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A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice.

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OBJECTIVES: To appraise the quality of guidelines developed by the International Federation of Red Cross and Red Crescent Societies (IFRC) between 2001 and 2015. STUDY DESIGN: Cross-sectional. METHODS: 2 authors independently assessed the quality of IFRC guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Average domain scores were calculated and overall quality scores and recommendation for use were determined. RESULTS: Out of 77 identified guidelines, 27 met the inclusion criteria and were assessed. The domains with the highest average scores across guidelines were 'scope and purpose', 'clarity of presentation' and 'applicability'. The lowest scoring domains were 'rigour of development' and 'editorial independence'. No guideline can be 'recommended for immediate use', 23 guidelines are 'recommended with modifications' and 4 guidelines are 'not recommended'. CONCLUSIONS: The IFRC produces guidelines that should be adhered to by millions of staff and volunteers in 190 countries. These guidelines should therefore be of high quality. Up until now, the IFRC had no uniform guideline development process. The results of the AGREE II appraisal indicate that the quality of the guidelines needs to be improved.

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First aid (FA) services are provisioned on-site as a preventive measure at most public events. In Flanders, Belgium, the Belgian Red Cross-Flanders (BRCF) is the major provider of these FA services with volunteers being deployed at approximately 10,000 public events annually. The BRCF has systematically registered information on the patients being treated in FA posts at major events and mass gatherings during the last 10 years. This information has been collected in a web-based client server system called "MedTRIS" (Medical Triage and Registration Informatics System). MedTRIS contains data on more than 200,000 patients at 335 mass events. This report describes the MedTRIS architecture, the data collected, and how the system operates in the field. This database consolidates different types of information with regards to FA interventions in a standardized way for a variety of public events. MedTRIS allows close monitoring in "real time" of the situation at mass gatherings and immediate intervention, when necessary; allows more accurate prediction of resources needed; allows to validate conceptual and predictive models for medical resources at (mass) public events; and can contribute to the definition of a standardized minimum data set (MDS) for mass-gathering health research and evaluation. Gogaert S , Vande veegaete A , Scholliers A , Vandekerckhove P . "MedTRIS" (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562.

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BACKGROUND: In order to improve the effectiveness and efficiency of humanitarian efforts, minimum standards for humanitarian assistance and key indicators, showing whether a standard has been attained, have been developed. However, many of these standards and indicators are based on a consensus on best practices and experiences in humanitarian response, because relevant evidence on the impact of humanitarian interventions is often lacking. OBJECTIVES: One important example of a standard in humanitarian aid in a disaster setting is "water quantity." The accompanying indicator states how many litres of water are needed per person per day in a disaster setting. It was our objective to determine the evidence base behind this indicator, in order to improve health outcomes such as morbidity (e.g., diarrhoea) and mortality. METHODS: A systematic review was performed searching The Cochrane Library, Medline and Embase. We included studies performed during disasters and in refugee camps that reported a specific water amount and health-related outcomes related to water shortages, including diarrhoea, cholera, and mortality. We used GRADE to determine the quality of evidence. RESULTS: Out of 3,630 articles, 111 references relevant to our question were selected. Based on our selection criteria, we finally retained 6 observational studies, including 1 study that was performed during the disaster and 5 studies in a post-disaster phase. From two studies there is conclusive evidence on the relationship between the amount of water received and diarrhoea or mortality rates in refugee camps. However, overall, these studies do not contain enough data with relevance to a specific amount of water, and the level of evidence is very low. CONCLUSIONS: More primary research on water amounts in a disaster setting is necessary, so that the humanitarian sector can further professionalise its water-related standards, indicators and interventions.

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