Abstract Urban sanitation remains a challenge globally, and the Citywide Inclusive Sanitation (CWIS) approach is increasingly being adopted to facilitate progress of safely managed sanitation services that reach all urban residents. The International Water Association's (IWA) Inclusive Urban Sanitation (IUS) initiative conducted this study to explore the status of CWIS implementation globally and to inform its future role in the post-Sustainable Development Goal (SDG) sanitation agenda.

Previous research has shown that online support groups for Long Covid may improve group members' wellbeing, but there is limited evidence on the role of group moderators in influencing such outcomes. Applying the social identity approach to leadership, this study sought to understand the extent to which group moderators display identity leadership and their role in influencing group members' health and wellbeing. Interviews were conducted with 10 members and seven moderators, with participants explaining how the moderators of their groups had, or had recovered from, Long Covid (prototypicality), developed and maintained the ethos of the group (entrepreneurship), hosted activities for group members (impresarioship), and engaged with policymakers, the media, and healthcare professionals (advancement). Group members reported improvements in symptom management, adjustment, and social wellbeing by engaging with online support groups, but members mostly attributed this to the support from other group members. Moderators reported finding purpose through moderating the groups, but sometimes this was to the detriment of their physical health. Overall, by engaging in identity leadership, group moderators indirectly influence the experiences between group members. Seven recommendations are provided to enhance the experiences of online support groups for both group moderators and members.

Background: Meningitis outbreaks require the rapid implementation of prophylaxis to limit transmission and reduce severe health outcomes. Evidence from similar outbreaks indicates that uptake (i.e. initiation of) and adherence to (i.e. completion of) prophylaxis can vary substantially, with implications for outbreak control. Aim: To synthesise evidence on uptake of, and adherence to, prophylactic antibiotics and vaccination during meningitis outbreaks globally and the factors associated with these health behaviours. Method: This rapid review was pre-registered (https://osf.io/mwdch). Searches were conducted in MEDLINE, Embase, APA PsycInfo, and Web of Science on 01 April 2026. PRISMA and synthesis without meta-analysis (SWiM) guidelines and NICE recommendations for risk of bias assessment were followed. Data were extracted on study context and population, outbreak characteristics, and rates and factors associated with uptake and adherence. Results: Of 8,370 records screened, 21 studies were included. Reported rates of uptake and adherence differed widely between studies. Studies consistently identified higher uptake among younger people, women/females (vs men/males), and those with higher socioeconomic status. Social and structural factors, particularly education settings, parental influence, and trust in healthcare providers affected behaviours. No patterns were observed by serotype. Evidence on adherence, particularly for antibiotics, was limited. Conclusion: The consistent finding of higher uptake in younger groups contrasts with other outbreak contexts and highlights the importance of risk perception during outbreaks. During meningitis outbreaks, older people and those who consider themselves at low risk are less likely to follow prophylaxis regimes. Accessible delivery and risk-based communication may help address this.

Recent years have seen increased reports of disruptive behavior at live music events, leading many to question the capacity of audiences to regulate their behavior. This matters both for positive audience experience and for crowd safety. Whilst some previous studies have examined violence in music audiences, there is almost no research looking at the current phenomenon of varied forms of disruption, the psychological antecedents of disruptive behavior, and potential mitigations. We report three studies addressing these questions experientially, observationally, and statistically, with interviews (n = 27), an ethnographic field study at a live music festival (n performances = 13, n interviews = 44), and a pre-registered questionnaire survey (n = 2,025). Results suggest that audience perceptions of disruption are sometimes contingent upon perceived group norms. Reports of disruption can occur where there is normative misalignment between disparate groups in attendance at the same event. Audience members do attempt to regulate each other's behavior, based on expectations of support, but some interventions can themselves be disruptive. We offer recommendations to venues and event organizers on how to reduce disruptive behavior, based on social identity and group norms. The results from the questionnaire survey have been certified as computationally reproducible by an independent statistician. Recent years have seen a rise in reports of disruptive behavior by audience members at live music events. This research suggests that some of the experiences of disruptive behavior among audience members are due to the co-presence of different groups with different understandings of appropriate conduct, but that audience members do try to regulate each other's behavior in line with assumed shared standards.

