Associate Professor, Department of Public Health, School of Pharmacy and Public Health, Independent University, Bangladesh Email: [email protected]. The pursuit of a Masters in Public Health, in the midst of the global pandemic, still feels like a miracle to me. I wonder how it could ever be possible without the mercy of Almighty Allah; all credit for all the kindness he showed me to get this far.
I am also very grateful to all my instructors at the Department of Public Health, Faculty of Pharmacy and Public Health, IUB. It is indescribable how much effort they put into educating us with all the problems related to the pandemic and online teaching. I express my humble thanks to all the members of the department for everything they have done to enlighten us with knowledge.
INTRODUCTION
- Global Humanitarian Crisis: Stages and Evidence
- An Overview on Global Access to Safe Drinking Water
- Drinking Water Interventions in Global Humanitarian Crisis Context
- Thesis Organization
Access to safe drinking water is not only an essential basic human need to survive, but is also often considered a fundamental indicator to assess the living status of any individual. According to the UN Committee on Economic, Social and Cultural Rights, access to safe drinking water is a prerequisite for the realization of human rights and human dignity (UN Committee on Economic, Social and Cultural Rights, 2003). Despite drastic advances in technological and economic sectors around the globe, it is extremely unfortunate to leave a large part of the global population deprived of basic human needs that include inadequate access to safe drinking water.
According to WHO (2019), more than 29% of the world's population has almost no access to a safely managed source of drinking water, indicating that one in three people is forced to drink water from unsafe sources. Thus, global access to safe drinking water is still a matter of concern and needs to be given special priority in this regard. As any emergency situation is associated with major time and resource constraints, certain time-efficient and easily feasible measures must be taken to assess the effectiveness of interventions in drinking water in raising factors, i.e.
RESEARCH QUESTION & OBJECTIVES OF THE STUDY
Research Question of the Study
The following chapter of the thesis includes the research question addressed by this study along with the objectives of the study. Finally, the study discusses the main themes emerging from the study's findings and concludes with concluding remarks.
General Objective of the Study
Specific Objectives of the Study
METHODS
- Search Strategy Formulation
- Literature Searching and Paper Selection
- Data Extraction and Analysis
- Study Quality Assessment
Also, the reference lists of the primarily selected articles were searched to find more suitable journal articles that have relevant study titles. Thus, all the finally selected articles were imported into the reference manager, Mendeley, to produce a study library and some important facts (author name, facts, study title, etc.) were extracted from each of the selected articles. To ensure better organization of the papers, each paper has been assigned a unique paper ID for future convenience.
At this stage, according to the exclusion and inclusion criteria, relevant articles were selected based on the final selection. The global population receiving humanitarian assistance after being affected by any humanitarian crisis (ie refugees, internally displaced persons and forcibly displaced populations). At this stage of the study, each of the selected papers was carefully reviewed and an Excel database was prepared, where the following 18 pieces of information were entered for each of the 7 selected articles, .. a) Reference in the text (authors and year of publication) b) Country.
Each item on the checklist was given an equal score, and there were comparatively more sections for some segments of the research paper (i.e. After the review by the author, an overall quality score and rationale was given to the articles using the STROBE and CONSORT checklists Both the two checklists, together with the steps followed in the assessment of study quality, have been illustrated in APPENDIX B.
RESULTS
- Findings from Literature Searching
- Study Contexts of the Selected Articles
- Methodology of the Selected Articles
- Findings from the Selected Articles
- Quality Rating of the Selected Studies
Such results from the literature search indicate that none of the selected bibliographic databases was a very effective source for article searches for this specific topic in humanitarian emergency. Source databases used for the identification of each of the selected articles have been mentioned in Table 1. This table also includes some additional information (eg article title, authors, year of publication, journal name, etc.) to better understand different features of the selected articles .
