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BT 15.000 718.042 Td /F2 21.0 Tf  [(Health Effects of Drought: a Systematic Review of the Evidence)] TJ ET
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BT 15.000 700.036 Td /F3 9.8 Tf  [(June 5, 2013)] TJ ET
BT 69.971 700.036 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 74.846 700.036 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 688.195 Td /F1 9.8 Tf  [(Carla Stanke)] TJ ET
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BT 320.410 688.195 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
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BT 26.250 677.023 Td /F4 9.0 Tf  [(1)] TJ ET
BT 31.254 677.023 Td /F1 9.0 Tf  [( Extreme Events and Health Protection Section, Health Protection Agency, London, UK)] TJ ET
BT 26.250 665.301 Td /F1 9.8 Tf  [(Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the Evidence. )] TJ ET
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BT 26.250 624.294 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 604.340 Td /F1 9.8 Tf  [(Introduction.)] TJ ET
BT 26.250 592.435 Td /F1 9.8 Tf  [(Climate change projections indicate that droughts will become more intense in the 21 century in some areas of the world. The )] TJ ET
BT 569.237 592.435 Td /F1 9.8 Tf  [(El )] TJ ET
BT 26.250 580.530 Td /F1 9.8 Tf  [(Ni�o Southern Oscillation is associated with drought in some countries, and forecasts can provide advance warning of the )] TJ ET
BT 26.250 568.626 Td /F1 9.8 Tf  [(increased risk of adverse climate conditions. The most recent available data from EMDAT estimates that over 50 million people )] TJ ET
BT 26.250 556.721 Td /F1 9.8 Tf  [(globally were affected by drought in 2011. Documentation of the health effects of drought is difficult, given the complexity in )] TJ ET
BT 26.250 544.816 Td /F1 9.8 Tf  [(assigning a beginning/end and because effects tend to accumulate over time. Most health impacts are indirect because of its )] TJ ET
BT 26.250 532.911 Td /F1 9.8 Tf  [(link to other mediating circumstances like loss of livelihoods.)] TJ ET
BT 26.250 513.507 Td /F1 9.8 Tf  [(Methods.)] TJ ET
BT 26.250 501.602 Td /F1 9.8 Tf  [(The following databases were searched: MEDLINE; CINAHL; Embase; PsychINFO, Cochrane Collection. Key references from )] TJ ET
BT 26.250 489.697 Td /F1 9.8 Tf  [(extracted papers were hand-searched, and advice from experts was sought for further sources of literature. Inclusion criteria for )] TJ ET
BT 26.250 477.792 Td /F1 9.8 Tf  [(papers summarised in tables include: explicit link made between drought as exposure and human health outcomes; all study )] TJ ET
BT 26.250 465.888 Td /F1 9.8 Tf  [(designs/methods; all countries/contexts; any year of publication. Exclusion criteria include: drought meaning shortage unrelated )] TJ ET
BT 26.250 453.983 Td /F1 9.8 Tf  [(to climate; papers not published in English; studies on dry/arid climates unless drought was noted as an abnormal climatological )] TJ ET
BT 26.250 442.078 Td /F1 9.8 Tf  [(event. No formal quality evaluation was used on papers meeting inclusion criteria.)] TJ ET
BT 26.250 422.673 Td /F1 9.8 Tf  [(Results.)] TJ ET
BT 26.250 410.769 Td /F1 9.8 Tf  [(87 papers meeting the inclusion criteria are summarised in tables. Additionally, 59 papers not strictly meeting the inclusion )] TJ ET
BT 26.250 398.864 Td /F1 9.8 Tf  [(criteria are used as supporting text in relevant parts of the results section. Main categories of findings include: nutrition-related )] TJ ET
BT 26.250 386.959 Td /F1 9.8 Tf  [(effects \(including general malnutrition and mortality, micronutrient malnutrition, and anti-nutrient consumption\); water-related )] TJ ET
BT 26.250 375.054 Td /F1 9.8 Tf  [(disease \(including E coli, cholera and algal bloom\); airborne and dust-related disease \(including silo gas exposure and )] TJ ET
BT 26.250 363.150 Td /F1 9.8 Tf  [(coccidioidomycosis\); vector borne disease \(including malaria, dengue and West Nile Virus\); mental health effects \(including )] TJ ET
BT 26.250 351.245 Td /F1 9.8 Tf  [(distress and other emotional consequences\); and other health effects \(including wildfire, effects of migration, and damage to )] TJ ET
BT 26.250 339.340 Td /F1 9.8 Tf  [(infrastructure\).)] TJ ET
BT 26.250 319.935 Td /F1 9.8 Tf  [(Conclusions.)] TJ ET
BT 26.250 308.031 Td /F1 9.8 Tf  [(The probability of drought-related health impacts varies widely and largely depends upon drought severity, baseline population )] TJ ET
BT 26.250 296.126 Td /F1 9.8 Tf  [(vulnerability, existing health and sanitation infrastructure, and available resources with which to mitigate impacts as they occur. )] TJ ET
BT 26.250 284.221 Td /F1 9.8 Tf  [(The socio-economic environment in which drought occurs influences the resilience of the affected population. Forecasting can )] TJ ET
BT 26.250 272.316 Td /F1 9.8 Tf  [(be used to provide advance warning of the increased risk of adverse climate conditions and can support the disaster risk )] TJ ET
BT 26.250 260.412 Td /F1 9.8 Tf  [(reduction process. Despite the complexities involved in documentation, research should continue and results should be shared )] TJ ET
BT 26.250 248.507 Td /F1 9.8 Tf  [(widely in an effort to strengthen drought preparedness and response activities.)] TJ ET
BT 26.250 211.904 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 191.950 Td /F1 9.8 Tf  [(There are no financial relationships relevant to this article to disclose.)] TJ ET
BT 26.250 162.848 Td /F4 12.0 Tf  [(INTRODUCTION)] TJ ET
BT 26.250 142.893 Td /F1 9.8 Tf  [(Reflecting awareness of the realities of climate change and the need to manage its wide-ranging effects)] TJ ET
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BT 26.250 130.989 Td /F1 9.8 Tf  [(great international interest by emergency coordinators and humanitarian assistance agencies in the impacts of extreme weather )] TJ ET
BT 26.250 119.084 Td /F1 9.8 Tf  [(events and natural disasters on human health. While the health impacts of events such as flooding )] TJ ET
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BT 38.297 107.179 Td /F1 9.8 Tf  [( are relatively well described, there is limited evidence on the health impacts of drought.)] TJ ET
BT 26.250 87.774 Td /F1 9.8 Tf  [(While there are uncertainties about global-scale trends in droughts, the Intergovernmental Panel on Climate Change \(IPCC\) has )] TJ ET
BT 26.250 75.870 Td /F1 9.8 Tf  [(identified some worrying projections on the future of drought events worldwide. Some regions of the world have experienced )] TJ ET
BT 26.250 63.965 Td /F1 9.8 Tf  [(longer and more intense droughts \(southern Europe and West Africa\) while in other regions droughts have become less )] TJ ET
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BT 26.250 40.155 Td /F1 9.8 Tf  [(influence has contributed to the increase in droughts in the second half of the 20)] TJ ET
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Health Effects of Drought: a Systematic Review of the Evidence)] TJ ET
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BT 15.000 700.036 Td /F3 9.8 Tf  [(June 5, 2013)] TJ ET
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BT 74.846 700.036 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 688.195 Td /F1 9.8 Tf  [(Carla Stanke)] TJ ET
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BT 247.801 688.195 Td /F1 9.8 Tf  [(Jolyon Medlock)] TJ ET
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BT 320.410 688.195 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
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BT 31.254 677.023 Td /F1 9.0 Tf  [( Extreme Events and Health Protection Section, Health Protection Agency, London, UK)] TJ ET
BT 26.250 665.301 Td /F1 9.8 Tf  [(Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the Evidence. )] TJ ET
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BT 26.250 624.294 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 604.340 Td /F1 9.8 Tf  [(Introduction.)] TJ ET
BT 26.250 592.435 Td /F1 9.8 Tf  [(Climate change projections indicate that droughts will become more intense in the 21 century in some areas of the world. The )] TJ ET
BT 569.237 592.435 Td /F1 9.8 Tf  [(El )] TJ ET
BT 26.250 580.530 Td /F1 9.8 Tf  [(Ni�o Southern Oscillation is associated with drought in some countries, and forecasts can provide advance warning of the )] TJ ET
BT 26.250 568.626 Td /F1 9.8 Tf  [(increased risk of adverse climate conditions. The most recent available data from EMDAT estimates that over 50 million people )] TJ ET
BT 26.250 556.721 Td /F1 9.8 Tf  [(globally were affected by drought in 2011. Documentation of the health effects of drought is difficult, given the complexity in )] TJ ET
BT 26.250 544.816 Td /F1 9.8 Tf  [(assigning a beginning/end and because effects tend to accumulate over time. Most health impacts are indirect because of its )] TJ ET
BT 26.250 532.911 Td /F1 9.8 Tf  [(link to other mediating circumstances like loss of livelihoods.)] TJ ET
BT 26.250 513.507 Td /F1 9.8 Tf  [(Methods.)] TJ ET
BT 26.250 501.602 Td /F1 9.8 Tf  [(The following databases were searched: MEDLINE; CINAHL; Embase; PsychINFO, Cochrane Collection. Key references from )] TJ ET
BT 26.250 489.697 Td /F1 9.8 Tf  [(extracted papers were hand-searched, and advice from experts was sought for further sources of literature. Inclusion criteria for )] TJ ET
BT 26.250 477.792 Td /F1 9.8 Tf  [(papers summarised in tables include: explicit link made between drought as exposure and human health outcomes; all study )] TJ ET
BT 26.250 465.888 Td /F1 9.8 Tf  [(designs/methods; all countries/contexts; any year of publication. Exclusion criteria include: drought meaning shortage unrelated )] TJ ET
BT 26.250 453.983 Td /F1 9.8 Tf  [(to climate; papers not published in English; studies on dry/arid climates unless drought was noted as an abnormal climatological )] TJ ET
BT 26.250 442.078 Td /F1 9.8 Tf  [(event. No formal quality evaluation was used on papers meeting inclusion criteria.)] TJ ET
BT 26.250 422.673 Td /F1 9.8 Tf  [(Results.)] TJ ET
BT 26.250 410.769 Td /F1 9.8 Tf  [(87 papers meeting the inclusion criteria are summarised in tables. Additionally, 59 papers not strictly meeting the inclusion )] TJ ET
BT 26.250 398.864 Td /F1 9.8 Tf  [(criteria are used as supporting text in relevant parts of the results section. Main categories of findings include: nutrition-related )] TJ ET
BT 26.250 386.959 Td /F1 9.8 Tf  [(effects \(including general malnutrition and mortality, micronutrient malnutrition, and anti-nutrient consumption\); water-related )] TJ ET
BT 26.250 375.054 Td /F1 9.8 Tf  [(disease \(including E coli, cholera and algal bloom\); airborne and dust-related disease \(including silo gas exposure and )] TJ ET
BT 26.250 363.150 Td /F1 9.8 Tf  [(coccidioidomycosis\); vector borne disease \(including malaria, dengue and West Nile Virus\); mental health effects \(including )] TJ ET
BT 26.250 351.245 Td /F1 9.8 Tf  [(distress and other emotional consequences\); and other health effects \(including wildfire, effects of migration, and damage to )] TJ ET
BT 26.250 339.340 Td /F1 9.8 Tf  [(infrastructure\).)] TJ ET
BT 26.250 319.935 Td /F1 9.8 Tf  [(Conclusions.)] TJ ET
BT 26.250 308.031 Td /F1 9.8 Tf  [(The probability of drought-related health impacts varies widely and largely depends upon drought severity, baseline population )] TJ ET
BT 26.250 296.126 Td /F1 9.8 Tf  [(vulnerability, existing health and sanitation infrastructure, and available resources with which to mitigate impacts as they occur. )] TJ ET
BT 26.250 284.221 Td /F1 9.8 Tf  [(The socio-economic environment in which drought occurs influences the resilience of the affected population. Forecasting can )] TJ ET
BT 26.250 272.316 Td /F1 9.8 Tf  [(be used to provide advance warning of the increased risk of adverse climate conditions and can support the disaster risk )] TJ ET
BT 26.250 260.412 Td /F1 9.8 Tf  [(reduction process. Despite the complexities involved in documentation, research should continue and results should be shared )] TJ ET
BT 26.250 248.507 Td /F1 9.8 Tf  [(widely in an effort to strengthen drought preparedness and response activities.)] TJ ET
BT 26.250 211.904 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 191.950 Td /F1 9.8 Tf  [(There are no financial relationships relevant to this article to disclose.)] TJ ET
BT 26.250 162.848 Td /F4 12.0 Tf  [(INTRODUCTION)] TJ ET
BT 26.250 142.893 Td /F1 9.8 Tf  [(Reflecting awareness of the realities of climate change and the need to manage its wide-ranging effects)] TJ ET
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BT 472.800 144.401 Td /F4 8.7 Tf  [(1)] TJ ET
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BT 477.619 142.893 Td /F1 9.8 Tf  [(, there is currently )] TJ ET
BT 26.250 130.989 Td /F1 9.8 Tf  [(great international interest by emergency coordinators and humanitarian assistance agencies in the impacts of extreme weather )] TJ ET
BT 26.250 119.084 Td /F1 9.8 Tf  [(events and natural disasters on human health. While the health impacts of events such as flooding )] TJ ET
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BT 453.300 120.591 Td /F4 8.7 Tf  [(2)] TJ ET
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BT 458.119 119.084 Td /F1 9.8 Tf  [(, heat waves )] TJ ET
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BT 515.566 120.591 Td /F4 8.7 Tf  [(3)] TJ ET
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BT 520.384 119.084 Td /F1 9.8 Tf  [( and wildfires )] TJ ET
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BT 31.069 111.067 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 33.478 108.686 Td /F4 8.7 Tf  [(5)] TJ ET
0.271 0.267 0.267 rg
BT 38.297 107.179 Td /F1 9.8 Tf  [( are relatively well described, there is limited evidence on the health impacts of drought.)] TJ ET
BT 26.250 87.774 Td /F1 9.8 Tf  [(While there are uncertainties about global-scale trends in droughts, the Intergovernmental Panel on Climate Change \(IPCC\) has )] TJ ET
BT 26.250 75.870 Td /F1 9.8 Tf  [(identified some worrying projections on the future of drought events worldwide. Some regions of the world have experienced )] TJ ET
BT 26.250 63.965 Td /F1 9.8 Tf  [(longer and more intense droughts \(southern Europe and West Africa\) while in other regions droughts have become less )] TJ ET
BT 26.250 52.060 Td /F1 9.8 Tf  [(frequent, less intense or shorter \(central North America and northwestern Australia\))] TJ ET
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BT 385.508 53.567 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 390.327 52.060 Td /F1 9.8 Tf  [(, and it is more likely than not that human )] TJ ET
BT 26.250 40.155 Td /F1 9.8 Tf  [(influence has contributed to the increase in droughts in the second half of the 20)] TJ ET
BT 372.034 44.044 Td /F1 8.7 Tf  [(th)] TJ ET
BT 379.262 40.155 Td /F1 9.8 Tf  [( century )] TJ ET
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BT 416.653 41.663 Td /F4 8.7 Tf  [(6)] TJ ET
0.271 0.267 0.267 rg
BT 421.472 40.155 Td /F1 9.8 Tf  [(. Because of reduced precipitation )] TJ ET
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15.000 709.302 577.500 28.698 re W n
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Health Effects of Drought: a Systematic Review of the Evidence)] TJ ET
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BT 15.000 700.036 Td /F3 9.8 Tf  [(June 5, 2013)] TJ ET
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BT 74.846 700.036 Td /F3 9.8 Tf  [(Research Article)] TJ ET
BT 26.250 688.195 Td /F1 9.8 Tf  [(Carla Stanke)] TJ ET
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BT 82.605 692.083 Td /F1 8.7 Tf  [(1)] TJ ET
BT 87.424 688.195 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 92.845 688.195 Td /F1 9.8 Tf  [(Marko Kerac)] TJ ET
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BT 148.108 688.195 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 153.529 688.195 Td /F1 9.8 Tf  [(Christel Prudhomme)] TJ ET
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BT 242.380 688.195 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 247.801 688.195 Td /F1 9.8 Tf  [(Jolyon Medlock)] TJ ET
0.271 0.267 0.267 rg
BT 314.989 688.195 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 320.410 688.195 Td /F1 9.8 Tf  [(Virginia Murray)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 677.023 Td /F4 9.0 Tf  [(1)] TJ ET
BT 31.254 677.023 Td /F1 9.0 Tf  [( Extreme Events and Health Protection Section, Health Protection Agency, London, UK)] TJ ET
BT 26.250 665.301 Td /F1 9.8 Tf  [(Stanke C, Kerac M, Prudhomme C, Medlock J, Murray V. Health Effects of Drought: a Systematic Review of the Evidence. )] TJ ET
BT 26.250 653.397 Td /F1 9.8 Tf  [(PLOS Currents Disasters. 2013 Jun 5 . Edition 1. doi: 10.1371/currents.dis.7a2cee9e980f91ad7697b570bcc4b004.)] TJ ET
q
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0.271 0.267 0.267 rg
BT 26.250 624.294 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 604.340 Td /F1 9.8 Tf  [(Introduction.)] TJ ET
BT 26.250 592.435 Td /F1 9.8 Tf  [(Climate change projections indicate that droughts will become more intense in the 21 century in some areas of the world. The )] TJ ET
BT 569.237 592.435 Td /F1 9.8 Tf  [(El )] TJ ET
BT 26.250 580.530 Td /F1 9.8 Tf  [(Ni�o Southern Oscillation is associated with drought in some countries, and forecasts can provide advance warning of the )] TJ ET
BT 26.250 568.626 Td /F1 9.8 Tf  [(increased risk of adverse climate conditions. The most recent available data from EMDAT estimates that over 50 million people )] TJ ET
BT 26.250 556.721 Td /F1 9.8 Tf  [(globally were affected by drought in 2011. Documentation of the health effects of drought is difficult, given the complexity in )] TJ ET
BT 26.250 544.816 Td /F1 9.8 Tf  [(assigning a beginning/end and because effects tend to accumulate over time. Most health impacts are indirect because of its )] TJ ET
BT 26.250 532.911 Td /F1 9.8 Tf  [(link to other mediating circumstances like loss of livelihoods.)] TJ ET
BT 26.250 513.507 Td /F1 9.8 Tf  [(Methods.)] TJ ET
BT 26.250 501.602 Td /F1 9.8 Tf  [(The following databases were searched: MEDLINE; CINAHL; Embase; PsychINFO, Cochrane Collection. Key references from )] TJ ET
BT 26.250 489.697 Td /F1 9.8 Tf  [(extracted papers were hand-searched, and advice from experts was sought for further sources of literature. Inclusion criteria for )] TJ ET
BT 26.250 477.792 Td /F1 9.8 Tf  [(papers summarised in tables include: explicit link made between drought as exposure and human health outcomes; all study )] TJ ET
BT 26.250 465.888 Td /F1 9.8 Tf  [(designs/methods; all countries/contexts; any year of publication. Exclusion criteria include: drought meaning shortage unrelated )] TJ ET
BT 26.250 453.983 Td /F1 9.8 Tf  [(to climate; papers not published in English; studies on dry/arid climates unless drought was noted as an abnormal climatological )] TJ ET
BT 26.250 442.078 Td /F1 9.8 Tf  [(event. No formal quality evaluation was used on papers meeting inclusion criteria.)] TJ ET
BT 26.250 422.673 Td /F1 9.8 Tf  [(Results.)] TJ ET
BT 26.250 410.769 Td /F1 9.8 Tf  [(87 papers meeting the inclusion criteria are summarised in tables. Additionally, 59 papers not strictly meeting the inclusion )] TJ ET
BT 26.250 398.864 Td /F1 9.8 Tf  [(criteria are used as supporting text in relevant parts of the results section. Main categories of findings include: nutrition-related )] TJ ET
BT 26.250 386.959 Td /F1 9.8 Tf  [(effects \(including general malnutrition and mortality, micronutrient malnutrition, and anti-nutrient consumption\); water-related )] TJ ET
BT 26.250 375.054 Td /F1 9.8 Tf  [(disease \(including E coli, cholera and algal bloom\); airborne and dust-related disease \(including silo gas exposure and )] TJ ET
BT 26.250 363.150 Td /F1 9.8 Tf  [(coccidioidomycosis\); vector borne disease \(including malaria, dengue and West Nile Virus\); mental health effects \(including )] TJ ET
BT 26.250 351.245 Td /F1 9.8 Tf  [(distress and other emotional consequences\); and other health effects \(including wildfire, effects of migration, and damage to )] TJ ET
BT 26.250 339.340 Td /F1 9.8 Tf  [(infrastructure\).)] TJ ET
BT 26.250 319.935 Td /F1 9.8 Tf  [(Conclusions.)] TJ ET
BT 26.250 308.031 Td /F1 9.8 Tf  [(The probability of drought-related health impacts varies widely and largely depends upon drought severity, baseline population )] TJ ET
BT 26.250 296.126 Td /F1 9.8 Tf  [(vulnerability, existing health and sanitation infrastructure, and available resources with which to mitigate impacts as they occur. )] TJ ET
BT 26.250 284.221 Td /F1 9.8 Tf  [(The socio-economic environment in which drought occurs influences the resilience of the affected population. Forecasting can )] TJ ET
BT 26.250 272.316 Td /F1 9.8 Tf  [(be used to provide advance warning of the increased risk of adverse climate conditions and can support the disaster risk )] TJ ET
BT 26.250 260.412 Td /F1 9.8 Tf  [(reduction process. Despite the complexities involved in documentation, research should continue and results should be shared )] TJ ET
BT 26.250 248.507 Td /F1 9.8 Tf  [(widely in an effort to strengthen drought preparedness and response activities.)] TJ ET
BT 26.250 211.904 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 191.950 Td /F1 9.8 Tf  [(There are no financial relationships relevant to this article to disclose.)] TJ ET
BT 26.250 162.848 Td /F4 12.0 Tf  [(INTRODUCTION)] TJ ET
BT 26.250 142.893 Td /F1 9.8 Tf  [(Reflecting awareness of the realities of climate change and the need to manage its wide-ranging effects)] TJ ET
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BT 26.250 130.989 Td /F1 9.8 Tf  [(great international interest by emergency coordinators and humanitarian assistance agencies in the impacts of extreme weather )] TJ ET
BT 26.250 119.084 Td /F1 9.8 Tf  [(events and natural disasters on human health. While the health impacts of events such as flooding )] TJ ET
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BT 26.250 87.774 Td /F1 9.8 Tf  [(While there are uncertainties about global-scale trends in droughts, the Intergovernmental Panel on Climate Change \(IPCC\) has )] TJ ET
BT 26.250 75.870 Td /F1 9.8 Tf  [(identified some worrying projections on the future of drought events worldwide. Some regions of the world have experienced )] TJ ET
BT 26.250 63.965 Td /F1 9.8 Tf  [(longer and more intense droughts \(southern Europe and West Africa\) while in other regions droughts have become less )] TJ ET
BT 26.250 52.060 Td /F1 9.8 Tf  [(frequent, less intense or shorter \(central North America and northwestern Australia\))] TJ ET
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BT 372.034 44.044 Td /F1 8.7 Tf  [(th)] TJ ET
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BT 95.338 446.305 Td /F1 9.8 Tf  [(Low confidence because of spatially varying trends and )] TJ ET
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BT 361.720 446.305 Td /F1 9.8 Tf  [(Low to medium confidence, depending on the )] TJ ET
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BT 95.338 407.530 Td /F1 9.8 Tf  [(Low to medium confidence, depending on region. Low )] TJ ET
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BT 95.338 345.862 Td /F1 9.8 Tf  [(Medium confidence in an overall increase in dryness, )] TJ ET
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BT 361.720 345.862 Td /F1 9.8 Tf  [(Low to medium confidence, depending on )] TJ ET
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90.088 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 95.338 299.455 Td /F1 9.8 Tf  [(Medium confidence: some regions with dryness )] TJ ET
BT 95.338 291.824 Td /F1 9.8 Tf  [(decreases, others with dryness increases.)] TJ ET
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356.470 309.310 224.405 0.750 re f
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580.125 224.748 0.750 85.313 re f
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BT 361.720 299.455 Td /F1 9.8 Tf  [(Low to medium confidence depending on region. )] TJ ET
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26.625 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 31.875 214.893 Td /F4 9.8 Tf  [(Summary)] TJ ET
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90.088 140.185 267.132 0.750 re f
90.088 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 95.338 214.893 Td /F4 9.8 Tf  [(There is medium confidence that since the 1950s, )] TJ ET
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BT 95.338 184.368 Td /F4 9.8 Tf  [(regions \(e.g., central North America, north western )] TJ ET
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BT 95.338 169.105 Td /F4 9.8 Tf  [(suggest high confidence in observed trends in )] TJ ET
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BT 95.338 153.843 Td /F4 9.8 Tf  [(geographical inconsistencies in the trends.)] TJ ET
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356.470 140.185 0.750 85.313 re f
580.125 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 361.720 214.893 Td /F4 9.8 Tf  [(There is )] TJ ET
BT 401.822 214.893 Td /F4 9.8 Tf  [(medium confidence )] TJ ET
BT 496.095 214.893 Td /F4 9.8 Tf  [(in a projected )] TJ ET
BT 361.720 207.262 Td /F4 9.8 Tf  [(increase in duration and intensity of )] TJ ET
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BT 361.720 153.843 Td /F4 9.8 Tf  [(because of insufficient agreement of )] TJ ET
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BT 26.250 85.287 Td /F1 9.8 Tf  [(The El Ni�o Southern Oscillation \(ENSO\) describes natural variations in the global climate system and involves changes in sea )] TJ ET
BT 26.250 73.382 Td /F1 9.8 Tf  [(temperature and atmospheric pressure across the Pacific basin. �Southern Oscillation� refers to above-average atmospheric )] TJ ET
BT 26.250 61.477 Td /F1 9.8 Tf  [(pressures in the Indian Ocean associated with below-average pressures in the Pacific \(and vice versa\); �El Ni�o� episodes refer )] TJ ET
BT 26.250 49.572 Td /F1 9.8 Tf  [(to a phase of abnormally warm Pacific Ocean surface temperatures, while �La Ni�a� episodes refer to a phase of abnormally )] TJ ET
BT 26.250 37.668 Td /F1 9.8 Tf  [(cool ocean temperatures in the region. Both El Ni�o and La Ni�a phases are associated with spatial patterns of droughts and )] TJ ET
Q
q
15.000 23.382 577.500 753.618 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(and/or increased evapotranspiration, there is medium confidence that droughts will become more intense in the 21st century in )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(some areas including southern Europe and the Mediterranean, central Europe, central North America, Central America and )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(Mexico, northeast Brazil and southern Africa. Elsewhere in the world there is low confidence because of inconsistencies in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(drought change projections )] TJ ET
0.267 0.267 0.267 rg
BT 146.565 733.269 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 151.384 731.762 Td /F1 9.8 Tf  [(. Table 1 summarizes both the observed changes in global-scale drought trends since 1950 and )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the changes projected in drought for the end of the 21)] TJ ET
BT 258.232 723.745 Td /F1 8.7 Tf  [(st)] TJ ET
BT 264.974 719.857 Td /F1 9.8 Tf  [(century.)] TJ ET
q
26.250 696.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 698.987 Td /F1 9.8 Tf  [(Table 1: Observed changes in drought trends regionally)] TJ ET
Q
0.965 0.965 0.965 rg
26.250 589.545 555.000 99.195 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 688.740 m 581.250 688.740 l 580.500 687.990 l 27.000 687.990 l  f
581.250 688.740 m 581.250 589.545 l 580.500 589.545 l 580.500 687.990 l  f
26.250 688.740 m 26.250 589.545 l 27.000 589.545 l 27.000 687.990 l  f
0.271 0.267 0.267 rg
BT 33.000 674.664 Td /F1 9.0 Tf  [(How confidence is defined)] TJ ET
BT 33.000 658.006 Td /F1 9.0 Tf  [(Increasing levels of evidence combined with increasing degrees of agreement about the evidence are correlated with increasing levels )] TJ ET
BT 33.000 648.849 Td /F1 9.0 Tf  [(of confidence.)] TJ ET
BT 33.000 632.191 Td /F1 9.0 Tf  [(Low confidence: Low-medium available evidence, low agreement about the evidence)] TJ ET
BT 33.000 615.534 Td /F1 9.0 Tf  [(Medium confidence: Medium-robust available evidence, medium agreement about the evidence)] TJ ET
BT 33.000 598.876 Td /F1 9.0 Tf  [(High confidence: Medium-robust available evidence, high agreement about the evidence)] TJ ET
1.000 1.000 1.000 rg
26.250 139.810 555.000 449.735 re f
0.965 0.965 0.965 rg
27.000 564.610 63.463 24.185 re f
0.267 0.267 0.267 rg
26.625 588.420 63.838 0.750 re f
26.625 564.235 0.750 24.935 re f
0.271 0.267 0.267 rg
BT 31.500 579.271 Td /F4 9.8 Tf  [(Region)] TJ ET
0.965 0.965 0.965 rg
90.463 564.610 266.382 24.185 re f
0.267 0.267 0.267 rg
90.463 588.420 266.382 0.750 re f
0.271 0.267 0.267 rg
BT 94.963 579.271 Td /F4 9.8 Tf  [(Observed changes in global-scale trends in droughts )] TJ ET
BT 94.963 567.366 Td /F4 9.8 Tf  [(since 1950 )] TJ ET
0.267 0.267 0.267 rg
BT 146.999 567.366 Td /F4 8.7 Tf  [(1)] TJ ET
0.965 0.965 0.965 rg
356.845 564.610 223.655 24.185 re f
0.267 0.267 0.267 rg
356.845 588.420 224.030 0.750 re f
580.125 564.235 0.750 24.935 re f
0.271 0.267 0.267 rg
BT 361.345 579.271 Td /F4 9.8 Tf  [(Projected changes in drought for the end of )] TJ ET
BT 361.345 567.366 Td /F4 9.8 Tf  [(the 21)] TJ ET
BT 389.523 567.366 Td /F4 8.7 Tf  [(st)] TJ ET
BT 397.228 567.366 Td /F4 9.8 Tf  [( century )] TJ ET
0.267 0.267 0.267 rg
BT 437.866 567.366 Td /F4 8.7 Tf  [(1)] TJ ET
26.625 564.235 64.213 0.750 re f
26.625 502.567 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 31.875 554.380 Td /F4 9.8 Tf  [(North )] TJ ET
BT 31.875 546.749 Td /F4 9.8 Tf  [(America)] TJ ET
0.267 0.267 0.267 rg
90.088 564.235 267.132 0.750 re f
90.088 502.567 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 95.338 554.380 Td /F1 9.8 Tf  [(Medium confidence that there has been an overall slight )] TJ ET
BT 95.338 546.749 Td /F1 9.8 Tf  [(tendency toward less dryness, although analyses for some )] TJ ET
BT 95.338 539.118 Td /F1 9.8 Tf  [(sub regions also indicate tendencies toward increasing )] TJ ET
BT 95.338 531.487 Td /F1 9.8 Tf  [(dryness. Recent regional trends toward more severe )] TJ ET
BT 95.338 523.855 Td /F1 9.8 Tf  [(drought conditions were identified over southern and )] TJ ET
BT 95.338 516.224 Td /F1 9.8 Tf  [(western Canada, Alaska and Mexico, with subregional )] TJ ET
BT 95.338 508.593 Td /F1 9.8 Tf  [(exceptions.)] TJ ET
0.267 0.267 0.267 rg
356.470 564.235 224.405 0.750 re f
356.470 502.567 0.750 62.419 re f
580.125 502.567 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 361.720 554.380 Td /F1 9.8 Tf  [(Low to medium confidence depending on the )] TJ ET
BT 361.720 546.749 Td /F1 9.8 Tf  [(region. Medium confidence regarding increase in )] TJ ET
BT 361.720 539.118 Td /F1 9.8 Tf  [(consecutive dry days and soil moisture anomaly )] TJ ET
BT 361.720 531.487 Td /F1 9.8 Tf  [(in Texas and New Mexico; low confidence in )] TJ ET
BT 361.720 523.855 Td /F1 9.8 Tf  [(other regions because of inconsistent change.)] TJ ET
0.267 0.267 0.267 rg
26.625 502.567 64.213 0.750 re f
26.625 456.160 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 492.712 Td /F4 9.8 Tf  [(Europe)] TJ ET
0.267 0.267 0.267 rg
90.088 502.567 267.132 0.750 re f
90.088 456.160 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 95.338 492.712 Td /F1 9.8 Tf  [(Medium confidence regarding increases in drynessbased )] TJ ET
BT 95.338 485.080 Td /F1 9.8 Tf  [(on some indices in the southern part of the continent, but )] TJ ET
BT 95.338 477.449 Td /F1 9.8 Tf  [(largeinconsistencies between indices in this region, and )] TJ ET
BT 95.338 469.818 Td /F1 9.8 Tf  [(inconsistent or statistically insignificant trends in the rest of )] TJ ET
BT 95.338 462.187 Td /F1 9.8 Tf  [(the continent.)] TJ ET
0.267 0.267 0.267 rg
356.470 502.567 224.405 0.750 re f
356.470 456.160 0.750 47.156 re f
580.125 456.160 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 361.720 492.712 Td /F1 9.8 Tf  [(Medium confidence: European area affected by )] TJ ET
BT 361.720 485.080 Td /F1 9.8 Tf  [(stronger dryness \(reduced soil moisture anomaly )] TJ ET
BT 361.720 477.449 Td /F1 9.8 Tf  [(and consecutive dry days\) with largest and most )] TJ ET
BT 361.720 469.818 Td /F1 9.8 Tf  [(consistent changes in Mediterranean Europe.)] TJ ET
0.267 0.267 0.267 rg
26.625 456.160 64.213 0.750 re f
26.625 417.385 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 446.305 Td /F4 9.8 Tf  [(South )] TJ ET
BT 31.875 438.674 Td /F4 9.8 Tf  [(America)] TJ ET
0.267 0.267 0.267 rg
90.088 456.160 267.132 0.750 re f
90.088 417.385 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 95.338 446.305 Td /F1 9.8 Tf  [(Low confidence because of spatially varying trends and )] TJ ET
BT 95.338 438.674 Td /F1 9.8 Tf  [(inconsistencies between studies. For the Amazon, )] TJ ET
BT 95.338 431.043 Td /F1 9.8 Tf  [(repeated intense droughts have been occurring in the last )] TJ ET
BT 95.338 423.412 Td /F1 9.8 Tf  [(decades but no particular trend has been reported.)] TJ ET
0.267 0.267 0.267 rg
356.470 456.160 224.405 0.750 re f
356.470 417.385 0.750 39.525 re f
580.125 417.385 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 361.720 446.305 Td /F1 9.8 Tf  [(Low to medium confidence, depending on the )] TJ ET
BT 361.720 438.674 Td /F1 9.8 Tf  [(region: inconsistent signal except for dryness )] TJ ET
BT 361.720 431.043 Td /F1 9.8 Tf  [(increase \(consecutive dry days and soil moisture )] TJ ET
BT 361.720 423.412 Td /F1 9.8 Tf  [(anomaly\) in north-eastern Brazil.)] TJ ET
0.267 0.267 0.267 rg
26.625 417.385 64.213 0.750 re f
26.625 355.717 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 31.875 407.530 Td /F4 9.8 Tf  [(Asia)] TJ ET
0.267 0.267 0.267 rg
90.088 417.385 267.132 0.750 re f
90.088 355.717 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 95.338 407.530 Td /F1 9.8 Tf  [(Low to medium confidence, depending on region. Low )] TJ ET
BT 95.338 399.899 Td /F1 9.8 Tf  [(confidence in most regions due to spatially varying trends. )] TJ ET
BT 95.338 392.268 Td /F1 9.8 Tf  [(Some areas have consistent increases but others display )] TJ ET
BT 95.338 384.637 Td /F1 9.8 Tf  [(decreases in dryness indicated by different measures \(soil )] TJ ET
BT 95.338 377.005 Td /F1 9.8 Tf  [(moisture anomaly, Palmer Drought Severity Index, )] TJ ET
BT 95.338 369.374 Td /F1 9.8 Tf  [(consecutive dry days\). In East Asia, there is medium )] TJ ET
BT 95.338 361.743 Td /F1 9.8 Tf  [(confidence in an overall tendency for increased dryness.)] TJ ET
0.267 0.267 0.267 rg
356.470 417.385 224.405 0.750 re f
356.470 355.717 0.750 62.419 re f
580.125 355.717 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 361.720 407.530 Td /F1 9.8 Tf  [(Low confidence because of inconsistent change )] TJ ET
BT 361.720 399.899 Td /F1 9.8 Tf  [(in consecutive dry days and soil moisture )] TJ ET
BT 361.720 392.268 Td /F1 9.8 Tf  [(anomaly between models in large part of domain.)] TJ ET
0.267 0.267 0.267 rg
26.625 355.717 64.213 0.750 re f
26.625 309.310 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 345.862 Td /F4 9.8 Tf  [(Africa)] TJ ET
0.267 0.267 0.267 rg
90.088 355.717 267.132 0.750 re f
90.088 309.310 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 95.338 345.862 Td /F1 9.8 Tf  [(Medium confidence in an overall increase in dryness, )] TJ ET
BT 95.338 338.230 Td /F1 9.8 Tf  [(based on soil moisture anomaly and Palmer Drought )] TJ ET
BT 95.338 330.599 Td /F1 9.8 Tf  [(Severity Index. For the Sahel, recent years have been )] TJ ET
BT 95.338 322.968 Td /F1 9.8 Tf  [(characterized by greater interannual variability than the )] TJ ET
BT 95.338 315.337 Td /F1 9.8 Tf  [(previous 40 years.)] TJ ET
0.267 0.267 0.267 rg
356.470 355.717 224.405 0.750 re f
356.470 309.310 0.750 47.156 re f
580.125 309.310 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 361.720 345.862 Td /F1 9.8 Tf  [(Low to medium confidence, depending on )] TJ ET
BT 361.720 338.230 Td /F1 9.8 Tf  [(region. Low confidence in most regions, medium )] TJ ET
BT 361.720 330.599 Td /F1 9.8 Tf  [(confidence of increase in dryness \(consecutive )] TJ ET
BT 361.720 322.968 Td /F1 9.8 Tf  [(dry days and soil moisture anomaly\) in southern )] TJ ET
BT 361.720 315.337 Td /F1 9.8 Tf  [(Africa except eastern part.)] TJ ET
0.267 0.267 0.267 rg
26.625 309.310 64.213 0.750 re f
26.625 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 31.875 299.455 Td /F4 9.8 Tf  [(Australia/ )] TJ ET
BT 31.875 291.824 Td /F4 9.8 Tf  [(New )] TJ ET
BT 31.875 284.193 Td /F4 9.8 Tf  [(Zealand)] TJ ET
0.267 0.267 0.267 rg
90.088 309.310 267.132 0.750 re f
90.088 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 95.338 299.455 Td /F1 9.8 Tf  [(Medium confidence: some regions with dryness )] TJ ET
BT 95.338 291.824 Td /F1 9.8 Tf  [(decreases, others with dryness increases.)] TJ ET
0.267 0.267 0.267 rg
356.470 309.310 224.405 0.750 re f
356.470 224.748 0.750 85.313 re f
580.125 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 361.720 299.455 Td /F1 9.8 Tf  [(Low to medium confidence depending on region. )] TJ ET
BT 361.720 291.824 Td /F1 9.8 Tf  [(Models agree on increase in consecutive dry )] TJ ET
BT 361.720 284.193 Td /F1 9.8 Tf  [(days in South Australia, but inconsistent signal )] TJ ET
BT 361.720 276.562 Td /F1 9.8 Tf  [(over most of South Australia in soil moisture )] TJ ET
BT 361.720 268.930 Td /F1 9.8 Tf  [(anomaly. Inconsistent signal in consecutive dry )] TJ ET
BT 361.720 261.299 Td /F1 9.8 Tf  [(days and soil moisture anomaly in North )] TJ ET
BT 361.720 253.668 Td /F1 9.8 Tf  [(Australia. Strongest consecutive dry day )] TJ ET
BT 361.720 246.037 Td /F1 9.8 Tf  [(increases in western half of Australia. )] TJ ET
BT 361.720 238.405 Td /F1 9.8 Tf  [(Inconsistent change in area of drought )] TJ ET
BT 361.720 230.774 Td /F1 9.8 Tf  [(depending on index used.)] TJ ET
0.267 0.267 0.267 rg
26.625 224.748 64.213 0.750 re f
26.625 140.185 64.213 0.750 re f
26.625 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 31.875 214.893 Td /F4 9.8 Tf  [(Summary)] TJ ET
0.267 0.267 0.267 rg
90.088 224.748 267.132 0.750 re f
90.088 140.185 267.132 0.750 re f
90.088 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 95.338 214.893 Td /F4 9.8 Tf  [(There is medium confidence that since the 1950s, )] TJ ET
BT 95.338 207.262 Td /F4 9.8 Tf  [(some regions of the world have experienced more )] TJ ET
BT 95.338 199.630 Td /F4 9.8 Tf  [(intense and longer droughts \(e.g., southern Europe, )] TJ ET
BT 95.338 191.999 Td /F4 9.8 Tf  [(west Africa\) but also opposite trends exist in other )] TJ ET
BT 95.338 184.368 Td /F4 9.8 Tf  [(regions \(e.g., central North America, north western )] TJ ET
BT 95.338 176.737 Td /F4 9.8 Tf  [(Australia\). There is not enough evidence at present to )] TJ ET
BT 95.338 169.105 Td /F4 9.8 Tf  [(suggest high confidence in observed trends in )] TJ ET
BT 95.338 161.474 Td /F4 9.8 Tf  [(dryness due to lack of direct observations and some )] TJ ET
BT 95.338 153.843 Td /F4 9.8 Tf  [(geographical inconsistencies in the trends.)] TJ ET
0.267 0.267 0.267 rg
356.470 224.748 224.405 0.750 re f
356.470 140.185 224.405 0.750 re f
356.470 140.185 0.750 85.313 re f
580.125 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 361.720 214.893 Td /F4 9.8 Tf  [(There is )] TJ ET
BT 401.822 214.893 Td /F4 9.8 Tf  [(medium confidence )] TJ ET
BT 496.095 214.893 Td /F4 9.8 Tf  [(in a projected )] TJ ET
BT 361.720 207.262 Td /F4 9.8 Tf  [(increase in duration and intensity of )] TJ ET
BT 361.720 199.630 Td /F4 9.8 Tf  [(droughts in some regions of the world, )] TJ ET
BT 361.720 191.999 Td /F4 9.8 Tf  [(including southern Europe and the )] TJ ET
BT 361.720 184.368 Td /F4 9.8 Tf  [(Mediterranean region, central Europe, central )] TJ ET
BT 361.720 176.737 Td /F4 9.8 Tf  [(North America, Central America and Mexico, )] TJ ET
BT 361.720 169.105 Td /F4 9.8 Tf  [(northeast Brazil, and southern Africa. )] TJ ET
BT 361.720 161.474 Td /F4 9.8 Tf  [(Elsewhere there is overall )] TJ ET
BT 484.200 161.474 Td /F4 9.8 Tf  [(low confidence )] TJ ET
BT 361.720 153.843 Td /F4 9.8 Tf  [(because of insufficient agreement of )] TJ ET
BT 361.720 146.212 Td /F4 9.8 Tf  [(projections of drought changes.)] TJ ET
BT 26.250 85.287 Td /F1 9.8 Tf  [(The El Ni�o Southern Oscillation \(ENSO\) describes natural variations in the global climate system and involves changes in sea )] TJ ET
BT 26.250 73.382 Td /F1 9.8 Tf  [(temperature and atmospheric pressure across the Pacific basin. �Southern Oscillation� refers to above-average atmospheric )] TJ ET
BT 26.250 61.477 Td /F1 9.8 Tf  [(pressures in the Indian Ocean associated with below-average pressures in the Pacific \(and vice versa\); �El Ni�o� episodes refer )] TJ ET
BT 26.250 49.572 Td /F1 9.8 Tf  [(to a phase of abnormally warm Pacific Ocean surface temperatures, while �La Ni�a� episodes refer to a phase of abnormally )] TJ ET
BT 26.250 37.668 Td /F1 9.8 Tf  [(cool ocean temperatures in the region. Both El Ni�o and La Ni�a phases are associated with spatial patterns of droughts and )] TJ ET
Q
q
15.000 23.382 577.500 753.618 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(and/or increased evapotranspiration, there is medium confidence that droughts will become more intense in the 21st century in )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(some areas including southern Europe and the Mediterranean, central Europe, central North America, Central America and )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(Mexico, northeast Brazil and southern Africa. Elsewhere in the world there is low confidence because of inconsistencies in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(drought change projections )] TJ ET
0.267 0.267 0.267 rg
BT 146.565 733.269 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 151.384 731.762 Td /F1 9.8 Tf  [(. Table 1 summarizes both the observed changes in global-scale drought trends since 1950 and )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the changes projected in drought for the end of the 21)] TJ ET
BT 258.232 723.745 Td /F1 8.7 Tf  [(st)] TJ ET
BT 264.974 719.857 Td /F1 9.8 Tf  [(century.)] TJ ET
q
26.250 696.240 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 698.987 Td /F1 9.8 Tf  [(Table 1: Observed changes in drought trends regionally)] TJ ET
Q
0.965 0.965 0.965 rg
26.250 589.545 555.000 99.195 re f
0.267 0.267 0.267 rg
0.267 0.267 0.267 RG
26.250 688.740 m 581.250 688.740 l 580.500 687.990 l 27.000 687.990 l  f
581.250 688.740 m 581.250 589.545 l 580.500 589.545 l 580.500 687.990 l  f
26.250 688.740 m 26.250 589.545 l 27.000 589.545 l 27.000 687.990 l  f
0.271 0.267 0.267 rg
BT 33.000 674.664 Td /F1 9.0 Tf  [(How confidence is defined)] TJ ET
BT 33.000 658.006 Td /F1 9.0 Tf  [(Increasing levels of evidence combined with increasing degrees of agreement about the evidence are correlated with increasing levels )] TJ ET
BT 33.000 648.849 Td /F1 9.0 Tf  [(of confidence.)] TJ ET
BT 33.000 632.191 Td /F1 9.0 Tf  [(Low confidence: Low-medium available evidence, low agreement about the evidence)] TJ ET
BT 33.000 615.534 Td /F1 9.0 Tf  [(Medium confidence: Medium-robust available evidence, medium agreement about the evidence)] TJ ET
BT 33.000 598.876 Td /F1 9.0 Tf  [(High confidence: Medium-robust available evidence, high agreement about the evidence)] TJ ET
1.000 1.000 1.000 rg
26.250 139.810 555.000 449.735 re f
0.965 0.965 0.965 rg
27.000 564.610 63.463 24.185 re f
0.267 0.267 0.267 rg
26.625 588.420 63.838 0.750 re f
26.625 564.235 0.750 24.935 re f
0.271 0.267 0.267 rg
BT 31.500 579.271 Td /F4 9.8 Tf  [(Region)] TJ ET
0.965 0.965 0.965 rg
90.463 564.610 266.382 24.185 re f
0.267 0.267 0.267 rg
90.463 588.420 266.382 0.750 re f
0.271 0.267 0.267 rg
BT 94.963 579.271 Td /F4 9.8 Tf  [(Observed changes in global-scale trends in droughts )] TJ ET
BT 94.963 567.366 Td /F4 9.8 Tf  [(since 1950 )] TJ ET
0.267 0.267 0.267 rg
BT 146.999 567.366 Td /F4 8.7 Tf  [(1)] TJ ET
0.965 0.965 0.965 rg
356.845 564.610 223.655 24.185 re f
0.267 0.267 0.267 rg
356.845 588.420 224.030 0.750 re f
580.125 564.235 0.750 24.935 re f
0.271 0.267 0.267 rg
BT 361.345 579.271 Td /F4 9.8 Tf  [(Projected changes in drought for the end of )] TJ ET
BT 361.345 567.366 Td /F4 9.8 Tf  [(the 21)] TJ ET
BT 389.523 567.366 Td /F4 8.7 Tf  [(st)] TJ ET
BT 397.228 567.366 Td /F4 9.8 Tf  [( century )] TJ ET
0.267 0.267 0.267 rg
BT 437.866 567.366 Td /F4 8.7 Tf  [(1)] TJ ET
26.625 564.235 64.213 0.750 re f
26.625 502.567 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 31.875 554.380 Td /F4 9.8 Tf  [(North )] TJ ET
BT 31.875 546.749 Td /F4 9.8 Tf  [(America)] TJ ET
0.267 0.267 0.267 rg
90.088 564.235 267.132 0.750 re f
90.088 502.567 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 95.338 554.380 Td /F1 9.8 Tf  [(Medium confidence that there has been an overall slight )] TJ ET
BT 95.338 546.749 Td /F1 9.8 Tf  [(tendency toward less dryness, although analyses for some )] TJ ET
BT 95.338 539.118 Td /F1 9.8 Tf  [(sub regions also indicate tendencies toward increasing )] TJ ET
BT 95.338 531.487 Td /F1 9.8 Tf  [(dryness. Recent regional trends toward more severe )] TJ ET
BT 95.338 523.855 Td /F1 9.8 Tf  [(drought conditions were identified over southern and )] TJ ET
BT 95.338 516.224 Td /F1 9.8 Tf  [(western Canada, Alaska and Mexico, with subregional )] TJ ET
BT 95.338 508.593 Td /F1 9.8 Tf  [(exceptions.)] TJ ET
0.267 0.267 0.267 rg
356.470 564.235 224.405 0.750 re f
356.470 502.567 0.750 62.419 re f
580.125 502.567 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 361.720 554.380 Td /F1 9.8 Tf  [(Low to medium confidence depending on the )] TJ ET
BT 361.720 546.749 Td /F1 9.8 Tf  [(region. Medium confidence regarding increase in )] TJ ET
BT 361.720 539.118 Td /F1 9.8 Tf  [(consecutive dry days and soil moisture anomaly )] TJ ET
BT 361.720 531.487 Td /F1 9.8 Tf  [(in Texas and New Mexico; low confidence in )] TJ ET
BT 361.720 523.855 Td /F1 9.8 Tf  [(other regions because of inconsistent change.)] TJ ET
0.267 0.267 0.267 rg
26.625 502.567 64.213 0.750 re f
26.625 456.160 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 492.712 Td /F4 9.8 Tf  [(Europe)] TJ ET
0.267 0.267 0.267 rg
90.088 502.567 267.132 0.750 re f
90.088 456.160 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 95.338 492.712 Td /F1 9.8 Tf  [(Medium confidence regarding increases in drynessbased )] TJ ET
BT 95.338 485.080 Td /F1 9.8 Tf  [(on some indices in the southern part of the continent, but )] TJ ET
BT 95.338 477.449 Td /F1 9.8 Tf  [(largeinconsistencies between indices in this region, and )] TJ ET
BT 95.338 469.818 Td /F1 9.8 Tf  [(inconsistent or statistically insignificant trends in the rest of )] TJ ET
BT 95.338 462.187 Td /F1 9.8 Tf  [(the continent.)] TJ ET
0.267 0.267 0.267 rg
356.470 502.567 224.405 0.750 re f
356.470 456.160 0.750 47.156 re f
580.125 456.160 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 361.720 492.712 Td /F1 9.8 Tf  [(Medium confidence: European area affected by )] TJ ET
BT 361.720 485.080 Td /F1 9.8 Tf  [(stronger dryness \(reduced soil moisture anomaly )] TJ ET
BT 361.720 477.449 Td /F1 9.8 Tf  [(and consecutive dry days\) with largest and most )] TJ ET
BT 361.720 469.818 Td /F1 9.8 Tf  [(consistent changes in Mediterranean Europe.)] TJ ET
0.267 0.267 0.267 rg
26.625 456.160 64.213 0.750 re f
26.625 417.385 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 446.305 Td /F4 9.8 Tf  [(South )] TJ ET
BT 31.875 438.674 Td /F4 9.8 Tf  [(America)] TJ ET
0.267 0.267 0.267 rg
90.088 456.160 267.132 0.750 re f
90.088 417.385 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 95.338 446.305 Td /F1 9.8 Tf  [(Low confidence because of spatially varying trends and )] TJ ET
BT 95.338 438.674 Td /F1 9.8 Tf  [(inconsistencies between studies. For the Amazon, )] TJ ET
BT 95.338 431.043 Td /F1 9.8 Tf  [(repeated intense droughts have been occurring in the last )] TJ ET
BT 95.338 423.412 Td /F1 9.8 Tf  [(decades but no particular trend has been reported.)] TJ ET
0.267 0.267 0.267 rg
356.470 456.160 224.405 0.750 re f
356.470 417.385 0.750 39.525 re f
580.125 417.385 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 361.720 446.305 Td /F1 9.8 Tf  [(Low to medium confidence, depending on the )] TJ ET
BT 361.720 438.674 Td /F1 9.8 Tf  [(region: inconsistent signal except for dryness )] TJ ET
BT 361.720 431.043 Td /F1 9.8 Tf  [(increase \(consecutive dry days and soil moisture )] TJ ET
BT 361.720 423.412 Td /F1 9.8 Tf  [(anomaly\) in north-eastern Brazil.)] TJ ET
0.267 0.267 0.267 rg
26.625 417.385 64.213 0.750 re f
26.625 355.717 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 31.875 407.530 Td /F4 9.8 Tf  [(Asia)] TJ ET
0.267 0.267 0.267 rg
90.088 417.385 267.132 0.750 re f
90.088 355.717 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 95.338 407.530 Td /F1 9.8 Tf  [(Low to medium confidence, depending on region. Low )] TJ ET
BT 95.338 399.899 Td /F1 9.8 Tf  [(confidence in most regions due to spatially varying trends. )] TJ ET
BT 95.338 392.268 Td /F1 9.8 Tf  [(Some areas have consistent increases but others display )] TJ ET
BT 95.338 384.637 Td /F1 9.8 Tf  [(decreases in dryness indicated by different measures \(soil )] TJ ET
BT 95.338 377.005 Td /F1 9.8 Tf  [(moisture anomaly, Palmer Drought Severity Index, )] TJ ET
BT 95.338 369.374 Td /F1 9.8 Tf  [(consecutive dry days\). In East Asia, there is medium )] TJ ET
BT 95.338 361.743 Td /F1 9.8 Tf  [(confidence in an overall tendency for increased dryness.)] TJ ET
0.267 0.267 0.267 rg
356.470 417.385 224.405 0.750 re f
356.470 355.717 0.750 62.419 re f
580.125 355.717 0.750 62.419 re f
0.271 0.267 0.267 rg
BT 361.720 407.530 Td /F1 9.8 Tf  [(Low confidence because of inconsistent change )] TJ ET
BT 361.720 399.899 Td /F1 9.8 Tf  [(in consecutive dry days and soil moisture )] TJ ET
BT 361.720 392.268 Td /F1 9.8 Tf  [(anomaly between models in large part of domain.)] TJ ET
0.267 0.267 0.267 rg
26.625 355.717 64.213 0.750 re f
26.625 309.310 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 345.862 Td /F4 9.8 Tf  [(Africa)] TJ ET
0.267 0.267 0.267 rg
90.088 355.717 267.132 0.750 re f
90.088 309.310 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 95.338 345.862 Td /F1 9.8 Tf  [(Medium confidence in an overall increase in dryness, )] TJ ET
BT 95.338 338.230 Td /F1 9.8 Tf  [(based on soil moisture anomaly and Palmer Drought )] TJ ET
BT 95.338 330.599 Td /F1 9.8 Tf  [(Severity Index. For the Sahel, recent years have been )] TJ ET
BT 95.338 322.968 Td /F1 9.8 Tf  [(characterized by greater interannual variability than the )] TJ ET
BT 95.338 315.337 Td /F1 9.8 Tf  [(previous 40 years.)] TJ ET
0.267 0.267 0.267 rg
356.470 355.717 224.405 0.750 re f
356.470 309.310 0.750 47.156 re f
580.125 309.310 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 361.720 345.862 Td /F1 9.8 Tf  [(Low to medium confidence, depending on )] TJ ET
BT 361.720 338.230 Td /F1 9.8 Tf  [(region. Low confidence in most regions, medium )] TJ ET
BT 361.720 330.599 Td /F1 9.8 Tf  [(confidence of increase in dryness \(consecutive )] TJ ET
BT 361.720 322.968 Td /F1 9.8 Tf  [(dry days and soil moisture anomaly\) in southern )] TJ ET
BT 361.720 315.337 Td /F1 9.8 Tf  [(Africa except eastern part.)] TJ ET
0.267 0.267 0.267 rg
26.625 309.310 64.213 0.750 re f
26.625 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 31.875 299.455 Td /F4 9.8 Tf  [(Australia/ )] TJ ET
BT 31.875 291.824 Td /F4 9.8 Tf  [(New )] TJ ET
BT 31.875 284.193 Td /F4 9.8 Tf  [(Zealand)] TJ ET
0.267 0.267 0.267 rg
90.088 309.310 267.132 0.750 re f
90.088 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 95.338 299.455 Td /F1 9.8 Tf  [(Medium confidence: some regions with dryness )] TJ ET
BT 95.338 291.824 Td /F1 9.8 Tf  [(decreases, others with dryness increases.)] TJ ET
0.267 0.267 0.267 rg
356.470 309.310 224.405 0.750 re f
356.470 224.748 0.750 85.313 re f
580.125 224.748 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 361.720 299.455 Td /F1 9.8 Tf  [(Low to medium confidence depending on region. )] TJ ET
BT 361.720 291.824 Td /F1 9.8 Tf  [(Models agree on increase in consecutive dry )] TJ ET
BT 361.720 284.193 Td /F1 9.8 Tf  [(days in South Australia, but inconsistent signal )] TJ ET
BT 361.720 276.562 Td /F1 9.8 Tf  [(over most of South Australia in soil moisture )] TJ ET
BT 361.720 268.930 Td /F1 9.8 Tf  [(anomaly. Inconsistent signal in consecutive dry )] TJ ET
BT 361.720 261.299 Td /F1 9.8 Tf  [(days and soil moisture anomaly in North )] TJ ET
BT 361.720 253.668 Td /F1 9.8 Tf  [(Australia. Strongest consecutive dry day )] TJ ET
BT 361.720 246.037 Td /F1 9.8 Tf  [(increases in western half of Australia. )] TJ ET
BT 361.720 238.405 Td /F1 9.8 Tf  [(Inconsistent change in area of drought )] TJ ET
BT 361.720 230.774 Td /F1 9.8 Tf  [(depending on index used.)] TJ ET
0.267 0.267 0.267 rg
26.625 224.748 64.213 0.750 re f
26.625 140.185 64.213 0.750 re f
26.625 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 31.875 214.893 Td /F4 9.8 Tf  [(Summary)] TJ ET
0.267 0.267 0.267 rg
90.088 224.748 267.132 0.750 re f
90.088 140.185 267.132 0.750 re f
90.088 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 95.338 214.893 Td /F4 9.8 Tf  [(There is medium confidence that since the 1950s, )] TJ ET
BT 95.338 207.262 Td /F4 9.8 Tf  [(some regions of the world have experienced more )] TJ ET
BT 95.338 199.630 Td /F4 9.8 Tf  [(intense and longer droughts \(e.g., southern Europe, )] TJ ET
BT 95.338 191.999 Td /F4 9.8 Tf  [(west Africa\) but also opposite trends exist in other )] TJ ET
BT 95.338 184.368 Td /F4 9.8 Tf  [(regions \(e.g., central North America, north western )] TJ ET
BT 95.338 176.737 Td /F4 9.8 Tf  [(Australia\). There is not enough evidence at present to )] TJ ET
BT 95.338 169.105 Td /F4 9.8 Tf  [(suggest high confidence in observed trends in )] TJ ET
BT 95.338 161.474 Td /F4 9.8 Tf  [(dryness due to lack of direct observations and some )] TJ ET
BT 95.338 153.843 Td /F4 9.8 Tf  [(geographical inconsistencies in the trends.)] TJ ET
0.267 0.267 0.267 rg
356.470 224.748 224.405 0.750 re f
356.470 140.185 224.405 0.750 re f
356.470 140.185 0.750 85.313 re f
580.125 140.185 0.750 85.313 re f
0.271 0.267 0.267 rg
BT 361.720 214.893 Td /F4 9.8 Tf  [(There is )] TJ ET
BT 401.822 214.893 Td /F4 9.8 Tf  [(medium confidence )] TJ ET
BT 496.095 214.893 Td /F4 9.8 Tf  [(in a projected )] TJ ET
BT 361.720 207.262 Td /F4 9.8 Tf  [(increase in duration and intensity of )] TJ ET
BT 361.720 199.630 Td /F4 9.8 Tf  [(droughts in some regions of the world, )] TJ ET
BT 361.720 191.999 Td /F4 9.8 Tf  [(including southern Europe and the )] TJ ET
BT 361.720 184.368 Td /F4 9.8 Tf  [(Mediterranean region, central Europe, central )] TJ ET
BT 361.720 176.737 Td /F4 9.8 Tf  [(North America, Central America and Mexico, )] TJ ET
BT 361.720 169.105 Td /F4 9.8 Tf  [(northeast Brazil, and southern Africa. )] TJ ET
BT 361.720 161.474 Td /F4 9.8 Tf  [(Elsewhere there is overall )] TJ ET
BT 484.200 161.474 Td /F4 9.8 Tf  [(low confidence )] TJ ET
BT 361.720 153.843 Td /F4 9.8 Tf  [(because of insufficient agreement of )] TJ ET
BT 361.720 146.212 Td /F4 9.8 Tf  [(projections of drought changes.)] TJ ET
BT 26.250 85.287 Td /F1 9.8 Tf  [(The El Ni�o Southern Oscillation \(ENSO\) describes natural variations in the global climate system and involves changes in sea )] TJ ET
BT 26.250 73.382 Td /F1 9.8 Tf  [(temperature and atmospheric pressure across the Pacific basin. �Southern Oscillation� refers to above-average atmospheric )] TJ ET
BT 26.250 61.477 Td /F1 9.8 Tf  [(pressures in the Indian Ocean associated with below-average pressures in the Pacific \(and vice versa\); �El Ni�o� episodes refer )] TJ ET
BT 26.250 49.572 Td /F1 9.8 Tf  [(to a phase of abnormally warm Pacific Ocean surface temperatures, while �La Ni�a� episodes refer to a phase of abnormally )] TJ ET
BT 26.250 37.668 Td /F1 9.8 Tf  [(cool ocean temperatures in the region. Both El Ni�o and La Ni�a phases are associated with spatial patterns of droughts and )] TJ ET
Q
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BT 291.710 19.825 Td /F1 11.0 Tf  [(2)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(floods; pacific islands are strongly affected by ENSO variations, and an El Ni�o episode is usually accompanied by drought in )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(southeast Asia, India, Australia, southeast Africa, Amazonia and northeast Brazil )] TJ ET
0.267 0.267 0.267 rg
BT 376.334 757.079 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 381.152 755.571 Td /F1 9.8 Tf  [(. Globally, disasters triggered by droughts are )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(twice as frequent in the year following the onset of El Ni�o \(warm events\) than during other years )] TJ ET
0.267 0.267 0.267 rg
BT 446.767 745.174 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 451.586 743.667 Td /F1 9.8 Tf  [(. In areas where droughts )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(can be anticipated, i.e., when linked with the El Ni�o Southern Oscillation, forecasts can be used to provide advance warning of )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the increased risk of adverse climate conditions and can support the disaster risk reduction process )] TJ ET
0.267 0.267 0.267 rg
BT 457.054 721.364 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 461.872 723.745 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 464.282 721.364 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 469.100 719.857 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(Documentation of the impacts of drought is difficult for a variety of reasons. Numerous indicators are used to capture and )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(quantify the onset, duration, extent and beginning/ end of droughts )] TJ ET
0.267 0.267 0.267 rg
BT 315.688 690.055 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 320.507 688.548 Td /F1 9.8 Tf  [(. Droughts are slow-onset phenomena, which generally )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(develop over an extended period of time and lack highly visible and structural impacts. They can be geographically extensive, )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(affecting large areas regardless of geopolitical/country boundaries, and can exhibit complex spatial patterns. The societal )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(impacts of drought can be slow to develop as they accumulate over time as the event continues, and the impacts can last for )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(years. Finally, there is a lack of standardization in drought hazard characterization and in definitions of drought )] TJ ET
0.267 0.267 0.267 rg
BT 504.224 642.436 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 513.862 644.817 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 516.271 642.436 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 525.908 640.929 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(complexities of drought are reflected in over 150 published definitions )] TJ ET
0.267 0.267 0.267 rg
BT 328.100 630.531 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 332.919 629.024 Td /F1 9.8 Tf  [( including:)] TJ ET
0.271 0.267 0.267 RG
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40.337 613.033 40.154 613.477 39.838 613.793 c
39.522 614.109 39.078 614.293 38.631 614.293 c
38.185 614.293 37.741 614.109 37.425 613.793 c
37.109 613.477 36.925 613.033 36.925 612.587 c
36.925 612.140 37.109 611.696 37.425 611.380 c
37.741 611.064 38.185 610.880 38.631 610.880 c
39.078 610.880 39.522 611.064 39.838 611.380 c
40.154 611.696 40.337 612.140 40.337 612.587 c f
BT 45.750 609.619 Td /F1 9.8 Tf  [(A prolonged dry period in the natural climate cycle )] TJ ET
0.267 0.267 0.267 rg
BT 264.677 611.126 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 274.314 609.619 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 596.932 m 
40.337 597.379 40.154 597.823 39.838 598.139 c
39.522 598.454 39.078 598.638 38.631 598.638 c
38.185 598.638 37.741 598.454 37.425 598.139 c
37.109 597.823 36.925 597.379 36.925 596.932 c
36.925 596.485 37.109 596.041 37.425 595.725 c
37.741 595.410 38.185 595.226 38.631 595.226 c
39.078 595.226 39.522 595.410 39.838 595.725 c
40.154 596.041 40.337 596.485 40.337 596.932 c f
BT 45.750 593.964 Td /F1 9.8 Tf  [(A period of abnormally dry weather long enough to cause a serious hydrological imbalance )] TJ ET
0.267 0.267 0.267 rg
BT 439.718 595.472 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 444.537 593.964 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 581.277 m 
40.337 581.724 40.154 582.168 39.838 582.484 c
39.522 582.800 39.078 582.983 38.631 582.983 c
38.185 582.983 37.741 582.800 37.425 582.484 c
37.109 582.168 36.925 581.724 36.925 581.277 c
36.925 580.831 37.109 580.387 37.425 580.071 c
37.741 579.755 38.185 579.571 38.631 579.571 c
39.078 579.571 39.522 579.755 39.838 580.071 c
40.154 580.387 40.337 580.831 40.337 581.277 c f
BT 45.750 578.310 Td /F1 9.8 Tf  [(An extended period of time characterized by a deficiency in a region�s water supply that is the result of constantly below )] TJ ET
BT 45.750 566.405 Td /F1 9.8 Tf  [(average precipitation )] TJ ET
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BT 138.960 567.912 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 148.597 566.405 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 553.718 m 
40.337 554.164 40.154 554.608 39.838 554.924 c
39.522 555.240 39.078 555.424 38.631 555.424 c
38.185 555.424 37.741 555.240 37.425 554.924 c
37.109 554.608 36.925 554.164 36.925 553.718 c
36.925 553.271 37.109 552.827 37.425 552.511 c
37.741 552.195 38.185 552.011 38.631 552.011 c
39.078 552.011 39.522 552.195 39.838 552.511 c
40.154 552.827 40.337 553.271 40.337 553.718 c f
BT 45.750 550.750 Td /F1 9.8 Tf  [(A temporary decrease of the average water availability due to rainfall deficiency )] TJ ET
0.267 0.267 0.267 rg
BT 390.939 552.257 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 400.576 550.750 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(Central to most definitions is a deficit of water from a �norm� for a given spatial area. Drought can be further categorized based )] TJ ET
BT 26.250 515.691 Td /F1 9.8 Tf  [(on how it is measured )] TJ ET
0.267 0.267 0.267 rg
BT 123.789 517.198 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 128.608 519.579 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 131.017 517.198 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 140.654 515.691 Td /F1 9.8 Tf  [(:)] TJ ET
40.337 499.253 m 
40.337 499.700 40.154 500.144 39.838 500.460 c
39.522 500.776 39.078 500.960 38.631 500.960 c
38.185 500.960 37.741 500.776 37.425 500.460 c
37.109 500.144 36.925 499.700 36.925 499.253 c
36.925 498.807 37.109 498.363 37.425 498.047 c
37.741 497.731 38.185 497.547 38.631 497.547 c
39.078 497.547 39.522 497.731 39.838 498.047 c
40.154 498.363 40.337 498.807 40.337 499.253 c f
BT 45.750 496.286 Td /F1 9.8 Tf  [(meteorological drought, which is defined based on the degree of dryness and the duration of the dry period due to less )] TJ ET
BT 45.750 484.381 Td /F1 9.8 Tf  [(precipitation than normal;)] TJ ET
40.337 471.694 m 
40.337 472.141 40.154 472.585 39.838 472.901 c
39.522 473.216 39.078 473.400 38.631 473.400 c
38.185 473.400 37.741 473.216 37.425 472.901 c
37.109 472.585 36.925 472.141 36.925 471.694 c
36.925 471.247 37.109 470.803 37.425 470.487 c
37.741 470.172 38.185 469.988 38.631 469.988 c
39.078 469.988 39.522 470.172 39.838 470.487 c
40.154 470.803 40.337 471.247 40.337 471.694 c f
BT 45.750 468.726 Td /F1 9.8 Tf  [(hydrological drought, which is based on the impacts of precipitation shortages on surface or sub-surface \(groundwater\) )] TJ ET
BT 45.750 456.822 Td /F1 9.8 Tf  [(water supplies;)] TJ ET
40.337 444.135 m 
40.337 444.581 40.154 445.025 39.838 445.341 c
39.522 445.657 39.078 445.841 38.631 445.841 c
38.185 445.841 37.741 445.657 37.425 445.341 c
37.109 445.025 36.925 444.581 36.925 444.135 c
36.925 443.688 37.109 443.244 37.425 442.928 c
37.741 442.612 38.185 442.428 38.631 442.428 c
39.078 442.428 39.522 442.612 39.838 442.928 c
40.154 443.244 40.337 443.688 40.337 444.135 c f
BT 45.750 441.167 Td /F1 9.8 Tf  [(agricultural drought, which links characteristics of meteorological or hydrological drought to agricultural impacts, where the )] TJ ET
BT 45.750 429.262 Td /F1 9.8 Tf  [(amount of moisture in the soil no longer meets the needs of a particular crop;)] TJ ET
40.337 416.575 m 
40.337 417.022 40.154 417.466 39.838 417.782 c
39.522 418.097 39.078 418.281 38.631 418.281 c
38.185 418.281 37.741 418.097 37.425 417.782 c
37.109 417.466 36.925 417.022 36.925 416.575 c
36.925 416.128 37.109 415.684 37.425 415.368 c
37.741 415.053 38.185 414.869 38.631 414.869 c
39.078 414.869 39.522 415.053 39.838 415.368 c
40.154 415.684 40.337 416.128 40.337 416.575 c f
BT 45.750 413.607 Td /F1 9.8 Tf  [(socioeconomic drought, which occurs when the demand for a particular economic good exceeds supply as a result of )] TJ ET
BT 45.750 401.703 Td /F1 9.8 Tf  [(weather-related shortfall in water supply and when water shortages begin to affect people.)] TJ ET
BT 26.250 378.548 Td /F1 9.8 Tf  [(Water source of interest is also key: meteorological drought is critical for rain-dependant areas such as the Sahel; agricultural )] TJ ET
BT 26.250 366.643 Td /F1 9.8 Tf  [(\(or soil moisture\) drought is important for plant development; hydrological drought impacts on freshwater ecosystems, and )] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(groundwater drought for pumped water supply. While these different types of drought are not independent, they focus on )] TJ ET
BT 26.250 342.834 Td /F1 9.8 Tf  [(physical processes of different complexity, scale and speed )] TJ ET
0.267 0.267 0.267 rg
BT 285.278 344.341 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 294.916 342.834 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(The impacts of drought are usually indirect. Being a slow-onset, long duration, spatially diffuse emergency, rather than a )] TJ ET
BT 26.250 311.524 Td /F1 9.8 Tf  [(sudden, high-impact event \(such as a flash flood or earthquake\), drought differs from other natural hazards )] TJ ET
0.267 0.267 0.267 rg
BT 489.053 313.031 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 498.691 311.524 Td /F1 9.8 Tf  [( and has many )] TJ ET
BT 26.250 299.619 Td /F1 9.8 Tf  [(multiple �downstream� effects. In the published literature, original links to drought are easily overlooked, e.g. wildfires are more )] TJ ET
BT 26.250 287.715 Td /F1 9.8 Tf  [(common during times of drought, but resulting burn injuries are often attributed to the fire alone.)] TJ ET
BT 26.250 268.310 Td /F1 9.8 Tf  [(The effects of drought are critically dependent on context and underlying population vulnerability. Drought development and )] TJ ET
BT 26.250 256.405 Td /F1 9.8 Tf  [(severity depend on the background level of water use \(which might aggravate drought onset, duration and end\) and )] TJ ET
BT 26.250 244.500 Td /F1 9.8 Tf  [(infrastructure \(which aims to mitigate the consequences of water deficit\). The impact on health is particularly dependent on the )] TJ ET
BT 26.250 232.596 Td /F1 9.8 Tf  [(socio-economic environment that can influence the resilience of the population. Poor health, poverty, and conflict are additional )] TJ ET
BT 26.250 220.691 Td /F1 9.8 Tf  [(contributing factors to the impact of drought )] TJ ET
0.267 0.267 0.267 rg
BT 216.472 222.198 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 226.110 220.691 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 201.286 Td /F1 9.8 Tf  [(The most recent available data \(covering drought disasters from 1900-2012\) from EM-DAT, a worldwide disaster database )] TJ ET
BT 26.250 189.381 Td /F1 9.8 Tf  [(maintained by the Centre for Research on the Epidemiology of Disasters, gives an indication of the devastating effects of )] TJ ET
BT 26.250 177.477 Td /F1 9.8 Tf  [(drought on countries around the world. In 2011, it is estimated that 35 million people were affected by drought in China, while 17 )] TJ ET
BT 26.250 165.572 Td /F1 9.8 Tf  [(million people were affected in Ethiopia, Kenya, Somalia, Uganda, Djibouti, Burundi and Niger. Droughts in the United States )] TJ ET
BT 26.250 153.667 Td /F1 9.8 Tf  [(and Mexico were estimated to have resulted in $8 billion in damages, while droughts in China resulted in $2.4 billion in )] TJ ET
BT 26.250 141.762 Td /F1 9.8 Tf  [(damages. Reported damages are often underestimated because of a lack of standardization methods for reporting and )] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(quantifying losses )] TJ ET
0.267 0.267 0.267 rg
BT 106.454 131.365 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 116.091 129.858 Td /F1 9.8 Tf  [(. For the period of 1900-2012, the countries with the greatest number of people affected by drought were )] TJ ET
BT 26.250 117.953 Td /F1 9.8 Tf  [(India and China; for the same period, the countries with the greatest number of recorded drought-related mortalities were China, )] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(Bangladesh, India, Soviet Union, Ethiopia and Sudan )] TJ ET
0.267 0.267 0.267 rg
BT 258.222 107.555 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 267.859 106.048 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(Despite the challenges of describing the health impacts of drought, it is important to attempt to do so in order to better plan )] TJ ET
BT 26.250 74.739 Td /F1 9.8 Tf  [(preparedness, mitigation, adaptation and response strategies. Systems already exist to predict drought )] TJ ET
0.267 0.267 0.267 rg
BT 472.254 76.246 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 477.073 78.627 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 479.482 76.246 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 489.119 74.739 Td /F1 9.8 Tf  [(; for these to benefit )] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(individual and societal wellbeing, it is important to know what impacts droughts might have. Actions trying to mitigate the worst )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(effects can therefore be taken both in advance of and during a drought. Other reports have outlined some of the health impacts )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(associated with drought in different contexts )] TJ ET
0.267 0.267 0.267 rg
BT 218.637 40.532 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 228.274 42.913 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 230.684 40.532 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 240.321 39.024 Td /F1 9.8 Tf  [(; this report offers the first systematic review of the global evidence on the )] TJ ET