OBJECTIVE:This study assessed the feasibility of delivering and evaluating the Group Responses After Disasters and Emergencies (GRADE) training intervention among managers in trauma-exposed roles. METHOD:A pre-registered two-arm randomised controlled feasibility trial was conducted with managers from UK Government ( https://osf.io/4jt7f ). Outcomes were assessed via online surveys at three time points. Qualitative interviews explored participants' experiences of the training. RESULTS:Recruitment generated interest, but participant uptake and retention were limited. Although underpowered, peer literacy was responsive to the intervention showing a large immediate effect. There was not a reliable intervention effect on attitudes towards mental health, but qualitative findings suggest that this could be due to high pre-existing attitudes. CONCLUSION:This study suggests that the GRADE training intervention is feasible and had a positive impact on increasing managers' confidence to speak with their employees.

This pre-registered systematic review aimed to examine whether online support groups affect the health and wellbeing of individuals with a chronic condition, and what mechanisms may influence such effects. In September 2024, literature searches were conducted across electronic databases (Medline, Embase, PsycInfo, Web of Science and Google Scholar), pre-publication websites (MedRxiv and PsyArXiv) and grey literature websites. Qualitative and quantitative studies were included if they explored the impact of online support groups on the health and wellbeing outcomes of individuals with a chronic condition. The Mixed Methods Appraisal Tool was used to appraise the quality of the included studies. In total 100 papers met the inclusion criteria with their findings presented in a thematic synthesis. Health and wellbeing outcomes were categorised as: physical health, mental health, quality of life, social wellbeing, behaviour and decision-making, and adjustment. Mechanisms reported in these studies related to exchanging support, sharing experiences, content expression, and social comparison. User and group characteristics were also explored. The included studies suggest that online support groups can have a positive impact on social wellbeing, behaviour, and adjustment, with inconclusive findings for physical health and quality of life. However, there is also the possibility of a negative effect on anxiety and distress, particularly when exposed to other group members' difficult experiences. Research comparing different online group features, such as platforms, size, and duration is needed. In particular, future research should be experimental to overcome the limitations of some of the cross-sectional designs of the included studies. The review was funded by the National Institute for Health and Care Research Health Protection Research in Emergency Preparedness and Response. Pre-registration ID: CRD42023399258.

In Indonesia and many urban areas, the coexistence of on-site sanitation and groundwater supply poses faecal contamination risks. Indonesian standards recommend a minimum 10-m horizontal separation and 2-m groundwater depth for siting sanitation systems. This study evaluated the effectiveness of these criteria in Metro City by mapping wells and sanitation systems, controlling for other risk factors, and repeat measurements of groundwater depth and well contamination. E. coli was detected in 70% of wells, with a median concentration of positive samples of 47 MPN/100 mL (interquartile range 6 -727 MPN/100 mL). Although 60% of wells were within 10-m of a sanitation system, horizontal separation was not significantly associated with contamination. Shallower groundwater was significantly associated with an increased presence and high concentrations of E. coli. The 2-m threshold was associated with high contamination but not E. coli presence. Water quality and groundwater depth varied over the 2-month dry season sampling period, and associations with risk factors varied between repeat and single sample analyses. Other factors also contributed to contamination, including uncovered wells, presence of livestock and rainfall. The findings highlight the limitations of standardised siting criteria, suggesting that site-specific risk assessments may be more effective in managing water and sanitation risks.

Recent years have seen multiple reports of disruptive behaviour at live music events, leading many to question the capacity of audiences to regulate their behaviour. This matters both for positive audience experience and for crowd safety. Whilst some previous studies have examined violence in music audiences, there is almost no research looking at the current phenomenon of varied forms of disruption, the psychological antecedents of disruptive behaviour, and potential mitigations. We report three studies addressing these questions experientially, observationally, and statistically, with interviews (n = 27), an ethnographic field study (n performances = 13, n interviews = 44), and a pre-registered questionnaire survey (n = 2,025). Results suggest that audience perceptions of disruption are partly contingent upon perceived group norms. Reports of disruption are more likely to occur where there is normative misalignment between disparate groups in attendance at the same event. Audience members do attempt to regulate each other’s behaviour, based on expectations of support and normative alignment, but some interventions can themselves be disruptive. We offer recommendations to venues and event organisers on how to reduce disruptive behaviour, based on social identity and group norms.

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. It identifies twenty-seven (n=27) attributes and adaptation actions with potential to enhance resilience. However, with only seventeen (n=17) studies meeting the inclusion criteria and limited empirical evidence, substantial knowledge gaps remain. These findings underscore the urgent need for targeted research and the development of measurable indicators of climate resilience to inform international monitoring frameworks and guide effective adaptation strategies.

