WASH Interventions in Disease Outbreak Response | Hygiene | Sanitation

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Water, sanitation and hygiene interventions (WASH) are commonly implemented as part of emergency response activities (i.e. in response to disease outbreaks) in low and middle-income countries. But what does the existing evidence tell us about what works? How does the use of WASH interventions reduce disease outbreaks? What are the programme design and implementation characteristics associated with more effective programmes? What is the cost effectiveness of WASH interventions in emergency outbreak situations? What are the barriers and facilitators to WASH interventions in outbreaks? This evidence synthesis identifies, synthesizes and evaluates the available evidence in order to find a response. It forms part of a series of humanitarian evidence syntheses and systematic reviews commissioned by the Humanitarian Evidence Programme. 
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  Evidence Synthesis Humanitarian Evidence Programme FEBRUARY 2017 WASH INTERVENTIONS IN DISEASE OUTBREAK RESPONSE  About this evidence synthesis   This is an independent evidence synthesis commissioned by the Humanitarian Evidence Programme, a partnership between Oxfam GB and the Feinstein International Center at the Friedman School of Nutrition Science and Policy, Tufts University, and funded by the UK government through the Humanitarian Innovation and Evidence Programme at the Department for International Development. The views and opinions expressed herein are those of the authors and do not necessarily represent those of Oxfam, Feinstein or the UK government. The initial database and website searches took place between September 2015 and March 2016. The searches were re-run in September 2016 to check for updated studies. About the research team This evidence synthesis was conducted by Travis Yates (Tufts University), Jelena V. Allen (Consultant), Myriam Leandre Joseph (Consultant) and Daniele Lantagne (Tufts University). There were no conflicts of interest in the writing of this report. Authors of this report are also authors of several included evaluations in this review; however, we maintained the systematic review procedure for all documents reviewed. Citation Yates, T., Allen, J., Leandre Joseph, M. and Lantagne, D. (2017). WASH interventions in disease outbreak response . Humanitarian Evidence Programme. Oxford: Oxfam GB. Acknowledgments We would like to thank the Advisory Board members: Andy Bastable, William Carter, Tom Handzel, Melissa Opryszko, Clair Null and Pavani Ram for guidance throughout this project. This work could not have been completed without the help of numerous research assistants at Tufts University who searched websites, screened references and coded evaluations: Shannon Ball, Sean DeLawder, Meagan Erhart, Qais Iqbal, Brittany Mitro, Kyle Monahan, Bhushan Suwal and Marisa Zellmer. We would also like to thank Karin Gallandat for assistance in processing the French evaluations and Karen Vagts, a Tufts University librarian, for helping with the search strategy. Finally, we would like to thank the organizations and individuals who contributed grey literature documents that were critical to this review. Action Contre la Faim and Oxfam, in particular, made significant contributions to advance this review.   Series editors The report forms part of a series of humanitarian evidence syntheses and systematic reviews covering child protection, market support, mental health, nutrition, pastoralist livelihoods, shelter, urban contexts and water, sanitation and hygiene. The reports and corresponding protocols (methodology) can be found at:    https://www.gov.uk/dfid-research-outputs    http://fic.tufts.edu/research-item/the-humanitarian-evidence-program/    http://policy-practice.oxfam.org.uk/our-work/humanitarian/humanitarian-evidence-programme The series editors are: Roxanne Krystalli, Eleanor Ott and Lisa Walmsley. Photo credit  As part of Oxfam’s cholera response in Juba, South Sudan, teams of public health volunteers have been teaching affected communities about the importance of keeping themselves and their environment clean. May 2014. Kieran Doherty/Oxfam.  © Copyright Oxfam GB 2017 This publication is subject to copyright but the text may be used free of charge for the purposes of advocacy, campaigning, education and research, provided that the source is acknowledged in full. The copyright holder requests that all such use be registered with them for impact assessment purposes. For copying in any other circumstances, or for reuse in other publications, or for translation or adaptation, permission must be secured and a fee may be charged. Email: lwalmsley1@ght.oxfam.org  CONTENTS 0 EXECUTIVE SUMMARY I   1 BACKGROUND 1   1.1 Introduction and objective of review 1   1.2 Outbreak burden and the role of WASH 1   1.3 Theory of change 4   1.4 Importance of review 6   2 METHODS 8   2.1 Identification of studies 8   2.2 Inclusion criteria 9   2.3 Synthesis 11   2.4 Selection of documents 12   2.5 Quality appraisal 13   2.6 Contingency analysis and deviations from the protocol 14   3 RESULTS 16   3.1 Overview 16   3.2 Water: Source-based interventions 18   3.3 Water: Household water treatment and safe storage 22   3.4 Sanitation 29   3.5 Hygiene 31   3.6 WASH package 39   3.7 Beyond the scope of review 40   3.8 Economic analysis 41   3.9 Summary of interventions 41   4 DISCUSSION AND CONCLUSIONS 44   4.1 Review objectives 44   4.2 Limitations 46   4.3 Recommendations and opportunities for future research 48   4.4 Conclusions 49   5 REFERENCES 50   5.1 Studies included in evidence synthesis 50   5.2 Other studies cited in review 52   APPENDIX A  –  DESCRIPTION OF INCLUDED EVALUATIONS 55   Water 56   Sanitation 60   Hygiene 61   WASH package 65   APPENDIX B  –  SEARCHING SUMMARY 68   APPENDIX C  –  SUMMARY OF EVIDENCE 71   APPENDIX D  –  RISK OF BIAS FOR INDIVIDUAL STUDIES 73   Quanitative studies 73   Qualitative and field commentary studies 75    ABBREVIATIONS ACF  Action Contre La Faim (Action Against Hunger) CATS Community Approach to Total Sanitation CHW CI Community health worker Confidence interval CLEME CLTS Community-Led Ebola Management and Eradication Community-Led Total Sanitation DRC Democratic Republic of Congo FCR Free chlorine residual FGD GRADE Focus group discussion Grading of Recommendations Assessment, Development and Evaluation HH Household HTH High test hypochlorite  HWT Household water treatment KII LMIC Key informant interview Low and middle-income country NFI Non-food item NGO Non-governmental organization OR Odds ratio PHAST Participatory Hygiene and Sanitation Transformation PICOS Populations, interventions, comparisons, outcomes and study types RCT Randomized controlled trial RR Risk ratio SWS SODIS Safe Water System Solar disinfection ASH Water, sanitation and hygiene HO World Health Organization UN United Nations UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children’s Fund  
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