Effectiveness of Emergency Sanitation Strategies in Disaster Prone Areas of Africa: A Systematic Review

Effectiveness of Emergency Sanitation Strategies in Disaster Prone Areas of Africa: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Effectiveness of Emergency Sanitation Strategies in Disaster Prone Areas of Africa: A Systematic Review Ellacy Chirwa, Atusaye Mwalwanda, Margret Soko, Balwani Chingatichifwe Mbakaya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7170040/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction 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. Methods 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 acceptable best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles. A search string was applied across these databases, using Boolean operators to differentiate the key terms. In addition, a PRISMA flow diagram was used to elaborate on the number of articles retrieved, retained, excluded and 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 method appraisal tool was used to appraise studies. Results Six articles met the eligibility criteria. Out of the 6 articles, only three reported the challenges faced during 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 specific disaster type. However, the nature of the emergency context (e.g. displaced populations, poor water quality, makeshift facilities) allows 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 Conclusion 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. Preventive Medicine Effectiveness Emergency Sanitation Strategies Disaster Africa Systematic Review Figures Figure 1 Background information The United Nations (2010) declared Sanitation as an essential human right and it is a vital element of disaster management, especially in areas where both natural and man-made disasters often disrupt water and sanitation services. This urgency is highlighted by statistics from the Emergency Events Database (EM-DAT), which documented 399 disasters related to natural hazards in 2023. These incidents resulted in 86,473 deaths, impacted around 93.1 million individuals, and caused an estimated economic loss of US $ 202.7 billion annually. In areas impacted by disasters, insufficient sanitation can result in significant public health issues, including the spread of cholera, dysentery, and other diseases transmitted through contaminated water (Sphere Association, 2018). The interruption of sanitation services often heightens vulnerabilities, especially among displaced individuals who do not have access to safe drinking water and appropriate waste disposal facilities. Effective emergency sanitation measures such as providing latrines, promoting hygiene, and managing waste are essential for reducing these risks and maintaining human dignity. Research indicates that incorporating sanitation into disaster response plans can considerably lower morbidity and mortality rates, while also enhancing the overall resilience of the communities affected (Ramesh et al., 2015 ). Globally accepted humanitarian standards for emergency response, including sanitation, have been detailed in numerous studies. These standards prioritize accessibility, safety, and cultural relevance, emphasizing effective waste management, sufficient toilet facilities, and community involvement in sanitation initiatives. Adherence to these standards has been shown to improve sanitation outcomes and reduce disease transmission in disaster-affected environments. For instance, a study by Bako, Barakagira, and Nabukonde ( 2021 ) assessed sanitation facilities in Uganda's Bidibidi refugee camp, highlighting the importance of meeting Sphere Standards to prevent sanitation-related diseases. The significance of water, sanitation, and hygiene (WASH) measures during humanitarian emergencies is crucial. Strategies for emergency sanitation need to be coordinated with hygiene promotion and a clean water supply to enhance their effectiveness. Research by Sekine and Roskosky ( 2018 ) shows that emergency sanitation measures can substantially lower child mortality and illness in regions impacted by disasters. Investing in emergency sanitation plays a crucial role in enhancing disaster resilience. Research conducted by Zakaria et al., ( 2015 ) created a decision support system for planning sanitation responses during emergencies, highlighting the necessity for flexible sanitation solutions capable of adapting to various disaster-related obstacles, such as floods, earthquakes, and conflicts. Furthermore, it emphasizes the importance of collaboration across multiple sectors to ensure sustainable sanitation responses. Numerous studies have offered valuable perspectives on sanitation strategies for displaced individuals. The swift installation of portable sanitation facilities and decentralized waste management systems is vital during humanitarian emergencies. It is essential to take into account local circumstances, cultural norms, and available resources when executing emergency sanitation initiatives. Analysis of case studies indicates that employing community-driven approaches results in greater acceptance and enhanced long-term sustainability of sanitation solutions (Lai et al., 2015). The difficulties of ensuring proper sanitation in overcrowded refugee camps, where open defecation and improper waste management present significant health threats, have been underscored by various field experiences in zones affected by disasters and conflicts. Innovative strategies, such as container-based sanitation and waste-to-energy methods, are recommended to enhance sanitation coverage and lessen environmental pollution (Chatila et al., 2021 ). Gap analyses conducted in emergency Water, Sanitation and Hygiene (WASH) interventions have pinpointed essential obstacles to the effective implementation of sanitation in disaster scenarios. Research has revealed that logistical challenges, insufficient funding, and socio-cultural influences frequently obstruct the success of sanitation initiatives. Scholars stress the need for sanitation solutions that are tailored to local contexts, improved collaboration among humanitarian organizations, and increased investment in sanitation infrastructure Sekine & Roskosky, 2018 ). The impact of emergency sanitation measures and their role in public health has been investigated in multiple studies. Findings show that well-maintained sanitation facilities greatly lessen the spread of diseases among populations affected by disasters. The significance of combining sanitation with other WASH initiatives to optimize health outcomes is also emphasized. The use of innovative technologies like solar-powered toilets and biodegradable waste bags is suggested to improve sanitation accessibility in settings with limited resources (Zakaria et al., 2015 ). The Sphere Handbook establishes internationally accepted humanitarian standards for emergency responses, particularly in sanitation. The Sphere Association (2018) highlights the essential requirements for sanitation during crises, emphasizing accessibility, safety, and cultural relevance. It underscores the significance of effective waste management, sufficient toilet availability, and community involvement in sanitation initiatives. Following these standards has demonstrated improved sanitation results and decreased disease spread in disaster situations. This systematic review aimed to gather and consolidate evidence on the effectiveness of emergency sanitation strategies in areas that experience disasters. The outcomes of this review included, health outcomes related to sanitation interventions and effectiveness of sanitation strategies (impact on disease prevention). The following are the questions that the systematic review tried to address. How effective are emergency sanitation strategies in addressing sanitation needs in disaster areas of Africa? Which emergency sanitation strategies are most suitable for specific disaster types, such as floods, earthquakes, and conflict zones in Africa? What challenges are commonly faced in implementing emergency sanitation interventions in disaster areas of Africa? What are the impact of emergency sanitation interventions on health outcomes, particularly in preventing waterborne diseases among populations affected by disasters? Methods Protocol This review was written following the acceptable best practice developed by the PROSPERO for systematic search and selection of articles. The protocol was published in the PROSPERO database with registration number CRD42024628289 [Effectiveness of Emergency Sanitation Strategies in Disaster-Prone Areas of Africa] ( https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628289 ). Inclusion criteria The review focused on peer-reviewed studies, that evaluated emergency sanitation strategies in disaster areas of Africa, which were interventional in nature. Studies conducted during or immediately following disaster events, from 2014 to 2024, were included to ensure relevance to emergency sanitation situations and the health impacts associated with these interventions. Exclusion criteria Research focusing on non-emergency sanitation solutions, non-peer-reviewed articles, and studies conducted outside of Africa were omitted. Additionally, studies lacking sufficient data on the effectiveness or health outcomes of sanitation interventions, or those that did not specifically evaluate emergency sanitation approaches, were not considered for inclusion in the review. In addition, studies written in languages other than English were excluded. Information Source/ Search strategy The necessary data was obtained from the following database sources: Relief Web, 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. A search string was applied across these databases, using Boolean operators to differentiate the key terms; Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges (See Table 1 ). Efforts were made to identify both published and unpublished interventional studies by manually checking the reference list of the articles that met the inclusion criteria. Several strategies were used to identify unpublished studies. First, we reviewed the methodology and reference list of the included studies to assess if they identified any unpublished research related to the review question. Second, we manually searched conference proceedings such as Development International Conference, Water Engineering and Development Centre and the University of North Caroline Water and Health Conference for any suitable studies. Further searches were conducted in clinical trial website such as ClinicalTrials.gov website ( https://clinicaltrials.gov/ ). Efforts were also made to contact the authors of the unpublished studies. Reference lists of the included studies were checked and hand searching in the key journals was also done. The search period for the research articles in the mentioned databases was from 2014 to July 2024. The search for the eligible studies in the database was conducted between January 2025 to April 2025. Table 1 Search strategy. Database Search Terms Search string Results Relief Web Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 International Organization for Migration (IOM) Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 World Health Organization (WHO) Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 United Nations Office for the Coordination of Humanitarian Affairs (OCHA) Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Hand search internet Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges 5 Google Scholar Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 128 PUBMED Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 25 Directory of Open Access Journals (DOAJ) Title and abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 BASE (Bielefeld Academic Search Engine Title and abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Web of Science Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Scopus Title and abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Cochrane Library Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Hinari Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Medline Title and Abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 African Index Medicus Title and abstract Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges. 0 Total articles obtained 158 Total articles included 6 Study Selection Titles obtained from the databases were organized into distinct folders according to the name of each database. Subsequently, duplicates were removed. The abstracts linked to the identified titles were gathered and assessed for eligibility. Full articles were acquired for the pertinent abstracts and evaluated thoroughly to establish their inclusion suitability. The article eligibility assessment was performed independently by three reviewers applying pre-defined inclusion and exclusion criteria. Any differences in opinions among the reviewers concerning the eligibility of specific studies were resolved through discussions with a fourth reviewer. Data Collection Process The data extraction process commenced with a database search for relevant articles utilizing search terms while adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, as illustrated in (Fig. 1). A standardized form was employed to gather data from the included studies for evaluating study quality and evidence synthesis. The details extracted included the author, study year, participant type, age, setting, country, sample size, study design and methods, study purpose and objectives, intervention description, outcomes, and results (refer to supplementary material A). Relevant information from each article was summarized and documented (see Table 2 ). The three reviewers conducted independent data extraction, and any discrepancies identified were resolved through discussions with the fourth reviewer of the study. Search Outcome The search produced a total of 158 articles, of which 140 were noted during the preliminary assessment phase following the removal of duplicates. From the returned articles, 12 were further excluded from the analysis due to the outcomes being unclear. Subsequently 6 articles were qualified according to the inclusion criteria, and their complete texts were retrieved and evaluated by three authors for eligibility. The fourth author confirmed the eligibility of the articles for inclusion in the review. Following this assessment, only 6 articles fulfilled the inclusion criteria, while 152 articles were discarded from the systematic review as they did not satisfy the eligibility requirements (see Fig. 1). Table 2 Summary of studies Author & Year Population Sample Size Study design & Methods Study purpose &objectives Objectives/aims Participants Age Setting Country Outcomes Results D`mello-Guyett et al., (2020) Médecins Sans Frontières (MSF) staff. NGOs Staff. Kit recipients and Households Household average age was 43 years. Staff age not provided Household. Health Care Facility. Treatment Unit and center Democratic Republic of Congo 7 MSF staff. 17 staff from NGOs. 27 random kit recipients (13 females and 14 males) Qualitative and Quantitative methods. Data were collected through key informative interviews with 7 MSF staff, 17 staff from NGOs and 27 hygiene kit recipients. Structured observations and secondary data from reports were conducted. Semi structured interviews were conducted at Household of a random sample enrolled in the parallel prospective cohort study who received hygiene kits. Water testing was conducted. To identify the successes and barriers of the hygiene kit distribution strategy for Cholera control in order to understand delivery, use and scalability and to propose recommendations to optimize future programs Effectiveness of the hygiene kit to reduce transmission of Cholera among Household contacts of cases and overall Cholera incidence Only 52% of admitted cholera cases received interventions on the day of admission. Hygiene kit distribution was identified as a promising control measure, but its effectiveness was limited by delays, supply shortages, and inadequate distribution. Many households received kits too late, reducing their impact on transmission and incidence. The study highlights the potential of health facility-based and case-centered WASH interventions. M.Habtu et al., ( 2024 ) Community. Refugees Age Not provided Household. Community. Institution. Refugees’ camps and communities Kenya 480,000 people. Cross sectional study. Water sample collection. Assessment of water and Monitoring To evaluate the impact of the evidence-based WASH interventions that contributed to the control of the recent Cholera outbreak Minimize the spread and impact of the Cholera outbreak 87% of tested drinking water sources were fecally contaminated. In response, targeted WASH interventions and capacity building resulted in a positive impact in the fight against Cholera. Prioritizing water quality management, sustainable solutions, and community engagement and collaboration is key to ensuring safe water and preventing future outbreaks. Appiah. Effah et al., (2020) Opinion leaders. School officials. Health Officials and Households. Age not provided on officials and leaders. Diarrhea cases recorded 56% (below 5 years ) and 26% (above 5 years) Community. Schools. Health Facility. Ghana 2315 cases (83% diarrhea cases). 9 interventions communities. 