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Abstract Background Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa. Methods Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981–2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre’s latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre. Results Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32–46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07–1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01–1.09]). Levels of rainfall were not strongly associated with CD4 counts 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66–0.98] per 10 percentile rainfall rank decrease). Conclusions Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.

This study set out to determine the sanitary risk scores and microbial health risks associated with wells and boreholes in Ilara-Mokin and Ibule-Soro, Nigeria. Water samples (n = 96) were collected over a period of five months to determine the levels of enteric bacteria and to perform a Quantitative Microbial Risk Assessment (QMRA) of drinking water quality. Sanitary risk scores revealed `medium' and `low' overall risks for the wells and boreholes, respectively. Three risk factors (faulty fence; small apron; pollution sources) exhibited high significant (p < 0.01) association with the presence of E. coli and thermotolerant coliforms in water samples from the wells. E. coli and Salmonella ranged from 1.82 to 2.28 and 2.15 to 2.63 log10 CFU/100 ml respectively in water from the wells, but were below detection limit in water from the boreholes. Shigella and Campylobacter were detected in all water samples. Estimated risks of infection associated with Shigella (2.1 × 10−2 to 2.3 × 10−1) were higher than those of Campylobacter (6.7 × 10−2 to 1.9 × 10−1) and Salmonella (1.9×10−3 to 5.6×10−3). Adaption of water safety plans may be advantageous in these settings, since intentional ingestion of water from the wells and boreholes may pose potential risks of diarrheal illness to humans. HIGHLIGHTS Sanitary risks and water samples were collected from wells and boreholes.; Microbial risk assessment was used to evaluate human dose-response data.; Sanitary risk scores correlated positively with microbial water quality.; Risk factors exhibited significant association with the presence of E. coli.; Estimated risks of infection associated with Shigella were higher than those of Campylobacter and Salmonella.;

Abstract Climate change poses a threat to water security where both current and future generations are concerned, with its accompanying impacts set to be greater in low‐ and middle‐income countries (LMICs). As a result, questions pertaining to climate change adaption in LMICs are receiving increased attention from academics and policymakers alike. It is broadly accepted that top‐down approaches to developing resilience to climate change challenges have been shown to be limited and that concerted efforts need to be made to engage local communities in advancing adaptive strategies. Based on the above, we make two main arguments: (1) while there has been a shift towards acknowledging the importance of community‐driven data in generating a broader and deeper understanding of climate change, far better use could be made of local knowledge and (2) efforts at community‐based solutions to problems of resilience are currently limited by issues of capacity, specifically linked to the need for further education and training, and improved representation with respect to gender, class and caste (as well as financial support). To illustrate these arguments, we present evidence provided by rural communities located in two countries affected heavily by climate change: Ethiopia and Nepal.

The Western Pacific Region (WPR) is on the front line of climate change challenges. Understanding how these challenges affect the WPR populations' mental health is essential to design effective prevention and care policies. Thus, the present study conducted an umbrella scoping review that examined the influence of climate change on mental health in the WPR, using review articles as a source of information. Ten review articles were selected according to eligibility criteria, and the findings were synthesized according to the socio-economic status of the countries identified: Australia, the Republic of Korea, the Philippines, Vietnam, the Pacific Islands (broadly), and China. The findings revealed that each country and sub-region has its own unique profile of climate change-related challenges and vulnerable populations, highlighting the need for specific approaches to mental health care. Specifically, the influence of climate-related challenges differed according to populations' region (e.g., rural populations), demographic characteristics (e.g., age and gender), culture (e.g., traditional tights to land), and employment (e.g., farmers and fishers). The most frequently reported mental health outcomes in response to climate change-related challenges such as droughts, floods, storms, tornadoes, typhoons, and climate-related migration were the decline in mental well-being and the increase in post-traumatic stress disorder symptoms. In addition, using the GRADE framework for assessing the certainty of the findings, we identified that the number of articles discussing associations between a given climate change challenge and a mental health outcome was overall limited. Based on our findings and findings on a global scale, we identified several key research gaps in WPR and provided recommendations for future research and policy strategies.

