wow-inequalities/02-data/intermediate/wos_sample/2acaea481ba7ff889c0cb4138bd17ec2-chirgwin-hannah-and/info.yaml

abstract: 'Background Lack of access to and use of water, sanitation and hygiene

  (WASH) cause 1.6 million deaths every year, of which 1.2 million are due

  to gastrointestinal illnesses like diarrhoea and acute respiratory

  infections like pneumonia. Poor WASH access and use also diminish

  nutrition and educational attainment, and cause danger and stress for

  vulnerable populations, especially for women and girls. The hardest hit

  regions are sub-Saharan Africa and South Asia. Sustainable Development

  Goal (SDG) 6 calls for the end of open defecation, and universal access

  to safely managed water and sanitation facilities, and basic hand

  hygiene, by 2030. WASH access and use also underpin progress in other

  areas such as SDG1 poverty targets, SDG3 health and SDG4 education

  targets. Meeting the SDG equity agenda to ``leave none behind{''''} will

  require WASH providers prioritise the hardest to reach including those

  living remotely and people who are disadvantaged. Objectives Decision

  makers need access to high-quality evidence on what works in WASH

  promotion in different contexts, and for different groups of people, to

  reach the most disadvantaged populations and thereby achieve universal

  targets. The WASH evidence map is envisioned as a tool for commissioners

  and researchers to identify existing studies to fill synthesis gaps, as

  well as helping to prioritise new studies where there are gaps in

  knowledge. It also supports policymakers and practitioners to navigate

  the evidence base, including presenting critically appraised findings

  from existing systematic reviews. Methods This evidence map presents

  impact evaluations and systematic reviews from the WASH sector,

  organised according to the types of intervention mechanisms, WASH

  technologies promoted, and outcomes measured. It is based on a framework

  of intervention mechanisms (e.g., behaviour change triggering or

  microloans) and outcomes along the causal pathway, specifically

  behavioural outcomes (e.g., handwashing and food hygiene practices),

  ill-health outcomes (e.g., diarrhoeal morbidity and mortality),

  nutrition and socioeconomic outcomes (e.g., school absenteeism and

  household income). The map also provides filters to examine the evidence

  for a particular WASH technology (e.g., latrines), place of use (e.g.,

  home, school or health facility), location (e.g., global region,

  country, rural and urban) and group (e.g., people living with

  disability). Systematic searches for published and unpublished

  literature and trial registries were conducted of studies in low- and

  middle-income countries (LMICs). Searches were conducted in March 2018,

  and searches for completed trials were done in May 2020. Coding of

  information for the map was done by two authors working independently.

  Impact evaluations were critically appraised according to methods of

  conduct and reporting. Systematic reviews were critically appraised

  using a new approach to assess theory-based, mixed-methods evidence

  synthesis. Results There has been an enormous growth in impact

  evaluations and systematic reviews of WASH interventions since the

  International Year of Sanitation, 2008. There are now at least 367

  completed or ongoing rigorous impact evaluations in LMICs, nearly

  three-quarters of which have been conducted since 2008, plus 43

  systematic reviews. Studies have been done in 83 LMICs, with a high

  concentration in Bangladesh, India, and Kenya. WASH sector programming

  has increasingly shifted in focus from what technology to supply (e.g.

  , a handwashing station or child''s potty), to the best way in which to

  do so to promote demand. Research also covers a broader set of

  intervention mechanisms. For example, there has been increased interest

  in behaviour change communication using psychosocial ``triggering{''''},

  such as social marketing and community-led total sanitation. These

  studies report primarily on behavioural outcomes. With the advent of

  large-scale funding, in particular by the Bill \& Melinda Gates

  Foundation, there has been a substantial increase in the number of

  studies on sanitation technologies, particularly latrines. Sustaining

  behaviour is fundamental for sustaining health and other quality of life

  improvements. However, few studies have been done of intervention

  mechanisms for, or measuring outcomes on sustained adoption of latrines

  to stop open defaecation. There has also been some increase in the

  number of studies looking at outcomes and interventions that

  disproportionately affect women and girls, who quite literally carry

  most of the burden of poor water and sanitation access. However, most

  studies do not report sex disaggregated outcomes, let alone integrate

  gender analysis into their framework. Other vulnerable populations are

  even less addressed; no studies eligible for inclusion in the map were

  done of interventions targeting, or reporting on outcomes for, people

  living with disabilities. We were only able to find a single controlled

  evaluation of WASH interventions in a health care facility, in spite of

  the importance of WASH in health facilities in global policy debates.

