Short-term hygiene interventions in emergency response situations: a systematic review and impact analysis

Publication Details

Yates, T., Allen, J., Joseph, M.L. and Lantagne, D., (2017) Short term WASH interventions in emergency response: a systematic review. 3ie Systematic Review 33. London: International Initiative for Impact Evaluation (3ie).

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Travis Yates, Jelena Vujcic, Myriam Leandre Joseph, Daniele Lantagne
All Low and Middle Income Countries
Water and Sanitation, Environment and Disaster Management, Health Nutrition and Population
Climate Change , Disaster Relief, Health Services, Water Supply and Sanitation Reform, Urban Water and Sanitation, Rural Water and Sanitation, Specific Diseases (Diarrhoea)
Equity Focus
Conflict afflicted, Vulnerable groups
Review Type
Effectiveness review

Main findings

Headline Findings: a summary statement

There was evidence of the efficacy of 12 of the 13 interventions in improving WASH conditions and reducing the risk of disease transmission.

Evidence Base

The review includes 106 studies with 114 unique evaluations. It includes interventions from 39 different countries in East Asia and Pacific (including South East Asia), South Asia, Middle East and North Africa, Sub-Saharan Africa, Latin America and the Caribbean. The review idetifies 13 specific interventions, including water source treatments, household water treatment, sanitation, hygiene promotion and environmental hygiene.

Implications for policy and practice

Water dispensers and water treatment for households, and latrines and hygiene promotion were effective at the beneficiary level.

Pumping wells flooded with seawater is not effective in reducing salinity.

There was limited evidence that WASH interventions reduce disease risk.

Simple messages through multiple communication modes, timing of interventions and encouraging community involvement, among other factors, had an impact on the success of emergency interventions.

At the community level, perceptions and preferences of WASH interventions are influenced by taste and smell of treated water, and ease of use of promoted technologies.

Communities overestimated impacts of some WASH interventions, such as household spraying and well disinfection.

Implications for further research

Additional evidence is needed for interventions, such as bucket chlorination, bulk water treatment, handwashing, household spraying, water trucking, environmental clean-up and formal economic analysis of all WASH interventions. Evaluation methodologies that require significant time and resources, such as randomised controlled trials, are not always appropriate or necessary for emergency WASH interventions. Non-experimental evaluations with consistent methods can also provide sufficient evidence across emergency settings. Programmes involving multiple WASH interventions simultaneously are commonly carried out by responders to emergencies. However, these are complex and difficult to research. Complex evaluation strategies, which help investigate synergies and spillover impacts of a combination of WASH interventions, are needed. Numerous best practice and guidance documents are available from UN agencies, donors and responding organisations, but they are often contradictory. An analysis to identify inconsistencies and consolidate what is considered best practice and what is evidence-based is needed to align best practice across the sector.


An increasing number of people are affected by natural disasters, disease outbreaks and conflict. Water, sanitation and hygiene (WASH) interventions are used in nearly all emergency contexts to help reduce the risk of disease by providing safe water, reducing open defecation and promoting hygiene practices. However, evidence to support emergency WASH interventions is limited, forcing responders to rely on past experiences or extrapolated evidence from development settings.

Research objectives

The objective of this review was to assess the outcomes and impacts of short-term emergency WASH interventions in low- and middle-income countries (L&MICs).

Specific research objectives were aimed at addressing five knowledge gaps in emergency WASH interventions: 1. What are the effects of the use of services in emergency WASH situations? 2. What are the health-related outcomes in emergency WASH situations? 3. What are the non-health-related outcomes in emergency WASH interventions? 4. What contextual factors act as barriers or facilitators to implementation and uptake and the effectiveness in emergency WASH situations? 5. What is the cost-effectiveness of emergency WASH interventions?


The review uses a systematic review process to capture the available research in the emergency WASH sector from published and unpublished ‘grey’ literature. They searched sources of published and grey literature including academic databases including Cochrane Library, Google Scholar, IDEAS, LILACs, Ovid Medline (Pubmed), Scopus, and Web of Science, and directly solicited studies. The scope of the review focuses on studies on populations affected by an emergency in a low or middle-income country and published between 1995-2016. The review includes both quantitative and qualitative studies. Authors’ independently screened results by title, then abstract and full text. Authors also undertook independent data extraction and a risk  of bias analysis for inlcuded studies. The authors grouped results by intervention and summarized findings based on reported outcomes through narrative synthesis.

Quality assessment

This review is of a high quality. No strong conclusions for policy or practice.

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