Social and geographic inequalities in water, sanitation and hygiene access in 21 refugee camps and settlements in Bangladesh, Kenya, Uganda, South Sudan, and Zimbabwe

Menstrual hygiene management among girls and women refugees in Africa: a scoping review

BACKGROUND

Menstrual Hygiene Management (MHM) presents a significant public health challenge for refugee women and girls in Africa. Displaced populations often lack access to menstrual products, adequate Water, Sanitation, and Hygiene (WASH) infrastructure, as well as comprehensive menstrual health education.

AIM

This scoping review aimed to understand the state of MHM, identify key challenges, and evaluate existing interventions among refugee women and girls in Africa.

METHODS

Employing Levac et al.'s framework, the review analysed evidence from databases like CINAHL, Emcare, PubMed, Scopus, and Web of Science, focusing on studies published between 2014 and 2024. Sixteen articles met the inclusion criteria, and both numerical summaries and descriptive analyses were conducted.

RESULTS

Refugee women and girls often lack access to both disposable and reusable menstrual products, resorting to unhygienic alternatives such as clothing, leaves, and paper. Inadequate WASH facilities restrict safe and private spaces for menstrual management. Cultural stigma and taboos surrounding menstruation contribute to social exclusion and school absenteeism among girls. The interventions included distributing dignity kits, enhancing WASH infrastructure, and providing menstrual health education; however, they were inconsistently implemented due to resource limitations and cultural obstacles.

CONCLUSION

This study highlights the urgent need for sustainable menstrual health solutions in refugee settings. Without access to necessary products, WASH facilities, and stigma-free education, women and girls risk exclusion, health issues, and interrupted education. Addressing these barriers requires consistent, well-resourced interventions that integrate cultural sensitivity to ensure dignity and long-term impact.

Rodriguez-Morales A, Furqan Ilyas M, Santos Ferreira MDN, Singh Malik Y, Kalantari R, Shahrokhabadi A, Jafari N, Shahabinejad F, Maleki Y, Montajeb S, Mehrpouya R, Ahmadi H, Vazir B, Kabir F, Rehman A, Elmi Z, Hajipour P, El-Seedi HR, Eisenreich W, Shehata AA. Migratory Wave due to Conflicts: Risk of Increased Infection From Zoonotic Diseases

Wars have devastating effects on all the components of the One Health approach: humans, animals, and ecosystems. Wars and the resulting migratory waves massively disrupt normal animal health services and surveillance. Among other consequences, they adversely impact the early detection, prevention, and control of animal diseases. Uncontrolled movement of animals or their undisposed carcasses, the destruction of wildlife habitats, and the increased interface between humans, wildlife, and domestic animals contribute to uncontrolled transmission and spread of zoonotic pathogens from animals to humans. In the last millennium, zoonotic diseases such as the "Black Death" were triggered by devastating wars and led to the deaths of a large fraction of the human population. However, also recent and ongoing wars carry the risk of an uncontrollable increase in zoonotic diseases. The most significant zoonotic diseases reported during the recent wars are African swine fever, highly pathogenic avian influenza, rabies, leptospirosis, and brucellosis, as well as foodborne and waterborne zoonotic diseases. Indeed, alarming rates of infections by antimicrobial-resistant pathogens such as Mycobacterium tuberculosis go along with wars, as seen in the current Ukraine-Russia conflict. Considering human migration, foodborne and waterborne zoonotic diseases are key health threats for refugees due to the consumption of unsafe food, lack of safe water, and disruption of the water supply and sanitation system. This review summarizes the potential factors and some data associated with the increased risk of zoonotic disease emergence and transmission during recent and ongoing conflicts.

Resettlement needs of refugee women in the United States: An American Academy of Nursing consensus paper

When people must flee their homes due to persecution or conflict, they embark on a journey from loss toward safety that is a global concern and the resettlement country's responsibility. Refugees experience stressors as they secure basic needs such as adequate nutrition, healthcare, transportation, housing, education, and income-generating activities. For refugee women, these stressors are further exacerbated by gender-related roles and experiences. Addressing the unique healthcare needs of refugee women is vital to their well-being as they resettle into life in the United States. Access to care that is provided with cultural humility and fosters trust is critical. Policies are needed that expand health literacy programs and interpreting services, grow, diversify, and train the physical healthcare workforce, grow and diversify the mental healthcare workforce, expand Medicaid coverage in all 50 states, develop and fund peer-to-peer education programs for refugee women, finance access to care and programmatic services, and expand federal funding toward refugee health research.

