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Authors: Susana López-Gutiérrez, Laura A. Espinosa-Barrera, Arianna Soto-Hernández, Holber Zuleta-Prada, Celia Bustos-Brito, César S. Cardona-Félix, José Utrilla, Beatriz Velazquez-Cruz, Yair Cárdenas-Conejo, Jesus Alfredo Araujo-León, Victor Aguilar-Hernández, Juan A. Osuna-Castro, Baldomero Esquivel, Hugo Serrano-Posada, Sara Centeno-Leija

Marine microorganisms are a prolific source of novel polyketide synthases (PKSs) that generate structurally diverse and functional polyketides. Here, we identify a novel type III PKS, ArsMB, from Pontimonas sp. via metagenomic mining of a Baltic Sea microbiome. Heterologous expression of arsMB synthetic gene in an Escherichia coli host that lacks a native type III PKS, combined with a two-step strategy to boost acyl-CoA precursor availability in a glucose-mineral medium, enabled the in vivo synthesis of two cell-associated alkylresorcinols, identified by GC-MS as 5-pentadecyl-1,3-benzenediol (ars1) and 5-tridecyl-1,3-benzenediol (ars2). The product profile is consistent with a tetraketide alkylresorcinol biosynthetic pathway utilizing C16 and C14 acyl starter units, drawn from the host acyl-CoA pool. In agreement, AlphaFold2-based structural modeling predicts a Cys139/His275/Asn308 catalytic triad and a long hydrophobic substrate tunnel compatible with long-chain acyl starter units. E. coli producing the amphipathic cell-associated alkylresorcinols ars1/ars2 exhibited increased resistance to muralytic digestion by endolysins and to hydrogen peroxide. These findings expand the known repertoire of marine-derived type III PKSs and highlight the biotechnological potential of ArsMB-derived alkylresorcinols.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361965. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Heidi M. Soeters, Sébastien Antoni, Shilpa S. Iyer, Goitom Weldegebriel, Joseph Biey, Jason M. Mwenda, Gloria Rey-Benito, Claudia Ortiz, Roberta Pastore, Dovile Videbaek, Simarjit Singh, Emmanuel Njambe, Lucky Sangal, Deepak Dhongde, Varja Grabovac, Josephine Logronio, Kamal Fahmy, Amany Ghoniem, George Armah, Francis E. Dennis, Mapaseka L. Seheri, Nonkululeko Magagula, Kebareng Rakau-Nondela, Tulio M. Fumian, Irene T.A. Maciel, Elena Samoilovich, Galina Semeiko, Tintu Varghese, Sarah Thomas, Julie E. Bines, Dandi Li, Furqan Kabir, Jie Liu, Eric R. Houpt, Rashi Gautam, Sara A. Mirza, Jan Vinjé, Mick N. Mulders, Jacqueline E. Tate, Umesh D. Parashar, James A. Platts-Mills, for the Global Pediatric Diarrhea Surveillance network