Outdoor food markets represent important locations where foodborne illnesses and other infectious diseases can spread. Countries in Africa face particular challenges given the importance of these markets in food supply and low rates of access to safely managed water and sanitation. We undertook a scoping review of evidence related to disease transmission in food markets in sub-Saharan Africa, North Africa and identified 46 papers for data extraction and synthesis. Vendor behaviour or awareness was reported in the majority of papers and about half reported on market infrastructure. Fewer studies have been reported on regulatory environments or food contamination. Studies on water supply, sanitation and handwashing facilities focused on the presence of services and did not evaluate quality, thus conclusions cannot be drawn on service adequacy. Studies of vendor behaviour were primarily based on self-reporting and subject to bias. Most studies reported high levels of vendor awareness of the need for hygiene, but where observations were also conducted, these showed lower levels of behaviours in practice. Our findings suggest that there are limited studies on environmental hygiene in outdoor food markets and this is an area warranting further research, including into the quality of services and addressing methodological weaknesses. HIGHLIGHTS First scoping review on environmental hygiene in outdoor food markets.; Studies did not report on the adequacy of water supply, toilets, handwashing facilities, waste management or drainage reviewed.; Reports of handwashing among vendors were primarily based on self-reporting.; We suggest a minimum package of services to support the development of national standards for services.;

On-site sanitation systems (OSS) are a source of greenhouse gas (GHG) emissions. Although efforts have been made recently to measure and quantify emissions from septic tanks using various field-based methods, the vast majority of published literature reporting GHG emissions from OSS units (e.g., pits and tanks) is based on non-empirical evidence. This systematic review presents an overview and limitations of field-based methods used for the quantification of GHG emissions from OSS. Papers published in English were searched in three databases: Google Scholar, PubMed, and Directory of Articles and Journals. Peer-reviewed papers that reported field-based methods applied to containment units in OSS were included in this study. Only eight out of 2085 papers met the inclusion criteria with septic tanks as the sole technology reported and were thus, considered for the review. Most of the studies have been conducted in middle- and high-income countries. Field-based measurements of GHGs are conducted using a flux chamber (FC) and the most commonly used FC methods are (a) the modified simple static FC, (b) automated static FC, and (c) floating FC. Data reported in published studies do not provide sufficient information on the calibration and validation of the results from the FCs used. The complex FC designs, laborious fieldwork operations, and reliance on expensive, specialist equipment, suggest that such methods may not be suitable in Low and Middle-Income countries (LMICs), where resources and access to laboratory facilities are limited. Also, the complexity of pits and tank typology in LMICs (i.e., unstandardised designs and sizes) may be a challenge to the use of FCs with fixed dimensions and set operational conditions. The variation in the quantification methods and resulting emission rates among the studies indicates that gaps prevail in the use of existing methods. Therefore, there is still a need for a simple field-based, easily adaptable FC method with adequate calibration and validation that can help in reliably quantifying the emissions from different OSS in any LMICs.

This study evaluated the experience of implementing water safety plans (WSPs) in Vietnam. WSPs were introduced in Vietnam by the World Health Organization (WHO) in collaboration with the Ministry of Construction in 2006 and have been a mandatory requirement for municipal water supplies since 2012. Using a mixed-methods approach, we collected data on the perceived benefits and challenges of WSP implementation from 23 provincial water companies between August and November 2021. Potential public health benefits of improved water quality were a key motivation; 87% of the water utilities were also motivated by the risk of climate change and prepared response plans to climate-related extreme events as part of WSPs. A decrease in E. coli and an improvement in disinfectant residual in treated water were reported by 61 and 83% of the water supplies, respectively. Sixty-five percent of the water supplies also reported improved revenue and cost recovery. Key barriers to WSP implementation were a lack of WSP guidance suitable for the local context (87%) and insufficient funds for WSP implementation (43%). Our study highlights the need for improved support and capacity building along with locally suited guidance on WSP implementation and audit. HIGHLIGHTS Increasing water pollution, emerging climate change, process of equitization, and expansion of service areas are important impacts on water safety plan (WSP).; WSP has led to tangible benefits. The WSP is a useful vehicle for climate change adaptations, improve resilience.; The commitment from Government and from water utilities is strong.; The critical financial barriers, training needs, and support in WSP need to be addressed.;

