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Climate change is projected to negatively affect human health and nutrition. There is a growing literature on the effects of climatic changes on food availability, quantity, and agricultural production, but impacts on the nutritional content of foods has not been widely studied. The aim of this paper is to systematically characterise empirical literature exploring the effects of climatic drivers on macronutrients and micronutrients in foods causing malnutrition globally. 69 peer-reviewed empirical articles (excluding experimental and modelling studies) analysing the effect of climatic drivers on nutrients in foods were retrieved from Web of Science ^TM , Scopus ^® and PubMed ^® databases (2013–2019). Publication frequency and trends, and existing evidence of the extent of nutrient change associated with variation in climate-related conditions were assessed. There is relatively limited literature on associations between climate and nutrients in foods. Where it exists, only crude proxies of climate (e.g. wet/dry season) are used, with limited interrogation of the potential causal mechanisms linking climate to nutrient content. 98% of the articles showed a change in nutrient content in relation to a seasonal or meteorological variable. Most analysed the association of nutrient changes between seasons over 1–2 years, rarely over longer periods of time. Preliminary descriptive estimates point to variation in nutrient content by meteorological variability, particularly in ocean and freshwater food sources. Robust assessment of potential climate impacts on nutrient content of foods would benefit from more precise estimation of specific causal pathways and variables that mediate climate impacts on food, going beyond seasonal or crude proxies. There is need for clear articulation of how climate change might impact nutrient content given mechanisms linking meteorological and seasonal variation with nutrients. This research highlights emerging evidence that climate change may have impacts beyond agricultural productivity by affecting food nutrient content, an understudied but potentially important pathway for climate impact on global food and nutrition security.

