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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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