Water, sanitation, and hygiene (WASH) practices in Africa: exploring the effects on public health and sustainable development plans

BACKGROUND

Suboptimal water, sanitation, and hygiene (WASH) practices constitute a serious public health risk, affecting one-third of the world's population. Remarkable progress has been made to improve WASH; however, challenges remain, with rapid population growth adding pressure on WASH systems. This study explores the current state of WASH practices and diseases in Africa, identifies challenges, and proposes public health recommendations for sustainable implementation.

MAIN BODY

The staggering burden of WASH-related diseases in low- and middle-income countries (LMICs), particularly in Africa, threatens public health, with millions of deaths and disability-adjusted life years (DALYs) attributed to poor WASH practices annually. Notable challenges plaguing WASH practices in the region include poverty, malnutrition, poor data reporting, illiteracy, climate change, and poor healthcare financing. This results in adverse health consequences, including waterborne infections like cholera, typhoid, dysentery, and diarrheal diseases. Additionally, neglected tropical diseases (NTDs) such as intestinal worms, schistosomiasis, trachoma, lost productivity, and environmental pollution from soil and underground water contamination have been implicated. Geographical disparities, cultural norms, and inadequate funding further complicate efforts to improve WASH infrastructure and practices. Globally concerted efforts are required to address these issues and permit WASH practices to protect human health by preventing infectious diseases and contributing to economic growth. Strong financial frameworks, skills training, and tools like WASH Fit are recommended for a stronger WASH approach in Africa.

CONCLUSION

The consequences of poor WASH extend beyond public health, impacting economic growth, gender equality, and environmental sustainability. WaterAid's policy recommendations prioritizing government administration, institutional capacity enhancement, and more financial resources are expedient.

Disparities in access to water, sanitation, and hygiene (WASH) services and the status of SDG-6 implementation across districts and states in India

Introduction

Access to affordable and improved Water, Sanitation, and Hygiene (WASH) facilities is essential for people's daily lives, and it is the primary goal of Sustainable Development Goal 6 (SDG-6). However, achieving this goal is a significant challenge for many countries, including India. The aim of this study is to assess the progress made towards achieving SDG-6 targets in Indian districts, states, and Union Territories (UTs) and to identify clusters by measuring spatial inequality of WASH coverage in India.

Aim and objective

The primary objective of this study is to measure the progress made towards achieving the SDG-6 targets for WASH facilities in Indian districts, states, and UTs. To fulfill this objective, the study used the household data of the National Family Health Survey-5 (NFHS-5) conducted from 2019 to 21.

Data and methods

The study used the household data of NFHS-5, which is a nationally representative survey that provides information on household and individual-level characteristics related to health and nutrition. The study identified the variables associated with WASH and created a composite index to measure WASH coverage separately and combined. The study used Gini coefficient to show WASH inequality, and Moran's statistics were used to show spatial dependency.

Result

The study found that the inequality of improved water coverage sources in Indian districts was high. Western and northeastern districts need to catch up in terms of achieving the SDG-6 targets. The value of the Gini coefficient (0.29) indicates that inequality in sanitation coverage is also high. All states have reached close to SDG-6 achievement in hygiene indicators. Goa, Sikkim, Andaman & Nicobar Islands, and Lakshadweep are close to the overall WASH coverage achievements of SDG-6. However, Jharkhand, Orissa, Tripura, Assam, and Rajasthan are behind in meeting the goal of SDG-6.

Conclusion

The study suggests that more government initiatives and investments are needed to increase the availability, accessibility, and affordability of WASH facilities to improve WASH conditions in western and northeastern Indian districts. The localization or bottom-up approach by giving responsibility to rural and urban local bodies can also help enforce the achievement of SDG-6. The findings of this study can be used to guide policymakers in developing targeted interventions to improve WASH conditions and reduce inequality in India.

