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In this Personal View, we explain the ways that climatic risks affect the transmission, perception, response, and lived experience of COVID-19. First, temperature, wind, and humidity influence the transmission of COVID-19 in ways not fully understood, although non-climatic factors appear more important than climatic factors in explaining disease transmission. Second, climatic extremes coinciding with COVID-19 have affected disease exposure, increased susceptibility of people to COVID-19, compromised emergency responses, and reduced health system resilience to multiple stresses. Third, long-term climate change and prepandemic vulnerabilities have increased COVID-19 risk for some populations (eg, marginalised communities). The ways climate and COVID-19 interact vary considerably between and within populations and regions, and are affected by dynamic and complex interactions with underlying socioeconomic, political, demographic, and cultural conditions. These conditions can lead to vulnerability, resilience, transformation, or collapse of health systems, communities, and livelihoods throughout varying timescales. It is important that COVID-19 response and recovery measures consider climatic risks, particularly in locations that are susceptible to climate extremes, through integrated planning that includes public health, disaster preparedness, emergency management, sustainable development, and humanitarian response.

Context: It is now widely accepted that the climate is changing, and that societal response will need to be rapid and comprehensive to prevent the most severe impacts. A key milestone in global climate governance is to assess progress on adaptation. To-date, however, there has been negligible robust, systematic synthesis of progress on adaptation or adaptation-relevant responses globally. Aim: The purpose of this review protocol is to outline the methods used by the Global Adaptation Mapping Initiative (GAMI) to systematically review human adaptation responses to climate-related changes that have been documented globally since 2013 in the scientific literature. The broad question underpinning this review is: Are we adapting to climate change? More specifically, we ask ‘what is the evidence relating to human adaptation-related responses that can (or are) directly reducing risk, exposure, and/or vulnerability to climate change?’ Methods: We review scientific literature 2013-2019 to identify documents empirically reporting on observed adaptation-related responses to climate change in human systems that can directly reduce risk. We exclude non-empirical (theoretical & conceptual) literature and adaptation in natural systems that occurs without human intervention. Included documents were coded across a set of questions focused on: Who is responding? What responses are documented? What is the extent of the adaptation-related response? What is the evidence that adaptation-related responses reduce risk, exposure and/or vulnerability? Once articles are coded, we conduct a quality appraisal of the coding and develop ‘evidence packages’ for regions and sectors. We supplement this systematic mapping with an expert elicitation exercise, undertaken to assess bias and validity of insights from included/coded literature vis a vis perceptions of real-world adaptation for global regions and sectors, with associated confidence assessments. Related protocols: This protocol represents Part 3 of a 5-part series outlining the phases of this initiative. Part 3 outlines the methods used to extract data on adaptation from documents (coding), as well as procedures for data quality assurance. See Figure 1.

Context: It is now widely accepted that the climate is changing, and that societal response will need to be rapid and comprehensive to prevent the most severe impacts. A key milestone in global climate governance is to assess progress on adaptation. To-date, however, there has been negligible robust, systematic synthesis of progress on adaptation or adaptation-relevant responses globally. Aim: The purpose of this review protocol is to outline the methods used by the Global Adaptation Mapping Initiative (GAMI) to systematically review human adaptation responses to climate-related changes that have been documented globally since 2013 in the scientific literature. The broad question underpinning this review is: Are we adapting to climate change? More specifically, we ask ‘what is the evidence relating to human adaptation-related responses that can (or are) directly reducing risk, exposure, and/or vulnerability to climate change?’ Methods: We review scientific literature 2013-2019 to identify documents empirically reporting on observed adaptation-related responses to climate change in human systems that can directly reduce risk. We exclude non-empirical (theoretical & conceptual) literature and adaptation in natural systems that occurs without human intervention. Included documents were coded across a set of questions focused on: Who is responding? What responses are documented? What is the extent of the adaptation-related response? What is the evidence that adaptation-related responses reduce risk, exposure and/or vulnerability? Once articles are coded, we conduct a quality appraisal of the coding and develop ‘evidence packages’ for regions and sectors. We supplement this systematic mapping with an expert elicitation exercise, undertaken to assess bias and validity of insights from included/coded literature vis a vis perceptions of real-world adaptation for global regions and sectors, with associated confidence assessments. Related protocols: This protocol represents Part 2 of a 5-part series outlining the phases of methods for this initiative. Part 2 outlines the methods used to conduct keyword searches and implement machine-assisted screening of documents based on inclusion and exclusion criteria. See Figures 1 and 2.