Diarrhea remains a leading cause of child morbidity and mortality. Improved and ongoing estimates of the etiology of hospitalized pediatric diarrhea in low- and middle-income countries (LMICs) are needed to help prioritize and evaluate the use of existing and upcoming vaccines and interventions. The Global Pediatric Diarrhea Surveillance (GPDS) network is a World Health Organization (WHO)-coordinated public health surveillance network investigating the etiology of hospitalized diarrhea among children aged <5 years in LMICs. The GPDS network enrolls children hospitalized with diarrhea at 38 sentinel surveillance sites in 31 LMICs. Randomly selected stool specimens were tested by TaqMan Array Card quantitative reverse-transcription polymerase chain reaction (qPCR) for 16 pathogens associated with diarrhea. We estimated pathogen-specific attributable fractions (AFs) and incidence of diarrheal hospitalizations at the global, regional, and country levels during 3 time periods: 2017–2018, 2019–2020, and 2021–2022, with a focus on the most recent results. During 2017–2022, the GPDS network enrolled 70,750 children aged <5 years hospitalized with diarrhea, of which 16,458 (23.3%) were randomly selected for qPCR testing. The most prevalent pathogen detected, regardless of quantity or modeled etiologic attribution, was rotavirus (weighted prevalence 30.4%), followed by adenovirus 40/41 (19.1%), norovirus (17.9%), Shigella (14.1%), and Campylobacter jejuni/coli (8.6%). Overall, in 2017–2022, rotavirus was the leading etiology globally (AF 32.5%; 95% Confidence Interval (CI): 27.4, 37.6), followed by Shigella (9.8%; 8.4, 11.3), adenovirus 40/41 (8.6%; 6.3, 10.8) and norovirus (6.7%; 5.6, 7.7). Over time, rotavirus consistently declined from an AF of 36.7% (95% CI: 28.7, 46.7) in 2017–2018 to 26.7% (20.7, 34.1) in 2021–2022. Norovirus AF increased slightly from 6.2% (4.7, 7.7) in 2017–2018 to 7.3% (5.0, 9.2) in 2021–2022. Global Shigella burden remained stable, and adenovirus 40/41 demonstrated significant volatility, peaking globally in 2019–2020 (11.9%; 5.9, 17.5). In 2021–2022, rotavirus was the leading cause of hospitalized diarrhea in 6 of 9 geographic groupings, norovirus predominated in Central and South America, and Shigella was the leading etiology in South Asia. In the subset of countries that had introduced rotavirus vaccine, the leading etiologies in 2021–2022 were rotavirus (18.4%; 15.8, 21.5) and Shigella (16.4%; 11.8, 21.1). In 2021–2022, rotavirus had the highest attributable incidence of hospitalized diarrhea in children (2.3 per 1,000 child-years; 1.8, 3.0), followed by Shigella (0.9; 0.7, 1.1), norovirus (0.6; 0.4, 0.8) and adenovirus 40/41 (0.6; 0.4, 0.8). Despite the widespread use of rotavirus vaccines, rotavirus remained the leading cause of severe diarrhea among children aged <5 years in LMICs globally. However, the proportion of pediatric diarrhea attributable to rotavirus consistently declined from 2017-2018–2021–2022, and there were notable differences in the distribution of diarrheal etiologies between regions and across time periods. Shigella, norovirus, and enteric adenoviruses were also associated with a substantial burden of disease. Improving the efficacy and coverage of rotavirus vaccination and prioritizing interventions against other enteric pathogens could further reduce diarrhea morbidity and mortality.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006655. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Yael Velleman, Anne Straily, W. Evan Secor, Susana Vaz Nery, Laura Braun

Soil-transmitted helminths (STH) are parasitic intestinal worms infecting humans through contact with, or ingestion of, soil contaminated with eggs shed by infected individuals. STHs include roundworms (Ascaris lumbricoides, Strongyloides stercoralis), whipworm (Trichuris trichiura) and hookworms (Ancylostoma duodenale, Necator americanus, Ancylostoma ceylanicum). Their transmission is influenced by water, sanitation and hygiene (WASH) services and practices. Unlike past reviews, this scoping review did not assess effect sizes or strength of associations. Instead, it aimed to: map WASH-related risk factors in relation to STH infection; assess whether these align with plausible transmission pathways and conceptual frameworks; and characterise methodological features of the evidence base, including diagnostic approaches, that affect comparability of findings. We analysed 197 studies, of which 174 were observational and 23 were intervention studies. We found a substantial and growing body of evidence examining the relationship between WASH and other environmental exposures and the prevalence and intensity of STH infection. Nonetheless, important aspects such as food chain pathways, environmental surveillance, under-studied species, and measures of service and infrastructure uptake and use, quality, and community coverage over time, remain under-investigated, hampering drawing practical conclusions for improvement of service delivery. Existing and new research can be enhanced in several areas. Routine investigations like prevalence surveys should apply standard WASH definitions to reduce heterogeneity, and apply a conceptual framework of transmission in study design. Intervention studies should be based on theories of change that map actions disrupting transmission pathways, implementing a comprehensive intervention package and examining factors affecting behaviours or intervention compliance. Evaluation of intervention uptake should also be included. New research should address the evidence gaps identified, and incorporate timelines with realistic likelihood of impact into study planning and proposals, given the environmental persistence of certain STH species and the fact that developing lasting and sustained behaviour change can be slow.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006196. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Rie Kudoh, Taiga Shibayama

