Strategies to promote uptake and sustainability of Water, Sanitation and Hygiene (WASH) interventions in basic education institutions in conflict settings: a scoping review of the Horn of Africa.

Introduction: Water, sanitation and hygiene (WASH) interventions have been associated with positive outcomes among school-going children. With the protracted water and conflict crises in the Horn of Africa, multiple interventions have been implemented to ensure adequate WASH facilities in basic education institutions. However, research mapping out this evidence is lacking. This scoping review aimed to map out the enablers, barriers and lessons learnt from implementing interventions promoting sustainable WASH in basic education institutions in conflict-affected contexts of the Horn of Africa. Methods: We searched PubMed African Index Medicus, Cochrane Library and Google Scholar from 2015 to 2024. Two independent reviewers conducted screening and data extraction in duplicate. Results were presented descriptively. Results: Our search yielded 3003 articles. This review included eight studies all on mixed-sex students in Ethiopian primary schools between 2015 and 2024. Seven studies were quasi-experimental. Most reported enablers, whereas only one reported sustainability. None reported lessons learnt. Half of the studies reported health outcomes, such as diarrhoea, and only one reported school attendance outcomes. Five studies employed WASH education interventions, such as WASH curricula development in two studies. Three studies reported improved WASH facilities, such as toilets. Six studies reported enablers such as a prior needs assessment and including both sexes in menstrual hygiene. Three studies reported barriers such as poor WASH support facilities (latrines and handwashing) for menstrual hygiene. One study reported training government officials, health champions and school administrators as a method of ensuring sustainability. Conclusions: Published research on this topic is limited in the Horn of Africa, calling for further research. Institutionalising WASH curricula in schools could positively affect students' outcomes. Successful WASH interventions call for prior needs assessments, incorporating both sexes and improving support facilities for menstrual hygiene interventions and training diverse stakeholders in the education system to ensure sustainability.