We present the first systematic, global stocktake of the academic literature on human adaptation. We screen 48,316 documents and identify 1,682 articles that present empirical research documenting human efforts to reduce risk from climate change and associated hazards. Coding and synthesizing this literature highlights that the overall extent of adaptation across global regions and sectors is low. Adaptations are largely local and incremental rather than transformative. Behavioural adjustments by individuals and households are more prevalent than any other type of response, largely motivated by drought and precipitation variability. Local governments and civil society are engaging in risk reduction across all sectors and regions, particularly in response to flooding. Urban technological and infrastructural adaptations to flood risk are prevalent in Europe, while shifts in farming practices dominate reporting from Africa and Asia. Despite increasing evidence of adaptation responses, evidence that these responses are reducing risks (observed and projected) remains limited.

Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses. Determining progress in adaptation to climate change is challenging, yet critical as climate change impacts increase. A stocktake of the scientific literature on implemented adaptation now shows that adaptation is mostly fragmented and incremental, with evidence lacking for its impact on reducing risk.

BackgroundThe effects of food insecurity linked to climate change will be exacerbated in subsistence communities that are dependent upon food systems for their livelihoods and sustenance. Place-and community-based forms of surveillance are important for growing an equitable evidence base that integrates climate, food, and health information as well as informs our understanding of how climate change impacts health through local and Indigenous subsistence food systems.MethodsWe present a case-study from southwestern Uganda with Batwa and Bakiga subsistence communities in Kanungu District. We conducted 22 key informant interviews to map what forms of monitoring and knowledge exist about health and subsistence food systems as they relate to seasonal variability. A participatory mapping exercise accompanied key informant interviews to identify who holds knowledge about health and subsistence food systems. Social network theory and analysis methods were used to explore how information flows between knowledge holders as well as the power and agency that is involved in knowledge production and exchange processes.ResultsThis research maps existing networks of trusted relationships that are already used for integrating diverse knowledges, information, and administrative action. Narratives reveal inventories of ongoing and repeated cycles of observations, interpretations, evaluations, and adjustments that make up existing health and subsistence food monitoring and response. These networks of local health and subsistence food systems were not supported by distinct systems of climate and meteorological information. Our findings demonstrate how integrating surveillance systems is not just aboutwhattypes of information we monitor, but alsowhoandhowknowledges are connected through existing networks of monitoring and response.ConclusionApplying conventional approaches to surveillance, without deliberate consideration of the broader contextual and relational processes, can lead to the re-marginalization of peoples and the reproduction of inequalities in power between groups of people. We anticipate that our findings can be used to inform the initiation of a place-based integrated climate-food-health surveillance system in Kanungu District as well as other contexts with a rich diversity of knowledges and existing forms of monitoring and response.

In April–May of 2013, Sampang Regency (Madura Island), experienced extreme seasonal rains, and subsequent flooding, followed by dramatic peaks in reported leptospirosis. Local public health surveillance efforts responded to these events and an investigative regional report was launched by the Centre for Environmental Health Engineering and Disease Control, Sampang Regional Health Office. In light of this outbreak and targeted investigation, this study sought to combine existing surveillance data with descriptive household data to investigate leptospirosis incidence and its associated socio-environmental exposures in Sampang and two neighbouring regencies of Gresik and Surabaya in East Java, Indonesia. Leptospirosis has a complex and variable disease epidemiology. In order to identify environmental and social risk determinants of cases of leptospirosis, a total of 275 household questionnaires were administered across nine targeted sample sites in the regencies of Gresik, Sampang, and Surabaya, East Java, Indonesia. Univariate analysis and binomial logistic regression were used to analyze associations of independent predictor variables with suspected and probable case reporting.

