This study focused on the usage of urinals in Kenyan schools and the potential impact of constructing urinals to improve access to school sanitation facilities. Our objectives were: to assess the latrine use patterns for sanitation infrastructure at Kenyan primary schools and to determine the optimal pupil: latrine ratio where adequate urinals are provided. Calculations were based on observation and pupil report. Boys' urinals are relatively inexpensive to construct and maintain, may be longer lasting, require little in the way of behaviour change, and can accommodate a large number of boys at one time. Construction of boys' urinals in order to provide additional latrines for girls may be the most cost-effective, equitable solution in both the short and long term and may offset the cost of more expensive facilities for girls. Access to urinals will help alleviate congestion at latrines, improve conditions, reduce maintenance costs, and sustain latrines longer.

Blanton, E., Ombeki, S., Oluoch, G., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households: Nyanza Province, Western Kenya, 2007’, American Journal of Tropical Medicine and Hygiene 82: 664-671 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422≯.

Brooker, S. and Bundy, D.A.P. (2008) ‘Soil-transmitted helminths (geohelminths)’, in G.C. Cook and A.I. Zumla (eds), Manson's Tropical Diseases, 22nd edn, Elsevier, London.

Centre for the Study of African Economies (CSAE) (2008) Lessons from Kenya's Introduction of Free Primary Education, Centre for the Study of African Economies, Oxford, UK.

Crompton, D.W. (1999) ‘How much human helminthiasis is there in the world?’ Journal of Parasitology 85: 397-403.

Emory University (2006) SWASH+ Baseline Report, Emory University, Atlanta, Georgia.

Esrey, S.A., Feachem, R.G. and Hughes, J.M. (1985) ‘Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities’, Bulletin of the World Health Organization 63: 757-72.

Esrey, S.A., Potash, J.B., Roberts, L. and Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69: 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and metaanalysis’, The Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Freeman, M., Greene, L., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene, and sanitation program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial’, Tropical Medicine & International Health 17: 380-391 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x≯.

Government of Kenya (2008) Sector Plan for Environment, Water and Sanitation: 2008-2012. Government of Kenya.

Hotez, P.J., Bundy, D.A.P., Beegle, K., Brooker, S., Drake, L., Silva, N.D., Montresor, A., Engels, D., Jukes, M., Chitsulo, L., Chow, J., Laxminarayan, R., Michaud, C.M., Bethony, J., Correa-Oliveira, R., Shu-Hua, X., Fenwick, A. and Savioli, L. (2006) ‘Helminth infections: Soil-transmitted helminth infections and schistosomiasis’, in Disease Control Priorities in Developing Countries, 2nd edn, Oxford University Press, New York.

Njuguna, V., Karanja, B., Thuranira, M., Shordt, K., Snel, M., Cairncross, S., Biran, A. and Schmidt, W.-P. (2009) The Impact and Sustainability of WASH in Schools Research, IRC, The Hague and UNICEF, Geneva.

O’Reilly, C., Freeman, M., Ravani, M., Migele, J., Mwaki, A., Ayalo, M., Ombeki, S., Hoekstra, M.R. and Quick, R. (2008) ‘The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006’, Epidemiology & Infection 136: 80-91 <http://dx.doi.org/10.1017/S0950268807008060≯.

Pearson, J. and McPhedran, K. (2008) ‘A literature review of the non-health impacts of sanitation’, Waterlines 27: 48-61 <http://dx.doi.org/10.3362/1756-3488.2008.005≯.

Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29: 329-336 <http://dx.doi.org/10.3362/1756-3488.2010.035≯.

UNICEF (2006) Progress for children: A report card on water and sanitation (No. 5), UNICEF, Geneva.

UNICEF (2009) Water, Sanitation and Hygiene Annual Report, 2008, UNICEF, Geneva.

UNICEF (2010) Raising Clean Hands: Advancing Learning, Health, and Participation through WASH in Schools, UNICEF, Geneva.