Child feces disposal practices in humanitarian and non-humanitarian settings across 34 low- and middle-income countries

Globally, safe sanitation has improved significantly in the last two decades, but unsafe child feces disposal remains a growing challenge in many regions, exposing household members and communities to infectious pathogens. The drivers associated with child feces disposal in several contexts including humanitarian settings are not well understood. This study investigated child feces disposal (CFD) practices and associated factors in low- and middle-income countries, including in humanitarian settings. Data from 352,173 women in 34 countries, collected between 2012 and 2021 through Demographic and Health Surveys (DHS), were used. We utilized multivariate logistic regression to assess CFD practices among children under two years old and the factors linked to these practices. We incorporated data from the United Nations High Commissioner for Refugees (UNHCR) regarding refugee camps' locations in the analysis. Time series and local spatial autocorrelation analyses were run to examine changes in safe CFD practices over time and space, respectively. Results showed minimal improvement in safe child feces disposal over the past decade, with 55.6 % of respondents in non-humanitarian settings and 38.1 % in humanitarian settings improperly disposing of feces. Improper CFD significantly correlated with increased odds of diarrhea in non-humanitarian settings (OR 1.09 95 % CI: 1.05-1.13) but not in humanitarian settings (OR 1.14 95 % CI: 0.53-2.49). The most significant factors (p < 0.05) associated with safe CFD included being in the richest wealth quintile (OR 3.27 95 % CI: 3.06-3.49), having basic education (OR 1.28 95 % CI: 1.22-1.33), children eating solid food (OR 1.53 95 % CI: 1.48-1.57), improved sanitation access (OR 1.88 95 % CI: 1.81-1.96), and listening to radio at least weekly (OR 1.40 95 % CI: 135-1.46). Policymakers and development partners must include safe CFD guidelines in national policies and programs, as well as prioritize investments in household-level sanitation and educate caregivers about safe CFD practices.

Exposure behaviour to Escherichia coli among households in Imvepi refugee settlement, Terego district Uganda

INTRODUCTION

Exposure to Escherichia coli (E. coli) is a risk factor for diarrhoeal diseases, which pose a significant problem in refugee settlements. Refugee populations are exposed to faecal microorganisms through multiple pathways including sub-optimal sanitary facilities, contaminated drinking water, produce and food, flood water, bathing water, and soil among others. While these pathways are well-documented, specific exposure behaviours remain underexplored. We assessed exposure behaviour to E. coli among households in Imvepi refugee settlement, Uganda, and provided evidence-based recommendations for the design of interventions to reduce excreta-related disease in refugee settlements.

METHODS

Guided by the Sanitation Safety Planning approach, we surveyed 426 households in Imvepi refugee settlement, Uganda, using a digitized questionnaire and an observation checklist. We collected data on the background characteristics and exposure behaviour of women and emancipated girls (minors living on their own, having borne a child, married, or pregnant). The outcome variable, E. coli exposure behaviour, was measured using a five-point Likert scale, assessing behaviours that increase the risk of exposure. Data were cleaned in Microsoft Excel and analyzed in Stata version 17. Descriptive statistics were performed to summarize the data. We used modified Poisson regression to determine the factors associated with the outcome.

RESULTS

Over 59.4% (253) exhibited high-risk exposure behaviour. Residing in compound homes (Adjusted Prevalence Ratio (APR) = 0.72, 95% Confidence interval (CI): 0.58-0.90), being aged 35-49 years (APR = 0.76, 95% CI: 0.60-0.97), having household heads with post-primary education (APR = 0.54, 95% CI: 0.38-0.77), high knowledge (APR = 0.69, 95% CI: 0.59-0.80), and high-risk perceptions regarding exposure to E. coli (APR = 0.75, 95% CI: 0.64-0.88) were associated with a lower prevalence of high-risk E. coli exposure behaviours. Conversely, having sanitary facilities with excreta overflowing from the squat hole (APR = 1.26, 95% CI: 1.08-1.48) was associated with a higher prevalence of high-risk exposure behaviours.

CONCLUSION

The study indicates a substantial prevalence of high-risk E. coli exposure behaviours in the refugee settlement.. There's a need to implement behaviour change interventions targeted at preventing or minimizing exposure, especially among households whose heads have low education attainment, those with young caretakers and those with limited knowledge and low-risk perceptions regarding exposure to E. coli.

Lot quality assurance sampling survey for water, sanitation and hygiene monitoring and evidence-based advocacy in Bentiu IDP camp, South Sudan

BACKGROUND

Every year, 60% of deaths from diarrhoeal disease occur in low and middle-income countries due to inadequate water, sanitation, and hygiene. In these countries, diarrhoeal diseases are the second leading cause of death in children under five, excluding neonatal deaths. The approximately 100,000 people residing in the Bentiu Internally Displaced Population (IDP) camp in South Sudan have previously experienced water, sanitation, and hygiene outbreaks, including an ongoing Hepatitis E outbreak in 2021. This study aimed to assess the gaps in Water, Sanitation, and Hygiene (WASH), prioritise areas for intervention, and advocate for the improvement of WASH services based on the findings.