Q
q
15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(floods; pacific islands are strongly affected by ENSO variations, and an El Ni�o episode is usually accompanied by drought in )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(southeast Asia, India, Australia, southeast Africa, Amazonia and northeast Brazil )] TJ ET
0.267 0.267 0.267 rg
BT 376.334 757.079 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 381.152 755.571 Td /F1 9.8 Tf  [(. Globally, disasters triggered by droughts are )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(twice as frequent in the year following the onset of El Ni�o \(warm events\) than during other years )] TJ ET
0.267 0.267 0.267 rg
BT 446.767 745.174 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 451.586 743.667 Td /F1 9.8 Tf  [(. In areas where droughts )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(can be anticipated, i.e., when linked with the El Ni�o Southern Oscillation, forecasts can be used to provide advance warning of )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the increased risk of adverse climate conditions and can support the disaster risk reduction process )] TJ ET
0.267 0.267 0.267 rg
BT 457.054 721.364 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 461.872 723.745 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 464.282 721.364 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 469.100 719.857 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(Documentation of the impacts of drought is difficult for a variety of reasons. Numerous indicators are used to capture and )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(quantify the onset, duration, extent and beginning/ end of droughts )] TJ ET
0.267 0.267 0.267 rg
BT 315.688 690.055 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 320.507 688.548 Td /F1 9.8 Tf  [(. Droughts are slow-onset phenomena, which generally )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(develop over an extended period of time and lack highly visible and structural impacts. They can be geographically extensive, )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(affecting large areas regardless of geopolitical/country boundaries, and can exhibit complex spatial patterns. The societal )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(impacts of drought can be slow to develop as they accumulate over time as the event continues, and the impacts can last for )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(years. Finally, there is a lack of standardization in drought hazard characterization and in definitions of drought )] TJ ET
0.267 0.267 0.267 rg
BT 504.224 642.436 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 513.862 644.817 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 516.271 642.436 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 525.908 640.929 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(complexities of drought are reflected in over 150 published definitions )] TJ ET
0.267 0.267 0.267 rg
BT 328.100 630.531 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 332.919 629.024 Td /F1 9.8 Tf  [( including:)] TJ ET
0.271 0.267 0.267 RG
40.337 612.587 m 
40.337 613.033 40.154 613.477 39.838 613.793 c
39.522 614.109 39.078 614.293 38.631 614.293 c
38.185 614.293 37.741 614.109 37.425 613.793 c
37.109 613.477 36.925 613.033 36.925 612.587 c
36.925 612.140 37.109 611.696 37.425 611.380 c
37.741 611.064 38.185 610.880 38.631 610.880 c
39.078 610.880 39.522 611.064 39.838 611.380 c
40.154 611.696 40.337 612.140 40.337 612.587 c f
BT 45.750 609.619 Td /F1 9.8 Tf  [(A prolonged dry period in the natural climate cycle )] TJ ET
0.267 0.267 0.267 rg
BT 264.677 611.126 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 274.314 609.619 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 596.932 m 
40.337 597.379 40.154 597.823 39.838 598.139 c
39.522 598.454 39.078 598.638 38.631 598.638 c
38.185 598.638 37.741 598.454 37.425 598.139 c
37.109 597.823 36.925 597.379 36.925 596.932 c
36.925 596.485 37.109 596.041 37.425 595.725 c
37.741 595.410 38.185 595.226 38.631 595.226 c
39.078 595.226 39.522 595.410 39.838 595.725 c
40.154 596.041 40.337 596.485 40.337 596.932 c f
BT 45.750 593.964 Td /F1 9.8 Tf  [(A period of abnormally dry weather long enough to cause a serious hydrological imbalance )] TJ ET
0.267 0.267 0.267 rg
BT 439.718 595.472 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 444.537 593.964 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 581.277 m 
40.337 581.724 40.154 582.168 39.838 582.484 c
39.522 582.800 39.078 582.983 38.631 582.983 c
38.185 582.983 37.741 582.800 37.425 582.484 c
37.109 582.168 36.925 581.724 36.925 581.277 c
36.925 580.831 37.109 580.387 37.425 580.071 c
37.741 579.755 38.185 579.571 38.631 579.571 c
39.078 579.571 39.522 579.755 39.838 580.071 c
40.154 580.387 40.337 580.831 40.337 581.277 c f
BT 45.750 578.310 Td /F1 9.8 Tf  [(An extended period of time characterized by a deficiency in a region�s water supply that is the result of constantly below )] TJ ET
BT 45.750 566.405 Td /F1 9.8 Tf  [(average precipitation )] TJ ET
0.267 0.267 0.267 rg
BT 138.960 567.912 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 148.597 566.405 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 553.718 m 
40.337 554.164 40.154 554.608 39.838 554.924 c
39.522 555.240 39.078 555.424 38.631 555.424 c
38.185 555.424 37.741 555.240 37.425 554.924 c
37.109 554.608 36.925 554.164 36.925 553.718 c
36.925 553.271 37.109 552.827 37.425 552.511 c
37.741 552.195 38.185 552.011 38.631 552.011 c
39.078 552.011 39.522 552.195 39.838 552.511 c
40.154 552.827 40.337 553.271 40.337 553.718 c f
BT 45.750 550.750 Td /F1 9.8 Tf  [(A temporary decrease of the average water availability due to rainfall deficiency )] TJ ET
0.267 0.267 0.267 rg
BT 390.939 552.257 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 400.576 550.750 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(Central to most definitions is a deficit of water from a �norm� for a given spatial area. Drought can be further categorized based )] TJ ET
BT 26.250 515.691 Td /F1 9.8 Tf  [(on how it is measured )] TJ ET
0.267 0.267 0.267 rg
BT 123.789 517.198 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 128.608 519.579 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 131.017 517.198 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 140.654 515.691 Td /F1 9.8 Tf  [(:)] TJ ET
40.337 499.253 m 
40.337 499.700 40.154 500.144 39.838 500.460 c
39.522 500.776 39.078 500.960 38.631 500.960 c
38.185 500.960 37.741 500.776 37.425 500.460 c
37.109 500.144 36.925 499.700 36.925 499.253 c
36.925 498.807 37.109 498.363 37.425 498.047 c
37.741 497.731 38.185 497.547 38.631 497.547 c
39.078 497.547 39.522 497.731 39.838 498.047 c
40.154 498.363 40.337 498.807 40.337 499.253 c f
BT 45.750 496.286 Td /F1 9.8 Tf  [(meteorological drought, which is defined based on the degree of dryness and the duration of the dry period due to less )] TJ ET
BT 45.750 484.381 Td /F1 9.8 Tf  [(precipitation than normal;)] TJ ET
40.337 471.694 m 
40.337 472.141 40.154 472.585 39.838 472.901 c
39.522 473.216 39.078 473.400 38.631 473.400 c
38.185 473.400 37.741 473.216 37.425 472.901 c
37.109 472.585 36.925 472.141 36.925 471.694 c
36.925 471.247 37.109 470.803 37.425 470.487 c
37.741 470.172 38.185 469.988 38.631 469.988 c
39.078 469.988 39.522 470.172 39.838 470.487 c
40.154 470.803 40.337 471.247 40.337 471.694 c f
BT 45.750 468.726 Td /F1 9.8 Tf  [(hydrological drought, which is based on the impacts of precipitation shortages on surface or sub-surface \(groundwater\) )] TJ ET
BT 45.750 456.822 Td /F1 9.8 Tf  [(water supplies;)] TJ ET
40.337 444.135 m 
40.337 444.581 40.154 445.025 39.838 445.341 c
39.522 445.657 39.078 445.841 38.631 445.841 c
38.185 445.841 37.741 445.657 37.425 445.341 c
37.109 445.025 36.925 444.581 36.925 444.135 c
36.925 443.688 37.109 443.244 37.425 442.928 c
37.741 442.612 38.185 442.428 38.631 442.428 c
39.078 442.428 39.522 442.612 39.838 442.928 c
40.154 443.244 40.337 443.688 40.337 444.135 c f
BT 45.750 441.167 Td /F1 9.8 Tf  [(agricultural drought, which links characteristics of meteorological or hydrological drought to agricultural impacts, where the )] TJ ET
BT 45.750 429.262 Td /F1 9.8 Tf  [(amount of moisture in the soil no longer meets the needs of a particular crop;)] TJ ET
40.337 416.575 m 
40.337 417.022 40.154 417.466 39.838 417.782 c
39.522 418.097 39.078 418.281 38.631 418.281 c
38.185 418.281 37.741 418.097 37.425 417.782 c
37.109 417.466 36.925 417.022 36.925 416.575 c
36.925 416.128 37.109 415.684 37.425 415.368 c
37.741 415.053 38.185 414.869 38.631 414.869 c
39.078 414.869 39.522 415.053 39.838 415.368 c
40.154 415.684 40.337 416.128 40.337 416.575 c f
BT 45.750 413.607 Td /F1 9.8 Tf  [(socioeconomic drought, which occurs when the demand for a particular economic good exceeds supply as a result of )] TJ ET
BT 45.750 401.703 Td /F1 9.8 Tf  [(weather-related shortfall in water supply and when water shortages begin to affect people.)] TJ ET
BT 26.250 378.548 Td /F1 9.8 Tf  [(Water source of interest is also key: meteorological drought is critical for rain-dependant areas such as the Sahel; agricultural )] TJ ET
BT 26.250 366.643 Td /F1 9.8 Tf  [(\(or soil moisture\) drought is important for plant development; hydrological drought impacts on freshwater ecosystems, and )] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(groundwater drought for pumped water supply. While these different types of drought are not independent, they focus on )] TJ ET
BT 26.250 342.834 Td /F1 9.8 Tf  [(physical processes of different complexity, scale and speed )] TJ ET
0.267 0.267 0.267 rg
BT 285.278 344.341 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 294.916 342.834 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(The impacts of drought are usually indirect. Being a slow-onset, long duration, spatially diffuse emergency, rather than a )] TJ ET
BT 26.250 311.524 Td /F1 9.8 Tf  [(sudden, high-impact event \(such as a flash flood or earthquake\), drought differs from other natural hazards )] TJ ET
0.267 0.267 0.267 rg
BT 489.053 313.031 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 498.691 311.524 Td /F1 9.8 Tf  [( and has many )] TJ ET
BT 26.250 299.619 Td /F1 9.8 Tf  [(multiple �downstream� effects. In the published literature, original links to drought are easily overlooked, e.g. wildfires are more )] TJ ET
BT 26.250 287.715 Td /F1 9.8 Tf  [(common during times of drought, but resulting burn injuries are often attributed to the fire alone.)] TJ ET
BT 26.250 268.310 Td /F1 9.8 Tf  [(The effects of drought are critically dependent on context and underlying population vulnerability. Drought development and )] TJ ET
BT 26.250 256.405 Td /F1 9.8 Tf  [(severity depend on the background level of water use \(which might aggravate drought onset, duration and end\) and )] TJ ET
BT 26.250 244.500 Td /F1 9.8 Tf  [(infrastructure \(which aims to mitigate the consequences of water deficit\). The impact on health is particularly dependent on the )] TJ ET
BT 26.250 232.596 Td /F1 9.8 Tf  [(socio-economic environment that can influence the resilience of the population. Poor health, poverty, and conflict are additional )] TJ ET
BT 26.250 220.691 Td /F1 9.8 Tf  [(contributing factors to the impact of drought )] TJ ET
0.267 0.267 0.267 rg
BT 216.472 222.198 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 226.110 220.691 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 201.286 Td /F1 9.8 Tf  [(The most recent available data \(covering drought disasters from 1900-2012\) from EM-DAT, a worldwide disaster database )] TJ ET
BT 26.250 189.381 Td /F1 9.8 Tf  [(maintained by the Centre for Research on the Epidemiology of Disasters, gives an indication of the devastating effects of )] TJ ET
BT 26.250 177.477 Td /F1 9.8 Tf  [(drought on countries around the world. In 2011, it is estimated that 35 million people were affected by drought in China, while 17 )] TJ ET
BT 26.250 165.572 Td /F1 9.8 Tf  [(million people were affected in Ethiopia, Kenya, Somalia, Uganda, Djibouti, Burundi and Niger. Droughts in the United States )] TJ ET
BT 26.250 153.667 Td /F1 9.8 Tf  [(and Mexico were estimated to have resulted in $8 billion in damages, while droughts in China resulted in $2.4 billion in )] TJ ET
BT 26.250 141.762 Td /F1 9.8 Tf  [(damages. Reported damages are often underestimated because of a lack of standardization methods for reporting and )] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(quantifying losses )] TJ ET
0.267 0.267 0.267 rg
BT 106.454 131.365 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 116.091 129.858 Td /F1 9.8 Tf  [(. For the period of 1900-2012, the countries with the greatest number of people affected by drought were )] TJ ET
BT 26.250 117.953 Td /F1 9.8 Tf  [(India and China; for the same period, the countries with the greatest number of recorded drought-related mortalities were China, )] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(Bangladesh, India, Soviet Union, Ethiopia and Sudan )] TJ ET
0.267 0.267 0.267 rg
BT 258.222 107.555 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 267.859 106.048 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(Despite the challenges of describing the health impacts of drought, it is important to attempt to do so in order to better plan )] TJ ET
BT 26.250 74.739 Td /F1 9.8 Tf  [(preparedness, mitigation, adaptation and response strategies. Systems already exist to predict drought )] TJ ET
0.267 0.267 0.267 rg
BT 472.254 76.246 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 477.073 78.627 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 479.482 76.246 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 489.119 74.739 Td /F1 9.8 Tf  [(; for these to benefit )] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(individual and societal wellbeing, it is important to know what impacts droughts might have. Actions trying to mitigate the worst )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(effects can therefore be taken both in advance of and during a drought. Other reports have outlined some of the health impacts )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(associated with drought in different contexts )] TJ ET
0.267 0.267 0.267 rg
BT 218.637 40.532 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 228.274 42.913 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 230.684 40.532 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 240.321 39.024 Td /F1 9.8 Tf  [(; this report offers the first systematic review of the global evidence on the )] TJ ET
Q
q
15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(floods; pacific islands are strongly affected by ENSO variations, and an El Ni�o episode is usually accompanied by drought in )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(southeast Asia, India, Australia, southeast Africa, Amazonia and northeast Brazil )] TJ ET
0.267 0.267 0.267 rg
BT 376.334 757.079 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 381.152 755.571 Td /F1 9.8 Tf  [(. Globally, disasters triggered by droughts are )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(twice as frequent in the year following the onset of El Ni�o \(warm events\) than during other years )] TJ ET
0.267 0.267 0.267 rg
BT 446.767 745.174 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 451.586 743.667 Td /F1 9.8 Tf  [(. In areas where droughts )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(can be anticipated, i.e., when linked with the El Ni�o Southern Oscillation, forecasts can be used to provide advance warning of )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(the increased risk of adverse climate conditions and can support the disaster risk reduction process )] TJ ET
0.267 0.267 0.267 rg
BT 457.054 721.364 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 461.872 723.745 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 464.282 721.364 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 469.100 719.857 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(Documentation of the impacts of drought is difficult for a variety of reasons. Numerous indicators are used to capture and )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(quantify the onset, duration, extent and beginning/ end of droughts )] TJ ET
0.267 0.267 0.267 rg
BT 315.688 690.055 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 320.507 688.548 Td /F1 9.8 Tf  [(. Droughts are slow-onset phenomena, which generally )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(develop over an extended period of time and lack highly visible and structural impacts. They can be geographically extensive, )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(affecting large areas regardless of geopolitical/country boundaries, and can exhibit complex spatial patterns. The societal )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(impacts of drought can be slow to develop as they accumulate over time as the event continues, and the impacts can last for )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(years. Finally, there is a lack of standardization in drought hazard characterization and in definitions of drought )] TJ ET
0.267 0.267 0.267 rg
BT 504.224 642.436 Td /F4 8.7 Tf  [(10)] TJ ET
0.271 0.267 0.267 rg
BT 513.862 644.817 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 516.271 642.436 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 525.908 640.929 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(complexities of drought are reflected in over 150 published definitions )] TJ ET
0.267 0.267 0.267 rg
BT 328.100 630.531 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 332.919 629.024 Td /F1 9.8 Tf  [( including:)] TJ ET
0.271 0.267 0.267 RG
40.337 612.587 m 
40.337 613.033 40.154 613.477 39.838 613.793 c
39.522 614.109 39.078 614.293 38.631 614.293 c
38.185 614.293 37.741 614.109 37.425 613.793 c
37.109 613.477 36.925 613.033 36.925 612.587 c
36.925 612.140 37.109 611.696 37.425 611.380 c
37.741 611.064 38.185 610.880 38.631 610.880 c
39.078 610.880 39.522 611.064 39.838 611.380 c
40.154 611.696 40.337 612.140 40.337 612.587 c f
BT 45.750 609.619 Td /F1 9.8 Tf  [(A prolonged dry period in the natural climate cycle )] TJ ET
0.267 0.267 0.267 rg
BT 264.677 611.126 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 274.314 609.619 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 596.932 m 
40.337 597.379 40.154 597.823 39.838 598.139 c
39.522 598.454 39.078 598.638 38.631 598.638 c
38.185 598.638 37.741 598.454 37.425 598.139 c
37.109 597.823 36.925 597.379 36.925 596.932 c
36.925 596.485 37.109 596.041 37.425 595.725 c
37.741 595.410 38.185 595.226 38.631 595.226 c
39.078 595.226 39.522 595.410 39.838 595.725 c
40.154 596.041 40.337 596.485 40.337 596.932 c f
BT 45.750 593.964 Td /F1 9.8 Tf  [(A period of abnormally dry weather long enough to cause a serious hydrological imbalance )] TJ ET
0.267 0.267 0.267 rg
BT 439.718 595.472 Td /F4 8.7 Tf  [(1)] TJ ET
0.271 0.267 0.267 rg
BT 444.537 593.964 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 581.277 m 
40.337 581.724 40.154 582.168 39.838 582.484 c
39.522 582.800 39.078 582.983 38.631 582.983 c
38.185 582.983 37.741 582.800 37.425 582.484 c
37.109 582.168 36.925 581.724 36.925 581.277 c
36.925 580.831 37.109 580.387 37.425 580.071 c
37.741 579.755 38.185 579.571 38.631 579.571 c
39.078 579.571 39.522 579.755 39.838 580.071 c
40.154 580.387 40.337 580.831 40.337 581.277 c f
BT 45.750 578.310 Td /F1 9.8 Tf  [(An extended period of time characterized by a deficiency in a region�s water supply that is the result of constantly below )] TJ ET
BT 45.750 566.405 Td /F1 9.8 Tf  [(average precipitation )] TJ ET
0.267 0.267 0.267 rg
BT 138.960 567.912 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 148.597 566.405 Td /F1 9.8 Tf  [(;)] TJ ET
40.337 553.718 m 
40.337 554.164 40.154 554.608 39.838 554.924 c
39.522 555.240 39.078 555.424 38.631 555.424 c
38.185 555.424 37.741 555.240 37.425 554.924 c
37.109 554.608 36.925 554.164 36.925 553.718 c
36.925 553.271 37.109 552.827 37.425 552.511 c
37.741 552.195 38.185 552.011 38.631 552.011 c
39.078 552.011 39.522 552.195 39.838 552.511 c
40.154 552.827 40.337 553.271 40.337 553.718 c f
BT 45.750 550.750 Td /F1 9.8 Tf  [(A temporary decrease of the average water availability due to rainfall deficiency )] TJ ET
0.267 0.267 0.267 rg
BT 390.939 552.257 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 400.576 550.750 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 527.595 Td /F1 9.8 Tf  [(Central to most definitions is a deficit of water from a �norm� for a given spatial area. Drought can be further categorized based )] TJ ET
BT 26.250 515.691 Td /F1 9.8 Tf  [(on how it is measured )] TJ ET
0.267 0.267 0.267 rg
BT 123.789 517.198 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 128.608 519.579 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 131.017 517.198 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 140.654 515.691 Td /F1 9.8 Tf  [(:)] TJ ET
40.337 499.253 m 
40.337 499.700 40.154 500.144 39.838 500.460 c
39.522 500.776 39.078 500.960 38.631 500.960 c
38.185 500.960 37.741 500.776 37.425 500.460 c
37.109 500.144 36.925 499.700 36.925 499.253 c
36.925 498.807 37.109 498.363 37.425 498.047 c
37.741 497.731 38.185 497.547 38.631 497.547 c
39.078 497.547 39.522 497.731 39.838 498.047 c
40.154 498.363 40.337 498.807 40.337 499.253 c f
BT 45.750 496.286 Td /F1 9.8 Tf  [(meteorological drought, which is defined based on the degree of dryness and the duration of the dry period due to less )] TJ ET
BT 45.750 484.381 Td /F1 9.8 Tf  [(precipitation than normal;)] TJ ET
40.337 471.694 m 
40.337 472.141 40.154 472.585 39.838 472.901 c
39.522 473.216 39.078 473.400 38.631 473.400 c
38.185 473.400 37.741 473.216 37.425 472.901 c
37.109 472.585 36.925 472.141 36.925 471.694 c
36.925 471.247 37.109 470.803 37.425 470.487 c
37.741 470.172 38.185 469.988 38.631 469.988 c
39.078 469.988 39.522 470.172 39.838 470.487 c
40.154 470.803 40.337 471.247 40.337 471.694 c f
BT 45.750 468.726 Td /F1 9.8 Tf  [(hydrological drought, which is based on the impacts of precipitation shortages on surface or sub-surface \(groundwater\) )] TJ ET
BT 45.750 456.822 Td /F1 9.8 Tf  [(water supplies;)] TJ ET
40.337 444.135 m 
40.337 444.581 40.154 445.025 39.838 445.341 c
39.522 445.657 39.078 445.841 38.631 445.841 c
38.185 445.841 37.741 445.657 37.425 445.341 c
37.109 445.025 36.925 444.581 36.925 444.135 c
36.925 443.688 37.109 443.244 37.425 442.928 c
37.741 442.612 38.185 442.428 38.631 442.428 c
39.078 442.428 39.522 442.612 39.838 442.928 c
40.154 443.244 40.337 443.688 40.337 444.135 c f
BT 45.750 441.167 Td /F1 9.8 Tf  [(agricultural drought, which links characteristics of meteorological or hydrological drought to agricultural impacts, where the )] TJ ET
BT 45.750 429.262 Td /F1 9.8 Tf  [(amount of moisture in the soil no longer meets the needs of a particular crop;)] TJ ET
40.337 416.575 m 
40.337 417.022 40.154 417.466 39.838 417.782 c
39.522 418.097 39.078 418.281 38.631 418.281 c
38.185 418.281 37.741 418.097 37.425 417.782 c
37.109 417.466 36.925 417.022 36.925 416.575 c
36.925 416.128 37.109 415.684 37.425 415.368 c
37.741 415.053 38.185 414.869 38.631 414.869 c
39.078 414.869 39.522 415.053 39.838 415.368 c
40.154 415.684 40.337 416.128 40.337 416.575 c f
BT 45.750 413.607 Td /F1 9.8 Tf  [(socioeconomic drought, which occurs when the demand for a particular economic good exceeds supply as a result of )] TJ ET
BT 45.750 401.703 Td /F1 9.8 Tf  [(weather-related shortfall in water supply and when water shortages begin to affect people.)] TJ ET
BT 26.250 378.548 Td /F1 9.8 Tf  [(Water source of interest is also key: meteorological drought is critical for rain-dependant areas such as the Sahel; agricultural )] TJ ET
BT 26.250 366.643 Td /F1 9.8 Tf  [(\(or soil moisture\) drought is important for plant development; hydrological drought impacts on freshwater ecosystems, and )] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(groundwater drought for pumped water supply. While these different types of drought are not independent, they focus on )] TJ ET
BT 26.250 342.834 Td /F1 9.8 Tf  [(physical processes of different complexity, scale and speed )] TJ ET
0.267 0.267 0.267 rg
BT 285.278 344.341 Td /F4 8.7 Tf  [(15)] TJ ET
0.271 0.267 0.267 rg
BT 294.916 342.834 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 323.429 Td /F1 9.8 Tf  [(The impacts of drought are usually indirect. Being a slow-onset, long duration, spatially diffuse emergency, rather than a )] TJ ET
BT 26.250 311.524 Td /F1 9.8 Tf  [(sudden, high-impact event \(such as a flash flood or earthquake\), drought differs from other natural hazards )] TJ ET
0.267 0.267 0.267 rg
BT 489.053 313.031 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 498.691 311.524 Td /F1 9.8 Tf  [( and has many )] TJ ET
BT 26.250 299.619 Td /F1 9.8 Tf  [(multiple �downstream� effects. In the published literature, original links to drought are easily overlooked, e.g. wildfires are more )] TJ ET
BT 26.250 287.715 Td /F1 9.8 Tf  [(common during times of drought, but resulting burn injuries are often attributed to the fire alone.)] TJ ET
BT 26.250 268.310 Td /F1 9.8 Tf  [(The effects of drought are critically dependent on context and underlying population vulnerability. Drought development and )] TJ ET
BT 26.250 256.405 Td /F1 9.8 Tf  [(severity depend on the background level of water use \(which might aggravate drought onset, duration and end\) and )] TJ ET
BT 26.250 244.500 Td /F1 9.8 Tf  [(infrastructure \(which aims to mitigate the consequences of water deficit\). The impact on health is particularly dependent on the )] TJ ET
BT 26.250 232.596 Td /F1 9.8 Tf  [(socio-economic environment that can influence the resilience of the population. Poor health, poverty, and conflict are additional )] TJ ET
BT 26.250 220.691 Td /F1 9.8 Tf  [(contributing factors to the impact of drought )] TJ ET
0.267 0.267 0.267 rg
BT 216.472 222.198 Td /F4 8.7 Tf  [(17)] TJ ET
0.271 0.267 0.267 rg
BT 226.110 220.691 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 201.286 Td /F1 9.8 Tf  [(The most recent available data \(covering drought disasters from 1900-2012\) from EM-DAT, a worldwide disaster database )] TJ ET
BT 26.250 189.381 Td /F1 9.8 Tf  [(maintained by the Centre for Research on the Epidemiology of Disasters, gives an indication of the devastating effects of )] TJ ET
BT 26.250 177.477 Td /F1 9.8 Tf  [(drought on countries around the world. In 2011, it is estimated that 35 million people were affected by drought in China, while 17 )] TJ ET
BT 26.250 165.572 Td /F1 9.8 Tf  [(million people were affected in Ethiopia, Kenya, Somalia, Uganda, Djibouti, Burundi and Niger. Droughts in the United States )] TJ ET
BT 26.250 153.667 Td /F1 9.8 Tf  [(and Mexico were estimated to have resulted in $8 billion in damages, while droughts in China resulted in $2.4 billion in )] TJ ET
BT 26.250 141.762 Td /F1 9.8 Tf  [(damages. Reported damages are often underestimated because of a lack of standardization methods for reporting and )] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(quantifying losses )] TJ ET
0.267 0.267 0.267 rg
BT 106.454 131.365 Td /F4 8.7 Tf  [(11)] TJ ET
0.271 0.267 0.267 rg
BT 116.091 129.858 Td /F1 9.8 Tf  [(. For the period of 1900-2012, the countries with the greatest number of people affected by drought were )] TJ ET
BT 26.250 117.953 Td /F1 9.8 Tf  [(India and China; for the same period, the countries with the greatest number of recorded drought-related mortalities were China, )] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(Bangladesh, India, Soviet Union, Ethiopia and Sudan )] TJ ET
0.267 0.267 0.267 rg
BT 258.222 107.555 Td /F4 8.7 Tf  [(18)] TJ ET
0.271 0.267 0.267 rg
BT 267.859 106.048 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(Despite the challenges of describing the health impacts of drought, it is important to attempt to do so in order to better plan )] TJ ET
BT 26.250 74.739 Td /F1 9.8 Tf  [(preparedness, mitigation, adaptation and response strategies. Systems already exist to predict drought )] TJ ET
0.267 0.267 0.267 rg
BT 472.254 76.246 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 477.073 78.627 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 479.482 76.246 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 489.119 74.739 Td /F1 9.8 Tf  [(; for these to benefit )] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(individual and societal wellbeing, it is important to know what impacts droughts might have. Actions trying to mitigate the worst )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(effects can therefore be taken both in advance of and during a drought. Other reports have outlined some of the health impacts )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(associated with drought in different contexts )] TJ ET
0.267 0.267 0.267 rg
BT 218.637 40.532 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 228.274 42.913 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 230.684 40.532 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 240.321 39.024 Td /F1 9.8 Tf  [(; this report offers the first systematic review of the global evidence on the )] TJ ET
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40.337 194.705 40.154 195.149 39.838 195.465 c
39.522 195.781 39.078 195.965 38.631 195.965 c
38.185 195.965 37.741 195.781 37.425 195.465 c
37.109 195.149 36.925 194.705 36.925 194.258 c
36.925 193.812 37.109 193.368 37.425 193.052 c
37.741 192.736 38.185 192.552 38.631 192.552 c
39.078 192.552 39.522 192.736 39.838 193.052 c
40.154 193.368 40.337 193.812 40.337 194.258 c f
BT 45.750 191.291 Td /F1 9.8 Tf  [(All countries/contexts;)] TJ ET
40.337 178.604 m 
40.337 179.050 40.154 179.494 39.838 179.810 c
39.522 180.126 39.078 180.310 38.631 180.310 c
38.185 180.310 37.741 180.126 37.425 179.810 c
37.109 179.494 36.925 179.050 36.925 178.604 c
36.925 178.157 37.109 177.713 37.425 177.397 c
37.741 177.081 38.185 176.897 38.631 176.897 c
39.078 176.897 39.522 177.081 39.838 177.397 c
40.154 177.713 40.337 178.157 40.337 178.604 c f
BT 45.750 175.636 Td /F1 9.8 Tf  [(Papers published in any year, until May 2012, based on individual database capabilities.)] TJ ET
BT 26.250 152.481 Td /F1 9.8 Tf  [(Papers which examined the link between drought and its impact on human health without explicitly quantifying or qualifying the )] TJ ET
BT 26.250 140.577 Td /F1 9.8 Tf  [(impact are included in supporting text but not in the tables.)] TJ ET
BT 26.250 121.172 Td /F1 9.8 Tf  [(Exclusion criteria were:)] TJ ET
40.337 104.735 m 
40.337 105.181 40.154 105.625 39.838 105.941 c
39.522 106.257 39.078 106.441 38.631 106.441 c
38.185 106.441 37.741 106.257 37.425 105.941 c
37.109 105.625 36.925 105.181 36.925 104.735 c
36.925 104.288 37.109 103.844 37.425 103.528 c
37.741 103.212 38.185 103.028 38.631 103.028 c
39.078 103.028 39.522 103.212 39.838 103.528 c
40.154 103.844 40.337 104.288 40.337 104.735 c f
BT 45.750 101.767 Td /F1 9.8 Tf  [(Drought as meaning shortage/deficiency unrelated to climate�as in �heroin drought�;)] TJ ET
40.337 89.080 m 
40.337 89.527 40.154 89.971 39.838 90.287 c
39.522 90.602 39.078 90.786 38.631 90.786 c
38.185 90.786 37.741 90.602 37.425 90.287 c
37.109 89.971 36.925 89.527 36.925 89.080 c
36.925 88.633 37.109 88.189 37.425 87.873 c
37.741 87.558 38.185 87.374 38.631 87.374 c
39.078 87.374 39.522 87.558 39.838 87.873 c
40.154 88.189 40.337 88.633 40.337 89.080 c f
BT 45.750 86.112 Td /F1 9.8 Tf  [(Papers not published in English;)] TJ ET
40.337 73.425 m 
40.337 73.872 40.154 74.316 39.838 74.632 c
39.522 74.948 39.078 75.131 38.631 75.131 c
38.185 75.131 37.741 74.948 37.425 74.632 c
37.109 74.316 36.925 73.872 36.925 73.425 c
36.925 72.979 37.109 72.535 37.425 72.219 c
37.741 71.903 38.185 71.719 38.631 71.719 c
39.078 71.719 39.522 71.903 39.838 72.219 c
40.154 72.535 40.337 72.979 40.337 73.425 c f
BT 45.750 70.458 Td /F1 9.8 Tf  [(Papers which discuss �dry season� or arid conditions \(unless drought was explicitly noted as an extreme event/unusual )] TJ ET
BT 45.750 58.553 Td /F1 9.8 Tf  [(occurrence in the normal climate variability of the area\).)] TJ ET
Q
q
15.000 44.922 577.500 732.078 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(known impacts of drought, aims to inform short-term drought-related policy and planning, and provides a basis for continuing )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(research efforts.)] TJ ET
BT 26.250 718.969 Td /F4 12.0 Tf  [(AIM AND OBJECTIVES)] TJ ET
BT 26.250 699.015 Td /F5 9.8 Tf  [(Aim)] TJ ET
BT 26.250 679.610 Td /F1 9.8 Tf  [(This review aims to support drought policy, planning and implementation of intervention strategies and adaptation measures by )] TJ ET
BT 26.250 667.705 Td /F1 9.8 Tf  [(summarising available evidence of the health impacts of drought.)] TJ ET
BT 26.250 648.300 Td /F5 9.8 Tf  [(Objectives)] TJ ET
0.271 0.267 0.267 RG
40.337 631.863 m 
40.337 632.310 40.154 632.754 39.838 633.070 c
39.522 633.386 39.078 633.569 38.631 633.569 c
38.185 633.569 37.741 633.386 37.425 633.070 c
37.109 632.754 36.925 632.310 36.925 631.863 c
36.925 631.417 37.109 630.973 37.425 630.657 c
37.741 630.341 38.185 630.157 38.631 630.157 c
39.078 630.157 39.522 630.341 39.838 630.657 c
40.154 630.973 40.337 631.417 40.337 631.863 c f
BT 45.750 628.896 Td /F1 9.8 Tf  [(To systematically review published literature on the global health effects of drought;)] TJ ET
40.337 616.208 m 
40.337 616.655 40.154 617.099 39.838 617.415 c
39.522 617.731 39.078 617.915 38.631 617.915 c
38.185 617.915 37.741 617.731 37.425 617.415 c
37.109 617.099 36.925 616.655 36.925 616.208 c
36.925 615.762 37.109 615.318 37.425 615.002 c
37.741 614.686 38.185 614.502 38.631 614.502 c
39.078 614.502 39.522 614.686 39.838 615.002 c
40.154 615.318 40.337 615.762 40.337 616.208 c f
BT 45.750 613.241 Td /F1 9.8 Tf  [(To explore contextual factors and population characteristics which contribute to different health outcomes;)] TJ ET
40.337 600.554 m 
40.337 601.000 40.154 601.444 39.838 601.760 c
39.522 602.076 39.078 602.260 38.631 602.260 c
38.185 602.260 37.741 602.076 37.425 601.760 c
37.109 601.444 36.925 601.000 36.925 600.554 c
36.925 600.107 37.109 599.663 37.425 599.347 c
37.741 599.031 38.185 598.848 38.631 598.848 c
39.078 598.848 39.522 599.031 39.838 599.347 c
40.154 599.663 40.337 600.107 40.337 600.554 c f
BT 45.750 597.586 Td /F1 9.8 Tf  [(To identify gaps in knowledge to support further research efforts.)] TJ ET
BT 26.250 557.234 Td /F4 12.0 Tf  [(METHODS)] TJ ET
BT 26.250 537.279 Td /F1 9.8 Tf  [(We conducted a systematic review of published literature following PRISMA guidelines )] TJ ET
0.267 0.267 0.267 rg
BT 402.308 538.787 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 411.945 537.279 Td /F1 9.8 Tf  [(. Search terms were adapted from )] TJ ET
BT 26.250 525.375 Td /F1 9.8 Tf  [(previous publications on the health impact of related extreme events )] TJ ET
0.267 0.267 0.267 rg
BT 323.225 526.882 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 328.044 525.375 Td /F1 9.8 Tf  [( \(Box 1\), and were also based on preliminary informal )] TJ ET
BT 26.250 513.470 Td /F1 9.8 Tf  [(scoping studies of the literature.)] TJ ET
q
26.250 489.853 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 492.600 Td /F1 9.8 Tf  [(Box 1 � Search Terms Use)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 378.553 555.000 103.800 re f
0.267 0.267 0.267 rg
26.625 481.228 554.250 0.750 re f
26.625 465.346 0.750 16.631 re f
580.125 465.346 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 471.373 Td /F4 9.8 Tf  [(Exposure terms)] TJ ET
0.267 0.267 0.267 rg
26.625 465.346 554.250 0.750 re f
26.625 449.465 0.750 16.631 re f
580.125 449.465 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 455.491 Td /F1 9.8 Tf  [(Drought* OR arid* OR rain*)] TJ ET
0.267 0.267 0.267 rg
26.625 449.465 554.250 0.750 re f
26.625 433.584 0.750 16.631 re f
580.125 433.584 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 439.610 Td /F1 9.8 Tf  [(Combined by AND with:)] TJ ET
0.267 0.267 0.267 rg
26.625 433.584 554.250 0.750 re f
26.625 417.703 0.750 16.631 re f
580.125 417.703 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 423.729 Td /F4 9.8 Tf  [(Outcome terms)] TJ ET
0.267 0.267 0.267 rg
26.625 417.703 554.250 0.750 re f
26.625 378.928 554.250 0.750 re f
26.625 378.928 0.750 39.525 re f
580.125 378.928 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 407.848 Td /F1 9.8 Tf  [(Morbidity OR mortality OR health OR disease OR mental health OR injur* OR infect* OR diar* OR malnutrition OR water )] TJ ET
BT 31.875 400.216 Td /F1 9.8 Tf  [(borne OR vector OR trachoma OR nutrition OR cyanide OR malaria OR schistosomiasis OR famine OR resp* OR typhoid )] TJ ET
BT 31.875 392.585 Td /F1 9.8 Tf  [(fever OR amoebiasis OR cholera OR hepatitis A OR salmonellosis OR shigellosis OR dengue OR onchocerciasis OR )] TJ ET
BT 31.875 384.954 Td /F1 9.8 Tf  [(Japanese encephalitis OR scabies OR impetigo OR conjunctivitis OR scrub typhus OR leptospirosis OR PTSD OR depress*)] TJ ET
BT 26.250 324.029 Td /F5 9.8 Tf  [(Databases used)] TJ ET
BT 26.250 304.624 Td /F1 9.8 Tf  [(The following databases were searched: MEDLINE; CINAHL; Embase; PsychINFO, Cochrane Collection. Key references from )] TJ ET
BT 26.250 292.719 Td /F1 9.8 Tf  [(extracted papers were also hand-searched.)] TJ ET
BT 26.250 273.315 Td /F5 9.8 Tf  [(Inclusion and exclusion criteria)] TJ ET
BT 26.250 253.910 Td /F1 9.8 Tf  [(For extraction into summary tables, inclusion criteria were:)] TJ ET
0.271 0.267 0.267 RG
40.337 237.473 m 
40.337 237.919 40.154 238.363 39.838 238.679 c
39.522 238.995 39.078 239.179 38.631 239.179 c
38.185 239.179 37.741 238.995 37.425 238.679 c
37.109 238.363 36.925 237.919 36.925 237.473 c
36.925 237.026 37.109 236.582 37.425 236.266 c
37.741 235.950 38.185 235.766 38.631 235.766 c
39.078 235.766 39.522 235.950 39.838 236.266 c
40.154 236.582 40.337 237.026 40.337 237.473 c f
BT 45.750 234.505 Td /F1 9.8 Tf  [(Papers where an explicit link is made between drought as an exposure and human health outcomes, and where a health )] TJ ET
BT 45.750 222.600 Td /F1 9.8 Tf  [(outcome is measured;)] TJ ET
40.337 209.913 m 
40.337 210.360 40.154 210.804 39.838 211.120 c
39.522 211.436 39.078 211.619 38.631 211.619 c
38.185 211.619 37.741 211.436 37.425 211.120 c
37.109 210.804 36.925 210.360 36.925 209.913 c
36.925 209.467 37.109 209.023 37.425 208.707 c
37.741 208.391 38.185 208.207 38.631 208.207 c
39.078 208.207 39.522 208.391 39.838 208.707 c
40.154 209.023 40.337 209.467 40.337 209.913 c f
BT 45.750 206.946 Td /F1 9.8 Tf  [(All study designs and/or methods;)] TJ ET
40.337 194.258 m 
40.337 194.705 40.154 195.149 39.838 195.465 c
39.522 195.781 39.078 195.965 38.631 195.965 c
38.185 195.965 37.741 195.781 37.425 195.465 c
37.109 195.149 36.925 194.705 36.925 194.258 c
36.925 193.812 37.109 193.368 37.425 193.052 c
37.741 192.736 38.185 192.552 38.631 192.552 c
39.078 192.552 39.522 192.736 39.838 193.052 c
40.154 193.368 40.337 193.812 40.337 194.258 c f
BT 45.750 191.291 Td /F1 9.8 Tf  [(All countries/contexts;)] TJ ET
40.337 178.604 m 
40.337 179.050 40.154 179.494 39.838 179.810 c
39.522 180.126 39.078 180.310 38.631 180.310 c
38.185 180.310 37.741 180.126 37.425 179.810 c
37.109 179.494 36.925 179.050 36.925 178.604 c
36.925 178.157 37.109 177.713 37.425 177.397 c
37.741 177.081 38.185 176.897 38.631 176.897 c
39.078 176.897 39.522 177.081 39.838 177.397 c
40.154 177.713 40.337 178.157 40.337 178.604 c f
BT 45.750 175.636 Td /F1 9.8 Tf  [(Papers published in any year, until May 2012, based on individual database capabilities.)] TJ ET
BT 26.250 152.481 Td /F1 9.8 Tf  [(Papers which examined the link between drought and its impact on human health without explicitly quantifying or qualifying the )] TJ ET
BT 26.250 140.577 Td /F1 9.8 Tf  [(impact are included in supporting text but not in the tables.)] TJ ET
BT 26.250 121.172 Td /F1 9.8 Tf  [(Exclusion criteria were:)] TJ ET
40.337 104.735 m 
40.337 105.181 40.154 105.625 39.838 105.941 c
39.522 106.257 39.078 106.441 38.631 106.441 c
38.185 106.441 37.741 106.257 37.425 105.941 c
37.109 105.625 36.925 105.181 36.925 104.735 c
36.925 104.288 37.109 103.844 37.425 103.528 c
37.741 103.212 38.185 103.028 38.631 103.028 c
39.078 103.028 39.522 103.212 39.838 103.528 c
40.154 103.844 40.337 104.288 40.337 104.735 c f
BT 45.750 101.767 Td /F1 9.8 Tf  [(Drought as meaning shortage/deficiency unrelated to climate�as in �heroin drought�;)] TJ ET
40.337 89.080 m 
40.337 89.527 40.154 89.971 39.838 90.287 c
39.522 90.602 39.078 90.786 38.631 90.786 c
38.185 90.786 37.741 90.602 37.425 90.287 c
37.109 89.971 36.925 89.527 36.925 89.080 c
36.925 88.633 37.109 88.189 37.425 87.873 c
37.741 87.558 38.185 87.374 38.631 87.374 c
39.078 87.374 39.522 87.558 39.838 87.873 c
40.154 88.189 40.337 88.633 40.337 89.080 c f
BT 45.750 86.112 Td /F1 9.8 Tf  [(Papers not published in English;)] TJ ET
40.337 73.425 m 
40.337 73.872 40.154 74.316 39.838 74.632 c
39.522 74.948 39.078 75.131 38.631 75.131 c
38.185 75.131 37.741 74.948 37.425 74.632 c
37.109 74.316 36.925 73.872 36.925 73.425 c
36.925 72.979 37.109 72.535 37.425 72.219 c
37.741 71.903 38.185 71.719 38.631 71.719 c
39.078 71.719 39.522 71.903 39.838 72.219 c
40.154 72.535 40.337 72.979 40.337 73.425 c f
BT 45.750 70.458 Td /F1 9.8 Tf  [(Papers which discuss �dry season� or arid conditions \(unless drought was explicitly noted as an extreme event/unusual )] TJ ET
BT 45.750 58.553 Td /F1 9.8 Tf  [(occurrence in the normal climate variability of the area\).)] TJ ET
Q
q
15.000 44.922 577.500 732.078 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(known impacts of drought, aims to inform short-term drought-related policy and planning, and provides a basis for continuing )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(research efforts.)] TJ ET
BT 26.250 718.969 Td /F4 12.0 Tf  [(AIM AND OBJECTIVES)] TJ ET
BT 26.250 699.015 Td /F5 9.8 Tf  [(Aim)] TJ ET
BT 26.250 679.610 Td /F1 9.8 Tf  [(This review aims to support drought policy, planning and implementation of intervention strategies and adaptation measures by )] TJ ET
BT 26.250 667.705 Td /F1 9.8 Tf  [(summarising available evidence of the health impacts of drought.)] TJ ET
BT 26.250 648.300 Td /F5 9.8 Tf  [(Objectives)] TJ ET
0.271 0.267 0.267 RG
40.337 631.863 m 
40.337 632.310 40.154 632.754 39.838 633.070 c
39.522 633.386 39.078 633.569 38.631 633.569 c
38.185 633.569 37.741 633.386 37.425 633.070 c
37.109 632.754 36.925 632.310 36.925 631.863 c
36.925 631.417 37.109 630.973 37.425 630.657 c
37.741 630.341 38.185 630.157 38.631 630.157 c
39.078 630.157 39.522 630.341 39.838 630.657 c
40.154 630.973 40.337 631.417 40.337 631.863 c f
BT 45.750 628.896 Td /F1 9.8 Tf  [(To systematically review published literature on the global health effects of drought;)] TJ ET
40.337 616.208 m 
40.337 616.655 40.154 617.099 39.838 617.415 c
39.522 617.731 39.078 617.915 38.631 617.915 c
38.185 617.915 37.741 617.731 37.425 617.415 c
37.109 617.099 36.925 616.655 36.925 616.208 c
36.925 615.762 37.109 615.318 37.425 615.002 c
37.741 614.686 38.185 614.502 38.631 614.502 c
39.078 614.502 39.522 614.686 39.838 615.002 c
40.154 615.318 40.337 615.762 40.337 616.208 c f
BT 45.750 613.241 Td /F1 9.8 Tf  [(To explore contextual factors and population characteristics which contribute to different health outcomes;)] TJ ET
40.337 600.554 m 
40.337 601.000 40.154 601.444 39.838 601.760 c
39.522 602.076 39.078 602.260 38.631 602.260 c
38.185 602.260 37.741 602.076 37.425 601.760 c
37.109 601.444 36.925 601.000 36.925 600.554 c
36.925 600.107 37.109 599.663 37.425 599.347 c
37.741 599.031 38.185 598.848 38.631 598.848 c
39.078 598.848 39.522 599.031 39.838 599.347 c
40.154 599.663 40.337 600.107 40.337 600.554 c f
BT 45.750 597.586 Td /F1 9.8 Tf  [(To identify gaps in knowledge to support further research efforts.)] TJ ET
BT 26.250 557.234 Td /F4 12.0 Tf  [(METHODS)] TJ ET
BT 26.250 537.279 Td /F1 9.8 Tf  [(We conducted a systematic review of published literature following PRISMA guidelines )] TJ ET
0.267 0.267 0.267 rg
BT 402.308 538.787 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 411.945 537.279 Td /F1 9.8 Tf  [(. Search terms were adapted from )] TJ ET
BT 26.250 525.375 Td /F1 9.8 Tf  [(previous publications on the health impact of related extreme events )] TJ ET
0.267 0.267 0.267 rg
BT 323.225 526.882 Td /F4 8.7 Tf  [(2)] TJ ET
0.271 0.267 0.267 rg
BT 328.044 525.375 Td /F1 9.8 Tf  [( \(Box 1\), and were also based on preliminary informal )] TJ ET
BT 26.250 513.470 Td /F1 9.8 Tf  [(scoping studies of the literature.)] TJ ET
q
26.250 489.853 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 492.600 Td /F1 9.8 Tf  [(Box 1 � Search Terms Use)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 378.553 555.000 103.800 re f
0.267 0.267 0.267 rg
26.625 481.228 554.250 0.750 re f
26.625 465.346 0.750 16.631 re f
580.125 465.346 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 471.373 Td /F4 9.8 Tf  [(Exposure terms)] TJ ET
0.267 0.267 0.267 rg
26.625 465.346 554.250 0.750 re f
26.625 449.465 0.750 16.631 re f
580.125 449.465 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 455.491 Td /F1 9.8 Tf  [(Drought* OR arid* OR rain*)] TJ ET
0.267 0.267 0.267 rg
26.625 449.465 554.250 0.750 re f
26.625 433.584 0.750 16.631 re f
580.125 433.584 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 439.610 Td /F1 9.8 Tf  [(Combined by AND with:)] TJ ET
0.267 0.267 0.267 rg
26.625 433.584 554.250 0.750 re f
26.625 417.703 0.750 16.631 re f
580.125 417.703 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 423.729 Td /F4 9.8 Tf  [(Outcome terms)] TJ ET
0.267 0.267 0.267 rg
26.625 417.703 554.250 0.750 re f
26.625 378.928 554.250 0.750 re f
26.625 378.928 0.750 39.525 re f
580.125 378.928 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 407.848 Td /F1 9.8 Tf  [(Morbidity OR mortality OR health OR disease OR mental health OR injur* OR infect* OR diar* OR malnutrition OR water )] TJ ET
BT 31.875 400.216 Td /F1 9.8 Tf  [(borne OR vector OR trachoma OR nutrition OR cyanide OR malaria OR schistosomiasis OR famine OR resp* OR typhoid )] TJ ET
BT 31.875 392.585 Td /F1 9.8 Tf  [(fever OR amoebiasis OR cholera OR hepatitis A OR salmonellosis OR shigellosis OR dengue OR onchocerciasis OR )] TJ ET
BT 31.875 384.954 Td /F1 9.8 Tf  [(Japanese encephalitis OR scabies OR impetigo OR conjunctivitis OR scrub typhus OR leptospirosis OR PTSD OR depress*)] TJ ET
BT 26.250 324.029 Td /F5 9.8 Tf  [(Databases used)] TJ ET
BT 26.250 304.624 Td /F1 9.8 Tf  [(The following databases were searched: MEDLINE; CINAHL; Embase; PsychINFO, Cochrane Collection. Key references from )] TJ ET
BT 26.250 292.719 Td /F1 9.8 Tf  [(extracted papers were also hand-searched.)] TJ ET
BT 26.250 273.315 Td /F5 9.8 Tf  [(Inclusion and exclusion criteria)] TJ ET
BT 26.250 253.910 Td /F1 9.8 Tf  [(For extraction into summary tables, inclusion criteria were:)] TJ ET
0.271 0.267 0.267 RG
40.337 237.473 m 
40.337 237.919 40.154 238.363 39.838 238.679 c
39.522 238.995 39.078 239.179 38.631 239.179 c
38.185 239.179 37.741 238.995 37.425 238.679 c
37.109 238.363 36.925 237.919 36.925 237.473 c
36.925 237.026 37.109 236.582 37.425 236.266 c
37.741 235.950 38.185 235.766 38.631 235.766 c
39.078 235.766 39.522 235.950 39.838 236.266 c
40.154 236.582 40.337 237.026 40.337 237.473 c f
BT 45.750 234.505 Td /F1 9.8 Tf  [(Papers where an explicit link is made between drought as an exposure and human health outcomes, and where a health )] TJ ET
BT 45.750 222.600 Td /F1 9.8 Tf  [(outcome is measured;)] TJ ET
40.337 209.913 m 
40.337 210.360 40.154 210.804 39.838 211.120 c
39.522 211.436 39.078 211.619 38.631 211.619 c
38.185 211.619 37.741 211.436 37.425 211.120 c
37.109 210.804 36.925 210.360 36.925 209.913 c
36.925 209.467 37.109 209.023 37.425 208.707 c
37.741 208.391 38.185 208.207 38.631 208.207 c
39.078 208.207 39.522 208.391 39.838 208.707 c
40.154 209.023 40.337 209.467 40.337 209.913 c f
BT 45.750 206.946 Td /F1 9.8 Tf  [(All study designs and/or methods;)] TJ ET
40.337 194.258 m 
40.337 194.705 40.154 195.149 39.838 195.465 c
39.522 195.781 39.078 195.965 38.631 195.965 c
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37.109 195.149 36.925 194.705 36.925 194.258 c
36.925 193.812 37.109 193.368 37.425 193.052 c
37.741 192.736 38.185 192.552 38.631 192.552 c
39.078 192.552 39.522 192.736 39.838 193.052 c
40.154 193.368 40.337 193.812 40.337 194.258 c f
BT 45.750 191.291 Td /F1 9.8 Tf  [(All countries/contexts;)] TJ ET
40.337 178.604 m 
40.337 179.050 40.154 179.494 39.838 179.810 c
39.522 180.126 39.078 180.310 38.631 180.310 c
38.185 180.310 37.741 180.126 37.425 179.810 c
37.109 179.494 36.925 179.050 36.925 178.604 c
36.925 178.157 37.109 177.713 37.425 177.397 c
37.741 177.081 38.185 176.897 38.631 176.897 c
39.078 176.897 39.522 177.081 39.838 177.397 c
40.154 177.713 40.337 178.157 40.337 178.604 c f
BT 45.750 175.636 Td /F1 9.8 Tf  [(Papers published in any year, until May 2012, based on individual database capabilities.)] TJ ET
BT 26.250 152.481 Td /F1 9.8 Tf  [(Papers which examined the link between drought and its impact on human health without explicitly quantifying or qualifying the )] TJ ET
BT 26.250 140.577 Td /F1 9.8 Tf  [(impact are included in supporting text but not in the tables.)] TJ ET
BT 26.250 121.172 Td /F1 9.8 Tf  [(Exclusion criteria were:)] TJ ET
40.337 104.735 m 
40.337 105.181 40.154 105.625 39.838 105.941 c
39.522 106.257 39.078 106.441 38.631 106.441 c
38.185 106.441 37.741 106.257 37.425 105.941 c
37.109 105.625 36.925 105.181 36.925 104.735 c
36.925 104.288 37.109 103.844 37.425 103.528 c
37.741 103.212 38.185 103.028 38.631 103.028 c
39.078 103.028 39.522 103.212 39.838 103.528 c
40.154 103.844 40.337 104.288 40.337 104.735 c f
BT 45.750 101.767 Td /F1 9.8 Tf  [(Drought as meaning shortage/deficiency unrelated to climate�as in �heroin drought�;)] TJ ET
40.337 89.080 m 
40.337 89.527 40.154 89.971 39.838 90.287 c
39.522 90.602 39.078 90.786 38.631 90.786 c
38.185 90.786 37.741 90.602 37.425 90.287 c
37.109 89.971 36.925 89.527 36.925 89.080 c
36.925 88.633 37.109 88.189 37.425 87.873 c
37.741 87.558 38.185 87.374 38.631 87.374 c
39.078 87.374 39.522 87.558 39.838 87.873 c
40.154 88.189 40.337 88.633 40.337 89.080 c f
BT 45.750 86.112 Td /F1 9.8 Tf  [(Papers not published in English;)] TJ ET
40.337 73.425 m 
40.337 73.872 40.154 74.316 39.838 74.632 c
39.522 74.948 39.078 75.131 38.631 75.131 c
38.185 75.131 37.741 74.948 37.425 74.632 c
37.109 74.316 36.925 73.872 36.925 73.425 c
36.925 72.979 37.109 72.535 37.425 72.219 c
37.741 71.903 38.185 71.719 38.631 71.719 c
39.078 71.719 39.522 71.903 39.838 72.219 c
40.154 72.535 40.337 72.979 40.337 73.425 c f
BT 45.750 70.458 Td /F1 9.8 Tf  [(Papers which discuss �dry season� or arid conditions \(unless drought was explicitly noted as an extreme event/unusual )] TJ ET
BT 45.750 58.553 Td /F1 9.8 Tf  [(occurrence in the normal climate variability of the area\).)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Data from grey literature was not systematically searched for extraction into review tables, but sources including WHO, CDC, )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(and advice from key experts are discussed in the accompanying text. Similarly, papers not fulfilling inclusion criteria were )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(sometimes used to give a better contextual outline and are discussed in the relevant section.)] TJ ET
BT 26.250 724.262 Td /F5 9.8 Tf  [(Study selection)] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Full papers were identified following screening of all titles and abstracts by three study authors \(CS, MK, and VM\). These were )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(further reviewed for eligibility and inclusion in the review by a single author.)] TJ ET
BT 26.250 673.548 Td /F5 9.8 Tf  [(Data items, collection, synthesis and summary measures)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(Data from relevant papers was extracted into summary tables. Column headings are: drought exposure; study design/sample; )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(main health outcome measured; main results. Given the varied nature of studies and outcomes, meaningful quantitative )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(summary statistics were not possible.)] TJ ET
BT 26.250 610.929 Td /F5 9.8 Tf  [(Risk of bias and quality assessment)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(Because drought is a natural phenomenon which cannot be induced experimentally, intervention studies were neither expected )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(nor found. Most data was observational, and due to lack of data, we did not make any exclusions on the basis of study quality. )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(Formal assessment of bias was not possible for each individual study.)] TJ ET
BT 26.250 548.310 Td /F5 9.8 Tf  [(Analysis framework)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(We classified the health impacts of drought thematically, based on the results of our search.)] TJ ET
BT 26.250 492.302 Td /F4 12.0 Tf  [(RESULTS)] TJ ET
BT 26.250 472.348 Td /F1 9.8 Tf  [(Our search strategy identified over 6000 potential articles, of which 87 fulfilled inclusion criteria. Figure 1 summarises the study )] TJ ET
BT 26.250 460.443 Td /F1 9.8 Tf  [(screening and selection process.)] TJ ET
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BT 35.250 200.289 Td /F4 9.8 Tf  [(Fig. 1: Flow chart of literature search strategy)] TJ ET
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BT 26.250 163.634 Td /F1 9.8 Tf  [(87 papers met our inclusion criteria and are summarized in Appendix 1: Tables 1-6. Additionally, 59 papers which did not meet )] TJ ET
BT 26.250 151.729 Td /F1 9.8 Tf  [(our inclusion criteria yet offer supporting insights are included as text in relevant parts of the results section. Please see )] TJ ET
BT 26.250 139.824 Td /F1 9.8 Tf  [(Appendix 2 for a full list of these supporting papers. Six categories of health effects were identified: nutrition-related effects; )] TJ ET
BT 26.250 127.920 Td /F1 9.8 Tf  [(water-related disease; airborne and dust related disease; vector borne disease; mental health effects; and other health effects. )] TJ ET
BT 26.250 116.015 Td /F1 9.8 Tf  [(Figure 2 represents the findings of our review and the categorizations used to classify the identified health effects associated )] TJ ET
BT 26.250 104.110 Td /F1 9.8 Tf  [(with drought. Identified health effects follow a directional pathway: drought conditions affect the circumstances of living \(i.e., )] TJ ET
BT 26.250 92.205 Td /F1 9.8 Tf  [(water shortages and impacts on livelihoods\); these circumstances can lead to a series of health effects, which results in )] TJ ET
BT 26.250 80.301 Td /F1 9.8 Tf  [(increased morbidity and mortality. The factors linking drought with effects on health occur within the context of existing )] TJ ET
BT 26.250 68.396 Td /F1 9.8 Tf  [(infrastructure \(i.e., health, sanitation and other resources\) and baseline public health \(i.e., the capacity of populations to be )] TJ ET
BT 26.250 56.491 Td /F1 9.8 Tf  [(resilient in the face of adverse conditions\).)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Data from grey literature was not systematically searched for extraction into review tables, but sources including WHO, CDC, )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(and advice from key experts are discussed in the accompanying text. Similarly, papers not fulfilling inclusion criteria were )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(sometimes used to give a better contextual outline and are discussed in the relevant section.)] TJ ET
BT 26.250 724.262 Td /F5 9.8 Tf  [(Study selection)] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Full papers were identified following screening of all titles and abstracts by three study authors \(CS, MK, and VM\). These were )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(further reviewed for eligibility and inclusion in the review by a single author.)] TJ ET
BT 26.250 673.548 Td /F5 9.8 Tf  [(Data items, collection, synthesis and summary measures)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(Data from relevant papers was extracted into summary tables. Column headings are: drought exposure; study design/sample; )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(main health outcome measured; main results. Given the varied nature of studies and outcomes, meaningful quantitative )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(summary statistics were not possible.)] TJ ET
BT 26.250 610.929 Td /F5 9.8 Tf  [(Risk of bias and quality assessment)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(Because drought is a natural phenomenon which cannot be induced experimentally, intervention studies were neither expected )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(nor found. Most data was observational, and due to lack of data, we did not make any exclusions on the basis of study quality. )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(Formal assessment of bias was not possible for each individual study.)] TJ ET
BT 26.250 548.310 Td /F5 9.8 Tf  [(Analysis framework)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(We classified the health impacts of drought thematically, based on the results of our search.)] TJ ET
BT 26.250 492.302 Td /F4 12.0 Tf  [(RESULTS)] TJ ET
BT 26.250 472.348 Td /F1 9.8 Tf  [(Our search strategy identified over 6000 potential articles, of which 87 fulfilled inclusion criteria. Figure 1 summarises the study )] TJ ET
BT 26.250 460.443 Td /F1 9.8 Tf  [(screening and selection process.)] TJ ET
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BT 35.250 200.289 Td /F4 9.8 Tf  [(Fig. 1: Flow chart of literature search strategy)] TJ ET
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BT 26.250 163.634 Td /F1 9.8 Tf  [(87 papers met our inclusion criteria and are summarized in Appendix 1: Tables 1-6. Additionally, 59 papers which did not meet )] TJ ET
BT 26.250 151.729 Td /F1 9.8 Tf  [(our inclusion criteria yet offer supporting insights are included as text in relevant parts of the results section. Please see )] TJ ET
BT 26.250 139.824 Td /F1 9.8 Tf  [(Appendix 2 for a full list of these supporting papers. Six categories of health effects were identified: nutrition-related effects; )] TJ ET
BT 26.250 127.920 Td /F1 9.8 Tf  [(water-related disease; airborne and dust related disease; vector borne disease; mental health effects; and other health effects. )] TJ ET
BT 26.250 116.015 Td /F1 9.8 Tf  [(Figure 2 represents the findings of our review and the categorizations used to classify the identified health effects associated )] TJ ET
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BT 26.250 92.205 Td /F1 9.8 Tf  [(water shortages and impacts on livelihoods\); these circumstances can lead to a series of health effects, which results in )] TJ ET
BT 26.250 80.301 Td /F1 9.8 Tf  [(increased morbidity and mortality. The factors linking drought with effects on health occur within the context of existing )] TJ ET
BT 26.250 68.396 Td /F1 9.8 Tf  [(infrastructure \(i.e., health, sanitation and other resources\) and baseline public health \(i.e., the capacity of populations to be )] TJ ET
BT 26.250 56.491 Td /F1 9.8 Tf  [(resilient in the face of adverse conditions\).)] TJ ET
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BT 26.250 755.571 Td /F1 9.8 Tf  [(and advice from key experts are discussed in the accompanying text. Similarly, papers not fulfilling inclusion criteria were )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(sometimes used to give a better contextual outline and are discussed in the relevant section.)] TJ ET
BT 26.250 724.262 Td /F5 9.8 Tf  [(Study selection)] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Full papers were identified following screening of all titles and abstracts by three study authors \(CS, MK, and VM\). These were )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(further reviewed for eligibility and inclusion in the review by a single author.)] TJ ET
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BT 26.250 642.238 Td /F1 9.8 Tf  [(main health outcome measured; main results. Given the varied nature of studies and outcomes, meaningful quantitative )] TJ ET
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BT 26.250 610.929 Td /F5 9.8 Tf  [(Risk of bias and quality assessment)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(Because drought is a natural phenomenon which cannot be induced experimentally, intervention studies were neither expected )] TJ ET
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BT 26.250 567.714 Td /F1 9.8 Tf  [(Formal assessment of bias was not possible for each individual study.)] TJ ET
BT 26.250 548.310 Td /F5 9.8 Tf  [(Analysis framework)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(We classified the health impacts of drought thematically, based on the results of our search.)] TJ ET
BT 26.250 492.302 Td /F4 12.0 Tf  [(RESULTS)] TJ ET
BT 26.250 472.348 Td /F1 9.8 Tf  [(Our search strategy identified over 6000 potential articles, of which 87 fulfilled inclusion criteria. Figure 1 summarises the study )] TJ ET
BT 26.250 460.443 Td /F1 9.8 Tf  [(screening and selection process.)] TJ ET
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BT 26.250 116.015 Td /F1 9.8 Tf  [(Figure 2 represents the findings of our review and the categorizations used to classify the identified health effects associated )] TJ ET
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BT 26.250 92.205 Td /F1 9.8 Tf  [(water shortages and impacts on livelihoods\); these circumstances can lead to a series of health effects, which results in )] TJ ET
BT 26.250 80.301 Td /F1 9.8 Tf  [(increased morbidity and mortality. The factors linking drought with effects on health occur within the context of existing )] TJ ET
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BT 26.250 150.345 Td /F1 9.8 Tf  [(qualitative messages do emerge.)] TJ ET
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BT 26.250 233.679 Td /F1 9.8 Tf  [(An impact on nutrition with implications for morbidity and mortality is the most obvious and best recognized health impact of )] TJ ET
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BT 26.250 209.869 Td /F1 9.8 Tf  [(are summarized in Table 2. The studies are all observational but vary in quality. Most are simple descriptions of population-level )] TJ ET
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BT 69.721 187.567 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 79.358 186.060 Td /F1 9.8 Tf  [(. Few attempt to measure individual exposures or account for obvious confounders such as household )] TJ ET
BT 26.250 174.155 Td /F1 9.8 Tf  [(socioeconomic status or normal seasonal variations in nutritional status. Fewer still define the exact nature or details of the )] TJ ET
BT 26.250 162.250 Td /F1 9.8 Tf  [(underlying drought. Settings, methods and outcomes are too varied to make quantitative synthesis meaningful, but strong )] TJ ET
BT 26.250 150.345 Td /F1 9.8 Tf  [(qualitative messages do emerge.)] TJ ET
BT 26.250 130.941 Td /F1 9.8 Tf  [(Context and underlying vulnerabilities are critical. It is not by chance that the reports in Table 2 are from low and low-middle )] TJ ET
BT 26.250 119.036 Td /F1 9.8 Tf  [(income countries. This does not mean that only they experience drought. Drought-related food shortage is only one aspect of )] TJ ET
BT 26.250 107.131 Td /F1 9.8 Tf  [(the much more important concept of food security \(defined as ��physical and economic access to sufficient, safe and nutritious )] TJ ET
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0.271 0.267 0.267 rg
BT 167.035 95.226 Td /F1 9.8 Tf  [(\). Populations in resource rich developed countries do not usually experience drought-)] TJ ET
BT 26.250 83.322 Td /F1 9.8 Tf  [(associated malnutrition because their populations have diverse diets sourced from geographically scattered suppliers: a )] TJ ET
BT 26.250 71.417 Td /F1 9.8 Tf  [(production shortfall in one geographical area is easily made up for by another. Even in resource poor settings, �when famine is )] TJ ET
BT 26.250 59.512 Td /F1 9.8 Tf  [(attributed to a natural factor, it is more likely true that the natural event is simply the triggering event among many contributing )] TJ ET
BT 26.250 47.607 Td /F1 9.8 Tf  [(factors, rather than the main cause of famine� )] TJ ET
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BT 225.677 49.115 Td /F4 8.7 Tf  [(24)] TJ ET
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BT 235.314 47.607 Td /F1 9.8 Tf  [(. Studies that do control for confounding also illustrate this point even in low-)] TJ ET
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0.271 0.267 0.267 rg
q
15.000 32.893 577.500 744.107 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(income settings. For example, crude analysis of 2004 data from Ethiopia shows greater mortality in drought affected areas )] TJ ET
0.267 0.267 0.267 rg
BT 555.149 768.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 564.786 767.476 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(However, on multivariable analysis, drought drops out as a risk factor \(p=0.8\). In this study, the factors which did influence )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(survival included household demographics, socioeconomic status, neighborhood characteristics, and receipt of food aid.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(The malnutrition/mortality impacts of drought are often indirect and complex. In the simplest case, drought affects ecosystems, )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(thereby reducing food supplies \(principally crops and livestock\). This in turn reduces quantity and/or quality of nutrient intake, )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(which leads to greater vulnerability to illness, which can increase mortality risk. Many studies in Table 2 show a high prevalence )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(of malnutrition and/or mortality at the time of drought. This alone does not prove causality. Better evidence was from studies )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(where spikes of malnutrition and mortality associated with drought were observed )] TJ ET
0.267 0.267 0.267 rg
BT 380.097 678.150 Td /F4 8.7 Tf  [(30)] TJ ET
0.271 0.267 0.267 rg
BT 389.734 680.531 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 392.144 678.150 Td /F4 8.7 Tf  [(31)] TJ ET
0.271 0.267 0.267 rg
BT 401.781 676.643 Td /F1 9.8 Tf  [(. Causes of mortality reflected prevalent )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(conditions such as diarrhea, pneumonia and other infectious disease )] TJ ET
0.267 0.267 0.267 rg
BT 325.399 666.245 Td /F4 8.7 Tf  [(32)] TJ ET
0.271 0.267 0.267 rg
BT 335.037 668.626 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 337.446 666.245 Td /F4 8.7 Tf  [(33)] TJ ET
0.271 0.267 0.267 rg
BT 347.084 664.738 Td /F1 9.8 Tf  [(. However, while malnutrition and excess )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(morbidity/mortality are directly and causally related )] TJ ET
0.267 0.267 0.267 rg
BT 247.858 654.341 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 257.495 652.833 Td /F1 9.8 Tf  [(, the relationship to the �upstream� drought is neither straightforward nor )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(linear and is influenced by multiple other factors. Illustrating the complexity:)] TJ ET
0.271 0.267 0.267 RG
40.337 624.491 m 
40.337 624.938 40.154 625.382 39.838 625.698 c
39.522 626.014 39.078 626.198 38.631 626.198 c
38.185 626.198 37.741 626.014 37.425 625.698 c
37.109 625.382 36.925 624.938 36.925 624.491 c
36.925 624.045 37.109 623.601 37.425 623.285 c
37.741 622.969 38.185 622.785 38.631 622.785 c
39.078 622.785 39.522 622.969 39.838 623.285 c
40.154 623.601 40.337 624.045 40.337 624.491 c f
BT 45.750 621.524 Td /F1 9.8 Tf  [(During a 1973-4 Ethiopian drought, distribution of malnutrition did not always reflect drought�s effects on food supply: the )] TJ ET
BT 45.750 609.619 Td /F1 9.8 Tf  [(drought-affected North Ogaden area showed high malnutrition prevalence but the Issa desert did not. Issa, however, while )] TJ ET
BT 45.750 597.714 Td /F1 9.8 Tf  [(having lowest rates of malnutrition among the areas studied also had the highest mortality rate )] TJ ET
0.267 0.267 0.267 rg
BT 454.899 599.222 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 464.536 597.714 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 585.027 m 
40.337 585.474 40.154 585.918 39.838 586.234 c
39.522 586.550 39.078 586.733 38.631 586.733 c
38.185 586.733 37.741 586.550 37.425 586.234 c
37.109 585.918 36.925 585.474 36.925 585.027 c
36.925 584.581 37.109 584.137 37.425 583.821 c
37.741 583.505 38.185 583.321 38.631 583.321 c
39.078 583.321 39.522 583.505 39.838 583.821 c
40.154 584.137 40.337 584.581 40.337 585.027 c f
BT 45.750 582.060 Td /F1 9.8 Tf  [(In another Ethiopian drought, type of economy was associated with manifestation of malnutrition: kwashiorkor \(oedematous )] TJ ET
BT 45.750 570.155 Td /F1 9.8 Tf  [(malnutrition\) was not seen in agro-pastoralist areas )] TJ ET
0.267 0.267 0.267 rg
BT 269.542 571.662 Td /F4 8.7 Tf  [(36)] TJ ET
0.271 0.267 0.267 rg
BT 279.179 570.155 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 557.468 m 
40.337 557.914 40.154 558.358 39.838 558.674 c
39.522 558.990 39.078 559.174 38.631 559.174 c
38.185 559.174 37.741 558.990 37.425 558.674 c
37.109 558.358 36.925 557.914 36.925 557.468 c
36.925 557.021 37.109 556.577 37.425 556.261 c
37.741 555.945 38.185 555.761 38.631 555.761 c
39.078 555.761 39.522 555.945 39.838 556.261 c
40.154 556.577 40.337 557.021 40.337 557.468 c f
BT 45.750 554.500 Td /F1 9.8 Tf  [(In a multi-country study in Southern Africa, areas which deteriorated most rapidly during drought included those which were )] TJ ET
BT 45.750 542.595 Td /F1 9.8 Tf  [(better off pre-drought and those with high HIV prevalence )] TJ ET
0.267 0.267 0.267 rg
BT 296.130 544.103 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 305.767 542.595 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 529.908 m 
40.337 530.355 40.154 530.799 39.838 531.115 c
39.522 531.431 39.078 531.614 38.631 531.614 c
38.185 531.614 37.741 531.431 37.425 531.115 c
37.109 530.799 36.925 530.355 36.925 529.908 c
36.925 529.462 37.109 529.018 37.425 528.702 c