Sanitation approaches in low-income urban areas are predominately on-site sanitation, with septic tanks promoted as an improved sanitation solution. While a septic tank system is designed to contain sludge in the tank and discharge effluent to a soil infiltration system, in many urban contexts effluent from tanks discharge directly to open drains or surface waters. This research addresses the paucity of data on pathogen removal and discharge from septic tanks as operated in low-income contexts and the significance of this public health hazard. This study assessed the performance and risks of "septic tanks" discharging to open drains in a low-income neighbourhood in Dhaka, Bangladesh, considering the influence of usage and tank operation on concentrations of Norovirus GII, Salmonella Typhi, Vibrio cholerae, Giardia, Shigella and E. coli in the effluent and receiving drains. While 66% of septic tanks were functioning within design limits, multiple pathogens were detected in all effluent samples, with a mean concentration of 7.6 log10 MPN/100mL for E. coli and 4.2-5.6 log10 genome copies/100mL for pathogens, excluding S. Typhi which was not detected. Children's exposure to septic tank discharge in drains could result in an 18% risk of illness from Norovirus GII and 3% from Giardia annually. The pathogen reduction between the estimated septic tank inflows and measured effluent concentration ranged from 1.3 log10 MPN reduction for E. coli to 2.2 log10 genome copies reduction for Giardia. Increased coverage of septic tanks was significantly associated with reduced concentrations of Shigella in open drains compared to direct discharge from toilets, with increased reduction for septic tanks operating within design standards. Implementing septic tanks without sub-surface infiltration or treatment of effluent is a major concern. The potential health risk of exposure to septic tank effluent warrants increased attention to appropriate technical design, effluent management and alternatives such as networked sanitation.

During an emergency, it is necessary to quickly disseminate messages to the public. These communications often provide information about the emergency as well as guidance or advice aimed at ensuring the safety of the population. Successful emergency communication depends upon how rapidly and reliably a message can be disseminated, but also on how people respond to the message that they receive. To assist emergency planners tasked with developing message sets for future incidents, in this paper we report a systematic review of all studies that assessed the impact of mobile telephone alerting systems on intended and actual behaviour, to identify factors that affect their likely impact. We searched multiple databases and conferred with topic experts, resulting in a total of 22 studies which met the inclusion criteria. Our results indicate that limited data exist on how people respond to text-based warning messages and that much of the data is poor quality, indicating a need for more real-world studies.

As many individuals with Long Covid are left without formal support, they have turned to online support groups for help. Using pre-registered interviews with 21 adults with Long Covid, this study sought to understand how online support groups affected group members’ health and wellbeing and to identify whether group members develop a social identity. The reported benefits varied by the nature and size of the online support group: participants reported that smaller groups enabled a sense of community; occupation groups provided work-specific support; and larger groups helped with symptom management. Support groups validated members’ experiences, made them feel less alone, and enhanced self-efficacy through offering support and enabling participants to learn new skills. However, negative outcomes were also reported, such as increased fear and reduced wellbeing. Shared identities developed based on mutual Long Covid experiences, shared values towards illness management and pre-existing identities. Experiences also varied throughout the course of the illness as some members took time away from the support groups due to difficult posts or personal recovery. Whilst this study recognises the necessity of medical treatment for Long Covid, we recommended that individuals with Long Covid explore different support groups to find the right group for them.

Abstract Halfway through the Sustainable Development Goal (SDG) period, there has been little research on the criteria for monitoring safely managed sanitation under SDG target 6.2. For reporting against SDGs, global indicators are necessarily limited and exclude many safety aspects from a public and environmental health perspective. Primary survey data from 31,784 households in seven countries in Asia and Africa were analysed, comparing estimates of safely managed on-site sanitation based on global indicators with five complementary indicators of safety: animal access to excreta, flooding and overflow, groundwater contamination, emptying frequency, and the safety of emptying. Application of additional criteria reduced the population with safely managed sanitation by 0.4-38% for specific indicators, with the largest impact due to the risk of groundwater contamination, animal access, and containments overdue for emptying. Combining these indicators across the service chain, excluding transport and treatment, found three-quarters of on-site systems currently assessed as safely managed with global indicators were considered unsafe based on complementary indicators. A more comprehensive assessment of safety of on-site sanitation can be achieved through these indicators, which could be integrated into national monitoring systems and used to inform sanitation investments that address local health related risks.