Understanding how climate change will affect global health is a defining challenge of this century. This is predicated, however, on our ability to combine climate and health data to investigate the ways in which variations in climate, weather, and health outcomes interact. There is growing evidence to support the value of place- and community-based monitoring and surveillance efforts, which can contribute to improving both the quality and equity of data collection needed to investigate and understand the impacts of climate change on health. The inclusion of multiple and diverse knowledge systems in climate-health surveillance presents many benefits, as well as challenges. We conducted a systematic review, synthesis, and confidence assessment of the published literature on integrated monitoring and surveillance systems for climate change and public health. We examined the inclusion of diverse knowledge systems in climate-health literature, focusing on: (1) analytical framing of integrated monitoring and surveillance system processes; (2) key contributions of Indigenous knowledge and local knowledge systems to integrated monitoring and surveillance systems processes; and (3) patterns of inclusion within these processes. In total, 24 studies met the inclusion criteria and were included for data extraction, appraisal, and analysis. Our findings indicate that the inclusion of diverse knowledge systems contributes to integrated climate-health monitoring and surveillance systems across multiple processes of detection, attribution, and action. These contributions include: the definition of meaningful problems; the collection of more responsive data; the reduction of selection and source biases; the processing and interpretation of more comprehensive datasets; the reduction of scale dependent biases; the development of multi-scale policy; long-term future planning; immediate decision making and prioritization of key issues; as well as creating effective knowledge-information-action pathways. The value of our findings and this review is to demonstrate how neither scientific, Indigenous, nor local knowledge systems alone will be able to contribute the breadth and depth of information necessary to detect, attribute, and inform action along pathways of climate-health impact. Rather, it is the divergence or discordance between the methodologies and evidences of different knowledge systems that can contribute uniquely to this understanding. We critically discuss the possibility of what we, mainly local communities and experts, stand to lose if these processes of inclusion are not equitable. We explore how to shift the existing patterns of inclusion into balance by ensuring the equity of contributions and justice of inclusion in these integrated monitoring and surveillance system processes.

Impoverished communities often turn to illegal extraction of resources from protected areas to alleviate economic pressures or to make monetary gains. Such practices can cause ecological damage and threaten animal populations. These communities also often face a high disease burden and typically do not have access to affordable health care. Here we argue that these two seemingly separate challenges may have a common solution. In particular, providing health care to communities adjacent to protected areas may be an efficient and effective way to reduce the disease burden while also improving local perceptions about protected areas, potentially reducing illegal extraction. We present a case study of a health centre on the edge of Kibale National Park, Uganda. The centre has provided care to c. 7,200 people since 2008 and its outreach programme extends to c. 4,500 schoolchildren each year. Contrasting the provision of health care to other means of improving community perceptions of protected areas suggests that health clinics have potential as a conservation tool in some situations and should be considered in future efforts to manage protected areas.

Introduction : Amidst changes to traditional family caregiving in Ireland, with families becoming smaller, people waiting longer before having children, and increasing life expectancy, the question of how to ensure the health and wellbeing of persons with intellectual disability and their families challenges the interface of formal and informal care provision. This study examines professional and family supports in place for families caring for a person with intellectual disability, and the relationship with carer resilience. Methods : A cross-sectional survey of family carers for a person with intellectual disability was conducted. All carers surveyed were in receipt of a social welfare payment for the care they provided. The questionnaire comprised of a number of psychometric instruments. The Family Support Scale was used to assess the availability and perceived helpfulness of family, friends, informal, and formal supports to carers and their families during the past three to six months. [1] Information was collected about the range of multidisciplinary support services required by carers during the preceding six months. [2] Carer resilience, the process that enables carers and their families to adapt, manage, and negotiate in the face of adversities [3], was also measured. The quantitative survey data was descriptively and inferentially analysed using SPSS 20 statistical software. Results : A total of 247 carers participated in the survey. The findings revealed that the main sources of support available to carers were their family General Practitioner (81.4%), their other children (74.6%), their friends (72.7%), and relatives (72.5%).From those supports availed of by carers, their partner (88.7%), school/college/day-centre (79.9%), and their other children (73.1%) were rated as the most helpful by carers. Levels of perceived family support, other informal supports, and formal supports were positively correlated with carer resilience. Discussion and Conclusion : Findings from this study provide a better understanding of the supports availed of and those perceived as helpful by families caring for a person with intellectual disability. Findings also highlight the importance of perceived family and professional support on carer resilience. With the changing nature of family caregiving, families with a person with intellectual disability need to be valued and sustained with support from both formal and informal supports, services, and resources. Therefore carers should be included and consulted as part of service evaluations, so that resources can be appropriately tailored, allocated, and best utilised by families. Caregiving situations should be assessed individually, and service providers and policies need to acknowledge and take into account this diversity in caregiving circumstances and integrate with families in order to provide care for people with intellectual disability living in the community. Limitations : This study comprised a cross-sectional survey of family carers of a person with intellectual disability, who were in receipt of a social welfare payment for the care they provided. This is only a subset of carers and further research is needed to examine the experiences of other cohorts of carers. References : 1- Dunst CJ, Jenkins V, Trivette CM. Family support scale: Reliability and validity. Journal of Individual, Family, and Community Wellness. 1984;1(4):45-52. 2- Beecham, J. Collecting and Estimating Costs. In M.R.J. Knapp (ed.) The Economic Evaluation of Mental Health Care. 1995; 157-174. 3- McCubbin HI, McCubbin MA. Typologies of resilient families: Emerging roles of social class and ethnicity. Family relations. 1988; 1:247-54.