37.741 528.386 38.185 528.202 38.631 528.202 c
39.078 528.202 39.522 528.386 39.838 528.702 c
40.154 529.018 40.337 529.462 40.337 529.908 c f
BT 45.750 526.941 Td /F1 9.8 Tf  [(Drought�s interaction with HIV was different in different countries )] TJ ET
0.267 0.267 0.267 rg
BT 325.361 528.448 Td /F4 8.7 Tf  [(38)] TJ ET
0.271 0.267 0.267 rg
40.337 514.253 m 
40.337 514.700 40.154 515.144 39.838 515.460 c
39.522 515.776 39.078 515.960 38.631 515.960 c
38.185 515.960 37.741 515.776 37.425 515.460 c
37.109 515.144 36.925 514.700 36.925 514.253 c
36.925 513.807 37.109 513.363 37.425 513.047 c
37.741 512.731 38.185 512.547 38.631 512.547 c
39.078 512.547 39.522 512.731 39.838 513.047 c
40.154 513.363 40.337 513.807 40.337 514.253 c f
BT 45.750 511.286 Td /F1 9.8 Tf  [(Not all population subgroups are equally vulnerable \(see section below\))] TJ ET
BT 26.250 488.131 Td /F1 9.8 Tf  [(The potential effects of drought can be minimized by interventions. For example, several studies reported food aid being )] TJ ET
BT 26.250 476.226 Td /F1 9.8 Tf  [(distributed at the time of nutrition surveys )] TJ ET
0.267 0.267 0.267 rg
BT 206.703 477.734 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 216.340 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 218.750 477.734 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 228.387 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 230.796 477.734 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 240.434 476.226 Td /F1 9.8 Tf  [(; some looked for and observed a protective effect )] TJ ET
0.267 0.267 0.267 rg
BT 459.380 477.734 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 469.017 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 471.426 477.734 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 481.064 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 483.473 477.734 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 493.110 476.226 Td /F1 9.8 Tf  [(. Less obvious but )] TJ ET
BT 26.250 464.322 Td /F1 9.8 Tf  [(perhaps even more important are interventions at household level. One study from Kenya observed that toddlers \(but not )] TJ ET
BT 26.250 452.417 Td /F1 9.8 Tf  [(schoolchildren\) were �protected� from drought, seemingly by changes in family behavior and food distribution: carers lost weight )] TJ ET
BT 26.250 440.512 Td /F1 9.8 Tf  [(but toddlers� food intake did not change and they continued to grow )] TJ ET
0.267 0.267 0.267 rg
BT 318.925 442.019 Td /F4 8.7 Tf  [(42)] TJ ET
0.271 0.267 0.267 rg
BT 328.563 440.512 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 421.107 Td /F5 9.8 Tf  [(Micronutrient malnutrition)] TJ ET
BT 26.250 401.703 Td /F1 9.8 Tf  [(Table 2b shows a smaller number of studies focusing on micronutrient deficit resulting from drought as the primary drought-)] TJ ET
BT 26.250 389.798 Td /F1 9.8 Tf  [(related outcome. Some of the studies in Table 2a also note micronutrient deficit as a secondary outcome)] TJ ET
0.267 0.267 0.267 rg
BT 477.129 391.305 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 486.766 393.686 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 489.176 391.305 Td /F4 8.7 Tf  [(43)] TJ ET
0.271 0.267 0.267 rg
BT 498.813 393.686 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 501.222 391.305 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 510.860 393.686 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 513.269 391.305 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 522.906 389.798 Td /F1 9.8 Tf  [( . Type of )] TJ ET
BT 26.250 377.893 Td /F1 9.8 Tf  [(deficit varies and ranges from lack of iron causing anaemia to lack of vitamins \(vitamin A\) causing specific problems such as )] TJ ET
BT 26.250 365.988 Td /F1 9.8 Tf  [(night blindness )] TJ ET
0.267 0.267 0.267 rg
BT 93.993 367.496 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 103.630 369.877 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 106.040 367.496 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 115.677 365.988 Td /F1 9.8 Tf  [( and scurvy \(vitamin C deficiency\) )] TJ ET
0.267 0.267 0.267 rg
BT 264.131 367.496 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 273.768 369.877 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 276.177 367.496 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 285.815 365.988 Td /F1 9.8 Tf  [(. Subclinical deficit, detected by low blood levels of a particular )] TJ ET
BT 26.250 354.084 Td /F1 9.8 Tf  [(micronutrient was, unsurprisingly, more prevalent than clinical deficit )] TJ ET
0.267 0.267 0.267 rg
BT 323.176 355.591 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 332.814 354.084 Td /F1 9.8 Tf  [(. Again, mechanisms are indirect and vary according to )] TJ ET
BT 26.250 342.179 Td /F1 9.8 Tf  [(micronutrient: one study which attempted to correlate micronutrient deficit against drought severity found a link for some but not )] TJ ET
BT 26.250 330.274 Td /F1 9.8 Tf  [(all micronutrients )] TJ ET
0.267 0.267 0.267 rg
BT 102.641 331.781 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 112.279 330.274 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 310.869 Td /F1 9.8 Tf  [(The message from these studies is that it is not only energy and protein content of diet that is important, but also quality and )] TJ ET
BT 26.250 298.965 Td /F1 9.8 Tf  [(micronutrient content�the different types of malnutrition often co-exist )] TJ ET
0.267 0.267 0.267 rg
BT 327.554 300.472 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 337.192 298.965 Td /F1 9.8 Tf  [(. Specific risks in specific settings should be taken into )] TJ ET
BT 26.250 287.060 Td /F1 9.8 Tf  [(account when planning drought-related interventions.)] TJ ET
BT 26.250 267.655 Td /F5 9.8 Tf  [(Anti-nutrient consumption)] TJ ET
BT 26.250 248.250 Td /F1 9.8 Tf  [(In resource poor settings, when a staple food crop fails and becomes less available following drought, people can be forced to )] TJ ET
BT 26.250 236.346 Td /F1 9.8 Tf  [(make major changes to their usual diet )] TJ ET
0.267 0.267 0.267 rg
BT 196.407 237.853 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 206.044 236.346 Td /F1 9.8 Tf  [(. This can include eating less familiar foods or cutting corners in processing foods: )] TJ ET
BT 26.250 224.441 Td /F1 9.8 Tf  [(Table 2c summarises some of the health risks can ensue. In Afghanistan in 1970-2, 22% of a drought-affected population )] TJ ET
BT 26.250 212.536 Td /F1 9.8 Tf  [(developed veno-occlusive liver disease associated with eating wheat that had not been properly winnowed from a plant )] TJ ET
BT 26.250 200.631 Td /F1 9.8 Tf  [(contaminant containing pyrrolizidine alkaloids )] TJ ET
0.267 0.267 0.267 rg
BT 224.575 202.139 Td /F4 8.7 Tf  [(49)] TJ ET
0.271 0.267 0.267 rg
BT 234.212 200.631 Td /F1 9.8 Tf  [(. In India, drought was associated with aflatoxicosis due to mould-affected food, )] TJ ET
BT 26.250 188.727 Td /F1 9.8 Tf  [(attributed to unseasonal rains prior to harvest and chronic drought conditions )] TJ ET
0.267 0.267 0.267 rg
BT 360.080 190.234 Td /F4 8.7 Tf  [(50)] TJ ET
0.271 0.267 0.267 rg
BT 369.718 188.727 Td /F1 9.8 Tf  [(. In China, a drought caused selenium to enter )] TJ ET
BT 26.250 176.822 Td /F1 9.8 Tf  [(the food chain causing problems which included hair and nail loss, skin lesions, tooth decay, and nervous system problems )] TJ ET
0.267 0.267 0.267 rg
BT 558.941 178.329 Td /F4 8.7 Tf  [(51)] TJ ET
0.271 0.267 0.267 rg
BT 568.579 176.822 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 164.917 Td /F1 9.8 Tf  [(In Ethiopia, consumption of drought-resistant grass pea led to irreversible neurodegenerative disease due to neurolathyrism )] TJ ET
0.267 0.267 0.267 rg
BT 561.662 166.424 Td /F4 8.7 Tf  [(52)] TJ ET
0.271 0.267 0.267 rg
BT 571.299 164.917 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 153.012 Td /F1 9.8 Tf  [(In Tanzania and Mozambique, outbreaks of Konzo, another serious neurological disease which causes irreversible paralysis, )] TJ ET
BT 26.250 141.108 Td /F1 9.8 Tf  [(were due to inadequately processed cassava )] TJ ET
0.267 0.267 0.267 rg
BT 224.058 142.615 Td /F4 8.7 Tf  [(53)] TJ ET
BT 233.695 142.615 Td /F4 8.7 Tf  [(54)] TJ ET
0.271 0.267 0.267 rg
BT 243.333 144.996 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 245.742 142.615 Td /F4 8.7 Tf  [(55)] TJ ET
0.271 0.267 0.267 rg
BT 255.379 144.996 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 257.789 142.615 Td /F4 8.7 Tf  [(56)] TJ ET
0.271 0.267 0.267 rg
BT 267.426 141.108 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 121.703 Td /F5 9.8 Tf  [(Malnutrition, vulnerable groups and drought)] TJ ET
BT 26.250 102.298 Td /F1 9.8 Tf  [(Studies in Table 2 also demonstrate that not all subgroups within a population are equally vulnerable to the adverse effects of )] TJ ET
BT 26.250 90.393 Td /F1 9.8 Tf  [(drought. This is likely true for all health outcomes, but is most clearly seen in the malnutrition/mortality papers. Risk is never )] TJ ET
BT 26.250 78.489 Td /F1 9.8 Tf  [(equally distributed, but it is important to distinguish between unavoidable and avoidable excess risks. These can and often do )] TJ ET
BT 26.250 66.584 Td /F1 9.8 Tf  [(co-exist. Understanding their role in different settings may help with targeting interventions to reduce adverse effects of drought.)] TJ ET
BT 26.250 47.179 Td /F1 9.8 Tf  [(Unavoidable risks are relatively constant across different drought contexts and are due to physiological vulnerabilities. This )] TJ ET
Q
q
15.000 32.893 577.500 744.107 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(income settings. For example, crude analysis of 2004 data from Ethiopia shows greater mortality in drought affected areas )] TJ ET
0.267 0.267 0.267 rg
BT 555.149 768.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 564.786 767.476 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(However, on multivariable analysis, drought drops out as a risk factor \(p=0.8\). In this study, the factors which did influence )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(survival included household demographics, socioeconomic status, neighborhood characteristics, and receipt of food aid.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(The malnutrition/mortality impacts of drought are often indirect and complex. In the simplest case, drought affects ecosystems, )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(thereby reducing food supplies \(principally crops and livestock\). This in turn reduces quantity and/or quality of nutrient intake, )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(which leads to greater vulnerability to illness, which can increase mortality risk. Many studies in Table 2 show a high prevalence )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(of malnutrition and/or mortality at the time of drought. This alone does not prove causality. Better evidence was from studies )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(where spikes of malnutrition and mortality associated with drought were observed )] TJ ET
0.267 0.267 0.267 rg
BT 380.097 678.150 Td /F4 8.7 Tf  [(30)] TJ ET
0.271 0.267 0.267 rg
BT 389.734 680.531 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 392.144 678.150 Td /F4 8.7 Tf  [(31)] TJ ET
0.271 0.267 0.267 rg
BT 401.781 676.643 Td /F1 9.8 Tf  [(. Causes of mortality reflected prevalent )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(conditions such as diarrhea, pneumonia and other infectious disease )] TJ ET
0.267 0.267 0.267 rg
BT 325.399 666.245 Td /F4 8.7 Tf  [(32)] TJ ET
0.271 0.267 0.267 rg
BT 335.037 668.626 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 337.446 666.245 Td /F4 8.7 Tf  [(33)] TJ ET
0.271 0.267 0.267 rg
BT 347.084 664.738 Td /F1 9.8 Tf  [(. However, while malnutrition and excess )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(morbidity/mortality are directly and causally related )] TJ ET
0.267 0.267 0.267 rg
BT 247.858 654.341 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 257.495 652.833 Td /F1 9.8 Tf  [(, the relationship to the �upstream� drought is neither straightforward nor )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(linear and is influenced by multiple other factors. Illustrating the complexity:)] TJ ET
0.271 0.267 0.267 RG
40.337 624.491 m 
40.337 624.938 40.154 625.382 39.838 625.698 c
39.522 626.014 39.078 626.198 38.631 626.198 c
38.185 626.198 37.741 626.014 37.425 625.698 c
37.109 625.382 36.925 624.938 36.925 624.491 c
36.925 624.045 37.109 623.601 37.425 623.285 c
37.741 622.969 38.185 622.785 38.631 622.785 c
39.078 622.785 39.522 622.969 39.838 623.285 c
40.154 623.601 40.337 624.045 40.337 624.491 c f
BT 45.750 621.524 Td /F1 9.8 Tf  [(During a 1973-4 Ethiopian drought, distribution of malnutrition did not always reflect drought�s effects on food supply: the )] TJ ET
BT 45.750 609.619 Td /F1 9.8 Tf  [(drought-affected North Ogaden area showed high malnutrition prevalence but the Issa desert did not. Issa, however, while )] TJ ET
BT 45.750 597.714 Td /F1 9.8 Tf  [(having lowest rates of malnutrition among the areas studied also had the highest mortality rate )] TJ ET
0.267 0.267 0.267 rg
BT 454.899 599.222 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 464.536 597.714 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 585.027 m 
40.337 585.474 40.154 585.918 39.838 586.234 c
39.522 586.550 39.078 586.733 38.631 586.733 c
38.185 586.733 37.741 586.550 37.425 586.234 c
37.109 585.918 36.925 585.474 36.925 585.027 c
36.925 584.581 37.109 584.137 37.425 583.821 c
37.741 583.505 38.185 583.321 38.631 583.321 c
39.078 583.321 39.522 583.505 39.838 583.821 c
40.154 584.137 40.337 584.581 40.337 585.027 c f
BT 45.750 582.060 Td /F1 9.8 Tf  [(In another Ethiopian drought, type of economy was associated with manifestation of malnutrition: kwashiorkor \(oedematous )] TJ ET
BT 45.750 570.155 Td /F1 9.8 Tf  [(malnutrition\) was not seen in agro-pastoralist areas )] TJ ET
0.267 0.267 0.267 rg
BT 269.542 571.662 Td /F4 8.7 Tf  [(36)] TJ ET
0.271 0.267 0.267 rg
BT 279.179 570.155 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 557.468 m 
40.337 557.914 40.154 558.358 39.838 558.674 c
39.522 558.990 39.078 559.174 38.631 559.174 c
38.185 559.174 37.741 558.990 37.425 558.674 c
37.109 558.358 36.925 557.914 36.925 557.468 c
36.925 557.021 37.109 556.577 37.425 556.261 c
37.741 555.945 38.185 555.761 38.631 555.761 c
39.078 555.761 39.522 555.945 39.838 556.261 c
40.154 556.577 40.337 557.021 40.337 557.468 c f
BT 45.750 554.500 Td /F1 9.8 Tf  [(In a multi-country study in Southern Africa, areas which deteriorated most rapidly during drought included those which were )] TJ ET
BT 45.750 542.595 Td /F1 9.8 Tf  [(better off pre-drought and those with high HIV prevalence )] TJ ET
0.267 0.267 0.267 rg
BT 296.130 544.103 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 305.767 542.595 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 529.908 m 
40.337 530.355 40.154 530.799 39.838 531.115 c
39.522 531.431 39.078 531.614 38.631 531.614 c
38.185 531.614 37.741 531.431 37.425 531.115 c
37.109 530.799 36.925 530.355 36.925 529.908 c
36.925 529.462 37.109 529.018 37.425 528.702 c
37.741 528.386 38.185 528.202 38.631 528.202 c
39.078 528.202 39.522 528.386 39.838 528.702 c
40.154 529.018 40.337 529.462 40.337 529.908 c f
BT 45.750 526.941 Td /F1 9.8 Tf  [(Drought�s interaction with HIV was different in different countries )] TJ ET
0.267 0.267 0.267 rg
BT 325.361 528.448 Td /F4 8.7 Tf  [(38)] TJ ET
0.271 0.267 0.267 rg
40.337 514.253 m 
40.337 514.700 40.154 515.144 39.838 515.460 c
39.522 515.776 39.078 515.960 38.631 515.960 c
38.185 515.960 37.741 515.776 37.425 515.460 c
37.109 515.144 36.925 514.700 36.925 514.253 c
36.925 513.807 37.109 513.363 37.425 513.047 c
37.741 512.731 38.185 512.547 38.631 512.547 c
39.078 512.547 39.522 512.731 39.838 513.047 c
40.154 513.363 40.337 513.807 40.337 514.253 c f
BT 45.750 511.286 Td /F1 9.8 Tf  [(Not all population subgroups are equally vulnerable \(see section below\))] TJ ET
BT 26.250 488.131 Td /F1 9.8 Tf  [(The potential effects of drought can be minimized by interventions. For example, several studies reported food aid being )] TJ ET
BT 26.250 476.226 Td /F1 9.8 Tf  [(distributed at the time of nutrition surveys )] TJ ET
0.267 0.267 0.267 rg
BT 206.703 477.734 Td /F4 8.7 Tf  [(39)] TJ ET
0.271 0.267 0.267 rg
BT 216.340 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 218.750 477.734 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 228.387 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 230.796 477.734 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 240.434 476.226 Td /F1 9.8 Tf  [(; some looked for and observed a protective effect )] TJ ET
0.267 0.267 0.267 rg
BT 459.380 477.734 Td /F4 8.7 Tf  [(27)] TJ ET
0.271 0.267 0.267 rg
BT 469.017 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 471.426 477.734 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 481.064 480.115 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 483.473 477.734 Td /F4 8.7 Tf  [(40)] TJ ET
0.271 0.267 0.267 rg
BT 493.110 476.226 Td /F1 9.8 Tf  [(. Less obvious but )] TJ ET
BT 26.250 464.322 Td /F1 9.8 Tf  [(perhaps even more important are interventions at household level. One study from Kenya observed that toddlers \(but not )] TJ ET
BT 26.250 452.417 Td /F1 9.8 Tf  [(schoolchildren\) were �protected� from drought, seemingly by changes in family behavior and food distribution: carers lost weight )] TJ ET
BT 26.250 440.512 Td /F1 9.8 Tf  [(but toddlers� food intake did not change and they continued to grow )] TJ ET
0.267 0.267 0.267 rg
BT 318.925 442.019 Td /F4 8.7 Tf  [(42)] TJ ET
0.271 0.267 0.267 rg
BT 328.563 440.512 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 421.107 Td /F5 9.8 Tf  [(Micronutrient malnutrition)] TJ ET
BT 26.250 401.703 Td /F1 9.8 Tf  [(Table 2b shows a smaller number of studies focusing on micronutrient deficit resulting from drought as the primary drought-)] TJ ET
BT 26.250 389.798 Td /F1 9.8 Tf  [(related outcome. Some of the studies in Table 2a also note micronutrient deficit as a secondary outcome)] TJ ET
0.267 0.267 0.267 rg
BT 477.129 391.305 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 486.766 393.686 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 489.176 391.305 Td /F4 8.7 Tf  [(43)] TJ ET
0.271 0.267 0.267 rg
BT 498.813 393.686 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 501.222 391.305 Td /F4 8.7 Tf  [(44)] TJ ET
0.271 0.267 0.267 rg
BT 510.860 393.686 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 513.269 391.305 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 522.906 389.798 Td /F1 9.8 Tf  [( . Type of )] TJ ET
BT 26.250 377.893 Td /F1 9.8 Tf  [(deficit varies and ranges from lack of iron causing anaemia to lack of vitamins \(vitamin A\) causing specific problems such as )] TJ ET
BT 26.250 365.988 Td /F1 9.8 Tf  [(night blindness )] TJ ET
0.267 0.267 0.267 rg
BT 93.993 367.496 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 103.630 369.877 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 106.040 367.496 Td /F4 8.7 Tf  [(46)] TJ ET
0.271 0.267 0.267 rg
BT 115.677 365.988 Td /F1 9.8 Tf  [( and scurvy \(vitamin C deficiency\) )] TJ ET
0.267 0.267 0.267 rg
BT 264.131 367.496 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 273.768 369.877 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 276.177 367.496 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 285.815 365.988 Td /F1 9.8 Tf  [(. Subclinical deficit, detected by low blood levels of a particular )] TJ ET
BT 26.250 354.084 Td /F1 9.8 Tf  [(micronutrient was, unsurprisingly, more prevalent than clinical deficit )] TJ ET
0.267 0.267 0.267 rg
BT 323.176 355.591 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 332.814 354.084 Td /F1 9.8 Tf  [(. Again, mechanisms are indirect and vary according to )] TJ ET
BT 26.250 342.179 Td /F1 9.8 Tf  [(micronutrient: one study which attempted to correlate micronutrient deficit against drought severity found a link for some but not )] TJ ET
BT 26.250 330.274 Td /F1 9.8 Tf  [(all micronutrients )] TJ ET
0.267 0.267 0.267 rg
BT 102.641 331.781 Td /F4 8.7 Tf  [(41)] TJ ET
0.271 0.267 0.267 rg
BT 112.279 330.274 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 310.869 Td /F1 9.8 Tf  [(The message from these studies is that it is not only energy and protein content of diet that is important, but also quality and )] TJ ET
BT 26.250 298.965 Td /F1 9.8 Tf  [(micronutrient content�the different types of malnutrition often co-exist )] TJ ET
0.267 0.267 0.267 rg
BT 327.554 300.472 Td /F4 8.7 Tf  [(47)] TJ ET
0.271 0.267 0.267 rg
BT 337.192 298.965 Td /F1 9.8 Tf  [(. Specific risks in specific settings should be taken into )] TJ ET
BT 26.250 287.060 Td /F1 9.8 Tf  [(account when planning drought-related interventions.)] TJ ET
BT 26.250 267.655 Td /F5 9.8 Tf  [(Anti-nutrient consumption)] TJ ET
BT 26.250 248.250 Td /F1 9.8 Tf  [(In resource poor settings, when a staple food crop fails and becomes less available following drought, people can be forced to )] TJ ET
BT 26.250 236.346 Td /F1 9.8 Tf  [(make major changes to their usual diet )] TJ ET
0.267 0.267 0.267 rg
BT 196.407 237.853 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 206.044 236.346 Td /F1 9.8 Tf  [(. This can include eating less familiar foods or cutting corners in processing foods: )] TJ ET
BT 26.250 224.441 Td /F1 9.8 Tf  [(Table 2c summarises some of the health risks can ensue. In Afghanistan in 1970-2, 22% of a drought-affected population )] TJ ET
BT 26.250 212.536 Td /F1 9.8 Tf  [(developed veno-occlusive liver disease associated with eating wheat that had not been properly winnowed from a plant )] TJ ET
BT 26.250 200.631 Td /F1 9.8 Tf  [(contaminant containing pyrrolizidine alkaloids )] TJ ET
0.267 0.267 0.267 rg
BT 224.575 202.139 Td /F4 8.7 Tf  [(49)] TJ ET
0.271 0.267 0.267 rg
BT 234.212 200.631 Td /F1 9.8 Tf  [(. In India, drought was associated with aflatoxicosis due to mould-affected food, )] TJ ET
BT 26.250 188.727 Td /F1 9.8 Tf  [(attributed to unseasonal rains prior to harvest and chronic drought conditions )] TJ ET
0.267 0.267 0.267 rg
BT 360.080 190.234 Td /F4 8.7 Tf  [(50)] TJ ET
0.271 0.267 0.267 rg
BT 369.718 188.727 Td /F1 9.8 Tf  [(. In China, a drought caused selenium to enter )] TJ ET
BT 26.250 176.822 Td /F1 9.8 Tf  [(the food chain causing problems which included hair and nail loss, skin lesions, tooth decay, and nervous system problems )] TJ ET
0.267 0.267 0.267 rg
BT 558.941 178.329 Td /F4 8.7 Tf  [(51)] TJ ET
0.271 0.267 0.267 rg
BT 568.579 176.822 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 164.917 Td /F1 9.8 Tf  [(In Ethiopia, consumption of drought-resistant grass pea led to irreversible neurodegenerative disease due to neurolathyrism )] TJ ET
0.267 0.267 0.267 rg
BT 561.662 166.424 Td /F4 8.7 Tf  [(52)] TJ ET
0.271 0.267 0.267 rg
BT 571.299 164.917 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 153.012 Td /F1 9.8 Tf  [(In Tanzania and Mozambique, outbreaks of Konzo, another serious neurological disease which causes irreversible paralysis, )] TJ ET
BT 26.250 141.108 Td /F1 9.8 Tf  [(were due to inadequately processed cassava )] TJ ET
0.267 0.267 0.267 rg
BT 224.058 142.615 Td /F4 8.7 Tf  [(53)] TJ ET
BT 233.695 142.615 Td /F4 8.7 Tf  [(54)] TJ ET
0.271 0.267 0.267 rg
BT 243.333 144.996 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 245.742 142.615 Td /F4 8.7 Tf  [(55)] TJ ET
0.271 0.267 0.267 rg
BT 255.379 144.996 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 257.789 142.615 Td /F4 8.7 Tf  [(56)] TJ ET
0.271 0.267 0.267 rg
BT 267.426 141.108 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 121.703 Td /F5 9.8 Tf  [(Malnutrition, vulnerable groups and drought)] TJ ET
BT 26.250 102.298 Td /F1 9.8 Tf  [(Studies in Table 2 also demonstrate that not all subgroups within a population are equally vulnerable to the adverse effects of )] TJ ET
BT 26.250 90.393 Td /F1 9.8 Tf  [(drought. This is likely true for all health outcomes, but is most clearly seen in the malnutrition/mortality papers. Risk is never )] TJ ET
BT 26.250 78.489 Td /F1 9.8 Tf  [(equally distributed, but it is important to distinguish between unavoidable and avoidable excess risks. These can and often do )] TJ ET
BT 26.250 66.584 Td /F1 9.8 Tf  [(co-exist. Understanding their role in different settings may help with targeting interventions to reduce adverse effects of drought.)] TJ ET
BT 26.250 47.179 Td /F1 9.8 Tf  [(Unavoidable risks are relatively constant across different drought contexts and are due to physiological vulnerabilities. This )] TJ ET
Q
q
15.000 32.893 577.500 744.107 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(income settings. For example, crude analysis of 2004 data from Ethiopia shows greater mortality in drought affected areas )] TJ ET
0.267 0.267 0.267 rg
BT 555.149 768.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 564.786 767.476 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(However, on multivariable analysis, drought drops out as a risk factor \(p=0.8\). In this study, the factors which did influence )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(survival included household demographics, socioeconomic status, neighborhood characteristics, and receipt of food aid.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(The malnutrition/mortality impacts of drought are often indirect and complex. In the simplest case, drought affects ecosystems, )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(thereby reducing food supplies \(principally crops and livestock\). This in turn reduces quantity and/or quality of nutrient intake, )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(which leads to greater vulnerability to illness, which can increase mortality risk. Many studies in Table 2 show a high prevalence )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(of malnutrition and/or mortality at the time of drought. This alone does not prove causality. Better evidence was from studies )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(where spikes of malnutrition and mortality associated with drought were observed )] TJ ET
0.267 0.267 0.267 rg
BT 380.097 678.150 Td /F4 8.7 Tf  [(30)] TJ ET
0.271 0.267 0.267 rg
BT 389.734 680.531 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 392.144 678.150 Td /F4 8.7 Tf  [(31)] TJ ET
0.271 0.267 0.267 rg
BT 401.781 676.643 Td /F1 9.8 Tf  [(. Causes of mortality reflected prevalent )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(conditions such as diarrhea, pneumonia and other infectious disease )] TJ ET
0.267 0.267 0.267 rg
BT 325.399 666.245 Td /F4 8.7 Tf  [(32)] TJ ET
0.271 0.267 0.267 rg
BT 335.037 668.626 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 337.446 666.245 Td /F4 8.7 Tf  [(33)] TJ ET
0.271 0.267 0.267 rg
BT 347.084 664.738 Td /F1 9.8 Tf  [(. However, while malnutrition and excess )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(morbidity/mortality are directly and causally related )] TJ ET
0.267 0.267 0.267 rg
BT 247.858 654.341 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 257.495 652.833 Td /F1 9.8 Tf  [(, the relationship to the �upstream� drought is neither straightforward nor )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(linear and is influenced by multiple other factors. Illustrating the complexity:)] TJ ET
0.271 0.267 0.267 RG
40.337 624.491 m 
40.337 624.938 40.154 625.382 39.838 625.698 c
39.522 626.014 39.078 626.198 38.631 626.198 c
38.185 626.198 37.741 626.014 37.425 625.698 c
37.109 625.382 36.925 624.938 36.925 624.491 c
36.925 624.045 37.109 623.601 37.425 623.285 c
37.741 622.969 38.185 622.785 38.631 622.785 c
39.078 622.785 39.522 622.969 39.838 623.285 c
40.154 623.601 40.337 624.045 40.337 624.491 c f
BT 45.750 621.524 Td /F1 9.8 Tf  [(During a 1973-4 Ethiopian drought, distribution of malnutrition did not always reflect drought�s effects on food supply: the )] TJ ET
BT 45.750 609.619 Td /F1 9.8 Tf  [(drought-affected North Ogaden area showed high malnutrition prevalence but the Issa desert did not. Issa, however, while )] TJ ET
BT 45.750 597.714 Td /F1 9.8 Tf  [(having lowest rates of malnutrition among the areas studied also had the highest mortality rate )] TJ ET
0.267 0.267 0.267 rg
BT 454.899 599.222 Td /F4 8.7 Tf  [(35)] TJ ET
0.271 0.267 0.267 rg
BT 464.536 597.714 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 585.027 m 
40.337 585.474 40.154 585.918 39.838 586.234 c
39.522 586.550 39.078 586.733 38.631 586.733 c
38.185 586.733 37.741 586.550 37.425 586.234 c
37.109 585.918 36.925 585.474 36.925 585.027 c
36.925 584.581 37.109 584.137 37.425 583.821 c
37.741 583.505 38.185 583.321 38.631 583.321 c
39.078 583.321 39.522 583.505 39.838 583.821 c
40.154 584.137 40.337 584.581 40.337 585.027 c f
BT 45.750 582.060 Td /F1 9.8 Tf  [(In another Ethiopian drought, type of economy was associated with manifestation of malnutrition: kwashiorkor \(oedematous )] TJ ET
BT 45.750 570.155 Td /F1 9.8 Tf  [(malnutrition\) was not seen in agro-pastoralist areas )] TJ ET
0.267 0.267 0.267 rg
BT 269.542 571.662 Td /F4 8.7 Tf  [(36)] TJ ET
0.271 0.267 0.267 rg
BT 279.179 570.155 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 557.468 m 
40.337 557.914 40.154 558.358 39.838 558.674 c
39.522 558.990 39.078 559.174 38.631 559.174 c
38.185 559.174 37.741 558.990 37.425 558.674 c
37.109 558.358 36.925 557.914 36.925 557.468 c
36.925 557.021 37.109 556.577 37.425 556.261 c
37.741 555.945 38.185 555.761 38.631 555.761 c
39.078 555.761 39.522 555.945 39.838 556.261 c
40.154 556.577 40.337 557.021 40.337 557.468 c f
BT 45.750 554.500 Td /F1 9.8 Tf  [(In a multi-country study in Southern Africa, areas which deteriorated most rapidly during drought included those which were )] TJ ET
BT 45.750 542.595 Td /F1 9.8 Tf  [(better off pre-drought and those with high HIV prevalence )] TJ ET
0.267 0.267 0.267 rg
BT 296.130 544.103 Td /F4 8.7 Tf  [(37)] TJ ET
0.271 0.267 0.267 rg
BT 305.767 542.595 Td /F1 9.8 Tf  [(.)] TJ ET
40.337 529.908 m 
40.337 530.355 40.154 530.799 39.838 531.115 c
39.522 531.431 39.078 531.614 38.631 531.614 c
38.185 531.614 37.741 531.431 37.425 531.115 c
37.109 530.799 36.925 530.355 36.925 529.908 c
36.925 529.462 37.109 529.018 37.425 528.702 c
37.741 528.386 38.185 528.202 38.631 528.202 c
39.078 528.202 39.522 528.386 39.838 528.702 c
40.154 529.018 40.337 529.462 40.337 529.908 c f
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BT 26.250 614.024 Td /F1 9.8 Tf  [(should be considered as a prolonged dry season or a separate phenomenon altogether is a matter for debate.)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(As water discharge and water levels associated with droughts are typically low, dilution capacity is reduced and secondary )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(impacts on freshwater systems emerge such as poorer water quality \(e.g., higher concentration in chemical, nutrients and solid )] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(particles, lower dissolved oxygen\) )] TJ ET
0.267 0.267 0.267 rg
BT 174.713 572.317 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 184.351 570.810 Td /F1 9.8 Tf  [(. Water quality can further worsen when intense rainfall follows a long dry spell \(typically )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(from convective storms associated with high summer temperature\) and chemicals accumulated on the ground or roads wash )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(out to the rivers )] TJ ET
0.267 0.267 0.267 rg
BT 96.157 548.507 Td /F4 8.7 Tf  [(69)] TJ ET
0.271 0.267 0.267 rg
BT 105.795 547.000 Td /F1 9.8 Tf  [(. When dry spells are associated with anticyclonic conditions and high temperatures, this can speed up the )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(development of droughts and increase the risk of secondary impacts. In particular, high temperatures result in high evaporative )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(losses, drying up soil and plants; this can trigger agricultural droughts and increase wildfire risk. With dryer soils, infiltration )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(capacity can also reduce and flooding risk can increase.)] TJ ET
BT 26.250 491.881 Td /F1 9.8 Tf  [(Also relevant to resource-rich countries as well as resource-poor is that people may switch their water source during drought, )] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(often to a lower quality supply. For instance, recent droughts in the UK have tempted people to consider private water supplies )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(which are not under such direct control of water company drought restrictions )] TJ ET
0.267 0.267 0.267 rg
BT 361.679 469.579 Td /F4 8.7 Tf  [(70)] TJ ET
0.271 0.267 0.267 rg
BT 371.317 468.072 Td /F1 9.8 Tf  [(. A risk of this is potentially poorer quality )] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(control: several outbreaks of infectious disease associated with private water supplies in England and Wales have been )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(described )] TJ ET
0.267 0.267 0.267 rg
BT 71.227 445.769 Td /F4 8.7 Tf  [(71)] TJ ET
0.271 0.267 0.267 rg
BT 80.864 444.262 Td /F1 9.8 Tf  [(. Recycling water is another option which people may resort to during drought: this too has risks for human health )] TJ ET
0.267 0.267 0.267 rg
BT 571.289 445.769 Td /F4 8.7 Tf  [(72)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 432.357 Td /F1 9.8 Tf  [(. Table 3 summarises studies which were explicit about drought linked to water-related disease. There were several categories )] TJ ET
BT 26.250 420.453 Td /F1 9.8 Tf  [(of effect:)] TJ ET
BT 26.250 401.048 Td /F5 9.8 Tf  [(Water-related disease caused by faecal/urine pollution)] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(Paucity of water sources during drought may increase the risk of remaining sources being contaminated by faces or urine: for )] TJ ET
BT 26.250 369.738 Td /F1 9.8 Tf  [(instance, if an increased number of animals are drawn to drink by a river or borehole )] TJ ET
0.267 0.267 0.267 rg
BT 392.567 371.246 Td /F4 8.7 Tf  [(73)] TJ ET
0.271 0.267 0.267 rg
BT 402.205 369.738 Td /F1 9.8 Tf  [(. Infected humans can also contribute to )] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(transmission around a water source: the more users there are, the more are at-risk and the more likely an outbreak of infectious )] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(disease. Associated risks might be further exacerbated if the water source in question is running at low levels; pathogens are )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(more concentrated than normal )] TJ ET
0.267 0.267 0.267 rg
BT 164.437 335.531 Td /F4 8.7 Tf  [(74)] TJ ET
0.271 0.267 0.267 rg
BT 174.074 334.024 Td /F1 9.8 Tf  [( and it is more likely that anybody consuming the water would ingest a minimum infective )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(dose.)] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(Diseases which are transmitted by water and hence potentially affected by drought include amoebiasis, hepatitis A, )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(salmonellosis, schistosomiasis, shigellosis, typhoid and paratyphoid \(enteric fever\). Evidence is, however, scarce. Few papers )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(directly addressed this topic and were limited to drought-associated E.coli O157 )] TJ ET
0.267 0.267 0.267 rg
BT 372.521 280.412 Td /F4 8.7 Tf  [(75)] TJ ET
0.271 0.267 0.267 rg
BT 382.159 278.905 Td /F1 9.8 Tf  [(; cholera )] TJ ET
0.267 0.267 0.267 rg
BT 422.260 280.412 Td /F4 8.7 Tf  [(76)] TJ ET
0.271 0.267 0.267 rg
BT 431.898 282.793 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 434.307 280.412 Td /F4 8.7 Tf  [(77)] TJ ET
0.271 0.267 0.267 rg
BT 443.944 278.905 Td /F1 9.8 Tf  [(, and leptospirosis )] TJ ET
0.267 0.267 0.267 rg
BT 525.230 280.412 Td /F4 8.7 Tf  [(78)] TJ ET
0.271 0.267 0.267 rg
BT 534.867 278.905 Td /F1 9.8 Tf  [(. In all )] TJ ET
BT 26.250 267.000 Td /F1 9.8 Tf  [(these studies, it is important to note that drought was not the only exposure underlying the outbreak� a whole chain of risk )] TJ ET
BT 26.250 255.096 Td /F1 9.8 Tf  [(factors was responsible. Reflecting this upstream role, drought-related potential disease risk does not always translate to actual )] TJ ET
BT 26.250 243.191 Td /F1 9.8 Tf  [(disease. In Haiti in 1976-1977, area-level comparison of severely and moderately drought affected areas showed no differences )] TJ ET
BT 26.250 231.286 Td /F1 9.8 Tf  [(in reported diarrhoeal disease )] TJ ET
0.267 0.267 0.267 rg
BT 157.934 232.793 Td /F4 8.7 Tf  [(79)] TJ ET
0.271 0.267 0.267 rg
BT 167.571 231.286 Td /F1 9.8 Tf  [(. Factors which did show an effect were: unemployed head of household; household )] TJ ET
BT 26.250 219.381 Td /F1 9.8 Tf  [(socioeconomic status; large family size; quantity of water used \(<19 litres/person/day\).)] TJ ET
BT 26.250 199.977 Td /F5 9.8 Tf  [(Water-related disease caused by poor handwashing/ hygiene)] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(Though it did not formally explore disease mechanisms, a 1978 study from Wales supports the plausible hypothesis that poor )] TJ ET
BT 26.250 168.667 Td /F1 9.8 Tf  [(hand-washing \(due to decreased water supply during drought\) can also contribute to drought-associated diarrhoeal disease. )] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(Areas with the longest cuts to mains supply had significantly greater diarrhoea prevalence than areas with shorter-lasting or no )] TJ ET
BT 26.250 144.858 Td /F1 9.8 Tf  [(daily cuts. Mains water meant that source contamination is an unlikely explanation for these results )] TJ ET
0.267 0.267 0.267 rg
BT 454.889 146.365 Td /F4 8.7 Tf  [(80)] TJ ET
0.271 0.267 0.267 rg
BT 464.527 144.858 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 125.453 Td /F5 9.8 Tf  [(Skin, eye and louse-borne disease that occur when there is lack of water for personal hygiene)] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(Skin infections associated with lack of water for washing include scabies )] TJ ET
0.267 0.267 0.267 rg
BT 340.541 107.555 Td /F4 8.7 Tf  [(79)] TJ ET
0.271 0.267 0.267 rg
BT 350.179 106.048 Td /F1 9.8 Tf  [(, and impetigo � though we found no clear drought-)] TJ ET
BT 26.250 94.143 Td /F1 9.8 Tf  [(associated references for the latter. Eye infections including conjunctivitis )] TJ ET
0.267 0.267 0.267 rg
BT 344.344 95.651 Td /F4 8.7 Tf  [(79)] TJ ET
0.271 0.267 0.267 rg
BT 353.981 94.143 Td /F1 9.8 Tf  [( were also associated with drought-related lack of )] TJ ET
BT 26.250 82.239 Td /F1 9.8 Tf  [(water for washing.)] TJ ET
BT 26.250 62.834 Td /F5 9.8 Tf  [(Disease caused by chemical and pollutant concentration)] TJ ET
BT 26.250 43.429 Td /F1 9.8 Tf  [(Reduced water from a fixed source such as reservoir or lake concentrates its dissolved contents, including chemicals, metals )] TJ ET
Q
q
15.000 29.143 577.500 747.857 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(explains consistently higher malnutrition/mortality rates among infants )] TJ ET
0.267 0.267 0.267 rg
BT 329.153 768.983 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 338.791 771.364 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 341.200 768.983 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 350.837 767.476 Td /F1 9.8 Tf  [( and young children compared to older children )] TJ ET
0.267 0.267 0.267 rg
BT 556.767 768.983 Td /F4 8.7 Tf  [(29)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 755.571 Td /F1 9.8 Tf  [(and adults )] TJ ET
0.267 0.267 0.267 rg
BT 73.947 757.079 Td /F4 8.7 Tf  [(26)] TJ ET
0.271 0.267 0.267 rg
BT 83.584 755.571 Td /F1 9.8 Tf  [(. It also likely contributes to lost pregnancies in Mozambique )] TJ ET
0.267 0.267 0.267 rg
BT 345.859 757.079 Td /F4 8.7 Tf  [(58)] TJ ET
0.271 0.267 0.267 rg
BT 355.497 755.571 Td /F1 9.8 Tf  [( and, to a lesser extent, to malnutrition among the )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(elderly in India )] TJ ET
0.267 0.267 0.267 rg
BT 91.819 745.174 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 101.456 747.555 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 103.865 745.174 Td /F4 8.7 Tf  [(60)] TJ ET
0.271 0.267 0.267 rg
BT 113.503 743.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Avoidable risks are more socially or culturally mediated. Examples include: rural-urban differences )] TJ ET
0.267 0.267 0.267 rg
BT 451.594 725.769 Td /F4 8.7 Tf  [(61)] TJ ET
0.271 0.267 0.267 rg
BT 461.231 724.262 Td /F1 9.8 Tf  [( and tribal and ethnic )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(variations )] TJ ET
0.267 0.267 0.267 rg
BT 70.681 713.864 Td /F4 8.7 Tf  [(62)] TJ ET
0.271 0.267 0.267 rg
BT 80.318 712.357 Td /F1 9.8 Tf  [(. Avoidable risks are particularly important to understand since they vary across settings and hence the same risk )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(factor will require a different response depending on where it occurs. For example, boys are more vulnerable in some settings )] TJ ET
0.267 0.267 0.267 rg
BT 569.764 701.960 Td /F4 8.7 Tf  [(58)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 688.548 Td /F1 9.8 Tf  [(, girls in others )] TJ ET
0.267 0.267 0.267 rg
BT 92.355 690.055 Td /F4 8.7 Tf  [(57)] TJ ET
0.271 0.267 0.267 rg
BT 101.992 688.548 Td /F1 9.8 Tf  [(; and socioeconomic gradients are seen in some )] TJ ET
0.267 0.267 0.267 rg
BT 313.879 690.055 Td /F4 8.7 Tf  [(59)] TJ ET
0.271 0.267 0.267 rg
BT 323.517 688.548 Td /F1 9.8 Tf  [( but not all studies )] TJ ET
0.267 0.267 0.267 rg
BT 404.812 690.055 Td /F4 8.7 Tf  [(63)] TJ ET
0.271 0.267 0.267 rg
BT 414.450 688.548 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 669.143 Td /F4 9.8 Tf  [(2\) WATER-RELATED DISEASE)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Decreased water availability is a defining feature of most droughts. Related to this, water quality can also be affected )] TJ ET
0.267 0.267 0.267 rg
BT 531.320 651.245 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 540.957 649.738 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(relationship between water quantity and quality is complex )] TJ ET
0.267 0.267 0.267 rg
BT 280.403 639.341 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 290.041 637.833 Td /F1 9.8 Tf  [(. An important point, not always fully appreciated, is that both are )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(necessary for good health )] TJ ET
0.267 0.267 0.267 rg
BT 141.144 627.436 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 150.781 625.929 Td /F1 9.8 Tf  [(. Seasonal variations in water related health outcomes are well-recognised )] TJ ET
0.267 0.267 0.267 rg
BT 474.832 627.436 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 484.470 625.929 Td /F1 9.8 Tf  [( but whether drought )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(should be considered as a prolonged dry season or a separate phenomenon altogether is a matter for debate.)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(As water discharge and water levels associated with droughts are typically low, dilution capacity is reduced and secondary )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(impacts on freshwater systems emerge such as poorer water quality \(e.g., higher concentration in chemical, nutrients and solid )] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(particles, lower dissolved oxygen\) )] TJ ET
0.267 0.267 0.267 rg
BT 174.713 572.317 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 184.351 570.810 Td /F1 9.8 Tf  [(. Water quality can further worsen when intense rainfall follows a long dry spell \(typically )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(from convective storms associated with high summer temperature\) and chemicals accumulated on the ground or roads wash )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(out to the rivers )] TJ ET
0.267 0.267 0.267 rg
BT 96.157 548.507 Td /F4 8.7 Tf  [(69)] TJ ET
0.271 0.267 0.267 rg
BT 105.795 547.000 Td /F1 9.8 Tf  [(. When dry spells are associated with anticyclonic conditions and high temperatures, this can speed up the )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(development of droughts and increase the risk of secondary impacts. In particular, high temperatures result in high evaporative )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(losses, drying up soil and plants; this can trigger agricultural droughts and increase wildfire risk. With dryer soils, infiltration )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(capacity can also reduce and flooding risk can increase.)] TJ ET
BT 26.250 491.881 Td /F1 9.8 Tf  [(Also relevant to resource-rich countries as well as resource-poor is that people may switch their water source during drought, )] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(often to a lower quality supply. For instance, recent droughts in the UK have tempted people to consider private water supplies )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(which are not under such direct control of water company drought restrictions )] TJ ET
0.267 0.267 0.267 rg
BT 361.679 469.579 Td /F4 8.7 Tf  [(70)] TJ ET
0.271 0.267 0.267 rg
BT 371.317 468.072 Td /F1 9.8 Tf  [(. A risk of this is potentially poorer quality )] TJ ET
BT 26.250 456.167 Td /F1 9.8 Tf  [(control: several outbreaks of infectious disease associated with private water supplies in England and Wales have been )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(described )] TJ ET
0.267 0.267 0.267 rg
BT 71.227 445.769 Td /F4 8.7 Tf  [(71)] TJ ET
0.271 0.267 0.267 rg
BT 80.864 444.262 Td /F1 9.8 Tf  [(. Recycling water is another option which people may resort to during drought: this too has risks for human health )] TJ ET
0.267 0.267 0.267 rg
BT 571.289 445.769 Td /F4 8.7 Tf  [(72)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 432.357 Td /F1 9.8 Tf  [(. Table 3 summarises studies which were explicit about drought linked to water-related disease. There were several categories )] TJ ET
BT 26.250 420.453 Td /F1 9.8 Tf  [(of effect:)] TJ ET
BT 26.250 401.048 Td /F5 9.8 Tf  [(Water-related disease caused by faecal/urine pollution)] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(Paucity of water sources during drought may increase the risk of remaining sources being contaminated by faces or urine: for )] TJ ET
BT 26.250 369.738 Td /F1 9.8 Tf  [(instance, if an increased number of animals are drawn to drink by a river or borehole )] TJ ET
0.267 0.267 0.267 rg
BT 392.567 371.246 Td /F4 8.7 Tf  [(73)] TJ ET
0.271 0.267 0.267 rg
BT 402.205 369.738 Td /F1 9.8 Tf  [(. Infected humans can also contribute to )] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(transmission around a water source: the more users there are, the more are at-risk and the more likely an outbreak of infectious )] TJ ET
BT 26.250 345.929 Td /F1 9.8 Tf  [(disease. Associated risks might be further exacerbated if the water source in question is running at low levels; pathogens are )] TJ ET
BT 26.250 334.024 Td /F1 9.8 Tf  [(more concentrated than normal )] TJ ET
0.267 0.267 0.267 rg
BT 164.437 335.531 Td /F4 8.7 Tf  [(74)] TJ ET
0.271 0.267 0.267 rg
BT 174.074 334.024 Td /F1 9.8 Tf  [( and it is more likely that anybody consuming the water would ingest a minimum infective )] TJ ET
BT 26.250 322.119 Td /F1 9.8 Tf  [(dose.)] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(Diseases which are transmitted by water and hence potentially affected by drought include amoebiasis, hepatitis A, )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(salmonellosis, schistosomiasis, shigellosis, typhoid and paratyphoid \(enteric fever\). Evidence is, however, scarce. Few papers )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(directly addressed this topic and were limited to drought-associated E.coli O157 )] TJ ET
0.267 0.267 0.267 rg
BT 372.521 280.412 Td /F4 8.7 Tf  [(75)] TJ ET
0.271 0.267 0.267 rg
BT 382.159 278.905 Td /F1 9.8 Tf  [(; cholera )] TJ ET
0.267 0.267 0.267 rg
BT 422.260 280.412 Td /F4 8.7 Tf  [(76)] TJ ET
0.271 0.267 0.267 rg
BT 431.898 282.793 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 434.307 280.412 Td /F4 8.7 Tf  [(77)] TJ ET
0.271 0.267 0.267 rg
BT 443.944 278.905 Td /F1 9.8 Tf  [(, and leptospirosis )] TJ ET
0.267 0.267 0.267 rg
BT 525.230 280.412 Td /F4 8.7 Tf  [(78)] TJ ET
0.271 0.267 0.267 rg
BT 534.867 278.905 Td /F1 9.8 Tf  [(. In all )] TJ ET
BT 26.250 267.000 Td /F1 9.8 Tf  [(these studies, it is important to note that drought was not the only exposure underlying the outbreak� a whole chain of risk )] TJ ET
BT 26.250 255.096 Td /F1 9.8 Tf  [(factors was responsible. Reflecting this upstream role, drought-related potential disease risk does not always translate to actual )] TJ ET
BT 26.250 243.191 Td /F1 9.8 Tf  [(disease. In Haiti in 1976-1977, area-level comparison of severely and moderately drought affected areas showed no differences )] TJ ET
BT 26.250 231.286 Td /F1 9.8 Tf  [(in reported diarrhoeal disease )] TJ ET
0.267 0.267 0.267 rg
BT 157.934 232.793 Td /F4 8.7 Tf  [(79)] TJ ET
0.271 0.267 0.267 rg
BT 167.571 231.286 Td /F1 9.8 Tf  [(. Factors which did show an effect were: unemployed head of household; household )] TJ ET
BT 26.250 219.381 Td /F1 9.8 Tf  [(socioeconomic status; large family size; quantity of water used \(<19 litres/person/day\).)] TJ ET
BT 26.250 199.977 Td /F5 9.8 Tf  [(Water-related disease caused by poor handwashing/ hygiene)] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(Though it did not formally explore disease mechanisms, a 1978 study from Wales supports the plausible hypothesis that poor )] TJ ET
BT 26.250 168.667 Td /F1 9.8 Tf  [(hand-washing \(due to decreased water supply during drought\) can also contribute to drought-associated diarrhoeal disease. )] TJ ET
BT 26.250 156.762 Td /F1 9.8 Tf  [(Areas with the longest cuts to mains supply had significantly greater diarrhoea prevalence than areas with shorter-lasting or no )] TJ ET
BT 26.250 144.858 Td /F1 9.8 Tf  [(daily cuts. Mains water meant that source contamination is an unlikely explanation for these results )] TJ ET
0.267 0.267 0.267 rg
BT 454.889 146.365 Td /F4 8.7 Tf  [(80)] TJ ET
0.271 0.267 0.267 rg
BT 464.527 144.858 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 125.453 Td /F5 9.8 Tf  [(Skin, eye and louse-borne disease that occur when there is lack of water for personal hygiene)] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(Skin infections associated with lack of water for washing include scabies )] TJ ET
0.267 0.267 0.267 rg
BT 340.541 107.555 Td /F4 8.7 Tf  [(79)] TJ ET
0.271 0.267 0.267 rg
BT 350.179 106.048 Td /F1 9.8 Tf  [(, and impetigo � though we found no clear drought-)] TJ ET
BT 26.250 94.143 Td /F1 9.8 Tf  [(associated references for the latter. Eye infections including conjunctivitis )] TJ ET
0.267 0.267 0.267 rg
BT 344.344 95.651 Td /F4 8.7 Tf  [(79)] TJ ET
0.271 0.267 0.267 rg
BT 353.981 94.143 Td /F1 9.8 Tf  [( were also associated with drought-related lack of )] TJ ET
BT 26.250 82.239 Td /F1 9.8 Tf  [(water for washing.)] TJ ET
BT 26.250 62.834 Td /F5 9.8 Tf  [(Disease caused by chemical and pollutant concentration)] TJ ET
BT 26.250 43.429 Td /F1 9.8 Tf  [(Reduced water from a fixed source such as reservoir or lake concentrates its dissolved contents, including chemicals, metals )] TJ ET
Q
q
15.000 29.143 577.500 747.857 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(explains consistently higher malnutrition/mortality rates among infants )] TJ ET
0.267 0.267 0.267 rg
BT 329.153 768.983 Td /F4 8.7 Tf  [(45)] TJ ET
0.271 0.267 0.267 rg
BT 338.791 771.364 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
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BT 83.584 755.571 Td /F1 9.8 Tf  [(. It also likely contributes to lost pregnancies in Mozambique )] TJ ET
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0.271 0.267 0.267 rg
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BT 26.250 724.262 Td /F1 9.8 Tf  [(Avoidable risks are more socially or culturally mediated. Examples include: rural-urban differences )] TJ ET
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BT 26.250 712.357 Td /F1 9.8 Tf  [(variations )] TJ ET
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BT 323.517 688.548 Td /F1 9.8 Tf  [( but not all studies )] TJ ET
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BT 414.450 688.548 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 669.143 Td /F4 9.8 Tf  [(2\) WATER-RELATED DISEASE)] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(Decreased water availability is a defining feature of most droughts. Related to this, water quality can also be affected )] TJ ET
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BT 531.320 651.245 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 540.957 649.738 Td /F1 9.8 Tf  [(. The )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(relationship between water quantity and quality is complex )] TJ ET
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BT 280.403 639.341 Td /F4 8.7 Tf  [(65)] TJ ET
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BT 290.041 637.833 Td /F1 9.8 Tf  [(. An important point, not always fully appreciated, is that both are )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(necessary for good health )] TJ ET
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BT 141.144 627.436 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 150.781 625.929 Td /F1 9.8 Tf  [(. Seasonal variations in water related health outcomes are well-recognised )] TJ ET
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BT 474.832 627.436 Td /F4 8.7 Tf  [(67)] TJ ET
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BT 484.470 625.929 Td /F1 9.8 Tf  [( but whether drought )] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(should be considered as a prolonged dry season or a separate phenomenon altogether is a matter for debate.)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(As water discharge and water levels associated with droughts are typically low, dilution capacity is reduced and secondary )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(impacts on freshwater systems emerge such as poorer water quality \(e.g., higher concentration in chemical, nutrients and solid )] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(particles, lower dissolved oxygen\) )] TJ ET
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BT 174.713 572.317 Td /F4 8.7 Tf  [(68)] TJ ET
0.271 0.267 0.267 rg
BT 184.351 570.810 Td /F1 9.8 Tf  [(. Water quality can further worsen when intense rainfall follows a long dry spell \(typically )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(from convective storms associated with high summer temperature\) and chemicals accumulated on the ground or roads wash )] TJ ET
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BT 26.250 535.095 Td /F1 9.8 Tf  [(development of droughts and increase the risk of secondary impacts. In particular, high temperatures result in high evaporative )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(losses, drying up soil and plants; this can trigger agricultural droughts and increase wildfire risk. With dryer soils, infiltration )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(capacity can also reduce and flooding risk can increase.)] TJ ET
BT 26.250 491.881 Td /F1 9.8 Tf  [(Also relevant to resource-rich countries as well as resource-poor is that people may switch their water source during drought, )] TJ ET
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BT 26.250 456.167 Td /F1 9.8 Tf  [(control: several outbreaks of infectious disease associated with private water supplies in England and Wales have been )] TJ ET
BT 26.250 444.262 Td /F1 9.8 Tf  [(described )] TJ ET
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BT 26.250 302.715 Td /F1 9.8 Tf  [(Diseases which are transmitted by water and hence potentially affected by drought include amoebiasis, hepatitis A, )] TJ ET
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BT 534.867 278.905 Td /F1 9.8 Tf  [(. In all )] TJ ET
BT 26.250 267.000 Td /F1 9.8 Tf  [(these studies, it is important to note that drought was not the only exposure underlying the outbreak� a whole chain of risk )] TJ ET
BT 26.250 255.096 Td /F1 9.8 Tf  [(factors was responsible. Reflecting this upstream role, drought-related potential disease risk does not always translate to actual )] TJ ET
BT 26.250 243.191 Td /F1 9.8 Tf  [(disease. In Haiti in 1976-1977, area-level comparison of severely and moderately drought affected areas showed no differences )] TJ ET
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BT 26.250 168.667 Td /F1 9.8 Tf  [(hand-washing \(due to decreased water supply during drought\) can also contribute to drought-associated diarrhoeal disease. )] TJ ET
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BT 26.250 125.453 Td /F5 9.8 Tf  [(Skin, eye and louse-borne disease that occur when there is lack of water for personal hygiene)] TJ ET
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0.271 0.267 0.267 rg
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BT 26.250 767.476 Td /F1 9.8 Tf  [(and other pollutants. No studies directly examining the health effects of these as related to drought were found but there is )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(certainly potential for adverse impact )] TJ ET
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BT 187.730 757.079 Td /F4 8.7 Tf  [(81)] TJ ET
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BT 197.367 759.460 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 199.776 757.079 Td /F4 8.7 Tf  [(82)] TJ ET
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BT 209.414 755.571 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 736.167 Td /F5 9.8 Tf  [(Water-related disease caused by algae)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(Following a drought in north-east Brazil in 1996, 126 patients in a haemodialysis unit developed signs and symptoms of acute )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(neurotoxicity and hepatoxicity after water contaminated by cyanobacteria was used for dialysis; 60 subsequently died )] TJ ET
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BT 533.484 706.364 Td /F4 8.7 Tf  [(83)] TJ ET
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BT 543.121 704.857 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(In the United States, after two dogs died drinking lake water contaminated by microcystin toxins, authorities launched a series of )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(testing of cyanobacteria levels in lakes in Nebraska. High levels of microcystins were discovered in one lake, and failure to )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(adequately notify the public resulted in more than 50 telephone calls to public health authorities complaining of skin rashes, )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(lesions, blisters, vomiting, headaches and diarrhoea after swimming in the lake. Reduced lake levels as the result of a recent )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(drought may have contributed to the increased cyanobacteria levels )] TJ ET
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BT 321.061 639.341 Td /F4 8.7 Tf  [(84)] TJ ET
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BT 330.698 637.833 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(While not explicitly linked to drought, another study from Kenya discovered that, during the dry season, reservoirs used as a )] TJ ET
BT 26.250 606.524 Td /F1 9.8 Tf  [(source of drinking water for humans showed microcystin levels of more than twice the WHO tolerable level for daily intake )] TJ ET
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BT 562.573 606.524 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(These results are particularly worrying for countries which lack systems to provide safe drinking water on a widespread scale, )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(and more research is needed to understand the extent of the problem.)] TJ ET
BT 26.250 563.310 Td /F4 9.8 Tf  [(3\) AIRBORNE AND DUST-RELATED DISEASE)] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(As soils become increasingly dry during a drought, dust circulated in the air is more likely. The United States dust bowl drought )] TJ ET
BT 26.250 532.000 Td /F1 9.8 Tf  [(of the 1930s is a particularly well known example of this: hundreds and perhaps thousands of people who lived in the Great )] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(Plains died from �dust pneumonia,� a respiratory condition brought on by inhalation of excessive amounts of dust and dirt )] TJ ET
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BT 26.250 508.191 Td /F1 9.8 Tf  [(Dust can be harmful via two mechanisms: pathogen carriage and direct trauma from inhaled particulates. In South Korea, one )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(examination of dust clouds blown in by winds from the Mongolian desert found weak evidence of an association with mortality: a )] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(1.7% \(95% CI -1.6 to 5.3\) increase in all cause deaths; a 2.2% \(95% CI -3.5 to 8.3\) increase in deaths among those aged 65 )] TJ ET
BT 26.250 472.476 Td /F1 9.8 Tf  [(years and older; a 4.1% \(95% CI -3.8 to 12.6\) increase in deaths from cardiovascular and respiratory causes )] TJ ET
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BT 505.711 472.476 Td /F1 9.8 Tf  [(. A 2012 review )] TJ ET
BT 26.250 460.572 Td /F1 9.8 Tf  [(of health impacts of desert dust found 50 studies describing a range of health effects including respiratory, cardiovascular and )] TJ ET
BT 26.250 448.667 Td /F1 9.8 Tf  [(cardiopulmonary disease )] TJ ET
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BT 26.250 429.262 Td /F1 9.8 Tf  [(Table 4 summarizes reports linking drought to airborne/dust-related disease. Few studies were found making this link. Possible )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(reasons for this lack of evidence include: 1\) because the bulk of morbidity is in permanently dry \(arid\) areas, and our search did )] TJ ET
BT 26.250 405.453 Td /F1 9.8 Tf  [(not include permanently arid conditions; 2\) because the drought-dust link is often only implicit, not well enough described to be )] TJ ET
BT 26.250 393.548 Td /F1 9.8 Tf  [(flagged by our search terms; 3\) because the difference between an arid area and one affected by long term drought is a matter )] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(of degree and hence subjective. It is biologically plausible to assume that the health effects of drought-related dusts will be )] TJ ET
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BT 26.250 357.834 Td /F1 9.8 Tf  [(drought is a time-limited event\). As with previous sections, many of the respiratory effects of drought were indirect.)] TJ ET
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BT 541.606 316.127 Td /F4 8.7 Tf  [(89)] TJ ET
0.271 0.267 0.267 rg
BT 551.243 314.619 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 295.215 Td /F1 9.8 Tf  [(Another example of drought-related problems due to inhalation \(this time of gas rather than dust\) comes from case reports from )] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(New York. These described silo-gas exposure associated with the fact that a dry growing season raises nitrate levels in corn )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(plants. As plants in silos biodegrade, they release nitrogen dioxide \(NO2\). Farm workers maintaining the silos were exposed to )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(unusually high levels of NO2 resulting in hospitalization some cases: though important to note that this could have been fatal )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(had levels been higher or exposure longer )] TJ ET
0.267 0.267 0.267 rg
BT 211.052 249.103 Td /F4 8.7 Tf  [(90)] TJ ET
0.271 0.267 0.267 rg
BT 220.689 247.596 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 228.191 Td /F1 9.8 Tf  [(Coccidioidomycosis \(Valley Fever\) shows the complex relationship with drought and other environmental events. It is caused by )] TJ ET
BT 26.250 216.286 Td /F1 9.8 Tf  [(a fungus, Coccidioides, which lives in the soil of dry, low rainfall areas and is acquired by breathing in spores from the air. It can, )] TJ ET
BT 26.250 204.381 Td /F1 9.8 Tf  [(for instance, be distributed during dust storms )] TJ ET
0.267 0.267 0.267 rg
BT 226.213 205.889 Td /F4 8.7 Tf  [(91)] TJ ET
0.271 0.267 0.267 rg
BT 235.850 204.381 Td /F1 9.8 Tf  [(. Outbreaks in California were associated with heavy rains following a drought, )] TJ ET
BT 26.250 192.477 Td /F1 9.8 Tf  [(possibly exacerbated by building work which disturbed the soil and released more spores than might otherwise have been the )] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(case )] TJ ET
0.267 0.267 0.267 rg
BT 49.552 182.079 Td /F4 8.7 Tf  [(92)] TJ ET
0.271 0.267 0.267 rg
BT 59.190 180.572 Td /F1 9.8 Tf  [(. Another study on coccidioidomycosis was one of the few in this review which correlated drought intensity with )] TJ ET
BT 26.250 168.667 Td /F1 9.8 Tf  [(increased incidence of disease, with a significant association \(p<0.01\) )] TJ ET
0.267 0.267 0.267 rg
BT 329.992 170.174 Td /F4 8.7 Tf  [(93)] TJ ET
0.271 0.267 0.267 rg
BT 339.629 168.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 149.262 Td /F4 9.8 Tf  [(4\) VECTOR-BORNE DISEASE)] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(Our search revealed a number of papers which examined the impact of drought on various vector-borne diseases; eight met the )] TJ ET
BT 26.250 117.953 Td /F1 9.8 Tf  [(inclusion criteria and are summarised in Table 5, and several others are used as supporting evidence in this section. The )] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(relationship between vector-borne diseases and climatological conditions is an important area to consider when planning public )] TJ ET
BT 26.250 94.143 Td /F1 9.8 Tf  [(health drought mitigation strategies, and more research on each disease is needed to strengthen the existing evidence which, in )] TJ ET
BT 26.250 82.239 Td /F1 9.8 Tf  [(many cases, is not definitive and quite sparse.)] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(The mosquito is one of the most important arthropod vectors involved in the transmission of various vector-borne pathogens, )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(and increased precipitation can cause mosquito densities to increase through provision of additional aquatic habitat. In a study )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(of US wetlands that never dry compared to wetlands that dry annually, it was found that mosquito densities increase )] TJ ET
Q
q
15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(and other pollutants. No studies directly examining the health effects of these as related to drought were found but there is )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(certainly potential for adverse impact )] TJ ET
0.267 0.267 0.267 rg
BT 187.730 757.079 Td /F4 8.7 Tf  [(81)] TJ ET
0.271 0.267 0.267 rg
BT 197.367 759.460 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 199.776 757.079 Td /F4 8.7 Tf  [(82)] TJ ET
0.271 0.267 0.267 rg
BT 209.414 755.571 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 736.167 Td /F5 9.8 Tf  [(Water-related disease caused by algae)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(Following a drought in north-east Brazil in 1996, 126 patients in a haemodialysis unit developed signs and symptoms of acute )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(neurotoxicity and hepatoxicity after water contaminated by cyanobacteria was used for dialysis; 60 subsequently died )] TJ ET
0.267 0.267 0.267 rg
BT 533.484 706.364 Td /F4 8.7 Tf  [(83)] TJ ET
0.271 0.267 0.267 rg
BT 543.121 704.857 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(In the United States, after two dogs died drinking lake water contaminated by microcystin toxins, authorities launched a series of )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(testing of cyanobacteria levels in lakes in Nebraska. High levels of microcystins were discovered in one lake, and failure to )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(adequately notify the public resulted in more than 50 telephone calls to public health authorities complaining of skin rashes, )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(lesions, blisters, vomiting, headaches and diarrhoea after swimming in the lake. Reduced lake levels as the result of a recent )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(drought may have contributed to the increased cyanobacteria levels )] TJ ET
0.267 0.267 0.267 rg
BT 321.061 639.341 Td /F4 8.7 Tf  [(84)] TJ ET
0.271 0.267 0.267 rg
BT 330.698 637.833 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(While not explicitly linked to drought, another study from Kenya discovered that, during the dry season, reservoirs used as a )] TJ ET
BT 26.250 606.524 Td /F1 9.8 Tf  [(source of drinking water for humans showed microcystin levels of more than twice the WHO tolerable level for daily intake )] TJ ET
0.267 0.267 0.267 rg
BT 552.935 608.031 Td /F4 8.7 Tf  [(85)] TJ ET
0.271 0.267 0.267 rg
BT 562.573 606.524 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(These results are particularly worrying for countries which lack systems to provide safe drinking water on a widespread scale, )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(and more research is needed to understand the extent of the problem.)] TJ ET
BT 26.250 563.310 Td /F4 9.8 Tf  [(3\) AIRBORNE AND DUST-RELATED DISEASE)] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(As soils become increasingly dry during a drought, dust circulated in the air is more likely. The United States dust bowl drought )] TJ ET
BT 26.250 532.000 Td /F1 9.8 Tf  [(of the 1930s is a particularly well known example of this: hundreds and perhaps thousands of people who lived in the Great )] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(Plains died from �dust pneumonia,� a respiratory condition brought on by inhalation of excessive amounts of dust and dirt )] TJ ET
0.267 0.267 0.267 rg
BT 549.201 521.603 Td /F4 8.7 Tf  [(86)] TJ ET
0.271 0.267 0.267 rg