METHODS

A cross-sectional lot quality assurance sampling (LQAS) survey was conducted in ninety-five households to collect data on water, sanitation, and hygiene (WASH) coverage performance across five sectors. Nineteen households were allocated to each sector, referred to as supervision areas in LQAS surveys. Probability proportional to size sampling was used to determine the number of households to sample in each sector block selected using a geographic positioning system. One adult respondent, familiar with the household, was chosen to answer WASH-related questions, and one child under the age of five was selected through a lottery method to assess the prevalence of WASH-related disease morbidities in the previous two weeks. The data were collected using the KoBoCollect mobile application. Data analysis was conducted using R statistical software and a generic LQAS Excel analyser. Crude values, weighted averages, and 95% confidence intervals were calculated for each indicator. Target coverage benchmarks set by program managers and WASH guidelines were used to classify the performance of each indicator.

RESULTS

The LQAS survey revealed that five out of 13 clean water supply indicators, eight out of 10 hygiene and sanitation indicators, and two out of four health indicators did not meet the target coverage. Regarding the clean water supply indicators, 68.9% (95% CI 60.8%-77.1%) of households reported having water available six days a week, while 37% (95% CI 27%-46%) had water containers in adequate condition. For the hygiene and sanitation indicators, 17.9% (95% CI 10.9%-24.8%) of households had handwashing points in their living area, 66.8% (95% CI 49%-84.6%) had their own jug for cleansing after defaecation, and 26.4% (95% CI 17.4%-35.3%) of households had one piece of soap. More than 40% of households wash dead bodies at funerals and wash their hands in a shared bowl. Households with sanitary facilities at an acceptable level were 22.8% (95% CI 15.6%-30.1%), while 13.2% (95% CI 6.6%-19.9%) of households had functioning handwashing points at the latrines. Over the previous two weeks, 57.9% (95% CI 49.6-69.7%) of households reported no diarrhoea, and 71.3% (95% CI 62.1%-80.6%) reported no eye infections among children under five.

CONCLUSION

The camp's hygiene and sanitation situation necessitated immediate intervention to halt the hepatitis E outbreak and prevent further WASH-related outbreaks and health issues. The LQAS findings were employed to advocate for interventions addressing the WASH gaps, resulting in WASH and health actors stepping in.

Human biology and the study of precarity: How the intersection of uncertainty and inequality is taking us to new extremes

Inequality represents an extreme environment to which humans must respond. One phenomenon that contributes to this growing extreme is precarity or the intersection of uncertainty and some form of inequality. While precarity has an important intellectual history in the fields of sociology and sociocultural anthropology, it has not been well studied in the field of human biology. Rather human biologists have engaged with the study of closely related concepts such as uncertainty and resource insecurity. In this article, we propose that human biology take on the study of precarity as a novel way of investigating inequality. We first provide a brief intellectual history of precarity which is followed by a review of research on uncertainty and resource security in human biology which, while not exhaustive, illustrates some key gaps that precarity may aid us in addressing. We then review some of the pathways through which precarity comes to affect human biology and health and some of the evidence for why the unpredictable nature of precarity may make it a unique physiological stress. A case study based on research in Nuñoa, Peru provides an important example of how precarity can elucidate the influences of health in an extreme setting, albeit with insights that apply more broadly. We conclude that precarity holds important potential for the study of human biology, including helping us more effectively operationalize and study uncertainty, encouraging us to explore the predictability of resources and stressors, and reminding us to think about the intersectional nature of stressors.

Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions

INTRODUCTION

Armed conflicts have a severe impact on the health of women and children. Global health emergencies such as pandemics and disease outbreaks further exacerbate the challenges faced by vulnerable populations in accessing maternal, neonatal, and child healthcare (MNCH). There is a lack of evidence that summarizes the challenges faced by conflict-affected pregnant women, mothers, and children in accessing MNCH services during global health emergencies, mainly the Ebola and COVID-19 pandemics. This scoping review aimed to analyze studies evaluating and addressing barriers to accessing comprehensive MNCH services during Ebola and COVID-19 emergencies in populations affected by conflict.

