Temporal analysis of water, sanitation, and hygiene data from knowledge, attitudes, and practices surveys in the protracted humanitarian crisis in Myanmar

Knowledge, attitudes, and practices (KAP) surveys are commonly conducted by humanitarian actors at project baseline and endline. We hypothesized summarized KAP data could inform water, sanitation, and hygiene (WASH) programming and strategies. In conflict-affected Myanmar, the WASH Cluster collated KAP documents from 2011 to 2016. After developing a methodology for KAP temporal analysis, we reviewed provided documents against inclusion criteria; extracted and categorized data; created a WASH activities and emergency events timeline; completed temporal analysis; and triangulated and summarized results. Sixteen documents met inclusion criteria assessing WASH data at the national level (19%), in Rakhine (56%) or Kachin State (25%). Twenty-five WASH metrics were extracted and categorized. We found WASH knowledge and attitudes (e.g. handwashing knowledge) increased over time; practices (e.g. handwashing) also increased, but at a lower rate and less consistently; and increases were related to WASH programming. Using this methodology, we identified gaps (safe water storage, risk of children's feces, focus on vulnerable populations), barriers (cultural and religious beliefs), and programmatic recommendations (continue hygiene promotion, focusing on closing gaps, and improve waste collection systems) in Myanmar. Additionally, to enable temporal analysis and improve WASH programming, we recommend WASH Clusters standardize KAP data collection tools and analysis in the future.