A global initiative to develop low-carbon, resilient health systems-the COP26 Health Programme-launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop robust ones that are adaptable to different health-care system contexts. These indicators should be designed to capture tangible outcomes, support policy making, and prevent greenwashing. Integration of more robust indicators into independent scientific monitoring can support systematic inclusion of health care in global climate strategies, thereby enhancing the overall effectiveness of the COP26 Health Programme., Competing Interests: Declaration of interests IMB received grants from the Prince Bernhard Culture Fund, Stichting VSBFonds, and Dr Hendrik Mullerfonds, and travel grants from the London School of Hygiene & Tropical Medicine. ME received US National Science Foundation award 1454414; has received consulting fees from AstraZeneca and the WorldBank; and declares honoraria from the Institute for Healthcare Improvement and Colombia University. MH has received honoraria from the University of Bayreuth, Novartis South Africa, and Netzwerk Plurale Ökonomik; travel support from the Preventing Overdiagnosis Conference and the Lancet Commission on Sustainable Healthcare; and holds advisory roles (paid) with the South Australian Health Performance Council and Glenview Community Services. AM has received grant funding from the Wellcome Trust; has been employed by the UK National Health Service, and is currently employed by the Australian Government Department of Health and Aged Care; has been paid for consultancy services to WHO; and has received travel support from the Public Health Association of Australia. AJM has received funding from the University of British Columbia and the Canadian Medical Association, and honoraria from both for speaking. XN received partial support from the Yale Center on Climate Change and Health. PP provides consultation services (paid) for the World Bank India Office and Health Care Without Harm (Ikea Foundation), and holds advisory roles (unpaid) with CAFÉ, Connecting Climate Minds, and the Climate and Health Hub for G-20 countries. FNR has received consulting payments from Aga Khan Health Services, travel support from WISH Foundation, and is a member of the Geneva Sustainability Centre Steering Committee. MR is funded by Wellcome and Horizon Europe programmes via IDAlert and CATALYSE (payments to institution). RGR declares a research grant from the Adaptation Research Alliance, which is funded by the UK Foreign, Commonwealth and Development Office; consulting fees from Wellcome; honorarium for lectures from USAID; is a member of the International Advisory Board for The Lancet Planetary Health, chair of the Thematic Working Group on Climate-Resilient and Sustainable Health Systems of Health Systems Global, member of the WHO Technical Advisory Group on Embedding Ethics in Health and Climate Change Policy, and member of the National Panel of Technical Experts of the Climate Change Commission of the Philippines. HS has received grants from the Agency for Healthcare Research and Quality, the US Department of Veteran's Affairs Health Services Research & Development and the VA National Center for Patient Safety; and declares honoraria from the Institute for Healthcare Improvement. JDS received partial grant support (paid to institution) from the Canadian Institutes of Health Research, Commonwealth Fund, Institute for Health Research, and National Science Foundation; declares honoraria for lecture and travel from various organisations; and holds leadership roles with the American Society of Anesthesiologists and the World Federation of Societies of Anesthesiologists. DvA provides consultation services (paid) for the Pan American Health Organization (unrelated to this work). JCY is supported by the University of British Columbia. CZ-C declares salary support through contracts between Cayetano Heredia University with the University of Leeds and WHO; has provided consultation services (paid) for the University of Alberta; declares an advisory role (unpaid) with the Global Environment Outlook of the UN Environment Programme and the Indigenous Peoples Food and Agriculture Organization. All other authors declare no competing interests. All authors declare no other support from any organisation for the submitted work, no other financial relationships with any organisations that might have an interest in the submitted work in the previous 36 months, and no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Indigenous knowledge and responses were implemented during the COVID-19 pandemic to protect health, showcasing how Indigenous communities participation in health systems could be a pathway to increase resilience to emergent hazards like climate change. This study aimed to inform efforts to enhance climate change resilience in a health context by: (1) examining if and how adaptation to climate change is taking place within health systems in the Peruvian Amazon, (2) understanding how Indigenous communities and leaders' responses to climatic hazards are being articulated within the official health system and (3) to provide recommendations to increase the climate change resilience of Amazon health systems., Methods: This study was conducted among two Peruvian Amazon healthcare networks in Junin and Loreto regions. A mixed methodology design was performed using a cross-sectional survey (13 healthcare facilities), semistructured interviews (27 official health system participants and 17 Indigenous participants) and two in-person workshops to validate and select key priorities (32 participants). We used a climate-resilient health system framework linked to the WHO health systems building blocks., Results: Indigenous and official health systems in the Peruvian Amazon are adapting to climate change. Indigenous responses included the use of Indigenous knowledge on weather variability, vegetal medicine to manage health risks and networks to share food and resources. Official health responses included strategies for climate change and response platforms that acted mainly after the occurrence of climate hazards. Key pathways to articulate Indigenous and official health systems encompass incorporating Indigenous representations in climate and health governance, training the health work force, improving service delivery and access, strengthening the evidence to support Indigenous responses and increasing the budget for climate emergency responses., Conclusions: Key resilience pathways call for a broader paradigm shift in health systems that recognises Indigenous resilience as valuable for health adaptation, moves towards a more participatory health system and broadens the vision of health as a dimension inherently tied to the environment., Competing Interests: Competing interests: CZ-C declares that her salary was covered partially with funds of this study. All other authors declare no competing interests., (© World Health Organization 2024. Licensee BMJ.)

Background and Objectives: Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health., Methods: We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study., Results: From 13,041 publications screened, 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were greater in Aboriginal and Torres Strait Islander Australians (1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), compared with respective non-Indigenous populations. Studies had substantial heterogeneity in design and risk of bias. Attack rates, male-female rate ratios, and time trends are reported where available. Few investigators reported Indigenous stakeholder involvement, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations., Discussion: In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building., Registration Information: PROSPERO registration: CRD42021242367.