METHODS

The search was conducted on PubMed, Scopus, and Web of Science databases using terms related to Ebola and COVID-19, conflicts, and MNCH. Original studies published between 1990 and 2022 were retrieved. Articles addressing the challenges in accessing MNCH-related services during pandemics in conflict-affected settings were included. Thematic analysis was performed to categorize the findings and identify barriers and solutions.

RESULTS

Twenty-nine studies met the inclusion criteria. Challenges were identified in various MNCH domains, including antenatal care, intrapartum care, postnatal care, vaccination, family planning, and the management of childhood illnesses. Ebola-related supply-side challenges mainly concerned accessibility issues, health workforce constraints, and the adoption of stringent protocols. COVID-19 has resulted in barriers related to access to care, challenges pertaining to the health workforce, and new service adoption. On the demand-side, Ebola- and COVID-19-related risks and apprehensions were the leading barriers in accessing MNCH care. Community constraints on utilizing services during Ebola were caused by a lack of trust and awareness. Demand-side challenges of COVID-19 included fear of disease, language barriers, and communication difficulties. Strategies such as partnerships, strengthening of health systems, service innovation, and community-based initiatives have been employed to overcome these barriers.

CONCLUSION

Global health emergencies amplify the barriers to accessing MNCH services faced by conflict-affected populations. Cultural, linguistic, and supply-side factors are key challenges affecting various MNCH domains. Community-sensitive initiatives enhancing primary health care (PHC), mobile clinics, or outreach programs, and the integration of MNCH into PHC delivery should be implemented. Efforts should prioritize the well-being and empowerment of vulnerable populations. Addressing these barriers is crucial for achieving universal health coverage and the Sustainable Development Goals.

Water, sanitation, and hygiene global research: evolution, trends, and knowledge structure

Water, sanitation, and hygiene (WASH) services play a crucial role in promoting public and environmental health as well as social and economic development. At the global level, particularly in the developing world, WASH issues continue to present significant challenges. These challenges have been further intensified by factors such as the COVID-19 pandemic, escalating conflicts, climate change, water scarcity, and rising inequality. The scientific community has actively engaged in constructive discussions on these issues, as evidenced by the notable research findings. Therefore, the aim of this study was to comprehensively examine and evaluate global knowledge on WASH. To search for relevant publications, the Scopus database was utilized using specific terms associated with WASH. VOSviewer 1.6.18 software was employed to generate network visualization maps, which assessed collaborative patterns and research trends in the field of WASH. The research output of countries was adjusted considering their gross domestic product (GDP) and population size. The total number of WASH-related publications, including all types of documents, was 1805. By narrowing the search to articles and reviews, the overall global productivity yielded 1589 documents: 1367 (86.0%) original articles and 222 (14.0%) review articles. The USA had the highest number of WASH publications (n = 668; 42.0%), followed by the UK (n = 396; 24.9%), Switzerland (n = 151; 9.5%), and Australia (n = 141; 8.9%). Ethiopia emerged as the leading country in terms of GDP per capita and the number of publications, followed by Uganda, Malawi, India, and Bangladesh. The USA, the UK, and Switzerland exhibited the most extensive collaboration among countries. The main research areas encompassed the role of WASH in sustainable development, the impacts of inadequate access to WASH services on gender equality, children, infants, and the outbreak of COVID-19 and other diseases, as well as the significance of hygiene practices and community and school-based WASH interventions in reducing infections. This study provides a novel analysis of global WASH-related research and highlights the distribution of outcomes across nations. Continued and increased collaboration between developed and developing nations will facilitate the sharing of responsibility for WASH research outcomes and the implementation of effective policies.

Migrants' living conditions, perceived health needs and implications for the use of antibiotics and antimicrobial resistance in the United Kingdom: A qualitative study

Background and Aims

Antimicrobial resistance (AMR) is among the top public health concerns around the globe. Migrants, especially forced migrants, could be at higher risk of acquiring and transmitting AMR during their journeys or in host countries. There is limited understanding regarding migrants' living conditions and the wider factors contributing to their risk of acquiring infections, and behaviors around antimicrobial use, and AMR development. In this study, we aimed to explore transit experiences, living conditions, and antibiotic use of migrants living in the United Kingdom.