Evidence-based data are fundamental in enhancing the delivery of sustainable and resilient water and sanitation services in informal settlements of urban cities in low- and middle-income countries (LMICs). This paper describes the water and sanitation service situation of an urban informal settlement of Freetown, Sierra Leone's capital city. Data were collected from 385 households through a cross-sectional design. More than 80% of the respondents use sachet water as the main drinking source and 59% use protected wells for non-drinking needs. One-third (32%) of the respondents use unimproved sanitation services. Lined pit latrines are the most used facilities (39%), followed by hanging toilets (14.3%). Sanitation facilities mostly shared (69.6%) with a poor hygiene level and the risk of using them at night are reported as main threats. These findings point to the need for greater priority for investments and improvements for safely managed water and sanitation services. HIGHLIGHTS Water and sanitation access mainly provides limited service levels.; Sachet water is the main source for drinking.; Access to piped water is limited in the community and available taps provide water during the rainy season.; Wells are the main sources for domestic water needs.; Pit latrines and hanging toilets are the most dominant in the community.;

The primary goal of this study is to analyze the hydrogeochemical properties and assess the groundwater quality for drinking, domestic, and irrigation purposes in West El Minia, Egypt. Major components were determined in 49 groundwater samples to evaluate water quality in the study area. Principal component analysis (PCA), hierarchical cluster analysis (HCA), geostatistics, and spatial mapping were used to identify the chemical components and processes that influence groundwater quality and highlight areas of health risks. According to the TDS values, about 22% of the groundwater samples are suitable for drinking. Due to the elevated values of hardness in the examined water, none of the water samples are suitable for use in a household. The majority of groundwater samples are acceptable for irrigation based on the sodium adsorption ratio (SAR), residual sodium carbonate (RSC), Kelley ratio (KR), magnesium hazard (MH), and permeability index, and some can be adequately treated. The study indicated that different groundwater characteristics (such as TDS, Na+, K+, HCO3−, Cl−, and SO42−) do not comply with WHO requirements in some regions, which may pose a threat to human health.

This study aimed to compare the metabolic profile of unstimulated (US) and stimulated (SS) saliva samples from pregnant women with/without obesity and periodontitis. Ninety-six pregnant women were divided into: obesity + periodontitis (OP = 20); obesity/no periodontitis (OWP = 27); normal BMI + periodontitis (NP = 20); and normal BMI/no periodontitis (NWP = 29). US and SS samples were collected by expectoration and chewing of sterilized parafilm gum, respectively, and samples were individually analyzed by Proton Nuclear Magnetic Resonance (1H-NMR). Univariate (t test and correlations) and multivariate (Principal Component Analysis–PCA, and Partial Least Square–Discriminant Analysis—PLS-DA with Variance Importance Projection–VIP scores) and Metabolite Set Enrichment Analysis were done (p < 0.05). Metabolites commonly found in all groups in elevated concentration in US samples were 5-Aminopentoate, Acetic acid, Butyric acid, Propionic acid, Pyruvic acid, and Succinic acid. They were mainly related to the butyrate metabolism, citric acid cycle, amino sugar metabolism, fatty acids biosynthesis, pyruvate metabolism, glutamate metabolism, and Warburg effect. Metabolites commonly found in all groups that were in elevated concentration in SS samples were Citrulline, Fumaric acid, Histidine, N-acetyl glutamine, N-acetylneuraminic acid, para-hydroxyphenylacetic acid, Proline, Tyrosine. Although some differences were found between unstimulated and stimulated saliva samples from pregnant women with/without obesity and periodontitis, stimulated saliva collection seems adequate, demonstrating similar metabolic pathways to unstimulated saliva samples when groups are compared.

On-site sanitation systems (OSS), such as pit latrines, are an important source of methane (CH4), with emissions increasing when they are wet, and this occurs when anaerobic conditions dominate. This paper presents the development of a model, which uses seasonal changes in groundwater to account for the fluctuating inundation of pit latrines, and, therefore, the associated CH4 emissions from varying degrees of anerobic conditions are examined. Given that observed timeseries of groundwater table depth at high enough spatial and temporal resolutions are often difficult to obtain in low- and middle-income countries (LMICs), inverse distance weighted (IDW) interpolation is used to generate values for a whole region, which is then used, alongside average pit latrine depth, to determine areas of pit latrine inundation. Outcomes are further informed with open-source contextual data, covering population, urban/rural split, and sanitation facility data, before using methodologies from the Intergovernmental Panel on Climate Change (IPCC) to generate CH4 emissions data. As a case study, we use data from Senegal to illustrate how this model works. Results show total CH4 emissions for the month of January to be ~1.69 kt CH4. We have also discussed the potential use of satellite remote sensing data in regions where access to historical groundwater data is limited. Understanding when the pit conditions are most likely to change could lead to incentives for better management strategies, as well as a reduction in CH4 production.

