Water, Sanitation and Hygiene in Ebola Preparedness and Response in South Sudan, Uganda and the Democratic Republic of the Congo: A Scoping Review
Abstract
Water, sanitation and hygiene (WASH) services are fundamental to infection prevention and control during Ebola virus disease outbreaks. However, their contribution to outbreak preparedness and response remains insufficiently synthesised, particularly in fragile and outbreak-prone settings. This scoping review examined the importance of WASH in Ebola preparedness and response in Uganda, the Democratic Republic of the Congo (DRC) and South Sudan. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Literature published between 2014 and 2026 was searched through PubMed, African Index Medicus, Google Scholar, African Journals Online (AJOL) and the World Health Organization Institutional Repository for Information Sharing (IRIS). Peer-reviewed and grey-literature sources addressing WASH, infection prevention and control, preparedness or response to Ebola in the three countries were considered. The evidence was charted and synthesised thematically. The searches displayed 1,963 results, of which 861 were captured for title, abstract, summary, or full-text screening. After eligibility assessment and cross-platform deduplication, 41 unique sources were included. Six themes emerged: WASH infrastructure and service readiness; infection prevention and control preparedness; healthcare-worker preparedness; community engagement and risk communication; cross-border surveillance and institutional coordination; and institutional, financial and logistical constraints. Reliable water supplies, sanitation facilities, handwashing stations, environmental cleaning and waste-management systems supported effective infection-control practices. Nevertheless, preparedness was weakened by inadequate infrastructure, insufficient protective supplies, limited practical training, weak maintenance systems and dependence on temporary external assistance. Evidence from Uganda documented established surveillance and rapid-response arrangements alongside persistent facility-level weaknesses, while evidence from the DRC reflected extensive outbreak experience but continuing gaps in healthcare preparedness. Evidence from South Sudan identified substantial infrastructural and humanitarian constraints. However, the uneven geographical and methodological distribution of the evidence precluded direct comparison or ranking of preparedness across the three countries. Sustainable Ebola preparedness requires WASH infrastructure, practical healthcare-worker training, community participation and cross-border coordination to be incorporated into routine health-system planning and financing. Further comparative and country-specific research is required to measure the independent contribution and long-term functionality of WASH interventions.
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