BT 558.838 520.095 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(Dust can be harmful via two mechanisms: pathogen carriage and direct trauma from inhaled particulates. In South Korea, one )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(examination of dust clouds blown in by winds from the Mongolian desert found weak evidence of an association with mortality: a )] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(1.7% \(95% CI -1.6 to 5.3\) increase in all cause deaths; a 2.2% \(95% CI -3.5 to 8.3\) increase in deaths among those aged 65 )] TJ ET
BT 26.250 472.476 Td /F1 9.8 Tf  [(years and older; a 4.1% \(95% CI -3.8 to 12.6\) increase in deaths from cardiovascular and respiratory causes )] TJ ET
0.267 0.267 0.267 rg
BT 496.073 473.984 Td /F4 8.7 Tf  [(87)] TJ ET
0.271 0.267 0.267 rg
BT 505.711 472.476 Td /F1 9.8 Tf  [(. A 2012 review )] TJ ET
BT 26.250 460.572 Td /F1 9.8 Tf  [(of health impacts of desert dust found 50 studies describing a range of health effects including respiratory, cardiovascular and )] TJ ET
BT 26.250 448.667 Td /F1 9.8 Tf  [(cardiopulmonary disease )] TJ ET
0.267 0.267 0.267 rg
BT 137.332 450.174 Td /F4 8.7 Tf  [(88)] TJ ET
0.271 0.267 0.267 rg
BT 146.969 448.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(Table 4 summarizes reports linking drought to airborne/dust-related disease. Few studies were found making this link. Possible )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(reasons for this lack of evidence include: 1\) because the bulk of morbidity is in permanently dry \(arid\) areas, and our search did )] TJ ET
BT 26.250 405.453 Td /F1 9.8 Tf  [(not include permanently arid conditions; 2\) because the drought-dust link is often only implicit, not well enough described to be )] TJ ET
BT 26.250 393.548 Td /F1 9.8 Tf  [(flagged by our search terms; 3\) because the difference between an arid area and one affected by long term drought is a matter )] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(of degree and hence subjective. It is biologically plausible to assume that the health effects of drought-related dusts will be )] TJ ET
BT 26.250 369.738 Td /F1 9.8 Tf  [(similar to those of dust in general )] TJ ET
0.267 0.267 0.267 rg
BT 172.022 371.246 Td /F4 8.7 Tf  [(88)] TJ ET
0.271 0.267 0.267 rg
BT 181.660 369.738 Td /F1 9.8 Tf  [( � possibly less severe for conditions where duration of exposure is relevant \(assuming a )] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(drought is a time-limited event\). As with previous sections, many of the respiratory effects of drought were indirect.)] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(In a 1987-1989 Canadian drought, dust from a dried lake was associated with significant self-reported respiratory problems )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(including cough and wheeze. Lung function did not, however, seem to be affected. Anxiety may have been responsible for )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(symptom self-reporting, and short term exposure to dust may have been insufficient to cause measurable lung damage )] TJ ET
0.267 0.267 0.267 rg
BT 541.606 316.127 Td /F4 8.7 Tf  [(89)] TJ ET
0.271 0.267 0.267 rg
BT 551.243 314.619 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 295.215 Td /F1 9.8 Tf  [(Another example of drought-related problems due to inhalation \(this time of gas rather than dust\) comes from case reports from )] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(New York. These described silo-gas exposure associated with the fact that a dry growing season raises nitrate levels in corn )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(plants. As plants in silos biodegrade, they release nitrogen dioxide \(NO2\). Farm workers maintaining the silos were exposed to )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(unusually high levels of NO2 resulting in hospitalization some cases: though important to note that this could have been fatal )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(had levels been higher or exposure longer )] TJ ET
0.267 0.267 0.267 rg
BT 211.052 249.103 Td /F4 8.7 Tf  [(90)] TJ ET
0.271 0.267 0.267 rg
BT 220.689 247.596 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 228.191 Td /F1 9.8 Tf  [(Coccidioidomycosis \(Valley Fever\) shows the complex relationship with drought and other environmental events. It is caused by )] TJ ET
BT 26.250 216.286 Td /F1 9.8 Tf  [(a fungus, Coccidioides, which lives in the soil of dry, low rainfall areas and is acquired by breathing in spores from the air. It can, )] TJ ET
BT 26.250 204.381 Td /F1 9.8 Tf  [(for instance, be distributed during dust storms )] TJ ET
0.267 0.267 0.267 rg
BT 226.213 205.889 Td /F4 8.7 Tf  [(91)] TJ ET
0.271 0.267 0.267 rg
BT 235.850 204.381 Td /F1 9.8 Tf  [(. Outbreaks in California were associated with heavy rains following a drought, )] TJ ET
BT 26.250 192.477 Td /F1 9.8 Tf  [(possibly exacerbated by building work which disturbed the soil and released more spores than might otherwise have been the )] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(case )] TJ ET
0.267 0.267 0.267 rg
BT 49.552 182.079 Td /F4 8.7 Tf  [(92)] TJ ET
0.271 0.267 0.267 rg
BT 59.190 180.572 Td /F1 9.8 Tf  [(. Another study on coccidioidomycosis was one of the few in this review which correlated drought intensity with )] TJ ET
BT 26.250 168.667 Td /F1 9.8 Tf  [(increased incidence of disease, with a significant association \(p<0.01\) )] TJ ET
0.267 0.267 0.267 rg
BT 329.992 170.174 Td /F4 8.7 Tf  [(93)] TJ ET
0.271 0.267 0.267 rg
BT 339.629 168.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 149.262 Td /F4 9.8 Tf  [(4\) VECTOR-BORNE DISEASE)] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(Our search revealed a number of papers which examined the impact of drought on various vector-borne diseases; eight met the )] TJ ET
BT 26.250 117.953 Td /F1 9.8 Tf  [(inclusion criteria and are summarised in Table 5, and several others are used as supporting evidence in this section. The )] TJ ET
BT 26.250 106.048 Td /F1 9.8 Tf  [(relationship between vector-borne diseases and climatological conditions is an important area to consider when planning public )] TJ ET
BT 26.250 94.143 Td /F1 9.8 Tf  [(health drought mitigation strategies, and more research on each disease is needed to strengthen the existing evidence which, in )] TJ ET
BT 26.250 82.239 Td /F1 9.8 Tf  [(many cases, is not definitive and quite sparse.)] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(The mosquito is one of the most important arthropod vectors involved in the transmission of various vector-borne pathogens, )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(and increased precipitation can cause mosquito densities to increase through provision of additional aquatic habitat. In a study )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(of US wetlands that never dry compared to wetlands that dry annually, it was found that mosquito densities increase )] TJ ET
Q
q
15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(and other pollutants. No studies directly examining the health effects of these as related to drought were found but there is )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(certainly potential for adverse impact )] TJ ET
0.267 0.267 0.267 rg
BT 187.730 757.079 Td /F4 8.7 Tf  [(81)] TJ ET
0.271 0.267 0.267 rg
BT 197.367 759.460 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 199.776 757.079 Td /F4 8.7 Tf  [(82)] TJ ET
0.271 0.267 0.267 rg
BT 209.414 755.571 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 736.167 Td /F5 9.8 Tf  [(Water-related disease caused by algae)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(Following a drought in north-east Brazil in 1996, 126 patients in a haemodialysis unit developed signs and symptoms of acute )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(neurotoxicity and hepatoxicity after water contaminated by cyanobacteria was used for dialysis; 60 subsequently died )] TJ ET
0.267 0.267 0.267 rg
BT 533.484 706.364 Td /F4 8.7 Tf  [(83)] TJ ET
0.271 0.267 0.267 rg
BT 543.121 704.857 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(In the United States, after two dogs died drinking lake water contaminated by microcystin toxins, authorities launched a series of )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(testing of cyanobacteria levels in lakes in Nebraska. High levels of microcystins were discovered in one lake, and failure to )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(adequately notify the public resulted in more than 50 telephone calls to public health authorities complaining of skin rashes, )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(lesions, blisters, vomiting, headaches and diarrhoea after swimming in the lake. Reduced lake levels as the result of a recent )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(drought may have contributed to the increased cyanobacteria levels )] TJ ET
0.267 0.267 0.267 rg
BT 321.061 639.341 Td /F4 8.7 Tf  [(84)] TJ ET
0.271 0.267 0.267 rg
BT 330.698 637.833 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(While not explicitly linked to drought, another study from Kenya discovered that, during the dry season, reservoirs used as a )] TJ ET
BT 26.250 606.524 Td /F1 9.8 Tf  [(source of drinking water for humans showed microcystin levels of more than twice the WHO tolerable level for daily intake )] TJ ET
0.267 0.267 0.267 rg
BT 552.935 608.031 Td /F4 8.7 Tf  [(85)] TJ ET
0.271 0.267 0.267 rg
BT 562.573 606.524 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(These results are particularly worrying for countries which lack systems to provide safe drinking water on a widespread scale, )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(and more research is needed to understand the extent of the problem.)] TJ ET
BT 26.250 563.310 Td /F4 9.8 Tf  [(3\) AIRBORNE AND DUST-RELATED DISEASE)] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(As soils become increasingly dry during a drought, dust circulated in the air is more likely. The United States dust bowl drought )] TJ ET
BT 26.250 532.000 Td /F1 9.8 Tf  [(of the 1930s is a particularly well known example of this: hundreds and perhaps thousands of people who lived in the Great )] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(Plains died from �dust pneumonia,� a respiratory condition brought on by inhalation of excessive amounts of dust and dirt )] TJ ET
0.267 0.267 0.267 rg
BT 549.201 521.603 Td /F4 8.7 Tf  [(86)] TJ ET
0.271 0.267 0.267 rg
BT 558.838 520.095 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(Dust can be harmful via two mechanisms: pathogen carriage and direct trauma from inhaled particulates. In South Korea, one )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(examination of dust clouds blown in by winds from the Mongolian desert found weak evidence of an association with mortality: a )] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(1.7% \(95% CI -1.6 to 5.3\) increase in all cause deaths; a 2.2% \(95% CI -3.5 to 8.3\) increase in deaths among those aged 65 )] TJ ET
BT 26.250 472.476 Td /F1 9.8 Tf  [(years and older; a 4.1% \(95% CI -3.8 to 12.6\) increase in deaths from cardiovascular and respiratory causes )] TJ ET
0.267 0.267 0.267 rg
BT 496.073 473.984 Td /F4 8.7 Tf  [(87)] TJ ET
0.271 0.267 0.267 rg
BT 505.711 472.476 Td /F1 9.8 Tf  [(. A 2012 review )] TJ ET
BT 26.250 460.572 Td /F1 9.8 Tf  [(of health impacts of desert dust found 50 studies describing a range of health effects including respiratory, cardiovascular and )] TJ ET
BT 26.250 448.667 Td /F1 9.8 Tf  [(cardiopulmonary disease )] TJ ET
0.267 0.267 0.267 rg
BT 137.332 450.174 Td /F4 8.7 Tf  [(88)] TJ ET
0.271 0.267 0.267 rg
BT 146.969 448.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(Table 4 summarizes reports linking drought to airborne/dust-related disease. Few studies were found making this link. Possible )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(reasons for this lack of evidence include: 1\) because the bulk of morbidity is in permanently dry \(arid\) areas, and our search did )] TJ ET
BT 26.250 405.453 Td /F1 9.8 Tf  [(not include permanently arid conditions; 2\) because the drought-dust link is often only implicit, not well enough described to be )] TJ ET
BT 26.250 393.548 Td /F1 9.8 Tf  [(flagged by our search terms; 3\) because the difference between an arid area and one affected by long term drought is a matter )] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(of degree and hence subjective. It is biologically plausible to assume that the health effects of drought-related dusts will be )] TJ ET
BT 26.250 369.738 Td /F1 9.8 Tf  [(similar to those of dust in general )] TJ ET
0.267 0.267 0.267 rg
BT 172.022 371.246 Td /F4 8.7 Tf  [(88)] TJ ET
0.271 0.267 0.267 rg
BT 181.660 369.738 Td /F1 9.8 Tf  [( � possibly less severe for conditions where duration of exposure is relevant \(assuming a )] TJ ET
BT 26.250 357.834 Td /F1 9.8 Tf  [(drought is a time-limited event\). As with previous sections, many of the respiratory effects of drought were indirect.)] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(In a 1987-1989 Canadian drought, dust from a dried lake was associated with significant self-reported respiratory problems )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(including cough and wheeze. Lung function did not, however, seem to be affected. Anxiety may have been responsible for )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(symptom self-reporting, and short term exposure to dust may have been insufficient to cause measurable lung damage )] TJ ET
0.267 0.267 0.267 rg
BT 541.606 316.127 Td /F4 8.7 Tf  [(89)] TJ ET
0.271 0.267 0.267 rg
BT 551.243 314.619 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 295.215 Td /F1 9.8 Tf  [(Another example of drought-related problems due to inhalation \(this time of gas rather than dust\) comes from case reports from )] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(New York. These described silo-gas exposure associated with the fact that a dry growing season raises nitrate levels in corn )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(plants. As plants in silos biodegrade, they release nitrogen dioxide \(NO2\). Farm workers maintaining the silos were exposed to )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(unusually high levels of NO2 resulting in hospitalization some cases: though important to note that this could have been fatal )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(had levels been higher or exposure longer )] TJ ET
0.267 0.267 0.267 rg
BT 211.052 249.103 Td /F4 8.7 Tf  [(90)] TJ ET
0.271 0.267 0.267 rg
BT 220.689 247.596 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 228.191 Td /F1 9.8 Tf  [(Coccidioidomycosis \(Valley Fever\) shows the complex relationship with drought and other environmental events. It is caused by )] TJ ET
BT 26.250 216.286 Td /F1 9.8 Tf  [(a fungus, Coccidioides, which lives in the soil of dry, low rainfall areas and is acquired by breathing in spores from the air. It can, )] TJ ET
BT 26.250 204.381 Td /F1 9.8 Tf  [(for instance, be distributed during dust storms )] TJ ET
0.267 0.267 0.267 rg
BT 226.213 205.889 Td /F4 8.7 Tf  [(91)] TJ ET
0.271 0.267 0.267 rg
BT 235.850 204.381 Td /F1 9.8 Tf  [(. Outbreaks in California were associated with heavy rains following a drought, )] TJ ET
BT 26.250 192.477 Td /F1 9.8 Tf  [(possibly exacerbated by building work which disturbed the soil and released more spores than might otherwise have been the )] TJ ET
BT 26.250 180.572 Td /F1 9.8 Tf  [(case )] TJ ET
0.267 0.267 0.267 rg
BT 49.552 182.079 Td /F4 8.7 Tf  [(92)] TJ ET
0.271 0.267 0.267 rg
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BT 26.250 149.262 Td /F4 9.8 Tf  [(4\) VECTOR-BORNE DISEASE)] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(Our search revealed a number of papers which examined the impact of drought on various vector-borne diseases; eight met the )] TJ ET
BT 26.250 117.953 Td /F1 9.8 Tf  [(inclusion criteria and are summarised in Table 5, and several others are used as supporting evidence in this section. The )] TJ ET
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BT 26.250 82.239 Td /F1 9.8 Tf  [(many cases, is not definitive and quite sparse.)] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(The mosquito is one of the most important arthropod vectors involved in the transmission of various vector-borne pathogens, )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(and increased precipitation can cause mosquito densities to increase through provision of additional aquatic habitat. In a study )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 221.328 768.983 Td /F4 8.7 Tf  [(94)] TJ ET
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BT 230.965 767.476 Td /F1 9.8 Tf  [(, and this was explained in the main through loss of competitors and predators )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(thus allowing a rapid increase in mosquito numbers following re-colonisation resulting from re-wetting post-drought.)] TJ ET
BT 26.250 736.167 Td /F5 9.8 Tf  [(Dengue)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(An outbreak of dengue in1994 in Brazil was linked to a shortage of public water supplies as the result of a prolonged drought; )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(increased mosquito abundance correlated with widespread household storage of water and with interrupted dengue )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(suppression activities )] TJ ET
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BT 26.250 673.548 Td /F1 9.8 Tf  [(Given the prospect of climate change forecasts projecting increased drying conditions and decreased rainfall in Australia, )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(projections of )] TJ ET
BT 86.944 661.643 Td /F6 9.8 Tf  [(Aedes aegypti)] TJ ET
BT 148.730 661.643 Td /F1 9.8 Tf  [( mosquito distribution were studied under current climate conditions and climate change scenarios )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(for 2030 and 2050. Results indicate that the proliferation of domestic water storage tanks, used as an adaptation strategy during )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(drought conditions, may expand the range of )] TJ ET
BT 221.903 637.833 Td /F6 9.8 Tf  [(Ae. aegypti)] TJ ET
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BT 26.250 587.119 Td /F1 9.8 Tf  [(Evidence of malaria associated with drought is mixed, and research on the effects of El Ni�o Southern Oscillation \(ENSO\) )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(should be consulted to understand the global trends of drought patterns and their relationship to health.)] TJ ET
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BT 26.250 453.072 Td /F1 9.8 Tf  [(therefore crucial in determining the impact of drought on malaria.)] TJ ET
BT 26.250 433.667 Td /F1 9.8 Tf  [(In the Sahel, one study looked at )] TJ ET
BT 170.969 433.667 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 256.603 433.667 Td /F1 9.8 Tf  [( and changes over time in malaria prevalence and incidence. In Senegal, )] TJ ET
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BT 148.776 186.484 Td /F4 8.7 Tf  [(103)] TJ ET
0.271 0.267 0.267 rg
BT 163.232 184.977 Td /F1 9.8 Tf  [(. In another study water table depth was compared with human cases of SLE in Florida and )] TJ ET
BT 26.250 173.072 Td /F1 9.8 Tf  [(results showed that May drought occurred in 83% of the areas studied prior to the report of at least one human case of SLE )] TJ ET
0.267 0.267 0.267 rg
BT 560.609 174.579 Td /F4 8.7 Tf  [(104)] TJ ET
0.271 0.267 0.267 rg
BT 575.065 173.072 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 161.167 Td /F1 9.8 Tf  [(This study builds on the previous studies and provides further evidence that antecedent drought and near-coincident wetting are )] TJ ET
BT 26.250 149.262 Td /F1 9.8 Tf  [(significantly associated with human SLE cases. )] TJ ET
BT 233.252 149.262 Td /F6 9.8 Tf  [(Culex)] TJ ET
BT 258.173 149.262 Td /F1 9.8 Tf  [( mosquitoes tend to exploit transient water bodies and can proliferate in )] TJ ET
BT 26.250 137.358 Td /F1 9.8 Tf  [(the absence of predators.)] TJ ET
BT 26.250 117.953 Td /F5 9.8 Tf  [(West Nile Virus)] TJ ET
BT 26.250 98.548 Td /F1 9.8 Tf  [(A number of studies have identified links between human West Nile virus \(WNV\) and drought in the United States. In a study )] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(comparing transmission patterns of WNV in California from 2004-2007, increases in human infection in 2007 were associated )] TJ ET
BT 26.250 74.739 Td /F1 9.8 Tf  [(with severe drought conditions as well as other surveillance indicators including neglected swimming pools )] TJ ET
0.267 0.267 0.267 rg
BT 487.922 76.246 Td /F4 8.7 Tf  [(105)] TJ ET
0.271 0.267 0.267 rg
BT 502.378 74.739 Td /F1 9.8 Tf  [(. In a study of )] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(human WNV incidences compared with annual rainfall levels in Mississippi, an inverse relationship was identified between )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(precipitation levels of the previous year and the relative risk of human WNV, suggesting that drought acts as a potential )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(mechanism for increased risk of human WNV transmission; given climate change projections for increased drought in certain )] TJ ET
Q
q
15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(dramatically following natural drought events )] TJ ET
0.267 0.267 0.267 rg
BT 221.328 768.983 Td /F4 8.7 Tf  [(94)] TJ ET
0.271 0.267 0.267 rg
BT 230.965 767.476 Td /F1 9.8 Tf  [(, and this was explained in the main through loss of competitors and predators )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(thus allowing a rapid increase in mosquito numbers following re-colonisation resulting from re-wetting post-drought.)] TJ ET
BT 26.250 736.167 Td /F5 9.8 Tf  [(Dengue)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(An outbreak of dengue in1994 in Brazil was linked to a shortage of public water supplies as the result of a prolonged drought; )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(increased mosquito abundance correlated with widespread household storage of water and with interrupted dengue )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(suppression activities )] TJ ET
0.267 0.267 0.267 rg
BT 121.615 694.460 Td /F4 8.7 Tf  [(95)] TJ ET
0.271 0.267 0.267 rg
BT 131.252 692.952 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Given the prospect of climate change forecasts projecting increased drying conditions and decreased rainfall in Australia, )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(projections of )] TJ ET
BT 86.944 661.643 Td /F6 9.8 Tf  [(Aedes aegypti)] TJ ET
BT 148.730 661.643 Td /F1 9.8 Tf  [( mosquito distribution were studied under current climate conditions and climate change scenarios )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(for 2030 and 2050. Results indicate that the proliferation of domestic water storage tanks, used as an adaptation strategy during )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(drought conditions, may expand the range of )] TJ ET
BT 221.903 637.833 Td /F6 9.8 Tf  [(Ae. aegypti)] TJ ET
BT 270.683 637.833 Td /F1 9.8 Tf  [( and create a high potential for dengue transmission during warm )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(summer months )] TJ ET
0.267 0.267 0.267 rg
BT 98.849 627.436 Td /F4 8.7 Tf  [(96)] TJ ET
0.271 0.267 0.267 rg
BT 108.486 625.929 Td /F1 9.8 Tf  [(. This phenomenon is likely to impact all urban mosquitoes that have adapted to exploit container habitats.)] TJ ET
BT 26.250 606.524 Td /F5 9.8 Tf  [(Malaria)] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(Evidence of malaria associated with drought is mixed, and research on the effects of El Ni�o Southern Oscillation \(ENSO\) )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(should be consulted to understand the global trends of drought patterns and their relationship to health.)] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(One study which examined the link between malaria and ENSO found that malaria mortality is strongly related to drought in the )] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(year before outbreaks in Venezuela )] TJ ET
0.267 0.267 0.267 rg
BT 182.874 545.412 Td /F4 8.7 Tf  [(97)] TJ ET
0.271 0.267 0.267 rg
BT 192.511 543.905 Td /F1 9.8 Tf  [(. Another study which examined ENSO and malaria epidemics in South America found )] TJ ET
BT 26.250 532.000 Td /F1 9.8 Tf  [(that droughts are associated with malaria epidemics in Colombia \(in the first year of an El Ni�o episode or in the year following )] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(the onset\), Guyana \(in the first year of an El Ni�o episode or in the year following the onset\) and Venezuela \(epidemics follow )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(drought by one year\) )] TJ ET
0.267 0.267 0.267 rg
BT 118.924 509.698 Td /F4 8.7 Tf  [(98)] TJ ET
0.271 0.267 0.267 rg
BT 128.561 508.191 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 488.786 Td /F1 9.8 Tf  [(It is important to consider that some anopheline species exploit container habitats \(water storage, or rainwater collecting )] TJ ET
BT 26.250 476.881 Td /F1 9.8 Tf  [(habitats\), while others require permanent water. The former applies to )] TJ ET
BT 330.245 476.881 Td /F6 9.8 Tf  [(Anopheles arabiensis)] TJ ET
BT 423.455 476.881 Td /F1 9.8 Tf  [(, and the latter applies to )] TJ ET
BT 26.250 464.976 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 111.884 464.976 Td /F1 9.8 Tf  [(; both principle malaria vectors in Africa. The aquatic habitat favoured by the local malaria vectors is )] TJ ET
BT 26.250 453.072 Td /F1 9.8 Tf  [(therefore crucial in determining the impact of drought on malaria.)] TJ ET
BT 26.250 433.667 Td /F1 9.8 Tf  [(In the Sahel, one study looked at )] TJ ET
BT 170.969 433.667 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 256.603 433.667 Td /F1 9.8 Tf  [( and changes over time in malaria prevalence and incidence. In Senegal, )] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(between 1967 and 1992, parasite prevalence in children fell by 84%, and incidence fell by 82%. In Niger, malaria prevalence fell )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(from 69% in 1969 to 23% in 1994 in the Niger River area; in Zinder, prevalence dropped from 89% in 1922 to 32% in 1994, and )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(near Lake Chad, prevalence dropped from 40% in 1967 to 7% in 1996. The authors report that the decreases in malaria )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(prevalence and incidence are likely due to the disappearance of the )] TJ ET
BT 320.534 386.048 Td /F6 9.8 Tf  [(A. funestus)] TJ ET
BT 369.313 386.048 Td /F1 9.8 Tf  [( as a result of severe droughts in the region )] TJ ET
0.267 0.267 0.267 rg
BT 559.536 387.555 Td /F4 8.7 Tf  [(99)] TJ ET
0.271 0.267 0.267 rg
BT 569.173 386.048 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(Another study of )] TJ ET
BT 99.960 374.143 Td /F6 9.8 Tf  [(Plasmodium falciparum)] TJ ET
BT 201.272 374.143 Td /F1 9.8 Tf  [( transmission by )] TJ ET
BT 274.417 374.143 Td /F6 9.8 Tf  [(Anopheles arabiensis)] TJ ET
BT 367.627 374.143 Td /F1 9.8 Tf  [( and )] TJ ET
BT 389.311 374.143 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 474.945 374.143 Td /F1 9.8 Tf  [( during a period of )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(drought \(2004-2005\) in Zambia reported reduced mosquito activity and reduced numbers of malaria cases during the period of )] TJ ET
BT 26.250 350.334 Td /F1 9.8 Tf  [(drought. Numbers of )] TJ ET
BT 117.832 350.334 Td /F6 9.8 Tf  [(An. arabiensis)] TJ ET
BT 179.608 350.334 Td /F1 9.8 Tf  [( rebounded strongly when the rains returned in 2005-2006, while no )] TJ ET
BT 474.428 350.334 Td /F6 9.8 Tf  [(An. funestus)] TJ ET
BT 528.629 350.334 Td /F1 9.8 Tf  [( were )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(collected during this time )] TJ ET
0.267 0.267 0.267 rg
BT 136.250 339.936 Td /F4 8.7 Tf  [(100)] TJ ET
0.271 0.267 0.267 rg
BT 150.706 338.429 Td /F1 9.8 Tf  [(. The former is able to exploit the multitude of transient aquatic habitats following rain events with )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(numbers increasing rapidly in the absence of predators and competitors.)] TJ ET
BT 26.250 307.119 Td /F1 9.8 Tf  [(Finally, highlighting the indirect nature of many of the health effects associated with drought, during a period of drought \(1997\) in )] TJ ET
BT 26.250 295.215 Td /F1 9.8 Tf  [(the Irian Jaya province of Indonesia, two factors are believed responsible for a sharp rise in malaria cases \(554 deaths in three )] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(months\) amongst highland populations not normally exposed to malaria: severe food and water shortages in the highlands )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(contributed to population migration to lower elevations where intense malaria transmission is common, and drought conditions )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(resulted in numerous pools of standing water \(normally fast-flowing\), permitting a rapid increase in vector populations. The )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(findings show a temporal association with ENSO-related drought and increases in malaria and associated deaths )] TJ ET
0.267 0.267 0.267 rg
BT 516.129 249.103 Td /F4 8.7 Tf  [(101)] TJ ET
0.271 0.267 0.267 rg
BT 530.585 247.596 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 228.191 Td /F5 9.8 Tf  [(St Louis encephalitis virus)] TJ ET
BT 26.250 208.786 Td /F1 9.8 Tf  [(Evidence suggests that antecedent drought followed by wet conditions facilitated the amplification of the St Louis encephalitis )] TJ ET
BT 26.250 196.881 Td /F1 9.8 Tf  [(\(SLE\) virus among )] TJ ET
BT 109.691 196.881 Td /F6 9.8 Tf  [(Culex nigripalpus)] TJ ET
BT 184.463 196.881 Td /F1 9.8 Tf  [( mosquitoes and a portion of wild birds in Florida, USA, resulting in subsequent )] TJ ET
BT 26.250 184.977 Td /F1 9.8 Tf  [(transmission to humans )] TJ ET
0.267 0.267 0.267 rg
BT 131.911 186.484 Td /F4 8.7 Tf  [(102)] TJ ET
0.271 0.267 0.267 rg
BT 146.367 188.865 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 148.776 186.484 Td /F4 8.7 Tf  [(103)] TJ ET
0.271 0.267 0.267 rg
BT 163.232 184.977 Td /F1 9.8 Tf  [(. In another study water table depth was compared with human cases of SLE in Florida and )] TJ ET
BT 26.250 173.072 Td /F1 9.8 Tf  [(results showed that May drought occurred in 83% of the areas studied prior to the report of at least one human case of SLE )] TJ ET
0.267 0.267 0.267 rg
BT 560.609 174.579 Td /F4 8.7 Tf  [(104)] TJ ET
0.271 0.267 0.267 rg
BT 575.065 173.072 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 161.167 Td /F1 9.8 Tf  [(This study builds on the previous studies and provides further evidence that antecedent drought and near-coincident wetting are )] TJ ET
BT 26.250 149.262 Td /F1 9.8 Tf  [(significantly associated with human SLE cases. )] TJ ET
BT 233.252 149.262 Td /F6 9.8 Tf  [(Culex)] TJ ET
BT 258.173 149.262 Td /F1 9.8 Tf  [( mosquitoes tend to exploit transient water bodies and can proliferate in )] TJ ET
BT 26.250 137.358 Td /F1 9.8 Tf  [(the absence of predators.)] TJ ET
BT 26.250 117.953 Td /F5 9.8 Tf  [(West Nile Virus)] TJ ET
BT 26.250 98.548 Td /F1 9.8 Tf  [(A number of studies have identified links between human West Nile virus \(WNV\) and drought in the United States. In a study )] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(comparing transmission patterns of WNV in California from 2004-2007, increases in human infection in 2007 were associated )] TJ ET
BT 26.250 74.739 Td /F1 9.8 Tf  [(with severe drought conditions as well as other surveillance indicators including neglected swimming pools )] TJ ET
0.267 0.267 0.267 rg
BT 487.922 76.246 Td /F4 8.7 Tf  [(105)] TJ ET
0.271 0.267 0.267 rg
BT 502.378 74.739 Td /F1 9.8 Tf  [(. In a study of )] TJ ET
BT 26.250 62.834 Td /F1 9.8 Tf  [(human WNV incidences compared with annual rainfall levels in Mississippi, an inverse relationship was identified between )] TJ ET
BT 26.250 50.929 Td /F1 9.8 Tf  [(precipitation levels of the previous year and the relative risk of human WNV, suggesting that drought acts as a potential )] TJ ET
BT 26.250 39.024 Td /F1 9.8 Tf  [(mechanism for increased risk of human WNV transmission; given climate change projections for increased drought in certain )] TJ ET
Q
q
15.000 24.739 577.500 752.261 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(dramatically following natural drought events )] TJ ET
0.267 0.267 0.267 rg
BT 221.328 768.983 Td /F4 8.7 Tf  [(94)] TJ ET
0.271 0.267 0.267 rg
BT 230.965 767.476 Td /F1 9.8 Tf  [(, and this was explained in the main through loss of competitors and predators )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(thus allowing a rapid increase in mosquito numbers following re-colonisation resulting from re-wetting post-drought.)] TJ ET
BT 26.250 736.167 Td /F5 9.8 Tf  [(Dengue)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(An outbreak of dengue in1994 in Brazil was linked to a shortage of public water supplies as the result of a prolonged drought; )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(increased mosquito abundance correlated with widespread household storage of water and with interrupted dengue )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(suppression activities )] TJ ET
0.267 0.267 0.267 rg
BT 121.615 694.460 Td /F4 8.7 Tf  [(95)] TJ ET
0.271 0.267 0.267 rg
BT 131.252 692.952 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Given the prospect of climate change forecasts projecting increased drying conditions and decreased rainfall in Australia, )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(projections of )] TJ ET
BT 86.944 661.643 Td /F6 9.8 Tf  [(Aedes aegypti)] TJ ET
BT 148.730 661.643 Td /F1 9.8 Tf  [( mosquito distribution were studied under current climate conditions and climate change scenarios )] TJ ET
BT 26.250 649.738 Td /F1 9.8 Tf  [(for 2030 and 2050. Results indicate that the proliferation of domestic water storage tanks, used as an adaptation strategy during )] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(drought conditions, may expand the range of )] TJ ET
BT 221.903 637.833 Td /F6 9.8 Tf  [(Ae. aegypti)] TJ ET
BT 270.683 637.833 Td /F1 9.8 Tf  [( and create a high potential for dengue transmission during warm )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(summer months )] TJ ET
0.267 0.267 0.267 rg
BT 98.849 627.436 Td /F4 8.7 Tf  [(96)] TJ ET
0.271 0.267 0.267 rg
BT 108.486 625.929 Td /F1 9.8 Tf  [(. This phenomenon is likely to impact all urban mosquitoes that have adapted to exploit container habitats.)] TJ ET
BT 26.250 606.524 Td /F5 9.8 Tf  [(Malaria)] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(Evidence of malaria associated with drought is mixed, and research on the effects of El Ni�o Southern Oscillation \(ENSO\) )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(should be consulted to understand the global trends of drought patterns and their relationship to health.)] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(One study which examined the link between malaria and ENSO found that malaria mortality is strongly related to drought in the )] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(year before outbreaks in Venezuela )] TJ ET
0.267 0.267 0.267 rg
BT 182.874 545.412 Td /F4 8.7 Tf  [(97)] TJ ET
0.271 0.267 0.267 rg
BT 192.511 543.905 Td /F1 9.8 Tf  [(. Another study which examined ENSO and malaria epidemics in South America found )] TJ ET
BT 26.250 532.000 Td /F1 9.8 Tf  [(that droughts are associated with malaria epidemics in Colombia \(in the first year of an El Ni�o episode or in the year following )] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(the onset\), Guyana \(in the first year of an El Ni�o episode or in the year following the onset\) and Venezuela \(epidemics follow )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(drought by one year\) )] TJ ET
0.267 0.267 0.267 rg
BT 118.924 509.698 Td /F4 8.7 Tf  [(98)] TJ ET
0.271 0.267 0.267 rg
BT 128.561 508.191 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 488.786 Td /F1 9.8 Tf  [(It is important to consider that some anopheline species exploit container habitats \(water storage, or rainwater collecting )] TJ ET
BT 26.250 476.881 Td /F1 9.8 Tf  [(habitats\), while others require permanent water. The former applies to )] TJ ET
BT 330.245 476.881 Td /F6 9.8 Tf  [(Anopheles arabiensis)] TJ ET
BT 423.455 476.881 Td /F1 9.8 Tf  [(, and the latter applies to )] TJ ET
BT 26.250 464.976 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 111.884 464.976 Td /F1 9.8 Tf  [(; both principle malaria vectors in Africa. The aquatic habitat favoured by the local malaria vectors is )] TJ ET
BT 26.250 453.072 Td /F1 9.8 Tf  [(therefore crucial in determining the impact of drought on malaria.)] TJ ET
BT 26.250 433.667 Td /F1 9.8 Tf  [(In the Sahel, one study looked at )] TJ ET
BT 170.969 433.667 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 256.603 433.667 Td /F1 9.8 Tf  [( and changes over time in malaria prevalence and incidence. In Senegal, )] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(between 1967 and 1992, parasite prevalence in children fell by 84%, and incidence fell by 82%. In Niger, malaria prevalence fell )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(from 69% in 1969 to 23% in 1994 in the Niger River area; in Zinder, prevalence dropped from 89% in 1922 to 32% in 1994, and )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(near Lake Chad, prevalence dropped from 40% in 1967 to 7% in 1996. The authors report that the decreases in malaria )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(prevalence and incidence are likely due to the disappearance of the )] TJ ET
BT 320.534 386.048 Td /F6 9.8 Tf  [(A. funestus)] TJ ET
BT 369.313 386.048 Td /F1 9.8 Tf  [( as a result of severe droughts in the region )] TJ ET
0.267 0.267 0.267 rg
BT 559.536 387.555 Td /F4 8.7 Tf  [(99)] TJ ET
0.271 0.267 0.267 rg
BT 569.173 386.048 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(Another study of )] TJ ET
BT 99.960 374.143 Td /F6 9.8 Tf  [(Plasmodium falciparum)] TJ ET
BT 201.272 374.143 Td /F1 9.8 Tf  [( transmission by )] TJ ET
BT 274.417 374.143 Td /F6 9.8 Tf  [(Anopheles arabiensis)] TJ ET
BT 367.627 374.143 Td /F1 9.8 Tf  [( and )] TJ ET
BT 389.311 374.143 Td /F6 9.8 Tf  [(Anopheles funestus)] TJ ET
BT 474.945 374.143 Td /F1 9.8 Tf  [( during a period of )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(drought \(2004-2005\) in Zambia reported reduced mosquito activity and reduced numbers of malaria cases during the period of )] TJ ET
BT 26.250 350.334 Td /F1 9.8 Tf  [(drought. Numbers of )] TJ ET
BT 117.832 350.334 Td /F6 9.8 Tf  [(An. arabiensis)] TJ ET
BT 179.608 350.334 Td /F1 9.8 Tf  [( rebounded strongly when the rains returned in 2005-2006, while no )] TJ ET
BT 474.428 350.334 Td /F6 9.8 Tf  [(An. funestus)] TJ ET
BT 528.629 350.334 Td /F1 9.8 Tf  [( were )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(collected during this time )] TJ ET
0.267 0.267 0.267 rg
BT 136.250 339.936 Td /F4 8.7 Tf  [(100)] TJ ET
0.271 0.267 0.267 rg
BT 150.706 338.429 Td /F1 9.8 Tf  [(. The former is able to exploit the multitude of transient aquatic habitats following rain events with )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(numbers increasing rapidly in the absence of predators and competitors.)] TJ ET
BT 26.250 307.119 Td /F1 9.8 Tf  [(Finally, highlighting the indirect nature of many of the health effects associated with drought, during a period of drought \(1997\) in )] TJ ET
BT 26.250 295.215 Td /F1 9.8 Tf  [(the Irian Jaya province of Indonesia, two factors are believed responsible for a sharp rise in malaria cases \(554 deaths in three )] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(months\) amongst highland populations not normally exposed to malaria: severe food and water shortages in the highlands )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(contributed to population migration to lower elevations where intense malaria transmission is common, and drought conditions )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(resulted in numerous pools of standing water \(normally fast-flowing\), permitting a rapid increase in vector populations. The )] TJ ET
BT 26.250 247.596 Td /F1 9.8 Tf  [(findings show a temporal association with ENSO-related drought and increases in malaria and associated deaths )] TJ ET
0.267 0.267 0.267 rg
BT 516.129 249.103 Td /F4 8.7 Tf  [(101)] TJ ET
0.271 0.267 0.267 rg
BT 530.585 247.596 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 228.191 Td /F5 9.8 Tf  [(St Louis encephalitis virus)] TJ ET
BT 26.250 208.786 Td /F1 9.8 Tf  [(Evidence suggests that antecedent drought followed by wet conditions facilitated the amplification of the St Louis encephalitis )] TJ ET
BT 26.250 196.881 Td /F1 9.8 Tf  [(\(SLE\) virus among )] TJ ET
BT 109.691 196.881 Td /F6 9.8 Tf  [(Culex nigripalpus)] TJ ET
BT 184.463 196.881 Td /F1 9.8 Tf  [( mosquitoes and a portion of wild birds in Florida, USA, resulting in subsequent )] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(areas of the world, the authors believe that the risk of human WNV will also increase )] TJ ET
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BT 392.567 768.983 Td /F4 8.7 Tf  [(106)] TJ ET
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BT 26.250 633.429 Td /F1 9.8 Tf  [(eggs\) emerge to transmit the virus to animals. The pathogen is then passed from animals onto the local )] TJ ET
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0.271 0.267 0.267 rg
BT 311.113 87.953 Td /F1 9.8 Tf  [(. A number of studies, mainly from Australia, have )] TJ ET
BT 26.250 76.048 Td /F1 9.8 Tf  [(documented the impacts of drought on mental health. Distress or �emotional consequences of drought� \(or similar terminology\) )] TJ ET
BT 26.250 64.143 Td /F1 9.8 Tf  [(were the indicators most often measured as drought-related mental health outcomes; depression, anxiety and post-traumatic )] TJ ET
BT 26.250 52.239 Td /F1 9.8 Tf  [(stress disorder were not often measured. Most studies utilized focus group or one-to-one interviews as the main study design )] TJ ET
BT 26.250 40.334 Td /F1 9.8 Tf  [(methodology, with small sample sizes; postal surveys and self-report questionnaires were also used. Of the 16 papers )] TJ ET
Q
q
15.000 26.048 577.500 750.952 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(areas of the world, the authors believe that the risk of human WNV will also increase )] TJ ET
0.267 0.267 0.267 rg
BT 392.567 768.983 Td /F4 8.7 Tf  [(106)] TJ ET
0.271 0.267 0.267 rg
BT 407.023 767.476 Td /F1 9.8 Tf  [(. In western Colorado, dry spring and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(summer conditions appear to increase the risk of human WNV infection )] TJ ET
0.267 0.267 0.267 rg
BT 336.202 757.079 Td /F4 8.7 Tf  [(107)] TJ ET
0.271 0.267 0.267 rg
BT 350.659 755.571 Td /F1 9.8 Tf  [(. In the eastern US, another study found that WNV )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(proliferates under drought conditions )] TJ ET
0.267 0.267 0.267 rg
BT 187.203 745.174 Td /F4 8.7 Tf  [(108)] TJ ET
0.271 0.267 0.267 rg
BT 201.659 743.667 Td /F1 9.8 Tf  [(. Similar to findings about SLE, one study found that widespread drought conditions in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(the spring, followed by a wetter summer, increase the probability of human WNV cases )] TJ ET
0.267 0.267 0.267 rg
BT 403.936 733.269 Td /F4 8.7 Tf  [(109)] TJ ET
0.271 0.267 0.267 rg
BT 418.392 731.762 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 712.357 Td /F5 9.8 Tf  [(Rift Valley fever virus)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(Transmission of Rift Valley fever virus \(RVFV\) is reported to be epizootic during wet years, especially following droughts; )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(uncontrolled air travel could introduce RVFV to North America or Europe where susceptible hosts and suitable vectors reside, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(and could potentially have serious impacts on human health )] TJ ET
0.267 0.267 0.267 rg
BT 287.462 670.650 Td /F4 8.7 Tf  [(110)] TJ ET
0.271 0.267 0.267 rg
BT 301.918 669.143 Td /F1 9.8 Tf  [(. The virus survives in the eggs of )] TJ ET
BT 449.855 669.143 Td /F6 9.8 Tf  [(Aedes)] TJ ET
BT 477.496 669.143 Td /F1 9.8 Tf  [( mosquitoes. These )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(mosquitoes survive out of water in areas prone to flooding, such as dambos or depressions, which are their main aquatic )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(habitats in West Africa. Following heavy rainfall events, these habitats flood, and the resulting infected adults \(from infected )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(eggs\) emerge to transmit the virus to animals. The pathogen is then passed from animals onto the local )] TJ ET
BT 474.409 633.429 Td /F6 9.8 Tf  [(Culex)] TJ ET
BT 499.330 633.429 Td /F1 9.8 Tf  [( populations )] TJ ET
BT 26.250 621.524 Td /F1 9.8 Tf  [(precipitating a much larger outbreak. Flooding following drought results in large-scale simultaneous hatching of infected eggs )] TJ ET
BT 26.250 609.619 Td /F1 9.8 Tf  [(and thus simultaneous outbreaks of RVFV across Africa.)] TJ ET
BT 26.250 590.214 Td /F5 9.8 Tf  [(Japanese encephalitis)] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(One study which examined an epidemic of Japanese encephalitis in Andhra Pradesh, India, noted that drought conditions )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(existed before the epidemic started in the sample population; however, this was not explored thoroughly as a potential risk )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(factor which contributed to the outbreak )] TJ ET
0.267 0.267 0.267 rg
BT 199.673 548.507 Td /F4 8.7 Tf  [(111)] TJ ET
0.271 0.267 0.267 rg
BT 214.129 547.000 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 527.595 Td /F5 9.8 Tf  [(Chikungunya)] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(One study which used satellite data and epidemiologic investigation to examine epidemics of chikungunya in Kenya found that )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(unusually warm and dry conditions preceded outbreaks of chikungunya \(63% of population tested\), suggesting that drought-)] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(affected populations may be at a higher risk for chikungunya infection )] TJ ET
0.267 0.267 0.267 rg
BT 328.110 485.888 Td /F4 8.7 Tf  [(112)] TJ ET
0.271 0.267 0.267 rg
BT 342.566 484.381 Td /F1 9.8 Tf  [(. The study�s small sample size and lack of other )] TJ ET
BT 26.250 472.476 Td /F1 9.8 Tf  [(studies to compare make it difficult to generalize findings. Throughout its range chikungunya is transmitted by )] TJ ET
BT 499.876 472.476 Td /F6 9.8 Tf  [(Aedes)] TJ ET
BT 26.250 460.572 Td /F1 9.8 Tf  [(mosquitoes that exploit container habitats in urban areas, so water storage during drought is likely to favour these vectors and )] TJ ET
BT 26.250 448.667 Td /F1 9.8 Tf  [(transmission of this virus.)] TJ ET
BT 26.250 429.262 Td /F5 9.8 Tf  [(Tick-borne disease)] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(A study measuring both the prevalence and incidence of tick-borne borreliosis in Senegal reports an average annual incidence )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(rate of 5.1% in the sample population and 0.09% prevalence in a different sample population. The authors attribute the )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(persistence of sub-Saharan drought as a possible source responsible for the spread of the )] TJ ET
BT 418.073 386.048 Td /F6 9.8 Tf  [(Alectorobius sonrai)] TJ ET
BT 500.977 386.048 Td /F1 9.8 Tf  [( vector to new )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(areas of West Africa )] TJ ET
0.267 0.267 0.267 rg
BT 116.740 375.650 Td /F4 8.7 Tf  [(113)] TJ ET
0.271 0.267 0.267 rg
BT 131.196 378.031 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 133.605 375.650 Td /F4 8.7 Tf  [(114)] TJ ET
0.271 0.267 0.267 rg
BT 148.061 374.143 Td /F1 9.8 Tf  [(; further investigation is necessary to confirm these findings.)] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(Another study of tick-borne relapsing fever from the same site in Senegal, this one a 14 year longitudinal study, found an )] TJ ET
BT 26.250 342.834 Td /F1 9.8 Tf  [(average incidence rate of 11 per 100 person-years; the authors also attributed the ongoing sub-Saharan drought as a factor )] TJ ET
BT 26.250 330.929 Td /F1 9.8 Tf  [(responsible for the spread of the)] TJ ET
BT 26.250 311.524 Td /F6 9.8 Tf  [(Ornithodoros sonrai)] TJ ET
BT 111.865 311.524 Td /F1 9.8 Tf  [( vector to the West African savannah )] TJ ET
0.267 0.267 0.267 rg
BT 273.900 313.031 Td /F4 8.7 Tf  [(115)] TJ ET
0.271 0.267 0.267 rg
BT 288.356 311.524 Td /F1 9.8 Tf  [(. Again, more research is necessary to understand the possible )] TJ ET
BT 26.250 299.619 Td /F1 9.8 Tf  [(relationship between drought and this disease. As the majority of tick species in more temperate parts of the world are reliant )] TJ ET
BT 26.250 287.715 Td /F1 9.8 Tf  [(upon retaining their body moisture content, drought conditions would not tend to favour such �forest-species�. However, in arid )] TJ ET
BT 26.250 275.810 Td /F1 9.8 Tf  [(areas, the effect of drought is likely to be much less.)] TJ ET
BT 26.250 256.405 Td /F5 9.8 Tf  [(Schistosomiasis)] TJ ET
BT 26.250 237.000 Td /F1 9.8 Tf  [(One study which compared the prevalence of )] TJ ET
BT 224.594 237.000 Td /F6 9.8 Tf  [(Schistosoma haematobium)] TJ ET
BT 342.179 237.000 Td /F1 9.8 Tf  [( in coastal Kenya in 2000 and 2009 recorded the )] TJ ET
BT 26.250 225.096 Td /F1 9.8 Tf  [(disappearance of schistosomiasis infection clusters and a slight decline in prevalence from 55.7% to 43.2% following periods of )] TJ ET
BT 26.250 213.191 Td /F1 9.8 Tf  [(prolonged drought )] TJ ET
0.267 0.267 0.267 rg
BT 108.091 214.698 Td /F4 8.7 Tf  [(116)] TJ ET
0.271 0.267 0.267 rg
BT 122.548 213.191 Td /F1 9.8 Tf  [(. )] TJ ET
BT 127.969 213.191 Td /F6 9.8 Tf  [(Schistosoma)] TJ ET
BT 183.778 213.191 Td /F1 9.8 Tf  [( parasites require an aquatic snail as a vector, hence drought probably reduces the number )] TJ ET
BT 26.250 201.286 Td /F1 9.8 Tf  [(of these snails and reduces the transmission potential. Furthermore, humans become infected when standing in water with )] TJ ET
BT 26.250 189.381 Td /F1 9.8 Tf  [(infective metacercariae, therefore less available water during a drought will mean a lower exposure to the pathogens.)] TJ ET
BT 26.250 169.977 Td /F5 9.8 Tf  [(Chagas disease)] TJ ET
BT 26.250 150.572 Td /F1 9.8 Tf  [(One study examining an unusually high incidence of Chagas disease in Brazil reported that drought conditions may contribute )] TJ ET
BT 26.250 138.667 Td /F1 9.8 Tf  [(to outbreaks in humans, yet no information was provided to give evidence of the link between the two )] TJ ET
0.267 0.267 0.267 rg
BT 464.678 140.174 Td /F4 8.7 Tf  [(117)] TJ ET
0.271 0.267 0.267 rg
BT 479.134 138.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 119.262 Td /F4 9.8 Tf  [(5\) MENTAL HEALTH)] TJ ET
BT 26.250 99.858 Td /F1 9.8 Tf  [(Research suggests that drought contributes to the business-related pressures that farmers must face, with severe drought )] TJ ET
BT 26.250 87.953 Td /F1 9.8 Tf  [(resulting in financial impacts and consequent emotional stress )] TJ ET
0.267 0.267 0.267 rg
BT 296.656 89.460 Td /F4 8.7 Tf  [(118)] TJ ET
0.271 0.267 0.267 rg
BT 311.113 87.953 Td /F1 9.8 Tf  [(. A number of studies, mainly from Australia, have )] TJ ET
BT 26.250 76.048 Td /F1 9.8 Tf  [(documented the impacts of drought on mental health. Distress or �emotional consequences of drought� \(or similar terminology\) )] TJ ET
BT 26.250 64.143 Td /F1 9.8 Tf  [(were the indicators most often measured as drought-related mental health outcomes; depression, anxiety and post-traumatic )] TJ ET
BT 26.250 52.239 Td /F1 9.8 Tf  [(stress disorder were not often measured. Most studies utilized focus group or one-to-one interviews as the main study design )] TJ ET
BT 26.250 40.334 Td /F1 9.8 Tf  [(methodology, with small sample sizes; postal surveys and self-report questionnaires were also used. Of the 16 papers )] TJ ET
Q
q
15.000 26.048 577.500 750.952 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(areas of the world, the authors believe that the risk of human WNV will also increase )] TJ ET
0.267 0.267 0.267 rg
BT 392.567 768.983 Td /F4 8.7 Tf  [(106)] TJ ET
0.271 0.267 0.267 rg
BT 407.023 767.476 Td /F1 9.8 Tf  [(. In western Colorado, dry spring and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(summer conditions appear to increase the risk of human WNV infection )] TJ ET
0.267 0.267 0.267 rg
BT 336.202 757.079 Td /F4 8.7 Tf  [(107)] TJ ET
0.271 0.267 0.267 rg
BT 350.659 755.571 Td /F1 9.8 Tf  [(. In the eastern US, another study found that WNV )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(proliferates under drought conditions )] TJ ET
0.267 0.267 0.267 rg
BT 187.203 745.174 Td /F4 8.7 Tf  [(108)] TJ ET
0.271 0.267 0.267 rg
BT 201.659 743.667 Td /F1 9.8 Tf  [(. Similar to findings about SLE, one study found that widespread drought conditions in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(the spring, followed by a wetter summer, increase the probability of human WNV cases )] TJ ET
0.267 0.267 0.267 rg
BT 403.936 733.269 Td /F4 8.7 Tf  [(109)] TJ ET
0.271 0.267 0.267 rg
BT 418.392 731.762 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 712.357 Td /F5 9.8 Tf  [(Rift Valley fever virus)] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(Transmission of Rift Valley fever virus \(RVFV\) is reported to be epizootic during wet years, especially following droughts; )] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(uncontrolled air travel could introduce RVFV to North America or Europe where susceptible hosts and suitable vectors reside, )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(and could potentially have serious impacts on human health )] TJ ET
0.267 0.267 0.267 rg
BT 287.462 670.650 Td /F4 8.7 Tf  [(110)] TJ ET
0.271 0.267 0.267 rg
BT 301.918 669.143 Td /F1 9.8 Tf  [(. The virus survives in the eggs of )] TJ ET
BT 449.855 669.143 Td /F6 9.8 Tf  [(Aedes)] TJ ET
BT 477.496 669.143 Td /F1 9.8 Tf  [( mosquitoes. These )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(mosquitoes survive out of water in areas prone to flooding, such as dambos or depressions, which are their main aquatic )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(habitats in West Africa. Following heavy rainfall events, these habitats flood, and the resulting infected adults \(from infected )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(eggs\) emerge to transmit the virus to animals. The pathogen is then passed from animals onto the local )] TJ ET
BT 474.409 633.429 Td /F6 9.8 Tf  [(Culex)] TJ ET
BT 499.330 633.429 Td /F1 9.8 Tf  [( populations )] TJ ET
BT 26.250 621.524 Td /F1 9.8 Tf  [(precipitating a much larger outbreak. Flooding following drought results in large-scale simultaneous hatching of infected eggs )] TJ ET
BT 26.250 609.619 Td /F1 9.8 Tf  [(and thus simultaneous outbreaks of RVFV across Africa.)] TJ ET
BT 26.250 590.214 Td /F5 9.8 Tf  [(Japanese encephalitis)] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(One study which examined an epidemic of Japanese encephalitis in Andhra Pradesh, India, noted that drought conditions )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(existed before the epidemic started in the sample population; however, this was not explored thoroughly as a potential risk )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(factor which contributed to the outbreak )] TJ ET
0.267 0.267 0.267 rg
BT 199.673 548.507 Td /F4 8.7 Tf  [(111)] TJ ET
0.271 0.267 0.267 rg
BT 214.129 547.000 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 527.595 Td /F5 9.8 Tf  [(Chikungunya)] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(One study which used satellite data and epidemiologic investigation to examine epidemics of chikungunya in Kenya found that )] TJ ET
BT 26.250 496.286 Td /F1 9.8 Tf  [(unusually warm and dry conditions preceded outbreaks of chikungunya \(63% of population tested\), suggesting that drought-)] TJ ET
BT 26.250 484.381 Td /F1 9.8 Tf  [(affected populations may be at a higher risk for chikungunya infection )] TJ ET
0.267 0.267 0.267 rg
BT 328.110 485.888 Td /F4 8.7 Tf  [(112)] TJ ET
0.271 0.267 0.267 rg
BT 342.566 484.381 Td /F1 9.8 Tf  [(. The study�s small sample size and lack of other )] TJ ET
BT 26.250 472.476 Td /F1 9.8 Tf  [(studies to compare make it difficult to generalize findings. Throughout its range chikungunya is transmitted by )] TJ ET
BT 499.876 472.476 Td /F6 9.8 Tf  [(Aedes)] TJ ET
BT 26.250 460.572 Td /F1 9.8 Tf  [(mosquitoes that exploit container habitats in urban areas, so water storage during drought is likely to favour these vectors and )] TJ ET
BT 26.250 448.667 Td /F1 9.8 Tf  [(transmission of this virus.)] TJ ET
BT 26.250 429.262 Td /F5 9.8 Tf  [(Tick-borne disease)] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(A study measuring both the prevalence and incidence of tick-borne borreliosis in Senegal reports an average annual incidence )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(rate of 5.1% in the sample population and 0.09% prevalence in a different sample population. The authors attribute the )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(persistence of sub-Saharan drought as a possible source responsible for the spread of the )] TJ ET
BT 418.073 386.048 Td /F6 9.8 Tf  [(Alectorobius sonrai)] TJ ET
BT 500.977 386.048 Td /F1 9.8 Tf  [( vector to new )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(areas of West Africa )] TJ ET
0.267 0.267 0.267 rg
BT 116.740 375.650 Td /F4 8.7 Tf  [(113)] TJ ET
0.271 0.267 0.267 rg
BT 131.196 378.031 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 133.605 375.650 Td /F4 8.7 Tf  [(114)] TJ ET
0.271 0.267 0.267 rg
BT 148.061 374.143 Td /F1 9.8 Tf  [(; further investigation is necessary to confirm these findings.)] TJ ET
BT 26.250 354.738 Td /F1 9.8 Tf  [(Another study of tick-borne relapsing fever from the same site in Senegal, this one a 14 year longitudinal study, found an )] TJ ET
BT 26.250 342.834 Td /F1 9.8 Tf  [(average incidence rate of 11 per 100 person-years; the authors also attributed the ongoing sub-Saharan drought as a factor )] TJ ET
BT 26.250 330.929 Td /F1 9.8 Tf  [(responsible for the spread of the)] TJ ET
BT 26.250 311.524 Td /F6 9.8 Tf  [(Ornithodoros sonrai)] TJ ET
BT 111.865 311.524 Td /F1 9.8 Tf  [( vector to the West African savannah )] TJ ET
0.267 0.267 0.267 rg
BT 273.900 313.031 Td /F4 8.7 Tf  [(115)] TJ ET
0.271 0.267 0.267 rg
BT 288.356 311.524 Td /F1 9.8 Tf  [(. Again, more research is necessary to understand the possible )] TJ ET
BT 26.250 299.619 Td /F1 9.8 Tf  [(relationship between drought and this disease. As the majority of tick species in more temperate parts of the world are reliant )] TJ ET
BT 26.250 287.715 Td /F1 9.8 Tf  [(upon retaining their body moisture content, drought conditions would not tend to favour such �forest-species�. However, in arid )] TJ ET
BT 26.250 275.810 Td /F1 9.8 Tf  [(areas, the effect of drought is likely to be much less.)] TJ ET
BT 26.250 256.405 Td /F5 9.8 Tf  [(Schistosomiasis)] TJ ET
BT 26.250 237.000 Td /F1 9.8 Tf  [(One study which compared the prevalence of )] TJ ET
BT 224.594 237.000 Td /F6 9.8 Tf  [(Schistosoma haematobium)] TJ ET
BT 342.179 237.000 Td /F1 9.8 Tf  [( in coastal Kenya in 2000 and 2009 recorded the )] TJ ET
BT 26.250 225.096 Td /F1 9.8 Tf  [(disappearance of schistosomiasis infection clusters and a slight decline in prevalence from 55.7% to 43.2% following periods of )] TJ ET
BT 26.250 213.191 Td /F1 9.8 Tf  [(prolonged drought )] TJ ET
0.267 0.267 0.267 rg
BT 108.091 214.698 Td /F4 8.7 Tf  [(116)] TJ ET
0.271 0.267 0.267 rg
BT 122.548 213.191 Td /F1 9.8 Tf  [(. )] TJ ET
BT 127.969 213.191 Td /F6 9.8 Tf  [(Schistosoma)] TJ ET
BT 183.778 213.191 Td /F1 9.8 Tf  [( parasites require an aquatic snail as a vector, hence drought probably reduces the number )] TJ ET
BT 26.250 201.286 Td /F1 9.8 Tf  [(of these snails and reduces the transmission potential. Furthermore, humans become infected when standing in water with )] TJ ET
BT 26.250 189.381 Td /F1 9.8 Tf  [(infective metacercariae, therefore less available water during a drought will mean a lower exposure to the pathogens.)] TJ ET
BT 26.250 169.977 Td /F5 9.8 Tf  [(Chagas disease)] TJ ET
BT 26.250 150.572 Td /F1 9.8 Tf  [(One study examining an unusually high incidence of Chagas disease in Brazil reported that drought conditions may contribute )] TJ ET
BT 26.250 138.667 Td /F1 9.8 Tf  [(to outbreaks in humans, yet no information was provided to give evidence of the link between the two )] TJ ET
0.267 0.267 0.267 rg
BT 464.678 140.174 Td /F4 8.7 Tf  [(117)] TJ ET
0.271 0.267 0.267 rg
BT 479.134 138.667 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 119.262 Td /F4 9.8 Tf  [(5\) MENTAL HEALTH)] TJ ET
BT 26.250 99.858 Td /F1 9.8 Tf  [(Research suggests that drought contributes to the business-related pressures that farmers must face, with severe drought )] TJ ET
BT 26.250 87.953 Td /F1 9.8 Tf  [(resulting in financial impacts and consequent emotional stress )] TJ ET
0.267 0.267 0.267 rg
BT 296.656 89.460 Td /F4 8.7 Tf  [(118)] TJ ET
0.271 0.267 0.267 rg
BT 311.113 87.953 Td /F1 9.8 Tf  [(. A number of studies, mainly from Australia, have )] TJ ET
BT 26.250 76.048 Td /F1 9.8 Tf  [(documented the impacts of drought on mental health. Distress or �emotional consequences of drought� \(or similar terminology\) )] TJ ET
BT 26.250 64.143 Td /F1 9.8 Tf  [(were the indicators most often measured as drought-related mental health outcomes; depression, anxiety and post-traumatic )] TJ ET
BT 26.250 52.239 Td /F1 9.8 Tf  [(stress disorder were not often measured. Most studies utilized focus group or one-to-one interviews as the main study design )] TJ ET
BT 26.250 40.334 Td /F1 9.8 Tf  [(methodology, with small sample sizes; postal surveys and self-report questionnaires were also used. Of the 16 papers )] TJ ET
Q
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BT 291.710 19.825 Td /F1 11.0 Tf  [(11)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F1 9.8 Tf  [(summarized in Table 6, three focused on the effects on children and the remainder focused on adults; most studied rural )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(populations whose livelihoods \(i.e., farming\) are environment-dependent. A full list of mental health papers identified through our )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(search is available in Table 6.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Not surprisingly, results indicate that prolonged drought does indeed have negative impacts on the mental health of the )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(populations studied. For those studies which examined the effects of drought on children, worry about family )] TJ ET
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BT 526.332 712.357 Td /F1 9.8 Tf  [( and )] TJ ET
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BT 124.768 700.452 Td /F1 9.8 Tf  [( were common identified themes.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Those studies that examined the mental health impacts of drought on farmers yield a number of findings that support the idea )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(that drought negatively impacts on mental health. Drought-related stress was identified as �high� in 71.8% of farm workers in one )] TJ ET
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BT 484.619 645.333 Td /F1 9.8 Tf  [(. One study found )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(twice the rate of mental health problems in farmers currently in drought compared to farmers not currently in drought )] TJ ET
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BT 26.250 614.024 Td /F1 9.8 Tf  [(Other broad findings from all the studies include increased alcohol consumption )] TJ ET
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BT 420.172 614.024 Td /F1 9.8 Tf  [( and various experiences of loss or )] TJ ET
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BT 168.438 602.119 Td /F1 9.8 Tf  [( as a consequence of drought. One study from Brazil compared anxiety levels of drought-)] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(affected communities with drought-free communities and found that study participants from drought communities had )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(significantly higher levels of state and trait anxiety than drought-free participants. Participants from drought communities also )] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(scored significantly higher in emotional distress than drought-free participants )] TJ ET
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BT 26.250 547.000 Td /F1 9.8 Tf  [(A related study which examined the impacts on dryland salinity \(defined as salinity in un-irrigated landscapes\) on the mental )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(health of populations living in the rural south-western corner of Western Australia found that living in areas of dryland salinity )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(was associated with increased relative risk for hospitalization for depression. The authors liken these findings to those of )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(drought in that salinity of farmland results in loss of farm productivity and decreased land values with subsequent increases in )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(financial pressures )] TJ ET
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BT 26.250 479.976 Td /F1 9.8 Tf  [(The available evidence suggests that drought has negatively impacted the mental health of people in rural communities whose )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(livelihoods often depend on rainfall.)] TJ ET
BT 26.250 448.667 Td /F5 9.8 Tf  [(Suicide)] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(While higher rates of suicide have been observed in rural farming communities in Australia compared to non-farming )] TJ ET
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BT 26.250 405.453 Td /F1 9.8 Tf  [(suicide in farmers during a prolonged drought \(2001-2007\) in Victoria, Australia, there was no evidence of a pattern of increased )] TJ ET
BT 26.250 393.548 Td /F1 9.8 Tf  [(farming suicides during the drought years studied. However, drought as a risk factor that contributes to stress in rural )] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(communities should not be dismissed )] TJ ET
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BT 205.432 381.643 Td /F1 9.8 Tf  [(. Another study identified suicide or suicidal thoughts as a result of drought-related )] TJ ET
BT 26.250 369.738 Td /F1 9.8 Tf  [(stress yet no quantification of this was reported )] TJ ET
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BT 26.250 350.334 Td /F1 9.8 Tf  [(While most of the studies offer good qualitative insights into the emotional consequences of drought, more rigorous study is )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(needed to measure the potential impacts of drought on mental illnesses, including depression, anxiety and suicide, in order to )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(determine the extent of the problem and to determine if findings are applicable to other contexts. It is also important to note that )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(most of the mental health studies included in this review were conducted in a wealthy country context \(i.e., Australia\); more )] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(studies from different settings are needed to help understand the impacts of drought on mental health in other populations.)] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(A number of interventions have been implemented to support the mental health of rural populations affected by prolonged )] TJ ET
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BT 26.250 240.096 Td /F4 9.8 Tf  [(6\) OTHER HEALTH EFFECTS)] TJ ET
BT 26.250 220.691 Td /F1 9.8 Tf  [(A number of other health outcomes have been associated with drought. See Table 7 for more detailed information on studies )] TJ ET
BT 26.250 208.786 Td /F1 9.8 Tf  [(that met the inclusion criteria of the review.)] TJ ET
BT 26.250 189.381 Td /F5 9.8 Tf  [(Injury)] TJ ET
BT 26.250 169.977 Td /F1 9.8 Tf  [(Drought can cause rivers, lakes and streams to have lower than normal levels of water. Diving into these bodies of water can )] TJ ET
BT 26.250 158.072 Td /F1 9.8 Tf  [(result in injury, which was observed following a drought in Wisconsin, USA, in 1988. Seven people sustained spinal cord injuries )] TJ ET
BT 26.250 146.167 Td /F1 9.8 Tf  [(after diving in familiar sites they believed were deeper than they actually were )] TJ ET
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0.271 0.267 0.267 rg
BT 394.629 146.167 Td /F1 9.8 Tf  [(. More research is necessary to )] TJ ET
BT 26.250 134.262 Td /F1 9.8 Tf  [(understand the extent of this problem. During high heat and drought conditions it is important to monitor water depth levels in )] TJ ET
BT 26.250 122.358 Td /F1 9.8 Tf  [(popular recreation areas and provide adequate public health messaging about the potential health hazards associated with )] TJ ET
BT 26.250 110.453 Td /F1 9.8 Tf  [(diving.)] TJ ET
BT 26.250 91.048 Td /F5 9.8 Tf  [(Cancer)] TJ ET
BT 26.250 71.643 Td /F1 9.8 Tf  [(Using GIS mapping technology to compare esophageal cancer mortality and drought indices in China, studies suggest an )] TJ ET
BT 26.250 59.739 Td /F1 9.8 Tf  [(association may exist between areas with high drought index and high esophageal cancer mortality. Possible reasons given )] TJ ET
BT 26.250 47.834 Td /F1 9.8 Tf  [(include high salinity of water in water-scarce regions, which promotes nitrosamine \(a carcinogen of esophageal cancer\) )] TJ ET
Q
q