WSCC and WHO (2005) Sanitation and Hygiene Promotion, Programming Guidance, Water and Sanitation Collaborative Council and World Health Organization, Geneva.

Ziegelbauer, K., Speich, B., Mausezahl, D., Bos, R., Keiser, J. and Utzinger, J. (2012) ‘Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis’, PLoS Med 9: e1001162 <http://dx.doi.org/10.1371/journal.pmed.1001162≯.

Blanton, E., Ombeki, S., Oluoch, G., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households: Nyanza Province, Western Kenya, 2007’, American Journal of Tropical Medicine and Hygiene 82: 664-671 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422≯.

Brooker, S. and Bundy, D.A.P. (2008) ‘Soil-transmitted helminths (geohelminths)’, in G.C. Cook and A.I. Zumla (eds), Manson's Tropical Diseases, 22nd edn, Elsevier, London.

Centre for the Study of African Economies (CSAE) (2008) Lessons from Kenya's Introduction of Free Primary Education, Centre for the Study of African Economies, Oxford, UK.

Crompton, D.W. (1999) ‘How much human helminthiasis is there in the world?’ Journal of Parasitology 85: 397-403.

Emory University (2006) SWASH+ Baseline Report, Emory University, Atlanta, Georgia.

Esrey, S.A., Feachem, R.G. and Hughes, J.M. (1985) ‘Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities’, Bulletin of the World Health Organization 63: 757-72.

Esrey, S.A., Potash, J.B., Roberts, L. and Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69: 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and metaanalysis’, The Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Freeman, M., Greene, L., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene, and sanitation program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial’, Tropical Medicine & International Health 17: 380-391 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x≯.

Government of Kenya (2008) Sector Plan for Environment, Water and Sanitation: 2008-2012. Government of Kenya.

Hotez, P.J., Bundy, D.A.P., Beegle, K., Brooker, S., Drake, L., Silva, N.D., Montresor, A., Engels, D., Jukes, M., Chitsulo, L., Chow, J., Laxminarayan, R., Michaud, C.M., Bethony, J., Correa-Oliveira, R., Shu-Hua, X., Fenwick, A. and Savioli, L. (2006) ‘Helminth infections: Soil-transmitted helminth infections and schistosomiasis’, in Disease Control Priorities in Developing Countries, 2nd edn, Oxford University Press, New York.

Njuguna, V., Karanja, B., Thuranira, M., Shordt, K., Snel, M., Cairncross, S., Biran, A. and Schmidt, W.-P. (2009) The Impact and Sustainability of WASH in Schools Research, IRC, The Hague and UNICEF, Geneva.

O’Reilly, C., Freeman, M., Ravani, M., Migele, J., Mwaki, A., Ayalo, M., Ombeki, S., Hoekstra, M.R. and Quick, R. (2008) ‘The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006’, Epidemiology & Infection 136: 80-91 <http://dx.doi.org/10.1017/S0950268807008060≯.

Pearson, J. and McPhedran, K. (2008) ‘A literature review of the non-health impacts of sanitation’, Waterlines 27: 48-61 <http://dx.doi.org/10.3362/1756-3488.2008.005≯.

Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29: 329-336 <http://dx.doi.org/10.3362/1756-3488.2010.035≯.

UNICEF (2006) Progress for children: A report card on water and sanitation (No. 5), UNICEF, Geneva.

UNICEF (2009) Water, Sanitation and Hygiene Annual Report, 2008, UNICEF, Geneva.

UNICEF (2010) Raising Clean Hands: Advancing Learning, Health, and Participation through WASH in Schools, UNICEF, Geneva.

WSCC and WHO (2005) Sanitation and Hygiene Promotion, Programming Guidance, Water and Sanitation Collaborative Council and World Health Organization, Geneva.

Ziegelbauer, K., Speich, B., Mausezahl, D., Bos, R., Keiser, J. and Utzinger, J. (2012) ‘Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis’, PLoS Med 9: e1001162 <http://dx.doi.org/10.1371/journal.pmed.1001162≯.

