Effectiveness of emergency WASH strategies in disaster-prone areas of Africa: a systematic review

Abstract

ABSTRACT Structured summary diagram of a systematic review showing three columns: disaster context (cholera outbreaks, floods, conflict, displaced populations), WASH interventions (water treatment, hygiene kits, latrines, handwashing, health promotion), and health outcomes and challenges, linked by a conclusion that effectiveness depends on timely delivery, community engagement, and equitable resource distribution across six African countries. Gap analyses conducted in emergency water, sanitation, and hygiene (WASH) interventions have pinpointed essential obstacles to the effective implementation of sanitation in disaster scenarios. This systematic review aimed to gather and consolidate evidence on the effectiveness of emergency sanitation strategies in areas that experience disasters. We systematically searched for articles in the ReliefWeb, International Organization for Migration (IOM), World Health Organization (WHO), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Google Scholar, PubMed, Directory of Open Access Journals (DOAJ), BASE (Bielefeld Academic Search Engine), Web of Science, Scopus, Cochrane Library, Hinari, Medline, and African Index Medicus databases, guided by the best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles. Search strings were applied across these databases. In addition, a PRISMA flow diagram was used to elaborate on the number of articles retrieved, retained, excluded, and the reasons for every action. Studies that evaluated emergency sanitation strategies in disaster areas of Africa, which were interventional in nature, were included in this review. A mixed-methods appraisal tool was used to appraise studies. Six articles met the eligibility criteria. Of the six articles, only three reported the challenges faced during the implementation of emergency sanitation interventions during an emergency, particularly in response to cholera outbreaks. The findings from all the studies have not directly specified the sanitation strategies suitable for a specific type of disaster. However, the nature of the emergency context (e.g., displaced populations, poor water quality, makeshift facilities) allows us to infer suitability for specific disaster types. One study found that 87% of the drinking water sources tested were contaminated with fecal matter, which was likely a major contributor to the continued cholera outbreak. However, emergency sanitation measures introduced in response showed a positive impact (water testing and treatment, chlorine sprayers, waste incineration, water storage tanks, and health promotion), reflected by a downward trend in cholera cases, as was seen in the epidemic curve. This systematic review emphasizes that while emergency sanitation measures in Africa have considerable potential to lessen disease spread during disasters, their effectiveness is frequently hampered by contextual, logistical, behavioral, and infrastructural challenges. The success of these measures is closely linked to prompt execution, cultural relevance, fair distribution of resources, and ongoing community involvement.