INTRODUCTION:The concept of "working from home" is extremely topical following the COVID-19 pandemic; therefore, it is unsurprising that there has been an increased interest in collating research related to homeworking. This has been carried out by multiple reviews, all with slightly different research aims and methodologies. Collating the findings from the available reviews is therefore highly beneficial to establish the experience of homeworking to create recommendations for the future of home-based work.METHODS:An umbrella review was carried out. In June 2022, literature searches were conducted across 4 electronic databases. Published reviews of literature that used a systematic process, were focused on working from home populations, and detailed factors that could be related to the personal experience of homeworking (eg, barriers, facilitators, advantages, disadvantages) were included.RESULTS:A total of 1930 records were screened and 6 review articles were included. Results report on the following sections: working environment (eg, workplace design, space conditions), personal impact (eg, satisfaction, career impact), and health (eg, physical health, well-being) including a total of 19 themes. Mixed findings were apparent for nearly all included themes, highlighting the need to consider individual and contextual circumstances when researching working from home.CONCLUSIONS:This review establishes the importance of retaining flexibility while homeworking for employees, managers, and organizations. Essentially, a one-size-fits-all approach to working from home is impractical as individual circumstances limit application. Eight recommendations for the future of working from home are suggested.

The level of risk that onsite sanitation systems (OSS) pose to groundwater quality remains uncertain. The link between contamination and OSS can only be proved if the source, pathway, and receptor are investigated and confirmed when assessing contamination. The literature on the connection between OSS and groundwater contamination has been reviewed several times but with limited assessments of the extent to which the literature confirms that the source of contamination is an OSS, that a pathway has been identified, and that the receptor is groundwater. A systematic review was conducted on published studies and supports previous work that concluded that the removal and transport of contaminants from OSS to groundwater is complex and varies significantly according to local conditions. This variability means simple siting guidelines based on horizontal separation are not reliable. Though not always recognised in the literature, formation of a biological layer is important for removal of microbial pathogens. This layer takes months to form which impacts the performance of OSS that are new or subject to highly variable loading. Under ideal conditions of an unsaturated zone comprising fine material, faecal indicator bacteria can be reduced to detection limits within 10 metres distance. However, ideal conditions are very often not present. Multiple studies showed the presence of viruses in the absence of faecal indicator bacteria. Ingress of contaminated surface water into faulty boreholes/wells and contamination of wells from users are both often significant yet not adequately covered in the included literature. The review established that it is extremely difficult to eliminate the risk of groundwater contamination when OSS effluent is discharged into the subsurface. It is unsafe to assume that contamination can be prevented in areas with high OSS density, and further research is needed to determine the critical density threshold for different ground conditions.

Introduction Effective and safe vaccines against COVID-19 are essential to achieve global control of the coronavirus (SARS-CoV-2). Using faith centres may offer a promising route for promoting higher vaccine uptake from certain minority ethnic groups known to be more likely to be vaccine hesitant.Methods This cross-sectional study explored attendees' perceptions, experiences of being offered, and receiving COVID-19 vaccination in a local mosque in Woking, Surrey, UK. About 199 attendees completed a brief questionnaire on experiences, views, motivations about attending the mosque and vaccination on site.Results The most common ethnic groups reported were White British (39.2%) and Pakistani (22.6%); 36.2% identified as Christian, 23.6% as Muslim, 5.5% as Hindu, and 17.1% had no religion. Genders was relatively equal with 90 men (45.2%) and 98 women (49.2%), and 35-44-year-olds represented the most common age group (28.1%). Views and experiences around receiving vaccinations at the mosque were predominantly positive. Primary reasons for getting vaccinated at the mosque included convenience, accessibility, positive aspects of the venue's intercultural relations, and intentions to protect oneself against COVID-19, regardless of venue type. Negative views and experiences in regards to receiving the vaccination at the mosque were less common (7% expressed no intention of recommending the centre to others), and disliked aspects mostly referred to the travel distance and long waiting times.Conclusions Offering COVID-19 vaccination in faith centres appears acceptable for different faith groups, ensuring convenient access for communities from all religions and ethnic backgrounds. Key message What is already known on this topic Effective and safe vaccines against COVID-19 are essential to achieve global control of the coronavirus Using faith centres for providing access to health services may offer a promising route for promoting higher vaccine uptake from certain minority ethnic groups known to be more likely to be vaccine hesitant. What this study adds Convenience, accessibility, positive aspects of the venue, the importance of promoting intercultural relations, and getting vaccinated to protect oneself against COVID-19 appear to be major influencers relevant for the specific type of venue where the vaccine was offered, i.e. a mosque. Long travel distance and waiting times were barriers to recommending the centre to others. How this study might affect research, practice or policy Offering COVID-19 vaccination in faith centres appears acceptable for different faith groups. Vaccine uptake can be maximized by ensuring convenient access to the centre for communities from all religions and ethnic backgrounds. Future research should continue to explore COVID-19 vaccination behaviours and underlying beliefs in larger ethnic minority samples. Faith centres could provide an alternative location for preventative healthcare offers, such as vaccines, in local communities, therefore representing a promising approach to maximize public health impacts.

