The food-water-land-ecosystems nexus in Europe: an integrated assessment

Climate and socio-economic change impacts interact in complex ways. These are likely to cross traditional sectoral and regional boundaries with cascading indirect and potentially far reaching repercussions. This is particularly important for the food-water-land-ecosystems (FWLE) nexus. A holistic understanding of these interactions is central for devising appropriate adaptation strategies. This thesis presents a systematic methodological framework that provides new insights into understanding key sensitivities and uncertainties of these possible cross-sectoral impacts for informing future adaptation policies. The research is based on: (1) appraisal of integrated assessment models (IAMs), and (2) investigation of the direct and indirect implications of a wide range of climate and socio-economic scenarios taking into account important cross-sectoral linkages and interactions between six key European land- and water-based sectors/sub-systems (agriculture, biodiversity, coasts, forests, urban, and water). This is achieved through (1) a review of existing integrated approaches and tools, and (2) assessment and extensive application of one European IAM – the CLIMSAVE* Integrated Assessment Platform (IAP). The IAP application uses a combined approach drawing on a systematic: (i) Sensitivity analysis based on a One-Driver-at-a-Time (ODAT) approach, (ii) Scenario and uncertainty analysis based on Multiple-Drivers-at-a-Time (MDAT) approach, and (iii) Robustness Assessment of Adaptation Policies (RAAP). The key outputs include: (i) new quantitative insights into the complex interactions of the FWLE nexus and associated synergies, conflicts and trade-offs in Europe, (ii) identifying key sensitivities and uncertainties of the potential cross-sectoral impacts and adaptation policies under various scenarios of future changes in climate as well as social, technological, economic, environmental, and policy governance settings, (iii) development of a new nexus-based conceptual framework for a long-term, multi- and cross-sectoral adaptation planning, and (iv) identification of potential areas of improvement of the IAP to inform development of the next generation of IAMs to assess the FWLE nexus.The ODAT analysis demonstrates that while a large number of drivers (20 out of 25) affect most sectors/sub-systems either directly or indirectly, eight drivers are key parameters at the European scale, with important cross-sectoral implications (i.e., ‘strong’ and ‘non-linear’ impacts on more than one sector/sub-system). These include: four climatic (temperature, summer and winter precipitation, and CO2 concentration) and four socio-economic (population, GDP, food imports, and agricultural yields) factors. Considering a wide range of scenario combinations of these drivers (taking into account the ‘full’ and ‘plausible sample’ scenario ranges), the MDAT analysis demonstrates that: (i) food production is likely to be the main driver of Europe’s future landscape change dynamics (even without climate change), (ii) agriculture and land use allocation in general is often driven by complex interactions between various sectors/sub-systems, (iii) there are no clear trends/patterns in future food production under most climate scenarios, (iv) agricultural changes have significant cascading effects on other sectors/sub-systems such as forestry, biodiversity, and water and (v) there are consistent trends for biodiversity, water and flood impacts with regional variations. The results also demonstrate that the combined effects of socio-economic and climatic factors are not always additive, highlighting the complexity of understanding impacts across sectors/sub-systems and regions. As a result, adaptation policy choices are complicated and difficult, even without climate change. A better understanding of the critical trade-offs across sectors/sub-systems and regions under various adaptation options is required. Such systematic analysis provides important insights for decision-makers to devise robust adaptation policies that maximise benefits and minimise unintended consequences across sectors/sub-systems and scales. *CLIMSAVE (Climate change integrated assessment methodology for cross-sectoral adaptation and vulnerability in Europe) is an FP7 project (2010–2013) funded by the European Commission. The CLIMSAVE IAP is an interactive exploratory web-based integrated landscape change assessment model that allows stakeholders to investigate climate and socio-economic change impacts, adaptation and vulnerabilities for six key sectors/sub-systems (agriculture, biodiversity, coasts, forests, urban areas and water resources) (Harrison et al. 2013; 2015a)

Magnitude of Antiretroviral Drug toxicity in adult HIV patients in Ethiopia: A cohort study at seven teaching hospitals

