21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition.

ABSTRACT

Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue - 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening. Abbreviations CBA Controlled Before and After; GSD Government Service Delivery; IWDSSD International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP Knowledge, Attitudes and Practices; IBD Irritable Bowel Diseases; MDG Millennium Development Goals; NTD Neglected Tropical Diseases; PSSD Private Sector Service Delivery; SDG Sustainable Development Goals; SSA Sub Saharan Africa; SODIS Solar Disinfection System; STH Soil Transmitted Helminths; RCT Randomised Control Trial; WASH Water Sanitation and Hygiene; WHO World Health Organization.