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Abstract The influx of refugees, population growth and current agricultural practices have led to an increase in water demand in Jordan, placing pressure on existing water provision. Climate change further exacerbates declining water availability. Against this backdrop, the techno-economic feasibility of four water supply and sanitation alternatives for small and medium scale cities in Jordan were explored, using local unit costs and Al-Mafraq as a case study. City level piped network combined with household rooftop rainwater harvesting and surface runoff collection into local ponds and piped networks with treatment using the nature-based solution of root-zone for sanitation were demonstrated to provide the highest benefits in terms of cost, convenience and water conservation. Our work highlights the need to invest in long-term urban infrastructure networks to promote sustainable future growth of cities. This is vital to address severe water scarcity challenges that ultimately impact those at the urban fringes most.

Background: Slum communities face health risks influenced by environmental, human, and animal health factors, particularly antimicrobial resistance (AMR). Tailored, community-driven solutions are needed to address these multifactorial health determinants. This study explores One Health challenges in urban slums using a Patient and Public Involvement (PPI) approach. Objectives: This study aims to use qualitative methods within a PPI framework to examine the social, environmental, and animal health factors contributing to AMR and other health challenges in urban slums. Focusing on One Health, we engaged slum residents in Jaipur, Jakarta, Antofagasta, and Istanbul through participatory approaches like social mapping and transect walks to identify health risks and develop intervention strategies. Methods: A PPI approach was employed to involve communities in the research process, ensuring culturally relevant insights. Data collection included social mapping, transect walks, and key informant interviews in the four cities, highlighting critical health determinants such as environmental contamination, healthcare access, and animal-related risks. Thematic analysis identified common challenges and intervention opportunities within the One Health framework. Conclusion: The study underscores the importance of PPI in addressing One Health challenges in urban slums and reveals interconnected human, environmental, and animal health risks. Engaging communities fostered trust and provided locally relevant solutions to complex health issues like AMR. Future interventions should be co-designed with communities to address social determinants like sanitation and healthcare access for sustainable outcomes.

Abstract Emerging economies, low- and middle-income countries experiencing rapid population and GDP growth, face the challenge of improving their living standards while stabilizing CO2 emissions to meet net-zero goals. In this study, we quantify the CO2 emissions required for achieving decent living standards (DLS) in emerging economies. The results show that, compared to other regions, achieving DLS in emerging Asian and African economies will result in more additional CO2 emissions, particularly in the DLS indicators of Mobility and Electricity. Achievement of DLS in emerging economies will result in 8.6 Gt of additional CO2 emissions, which should not jeopardize global climate targets. However, a concerning trend arises as more than half of the emerging economies (62 out of 121) will face substantial challenges in aligning their expected emission growth for achieving DLS with their national emission mitigation targets.

Adequate water, sanitation, and hygiene (WASH) facilities in schools are vital, especially for girls. This study addresses a gap in assessing the adequacy of WASH facilities' repair at schools affected by natural hazards. Central Sulawesi was used as a case study where principal interviews were conducted at 26 schools, and structured observations were made at 18 schools, 3 years after the earthquake in September 2018. Ten of 26 principals reported no damage to the toilets from the events of September 2018. Among those who did, a third felt that the fixes insufficiently met basic needs and that they did not deliver WASH services as well as they used to. Not all WASH inadequacy stemmed from the earthquake. Structured observations revealed that most toilets lacked soap, open water reserves were placed next to non-flush latrines, posing a high potential for vector-breeding, and there were inadequate facilities for menstrual hygiene management, including no bins. Recommendations include ensuring a supply of soap, adding lids to water storage containers, and providing sanitary napkins and lidded bins. Observations suggested that private schools provided a better level of WASH service than state schools, and schools in more hazardous zones did not take longer to recover. HIGHLIGHTS Structured observations and interviews with school principals were used to assess WASH facilities, 3 years after the 2018 earthquake in Central Sulawesi, Indonesia.; Coping mechanisms for damage to main pipelines include storing water in buckets in toilets.; State schools lagged behind private schools in WASH facilities.; Inadequate menstrual hygiene management in schools.;