Point-of-use water treatment and diarrhea reduction in emergencies: An effectiveness trial in Liberia. Evaluation of the sustained health impact of household chlorination of drinking water in rural (earthquake-prone) Haiti. The initial information for all seven selected articles is illustrated in Table 4 including the corresponding country name, type of population affected, type of crisis, type of drinking water intervention adopted, measure of intervention and health outcome assessed in the study.
The seven selected articles followed different study designs which are discussed in Table 5 with a focus on the process of outcome assessment, type of study design, sampling strategy and type of statistical analysis. Systematic sampling of 400 interviewed households and random sampling of 100 intervention households from the 400 interviewed households. Findings of the seven selected articles are detailed in Table 6 under categories such as – notable statistical findings, successes of the intervention, limitations of the interventions, identified confounding factors and summarized outcome.
Although providing a safe water storage bucket played a role in reducing diarrhea, it is not considered an intervention. Incidence: 90% reduction in incidence of diarrhea through intervention; 10 times higher incidence rate for control families than intervention.
ARTICLE SUMMARY & CRITICAL APPRAISAL
In addition, information was collected on the behavior and practices in the field of water abstraction, transport and storage behavior, both at the water abstraction point and at the household level. In addition, each of the interviewed households was visited twice a week to assess for any diarrhea (defined as 3 or more loose stools in a 24-hour period). This study was conducted with chlorination as a drinking water intervention in a non-epidemic situation of the camp with approximately 7,000 people.
Chlorination was carried out for 88% of the water containers used at the camp (13,224 containers) according to WHO guidelines. Also, since the intervention was applied at a population level, it is expected that the findings will be more reliable and adaptable to similar cases in other parts of the world. The study by Doocy & Burnham (2006) focused on the minimization of the water, sanitation and hygiene practices-communicable diseases (eg diarrhoea, cholera etc.) during acute emergency crisis, especially in a camp environment.
For the statistical analysis of the collected data, instead of the number of participants, the family level was taken into consideration. Findings: This study found the effectiveness of the adopted water treatment process in the selected emergency crisis context. Here, the adjusted hazard ratio for the control group in terms of diarrhea prevalence and intervention group incidence was 4.4 and 3.0, respectively.
Critical Appraisal: This study is well planned and organized with many small matters addressed at various stages of the study. This is because the poor quality and unavailability of water containers in the selected camps (as observed during the baseline survey) may contribute to the diarrheal episodes in the area, which is why improved water storage containers were provided to both the control and intervention groups to measure the exact contribution of the treatment . The authors also chose systematic sampling to cover a wider range of the area in the camp, which is useful for understanding a wider scenario.
Methodology: For this study, the authors selected eight study sites, 2 from each of the four aforementioned countries.
DISCUSSIONS
In order to measure the effects of the interventions, self-report was chosen as the most appropriate measure for all articles. In addition, the methodology and findings of the selected articles covered several aspects with a detailed description. The study plans of the selected articles were not at all the same, and the methodologies were contextualized as necessary.
Therefore, different types of sampling procedures and study types have been noted in the tables of the results section. The study quality of the chosen articles was assessed using the standardized CONSORT and STROBE checklist and the study quality for all chosen articles is below 80%. The authors of the selected articles could have gone through these checklists to improve their study quality.
However, the overall quality of the existing studies was not found to be very satisfactory when tested with the CONSORT and STROBE checklist. Furthermore, more sophisticated reduction of the effects of bias and confounding factors is also necessary for most of the selected articles. In addition, the following recommendations can be suggested based on the results of the study. one).
A study of the use and impacts of LifeStraw™ in a settlement camp in southern Gezira, Sudan. 8 Specify the methods used to decide whether a study met the review's inclusion criteria, including the number of reviewers who checked each record and each report received, whether they worked independently and, if applicable, details of the means of automation used in the process. 11 Specify the methods used to assess the risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of the tools of automation used in the process.
16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, preferably using a flowchart. 20d Present the results of all sensitivity analyzes performed to assess the robustness of the synthesized results. Cross-sectional study: Report on the number of events or a) Report the number of individuals at each stage of the study: e.g. number.