15.000 33.548 577.500 743.452 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(summarized in Table 6, three focused on the effects on children and the remainder focused on adults; most studied rural )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(populations whose livelihoods \(i.e., farming\) are environment-dependent. A full list of mental health papers identified through our )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(search is available in Table 6.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Not surprisingly, results indicate that prolonged drought does indeed have negative impacts on the mental health of the )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(populations studied. For those studies which examined the effects of drought on children, worry about family )] TJ ET
0.267 0.267 0.267 rg
BT 495.010 713.864 Td /F4 8.7 Tf  [(119)] TJ ET
0.271 0.267 0.267 rg
BT 509.467 716.245 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 511.876 713.864 Td /F4 8.7 Tf  [(120)] TJ ET
0.271 0.267 0.267 rg
BT 526.332 712.357 Td /F1 9.8 Tf  [( and )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(feelings of loss )] TJ ET
0.267 0.267 0.267 rg
BT 93.447 701.960 Td /F4 8.7 Tf  [(120)] TJ ET
0.271 0.267 0.267 rg
BT 107.903 704.341 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 110.312 701.960 Td /F4 8.7 Tf  [(121)] TJ ET
0.271 0.267 0.267 rg
BT 124.768 700.452 Td /F1 9.8 Tf  [( were common identified themes.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Those studies that examined the mental health impacts of drought on farmers yield a number of findings that support the idea )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(that drought negatively impacts on mental health. Drought-related stress was identified as �high� in 71.8% of farm workers in one )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(study )] TJ ET
0.267 0.267 0.267 rg
BT 52.263 658.745 Td /F4 8.7 Tf  [(122)] TJ ET
0.271 0.267 0.267 rg
BT 66.719 657.238 Td /F1 9.8 Tf  [(; another study reported that 34% of participants experienced stress �fairly often� or �very often� )] TJ ET
0.267 0.267 0.267 rg
BT 475.322 658.745 Td /F4 8.7 Tf  [(123)] TJ ET
0.271 0.267 0.267 rg
BT 489.778 657.238 Td /F1 9.8 Tf  [(, and other studies )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(report physical symptoms associated with stress \(including disturbed sleep, crying, being tired\) )] TJ ET
0.267 0.267 0.267 rg
BT 436.433 646.841 Td /F4 8.7 Tf  [(124)] TJ ET
0.271 0.267 0.267 rg
BT 450.889 649.222 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 453.298 646.841 Td /F4 8.7 Tf  [(125)] TJ ET
0.271 0.267 0.267 rg
BT 467.754 649.222 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 470.163 646.841 Td /F4 8.7 Tf  [(126)] TJ ET
0.271 0.267 0.267 rg
BT 484.619 645.333 Td /F1 9.8 Tf  [(. One study found )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(twice the rate of mental health problems in farmers currently in drought compared to farmers not currently in drought )] TJ ET
0.267 0.267 0.267 rg
BT 529.116 634.936 Td /F4 8.7 Tf  [(127)] TJ ET
0.271 0.267 0.267 rg
BT 543.572 633.429 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(Other broad findings from all the studies include increased alcohol consumption )] TJ ET
0.267 0.267 0.267 rg
BT 371.985 615.531 Td /F4 8.7 Tf  [(122)] TJ ET
0.271 0.267 0.267 rg
BT 386.441 617.912 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 388.850 615.531 Td /F4 8.7 Tf  [(126)] TJ ET
0.271 0.267 0.267 rg
BT 403.306 617.912 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 405.716 615.531 Td /F4 8.7 Tf  [(128)] TJ ET
0.271 0.267 0.267 rg
BT 420.172 614.024 Td /F1 9.8 Tf  [( and various experiences of loss or )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(worry )] TJ ET
0.267 0.267 0.267 rg
BT 52.790 603.626 Td /F4 8.7 Tf  [(119)] TJ ET
0.271 0.267 0.267 rg
BT 67.246 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 69.655 603.626 Td /F4 8.7 Tf  [(120)] TJ ET
0.271 0.267 0.267 rg
BT 84.111 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 86.520 603.626 Td /F4 8.7 Tf  [(124)] TJ ET
0.271 0.267 0.267 rg
BT 100.976 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 103.386 603.626 Td /F4 8.7 Tf  [(126)] TJ ET
0.271 0.267 0.267 rg
BT 117.842 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 120.251 603.626 Td /F4 8.7 Tf  [(129)] TJ ET
0.271 0.267 0.267 rg
BT 134.707 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 137.116 603.626 Td /F4 8.7 Tf  [(130)] TJ ET
0.271 0.267 0.267 rg
BT 151.572 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 153.982 603.626 Td /F4 8.7 Tf  [(131)] TJ ET
0.271 0.267 0.267 rg
BT 168.438 602.119 Td /F1 9.8 Tf  [( as a consequence of drought. One study from Brazil compared anxiety levels of drought-)] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(affected communities with drought-free communities and found that study participants from drought communities had )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(significantly higher levels of state and trait anxiety than drought-free participants. Participants from drought communities also )] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(scored significantly higher in emotional distress than drought-free participants )] TJ ET
0.267 0.267 0.267 rg
BT 362.762 567.912 Td /F4 8.7 Tf  [(132)] TJ ET
0.271 0.267 0.267 rg
BT 377.218 566.405 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(A related study which examined the impacts on dryland salinity \(defined as salinity in un-irrigated landscapes\) on the mental )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(health of populations living in the rural south-western corner of Western Australia found that living in areas of dryland salinity )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(was associated with increased relative risk for hospitalization for depression. The authors liken these findings to those of )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(drought in that salinity of farmland results in loss of farm productivity and decreased land values with subsequent increases in )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(financial pressures )] TJ ET
0.267 0.267 0.267 rg
BT 110.237 500.888 Td /F4 8.7 Tf  [(133)] TJ ET
0.271 0.267 0.267 rg
BT 124.693 499.381 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(The available evidence suggests that drought has negatively impacted the mental health of people in rural communities whose )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(livelihoods often depend on rainfall.)] TJ ET
BT 26.250 448.667 Td /F5 9.8 Tf  [(Suicide)] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(While higher rates of suicide have been observed in rural farming communities in Australia compared to non-farming )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(communities )] TJ ET
0.267 0.267 0.267 rg
BT 83.678 418.865 Td /F4 8.7 Tf  [(134)] TJ ET
0.271 0.267 0.267 rg
BT 98.134 417.357 Td /F1 9.8 Tf  [(, an explicit link to drought as a causal factor has not yet been established. In a study which examined rates of )] TJ ET
BT 26.250 405.453 Td /F1 9.8 Tf  [(suicide in farmers during a prolonged drought \(2001-2007\) in Victoria, Australia, there was no evidence of a pattern of increased )] TJ ET
BT 26.250 393.548 Td /F1 9.8 Tf  [(farming suicides during the drought years studied. However, drought as a risk factor that contributes to stress in rural )] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(communities should not be dismissed )] TJ ET
0.267 0.267 0.267 rg
BT 190.976 383.150 Td /F4 8.7 Tf  [(135)] TJ ET
0.271 0.267 0.267 rg
BT 205.432 381.643 Td /F1 9.8 Tf  [(. Another study identified suicide or suicidal thoughts as a result of drought-related )] TJ ET
BT 26.250 369.738 Td /F1 9.8 Tf  [(stress yet no quantification of this was reported )] TJ ET
0.267 0.267 0.267 rg
BT 232.180 371.246 Td /F4 8.7 Tf  [(128)] TJ ET
0.271 0.267 0.267 rg
BT 246.636 369.738 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 350.334 Td /F1 9.8 Tf  [(While most of the studies offer good qualitative insights into the emotional consequences of drought, more rigorous study is )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(needed to measure the potential impacts of drought on mental illnesses, including depression, anxiety and suicide, in order to )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(determine the extent of the problem and to determine if findings are applicable to other contexts. It is also important to note that )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(most of the mental health studies included in this review were conducted in a wealthy country context \(i.e., Australia\); more )] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(studies from different settings are needed to help understand the impacts of drought on mental health in other populations.)] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(A number of interventions have been implemented to support the mental health of rural populations affected by prolonged )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(drought in Australia, which suggests that local authorities recognize the magnitude of the problem and the importance of )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(addressing it )] TJ ET
0.267 0.267 0.267 rg
BT 84.233 261.008 Td /F4 8.7 Tf  [(136)] TJ ET
0.271 0.267 0.267 rg
BT 98.689 263.389 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 101.099 261.008 Td /F4 8.7 Tf  [(137)] TJ ET
0.271 0.267 0.267 rg
BT 115.555 263.389 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 117.964 261.008 Td /F4 8.7 Tf  [(138)] TJ ET
0.271 0.267 0.267 rg
BT 132.420 263.389 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 134.829 261.008 Td /F4 8.7 Tf  [(139)] TJ ET
0.271 0.267 0.267 rg
BT 149.285 263.389 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 151.695 261.008 Td /F4 8.7 Tf  [(140)] TJ ET
0.271 0.267 0.267 rg
BT 166.151 259.500 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 240.096 Td /F4 9.8 Tf  [(6\) OTHER HEALTH EFFECTS)] TJ ET
BT 26.250 220.691 Td /F1 9.8 Tf  [(A number of other health outcomes have been associated with drought. See Table 7 for more detailed information on studies )] TJ ET
BT 26.250 208.786 Td /F1 9.8 Tf  [(that met the inclusion criteria of the review.)] TJ ET
BT 26.250 189.381 Td /F5 9.8 Tf  [(Injury)] TJ ET
BT 26.250 169.977 Td /F1 9.8 Tf  [(Drought can cause rivers, lakes and streams to have lower than normal levels of water. Diving into these bodies of water can )] TJ ET
BT 26.250 158.072 Td /F1 9.8 Tf  [(result in injury, which was observed following a drought in Wisconsin, USA, in 1988. Seven people sustained spinal cord injuries )] TJ ET
BT 26.250 146.167 Td /F1 9.8 Tf  [(after diving in familiar sites they believed were deeper than they actually were )] TJ ET
0.267 0.267 0.267 rg
BT 363.308 147.674 Td /F4 8.7 Tf  [(141)] TJ ET
0.271 0.267 0.267 rg
BT 377.764 150.055 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 380.173 147.674 Td /F4 8.7 Tf  [(142)] TJ ET
0.271 0.267 0.267 rg
BT 394.629 146.167 Td /F1 9.8 Tf  [(. More research is necessary to )] TJ ET
BT 26.250 134.262 Td /F1 9.8 Tf  [(understand the extent of this problem. During high heat and drought conditions it is important to monitor water depth levels in )] TJ ET
BT 26.250 122.358 Td /F1 9.8 Tf  [(popular recreation areas and provide adequate public health messaging about the potential health hazards associated with )] TJ ET
BT 26.250 110.453 Td /F1 9.8 Tf  [(diving.)] TJ ET
BT 26.250 91.048 Td /F5 9.8 Tf  [(Cancer)] TJ ET
BT 26.250 71.643 Td /F1 9.8 Tf  [(Using GIS mapping technology to compare esophageal cancer mortality and drought indices in China, studies suggest an )] TJ ET
BT 26.250 59.739 Td /F1 9.8 Tf  [(association may exist between areas with high drought index and high esophageal cancer mortality. Possible reasons given )] TJ ET
BT 26.250 47.834 Td /F1 9.8 Tf  [(include high salinity of water in water-scarce regions, which promotes nitrosamine \(a carcinogen of esophageal cancer\) )] TJ ET
Q
q
15.000 33.548 577.500 743.452 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(summarized in Table 6, three focused on the effects on children and the remainder focused on adults; most studied rural )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(populations whose livelihoods \(i.e., farming\) are environment-dependent. A full list of mental health papers identified through our )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(search is available in Table 6.)] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(Not surprisingly, results indicate that prolonged drought does indeed have negative impacts on the mental health of the )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(populations studied. For those studies which examined the effects of drought on children, worry about family )] TJ ET
0.267 0.267 0.267 rg
BT 495.010 713.864 Td /F4 8.7 Tf  [(119)] TJ ET
0.271 0.267 0.267 rg
BT 509.467 716.245 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 511.876 713.864 Td /F4 8.7 Tf  [(120)] TJ ET
0.271 0.267 0.267 rg
BT 526.332 712.357 Td /F1 9.8 Tf  [( and )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(feelings of loss )] TJ ET
0.267 0.267 0.267 rg
BT 93.447 701.960 Td /F4 8.7 Tf  [(120)] TJ ET
0.271 0.267 0.267 rg
BT 107.903 704.341 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 110.312 701.960 Td /F4 8.7 Tf  [(121)] TJ ET
0.271 0.267 0.267 rg
BT 124.768 700.452 Td /F1 9.8 Tf  [( were common identified themes.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Those studies that examined the mental health impacts of drought on farmers yield a number of findings that support the idea )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(that drought negatively impacts on mental health. Drought-related stress was identified as �high� in 71.8% of farm workers in one )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(study )] TJ ET
0.267 0.267 0.267 rg
BT 52.263 658.745 Td /F4 8.7 Tf  [(122)] TJ ET
0.271 0.267 0.267 rg
BT 66.719 657.238 Td /F1 9.8 Tf  [(; another study reported that 34% of participants experienced stress �fairly often� or �very often� )] TJ ET
0.267 0.267 0.267 rg
BT 475.322 658.745 Td /F4 8.7 Tf  [(123)] TJ ET
0.271 0.267 0.267 rg
BT 489.778 657.238 Td /F1 9.8 Tf  [(, and other studies )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(report physical symptoms associated with stress \(including disturbed sleep, crying, being tired\) )] TJ ET
0.267 0.267 0.267 rg
BT 436.433 646.841 Td /F4 8.7 Tf  [(124)] TJ ET
0.271 0.267 0.267 rg
BT 450.889 649.222 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 453.298 646.841 Td /F4 8.7 Tf  [(125)] TJ ET
0.271 0.267 0.267 rg
BT 467.754 649.222 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 470.163 646.841 Td /F4 8.7 Tf  [(126)] TJ ET
0.271 0.267 0.267 rg
BT 484.619 645.333 Td /F1 9.8 Tf  [(. One study found )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(twice the rate of mental health problems in farmers currently in drought compared to farmers not currently in drought )] TJ ET
0.267 0.267 0.267 rg
BT 529.116 634.936 Td /F4 8.7 Tf  [(127)] TJ ET
0.271 0.267 0.267 rg
BT 543.572 633.429 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(Other broad findings from all the studies include increased alcohol consumption )] TJ ET
0.267 0.267 0.267 rg
BT 371.985 615.531 Td /F4 8.7 Tf  [(122)] TJ ET
0.271 0.267 0.267 rg
BT 386.441 617.912 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 388.850 615.531 Td /F4 8.7 Tf  [(126)] TJ ET
0.271 0.267 0.267 rg
BT 403.306 617.912 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 405.716 615.531 Td /F4 8.7 Tf  [(128)] TJ ET
0.271 0.267 0.267 rg
BT 420.172 614.024 Td /F1 9.8 Tf  [( and various experiences of loss or )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(worry )] TJ ET
0.267 0.267 0.267 rg
BT 52.790 603.626 Td /F4 8.7 Tf  [(119)] TJ ET
0.271 0.267 0.267 rg
BT 67.246 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 69.655 603.626 Td /F4 8.7 Tf  [(120)] TJ ET
0.271 0.267 0.267 rg
BT 84.111 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 86.520 603.626 Td /F4 8.7 Tf  [(124)] TJ ET
0.271 0.267 0.267 rg
BT 100.976 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 103.386 603.626 Td /F4 8.7 Tf  [(126)] TJ ET
0.271 0.267 0.267 rg
BT 117.842 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 120.251 603.626 Td /F4 8.7 Tf  [(129)] TJ ET
0.271 0.267 0.267 rg
BT 134.707 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 137.116 603.626 Td /F4 8.7 Tf  [(130)] TJ ET
0.271 0.267 0.267 rg
BT 151.572 606.007 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 153.982 603.626 Td /F4 8.7 Tf  [(131)] TJ ET
0.271 0.267 0.267 rg
BT 168.438 602.119 Td /F1 9.8 Tf  [( as a consequence of drought. One study from Brazil compared anxiety levels of drought-)] TJ ET
BT 26.250 590.214 Td /F1 9.8 Tf  [(affected communities with drought-free communities and found that study participants from drought communities had )] TJ ET
BT 26.250 578.310 Td /F1 9.8 Tf  [(significantly higher levels of state and trait anxiety than drought-free participants. Participants from drought communities also )] TJ ET
BT 26.250 566.405 Td /F1 9.8 Tf  [(scored significantly higher in emotional distress than drought-free participants )] TJ ET
0.267 0.267 0.267 rg
BT 362.762 567.912 Td /F4 8.7 Tf  [(132)] TJ ET
0.271 0.267 0.267 rg
BT 377.218 566.405 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(A related study which examined the impacts on dryland salinity \(defined as salinity in un-irrigated landscapes\) on the mental )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(health of populations living in the rural south-western corner of Western Australia found that living in areas of dryland salinity )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(was associated with increased relative risk for hospitalization for depression. The authors liken these findings to those of )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(drought in that salinity of farmland results in loss of farm productivity and decreased land values with subsequent increases in )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(financial pressures )] TJ ET
0.267 0.267 0.267 rg
BT 110.237 500.888 Td /F4 8.7 Tf  [(133)] TJ ET
0.271 0.267 0.267 rg
BT 124.693 499.381 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(The available evidence suggests that drought has negatively impacted the mental health of people in rural communities whose )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(livelihoods often depend on rainfall.)] TJ ET
BT 26.250 448.667 Td /F5 9.8 Tf  [(Suicide)] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(While higher rates of suicide have been observed in rural farming communities in Australia compared to non-farming )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(communities )] TJ ET
0.267 0.267 0.267 rg
BT 83.678 418.865 Td /F4 8.7 Tf  [(134)] TJ ET
0.271 0.267 0.267 rg
BT 98.134 417.357 Td /F1 9.8 Tf  [(, an explicit link to drought as a causal factor has not yet been established. In a study which examined rates of )] TJ ET
BT 26.250 405.453 Td /F1 9.8 Tf  [(suicide in farmers during a prolonged drought \(2001-2007\) in Victoria, Australia, there was no evidence of a pattern of increased )] TJ ET
BT 26.250 393.548 Td /F1 9.8 Tf  [(farming suicides during the drought years studied. However, drought as a risk factor that contributes to stress in rural )] TJ ET
BT 26.250 381.643 Td /F1 9.8 Tf  [(communities should not be dismissed )] TJ ET
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BT 190.976 383.150 Td /F4 8.7 Tf  [(135)] TJ ET
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BT 26.250 369.738 Td /F1 9.8 Tf  [(stress yet no quantification of this was reported )] TJ ET
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BT 26.250 350.334 Td /F1 9.8 Tf  [(While most of the studies offer good qualitative insights into the emotional consequences of drought, more rigorous study is )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(needed to measure the potential impacts of drought on mental illnesses, including depression, anxiety and suicide, in order to )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(determine the extent of the problem and to determine if findings are applicable to other contexts. It is also important to note that )] TJ ET
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BT 26.250 302.715 Td /F1 9.8 Tf  [(studies from different settings are needed to help understand the impacts of drought on mental health in other populations.)] TJ ET
BT 26.250 283.310 Td /F1 9.8 Tf  [(A number of interventions have been implemented to support the mental health of rural populations affected by prolonged )] TJ ET
BT 26.250 271.405 Td /F1 9.8 Tf  [(drought in Australia, which suggests that local authorities recognize the magnitude of the problem and the importance of )] TJ ET
BT 26.250 259.500 Td /F1 9.8 Tf  [(addressing it )] TJ ET
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BT 117.964 261.008 Td /F4 8.7 Tf  [(138)] TJ ET
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BT 26.250 240.096 Td /F4 9.8 Tf  [(6\) OTHER HEALTH EFFECTS)] TJ ET
BT 26.250 220.691 Td /F1 9.8 Tf  [(A number of other health outcomes have been associated with drought. See Table 7 for more detailed information on studies )] TJ ET
BT 26.250 208.786 Td /F1 9.8 Tf  [(that met the inclusion criteria of the review.)] TJ ET
BT 26.250 189.381 Td /F5 9.8 Tf  [(Injury)] TJ ET
BT 26.250 169.977 Td /F1 9.8 Tf  [(Drought can cause rivers, lakes and streams to have lower than normal levels of water. Diving into these bodies of water can )] TJ ET
BT 26.250 158.072 Td /F1 9.8 Tf  [(result in injury, which was observed following a drought in Wisconsin, USA, in 1988. Seven people sustained spinal cord injuries )] TJ ET
BT 26.250 146.167 Td /F1 9.8 Tf  [(after diving in familiar sites they believed were deeper than they actually were )] TJ ET
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BT 394.629 146.167 Td /F1 9.8 Tf  [(. More research is necessary to )] TJ ET
BT 26.250 134.262 Td /F1 9.8 Tf  [(understand the extent of this problem. During high heat and drought conditions it is important to monitor water depth levels in )] TJ ET
BT 26.250 122.358 Td /F1 9.8 Tf  [(popular recreation areas and provide adequate public health messaging about the potential health hazards associated with )] TJ ET
BT 26.250 110.453 Td /F1 9.8 Tf  [(diving.)] TJ ET
BT 26.250 91.048 Td /F5 9.8 Tf  [(Cancer)] TJ ET
BT 26.250 71.643 Td /F1 9.8 Tf  [(Using GIS mapping technology to compare esophageal cancer mortality and drought indices in China, studies suggest an )] TJ ET
BT 26.250 59.739 Td /F1 9.8 Tf  [(association may exist between areas with high drought index and high esophageal cancer mortality. Possible reasons given )] TJ ET
BT 26.250 47.834 Td /F1 9.8 Tf  [(include high salinity of water in water-scarce regions, which promotes nitrosamine \(a carcinogen of esophageal cancer\) )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 372.889 441.167 Td /F1 9.8 Tf  [(. Above-average temperatures in Russia in )] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(2010 were accompanied by extensive wildfire outbreaks in 22 regions across the Federation )] TJ ET
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BT 440.632 429.262 Td /F1 9.8 Tf  [(; in an analysis of the effects of )] TJ ET
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BT 26.250 354.738 Td /F1 9.8 Tf  [(In certain regions of the world, drought contributes to the mass migration of people fleeing conditions where sustaining )] TJ ET
BT 26.250 342.834 Td /F1 9.8 Tf  [(livelihoods is no longer possible. The literature on the impacts of drought-related migration is vast, and given the complexities )] TJ ET
BT 26.250 330.929 Td /F1 9.8 Tf  [(potentially involved \(climatological conditions, conflict, baseline health of populations, sanitation and living conditions in refuge )] TJ ET
BT 26.250 319.024 Td /F1 9.8 Tf  [(areas, community resistance to infections, etc.\), it is difficult to identify drought as the sole exposure variable linked to a given )] TJ ET
BT 26.250 307.119 Td /F1 9.8 Tf  [(health outcome.)] TJ ET
BT 26.250 287.715 Td /F1 9.8 Tf  [(One paper examined the health effects of the 1984-85 resettlement program in Ethiopia where 600,000 drought victims )] TJ ET
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BT 26.250 192.477 Td /F1 9.8 Tf  [(settlers.)] TJ ET
BT 26.250 173.072 Td /F1 9.8 Tf  [(Following the most severe drought ever recorded in Brazil, thousands of people migrated to the city of Fortaleza in 1878. )] TJ ET
BT 26.250 161.167 Td /F1 9.8 Tf  [(Smallpox was introduced to the city through a sailor, and the disease quickly spread through the drought re-settlement )] TJ ET
BT 26.250 149.262 Td /F1 9.8 Tf  [(communities; over 35,000 people died of smallpox in the span of four months )] TJ ET
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BT 26.250 117.953 Td /F1 9.8 Tf  [(Reports of a drought-induced migration of pastoralists in West Africa in the 1970s note exacerbation of cholera in settlement )] TJ ET
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BT 26.250 716.762 Td /F1 9.8 Tf  [(The effects of drought on the health of nomads have not been well-documented. Nomadic populations live in close proximity to )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(livestock and as such are susceptible to parasites transmitted by animals. Drought conditions may cause nomadic people to )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(abandon their lifestyles and settle in urban areas, which can be accompanied by a host of potential disease threats including )] TJ ET
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BT 26.250 669.143 Td /F1 9.8 Tf  [(understand the relationship between drought and health on populations who regularly migrate to sustain their livelihoods.)] TJ ET
BT 26.250 649.738 Td /F5 9.8 Tf  [(Zoonotic disease)] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(Our search revealed one study which identified El-Ni�o-related drought as one of the factors which contributed to the spillover of )] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(Nipah virus from pig populations to human populations in Malaysia, yet details of how drought conditions may have affected the )] TJ ET
BT 26.250 606.524 Td /F1 9.8 Tf  [(outbreak are not clear )] TJ ET
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BT 26.250 575.214 Td /F5 9.8 Tf  [(Heat wave and Wildfire)] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(In temperate areas, long droughts can be associated with heat waves during the summer, especially when anti-cyclonic )] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(conditions \(high pressure usually associated with clear skies and in the summer increased temperature due to increased )] TJ ET
BT 26.250 532.000 Td /F1 9.8 Tf  [(radiation\) remain on land masses over an extended period. This was the case in August 2003 when Western Europe )] TJ ET
BT 26.250 520.095 Td /F1 9.8 Tf  [(experienced some extreme temperatures )] TJ ET
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BT 221.149 520.095 Td /F1 9.8 Tf  [(: 70,000 additional deaths occurred during the summer period, with over 30,000 of )] TJ ET
BT 26.250 508.191 Td /F1 9.8 Tf  [(these occurring during the heatwave, and over 25,000 wildfires were recorded )] TJ ET
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BT 358.433 442.674 Td /F4 8.7 Tf  [(151)] TJ ET
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BT 372.889 441.167 Td /F1 9.8 Tf  [(. Above-average temperatures in Russia in )] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(2010 were accompanied by extensive wildfire outbreaks in 22 regions across the Federation )] TJ ET
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BT 50.645 406.960 Td /F4 8.7 Tf  [(153)] TJ ET
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BT 26.250 354.738 Td /F1 9.8 Tf  [(In certain regions of the world, drought contributes to the mass migration of people fleeing conditions where sustaining )] TJ ET
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BT 26.250 204.381 Td /F1 9.8 Tf  [(settlement populations were based; unsurprisingly, reasons included family separation, uncertainty, and hostilities towards )] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Observational accounts of a drought-induced migration in Sudan note the impoverished living conditions in migrant )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(communities, including poor sanitation systems, unsafe drinking water and inadequate health services. Diarrhoeal disease, )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(malnutrition, typhoid, hepatitis, meningococcal meningitis, and cutaneous leishmaniasis were some of the diseases observed in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(those who migrated )] TJ ET
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BT 114.039 733.269 Td /F4 8.7 Tf  [(158)] TJ ET
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BT 128.495 731.762 Td /F1 9.8 Tf  [(. Certainly there are countless reports of drought-induced health problems related to migration similar to )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(this one, and continued effort should be made to document the health issues indirectly related to drought.)] TJ ET
BT 26.250 700.452 Td /F5 9.8 Tf  [(Damage to healthcare system)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Surprisingly, our search revealed virtually nothing on the impacts of drought on healthcare services and facilities. One report )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(offering anecdotal observations from a rural hospital in east Swaziland following �the worst drought in living memory� noted )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(overcrowding in the hospital and increased workload of staff )] TJ ET
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BT 287.452 658.745 Td /F4 8.7 Tf  [(159)] TJ ET
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BT 301.909 657.238 Td /F1 9.8 Tf  [(. A combination of the limitations of our search and lack of )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(documentation of the �downstream� effects of drought, i.e., impacts on healthcare services, may contribute to the lack of )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(literature on this topic.)] TJ ET
BT 26.250 614.024 Td /F5 9.8 Tf  [(Damage to infrastructure)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(Drought can affect the production of electricity when water levels in lakes, rivers or reservoirs fall below intakes used for drawing )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(water for cooling of power plants, and again when surface water becomes too warm to be used for cooling )] TJ ET
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BT 485.797 584.222 Td /F4 8.7 Tf  [(160)] TJ ET
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BT 500.253 582.714 Td /F1 9.8 Tf  [(. The obvious )] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(indirect effects of disrupted power supplies involve those people who rely on electricity to sustain their health, i.e. the use of )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(medical equipment or refrigeration of medications. From a report summarizing the 2003 heat wave in France, the impacts of the )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(extreme heat on water levels in dams resulted in hydroelectric energy not able to be used as it should be because of reduced )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(water levels, likely an effect of the drought-like conditions of reduced rainfall combined with excessive heat )] TJ ET
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BT 487.406 536.603 Td /F4 8.7 Tf  [(161)] TJ ET
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BT 501.862 535.095 Td /F1 9.8 Tf  [(. A recent report )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(concluded that thermoelectric power production in southern and southeastern Europe and the southeastern US will be affected )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(by climate change through a combination of increased water temperatures and reduced river flows, especially during the )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(summer )] TJ ET
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BT 64.168 500.888 Td /F4 8.7 Tf  [(162)] TJ ET
0.271 0.267 0.267 rg
BT 78.624 499.381 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(The health effects of disrupted electricity as a result of drought, particularly on vulnerable groups dependent upon power to )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(sustain their health care needs, deserves significant further research.)] TJ ET
BT 26.250 431.469 Td /F4 12.0 Tf  [(DISCUSSION)] TJ ET
BT 26.250 411.515 Td /F1 9.8 Tf  [(There is no doubt that drought has multiple adverse indirect health outcomes; our review illustrates how varied and wide-)] TJ ET
BT 26.250 399.610 Td /F1 9.8 Tf  [(ranging these are, and serves as a call for policy makers and funders to treat drought as seriously as other more dramatic and )] TJ ET
BT 26.250 387.705 Td /F1 9.8 Tf  [(visible extreme weather events. To do this, they should consider they key message permeating almost all our studies: that )] TJ ET
BT 26.250 375.801 Td /F1 9.8 Tf  [(underlying population and individual vulnerability/resilience factors are critical.)] TJ ET
BT 26.250 356.396 Td /F1 9.8 Tf  [(The probability of drought related health impact varies from high \(e.g. risk of drought-associated malnutrition in a resource-poor )] TJ ET
BT 26.250 344.491 Td /F1 9.8 Tf  [(developing country\) to negligible \(e.g. risk of drought-associated malnutrition for wealthy individuals in the same developing )] TJ ET
BT 26.250 332.586 Td /F1 9.8 Tf  [(country, or for developed country populations\), based on the drought characteristics, existing infrastructure, and available )] TJ ET
BT 26.250 320.682 Td /F1 9.8 Tf  [(resources with which to mitigate health impacts as they appear.)] TJ ET
BT 26.250 301.277 Td /F1 9.8 Tf  [(The severity of impact also varies according to underlying vulnerability: from death at one extreme to minimal or no effect where )] TJ ET
BT 26.250 289.372 Td /F1 9.8 Tf  [(the population/individuals have financial and other resources to buffer themselves from any potential effects.)] TJ ET
BT 26.250 269.967 Td /F1 9.8 Tf  [(As well as the categories of impact presented in our results section, it is useful to summarise our findings according to another )] TJ ET
BT 26.250 258.063 Td /F1 9.8 Tf  [(framework outlining the long terms impacts of disasters on community health )] TJ ET
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BT 359.495 259.570 Td /F4 8.7 Tf  [(163)] TJ ET
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BT 373.951 258.063 Td /F1 9.8 Tf  [(. This helps put drought in context with other )] TJ ET
BT 26.250 246.158 Td /F1 9.8 Tf  [(natural hazards and identifies the need for enhanced disease surveillance following disasters in order to better capture those )] TJ ET
BT 26.250 234.253 Td /F1 9.8 Tf  [(health impacts which manifest in the longer term. Five categories of long-term health effects associated with natural hazards )] TJ ET
BT 26.250 222.348 Td /F1 9.8 Tf  [(were identified:)] TJ ET
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40.154 205.021 40.337 205.465 40.337 205.911 c f
BT 45.750 202.944 Td /F6 9.8 Tf  [(Effects of malnutrition and trace element toxicity)] TJ ET
BT 26.250 179.789 Td /F1 9.8 Tf  [(These effects are exclusive to populations vulnerable to food insecurity and poverty in resource poor developing countries.)] TJ ET
40.337 170.852 m 
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38.185 172.558 37.741 172.374 37.425 172.058 c
37.109 171.742 36.925 171.298 36.925 170.852 c
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39.078 169.145 39.522 169.329 39.838 169.645 c
40.154 169.961 40.337 170.405 40.337 170.852 c f
BT 45.750 167.884 Td /F6 9.8 Tf  [(Infectious disease risk)] TJ ET
BT 26.250 144.729 Td /F1 9.8 Tf  [(Vulnerable populations are most at risk, but our review shows some evidence that even in developed countries with high quality )] TJ ET
BT 26.250 132.825 Td /F1 9.8 Tf  [(water sources, drought-related behaviours such as worsened hand washing can result in spread of infectious disease. Of )] TJ ET
BT 26.250 120.920 Td /F1 9.8 Tf  [(particular concern is population displacement and the often-associated risk of increased infectious disease transmission.)] TJ ET
40.337 111.983 m 
40.337 112.429 40.154 112.873 39.838 113.189 c
39.522 113.505 39.078 113.689 38.631 113.689 c
38.185 113.689 37.741 113.505 37.425 113.189 c
37.109 112.873 36.925 112.429 36.925 111.983 c
36.925 111.536 37.109 111.092 37.425 110.776 c
37.741 110.460 38.185 110.276 38.631 110.276 c
39.078 110.276 39.522 110.460 39.838 110.776 c
40.154 111.092 40.337 111.536 40.337 111.983 c f
BT 45.750 109.015 Td /F6 9.8 Tf  [(Chronic systemic illness)] TJ ET
BT 26.250 85.860 Td /F1 9.8 Tf  [(Chronic systemic illness is most associated with interruptions in the delivery of health care, which may be affected by )] TJ ET
BT 26.250 73.956 Td /F1 9.8 Tf  [(disruptions in electricity supply.)] TJ ET
40.337 65.018 m 
40.337 65.465 40.154 65.909 39.838 66.225 c
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38.185 66.725 37.741 66.541 37.425 66.225 c
37.109 65.909 36.925 65.465 36.925 65.018 c
36.925 64.572 37.109 64.128 37.425 63.812 c
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39.078 63.312 39.522 63.496 39.838 63.812 c
40.154 64.128 40.337 64.572 40.337 65.018 c f
BT 45.750 62.051 Td /F6 9.8 Tf  [(Chronic disability/pain following physical injury)] TJ ET
BT 26.250 38.896 Td /F1 9.8 Tf  [(Though not a major feature of drought, examples include the neurological diseases due to toxin ingestion and spinal cord injury )] TJ ET
Q
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Observational accounts of a drought-induced migration in Sudan note the impoverished living conditions in migrant )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(communities, including poor sanitation systems, unsafe drinking water and inadequate health services. Diarrhoeal disease, )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(malnutrition, typhoid, hepatitis, meningococcal meningitis, and cutaneous leishmaniasis were some of the diseases observed in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(those who migrated )] TJ ET
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BT 114.039 733.269 Td /F4 8.7 Tf  [(158)] TJ ET
0.271 0.267 0.267 rg
BT 128.495 731.762 Td /F1 9.8 Tf  [(. Certainly there are countless reports of drought-induced health problems related to migration similar to )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(this one, and continued effort should be made to document the health issues indirectly related to drought.)] TJ ET
BT 26.250 700.452 Td /F5 9.8 Tf  [(Damage to healthcare system)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Surprisingly, our search revealed virtually nothing on the impacts of drought on healthcare services and facilities. One report )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(offering anecdotal observations from a rural hospital in east Swaziland following �the worst drought in living memory� noted )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(overcrowding in the hospital and increased workload of staff )] TJ ET
0.267 0.267 0.267 rg
BT 287.452 658.745 Td /F4 8.7 Tf  [(159)] TJ ET
0.271 0.267 0.267 rg
BT 301.909 657.238 Td /F1 9.8 Tf  [(. A combination of the limitations of our search and lack of )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(documentation of the �downstream� effects of drought, i.e., impacts on healthcare services, may contribute to the lack of )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(literature on this topic.)] TJ ET
BT 26.250 614.024 Td /F5 9.8 Tf  [(Damage to infrastructure)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(Drought can affect the production of electricity when water levels in lakes, rivers or reservoirs fall below intakes used for drawing )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(water for cooling of power plants, and again when surface water becomes too warm to be used for cooling )] TJ ET
0.267 0.267 0.267 rg
BT 485.797 584.222 Td /F4 8.7 Tf  [(160)] TJ ET
0.271 0.267 0.267 rg
BT 500.253 582.714 Td /F1 9.8 Tf  [(. The obvious )] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(indirect effects of disrupted power supplies involve those people who rely on electricity to sustain their health, i.e. the use of )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(medical equipment or refrigeration of medications. From a report summarizing the 2003 heat wave in France, the impacts of the )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(extreme heat on water levels in dams resulted in hydroelectric energy not able to be used as it should be because of reduced )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(water levels, likely an effect of the drought-like conditions of reduced rainfall combined with excessive heat )] TJ ET
0.267 0.267 0.267 rg
BT 487.406 536.603 Td /F4 8.7 Tf  [(161)] TJ ET
0.271 0.267 0.267 rg
BT 501.862 535.095 Td /F1 9.8 Tf  [(. A recent report )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(concluded that thermoelectric power production in southern and southeastern Europe and the southeastern US will be affected )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(by climate change through a combination of increased water temperatures and reduced river flows, especially during the )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(summer )] TJ ET
0.267 0.267 0.267 rg
BT 64.168 500.888 Td /F4 8.7 Tf  [(162)] TJ ET
0.271 0.267 0.267 rg
BT 78.624 499.381 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(The health effects of disrupted electricity as a result of drought, particularly on vulnerable groups dependent upon power to )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(sustain their health care needs, deserves significant further research.)] TJ ET
BT 26.250 431.469 Td /F4 12.0 Tf  [(DISCUSSION)] TJ ET
BT 26.250 411.515 Td /F1 9.8 Tf  [(There is no doubt that drought has multiple adverse indirect health outcomes; our review illustrates how varied and wide-)] TJ ET
BT 26.250 399.610 Td /F1 9.8 Tf  [(ranging these are, and serves as a call for policy makers and funders to treat drought as seriously as other more dramatic and )] TJ ET
BT 26.250 387.705 Td /F1 9.8 Tf  [(visible extreme weather events. To do this, they should consider they key message permeating almost all our studies: that )] TJ ET
BT 26.250 375.801 Td /F1 9.8 Tf  [(underlying population and individual vulnerability/resilience factors are critical.)] TJ ET
BT 26.250 356.396 Td /F1 9.8 Tf  [(The probability of drought related health impact varies from high \(e.g. risk of drought-associated malnutrition in a resource-poor )] TJ ET
BT 26.250 344.491 Td /F1 9.8 Tf  [(developing country\) to negligible \(e.g. risk of drought-associated malnutrition for wealthy individuals in the same developing )] TJ ET
BT 26.250 332.586 Td /F1 9.8 Tf  [(country, or for developed country populations\), based on the drought characteristics, existing infrastructure, and available )] TJ ET
BT 26.250 320.682 Td /F1 9.8 Tf  [(resources with which to mitigate health impacts as they appear.)] TJ ET
BT 26.250 301.277 Td /F1 9.8 Tf  [(The severity of impact also varies according to underlying vulnerability: from death at one extreme to minimal or no effect where )] TJ ET
BT 26.250 289.372 Td /F1 9.8 Tf  [(the population/individuals have financial and other resources to buffer themselves from any potential effects.)] TJ ET
BT 26.250 269.967 Td /F1 9.8 Tf  [(As well as the categories of impact presented in our results section, it is useful to summarise our findings according to another )] TJ ET
BT 26.250 258.063 Td /F1 9.8 Tf  [(framework outlining the long terms impacts of disasters on community health )] TJ ET
0.267 0.267 0.267 rg
BT 359.495 259.570 Td /F4 8.7 Tf  [(163)] TJ ET
0.271 0.267 0.267 rg
BT 373.951 258.063 Td /F1 9.8 Tf  [(. This helps put drought in context with other )] TJ ET
BT 26.250 246.158 Td /F1 9.8 Tf  [(natural hazards and identifies the need for enhanced disease surveillance following disasters in order to better capture those )] TJ ET
BT 26.250 234.253 Td /F1 9.8 Tf  [(health impacts which manifest in the longer term. Five categories of long-term health effects associated with natural hazards )] TJ ET
BT 26.250 222.348 Td /F1 9.8 Tf  [(were identified:)] TJ ET
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40.337 205.911 m 
40.337 206.358 40.154 206.802 39.838 207.118 c
39.522 207.434 39.078 207.617 38.631 207.617 c
38.185 207.617 37.741 207.434 37.425 207.118 c
37.109 206.802 36.925 206.358 36.925 205.911 c
36.925 205.465 37.109 205.021 37.425 204.705 c
37.741 204.389 38.185 204.205 38.631 204.205 c
39.078 204.205 39.522 204.389 39.838 204.705 c
40.154 205.021 40.337 205.465 40.337 205.911 c f
BT 45.750 202.944 Td /F6 9.8 Tf  [(Effects of malnutrition and trace element toxicity)] TJ ET
BT 26.250 179.789 Td /F1 9.8 Tf  [(These effects are exclusive to populations vulnerable to food insecurity and poverty in resource poor developing countries.)] TJ ET
40.337 170.852 m 
40.337 171.298 40.154 171.742 39.838 172.058 c
39.522 172.374 39.078 172.558 38.631 172.558 c
38.185 172.558 37.741 172.374 37.425 172.058 c
37.109 171.742 36.925 171.298 36.925 170.852 c
36.925 170.405 37.109 169.961 37.425 169.645 c
37.741 169.329 38.185 169.145 38.631 169.145 c
39.078 169.145 39.522 169.329 39.838 169.645 c
40.154 169.961 40.337 170.405 40.337 170.852 c f
BT 45.750 167.884 Td /F6 9.8 Tf  [(Infectious disease risk)] TJ ET
BT 26.250 144.729 Td /F1 9.8 Tf  [(Vulnerable populations are most at risk, but our review shows some evidence that even in developed countries with high quality )] TJ ET
BT 26.250 132.825 Td /F1 9.8 Tf  [(water sources, drought-related behaviours such as worsened hand washing can result in spread of infectious disease. Of )] TJ ET
BT 26.250 120.920 Td /F1 9.8 Tf  [(particular concern is population displacement and the often-associated risk of increased infectious disease transmission.)] TJ ET
40.337 111.983 m 
40.337 112.429 40.154 112.873 39.838 113.189 c
39.522 113.505 39.078 113.689 38.631 113.689 c
38.185 113.689 37.741 113.505 37.425 113.189 c
37.109 112.873 36.925 112.429 36.925 111.983 c
36.925 111.536 37.109 111.092 37.425 110.776 c
37.741 110.460 38.185 110.276 38.631 110.276 c
39.078 110.276 39.522 110.460 39.838 110.776 c
40.154 111.092 40.337 111.536 40.337 111.983 c f
BT 45.750 109.015 Td /F6 9.8 Tf  [(Chronic systemic illness)] TJ ET
BT 26.250 85.860 Td /F1 9.8 Tf  [(Chronic systemic illness is most associated with interruptions in the delivery of health care, which may be affected by )] TJ ET
BT 26.250 73.956 Td /F1 9.8 Tf  [(disruptions in electricity supply.)] TJ ET
40.337 65.018 m 
40.337 65.465 40.154 65.909 39.838 66.225 c
39.522 66.541 39.078 66.725 38.631 66.725 c
38.185 66.725 37.741 66.541 37.425 66.225 c
37.109 65.909 36.925 65.465 36.925 65.018 c
36.925 64.572 37.109 64.128 37.425 63.812 c
37.741 63.496 38.185 63.312 38.631 63.312 c
39.078 63.312 39.522 63.496 39.838 63.812 c
40.154 64.128 40.337 64.572 40.337 65.018 c f
BT 45.750 62.051 Td /F6 9.8 Tf  [(Chronic disability/pain following physical injury)] TJ ET
BT 26.250 38.896 Td /F1 9.8 Tf  [(Though not a major feature of drought, examples include the neurological diseases due to toxin ingestion and spinal cord injury )] TJ ET
Q
q
15.000 24.610 577.500 752.390 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Observational accounts of a drought-induced migration in Sudan note the impoverished living conditions in migrant )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(communities, including poor sanitation systems, unsafe drinking water and inadequate health services. Diarrhoeal disease, )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(malnutrition, typhoid, hepatitis, meningococcal meningitis, and cutaneous leishmaniasis were some of the diseases observed in )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(those who migrated )] TJ ET
0.267 0.267 0.267 rg
BT 114.039 733.269 Td /F4 8.7 Tf  [(158)] TJ ET
0.271 0.267 0.267 rg
BT 128.495 731.762 Td /F1 9.8 Tf  [(. Certainly there are countless reports of drought-induced health problems related to migration similar to )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(this one, and continued effort should be made to document the health issues indirectly related to drought.)] TJ ET
BT 26.250 700.452 Td /F5 9.8 Tf  [(Damage to healthcare system)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(Surprisingly, our search revealed virtually nothing on the impacts of drought on healthcare services and facilities. One report )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(offering anecdotal observations from a rural hospital in east Swaziland following �the worst drought in living memory� noted )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(overcrowding in the hospital and increased workload of staff )] TJ ET
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BT 287.452 658.745 Td /F4 8.7 Tf  [(159)] TJ ET
0.271 0.267 0.267 rg
BT 301.909 657.238 Td /F1 9.8 Tf  [(. A combination of the limitations of our search and lack of )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(documentation of the �downstream� effects of drought, i.e., impacts on healthcare services, may contribute to the lack of )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(literature on this topic.)] TJ ET
BT 26.250 614.024 Td /F5 9.8 Tf  [(Damage to infrastructure)] TJ ET
BT 26.250 594.619 Td /F1 9.8 Tf  [(Drought can affect the production of electricity when water levels in lakes, rivers or reservoirs fall below intakes used for drawing )] TJ ET
BT 26.250 582.714 Td /F1 9.8 Tf  [(water for cooling of power plants, and again when surface water becomes too warm to be used for cooling )] TJ ET
0.267 0.267 0.267 rg
BT 485.797 584.222 Td /F4 8.7 Tf  [(160)] TJ ET
0.271 0.267 0.267 rg
BT 500.253 582.714 Td /F1 9.8 Tf  [(. The obvious )] TJ ET
BT 26.250 570.810 Td /F1 9.8 Tf  [(indirect effects of disrupted power supplies involve those people who rely on electricity to sustain their health, i.e. the use of )] TJ ET
BT 26.250 558.905 Td /F1 9.8 Tf  [(medical equipment or refrigeration of medications. From a report summarizing the 2003 heat wave in France, the impacts of the )] TJ ET
BT 26.250 547.000 Td /F1 9.8 Tf  [(extreme heat on water levels in dams resulted in hydroelectric energy not able to be used as it should be because of reduced )] TJ ET
BT 26.250 535.095 Td /F1 9.8 Tf  [(water levels, likely an effect of the drought-like conditions of reduced rainfall combined with excessive heat )] TJ ET
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BT 487.406 536.603 Td /F4 8.7 Tf  [(161)] TJ ET
0.271 0.267 0.267 rg
BT 501.862 535.095 Td /F1 9.8 Tf  [(. A recent report )] TJ ET
BT 26.250 523.191 Td /F1 9.8 Tf  [(concluded that thermoelectric power production in southern and southeastern Europe and the southeastern US will be affected )] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(by climate change through a combination of increased water temperatures and reduced river flows, especially during the )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(summer )] TJ ET
0.267 0.267 0.267 rg
BT 64.168 500.888 Td /F4 8.7 Tf  [(162)] TJ ET
0.271 0.267 0.267 rg
BT 78.624 499.381 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 479.976 Td /F1 9.8 Tf  [(The health effects of disrupted electricity as a result of drought, particularly on vulnerable groups dependent upon power to )] TJ ET
BT 26.250 468.072 Td /F1 9.8 Tf  [(sustain their health care needs, deserves significant further research.)] TJ ET
BT 26.250 431.469 Td /F4 12.0 Tf  [(DISCUSSION)] TJ ET
BT 26.250 411.515 Td /F1 9.8 Tf  [(There is no doubt that drought has multiple adverse indirect health outcomes; our review illustrates how varied and wide-)] TJ ET
BT 26.250 399.610 Td /F1 9.8 Tf  [(ranging these are, and serves as a call for policy makers and funders to treat drought as seriously as other more dramatic and )] TJ ET
BT 26.250 387.705 Td /F1 9.8 Tf  [(visible extreme weather events. To do this, they should consider they key message permeating almost all our studies: that )] TJ ET
BT 26.250 375.801 Td /F1 9.8 Tf  [(underlying population and individual vulnerability/resilience factors are critical.)] TJ ET
BT 26.250 356.396 Td /F1 9.8 Tf  [(The probability of drought related health impact varies from high \(e.g. risk of drought-associated malnutrition in a resource-poor )] TJ ET
BT 26.250 344.491 Td /F1 9.8 Tf  [(developing country\) to negligible \(e.g. risk of drought-associated malnutrition for wealthy individuals in the same developing )] TJ ET
BT 26.250 332.586 Td /F1 9.8 Tf  [(country, or for developed country populations\), based on the drought characteristics, existing infrastructure, and available )] TJ ET
BT 26.250 320.682 Td /F1 9.8 Tf  [(resources with which to mitigate health impacts as they appear.)] TJ ET
BT 26.250 301.277 Td /F1 9.8 Tf  [(The severity of impact also varies according to underlying vulnerability: from death at one extreme to minimal or no effect where )] TJ ET
BT 26.250 289.372 Td /F1 9.8 Tf  [(the population/individuals have financial and other resources to buffer themselves from any potential effects.)] TJ ET
BT 26.250 269.967 Td /F1 9.8 Tf  [(As well as the categories of impact presented in our results section, it is useful to summarise our findings according to another )] TJ ET
BT 26.250 258.063 Td /F1 9.8 Tf  [(framework outlining the long terms impacts of disasters on community health )] TJ ET
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BT 359.495 259.570 Td /F4 8.7 Tf  [(163)] TJ ET
0.271 0.267 0.267 rg
BT 373.951 258.063 Td /F1 9.8 Tf  [(. This helps put drought in context with other )] TJ ET
BT 26.250 246.158 Td /F1 9.8 Tf  [(natural hazards and identifies the need for enhanced disease surveillance following disasters in order to better capture those )] TJ ET
BT 26.250 234.253 Td /F1 9.8 Tf  [(health impacts which manifest in the longer term. Five categories of long-term health effects associated with natural hazards )] TJ ET
BT 26.250 222.348 Td /F1 9.8 Tf  [(were identified:)] TJ ET
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40.337 205.911 m 
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39.522 207.434 39.078 207.617 38.631 207.617 c
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37.109 206.802 36.925 206.358 36.925 205.911 c
36.925 205.465 37.109 205.021 37.425 204.705 c
37.741 204.389 38.185 204.205 38.631 204.205 c
39.078 204.205 39.522 204.389 39.838 204.705 c
40.154 205.021 40.337 205.465 40.337 205.911 c f
BT 45.750 202.944 Td /F6 9.8 Tf  [(Effects of malnutrition and trace element toxicity)] TJ ET
BT 26.250 179.789 Td /F1 9.8 Tf  [(These effects are exclusive to populations vulnerable to food insecurity and poverty in resource poor developing countries.)] TJ ET
40.337 170.852 m 
40.337 171.298 40.154 171.742 39.838 172.058 c
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38.185 172.558 37.741 172.374 37.425 172.058 c
37.109 171.742 36.925 171.298 36.925 170.852 c
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39.078 169.145 39.522 169.329 39.838 169.645 c
40.154 169.961 40.337 170.405 40.337 170.852 c f
BT 45.750 167.884 Td /F6 9.8 Tf  [(Infectious disease risk)] TJ ET
BT 26.250 144.729 Td /F1 9.8 Tf  [(Vulnerable populations are most at risk, but our review shows some evidence that even in developed countries with high quality )] TJ ET
BT 26.250 132.825 Td /F1 9.8 Tf  [(water sources, drought-related behaviours such as worsened hand washing can result in spread of infectious disease. Of )] TJ ET
BT 26.250 120.920 Td /F1 9.8 Tf  [(particular concern is population displacement and the often-associated risk of increased infectious disease transmission.)] TJ ET
40.337 111.983 m 
40.337 112.429 40.154 112.873 39.838 113.189 c
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37.109 112.873 36.925 112.429 36.925 111.983 c
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40.154 111.092 40.337 111.536 40.337 111.983 c f
BT 45.750 109.015 Td /F6 9.8 Tf  [(Chronic systemic illness)] TJ ET
BT 26.250 85.860 Td /F1 9.8 Tf  [(Chronic systemic illness is most associated with interruptions in the delivery of health care, which may be affected by )] TJ ET
BT 26.250 73.956 Td /F1 9.8 Tf  [(disruptions in electricity supply.)] TJ ET
40.337 65.018 m 
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39.078 63.312 39.522 63.496 39.838 63.812 c
40.154 64.128 40.337 64.572 40.337 65.018 c f
BT 45.750 62.051 Td /F6 9.8 Tf  [(Chronic disability/pain following physical injury)] TJ ET
BT 26.250 38.896 Td /F1 9.8 Tf  [(Though not a major feature of drought, examples include the neurological diseases due to toxin ingestion and spinal cord injury )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F1 9.8 Tf  [(due to diving into shallow water.)] TJ ET
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40.154 757.648 40.337 758.092 40.337 758.539 c f
BT 45.750 755.571 Td /F6 9.8 Tf  [(Mental health outcomes)] TJ ET
BT 26.250 732.417 Td /F1 9.8 Tf  [(This is a universal feature of drought, mainly for people whose livelihoods depend on rainfall or who are forced to migrate. Even )] TJ ET
BT 26.250 720.512 Td /F1 9.8 Tf  [(though developed country populations are not at risk of drought�s most severe consequences, the impact of drought on certain )] TJ ET
BT 26.250 708.607 Td /F1 9.8 Tf  [(occupations/livelihoods and the stress that it causes is not to be underestimated. Mental health outcomes are not specific to )] TJ ET
BT 26.250 696.702 Td /F1 9.8 Tf  [(drought but do underlie the point that psychological wellbeing is a critical part of health. )] TJ ET
BT 26.250 684.798 Td /F1 9.8 Tf  [(Other issues associated with drought and health include regulated vs. unregulated water supplies. In developed countries, )] TJ ET
BT 26.250 672.893 Td /F1 9.8 Tf  [(public water supplies are tightly regulated and quality controlled; populations without widespread access to regulated drinking )] TJ ET
BT 26.250 660.988 Td /F1 9.8 Tf  [(water supplies may be particularly vulnerable to water-related health effects. A related issue is that of public vs. private water )] TJ ET
BT 26.250 649.083 Td /F1 9.8 Tf  [(supply. In the UK, for example, 1% of the population relies on private water supplies which are not managed in the same way as )] TJ ET
BT 26.250 637.179 Td /F1 9.8 Tf  [(public water supplies, and water-related health effects have been documented )] TJ ET
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BT 375.685 637.179 Td /F1 9.8 Tf  [(; as people may seek alternate water supplies )] TJ ET
BT 26.250 625.274 Td /F1 9.8 Tf  [(during times of drought, this may be an issue for both developed and developing countries. Population growth and urban )] TJ ET
BT 26.250 613.369 Td /F1 9.8 Tf  [(expansion place additional stress on local water supplies in many places, potentially exacerbating competition for already-)] TJ ET
BT 26.250 601.464 Td /F1 9.8 Tf  [(scarce water resources )] TJ ET
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BT 129.737 602.972 Td /F4 8.7 Tf  [(164)] TJ ET
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BT 144.193 601.464 Td /F1 9.8 Tf  [(. It is vital not to confuse the current �absence of evidence� regarding health and drought with )] TJ ET
BT 26.250 589.560 Td /F1 9.8 Tf  [(�evidence of absence� of health impacts�a relative lack of documentation on the health impacts of drought should not be )] TJ ET
BT 26.250 577.655 Td /F1 9.8 Tf  [(interpreted to mean that drought has no effect on human health.)] TJ ET
BT 26.250 558.250 Td /F1 9.8 Tf  [(The Hyogo Framework for Action \(HFA\) is a major international initiative to build the resilience of nations and communities to )] TJ ET
BT 26.250 546.345 Td /F1 9.8 Tf  [(disasters )] TJ ET
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BT 82.426 546.345 Td /F1 9.8 Tf  [(. HFA actions include:)] TJ ET
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39.522 531.431 39.078 531.614 38.631 531.614 c
38.185 531.614 37.741 531.431 37.425 531.115 c
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39.078 528.202 39.522 528.386 39.838 528.702 c
40.154 529.018 40.337 529.462 40.337 529.908 c f
BT 45.750 526.941 Td /F1 9.8 Tf  [(ensure disaster risk reduction is a national and local priority;)] TJ ET
40.337 514.253 m 
40.337 514.700 40.154 515.144 39.838 515.460 c
39.522 515.776 39.078 515.960 38.631 515.960 c
38.185 515.960 37.741 515.776 37.425 515.460 c
37.109 515.144 36.925 514.700 36.925 514.253 c
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39.078 512.547 39.522 512.731 39.838 513.047 c
40.154 513.363 40.337 513.807 40.337 514.253 c f
BT 45.750 511.286 Td /F1 9.8 Tf  [(identify, assess and monitor disaster risks and enhance early warning;)] TJ ET
40.337 498.599 m 
40.337 499.045 40.154 499.489 39.838 499.805 c
39.522 500.121 39.078 500.305 38.631 500.305 c
38.185 500.305 37.741 500.121 37.425 499.805 c
37.109 499.489 36.925 499.045 36.925 498.599 c
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39.078 496.892 39.522 497.076 39.838 497.392 c
40.154 497.708 40.337 498.152 40.337 498.599 c f
BT 45.750 495.631 Td /F1 9.8 Tf  [(use knowledge, innovation and education to build a culture of safety and resilience;)] TJ ET
40.337 482.944 m 
40.337 483.391 40.154 483.835 39.838 484.151 c
39.522 484.466 39.078 484.650 38.631 484.650 c
38.185 484.650 37.741 484.466 37.425 484.151 c
37.109 483.835 36.925 483.391 36.925 482.944 c
36.925 482.497 37.109 482.053 37.425 481.737 c
37.741 481.422 38.185 481.238 38.631 481.238 c
39.078 481.238 39.522 481.422 39.838 481.737 c
40.154 482.053 40.337 482.497 40.337 482.944 c f
BT 45.750 479.976 Td /F1 9.8 Tf  [(reduce underlying risk factors;)] TJ ET
40.337 467.289 m 
40.337 467.736 40.154 468.180 39.838 468.496 c
39.522 468.812 39.078 468.995 38.631 468.995 c
38.185 468.995 37.741 468.812 37.425 468.496 c
37.109 468.180 36.925 467.736 36.925 467.289 c
36.925 466.843 37.109 466.399 37.425 466.083 c
37.741 465.767 38.185 465.583 38.631 465.583 c
39.078 465.583 39.522 465.767 39.838 466.083 c
40.154 466.399 40.337 466.843 40.337 467.289 c f
BT 45.750 464.322 Td /F1 9.8 Tf  [(strengthen disaster preparedness for effective response at all levels.)] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(To be effective, these actions require strong underpinning evidence to identify the known impacts associated with each hazard.)] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(Drought preparedness measures are key and should incorporate the wide-ranging impacts that drought may have on human )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(health. Drought policies, based in local contexts, should emphasize prevention, preparedness and mitigation rather than relying )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(solely on crisis management as actions can be taken before a drought to minimize the potential effects on people. Essential to )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(drought preparedness, and therefore of use in reducing the effects of drought on human health, are early warnings and drought )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(monitoring systems \(to warn people of potential threats to wellbeing, and to create a historical record to assess changing )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(conditions\), and risk identification of vulnerable population groups, regions, and sectors most at risk of the effects of drought )] TJ ET
0.267 0.267 0.267 rg
BT 562.217 363.746 Td /F4 8.7 Tf  [(166)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 350.334 Td /F1 9.8 Tf  [(. Additionally, further adaptation strategies exist to strengthen health sector preparedness for drought, including: heat-health )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(action plans; emergency medical services; improved climate-sensitive disease surveillance and control; safe water and )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(improved sanitation )] TJ ET
0.267 0.267 0.267 rg
BT 113.493 328.031 Td /F4 8.7 Tf  [(167)] TJ ET
0.271 0.267 0.267 rg
BT 127.949 326.524 Td /F1 9.8 Tf  [(. In an example from Vietnam, health-related drought adaptation measures included provision of first aid )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(training \(for treatment of diarrhoea and respiratory diseases\), raised awareness of nutrition, improved access to clean water, )] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(and provision of hygiene kits )] TJ ET
0.267 0.267 0.267 rg
BT 151.976 304.222 Td /F4 8.7 Tf  [(166)] TJ ET
0.271 0.267 0.267 rg
BT 166.432 302.715 Td /F1 9.8 Tf  [(. In the case of drought-related effects on nutrition, preparedness can be strengthened with the )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(knowledge that improvements in nutritional status may best be achieved based on an understanding of the local causes of )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(malnutrition, as poor nutrition may be a chronic or structural problem independent of drought in a given area )] TJ ET
0.267 0.267 0.267 rg
BT 493.382 280.412 Td /F4 8.7 Tf  [(168)] TJ ET
0.271 0.267 0.267 rg
BT 507.838 278.905 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 259.500 Td /F5 9.8 Tf  [(Limitations)] TJ ET
BT 26.250 240.096 Td /F1 9.8 Tf  [(Due to its slow onset and association with other emergencies, most health effects of drought are indirect and therefore under-)] TJ ET
BT 26.250 228.191 Td /F1 9.8 Tf  [(investigated, under-recognised and under-reported. As it is difficult to identify drought as the sole exposure responsible for a )] TJ ET
BT 26.250 216.286 Td /F1 9.8 Tf  [(given health outcome, it is likely that this search did not locate all published studies.)] TJ ET
BT 26.250 196.881 Td /F1 9.8 Tf  [(The studies included in the tables were all observational studies with widely varying study designs, of varying quality levels. )] TJ ET
BT 26.250 184.977 Td /F1 9.8 Tf  [(However, since it is unethical to conduct experimental studies on this topic, good quality observational studies must continue to )] TJ ET
BT 26.250 173.072 Td /F1 9.8 Tf  [(be done.)] TJ ET
BT 26.250 153.667 Td /F1 9.8 Tf  [(Some health outcomes, such as �injuries,� yielded very few studies, and as such it is difficult to generalize the findings and )] TJ ET
BT 26.250 141.762 Td /F1 9.8 Tf  [(extrapolate results to other settings; caution is needed in interpretation of these results, and more research is needed on several )] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(topics in order to strengthen the evidence base.)] TJ ET
BT 26.250 110.453 Td /F1 9.8 Tf  [(Reporting bias is very likely \(as severe droughts are more likely to be reported and associated with adverse health outcomes\), )] TJ ET
BT 26.250 98.548 Td /F1 9.8 Tf  [(which is one of several reasons why quantitative meta-analysis is neither possible nor sensible in order to quantify impact of )] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(drought. Important lessons on how to successfully manage drought to avert/minimise health effects may have been missed.)] TJ ET
BT 26.250 67.239 Td /F1 9.8 Tf  [(This review did not address conflict, either as an exposure variable \(i.e., in the case of countries engaged in conflict, with co-)] TJ ET
BT 26.250 55.334 Td /F1 9.8 Tf  [(existent drought as an additional variable\) nor as a health outcome \(i.e., in the case of countries engaged in �water wars� over )] TJ ET
BT 26.250 43.429 Td /F1 9.8 Tf  [(scarce water resources, with conflict-related consequential impacts on human health\). The issue of conflict is too complex to be )] TJ ET
Q
q
15.000 29.143 577.500 747.857 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(due to diving into shallow water.)] TJ ET
0.271 0.267 0.267 RG
40.337 758.539 m 
40.337 758.986 40.154 759.430 39.838 759.746 c
39.522 760.061 39.078 760.245 38.631 760.245 c
38.185 760.245 37.741 760.061 37.425 759.746 c
37.109 759.430 36.925 758.986 36.925 758.539 c
36.925 758.092 37.109 757.648 37.425 757.332 c
37.741 757.017 38.185 756.833 38.631 756.833 c
39.078 756.833 39.522 757.017 39.838 757.332 c
40.154 757.648 40.337 758.092 40.337 758.539 c f
BT 45.750 755.571 Td /F6 9.8 Tf  [(Mental health outcomes)] TJ ET
BT 26.250 732.417 Td /F1 9.8 Tf  [(This is a universal feature of drought, mainly for people whose livelihoods depend on rainfall or who are forced to migrate. Even )] TJ ET
BT 26.250 720.512 Td /F1 9.8 Tf  [(though developed country populations are not at risk of drought�s most severe consequences, the impact of drought on certain )] TJ ET
BT 26.250 708.607 Td /F1 9.8 Tf  [(occupations/livelihoods and the stress that it causes is not to be underestimated. Mental health outcomes are not specific to )] TJ ET
BT 26.250 696.702 Td /F1 9.8 Tf  [(drought but do underlie the point that psychological wellbeing is a critical part of health. )] TJ ET
BT 26.250 684.798 Td /F1 9.8 Tf  [(Other issues associated with drought and health include regulated vs. unregulated water supplies. In developed countries, )] TJ ET
BT 26.250 672.893 Td /F1 9.8 Tf  [(public water supplies are tightly regulated and quality controlled; populations without widespread access to regulated drinking )] TJ ET
BT 26.250 660.988 Td /F1 9.8 Tf  [(water supplies may be particularly vulnerable to water-related health effects. A related issue is that of public vs. private water )] TJ ET
BT 26.250 649.083 Td /F1 9.8 Tf  [(supply. In the UK, for example, 1% of the population relies on private water supplies which are not managed in the same way as )] TJ ET
BT 26.250 637.179 Td /F1 9.8 Tf  [(public water supplies, and water-related health effects have been documented )] TJ ET
0.267 0.267 0.267 rg
BT 366.047 638.686 Td /F4 8.7 Tf  [(70)] TJ ET
0.271 0.267 0.267 rg
BT 375.685 637.179 Td /F1 9.8 Tf  [(; as people may seek alternate water supplies )] TJ ET
BT 26.250 625.274 Td /F1 9.8 Tf  [(during times of drought, this may be an issue for both developed and developing countries. Population growth and urban )] TJ ET
BT 26.250 613.369 Td /F1 9.8 Tf  [(expansion place additional stress on local water supplies in many places, potentially exacerbating competition for already-)] TJ ET
BT 26.250 601.464 Td /F1 9.8 Tf  [(scarce water resources )] TJ ET
0.267 0.267 0.267 rg
BT 129.737 602.972 Td /F4 8.7 Tf  [(164)] TJ ET