Climate hazards threaten the health and wellbeing of people living in urban areas. This study characterized reported climate hazards, adaptation action, and barriers to adaptation in 124 Latin American cities, and associations of climate hazards with urban social and built environment characteristics. We examined cities that responded to a global environmental disclosure system and that were included in the Urban Health in Latin America (SALURBAL) Project database. The cities studied reported a median of three climate hazards. The most reported hazards were storms (61%) water scarcity (57%) extreme temperature (52%) and wildfires (51%). Thirty-eight percent of cities reported four or more distinct types of hazards. City size, density, GDP, and greenness were related to hazard reports, and although most cities reported taking actions to reduce vulnerability to climate change, 23% reported no actions at all. The most frequently reported actions were hazard mapping and modeling (47%) and increasing vegetation or greenspace coverage (45%). Other actions, such as air quality initiatives and urban planning, were much less common (8% and 3%, respectively). In terms of challenges in adapting to climate change, 35% of cities reported no challenges. The most frequently reported challenges were urban environment and development (43%) and living conditions (35%). Access to data, migration, public health, and safety/security were rarely reported as challenges. Our results suggest that climate hazards are recognized, but that adaptation responses are limited and that many important challenges to response action are not fully recognized. This study contributes to understanding of local priorities, ongoing actions, and required support for urban climate vulnerability assessment and adaptation responses. Findings suggest the need for future research documenting local perceptions of climate hazards and comparison with documented climate hazards., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020-August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises., (© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Introduction: Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon., Methods: A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted., Results: A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not., Conclusion: The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Competing Interests: CZ-C declares that the university where she works received funds from the UK Research and Innovation (UKRI) agency under a Global Challenges Research Fund and Newton Fund Consolidation Account (GCNA) award, via the University of Leeds, to complete the current research in Peru. DBN declares that the institution where he works received funds from UKRI under a GCNA award, via the University of Leeds, to complete the current research in Uganda. JJM declares that grant support and payments have been made to his institution from the Alliance for Health Policy and Systems Research, Bloomberg Philanthropies (via the University of North Carolina Gillings School of Global Public Health), the Chilean National Fund for Scientific and Technological Development (via CIENCIACTIVA/CONCYTEC), the British Council, the British Embassy and the Newton-Paulet Fund, Wellcome Global Health Trials, Fogarty International Center, Grand Challenges Canada, International Development Research Center Canada, the Inter-American Institute for Global Change Research, the US National Cancer Institute, the US National Heart, Lung and Blood Institute, the US National Institute of Mental Health, the Swiss National Science Foundation, the UKRI Biotechnology and Biological Sciences Research Council, the UKRI Engineering and Physical Sciences Research Council, the UKRI Medical Research Council, and the World Diabetes Foundation, and had a contract with Health Action International, all of which were unrelated to this work. JJM is also co-chair of the UN Independent Group of Scientists 2023 Global Sustainable Development Report, a member of the Scientific Expert Committee of the Global Data Collaborative for CV Population Health of the World Heart Federation, Microsoft, and Novartis Foundation, a member of the Scientific and Technical Advisory Committee of the Alliance for Health Policy and Systems Research, WHO, a member of the WHO Technical Advisory Group on NCD-related Research and Innovation of the Department of Noncommunicable Diseases, WHO, and a member of the Advisory Scientific Committee of the Instituto de Investigación Nutricional (Peru). JJM also participated in the data safety monitoring board for the Nigeria Sodium Study (NaSS), the trial steering committee of the Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage trial (INTERACT 3), the international advisory board of the Latin American Brain Health Institute of Universidad Adolfo Ibáñez (Chile), the consultative board of the Programa de Gastronomía of the Facultad de Estudios Interdisciplinarios, Pontificia Universidad Católica del Perú, and an advisory board for the InterAmerican Heart Foundation. All other authors declare no competing interests.

Background : Undernutrition is projected to be a major consequence of climate change. Biodiversity could enhance climate change resilience by improving nutritional outcomes and providing healthy food resources during and/or after climate-related events. For Indigenous populations who currently base their diet on local biodiversity, rapid climate changes may affect their ability to produce, access or gather food and consequently impact their nutritional status. There is a knowledge gap regarding whether nutritional status among Indigenous populations is better among those who consume a diet with greater biodiversity than those who have a diet with low biodiversity. Objective : This study aims to investigate the role of food biodiversity (FBD) in nutritional resilience to extreme flooding events of Shawi Amazon Indigenous adults living in Peruvian communities that have experienced extreme floods in the past five years. Methods : This study will use a mixed-method sequential explanatory design. The quantitative component includes a cross-sectional survey to assess the association between food biodiversity (FBD) and the prevalence of anaemia in adults aged 15 to 60 years old (n=365). Anaemia will be evaluated using blood hemoglobin and serum ferritin. FBD will be measured with a food frequency questionnaire and a 24-hour dietary recall. Soil-transmitted helminth infections, malaria, and inflammatory biomarkers will also be evaluated. The qualitative component will include a community-based participatory approach to investigate the role of FBD in the responses to extreme floods. Male (n=14) and female (n=14) participants, previously identified in the quantitative phase with high and low levels of FBD, will be invited to participate in a Photovoice activity and semi-structured interviews. A analytical framework for climate change resilience will be used to integrate the data. Discussion : Findings will be integrated to identify nutritional resilience indicators that can inform adaptative interventions to changing climatic conditions in the Amazon and that respect Indigenous worldviews., Competing Interests: Competing interests: JC is a Director of Dietary Assessment Ltd which supports myfood24., (Copyright: © 2023 Zavaleta-Cortijo C et al.)