9 controls communities. Qualitative and Quantitative methodologies. Before and after study with concurrent control (BAC) method to evaluate the impact. Cluster randomized design was used. Data were collected through document, reviews, data from health facility. Key informative interviews and household survey were conducted. Semi structured questionnaire was used for the Household survey. To evaluate the health impacts of WASH interventions in 9 interventions communities against 9 control communities in disaster prone areas. Reduction in Diarrhea incidence Diarrhea was the most common WASH-related disease, accounting for over 80% of cases. The highest reduction (7%) occurred in a community where the chief actively promoted WASH practices. While interventions helped reduce diarrhea, the impact was lower than in other studies and the study could not measure the extent to which WASH independently contributed to reduction in diarrhea diseases, since it could not gather detailed information on quality of service delivered. Okeeffe et. al. (2024) General population Age not specified Community Nigeria 44597 households (1,615 case and 42,982 neighbor Households) Prospective observational cohort study Kobo Toolbox (SI) and mWater (ACF) were used to collect data Interventions used; Case household received: Aquatabs, Soap and Jerrycan; Neighbor household received: Aquatabs and Soap; and Household (case or neighbor) received: Hygiene promotion, Bedding disinfection and Latrine disinfection To investigate Case Area targeted interventions (CATI) association on cholera transmission in a real-world, uncontrolled environment using a novel spatial-temporal cluster detection approach. Significant reductions in cholera clustering CATIs were associated with a reduction in cholera clusters during the outbreak; clusters were fewer and smaller, occurred for shorter duration, and were less likely to reoccur in the presence of CATIs. Tamene, A. ( 2021 ) General population Age not specified Hospital Ethiopia 8 Key informants 35 treatment centers Mixed design study Observational Checklist and key informant interviews, were used for data collection. To examine the availability, accessibility, functionality, and disparity of water, sanitation, and hygiene (WASH) facilities in temporary COVID-19 isolation and treatment centers Availability, accessibility and, functionality of water supply, excreta disposal system, shower and laundry system, hand washing stations, waste disposal system and infection prevention and control syst in temporary treatment centers Of the 35 temporary treatment centers, an overwhelming majority, i.e., 27 (77.1%) had daily water supply interruptions All 35 of the temporary treatment centers had bathrooms within their premises. However, only 30 (85.72%) of the centers had toilets separated for staff, patients, and visitors. Almost all (94.7%) of the laundries in the treatment facilities were not functional. Twenty-six (74.28%) of the treatment centers had functional handwashing points in service areas and in any location where healthcare is delivered. Soap stands were also available at each hand washing facility, for the majority i.e., 28(80%) of the treatment centers. Similarly, while 21(60%) of the handwashing stations had running water, the rest stored water near hand washing facilities A small number of the treatment centers surveyed 6(17.14%) had insufficient, and/or overflowing containers for waste disposal. Likewise, 7(20%) of the evaluated centers had no mechanism for hazardous waste separation. Sixteen (45.71%) of the treatment facilities assessed were inadequately supplied with personal protective equipment (gloves, overalls, masks, etc.). Asmally et. al. ( 2025 ) Internally displaced individuals Median age 35 Community/village Rural villages in South Kordofan Sudan 784 (471 females and 313 males) A cross-sectional study design The patient forms which included clinical characteristics of the participants. A structured interviewer-administered questionnaire Water sample analysis To evaluate the quality and availability of drinking water, as well as sanitation and hygiene practices in rural South Kordofan. To identify factors affecting community satisfaction with WASH services and to establish a data-driven basis for future interventions addressing these issues. Water Quality & Availability Sanitation & Hygiene Practices Community Satisfaction & Key Influencing Factors Conflict-Related Challenges Policy & Intervention Implications Tube wells/boreholes were the primary water source (68.1%), and most participants (70.9%) lived near their water source (less than 30 min). Dissatisfaction with water services was reported by 56.8%, and satisfaction associated with method of delivery (OR = 0.081, CI = 0.024–0.276)), appearance (OR = 0.299, CI = 0.182–0.489), distance (OR = 0.264, CI = 0.099–0.705), water unavailability (OR = 0.477, CI = 0.297–0.765), and obligation to pay (OR = 0.351, CI = 0.185–0.665). Samples showed high levels of contamination, both microbial and physicochemical. Regarding sanitation, over a third of the participants (41.5%) disposed of children’s stool by leaving it outdoors. About 10% of the participants reported having diarrhea during the week before the study. However, about two-thirds of the participants (68.1%) showed good hygienic practices by using soap or detergents for hand washing. Risk of Bias/ Quality appraisal The quality of the design and the reporting system were the main focus on this stage. Three review authors independently assessed the risk of bias in the included studies. The MMAT was used to appraise the studies. The MMAT (Pluye et. Al., 2011) was used to appraise the six studies included in the review. MMAT is a validated checklist used to appraise the quality of studies included in any systematic review with a quantitative, qualitative and mixed methods approach (Pluye et. Al., 2011). The MMAT has two general screening questions applicable to all study designs: 1) Are there clear qualitative and quantitative research questions or objectives, or is there a clear mixed-methods’ question or objective? 2) Do the collected data address the research question or objective? The MMAT appraises the following study methodologies and designs: qualitative, quantitative randomised controlled, quantitative non-randomized, quantitative descriptive and mixed methods study designs. The tool is divided into five components and each component is designed to assess the quality of a specific study design. These components are qualitative, quantitative randomised controlled, quantitative non-randomized, quantitative descriptive, and mixed methods studies. All components are numbered, and each section has five assessment criteria. For example, assessment criteria for assessing for Quantitative non-randomized studies included: 1) Are the participants representative of the target population? 2) Are measurements appropriate regarding both the outcome and intervention (or exposure)? 3) Are there complete outcome data? 4) Are the confounders accounted for in the design and analysis? 5) During the study period, is the intervention administered (or exposure occurred) as intended? Each criterion is rated as “Yes”, or “No” or “Can’t tell”. It is discouraged to calculate an overall score from the ratings of each criterion. Instead, it is advised to provide a more detailed presentation of the ratings of each criterion to better inform the quality of the included studies. It is also discouraged to exclude studies with low methodological quality. MMAT was chosen to appraise studies in this review because it can simultaneously appraise studies of different designs, which suits different study methodologies included in this systematic review. Data synthesis A narrative approach was used to synthesise data. Narrative synthesis in systematic reviews is recommended when there is a great variation in variables such as outcomes, interventions, population, and methods across studies (Popay et al., 2006). We used study outcomes as themes to synthesise data. A narrative approach was also used to synthesis the quality of study and characteristics of the study. The main category of the analysis was based on; the health outcomes related to sanitation interventions and effectiveness of sanitation strategies. Under this category, the reviewers came up with four subcategories, namely: Effectiveness of emergency sanitation strategies in addressing sanitation needs and improving health outcomes in disaster areas in Africa; Emergency sanitation strategies most suitable for specific disaster types in Africa; Challenges commonly faced in implementing emergency sanitation interventions in disaster areas of Africa; Impact of emergency sanitation interventions on health outcomes in preventing waterborne diseases among populations affected by disasters. Effectiveness of emergency sanitation strategies in this study refers to proxy data of reducing infectious diseases such as diarrhea. Sanitation needs in this study shall mean “having clean and readily available toilets, managing human excreta safely, and ensuring proper disposal of garbage and wastewater”. Content analysis was carried out to synthesise the extracted data and similar information was grouped (see Table 2 ). Findings were presented in narrative form as shown below. The interventions were also classified according the settings where they were implemented. The settings of the study were classified as households (peoples’ houses), schools, refugee camps, and communities/villages. Statistical meta-analysis was not possible as the studies varied considerably on how the study outcomes were analysed by the researchers. Results Quality appraisal Based on MMAT, three studies scored a “Yes” on all the five parameters [Appiah, 2020; Okeeffe, 2024; Asmally, 2025]. of these three, one used a mixed methods design, one used a prospective cohort study design, and one use a cross-sectional study design. Two studies scored a “No” on one parameter and scored a Yes’ on the four parameters [Mello, 2020; Tamene, 2021]. Both were mixed methods studies that had no adequate rationale for using a mixed methods design to address the research question. One study scored “Can’t tell” on one parameter, and scored a “Yes” on the four parameters [Habtu, 2024]. This was a cross-sectional study that did not indicate whether the risk of nonresponse was low. However, non response bias was not applicable because the study was dealing with water samples. MMAT has no cut-off point for the quality of studies, and it is discouraged to calculate an overall score from the ratings of each criterion. As such, we considered studies with more that had scored a ‘Yes” on more than half of the observation/parameters as having high quality, and those that had a score of a “No: on more than half of the observation/parameters as of poor quality. With the above description on all the six included studies, the studies are considered to be of high quality. Table 3: MMAT Name of study author Type of study Methodological quality criteria Yes No Can’t tell Comment D`mello-Guyett et al., (2020) Qualitative and Quantitative methods. 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? ✔ The reasons for conducting a mixed methods study has not been explained. 5.2. Are the different components of the study effectively integrated to answer the research question? ✔ 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? ✔ 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? ✔ 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? ✔ M.Habtu et al.,(2024) Cross sectional study 4.1. Is the sampling strategy relevant to address the research question? ✔ 4.2. Is the sample representative of the target population? ✔ 4.3. Are the measurements appropriate? ✔ 4.4. Is the risk of nonresponse bias low? ✔ Non response bias is not applicable because the study was dealing with water samples 4.5. Is the statistical analysis appropriate to answer the research question? ✔ Appiah. Effah et al., (2020) Qualitative and Quantitative methods 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? ✔ 5.2. Are the different components of the study effectively integrated to answer the research question? ✔ 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? ✔ 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? ✔ 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? ✔ Okeeffe et. al. (2024) Prospective observational cohort study 3.1. Are the participants representative of the target population? ✔ 3.2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? ✔ 3.3. Are there complete outcome data? ✔ 3.4. Are the confounders accounted for in the design and analysis? ✔ 3.5. During the study period, is the intervention administered (or exposure occurred) as intended? ✔ Tamene, A. (2021) Mixed method design 5.1. Is there an adequate rationale for using a mixed methods design to address the research question? ✔ The reasons for conducting a mixed methods study has not been explained 5.2. Are the different components of the study effectively integrated to answer the research question? ✔ 5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted? ✔ 5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? ✔ 5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved? ✔ Asmally et. al. (2025) A Cross-sectional study design 4.1. Is the sampling strategy relevant to address the research question? ✔ 4.2. Is the sample representative of the target population? ✔ 4.3. Are the measurements appropriate? ✔ 4.4. Is the risk of nonresponse bias low? ✔ 4.5. Is the statistical analysis appropriate to answer the research question? ✔ Study Characteristics Six studies met the eligible criteria. Of these, one study was conducted in Democratic Republic of Congo [D`mello-Guyett et al., 2020], one in Kenya [Habtu et al.,2024], one in Ghana [Appiah. Effah et al., 2020], one in Nigeria [Okeeffe et. al. 2024], one in Ethiopia [Tamene, A. 2021], and one in Sudan [Asmally et. al. 2025]. (See Table 2). In terms of study design, three mixed method design. [D`mello-Guyett et al., (2020); Appiah. Effah et al., 2020, & Tamene, A. 2021], two cross-sectional studies [Habtu et al.,2024, & Asmally et. al. 2025], and one prospective cohort study [Okeeffe et. al. 2024] were evaluated. Data collection in the cross-sectional study was mainly through semi-structured questionnaire, and water samples. The prospective cohort study utilized kobo tool, mWater. The mixed method study utilized key informant interviews, structured observations, and semi structured interviews. (see Table 2). The study population in two studies were the general population [Tamene, A. 2021; Okeeffe et. al. 2024]. One study was conducted with the internally displaced population [Asmally et. al. 2025]. One study involved the community and the refuges [Habtu et al.,2024]. While the other two involved the households, staff/officials, school children [D`mello-Guyett et al., 2020; Appiah. Effah et al., 2020]. In terms of the setting, two studies were conducted in community settings only [Asmally et. al. 2025; Okeeffe et. al. 2024]. one study was purely conducted in a hospital setting, while the other three combine one or two of the following settings; household, health care, treatment centres, refugee camps and school setting [Habtu et al.,2024; Habtu et al.,2024; D`mello-Guyett et al., 2020]. The median of the participants in a study by Asmally et. al. 2025 was 15, while the mean aged in the study by D`mello-Guyett et al., 2020 was 45 years. Three studies did not indicate the age of the participants involved in their studies [Appiah. Effah et al., 2020; Tamene, A. 2021; & Okeeffe et. al. 2024]. In a study by Habtu et al.,2024, the authors used the water samples. As such the age of the population did not apply. The number of participants in each study varied from 7 [D`mello-Guyett et al., 2020] to 480,000 [Habtu et al.,2024]. Summary of the Findings Effectiveness of emergency sanitation strategies in addressing sanitation needs in disaster areas in Africa; In Adamawa State, emergency sanitation efforts were less effective, as they had lower latrine coverage and fewer hygiene promotion initiatives. In contrast, the response was most effective in Yobe State , where improved latrine coverage (89.6%) and handwashing station presence (49.6%) were relatively high. Yobe also showed near-universal implementation of hygiene promotion and latrine disinfection activities and had a higher percentage of households receiving the complete CATI package compared to Adamawa. These results emphasize the importance of strengthening baseline WASH infrastructure, improving logistical coordination, and ensuring timely and comprehensive response to effectively meet sanitation needs in disaster-affected settings across Africa. Tamene, A. (2021) study, assessed the availability, accessibility, and functionality of WASH services in all 35 temporary COVID-19 treatment centers across the Southern Nations, Nationalities, and Peoples' Region (SNNPR). Regardless of the presence of piped water in all facilities, 77.1% faced frequent interruptions. Some facilities resorted to unimproved or unchlorinated water sources, increasing the risk of contamination. One infection prevention officer noted, ‘‘There is a frequent discontinuity of water but , there is a backup tanker for our services . The water and sewerage service authority should focus on the continuous water supply to the treatment center . ” Even though 74.28% of centers had functional handwashing stations, only 60% had running water. Toilets were available at all centers, but only 85.7% had them separated for different users, and accessibility for persons with disabilities was largely inadequate A regional taskforce officer explained, ‘‘Most HCFs store their water in a covered storage container , the majority of latrine users fail to safely collect water from these containers . Instead , they use a cup , bowl , or their hands to scoop water from the container , which might introduce contaminants . ” ‘‘This is a university building ; it has latrines built to accommodate the disabled but it has been in use for some 50 plus years . It is dilapidated . ” Laundry and shower systems were severely lacking, with 94.7% of laundry services nonfunctional, forcing manual washing that raised safety concerns. Waste management was also problematic17.1% had overflowing waste containers and 60% lacked adequate incineration capacity. As one officer put it, ‘‘Nowadays , our workers toil hard to make up for the downed washing machines this manual washing puts them and their families at great risk . ” ‘‘There are lots of design gaps in this treatment center . However , since the building is registered as a cultural and tourism site; it is difficult to get a construction permit to build a more compatible incinerator . ” Furthermore, the study highlighted that 45.71% of centers were undersupplied with personal protective equipment, and in some facilities, WASH duties were shifted to untrained nurses due to a lack of environmental health professionals. The study revealed significant disparities in WASH services between urban and rural COVID-19 isolation and treatment centers, with rural centers facing greater challenges in latrine maintenance (68.4% vs. 31.2%), implementation of WHO-recommended hand hygiene protocols (26.3% vs. 62.5%), and incineration capacity (73.4% vs. 62.5%). These differences were statistically significant, indicating unequal emergency preparedness across settings. According to M. Habtu et al., (2024), his findings highlight significant challenges in meeting water quality standards, particularly regarding fecal coliform contamination, which is a key indicator of water safety. In total, 87.2% of the 109 drinking water samples did not meet the required threshold for thermotolerant coliforms, indicating widespread contamination. Most concerning is that a large percentage of samples from various sources household storage containers (92.5%), institutional storage tanks (85.7%), water truckers (100%), and community water kiosks (83.3%) failed to meet the recommended standard, posing potential health risks to the community. Despite some compliance with other in-situ parameters like pH, electrical conductivity, and turbidity, the lack of residual chlorine in all the samples suggests a gap in effective water treatment, further underscoring the need for improved water management and treatment practices. D`mello-Guyett et al., (2020), reveals that while hygiene kits were generally accepted and considered useful by recipients, their overall effectiveness was limited by several critical factors. Delays in kit distribution, inadequate coverage (only 40% of suspected cholera cases received kits), and inconsistent implementation protocols significantly hindered the reach and timeliness of the intervention. Additionally, although most recipients attended hygiene demonstrations and reported improved hygiene behaviors, poor recall and low adherence to key practices, such as water treatment, weakened the impact. The kits were also not sustained for the intended duration, especially in large and polygamous households, due to insufficient supplies and maintenance challenges. Furthermore, logistical barriers such as poor road access, delayed outbreak response, and lack of WASH infrastructure further compromised effectiveness. Although no harm was reported from using the kits, the inequitable distribution created social tensions within the community. These findings suggest that while emergency sanitation strategies have potential, their effectiveness in disaster settings depends heavily on timely delivery, adequate coverage, clear protocols, and sustained support tailored to the local context. The findings from Asmally et al., (2025) study highlight several critical gaps that undermine the overall effectiveness of such interventions. Although tube wells were the predominant source of drinking water, issues such