0.271 0.267 0.267 rg
BT 144.193 601.464 Td /F1 9.8 Tf  [(. It is vital not to confuse the current �absence of evidence� regarding health and drought with )] TJ ET
BT 26.250 589.560 Td /F1 9.8 Tf  [(�evidence of absence� of health impacts�a relative lack of documentation on the health impacts of drought should not be )] TJ ET
BT 26.250 577.655 Td /F1 9.8 Tf  [(interpreted to mean that drought has no effect on human health.)] TJ ET
BT 26.250 558.250 Td /F1 9.8 Tf  [(The Hyogo Framework for Action \(HFA\) is a major international initiative to build the resilience of nations and communities to )] TJ ET
BT 26.250 546.345 Td /F1 9.8 Tf  [(disasters )] TJ ET
0.267 0.267 0.267 rg
BT 67.970 547.853 Td /F4 8.7 Tf  [(165)] TJ ET
0.271 0.267 0.267 rg
BT 82.426 546.345 Td /F1 9.8 Tf  [(. HFA actions include:)] TJ ET
40.337 529.908 m 
40.337 530.355 40.154 530.799 39.838 531.115 c
39.522 531.431 39.078 531.614 38.631 531.614 c
38.185 531.614 37.741 531.431 37.425 531.115 c
37.109 530.799 36.925 530.355 36.925 529.908 c
36.925 529.462 37.109 529.018 37.425 528.702 c
37.741 528.386 38.185 528.202 38.631 528.202 c
39.078 528.202 39.522 528.386 39.838 528.702 c
40.154 529.018 40.337 529.462 40.337 529.908 c f
BT 45.750 526.941 Td /F1 9.8 Tf  [(ensure disaster risk reduction is a national and local priority;)] TJ ET
40.337 514.253 m 
40.337 514.700 40.154 515.144 39.838 515.460 c
39.522 515.776 39.078 515.960 38.631 515.960 c
38.185 515.960 37.741 515.776 37.425 515.460 c
37.109 515.144 36.925 514.700 36.925 514.253 c
36.925 513.807 37.109 513.363 37.425 513.047 c
37.741 512.731 38.185 512.547 38.631 512.547 c
39.078 512.547 39.522 512.731 39.838 513.047 c
40.154 513.363 40.337 513.807 40.337 514.253 c f
BT 45.750 511.286 Td /F1 9.8 Tf  [(identify, assess and monitor disaster risks and enhance early warning;)] TJ ET
40.337 498.599 m 
40.337 499.045 40.154 499.489 39.838 499.805 c
39.522 500.121 39.078 500.305 38.631 500.305 c
38.185 500.305 37.741 500.121 37.425 499.805 c
37.109 499.489 36.925 499.045 36.925 498.599 c
36.925 498.152 37.109 497.708 37.425 497.392 c
37.741 497.076 38.185 496.892 38.631 496.892 c
39.078 496.892 39.522 497.076 39.838 497.392 c
40.154 497.708 40.337 498.152 40.337 498.599 c f
BT 45.750 495.631 Td /F1 9.8 Tf  [(use knowledge, innovation and education to build a culture of safety and resilience;)] TJ ET
40.337 482.944 m 
40.337 483.391 40.154 483.835 39.838 484.151 c
39.522 484.466 39.078 484.650 38.631 484.650 c
38.185 484.650 37.741 484.466 37.425 484.151 c
37.109 483.835 36.925 483.391 36.925 482.944 c
36.925 482.497 37.109 482.053 37.425 481.737 c
37.741 481.422 38.185 481.238 38.631 481.238 c
39.078 481.238 39.522 481.422 39.838 481.737 c
40.154 482.053 40.337 482.497 40.337 482.944 c f
BT 45.750 479.976 Td /F1 9.8 Tf  [(reduce underlying risk factors;)] TJ ET
40.337 467.289 m 
40.337 467.736 40.154 468.180 39.838 468.496 c
39.522 468.812 39.078 468.995 38.631 468.995 c
38.185 468.995 37.741 468.812 37.425 468.496 c
37.109 468.180 36.925 467.736 36.925 467.289 c
36.925 466.843 37.109 466.399 37.425 466.083 c
37.741 465.767 38.185 465.583 38.631 465.583 c
39.078 465.583 39.522 465.767 39.838 466.083 c
40.154 466.399 40.337 466.843 40.337 467.289 c f
BT 45.750 464.322 Td /F1 9.8 Tf  [(strengthen disaster preparedness for effective response at all levels.)] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(To be effective, these actions require strong underpinning evidence to identify the known impacts associated with each hazard.)] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(Drought preparedness measures are key and should incorporate the wide-ranging impacts that drought may have on human )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(health. Drought policies, based in local contexts, should emphasize prevention, preparedness and mitigation rather than relying )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(solely on crisis management as actions can be taken before a drought to minimize the potential effects on people. Essential to )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(drought preparedness, and therefore of use in reducing the effects of drought on human health, are early warnings and drought )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(monitoring systems \(to warn people of potential threats to wellbeing, and to create a historical record to assess changing )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(conditions\), and risk identification of vulnerable population groups, regions, and sectors most at risk of the effects of drought )] TJ ET
0.267 0.267 0.267 rg
BT 562.217 363.746 Td /F4 8.7 Tf  [(166)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 350.334 Td /F1 9.8 Tf  [(. Additionally, further adaptation strategies exist to strengthen health sector preparedness for drought, including: heat-health )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(action plans; emergency medical services; improved climate-sensitive disease surveillance and control; safe water and )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(improved sanitation )] TJ ET
0.267 0.267 0.267 rg
BT 113.493 328.031 Td /F4 8.7 Tf  [(167)] TJ ET
0.271 0.267 0.267 rg
BT 127.949 326.524 Td /F1 9.8 Tf  [(. In an example from Vietnam, health-related drought adaptation measures included provision of first aid )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(training \(for treatment of diarrhoea and respiratory diseases\), raised awareness of nutrition, improved access to clean water, )] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(and provision of hygiene kits )] TJ ET
0.267 0.267 0.267 rg
BT 151.976 304.222 Td /F4 8.7 Tf  [(166)] TJ ET
0.271 0.267 0.267 rg
BT 166.432 302.715 Td /F1 9.8 Tf  [(. In the case of drought-related effects on nutrition, preparedness can be strengthened with the )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(knowledge that improvements in nutritional status may best be achieved based on an understanding of the local causes of )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(malnutrition, as poor nutrition may be a chronic or structural problem independent of drought in a given area )] TJ ET
0.267 0.267 0.267 rg
BT 493.382 280.412 Td /F4 8.7 Tf  [(168)] TJ ET
0.271 0.267 0.267 rg
BT 507.838 278.905 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 259.500 Td /F5 9.8 Tf  [(Limitations)] TJ ET
BT 26.250 240.096 Td /F1 9.8 Tf  [(Due to its slow onset and association with other emergencies, most health effects of drought are indirect and therefore under-)] TJ ET
BT 26.250 228.191 Td /F1 9.8 Tf  [(investigated, under-recognised and under-reported. As it is difficult to identify drought as the sole exposure responsible for a )] TJ ET
BT 26.250 216.286 Td /F1 9.8 Tf  [(given health outcome, it is likely that this search did not locate all published studies.)] TJ ET
BT 26.250 196.881 Td /F1 9.8 Tf  [(The studies included in the tables were all observational studies with widely varying study designs, of varying quality levels. )] TJ ET
BT 26.250 184.977 Td /F1 9.8 Tf  [(However, since it is unethical to conduct experimental studies on this topic, good quality observational studies must continue to )] TJ ET
BT 26.250 173.072 Td /F1 9.8 Tf  [(be done.)] TJ ET
BT 26.250 153.667 Td /F1 9.8 Tf  [(Some health outcomes, such as �injuries,� yielded very few studies, and as such it is difficult to generalize the findings and )] TJ ET
BT 26.250 141.762 Td /F1 9.8 Tf  [(extrapolate results to other settings; caution is needed in interpretation of these results, and more research is needed on several )] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(topics in order to strengthen the evidence base.)] TJ ET
BT 26.250 110.453 Td /F1 9.8 Tf  [(Reporting bias is very likely \(as severe droughts are more likely to be reported and associated with adverse health outcomes\), )] TJ ET
BT 26.250 98.548 Td /F1 9.8 Tf  [(which is one of several reasons why quantitative meta-analysis is neither possible nor sensible in order to quantify impact of )] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(drought. Important lessons on how to successfully manage drought to avert/minimise health effects may have been missed.)] TJ ET
BT 26.250 67.239 Td /F1 9.8 Tf  [(This review did not address conflict, either as an exposure variable \(i.e., in the case of countries engaged in conflict, with co-)] TJ ET
BT 26.250 55.334 Td /F1 9.8 Tf  [(existent drought as an additional variable\) nor as a health outcome \(i.e., in the case of countries engaged in �water wars� over )] TJ ET
BT 26.250 43.429 Td /F1 9.8 Tf  [(scarce water resources, with conflict-related consequential impacts on human health\). The issue of conflict is too complex to be )] TJ ET
Q
q
15.000 29.143 577.500 747.857 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(due to diving into shallow water.)] TJ ET
0.271 0.267 0.267 RG
40.337 758.539 m 
40.337 758.986 40.154 759.430 39.838 759.746 c
39.522 760.061 39.078 760.245 38.631 760.245 c
38.185 760.245 37.741 760.061 37.425 759.746 c
37.109 759.430 36.925 758.986 36.925 758.539 c
36.925 758.092 37.109 757.648 37.425 757.332 c
37.741 757.017 38.185 756.833 38.631 756.833 c
39.078 756.833 39.522 757.017 39.838 757.332 c
40.154 757.648 40.337 758.092 40.337 758.539 c f
BT 45.750 755.571 Td /F6 9.8 Tf  [(Mental health outcomes)] TJ ET
BT 26.250 732.417 Td /F1 9.8 Tf  [(This is a universal feature of drought, mainly for people whose livelihoods depend on rainfall or who are forced to migrate. Even )] TJ ET
BT 26.250 720.512 Td /F1 9.8 Tf  [(though developed country populations are not at risk of drought�s most severe consequences, the impact of drought on certain )] TJ ET
BT 26.250 708.607 Td /F1 9.8 Tf  [(occupations/livelihoods and the stress that it causes is not to be underestimated. Mental health outcomes are not specific to )] TJ ET
BT 26.250 696.702 Td /F1 9.8 Tf  [(drought but do underlie the point that psychological wellbeing is a critical part of health. )] TJ ET
BT 26.250 684.798 Td /F1 9.8 Tf  [(Other issues associated with drought and health include regulated vs. unregulated water supplies. In developed countries, )] TJ ET
BT 26.250 672.893 Td /F1 9.8 Tf  [(public water supplies are tightly regulated and quality controlled; populations without widespread access to regulated drinking )] TJ ET
BT 26.250 660.988 Td /F1 9.8 Tf  [(water supplies may be particularly vulnerable to water-related health effects. A related issue is that of public vs. private water )] TJ ET
BT 26.250 649.083 Td /F1 9.8 Tf  [(supply. In the UK, for example, 1% of the population relies on private water supplies which are not managed in the same way as )] TJ ET
BT 26.250 637.179 Td /F1 9.8 Tf  [(public water supplies, and water-related health effects have been documented )] TJ ET
0.267 0.267 0.267 rg
BT 366.047 638.686 Td /F4 8.7 Tf  [(70)] TJ ET
0.271 0.267 0.267 rg
BT 375.685 637.179 Td /F1 9.8 Tf  [(; as people may seek alternate water supplies )] TJ ET
BT 26.250 625.274 Td /F1 9.8 Tf  [(during times of drought, this may be an issue for both developed and developing countries. Population growth and urban )] TJ ET
BT 26.250 613.369 Td /F1 9.8 Tf  [(expansion place additional stress on local water supplies in many places, potentially exacerbating competition for already-)] TJ ET
BT 26.250 601.464 Td /F1 9.8 Tf  [(scarce water resources )] TJ ET
0.267 0.267 0.267 rg
BT 129.737 602.972 Td /F4 8.7 Tf  [(164)] TJ ET
0.271 0.267 0.267 rg
BT 144.193 601.464 Td /F1 9.8 Tf  [(. It is vital not to confuse the current �absence of evidence� regarding health and drought with )] TJ ET
BT 26.250 589.560 Td /F1 9.8 Tf  [(�evidence of absence� of health impacts�a relative lack of documentation on the health impacts of drought should not be )] TJ ET
BT 26.250 577.655 Td /F1 9.8 Tf  [(interpreted to mean that drought has no effect on human health.)] TJ ET
BT 26.250 558.250 Td /F1 9.8 Tf  [(The Hyogo Framework for Action \(HFA\) is a major international initiative to build the resilience of nations and communities to )] TJ ET
BT 26.250 546.345 Td /F1 9.8 Tf  [(disasters )] TJ ET
0.267 0.267 0.267 rg
BT 67.970 547.853 Td /F4 8.7 Tf  [(165)] TJ ET
0.271 0.267 0.267 rg
BT 82.426 546.345 Td /F1 9.8 Tf  [(. HFA actions include:)] TJ ET
40.337 529.908 m 
40.337 530.355 40.154 530.799 39.838 531.115 c
39.522 531.431 39.078 531.614 38.631 531.614 c
38.185 531.614 37.741 531.431 37.425 531.115 c
37.109 530.799 36.925 530.355 36.925 529.908 c
36.925 529.462 37.109 529.018 37.425 528.702 c
37.741 528.386 38.185 528.202 38.631 528.202 c
39.078 528.202 39.522 528.386 39.838 528.702 c
40.154 529.018 40.337 529.462 40.337 529.908 c f
BT 45.750 526.941 Td /F1 9.8 Tf  [(ensure disaster risk reduction is a national and local priority;)] TJ ET
40.337 514.253 m 
40.337 514.700 40.154 515.144 39.838 515.460 c
39.522 515.776 39.078 515.960 38.631 515.960 c
38.185 515.960 37.741 515.776 37.425 515.460 c
37.109 515.144 36.925 514.700 36.925 514.253 c
36.925 513.807 37.109 513.363 37.425 513.047 c
37.741 512.731 38.185 512.547 38.631 512.547 c
39.078 512.547 39.522 512.731 39.838 513.047 c
40.154 513.363 40.337 513.807 40.337 514.253 c f
BT 45.750 511.286 Td /F1 9.8 Tf  [(identify, assess and monitor disaster risks and enhance early warning;)] TJ ET
40.337 498.599 m 
40.337 499.045 40.154 499.489 39.838 499.805 c
39.522 500.121 39.078 500.305 38.631 500.305 c
38.185 500.305 37.741 500.121 37.425 499.805 c
37.109 499.489 36.925 499.045 36.925 498.599 c
36.925 498.152 37.109 497.708 37.425 497.392 c
37.741 497.076 38.185 496.892 38.631 496.892 c
39.078 496.892 39.522 497.076 39.838 497.392 c
40.154 497.708 40.337 498.152 40.337 498.599 c f
BT 45.750 495.631 Td /F1 9.8 Tf  [(use knowledge, innovation and education to build a culture of safety and resilience;)] TJ ET
40.337 482.944 m 
40.337 483.391 40.154 483.835 39.838 484.151 c
39.522 484.466 39.078 484.650 38.631 484.650 c
38.185 484.650 37.741 484.466 37.425 484.151 c
37.109 483.835 36.925 483.391 36.925 482.944 c
36.925 482.497 37.109 482.053 37.425 481.737 c
37.741 481.422 38.185 481.238 38.631 481.238 c
39.078 481.238 39.522 481.422 39.838 481.737 c
40.154 482.053 40.337 482.497 40.337 482.944 c f
BT 45.750 479.976 Td /F1 9.8 Tf  [(reduce underlying risk factors;)] TJ ET
40.337 467.289 m 
40.337 467.736 40.154 468.180 39.838 468.496 c
39.522 468.812 39.078 468.995 38.631 468.995 c
38.185 468.995 37.741 468.812 37.425 468.496 c
37.109 468.180 36.925 467.736 36.925 467.289 c
36.925 466.843 37.109 466.399 37.425 466.083 c
37.741 465.767 38.185 465.583 38.631 465.583 c
39.078 465.583 39.522 465.767 39.838 466.083 c
40.154 466.399 40.337 466.843 40.337 467.289 c f
BT 45.750 464.322 Td /F1 9.8 Tf  [(strengthen disaster preparedness for effective response at all levels.)] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(To be effective, these actions require strong underpinning evidence to identify the known impacts associated with each hazard.)] TJ ET
BT 26.250 421.762 Td /F1 9.8 Tf  [(Drought preparedness measures are key and should incorporate the wide-ranging impacts that drought may have on human )] TJ ET
BT 26.250 409.857 Td /F1 9.8 Tf  [(health. Drought policies, based in local contexts, should emphasize prevention, preparedness and mitigation rather than relying )] TJ ET
BT 26.250 397.953 Td /F1 9.8 Tf  [(solely on crisis management as actions can be taken before a drought to minimize the potential effects on people. Essential to )] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(drought preparedness, and therefore of use in reducing the effects of drought on human health, are early warnings and drought )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(monitoring systems \(to warn people of potential threats to wellbeing, and to create a historical record to assess changing )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(conditions\), and risk identification of vulnerable population groups, regions, and sectors most at risk of the effects of drought )] TJ ET
0.267 0.267 0.267 rg
BT 562.217 363.746 Td /F4 8.7 Tf  [(166)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 350.334 Td /F1 9.8 Tf  [(. Additionally, further adaptation strategies exist to strengthen health sector preparedness for drought, including: heat-health )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(action plans; emergency medical services; improved climate-sensitive disease surveillance and control; safe water and )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(improved sanitation )] TJ ET
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BT 113.493 328.031 Td /F4 8.7 Tf  [(167)] TJ ET
0.271 0.267 0.267 rg
BT 127.949 326.524 Td /F1 9.8 Tf  [(. In an example from Vietnam, health-related drought adaptation measures included provision of first aid )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(training \(for treatment of diarrhoea and respiratory diseases\), raised awareness of nutrition, improved access to clean water, )] TJ ET
BT 26.250 302.715 Td /F1 9.8 Tf  [(and provision of hygiene kits )] TJ ET
0.267 0.267 0.267 rg
BT 151.976 304.222 Td /F4 8.7 Tf  [(166)] TJ ET
0.271 0.267 0.267 rg
BT 166.432 302.715 Td /F1 9.8 Tf  [(. In the case of drought-related effects on nutrition, preparedness can be strengthened with the )] TJ ET
BT 26.250 290.810 Td /F1 9.8 Tf  [(knowledge that improvements in nutritional status may best be achieved based on an understanding of the local causes of )] TJ ET
BT 26.250 278.905 Td /F1 9.8 Tf  [(malnutrition, as poor nutrition may be a chronic or structural problem independent of drought in a given area )] TJ ET
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BT 493.382 280.412 Td /F4 8.7 Tf  [(168)] TJ ET
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BT 507.838 278.905 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 259.500 Td /F5 9.8 Tf  [(Limitations)] TJ ET
BT 26.250 240.096 Td /F1 9.8 Tf  [(Due to its slow onset and association with other emergencies, most health effects of drought are indirect and therefore under-)] TJ ET
BT 26.250 228.191 Td /F1 9.8 Tf  [(investigated, under-recognised and under-reported. As it is difficult to identify drought as the sole exposure responsible for a )] TJ ET
BT 26.250 216.286 Td /F1 9.8 Tf  [(given health outcome, it is likely that this search did not locate all published studies.)] TJ ET
BT 26.250 196.881 Td /F1 9.8 Tf  [(The studies included in the tables were all observational studies with widely varying study designs, of varying quality levels. )] TJ ET
BT 26.250 184.977 Td /F1 9.8 Tf  [(However, since it is unethical to conduct experimental studies on this topic, good quality observational studies must continue to )] TJ ET
BT 26.250 173.072 Td /F1 9.8 Tf  [(be done.)] TJ ET
BT 26.250 153.667 Td /F1 9.8 Tf  [(Some health outcomes, such as �injuries,� yielded very few studies, and as such it is difficult to generalize the findings and )] TJ ET
BT 26.250 141.762 Td /F1 9.8 Tf  [(extrapolate results to other settings; caution is needed in interpretation of these results, and more research is needed on several )] TJ ET
BT 26.250 129.858 Td /F1 9.8 Tf  [(topics in order to strengthen the evidence base.)] TJ ET
BT 26.250 110.453 Td /F1 9.8 Tf  [(Reporting bias is very likely \(as severe droughts are more likely to be reported and associated with adverse health outcomes\), )] TJ ET
BT 26.250 98.548 Td /F1 9.8 Tf  [(which is one of several reasons why quantitative meta-analysis is neither possible nor sensible in order to quantify impact of )] TJ ET
BT 26.250 86.643 Td /F1 9.8 Tf  [(drought. Important lessons on how to successfully manage drought to avert/minimise health effects may have been missed.)] TJ ET
BT 26.250 67.239 Td /F1 9.8 Tf  [(This review did not address conflict, either as an exposure variable \(i.e., in the case of countries engaged in conflict, with co-)] TJ ET
BT 26.250 55.334 Td /F1 9.8 Tf  [(existent drought as an additional variable\) nor as a health outcome \(i.e., in the case of countries engaged in �water wars� over )] TJ ET
BT 26.250 43.429 Td /F1 9.8 Tf  [(scarce water resources, with conflict-related consequential impacts on human health\). The issue of conflict is too complex to be )] TJ ET
Q
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BT 291.710 19.825 Td /F1 11.0 Tf  [(15)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 767.476 Td /F1 9.8 Tf  [(included in a general overview of the literature as presented here, and the complicated relationship between drought and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(conflict deserves further attention.)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Finally, this is a systematic but not exhaustive review, which included results from peer-reviewed articles only in the final )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(analyses; there are many other valuable reports in grey literature \(sources may include World Food Programme; Food and )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(Agriculture Organization of the United Nations; the International Fund for Agricultural Development, and the Joint United Nations )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(Programme on HIV/AIDS, among others\), in other languages, or found under other search terms such as ENSO. However, )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(these are extremely unlikely to change overall conclusions and interpretations, and may be lower quality than the peer review )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(published reports which were found.)] TJ ET
BT 26.250 657.238 Td /F5 9.8 Tf  [(Calls for the future)] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Although this review represents an initial attempt at summarising the available evidence on the global health effects of drought, )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(a number of suggestions for improved documentation were identified:)] TJ ET
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40.337 609.492 m 
40.337 609.938 40.154 610.382 39.838 610.698 c
39.522 611.014 39.078 611.198 38.631 611.198 c
38.185 611.198 37.741 611.014 37.425 610.698 c
37.109 610.382 36.925 609.938 36.925 609.492 c
36.925 609.045 37.109 608.601 37.425 608.285 c
37.741 607.969 38.185 607.785 38.631 607.785 c
39.078 607.785 39.522 607.969 39.838 608.285 c
40.154 608.601 40.337 609.045 40.337 609.492 c f
BT 45.750 606.524 Td /F1 9.8 Tf  [(Drought with clear identification as a keyword/risk factor)] TJ ET
40.337 593.837 m 
40.337 594.283 40.154 594.727 39.838 595.043 c
39.522 595.359 39.078 595.543 38.631 595.543 c
38.185 595.543 37.741 595.359 37.425 595.043 c
37.109 594.727 36.925 594.283 36.925 593.837 c
36.925 593.390 37.109 592.946 37.425 592.630 c
37.741 592.314 38.185 592.131 38.631 592.131 c
39.078 592.131 39.522 592.314 39.838 592.630 c
40.154 592.946 40.337 593.390 40.337 593.837 c f
BT 45.750 590.869 Td /F1 9.8 Tf  [(More systematic reporting of drought impacts)] TJ ET
40.337 578.182 m 
40.337 578.629 40.154 579.073 39.838 579.389 c
39.522 579.704 39.078 579.888 38.631 579.888 c
38.185 579.888 37.741 579.704 37.425 579.389 c
37.109 579.073 36.925 578.629 36.925 578.182 c
36.925 577.735 37.109 577.291 37.425 576.975 c
37.741 576.660 38.185 576.476 38.631 576.476 c
39.078 576.476 39.522 576.660 39.838 576.975 c
40.154 577.291 40.337 577.735 40.337 578.182 c f
BT 45.750 575.214 Td /F1 9.8 Tf  [(Standardization of definitions to facilitate future trend analysis and meta-analysis / comparative analysis.)] TJ ET
40.337 562.527 m 
40.337 562.974 40.154 563.418 39.838 563.734 c
39.522 564.050 39.078 564.234 38.631 564.234 c
38.185 564.234 37.741 564.050 37.425 563.734 c
37.109 563.418 36.925 562.974 36.925 562.527 c
36.925 562.081 37.109 561.637 37.425 561.321 c
37.741 561.005 38.185 560.821 38.631 560.821 c
39.078 560.821 39.522 561.005 39.838 561.321 c
40.154 561.637 40.337 562.081 40.337 562.527 c f
BT 45.750 559.560 Td /F1 9.8 Tf  [(Good baseline data to facilitate better understanding of the impacts of drought, the role of drought plans and drought )] TJ ET
BT 45.750 547.655 Td /F1 9.8 Tf  [(mitigation strategies)] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(Recommendations for research into other areas of drought include:)] TJ ET
40.337 508.063 m 
40.337 508.510 40.154 508.954 39.838 509.270 c
39.522 509.585 39.078 509.769 38.631 509.769 c
38.185 509.769 37.741 509.585 37.425 509.270 c
37.109 508.954 36.925 508.510 36.925 508.063 c
36.925 507.616 37.109 507.172 37.425 506.856 c
37.741 506.541 38.185 506.357 38.631 506.357 c
39.078 506.357 39.522 506.541 39.838 506.856 c
40.154 507.172 40.337 507.616 40.337 508.063 c f
BT 45.750 505.095 Td /F1 9.8 Tf  [(Links with other extreme events, especially flood, heat and wildfires)] TJ ET
40.337 492.408 m 
40.337 492.855 40.154 493.299 39.838 493.615 c
39.522 493.931 39.078 494.115 38.631 494.115 c
38.185 494.115 37.741 493.931 37.425 493.615 c
37.109 493.299 36.925 492.855 36.925 492.408 c
36.925 491.962 37.109 491.518 37.425 491.202 c
37.741 490.886 38.185 490.702 38.631 490.702 c
39.078 490.702 39.522 490.886 39.838 491.202 c
40.154 491.518 40.337 491.962 40.337 492.408 c f
BT 45.750 489.441 Td /F1 9.8 Tf  [(Long term impacts of malnutrition \(reflecting the Barker hypothesis of how nutrition influences heart health\) )] TJ ET
BT 45.750 477.536 Td /F1 9.8 Tf  [(\(https://www.thebarkertheory.org/index.php\);)] TJ ET
40.337 464.849 m 
40.337 465.295 40.154 465.739 39.838 466.055 c
39.522 466.371 39.078 466.555 38.631 466.555 c
38.185 466.555 37.741 466.371 37.425 466.055 c
37.109 465.739 36.925 465.295 36.925 464.849 c
36.925 464.402 37.109 463.958 37.425 463.642 c
37.741 463.326 38.185 463.143 38.631 463.143 c
39.078 463.143 39.522 463.326 39.838 463.642 c
40.154 463.958 40.337 464.402 40.337 464.849 c f
BT 45.750 461.881 Td /F1 9.8 Tf  [(Alcohol use and its relationship to sufferers of drought;)] TJ ET
40.337 449.194 m 
40.337 449.641 40.154 450.085 39.838 450.401 c
39.522 450.716 39.078 450.900 38.631 450.900 c
38.185 450.900 37.741 450.716 37.425 450.401 c
37.109 450.085 36.925 449.641 36.925 449.194 c
36.925 448.747 37.109 448.303 37.425 447.987 c
37.741 447.672 38.185 447.488 38.631 447.488 c
39.078 447.488 39.522 447.672 39.838 447.987 c
40.154 448.303 40.337 448.747 40.337 449.194 c f
BT 45.750 446.226 Td /F1 9.8 Tf  [(Gender differences in experiences of drought-related mental health problems;)] TJ ET
40.337 433.539 m 
40.337 433.986 40.154 434.430 39.838 434.746 c
39.522 435.062 39.078 435.246 38.631 435.246 c
38.185 435.246 37.741 435.062 37.425 434.746 c
37.109 434.430 36.925 433.986 36.925 433.539 c
36.925 433.093 37.109 432.649 37.425 432.333 c
37.741 432.017 38.185 431.833 38.631 431.833 c
39.078 431.833 39.522 432.017 39.838 432.333 c
40.154 432.649 40.337 433.093 40.337 433.539 c f
BT 45.750 430.572 Td /F1 9.8 Tf  [(The impacts of disrupted electricity supply on the health of vulnerable populations;)] TJ ET
40.337 417.885 m 
40.337 418.331 40.154 418.775 39.838 419.091 c
39.522 419.407 39.078 419.591 38.631 419.591 c
38.185 419.591 37.741 419.407 37.425 419.091 c
37.109 418.775 36.925 418.331 36.925 417.885 c
36.925 417.438 37.109 416.994 37.425 416.678 c
37.741 416.362 38.185 416.178 38.631 416.178 c
39.078 416.178 39.522 416.362 39.838 416.678 c
40.154 416.994 40.337 417.438 40.337 417.885 c f
BT 45.750 414.917 Td /F1 9.8 Tf  [(The impacts of drought on vector borne disease;)] TJ ET
40.337 402.230 m 
40.337 402.676 40.154 403.120 39.838 403.436 c
39.522 403.752 39.078 403.936 38.631 403.936 c
38.185 403.936 37.741 403.752 37.425 403.436 c
37.109 403.120 36.925 402.676 36.925 402.230 c
36.925 401.783 37.109 401.339 37.425 401.023 c
37.741 400.707 38.185 400.524 38.631 400.524 c
39.078 400.524 39.522 400.707 39.838 401.023 c
40.154 401.339 40.337 401.783 40.337 402.230 c f
BT 45.750 399.262 Td /F1 9.8 Tf  [(The impacts that drought adaptation strategies may have on human health \(i.e., storing rain water and implications for )] TJ ET
BT 45.750 387.357 Td /F1 9.8 Tf  [(increased vector borne disease in some settings\);)] TJ ET
40.337 374.670 m 
40.337 375.117 40.154 375.561 39.838 375.877 c
39.522 376.193 39.078 376.377 38.631 376.377 c
38.185 376.377 37.741 376.193 37.425 375.877 c
37.109 375.561 36.925 375.117 36.925 374.670 c
36.925 374.224 37.109 373.780 37.425 373.464 c
37.741 373.148 38.185 372.964 38.631 372.964 c
39.078 372.964 39.522 373.148 39.838 373.464 c
40.154 373.780 40.337 374.224 40.337 374.670 c f
BT 45.750 371.703 Td /F1 9.8 Tf  [(The complex relationship between drought, conflict and consequent impacts on human health. Related to this may be )] TJ ET
BT 45.750 359.798 Td /F1 9.8 Tf  [(issues of migration and its enormous influence on health.)] TJ ET
BT 26.250 319.445 Td /F4 12.0 Tf  [(CONCLUSIONS)] TJ ET
BT 26.250 299.491 Td /F1 9.8 Tf  [(This review provides valuable evidence which will support emergency coordinators and international assistance agencies in )] TJ ET
BT 26.250 287.586 Td /F1 9.8 Tf  [(efforts to plan for and respond to drought emergencies.)] TJ ET
BT 26.250 268.182 Td /F1 9.8 Tf  [(Health effects identified in the review include nutrition-related effects \(including general malnutrition and mortality, micronutrient )] TJ ET
BT 26.250 256.277 Td /F1 9.8 Tf  [(malnutrition, and anti-nutrient consumption\); water-related disease \(including E coli, cholera and algal bloom\); airborne and dust-)] TJ ET
BT 26.250 244.372 Td /F1 9.8 Tf  [(related disease \(including silo gas exposure and coccidioidomycosis\); vector borne disease \(including malaria, dengue and )] TJ ET
BT 26.250 232.467 Td /F1 9.8 Tf  [(West Nile virus\); mental health effects \(including distress and other emotional consequences\); and other health effects )] TJ ET
BT 26.250 220.563 Td /F1 9.8 Tf  [(\(including wildfire, effects of migration, and damage to infrastructure\). Individual and population vulnerability and resilience )] TJ ET
BT 26.250 208.658 Td /F1 9.8 Tf  [(factors are critical in exacerbating or mitigating any drought-related impact. Understanding these provides valuable opportunities )] TJ ET
BT 26.250 196.753 Td /F1 9.8 Tf  [(for enhancing resilience at both national and community levels, reflecting the call of the Hyogo Framework for Action.)] TJ ET
BT 26.250 177.348 Td /F1 9.8 Tf  [(Forecasting can be used to provide advance warning of the increased risk of adverse climate conditions and can support the )] TJ ET
BT 26.250 165.444 Td /F1 9.8 Tf  [(disaster risk reduction process. In the short to medium term, robust warning and response systems available to resource-rich )] TJ ET
BT 26.250 153.539 Td /F1 9.8 Tf  [(developed countries often mitigate many of the worst adverse health effects of drought. The downside of this success is that the )] TJ ET
BT 26.250 141.634 Td /F1 9.8 Tf  [(health risks of drought may be insufficiently appreciated in these contexts. In the longer term, climate change is likely to lead to )] TJ ET
BT 26.250 129.729 Td /F1 9.8 Tf  [(more frequent and severe droughts in certain areas of the world. Even wealthy countries� drought management systems may )] TJ ET
BT 26.250 117.825 Td /F1 9.8 Tf  [(eventually become overwhelmed and as this happens, the impacts of drought could become correspondingly more marked. )] TJ ET
BT 26.250 105.920 Td /F1 9.8 Tf  [(Consideration of the existing evidence on the health risks associated with drought, combined with continued efforts to improve )] TJ ET
BT 26.250 94.015 Td /F1 9.8 Tf  [(research methodologies to record these complex health effects, will support drought policy, mitigation and adaptation measures )] TJ ET
BT 26.250 82.110 Td /F1 9.8 Tf  [(locally, nationally and internationally.)] TJ ET
Q
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15.000 35.077 577.500 741.923 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(included in a general overview of the literature as presented here, and the complicated relationship between drought and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(conflict deserves further attention.)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Finally, this is a systematic but not exhaustive review, which included results from peer-reviewed articles only in the final )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(analyses; there are many other valuable reports in grey literature \(sources may include World Food Programme; Food and )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(Agriculture Organization of the United Nations; the International Fund for Agricultural Development, and the Joint United Nations )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(Programme on HIV/AIDS, among others\), in other languages, or found under other search terms such as ENSO. However, )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(these are extremely unlikely to change overall conclusions and interpretations, and may be lower quality than the peer review )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(published reports which were found.)] TJ ET
BT 26.250 657.238 Td /F5 9.8 Tf  [(Calls for the future)] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Although this review represents an initial attempt at summarising the available evidence on the global health effects of drought, )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(a number of suggestions for improved documentation were identified:)] TJ ET
0.271 0.267 0.267 RG
40.337 609.492 m 
40.337 609.938 40.154 610.382 39.838 610.698 c
39.522 611.014 39.078 611.198 38.631 611.198 c
38.185 611.198 37.741 611.014 37.425 610.698 c
37.109 610.382 36.925 609.938 36.925 609.492 c
36.925 609.045 37.109 608.601 37.425 608.285 c
37.741 607.969 38.185 607.785 38.631 607.785 c
39.078 607.785 39.522 607.969 39.838 608.285 c
40.154 608.601 40.337 609.045 40.337 609.492 c f
BT 45.750 606.524 Td /F1 9.8 Tf  [(Drought with clear identification as a keyword/risk factor)] TJ ET
40.337 593.837 m 
40.337 594.283 40.154 594.727 39.838 595.043 c
39.522 595.359 39.078 595.543 38.631 595.543 c
38.185 595.543 37.741 595.359 37.425 595.043 c
37.109 594.727 36.925 594.283 36.925 593.837 c
36.925 593.390 37.109 592.946 37.425 592.630 c
37.741 592.314 38.185 592.131 38.631 592.131 c
39.078 592.131 39.522 592.314 39.838 592.630 c
40.154 592.946 40.337 593.390 40.337 593.837 c f
BT 45.750 590.869 Td /F1 9.8 Tf  [(More systematic reporting of drought impacts)] TJ ET
40.337 578.182 m 
40.337 578.629 40.154 579.073 39.838 579.389 c
39.522 579.704 39.078 579.888 38.631 579.888 c
38.185 579.888 37.741 579.704 37.425 579.389 c
37.109 579.073 36.925 578.629 36.925 578.182 c
36.925 577.735 37.109 577.291 37.425 576.975 c
37.741 576.660 38.185 576.476 38.631 576.476 c
39.078 576.476 39.522 576.660 39.838 576.975 c
40.154 577.291 40.337 577.735 40.337 578.182 c f
BT 45.750 575.214 Td /F1 9.8 Tf  [(Standardization of definitions to facilitate future trend analysis and meta-analysis / comparative analysis.)] TJ ET
40.337 562.527 m 
40.337 562.974 40.154 563.418 39.838 563.734 c
39.522 564.050 39.078 564.234 38.631 564.234 c
38.185 564.234 37.741 564.050 37.425 563.734 c
37.109 563.418 36.925 562.974 36.925 562.527 c
36.925 562.081 37.109 561.637 37.425 561.321 c
37.741 561.005 38.185 560.821 38.631 560.821 c
39.078 560.821 39.522 561.005 39.838 561.321 c
40.154 561.637 40.337 562.081 40.337 562.527 c f
BT 45.750 559.560 Td /F1 9.8 Tf  [(Good baseline data to facilitate better understanding of the impacts of drought, the role of drought plans and drought )] TJ ET
BT 45.750 547.655 Td /F1 9.8 Tf  [(mitigation strategies)] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(Recommendations for research into other areas of drought include:)] TJ ET
40.337 508.063 m 
40.337 508.510 40.154 508.954 39.838 509.270 c
39.522 509.585 39.078 509.769 38.631 509.769 c
38.185 509.769 37.741 509.585 37.425 509.270 c
37.109 508.954 36.925 508.510 36.925 508.063 c
36.925 507.616 37.109 507.172 37.425 506.856 c
37.741 506.541 38.185 506.357 38.631 506.357 c
39.078 506.357 39.522 506.541 39.838 506.856 c
40.154 507.172 40.337 507.616 40.337 508.063 c f
BT 45.750 505.095 Td /F1 9.8 Tf  [(Links with other extreme events, especially flood, heat and wildfires)] TJ ET
40.337 492.408 m 
40.337 492.855 40.154 493.299 39.838 493.615 c
39.522 493.931 39.078 494.115 38.631 494.115 c
38.185 494.115 37.741 493.931 37.425 493.615 c
37.109 493.299 36.925 492.855 36.925 492.408 c
36.925 491.962 37.109 491.518 37.425 491.202 c
37.741 490.886 38.185 490.702 38.631 490.702 c
39.078 490.702 39.522 490.886 39.838 491.202 c
40.154 491.518 40.337 491.962 40.337 492.408 c f
BT 45.750 489.441 Td /F1 9.8 Tf  [(Long term impacts of malnutrition \(reflecting the Barker hypothesis of how nutrition influences heart health\) )] TJ ET
BT 45.750 477.536 Td /F1 9.8 Tf  [(\(https://www.thebarkertheory.org/index.php\);)] TJ ET
40.337 464.849 m 
40.337 465.295 40.154 465.739 39.838 466.055 c
39.522 466.371 39.078 466.555 38.631 466.555 c
38.185 466.555 37.741 466.371 37.425 466.055 c
37.109 465.739 36.925 465.295 36.925 464.849 c
36.925 464.402 37.109 463.958 37.425 463.642 c
37.741 463.326 38.185 463.143 38.631 463.143 c
39.078 463.143 39.522 463.326 39.838 463.642 c
40.154 463.958 40.337 464.402 40.337 464.849 c f
BT 45.750 461.881 Td /F1 9.8 Tf  [(Alcohol use and its relationship to sufferers of drought;)] TJ ET
40.337 449.194 m 
40.337 449.641 40.154 450.085 39.838 450.401 c
39.522 450.716 39.078 450.900 38.631 450.900 c
38.185 450.900 37.741 450.716 37.425 450.401 c
37.109 450.085 36.925 449.641 36.925 449.194 c
36.925 448.747 37.109 448.303 37.425 447.987 c
37.741 447.672 38.185 447.488 38.631 447.488 c
39.078 447.488 39.522 447.672 39.838 447.987 c
40.154 448.303 40.337 448.747 40.337 449.194 c f
BT 45.750 446.226 Td /F1 9.8 Tf  [(Gender differences in experiences of drought-related mental health problems;)] TJ ET
40.337 433.539 m 
40.337 433.986 40.154 434.430 39.838 434.746 c
39.522 435.062 39.078 435.246 38.631 435.246 c
38.185 435.246 37.741 435.062 37.425 434.746 c
37.109 434.430 36.925 433.986 36.925 433.539 c
36.925 433.093 37.109 432.649 37.425 432.333 c
37.741 432.017 38.185 431.833 38.631 431.833 c
39.078 431.833 39.522 432.017 39.838 432.333 c
40.154 432.649 40.337 433.093 40.337 433.539 c f
BT 45.750 430.572 Td /F1 9.8 Tf  [(The impacts of disrupted electricity supply on the health of vulnerable populations;)] TJ ET
40.337 417.885 m 
40.337 418.331 40.154 418.775 39.838 419.091 c
39.522 419.407 39.078 419.591 38.631 419.591 c
38.185 419.591 37.741 419.407 37.425 419.091 c
37.109 418.775 36.925 418.331 36.925 417.885 c
36.925 417.438 37.109 416.994 37.425 416.678 c
37.741 416.362 38.185 416.178 38.631 416.178 c
39.078 416.178 39.522 416.362 39.838 416.678 c
40.154 416.994 40.337 417.438 40.337 417.885 c f
BT 45.750 414.917 Td /F1 9.8 Tf  [(The impacts of drought on vector borne disease;)] TJ ET
40.337 402.230 m 
40.337 402.676 40.154 403.120 39.838 403.436 c
39.522 403.752 39.078 403.936 38.631 403.936 c
38.185 403.936 37.741 403.752 37.425 403.436 c
37.109 403.120 36.925 402.676 36.925 402.230 c
36.925 401.783 37.109 401.339 37.425 401.023 c
37.741 400.707 38.185 400.524 38.631 400.524 c
39.078 400.524 39.522 400.707 39.838 401.023 c
40.154 401.339 40.337 401.783 40.337 402.230 c f
BT 45.750 399.262 Td /F1 9.8 Tf  [(The impacts that drought adaptation strategies may have on human health \(i.e., storing rain water and implications for )] TJ ET
BT 45.750 387.357 Td /F1 9.8 Tf  [(increased vector borne disease in some settings\);)] TJ ET
40.337 374.670 m 
40.337 375.117 40.154 375.561 39.838 375.877 c
39.522 376.193 39.078 376.377 38.631 376.377 c
38.185 376.377 37.741 376.193 37.425 375.877 c
37.109 375.561 36.925 375.117 36.925 374.670 c
36.925 374.224 37.109 373.780 37.425 373.464 c
37.741 373.148 38.185 372.964 38.631 372.964 c
39.078 372.964 39.522 373.148 39.838 373.464 c
40.154 373.780 40.337 374.224 40.337 374.670 c f
BT 45.750 371.703 Td /F1 9.8 Tf  [(The complex relationship between drought, conflict and consequent impacts on human health. Related to this may be )] TJ ET
BT 45.750 359.798 Td /F1 9.8 Tf  [(issues of migration and its enormous influence on health.)] TJ ET
BT 26.250 319.445 Td /F4 12.0 Tf  [(CONCLUSIONS)] TJ ET
BT 26.250 299.491 Td /F1 9.8 Tf  [(This review provides valuable evidence which will support emergency coordinators and international assistance agencies in )] TJ ET
BT 26.250 287.586 Td /F1 9.8 Tf  [(efforts to plan for and respond to drought emergencies.)] TJ ET
BT 26.250 268.182 Td /F1 9.8 Tf  [(Health effects identified in the review include nutrition-related effects \(including general malnutrition and mortality, micronutrient )] TJ ET
BT 26.250 256.277 Td /F1 9.8 Tf  [(malnutrition, and anti-nutrient consumption\); water-related disease \(including E coli, cholera and algal bloom\); airborne and dust-)] TJ ET
BT 26.250 244.372 Td /F1 9.8 Tf  [(related disease \(including silo gas exposure and coccidioidomycosis\); vector borne disease \(including malaria, dengue and )] TJ ET
BT 26.250 232.467 Td /F1 9.8 Tf  [(West Nile virus\); mental health effects \(including distress and other emotional consequences\); and other health effects )] TJ ET
BT 26.250 220.563 Td /F1 9.8 Tf  [(\(including wildfire, effects of migration, and damage to infrastructure\). Individual and population vulnerability and resilience )] TJ ET
BT 26.250 208.658 Td /F1 9.8 Tf  [(factors are critical in exacerbating or mitigating any drought-related impact. Understanding these provides valuable opportunities )] TJ ET
BT 26.250 196.753 Td /F1 9.8 Tf  [(for enhancing resilience at both national and community levels, reflecting the call of the Hyogo Framework for Action.)] TJ ET
BT 26.250 177.348 Td /F1 9.8 Tf  [(Forecasting can be used to provide advance warning of the increased risk of adverse climate conditions and can support the )] TJ ET
BT 26.250 165.444 Td /F1 9.8 Tf  [(disaster risk reduction process. In the short to medium term, robust warning and response systems available to resource-rich )] TJ ET
BT 26.250 153.539 Td /F1 9.8 Tf  [(developed countries often mitigate many of the worst adverse health effects of drought. The downside of this success is that the )] TJ ET
BT 26.250 141.634 Td /F1 9.8 Tf  [(health risks of drought may be insufficiently appreciated in these contexts. In the longer term, climate change is likely to lead to )] TJ ET
BT 26.250 129.729 Td /F1 9.8 Tf  [(more frequent and severe droughts in certain areas of the world. Even wealthy countries� drought management systems may )] TJ ET
BT 26.250 117.825 Td /F1 9.8 Tf  [(eventually become overwhelmed and as this happens, the impacts of drought could become correspondingly more marked. )] TJ ET
BT 26.250 105.920 Td /F1 9.8 Tf  [(Consideration of the existing evidence on the health risks associated with drought, combined with continued efforts to improve )] TJ ET
BT 26.250 94.015 Td /F1 9.8 Tf  [(research methodologies to record these complex health effects, will support drought policy, mitigation and adaptation measures )] TJ ET
BT 26.250 82.110 Td /F1 9.8 Tf  [(locally, nationally and internationally.)] TJ ET
Q
q
15.000 35.077 577.500 741.923 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(included in a general overview of the literature as presented here, and the complicated relationship between drought and )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(conflict deserves further attention.)] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(Finally, this is a systematic but not exhaustive review, which included results from peer-reviewed articles only in the final )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(analyses; there are many other valuable reports in grey literature \(sources may include World Food Programme; Food and )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(Agriculture Organization of the United Nations; the International Fund for Agricultural Development, and the Joint United Nations )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(Programme on HIV/AIDS, among others\), in other languages, or found under other search terms such as ENSO. However, )] TJ ET
BT 26.250 688.548 Td /F1 9.8 Tf  [(these are extremely unlikely to change overall conclusions and interpretations, and may be lower quality than the peer review )] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(published reports which were found.)] TJ ET
BT 26.250 657.238 Td /F5 9.8 Tf  [(Calls for the future)] TJ ET
BT 26.250 637.833 Td /F1 9.8 Tf  [(Although this review represents an initial attempt at summarising the available evidence on the global health effects of drought, )] TJ ET
BT 26.250 625.929 Td /F1 9.8 Tf  [(a number of suggestions for improved documentation were identified:)] TJ ET
0.271 0.267 0.267 RG
40.337 609.492 m 
40.337 609.938 40.154 610.382 39.838 610.698 c
39.522 611.014 39.078 611.198 38.631 611.198 c
38.185 611.198 37.741 611.014 37.425 610.698 c
37.109 610.382 36.925 609.938 36.925 609.492 c
36.925 609.045 37.109 608.601 37.425 608.285 c
37.741 607.969 38.185 607.785 38.631 607.785 c
39.078 607.785 39.522 607.969 39.838 608.285 c
40.154 608.601 40.337 609.045 40.337 609.492 c f
BT 45.750 606.524 Td /F1 9.8 Tf  [(Drought with clear identification as a keyword/risk factor)] TJ ET
40.337 593.837 m 
40.337 594.283 40.154 594.727 39.838 595.043 c
39.522 595.359 39.078 595.543 38.631 595.543 c
38.185 595.543 37.741 595.359 37.425 595.043 c
37.109 594.727 36.925 594.283 36.925 593.837 c
36.925 593.390 37.109 592.946 37.425 592.630 c
37.741 592.314 38.185 592.131 38.631 592.131 c
39.078 592.131 39.522 592.314 39.838 592.630 c
40.154 592.946 40.337 593.390 40.337 593.837 c f
BT 45.750 590.869 Td /F1 9.8 Tf  [(More systematic reporting of drought impacts)] TJ ET
40.337 578.182 m 
40.337 578.629 40.154 579.073 39.838 579.389 c
39.522 579.704 39.078 579.888 38.631 579.888 c
38.185 579.888 37.741 579.704 37.425 579.389 c
37.109 579.073 36.925 578.629 36.925 578.182 c
36.925 577.735 37.109 577.291 37.425 576.975 c
37.741 576.660 38.185 576.476 38.631 576.476 c
39.078 576.476 39.522 576.660 39.838 576.975 c
40.154 577.291 40.337 577.735 40.337 578.182 c f
BT 45.750 575.214 Td /F1 9.8 Tf  [(Standardization of definitions to facilitate future trend analysis and meta-analysis / comparative analysis.)] TJ ET
40.337 562.527 m 
40.337 562.974 40.154 563.418 39.838 563.734 c
39.522 564.050 39.078 564.234 38.631 564.234 c
38.185 564.234 37.741 564.050 37.425 563.734 c
37.109 563.418 36.925 562.974 36.925 562.527 c
36.925 562.081 37.109 561.637 37.425 561.321 c
37.741 561.005 38.185 560.821 38.631 560.821 c
39.078 560.821 39.522 561.005 39.838 561.321 c
40.154 561.637 40.337 562.081 40.337 562.527 c f
BT 45.750 559.560 Td /F1 9.8 Tf  [(Good baseline data to facilitate better understanding of the impacts of drought, the role of drought plans and drought )] TJ ET
BT 45.750 547.655 Td /F1 9.8 Tf  [(mitigation strategies)] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(Recommendations for research into other areas of drought include:)] TJ ET
40.337 508.063 m 
40.337 508.510 40.154 508.954 39.838 509.270 c
39.522 509.585 39.078 509.769 38.631 509.769 c
38.185 509.769 37.741 509.585 37.425 509.270 c
37.109 508.954 36.925 508.510 36.925 508.063 c
36.925 507.616 37.109 507.172 37.425 506.856 c
37.741 506.541 38.185 506.357 38.631 506.357 c
39.078 506.357 39.522 506.541 39.838 506.856 c
40.154 507.172 40.337 507.616 40.337 508.063 c f
BT 45.750 505.095 Td /F1 9.8 Tf  [(Links with other extreme events, especially flood, heat and wildfires)] TJ ET
40.337 492.408 m 
40.337 492.855 40.154 493.299 39.838 493.615 c
39.522 493.931 39.078 494.115 38.631 494.115 c
38.185 494.115 37.741 493.931 37.425 493.615 c
37.109 493.299 36.925 492.855 36.925 492.408 c
36.925 491.962 37.109 491.518 37.425 491.202 c
37.741 490.886 38.185 490.702 38.631 490.702 c
39.078 490.702 39.522 490.886 39.838 491.202 c
40.154 491.518 40.337 491.962 40.337 492.408 c f
BT 45.750 489.441 Td /F1 9.8 Tf  [(Long term impacts of malnutrition \(reflecting the Barker hypothesis of how nutrition influences heart health\) )] TJ ET
BT 45.750 477.536 Td /F1 9.8 Tf  [(\(https://www.thebarkertheory.org/index.php\);)] TJ ET
40.337 464.849 m 
40.337 465.295 40.154 465.739 39.838 466.055 c
39.522 466.371 39.078 466.555 38.631 466.555 c
38.185 466.555 37.741 466.371 37.425 466.055 c
37.109 465.739 36.925 465.295 36.925 464.849 c
36.925 464.402 37.109 463.958 37.425 463.642 c
37.741 463.326 38.185 463.143 38.631 463.143 c
39.078 463.143 39.522 463.326 39.838 463.642 c
40.154 463.958 40.337 464.402 40.337 464.849 c f
BT 45.750 461.881 Td /F1 9.8 Tf  [(Alcohol use and its relationship to sufferers of drought;)] TJ ET
40.337 449.194 m 
40.337 449.641 40.154 450.085 39.838 450.401 c
39.522 450.716 39.078 450.900 38.631 450.900 c
38.185 450.900 37.741 450.716 37.425 450.401 c
37.109 450.085 36.925 449.641 36.925 449.194 c
36.925 448.747 37.109 448.303 37.425 447.987 c
37.741 447.672 38.185 447.488 38.631 447.488 c
39.078 447.488 39.522 447.672 39.838 447.987 c
40.154 448.303 40.337 448.747 40.337 449.194 c f
BT 45.750 446.226 Td /F1 9.8 Tf  [(Gender differences in experiences of drought-related mental health problems;)] TJ ET
40.337 433.539 m 
40.337 433.986 40.154 434.430 39.838 434.746 c
39.522 435.062 39.078 435.246 38.631 435.246 c
38.185 435.246 37.741 435.062 37.425 434.746 c
37.109 434.430 36.925 433.986 36.925 433.539 c
36.925 433.093 37.109 432.649 37.425 432.333 c
37.741 432.017 38.185 431.833 38.631 431.833 c
39.078 431.833 39.522 432.017 39.838 432.333 c
40.154 432.649 40.337 433.093 40.337 433.539 c f
BT 45.750 430.572 Td /F1 9.8 Tf  [(The impacts of disrupted electricity supply on the health of vulnerable populations;)] TJ ET
40.337 417.885 m 
40.337 418.331 40.154 418.775 39.838 419.091 c
39.522 419.407 39.078 419.591 38.631 419.591 c
38.185 419.591 37.741 419.407 37.425 419.091 c
37.109 418.775 36.925 418.331 36.925 417.885 c
36.925 417.438 37.109 416.994 37.425 416.678 c
37.741 416.362 38.185 416.178 38.631 416.178 c
39.078 416.178 39.522 416.362 39.838 416.678 c
40.154 416.994 40.337 417.438 40.337 417.885 c f
BT 45.750 414.917 Td /F1 9.8 Tf  [(The impacts of drought on vector borne disease;)] TJ ET
40.337 402.230 m 
40.337 402.676 40.154 403.120 39.838 403.436 c
39.522 403.752 39.078 403.936 38.631 403.936 c
38.185 403.936 37.741 403.752 37.425 403.436 c
37.109 403.120 36.925 402.676 36.925 402.230 c
36.925 401.783 37.109 401.339 37.425 401.023 c
37.741 400.707 38.185 400.524 38.631 400.524 c
39.078 400.524 39.522 400.707 39.838 401.023 c
40.154 401.339 40.337 401.783 40.337 402.230 c f
BT 45.750 399.262 Td /F1 9.8 Tf  [(The impacts that drought adaptation strategies may have on human health \(i.e., storing rain water and implications for )] TJ ET
BT 45.750 387.357 Td /F1 9.8 Tf  [(increased vector borne disease in some settings\);)] TJ ET
40.337 374.670 m 
40.337 375.117 40.154 375.561 39.838 375.877 c
39.522 376.193 39.078 376.377 38.631 376.377 c
38.185 376.377 37.741 376.193 37.425 375.877 c
37.109 375.561 36.925 375.117 36.925 374.670 c
36.925 374.224 37.109 373.780 37.425 373.464 c
37.741 373.148 38.185 372.964 38.631 372.964 c
39.078 372.964 39.522 373.148 39.838 373.464 c
40.154 373.780 40.337 374.224 40.337 374.670 c f
BT 45.750 371.703 Td /F1 9.8 Tf  [(The complex relationship between drought, conflict and consequent impacts on human health. Related to this may be )] TJ ET
BT 45.750 359.798 Td /F1 9.8 Tf  [(issues of migration and its enormous influence on health.)] TJ ET
BT 26.250 319.445 Td /F4 12.0 Tf  [(CONCLUSIONS)] TJ ET
BT 26.250 299.491 Td /F1 9.8 Tf  [(This review provides valuable evidence which will support emergency coordinators and international assistance agencies in )] TJ ET
BT 26.250 287.586 Td /F1 9.8 Tf  [(efforts to plan for and respond to drought emergencies.)] TJ ET
BT 26.250 268.182 Td /F1 9.8 Tf  [(Health effects identified in the review include nutrition-related effects \(including general malnutrition and mortality, micronutrient )] TJ ET
BT 26.250 256.277 Td /F1 9.8 Tf  [(malnutrition, and anti-nutrient consumption\); water-related disease \(including E coli, cholera and algal bloom\); airborne and dust-)] TJ ET
BT 26.250 244.372 Td /F1 9.8 Tf  [(related disease \(including silo gas exposure and coccidioidomycosis\); vector borne disease \(including malaria, dengue and )] TJ ET
BT 26.250 232.467 Td /F1 9.8 Tf  [(West Nile virus\); mental health effects \(including distress and other emotional consequences\); and other health effects )] TJ ET
BT 26.250 220.563 Td /F1 9.8 Tf  [(\(including wildfire, effects of migration, and damage to infrastructure\). Individual and population vulnerability and resilience )] TJ ET
BT 26.250 208.658 Td /F1 9.8 Tf  [(factors are critical in exacerbating or mitigating any drought-related impact. Understanding these provides valuable opportunities )] TJ ET
BT 26.250 196.753 Td /F1 9.8 Tf  [(for enhancing resilience at both national and community levels, reflecting the call of the Hyogo Framework for Action.)] TJ ET
BT 26.250 177.348 Td /F1 9.8 Tf  [(Forecasting can be used to provide advance warning of the increased risk of adverse climate conditions and can support the )] TJ ET
BT 26.250 165.444 Td /F1 9.8 Tf  [(disaster risk reduction process. In the short to medium term, robust warning and response systems available to resource-rich )] TJ ET
BT 26.250 153.539 Td /F1 9.8 Tf  [(developed countries often mitigate many of the worst adverse health effects of drought. The downside of this success is that the )] TJ ET
BT 26.250 141.634 Td /F1 9.8 Tf  [(health risks of drought may be insufficiently appreciated in these contexts. In the longer term, climate change is likely to lead to )] TJ ET
BT 26.250 129.729 Td /F1 9.8 Tf  [(more frequent and severe droughts in certain areas of the world. Even wealthy countries� drought management systems may )] TJ ET
BT 26.250 117.825 Td /F1 9.8 Tf  [(eventually become overwhelmed and as this happens, the impacts of drought could become correspondingly more marked. )] TJ ET
BT 26.250 105.920 Td /F1 9.8 Tf  [(Consideration of the existing evidence on the health risks associated with drought, combined with continued efforts to improve )] TJ ET
BT 26.250 94.015 Td /F1 9.8 Tf  [(research methodologies to record these complex health effects, will support drought policy, mitigation and adaptation measures )] TJ ET
BT 26.250 82.110 Td /F1 9.8 Tf  [(locally, nationally and internationally.)] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(16)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 750.278 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
BT 26.250 730.324 Td /F1 9.8 Tf  [(The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 693.722 Td /F4 12.0 Tf  [(Correspondence)] TJ ET
BT 26.250 673.767 Td /F1 9.8 Tf  [(Email: Carla.stanke@phe.gov.uk)] TJ ET
BT 26.250 637.165 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 617.211 Td /F1 9.8 Tf  [(The authors gratefully acknowledge the contributions of the following people: Sheila O�Malley, Katie Carmichael, Karen Hogan, )] TJ ET
BT 26.250 605.306 Td /F1 9.8 Tf  [(Richard Aml�t, Kasia Markiewicz, Owen Landeg, Angie Bone \(Public Health England, UK\); Irene Kreis \(University of )] TJ ET
BT 26.250 593.401 Td /F1 9.8 Tf  [(Wollongong, Australia\); Anthony Stonehouse.)] TJ ET
BT 26.250 564.299 Td /F4 12.0 Tf  [(APPENDIX 1)] TJ ET
BT 26.250 527.147 Td /F4 12.0 Tf  [(�Tables 2-7)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 507.192 Td /F1 9.8 Tf  [(Download PDF)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 470.590 Td /F4 12.0 Tf  [(APPENDIX 2)] TJ ET
BT 26.250 433.438 Td /F4 12.0 Tf  [(Papers)] TJ ET
BT 66.270 433.438 Td /F5 12.0 Tf  [(not)] TJ ET
BT 84.930 433.438 Td /F4 12.0 Tf  [( in tables, used as supporting text in Results section)] TJ ET
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26.625 421.883 176.929 0.750 re f
26.625 201.993 176.929 0.750 re f
26.625 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 31.875 409.667 Td /F1 9.8 Tf  [(Scrimshaw, 1987)] TJ ET
0.267 0.267 0.267 rg
BT 106.648 410.116 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 116.285 409.667 Td /F1 9.8 Tf  [(�)] TJ ET
BT 31.875 399.085 Td /F1 9.8 Tf  [(Yip, 1997)] TJ ET
0.267 0.267 0.267 rg
BT 73.069 399.534 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 388.503 Td /F1 9.8 Tf  [(Taye et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 104.503 388.952 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 377.921 Td /F1 9.8 Tf  [(Black et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 106.667 378.370 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 367.339 Td /F1 9.8 Tf  [(Lockett and Grivetti, 2000)] TJ ET
0.267 0.267 0.267 rg
BT 142.976 367.788 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 356.757 Td /F1 9.8 Tf  [(Moran et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 110.460 357.206 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 346.175 Td /F1 9.8 Tf  [(Gundry et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 114.799 346.624 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 335.593 Td /F1 9.8 Tf  [(Askenazy et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 125.095 336.042 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 325.011 Td /F1 9.8 Tf  [(Vargas et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 113.716 325.460 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 314.429 Td /F1 9.8 Tf  [(Said et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 102.338 314.878 Td /F4 8.7 Tf  [(71)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 303.847 Td /F1 9.8 Tf  [(O�Toole et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 116.963 304.296 Td /F4 8.7 Tf  [(72)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 293.265 Td /F1 9.8 Tf  [(Shehane et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 121.858 293.714 Td /F4 8.7 Tf  [(73)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 282.683 Td /F1 9.8 Tf  [(Kuntz and Murray, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 135.927 283.132 Td /F4 8.7 Tf  [(74)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 272.101 Td /F1 9.8 Tf  [(Snyder and Benotti, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 141.904 272.550 Td /F4 8.7 Tf  [(81)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 261.519 Td /F1 9.8 Tf  [(Soller et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 107.749 261.968 Td /F4 8.7 Tf  [(82)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 250.937 Td /F1 9.8 Tf  [(Walker et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 113.161 251.386 Td /F4 8.7 Tf  [(84)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 240.355 Td /F1 9.8 Tf  [(Mwaura et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 117.499 240.804 Td /F4 8.7 Tf  [(85)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 229.773 Td /F1 9.8 Tf  [(Cook et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 105.585 230.222 Td /F4 8.7 Tf  [(86)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 219.191 Td /F1 9.8 Tf  [(Kwon et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 107.213 219.640 Td /F4 8.7 Tf  [(87)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 208.609 Td /F1 9.8 Tf  [(De Longueville et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 147.315 209.058 Td /F4 8.7 Tf  [(88)] TJ ET
202.804 421.883 204.826 0.750 re f
202.804 201.993 204.826 0.750 re f
202.804 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 208.054 409.667 Td /F1 9.8 Tf  [(Zender and Talamantes, 2006)] TJ ET
0.267 0.267 0.267 rg
BT 338.665 410.116 Td /F4 8.7 Tf  [(91)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 399.085 Td /F1 9.8 Tf  [(Chase and Knight, 2003)] TJ ET
0.267 0.267 0.267 rg
BT 312.662 399.534 Td /F4 8.7 Tf  [(94)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 388.503 Td /F1 9.8 Tf  [(Pontes et al., 2000)] TJ ET
0.267 0.267 0.267 rg
BT 289.359 388.952 Td /F4 8.7 Tf  [(95)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 377.921 Td /F1 9.8 Tf  [(Beebe et al., 2009)] TJ ET
0.267 0.267 0.267 rg
BT 287.195 378.370 Td /F4 8.7 Tf  [(96)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 367.339 Td /F1 9.8 Tf  [(Bouma and Dye, 1997)] TJ ET
0.267 0.267 0.267 rg
BT 305.067 367.788 Td /F4 8.7 Tf  [(97)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 356.757 Td /F1 9.8 Tf  [(Gagnon et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 293.698 357.206 Td /F4 8.7 Tf  [(98)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 346.175 Td /F1 9.8 Tf  [(Kent et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 279.063 346.624 Td /F4 8.7 Tf  [(100)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 335.593 Td /F1 9.8 Tf  [(Shaman et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 336.042 Td /F4 8.7 Tf  [(102)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 325.011 Td /F1 9.8 Tf  [(Shaman et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 325.460 Td /F4 8.7 Tf  [(103)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 314.429 Td /F1 9.8 Tf  [(Shaman et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 314.878 Td /F4 8.7 Tf  [(104)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 303.847 Td /F1 9.8 Tf  [(Wang et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 284.475 304.296 Td /F4 8.7 Tf  [(106)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 293.265 Td /F1 9.8 Tf  [(Shaman et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 293.714 Td /F4 8.7 Tf  [(107)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 282.683 Td /F1 9.8 Tf  [(Deichmeister and Telang, 2011)] TJ ET
0.267 0.267 0.267 rg
BT 343.530 283.132 Td /F4 8.7 Tf  [(108)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 272.101 Td /F1 9.8 Tf  [(Shaman et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 272.550 Td /F4 8.7 Tf  [(109)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 261.519 Td /F1 9.8 Tf  [(Weaver and Reisen, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 320.774 261.968 Td /F4 8.7 Tf  [(110)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 250.937 Td /F1 9.8 Tf  [(Rao et al., 2000)] TJ ET
0.267 0.267 0.267 rg
BT 276.889 251.386 Td /F4 8.7 Tf  [(111)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 240.355 Td /F1 9.8 Tf  [(Barrett et al., 1979)] TJ ET
0.267 0.267 0.267 rg
BT 288.267 240.804 Td /F4 8.7 Tf  [(117)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 229.773 Td /F1 9.8 Tf  [(Fragar et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 287.721 230.222 Td /F4 8.7 Tf  [(118)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 219.191 Td /F1 9.8 Tf  [(Speldewinde et al., 2009)] TJ ET
0.267 0.267 0.267 rg
BT 314.826 219.640 Td /F4 8.7 Tf  [(133)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 208.609 Td /F1 9.8 Tf  [(Sartore et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 290.978 209.058 Td /F4 8.7 Tf  [(136)] TJ ET
406.880 421.883 173.995 0.750 re f
406.880 201.993 173.995 0.750 re f
406.880 201.993 0.750 220.640 re f
580.125 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 412.130 409.667 Td /F1 9.8 Tf  [(Sartore et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 495.054 410.116 Td /F4 8.7 Tf  [(137)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 399.085 Td /F1 9.8 Tf  [(Sartore et al., 2008b)] TJ ET
0.267 0.267 0.267 rg
BT 500.475 399.534 Td /F4 8.7 Tf  [(138)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 388.503 Td /F1 9.8 Tf  [(Fuller et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 487.458 388.952 Td /F4 8.7 Tf  [(139)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 377.921 Td /F1 9.8 Tf  [(Hart et al., 2011)] TJ ET
0.267 0.267 0.267 rg
BT 481.501 378.370 Td /F4 8.7 Tf  [(140)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 367.339 Td /F1 9.8 Tf  [(Page and Fragar, 2002)] TJ ET
0.267 0.267 0.267 rg
BT 512.399 367.788 Td /F4 8.7 Tf  [(134)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 356.757 Td /F1 9.8 Tf  [(Raymond, 1988)] TJ ET
0.267 0.267 0.267 rg
BT 480.955 357.206 Td /F4 8.7 Tf  [(142)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 346.175 Td /F1 9.8 Tf  [(Wu and Li, 2007)] TJ ET
0.267 0.267 0.267 rg
BT 483.129 346.624 Td /F4 8.7 Tf  [(143)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 335.593 Td /F1 9.8 Tf  [(Wu et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 477.708 336.042 Td /F4 8.7 Tf  [(144)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 325.011 Td /F1 9.8 Tf  [(Macpherson, 1994)] TJ ET
0.267 0.267 0.267 rg
BT 492.879 325.460 Td /F4 8.7 Tf  [(145)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 314.429 Td /F1 9.8 Tf  [(Chua, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 462.537 314.878 Td /F4 8.7 Tf  [(146)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 303.847 Td /F1 9.8 Tf  [(UNEP, 2004)] TJ ET
0.267 0.267 0.267 rg
BT 466.320 304.296 Td /F4 8.7 Tf  [(148)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 293.265 Td /F1 9.8 Tf  [(CDC, 2007b)] TJ ET
0.267 0.267 0.267 rg
BT 465.774 293.714 Td /F4 8.7 Tf  [(151)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 282.683 Td /F1 9.8 Tf  [(Finlay et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 489.087 283.132 Td /F4 8.7 Tf  [(154)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 272.101 Td /F1 9.8 Tf  [(Prothero, 1994)] TJ ET
0.267 0.267 0.267 rg
BT 476.626 272.550 Td /F4 8.7 Tf  [(157)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 261.519 Td /F1 9.8 Tf  [(Ahmed, 1990)] TJ ET
0.267 0.267 0.267 rg
BT 470.123 261.968 Td /F4 8.7 Tf  [(158)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 250.937 Td /F1 9.8 Tf  [(Wright and Ford, 1992)] TJ ET
0.267 0.267 0.267 rg
BT 509.133 251.386 Td /F4 8.7 Tf  [(159)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 240.355 Td /F1 9.8 Tf  [(NETL, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 464.156 240.804 Td /F4 8.7 Tf  [(160)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 229.773 Td /F1 9.8 Tf  [(Letard et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 490.725 230.222 Td /F4 8.7 Tf  [(161)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 219.191 Td /F1 9.8 Tf  [(Van Vliet et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 502.103 219.640 Td /F4 8.7 Tf  [(162)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 129.896 Td /F4 12.0 Tf  [(APPENDIX 3)] TJ ET
BT 26.250 92.744 Td /F4 12.0 Tf  [(PRISMA Checklist)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 72.790 Td /F1 9.8 Tf  [(Download PDF)] TJ ET
Q
q
15.000 25.757 577.500 751.243 re W n
0.271 0.267 0.267 rg
BT 26.250 750.278 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
BT 26.250 730.324 Td /F1 9.8 Tf  [(The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 693.722 Td /F4 12.0 Tf  [(Correspondence)] TJ ET
BT 26.250 673.767 Td /F1 9.8 Tf  [(Email: Carla.stanke@phe.gov.uk)] TJ ET
BT 26.250 637.165 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 617.211 Td /F1 9.8 Tf  [(The authors gratefully acknowledge the contributions of the following people: Sheila O�Malley, Katie Carmichael, Karen Hogan, )] TJ ET
BT 26.250 605.306 Td /F1 9.8 Tf  [(Richard Aml�t, Kasia Markiewicz, Owen Landeg, Angie Bone \(Public Health England, UK\); Irene Kreis \(University of )] TJ ET
BT 26.250 593.401 Td /F1 9.8 Tf  [(Wollongong, Australia\); Anthony Stonehouse.)] TJ ET
BT 26.250 564.299 Td /F4 12.0 Tf  [(APPENDIX 1)] TJ ET
BT 26.250 527.147 Td /F4 12.0 Tf  [(�Tables 2-7)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 507.192 Td /F1 9.8 Tf  [(Download PDF)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 470.590 Td /F4 12.0 Tf  [(APPENDIX 2)] TJ ET
BT 26.250 433.438 Td /F4 12.0 Tf  [(Papers)] TJ ET
BT 66.270 433.438 Td /F5 12.0 Tf  [(not)] TJ ET
BT 84.930 433.438 Td /F4 12.0 Tf  [( in tables, used as supporting text in Results section)] TJ ET
q
26.250 423.008 555.000 0.000 re W n
Q
1.000 1.000 1.000 rg
26.250 201.618 555.000 221.390 re f
0.267 0.267 0.267 rg
26.625 421.883 176.929 0.750 re f
26.625 201.993 176.929 0.750 re f
26.625 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 31.875 409.667 Td /F1 9.8 Tf  [(Scrimshaw, 1987)] TJ ET
0.267 0.267 0.267 rg
BT 106.648 410.116 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 116.285 409.667 Td /F1 9.8 Tf  [(�)] TJ ET
BT 31.875 399.085 Td /F1 9.8 Tf  [(Yip, 1997)] TJ ET
0.267 0.267 0.267 rg
BT 73.069 399.534 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 388.503 Td /F1 9.8 Tf  [(Taye et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 104.503 388.952 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 377.921 Td /F1 9.8 Tf  [(Black et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 106.667 378.370 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 367.339 Td /F1 9.8 Tf  [(Lockett and Grivetti, 2000)] TJ ET
0.267 0.267 0.267 rg
BT 142.976 367.788 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 356.757 Td /F1 9.8 Tf  [(Moran et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 110.460 357.206 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 346.175 Td /F1 9.8 Tf  [(Gundry et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 114.799 346.624 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 335.593 Td /F1 9.8 Tf  [(Askenazy et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 125.095 336.042 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 325.011 Td /F1 9.8 Tf  [(Vargas et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 113.716 325.460 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 314.429 Td /F1 9.8 Tf  [(Said et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 102.338 314.878 Td /F4 8.7 Tf  [(71)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 303.847 Td /F1 9.8 Tf  [(O�Toole et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 116.963 304.296 Td /F4 8.7 Tf  [(72)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 293.265 Td /F1 9.8 Tf  [(Shehane et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 121.858 293.714 Td /F4 8.7 Tf  [(73)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 282.683 Td /F1 9.8 Tf  [(Kuntz and Murray, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 135.927 283.132 Td /F4 8.7 Tf  [(74)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 272.101 Td /F1 9.8 Tf  [(Snyder and Benotti, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 141.904 272.550 Td /F4 8.7 Tf  [(81)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 261.519 Td /F1 9.8 Tf  [(Soller et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 107.749 261.968 Td /F4 8.7 Tf  [(82)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 250.937 Td /F1 9.8 Tf  [(Walker et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 113.161 251.386 Td /F4 8.7 Tf  [(84)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 240.355 Td /F1 9.8 Tf  [(Mwaura et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 117.499 240.804 Td /F4 8.7 Tf  [(85)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 229.773 Td /F1 9.8 Tf  [(Cook et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 105.585 230.222 Td /F4 8.7 Tf  [(86)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 219.191 Td /F1 9.8 Tf  [(Kwon et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 107.213 219.640 Td /F4 8.7 Tf  [(87)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 208.609 Td /F1 9.8 Tf  [(De Longueville et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 147.315 209.058 Td /F4 8.7 Tf  [(88)] TJ ET