Objectives Homelessness among families with children under 5 residing in temporary accommodation is a growing global concern, especially in high-income countries (HICs). Despite significant impacts on health and development, these ‘invisible’ children often fall through the gaps in policy and services. The study’s primary objective is to map the content and delivery methods of culturally sensitive interventions for children under 5 experiencing homelessness in HICs.Design A scoping review guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sources Databases include PubMed, Medline, SCOPUS, The Cochrane Library and Google Scholar were searched up to 24 March 2022.Eligibility criteria This scoping review includes studies that describe, measure or evaluate intervention strategies aimed at improving child health programmes, specifically those yielding positive outcomes in key areas like feeding, nutrition, care practices and parenting.Data extraction and synthesis Articles were selected and evaluated by two independent reviewers, with a dispute resolution system involving a third reviewer for contested selections. The methodological quality of the studies was assessed using various tools including the Risk of Bias (RoB) tool, Cochrane RoB V.2.0, the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), each selected according to the type of article.Results The database search yielded 951 results. After deduplication, abstract screening and full review, 13 articles met the inclusion criteria. Two predominant categories of intervention delivery methods were identified in this research: group-based interventions (educational sessions) and individual-based interventions (home visits).Conclusion This review highlights effective interventions for promoting the health and well-being of children under 5 experiencing homelessness, including educational sessions and home visits. Research has supported the importance of home visiting to be instrumental in breaking down language, cultural and health literacy barriers.

Background: The global 2030 Agenda covers a range of interconnected issues which need interdisciplinary and holistic approaches to improve human well-being and protect the natural environment. The COVID-19 pandemic has brought to light critical inequities in society and policy gaps in health services. As highlighted through analyses of the interlinkages among the Sustainable Development Goals (SDGs), connections between human health and well-being and the environment, can help support new policy needs in addressing systemic health crises, including widespread pandemics. Method: We identify links between the COVID-19 crisis and multiple SDGs in the context of Brazil based on a review of the current literature in the health sector.Findings: We identify synergistic connections between 88 out of 169 SDG targets and COVID-19, notably around themes such as City Environment, Contextual Policies and the value created by improved Information and Technology. Using the context of the Brazilian National Health Service (SUS) highlights recurrent interconnections from the focal point of target 3.8. This includes topics such as challenges for universal healthcare coverage, budget allocation, and universalisation. Conclusions: The framework developed for supporting policy-making decisions and the design of toolkits for dealing with future health-related emergency scenarios offers a practical solution in the health sector. It is worth noting that progress and action on public health systems and policies must go hand in hand with addressing existing socio-economic vulnerabilities in society. This is vital for tackling future pandemics and simultaneously addressing the SDGs.

Addressing the large carbon footprint of conferences such as the UN Climate Change Convention Conference of the Parties (COP) will be important for maintaining public confidence in climate policy. Transparency is also a vital aspect of creating equitable outcomes in climate policies, as often those most likely to be affected or who are able to create change on the ground are often unable to attend in person because of the high financial costs as well as having a large carbon footprint. The selection of host locations for the regular meetings of the UN Climate Change Convention is based on a rotation in amongst the five UN regions, which for 2022 is Africa. Here, we present UCL’s own carbon footprint calculator and use it to weigh the benefits of certain modes of transport to the 2021 COP 26 in Glasgow, UK and the 2022 COP 27 to be held in Sharm El-Sheikh, Egypt. The calculator demonstrates the well-known carbon-efficiency of coach and rail over flights, but shows that these benefits are only partly mitigated in the case of COP 27 due to insufficient transport links from Europe to the conference location. However, we also highlight some of the benefits of hosting a COP in the global South, particularly in the context of climate justice. Incorporating these principles into the calculator, we invite visitors to COP this year to carefully consider their options for carbon offsetting and how the tenets of climate justice could be integrated into the carbon accounting framework.

