1. Andrew Owusu Ph.D. Research Workshop in Water Supply, Sanitation and health related to schools and local communities in West Africa September 18 th – 20 th 2007 *A contribution to the WHO STEPwise approach to Surveillance Global School-Based Student Health Survey: Monitoring Student Hygiene/Sanitation Behaviors in Ghana

2. Presentation Overview Background Introduction to GSHS GSHS Purpose GSHS Modules (10) Hygiene Sampling and Questionnaire (hygiene questions) Implications for the future Summary

3. GSHS Introduction 2001: WHO with technical assistance from CDC, initiates development of the GSHS (CDC, 2006) GSHS relation to US Youth Risk Behavior Survey (YRBS). 2003: Ghana Nutritional Risk Behavior Survey (School-Based, Youth) 2006: Middle Tennessee State University initiates implementation work on GSHS 2007 GSHS data collection September 17 th – 28 th

4. GSHS Purpose To provide accurate data on students to: 1. Help countries develop priorities, establish programmes, and advocate for resources 2. Establish trends in the prevalence of health behaviors and protective factors by country 3. Allow countries and international agencies to make comparisons across countries

5. The GSHS Sample 2-stage probability sample 1 st stage – selection of schools selected with probability proportional to size schools with grades that 13-15 year olds attend selected at CDC 2nd stage – selection of classrooms selected randomly selected in country

6. Ghana Sample 75 Schools from all 10 regions in Ghana 3 Super Zones (SR) North, Central and South 25 Schools Per Zone *Target number is 1500 in each zone. Presented number reflects over sampling due to expect 80% participation rate Super RegionEnrollmentSample Size* North6,0841,875 Central4,4261,875 South4,6381,875 Eligible Population15,1485,625

7. Ghana Super Zones for 2007 GSHS Implementation Southern Zone Central Zone Northern Zone

8. GSHS Questionnaire

9. The GSHS questionnaire consists of: Core questionnaire modules Core-expanded questions Country-specific questions

10. Core Questionnaire Modules 10 core questionnaire modules Contain 52 questions Measure the most important health behaviors and protective factors Contain from 3 to 7 questions Must use at least 6 of the 10 modules with no changes Cannot have more than 99 questions total – fewer are recommended

11. GSHS Core Questionnaire Modules Respondent demographics Alcohol and other drug use Dietary behaviors Hygiene Mental health Physical activity Protective factors Sexual behaviors that contribute to HIV infection, other STI, and unintended pregnancy Tobacco use Violence & unintentional injury

12. Core Questionnaire Modules Respondent demographics – 3 Alcohol and other drug use – 6 Dietary behaviors – 5 Hygiene – 4 Mental health – 6 Physical activity - 5 Protective factors – 5 Sexual behaviors that contribute to HIV infection, other STI, and unintended pregnancy – 5 Tobacco use – 6 Unintentional injury and violence - 7

13. Core-expanded questions To collect more detailed information on selected core questionnaire module topics. More questions Behavior Attitude Knowledge Sources of information Hygiene (7)

14. Country Specific Questions Question on topics of unique interest and importance to a particular country. Ghana Hygiene Malaria Worm infestation

15. Ghana GSHS Hygiene Module The 2007 Ghana GSHS looks at hygiene in 2 settings A. General B. At School

16. GSHS Hygiene Components

22. Summary Youth health risk behavior assessment Assessment capacity building Use of prevalence data Future Issues

23. Sustainability Expansion to older youth Senior secondary schools Interventions/Programs Data based, customized Hypothesis generation and testing Promoting Hygiene/Sanitation through school sports Promoting Hygiene/Sanitation through school sports

25. SO, did I give you……