Abstract Climate change presents a major threat to water and sanitation services. There is an urgent need to understand and improve resilience, particularly in rural communities and small towns in low- and middle-income countries that already struggle to provide universal access to services and face increasing threats from climate change. To date, there is a lack of a simple framework to assess the resilience of water and sanitation services which hinders the development of strategies to improve services. An interdisciplinary team of engineers and environmental and social scientists were brought together to investigate the development of a resilience measurement framework for use in low- and middle-income countries. Six domains of interest were identified based on a literature review, expert opinion, and limited field assessments in two countries. A scoring system using a Likert scale is proposed to assess the resilience of services and allow analysis at local and national levels to support improvements in individual supplies, identifying systematic faults, and support prioritisation for action. This is a simple, multi-dimensional framework for assessing the resilience of rural and small-town water and sanitation services in LMICs. The framework is being further tested in Nepal and Ethiopia and future results will be reported on its application.

Water and sanitation services are critical for public health. The importance of these services is reflected in SDG 6 and the associated targets 6.1, 6.2 and 6.3. Much progress remains to be made to achieve these targets, but it is already becoming clear that greater ambition is needed. This paper looks at three global challenges: the need to increase the level of service to protect public health including infectious respiratory diseases; the role of sanitation in combatting anti-microbial resistance (AMR); and the urgent need to build more climate-resilient services. We need to upgrade the SDG targets to focus on universal access to piped water on premises, to incorporate action on AMR in definitions of safe sanitation and to embed actions to improve resilience, which take into account the greater ambition called for in the SDG 6 targets. This requires a shift in thinking in the sector, away from relying on households and communities to manage their services to properly funded, professional services staffed by trained technical, managerial and finance staff. This will require more public finance and better use of financial instruments that have proved effective in other sectors. Increasing our ambition will mean the world can achieve the aim of universal access to safe, sustainable, and resilient services and protect public health. HIGHLIGHTS Protecting public health requires higher levels of water and sanitation service.; Tackling anti-microbial resistance should become a key element of safe sanitation.; Climate change poses challenges for water and sanitation, investing in resilience is critical.; Greater professionalisation is needed to provide safe, sustainable and resilient services.; More and better use of public finance is needed for services.;

Obesity and pregnancy may have synergistic effects on periodontal condition, and proteomics could be an ideal approach to highlight the pathophysiological mechanisms associated with these outcomes. This study analyzed the salivary proteomics related to obesity and periodontitis in women during pregnancy (T1) and after delivery (T2). Initially, 126 women were recruited and forty were allocated into groups: with obesity and periodontitis (OP); with obesity, but without periodontitis (OWP); with normal BMI, but with periodontitis (NP); with normal BMI and without periodontitis (NWP). Whole-mouth saliva was collected in T1 and T2, and proteins were extracted and individually processed by label-free proteomics (nLC-ESI-MS/MS). The up-regulations of Heat shock 70 kDa protein 1A, 1B, and 1-like were related to both obesity and periodontitis, separately. Albumin and Thioredoxin were up-regulated in periodontitis cases, while Cystatins (mainly S, SA, SN) and Lactotransferrin were down-regulated. The high abundances of Submaxillary gland androgen-regulated protein 3B, Protein S100-A8, Matrix metalloproteinase-9, Heat shock 70 kDa protein 2 and 6, Putative Heat shock 70 kDa protein 7, Heat shock 71 kDa protein, Haptoglobin and Plastin-1 were significant in the combination of obesity and periodontitis. Obesity and periodontitis remarkably altered the proteome of the saliva during pregnancy with substantial alterations after delivery.