The UN High Level Panel on Water notes that a total annual capital expenditure (CAPEX) of $114 billion of $129 billion is required globally to meet the safe drinking water and sanitation targets 1 and 2 of Sustainable Development Goal 6 (SDG 6). Annual operation and maintenance expenditure (OPEX) will increase, averaging $129 billion by 2030. In Sub-Saharan Africa, $36 billion is required and UNICEF estimates $15 billion is required to meet these targets in 21 countries in East and Southern Africa. Currently, only 15% of the financial investments in the sector are accounted for, which falls significantly short of delivering SDG 6. Consequently, innovative finance tools that maximise taxes, tariffs and transfers (3ts) are required to mobilise finances for the region's sector. This paper presents a diagnostic methodology for identifying bankable and blended finance projects in East and Southern Africa's water and sanitation sector. Potential projects were identified in Malawi, Mozambique and Ethiopia. Findings from applying the AHP (analytical hierarchy process) analysis recommend the use of the decision-making tool for prioritisation and selection of water and sanitation projects in the context of multiple projects requiring blended finance. The methods are applicable to other parts of Sub-Saharan Africa to enhance project pipelines whose collective cost and revenue mitigate investment risk. HIGHLIGHTS A shortfall in finance in East and Southern Africa is a significant barrier to realising equitable water and sanitation services for all.; To address the financial gaps, the sector will need to apply innovative finance mechanisms such as blended finance.; Multicriteria decision-making tools such as the AHP provides a valuable technique for evaluating countries’ potential for blended finance in the region.;

Significant strides have been made in eThekwini Municipality, Durban, towards achieving Sustainable Development Goal 6 (SDG6) but with 27% of households lacking access to basic sanitation in 2020, challenges remain. While there is global evidence of sanitation linking to all 17 SDGs, similar localised linkages between sanitation and the SDGs in the context of Durban have not yet been verified. Evidencing these linkages and related co-benefits across SDGs could galvanise efforts towards mutually achieving SDG6 and other SDGs by highlighting potential funding efficiencies across multiple benefiting sectors and providing data for longer-term cross-departmental collaboration.This study bridges a persistent gap between research and policy through a collaborative process facilitating the localisation of links between sanitation and SDGs to aid reporting needs and optimise resource use based on evidence of multiple benefits across SDGs. A structured evidence appraisal process identifies linkages between sanitation and all 17 SDGs, including 83 synergies, 49 risks and 4 trade-offs.Our review reveals that lack of adequate sanitation in public spaces has implications for poverty, inequality, informality and dignity. Despite supportive policies, there is a need to enhance participation in decision-making to develop more appropriate sanitation solutions and enhance community acceptance. Findings demonstrate how local policies on sanitation contribute to reducing inequality and poverty but to achieve synergistic outcomes requires addressing existing risk, e.g. in relation to differentiated provision of sanitation solutions or policies that are not always well targeted.There are further opportunities in eThekwini to promote circularity through wastewater reuse and using faecal sludge for energy and fertilizer production. A key consideration for eThekwini's Water and Sanitation unit is to avoid negative environmental impacts whilst developing solutions for areas that lack infrastructure. The research also identified data gaps, particularly between sanitation interventions and climate action and sanitation data for vulnerable groups.

The productive use of energy (PUE) is a critical pathway to development, as it enhances productivity and facilitates income-generating activities. However, PUE is little understood in low-resource urban settings in the context of off-grid energy. Drawing on two projects implemented between 2019 and 2022, this paper presents a case of off-grid solar for PUE in a young, unelectrified informal settlement in Cape Town, South Africa. The projects investigated the state of energy access in the settlement using household surveys and interviews, and installed solar microgrids in partnership with a local off-grid solar provider who deployed a ‘service-based’ provision model. We find that limited energy options in the settlement commensurately limited energy usage mainly to domestic applications. The microgrids provided reliable refrigeration and lighting for small businesses which improved their operations, delivered energy autonomy, and stimulated aspirations for growth. Energy consumption from the microgrids revealed seasonal and temporal variations which requires flexible demand-responsive energy systems, and holds implications for sizing, storage, and scaling. Although targeted, the ‘service-based’ model limited productive uses to only those that fit within the remit of the model and high costs particularly for appliances prohibited wider PUE adoption. These challenges impact the scalability of off-grid solar in informal settlements which calls for innovative financing approaches and increased policy support for off-grid providers operating in these communities. Off-grid solar has the potential to stimulate PUE and alleviate energy poverty in informal settlements, but more case studies are required to widen the evidence-base, thereby advancing South Africa’s energy transitions agenda.

