Gaps in integrated school WASH services and drinking water safety in Bahir Dar City, Ethiopia

Abstract School based WASH services are critical for child health, educational performance, and equitable learning environments, yet context-specific evidence from rapidly urbanizing Ethiopian cities remains scarce. This study investigated WASH services and drinking water quality across schools in Bahir Dar City. A cross-sectional survey was conducted involving 117 randomly selected schools to assess WASH services alongside onsite physicochemical testing and membrane filtration for E. coli detection. Additionally, multivariable logistic regression was used to identify predictors of service coverage. The results indicate that 79.5% of schools met the criteria for basic water service, 97.4% for basic sanitation, and 41.9% for basic hygiene; however, only 27.4% achieved all three services simultaneously. Despite high reliance on piped water supply (91.5%), service continuity was limited (47.9%), and point-of-use water treatment was uncommon (26.5%). Furthermore, E. coli was detected in 32.3% of samples, with high-risk contamination observed in two kindergarten schools. Free chlorine residual met WHO guideline values in only 10 school water samples, indicating that chlorination is not routinely practiced. Additionally, despite near-universal basic sanitation coverage, insufficient student-to-toilet ratio (61.5%) and inadequate cleanliness remain major challenges. Multivariable regression analysis showed that kindergarten schools were more likely to have basic WASH services, and schools exposed to environmental impact were less likely to have basic hygiene service. Ultimately, this study identifies critical gaps in integrated WASH services, water quality monitoring, and service reliability, underscoring the need for targeted interventions to protect the well-being of students in schools.