as water shortages (reported by 40%), lack of year-round availability (47%), and poor water appearance (46% reported cloudy water) contributed to widespread dissatisfaction, with over half (56.8%) of participants unhappy with water services. Logistic regression revealed that water source type, time spent fetching water, and inconsistent supply, water clarity, and the obligation to pay for services significantly influenced satisfaction levels. Alarmingly, E. coli contamination was highest at the household level (73.91%), and surface water sources were universally non-compliant with safety guidelines. Sanitation and hygiene practices were suboptimal, with over 40% using pit latrines without slabs and outdoor stool disposal being common. While handwashing before meals was high, rates were much lower before cooking. Diarrheal diseases affected 20.5% of households, and statistical associations confirmed that the presence and use of soap significantly reduced the occurrence of diarrhea. However, no hygiene-related variables made a unique contribution in the logistic model predicting diarrhea. The microbial and physicochemical quality of water was poor, with high fluoride and Total Dissolved Solid (TDS) levels in multiple villages. These results suggest that while emergency sanitation strategies were implemented, their effectiveness was severely limited by unsafe water sources, poor water quality, inadequate sanitation facilities, and inconsistent hygiene practices ultimately failing to meet the critical sanitation needs during emergencies. Emergency sanitation strategies most suitable for specific disaster types, such as floods, earthquakes, and conflict zones in Africa; The findings from all the studies have not directly specified the sanitation strategies suitable for specific disaster type. However, the nature of the emergency context (e.g. displaced populations, poor water quality, makeshift facilities) allows to infer suitability for specific disaster types. The prevalent reliance on tube wells (68.1%) and a significant level of dissatisfaction regarding water collection times (over 70% if it takes longer than 31 minutes) indicates that in flood-affected and conflict areas, there is a need for water systems that are readily accessible and can be quickly set up, such as mobile water treatment units or water trucking. The notable effectiveness of using pottery for water storage highlights local adaptability in emergency situations (Asmally et al., 2025). There is a significant level of E. coli contamination, especially at the household level (73.91%), suggesting that displaced populations in areas affected by conflict or flooding may require more effective point-of-use treatment solutions like chlorination kits or filtration systems (Appiah-Effah et al., 2020). The presence of pit latrines without slabs (41.8%) and the outdoor disposal of children's waste (41.5%) point to unsanitary conditions often observed in emergency situations arising from conflict or floods. This underscores the necessity for prefabricated or elevated latrines in flood-prone regions and composting toilets in drought-affected conflict areas (Tamene, 2021). The presence and application of soap greatly decreased the incidence of diarrhea, although its usage prior to cooking was minimal. This is vital for all types of disasters and indicates that hygiene promotion campaigns and the distribution of soap are effective and adaptable approaches in various emergency contexts (D’mello-Guyett et al., 2020). Individuals who did not pay for water indicated greater levels of dissatisfaction, possibly due to the reliance on unsustainable, donor-funded emergency supplies typically found in conflict or flood-affected regions. This highlights the necessity of engaging communities in management to enhance satisfaction and sustainability (O’Keeffe et al., 2024). Unusual fluoride concentrations and TDS in water sources (notably in 13 villages) might be intensified by alterations in water tables caused by earthquakes. This underscores the requirement for consistent water quality monitoring and flexible purification technologies in such locations (M. Habtu et al., 2024). Challenges commonly faced in implementing emergency sanitation interventions in disaster areas in Africa Out of the 6 articles, only three reported the challenges faced during implementation of emergency sanitation interventions during an emergency particularly in response to cholera outbreaks (D’Mello-Guyett et al., 2020, Okeeffe et. al., 2024 and Appiah. Effah et al., 2020). However, the study by Appiah evaluated health impacts of long-term WASH interventions in disaster-prone areas rather than acute emergency response. Nonetheless, the challenges highlighted in the study reflect those encountered during the emergency sanitation interventions in the other studies. In a study conducted by D’mello-Guyett, findings report challenges on the timeliness and coverage of the emergency hygiene kit intervention during a Cholera outbreak. One of the major challenges reported was the limited distribution of hygiene kits, with the hygiene kits distributed between week 44 and 46. Out of the 250 kits that were estimated for the response, only 165 kits that were delivered, which were insufficient for the 196 patients admitted between week 43 and 47. The low coverage was attributed to late arrival of the kits to the project site which affected timely distribution such as being given the kits at exit rather than at admission when immediate use would have been most impactful. Additionally, some patients were not accompanied by a household member which caused confusion as to whom the kit should be given. Another major challenge was the inadequate quantities of items within hygiene kits. For example, all households received the same quantity of soap regardless of household size, which was insufficient for bigger and polygamous families. Similarly, the 20-litre Jerry cans provided for water storage were inadequate, with most households preferring larger containers. Sustainability in the use of hygiene kits by the households was also a challenge. Most households reported that they found it difficult to maintain kit use for longer than 2 to 3 weeks, falling short of the intended one-month duration. This was due to the breakage of some kit items, such as taps on the hand washing devices, and the distance to water sources affected the availability of stored water and water inside the hand washing device as all households had to travel over 5 km distances to access water sources. These challenges affected the overall impact and sustainability of the hygiene kit intervention during the outbreak response. Okeeffe et. al., (2024) reports similar operational challenges to those presented by D’Mello-Guyett et al., (2020). A major challenge in this study was the timing of the implementation of the outbreak response, which was inconsistently prompt across the 3 targeted states. In Borno, the Case area Targeted Interventions (CATIs) began 4 days after the outbreak was declared, while in Yobe, CATIs were initiated as the cases increased in Mid-August. However, in Adamawa, despite an increase in cases in Mid-August, CATIs were not initiated until September 17 delaying early containment efforts. The study emphasized that rapid response is crucial in preventing cholera clustering. Another challenge was the inadequate availability of the supplies as it was reported that stock-outs were common across the 3 states as reflected in the low percentage of households that received complete supplies. Additionally, the data collection did not record quantity but rather whether a certain supply was provided so the study only suggests the possibility that response teams may have provided fewer supplies than planned when facing supply shortages, which would underestimate the findings. Of the 44,597 households reached by CATIs in the 3 states, only 33.7% received complete supplies and overall, 33.5% of households received the complete CATI package. By state, the proportion of households that received the complete package was 33.5% in Borno, 17.7% in Adamawa and 29.6% Yobe. Appiah. Effah et al., (2020) assessed the health impacts of WASH interventions implemented in disaster-prone communities in Ghana comparing 9 intervention communities with 9 control communities. The study highlights challenges that are related to emergency sanitation interventions in disaster-prone African settings. Despite improvements in WASH infrastructure in Ghana, communities faced inadequate access to improved sanitation facilities, with open defecation remaining prevalent in some areas. In Arab-Yeri, for instance, the implementation of facilities had not begun as of the time of the assessment, as it was reported that no infrastructure had yet been provided under the project, despite it being a designated intervention community. Frequent breakdowns of water systems and delays in maintenance were also reported, which is particularly problematic during disasters as water needs increase. Even where water sources existed, water quantities were often inadequate, forcing communities to access water from unimproved sources such as rivers. Additionally, low uptake of the household latrines and limited hand washing practices were identified as the behavioral barriers to consistent hygiene practices that may have reduced the effectiveness of the interventions. Furthermore, the study reports weak health data and monitoring systems and poor integration of broader environmental sanitation components, such as waste management, as factors limiting the health impact of WASH interventions. Impact of emergency sanitation interventions on health outcome in preventing waterborne diseases among populations affected by disaster. All six articles reviewed included WASH-related interventions. Three studies (M. Habtu et al., (2024), Okeeffe et. al. (2024) and D`mello-Guyett et al., (2020)) used incidence of Cholera as the primary outcome measure while two studies, Appiah. Effah et al., (2020) and Asmally et. al. (2025) focused on the incidence of diarrhea diseases. A study by M. Habtu et al., (2024) 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 in Garissa. 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 observed by the epidemic curve Appiah. Effah et al., (2020) assessed the health impacts of WASH interventions in nine intervention communities compared to nine control communities in disaster prone areas. The evaluation considered factors such as the availability, condition and use of boreholes and latrines, as well as hygiene promotion and general sanitation practices. Using a Difference-in-Differences (DID) analysis, the study compared changes in outcomes over time between intervention and control groups. The highest recorded impact (DID) was a 7% reduction in diarrhea cases. Moderate and high DID scores (ranging from 3% to 7%) were observed in six intervention and control groups (Goh and Yaala 4%, Baase and Saan 5%, Banu and Pina 4%, Azum-Sapeliga and Kumpago 7%, Choggu Mmayili and Katariga 4% and Kpalba and Gbong 3%) of the nine intervention and nine controls communities, indicating a significant positive effect. In contrast, low or no impact (DID of 0 to 1%) was found in two groups (Wonjuga and Ando 0% and Nania and Badunu 1%). Additionally, one group (Alab-Yeri and Pungsa) showed a negative DID of -3% (control group experienced more improvement than the intervention group). Overall, the majority of the intervention communities demonstrated positive health impacts from the WASH interventions. D`mello-Guyett et al., (2020) assessed the timeliness of cholera interventions during an outbreak and their possible influence on case trends. The study reported that during weeks 43 to 47 of the cholera outbreak, only 52% of admitted cholera cases received interventions (such as Soap, Sachets of flocculants disinfectant, Chlorine tablets, hand washing devise-buckets/Jerry can and health promotion) on the day of admission . In the subsequent weeks (week 48 and 49), there was a decline in the number of reported suspected cholera cases , dropping from over 70 cases in week 44 to zero after receiving the WASH interventions . Additionally, the study highlighted an improved use of hygiene kits and handwashing practices with soap after demonstrations and health promotion. The study by Okeeffe et. al. (2024) found that cholera cases were highly concentrated in three conflict affected areas, with 291 clusters in Borno, 153 in Adamawa, and 128 in Yobe. When the model considered interventions like improved access to clean water, toilets, handwashing stations and cholera treatment centers, the number of clusters dropped significantly to 8 in Borno, 0 in Adamawa and 10 in Yobe. After further adjusting for CATI interventions such as chlorine distribution, beddings, ring coverage, latrine disinfection activities, response timelines, health and hygiene promotion and hygiene kit provision along with environmental factors, all remaining clusters/cases were eliminated in both Borno and Yobe. Asmally et. al. (2025) reported statistically significant associations between the presence of soap (P=0.002) and its use before eating (p=0.005), after using the toilet (P=0.005) and before cooking (P=0.004) with the occurrence of diarrhea. Households with soap had a lower diarrhea prevalence (43 cases, 8.1%) compared to those without (39 cases, 15.9%). Similarly, individuals who washed hands before eating (30 cases, 7.9%), after using the toilet (27 cases, 7.8%) and before cooking (10 cases, 7.0%) reported fewer diarrhea cases than those who did not practice handwashing at these times. Additionally, people who showered outdoors experienced a higher rate of diarrhea (6 cases, 22%) compared to those who showered indoors (76 cases, 10.1%). Tamene, A. (2021) reported no measurable impact from WASH interventions, as the study focused on assessing the availability, accessibility and functionality of WASH facilities in temporary COVID-19 isolation and treatment centers. The study also aimed to determine whether there were differences in WASH service provision between urban and rural sites. Discussion The success of emergency sanitation strategies in disaster-affected regions of Africa varies greatly based on the local context, infrastructure, and the quality of implementation. For example, in Yobe State, the effective rollout of latrines (89.6% coverage), handwashing stations (49.6%), and extensive hygiene promotion reflected a well-organized and prompt response. By contrast, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia, persistent interruptions in water supply, poor waste management practices, and insufficient sanitation facilities severely restricted effective service delivery during the COVID-19 pandemic (Tamene, 2021 ). Furthermore, the research conducted by D’mello-Guyett et al., (2020) highlighted that although hygiene kits were positively received, their late distribution, insufficient coverage, and transient impact particularly in larger households restricted their overall effectiveness. These results underline that while emergency measures can be beneficial, they necessitate solid logistical planning, fair access, and approaches tailored to the specific context to adequately address critical sanitation needs during emergencies. In comparison, other researchers highlight similar obstacles and constraints in the effectiveness of the emergency sanitation strategies. For example, Habtu et al., ( 2024 ) found that 87.2% of water samples obtained from various emergency water sources did not meet safety standards due to fecal contamination and insufficient chlorination, stressing that water quality represents a significant gap in emergency sanitation. Likewise, Asmally et al., ( 2025 ) observed a pervasive dissatisfaction with emergency water services within affected communities, pointing out inadequate sanitation practices, substandard latrine conditions, and elevated levels of E. coli contamination. The prevalence of diarrheal diseases (20.5%) and poor hygiene behaviors were additional signs of inadequate sanitation strategies. These investigations, emphasize the necessity for not only infrastructure and materials but also ongoing water treatment, hygiene education, and qualified WASH personnel to guarantee a genuinely effective emergency sanitation response in Africa. While none of the research explicitly grouped emergency sanitation methods according to disaster type, the contextual insights derived provide helpful guidance on which strategies may be most effective for particular emergencies such as floods, earthquakes, and conflict-affected regions in Africa. In areas vulnerable to flooding and those impacted by conflict, the heavy dependence on tube wells and the dissatisfaction related to lengthy water collection times (over 70% when exceeding 31 minutes) indicate a necessity for quickly deployable solutions, such as mobile water treatment systems and water trucking services. The pervasive E. coli contamination observed at the household level (73.91%) alongside unsanitary conditions like pit latrines lacking slabs and the practice of outdoor stool disposal (Asmally et al., 2025 ) suggest that elevated or prefabricated latrines are suitable for flood situations, and composting toilets are more appropriate for drought-prone conflict scenarios (Tamene, 2021 ). No matter the type of disaster, hygiene promotion and the provision of soap have proven to be universally impactful, as demonstrated by D’mello-Guyett et al., (2020), where the availability of soap led to a significant reduction in diarrhea despite minimal use during cooking. The discontent with free emergency water supplies emphasizes the necessity for community-managed water systems to provide sustainable solutions, particularly in conflict zones (O’Keeffe et al., 2024). Lastly, the elevated levels of fluoride and TDS potentially resulting from seismic activities underscore the importance of continuous water quality monitoring and the adaptation of purification technologies in areas affected by earthquakes (Habtu et al., 2024 ). Collectively, these insights highlight the need for sanitation strategies that are tailored to the specific context and type of each disaster. The systematic review reveals significant challenges in implementing emergency sanitation interventions across disaster prone areas in Africa ranging from delayed implementation, poor resource distribution and behavioural and contextual factors. D’mello-Guyett et al., (2020) and O’Keeffe et al., (2024) both identified delayed implementation as a critical barrier to effective response. While concerning, the delays documented in our review were comparatively shorter that those found in an MSF data review by D’mello-Guyett et al (2022), which reported response times ranging from 31 to 126 days across Malawi, DRC and Mozambique. Similarly, Ratnayake et al., ( 2020 ) reported delays of 10 days between alert and response. Inconsistency in the timeliness of intervention delivery was also noted by Sikder et al., ( 2021 ), where timeliness evaluations ranged from immediate intervention upon admission in Bangladesh to delays of up to 3.9 days in Nepal. These delays significantly undermine emergency sanitation effectiveness. WHO (2022) emphasizes that early detection and immediate response are vital for containing outbreaks and reducing Cholera mortality. This aligns with findings from Yates et al., ( 2017 ), who demonstrated that delays of even a few days in initiating WASH interventions during Cholera outbreak can significantly increase disease transmission and mortality rates. Sikder et al., ( 2021 ) provided quantitative evidence of this impact, reporting that in Haiti, timely responses within a day, reduced new cases by 76% and outbreak duration by 61% compared to delayed responses of more than 7 days. Logistical constraints frequently result in critical supplies arriving too late, with hygiene kits often distributed at patient discharge rather than admission when immediate use would be most beneficial (D’mello-Guyett et al., (2020). Several studies confirm that successful interventions require quick and flexible funding (Yates et al., 2017 ), adequate product stocks (Lantage and Clasen, 2012; and Yates et al., 2018 and supply readiness (WHO, 2022). The review also identified significant variations in intervention coverage. Okeefee et al., (2024) reported that only 33.7% of targeted households received complete supplies across the three Nigerian states. Similarly, Skider et al., (2021) found that coverage varied widely from 17% of households in Nepal to 92% of cases in DRC. This inconsistency reflects broader challenges in resource allocation and distribution during emergency responses. Low uptake of household latrines and limited hand washing practices were identified as behavioural barriers by Appiah-Effah et al., ( 2020 ), suggesting that technical solutions alone are insufficient without adequate attention to social and cultural factors. Brown et al., ( 2012 ) emphasize that safe excreta disposal is the first line of defense against faecal-oral pathogen transmission, yet in many low and middle income countries, WASH facilities remain inadequate. Globally, only 60% of the world’s population have access to basic hand washing facilities at the household level (UNICEF & WHO, 2019) and the situation is worse beyond the household settings, particularly in health care facilities in developing countries (UNICEF & WHO, 2019). The sub-Saharan Africa region has the lowest progress rate in expanding access to improved water services between 2000 and 2017 (WHO & UNICEF, 2021), further complicating emergency sanitation interventions. Access to water emerged as a critical constraint across the reviewed studies. D’mello-Guyett et al., (2020) reported that households had to travel over 5Km to access water sources affecting sustainability of handwashing interventions. Similarly, Appiah-Effah et al., ( 2020 ) noted that water quantities were often inadequate, forcing communities to access unimproved water sources such as rivers. This reliance on unimproved water sources is concerning as rivers are considered the main reservoir for Vibrio Cholerae and have been implicated in past Cholera outbreaks (Acosta, 2001). Two studies demonstrated a significant reduction in cholera cases after interventions such as water treatment, chlorine distribution, latrine disinfection and health promotion (M. Habtu et al., 2024 ; Okeeffe et al., 2024). Similarly, D’mello-Guyett and colleagues noted a clear decline in cholera cases, following WASH interventions and emphasized the importance of the timeliness of interventions during outbreaks, noting that delays in delivering hygiene kits and health promotion messages can affect case trends (D’mello-Guyett et al., 2020). This supports earlier findings by Taylor and colleagues, which showed that rapid deployment of hygiene interventions during outbreaks greatly improves outcomes (Taylor et al., 2015 ). Although most studies in this review reported positive effects, the scale and consistency of these impacts varied. One study found slight reductions in diarrhea cases, with some intervention communities achieving DID scores between 3–7%, while others showed little or no improvement although variations existed between locations, suggesting that intervention outcomes are influenced by a combination of factors (Appiah Effah et al., 2020). A study by Asmally et al., (Asmally et al., 2025 ) further highlighted those specific behaviors, like handwashing with soap before eating and after using the toilet, were significantly associated with lower diarrheal prevalence. This adds to the evidence from previous research that hand hygiene remains one of the most effective yet underutilized measures in controlling waterborne diseases (Solomon et al., 2021). The mixed outcomes from Appiah Effah et al., (2020) where some communities experienced low or negative impacts, highlight that local context, community engagement, behavior change, sustained hygiene promotion, functionality of WASH infrastructure, interventions timeliness, quality, quantity, and period and resource availability influence effectiveness. These findings imply that while emergency WASH interventions are generally effective in reducing cholera and diarrhea cases in outbreaks, their success depends on timely delivery, cultural acceptability, community involvement, intervention quality, quantity and period and continuous follow-up (Appiah Effah et al., 2020; D’mello-Guyett et al., 2020; Okeeffe et al., 2024). Although several years have passed since some of the studies were conducted, the findings from this systematic review reveal that gaps still exist in the consistency of impact across different community settings, emphasizing the need for context-specific strategies and regularly monitoring to ensure effectiveness. Additionally, this review highlights that while the provision of WASH resources such as clean water points, toilets and hygiene kits is essential in emergence, it is not sufficient on its own to effectively reduce diseases like cholera and diarrhea (Appiah Effah et al., 2020; D’mello-Guyett et al., 2020; Okeeffe et al., 2024). Limitations of the study This review has some limitations. First, our systematic review excluded all the studies that were conducted in languages other than English. This may have introduced bias to the findings of the study as some studies published in other languages may have had information that could be useful in answering the research question. Second, the review only included studies conducted in Africa, limiting the generalisation of the findings to other settings globally. In spite of these limitations, all the six studies rated to be of high quality when appraised using MMAT. This entails that the quality of the studies included in this review were of high quality, and that the evidence synthesized in this systematic review can be relied upon. Implications of the study findings for practice, research and policy The findings conducted by Tamene ( 2021 ), Dmello-Guyett et al., (2020), M. Habtu et al., ( 2024 ), and Asmally et al., ( 2025 ) exposes significant deficiencies in emergency sanitation approaches throughout Africa. Although infrastructure is present, issues such as water supply interruptions, unfiltered sources, and widespread E. coli contamination frequently occur. According to Dmello-Guyett et al., hygiene kits proved beneficial but faced challenges due to delays in delivery, lack of adherence, and inadequate quantities. Asmally et al., pointed out dissatisfaction with water services, insufficient sanitation facilities, and elevated rates of diarrhea. Tamene emphasized the gaps in WASH services between urban and rural areas. In flood situations, mobile water systems and raised latrines are crucial, while composting toilets and water purification kits are appropriate for drought and conflict-affected regions. It is essential for policies to reinforce WASH infrastructure, enhance local capabilities, and guarantee equitable responses, while research should concentrate on sanitation solutions tailored to specific disasters and long-term monitoring efforts. The review findings emphasize the importance of integrating multiple WASH strategies and CATI interventions with health education and promotion strategies to support community settings in adopting and sustaining healthy hygiene practices, improving outbreak control (Kaur et al., 2023; Endres et al., 2023). The review further emphasizes the need to strengthen implementation processes and effective behavior change strategies to improve the effectiveness of outbreak response interventions as demonstrated in Azum-Sapeliga community where the chief was actively involved in mobilizing members leading to improved WASH situation and steady decline in diarrhea cases (Appiah Effah et al., 2020). Conclusion 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. Critical gaps continue to exist due to delays in delivery, inadequate water access, inconsistent coverage, and low adherence to hygiene practices. Although essential WASH infrastructuresuch as latrines, handwashing stations, and hygiene kitsis provided, disease reduction results vary across regions because of differences in implementation quality, community engagement, and sustained changes in hygiene behavior. The review indicates that universal solutions are inadequate; instead, customized strategies that consider the type of disaster, local conditions, and the needs of the population are vital. Initiatives that integrate infrastructure development with behavior change communication, prompt response, and continuous water quality monitoring are more likely to achieve lasting results. Furthermore, evidence highlights the urgent need for comprehensive and well-funded emergency sanitation systems supported by rapid logistical frameworks, reinforced policies, and adaptive research. Ultimately, for emergency sanitation measures to be genuinely effective in various African disaster settings, stakeholders must emphasize timely actions, ensure sufficient and contextually appropriate resources, and foster robust community involvement. Closing existing gaps necessitates a collaborative approach that unites policy makers, practitioners, and researchers to create scalable, sustainable, and inclusive WASH solutions for emergencies. Abbreviations IOM: International Organization for Migration, WHO: World Health Organization, OCHA: United Nations Office for the Coordination of Humanitarian Affairs. BASE: Bielefeld Academic Search Engine, Web of Science, DOAJ: The Directory of Open Access Journals, EMBASE: Excerpta, Medica database, MMAT: The Mixed methods Appraisal Tool, PRISMA: Preferred Reporting Items for systematic Reviews and Meta-Analyses, PROSPERO: The International Prospective Register of Systematic Reviews, WASH: Water Sanitation and Hygiene, EM-DAT: Emergency Events Database, NGOs: Non-Governmental Organisations, MSF: Médecins Sans Frontières , CATI: Case Area Targeted Interventions, SNNPR: Southern Nations, Nationalities and People’s Region, HCFs: Health Care Facilities, COVID, Corona Virus Disease, TDS: Total Dissolved Solids, DID: Difference-in-Difference. pH: Power of Hydrogen. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials The data and materials used in this systematic review is available upon request from the corresponding Author. 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02:30:18","extension":"html","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":226323,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7170040/v1/a5e5d606cad2088d88b920df.html"},{"id":99746697,"identity":"40269ecd-582a-4e67-8cb6-e24b3112b5ab","added_by":"auto","created_at":"2026-01-08 02:30:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63513,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow Diagram\u003c/p\u003e\n\u003cp\u003eSource: Page MJ, et al., BMJ 2021; 372: n71. Doi: 10.1136/bmj. n71.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7170040/v1/cb0d5d65e43f3cfe144eadcf.png"},{"id":99805597,"identity":"c3e05c59-6bc4-484e-a27a-955c61c11402","added_by":"auto","created_at":"2026-01-08 14:16:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1706146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7170040/v1/b504e4c0-7f5d-4964-88cc-dd9bf38fc794.pdf"},{"id":99798284,"identity":"2c6ed5a3-ceee-44cd-ac37-15594b9edff4","added_by":"auto","created_at":"2026-01-08 13:47:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21150,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7170040/v1/79e6045bd53ebf41fff12181.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eEffectiveness of Emergency Sanitation Strategies in Disaster Prone Areas of Africa: A Systematic Review\u003c/p\u003e","fulltext":[{"header":"Background information","content":"\u003cp\u003eThe United Nations (2010) declared Sanitation as an essential human right and it is a vital element of disaster management, especially in areas where both natural and man-made disasters often disrupt water and sanitation services. This urgency is highlighted by statistics from the Emergency Events Database (EM-DAT), which documented 399 disasters related to natural hazards in 2023. These incidents resulted in 86,473 deaths, impacted around 93.1\u0026nbsp;million individuals, and caused an estimated economic loss of US\u003cspan\u003e$\u003c/span\u003e202.7\u0026nbsp;billion annually.\u003c/p\u003e \u003cp\u003eIn areas impacted by disasters, insufficient sanitation can result in significant public health issues, including the spread of cholera, dysentery, and other diseases transmitted through contaminated water (Sphere Association, 2018). The interruption of sanitation services often heightens vulnerabilities, especially among displaced individuals who do not have access to safe drinking water and appropriate waste disposal facilities. Effective emergency sanitation measures such as providing latrines, promoting hygiene, and managing waste are essential for reducing these risks and maintaining human dignity. Research indicates that incorporating sanitation into disaster response plans can considerably lower morbidity and mortality rates, while also enhancing the overall resilience of the communities affected (Ramesh et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally accepted humanitarian standards for emergency response, including sanitation, have been detailed in numerous studies. These standards prioritize accessibility, safety, and cultural relevance, emphasizing effective waste management, sufficient toilet facilities, and community involvement in sanitation initiatives. Adherence to these standards has been shown to improve sanitation outcomes and reduce disease transmission in disaster-affected environments. For instance, a study by Bako, Barakagira, and Nabukonde (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) assessed sanitation facilities in Uganda's Bidibidi refugee camp, highlighting the importance of meeting Sphere Standards to prevent sanitation-related diseases.\u003c/p\u003e \u003cp\u003eThe significance of water, sanitation, and hygiene (WASH) measures during humanitarian emergencies is crucial. Strategies for emergency sanitation need to be coordinated with hygiene promotion and a clean water supply to enhance their effectiveness. Research by Sekine and Roskosky (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) shows that emergency sanitation measures can substantially lower child mortality and illness in regions impacted by disasters.\u003c/p\u003e \u003cp\u003eInvesting in emergency sanitation plays a crucial role in enhancing disaster resilience. Research conducted by Zakaria et al., (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) created a decision support system for planning sanitation responses during emergencies, highlighting the necessity for flexible sanitation solutions capable of adapting to various disaster-related obstacles, such as floods, earthquakes, and conflicts. Furthermore, it emphasizes the importance of collaboration across multiple sectors to ensure sustainable sanitation responses.\u003c/p\u003e \u003cp\u003eNumerous studies have offered valuable perspectives on sanitation strategies for displaced individuals. The swift installation of portable sanitation facilities and decentralized waste management systems is vital during humanitarian emergencies. It is essential to take into account local circumstances, cultural norms, and available resources when executing emergency sanitation initiatives. Analysis of case studies indicates that employing community-driven approaches results in greater acceptance and enhanced long-term sustainability of sanitation solutions (Lai et al., 2015).\u003c/p\u003e \u003cp\u003eThe difficulties of ensuring proper sanitation in overcrowded refugee camps, where open defecation and improper waste management present significant health threats, have been underscored by various field experiences in zones affected by disasters and conflicts. Innovative strategies, such as container-based sanitation and waste-to-energy methods, are recommended to enhance sanitation coverage and lessen environmental pollution (Chatila et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGap analyses conducted in emergency Water, Sanitation and Hygiene (WASH) interventions have pinpointed essential obstacles to the effective implementation of sanitation in disaster scenarios. Research has revealed that logistical challenges, insufficient funding, and socio-cultural influences frequently obstruct the success of sanitation initiatives. Scholars stress the need for sanitation solutions that are tailored to local contexts, improved collaboration among humanitarian organizations, and increased investment in sanitation infrastructure Sekine \u0026amp; Roskosky, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe impact of emergency sanitation measures and their role in public health has been investigated in multiple studies. Findings show that well-maintained sanitation facilities greatly lessen the spread of diseases among populations affected by disasters. The significance of combining sanitation with other WASH initiatives to optimize health outcomes is also emphasized. The use of innovative technologies like solar-powered toilets and biodegradable waste bags is suggested to improve sanitation accessibility in settings with limited resources (Zakaria et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Sphere Handbook establishes internationally accepted humanitarian standards for emergency responses, particularly in sanitation. The Sphere Association (2018) highlights the essential requirements for sanitation during crises, emphasizing accessibility, safety, and cultural relevance. It underscores the significance of effective waste management, sufficient toilet availability, and community involvement in sanitation initiatives. Following these standards has demonstrated improved sanitation results and decreased disease spread in disaster situations.\u003c/p\u003e \u003cp\u003eThis systematic review aimed to gather and consolidate evidence on the effectiveness of emergency sanitation strategies in areas that experience disasters. The outcomes of this review included, health outcomes related to sanitation interventions and effectiveness of sanitation strategies (impact on disease prevention). The following are the questions that the systematic review tried to address.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHow effective are emergency sanitation strategies in addressing sanitation needs in disaster areas of Africa?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhich emergency sanitation strategies are most suitable for specific disaster types, such as floods, earthquakes, and conflict zones in Africa?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat challenges are commonly faced in implementing emergency sanitation interventions in disaster areas of Africa?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhat are the impact of emergency sanitation interventions on health outcomes, particularly in preventing waterborne diseases among populations affected by disasters?