Abstract Background The interdisciplinary Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages (PANChSHEEEL) study used a participatory approach to develop locally-feasible and tailored solutions to optimise Infant and Young Child Feeding (IYCF) practices at an individual, household, community, and environmental level. This paper aims to evaluate the influence of gender; migration; and Health, Education, Engineering and Environmental (HEEE) factors on IYCF practices, with the primary outcomes being three key complementary-feeding practices of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD). Methods A cross-sectional survey of 325 households with children aged 6–23 months was conducted in nine purposively selected villages in two blocks of Banswara district, Rajasthan, India. A survey tool was developed, translated into the local language, pre-tested, and administered in a gender-sensitive manner. Data-collection processes were standardized to ensure quality measures. Association of the primary outcome with 27 variables was tested using a Chi-square test (Mantel-Haenszel method); backward stepwise regression analysis was conducted to assess the impact of effect modifiers (gender, parental migration). Results Half of the surveyed children were of each gender, and fathers from half of the households were found to have migrated within the previous year to search for additional income. Parental literacy ranged from 60 to 70%. More than half of the households had access to milk-producing animals. Consumption of each of the seven food groups, eggs (4.7% vs 0.7%; p

As factors influencing the health and well-being of children are complex and cross-sectoral, integrated interventions are required to improve child health and hence address the Sustainable Development Goals. This paper explores linkages between environmental factors, feeding practices and potential infection pathways in India. The PANChSHEEEL project is a participatory interdisciplinary study, designed to explore HEEE (Health, Education, Engineering and Environment) factors influencing Infant and Young Child Feeding practices. This study uses data from observational transect walks and 445 household interviews from nine villages in Banswara district in India. Using the socio-ecological model, this study demonstrates how the lack of access to and quality of water resources, poor access to sanitation and hygiene practices, access to cooking fuels and flooding can influence feeding practices. The study finds that access to water, sanitation and cooking fuels can affect the preparation of food, contaminate water and food and place added time burden on caregivers. For infants, insufficient and contaminated water can lead to a higher risk of infection, diarrhoea and ultimately malnutrition. Recommendations include efforts to address waterlogging, promote safe storage of water, establish a water quality regime with stakeholders and develop appropriate, affordable and acceptable sanitation solutions. HIGHLIGHTS The use of observational transect walks to better capture linkages between environment and feeding practices.; The socio-ecological framework is used to map links between built environment and feeding practices at the village, household and individual level.; Opportunities to improve child health through linkages to SDG 2 (Hunger), SDG 3 (Health), SDG 6 (Baby WASH) and SDG 7 (Energy).;

Abstract Background Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall exposure factors to faecal pathogens through the numerous infection transmission pathways. Understanding the multiple and multifaceted factors contributing to enteric infections and their interconnectedness is key to inform future interventions. This study aimed to perform an in-depth holistic exploration of the environmental, socio-cultural, economic and institutional context surrounding infants to develop an integrated understanding of enteric infection drivers in rural tribal Banswara, in Rajasthan State, India. Methods This study relied on the triangulation of mixed-methods to capture critical influences contributing to infant enteric infection transmission. We conducted structured observations and exploratory qualitative research across 9 rural tribal villages, including transect walks, household observations, interviews with frontline health workers and group discussions with mothers. The emergent social themes and identified factors were mapped based on the scale of agency (individual, family or community-level factor) and on their nature (environmental, socio-cultural, economic and institutional factors). Results Infants aged 5 to 24 months were seen to have constant exposures to dirt via mouthing of soil, soiled hands, soiled objects and food. Rudimentary household environments with dirt floors and domestic animals lacked a hygiene-enabling environment that hindered hygienic behaviour adoption. Several unsafe behaviours failing to interrupt infants’ exposures to pathogens were captured, but caregivers reported a lack of self-efficacy skills to separate children from faecal exposures due to the rural farming environments where they lived. Conceptual mapping helped understand how wider-level societal factors such as socio-economic limitations, caste inequalities, and political corruption may have trickle-down effects on the caregivers’ motivation and perceived self-efficacy for improving hygiene levels around children, highlighting the influence of interconnected broader factors. Conclusions Conceptual mapping proved useful to develop an integrated understanding of the interlinked factors across socio-ecological levels and domains, highlighting the role of wider sociocultural, economic and institutional factors contributing to infant’s enteric infection risks. Future WASH interventions are likely to require similar integrated approaches that account for the complex factors at all levels.