202.804 421.883 204.826 0.750 re f
202.804 201.993 204.826 0.750 re f
202.804 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 208.054 409.667 Td /F1 9.8 Tf  [(Zender and Talamantes, 2006)] TJ ET
0.267 0.267 0.267 rg
BT 338.665 410.116 Td /F4 8.7 Tf  [(91)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 399.085 Td /F1 9.8 Tf  [(Chase and Knight, 2003)] TJ ET
0.267 0.267 0.267 rg
BT 312.662 399.534 Td /F4 8.7 Tf  [(94)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 388.503 Td /F1 9.8 Tf  [(Pontes et al., 2000)] TJ ET
0.267 0.267 0.267 rg
BT 289.359 388.952 Td /F4 8.7 Tf  [(95)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 377.921 Td /F1 9.8 Tf  [(Beebe et al., 2009)] TJ ET
0.267 0.267 0.267 rg
BT 287.195 378.370 Td /F4 8.7 Tf  [(96)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 367.339 Td /F1 9.8 Tf  [(Bouma and Dye, 1997)] TJ ET
0.267 0.267 0.267 rg
BT 305.067 367.788 Td /F4 8.7 Tf  [(97)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 356.757 Td /F1 9.8 Tf  [(Gagnon et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 293.698 357.206 Td /F4 8.7 Tf  [(98)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 346.175 Td /F1 9.8 Tf  [(Kent et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 279.063 346.624 Td /F4 8.7 Tf  [(100)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 335.593 Td /F1 9.8 Tf  [(Shaman et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 336.042 Td /F4 8.7 Tf  [(102)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 325.011 Td /F1 9.8 Tf  [(Shaman et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 325.460 Td /F4 8.7 Tf  [(103)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 314.429 Td /F1 9.8 Tf  [(Shaman et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 314.878 Td /F4 8.7 Tf  [(104)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 303.847 Td /F1 9.8 Tf  [(Wang et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 284.475 304.296 Td /F4 8.7 Tf  [(106)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 293.265 Td /F1 9.8 Tf  [(Shaman et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 293.714 Td /F4 8.7 Tf  [(107)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 282.683 Td /F1 9.8 Tf  [(Deichmeister and Telang, 2011)] TJ ET
0.267 0.267 0.267 rg
BT 343.530 283.132 Td /F4 8.7 Tf  [(108)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 272.101 Td /F1 9.8 Tf  [(Shaman et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 272.550 Td /F4 8.7 Tf  [(109)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 261.519 Td /F1 9.8 Tf  [(Weaver and Reisen, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 320.774 261.968 Td /F4 8.7 Tf  [(110)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 250.937 Td /F1 9.8 Tf  [(Rao et al., 2000)] TJ ET
0.267 0.267 0.267 rg
BT 276.889 251.386 Td /F4 8.7 Tf  [(111)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 240.355 Td /F1 9.8 Tf  [(Barrett et al., 1979)] TJ ET
0.267 0.267 0.267 rg
BT 288.267 240.804 Td /F4 8.7 Tf  [(117)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 229.773 Td /F1 9.8 Tf  [(Fragar et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 287.721 230.222 Td /F4 8.7 Tf  [(118)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 219.191 Td /F1 9.8 Tf  [(Speldewinde et al., 2009)] TJ ET
0.267 0.267 0.267 rg
BT 314.826 219.640 Td /F4 8.7 Tf  [(133)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 208.609 Td /F1 9.8 Tf  [(Sartore et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 290.978 209.058 Td /F4 8.7 Tf  [(136)] TJ ET
406.880 421.883 173.995 0.750 re f
406.880 201.993 173.995 0.750 re f
406.880 201.993 0.750 220.640 re f
580.125 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 412.130 409.667 Td /F1 9.8 Tf  [(Sartore et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 495.054 410.116 Td /F4 8.7 Tf  [(137)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 399.085 Td /F1 9.8 Tf  [(Sartore et al., 2008b)] TJ ET
0.267 0.267 0.267 rg
BT 500.475 399.534 Td /F4 8.7 Tf  [(138)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 388.503 Td /F1 9.8 Tf  [(Fuller et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 487.458 388.952 Td /F4 8.7 Tf  [(139)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 377.921 Td /F1 9.8 Tf  [(Hart et al., 2011)] TJ ET
0.267 0.267 0.267 rg
BT 481.501 378.370 Td /F4 8.7 Tf  [(140)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 367.339 Td /F1 9.8 Tf  [(Page and Fragar, 2002)] TJ ET
0.267 0.267 0.267 rg
BT 512.399 367.788 Td /F4 8.7 Tf  [(134)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 356.757 Td /F1 9.8 Tf  [(Raymond, 1988)] TJ ET
0.267 0.267 0.267 rg
BT 480.955 357.206 Td /F4 8.7 Tf  [(142)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 346.175 Td /F1 9.8 Tf  [(Wu and Li, 2007)] TJ ET
0.267 0.267 0.267 rg
BT 483.129 346.624 Td /F4 8.7 Tf  [(143)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 335.593 Td /F1 9.8 Tf  [(Wu et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 477.708 336.042 Td /F4 8.7 Tf  [(144)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 325.011 Td /F1 9.8 Tf  [(Macpherson, 1994)] TJ ET
0.267 0.267 0.267 rg
BT 492.879 325.460 Td /F4 8.7 Tf  [(145)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 314.429 Td /F1 9.8 Tf  [(Chua, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 462.537 314.878 Td /F4 8.7 Tf  [(146)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 303.847 Td /F1 9.8 Tf  [(UNEP, 2004)] TJ ET
0.267 0.267 0.267 rg
BT 466.320 304.296 Td /F4 8.7 Tf  [(148)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 293.265 Td /F1 9.8 Tf  [(CDC, 2007b)] TJ ET
0.267 0.267 0.267 rg
BT 465.774 293.714 Td /F4 8.7 Tf  [(151)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 282.683 Td /F1 9.8 Tf  [(Finlay et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 489.087 283.132 Td /F4 8.7 Tf  [(154)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 272.101 Td /F1 9.8 Tf  [(Prothero, 1994)] TJ ET
0.267 0.267 0.267 rg
BT 476.626 272.550 Td /F4 8.7 Tf  [(157)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 261.519 Td /F1 9.8 Tf  [(Ahmed, 1990)] TJ ET
0.267 0.267 0.267 rg
BT 470.123 261.968 Td /F4 8.7 Tf  [(158)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 250.937 Td /F1 9.8 Tf  [(Wright and Ford, 1992)] TJ ET
0.267 0.267 0.267 rg
BT 509.133 251.386 Td /F4 8.7 Tf  [(159)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 240.355 Td /F1 9.8 Tf  [(NETL, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 464.156 240.804 Td /F4 8.7 Tf  [(160)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 229.773 Td /F1 9.8 Tf  [(Letard et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 490.725 230.222 Td /F4 8.7 Tf  [(161)] TJ ET
0.271 0.267 0.267 rg
BT 412.130 219.191 Td /F1 9.8 Tf  [(Van Vliet et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 502.103 219.640 Td /F4 8.7 Tf  [(162)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 129.896 Td /F4 12.0 Tf  [(APPENDIX 3)] TJ ET
BT 26.250 92.744 Td /F4 12.0 Tf  [(PRISMA Checklist)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 72.790 Td /F1 9.8 Tf  [(Download PDF)] TJ ET
Q
q
15.000 25.757 577.500 751.243 re W n
0.271 0.267 0.267 rg
BT 26.250 750.278 Td /F4 12.0 Tf  [(Competing Interests)] TJ ET
BT 26.250 730.324 Td /F1 9.8 Tf  [(The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 693.722 Td /F4 12.0 Tf  [(Correspondence)] TJ ET
BT 26.250 673.767 Td /F1 9.8 Tf  [(Email: Carla.stanke@phe.gov.uk)] TJ ET
BT 26.250 637.165 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 617.211 Td /F1 9.8 Tf  [(The authors gratefully acknowledge the contributions of the following people: Sheila O�Malley, Katie Carmichael, Karen Hogan, )] TJ ET
BT 26.250 605.306 Td /F1 9.8 Tf  [(Richard Aml�t, Kasia Markiewicz, Owen Landeg, Angie Bone \(Public Health England, UK\); Irene Kreis \(University of )] TJ ET
BT 26.250 593.401 Td /F1 9.8 Tf  [(Wollongong, Australia\); Anthony Stonehouse.)] TJ ET
BT 26.250 564.299 Td /F4 12.0 Tf  [(APPENDIX 1)] TJ ET
BT 26.250 527.147 Td /F4 12.0 Tf  [(�Tables 2-7)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 507.192 Td /F1 9.8 Tf  [(Download PDF)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 470.590 Td /F4 12.0 Tf  [(APPENDIX 2)] TJ ET
BT 26.250 433.438 Td /F4 12.0 Tf  [(Papers)] TJ ET
BT 66.270 433.438 Td /F5 12.0 Tf  [(not)] TJ ET
BT 84.930 433.438 Td /F4 12.0 Tf  [( in tables, used as supporting text in Results section)] TJ ET
q
26.250 423.008 555.000 0.000 re W n
Q
1.000 1.000 1.000 rg
26.250 201.618 555.000 221.390 re f
0.267 0.267 0.267 rg
26.625 421.883 176.929 0.750 re f
26.625 201.993 176.929 0.750 re f
26.625 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 31.875 409.667 Td /F1 9.8 Tf  [(Scrimshaw, 1987)] TJ ET
0.267 0.267 0.267 rg
BT 106.648 410.116 Td /F4 8.7 Tf  [(23)] TJ ET
0.271 0.267 0.267 rg
BT 116.285 409.667 Td /F1 9.8 Tf  [(�)] TJ ET
BT 31.875 399.085 Td /F1 9.8 Tf  [(Yip, 1997)] TJ ET
0.267 0.267 0.267 rg
BT 73.069 399.534 Td /F4 8.7 Tf  [(24)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 388.503 Td /F1 9.8 Tf  [(Taye et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 104.503 388.952 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 377.921 Td /F1 9.8 Tf  [(Black et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 106.667 378.370 Td /F4 8.7 Tf  [(34)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 367.339 Td /F1 9.8 Tf  [(Lockett and Grivetti, 2000)] TJ ET
0.267 0.267 0.267 rg
BT 142.976 367.788 Td /F4 8.7 Tf  [(48)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 356.757 Td /F1 9.8 Tf  [(Moran et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 110.460 357.206 Td /F4 8.7 Tf  [(64)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 346.175 Td /F1 9.8 Tf  [(Gundry et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 114.799 346.624 Td /F4 8.7 Tf  [(65)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 335.593 Td /F1 9.8 Tf  [(Askenazy et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 125.095 336.042 Td /F4 8.7 Tf  [(66)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 325.011 Td /F1 9.8 Tf  [(Vargas et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 113.716 325.460 Td /F4 8.7 Tf  [(67)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 314.429 Td /F1 9.8 Tf  [(Said et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 102.338 314.878 Td /F4 8.7 Tf  [(71)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 303.847 Td /F1 9.8 Tf  [(O�Toole et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 116.963 304.296 Td /F4 8.7 Tf  [(72)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 293.265 Td /F1 9.8 Tf  [(Shehane et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 121.858 293.714 Td /F4 8.7 Tf  [(73)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 282.683 Td /F1 9.8 Tf  [(Kuntz and Murray, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 135.927 283.132 Td /F4 8.7 Tf  [(74)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 272.101 Td /F1 9.8 Tf  [(Snyder and Benotti, 2010)] TJ ET
0.267 0.267 0.267 rg
BT 141.904 272.550 Td /F4 8.7 Tf  [(81)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 261.519 Td /F1 9.8 Tf  [(Soller et al., 2005)] TJ ET
0.267 0.267 0.267 rg
BT 107.749 261.968 Td /F4 8.7 Tf  [(82)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 250.937 Td /F1 9.8 Tf  [(Walker et al., 2008)] TJ ET
0.267 0.267 0.267 rg
BT 113.161 251.386 Td /F4 8.7 Tf  [(84)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 240.355 Td /F1 9.8 Tf  [(Mwaura et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 117.499 240.804 Td /F4 8.7 Tf  [(85)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 229.773 Td /F1 9.8 Tf  [(Cook et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 105.585 230.222 Td /F4 8.7 Tf  [(86)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 219.191 Td /F1 9.8 Tf  [(Kwon et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 107.213 219.640 Td /F4 8.7 Tf  [(87)] TJ ET
0.271 0.267 0.267 rg
BT 31.875 208.609 Td /F1 9.8 Tf  [(De Longueville et al., 2012)] TJ ET
0.267 0.267 0.267 rg
BT 147.315 209.058 Td /F4 8.7 Tf  [(88)] TJ ET
202.804 421.883 204.826 0.750 re f
202.804 201.993 204.826 0.750 re f
202.804 201.993 0.750 220.640 re f
0.271 0.267 0.267 rg
BT 208.054 409.667 Td /F1 9.8 Tf  [(Zender and Talamantes, 2006)] TJ ET
0.267 0.267 0.267 rg
BT 338.665 410.116 Td /F4 8.7 Tf  [(91)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 399.085 Td /F1 9.8 Tf  [(Chase and Knight, 2003)] TJ ET
0.267 0.267 0.267 rg
BT 312.662 399.534 Td /F4 8.7 Tf  [(94)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 388.503 Td /F1 9.8 Tf  [(Pontes et al., 2000)] TJ ET
0.267 0.267 0.267 rg
BT 289.359 388.952 Td /F4 8.7 Tf  [(95)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 377.921 Td /F1 9.8 Tf  [(Beebe et al., 2009)] TJ ET
0.267 0.267 0.267 rg
BT 287.195 378.370 Td /F4 8.7 Tf  [(96)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 367.339 Td /F1 9.8 Tf  [(Bouma and Dye, 1997)] TJ ET
0.267 0.267 0.267 rg
BT 305.067 367.788 Td /F4 8.7 Tf  [(97)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 356.757 Td /F1 9.8 Tf  [(Gagnon et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 293.698 357.206 Td /F4 8.7 Tf  [(98)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 346.175 Td /F1 9.8 Tf  [(Kent et al., 2007)] TJ ET
0.267 0.267 0.267 rg
BT 279.063 346.624 Td /F4 8.7 Tf  [(100)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 335.593 Td /F1 9.8 Tf  [(Shaman et al., 2002)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 336.042 Td /F4 8.7 Tf  [(102)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 325.011 Td /F1 9.8 Tf  [(Shaman et al., 2003)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 325.460 Td /F4 8.7 Tf  [(103)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 314.429 Td /F1 9.8 Tf  [(Shaman et al., 2004)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 314.878 Td /F4 8.7 Tf  [(104)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 303.847 Td /F1 9.8 Tf  [(Wang et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 284.475 304.296 Td /F4 8.7 Tf  [(106)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 293.265 Td /F1 9.8 Tf  [(Shaman et al., 2010)] TJ ET
0.267 0.267 0.267 rg
BT 295.317 293.714 Td /F4 8.7 Tf  [(107)] TJ ET
0.271 0.267 0.267 rg
BT 208.054 282.683 Td /F1 9.8 Tf  [(Deichmeister and Telang, 2011)] TJ ET
0.267 0.267 0.267 rg
BT 343.530 283.132 Td /F4 8.7 Tf  [(108)] TJ ET
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BT 26.250 236.872 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 236.872 Td /F1 9.8 Tf  [(Eltahir EAB, Yeh PJF. \(1999\) On the asymmetric response of aquifer water level to floods and droughts in Illinois. Water )] TJ ET
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BT 26.250 205.563 Td /F1 9.8 Tf  [(16.)] TJ ET
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BT 26.250 299.491 Td /F1 9.8 Tf  [(13.)] TJ ET
BT 43.553 299.491 Td /F1 9.8 Tf  [(European Commission \(2012\) Water scarcity and droughts in the European Union. Available at: )] TJ ET
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BT 43.553 236.872 Td /F1 9.8 Tf  [(Eltahir EAB, Yeh PJF. \(1999\) On the asymmetric response of aquifer water level to floods and droughts in Illinois. Water )] TJ ET
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BT 26.250 205.563 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 205.563 Td /F1 9.8 Tf  [(Sheffield J, Wood EF. \(2011\) Drought - Past problems and future scenarios. London, Washington: Earthscan.)] TJ ET
BT 26.250 186.158 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 186.158 Td /F1 9.8 Tf  [(UNISDR \(2011\) Global assessment report on disaster risk reduction: revealing risk, redefining development. United Nations )] TJ ET
BT 26.250 174.253 Td /F1 9.8 Tf  [(International Strategy for Disaster Reduction, Geneva.)] TJ ET
BT 26.250 154.848 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 154.848 Td /F1 9.8 Tf  [(EM-DAT: The OFDA/CRED International Disaster Database, Universite Catholique de Louvain, Brussels, Belgium. )] TJ ET
BT 26.250 142.944 Td /F1 9.8 Tf  [(Available at: https://www.emdat.be/result-disaster-)] TJ ET
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BT 43.553 111.634 Td /F1 9.8 Tf  [(UNEP \(2012\) Early Warning Systems: A State of the Art Analysis and Future Directions. Division of Early Warning and )] TJ ET
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BT 26.250 68.420 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 68.420 Td /F1 9.8 Tf  [(CDC, U.S. Environmental Protection Agency, National Oceanic and Atmospheric Agency, and American Water Works )] TJ ET
BT 26.250 56.515 Td /F1 9.8 Tf  [(Association \(2010\) When every drop counts: protecting public health during drought conditions� a guide for public health )] TJ ET
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15.000 34.730 577.500 742.270 re W n
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BT 43.553 330.801 Td /F1 9.8 Tf  [(WHO \(2012b\) Drought--technical hazard sheet --natural disaster profiles. Available at: )] TJ ET
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BT 43.553 299.491 Td /F1 9.8 Tf  [(European Commission \(2012\) Water scarcity and droughts in the European Union. Available at: )] TJ ET
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BT 26.250 236.872 Td /F1 9.8 Tf  [(15.)] TJ ET
BT 43.553 236.872 Td /F1 9.8 Tf  [(Eltahir EAB, Yeh PJF. \(1999\) On the asymmetric response of aquifer water level to floods and droughts in Illinois. Water )] TJ ET
BT 26.250 224.967 Td /F1 9.8 Tf  [(Resources Research 35 \(4\), 1199-1217.)] TJ ET
BT 26.250 205.563 Td /F1 9.8 Tf  [(16.)] TJ ET
BT 43.553 205.563 Td /F1 9.8 Tf  [(Sheffield J, Wood EF. \(2011\) Drought - Past problems and future scenarios. London, Washington: Earthscan.)] TJ ET
BT 26.250 186.158 Td /F1 9.8 Tf  [(17.)] TJ ET
BT 43.553 186.158 Td /F1 9.8 Tf  [(UNISDR \(2011\) Global assessment report on disaster risk reduction: revealing risk, redefining development. United Nations )] TJ ET
BT 26.250 174.253 Td /F1 9.8 Tf  [(International Strategy for Disaster Reduction, Geneva.)] TJ ET
BT 26.250 154.848 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 154.848 Td /F1 9.8 Tf  [(EM-DAT: The OFDA/CRED International Disaster Database, Universite Catholique de Louvain, Brussels, Belgium. )] TJ ET
BT 26.250 142.944 Td /F1 9.8 Tf  [(Available at: https://www.emdat.be/result-disaster-)] TJ ET
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BT 26.250 111.634 Td /F1 9.8 Tf  [(19.)] TJ ET
BT 43.553 111.634 Td /F1 9.8 Tf  [(UNEP \(2012\) Early Warning Systems: A State of the Art Analysis and Future Directions. Division of Early Warning and )] TJ ET
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BT 26.250 68.420 Td /F1 9.8 Tf  [(20.)] TJ ET
BT 43.553 68.420 Td /F1 9.8 Tf  [(CDC, U.S. Environmental Protection Agency, National Oceanic and Atmospheric Agency, and American Water Works )] TJ ET
BT 26.250 56.515 Td /F1 9.8 Tf  [(Association \(2010\) When every drop counts: protecting public health during drought conditions� a guide for public health )] TJ ET
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Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(18)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 49.381 577.500 727.619 re W n
0.271 0.267 0.267 rg
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BT 43.553 71.167 Td /F1 9.8 Tf  [(CDC \(1986\) Rapid nutrition evaluation during drought conditions--Burkina Faso, 1985. Morbidity and Mortality Weekly )] TJ ET
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q
15.000 49.381 577.500 727.619 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. \(2004\) Health consequences of drought on the Canadian prairies. Eco )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Health 1 \(2\), Supplement SU144-SU154.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(22.)] TJ ET
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BT 26.250 716.762 Td /F1 9.8 Tf  [(statement.org/index.htm)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Scrimshaw NS. \(1987\) The phenomenon of famine. Annual review of nutrition 7, 1-21.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 677.952 Td /F1 9.8 Tf  [(Yip R. \(1997\) Chapter 15: Famine. In: The public health consequences of disasters [Ed. Eric Noji]. Oxford University Press, )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(New York and Oxford.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 646.643 Td /F1 9.8 Tf  [(Taye A, Mariam DH, Murray V. \(2010\) Interim report: review of evidence of the health impact of famine in Ethiopia. )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(Perspectives in Public Health. 130 \(5\), 222-226.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Biellik RJ, Henderson PL. \(1981\) Mortality, nutritional status, and diet during the famine in Karaomoja, Uganda, 1980. )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(Lancet 2 \(8259\), 1330-1333.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Renzaho AMN. \(2006\) Mortality, malnutrition and the humanitarian response to the food crises in Lesotho. Journal of )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(Emergency Primary Health Care 4 \(4\), 15p.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(FAO \(1996\) Rome Declaration on World Food Security and World Food Summit Plan of Action. World Food Summit 13-17 )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(November 1996. Rome.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 521.405 Td /F1 9.8 Tf  [(De Waal A, Taffesse AS, Carruth L. \(2006\) Child survival during the 2002-2003 drought in Ethiopia. Global public health 1 )] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(\(2\), 125-132.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Mason JB, Chotard S, Bailes A, Mebrahtu S, Hailey P. \(2010a\) Impact of drought and HIV on child nutrition in Eastern and )] TJ ET
BT 26.250 478.191 Td /F1 9.8 Tf  [(Southern Africa. Food & Nutrition Bulletin 31 \(3 Suppl\), S209-218.)] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 458.786 Td /F1 9.8 Tf  [(Chotard S, Mason JB, Oliphant NP, Mebrahtu S, Hailey P. \(2010\) Fluctuations in wasting in vulnerable child populations in )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(the Greater Horn of Africa. Food & Nutrition Bulletin 31 \(3 Suppl\), S219-233.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 427.476 Td /F1 9.8 Tf  [(CDC \(2001\) Mortality during a famine--Gode district, Ethiopia, July 2000. Morbidity and Mortality Weekly Report \(MMWR\) )] TJ ET
BT 26.250 415.572 Td /F1 9.8 Tf  [(50 \(15\), 285-288.)] TJ ET
BT 26.250 396.167 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 396.167 Td /F1 9.8 Tf  [(Assefa F, Jabarkhil M Z, Salama P, Spiegel P. \(2001\) Malnutrition and mortality in Kohistan District, Afghanistan, April 2001. )] TJ ET
BT 26.250 384.262 Td /F1 9.8 Tf  [(JAMA 286 \(21\), 2723-8.)] TJ ET
BT 26.250 364.857 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 364.857 Td /F1 9.8 Tf  [(Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. \(2008\) Maternal and child )] TJ ET
BT 26.250 352.953 Td /F1 9.8 Tf  [(undernutrition: global and regional exposures and health consequences. Lancet 371 \(9608\), 243-260.)] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 333.548 Td /F1 9.8 Tf  [(Seaman J, Holt J, Rivers J. \(1978\) The effects of drought on human nutrition in an Ethiopian province. International journal )] TJ ET
BT 26.250 321.643 Td /F1 9.8 Tf  [(of epidemiology 7 \(1\), 31-40.)] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 302.238 Td /F1 9.8 Tf  [(Lindtjorn B. \(1987\) Famine in Ethiopia 1983-1985: kwashiorkor and marasmus in four regions. Annals of Tropical )] TJ ET
BT 26.250 290.334 Td /F1 9.8 Tf  [(Paediatrics 7 \(1\), 1-5.)] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 270.929 Td /F1 9.8 Tf  [(Mason JB, Bailes A, Mason KE, Yambi O, Jonsson U, Hudspeth C, Hailey P, Kendle A, Brunet D, Martel P. \(2005\) AIDS, )] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(drought, and child malnutrition in southern Africa. Public health nutrition 8 \(6\), 551-563.)] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 239.619 Td /F1 9.8 Tf  [(Mason JB, Chotard S, Cercone E, Dieterich M, Oliphant NP, Mebrahtu S, Hailey P. \(2010b\) Identifying priorities for )] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(emergency intervention from child wasting and mortality estimates in vulnerable areas of the Horn of Africa. Food & Nutrition )] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(Bulletin 31 \(3 Suppl\), S234-247.)] TJ ET
BT 26.250 196.405 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 196.405 Td /F1 9.8 Tf  [(Lindtjorn B. \(1990\) Famine in southern Ethiopia 1985-6: population structure, nutritional state, and incidence of death )] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(among children. BMJ 301 \(6761\), 1123-1127.)] TJ ET
BT 26.250 165.096 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 165.096 Td /F1 9.8 Tf  [(CDC \(1985\) Rapid nutritional and health assessment of the population affected by drought-associated famine�Chad. )] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(Morbidity and Mortality Weekly Report \(MMWR\) 34 \(43\), 665-667.)] TJ ET
BT 26.250 133.786 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 133.786 Td /F1 9.8 Tf  [(Swaminathan MC, Rao KV, Rao DH. \(1967\) Food and nutrition in the drought-affected areas of Andhra Pradesh. Indian )] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(Journal of Medical Research 55 \(7\), 768-778.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 102.477 Td /F1 9.8 Tf  [(McDonald MA, Sigman M, Espinosa MP, Neumann CG. \(1994\) Impact of a temporary food shortage on children and their )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(mothers. Child development 65 \(2 Spec No\), 404-415.)] TJ ET
BT 26.250 71.167 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 71.167 Td /F1 9.8 Tf  [(CDC \(1986\) Rapid nutrition evaluation during drought conditions--Burkina Faso, 1985. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(Report \(MMWR\) 35 \(1\), 5-6, 11-12.)] TJ ET
Q
q
15.000 49.381 577.500 727.619 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Smoyer-Tomic K, Klaver J, Soskolne C, Spady D. \(2004\) Health consequences of drought on the Canadian prairies. Eco )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Health 1 \(2\), Supplement SU144-SU154.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(PRISMA: transparent reporting of systematic reviews and meta-analyses. Available at: https://www.prisma-)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(statement.org/index.htm)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(23.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Scrimshaw NS. \(1987\) The phenomenon of famine. Annual review of nutrition 7, 1-21.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(24.)] TJ ET
BT 43.553 677.952 Td /F1 9.8 Tf  [(Yip R. \(1997\) Chapter 15: Famine. In: The public health consequences of disasters [Ed. Eric Noji]. Oxford University Press, )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(New York and Oxford.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(25.)] TJ ET
BT 43.553 646.643 Td /F1 9.8 Tf  [(Taye A, Mariam DH, Murray V. \(2010\) Interim report: review of evidence of the health impact of famine in Ethiopia. )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(Perspectives in Public Health. 130 \(5\), 222-226.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(26.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Biellik RJ, Henderson PL. \(1981\) Mortality, nutritional status, and diet during the famine in Karaomoja, Uganda, 1980. )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(Lancet 2 \(8259\), 1330-1333.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(27.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Renzaho AMN. \(2006\) Mortality, malnutrition and the humanitarian response to the food crises in Lesotho. Journal of )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(Emergency Primary Health Care 4 \(4\), 15p.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(28.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(FAO \(1996\) Rome Declaration on World Food Security and World Food Summit Plan of Action. World Food Summit 13-17 )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(November 1996. Rome.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(29.)] TJ ET
BT 43.553 521.405 Td /F1 9.8 Tf  [(De Waal A, Taffesse AS, Carruth L. \(2006\) Child survival during the 2002-2003 drought in Ethiopia. Global public health 1 )] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(\(2\), 125-132.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(30.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Mason JB, Chotard S, Bailes A, Mebrahtu S, Hailey P. \(2010a\) Impact of drought and HIV on child nutrition in Eastern and )] TJ ET
BT 26.250 478.191 Td /F1 9.8 Tf  [(Southern Africa. Food & Nutrition Bulletin 31 \(3 Suppl\), S209-218.)] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(31.)] TJ ET
BT 43.553 458.786 Td /F1 9.8 Tf  [(Chotard S, Mason JB, Oliphant NP, Mebrahtu S, Hailey P. \(2010\) Fluctuations in wasting in vulnerable child populations in )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(the Greater Horn of Africa. Food & Nutrition Bulletin 31 \(3 Suppl\), S219-233.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(32.)] TJ ET
BT 43.553 427.476 Td /F1 9.8 Tf  [(CDC \(2001\) Mortality during a famine--Gode district, Ethiopia, July 2000. Morbidity and Mortality Weekly Report \(MMWR\) )] TJ ET
BT 26.250 415.572 Td /F1 9.8 Tf  [(50 \(15\), 285-288.)] TJ ET
BT 26.250 396.167 Td /F1 9.8 Tf  [(33.)] TJ ET
BT 43.553 396.167 Td /F1 9.8 Tf  [(Assefa F, Jabarkhil M Z, Salama P, Spiegel P. \(2001\) Malnutrition and mortality in Kohistan District, Afghanistan, April 2001. )] TJ ET
BT 26.250 384.262 Td /F1 9.8 Tf  [(JAMA 286 \(21\), 2723-8.)] TJ ET
BT 26.250 364.857 Td /F1 9.8 Tf  [(34.)] TJ ET
BT 43.553 364.857 Td /F1 9.8 Tf  [(Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. \(2008\) Maternal and child )] TJ ET
BT 26.250 352.953 Td /F1 9.8 Tf  [(undernutrition: global and regional exposures and health consequences. Lancet 371 \(9608\), 243-260.)] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(35.)] TJ ET
BT 43.553 333.548 Td /F1 9.8 Tf  [(Seaman J, Holt J, Rivers J. \(1978\) The effects of drought on human nutrition in an Ethiopian province. International journal )] TJ ET
BT 26.250 321.643 Td /F1 9.8 Tf  [(of epidemiology 7 \(1\), 31-40.)] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(36.)] TJ ET
BT 43.553 302.238 Td /F1 9.8 Tf  [(Lindtjorn B. \(1987\) Famine in Ethiopia 1983-1985: kwashiorkor and marasmus in four regions. Annals of Tropical )] TJ ET
BT 26.250 290.334 Td /F1 9.8 Tf  [(Paediatrics 7 \(1\), 1-5.)] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(37.)] TJ ET
BT 43.553 270.929 Td /F1 9.8 Tf  [(Mason JB, Bailes A, Mason KE, Yambi O, Jonsson U, Hudspeth C, Hailey P, Kendle A, Brunet D, Martel P. \(2005\) AIDS, )] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(drought, and child malnutrition in southern Africa. Public health nutrition 8 \(6\), 551-563.)] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(38.)] TJ ET
BT 43.553 239.619 Td /F1 9.8 Tf  [(Mason JB, Chotard S, Cercone E, Dieterich M, Oliphant NP, Mebrahtu S, Hailey P. \(2010b\) Identifying priorities for )] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(emergency intervention from child wasting and mortality estimates in vulnerable areas of the Horn of Africa. Food & Nutrition )] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(Bulletin 31 \(3 Suppl\), S234-247.)] TJ ET
BT 26.250 196.405 Td /F1 9.8 Tf  [(39.)] TJ ET
BT 43.553 196.405 Td /F1 9.8 Tf  [(Lindtjorn B. \(1990\) Famine in southern Ethiopia 1985-6: population structure, nutritional state, and incidence of death )] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(among children. BMJ 301 \(6761\), 1123-1127.)] TJ ET
BT 26.250 165.096 Td /F1 9.8 Tf  [(40.)] TJ ET
BT 43.553 165.096 Td /F1 9.8 Tf  [(CDC \(1985\) Rapid nutritional and health assessment of the population affected by drought-associated famine�Chad. )] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(Morbidity and Mortality Weekly Report \(MMWR\) 34 \(43\), 665-667.)] TJ ET
BT 26.250 133.786 Td /F1 9.8 Tf  [(41.)] TJ ET
BT 43.553 133.786 Td /F1 9.8 Tf  [(Swaminathan MC, Rao KV, Rao DH. \(1967\) Food and nutrition in the drought-affected areas of Andhra Pradesh. Indian )] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(Journal of Medical Research 55 \(7\), 768-778.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(42.)] TJ ET
BT 43.553 102.477 Td /F1 9.8 Tf  [(McDonald MA, Sigman M, Espinosa MP, Neumann CG. \(1994\) Impact of a temporary food shortage on children and their )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(mothers. Child development 65 \(2 Spec No\), 404-415.)] TJ ET
BT 26.250 71.167 Td /F1 9.8 Tf  [(43.)] TJ ET
BT 43.553 71.167 Td /F1 9.8 Tf  [(CDC \(1986\) Rapid nutrition evaluation during drought conditions--Burkina Faso, 1985. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(Report \(MMWR\) 35 \(1\), 5-6, 11-12.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(19)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 49.381 577.500 727.619 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(CDC \(1988a\) Rapid nutrition evaluation in drought-affected regions of Somalia�1987. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Report \(MMWR\) 37 \(7\), 104-107.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Singh MB, Fotedar R, Lakshminarayana J, Anand PK. \(2006a\) Studies on the nutritional status of children aged 0-5 years in )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(a drought-affected desert area of western Rajasthan, India. Public health nutrition 9 \(8\), 961-967.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Desai NC, Desai S, Desai R. \(1992\) Xerophthalmia clinics in rural eye camps. International Ophthalmology 16 \(3\), 139-145.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 677.952 Td /F1 9.8 Tf  [(Wolde-Gebriel Z, Gebru H, Fisseha T, West CE. \(1993\) Severe vitamin A deficiency in a rural village in the Hararge region )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(of Ethiopia. European Journal of Clinical Nutrition 47 \(2\), 104-114.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(48.)] TJ ET
BT 43.553 646.643 Td /F1 9.8 Tf  [(Lockett CT, Grivetti LE. \(2000\) Food-related behaviors during drought: a study of rural Fulani, northeastern Nigeria. )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(International Journal of Food Sciences & Nutrition 51 \(2\), 91-107.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(49.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Mohabbat O, Younos MS, Merzad AA, Srivastava RN, Sediq GG, Aram GN. \(1976\) An outbreak of hepatic veno-occlusive )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(disease in north-western Afghanistan. Lancet 2 \(7980\), 269-271.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(50.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Krishnamachari KA, Bhat VR, Nagarajan V, Tilak TB, Tulpule PG. \(1977\) The problem of aflatoxic human disease in parts of )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(India-epidemiological and ecological aspects. Annales de la nutrition et de l'alimentation 31 \(4-6\), 991-996.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(51.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Yang GQ, Wang SZ, Zhou RH, Sun SZ. \(1983\) Endemic selenium intoxication of humans in China. American Journal of )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(Clinical Nutrition 37 \(5\), 872-881.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(52.)] TJ ET
BT 43.553 521.405 Td /F1 9.8 Tf  [(Getahun H, Mekonnen A, TekleHaimanot R, Lambein F. \(1999\) Epidemic of neurolathyrism in Ethiopia. Lancet 354 \(9175\), )] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(306-307.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(53.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Mlingi NLV, Nkya S, Tatala SR, Rashid S, Bradbury JH. \(2011\) Recurrence of konzo in southern Tanzania: Rehabilitation )] TJ ET
BT 26.250 478.191 Td /F1 9.8 Tf  [(and prevention using the wetting method. Food and Chemical Toxicology 49, 673-677.)] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(54.)] TJ ET
BT 43.553 458.786 Td /F1 9.8 Tf  [(Cliff J, Lundqvist P, Martensson J, Rosling H, Sorbo B. \(1985\) Association of high cyanide and low sulphur intake in )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(cassava-induced spastic paraparesis. Lancet 2 \(8466\), 1211-1213.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(55.)] TJ ET
BT 43.553 427.476 Td /F1 9.8 Tf  [(Cliff J. \(1994\) Cassava safety in times of war and drought in Mozambique. Acta Horticulture 375, 373-378.)] TJ ET
BT 26.250 408.072 Td /F1 9.8 Tf  [(56.)] TJ ET
BT 43.553 408.072 Td /F1 9.8 Tf  [(Cliff J, Muquingue H, Nhassico D, Nzwalo H, Bradbury JH. \(2011\) Konzo and continuing cyanide intoxication from cassava )] TJ ET
BT 26.250 396.167 Td /F1 9.8 Tf  [(in Mozambique. Food and Chemical Toxicology 49, 631-635.)] TJ ET
BT 26.250 376.762 Td /F1 9.8 Tf  [(57.)] TJ ET
BT 43.553 376.762 Td /F1 9.8 Tf  [(Singh MB, Lakshminarayana J, Fotedar R, Anand PK. \(2006b\) Childhood illnesses and malnutrition in under five children in )] TJ ET
BT 26.250 364.857 Td /F1 9.8 Tf  [(drought affected desert area of western Rajasthan, India. Journal of Communicable Diseases 38 \(1\), 88-96.)] TJ ET
BT 26.250 345.453 Td /F1 9.8 Tf  [(58.)] TJ ET
BT 43.553 345.453 Td /F1 9.8 Tf  [(Renzaho AMN. \(2007\) Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-)] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(ravaged population of Tete province Mozambique. Prehospital & Disaster Medicine 22 \(1\), 26-34.)] TJ ET
BT 26.250 314.143 Td /F1 9.8 Tf  [(59.)] TJ ET
BT 43.553 314.143 Td /F1 9.8 Tf  [(Arlappa N, Rao K M, Venkaiah K, Brahmam G N V, Vijayaraghavan K. \(2009a\) Nutritional parameters and chronic energy )] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(deficiency in older adults of desert areas of Western Rajasthan, India. Journal of Nutrition for the Elderly 28 \(1\), 61-71.)] TJ ET
BT 26.250 282.834 Td /F1 9.8 Tf  [(60.)] TJ ET
BT 43.553 282.834 Td /F1 9.8 Tf  [(Arlappa N, Venkaiah K, Rao K M, Reddy G, Kumar S S, Ravindranath M, Brahmam G N V, Vijayaraghavan K. \(2009b\) )] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(Prevalence of chronic energy deficiency in rural-dwelling older Indian adults during a period of severe drought. Journal of )] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(Nutrition for the Elderly 28 \(3\), 301-312.)] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(61.)] TJ ET
BT 43.553 239.619 Td /F1 9.8 Tf  [(O'Keefe SJ. \(1983\) Malnutrition among adult hospitalized patients in Zululand during the drought of 1983. South African )] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde 64 \(16\), 628-629.)] TJ ET
BT 26.250 208.310 Td /F1 9.8 Tf  [(62.)] TJ ET
BT 43.553 208.310 Td /F1 9.8 Tf  [(Carnel MA, Guyon AB. \(1990\) Nutritional status, migration, mortality, and measles vaccine coverage during the 1983-1985 )] TJ ET
BT 26.250 196.405 Td /F1 9.8 Tf  [(drought period: Timbuktu, Mali. Journal of Tropical Pediatrics, 36 \(3\), 109-113.)] TJ ET
BT 26.250 177.000 Td /F1 9.8 Tf  [(63.)] TJ ET
BT 43.553 177.000 Td /F1 9.8 Tf  [(Kidane, A. \(1990\) Mortality estimates of the 1984-85. Ethiopian famine. Scandinavian Journal of Social Medicine 18 \(4\), 281-)] TJ ET
BT 26.250 165.096 Td /F1 9.8 Tf  [(286.)] TJ ET
BT 26.250 145.691 Td /F1 9.8 Tf  [(64.)] TJ ET
BT 43.553 145.691 Td /F1 9.8 Tf  [(Moran P, Nhandara C, Hove I, Charimari L, Katito C, Bradley M, Williams MA. \(1997\) Contamination of traditional drinking )] TJ ET
BT 26.250 133.786 Td /F1 9.8 Tf  [(water sources during a period of extreme drought in the Zvimba communal lands, Zimbabwe.[Erratum appears in Cent Afr J )] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(Med 1998 Jul;44\(7\):189], Central African Journal of Medicine 43 \(11\), 316-321.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(65.)] TJ ET
BT 43.553 102.477 Td /F1 9.8 Tf  [(Gundry S, Wright J, Conroy R. \(2004\) A systematic review of the health outcomes related to household water quality in )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(developing countries. Journal of water and health 2 \(1\), 1-13.)] TJ ET
BT 26.250 71.167 Td /F1 9.8 Tf  [(66.)] TJ ET
BT 43.553 71.167 Td /F1 9.8 Tf  [(Askenazy F L, Sorci K, Benoit M, Lestideau K, Myquel M, Lecrubier Y. \(2003\) Anxiety and impulsivity levels identify relevant )] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(subtypes in adolescents with at-risk behavior. Journal of Affective Disorders 74 \(3\), 219-227.)] TJ ET
Q
q
15.000 49.381 577.500 727.619 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(CDC \(1988a\) Rapid nutrition evaluation in drought-affected regions of Somalia�1987. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Report \(MMWR\) 37 \(7\), 104-107.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Singh MB, Fotedar R, Lakshminarayana J, Anand PK. \(2006a\) Studies on the nutritional status of children aged 0-5 years in )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(a drought-affected desert area of western Rajasthan, India. Public health nutrition 9 \(8\), 961-967.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Desai NC, Desai S, Desai R. \(1992\) Xerophthalmia clinics in rural eye camps. International Ophthalmology 16 \(3\), 139-145.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 677.952 Td /F1 9.8 Tf  [(Wolde-Gebriel Z, Gebru H, Fisseha T, West CE. \(1993\) Severe vitamin A deficiency in a rural village in the Hararge region )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(of Ethiopia. European Journal of Clinical Nutrition 47 \(2\), 104-114.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(48.)] TJ ET
BT 43.553 646.643 Td /F1 9.8 Tf  [(Lockett CT, Grivetti LE. \(2000\) Food-related behaviors during drought: a study of rural Fulani, northeastern Nigeria. )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(International Journal of Food Sciences & Nutrition 51 \(2\), 91-107.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(49.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Mohabbat O, Younos MS, Merzad AA, Srivastava RN, Sediq GG, Aram GN. \(1976\) An outbreak of hepatic veno-occlusive )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(disease in north-western Afghanistan. Lancet 2 \(7980\), 269-271.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(50.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Krishnamachari KA, Bhat VR, Nagarajan V, Tilak TB, Tulpule PG. \(1977\) The problem of aflatoxic human disease in parts of )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(India-epidemiological and ecological aspects. Annales de la nutrition et de l'alimentation 31 \(4-6\), 991-996.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(51.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Yang GQ, Wang SZ, Zhou RH, Sun SZ. \(1983\) Endemic selenium intoxication of humans in China. American Journal of )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(Clinical Nutrition 37 \(5\), 872-881.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(52.)] TJ ET
BT 43.553 521.405 Td /F1 9.8 Tf  [(Getahun H, Mekonnen A, TekleHaimanot R, Lambein F. \(1999\) Epidemic of neurolathyrism in Ethiopia. Lancet 354 \(9175\), )] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(306-307.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(53.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Mlingi NLV, Nkya S, Tatala SR, Rashid S, Bradbury JH. \(2011\) Recurrence of konzo in southern Tanzania: Rehabilitation )] TJ ET
BT 26.250 478.191 Td /F1 9.8 Tf  [(and prevention using the wetting method. Food and Chemical Toxicology 49, 673-677.)] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(54.)] TJ ET
BT 43.553 458.786 Td /F1 9.8 Tf  [(Cliff J, Lundqvist P, Martensson J, Rosling H, Sorbo B. \(1985\) Association of high cyanide and low sulphur intake in )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(cassava-induced spastic paraparesis. Lancet 2 \(8466\), 1211-1213.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(55.)] TJ ET
BT 43.553 427.476 Td /F1 9.8 Tf  [(Cliff J. \(1994\) Cassava safety in times of war and drought in Mozambique. Acta Horticulture 375, 373-378.)] TJ ET
BT 26.250 408.072 Td /F1 9.8 Tf  [(56.)] TJ ET
BT 43.553 408.072 Td /F1 9.8 Tf  [(Cliff J, Muquingue H, Nhassico D, Nzwalo H, Bradbury JH. \(2011\) Konzo and continuing cyanide intoxication from cassava )] TJ ET
BT 26.250 396.167 Td /F1 9.8 Tf  [(in Mozambique. Food and Chemical Toxicology 49, 631-635.)] TJ ET
BT 26.250 376.762 Td /F1 9.8 Tf  [(57.)] TJ ET
BT 43.553 376.762 Td /F1 9.8 Tf  [(Singh MB, Lakshminarayana J, Fotedar R, Anand PK. \(2006b\) Childhood illnesses and malnutrition in under five children in )] TJ ET
BT 26.250 364.857 Td /F1 9.8 Tf  [(drought affected desert area of western Rajasthan, India. Journal of Communicable Diseases 38 \(1\), 88-96.)] TJ ET
BT 26.250 345.453 Td /F1 9.8 Tf  [(58.)] TJ ET
BT 43.553 345.453 Td /F1 9.8 Tf  [(Renzaho AMN. \(2007\) Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-)] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(ravaged population of Tete province Mozambique. Prehospital & Disaster Medicine 22 \(1\), 26-34.)] TJ ET
BT 26.250 314.143 Td /F1 9.8 Tf  [(59.)] TJ ET
BT 43.553 314.143 Td /F1 9.8 Tf  [(Arlappa N, Rao K M, Venkaiah K, Brahmam G N V, Vijayaraghavan K. \(2009a\) Nutritional parameters and chronic energy )] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(deficiency in older adults of desert areas of Western Rajasthan, India. Journal of Nutrition for the Elderly 28 \(1\), 61-71.)] TJ ET
BT 26.250 282.834 Td /F1 9.8 Tf  [(60.)] TJ ET
BT 43.553 282.834 Td /F1 9.8 Tf  [(Arlappa N, Venkaiah K, Rao K M, Reddy G, Kumar S S, Ravindranath M, Brahmam G N V, Vijayaraghavan K. \(2009b\) )] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(Prevalence of chronic energy deficiency in rural-dwelling older Indian adults during a period of severe drought. Journal of )] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(Nutrition for the Elderly 28 \(3\), 301-312.)] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(61.)] TJ ET
BT 43.553 239.619 Td /F1 9.8 Tf  [(O'Keefe SJ. \(1983\) Malnutrition among adult hospitalized patients in Zululand during the drought of 1983. South African )] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde 64 \(16\), 628-629.)] TJ ET
BT 26.250 208.310 Td /F1 9.8 Tf  [(62.)] TJ ET
BT 43.553 208.310 Td /F1 9.8 Tf  [(Carnel MA, Guyon AB. \(1990\) Nutritional status, migration, mortality, and measles vaccine coverage during the 1983-1985 )] TJ ET
BT 26.250 196.405 Td /F1 9.8 Tf  [(drought period: Timbuktu, Mali. Journal of Tropical Pediatrics, 36 \(3\), 109-113.)] TJ ET
BT 26.250 177.000 Td /F1 9.8 Tf  [(63.)] TJ ET
BT 43.553 177.000 Td /F1 9.8 Tf  [(Kidane, A. \(1990\) Mortality estimates of the 1984-85. Ethiopian famine. Scandinavian Journal of Social Medicine 18 \(4\), 281-)] TJ ET
BT 26.250 165.096 Td /F1 9.8 Tf  [(286.)] TJ ET
BT 26.250 145.691 Td /F1 9.8 Tf  [(64.)] TJ ET
BT 43.553 145.691 Td /F1 9.8 Tf  [(Moran P, Nhandara C, Hove I, Charimari L, Katito C, Bradley M, Williams MA. \(1997\) Contamination of traditional drinking )] TJ ET
BT 26.250 133.786 Td /F1 9.8 Tf  [(water sources during a period of extreme drought in the Zvimba communal lands, Zimbabwe.[Erratum appears in Cent Afr J )] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(Med 1998 Jul;44\(7\):189], Central African Journal of Medicine 43 \(11\), 316-321.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(65.)] TJ ET
BT 43.553 102.477 Td /F1 9.8 Tf  [(Gundry S, Wright J, Conroy R. \(2004\) A systematic review of the health outcomes related to household water quality in )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(developing countries. Journal of water and health 2 \(1\), 1-13.)] TJ ET
BT 26.250 71.167 Td /F1 9.8 Tf  [(66.)] TJ ET
BT 43.553 71.167 Td /F1 9.8 Tf  [(Askenazy F L, Sorci K, Benoit M, Lestideau K, Myquel M, Lecrubier Y. \(2003\) Anxiety and impulsivity levels identify relevant )] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(subtypes in adolescents with at-risk behavior. Journal of Affective Disorders 74 \(3\), 219-227.)] TJ ET
Q
q
15.000 49.381 577.500 727.619 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(44.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(CDC \(1988a\) Rapid nutrition evaluation in drought-affected regions of Somalia�1987. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(Report \(MMWR\) 37 \(7\), 104-107.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(45.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Singh MB, Fotedar R, Lakshminarayana J, Anand PK. \(2006a\) Studies on the nutritional status of children aged 0-5 years in )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(a drought-affected desert area of western Rajasthan, India. Public health nutrition 9 \(8\), 961-967.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(46.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Desai NC, Desai S, Desai R. \(1992\) Xerophthalmia clinics in rural eye camps. International Ophthalmology 16 \(3\), 139-145.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(47.)] TJ ET
BT 43.553 677.952 Td /F1 9.8 Tf  [(Wolde-Gebriel Z, Gebru H, Fisseha T, West CE. \(1993\) Severe vitamin A deficiency in a rural village in the Hararge region )] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(of Ethiopia. European Journal of Clinical Nutrition 47 \(2\), 104-114.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(48.)] TJ ET
BT 43.553 646.643 Td /F1 9.8 Tf  [(Lockett CT, Grivetti LE. \(2000\) Food-related behaviors during drought: a study of rural Fulani, northeastern Nigeria. )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(International Journal of Food Sciences & Nutrition 51 \(2\), 91-107.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(49.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Mohabbat O, Younos MS, Merzad AA, Srivastava RN, Sediq GG, Aram GN. \(1976\) An outbreak of hepatic veno-occlusive )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(disease in north-western Afghanistan. Lancet 2 \(7980\), 269-271.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(50.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Krishnamachari KA, Bhat VR, Nagarajan V, Tilak TB, Tulpule PG. \(1977\) The problem of aflatoxic human disease in parts of )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(India-epidemiological and ecological aspects. Annales de la nutrition et de l'alimentation 31 \(4-6\), 991-996.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(51.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Yang GQ, Wang SZ, Zhou RH, Sun SZ. \(1983\) Endemic selenium intoxication of humans in China. American Journal of )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(Clinical Nutrition 37 \(5\), 872-881.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(52.)] TJ ET
BT 43.553 521.405 Td /F1 9.8 Tf  [(Getahun H, Mekonnen A, TekleHaimanot R, Lambein F. \(1999\) Epidemic of neurolathyrism in Ethiopia. Lancet 354 \(9175\), )] TJ ET
BT 26.250 509.500 Td /F1 9.8 Tf  [(306-307.)] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(53.)] TJ ET
BT 43.553 490.095 Td /F1 9.8 Tf  [(Mlingi NLV, Nkya S, Tatala SR, Rashid S, Bradbury JH. \(2011\) Recurrence of konzo in southern Tanzania: Rehabilitation )] TJ ET
BT 26.250 478.191 Td /F1 9.8 Tf  [(and prevention using the wetting method. Food and Chemical Toxicology 49, 673-677.)] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(54.)] TJ ET
BT 43.553 458.786 Td /F1 9.8 Tf  [(Cliff J, Lundqvist P, Martensson J, Rosling H, Sorbo B. \(1985\) Association of high cyanide and low sulphur intake in )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(cassava-induced spastic paraparesis. Lancet 2 \(8466\), 1211-1213.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(55.)] TJ ET
BT 43.553 427.476 Td /F1 9.8 Tf  [(Cliff J. \(1994\) Cassava safety in times of war and drought in Mozambique. Acta Horticulture 375, 373-378.)] TJ ET
BT 26.250 408.072 Td /F1 9.8 Tf  [(56.)] TJ ET
BT 43.553 408.072 Td /F1 9.8 Tf  [(Cliff J, Muquingue H, Nhassico D, Nzwalo H, Bradbury JH. \(2011\) Konzo and continuing cyanide intoxication from cassava )] TJ ET
BT 26.250 396.167 Td /F1 9.8 Tf  [(in Mozambique. Food and Chemical Toxicology 49, 631-635.)] TJ ET
BT 26.250 376.762 Td /F1 9.8 Tf  [(57.)] TJ ET
BT 43.553 376.762 Td /F1 9.8 Tf  [(Singh MB, Lakshminarayana J, Fotedar R, Anand PK. \(2006b\) Childhood illnesses and malnutrition in under five children in )] TJ ET
BT 26.250 364.857 Td /F1 9.8 Tf  [(drought affected desert area of western Rajasthan, India. Journal of Communicable Diseases 38 \(1\), 88-96.)] TJ ET
BT 26.250 345.453 Td /F1 9.8 Tf  [(58.)] TJ ET
BT 43.553 345.453 Td /F1 9.8 Tf  [(Renzaho AMN. \(2007\) Mortality rates, prevalence of malnutrition, and prevalence of lost pregnancies among the drought-)] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(ravaged population of Tete province Mozambique. Prehospital & Disaster Medicine 22 \(1\), 26-34.)] TJ ET
BT 26.250 314.143 Td /F1 9.8 Tf  [(59.)] TJ ET
BT 43.553 314.143 Td /F1 9.8 Tf  [(Arlappa N, Rao K M, Venkaiah K, Brahmam G N V, Vijayaraghavan K. \(2009a\) Nutritional parameters and chronic energy )] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(deficiency in older adults of desert areas of Western Rajasthan, India. Journal of Nutrition for the Elderly 28 \(1\), 61-71.)] TJ ET
BT 26.250 282.834 Td /F1 9.8 Tf  [(60.)] TJ ET
BT 43.553 282.834 Td /F1 9.8 Tf  [(Arlappa N, Venkaiah K, Rao K M, Reddy G, Kumar S S, Ravindranath M, Brahmam G N V, Vijayaraghavan K. \(2009b\) )] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(Prevalence of chronic energy deficiency in rural-dwelling older Indian adults during a period of severe drought. Journal of )] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(Nutrition for the Elderly 28 \(3\), 301-312.)] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(61.)] TJ ET
BT 43.553 239.619 Td /F1 9.8 Tf  [(O'Keefe SJ. \(1983\) Malnutrition among adult hospitalized patients in Zululand during the drought of 1983. South African )] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde 64 \(16\), 628-629.)] TJ ET
BT 26.250 208.310 Td /F1 9.8 Tf  [(62.)] TJ ET
BT 43.553 208.310 Td /F1 9.8 Tf  [(Carnel MA, Guyon AB. \(1990\) Nutritional status, migration, mortality, and measles vaccine coverage during the 1983-1985 )] TJ ET
BT 26.250 196.405 Td /F1 9.8 Tf  [(drought period: Timbuktu, Mali. Journal of Tropical Pediatrics, 36 \(3\), 109-113.)] TJ ET
BT 26.250 177.000 Td /F1 9.8 Tf  [(63.)] TJ ET
BT 43.553 177.000 Td /F1 9.8 Tf  [(Kidane, A. \(1990\) Mortality estimates of the 1984-85. Ethiopian famine. Scandinavian Journal of Social Medicine 18 \(4\), 281-)] TJ ET
BT 26.250 165.096 Td /F1 9.8 Tf  [(286.)] TJ ET
BT 26.250 145.691 Td /F1 9.8 Tf  [(64.)] TJ ET
BT 43.553 145.691 Td /F1 9.8 Tf  [(Moran P, Nhandara C, Hove I, Charimari L, Katito C, Bradley M, Williams MA. \(1997\) Contamination of traditional drinking )] TJ ET
BT 26.250 133.786 Td /F1 9.8 Tf  [(water sources during a period of extreme drought in the Zvimba communal lands, Zimbabwe.[Erratum appears in Cent Afr J )] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(Med 1998 Jul;44\(7\):189], Central African Journal of Medicine 43 \(11\), 316-321.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(65.)] TJ ET
BT 43.553 102.477 Td /F1 9.8 Tf  [(Gundry S, Wright J, Conroy R. \(2004\) A systematic review of the health outcomes related to household water quality in )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(developing countries. Journal of water and health 2 \(1\), 1-13.)] TJ ET
BT 26.250 71.167 Td /F1 9.8 Tf  [(66.)] TJ ET
BT 43.553 71.167 Td /F1 9.8 Tf  [(Askenazy F L, Sorci K, Benoit M, Lestideau K, Myquel M, Lecrubier Y. \(2003\) Anxiety and impulsivity levels identify relevant )] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(subtypes in adolescents with at-risk behavior. Journal of Affective Disorders 74 \(3\), 219-227.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(20)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 37.477 577.500 739.523 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(67.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Vargas M, Gascon J, Casals C, Schellenberg D, Urassa H, Kahigwa E, Ruiz J, Vila J. \(2004\) Etiology of diarrhea in children )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(less than five years of age in Ifakara, Tanzania. American Journal of Tropical Medicine & Hygiene 70 \(5\), 536-539.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(68.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Endale D, Fisher D, Owens L, Jenkins M, Schomberg H, Tebes-Stevens C, Bonta J. \(2011\) Runoff water quality during )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(drought in a zero-order Georgia Piedmont pasture: nitrogen and total organic carbon. Journal of Environmental Quality 40 \(3\), )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(969-979.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(69.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Whitworth K, Baldwin D, Kerr J. \(2012\) Drought, floods and water quality: drivers of a severe hypoxic blackwater event in a )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(major river system \(the southern Murray-Darling Basin, Australia\). Journal of Hydrology 450-451, 190-198.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(70.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Drinking Water Inspectorate \(DWI\) \(2011\). Keeping your private water supply safe. Available at: )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(https://dwi.defra.gov.uk/consumers/advice-leaflets/pws.pdf)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(71.)] TJ ET
BT 43.553 622.833 Td /F1 9.8 Tf  [(Said B, Wright F, Nichols GL, Reacher M, Rutter M. \(2003\) Outbreaks of infectious disease associated with private drinking )] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(water supplies in England and Wales 1970-2000. Epidemiology & Infection 130 \(3\), 469-479.)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(72.)] TJ ET
BT 43.553 591.524 Td /F1 9.8 Tf  [(O'Toole J, Leder K, Sinclair M. \(2007\) Recycled water and human health effects. Australian Family Physician 36 \(12\), 998-)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(1000.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(73.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Shehane SD, Harwood VJ, Whitlock JE. and Rose JB. \(2005\) The influence of rainfall on the incidence of microbial faecal )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(indicators and the dominant sources of faecal pollution in a Florida river. Journal of Applied Microbiology 98 \(5\), 1127-1136.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(74.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Kuntz J, Murray R. \(2009\) Predictability of swimming prohibitions by observational parameters: a proactive public health )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(policy, Stamford, Connecticut, 1989-2004. Journal of Environmental Health 72 \(1\), 17-22.)] TJ ET
BT 26.250 497.595 Td /F1 9.8 Tf  [(75.)] TJ ET
BT 43.553 497.595 Td /F1 9.8 Tf  [(Effler E, Isaacson M, Arntzen L, Heenan R, Canter P, Barrett T, Lee L, Mambo C, Levine W, Zaidi A, Griffin PM. \(2001\) )] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(Factors contributing to the emergence of Escherichia coli O157 in Africa. Emerging Infectious Diseases 7 \(5\), 812-819.)] TJ ET
BT 26.250 466.286 Td /F1 9.8 Tf  [(76.)] TJ ET
BT 43.553 466.286 Td /F1 9.8 Tf  [(Tauxe RV, Holmberg SD, Dodin A, Wells JV, Blake PA. \(1988\) Epidemic cholera in Mali: high mortality and multiple routes )] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(of transmission in a famine area. Epidemiology & Infection 100 \(2\), 279-289.)] TJ ET
BT 26.250 434.976 Td /F1 9.8 Tf  [(77.)] TJ ET
BT 43.553 434.976 Td /F1 9.8 Tf  [(Bradley M, Shakespeare R, Ruwende A, Woolhouse ME, Mason E, Munatsi A. \(1996\) Epidemiological features of epidemic )] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(cholera \(El Tor\) in Zimbabwe. Transactions of the Royal Society of Tropical Medicine & Hygiene, 90 \(4\), 378-382.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(78.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(Jackson LA, Kaufmann AF, Adams WG, Phelps MB, Andreasen C, Langkop CW, Francis BJ, Wenger JD. \(1993\) Outbreak )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(of leptospirosis associated with swimming. Pediatric Infectious Disease Journal 12 \(1\), 48-54.)] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(79.)] TJ ET
BT 43.553 372.357 Td /F1 9.8 Tf  [(Thacker SB, Music SI, Pollard RA, Berggren G, Boulos C, Nagy T, Brutus M, Pamphile M, Ferdinand RO, Joseph VR. )] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(\(1980\) Acute water shortage and health problems in Haiti. Lancet 1 \(8166\), 471-473.)] TJ ET
BT 26.250 341.048 Td /F1 9.8 Tf  [(80.)] TJ ET
BT 43.553 341.048 Td /F1 9.8 Tf  [(Burr ML, Davis AR, Zbijowski AG. \(1978\) Diarrhoea and the drought. Public Health, 92 \(2\), 86-87.)] TJ ET
BT 26.250 321.643 Td /F1 9.8 Tf  [(81.)] TJ ET
BT 43.553 321.643 Td /F1 9.8 Tf  [(Snyder SA, Benotti MJ. \(2010\) Endocrine disruptors and pharmaceuticals: implications for water sustainability. Water )] TJ ET
BT 26.250 309.738 Td /F1 9.8 Tf  [(Science & Technology 61 \(1\), 145-154.)] TJ ET
BT 26.250 290.334 Td /F1 9.8 Tf  [(82.)] TJ ET
BT 43.553 290.334 Td /F1 9.8 Tf  [(Soller J, Stephenson J, Olivieri K, Downing J, Olivieri AW. \(2005\) Evaluation of seasonal scale first flush pollutant loading )] TJ ET
BT 26.250 278.429 Td /F1 9.8 Tf  [(and implications for urban runoff management. Journal of Environmental Management 76 \(4\), 309-318.)] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(83.)] TJ ET
BT 43.553 259.024 Td /F1 9.8 Tf  [(Pouria S, de Andrade A, Barossa J, Cavalcanti R, Barreto V, Ward C, Preiser W, Poon G, Neild G, Codd G. \(1998\) Fatal )] TJ ET
BT 26.250 247.119 Td /F1 9.8 Tf  [(microcystin intoxication in haemodialysis unit in Caruaru, Brazil. Lancet 352, 21-26.)] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(84.)] TJ ET
BT 43.553 227.715 Td /F1 9.8 Tf  [(Walker S, Lund J, Schumacher D, Brakhage P, McManus B, Miller J, Augustine M, Carney J, Holland R, Hoagland K, Holz )] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(J, Barrow T, Rundquist D, Gitelson A. \(2008\) Chapter 6: Nebraska experience. In: Cyanobacterial harmful algal blooms: State of )] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(the science and research needs [Ed. H Kenneth Hudnell]. Springer.)] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(85.)] TJ ET
BT 43.553 184.500 Td /F1 9.8 Tf  [(Mwaura F, Koyo A, Zech B. \(2004\) Cyanobacterial blooms and the presence of cyanotoxins in small high altitude tropical )] TJ ET
BT 26.250 172.596 Td /F1 9.8 Tf  [(headwater reservoirs in Kenya. Journal of Water and Health 2 \(1\), 49-57.)] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(86.)] TJ ET
BT 43.553 153.191 Td /F1 9.8 Tf  [(Cook B, Miller R, Seager R. \(2007\) Did dust storms make the dust bowl drought worse? Lamont-Doherty Earth Observatory, )] TJ ET
BT 26.250 141.286 Td /F1 9.8 Tf  [(The Earth Institute at Colombia University. Available at: https://www.ldeo.columbia.edu/res/div/ocp/drought/dust_storms.shtml)] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(87.)] TJ ET
BT 43.553 121.881 Td /F1 9.8 Tf  [(Kwon H-J, Cho S-H, Chun Y, Lagarde F, Pershagen, G. \(2002\) Effects of the Asian dust events on daily mortality in Seoul, )] TJ ET
BT 26.250 109.977 Td /F1 9.8 Tf  [(Korea. Environmental Research 90 \(1\), 1-5.)] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(88.)] TJ ET
BT 43.553 90.572 Td /F1 9.8 Tf  [(de Longueville F, Ozer P, Doumbia S, Henry S. \(2012\) Desert dust impacts on human health: an alarming worldwide reality )] TJ ET
BT 26.250 78.667 Td /F1 9.8 Tf  [(and a need for studies in West Africa. International journal of biometeorology.)] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(89.)] TJ ET
BT 43.553 59.262 Td /F1 9.8 Tf  [(Gomez SR, Parker RA, Dosman JA, McDuffie HH. \(1992\) Respiratory health effects of alkali dust in residents near )] TJ ET
BT 26.250 47.358 Td /F1 9.8 Tf  [(desiccated Old Wives Lake. Archives of Environmental Health 47 \(5\), 364-369.)] TJ ET
Q
q
15.000 37.477 577.500 739.523 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(67.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Vargas M, Gascon J, Casals C, Schellenberg D, Urassa H, Kahigwa E, Ruiz J, Vila J. \(2004\) Etiology of diarrhea in children )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(less than five years of age in Ifakara, Tanzania. American Journal of Tropical Medicine & Hygiene 70 \(5\), 536-539.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(68.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Endale D, Fisher D, Owens L, Jenkins M, Schomberg H, Tebes-Stevens C, Bonta J. \(2011\) Runoff water quality during )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(drought in a zero-order Georgia Piedmont pasture: nitrogen and total organic carbon. Journal of Environmental Quality 40 \(3\), )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(969-979.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(69.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Whitworth K, Baldwin D, Kerr J. \(2012\) Drought, floods and water quality: drivers of a severe hypoxic blackwater event in a )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(major river system \(the southern Murray-Darling Basin, Australia\). Journal of Hydrology 450-451, 190-198.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(70.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Drinking Water Inspectorate \(DWI\) \(2011\). Keeping your private water supply safe. Available at: )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(https://dwi.defra.gov.uk/consumers/advice-leaflets/pws.pdf)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(71.)] TJ ET
BT 43.553 622.833 Td /F1 9.8 Tf  [(Said B, Wright F, Nichols GL, Reacher M, Rutter M. \(2003\) Outbreaks of infectious disease associated with private drinking )] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(water supplies in England and Wales 1970-2000. Epidemiology & Infection 130 \(3\), 469-479.)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(72.)] TJ ET
BT 43.553 591.524 Td /F1 9.8 Tf  [(O'Toole J, Leder K, Sinclair M. \(2007\) Recycled water and human health effects. Australian Family Physician 36 \(12\), 998-)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(1000.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(73.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Shehane SD, Harwood VJ, Whitlock JE. and Rose JB. \(2005\) The influence of rainfall on the incidence of microbial faecal )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(indicators and the dominant sources of faecal pollution in a Florida river. Journal of Applied Microbiology 98 \(5\), 1127-1136.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(74.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Kuntz J, Murray R. \(2009\) Predictability of swimming prohibitions by observational parameters: a proactive public health )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(policy, Stamford, Connecticut, 1989-2004. Journal of Environmental Health 72 \(1\), 17-22.)] TJ ET
BT 26.250 497.595 Td /F1 9.8 Tf  [(75.)] TJ ET
BT 43.553 497.595 Td /F1 9.8 Tf  [(Effler E, Isaacson M, Arntzen L, Heenan R, Canter P, Barrett T, Lee L, Mambo C, Levine W, Zaidi A, Griffin PM. \(2001\) )] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(Factors contributing to the emergence of Escherichia coli O157 in Africa. Emerging Infectious Diseases 7 \(5\), 812-819.)] TJ ET
BT 26.250 466.286 Td /F1 9.8 Tf  [(76.)] TJ ET
BT 43.553 466.286 Td /F1 9.8 Tf  [(Tauxe RV, Holmberg SD, Dodin A, Wells JV, Blake PA. \(1988\) Epidemic cholera in Mali: high mortality and multiple routes )] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(of transmission in a famine area. Epidemiology & Infection 100 \(2\), 279-289.)] TJ ET
BT 26.250 434.976 Td /F1 9.8 Tf  [(77.)] TJ ET
BT 43.553 434.976 Td /F1 9.8 Tf  [(Bradley M, Shakespeare R, Ruwende A, Woolhouse ME, Mason E, Munatsi A. \(1996\) Epidemiological features of epidemic )] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(cholera \(El Tor\) in Zimbabwe. Transactions of the Royal Society of Tropical Medicine & Hygiene, 90 \(4\), 378-382.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(78.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(Jackson LA, Kaufmann AF, Adams WG, Phelps MB, Andreasen C, Langkop CW, Francis BJ, Wenger JD. \(1993\) Outbreak )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(of leptospirosis associated with swimming. Pediatric Infectious Disease Journal 12 \(1\), 48-54.)] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(79.)] TJ ET
BT 43.553 372.357 Td /F1 9.8 Tf  [(Thacker SB, Music SI, Pollard RA, Berggren G, Boulos C, Nagy T, Brutus M, Pamphile M, Ferdinand RO, Joseph VR. )] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(\(1980\) Acute water shortage and health problems in Haiti. Lancet 1 \(8166\), 471-473.)] TJ ET
BT 26.250 341.048 Td /F1 9.8 Tf  [(80.)] TJ ET
BT 43.553 341.048 Td /F1 9.8 Tf  [(Burr ML, Davis AR, Zbijowski AG. \(1978\) Diarrhoea and the drought. Public Health, 92 \(2\), 86-87.)] TJ ET
BT 26.250 321.643 Td /F1 9.8 Tf  [(81.)] TJ ET