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps., (© 2023 The Author(s). Published by IOP Publishing Ltd.)

Background: Biomedical technologies have the potential to be advantageous in remote communities. However, information about barriers faced by users of technology in general and in remote Indigenous communities is scarce. The purpose of this study was to characterize the leading challenges faced by researchers who have used biomedical technologies in the Peruvian Amazon., Methods: This exploratory, qualitative study with a phenomenological approach depicts the lived experience of participants who were researchers with experience working with biomedical technologies in the Peruvian Amazon in the past five years. Analysis was based on three core themes: design, implementation, and acceptability. Sub-themes included environment, community, and culture. Of the 24 potential participants identified and contacted, 14 agreed to participate, and 13 met inclusion criteria and completed semi-structured interviews. Results were sent to each participant with the opportunity to provide feedback and partake in a 30-minute validation meeting. Five participants consented to a follow-up meeting to validate the results and provide further understanding., Results: Participants recognized significant challenges, including technologies designed out-of-context, difficulty transporting the technologies through the Amazon, the impact of the physical environment (e.g., humidity, flooding), and limited existing infrastructure, such as electricity and appropriately trained health personnel. Participants also identified cultural factors, including the need to address past experiences with technology and health interventions, understand and appropriately communicate community benefits, and understand the effect of demographics (e.g., age, education) on the acceptance and uptake of technology. Complementary challenges, such as corruption in authority and waste disposal, and recommendations for technological and health interventions such as co-design were also identified., Conclusions: This study proposes that technological and health interventions without efforts to respect local cultures and health priorities, or understand and anticipate contextual challenges, will not meet its goal of improving access to healthcare in remote Amazon communities. Furthermore, the implications of corruption on health services, and improper waste disposal on the environment may lead to more detrimental health inequities., (© 2022. The Author(s).)

The accelerating environmental degradation as a result of modernisation and climate change is an urgent threat to human health. Environment change can impact kidney health in a variety of ways such as water scarcity, global heating and changing biodiversity. Ever increasing industrialization of health care has a large carbon footprint, with dialysis being a major contributor. There have been calls for all stakeholders to adopt a 'one health approach' and develop mitigation and adaptation strategies to combat this challenge. Because of its exquisite sensitivity to various elements of environment change, kidney health can be a risk marker and a therapeutic target for such interventions. In this narrative review, we discuss the various mechanisms through which environmental change is linked to kidney health and the ways that the global kidney health communities can respond to environmental change.

Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: J.E.C. is Director of Dietary assessment Ltd. No other competing interests to declare., (Copyright: © 2022 Scarpa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services. The science and technology infrastructure has also evolved, although the need for substantial investments remains if advancing science is to be a national priority. Climate change will also bring significant challenges to population health given Peru's geographical and microclimates diversity. Looking back over the 200-years of independence, we present a summary of key advances in selected health-related fields, thus serving as the basis for reflections on pending agendas and future challenges, in order to look forward to ensuring the future health and wellbeing of the Peruvian population., Resumen Translated Abstract: El Perú cumple 200 años de independencia en 2021. Durante estos dos siglos de vida independiente, junto con periodos sociales y políticos turbulentos, incluyendo un conflicto armado interno, hiperinflación y la inestabilidad política de los últimos 40 años, el Perú ha experimentado importantes cambios en su perfil epidemiológico con repercusiones directas en la salud de la población. En las últimas décadas, los indicadores de salud materno-infantil y de las enfermedades transmisibles muestran mejoría importante, pero el país se enfrenta de manera simultánea a una carga cada vez mayor de enfermedades no transmisibles y de salud mental. En cuanto a los sistemas de salud pública, se han realizado esfuerzos por aumentar la cobertura y calidad de la atención de salud en todo el país, apostándose en particular por mejorar la atención primaria. La ciencia y tecnología relacionadas con la salud también han mejorado, aunque si se quiere que la ciencia sea una prioridad nacional, son necesarias inversiones sustanciales. El cambio climático traerá importantes desafíos para la salud de la población, dada la diversidad geográfica y de microclimas del país. Para conmemorar los 200 años de vida independiente del Perú, presentamos un resumen de avances clave en diversas áreas y temas relacionados con la salud. Este repaso sirve como base para reflexionar sobre agendas y desafíos pendientes y futuros, con el fin de asegurar la salud y el bienestar de la población peruana en las próximas décadas., Competing Interests: None. The arguments and opinions in this manuscript are solely those from the authors, and do not necessarily reflect the opinions from the institutions to which the authors belong., (© 2021 The Author(s).)