This study aimed to elucidate the metabolomic signature associated with obesity and periodontitis during pregnancy in plasma and saliva biofluids. Ninety-eight pregnant women were divided into: with obesity and periodontitis (OP = 20), with obesity but without periodontitis (OWP = 27), with normal BMI but with periodontitis (NP = 21), with normal BMI and without periodontitis (NWP = 30). Saliva and plasma were analyzed by 1H-NMR for metabolites identification. Partial Least Squares-Discriminant Analysis (PLS-DA), Sparse PLS-DA (sPLS-DA), and Variable Importance of Projection (VIP) were performed. ANOVA and Pearson’s correlation were applied (p < 0.05). Plasmatic analysis indicated the levels of glucose (p = 0.041) and phenylalanine (p = 0.015) were positively correlated with periodontal parameters and BMI, respectively. In saliva, periodontitis was mainly associated with high levels of acetic acid (p = 0.024), isovaleric acid, butyric acid, leucine, valine, isoleucine, and propionic acid (p < 0.001). High salivary concentrations of glycine (p = 0.015), succinic acid (p = 0.015), and lactate (p = 0.026) were associated with obesity. Saliva demonstrated a more elucidative difference than plasma, indicating the glucose-alanine cycle, alanine metabolism, valine, leucine and isoleucine degradation, glutamate metabolism, and Warburg effect as the main metabolic pathways.

Abstract Background Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations’ Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. Main body Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health. Conclusion These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that – in any context – a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.

Understanding the resilience of water supplies to climate change is becoming an urgent priority to ensure health targets are met. Addressing systemic issues and building the resilience of community-managed supplies, which serve millions of people in rural LMIC settings, will be critical to improve access to safe drinking water. The How Tough is WASH (HTIW) framework to assess resilience was applied to community-managed water supplies in Ethiopia and Nepal to assess the effectiveness of this framework in field conditions. The resilience of these water supplies was measured along six domains—the environment, infrastructure, management, institutional support, community governance and supply chains—that can affect how they respond to climate change effects. We found that the HTIW framework provided an objective measure of resilience and could be used to rank water supplies in order of priority for action. We also found that systemic issues could be identified. The tools and methods used in the framework were easy to deploy by field research teams. The water supplies studied in Ethiopia and Nepal had low to moderate resilience to climate change. Service management and institutional support were weak in both countries. The data from Ethiopia and Nepal suggests that many water supplies in rural and small-town communities are unlikely to be resilient to future climate change without increased investment and support. The use of simple frameworks such as HTIW will be important in supporting decisions around such investments by identifying priority communities and actions.

Taste and smell perceptions diminish in older age, impacting upon quality of life and nutrition, yet the causes of taste loss are largely unknown. Transient receptor potential channels (TRP) found on the oral mucosa are also involved in oral sensations including cooling and burning and may contribute to the eating experience of older people. Older adults often have reduced salivary flow and the physical properties of saliva may change, but the role of saliva in oral sensations of older adults is yet to be elucidated. Here, the effect of older age on subjective (perception) and objective (stimulated salivary response) measures of TRP stimulants, odors, and basic tastants was investigated. Whole mouth saliva was collected from younger (mean age 24 years) and older adults (mean age 72 years) following stimulation of taste [mono sodium glutamate (MSG) and caffeine], olfaction (menthol), and TRP receptors (capsaicin). Participants rated perceived intensity of each stimulus, and salivary properties were assessed. Older age was associated with 15% lower umami taste and 26% lower menthol odor perception, coupled with 17% lower salivary response to MSG. Interestingly, there were no differences for perception of TRP stimulants, so chemo-sensation was not affected by age. Younger adults had four times greater elasticity (Spinnbarkeit) with MUC7 levels almost double and 66% greater resting salivary flow rate. Stimulated salivary responses in the younger group were also higher compared to the older group, with changes in protein and viscoelasticity in response to taste and TRP stimulation. These results show the impact of older age upon taste and smell sensation which may lead to changes in the physical and compositional properties of saliva in response to taste/odor stimulation. Measurement of stimulated salivary flow and rheology provides an objective measure of taste in addition to subjective perceptions which can be influenced by participant bias. Chemo-sensation may be retained with age and trigeminal stimuli such as chili could be employed in future studies to enhance meals for an age group at risk of malnutrition. Alteration in salivary properties due to advanced age could impact on ability to taste due to poor diffusion of tastants and reduced oral surface protection.