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Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002–2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16–1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19–1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.

 

Climate change driven increases in the frequency of extreme heat events (EHE) and extreme precipitation events (EPE) are contributing to both infectious and non-infectious disease burden, particularly in urban city centers. While the share of urban populations continues to grow, a comprehensive assessment of populations impacted by these threats is lacking. Using data from weather stations, climate models, and urban population growth during 1980–2017, here, we show that the concurrent rise in the frequency of EHE, EPE, and urban populations has resulted in over 500% increases in individuals exposed to EHE and EPE in the 150 most populated cities of the world. Since most of the population increases over the next several decades are projected to take place in city centers within low- and middle-income countries, skillful early warnings and community specific response strategies are urgently needed to minimize public health impacts and associated costs to the global economy. 

Abstract. Over the past decade, our understanding of the IndianOcean has advanced through concerted efforts toward measuring the oceancirculation and air–sea exchanges, detecting changes in water masses, andlinking physical processes to ecologically important variables. Newcirculation pathways and mechanisms have been discovered that controlatmospheric and oceanic mean state and variability. This review bringstogether new understanding of the ocean–atmosphere system in the IndianOcean since the last comprehensive review, describing the Indian Oceancirculation patterns, air–sea interactions, and climate variability.Coordinated international focus on the Indian Ocean has motivated theapplication of new technologies to deliver higher-resolution observationsand models of Indian Ocean processes. As a result we are discovering theimportance of small-scale processes in setting the large-scale gradients andcirculation, interactions between physical and biogeochemical processes,interactions between boundary currents and the interior, and interactions between thesurface and the deep ocean. A newly discovered regional climate mode in thesoutheast Indian Ocean, the Ningaloo Niño, has instigated more regionalair–sea coupling and marine heatwave research in the global oceans. In thelast decade, we have seen rapid warming of the Indian Ocean overlaid withextremes in the form of marine heatwaves. These events have motivatedstudies that have delivered new insight into the variability in ocean heatcontent and exchanges in the Indian Ocean and have highlighted the criticalrole of the Indian Ocean as a clearing house for anthropogenic heat. Thissynthesis paper reviews the advances in these areas in the last decade.