Comprehensive food lists and databases are a critical input for programs aiming to alleviate undernutrition. However, standard methods for developing them may produce databases that are irrelevant for marginalised groups where nutritional needs are highest. Our study provides a method for identifying critical contextual information required to build relevant food lists for Indigenous populations. For our study, we used mixed-methods study design with a community-based approach. Between July and October 2019, we interviewed 74 participants among Batwa and Bakiga communities in south-western Uganda. We conducted focus groups discussions (FGDs), individual dietary surveys and markets and shops assessment. Locally validated information on foods consumed among Indigenous populations can provide results that differ from foods listed in the national food composition tables; in fact, the construction of food lists is influenced by multiple factors such as food culture and meaning of food, environmental changes, dietary transition, and social context. Without using a community-based approach to understanding socio-environmental contexts, we would have missed 33 commonly consumed recipes and foods, and we would not have known the variety of ingredients' quantity in each recipe, and traditional foraged foods. The food culture, food systems and nutrition of Indigenous and vulnerable communities are unique, and need to be considered when developing food lists.

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the 'Global Adaptation Mapping Initiative' database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013-2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action., (© 2021 The Author(s). Published by IOP Publishing Ltd.)

Objective: To develop an online food composition database of locally consumed foods among an Indigenous population in south-western Uganda., Design: Using a community-based approach and collaboration with local nutritionists, we collected a list of foods for inclusion in the database through focus group discussions, an individual dietary survey and markets and shops assessment. The food database was then created using seven steps: identification of foods for inclusion in the database; initial data cleaning and removal of duplicate items; linkage of foods to existing generic food composition tables; mapping and calculation of the nutrient content of recipes and foods; allocating portion sizes and accompanying foods; quality checks with local and international nutritionists; and translation into relevant local languages., Setting: Kanungu District, south-western Uganda., Participants: Seventy-four participants, 36 Indigenous Batwa and 38 Bakiga, were randomly selected and interviewed to inform the development of a food list prior the construction of the food database., Results: We developed an online food database for south-western Uganda including 148 commonly consumed foods complete with values for 120 micronutrients and macronutrients. This was for use with the online dietary assessment tool myfood24. Of the locally reported foods included, 56 % (n 82 items) of the items were already available in the myfood24 database, while 25 % (n 37 items) were found in existing Ugandan and Tanzanian food databases, 18 % (n 27 items) came from generated recipes and 1 % (n 2 items) from food packaging labels., Conclusion: Locally relevant food databases are sparse for African Indigenous communities. Here, we created a tool that can be used for assessing food intake and for tracking undernutrition among the communities living in Kanungu District. This will help to develop locally relevant food and nutrition policies.

Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.

Objectives: To determine the prevalence of hepatitis B virus (HVB) infection and seroprotection in indigenous children living in three draining basins of the Peruvian Amazon., Materials and Methods: A cross sectional study was conducted in three draining basins (Pastaza, Morona and Lower Urubamba rivers), home to six indigenous populations: shapra, candoshi, machiguenga, yine, ashaninka and nanti. Children under 5 years were included. A survey and review of the vaccination card was applied, and a serum sample was processed with ELISA for HBsAg, total anti-HBc and anti-HBs was obtained, defining "seroprotected children" if they were reactive to anti-HBs and non-reactive to anti-HBc., Results: A total of 742 children under 5 years old residents in six indigenous communities were included in the study. 380 (51.2%) were male and 169 (22.9%) one year old or younger. Regarding recorded HVB vaccination on the card, only 434 (58.5%) had received three doses; 208 (38.8%) received the first dose within 24 hours. No cases were detected with HBsAg. 88.8% of children had seroconverted, varying between 67-100% across the populations., Conclusions: No cases of chronic HBV infection were detected. The vaccination coverage by card revision is low, contrasting with high seroconversion rates.