Blanton, E., Ombeki, S., Oluoch, G., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households: Nyanza Province, Western Kenya, 2007’, American Journal of Tropical Medicine and Hygiene 82: 664-671 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422≯.

Brooker, S. and Bundy, D.A.P. (2008) ‘Soil-transmitted helminths (geohelminths)’, in G.C. Cook and A.I. Zumla (eds), Manson's Tropical Diseases, 22nd edn, Elsevier, London.

Centre for the Study of African Economies (CSAE) (2008) Lessons from Kenya's Introduction of Free Primary Education, Centre for the Study of African Economies, Oxford, UK.

Crompton, D.W. (1999) ‘How much human helminthiasis is there in the world?’ Journal of Parasitology 85: 397-403.

Emory University (2006) SWASH+ Baseline Report, Emory University, Atlanta, Georgia.

Esrey, S.A., Feachem, R.G. and Hughes, J.M. (1985) ‘Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities’, Bulletin of the World Health Organization 63: 757-72.

Esrey, S.A., Potash, J.B., Roberts, L. and Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69: 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and metaanalysis’, The Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Freeman, M., Greene, L., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene, and sanitation program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial’, Tropical Medicine & International Health 17: 380-391 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x≯.

Government of Kenya (2008) Sector Plan for Environment, Water and Sanitation: 2008-2012. Government of Kenya.

Hotez, P.J., Bundy, D.A.P., Beegle, K., Brooker, S., Drake, L., Silva, N.D., Montresor, A., Engels, D., Jukes, M., Chitsulo, L., Chow, J., Laxminarayan, R., Michaud, C.M., Bethony, J., Correa-Oliveira, R., Shu-Hua, X., Fenwick, A. and Savioli, L. (2006) ‘Helminth infections: Soil-transmitted helminth infections and schistosomiasis’, in Disease Control Priorities in Developing Countries, 2nd edn, Oxford University Press, New York.

Njuguna, V., Karanja, B., Thuranira, M., Shordt, K., Snel, M., Cairncross, S., Biran, A. and Schmidt, W.-P. (2009) The Impact and Sustainability of WASH in Schools Research, IRC, The Hague and UNICEF, Geneva.

O’Reilly, C., Freeman, M., Ravani, M., Migele, J., Mwaki, A., Ayalo, M., Ombeki, S., Hoekstra, M.R. and Quick, R. (2008) ‘The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006’, Epidemiology & Infection 136: 80-91 <http://dx.doi.org/10.1017/S0950268807008060≯.

Pearson, J. and McPhedran, K. (2008) ‘A literature review of the non-health impacts of sanitation’, Waterlines 27: 48-61 <http://dx.doi.org/10.3362/1756-3488.2008.005≯.

Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29: 329-336 <http://dx.doi.org/10.3362/1756-3488.2010.035≯.

UNICEF (2006) Progress for children: A report card on water and sanitation (No. 5), UNICEF, Geneva.

UNICEF (2009) Water, Sanitation and Hygiene Annual Report, 2008, UNICEF, Geneva.

UNICEF (2010) Raising Clean Hands: Advancing Learning, Health, and Participation through WASH in Schools, UNICEF, Geneva.

WSCC and WHO (2005) Sanitation and Hygiene Promotion, Programming Guidance, Water and Sanitation Collaborative Council and World Health Organization, Geneva.

Ziegelbauer, K., Speich, B., Mausezahl, D., Bos, R., Keiser, J. and Utzinger, J. (2012) ‘Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis’, PLoS Med 9: e1001162 <http://dx.doi.org/10.1371/journal.pmed.1001162≯.

Blanton, E., Ombeki, S., Oluoch, G., Mwaki, A., Wannemuehler, K. and Quick, R. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households: Nyanza Province, Western Kenya, 2007’, American Journal of Tropical Medicine and Hygiene 82: 664-671 <http://dx.doi.org/10.4269/ajtmh.2010.09-0422≯.