  The quality of impact evaluations has improved, such as the use of

  controlled designs as standard, attention to addressing reporting

  biases, and adequate cluster sample size. However, there remain

  important concerns about quality of reporting. The quality and

  usefulness of systematic reviews for policy is also improving, which

  draw clearer distinctions between intervention mechanisms and synthesise

  the evidence on outcomes along the causal pathway. Adopting

  mixed-methods approaches also provides information for programmes on

  barriers and enablers affecting implementation. Conclusion Ensuring

  everyone has access to appropriate water, sanitation, and hygiene

  facilities is one of the most fundamental of challenges for poverty

  elimination. Researchers and funders need to consider carefully where

  there is the need for new primary evidence, and new syntheses of that

  evidence. This study suggests the following priority areas: Impact

  evaluations incorporating understudied outcomes, such as sustainability

  and slippage, of WASH provision in understudied places of use, such as

  health care facilities, and of interventions targeting, or presenting

  disaggregated data for, vulnerable populations, particularly over the

  life-course and for people living with a disability; Improved reporting

  in impact evaluations, including presentation of participant flow

  diagrams; and Synthesis studies and updates in areas with sufficient

  existing and planned impact evaluations, such as for diarrhoea

  mortality, ARIs, WASH in schools and decentralisation. These studies

  will preferably be conducted as mixed-methods systematic reviews that

  are able to answer questions about programme targeting, implementation,

  effectiveness and cost-effectiveness, and compare alternative

  intervention mechanisms to achieve and sustain outcomes in particular

  contexts, preferably using network meta-analysis.'
affiliation: 'Waddington, HS (Corresponding Author), London Int Dev Ctr, London Sch
  Hyg \& Trop Med, Environm Hlth Grp, 20 Bloomsbury Sq, London WC1A 2NS, England.

  Chirgwin, Hannah, London Int Dev Ctr, Int Initiat Impact Evaluat 3ie, London, England.

  Cairncross, Sandy, London Sch Hyg \& Trop Med, London, England.

  Zehra, Dua, UCL, London, England.

  Waddington, Hugh Sharma, London Int Dev Ctr, London Sch Hyg \& Trop Med \& Int Initiat
  Impact Ev, London, England.'
article-number: e21194
author: Chirgwin, Hannah and Cairncross, Sandy and Zehra, Dua and Waddington, Hugh
  Sharma
author-email: hugh.waddington@lidc.ac.uk
author_list:
- family: Chirgwin
  given: Hannah
- family: Cairncross
  given: Sandy
- family: Zehra
  given: Dua
- family: Waddington
  given: Hugh Sharma
da: '2023-09-28'
doi: 10.1002/cl2.1194
eissn: 1891-1803
files: []
journal: CAMPBELL SYSTEMATIC REVIEWS
keywords-plus: 'RANDOMIZED-CONTROLLED-TRIAL; POINT-OF-USE; HOUSEHOLD DRINKING-WATER;

  REDUCE CHILDHOOD DIARRHEA; WILLINGNESS-TO-PAY; SCHOOL-BASED WATER; LED

  TOTAL SANITATION; TRANSMITTED HELMINTH INFECTIONS; PRIVATE-SECTOR

  PARTICIPATION; ACUTE RESPIRATORY-INFECTIONS'
language: English
month: DEC
number: '4'
number-of-cited-references: '887'
orcid-numbers: Sharma Waddington, Hugh/0000-0003-3859-3342
papis_id: 6b9c17a583f40c13f97b820b4bfbf584
ref: Chirgwin2021interventionspromoti
researcherid-numbers: Sharma Waddington, Hugh/CAF-8169-2022
times-cited: '9'
title: 'Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies
  in low- and middle-income countries: An evidence and gap map of effectiveness studies'
type: article
unique-id: WOS:000731087200002
usage-count-last-180-days: '7'
usage-count-since-2013: '40'
volume: '17'
web-of-science-categories: Social Sciences, Interdisciplinary
year: '2021'