Educational support for nurses is essential to promote oral health management education for patients with diabetes. However, few studies have focused on supporting nurses in this context. This study explored the effects of an audiovisual material designed to support nurses’ patient education on oral health management in diabetes care. Semi-structured interviews were conducted with eight certified diabetes nurse educators. Data were analyzed using content analysis. Four main themes emerged: (1) enhancement of nurses’ individual learning (8/8 participants), including improved knowledge of the connection between oral health and diabetes; (2) promotion of professional development and reflection (5/8); (3) provision of new insights into patient care (7/8), particularly regarding patient motivation strategies; and (4) identification of implementation considerations in diabetes outpatient settings. The findings suggest that the audiovisual material, designed to complement an existing evidence-based educational guide, was perceived as useful and may support nurses’ learning and educational practices related to oral health education for patients with diabetes.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361280. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Jeong-Eun Yang, SeolHwa Moon

Background Frailty in older adults is a critical public health concern associated with increased morbidity, disability, and healthcare utilization. Although systemic health and socioeconomic factors are well-established determinants of frailty, the multidimensional nature of oral health has received relatively limited attention in previous research. The aim of this study was to examine the associations between general characteristics, health-related factors, oral health factors, and frailty among community-dwelling older adults, and to identify sex differences in frailty. Methods This cross-sectional study used data from the 2022 Korean Longitudinal Study of Aging (KLoSA) and included 3,729 individuals aged 65 years and older. Frailty was categorized as robust, pre-frail, or frail using the Frailty Instrument developed for older Korean adults. General characteristics, health-related factors, and oral health-related factors (structural, behavioral, and subjective) were assessed through structured questionnaires. Hierarchical logistic regression analysis was performed in three steps to identify factors associated with frailty. Results Of the participants, 16.0% were frail and 84.0% were non-frail (31.5% pre-frail and 52.5% robust). Sex-stratified analyses also showed that structural oral health factors were most strongly associated with frailty in both sexes. Edentulous status without denture use was associated with the highest odds of frailty in both women (OR = 3.76, 95% CI = 3.72–3.80) and men (OR = 2.95, 95% CI = 2.91–2.98). In contrast, sex differences were observed for some subjective oral health factors: tooth sensitivity was associated with higher odds of frailty in women (OR = 1.82, 95% CI = 1.80–1.84) but lower odds in men (OR = 0.85, 95% CI = 0.84–0.86). Conclusions Oral health conditions, including untreated tooth loss, difficulty in chewing or swallowing, and oral pain, were significantly associated with frailty. These findings suggest that oral health may be an important factor to consider in relation to frailty among community-dwelling older adults.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360682. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Joseph Wells, Joseph Waiswa, Anifa Vala, Bahtisen Golla, Grace Mwashigadi, Hawanatu Jah, Marleen Temmerman, Robin Okello, Isaac Mwaniki, Herminio Cossa, Moses Mukhanya, Esperança Sevene, Yahaya Idris, Onesmus Wanje, Angela Koech, Anna Roca, Laura Braun, Marie-Laure Volvert, Fatima Touray, Umberto D’Alessandro, Peter von Dadelszen, Wendy Graham, Hannah Blencowe, the PRECISE and PRECISE-DYAD Networks