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eProtocol\u003c/h2\u003e\n \u003cp\u003eThis review was written following the acceptable best practice developed by the PROSPERO for systematic search and selection of articles. The protocol was published in the PROSPERO database with registration number CRD42024628289 [Effectiveness of Emergency Sanitation Strategies in Disaster-Prone Areas of Africa] (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024628289\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003eThe review focused on peer-reviewed studies, that evaluated emergency sanitation strategies in disaster areas of Africa, which were interventional in nature. Studies conducted during or immediately following disaster events, from 2014 to 2024, were included to ensure relevance to emergency sanitation situations and the health impacts associated with these interventions.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eResearch focusing on non-emergency sanitation solutions, non-peer-reviewed articles, and studies conducted outside of Africa were omitted. Additionally, studies lacking sufficient data on the effectiveness or health outcomes of sanitation interventions, or those that did not specifically evaluate emergency sanitation approaches, were not considered for inclusion in the review. In addition, studies written in languages other than English were excluded.\u003c/p\u003e\n\u003ch3\u003eInformation Source/ Search strategy\u003c/h3\u003e\n\u003cp\u003eThe necessary data was obtained from the following database sources: Relief Web, 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. A search string was applied across these databases, using Boolean operators to differentiate the key terms; Emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges (See Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Efforts were made to identify both published and unpublished interventional studies by manually checking the reference list of the articles that met the inclusion criteria. Several strategies were used to identify unpublished studies. First, we reviewed the methodology and reference list of the included studies to assess if they identified any unpublished research related to the review question. Second, we manually searched conference proceedings such as Development International Conference, Water Engineering and Development Centre and the University of North Caroline Water and Health Conference for any suitable studies. Further searches were conducted in clinical trial website such as ClinicalTrials.gov website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/\u003c/span\u003e\u003c/span\u003e). Efforts were also made to contact the authors of the unpublished studies. Reference lists of the included studies were checked and hand searching in the key journals was also done. The search period for the research articles in the mentioned databases was from 2014 to July 2024. The search for the eligible studies in the database was conducted between January 2025 to April 2025.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSearch strategy.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDatabase\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSearch Terms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSearch string\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResults\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelief Web\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternational Organization for Migration (IOM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorld Health Organization (WHO)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnited Nations Office for the Coordination of Humanitarian Affairs (OCHA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHand search internet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGoogle Scholar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePUBMED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDirectory of Open Access Journals (DOAJ)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBASE (Bielefeld Academic Search Engine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeb of Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScopus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCochrane Library\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHinari\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and Abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfrican Index Medicus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTitle and abstract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR temporary sanitation solutions OR sanitation in emergencies OR humanitarian sanitation interventions OR flood sanitation strategies OR earthquake sanitation response OR conflict zone sanitation OR natural disaster sanitation OR health outcomes of sanitation OR waterborne disease prevention OR public health in emergencies OR effectiveness of sanitation strategies OR implementation challenges in sanitation OR sanitation access during disasters OR community-based sanitation solutions OR rapid sanitation response OR emergency sanitation OR disaster sanitation OR emergency sanitation OR disaster sanitation OR portable toilets OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines OR emergency sanitation OR disaster sanitation OR portable toilets OR sanitation kits OR trench latrines AND floods OR earthquakes OR conflict OR natural disasters AND health outcomes OR waterborne diseases OR disease prevention OR public health AND effectiveness OR implementation OR strategies OR challenges.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal articles obtained\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e158\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal articles included\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eStudy Selection\u003c/h3\u003e\n\u003cp\u003eTitles obtained from the databases were organized into distinct folders according to the name of each database. Subsequently, duplicates were removed. The abstracts linked to the identified titles were gathered and assessed for eligibility. Full articles were acquired for the pertinent abstracts and evaluated thoroughly to establish their inclusion suitability. The article eligibility assessment was performed independently by three reviewers applying pre-defined inclusion and exclusion criteria. Any differences in opinions among the reviewers concerning the eligibility of specific studies were resolved through discussions with a fourth reviewer.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData Collection Process\u003c/h2\u003e\n \u003cp\u003eThe data extraction process commenced with a database search for relevant articles utilizing search terms while adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, as illustrated in (Fig. 1). A standardized form was employed to gather data from the included studies for evaluating study quality and evidence synthesis. The details extracted included the author, study year, participant type, age, setting, country, sample size, study design and methods, study purpose and objectives, intervention description, outcomes, and results (refer to supplementary material A). Relevant information from each article was summarized and documented (see Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The three reviewers conducted independent data extraction, and any discrepancies identified were resolved through discussions with the fourth reviewer of the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSearch Outcome\u003c/h3\u003e\n\u003cp\u003eThe search produced a total of 158 articles, of which 140 were noted during the preliminary assessment phase following the removal of duplicates. From the returned articles, 12 were further excluded from the analysis due to the outcomes being unclear. Subsequently 6 articles were qualified according to the inclusion criteria, and their complete texts were retrieved and evaluated by three authors for eligibility. The fourth author confirmed the eligibility of the articles for inclusion in the review. Following this assessment, only 6 articles fulfilled the inclusion criteria, while 152 articles were discarded from the systematic review as they did not satisfy the eligibility requirements (see Fig.\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of studies\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAuthor \u0026amp; Year\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePopulation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSample Size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy design \u0026amp; Methods\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy purpose \u0026amp;objectives\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eObjectives/aims\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSetting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCountry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResults\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD`mello-Guyett et al., (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u0026eacute;decins Sans Fronti\u0026egrave;res (MSF) staff.\u003c/p\u003e\n \u003cp\u003eNGOs Staff.\u003c/p\u003e\n \u003cp\u003eKit recipients and\u003c/p\u003e\n \u003cp\u003eHouseholds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousehold average age was 43 years.\u003c/p\u003e\n \u003cp\u003eStaff age not provided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousehold.\u003c/p\u003e\n \u003cp\u003eHealth Care Facility.\u003c/p\u003e\n \u003cp\u003eTreatment Unit and center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDemocratic Republic of Congo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 MSF staff.\u003c/p\u003e\n \u003cp\u003e17 staff from NGOs.\u003c/p\u003e\n \u003cp\u003e27 random kit recipients (13 females and 14 males)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative and Quantitative methods.\u003c/p\u003e\n \u003cp\u003eData were collected through key informative interviews with 7 MSF staff, 17 staff from NGOs and 27 hygiene kit recipients.\u003c/p\u003e\n \u003cp\u003eStructured observations and secondary data from reports were conducted.\u003c/p\u003e\n \u003cp\u003eSemi structured interviews were conducted at Household of a random sample enrolled in the parallel prospective cohort study who received hygiene kits. Water testing was conducted.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo identify the successes and barriers of the hygiene kit distribution strategy for Cholera control in order to understand delivery, use and scalability and to propose recommendations to optimize future programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEffectiveness of the hygiene kit to reduce transmission of Cholera among Household contacts of cases and overall Cholera incidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnly 52% of admitted cholera cases received interventions on the day of admission. Hygiene kit distribution was identified as a promising control measure, but its effectiveness was limited by delays, supply shortages, and inadequate distribution. Many households received kits too late, reducing their impact on transmission and incidence. The study highlights the potential of health facility-based and case-centered WASH interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM.Habtu et al., (\u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCommunity.\u003c/p\u003e\n \u003cp\u003eRefugees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge Not provided\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousehold.\u003c/p\u003e\n \u003cp\u003eCommunity.\u003c/p\u003e\n \u003cp\u003eInstitution.\u003c/p\u003e\n \u003cp\u003eRefugees\u0026rsquo; camps and communities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKenya\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e480,000 people.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCross sectional study. Water sample collection. Assessment of water and Monitoring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo evaluate the impact of the evidence-based WASH interventions that contributed to the control of the recent Cholera outbreak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimize the spread and impact of the Cholera outbreak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87% of tested drinking water sources were fecally contaminated. In response, targeted WASH interventions and capacity building resulted in a positive impact in the fight against Cholera. Prioritizing water quality management, sustainable solutions, and community engagement and collaboration is key to ensuring safe water and preventing future outbreaks.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppiah. Effah et al., (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpinion leaders.\u003c/p\u003e\n \u003cp\u003eSchool officials.\u003c/p\u003e\n \u003cp\u003eHealth Officials and\u003c/p\u003e\n \u003cp\u003eHouseholds.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge not provided on officials and leaders.\u003c/p\u003e\n \u003cp\u003eDiarrhea cases recorded 56% (below 5 years ) and 26% (above 5 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCommunity.\u003c/p\u003e\n \u003cp\u003eSchools.\u003c/p\u003e\n \u003cp\u003eHealth Facility.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGhana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2315 cases (83% diarrhea cases).\u003c/p\u003e\n \u003cp\u003e9 interventions communities.\u003c/p\u003e\n \u003cp\u003e9 controls communities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative and Quantitative methodologies. Before and after study with concurrent control (BAC) method to evaluate the impact. Cluster randomized design was used. Data were collected through document, reviews, data from health facility. Key informative interviews and household survey were conducted. Semi structured questionnaire was used for the Household survey.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo evaluate the health impacts of WASH interventions in 9 interventions communities against 9 control communities in disaster prone areas.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReduction in Diarrhea incidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiarrhea was the most common WASH-related disease, accounting for over 80% of cases. The highest reduction (7%) occurred in a community where the chief actively promoted WASH practices. While interventions helped reduce diarrhea, the impact was lower than in other studies and the study could not measure the extent to which WASH independently contributed to reduction in diarrhea diseases, since it could not gather detailed information on quality of service delivered.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOkeeffe et. al. (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral population\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge not specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCommunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44597 households (1,615 case and 42,982 neighbor\u003c/p\u003e\n \u003cp\u003eHouseholds)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProspective observational cohort study\u003c/p\u003e\n \u003cp\u003eKobo Toolbox (SI) and mWater (ACF) were used to collect data\u003c/p\u003e\n \u003cp\u003eInterventions used; Case household received: Aquatabs, Soap and Jerrycan; Neighbor household received: Aquatabs and Soap; and Household (case or neighbor) received: Hygiene promotion, Bedding disinfection and Latrine disinfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo investigate Case Area targeted interventions (CATI) association on cholera transmission in a real-world, uncontrolled environment using a novel spatial-temporal cluster detection approach.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSignificant reductions in cholera clustering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCATIs were associated with a reduction in cholera clusters during the outbreak; clusters were fewer and smaller, occurred for shorter duration, and were less likely to reoccur in the presence of CATIs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTamene, A. (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral population\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge not specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthiopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 Key informants\u003c/p\u003e\n \u003cp\u003e35 treatment centers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMixed design study\u003c/p\u003e\n \u003cp\u003eObservational Checklist and key informant interviews, were used for data collection.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo examine the availability, accessibility, functionality, and disparity of water, sanitation, and hygiene (WASH) facilities in temporary COVID-19 isolation\u003c/p\u003e\n \u003cp\u003eand treatment centers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAvailability, accessibility and, functionality of water supply, excreta disposal system, shower and laundry system, hand washing stations, waste disposal system and infection prevention and control syst in temporary treatment centers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOf the 35 temporary treatment centers, an overwhelming majority,\u003c/p\u003e\n \u003cp\u003ei.e., 27 (77.1%) had daily water supply interruptions\u003c/p\u003e\n \u003cp\u003eAll 35 of the temporary treatment centers had bathrooms within their premises. However,\u003c/p\u003e\n \u003cp\u003eonly 30 (85.72%) of the centers had toilets separated for staff, patients, and visitors.\u003c/p\u003e\n \u003cp\u003eAlmost all (94.7%) of the laundries in the treatment facilities were\u003c/p\u003e\n \u003cp\u003enot functional.\u003c/p\u003e\n \u003cp\u003eTwenty-six (74.28%) of the treatment centers had functional handwashing points\u003c/p\u003e\n \u003cp\u003ein service areas and in any location where healthcare is delivered. Soap stands were also available at each hand washing facility, for the majority i.e., 28(80%) of the treatment centers. Similarly, while 21(60%) of the handwashing stations had running water, the rest stored water near\u003c/p\u003e\n \u003cp\u003ehand washing facilities\u003c/p\u003e\n \u003cp\u003eA small number of the treatment centers surveyed 6(17.14%) had insufficient, and/or overflowing containers for waste disposal. Likewise, 7(20%) of the evaluated centers had no mechanism for hazardous waste separation.\u003c/p\u003e\n \u003cp\u003eSixteen (45.71%) of the treatment facilities assessed were inadequately supplied with personal protective equipment\u003c/p\u003e\n \u003cp\u003e(gloves, overalls, masks, etc.).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsmally et. al. (\u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternally displaced individuals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian age 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCommunity/village\u003c/p\u003e\n \u003cp\u003eRural villages in South Kordofan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e784 (471 females and 313 males)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA cross-sectional study design\u003c/p\u003e\n \u003cp\u003eThe patient forms which included clinical characteristics of the participants.\u003c/p\u003e\n \u003cp\u003eA structured interviewer-administered questionnaire\u003c/p\u003e\n \u003cp\u003eWater sample analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTo evaluate the quality and availability of drinking water, as well as sanitation and hygiene practices in rural South Kordofan.