Brooker, S. and Bundy, D.A.P. (2008) ‘Soil-transmitted helminths (geohelminths)’, in G.C. Cook and A.I. Zumla (eds), Manson's Tropical Diseases, 22nd edn, Elsevier, London.

Centre for the Study of African Economies (CSAE) (2008) Lessons from Kenya's Introduction of Free Primary Education, Centre for the Study of African Economies, Oxford, UK.

Crompton, D.W. (1999) ‘How much human helminthiasis is there in the world?’ Journal of Parasitology 85: 397-403.

Emory University (2006) SWASH+ Baseline Report, Emory University, Atlanta, Georgia.

Esrey, S.A., Feachem, R.G. and Hughes, J.M. (1985) ‘Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities’, Bulletin of the World Health Organization 63: 757-72.

Esrey, S.A., Potash, J.B., Roberts, L. and Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69: 609-21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and metaanalysis’, The Lancet Infectious Diseases 5: 42-52 <http://dx.doi.org/10.1016/S1473-3099(04)01253-8≯.

Freeman, M., Greene, L., Dreibelbis, R., Saboori, S., Muga, R., Brumback, B. and Rheingans, R. (2012) ‘Assessing the impact of a school-based water treatment, hygiene, and sanitation program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial’, Tropical Medicine & International Health 17: 380-391 <http://dx.doi.org/10.1111/j.1365-3156.2011.02927.x≯.

Government of Kenya (2008) Sector Plan for Environment, Water and Sanitation: 2008-2012. Government of Kenya.

Hotez, P.J., Bundy, D.A.P., Beegle, K., Brooker, S., Drake, L., Silva, N.D., Montresor, A., Engels, D., Jukes, M., Chitsulo, L., Chow, J., Laxminarayan, R., Michaud, C.M., Bethony, J., Correa-Oliveira, R., Shu-Hua, X., Fenwick, A. and Savioli, L. (2006) ‘Helminth infections: Soil-transmitted helminth infections and schistosomiasis’, in Disease Control Priorities in Developing Countries, 2nd edn, Oxford University Press, New York.

Njuguna, V., Karanja, B., Thuranira, M., Shordt, K., Snel, M., Cairncross, S., Biran, A. and Schmidt, W.-P. (2009) The Impact and Sustainability of WASH in Schools Research, IRC, The Hague and UNICEF, Geneva.

O’Reilly, C., Freeman, M., Ravani, M., Migele, J., Mwaki, A., Ayalo, M., Ombeki, S., Hoekstra, M.R. and Quick, R. (2008) ‘The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006’, Epidemiology & Infection 136: 80-91 <http://dx.doi.org/10.1017/S0950268807008060≯.

Pearson, J. and McPhedran, K. (2008) ‘A literature review of the non-health impacts of sanitation’, Waterlines 27: 48-61 <http://dx.doi.org/10.3362/1756-3488.2008.005≯.

Saboori, S., Mwaki, A. and Rheingans, R. (2010) ‘Is soapy water a viable solution for handwashing in schools?’ Waterlines 29: 329-336 <http://dx.doi.org/10.3362/1756-3488.2010.035≯.

UNICEF (2006) Progress for children: A report card on water and sanitation (No. 5), UNICEF, Geneva.

UNICEF (2009) Water, Sanitation and Hygiene Annual Report, 2008, UNICEF, Geneva.

UNICEF (2010) Raising Clean Hands: Advancing Learning, Health, and Participation through WASH in Schools, UNICEF, Geneva.

WSCC and WHO (2005) Sanitation and Hygiene Promotion, Programming Guidance, Water and Sanitation Collaborative Council and World Health Organization, Geneva.

Ziegelbauer, K., Speich, B., Mausezahl, D., Bos, R., Keiser, J. and Utzinger, J. (2012) ‘Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis’, PLoS Med 9: e1001162 <http://dx.doi.org/10.1371/journal.pmed.1001162≯.