BackgroundThe unprecedented access to mobile phones in resource-poor settings has seen the emergence of mobile-health (mHealth) applications specific for low- and middle-income contexts. One such application is the Mobile Technology for Community Health Suite (MOTECH Suite). Given the importance of community health worker (CHW) perceptions of a health program toward its successful implementation, this study explores whether the introduction of an mHealth application, as a human resource management tool, is associated with changes in CHW perceived supervision, motivation, work engagement, and job satisfaction over time.MethodsWe employed a 3-arm randomized longitudinal cohort design in Bonthe District, Sierra Leone. Three hundred twenty-seven CHWs were assessed over an 18-month period, with 3 different rounds of data collection. CHWs were assigned to 3 different intervention groups and given either a mobile phone with access to both the application and to a closed user group; a phone set up on a closed user group but with no application; or no mobile phone but the same level of training as the previous 2 groups.ResultsFindings indicated that there were no initial or sustained differences in perceived supervision and motivation across the 3 experimental groups over time with the introduction of the MOTECH Suite as a human resource management tool. Furthermore, there was no significant change in the self-reported measures of work engagement and job satisfaction across each of the intervention groups over time.Discussion/ConclusionFindings suggest that there are no systematic changes in perceived supervision, work engagement, job satisfaction, or motivation between CHWs who received a mobile phone set up on a closed user group with the MOTECH Suite application and those who either only received a phone with the closed user group or no phone at all. Therefore, the results of this study do not provide sufficient evidence to support the use of mobile technology or mHealth applications to strengthen these organizational factors within CHW programs and interventions. We argue that strengthening the organizational factors within CHW programs must therefore extend beyond the introduction of a technological solution.

Background The Centre for Global Health, Trinity College Dublin has as one of its goals, strengthening health systems in developing countries. In realising this goal we work across more than 40 countries with third-level, civil society, government, private sector and UN partners. Each of these requires that different relationships be established. Good principles must guide all global health research partnerships. An exploratory research project was undertaken with research partners of, and staff within, the Centre for Global Health. The aim was to build an evidence-based framework. Methods An inductive exploratory research process was undertaken using a grounded theory approach in three consecutive phases: Phase I: An open-ended questionnaire was sent via email to all identified partners. Phase II: A series of consultative meetings were held with the staff of the Centre for Global Health. Phase III: Data sets from Phases I and II were applied to the development of a unifying framework. Data was analysed using grounded theory three stage thematic analysis - open, axial and selective coding. Results Relational and operational aspects of partnership were highlighted as being relevant across every partnership. Seven equally important core concepts emerged (focus, values, equity, benefit, leadership, communication and resolution), and are described and discussed here. Of these, two (leadership and resolution) are less often considered in existing literature on partnerships. Conclusions Large complex partnerships can work well if all parties are agreed in advance to a common minimum programme, have been involved from the design stage, and have adequate resources specifically allocated. Based on this research, a framework for partnerships has been developed and is shared. Electronic supplementary material The online version of this article (doi:10.1186/s12992-016-0152-1) contains supplementary material, which is available to authorized users.