Halfway through the Sustainable Development Goal (SDG) period, there has been little research on the criteria for monitoring safely managed sanitation under SDG target 6.2. For reporting against SDGs, global indicators are necessarily limited and exclude many safety aspects from a public health perspective. Primary survey data from 31,784 households in seven countries in Asia and Africa were analysed, comparing estimates of safely managed on-site sanitation based on global indicators with five complementary indicators of safety: animal access to excreta, groundwater contamination, overdue emptying, entering containments to empty and inadequate protection during emptying. Application of additional criteria reduced the population with safely managed sanitation by 0.4-35% for specific indicators, with the largest impact due to the risk of groundwater contamination, animal access, and containments overdue for emptying. Combining these indicators across the service chain, excluding transport and treatment, found almost three-quarters of on-site systems currently assessed as safely managed with global indicators were considered unsafe based on complementary indicators. A more comprehensive assessment of safety of on-site sanitation can be achieved through these indicators, which could be integrated into national monitoring systems and used to inform sanitation investments that address local health-related risks.

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

Objective: The aim of this study was to compare the effects of different types of COVID-19 certification policy on subsequent behavioural expectations.Design: 4 x 2 between-subjects pre-registered randomised controlled trial.Method: In August 2022, participants (n = 2726) in England were presented with a scenario describing a rise in COVID-19 infections and the introduction of new protective measures. The protective measures described varied with regards to the setting (healthcare vs. recreational) and the type of policy (no certification vs. vaccination vs. vaccination or free Lateral Flow test vs. vaccination or Lateral Flow test at personal cost). Participants then answered questions on their expectations to receive another dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine and to adhere to other protective behaviours following the announcement, as well as questions based on Self-Determination Theory, COVID-19 vaccine hesitancy and broader vaccine hesitancy.Results: We found no main effects of setting or type of certification on expectation to receive the next dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine, or to adhere to other protective measures, when controlling for baseline expectations.Conclusions: These findings suggest that it is unlikely that the concept of certification, however it is framed, alters inclinations in the English population towards COVID-19 and seasonal flu vaccination or inclinations towards adhering to other protective behaviours within settings to which certification would apply. These findings are based on a hypothetical scenario and should be interpreted with caution.

Already climate-related hazards are impacting sanitation systems in Indonesia and elsewhere, and climate models indicate these hazards are likely to increase in frequency and intensity. Without due attention, to maintain existing progress on Sustainable Development Goal 6’s target 6.2 and to increase it to meet ambitions for 2030 will be difficult. City governments need new forms of evidence to respond, as well as approaches to enable them to consider sufficient breadth of strategies to adapt effectively. This paper describes a co-production research process which engaged local governments in four cities in Indonesia experiencing different climate hazards. Local government engagement took place across three stages of (i) inception and design, (ii) participation as key informants and (iii) joint analysis and engagement on the findings. We adapted and simplified a risk prioritisation process based on current literature and employed a novel framework of a ‘climate resilient sanitation system’ to prompt articulation of current and proposed climate change adaptation response actions. In contrast to many current framings of climate resilience in sanitation that focus narrowly on technical responses, the results paint a rich picture of efforts needed by city governments across all domains, including planning, institutions, financing, infrastructure and management options, user awareness, water cycle management and monitoring and evaluation. Local government commitment and improved comprehension on the implications of climate change for sanitation service delivery were key outcomes arising from the co-production process. With strengthened policy and capacity building initiatives from national level, this foundation can be supported, and Indonesian city governments will be equipped to move forward with adaptation actions that protect on-going access to sanitation services, public health and the environment.