Objective This interdisciplinary qualitative study aims to explore the health, education, engineering and environment factors impacting on feeding practices in rural India. The ultimate goal of the Participatory Approach for Nutrition in Children: Strengthening Health Education Engineering and Environment Linkages project is to identify challenges and opportunities for improvement to subsequently develop socioculturally appropriate, tailored, innovative interventions for the successful implementation of appropriate infant and young child feeding (IYCF) practices locally.Design Qualitative research method, involving five phases: (1) identification of local feeding practices; (2) identification of the local needs and opportunities for children aged 6–24 months; and (3–5) analysis of the gathered qualitative data, intervention design, review and distribution.Setting Nine villages in two community development blocks, that is, Ghatol and Kushalgarh, located in the Banswara district in Rajasthan, India.Participants 68 participants completed semistructured interviews or focus group discussions including: mothers, grandmothers, auxiliary nurse midwife, Anganwadi worker, ASHA Sahyogini, school teachers and local elected representative.Phenomenon of interest IYCF practices and the factors associated with it.Analysis Thematic analysis.Results Our results could be broadly categorised into two domains: (1) the current practices of IYCF and (2) the key drivers and challenges of IYCF. We explicate the complex phenomena and emergent model focusing on: mother’s role and autonomy, knowledge and attitude towards feeding of young children, availability of services and resources that shape these practices set against the context of agriculture and livelihood patterns and its contribution to availability of food as well as on migration cycles thereby affecting the lives of ‘left behind’, and access to basic health, education and infrastructure services.Conclusions This interdisciplinary and participatory study explored determinants impacting feeding practices across political, village and household environments. These results shaped the process for cocreation of our context-specific intervention package.

Abstract The lack of accessible crime data, especially geolocations, in developing countries often acts as a barrier to identifying environmental or situational factors in high crime areas that might contribute to the facilitation of those crimes. This paper presents a methodology for conducting fieldwork for creating heat maps to identify areas prone to violence against women (VAW) in Corregidora, Mexico. Heat maps were produced based on household survey data. The results were used to select specific high concentration locations to conduct structured observations and inductive visual analysis at street level in order to identify if and what situational factors might influence the perpetration of VAW in those locations. Four broad features were identified in the urban built environment during the site visits linked to the facilitation of opportunities for the commission of VAW: (1) lacking infrastructure, (2) presence of physical obstacles, (3) poor visibility and (4) restricted pedestrian mobility. The paper demonstrates the utility of this method for aiding situational crime prevention strategies in areas where official spatial crime data is unavailable or lacking. This study presents a relatively low cost (although labour intensive) and independent method of aiding crime prevention strategies, which will hopefully be of practical value for organisations in areas with poor crime recording practices and limited access to expensive mapping technologies.

Objective India has been struggling with infant malnutrition for decades. There is a need to identify suitable platforms for community engagement to promote locally feasible, resource efficient Infant and Young Child Feeding (IYCF) interventions. This study aims to explore if and how schools could represent a site for community engagement in rural India, acting as innovation hubs to foster positive change in partnership with the Angawadi centres.Design Five-phase formative study; A parallel mixed methods approach structured by a socioecological framework was used for data collection at individual, household and community levels. This paper focuses on the qualitative findings.Setting This study was undertaken in nine villages within two blocks, ‘Ghatol’ and ‘Kushalgarh’, in the Banswara district of Rajasthan, India.Participants 17 schools were identified. Interviews were conducted with local opinion leaders and representatives in the education sector, including principals, schoolteachers, block and district education officers. Across the nine study villages, information was gathered from 67 mothers, 58 paternal grandmothers using Focus Discussion Groups (FDGs) and 49 key respondents in Key Informant Interviews.Results Schools were considered an important community resource. Challenges included limited parental participation and student absenteeism; however, several drivers and opportunities were identified, which may render schools a suitable intervention delivery site. Enrolment rates were high, with schools and associated staff encouraging parental involvement and student attendance. Existing initiatives, including the mid-day meal, play opportunities and education on health and hygiene, further highlight the potential reliability of schools as a platform for community mobilisation.Conclusions Schools have been shown to be functional platforms frequently visited and trusted by community members. With teachers and children as change agents, schools could represent a suitable setting for community mobilisation in future wider scale intervention studies. Expanding the supportive environment around schools will be essential to reinforce healthy IYCF practices in the long term.