\u003c/p\u003e\n \u003cp\u003eTo identify factors affecting community satisfaction with WASH services and to establish a data-driven basis for future interventions addressing these issues.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWater Quality \u0026amp; Availability\u003c/p\u003e\n \u003cp\u003eSanitation \u0026amp; Hygiene Practices\u003c/p\u003e\n \u003cp\u003eCommunity Satisfaction \u0026amp; Key Influencing Factors\u003c/p\u003e\n \u003cp\u003eConflict-Related Challenges\u003c/p\u003e\n \u003cp\u003ePolicy \u0026amp; Intervention Implications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTube wells/boreholes were the primary water source (68.1%), and most participants (70.9%) lived near their water source (less than 30 min). Dissatisfaction with water services was reported by 56.8%, and satisfaction associated with method of delivery (OR\u0026thinsp;=\u0026thinsp;0.081, CI\u0026thinsp;=\u0026thinsp;0.024\u0026ndash;0.276)), appearance (OR\u0026thinsp;=\u0026thinsp;0.299, CI\u0026thinsp;=\u0026thinsp;0.182\u0026ndash;0.489), distance (OR\u0026thinsp;=\u0026thinsp;0.264, CI\u0026thinsp;=\u0026thinsp;0.099\u0026ndash;0.705), water unavailability (OR\u0026thinsp;=\u0026thinsp;0.477, CI\u0026thinsp;=\u0026thinsp;0.297\u0026ndash;0.765), and obligation to pay (OR\u0026thinsp;=\u0026thinsp;0.351, CI\u0026thinsp;=\u0026thinsp;0.185\u0026ndash;0.665). Samples showed high levels of contamination, both microbial and physicochemical. Regarding sanitation, over a third of the participants (41.5%) disposed of children\u0026rsquo;s stool by leaving it outdoors. About 10% of the participants reported having diarrhea during the week before the study. However, about two-thirds of the participants (68.1%) showed good hygienic practices by using soap or detergents for hand washing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eRisk of Bias/ Quality appraisal\u003c/h3\u003e\n\u003cp\u003eThe quality of the design and the reporting system were the main focus on this stage. Three review authors independently assessed the risk of bias in the included studies. The MMAT was used to appraise the studies. The MMAT (Pluye et. Al., 2011) was used to appraise the six studies included in the review. MMAT is a validated checklist used to appraise the quality of studies included in any systematic review with a quantitative, qualitative and mixed methods approach (Pluye et. Al., 2011). The MMAT has two general screening questions applicable to all study designs: 1) Are there clear qualitative and quantitative research questions or objectives, or is there a clear mixed-methods\u0026rsquo; question or objective? 2) Do the collected data address the research question or objective? The MMAT appraises the following study methodologies and designs: qualitative, quantitative randomised controlled, quantitative non-randomized, quantitative descriptive and mixed methods study designs. The tool is divided into five components and each component is designed to assess the quality of a specific study design. These components are qualitative, quantitative randomised controlled, quantitative non-randomized, quantitative descriptive, and mixed methods studies. All components are numbered, and each section has five assessment criteria. For example, assessment criteria for assessing for Quantitative non-randomized studies included: 1) Are the participants representative of the target population? 2) Are measurements appropriate regarding both the outcome and intervention (or exposure)? 3) Are there complete outcome data? 4) Are the confounders accounted for in the design and analysis? 5) During the study period, is the intervention administered (or exposure occurred) as intended? Each criterion is rated as \u0026ldquo;Yes\u0026rdquo;, or \u0026ldquo;No\u0026rdquo; or \u0026ldquo;Can\u0026rsquo;t tell\u0026rdquo;. It is discouraged to calculate an overall score from the ratings of each criterion. Instead, it is advised to provide a more detailed presentation of the ratings of each criterion to better inform the quality of the included studies. It is also discouraged to exclude studies with low methodological quality. MMAT was chosen to appraise studies in this review because it can simultaneously appraise studies of different designs, which suits different study methodologies included in this systematic review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA narrative approach was used to synthesise data. Narrative synthesis in systematic reviews is recommended when there is a great variation in variables such as outcomes, interventions, population, and methods across studies (Popay et al., 2006). We used study outcomes as themes to synthesise data. A narrative approach was also used to synthesis the quality of study and characteristics of the study. The main category of the analysis was based on; the health outcomes related to sanitation interventions and effectiveness of sanitation strategies. Under this category, the reviewers came up with four subcategories, namely: Effectiveness of emergency sanitation strategies in addressing sanitation needs and improving health outcomes in disaster areas in Africa; Emergency sanitation strategies most suitable for specific disaster types in Africa; Challenges commonly faced in implementing emergency sanitation interventions in disaster areas of Africa; Impact of emergency sanitation interventions on health outcomes in preventing waterborne diseases among populations affected by disasters. Effectiveness of emergency sanitation strategies in this study refers to proxy data of reducing infectious diseases such as diarrhea. Sanitation needs in this study shall mean \u0026ldquo;having clean and readily available toilets, managing human excreta safely, and ensuring proper disposal of garbage and wastewater\u0026rdquo;. Content analysis was carried out to synthesise the extracted data and similar information was grouped (see Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Findings were presented in narrative form as shown below. The interventions were also classified according the settings where they were implemented. The settings of the study were classified as households (peoples\u0026rsquo; houses), schools, refugee camps, and communities/villages. Statistical meta-analysis was not possible as the studies varied considerably on how the study outcomes were analysed by the researchers.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eQuality appraisal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on MMAT, three studies scored a \u0026ldquo;Yes\u0026rdquo; on all the five parameters [Appiah, 2020; Okeeffe, 2024; Asmally, 2025]. of these three, one used a mixed methods design, one used a prospective cohort study design, and one use a cross-sectional study design. Two studies scored a \u0026ldquo;No\u0026rdquo; on one parameter and scored a Yes\u0026rsquo; on the four parameters [Mello, 2020; Tamene, 2021]. Both were mixed methods studies that had no adequate rationale for using a mixed methods design to address the research question. One study scored \u0026ldquo;Can\u0026rsquo;t tell\u0026rdquo; on one parameter, and scored a \u0026ldquo;Yes\u0026rdquo; on the four parameters [Habtu, 2024]. This was a cross-sectional study that did not indicate whether the risk of nonresponse was low. However, non response bias was not applicable because the study was dealing with water samples. MMAT has no cut-off point for the quality of studies, and it is discouraged to calculate an overall score from the ratings of each criterion. As such, we considered studies with more that had scored a \u0026lsquo;Yes\u0026rdquo; on more than half of the observation/parameters as having high quality, and those that had a score of a \u0026ldquo;No: on more than half of the observation/parameters as of poor quality. With the above description on all the six included studies, the studies are considered to be of high quality.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;MMAT\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"756\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName of study author\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethodological quality criteria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCan\u0026rsquo;t tell\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eD`mello-Guyett \u0026nbsp;et al., (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eQualitative and Quantitative methods.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.1. Is there an adequate rationale for using a mixed methods design to address the research question?\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eThe reasons for conducting a mixed methods study has not been explained.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.2. Are the different components of the study effectively integrated to answer the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eM.Habtu et al.,(2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eCross sectional study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.1. Is the sampling strategy relevant to address the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.2. Is the sample representative of the target population?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.3. Are the measurements appropriate?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.4. Is the risk of nonresponse bias low?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eNon response bias is not applicable because the study was dealing with water samples\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.5. Is the statistical analysis appropriate to answer the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAppiah. Effah et al., (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eQualitative and Quantitative methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.1. Is there an adequate rationale for using a mixed methods design to address the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.2. Are the different components of the study effectively integrated to answer the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved?\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOkeeffe et. al. (2024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eProspective observational cohort study\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e3.1. Are the participants representative of the target population?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e3.2. Are measurements appropriate regarding both the outcome and intervention (or exposure)?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e3.3. Are there complete outcome data?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e3.4. Are the confounders accounted for in the design and analysis?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e3.5. During the study period, is the intervention administered (or exposure occurred) as intended?\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eTamene, A. (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eMixed method design\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.1. Is there an adequate rationale for using a mixed methods design to address the research question?\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eThe reasons for conducting a mixed methods study has not been explained\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.2. Are the different components of the study effectively integrated to answer the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.3. Are the outputs of the integration of qualitative and quantitative components adequately interpreted?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.4. Are divergences and inconsistencies between quantitative and qualitative results adequately addressed?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e5.5. Do the different components of the study adhere to the quality criteria of each tradition of the methods involved?\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAsmally et. al. (2025)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eA Cross-sectional study design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.1. Is the sampling strategy relevant to address the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.2. Is the sample representative of the target population?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.3. Are the measurements appropriate?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.4. Is the risk of nonresponse bias low?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e4.5. Is the statistical analysis appropriate to answer the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e✔\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix studies met the eligible criteria. Of these, one study was conducted in Democratic Republic of Congo [D`mello-Guyett \u0026nbsp;et al., 2020], one in Kenya [Habtu et al.,2024], one in Ghana [Appiah. Effah et al., 2020], one in Nigeria [Okeeffe et. al. 2024], one in Ethiopia [Tamene, A. 2021], and one in Sudan [Asmally et. al. 2025]. (See Table 2). In terms of study design, three mixed method design. [D`mello-Guyett \u0026nbsp;et al., (2020); Appiah. Effah et al., 2020, \u0026amp; Tamene, A. 2021], two cross-sectional studies [Habtu et al.,2024, \u0026amp; Asmally et. al. 2025], and one prospective cohort study [Okeeffe et. al. 2024] were evaluated. Data collection in the cross-sectional study was mainly through semi-structured questionnaire, and water samples. The prospective cohort study utilized kobo tool, mWater. The mixed method study utilized key informant interviews, structured observations, and semi structured interviews. (see Table 2). The study population in two studies were the general population [Tamene, A. 2021; Okeeffe et. al. 2024]. One study was conducted with the internally displaced population [Asmally et. al. 2025]. One study involved the community and the refuges [Habtu et al.,2024]. While the other two involved the households, staff/officials, school children [D`mello-Guyett \u0026nbsp;et al., 2020; Appiah. Effah et al., 2020]. In terms of the setting, two studies were conducted in community settings only [Asmally et. al. 2025; Okeeffe et. al. 2024]. one study was purely conducted in a hospital setting, while the other three combine one or two of the following settings; household, health care, treatment centres, refugee camps and school setting [Habtu et al.,2024; Habtu et al.,2024; D`mello-Guyett \u0026nbsp; et al., 2020]. The median of the participants in a study by Asmally et. al. 2025 was 15, while the mean aged in the study by D`mello-Guyett \u0026nbsp;et al., 2020 was 45 years. Three studies did not indicate the age of the participants involved in their studies [Appiah. Effah et al., 2020; Tamene, A. 2021; \u0026amp; Okeeffe et. al. 2024]. In a study by Habtu et al.,2024, the authors used the water samples. As such the age of the population did not apply. The number of participants in each study varied from 7 [D`mello-Guyett \u0026nbsp;et al., 2020] to 480,000 [Habtu et al.,2024].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of the Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffectiveness of emergency sanitation strategies in addressing sanitation needs in disaster areas in Africa;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Adamawa State, emergency sanitation efforts were less effective, as they had lower latrine coverage and fewer hygiene promotion initiatives.\u0026nbsp;In contrast, the response was \u003cstrong\u003emost effective in Yobe State\u003c/strong\u003e, where \u003cstrong\u003eimproved latrine coverage (89.6%)\u003c/strong\u003e and \u003cstrong\u003ehandwashing station presence (49.6%)\u003c/strong\u003e were relatively high. Yobe also showed \u003cstrong\u003enear-universal implementation\u003c/strong\u003e of hygiene promotion and latrine disinfection activities and had a higher percentage of households receiving the complete CATI package compared to Adamawa. These results emphasize the importance of strengthening baseline WASH infrastructure, improving logistical coordination, and ensuring timely and comprehensive response to effectively meet sanitation needs in disaster-affected settings across Africa.\u003c/p\u003e\n\u003cp\u003eTamene, A. (2021) study, assessed the availability, accessibility, and functionality of WASH services in all 35 temporary COVID-19 treatment centers across the Southern Nations, Nationalities, and Peoples\u0026apos; Region (SNNPR). Regardless of the presence of piped water in all facilities, 77.1% faced frequent interruptions. Some facilities resorted to unimproved or unchlorinated water sources, increasing the risk of contamination. One infection prevention officer noted,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;There is a frequent discontinuity of water but\u003c/em\u003e, \u003cem\u003ethere is a backup tanker for our services\u003c/em\u003e. \u003cem\u003eThe water and sewerage service authority should focus on the continuous water supply to the treatment center\u003c/em\u003e.\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEven though 74.28% of centers had functional handwashing stations, only 60% had running water. Toilets were available at all centers, but only 85.7% had them separated for different users, and accessibility for persons with disabilities was largely inadequate A regional taskforce officer explained,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;Most HCFs store their water in a covered storage container\u003c/em\u003e, \u003cem\u003ethe majority of latrine users fail to safely collect water from these containers\u003c/em\u003e. \u003cem\u003eInstead\u003c/em\u003e, \u003cem\u003ethey use a cup\u003c/em\u003e, \u003cem\u003ebowl\u003c/em\u003e, \u003cem\u003eor their hands to scoop water from the container\u003c/em\u003e, \u003cem\u003ewhich might introduce contaminants\u003c/em\u003e.\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;This is a university building\u003c/em\u003e; \u003cem\u003eit has latrines built to accommodate the disabled but it has been in use for some 50 plus years\u003c/em\u003e. \u003cem\u003eIt is dilapidated\u003c/em\u003e.\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLaundry and shower systems were severely lacking, with 94.7% of laundry services nonfunctional, forcing manual washing that raised safety concerns. Waste management was also problematic17.1% had overflowing waste containers and 60% lacked adequate incineration capacity. As one officer put it,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;Nowadays\u003c/em\u003e\u003cem\u003e,\u0026nbsp;\u003c/em\u003e\u003cem\u003eour workers toil hard to make up for the downed washing machines this manual washing puts them and their families at great risk\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026lsquo;There are lots of design gaps in this treatment center\u003c/em\u003e. \u003cem\u003eHowever\u003c/em\u003e, \u003cem\u003esince the building is registered as a cultural and tourism site; it is difficult to get a construction permit to build a more compatible incinerator\u003c/em\u003e.