Placenta-related complications contribute substantially to maternal and perinatal mortality globally, with the greatest burden in low- and middle-income countries (LMICs). However, the potential influence of inadequate household water, sanitation and hygiene (WASH) on these outcomes remains poorly characterised. We investigated associations between household WASH conditions and selected placenta-related complications, including pre-eclampsia, small-for-gestational-age (SGA) and stillbirth, in The Gambia, Kenya and Mozambique. This secondary analysis was nested within PRECISE (PREgnancy Care Integrating Translational Science, Everywhere), a prospective observational cohort of 5,745 unselected pregnant women. Multivariable modified Poisson regression with robust standard errors was used to assess associations between household WASH exposures and pre-eclampsia, SGA or stillbirth. Missing exposure and covariate data were low (<5%) and handled using multiple imputation. Compared with water piped into the dwelling or plot, other improved water sources (adjusted relative risk [aRR] 1.18, 95% confidence interval [CI] 1.07–1.31, p = 0.002) and unimproved water sources (aRR 1.23, 95% CI 1.00–1.50, p = 0.049) were associated with a higher risk of any selected placenta-related complication. Unimproved sanitation facilities, compared with improved facilities, were also associated with increased risk (aRR 1.15, 95% CI 1.02–1.30, p = 0.019). The findings suggest that household‑level WASH conditions may be associated with selected placenta‑related complications through both direct and indirect pathways. Water sources, whether unimproved or improved, may be contaminated, and collection, transport, and storage further increase contamination risks while adding a physical burden to water collectors. Unsafe sanitation may also increase exposure to enteric pathogens. Given the observed associations, targeted WASH interventions warrant investigation as a potential strategy to reduce placenta-related complications and improve maternal and neonatal health outcomes in LMICs. Future research should explore the mechanisms linking WASH to pre-eclampsia, SGA, stillbirth and other placenta-related complications, and assess the effect of comprehensive WASH interventions.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005004. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Catherine Sutherland, Anthony Odili, Msimelelo Gqaleni, Sibongile Buthelezi, Duduzile Khumalo, Fanelesibonge Magwaza, Bahle Mazeka, Lindani Mtshali, Mary Lawhon

As non-sewered sanitation (NSS) is being designed, developed, tested and rolled out, there is widespread support for the integration of social science. Yet what, precisely, social science can and should do remains much less clear. This paper explains the specific approach of social assessments, a process for analysing the context in which NSS exists, and how this context might impact NSS. Social assessments can be more resource intensive than more narrow approaches, making it important to understand its contributions and why it might contribute to NSS. Here, we draw on data from six different social assessment processes on NSS in eThekwini Municipal Area, showing how the questions, methodology and contributions changed. What has resulted from our learnings is not a set process, but ongoing experimentation with and adoption of diverse methods that respond to the particular goals of research teams in specific sites. We explain five potential contributions of social assessment: a) it can improve technologies; b) it can enable users to better understand technologies and interventions, enabling a deeper form of participation; c) broadens the framing of what matters for NSS, showing the relevance and potential changes of factors such as governance arrangements, gender dynamics, and resource costs; d) it offers specialist analysis of technologies’ relationship with the wider context; and e) it impacts relationships, potentially shifting power and building trust. We conclude by urging more explicit attention to the diverse ways of undertaking social science how it can contribute to NSS.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000527. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Yarrow Linden, Erin Kowalsky, Kevin Zhu, Christine Fagnant-Sperati, Sandra McGunegill, Arnaldo Cumbana, Magalhães Mangamela, Rassul Nalá, Matthew C. Freeman, Karen Levy, Joe Brown, The PAASIM Study Authorship Consortium

While nearly three-quarters of the globe use safely managed drinking water services, water quality can deteriorate between the point of service provision and point of consumption due to intermittent supply and the need to store water at the household level. To test if water storage contributes to waterborne pathogen hazards, we estimated prevalence and concentration of enteric pathogens in piped and stored drinking water samples in Beira, Mozambique, using large-volume sampling methods. We assessed water sample concentrates for microbial contamination from bacterial, protozoan, viral, helminthic, antimicrobial resistance (AMR), and microbial source tracking targets with RT-qPCR using a custom TaqMan Array Card. We found that enteric pathogens, AMR targets, and human mtDNA were more prevalent in stored drinking water compared to household tap water. We also detected enteric pathogens— including Cryptosporidium, Giardia, pathogenic Escherichia coli, and rotavirus— directly from 13% (11/87) of piped sources connected to a well-managed, but intermittent, water supply system, albeit less frequently than in stored water. These findings suggest that without continuity in service delivery combined with effective filtration treatment in piped supplies and safe storage microbial contamination of drinking water at the point of use may continue to occur.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000523. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Firayad Ayele, Tesfaye Assebe, Miheret Mandefro, Desalegn Admassu Ayana, Nega Assefa

