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4 Results for Health Topics

4.2 Water, sanitation and hygiene

4.2.1 Water, sanitation and hygiene

  • Of the returned 3963 articles related to Water, Sanitation and Hygiene (WASH), the vast majority (N=3957) either did not occur in humanitarian crises or did not measure the impact of WASH interventions on health outcomes. Although water quality/purity (e.g. faecal coliform or residual chlorine levels) outcomes have been commonly used as a proxy for health outcomes (e.g. diarrhoea) in humanitarian settings, this review exclusively focused on studies that directly measured the effectiveness of WASH interventions on health outcomes.
  • Only 7 peer reviewed papers met the inclusion criteria. Of these, 6 were category A and B papers and these are the focus of the review [1-6].
  • Five of the 6 category A and B papers conducted a test of statistical significance between WASH interventions and health outcomes (category A). One reported WASH interventions and health outcomes but without a test of significance (category B).
  • Three of the 5 category A papers were deemed high quality and 2 were deemed moderate quality. The category B paper was deemed low quality.
  • There has been increasing interest in WASH interventions in humanitarian crises over the past two decades, with all six papers published since 2000, but quality remains mixed over time.
  • Uncontrolled longitudinal designs were most common (3/6), followed by randomised controlled trials (RCTs) (2/6), and non-random trial (1/6) designs.
  • Five of the six studies occurred in armed conflicts and one in natural disasters. Of the conflict studies, 3 were with IDPs and 2 with refugees. The natural disaster study was with the general population.
  • Most of the studies occurred in the acute crisis stage (4/6), followed by early recovery (2/6); one study was conducted during both the acute crisis and early recovery stages.
  • Five of the 6 studies were conducted in Africa and 1 occurred in Latin America.
  • All 6 WASH intervention studies assessed the impact on the health outcome of diarrhoeal diseases, with 5 evaluating effectiveness against general diarrhoea and one evaluating suspected – although not laboratory confirmed – Shigella.
  • All 6 studies used self-reported diarrhoea outcomes, 2 studies also reported laboratory confirmed outcomes, and 2 studies reported health treatment outcomes (e.g. clinical admissions).
  • One study measured WASH intervention success in relation to both health and water quality outcomes; 1 study recorded uptake (use of soap) as well as health outcomes.
  • The 6 WASH studies covered multiple types and combinations of interventions. All 6 studies focussed on point of use interventions, with the two most popular intervention types being safe water storage (N=4) and household water treatment (e.g. flocculant disinfectant). Other interventions included WASH education (N=2), hand washing (including soap distribution) (N=1), latrine provision (N=1), and point of source disinfection (N=1).
  • No study investigated the feasibility and cost effectiveness of WASH interventions in humanitarian crises.

 Table 13 presents the details of the 6 category A and B papers, including a narrative analysis of the effectiveness of the interventions in the 6 studies (download the full report, page 96 to view table 13)

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