Assessment of water, sanitation, and hygiene infrastructure in educational institutions and its implications in war-affected Mekelle city, Ethiopia: a cross-sectional study

ABSTRACT The graphical abstract illustrates that one-third of schools had basic water services, 1 in 10 had no sanitation services, 2 out of 5 schools provided limited menstrual hygiene materials, and only 2% had basic hygiene services. These gaps in water, sanitation, and hygiene (WASH) services and menstrual hygiene management (MHM) will have implications for students' health, dignity, and educational outcomes. Urgent, collaborative efforts are required to strengthen WASH infrastructure and MHM initiatives in postconflict settings. According to World Health Organization (WHO) and UNICEF joint monitoring report water, sanitation, and hygiene (WASH) services are essentially linked to gender equality and women empowerment. A cross-sectional study was conducted to evaluate school WASH facilities in postconflict Mekelle, utilizing a standardized WASH assessment tool. Descriptive statistics were employed to summarize characteristics of the study variables. Of the 52 schools assessed, three out of five (61.5%) schools have piped water; one in five (21.2%) lacks any water service. Forty-three schools (82.7%) were equipped with pit latrines, and most provide sex-segregated facilities. However, only 20 (40%) offered limited access to menstrual hygiene materials and 32 (61.5%) provided awareness on menstrual hygiene. Access to basic hygiene in a private space for girls was available in only one school, with one-third (32.7%) of schools offering only water and two-thirds (65.4%) lacked access to water. One-third had a disposal mechanism for menstrual waste. The WASH services were not inclusive for individuals with disabilities and small children. The limited WASH and menstrual hygiene services in postconflict schools may negatively affect students' education, health, and dignity. Collaborative efforts are urgently needed to enhance WASH infrastructure and menstrual hygiene management initiatives in post- war Tigray, Ethiopia.