Background Rotavirus and norovirus are the leading viral causes of acute diarrheal disease worldwide. Both viruses encompass multiple genotypes and subgenotypes, and this genetic diversity presents a significant challenge to rotavirus vaccine effectiveness and development. High-quality evidence on the prevalence and circulating genotypes of these enteric viruses among children under five years of age remains limited, particularly following the introduction of rotavirus vaccination in low and middle-income countries (LMICs). Therefore, this systematic review and meta-analysis aimed to synthesizes available evidence on the prevalence and genotype distribution of norovirus and rotavirus in this population. Methods A systematic literature search was conducted across five major databases PubMed, Scopus, ScienceDirect, Embase, and Web of Science between February 20 and 28, 2026. Duplicate removal, title and abstract screening, full-text review and data extraction were performed independently by two investigators using the Rayyan web-based platform. STATA version 17 software was used for statistical analysis. A random-effects model was applied to estimate pooled prevalence and effect sizes. Heterogeneity was evaluated using Cochran’s Q statistic, the I2 statistic, forest plots, and Galbraith plots. Publication bias was assessed using both graphical (funnel plots) and statistical methods. Results A total of 35,704 children under five years with diarrheal infection from LMICs were included across eligible studies. The overall pooled prevalence of norovirus and rotavirus combined was 18% (95% CI: 15–21%). Rotavirus had a higher pooled prevalence than norovirus, at 24% (95% CI: 19.6–28.3%) and 13% (95% CI: 11–15%), respectively. Substantial heterogeneity was observed across studies (I2 = 98.72%, p < 0.001). Among norovirus genotypes, GII was predominant (76%), with subgenotype GII.4 accounting for 53% of cases, followed by GI (23%). The most frequently identified rotavirus genotypes were G3[P8] (39%) and G1[P8] (17%). Conclusions Norovirus and rotavirus remain significant causes of diarrheal disease among children under five in LMICs, even after the introduction of rotavirus vaccination. Approximately one in five children with diarrheal illness were infected with at least one of these virusesGII, particularly subgenotype GII.4, was the dominant norovirus strain, while G3[P8] and G1[P8] were the most prevalent rotavirus genotypes. These findings underscore the need to strengthen surveillance systems, consider circulating genotypes in vaccine formulation, and continuously monitor genotype shifts within the population.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0359886. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Xiang Qian, Yanjing Shen, Xianzhong Luo, Siqin Zhang, Li Wang, Hualin He, Bin Wang

Early-life antibiotic (ABX) exposure profoundly disrupts gut microbiota assembly, triggering long-lasting intestinal immune stress. While fecal microbiota transplantation (FMT) is a promising intervention, its immunological and ecological mechanisms in the juvenile gut remain underexplored. In this study, juvenile mice were subjected to a broad-spectrum ABX cocktail for 8 days followed by 4 days of adult-sourced FMT. 16S rRNA sequencing (n = 6/group) revealed that ABX drastically altered the microbial landscape, causing a severe relative reduction of core commensals and an opportunistic expansion of Bacteroides. Subsequent molecular analyses on day 13 (n = 3/group) demonstrated that this dysbiosis significantly upregulated the mucosal TLR4/MyD88 signaling axis and effector cytokines IL-17 and IL-22. Strikingly, adult FMT administration effectively attenuated the TLR4 cascade and reduced pro-inflammatory cytokine transcript levels while immunoregulatory IL-10 transcripts remained partially elevated. Ecologically, FMT did not merely revert the gut to its naive juvenile baseline. Instead, it suppressed Bacteroides overgrowth and established a distinctly new, highly complex community enriched with putative mature, adult-signature taxa such as Parabacteroides, Tannerellaceae, and Desulfobacterota. Interestingly, the downregulation of TLR4 occurred concurrently with the engraftment of these Gram-negative, LPS-bearing taxa. Collectively, adult-sourced FMT ameliorates ABX-induced immune stress not by restoring the original microbiota, but by driving the juvenile gut towards a putatively mature, structurally distinct, and potentially immunologically tolerant ecological state.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0359634. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Jiayi Peng, Ji Liu, Yufeng Shen, Miao Yin, Changzheng Liu, Jie Zhou, Jia Liu, Ronghua Zhang, Qi Hong