Objective: We propose a data-driven approach, that can be used by any state or region, to cluster county-level emergency medical services (EMS) and subsequently benchmark them against their peers using over- (OT) and under-triage (UT) rates as performance measures. Methods: The approach consists of three phases: data collection, clustering, and benchmarking. Collected data includes EMS trauma-specific capabilities, volume, and performance improvement activities aggregated at the county level. Clustering approaches include K-means, K-medoids, and CLARANS. Benchmarking of EMS performance in each county against its peer within the same cluster was conducted using guidelines from the American College of Surgeons (ACS) on over- (OT) and under-triage (UT) rates. To illustrate our data-driven approach, we used data collected from the state of Ohio (OH). This included a survey of 318 EMS agencies across 87 counties in the state of OH, and 6002 deidentified patient records from 2012 obtained from the state of Ohio's EMS Division. Results: Our proposed approach can handle both qualitative and quantitative data. It is capable of identifying key factors that allow for grouping of counties as peers, in a cluster, to enable subsequent benchmarking. Application of our approach on the state of OH data revealed that county-type (rural vs urban), number of trauma-related runs, number of paid vs. voluntary employees, and additional resources provided by EMS agencies in the county (to help with well-being and coping mechanisms for EMS providers) were key factors in clustering. A small number of clusters appeared sufficient to group counties based on various EMS attributes. Benchmarking based on ACS guidelines revealed a large variation in UT and OT rates among counties in the same cluster. Rates up to 3–4 times higher were observed in several counties compared to the best performing county in that cluster, even though some of these counties had better capabilities. Conclusion: Our novel, data-driven approach can enable any regional or state EMS agency in the United States (US) to quantitatively compare counties with their peers in the same cluster and help unravel new insights that could be used to target cluster-specific interventions that can achieve improved outcomes.

The UN 2030 Agenda is a global agenda which brings nations together to address global challenges for sustainable development. It is increasingly expected for bilateral and multilateral development projects and programmes in sub-Saharan Africa to address the Sustainable Development Goals (SDGs). However, Africa's agency in steering sustainable development priorities, notably by proposing its own development agenda and achievements’ visions such as those contained in the African Agenda 2063 (AA2063), must be better recognised. This paper aims to establish converging links between the SDGs and AA2063. The authors used a structured process to identify and ‘map’ commonalities between all SDG and AA2063 targets. This process involved reviewing 32,617 possible connections between the 169 SDG Targets and 193 Agenda 2063 Targets. Key results identified 4,434 (14%) connections and three approaches for selecting overlapping areas of action: based on strength of connections, number of connections, and a combination of both. By comparing and establishing areas of overlap between the two agendas a discussion around converging and diverging priorities is held, which can in turn inform project design and monitoring and allow development initiatives to consider how they connect with both agendas. The findings could facilitate funders, policy makers and practitioners to leverage multiple benefits through a targeted approach to address both agendas effectively.

Limiting global temperature rise to 1.5°C requires transformations in every aspect of our societies and economies. In contrast to 2°C pathways, the 1.5°C target requires even deeper and faster cuts in emissions. While this will bring enormous collective benefits, mitigation action also risks significant disruptions and losses to some groups. In this Perspective, we set out the justice implications of 1.5°C-consistent modelled pathways, focusing on fossil fuel extraction, critical resources, economic impacts and human needs. This leads to the identification of three cross-cutting characteristics of just transitions to 1.5°C-consistent pathways: the inherently politicised nature of transitions; the need to integrate multiple perspectives; and the challenges they present to values and assumptions. We propose a research agenda which recommends ways in which research must be interdisciplinary, integrative of diverse actors and perspectives, and able to robustly test and explore radical ideas if researchers are to rise to the challenge of delivering just transitions to 1.5°C.