Background: The introduction of antiretroviral therapy (ART) has resulted in significant mortality reduction and improvement in the quality of life. However, this has come at a cost of increased drug toxicity. The objective of this study was to assess the patterns and predictors of ART toxicity in adult HIV patients in Ethiopia.Methods: This is a prospective cohort study conducted at seven teaching hospitals between September 2009 and December 2013 involving 3921 HIV patients on ART. Adverse drug reactions (ADR) due to ART were identified based on clinical assessment and/or laboratory parameters. Multivariable random effects Poisson regression analysis was used to identify factors independently associated with toxicity.Result: ADR due to ART drugs was reported in 867 (22.1 %) of the participants; 374 (9.5%) had severe forms. About 87% of reported toxicities were limited to three organ systems – the skin, nervous system and blood. The overall incidence of ADR was 9 per 100 person years. About a third of toxicities occurred during the first six months after ART initiation with the incidence rate of 22.4 per 100 person years. Concomitant anti-tuberculosis treatment was the strongest independent predictor of toxicity.Conclusion: ADR was found to be highly prevalent in HIV patients on ART at tertiary hospitals in Ethiopia. Most of these conditions occurred early after ART initiation and in those with concomitant anti-tuberculosis treatment. Thus, routine monitoring of patients on ART should be strengthened with particular emphasis in the first 6 months. Strategies should also be devised to replace older and more toxic agents with newer and safer drugs available.Key words: HIV, ART, adverse drug reaction, incidence rate, ACM, Ethiopi

Exploratory analysis of time from HIV diagnosis to ART start, factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia

Background: the HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors.Methods: This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression.Results: 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality.Conclusion and recommendation: Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.Key words: HIV, HIV testing, enrollment, eligibility, antiretroviral therapy, mortality, Ethiopia

Choices:Future trade-offs and plausible pathways

Policy development and management of deltas in the Anthropocene involves the consideration of trade-offs and the balancing of positive and negative consequences for delta functions and the societies that rely on them. This assessment outlines policy-driven and spatial trade-offs that dominate the landscape of choice. It highlights examples of such trade-offs using plausible delta futures and the governance choices associated with them. The analysis is based on modelling broad-scale processes and individual adaptive actions. It highlights how policy choices to maximise economic growth can, for example, have unforeseen consequences such as diminished well-being for some populations. Hence the chapter concludes that trade-offs are a crucial governance challenge for future sustainability of deltas

Integrated assessment of the food-water-land-ecosystems nexus in Europe:Implications for sustainability

Climate and socio-economic change impacts are likely to cross traditional sectoral and regional boundaries with cascading indirect, and potentially far-reaching, repercussions. This is particularly important for the food-water-land-ecosystems (FWLE) nexus, which is fundamental for the achievement of at least six of the seventeen Sustainable Development Goals (SDGs). A holistic understanding of the FWLE nexus interactions and how and to what extent various exogenous drivers of change affect them is therefore central to cross-sectoral adaptation planning. Here, we present such an integrated assessment for Europe applying a regional Integrated Assessment Platform (IAP). The study explores a wide range of future climate and socio-economic scenarios using more than 900 model simulations. The results show that food production is likely to be the main driver of Europe's future landscape change dynamics (with or without climate change). Agriculture and land use allocation is often driven by complex cross-sectoral interactions with cascading effects on other sectors such as forestry, biodiversity, and water under the various scenarios. The modelling also highlighted that while sustaining current levels of food production at the European level could be achievable under most climate and socio-economic scenarios, there are significant regional differences with winners and losers. The analysis raises the question of whether current production and consumption policies are sustainable in the long-term. Such systematic integrated model-based analysis plays a crucial role in informing development of cross-sectoral policies that maximise synergies and minimise trade-offs across nexus sectors, regions, and scenarios. This is essential to achieve the SDGs