\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Furthermore, the study highlighted that 45.71% of centers were undersupplied with personal protective equipment, and in some facilities, WASH duties were shifted to untrained nurses due to a lack of environmental health professionals. The study revealed significant disparities in WASH services between urban and rural COVID-19 isolation and treatment centers, with rural centers facing greater challenges in latrine maintenance (68.4% vs. 31.2%), implementation of WHO-recommended hand hygiene protocols (26.3% vs. 62.5%), and incineration capacity (73.4% vs. 62.5%). These differences were statistically significant, indicating unequal emergency preparedness across settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to M. Habtu et al., (2024), his findings highlight significant challenges in meeting water quality standards, particularly regarding fecal coliform contamination, which is a key indicator of water safety. In total, 87.2% of the 109 drinking water samples did not meet the required threshold for thermotolerant coliforms, indicating widespread contamination. Most concerning is that a large percentage of samples from various sources household storage containers (92.5%), institutional storage tanks (85.7%), water truckers (100%), and community water kiosks (83.3%) failed to meet the recommended standard, posing potential health risks to the community. Despite some compliance with other in-situ parameters like pH, electrical conductivity, and turbidity, the lack of residual chlorine in all the samples suggests a gap in effective water treatment, further underscoring the need for improved water management and treatment practices.\u003c/p\u003e\n\u003cp\u003eD`mello-Guyett et al., (2020), reveals that while hygiene kits were generally accepted and considered useful by recipients, their overall effectiveness was limited by several critical factors. Delays in kit distribution, inadequate coverage (only 40% of suspected cholera cases received kits), and inconsistent implementation protocols significantly hindered the reach and timeliness of the intervention. Additionally, although most recipients attended hygiene demonstrations and reported improved hygiene behaviors, poor recall and low adherence to key practices, such as water treatment, weakened the impact. The kits were also not sustained for the intended duration, especially in large and polygamous households, due to insufficient supplies and maintenance challenges. Furthermore, logistical barriers such as poor road access, delayed outbreak response, and lack of WASH infrastructure further compromised effectiveness. Although no harm was reported from using the kits, the inequitable distribution created social tensions within the community. These findings suggest that while emergency sanitation strategies have potential, their effectiveness in disaster settings depends heavily on timely delivery, adequate coverage, clear protocols, and sustained support tailored to the local context.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe findings from Asmally et al., (2025) study highlight several critical gaps that undermine the overall effectiveness of such interventions. Although tube wells were the predominant source of drinking water, issues such as water shortages (reported by 40%), lack of year-round availability (47%), and poor water appearance (46% reported cloudy water) contributed to widespread dissatisfaction, with over half (56.8%) of participants unhappy with water services. Logistic regression revealed that water source type, time spent fetching water, and inconsistent supply, water clarity, and the obligation to pay for services significantly influenced satisfaction levels. Alarmingly, E. coli contamination was highest at the household level (73.91%), and surface water sources were universally non-compliant with safety guidelines. Sanitation and hygiene practices were suboptimal, with over 40% using pit latrines without slabs and outdoor stool disposal being common. While handwashing before meals was high, rates were much lower before cooking. Diarrheal diseases affected 20.5% of households, and statistical associations confirmed that the presence and use of soap significantly reduced the occurrence of diarrhea. However, no hygiene-related variables made a unique contribution in the logistic model predicting diarrhea. The microbial and physicochemical quality of water was poor, with high fluoride and Total Dissolved Solid (TDS) levels in multiple villages. These results suggest that while emergency sanitation strategies were implemented, their effectiveness was severely limited by unsafe water sources, poor water quality, inadequate sanitation facilities, and inconsistent hygiene practices ultimately failing to meet the critical sanitation needs during emergencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmergency sanitation strategies most suitable for specific disaster types, such as floods, earthquakes, and conflict zones in Africa;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from all the studies have not directly specified the sanitation strategies suitable for specific disaster type. However, the nature of the emergency context (e.g. displaced populations, poor water quality, makeshift facilities) allows to infer suitability for specific disaster types.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalent reliance on tube wells (68.1%) and a significant level of dissatisfaction regarding water collection times (over 70% if it takes longer than 31 minutes) indicates that in flood-affected and conflict areas, there is a need for water systems that are readily accessible and can be quickly set up, such as mobile water treatment units or water trucking. The notable effectiveness of using pottery for water storage highlights local adaptability in emergency situations (Asmally et al., 2025). There is a significant level of E. coli contamination, especially at the household level (73.91%), suggesting that displaced populations in areas affected by conflict or flooding may require more effective point-of-use treatment solutions like chlorination kits or filtration systems (Appiah-Effah et al., 2020). The presence of pit latrines without slabs (41.8%) and the outdoor disposal of children\u0026apos;s waste (41.5%) point to unsanitary conditions often observed in emergency situations arising from conflict or floods. This underscores the necessity for prefabricated or elevated latrines in flood-prone regions and composting toilets in drought-affected conflict areas (Tamene, 2021).\u003c/p\u003e\n\u003cp\u003eThe presence and application of soap greatly decreased the incidence of diarrhea, although its usage prior to cooking was minimal. This is vital for all types of disasters and indicates that hygiene promotion campaigns and the distribution of soap are effective and adaptable approaches in various emergency contexts (D\u0026rsquo;mello-Guyett et al., 2020). Individuals who did not pay for water indicated greater levels of dissatisfaction, possibly due to the reliance on unsustainable, donor-funded emergency supplies typically found in conflict or flood-affected regions. This highlights the necessity of engaging communities in management to enhance satisfaction and sustainability (O\u0026rsquo;Keeffe et al., 2024). Unusual fluoride concentrations and TDS in water sources (notably in 13 villages) might be intensified by alterations in water tables caused by earthquakes. This underscores the requirement for consistent water quality monitoring and flexible purification technologies in such locations (M. Habtu et al., 2024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChallenges commonly faced in implementing emergency sanitation interventions in disaster areas in Africa\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 6 articles, only three reported the challenges faced during implementation of emergency sanitation interventions during an emergency particularly in response to cholera outbreaks (D\u0026rsquo;Mello-Guyett et al., 2020, Okeeffe et. al., 2024 and Appiah. Effah et al., 2020). However, the study by Appiah evaluated health impacts of long-term WASH interventions in disaster-prone areas rather than acute emergency response. Nonetheless, the challenges highlighted in the study reflect those encountered during the emergency sanitation interventions in the other studies.\u003c/p\u003e\n\u003cp\u003eIn a study conducted by D\u0026rsquo;mello-Guyett, findings report challenges on the timeliness and coverage of the emergency hygiene kit intervention during a Cholera outbreak. One of the major challenges reported was the limited distribution of hygiene kits, with the hygiene kits distributed between week 44 and 46. Out of the 250 kits that were estimated for the response, \u0026nbsp;only 165 kits that were delivered, which were insufficient for the 196 patients admitted between week 43 and 47. \u0026nbsp;The low coverage was attributed to late arrival of the kits to the project site which affected timely distribution such as being given the kits at exit rather than at admission when immediate use would have been most impactful. Additionally, some patients were not accompanied by a household member which caused confusion as to whom the kit should be given. \u0026nbsp;Another major challenge was the inadequate quantities of items within hygiene kits. For example, all households received the same quantity of soap regardless of household size, which was insufficient for bigger and polygamous families. Similarly, the 20-litre Jerry cans provided for water storage were inadequate, with most households preferring larger containers. Sustainability in the use of hygiene kits by the households was also a challenge. Most households reported that they found it difficult to maintain kit use for longer than 2 to 3 weeks, falling short of the intended one-month duration. This was due to the breakage of some kit items, such as taps on the hand washing devices, and the distance to water sources affected the availability of stored water and water inside the hand washing device as all households had to travel over 5 km distances to access water sources. These challenges affected the overall impact and sustainability of the hygiene kit intervention during the outbreak response.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOkeeffe et. al., (2024) reports similar operational challenges to those presented by D\u0026rsquo;Mello-Guyett et al., (2020). A major challenge in this study was the timing of the implementation of the outbreak response, which was inconsistently prompt across the 3 targeted states. In Borno, the Case area Targeted Interventions (CATIs) began 4 days after the outbreak was declared, while in Yobe, CATIs were initiated as the cases increased in Mid-August. However, in Adamawa, despite an increase in cases in Mid-August, CATIs were not initiated until September 17 delaying early containment efforts. The study emphasized that rapid response is crucial in preventing cholera clustering. Another challenge was the inadequate availability of the supplies as it was reported that stock-outs were common across the 3 states as reflected in the low percentage of households that received complete supplies. Additionally, the data collection did not record quantity but rather whether a certain supply was provided so the study only suggests the possibility that response teams may have provided fewer supplies than planned when facing supply shortages, which would underestimate the findings. Of the 44,597 households reached by CATIs in the 3 states, only 33.7% received complete supplies and overall, 33.5% of households received the complete CATI package. By state, the proportion of households that received the complete package was 33.5% in Borno, 17.7% in Adamawa and 29.6% Yobe.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAppiah. Effah et al., (2020)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eassessed the health impacts of WASH interventions implemented in disaster-prone communities in Ghana comparing 9 intervention communities with 9 control communities. The study highlights challenges that are related to emergency sanitation interventions in disaster-prone African settings. Despite improvements in WASH infrastructure in Ghana, communities faced inadequate access to improved sanitation facilities, with open defecation remaining prevalent in some areas. In Arab-Yeri, for instance, the implementation of facilities had not begun as of the time of the assessment, as it was reported that no infrastructure had yet been provided under the project, despite it being a designated intervention community. Frequent breakdowns of water systems and delays in maintenance were also reported, which is particularly problematic during disasters as water needs increase. \u0026nbsp; Even where water sources existed, water quantities were often inadequate, forcing communities to access water from unimproved sources such as rivers. Additionally, low uptake of the household latrines and limited hand washing practices were identified as the behavioral barriers to consistent hygiene practices that may have reduced the effectiveness of the interventions. Furthermore, the study reports weak health data and monitoring systems and poor integration of broader environmental sanitation components, such as waste management, as factors limiting the health impact of WASH interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact of emergency sanitation interventions on health outcome in preventing waterborne diseases among populations affected by disaster.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll six articles reviewed included WASH-related interventions. Three studies (M. Habtu et al., (2024), Okeeffe et. al. (2024) and D`mello-Guyett et al., (2020)) used incidence of Cholera as the primary outcome measure while two studies, Appiah. Effah et al., (2020) and Asmally et. al. (2025) focused on the incidence of diarrhea diseases. A study by M. Habtu et al., (2024) 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 in Garissa. 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 observed by the epidemic curve\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAppiah. Effah et al., (2020) assessed the health impacts of WASH interventions in nine intervention communities compared to nine control communities in disaster prone areas. The evaluation considered factors such as the availability, condition and use of boreholes and latrines, as well as hygiene promotion and general sanitation practices. Using a Difference-in-Differences (DID) analysis, the study compared changes in outcomes over time between intervention and control groups. The highest recorded impact (DID) was a 7% reduction in diarrhea cases. Moderate and high DID scores (ranging from 3% to 7%) were observed in six intervention and control groups (Goh and Yaala 4%, Baase and Saan 5%, Banu and Pina 4%, Azum-Sapeliga and Kumpago 7%, Choggu Mmayili and Katariga 4% and Kpalba and Gbong 3%) of the nine intervention and nine controls communities, indicating a significant positive effect. In contrast, low or no impact (DID of 0 to 1%) was found in two groups (Wonjuga and Ando 0% and Nania and Badunu 1%). Additionally, one group (Alab-Yeri and Pungsa) showed a negative DID of -3% (control group experienced more improvement than the intervention group). Overall, the majority of the intervention communities demonstrated positive health impacts from the WASH interventions.\u003c/p\u003e\n\u003cp\u003eD`mello-Guyett et al., (2020) assessed the timeliness of cholera interventions during an outbreak and their possible influence on case trends. The study reported that during weeks 43 to 47 of the cholera outbreak, only \u003cstrong\u003e52% of admitted cholera cases received interventions (such as Soap, Sachets of flocculants disinfectant, Chlorine tablets, hand washing devise-buckets/Jerry can and health promotion) on the day of admission\u003c/strong\u003e. In the subsequent weeks (week 48 and 49), there was a \u003cstrong\u003edecline in the number of reported suspected cholera cases\u003c/strong\u003e, dropping from over \u003cstrong\u003e70 cases in week 44 to zero after receiving the WASH interventions\u003c/strong\u003e. Additionally, the study highlighted an improved use of hygiene kits and handwashing practices with soap after demonstrations and health promotion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study by Okeeffe et. al. (2024) found that cholera cases were highly concentrated in three conflict affected areas, with 291 clusters in Borno, 153 in Adamawa, and 128 in Yobe. When the model considered interventions like improved access to clean water, toilets, handwashing stations and cholera treatment centers, the number of clusters dropped significantly to 8 in Borno, 0 in Adamawa and 10 in Yobe. After further adjusting for CATI interventions such as chlorine distribution, beddings, ring coverage, latrine disinfection activities, response timelines, health and hygiene promotion and hygiene kit provision along with environmental factors, all remaining clusters/cases were eliminated in both Borno and Yobe. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAsmally et. al. (2025) reported statistically significant associations between the presence of soap (P=0.002) and its use before eating (p=0.005), after using the toilet (P=0.005) and before cooking (P=0.004) with the occurrence of diarrhea. Households with soap had a lower diarrhea prevalence (43 cases, 8.1%) compared to those without (39 cases, 15.9%). Similarly, individuals who washed hands before eating (30 cases, 7.9%), after using the toilet (27 cases, 7.8%) and before cooking (10 cases, 7.0%) reported fewer diarrhea cases than those who did not practice handwashing at these times. Additionally, people who showered outdoors experienced a higher rate of diarrhea (6 cases, 22%) compared to those who showered indoors (76 cases, 10.1%).\u003c/p\u003e\n\u003cp\u003eTamene, A. (2021) reported no measurable impact from WASH interventions, as the study focused on assessing the availability, accessibility and functionality of WASH facilities in temporary COVID-19 isolation and treatment centers. The study also aimed to determine whether there were differences in WASH service provision between urban and rural sites.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe success of emergency sanitation strategies in disaster-affected regions of Africa varies greatly based on the local context, infrastructure, and the quality of implementation. For example, in Yobe State, the effective rollout of latrines (89.6% coverage), handwashing stations (49.6%), and extensive hygiene promotion reflected a well-organized and prompt response. By contrast, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia, persistent interruptions in water supply, poor waste management practices, and insufficient sanitation facilities severely restricted effective service delivery during the COVID-19 pandemic (Tamene, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Furthermore, the research conducted by D\u0026rsquo;mello-Guyett et al., (2020) highlighted that although hygiene kits were positively received, their late distribution, insufficient coverage, and transient impact particularly in larger households restricted their overall effectiveness. These results underline that while emergency measures can be beneficial, they necessitate solid logistical planning, fair access, and approaches tailored to the specific context to adequately address critical sanitation needs during emergencies.