The aim of this paper is to highlight limits in the current conceptualisation and implementation of urban Green Infrastructure (GI), particularly in informal settlements. We propose a Multi-Level Perspective (MLP) that helps analyse and identify opportunities to overcome such limits. The article starts by discussing the concept of GI and proposes its definition through the principles of multifunctionality, interlinkages and exchange. Recognising current gaps in implementation in the context of informal settlements, we argue for the better understanding of the range of socio-political conditions which enable or impede GI practices. To reflect on these gaps, the article uses MLP to explore persisting socio-ecological-infrastructural problems in water management, which could be perpetuated through current GI practices. MLP is used as a heuristic framework to analyse influencing factors that exist at multiple interconnected societal and bio-physical levels. The framework is applied to the city of São Paulo in Brazil where traditional water management has resulted in tensions between social and ecological systems between the regime (which encompasses institutional structures) and the niche (where innovations emerge, for example through grassroots movements). Examples of community initiatives are used that demonstrate a disconnection between top-down structures and everyday practices. We conclude that if GI presents the potential to support a transition towards water management that benefits both social and ecological systems, further characterisation of the concept is required.

BackgroundRespiratory Tract Infections (RTIs) and Gastro-Intestinal (GI) infections are the leading causes of child mortality and morbidity. This study investigates the associations between the individual, household and slum-level determinants of children's health and vulnerability to RTIs and GI infections in peri-urban slums in India; an area of research interest at the Childhood Infections and Pollution Consortium.MethodsThe 2015-16 Indian National Family Health Survey was used for data analysis on children aged 0-5 years. NFHS-4 includes data on slums in eight Indian cities, including Delhi, Meerut, Kolkata, Indore, Mumbai, Nagpur, Hyderabad, Chennai. The outcome variables, having fever and cough (FeCo) and diarrhoea in the last two weeks, were used to define the phenotype of infections; for this analysis fever and cough were measures of RTIs and diarrhoea was used to measure GI infections. Exposures considered in this study include variables at the individual, household and slum level and were all informed by existing literature. Multilevel models were used to estimate the association between exposures and outcomes variables; a prior of Cauchy distribution with a scale of 2.5 was selected when building the multilevel logistic models.ResultsThe total sample size of the number of children included in the analysis was n = 1,424. Data was imputed to account for missingness, and the original and imputed sample showing similar distributions. Results showed that diarrhoea and FeCo were both found to be more present in younger children than older children by a few months. In fixed effects, the odds of developing FeCo were higher if the mother perceives the child was born smaller than average (AOR 4.41, 1.13-17.17, PConclusionThe determinants of health, both social and related to health care, at all levels demonstrated linkages to child morbidity in RTIs and GI infections. The empirical evidence highlights the need for contextualised ideas at each level, including one health approach when designing interventions to improve child health.

The WHO advocates the use of a One Health approach to address antimicrobial resistance (AMR), focusing on integrating human, animal and environmental health factors. Nevertheless, there is a dearth of AMR research investigating the complexity of down and upstream factors across the One Health spectrum, especially in resource-deprived settings. The Childhood Infections and Pollution Consortium (CHIP)11 CHIP: Childhood Infections and Pollution Consortium was designed to reduce the burden of childhood infections and AMR in urban slums, particularly in low-and middle-income countries, using One Health and technology-enabled Citizen Science approaches. Currently operationalized in three countries; India, Indonesia and Chile; CHIP is composed of interdisciplinary academics, healthcare professionals, veterinarians, international and local non-governmental organisations, current and former policymakers, local artists and community champions, amongst others. The CHIP Consortium invites collaborations for evidence-driven research, targeted investment and co-development of interventions in slums. We will host our third annual consortium workshop in Hong Kong in 2021 to build on our current work and explore new avenues to tackle childhood infections and AMR.

Urbanisation is one of the key challenges of this decade with 68% of the global population likely to be living in urban areas by 2050. This challenge is particularly acute in sub-Saharan Africa where future towns and cities will see an influx of residents living in spontaneous human settlements. As cities struggle to keep up with the speed of growth and spread of informal settlements, associated environmental challenges such as air and water pollution and waste management have been significantly increasing posing a health risk in high density settings. Using the case of Havelock informal settlement in Durban, the authors identified key challenges associated with poor environmental conditions, lack of basic infrastructure, and the implications for settlement upgrading. The study uses mixed methods combining transect walks, priority mapping, seasonal calendar, focus group discussions and household interviews to explore the households' most challenging environmental issues faced daily by informal dwellers. This paper seeks to make the case for targeted participatory environmental infrastructure and management delivery in urban settlements in South Africa. The research also highlights the value of adopting a holistic approach to infrastructure provision to effectively enhance the living conditions of communities. Targeted participatory processes are vital to ensure that holistic infrastructure interventions are acceptable, appropriate and embedded in local communities to create sustainable habitats.

Off-grid technologies, such as solar home systems (SHS), offer the opportunity to alleviate global energy poverty, providing a cost-effective alternative to an electricity grid connection. However, there is a paucity of high-quality SHS electricity usage data and thus a limited understanding of consumers’ past and future usage patterns. This study addresses this gap by providing a rare large-scale analysis of real-time energy consumption data for SHS customers (n = 63,299) in Rwanda. Our results show that 70% of SHS users’ electricity usage decreased a year after their SHS was installed. This paper is novel in its application of a three-dimensional convolutional neural network (CNN) architecture for electricity load forecasting using time series data. It also marks the first time a CNN was used to predict SHS customers’ electricity consumption. The model forecasts individual households’ usage 24 h and seven days ahead, as well as an average week across the next three months. The last scenario derived the best performance with a mean squared error of 0.369. SHS companies could use these predictions to offer a tailored service to customers, including providing feedback information on their likely future usage and expenditure. The CNN could also aid load balancing for SHS based microgrids.

Solar home systems (SHSs) are successfully addressing energy access deficits across the globe, particularly when combined with pay-as-you-go (PAYG) payment models, allowing households to pay for energy services in small instalments. To increase energy access, it is vital to understand the PAYG SHS customer journey in depth. To aid this, the paper presents unique data from active customers, consisting of structured interviews (n = 100) and two focus groups (n = 24) across two districts in Rwanda. These results are presented under a novel customer journey framework, which describes all the individual stages a customer might experience, including awareness and understanding, purchase, usage, upgrade, recommendation and retaining or switching energy source. The paper reveals that the customer journey is non-linear and cyclical in nature, acknowledging that a household operates in a social network within which they could influence or be influenced by others. It also highlights the growing importance of SHS recommendations in raising awareness of SHSs, pointing to the shifts in the off-grid energy market environment where customer awareness no longer appears to be a main adoption barrier.

Emissions associated with hydropower are often forgotten. Lifecycle assessments of greenhouse gas emissions emanating from hydropower must count embedded carbon, emissions from reservoir lakes and the loss of carbon sinks, as well as backup diesel generation emissions when dependence on hydropower fails to deliver energy. Using Zambia as a case study, we estimate using a bottom-up approach that the emissions associated with backup diesel generation from Zambia’s power utility ZESCO and three largest sectors of consumers were up to 27 000 tonnes of ${\text{C}}{{\text{O}}_2}$ in the worst months of drought in 2019. This is significantly higher than what a previous top-down approach would have estimated. We worked out ZESCO’s diesel generation attributable to drought using trend analysis. We worked out the mining sector’s emissions using copper production data, on-grid electricity consumption and calculated electricity intensity to infer off-grid electricity consumption in years of drought. From our household survey we learned average duration of generator use, average capacities of generators and acquired household income and generator use data which we ran in a Tobit regression. These together with labour force survey data helped us infer the level of diesel generation by households of different income brackets. For manufacturing firms we surveyed 123 firms. We collected rich diesel generation use data covering years of drought, input this into an OLS regression to identify predictors of diesel generation use (installed capacity of generator in kVA, in litres and whether generation was in a drought year) which we then used to extrapolate implied diesel generation for the firms for which we had less rich data. As global average temperatures and the frequency of El Niño droughts rise in hydropower dependent countries which account for a fifth of the world’s population, backup generation emissions have implications for the formulation of low carbon energy policy.

Axillary artery pseudoaneurysms are relatively rare, with few reported cases found in the literature. Furthermore, treatment with percutaneous thrombin injection has not yet been reported. We report the case of a 59-year-old man with a large (10 cm) post-traumatic pseudoaneurysm of the left axillary artery found five weeks after a motorcycle crash. The patient sustained multiple injuries, including fractures of the left scapula and clavicle. Edema was observed at the time of diagnosis. Arteriography with successful ultrasound-guided percutaneous thrombin injection was undertaken. The patient experienced no complications after the procedure.