Fresh produce, when consumed raw, can be a source of exposure to antimicrobial residues, antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) of clinical importance. This review aims to determine: (1) the presence and abundance of antimicrobial residues, ARB and ARGs in fresh agricultural products sold in retail markets and consumed raw; (2) associated health risks in humans; and (3) pathways through which fresh produce becomes contaminated with ARB/ARGs. We searched the Ovid Medline, Web of Science and Hinari databases as well as grey literature, and identified 40 articles for inclusion. All studies investigated the occurrence of multidrug-resistant bacteria, and ten studies focused on ARGs in fresh produce, while none investigated antimicrobial residues. The most commonly observed ARB were E. coli (42.5%) followed by Klebsiella spp. (22.5%), and Salmonella spp. (20%), mainly detected on lettuce. Twenty-five articles mentioned health risks from consuming fresh produce but none quantified the risk. About half of the articles stated produce contamination occurred during pre- and post-harvest processes. Our review indicates that good agricultural and manufacturing practices, behavioural change communication and awareness-raising programs are required for all stakeholders along the food production and consumption supply chain to prevent ARB/ARG exposure through produce.

Background: The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment. Objective: We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge. Methods: We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113). Results: This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases. Conclusions: Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals. International Registered Report Identifier (IRRID): PRR1-10.2196/33365

Citywide inclusive sanitation (CWIS) is becoming the dominant paradigm for achieving safe sanitation for all by 2030. Its technical benefits have been explored, but the bargaining over financial and organizational changes CWIS entails have not yet been adequately addressed. Our case study explains the stalled rollout of CWIS in Dhaka, Bangladesh. We analyse policy pathways over the past 30 years through a combined territorial political economy and power perspective to understand their effects on equality. We highlight how donors link the introduction of CWIS to the organization of sanitation through a market; how the utility uses CWIS as an opportunity to avoid costly responsibilities in non-sewered sanitation; and how service co-production through community-based solutions is neglected. CWIS has successfully overcome the dogmatic technological focus in the sanitation system, but for citywide sanitation to be scaled inclusively, the dogmatic focus in the organization and financing of the sanitation sector must also be overcome.

Background: Street food is readily available food and beverages sold by vendors, frequently situated along streets or other public spaces. Street food is largely popular because it is low cost and readily available. However, unsafe food hygiene behaviors and conditions contribute to a substantial burden of foodborne illness. There is a gap in understanding what factors determine food hygiene behavior among street food vendors and consumers in low-income countries (LICs) and low- and middle-income countries (LMICs). Objective: This review aims to identify the determinants of safe food hygiene behavior and explore the effectiveness of food hygiene interventions for vendors and consumers in LICs and LMICs. Methods: We will search the PubMed, Cochrane Library, Web of Science, ProQuest, and Scopus databases for peer-reviewed articles and Google and Google Scholar for gray literature published in the English language from inception to October 31, 2023. We will apply the World Bank 2023 definition of LICs and LMICs to include studies from these countries in this review. Two independent reviewers will search, screen, and analyze the included literature. Data will be analyzed by narrative synthesis for all objectives. Results: This protocol outlines the methodology for conducting a scoping review. The findings will identify gaps in the existing literature and map the determinants of street food hygiene, as well as the interventions implemented for street food vendors and consumers. The project received funding in October 2022 and institutional review board approval in December 2022. Data analysis is currently underway, and the first results are expected to be submitted for publication in April 2026. Conclusions: To the best of our knowledge, this will be the first scoping review to investigate the determinants of street food hygiene behaviors and the effectiveness of interventions for vendors and consumers on street food hygiene in LICs and LMICs.

BACKGROUND Street food comprises prepared and readily available food and drinks sold by vendors, frequently situated along streets. It is popular among people of all classes as it is low-cost and readily available. However, unsafe food hygiene practices contribute to a substantial burden of foodborne illness particularly in insufficient hygiene during street food preparation, handling, storage, and serving leads. There is a gap in understanding how to change food hygiene behaviour sustainably among street food vendors and consumers in low income countries (LICs) and low- and middle-income countries (LMICs). OBJECTIVE This review aims to identify the determinants of safe food hygiene behaviour and assess the effectiveness of food hygiene interventions for vendors and consumers in LICs and LMICs. METHODS We will search PubMed, Cochrane Library, Web of Science, ProQuest, and Scopus for peer-reviewed articles, and Google and Google Scholar for grey literature published in the English language from inception to 31 October 2023. We will apply the World Bank 2023 definition of LICs and LMICs to include studies from these countries in this review. Two independent reviewers will search, screen, and analyze the included literature. The determinant will be encoded in accordance with the behaviour centered design (BCD) checklist's definitions.Data will be analyzed by narrative synthesis for all objectives. If feasible, a meta-analysis will be performed for intervention studies. RESULTS This proposal outlines our proposed methodology for conducting a scoping review. The finding will generate an overview of the evidence available in the existing literature through searches of different databases. CONCLUSIONS To the best of our knowledge, this will be the first scoping review investigating the determinants of street food hygiene behaviours and evaluating the effectiveness of interventions for vendors and consumers on street food hygiene in LICs and LMICs. Findings will lay the groundwork for a future street food safety network.

Households without access to a functioning and well-managed sanitation system produce untreated faecal waste. While connecting households to sewers is ideal in densely populated low-income areas, the connection rates often remain low. Most interventions to increase connectivity focused on addressing financial, social, and legal barriers; there is limited evidence on the effectiveness of behaviour change interventions in promoting sewer connections. Thus, we aim to understand the effectiveness of behaviour change interventions in increasing the uptake of sewer connections. We developed a review protocol with key search terms relating to households, sewers, behaviour change interventions, promotion, and effectiveness. We aimed to identify both the types of interventions deployed and their impact on increasing household sewer connections. Eleven articles met the eligibility criteria and were included in the review. Findings indicate that changes in rates of connection were associated with interventions that included a blend of indirect financial subsidy in the form of a free connection and community-engagement activities. There was limited evidence that behaviour change campaigns without financial incentives lead to changes in sewer connection rates. A multi-component package involving financial subsidies with community engagement is likely to improve the sewer connection rate.