Add wos sample results library
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abstract: 'Background Lack of access to and use of water, sanitation and hygiene
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(WASH) cause 1.6 million deaths every year, of which 1.2 million are due
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to gastrointestinal illnesses like diarrhoea and acute respiratory
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infections like pneumonia. Poor WASH access and use also diminish
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nutrition and educational attainment, and cause danger and stress for
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vulnerable populations, especially for women and girls. The hardest hit
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regions are sub-Saharan Africa and South Asia. Sustainable Development
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Goal (SDG) 6 calls for the end of open defecation, and universal access
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to safely managed water and sanitation facilities, and basic hand
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hygiene, by 2030. WASH access and use also underpin progress in other
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areas such as SDG1 poverty targets, SDG3 health and SDG4 education
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targets. Meeting the SDG equity agenda to ``leave none behind{''''} will
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require WASH providers prioritise the hardest to reach including those
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living remotely and people who are disadvantaged. Objectives Decision
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makers need access to high-quality evidence on what works in WASH
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promotion in different contexts, and for different groups of people, to
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reach the most disadvantaged populations and thereby achieve universal
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targets. The WASH evidence map is envisioned as a tool for commissioners
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and researchers to identify existing studies to fill synthesis gaps, as
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well as helping to prioritise new studies where there are gaps in
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knowledge. It also supports policymakers and practitioners to navigate
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the evidence base, including presenting critically appraised findings
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from existing systematic reviews. Methods This evidence map presents
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impact evaluations and systematic reviews from the WASH sector,
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organised according to the types of intervention mechanisms, WASH
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technologies promoted, and outcomes measured. It is based on a framework
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of intervention mechanisms (e.g., behaviour change triggering or
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microloans) and outcomes along the causal pathway, specifically
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behavioural outcomes (e.g., handwashing and food hygiene practices),
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ill-health outcomes (e.g., diarrhoeal morbidity and mortality),
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nutrition and socioeconomic outcomes (e.g., school absenteeism and
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household income). The map also provides filters to examine the evidence
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for a particular WASH technology (e.g., latrines), place of use (e.g.,
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home, school or health facility), location (e.g., global region,
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country, rural and urban) and group (e.g., people living with
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disability). Systematic searches for published and unpublished
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literature and trial registries were conducted of studies in low- and
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middle-income countries (LMICs). Searches were conducted in March 2018,
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and searches for completed trials were done in May 2020. Coding of
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information for the map was done by two authors working independently.
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Impact evaluations were critically appraised according to methods of
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conduct and reporting. Systematic reviews were critically appraised
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using a new approach to assess theory-based, mixed-methods evidence
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synthesis. Results There has been an enormous growth in impact
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evaluations and systematic reviews of WASH interventions since the
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International Year of Sanitation, 2008. There are now at least 367
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completed or ongoing rigorous impact evaluations in LMICs, nearly
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three-quarters of which have been conducted since 2008, plus 43
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systematic reviews. Studies have been done in 83 LMICs, with a high
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concentration in Bangladesh, India, and Kenya. WASH sector programming
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has increasingly shifted in focus from what technology to supply (e.g.
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, a handwashing station or child''s potty), to the best way in which to
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do so to promote demand. Research also covers a broader set of
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intervention mechanisms. For example, there has been increased interest
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in behaviour change communication using psychosocial ``triggering{''''},
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such as social marketing and community-led total sanitation. These
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studies report primarily on behavioural outcomes. With the advent of
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large-scale funding, in particular by the Bill \& Melinda Gates
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Foundation, there has been a substantial increase in the number of
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studies on sanitation technologies, particularly latrines. Sustaining
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behaviour is fundamental for sustaining health and other quality of life
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improvements. However, few studies have been done of intervention
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mechanisms for, or measuring outcomes on sustained adoption of latrines
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to stop open defaecation. There has also been some increase in the
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number of studies looking at outcomes and interventions that
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disproportionately affect women and girls, who quite literally carry
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most of the burden of poor water and sanitation access. However, most
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studies do not report sex disaggregated outcomes, let alone integrate
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gender analysis into their framework. Other vulnerable populations are
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even less addressed; no studies eligible for inclusion in the map were
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done of interventions targeting, or reporting on outcomes for, people
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living with disabilities. We were only able to find a single controlled
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evaluation of WASH interventions in a health care facility, in spite of
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the importance of WASH in health facilities in global policy debates.