Methods

We conducted semistructured qualitative interviews with 27 participants and identified five themes regarding migrants' journey and their living conditions during transit and after arriving in the United Kingdom, their access to water, sanitation and hygiene (WASH), and their use of antibiotics.

Results

Migrants, particularly forced migrants, experienced unfavorable living conditions, poor access to WASH, and challenges in accessing healthcare, which further contributed to health conditions like urinary and skin problems. Isolation and difficulty in accessing healthcare played significant roles in migrants' perceived need for storing and using antibiotics as a safety net.

Conclusion

The findings highlight the need for coordinated and multilevel interventions to address these challenges and contribute toward tackling AMR and improving the health of this population group.

Handwashing among caregivers of young children in a protracted and complex refugee and immigration context: a mixed methods study on the Thai-Myanmar border

Introduction

Protracted refugee situations create complex contexts that present significant health risks for young children. Effective hand hygiene practices by caregivers can reduce respiratory infections and diarrhoeal disease, the two largest contributors to mortality among children between 1 month and 5 years of age. This study documented handwashing patterns and access to water, sanitation and hygiene (WASH) infrastructure among caregivers of young children living along the Thai-Myanmar border, one of the world's most protracted and complex refugee and immigration contexts. It also examined the association between handwashing and socio-demographic variables and captured participants' explanations for when and how hands are washed. The study broadened the scope of previous research by also including the large number of caregivers living outside formal camps.

Methods

Caregivers of children attending 11 preschools in Tak province, Thailand participated in a mixed-methods cross-sectional study. Quantitative questionnaire data (n = 384) were supplemented by a thematic analysis of data from in-depth interviews (n = 9).

Results

Fewer than half the caregivers reported routinely washing their hands before preparing meals or after using the latrine/toilet. Fewer than one-in-five routinely used soap in these situations. Interviewees explained that handwashing was only necessary when a substance could be felt or seen, in which case wiping with a cloth or a rinsing with water were sufficient to clean hands. However, their explanations also suggested some potential avenues for culturally appropriate and feasible interventions to improve hand hygiene.

Conclusion

The results confirmed previous research on the multi-dimensional barriers to good hand hygiene in protracted refugee situations and other low-resource settings. Additional investment to overcome shortages in the infrastructure necessary to support good hand hygiene and creative means of drawing on and developing human capital will be necessary to realize the potential hand hygiene holds for reducing ill-health and mortality among young children living in these contexts.

A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries

Background

Poor menstrual hygiene management (MHM) is linked to adverse health, and quality of life, particularly during emergencies. Although in recent times increased emphasis is being laid upon MHM during humanitarian crises-pandemics, disasters and conflicts, the essential components of complete MHM during an emergency are not clearly spelt out. We conducted a systematic review to examine, analyse and describe the existing evidence related to the challenges experienced by women and girls in practicing MHM during humanitarian crises and / or public health emergencies.

Methods

We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and registered in PROSPERO (CRD42022328636). We searched online repositories: PubMed, Embase, and PsycINFO for articles published between January 2000 and April 2022. For presenting key findings, we used the descriptive statistics and thematic analysis approach.

Results

We identified a total of 1,078 published articles, out of which 78 were selected for a full-text review, and finally 21 articles were included. The pooled prevalence of lack of access to sanitary pads during humanitarian crises was 34 percent (95 percent CI 0.24-0.45). The prevalence of safe and proper sanitary pad disposal practices ranged from 11 to 85 per cent, with a pooled prevalence of 54 per cent (95 per cent CI 0.21-86). Qualitative analyses projected three themes that emerged on MHM during humanitarian crises (1) Availability and affordability of menstrual products, and accessibility to water, sanitation and health (WASH) services, (2) Availability of support system and coping with "period poverty," and (3) Gender dimensions of menstrual hygiene management. Most studies reported non-availability of MHM products and WASH services during emergencies. Existence of barriers at systemic and personal level posed challenges in practicing menstrual hygiene. Privacy was identified as a common barrier, as emergency shelters were reportedly not women-friendly.

Conclusion

Availability of limited evidence on the subject is suggestive of the need to invest resources for strengthening primary research in low- and middle-income countries and more specifically during emergencies. Context-specific state level policies on MHM during emergencies would help to guide district and sub-district managers in strengthening systems and address barriers for the provision of MHM services during emergencies.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022328636, identifier CRD42022328636.