Effectiveness and implementation contexts of water, sanitation, and hygiene (WASH) interventions in Anglophone sub-Saharan Africa: a scoping review

Sub-Saharan Africa (SSA) has the world’s lowest coverage of safely managed water, sanitation, and hygiene (WASH) services. Numerous global and pan-African systematic reviews exist, but often has limited applicability to this sub-region. This scoping review maps the effectiveness and outcomes of WASH interventions implemented since 2010 in 17 Anglophone SSA - countries. Following JBI methodology and PRISMA-ScR guidelines, through searches of four databases (PubMed, Scopus, Google Scholar, and ResearchGate) and websites of relevant WASH organizations from July to December 2023. Two reviewers independently screened 523 unique records screened, 51 publications reporting 49 interventions. Most interventions (71%) combined all three WASH components and were delivered in rural areas (74%) via community- or school-based platforms. RCTs comprised (76%) of the study design. About 78% of interventions achieved increased latrine coverage, handwashing with soap, or reduced diarrhoeal/helminth infections. Major enablers were community ownership, participatory design, and sustained engagement. Dominant barriers were financial constraints, delayed funding, poor adherence and weak political/institutional support.Equity analyses were rare and showed mixed or pro-rich effects. By focusing exclusively on Anglophone SSA and systematically analyzing contextual and equity dimensions, this review provides implementation-focused evidence to inform more effective, equitable, and sustainable WASH policies.

撒哈拉以南非洲（Sub-Saharan Africa, SSA）是全球安全管理型水、环境卫生与个人卫生（WASH）服务覆盖率最低的区域。现有大量全球及泛非洲系统性综述，但这类综述往往对该次区域的适用性有限。本范围综述梳理了2010年以来在17个英语为官方语言的撒哈拉以南非洲国家所实施的WASH干预措施的有效性与实施效果。本研究遵循乔安娜布里格斯研究所（JBI）范围综述方法学及系统综述与元分析扩展范围综述指南（PRISMA-ScR），于2023年7月至12月期间，检索了PubMed、Scopus、Google Scholar、ResearchGate四大数据库及相关WASH组织的官方网站。两名评审员独立开展文献筛选，最终纳入523条独立记录，从中筛选出51篇文献，共报道49项WASH干预措施。其中71%的干预措施整合了WASH三大核心模块，74%的干预措施依托社区或学校平台在农村地区实施。纳入研究的设计类型中，随机对照试验（RCT）占比达76%。约78%的干预措施达成了提升厕所覆盖率、推广肥皂洗手行为或降低腹泻/蠕虫感染率的目标。干预实施的主要促进因素包括社区主体地位、参与式设计及持续的多方参与；而主要阻碍因素则为资金限制、拨款延迟、依从性不佳以及薄弱的政治与制度支持。本研究中公平性分析较为少见，且相关结果呈现两极分化或偏向富裕群体的特征。本综述仅聚焦英语官方语言的撒哈拉以南非洲地区，系统分析了场景语境与公平性维度，可为制定更具有效性、公平性与可持续性的WASH政策提供聚焦实践落地的证据支撑。