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The quality of impact evaluations has improved, such as the use of
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controlled designs as standard, attention to addressing reporting
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biases, and adequate cluster sample size. However, there remain
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important concerns about quality of reporting. The quality and
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usefulness of systematic reviews for policy is also improving, which
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draw clearer distinctions between intervention mechanisms and synthesise
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the evidence on outcomes along the causal pathway. Adopting
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mixed-methods approaches also provides information for programmes on
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barriers and enablers affecting implementation. Conclusion Ensuring
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everyone has access to appropriate water, sanitation, and hygiene
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facilities is one of the most fundamental of challenges for poverty
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elimination. Researchers and funders need to consider carefully where
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there is the need for new primary evidence, and new syntheses of that
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evidence. This study suggests the following priority areas: Impact
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evaluations incorporating understudied outcomes, such as sustainability
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and slippage, of WASH provision in understudied places of use, such as
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health care facilities, and of interventions targeting, or presenting
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disaggregated data for, vulnerable populations, particularly over the
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life-course and for people living with a disability; Improved reporting
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in impact evaluations, including presentation of participant flow
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diagrams; and Synthesis studies and updates in areas with sufficient
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existing and planned impact evaluations, such as for diarrhoea
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mortality, ARIs, WASH in schools and decentralisation. These studies
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will preferably be conducted as mixed-methods systematic reviews that
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are able to answer questions about programme targeting, implementation,
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effectiveness and cost-effectiveness, and compare alternative
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intervention mechanisms to achieve and sustain outcomes in particular
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contexts, preferably using network meta-analysis.'
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affiliation: 'Waddington, HS (Corresponding Author), London Int Dev Ctr, London Sch
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Hyg \& Trop Med, Environm Hlth Grp, 20 Bloomsbury Sq, London WC1A 2NS, England.
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Chirgwin, Hannah, London Int Dev Ctr, Int Initiat Impact Evaluat 3ie, London, England.
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Cairncross, Sandy, London Sch Hyg \& Trop Med, London, England.
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Zehra, Dua, UCL, London, England.
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Waddington, Hugh Sharma, London Int Dev Ctr, London Sch Hyg \& Trop Med \& Int Initiat
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Impact Ev, London, England.'
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article-number: e21194
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author: Chirgwin, Hannah and Cairncross, Sandy and Zehra, Dua and Waddington, Hugh
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Sharma
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author-email: hugh.waddington@lidc.ac.uk
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author_list:
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- family: Chirgwin
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given: Hannah
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- family: Cairncross
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given: Sandy
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- family: Zehra
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given: Dua
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- family: Waddington
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given: Hugh Sharma
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da: '2023-09-28'
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doi: 10.1002/cl2.1194
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eissn: 1891-1803
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files: []
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journal: CAMPBELL SYSTEMATIC REVIEWS
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keywords-plus: 'RANDOMIZED-CONTROLLED-TRIAL; POINT-OF-USE; HOUSEHOLD DRINKING-WATER;
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REDUCE CHILDHOOD DIARRHEA; WILLINGNESS-TO-PAY; SCHOOL-BASED WATER; LED
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TOTAL SANITATION; TRANSMITTED HELMINTH INFECTIONS; PRIVATE-SECTOR
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PARTICIPATION; ACUTE RESPIRATORY-INFECTIONS'
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language: English
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month: DEC
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number: '4'
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number-of-cited-references: '887'
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orcid-numbers: Sharma Waddington, Hugh/0000-0003-3859-3342
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papis_id: 6b9c17a583f40c13f97b820b4bfbf584
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ref: Chirgwin2021interventionspromoti
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researcherid-numbers: Sharma Waddington, Hugh/CAF-8169-2022
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times-cited: '9'
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title: 'Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies
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in low- and middle-income countries: An evidence and gap map of effectiveness studies'
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type: Article
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unique-id: WOS:000731087200002
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usage-count-last-180-days: '7'
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usage-count-since-2013: '40'
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volume: '17'
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web-of-science-categories: Social Sciences, Interdisciplinary
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year: '2021'
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