The cost of a knowledge silo: a systematic re-review of water, sanitation and hygiene interventions

Abstract

Divisions between communities, disciplinary and practice, impede understanding of how complex interventions in health and other sectors actually work and slow the development and spread of more effective ones. We test this hypothesis by re-reviewing a Cochrane-standard systematic review (SR) of water, sanitation and hygiene (WASH) interventions’ impact on child diarrhoea morbidity: can greater understanding of impacts and how they are achieved be gained when the same papers are reviewed jointly from health and development perspectives? Using realist review methods, researchers examined the 27 papers for evidence of other impact pathways operating than assumed in the papers and SR. Evidence relating to four questions was judged on a scale of likelihood. At the ‘more than possible’ or ‘likely’ level, 22% of interventions were judged to involve substantially more actions than the SR’s label indicated; 37% resulted in substantial additional impacts, beyond reduced diarrhoea morbidity; and unforeseen actions by individuals, households or communities substantially contributed to the impacts in 48% of studies. In 44%, it was judged that these additional impacts and actions would have substantially affected the intervention’s effect on diarrhoea morbidity. The prevalence of these impacts and actions might well be found greater in studies not so narrowly selected. We identify six impact pathways suggested by these studies that were not considered by the SR: these are tentative, given the limitations of the literature we reviewed, but may help stimulate wider review and primary evaluation efforts. This re-review offers a fuller understanding of the impacts of these interventions and how they are produced, pointing to several ways in which investments might enhance health and wellbeing. It suggests that some conclusions of the SR and earlier reviews should be reconsidered. Moreover, it contributes important experience to the continuing debate on appropriate methods to evaluate and synthesize evidence on complex interventions.

How community engagement in water and sanitation interventions impacts human health, infrastructure and service longevity in low- and middle-income countries: a realist review

“…Papers were excluded based on the following criteria (1) Contained secondary data only, or was a review or a commentary (2) It discussed existing management practice for water and health resources 3The outcome was not linked to linked to water, sanitation, health or sustainability (4) There was no clear community role in the intervention or organised activity (5) The study country was from a high-income country based, as defined by the World Bank (36) (6) The paper contained secondary data, or was a review and a commentary piece 7The paper was not available in English.…”

“…However, the literature reveals mixed results of these interventions and initiatives -some display positive impacts, with others showing no impact on health (2,3). There is an expanding array of literature seeking to understand the contextual of WASH interventions and initiatives and their influence (4)(5)(6)(7).…”

Climate Change and Water-Related Infectious Diseases

“…There were also inadequacies in behavioural models and frameworks for intervening in WASH specific interventions [102]. The impacts of WASH on child diarrhoeal morbidity has been examined in a number of studies [103] and there was a general lack of good quality studies of diarrhoea morbidity in children in India [104]. While water treatment (e.g., chlorine water treatment at point of use) can be effective, most studies are short term [105].…”

The Problem of Water and Sanitation on the Example of India and Russia

“…Diarrhoea, being one of malnutrition underlying conditions , increases the risk of stunting by about 5% in the first two years of life (Guerrantet al, 2002;Victora et al, 2008). Repeated diarrhoea episodes also have a negative long-term effect on child`s physical and mental development (Loevinsohn et al, 2015). Noteworthy is the evidence that the incidence of infectious diseases associated with diarrhoea in developing countries is directly proportional to the population (Pinfold, Horan, & Mara, 1991;Riddle, DuPont, & Connor, 2016;SBM-U, 2017).…”