Background Dental panoramic radiographs play an important role in oral disease screening, computer-aided diagnosis, and clinical treatment planning. However, accurate multi-class detection remains challenging due to small lesion sizes, ambiguous anatomical boundaries, insufficient multi-scale feature representation, and missed detections of complex dental structures. Objective This study aims to develop an accurate and efficient multi-class object detection framework for dental panoramic radiographs to improve the detection performance of small lesions, weak-boundary structures, and complex anatomical targets. Methods A novel re-parameterized cross-scale attention-enhanced framework, named RCTE, was proposed based on the YOLOv8n detector. The proposed framework integrates three complementary components: a Cross-Scale Channel Transformer (CSCT) module for cross-scale contextual interaction among P3, P4, and P5 features, a RepNCSPELAN4-based Re-parameterized Feature Pyramid Fusion (RPF) structure for enhancing multi-scale feature aggregation, and a Multi-Scale EMA (MS-EMA) mechanism for feature recalibration before the detection head. Experiments were conducted on a publicly available dental panoramic radiograph dataset containing 11 categories of dental structures and lesions. Model performance was evaluated using Precision, Recall, F1-score, mAP50, mAP75, and mAP50–95. Results Compared with the original YOLOv8n baseline, RCTE improved mAP50, mAP75, mAP50–95, and Recall by 2.55, 3.88, 2.40, and 5.10 percentage points, respectively. The proposed framework achieved better detection completeness and localization accuracy compared with other YOLO-based detectors. Furthermore, RCTE maintained real-time inference capability, demonstrating a favorable balance between detection accuracy and computational efficiency. Conclusion The proposed RCTE framework effectively improves multi-class object detection performance in dental panoramic radiographs by enhancing cross-scale feature interaction, multi-scale feature fusion, and detection feature recalibration. This method provides a potential solution for computer-aided dental image analysis.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0359630. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: J. L. Wallace, M. K. Wright, M. A. Camargo-Valero, K. J. Charles, B. Engebretson, B. Gordon, F. Gore, G. Howard, R. Johnston, J. Kohlitz, F. Mills, K. Moon, A. Nijhawan, T. Slaymaker, M. Takane, J. Willetts, B. E. Evans

Despite sustained efforts over several decades, no region is projected to achieve universal sanitation access by 2030, according to international monitoring frameworks. Climate change is increasingly disrupting human and ecological systems, in turn deepening existing inequalities in access to essential services, including sanitation. Coupled with broader socio-economic and political dynamics, these pressures are expected to further widen the global sanitation service gap. Strengthening the resilience of sanitation systems to climate-related impacts represents a critical component of addressing this challenge. Building resilience requires an understanding of the attributes of sanitation systems and the adaptation actions across scales that contribute to their capacity to anticipate, withstand and recover from climate hazards. While existing scholarship has primarily examined the impacts of climate hazards on sanitation system performance, less attention has been given to resilience-building processes and practices. This systematic review is the first to synthesise the evidence on resilience in sanitation systems. The review identifies twenty-seven (n = 27) attributes and adaptation actions with potential to enhance resilience, none of which are currently considered in existing global monitoring processes. Only seventeen (n = 17) studies met the inclusion criteria, and empirical evidence remains scarce, highlighting substantial knowledge gaps. Findings also reveal a dominance of user-level, infrastructure focussed actions in low-income settings, with minimal evidence on operational or enabling environment strategies implemented by service providers or government actors. These findings highlight a substantial gap between identifying potential resilience-building measures and demonstrating how they contribute to resilience sanitation systems. Strengthening the evidence base requires greater emphasis on evaluating resilience outcomes, understanding interactions across the sanitation system, and examining how institutional and operational conditions shape adaptation over time. The findings provide a foundation for developing measurable indicators of climate resilience while highlighting the need for further empirical evidence to inform international monitoring frameworks and guide effective climate resilient sanitation planning.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000474. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.