\u003c/p\u003e \u003cp\u003eIn comparison, other researchers highlight similar obstacles and constraints in the effectiveness of the emergency sanitation strategies. For example, Habtu et al., (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) found that 87.2% of water samples obtained from various emergency water sources did not meet safety standards due to fecal contamination and insufficient chlorination, stressing that water quality represents a significant gap in emergency sanitation. Likewise, Asmally et al., (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) observed a pervasive dissatisfaction with emergency water services within affected communities, pointing out inadequate sanitation practices, substandard latrine conditions, and elevated levels of E. coli contamination. The prevalence of diarrheal diseases (20.5%) and poor hygiene behaviors were additional signs of inadequate sanitation strategies. These investigations, emphasize the necessity for not only infrastructure and materials but also ongoing water treatment, hygiene education, and qualified WASH personnel to guarantee a genuinely effective emergency sanitation response in Africa.\u003c/p\u003e \u003cp\u003eWhile none of the research explicitly grouped emergency sanitation methods according to disaster type, the contextual insights derived provide helpful guidance on which strategies may be most effective for particular emergencies such as floods, earthquakes, and conflict-affected regions in Africa. In areas vulnerable to flooding and those impacted by conflict, the heavy dependence on tube wells and the dissatisfaction related to lengthy water collection times (over 70% when exceeding 31 minutes) indicate a necessity for quickly deployable solutions, such as mobile water treatment systems and water trucking services. The pervasive E. coli contamination observed at the household level (73.91%) alongside unsanitary conditions like pit latrines lacking slabs and the practice of outdoor stool disposal (Asmally et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) suggest that elevated or prefabricated latrines are suitable for flood situations, and composting toilets are more appropriate for drought-prone conflict scenarios (Tamene, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNo matter the type of disaster, hygiene promotion and the provision of soap have proven to be universally impactful, as demonstrated by D\u0026rsquo;mello-Guyett et al., (2020), where the availability of soap led to a significant reduction in diarrhea despite minimal use during cooking. The discontent with free emergency water supplies emphasizes the necessity for community-managed water systems to provide sustainable solutions, particularly in conflict zones (O\u0026rsquo;Keeffe et al., 2024). Lastly, the elevated levels of fluoride and TDS potentially resulting from seismic activities underscore the importance of continuous water quality monitoring and the adaptation of purification technologies in areas affected by earthquakes (Habtu et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Collectively, these insights highlight the need for sanitation strategies that are tailored to the specific context and type of each disaster.\u003c/p\u003e \u003cp\u003eThe systematic review reveals significant challenges in implementing emergency sanitation interventions across disaster prone areas in Africa ranging from delayed implementation, poor resource distribution and behavioural and contextual factors. D\u0026rsquo;mello-Guyett et al., (2020) and O\u0026rsquo;Keeffe et al., (2024) both identified delayed implementation as a critical barrier to effective response. While concerning, the delays documented in our review were comparatively shorter that those found in an MSF data review by D\u0026rsquo;mello-Guyett et al (2022), which reported response times ranging from 31 to 126 days across Malawi, DRC and Mozambique. Similarly, Ratnayake et al., (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) reported delays of 10 days between alert and response. Inconsistency in the timeliness of intervention delivery was also noted by Sikder et al., (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), where timeliness evaluations ranged from immediate intervention upon admission in Bangladesh to delays of up to 3.9 days in Nepal.\u003c/p\u003e \u003cp\u003eThese delays significantly undermine emergency sanitation effectiveness. WHO (2022) emphasizes that early detection and immediate response are vital for containing outbreaks and reducing Cholera mortality. This aligns with findings from Yates et al., (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), who demonstrated that delays of even a few days in initiating WASH interventions during Cholera outbreak can significantly increase disease transmission and mortality rates. Sikder et al., (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) provided quantitative evidence of this impact, reporting that in Haiti, timely responses within a day, reduced new cases by 76% and outbreak duration by 61% compared to delayed responses of more than 7 days.\u003c/p\u003e \u003cp\u003eLogistical constraints frequently result in critical supplies arriving too late, with hygiene kits often distributed at patient discharge rather than admission when immediate use would be most beneficial (D\u0026rsquo;mello-Guyett et al., (2020). Several studies confirm that successful interventions require quick and flexible funding (Yates et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), adequate product stocks (Lantage and Clasen, 2012; and Yates et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2018\u003c/span\u003e and supply readiness (WHO, 2022). The review also identified significant variations in intervention coverage. Okeefee et al., (2024) reported that only 33.7% of targeted households received complete supplies across the three Nigerian states. Similarly, Skider et al., (2021) found that coverage varied widely from 17% of households in Nepal to 92% of cases in DRC. This inconsistency reflects broader challenges in resource allocation and distribution during emergency responses.\u003c/p\u003e \u003cp\u003eLow uptake of household latrines and limited hand washing practices were identified as behavioural barriers by Appiah-Effah et al., (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), suggesting that technical solutions alone are insufficient without adequate attention to social and cultural factors. Brown et al., (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) emphasize that safe excreta disposal is the first line of defense against faecal-oral pathogen transmission, yet in many low and middle income countries, WASH facilities remain inadequate. Globally, only 60% of the world\u0026rsquo;s population have access to basic hand washing facilities at the household level (UNICEF \u0026amp; WHO, 2019) and the situation is worse beyond the household settings, particularly in health care facilities in developing countries (UNICEF \u0026amp; WHO, 2019). The sub-Saharan Africa region has the lowest progress rate in expanding access to improved water services between 2000 and 2017 (WHO \u0026amp; UNICEF, 2021), further complicating emergency sanitation interventions.\u003c/p\u003e \u003cp\u003eAccess to water emerged as a critical constraint across the reviewed studies. D\u0026rsquo;mello-Guyett et al., (2020) reported that households had to travel over 5Km to access water sources affecting sustainability of handwashing interventions. Similarly, Appiah-Effah et al., (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) noted that water quantities were often inadequate, forcing communities to access unimproved water sources such as rivers. This reliance on unimproved water sources is concerning as rivers are considered the main reservoir for \u003cem\u003eVibrio Cholerae\u003c/em\u003e and have been implicated in past Cholera outbreaks (Acosta, 2001).\u003c/p\u003e \u003cp\u003eTwo studies demonstrated a significant reduction in cholera cases after interventions such as water treatment, chlorine distribution, latrine disinfection and health promotion (M. Habtu et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Okeeffe et al., 2024). Similarly, D\u0026rsquo;mello-Guyett and colleagues noted a clear decline in cholera cases, following WASH interventions and emphasized the importance of the timeliness of interventions during outbreaks, noting that delays in delivering hygiene kits and health promotion messages can affect case trends (D\u0026rsquo;mello-Guyett et al., 2020). This supports earlier findings by Taylor and colleagues, which showed that rapid deployment of hygiene interventions during outbreaks greatly improves outcomes (Taylor et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough most studies in this review reported positive effects, the scale and consistency of these impacts varied. One study found slight reductions in diarrhea cases, with some intervention communities achieving DID scores between 3\u0026ndash;7%, while others showed little or no improvement although variations existed between locations, suggesting that intervention outcomes are influenced by a combination of factors (Appiah Effah et al., 2020). A study by Asmally et al., (Asmally et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) further highlighted those specific behaviors, like handwashing with soap before eating and after using the toilet, were significantly associated with lower diarrheal prevalence. This adds to the evidence from previous research that hand hygiene remains one of the most effective yet underutilized measures in controlling waterborne diseases (Solomon et al., 2021).\u003c/p\u003e \u003cp\u003eThe mixed outcomes from Appiah Effah et al., (2020) where some communities experienced low or negative impacts, highlight that local context, community engagement, behavior change, sustained hygiene promotion, functionality of WASH infrastructure, interventions timeliness, quality, quantity, and period and resource availability influence effectiveness. These findings imply that while emergency WASH interventions are generally effective in reducing cholera and diarrhea cases in outbreaks, their success depends on timely delivery, cultural acceptability, community involvement, intervention quality, quantity and period and continuous follow-up (Appiah Effah et al., 2020; D\u0026rsquo;mello-Guyett et al., 2020; Okeeffe et al., 2024). Although several years have passed since some of the studies were conducted, the findings from this systematic review reveal that gaps still exist in the consistency of impact across different community settings, emphasizing the need for context-specific strategies and regularly monitoring to ensure effectiveness. Additionally, this review highlights that while the provision of WASH resources such as clean water points, toilets and hygiene kits is essential in emergence, it is not sufficient on its own to effectively reduce diseases like cholera and diarrhea (Appiah Effah et al., 2020; D\u0026rsquo;mello-Guyett et al., 2020; Okeeffe et al., 2024).\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThis review has some limitations. First, our systematic review excluded all the studies that were conducted in languages other than English. This may have introduced bias to the findings of the study as some studies published in other languages may have had information that could be useful in answering the research question. Second, the review only included studies conducted in Africa, limiting the generalisation of the findings to other settings globally. In spite of these limitations, all the six studies rated to be of high quality when appraised using MMAT. This entails that the quality of the studies included in this review were of high quality, and that the evidence synthesized in this systematic review can be relied upon.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eImplications of the study findings for practice, research and policy\u003c/h2\u003e \u003cp\u003eThe findings conducted by Tamene (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), Dmello-Guyett et al., (2020), M. Habtu et al., (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), and Asmally et al., (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) exposes significant deficiencies in emergency sanitation approaches throughout Africa. Although infrastructure is present, issues such as water supply interruptions, unfiltered sources, and widespread E. coli contamination frequently occur. According to Dmello-Guyett et al., hygiene kits proved beneficial but faced challenges due to delays in delivery, lack of adherence, and inadequate quantities. Asmally et al., pointed out dissatisfaction with water services, insufficient sanitation facilities, and elevated rates of diarrhea. Tamene emphasized the gaps in WASH services between urban and rural areas. In flood situations, mobile water systems and raised latrines are crucial, while composting toilets and water purification kits are appropriate for drought and conflict-affected regions. It is essential for policies to reinforce WASH infrastructure, enhance local capabilities, and guarantee equitable responses, while research should concentrate on sanitation solutions tailored to specific disasters and long-term monitoring efforts. The review findings emphasize the importance of integrating multiple WASH strategies and CATI interventions with health education and promotion strategies to support community settings in adopting and sustaining healthy hygiene practices, improving outbreak control (Kaur et al., 2023; Endres et al., 2023). The review further emphasizes the need to strengthen implementation processes and effective behavior change strategies to improve the effectiveness of outbreak response interventions as demonstrated in Azum-Sapeliga community where the chief was actively involved in mobilizing members leading to improved WASH situation and steady decline in diarrhea cases (Appiah Effah et al., 2020).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis 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. Critical gaps continue to exist due to delays in delivery, inadequate water access, inconsistent coverage, and low adherence to hygiene practices. Although essential WASH infrastructuresuch as latrines, handwashing stations, and hygiene kitsis provided, disease reduction results vary across regions because of differences in implementation quality, community engagement, and sustained changes in hygiene behavior.\u003c/p\u003e \u003cp\u003eThe review indicates that universal solutions are inadequate; instead, customized strategies that consider the type of disaster, local conditions, and the needs of the population are vital. Initiatives that integrate infrastructure development with behavior change communication, prompt response, and continuous water quality monitoring are more likely to achieve lasting results. Furthermore, evidence highlights the urgent need for comprehensive and well-funded emergency sanitation systems supported by rapid logistical frameworks, reinforced policies, and adaptive research.\u003c/p\u003e \u003cp\u003eUltimately, for emergency sanitation measures to be genuinely effective in various African disaster settings, stakeholders must emphasize timely actions, ensure sufficient and contextually appropriate resources, and foster robust community involvement. Closing existing gaps necessitates a collaborative approach that unites policy makers, practitioners, and researchers to create scalable, sustainable, and inclusive WASH solutions for emergencies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIOM: International Organization for Migration, WHO: World Health Organization, OCHA: United Nations Office for the Coordination of Humanitarian Affairs. BASE: Bielefeld Academic Search Engine, Web of Science, DOAJ: The Directory of Open Access Journals, EMBASE: Excerpta, Medica database, MMAT: The Mixed methods Appraisal Tool, PRISMA: Preferred Reporting Items for systematic Reviews and Meta-Analyses, PROSPERO: The International Prospective Register of Systematic Reviews, WASH: Water Sanitation and Hygiene, EM-DAT: Emergency Events Database, NGOs: Non-Governmental Organisations, MSF: M\u0026eacute;decins Sans Fronti\u0026egrave;res , CATI: Case Area Targeted Interventions, SNNPR: Southern Nations, Nationalities and People\u0026rsquo;s Region, HCFs: Health Care Facilities, COVID, Corona Virus Disease, TDS: Total Dissolved Solids, DID: Difference-in-Difference. pH: Power of Hydrogen.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials used in this systematic review is available upon request from the corresponding Author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding for this systematic review\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors wrote the protocol that is published in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024628289). All authors searched the literature, did data analysis and also wrote the manuscript and contributed to the intellectual revisions and content. All the authors have read and approved the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAcosta CJ, Galindo CM, Kimario J, Senkoro K, Urassa H, Casals C, et al., Cholera outbreak in southern Tanzania: risk factors and patterns of transmission. Emerg Infect Dis. 2001;7(3 Suppl):583\u0026ndash;7. . [DOI] [PMC free article] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eAppiah-Effah, E., Sagoe, G., Afful, K. M., \u0026amp; Yamoah-Antwi, D. (2020). 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Efficacy and effectiveness of water, sanitation, and hygiene interventions in emergencies in low- and middle-income countries: a systematic review. \u003cem\u003eWaterlines\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(1), 31\u0026ndash;65. http://www.jstor.org/stable/26600890\u003c/li\u003e\n\u003cli\u003eZakaria, F., Garcia, H. A., Hooijmans, C. M., \u0026amp; Brdjanovic, D. (2015). Decision support system for the provision of emergency sanitation. Science of the Total Environment, 512\u0026ndash;513, 645\u0026ndash;657. https://doi.org/10.1016/j.scitotenv.2015.01.081 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Livingstonia","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Effectiveness, Emergency Sanitation Strategies, Disaster, Africa, Systematic Review","lastPublishedDoi":"10.21203/rs.3.rs-7170040/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7170040/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eGap 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe 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 acceptable best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles. A search string was applied across these databases, using Boolean operators to differentiate the key terms. In addition, a PRISMA flow diagram was used to elaborate on the number of articles retrieved, retained, excluded and 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 method appraisal tool was used to appraise studies.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSix articles met the eligibility criteria. Out of the 6 articles, only three reported the challenges faced during 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 specific disaster type. However, the nature of the emergency context (e.g. displaced populations, poor water quality, makeshift facilities) allows 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\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Emergency Sanitation Strategies in Disaster Prone Areas of Africa: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 02:30:11","doi":"10.21203/rs.3.rs-7170040/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aca442cf-a54c-4afb-b093-b5c1bfc07395","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":60741661,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2026-01-08T02:30:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 02:30:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7170040","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7170040","identity":"rs-7170040","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}