Designing adaptation policy trajectories

This document provides a description of the adaptation policy trajectories planned for use in the ‘Deltas, Vulnerability & Climate Change: Migration and Adaptation’ (DECCMA) model. It provides policy makers with insight into the impact of policy choices that specifically address adaptation to climate change. It explains the framework of elements that influence commitment to significant policy change and investment in adaptation policy trajectories. Interventions need to address drivers of vulnerability, disaster risk reduction, land use and ecosystem resilience. DECCMA’s geographical focus is on the Volta in Ghana, the Mahanadi in India, and the Ganges-Brahmaputra-Meghna (GBM) spanning India and Bangladesh.UK’s Department for International Development (DFID

Deltas, vulnerability and climate change ; migration and adaptation (DECCMA) CARIAA consortium final technical report 2018

This report summarises the main outcomes and learning from management and delivery of the nearly 5-year “DEltas, vulnerability and Climate Change; Migration and Adaptation” (DECCMA) project within the “Collaborative Adaptation Research Initiative in Africa and Asia” (CARIAA) programme. DECCMA considered climate change and deltas with a strong focus on adaptation and migration within deltas, including migration as an adaptation. It was committed to being gender-sensitive in research approach, data collection, and analysis. Globally deltas and their environs house 500 million (or 7 percent of global population) people on one percent of the land area, with a concentration of populated deltas at mid and low latitudes. Deltas are highly dynamic biophysically. This includes a high vulnerability to sea-level rise and climate change, and also subsidence (deltas sink), exacerbating global changes in sea level. Deltas are also socially dynamic, with changing land use, economies and strong trends of migration that have potential to be modified under future environmental and climate change

Burden of disease attributable to suboptimal diet, metabolic risks, and low physical activity in Ethiopia and comparison with Eastern sub-Saharan African countries, 1990-2015: findings from the Global Burden of Disease Study 2015

Background: Twelve of the 17 Sustainable Development Goals (SDGs) are related to malnutrition (both under- and overnutrition), other behavioral, and metabolic risk factors. However, comparative evidence on the impact of behavioral and metabolic risk factors on disease burden is limited in sub-Saharan Africa (SSA), including Ethiopia. Using data from the Global Burden of Disease (GBD) Study, we assessed mortality and disability-adjusted life years (DALYs) attributable to child and maternal undernutrition (CMU), dietary risks, metabolic risks and low physical activity for Ethiopia. The results were compared with 14 other Eastern SSA countries. Methods: Databases from GBD 2015, that consist of data from 1990 to 2015, were used. A comparative risk assessment approach was utilized to estimate the burden of disease attributable to CMU, dietary risks, metabolic risks and low physical activity. Exposure levels of the risk factors were estimated using spatiotemporal Gaussian process regression (ST-GPR) and Bayesian meta-regression models. Results: In 2015, there were 58,783 [95% uncertainty interval (UI): 43,653-76,020] or 8.9% [95% UI: 6.1-12.5] estimated all-cause deaths attributable to CMU, 66,269 [95% UI: 39,367-106,512] or 9.7% [95% UI: 7.4-12.3] to dietary risks, 105,057 [95% UI: 66,167-157,071] or 15.4% [95% UI: 12.8-17.6] to metabolic risks and 5808 [95% UI: 3449-9359] or 0.9% [95% UI: 0.6-1.1]to low physical activity in Ethiopia. While the age-adjusted proportion of all-cause mortality attributable to CMU decreased significantly between 1990 and 2015, it increased from 10.8% [95% UI: 8.8-13.3] to 14.5% [95% UI: 11.7-18.0] for dietary risks and from 17.0% [95% UI: 15.4-18.7] to 24.2% [95% UI: 22.2-26.1] for metabolic risks. In 2015, Ethiopia ranked among the top four countries (of 15 Eastern SSA countries) in terms of mortality and DALYs based on the age-standardized proportion of disease attributable to dietary risks and metabolic risks. Conclusions: In Ethiopia, while there was a decline in mortality and DALYs attributable to CMU over the last two and half decades, the burden attributable to dietary and metabolic risks have increased during the same period. Lifestyle and metabolic risks of NCDs require more attention by the primary health care system of in the country

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990–2013: findings from the Global Burden of Disease Study 2013

Background: Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990–2013. Methods: We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used. Results: Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1–4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap. Conclusions: LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors