part due to improved hydration leading to improved school experience for the children.