BT 43.553 321.643 Td /F1 9.8 Tf  [(Snyder SA, Benotti MJ. \(2010\) Endocrine disruptors and pharmaceuticals: implications for water sustainability. Water )] TJ ET
BT 26.250 309.738 Td /F1 9.8 Tf  [(Science & Technology 61 \(1\), 145-154.)] TJ ET
BT 26.250 290.334 Td /F1 9.8 Tf  [(82.)] TJ ET
BT 43.553 290.334 Td /F1 9.8 Tf  [(Soller J, Stephenson J, Olivieri K, Downing J, Olivieri AW. \(2005\) Evaluation of seasonal scale first flush pollutant loading )] TJ ET
BT 26.250 278.429 Td /F1 9.8 Tf  [(and implications for urban runoff management. Journal of Environmental Management 76 \(4\), 309-318.)] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(83.)] TJ ET
BT 43.553 259.024 Td /F1 9.8 Tf  [(Pouria S, de Andrade A, Barossa J, Cavalcanti R, Barreto V, Ward C, Preiser W, Poon G, Neild G, Codd G. \(1998\) Fatal )] TJ ET
BT 26.250 247.119 Td /F1 9.8 Tf  [(microcystin intoxication in haemodialysis unit in Caruaru, Brazil. Lancet 352, 21-26.)] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(84.)] TJ ET
BT 43.553 227.715 Td /F1 9.8 Tf  [(Walker S, Lund J, Schumacher D, Brakhage P, McManus B, Miller J, Augustine M, Carney J, Holland R, Hoagland K, Holz )] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(J, Barrow T, Rundquist D, Gitelson A. \(2008\) Chapter 6: Nebraska experience. In: Cyanobacterial harmful algal blooms: State of )] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(the science and research needs [Ed. H Kenneth Hudnell]. Springer.)] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(85.)] TJ ET
BT 43.553 184.500 Td /F1 9.8 Tf  [(Mwaura F, Koyo A, Zech B. \(2004\) Cyanobacterial blooms and the presence of cyanotoxins in small high altitude tropical )] TJ ET
BT 26.250 172.596 Td /F1 9.8 Tf  [(headwater reservoirs in Kenya. Journal of Water and Health 2 \(1\), 49-57.)] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(86.)] TJ ET
BT 43.553 153.191 Td /F1 9.8 Tf  [(Cook B, Miller R, Seager R. \(2007\) Did dust storms make the dust bowl drought worse? Lamont-Doherty Earth Observatory, )] TJ ET
BT 26.250 141.286 Td /F1 9.8 Tf  [(The Earth Institute at Colombia University. Available at: https://www.ldeo.columbia.edu/res/div/ocp/drought/dust_storms.shtml)] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(87.)] TJ ET
BT 43.553 121.881 Td /F1 9.8 Tf  [(Kwon H-J, Cho S-H, Chun Y, Lagarde F, Pershagen, G. \(2002\) Effects of the Asian dust events on daily mortality in Seoul, )] TJ ET
BT 26.250 109.977 Td /F1 9.8 Tf  [(Korea. Environmental Research 90 \(1\), 1-5.)] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(88.)] TJ ET
BT 43.553 90.572 Td /F1 9.8 Tf  [(de Longueville F, Ozer P, Doumbia S, Henry S. \(2012\) Desert dust impacts on human health: an alarming worldwide reality )] TJ ET
BT 26.250 78.667 Td /F1 9.8 Tf  [(and a need for studies in West Africa. International journal of biometeorology.)] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(89.)] TJ ET
BT 43.553 59.262 Td /F1 9.8 Tf  [(Gomez SR, Parker RA, Dosman JA, McDuffie HH. \(1992\) Respiratory health effects of alkali dust in residents near )] TJ ET
BT 26.250 47.358 Td /F1 9.8 Tf  [(desiccated Old Wives Lake. Archives of Environmental Health 47 \(5\), 364-369.)] TJ ET
Q
q
15.000 37.477 577.500 739.523 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(67.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Vargas M, Gascon J, Casals C, Schellenberg D, Urassa H, Kahigwa E, Ruiz J, Vila J. \(2004\) Etiology of diarrhea in children )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(less than five years of age in Ifakara, Tanzania. American Journal of Tropical Medicine & Hygiene 70 \(5\), 536-539.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(68.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Endale D, Fisher D, Owens L, Jenkins M, Schomberg H, Tebes-Stevens C, Bonta J. \(2011\) Runoff water quality during )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(drought in a zero-order Georgia Piedmont pasture: nitrogen and total organic carbon. Journal of Environmental Quality 40 \(3\), )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(969-979.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(69.)] TJ ET
BT 43.553 685.452 Td /F1 9.8 Tf  [(Whitworth K, Baldwin D, Kerr J. \(2012\) Drought, floods and water quality: drivers of a severe hypoxic blackwater event in a )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(major river system \(the southern Murray-Darling Basin, Australia\). Journal of Hydrology 450-451, 190-198.)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(70.)] TJ ET
BT 43.553 654.143 Td /F1 9.8 Tf  [(Drinking Water Inspectorate \(DWI\) \(2011\). Keeping your private water supply safe. Available at: )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(https://dwi.defra.gov.uk/consumers/advice-leaflets/pws.pdf)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(71.)] TJ ET
BT 43.553 622.833 Td /F1 9.8 Tf  [(Said B, Wright F, Nichols GL, Reacher M, Rutter M. \(2003\) Outbreaks of infectious disease associated with private drinking )] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(water supplies in England and Wales 1970-2000. Epidemiology & Infection 130 \(3\), 469-479.)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(72.)] TJ ET
BT 43.553 591.524 Td /F1 9.8 Tf  [(O'Toole J, Leder K, Sinclair M. \(2007\) Recycled water and human health effects. Australian Family Physician 36 \(12\), 998-)] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(1000.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(73.)] TJ ET
BT 43.553 560.214 Td /F1 9.8 Tf  [(Shehane SD, Harwood VJ, Whitlock JE. and Rose JB. \(2005\) The influence of rainfall on the incidence of microbial faecal )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(indicators and the dominant sources of faecal pollution in a Florida river. Journal of Applied Microbiology 98 \(5\), 1127-1136.)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(74.)] TJ ET
BT 43.553 528.905 Td /F1 9.8 Tf  [(Kuntz J, Murray R. \(2009\) Predictability of swimming prohibitions by observational parameters: a proactive public health )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(policy, Stamford, Connecticut, 1989-2004. Journal of Environmental Health 72 \(1\), 17-22.)] TJ ET
BT 26.250 497.595 Td /F1 9.8 Tf  [(75.)] TJ ET
BT 43.553 497.595 Td /F1 9.8 Tf  [(Effler E, Isaacson M, Arntzen L, Heenan R, Canter P, Barrett T, Lee L, Mambo C, Levine W, Zaidi A, Griffin PM. \(2001\) )] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(Factors contributing to the emergence of Escherichia coli O157 in Africa. Emerging Infectious Diseases 7 \(5\), 812-819.)] TJ ET
BT 26.250 466.286 Td /F1 9.8 Tf  [(76.)] TJ ET
BT 43.553 466.286 Td /F1 9.8 Tf  [(Tauxe RV, Holmberg SD, Dodin A, Wells JV, Blake PA. \(1988\) Epidemic cholera in Mali: high mortality and multiple routes )] TJ ET
BT 26.250 454.381 Td /F1 9.8 Tf  [(of transmission in a famine area. Epidemiology & Infection 100 \(2\), 279-289.)] TJ ET
BT 26.250 434.976 Td /F1 9.8 Tf  [(77.)] TJ ET
BT 43.553 434.976 Td /F1 9.8 Tf  [(Bradley M, Shakespeare R, Ruwende A, Woolhouse ME, Mason E, Munatsi A. \(1996\) Epidemiological features of epidemic )] TJ ET
BT 26.250 423.072 Td /F1 9.8 Tf  [(cholera \(El Tor\) in Zimbabwe. Transactions of the Royal Society of Tropical Medicine & Hygiene, 90 \(4\), 378-382.)] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(78.)] TJ ET
BT 43.553 403.667 Td /F1 9.8 Tf  [(Jackson LA, Kaufmann AF, Adams WG, Phelps MB, Andreasen C, Langkop CW, Francis BJ, Wenger JD. \(1993\) Outbreak )] TJ ET
BT 26.250 391.762 Td /F1 9.8 Tf  [(of leptospirosis associated with swimming. Pediatric Infectious Disease Journal 12 \(1\), 48-54.)] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(79.)] TJ ET
BT 43.553 372.357 Td /F1 9.8 Tf  [(Thacker SB, Music SI, Pollard RA, Berggren G, Boulos C, Nagy T, Brutus M, Pamphile M, Ferdinand RO, Joseph VR. )] TJ ET
BT 26.250 360.453 Td /F1 9.8 Tf  [(\(1980\) Acute water shortage and health problems in Haiti. Lancet 1 \(8166\), 471-473.)] TJ ET
BT 26.250 341.048 Td /F1 9.8 Tf  [(80.)] TJ ET
BT 43.553 341.048 Td /F1 9.8 Tf  [(Burr ML, Davis AR, Zbijowski AG. \(1978\) Diarrhoea and the drought. Public Health, 92 \(2\), 86-87.)] TJ ET
BT 26.250 321.643 Td /F1 9.8 Tf  [(81.)] TJ ET
BT 43.553 321.643 Td /F1 9.8 Tf  [(Snyder SA, Benotti MJ. \(2010\) Endocrine disruptors and pharmaceuticals: implications for water sustainability. Water )] TJ ET
BT 26.250 309.738 Td /F1 9.8 Tf  [(Science & Technology 61 \(1\), 145-154.)] TJ ET
BT 26.250 290.334 Td /F1 9.8 Tf  [(82.)] TJ ET
BT 43.553 290.334 Td /F1 9.8 Tf  [(Soller J, Stephenson J, Olivieri K, Downing J, Olivieri AW. \(2005\) Evaluation of seasonal scale first flush pollutant loading )] TJ ET
BT 26.250 278.429 Td /F1 9.8 Tf  [(and implications for urban runoff management. Journal of Environmental Management 76 \(4\), 309-318.)] TJ ET
BT 26.250 259.024 Td /F1 9.8 Tf  [(83.)] TJ ET
BT 43.553 259.024 Td /F1 9.8 Tf  [(Pouria S, de Andrade A, Barossa J, Cavalcanti R, Barreto V, Ward C, Preiser W, Poon G, Neild G, Codd G. \(1998\) Fatal )] TJ ET
BT 26.250 247.119 Td /F1 9.8 Tf  [(microcystin intoxication in haemodialysis unit in Caruaru, Brazil. Lancet 352, 21-26.)] TJ ET
BT 26.250 227.715 Td /F1 9.8 Tf  [(84.)] TJ ET
BT 43.553 227.715 Td /F1 9.8 Tf  [(Walker S, Lund J, Schumacher D, Brakhage P, McManus B, Miller J, Augustine M, Carney J, Holland R, Hoagland K, Holz )] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(J, Barrow T, Rundquist D, Gitelson A. \(2008\) Chapter 6: Nebraska experience. In: Cyanobacterial harmful algal blooms: State of )] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(the science and research needs [Ed. H Kenneth Hudnell]. Springer.)] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(85.)] TJ ET
BT 43.553 184.500 Td /F1 9.8 Tf  [(Mwaura F, Koyo A, Zech B. \(2004\) Cyanobacterial blooms and the presence of cyanotoxins in small high altitude tropical )] TJ ET
BT 26.250 172.596 Td /F1 9.8 Tf  [(headwater reservoirs in Kenya. Journal of Water and Health 2 \(1\), 49-57.)] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(86.)] TJ ET
BT 43.553 153.191 Td /F1 9.8 Tf  [(Cook B, Miller R, Seager R. \(2007\) Did dust storms make the dust bowl drought worse? Lamont-Doherty Earth Observatory, )] TJ ET
BT 26.250 141.286 Td /F1 9.8 Tf  [(The Earth Institute at Colombia University. Available at: https://www.ldeo.columbia.edu/res/div/ocp/drought/dust_storms.shtml)] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(87.)] TJ ET
BT 43.553 121.881 Td /F1 9.8 Tf  [(Kwon H-J, Cho S-H, Chun Y, Lagarde F, Pershagen, G. \(2002\) Effects of the Asian dust events on daily mortality in Seoul, )] TJ ET
BT 26.250 109.977 Td /F1 9.8 Tf  [(Korea. Environmental Research 90 \(1\), 1-5.)] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(88.)] TJ ET
BT 43.553 90.572 Td /F1 9.8 Tf  [(de Longueville F, Ozer P, Doumbia S, Henry S. \(2012\) Desert dust impacts on human health: an alarming worldwide reality )] TJ ET
BT 26.250 78.667 Td /F1 9.8 Tf  [(and a need for studies in West Africa. International journal of biometeorology.)] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(89.)] TJ ET
BT 43.553 59.262 Td /F1 9.8 Tf  [(Gomez SR, Parker RA, Dosman JA, McDuffie HH. \(1992\) Respiratory health effects of alkali dust in residents near )] TJ ET
BT 26.250 47.358 Td /F1 9.8 Tf  [(desiccated Old Wives Lake. Archives of Environmental Health 47 \(5\), 364-369.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(21)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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15.000 33.072 577.500 743.928 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(90.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Pavelchak N, Church L, Roerig S, London M, Welles W, Casey, G. \(1999\) Silo gas exposure in New York state following the )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(dry growing season of 1995. Applied Occupational & Environmental Hygiene 14 \(1\), 34-38.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(91.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Zender CS, Talamantes J. \(2006\) Climate controls on valley fever incidence in Kern County, California. International Journal )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(of Biometeorology 50 \(3\), 174-182.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(92.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Pappagianis D. \(1994\) Marked increase in cases of coccidioidomycosis in California: 1991, 1992, and 1993. Clinical )] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(Infectious Diseases 19 Suppl 1, S14-18.)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(93.)] TJ ET
BT 43.553 666.048 Td /F1 9.8 Tf  [(CDC \(2003\) Increase in coccidioidomycosis--Arizona, 1998-2001 Morbidity and Mortality Weekly Report \(MMWR\) 52 \(6\), )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(109-112.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(94.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(Chase J, Knight T. \(2003\) Drought-induced mosquito outbreaks in wetlands. Ecology Letters 6, 1017-1024.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(95.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Pontes R, Freeman J, Oliveira-Lima JW, Hodgson J, Spielman A. \(2000\) Vector densities that potentiate dengue outbreaks )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(in a Brazilian city. American Journal of Tropical Medicine and Hygiene 62 \(3\), 378-383.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(96.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Beebe N, Cooper R, Mottram P, Sweeney A. \(2009\) Australia�s dengue risk driven by human adaptation to climate change. )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(PLoS Neglected Tropical Diseases 3 \(5\), e429.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(97.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Bouma M, Dye C. \(1997\) Cycles of malaria associated with El Ni�o in Venezuela. JAMA 278 \(21\), 1772-1774.)] TJ ET
BT 26.250 533.310 Td /F1 9.8 Tf  [(98.)] TJ ET
BT 43.553 533.310 Td /F1 9.8 Tf  [(Gagnon A, Smoyer-Tomic K, Bush A. \(2002\) The El Ni�o Southern Oscillation and malaria epidemics in South America. )] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(International Journal of Biometeorology 46, 81-89.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(99.)] TJ ET
BT 43.553 502.000 Td /F1 9.8 Tf  [(Mouchet J, Faye O, Julvez, Manguin S. \(1996\) Drought and malaria retreat in the Sahel, West Africa. The Lancet 348, )] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(December 21-28, 1735-1736.)] TJ ET
BT 26.250 470.691 Td /F1 9.8 Tf  [(100.)] TJ ET
BT 48.974 470.691 Td /F1 9.8 Tf  [(Kent R, Thuma P, Mharakurwa S, Norris D. \(2007\) Seasonality, blood feeding behavior, and transmission of plasmodium )] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(falciparum by Anopheles arabiensis after an extended drought in southern Zambia. American Journal of Tropical Medicine and )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(Hygiene 76 \(2\), 267-274.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(101.)] TJ ET
BT 48.974 427.476 Td /F1 9.8 Tf  [(Bangs M, Subianto D. \(1999\) El Ni�o and associated outbreaks of severe malaria in highland populations in Irian Jaya, )] TJ ET
BT 26.250 415.572 Td /F1 9.8 Tf  [(Indonesia: A review and epidemiological perspective. Southeast Asian Journal of Tropical Medicine and Public Health 30 \(4\), )] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(608-619.)] TJ ET
BT 26.250 384.262 Td /F1 9.8 Tf  [(102.)] TJ ET
BT 48.974 384.262 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2002\) Drought-induced amplification of Saint Louis encephalitis virus, Florida. Emerging )] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(Infectious Diseases 8 \(6\), 575-580.)] TJ ET
BT 26.250 352.953 Td /F1 9.8 Tf  [(103.)] TJ ET
BT 48.974 352.953 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2003\) St. Louis encephalitis virus in wild birds during the 1990 south Florida epidemic: The )] TJ ET
BT 26.250 341.048 Td /F1 9.8 Tf  [(importance of drought, wetting conditions, and the emergence of Culex nigripalpus \(dipteral: culicidae\) to arboviral amplification )] TJ ET
BT 26.250 329.143 Td /F1 9.8 Tf  [(and transmission. Journal of Medical Entomology 40 \(4\), 547-554.)] TJ ET
BT 26.250 309.738 Td /F1 9.8 Tf  [(104.)] TJ ET
BT 48.974 309.738 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2004\) The spatial-temporal distribution of drought, wetting and human cases of St. Louis )] TJ ET
BT 26.250 297.834 Td /F1 9.8 Tf  [(encephalitis in south central Florida. American Journal of Tropical Medicine and Hygiene 71 \(3\), 251-261.)] TJ ET
BT 26.250 278.429 Td /F1 9.8 Tf  [(105.)] TJ ET
BT 48.974 278.429 Td /F1 9.8 Tf  [(Reisen W, Carroll B, Takahashi R, Fang Y, Garcia S, Martinez V, Quiring R. \(2009\) Repeated West Nile Virus Epidemic )] TJ ET
BT 26.250 266.524 Td /F1 9.8 Tf  [(Transmission in Kern County, California, 2004�2007. Journal of Medical Entomology 46 \(1\), 139-157.)] TJ ET
BT 26.250 247.119 Td /F1 9.8 Tf  [(106.)] TJ ET
BT 48.974 247.119 Td /F1 9.8 Tf  [(Wang G, Minnis R, Belant J, Wax C. \(2010\) Dry weather induces outbreaks of human West Nile virus infections. BMC )] TJ ET
BT 26.250 235.215 Td /F1 9.8 Tf  [(Infectious Diseases 10:38.)] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(107.)] TJ ET
BT 48.974 215.810 Td /F1 9.8 Tf  [(Shaman J, Day J, Komar N. \(2010\) Hydrologic conditions describe West Nile virus risk in Colorado. International Journal of )] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(Environmental Research and Public Health 7, 494-508.)] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(108.)] TJ ET
BT 48.974 184.500 Td /F1 9.8 Tf  [(Deichmeister J, Telang A. \(2011\) Abundance of West Nile virus mosquito vectors in relation to climate and landscape )] TJ ET
BT 26.250 172.596 Td /F1 9.8 Tf  [(variables. Journal of Vector Ecology 36 \(1\), 75-85.)] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(109.)] TJ ET
BT 48.974 153.191 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz. \(2005\) Drought-induced amplification and epidemic transmission of West Nile virus in southern )] TJ ET
BT 26.250 141.286 Td /F1 9.8 Tf  [(Florida. Journal of Medical Entomology 42 \(2\), 134-141.)] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(110.)] TJ ET
BT 48.974 121.881 Td /F1 9.8 Tf  [(Weaver S and Reisen W. \(2010\) Present and future arboviral threats. Antiviral Research 85, 328-345.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(111.)] TJ ET
BT 48.974 102.477 Td /F1 9.8 Tf  [(Rao JS, Misra SP, Patanayak SK, Varaprasada Rao TV, Das Gupta RK, Thapar BR. \(2000\) Japanese encephalitis )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(epidemic in Anantapur district, Andhra Pradesh \(October-November, 1999\). Journal of Communicable Diseases 32 \(4\), 306-)] TJ ET
BT 26.250 78.667 Td /F1 9.8 Tf  [(312.)] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(112.)] TJ ET
BT 48.974 59.262 Td /F1 9.8 Tf  [(Chretien J-P, Anyamba A, Bedno S, Breiman R, Sang R, Sergon K, Powers A, Onyango C, Small J, Tucker C, Linthicum )] TJ ET
BT 26.250 47.358 Td /F1 9.8 Tf  [(K. \(2007\) Drought-associated chikungunya emergence along coastal east Africa. American Journal of Tropical Medicine and )] TJ ET
Q
q
15.000 33.072 577.500 743.928 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(90.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Pavelchak N, Church L, Roerig S, London M, Welles W, Casey, G. \(1999\) Silo gas exposure in New York state following the )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(dry growing season of 1995. Applied Occupational & Environmental Hygiene 14 \(1\), 34-38.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(91.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Zender CS, Talamantes J. \(2006\) Climate controls on valley fever incidence in Kern County, California. International Journal )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(of Biometeorology 50 \(3\), 174-182.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(92.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Pappagianis D. \(1994\) Marked increase in cases of coccidioidomycosis in California: 1991, 1992, and 1993. Clinical )] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(Infectious Diseases 19 Suppl 1, S14-18.)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(93.)] TJ ET
BT 43.553 666.048 Td /F1 9.8 Tf  [(CDC \(2003\) Increase in coccidioidomycosis--Arizona, 1998-2001 Morbidity and Mortality Weekly Report \(MMWR\) 52 \(6\), )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(109-112.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(94.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(Chase J, Knight T. \(2003\) Drought-induced mosquito outbreaks in wetlands. Ecology Letters 6, 1017-1024.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(95.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Pontes R, Freeman J, Oliveira-Lima JW, Hodgson J, Spielman A. \(2000\) Vector densities that potentiate dengue outbreaks )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(in a Brazilian city. American Journal of Tropical Medicine and Hygiene 62 \(3\), 378-383.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(96.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Beebe N, Cooper R, Mottram P, Sweeney A. \(2009\) Australia�s dengue risk driven by human adaptation to climate change. )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(PLoS Neglected Tropical Diseases 3 \(5\), e429.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(97.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Bouma M, Dye C. \(1997\) Cycles of malaria associated with El Ni�o in Venezuela. JAMA 278 \(21\), 1772-1774.)] TJ ET
BT 26.250 533.310 Td /F1 9.8 Tf  [(98.)] TJ ET
BT 43.553 533.310 Td /F1 9.8 Tf  [(Gagnon A, Smoyer-Tomic K, Bush A. \(2002\) The El Ni�o Southern Oscillation and malaria epidemics in South America. )] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(International Journal of Biometeorology 46, 81-89.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(99.)] TJ ET
BT 43.553 502.000 Td /F1 9.8 Tf  [(Mouchet J, Faye O, Julvez, Manguin S. \(1996\) Drought and malaria retreat in the Sahel, West Africa. The Lancet 348, )] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(December 21-28, 1735-1736.)] TJ ET
BT 26.250 470.691 Td /F1 9.8 Tf  [(100.)] TJ ET
BT 48.974 470.691 Td /F1 9.8 Tf  [(Kent R, Thuma P, Mharakurwa S, Norris D. \(2007\) Seasonality, blood feeding behavior, and transmission of plasmodium )] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(falciparum by Anopheles arabiensis after an extended drought in southern Zambia. American Journal of Tropical Medicine and )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(Hygiene 76 \(2\), 267-274.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(101.)] TJ ET
BT 48.974 427.476 Td /F1 9.8 Tf  [(Bangs M, Subianto D. \(1999\) El Ni�o and associated outbreaks of severe malaria in highland populations in Irian Jaya, )] TJ ET
BT 26.250 415.572 Td /F1 9.8 Tf  [(Indonesia: A review and epidemiological perspective. Southeast Asian Journal of Tropical Medicine and Public Health 30 \(4\), )] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(608-619.)] TJ ET
BT 26.250 384.262 Td /F1 9.8 Tf  [(102.)] TJ ET
BT 48.974 384.262 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2002\) Drought-induced amplification of Saint Louis encephalitis virus, Florida. Emerging )] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(Infectious Diseases 8 \(6\), 575-580.)] TJ ET
BT 26.250 352.953 Td /F1 9.8 Tf  [(103.)] TJ ET
BT 48.974 352.953 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2003\) St. Louis encephalitis virus in wild birds during the 1990 south Florida epidemic: The )] TJ ET
BT 26.250 341.048 Td /F1 9.8 Tf  [(importance of drought, wetting conditions, and the emergence of Culex nigripalpus \(dipteral: culicidae\) to arboviral amplification )] TJ ET
BT 26.250 329.143 Td /F1 9.8 Tf  [(and transmission. Journal of Medical Entomology 40 \(4\), 547-554.)] TJ ET
BT 26.250 309.738 Td /F1 9.8 Tf  [(104.)] TJ ET
BT 48.974 309.738 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2004\) The spatial-temporal distribution of drought, wetting and human cases of St. Louis )] TJ ET
BT 26.250 297.834 Td /F1 9.8 Tf  [(encephalitis in south central Florida. American Journal of Tropical Medicine and Hygiene 71 \(3\), 251-261.)] TJ ET
BT 26.250 278.429 Td /F1 9.8 Tf  [(105.)] TJ ET
BT 48.974 278.429 Td /F1 9.8 Tf  [(Reisen W, Carroll B, Takahashi R, Fang Y, Garcia S, Martinez V, Quiring R. \(2009\) Repeated West Nile Virus Epidemic )] TJ ET
BT 26.250 266.524 Td /F1 9.8 Tf  [(Transmission in Kern County, California, 2004�2007. Journal of Medical Entomology 46 \(1\), 139-157.)] TJ ET
BT 26.250 247.119 Td /F1 9.8 Tf  [(106.)] TJ ET
BT 48.974 247.119 Td /F1 9.8 Tf  [(Wang G, Minnis R, Belant J, Wax C. \(2010\) Dry weather induces outbreaks of human West Nile virus infections. BMC )] TJ ET
BT 26.250 235.215 Td /F1 9.8 Tf  [(Infectious Diseases 10:38.)] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(107.)] TJ ET
BT 48.974 215.810 Td /F1 9.8 Tf  [(Shaman J, Day J, Komar N. \(2010\) Hydrologic conditions describe West Nile virus risk in Colorado. International Journal of )] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(Environmental Research and Public Health 7, 494-508.)] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(108.)] TJ ET
BT 48.974 184.500 Td /F1 9.8 Tf  [(Deichmeister J, Telang A. \(2011\) Abundance of West Nile virus mosquito vectors in relation to climate and landscape )] TJ ET
BT 26.250 172.596 Td /F1 9.8 Tf  [(variables. Journal of Vector Ecology 36 \(1\), 75-85.)] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(109.)] TJ ET
BT 48.974 153.191 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz. \(2005\) Drought-induced amplification and epidemic transmission of West Nile virus in southern )] TJ ET
BT 26.250 141.286 Td /F1 9.8 Tf  [(Florida. Journal of Medical Entomology 42 \(2\), 134-141.)] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(110.)] TJ ET
BT 48.974 121.881 Td /F1 9.8 Tf  [(Weaver S and Reisen W. \(2010\) Present and future arboviral threats. Antiviral Research 85, 328-345.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(111.)] TJ ET
BT 48.974 102.477 Td /F1 9.8 Tf  [(Rao JS, Misra SP, Patanayak SK, Varaprasada Rao TV, Das Gupta RK, Thapar BR. \(2000\) Japanese encephalitis )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(epidemic in Anantapur district, Andhra Pradesh \(October-November, 1999\). Journal of Communicable Diseases 32 \(4\), 306-)] TJ ET
BT 26.250 78.667 Td /F1 9.8 Tf  [(312.)] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(112.)] TJ ET
BT 48.974 59.262 Td /F1 9.8 Tf  [(Chretien J-P, Anyamba A, Bedno S, Breiman R, Sang R, Sergon K, Powers A, Onyango C, Small J, Tucker C, Linthicum )] TJ ET
BT 26.250 47.358 Td /F1 9.8 Tf  [(K. \(2007\) Drought-associated chikungunya emergence along coastal east Africa. American Journal of Tropical Medicine and )] TJ ET
Q
q
15.000 33.072 577.500 743.928 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(90.)] TJ ET
BT 43.553 759.976 Td /F1 9.8 Tf  [(Pavelchak N, Church L, Roerig S, London M, Welles W, Casey, G. \(1999\) Silo gas exposure in New York state following the )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(dry growing season of 1995. Applied Occupational & Environmental Hygiene 14 \(1\), 34-38.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(91.)] TJ ET
BT 43.553 728.667 Td /F1 9.8 Tf  [(Zender CS, Talamantes J. \(2006\) Climate controls on valley fever incidence in Kern County, California. International Journal )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(of Biometeorology 50 \(3\), 174-182.)] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(92.)] TJ ET
BT 43.553 697.357 Td /F1 9.8 Tf  [(Pappagianis D. \(1994\) Marked increase in cases of coccidioidomycosis in California: 1991, 1992, and 1993. Clinical )] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(Infectious Diseases 19 Suppl 1, S14-18.)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(93.)] TJ ET
BT 43.553 666.048 Td /F1 9.8 Tf  [(CDC \(2003\) Increase in coccidioidomycosis--Arizona, 1998-2001 Morbidity and Mortality Weekly Report \(MMWR\) 52 \(6\), )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(109-112.)] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(94.)] TJ ET
BT 43.553 634.738 Td /F1 9.8 Tf  [(Chase J, Knight T. \(2003\) Drought-induced mosquito outbreaks in wetlands. Ecology Letters 6, 1017-1024.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(95.)] TJ ET
BT 43.553 615.333 Td /F1 9.8 Tf  [(Pontes R, Freeman J, Oliveira-Lima JW, Hodgson J, Spielman A. \(2000\) Vector densities that potentiate dengue outbreaks )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(in a Brazilian city. American Journal of Tropical Medicine and Hygiene 62 \(3\), 378-383.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(96.)] TJ ET
BT 43.553 584.024 Td /F1 9.8 Tf  [(Beebe N, Cooper R, Mottram P, Sweeney A. \(2009\) Australia�s dengue risk driven by human adaptation to climate change. )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(PLoS Neglected Tropical Diseases 3 \(5\), e429.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(97.)] TJ ET
BT 43.553 552.714 Td /F1 9.8 Tf  [(Bouma M, Dye C. \(1997\) Cycles of malaria associated with El Ni�o in Venezuela. JAMA 278 \(21\), 1772-1774.)] TJ ET
BT 26.250 533.310 Td /F1 9.8 Tf  [(98.)] TJ ET
BT 43.553 533.310 Td /F1 9.8 Tf  [(Gagnon A, Smoyer-Tomic K, Bush A. \(2002\) The El Ni�o Southern Oscillation and malaria epidemics in South America. )] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(International Journal of Biometeorology 46, 81-89.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(99.)] TJ ET
BT 43.553 502.000 Td /F1 9.8 Tf  [(Mouchet J, Faye O, Julvez, Manguin S. \(1996\) Drought and malaria retreat in the Sahel, West Africa. The Lancet 348, )] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(December 21-28, 1735-1736.)] TJ ET
BT 26.250 470.691 Td /F1 9.8 Tf  [(100.)] TJ ET
BT 48.974 470.691 Td /F1 9.8 Tf  [(Kent R, Thuma P, Mharakurwa S, Norris D. \(2007\) Seasonality, blood feeding behavior, and transmission of plasmodium )] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(falciparum by Anopheles arabiensis after an extended drought in southern Zambia. American Journal of Tropical Medicine and )] TJ ET
BT 26.250 446.881 Td /F1 9.8 Tf  [(Hygiene 76 \(2\), 267-274.)] TJ ET
BT 26.250 427.476 Td /F1 9.8 Tf  [(101.)] TJ ET
BT 48.974 427.476 Td /F1 9.8 Tf  [(Bangs M, Subianto D. \(1999\) El Ni�o and associated outbreaks of severe malaria in highland populations in Irian Jaya, )] TJ ET
BT 26.250 415.572 Td /F1 9.8 Tf  [(Indonesia: A review and epidemiological perspective. Southeast Asian Journal of Tropical Medicine and Public Health 30 \(4\), )] TJ ET
BT 26.250 403.667 Td /F1 9.8 Tf  [(608-619.)] TJ ET
BT 26.250 384.262 Td /F1 9.8 Tf  [(102.)] TJ ET
BT 48.974 384.262 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2002\) Drought-induced amplification of Saint Louis encephalitis virus, Florida. Emerging )] TJ ET
BT 26.250 372.357 Td /F1 9.8 Tf  [(Infectious Diseases 8 \(6\), 575-580.)] TJ ET
BT 26.250 352.953 Td /F1 9.8 Tf  [(103.)] TJ ET
BT 48.974 352.953 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2003\) St. Louis encephalitis virus in wild birds during the 1990 south Florida epidemic: The )] TJ ET
BT 26.250 341.048 Td /F1 9.8 Tf  [(importance of drought, wetting conditions, and the emergence of Culex nigripalpus \(dipteral: culicidae\) to arboviral amplification )] TJ ET
BT 26.250 329.143 Td /F1 9.8 Tf  [(and transmission. Journal of Medical Entomology 40 \(4\), 547-554.)] TJ ET
BT 26.250 309.738 Td /F1 9.8 Tf  [(104.)] TJ ET
BT 48.974 309.738 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz M. \(2004\) The spatial-temporal distribution of drought, wetting and human cases of St. Louis )] TJ ET
BT 26.250 297.834 Td /F1 9.8 Tf  [(encephalitis in south central Florida. American Journal of Tropical Medicine and Hygiene 71 \(3\), 251-261.)] TJ ET
BT 26.250 278.429 Td /F1 9.8 Tf  [(105.)] TJ ET
BT 48.974 278.429 Td /F1 9.8 Tf  [(Reisen W, Carroll B, Takahashi R, Fang Y, Garcia S, Martinez V, Quiring R. \(2009\) Repeated West Nile Virus Epidemic )] TJ ET
BT 26.250 266.524 Td /F1 9.8 Tf  [(Transmission in Kern County, California, 2004�2007. Journal of Medical Entomology 46 \(1\), 139-157.)] TJ ET
BT 26.250 247.119 Td /F1 9.8 Tf  [(106.)] TJ ET
BT 48.974 247.119 Td /F1 9.8 Tf  [(Wang G, Minnis R, Belant J, Wax C. \(2010\) Dry weather induces outbreaks of human West Nile virus infections. BMC )] TJ ET
BT 26.250 235.215 Td /F1 9.8 Tf  [(Infectious Diseases 10:38.)] TJ ET
BT 26.250 215.810 Td /F1 9.8 Tf  [(107.)] TJ ET
BT 48.974 215.810 Td /F1 9.8 Tf  [(Shaman J, Day J, Komar N. \(2010\) Hydrologic conditions describe West Nile virus risk in Colorado. International Journal of )] TJ ET
BT 26.250 203.905 Td /F1 9.8 Tf  [(Environmental Research and Public Health 7, 494-508.)] TJ ET
BT 26.250 184.500 Td /F1 9.8 Tf  [(108.)] TJ ET
BT 48.974 184.500 Td /F1 9.8 Tf  [(Deichmeister J, Telang A. \(2011\) Abundance of West Nile virus mosquito vectors in relation to climate and landscape )] TJ ET
BT 26.250 172.596 Td /F1 9.8 Tf  [(variables. Journal of Vector Ecology 36 \(1\), 75-85.)] TJ ET
BT 26.250 153.191 Td /F1 9.8 Tf  [(109.)] TJ ET
BT 48.974 153.191 Td /F1 9.8 Tf  [(Shaman J, Day J, Stieglitz. \(2005\) Drought-induced amplification and epidemic transmission of West Nile virus in southern )] TJ ET
BT 26.250 141.286 Td /F1 9.8 Tf  [(Florida. Journal of Medical Entomology 42 \(2\), 134-141.)] TJ ET
BT 26.250 121.881 Td /F1 9.8 Tf  [(110.)] TJ ET
BT 48.974 121.881 Td /F1 9.8 Tf  [(Weaver S and Reisen W. \(2010\) Present and future arboviral threats. Antiviral Research 85, 328-345.)] TJ ET
BT 26.250 102.477 Td /F1 9.8 Tf  [(111.)] TJ ET
BT 48.974 102.477 Td /F1 9.8 Tf  [(Rao JS, Misra SP, Patanayak SK, Varaprasada Rao TV, Das Gupta RK, Thapar BR. \(2000\) Japanese encephalitis )] TJ ET
BT 26.250 90.572 Td /F1 9.8 Tf  [(epidemic in Anantapur district, Andhra Pradesh \(October-November, 1999\). Journal of Communicable Diseases 32 \(4\), 306-)] TJ ET
BT 26.250 78.667 Td /F1 9.8 Tf  [(312.)] TJ ET
BT 26.250 59.262 Td /F1 9.8 Tf  [(112.)] TJ ET
BT 48.974 59.262 Td /F1 9.8 Tf  [(Chretien J-P, Anyamba A, Bedno S, Breiman R, Sang R, Sergon K, Powers A, Onyango C, Small J, Tucker C, Linthicum )] TJ ET
BT 26.250 47.358 Td /F1 9.8 Tf  [(K. \(2007\) Drought-associated chikungunya emergence along coastal east Africa. American Journal of Tropical Medicine and )] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(22)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 52.477 577.500 724.523 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Hygiene 76 \(3\), 405-407.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(113.)] TJ ET
BT 48.974 748.071 Td /F1 9.8 Tf  [(Trape J-F, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier J-M. \(1996a\) Tick-borne borreliosis in )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(West Africa: Recent epidemiological studies. Rocz Akad Med Bialymst., 41\(1\), 136-41.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(114.)] TJ ET
BT 48.974 716.762 Td /F1 9.8 Tf  [(Trape J-F, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier J-M. \(1996b\) The spread of tick-)] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(borne borreliosis in west Africa and its relationship to sub-Saharan drought. American Journal of Tropical Medicine and Hygiene )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(54 \(3\), 289-293.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(115.)] TJ ET
BT 48.974 673.548 Td /F1 9.8 Tf  [(Vial L, Diatta G, Tall A, Ba EH, Bouganali H, Durand P, Sokhna C, Rogier C, Renaud F, Trape J-F. \(2006\) Incidence of tick-)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(borne relapsing fever in west Africa: longitudinal study. Lancet 368, 37-43.)] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(116.)] TJ ET
BT 48.974 642.238 Td /F1 9.8 Tf  [(Mutuku F, King C, Bustinduy A, Mungai P, Muchiri E, Kitron U. \(2011\) Impact of drought on the spatial pattern of )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(transmission of Schistosoma haematobium in coastal Kenya. American Journal of Tropical Medicine and Hygiene 85 \(6\), 1065-)] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(1070.)] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(117.)] TJ ET
BT 48.974 599.024 Td /F1 9.8 Tf  [(Barrett T, Hoff R, Mott K, Guedes F, Sherlock I. \(1979\) An outbreak of acute Chagas disease in the S�o Francisco Valley )] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(region of Bahia, Brazil: triatomine vectors and animal reservoirs of Trypanosoma cruzi. Transactions of the Royal Society of )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(Tropical Medicine and Hygiene 73 \(6\), 703-709.)] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(118.)] TJ ET
BT 48.974 555.810 Td /F1 9.8 Tf  [(Fragar L, Henderson A, Morton C, Pollock K. \(2008\) The mental health of people on Australian farms: The facts 2008. )] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(Rural Industries Research and Development Corporation and Australian Centre for Agricultural Health and Safety.)] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(119.)] TJ ET
BT 48.974 524.500 Td /F1 9.8 Tf  [(Carnie T-L, Berry H, Blinkhorn S, Hart C. \(2011\) In their own words: Young people�s mental health in drought-affected rural )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(and remote NSW. Australian Journal of Rural Health 19, 244-248.)] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(120.)] TJ ET
BT 48.974 493.191 Td /F1 9.8 Tf  [(Dean J, Stain H. \(2007\) The impact of drought on the emotional well-being of children and adolescents in rural and remote )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(new South Wales. Journal of Rural Health 23 \(4\), 356-364.)] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(121.)] TJ ET
BT 48.974 461.881 Td /F1 9.8 Tf  [(Dean J, Stain H. \(2010\) Mental health impact for adolescents living with prolonged drought. Australian Journal of Rural )] TJ ET
BT 26.250 449.976 Td /F1 9.8 Tf  [(Health 18, 32-37.)] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(122.)] TJ ET
BT 48.974 430.572 Td /F1 9.8 Tf  [(Stain H, Kelly B, Lewin T, Higginbotham N, Beard J; Hourihan F. \(2008\) Social networks and mental health among a )] TJ ET
BT 26.250 418.667 Td /F1 9.8 Tf  [(farming population. Social Psychiatry and Psychiatric Epidemiology 43, 843-849.)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(123.)] TJ ET
BT 48.974 399.262 Td /F1 9.8 Tf  [(Stehlik D, Gray I, Lawrence G. \(1999\) Drought in the 1990s: Australian farm families� experiences. Rural Social and )] TJ ET
BT 26.250 387.357 Td /F1 9.8 Tf  [(Economic Research Centre, Queensland and Centre for Rural Social Research, NSW.)] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(124.)] TJ ET
BT 48.974 367.953 Td /F1 9.8 Tf  [(Sartore G, Kelly B, Stain H, Albrecht G, Higginbotham N. \(2008a\) Control, uncertainty, and expectations for the future: A )] TJ ET
BT 26.250 356.048 Td /F1 9.8 Tf  [(qualitative study of the impact of drought on a rural Australian community. Rural and Remote Health 8, 950.)] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(125.)] TJ ET
BT 48.974 336.643 Td /F1 9.8 Tf  [(Staniford A, Dollard M, Guerin B. \(2009\) Stress and help-seeking for drought-stricken citrus growers in the Riverland of )] TJ ET
BT 26.250 324.738 Td /F1 9.8 Tf  [(South Australia. Australian Journal of Rural Health 17, 147-154.)] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(126.)] TJ ET
BT 48.974 305.334 Td /F1 9.8 Tf  [(Alston M, Kent J. \(2004\) Social impacts of drought: A report to NSW Agriculture. Centre for Rural Social Research, Wagga )] TJ ET
BT 26.250 293.429 Td /F1 9.8 Tf  [(Wagga NSW, Australia.)] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(127.)] TJ ET
BT 48.974 274.024 Td /F1 9.8 Tf  [(Edwards B, Gray M, Hunter B. \(2008\) Social and economic impacts of drought on farm families and rural communities: )] TJ ET
BT 26.250 262.119 Td /F1 9.8 Tf  [(Submission to the Productivity Commission�s Inquiry into Government Drought Support. Australian Institute of Family Studies, )] TJ ET
BT 26.250 250.215 Td /F1 9.8 Tf  [(Melbourne.)] TJ ET
BT 26.250 230.810 Td /F1 9.8 Tf  [(128.)] TJ ET
BT 48.974 230.810 Td /F1 9.8 Tf  [(Hossain D, Eley R, Coutts J, Gorman D. \(2008\) The mental health of landholders in Southern Queensland: Issues and )] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(support. Australian Journal of Rural Health 16 \(6\), 343-348.)] TJ ET
BT 26.250 199.500 Td /F1 9.8 Tf  [(129.)] TJ ET
BT 48.974 199.500 Td /F1 9.8 Tf  [(Rigby C, Rosen A, Berry H, Hart C. \(2011\) If the land�s sick, we�re sick:* The impact of prolonged drought on the social )] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(and emotional well-being of Aboriginal communities in rural New South Wales. Australian Journal of Rural Health 19, 249-254.)] TJ ET
BT 26.250 168.191 Td /F1 9.8 Tf  [(130.)] TJ ET
BT 48.974 168.191 Td /F1 9.8 Tf  [(Polain J, Berry H, Hoskin J. \(2011\) Rapid change, climate adversity and the next �big dry�: Older farmers� mental health. )] TJ ET
BT 26.250 156.286 Td /F1 9.8 Tf  [(Australian Journal of Rural Health 19, 239-243.)] TJ ET
BT 26.250 136.881 Td /F1 9.8 Tf  [(131.)] TJ ET
BT 48.974 136.881 Td /F1 9.8 Tf  [(Stain H, Kelly B, Carr V, Lewin T, Fitzgerald M, Fragar L. \(2011\) The psychological impact of chronic environmental )] TJ ET
BT 26.250 124.977 Td /F1 9.8 Tf  [(adversity: Responding to prolonged drought. Social Science & Medicine 73, 1593-1599.)] TJ ET
BT 26.250 105.572 Td /F1 9.8 Tf  [(132.)] TJ ET
BT 48.974 105.572 Td /F1 9.8 Tf  [(Co�lho A, Adair J, Mocellin J. \(2004\) Psychological responses to drought in northeastern Brazil. Interamerican Journal of )] TJ ET
BT 26.250 93.667 Td /F1 9.8 Tf  [(Psychology 38 \(1\), 95-103.)] TJ ET
BT 26.250 74.262 Td /F1 9.8 Tf  [(133.)] TJ ET
BT 48.974 74.262 Td /F1 9.8 Tf  [(Speldewinde P, Cook A, Davies P, Weinstein P. \(2009\) A relationship between environmental degradation and mental )] TJ ET
BT 26.250 62.358 Td /F1 9.8 Tf  [(health in rural Western Australia. Health and Place 15, 880-887.)] TJ ET
Q
q
15.000 52.477 577.500 724.523 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Hygiene 76 \(3\), 405-407.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(113.)] TJ ET
BT 48.974 748.071 Td /F1 9.8 Tf  [(Trape J-F, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier J-M. \(1996a\) Tick-borne borreliosis in )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(West Africa: Recent epidemiological studies. Rocz Akad Med Bialymst., 41\(1\), 136-41.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(114.)] TJ ET
BT 48.974 716.762 Td /F1 9.8 Tf  [(Trape J-F, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier J-M. \(1996b\) The spread of tick-)] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(borne borreliosis in west Africa and its relationship to sub-Saharan drought. American Journal of Tropical Medicine and Hygiene )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(54 \(3\), 289-293.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(115.)] TJ ET
BT 48.974 673.548 Td /F1 9.8 Tf  [(Vial L, Diatta G, Tall A, Ba EH, Bouganali H, Durand P, Sokhna C, Rogier C, Renaud F, Trape J-F. \(2006\) Incidence of tick-)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(borne relapsing fever in west Africa: longitudinal study. Lancet 368, 37-43.)] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(116.)] TJ ET
BT 48.974 642.238 Td /F1 9.8 Tf  [(Mutuku F, King C, Bustinduy A, Mungai P, Muchiri E, Kitron U. \(2011\) Impact of drought on the spatial pattern of )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(transmission of Schistosoma haematobium in coastal Kenya. American Journal of Tropical Medicine and Hygiene 85 \(6\), 1065-)] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(1070.)] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(117.)] TJ ET
BT 48.974 599.024 Td /F1 9.8 Tf  [(Barrett T, Hoff R, Mott K, Guedes F, Sherlock I. \(1979\) An outbreak of acute Chagas disease in the S�o Francisco Valley )] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(region of Bahia, Brazil: triatomine vectors and animal reservoirs of Trypanosoma cruzi. Transactions of the Royal Society of )] TJ ET
BT 26.250 575.214 Td /F1 9.8 Tf  [(Tropical Medicine and Hygiene 73 \(6\), 703-709.)] TJ ET
BT 26.250 555.810 Td /F1 9.8 Tf  [(118.)] TJ ET
BT 48.974 555.810 Td /F1 9.8 Tf  [(Fragar L, Henderson A, Morton C, Pollock K. \(2008\) The mental health of people on Australian farms: The facts 2008. )] TJ ET
BT 26.250 543.905 Td /F1 9.8 Tf  [(Rural Industries Research and Development Corporation and Australian Centre for Agricultural Health and Safety.)] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(119.)] TJ ET
BT 48.974 524.500 Td /F1 9.8 Tf  [(Carnie T-L, Berry H, Blinkhorn S, Hart C. \(2011\) In their own words: Young people�s mental health in drought-affected rural )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(and remote NSW. Australian Journal of Rural Health 19, 244-248.)] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(120.)] TJ ET
BT 48.974 493.191 Td /F1 9.8 Tf  [(Dean J, Stain H. \(2007\) The impact of drought on the emotional well-being of children and adolescents in rural and remote )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(new South Wales. Journal of Rural Health 23 \(4\), 356-364.)] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(121.)] TJ ET
BT 48.974 461.881 Td /F1 9.8 Tf  [(Dean J, Stain H. \(2010\) Mental health impact for adolescents living with prolonged drought. Australian Journal of Rural )] TJ ET
BT 26.250 449.976 Td /F1 9.8 Tf  [(Health 18, 32-37.)] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(122.)] TJ ET
BT 48.974 430.572 Td /F1 9.8 Tf  [(Stain H, Kelly B, Lewin T, Higginbotham N, Beard J; Hourihan F. \(2008\) Social networks and mental health among a )] TJ ET
BT 26.250 418.667 Td /F1 9.8 Tf  [(farming population. Social Psychiatry and Psychiatric Epidemiology 43, 843-849.)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(123.)] TJ ET
BT 48.974 399.262 Td /F1 9.8 Tf  [(Stehlik D, Gray I, Lawrence G. \(1999\) Drought in the 1990s: Australian farm families� experiences. Rural Social and )] TJ ET
BT 26.250 387.357 Td /F1 9.8 Tf  [(Economic Research Centre, Queensland and Centre for Rural Social Research, NSW.)] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(124.)] TJ ET
BT 48.974 367.953 Td /F1 9.8 Tf  [(Sartore G, Kelly B, Stain H, Albrecht G, Higginbotham N. \(2008a\) Control, uncertainty, and expectations for the future: A )] TJ ET
BT 26.250 356.048 Td /F1 9.8 Tf  [(qualitative study of the impact of drought on a rural Australian community. Rural and Remote Health 8, 950.)] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(125.)] TJ ET
BT 48.974 336.643 Td /F1 9.8 Tf  [(Staniford A, Dollard M, Guerin B. \(2009\) Stress and help-seeking for drought-stricken citrus growers in the Riverland of )] TJ ET
BT 26.250 324.738 Td /F1 9.8 Tf  [(South Australia. Australian Journal of Rural Health 17, 147-154.)] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(126.)] TJ ET
BT 48.974 305.334 Td /F1 9.8 Tf  [(Alston M, Kent J. \(2004\) Social impacts of drought: A report to NSW Agriculture. Centre for Rural Social Research, Wagga )] TJ ET
BT 26.250 293.429 Td /F1 9.8 Tf  [(Wagga NSW, Australia.)] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(127.)] TJ ET
BT 48.974 274.024 Td /F1 9.8 Tf  [(Edwards B, Gray M, Hunter B. \(2008\) Social and economic impacts of drought on farm families and rural communities: )] TJ ET
BT 26.250 262.119 Td /F1 9.8 Tf  [(Submission to the Productivity Commission�s Inquiry into Government Drought Support. Australian Institute of Family Studies, )] TJ ET
BT 26.250 250.215 Td /F1 9.8 Tf  [(Melbourne.)] TJ ET
BT 26.250 230.810 Td /F1 9.8 Tf  [(128.)] TJ ET
BT 48.974 230.810 Td /F1 9.8 Tf  [(Hossain D, Eley R, Coutts J, Gorman D. \(2008\) The mental health of landholders in Southern Queensland: Issues and )] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(support. Australian Journal of Rural Health 16 \(6\), 343-348.)] TJ ET
BT 26.250 199.500 Td /F1 9.8 Tf  [(129.)] TJ ET
BT 48.974 199.500 Td /F1 9.8 Tf  [(Rigby C, Rosen A, Berry H, Hart C. \(2011\) If the land�s sick, we�re sick:* The impact of prolonged drought on the social )] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(and emotional well-being of Aboriginal communities in rural New South Wales. Australian Journal of Rural Health 19, 249-254.)] TJ ET
BT 26.250 168.191 Td /F1 9.8 Tf  [(130.)] TJ ET
BT 48.974 168.191 Td /F1 9.8 Tf  [(Polain J, Berry H, Hoskin J. \(2011\) Rapid change, climate adversity and the next �big dry�: Older farmers� mental health. )] TJ ET
BT 26.250 156.286 Td /F1 9.8 Tf  [(Australian Journal of Rural Health 19, 239-243.)] TJ ET
BT 26.250 136.881 Td /F1 9.8 Tf  [(131.)] TJ ET
BT 48.974 136.881 Td /F1 9.8 Tf  [(Stain H, Kelly B, Carr V, Lewin T, Fitzgerald M, Fragar L. \(2011\) The psychological impact of chronic environmental )] TJ ET
BT 26.250 124.977 Td /F1 9.8 Tf  [(adversity: Responding to prolonged drought. Social Science & Medicine 73, 1593-1599.)] TJ ET
BT 26.250 105.572 Td /F1 9.8 Tf  [(132.)] TJ ET
BT 48.974 105.572 Td /F1 9.8 Tf  [(Co�lho A, Adair J, Mocellin J. \(2004\) Psychological responses to drought in northeastern Brazil. Interamerican Journal of )] TJ ET
BT 26.250 93.667 Td /F1 9.8 Tf  [(Psychology 38 \(1\), 95-103.)] TJ ET
BT 26.250 74.262 Td /F1 9.8 Tf  [(133.)] TJ ET
BT 48.974 74.262 Td /F1 9.8 Tf  [(Speldewinde P, Cook A, Davies P, Weinstein P. \(2009\) A relationship between environmental degradation and mental )] TJ ET
BT 26.250 62.358 Td /F1 9.8 Tf  [(health in rural Western Australia. Health and Place 15, 880-887.)] TJ ET
Q
q
15.000 52.477 577.500 724.523 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Hygiene 76 \(3\), 405-407.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(113.)] TJ ET
BT 48.974 748.071 Td /F1 9.8 Tf  [(Trape J-F, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier J-M. \(1996a\) Tick-borne borreliosis in )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(West Africa: Recent epidemiological studies. Rocz Akad Med Bialymst., 41\(1\), 136-41.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(114.)] TJ ET
BT 48.974 716.762 Td /F1 9.8 Tf  [(Trape J-F, Godeluck B, Diatta G, Rogier C, Legros F, Albergel J, Pepin Y, Duplantier J-M. \(1996b\) The spread of tick-)] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(borne borreliosis in west Africa and its relationship to sub-Saharan drought. American Journal of Tropical Medicine and Hygiene )] TJ ET
BT 26.250 692.952 Td /F1 9.8 Tf  [(54 \(3\), 289-293.)] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(115.)] TJ ET
BT 48.974 673.548 Td /F1 9.8 Tf  [(Vial L, Diatta G, Tall A, Ba EH, Bouganali H, Durand P, Sokhna C, Rogier C, Renaud F, Trape J-F. \(2006\) Incidence of tick-)] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(borne relapsing fever in west Africa: longitudinal study. Lancet 368, 37-43.)] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(116.)] TJ ET
BT 48.974 642.238 Td /F1 9.8 Tf  [(Mutuku F, King C, Bustinduy A, Mungai P, Muchiri E, Kitron U. \(2011\) Impact of drought on the spatial pattern of )] TJ ET
BT 26.250 630.333 Td /F1 9.8 Tf  [(transmission of Schistosoma haematobium in coastal Kenya. American Journal of Tropical Medicine and Hygiene 85 \(6\), 1065-)] TJ ET
BT 26.250 618.429 Td /F1 9.8 Tf  [(1070.)] TJ ET
BT 26.250 599.024 Td /F1 9.8 Tf  [(117.)] TJ ET
BT 48.974 599.024 Td /F1 9.8 Tf  [(Barrett T, Hoff R, Mott K, Guedes F, Sherlock I. \(1979\) An outbreak of acute Chagas disease in the S�o Francisco Valley )] TJ ET
BT 26.250 587.119 Td /F1 9.8 Tf  [(region of Bahia, Brazil: triatomine vectors and animal reservoirs of Trypanosoma cruzi. Transactions of the Royal Society of )] TJ ET
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BT 26.250 543.905 Td /F1 9.8 Tf  [(Rural Industries Research and Development Corporation and Australian Centre for Agricultural Health and Safety.)] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(119.)] TJ ET
BT 48.974 524.500 Td /F1 9.8 Tf  [(Carnie T-L, Berry H, Blinkhorn S, Hart C. \(2011\) In their own words: Young people�s mental health in drought-affected rural )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(and remote NSW. Australian Journal of Rural Health 19, 244-248.)] TJ ET
BT 26.250 493.191 Td /F1 9.8 Tf  [(120.)] TJ ET
BT 48.974 493.191 Td /F1 9.8 Tf  [(Dean J, Stain H. \(2007\) The impact of drought on the emotional well-being of children and adolescents in rural and remote )] TJ ET
BT 26.250 481.286 Td /F1 9.8 Tf  [(new South Wales. Journal of Rural Health 23 \(4\), 356-364.)] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(121.)] TJ ET
BT 48.974 461.881 Td /F1 9.8 Tf  [(Dean J, Stain H. \(2010\) Mental health impact for adolescents living with prolonged drought. Australian Journal of Rural )] TJ ET
BT 26.250 449.976 Td /F1 9.8 Tf  [(Health 18, 32-37.)] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(122.)] TJ ET
BT 48.974 430.572 Td /F1 9.8 Tf  [(Stain H, Kelly B, Lewin T, Higginbotham N, Beard J; Hourihan F. \(2008\) Social networks and mental health among a )] TJ ET
BT 26.250 418.667 Td /F1 9.8 Tf  [(farming population. Social Psychiatry and Psychiatric Epidemiology 43, 843-849.)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(123.)] TJ ET
BT 48.974 399.262 Td /F1 9.8 Tf  [(Stehlik D, Gray I, Lawrence G. \(1999\) Drought in the 1990s: Australian farm families� experiences. Rural Social and )] TJ ET
BT 26.250 387.357 Td /F1 9.8 Tf  [(Economic Research Centre, Queensland and Centre for Rural Social Research, NSW.)] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(124.)] TJ ET
BT 48.974 367.953 Td /F1 9.8 Tf  [(Sartore G, Kelly B, Stain H, Albrecht G, Higginbotham N. \(2008a\) Control, uncertainty, and expectations for the future: A )] TJ ET
BT 26.250 356.048 Td /F1 9.8 Tf  [(qualitative study of the impact of drought on a rural Australian community. Rural and Remote Health 8, 950.)] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(125.)] TJ ET
BT 48.974 336.643 Td /F1 9.8 Tf  [(Staniford A, Dollard M, Guerin B. \(2009\) Stress and help-seeking for drought-stricken citrus growers in the Riverland of )] TJ ET
BT 26.250 324.738 Td /F1 9.8 Tf  [(South Australia. Australian Journal of Rural Health 17, 147-154.)] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(126.)] TJ ET
BT 48.974 305.334 Td /F1 9.8 Tf  [(Alston M, Kent J. \(2004\) Social impacts of drought: A report to NSW Agriculture. Centre for Rural Social Research, Wagga )] TJ ET
BT 26.250 293.429 Td /F1 9.8 Tf  [(Wagga NSW, Australia.)] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(127.)] TJ ET
BT 48.974 274.024 Td /F1 9.8 Tf  [(Edwards B, Gray M, Hunter B. \(2008\) Social and economic impacts of drought on farm families and rural communities: )] TJ ET
BT 26.250 262.119 Td /F1 9.8 Tf  [(Submission to the Productivity Commission�s Inquiry into Government Drought Support. Australian Institute of Family Studies, )] TJ ET
BT 26.250 250.215 Td /F1 9.8 Tf  [(Melbourne.)] TJ ET
BT 26.250 230.810 Td /F1 9.8 Tf  [(128.)] TJ ET
BT 48.974 230.810 Td /F1 9.8 Tf  [(Hossain D, Eley R, Coutts J, Gorman D. \(2008\) The mental health of landholders in Southern Queensland: Issues and )] TJ ET
BT 26.250 218.905 Td /F1 9.8 Tf  [(support. Australian Journal of Rural Health 16 \(6\), 343-348.)] TJ ET
BT 26.250 199.500 Td /F1 9.8 Tf  [(129.)] TJ ET
BT 48.974 199.500 Td /F1 9.8 Tf  [(Rigby C, Rosen A, Berry H, Hart C. \(2011\) If the land�s sick, we�re sick:* The impact of prolonged drought on the social )] TJ ET
BT 26.250 187.596 Td /F1 9.8 Tf  [(and emotional well-being of Aboriginal communities in rural New South Wales. Australian Journal of Rural Health 19, 249-254.)] TJ ET
BT 26.250 168.191 Td /F1 9.8 Tf  [(130.)] TJ ET
BT 48.974 168.191 Td /F1 9.8 Tf  [(Polain J, Berry H, Hoskin J. \(2011\) Rapid change, climate adversity and the next �big dry�: Older farmers� mental health. )] TJ ET
BT 26.250 156.286 Td /F1 9.8 Tf  [(Australian Journal of Rural Health 19, 239-243.)] TJ ET
BT 26.250 136.881 Td /F1 9.8 Tf  [(131.)] TJ ET
BT 48.974 136.881 Td /F1 9.8 Tf  [(Stain H, Kelly B, Carr V, Lewin T, Fitzgerald M, Fragar L. \(2011\) The psychological impact of chronic environmental )] TJ ET
BT 26.250 124.977 Td /F1 9.8 Tf  [(adversity: Responding to prolonged drought. Social Science & Medicine 73, 1593-1599.)] TJ ET
BT 26.250 105.572 Td /F1 9.8 Tf  [(132.)] TJ ET
BT 48.974 105.572 Td /F1 9.8 Tf  [(Co�lho A, Adair J, Mocellin J. \(2004\) Psychological responses to drought in northeastern Brazil. Interamerican Journal of )] TJ ET
BT 26.250 93.667 Td /F1 9.8 Tf  [(Psychology 38 \(1\), 95-103.)] TJ ET
BT 26.250 74.262 Td /F1 9.8 Tf  [(133.)] TJ ET
BT 48.974 74.262 Td /F1 9.8 Tf  [(Speldewinde P, Cook A, Davies P, Weinstein P. \(2009\) A relationship between environmental degradation and mental )] TJ ET
BT 26.250 62.358 Td /F1 9.8 Tf  [(health in rural Western Australia. Health and Place 15, 880-887.)] TJ ET
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0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(23)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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q
15.000 29.977 577.500 747.023 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(134.)] TJ ET
BT 48.974 759.976 Td /F1 9.8 Tf  [(Page A, Fragar L. \(2002\) Suicide in Australian farming, 1988-1997. Australian and New Zealand Journal of Psychiatry 36, )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(81-85.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(135.)] TJ ET
BT 48.974 728.667 Td /F1 9.8 Tf  [(Guiney R. \(2012\) Farming suicides during the Victorian drought: 2001-2007. Australian Journal of Rural Health 20, 11-15.)] TJ ET
BT 26.250 709.262 Td /F1 9.8 Tf  [(136.)] TJ ET
BT 48.974 709.262 Td /F1 9.8 Tf  [(Sartore G, Hoolahan B, Tonna A, Kelly B, Stain H. \(2005\) Wisdom from the drought: recommendations from a consultative )] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(conference. Australian Journal of Rural Health 13, 315-320.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(137.)] TJ ET
BT 48.974 677.952 Td /F1 9.8 Tf  [(Sartore G. \(2007\) Drought and its effect on mental health: how GPs can help. Australian Family Physician 36 \(12\), 990-)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(993.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(138.)] TJ ET
BT 48.974 646.643 Td /F1 9.8 Tf  [(Sartore G, Kelly B, Stain H, Fuller J, Fragar L, Tonna A. \(2008b\) Improving mental health capacity in rural communities: )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(mental health first aid delivery in drought-affected rural New South Wales. Australian Journal of Rural Health 16, 313-318.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(139.)] TJ ET
BT 48.974 615.333 Td /F1 9.8 Tf  [(Fuller J, Kelly B, Sartore G, Fragar L, Tonna A, Pollard G, Hazell T. \(2007\) Use of social network analysis to describe )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(service links for farmers� mental health. Australian Journal of Rural Health 15, 99-106.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(140.)] TJ ET
BT 48.974 584.024 Td /F1 9.8 Tf  [(Hart C, Berry H, Tonna A. \(2011\) Improving the mental health of rural New South Wales communities facing drought and )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(other adversities. Australian Journal of Rural Health 19, 231-238.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(141.)] TJ ET
BT 48.974 552.714 Td /F1 9.8 Tf  [(CDC \(1988b\) Epidemiologic notes and report: Diving-associated spinal cord injuries during drought conditions�Wisconsin, )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(1988. Morbidity and Mortality Weekly Report \(MMWR\) 37 \(30\), 453-454.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(142.)] TJ ET
BT 48.974 521.405 Td /F1 9.8 Tf  [(Raymond C. \(1988\) Summer�s drought reinforces diving�s dangers. JAMA 260 \(9\), 1199-1200.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(143.)] TJ ET
BT 48.974 502.000 Td /F1 9.8 Tf  [(Wu K, Li K. \(2007\) Association between esophageal cancer and drought in China by using Geographic Information )] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(System. Environment International 33, 603-608.)] TJ ET
BT 26.250 470.691 Td /F1 9.8 Tf  [(144.)] TJ ET
BT 48.974 470.691 Td /F1 9.8 Tf  [(Wu K, Huo X, Zhu G. \(2008\) Relationships between esophageal cancer and spatial environment factors by using )] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(Geographic Information System. Science of the Total Environment 393, 219-225.)] TJ ET
BT 26.250 439.381 Td /F1 9.8 Tf  [(145.)] TJ ET
BT 48.974 439.381 Td /F1 9.8 Tf  [(Macpherson C. \(1994\) Epidemiology and control of parasites in nomadic situations. Veterinary Parasitology 54, 87-102.)] TJ ET
BT 26.250 419.976 Td /F1 9.8 Tf  [(146.)] TJ ET
BT 48.974 419.976 Td /F1 9.8 Tf  [(Chua K. \(2010\) Risk factors, prevention and communication strategy during Nipah virus outbreak in Malaysia. Malaysian )] TJ ET
BT 26.250 408.072 Td /F1 9.8 Tf  [(Journal of Pathology 32 \(2\), 75-80.)] TJ ET
BT 26.250 388.667 Td /F1 9.8 Tf  [(147.)] TJ ET
BT 48.974 388.667 Td /F1 9.8 Tf  [(Black E, Blackburn M, Harrison G, Hoskins B, Methven J. \(2004\) Factors contributing to the summer 2003 European heat )] TJ ET
BT 26.250 376.762 Td /F1 9.8 Tf  [(wave. Weather 59 \(8\), 217-223.)] TJ ET
BT 26.250 357.357 Td /F1 9.8 Tf  [(148.)] TJ ET
BT 48.974 357.357 Td /F1 9.8 Tf  [(UNEP \(2004\) Early warning on emerging environmental threats: impacts of summer 2003 heat wave in Europe. United )] TJ ET
BT 26.250 345.453 Td /F1 9.8 Tf  [(Nations Environment Programme, DEWA, GRID-Europe. Available at: )] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(https://www.preventionweb.net/files/1145_ewheatwave.en.pdf)] TJ ET
BT 26.250 314.143 Td /F1 9.8 Tf  [(149.)] TJ ET
BT 48.974 314.143 Td /F1 9.8 Tf  [(Robine J-M, Cheung S, Le Roy S, Van Oyen H, Griffiths C, Michel J-P, Herrmann F. \(2008\) Death toll exceeded 70,000 in )] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(Europe during the summer of 2003. Comptes Rendus Biologies 331 \(2\), 171-178.)] TJ ET
BT 26.250 282.834 Td /F1 9.8 Tf  [(150.)] TJ ET
BT 48.974 282.834 Td /F1 9.8 Tf  [(Fischer E, Seneviratne S, Vidale P, L�thi D, Sch�r C. \(2007\) Soil moisture-atmosphere interactions during the 2003 )] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(European summer heat wave. American Meteorological Society 20 \(20\), 5081-5099.)] TJ ET
BT 26.250 251.524 Td /F1 9.8 Tf  [(151.)] TJ ET
BT 48.974 251.524 Td /F1 9.8 Tf  [(CDC \(2007b\) Wildfire-related deaths�Texas, March 12-20, 2006. Morbidity and Mortality Weekly Report \(MMWR\) 56 \(30\), )] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(757-760.)] TJ ET
BT 26.250 220.215 Td /F1 9.8 Tf  [(152.)] TJ ET
BT 48.974 220.215 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2010a\) Wildfires and heat-wave in the Russian Federation-public health advice. )] TJ ET
BT 26.250 208.310 Td /F1 9.8 Tf  [(Available at : https://www.euro.who.int/__data/assets/pdf_file/0012/120090/190810_EN_Russia_wildfire_advisory.pdf)] TJ ET
BT 26.250 188.905 Td /F1 9.8 Tf  [(153.)] TJ ET
BT 48.974 188.905 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2010b\) Climate change, extreme weather events and public health-meeting report. )] TJ ET
BT 26.250 177.000 Td /F1 9.8 Tf  [(Available at: https://www.euro.who.int/__data/assets/pdf_file/0011/144389/e95103.pdf)] TJ ET
BT 26.250 157.596 Td /F1 9.8 Tf  [(154.)] TJ ET
BT 48.974 157.596 Td /F1 9.8 Tf  [(Finlay S, Moffat A, Gazzard R, Baker D, Murray V. \(2012\) Health impacts of wildfires. Health Protection Agency, London )] TJ ET
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BT 48.974 106.881 Td /F1 9.8 Tf  [(Sousa A, Pearson R. \(2009\) Drought, smallpox and emergence of Leishmania braziliensis in Northeastern Brazil. )] TJ ET
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BT 48.974 75.572 Td /F1 9.8 Tf  [(Prothero R. \(1994\) Forced movements of population and health hazards in tropical Africa. International Journal of )] TJ ET
BT 26.250 63.667 Td /F1 9.8 Tf  [(Epidemiology 23 \(4\), 657-664.)] TJ ET
BT 26.250 44.262 Td /F1 9.8 Tf  [(158.)] TJ ET
BT 48.974 44.262 Td /F1 9.8 Tf  [(Ahmed H. \(1990\) Effects of drought and desertification on health and social life in the Sudan. World Health Forum 11 \(4\), )] TJ ET
Q
q
15.000 29.977 577.500 747.023 re W n
0.271 0.267 0.267 rg
BT 26.250 759.976 Td /F1 9.8 Tf  [(134.)] TJ ET
BT 48.974 759.976 Td /F1 9.8 Tf  [(Page A, Fragar L. \(2002\) Suicide in Australian farming, 1988-1997. Australian and New Zealand Journal of Psychiatry 36, )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(81-85.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(135.)] TJ ET
BT 48.974 728.667 Td /F1 9.8 Tf  [(Guiney R. \(2012\) Farming suicides during the Victorian drought: 2001-2007. Australian Journal of Rural Health 20, 11-15.)] TJ ET
BT 26.250 709.262 Td /F1 9.8 Tf  [(136.)] TJ ET
BT 48.974 709.262 Td /F1 9.8 Tf  [(Sartore G, Hoolahan B, Tonna A, Kelly B, Stain H. \(2005\) Wisdom from the drought: recommendations from a consultative )] TJ ET
BT 26.250 697.357 Td /F1 9.8 Tf  [(conference. Australian Journal of Rural Health 13, 315-320.)] TJ ET
BT 26.250 677.952 Td /F1 9.8 Tf  [(137.)] TJ ET
BT 48.974 677.952 Td /F1 9.8 Tf  [(Sartore G. \(2007\) Drought and its effect on mental health: how GPs can help. Australian Family Physician 36 \(12\), 990-)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(993.)] TJ ET
BT 26.250 646.643 Td /F1 9.8 Tf  [(138.)] TJ ET
BT 48.974 646.643 Td /F1 9.8 Tf  [(Sartore G, Kelly B, Stain H, Fuller J, Fragar L, Tonna A. \(2008b\) Improving mental health capacity in rural communities: )] TJ ET
BT 26.250 634.738 Td /F1 9.8 Tf  [(mental health first aid delivery in drought-affected rural New South Wales. Australian Journal of Rural Health 16, 313-318.)] TJ ET
BT 26.250 615.333 Td /F1 9.8 Tf  [(139.)] TJ ET
BT 48.974 615.333 Td /F1 9.8 Tf  [(Fuller J, Kelly B, Sartore G, Fragar L, Tonna A, Pollard G, Hazell T. \(2007\) Use of social network analysis to describe )] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(service links for farmers� mental health. Australian Journal of Rural Health 15, 99-106.)] TJ ET
BT 26.250 584.024 Td /F1 9.8 Tf  [(140.)] TJ ET
BT 48.974 584.024 Td /F1 9.8 Tf  [(Hart C, Berry H, Tonna A. \(2011\) Improving the mental health of rural New South Wales communities facing drought and )] TJ ET
BT 26.250 572.119 Td /F1 9.8 Tf  [(other adversities. Australian Journal of Rural Health 19, 231-238.)] TJ ET
BT 26.250 552.714 Td /F1 9.8 Tf  [(141.)] TJ ET
BT 48.974 552.714 Td /F1 9.8 Tf  [(CDC \(1988b\) Epidemiologic notes and report: Diving-associated spinal cord injuries during drought conditions�Wisconsin, )] TJ ET
BT 26.250 540.810 Td /F1 9.8 Tf  [(1988. Morbidity and Mortality Weekly Report \(MMWR\) 37 \(30\), 453-454.)] TJ ET
BT 26.250 521.405 Td /F1 9.8 Tf  [(142.)] TJ ET
BT 48.974 521.405 Td /F1 9.8 Tf  [(Raymond C. \(1988\) Summer�s drought reinforces diving�s dangers. JAMA 260 \(9\), 1199-1200.)] TJ ET
BT 26.250 502.000 Td /F1 9.8 Tf  [(143.)] TJ ET
BT 48.974 502.000 Td /F1 9.8 Tf  [(Wu K, Li K. \(2007\) Association between esophageal cancer and drought in China by using Geographic Information )] TJ ET
BT 26.250 490.095 Td /F1 9.8 Tf  [(System. Environment International 33, 603-608.)] TJ ET
BT 26.250 470.691 Td /F1 9.8 Tf  [(144.)] TJ ET
BT 48.974 470.691 Td /F1 9.8 Tf  [(Wu K, Huo X, Zhu G. \(2008\) Relationships between esophageal cancer and spatial environment factors by using )] TJ ET
BT 26.250 458.786 Td /F1 9.8 Tf  [(Geographic Information System. Science of the Total Environment 393, 219-225.)] TJ ET
BT 26.250 439.381 Td /F1 9.8 Tf  [(145.)] TJ ET
BT 48.974 439.381 Td /F1 9.8 Tf  [(Macpherson C. \(1994\) Epidemiology and control of parasites in nomadic situations. Veterinary Parasitology 54, 87-102.)] TJ ET
BT 26.250 419.976 Td /F1 9.8 Tf  [(146.)] TJ ET
BT 48.974 419.976 Td /F1 9.8 Tf  [(Chua K. \(2010\) Risk factors, prevention and communication strategy during Nipah virus outbreak in Malaysia. Malaysian )] TJ ET
BT 26.250 408.072 Td /F1 9.8 Tf  [(Journal of Pathology 32 \(2\), 75-80.)] TJ ET
BT 26.250 388.667 Td /F1 9.8 Tf  [(147.)] TJ ET
BT 48.974 388.667 Td /F1 9.8 Tf  [(Black E, Blackburn M, Harrison G, Hoskins B, Methven J. \(2004\) Factors contributing to the summer 2003 European heat )] TJ ET
BT 26.250 376.762 Td /F1 9.8 Tf  [(wave. Weather 59 \(8\), 217-223.)] TJ ET
BT 26.250 357.357 Td /F1 9.8 Tf  [(148.)] TJ ET
BT 48.974 357.357 Td /F1 9.8 Tf  [(UNEP \(2004\) Early warning on emerging environmental threats: impacts of summer 2003 heat wave in Europe. United )] TJ ET
BT 26.250 345.453 Td /F1 9.8 Tf  [(Nations Environment Programme, DEWA, GRID-Europe. Available at: )] TJ ET
BT 26.250 333.548 Td /F1 9.8 Tf  [(https://www.preventionweb.net/files/1145_ewheatwave.en.pdf)] TJ ET
BT 26.250 314.143 Td /F1 9.8 Tf  [(149.)] TJ ET
BT 48.974 314.143 Td /F1 9.8 Tf  [(Robine J-M, Cheung S, Le Roy S, Van Oyen H, Griffiths C, Michel J-P, Herrmann F. \(2008\) Death toll exceeded 70,000 in )] TJ ET
BT 26.250 302.238 Td /F1 9.8 Tf  [(Europe during the summer of 2003. Comptes Rendus Biologies 331 \(2\), 171-178.)] TJ ET
BT 26.250 282.834 Td /F1 9.8 Tf  [(150.)] TJ ET
BT 48.974 282.834 Td /F1 9.8 Tf  [(Fischer E, Seneviratne S, Vidale P, L�thi D, Sch�r C. \(2007\) Soil moisture-atmosphere interactions during the 2003 )] TJ ET
BT 26.250 270.929 Td /F1 9.8 Tf  [(European summer heat wave. American Meteorological Society 20 \(20\), 5081-5099.)] TJ ET
BT 26.250 251.524 Td /F1 9.8 Tf  [(151.)] TJ ET
BT 48.974 251.524 Td /F1 9.8 Tf  [(CDC \(2007b\) Wildfire-related deaths�Texas, March 12-20, 2006. Morbidity and Mortality Weekly Report \(MMWR\) 56 \(30\), )] TJ ET
BT 26.250 239.619 Td /F1 9.8 Tf  [(757-760.)] TJ ET
BT 26.250 220.215 Td /F1 9.8 Tf  [(152.)] TJ ET
BT 48.974 220.215 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2010a\) Wildfires and heat-wave in the Russian Federation-public health advice. )] TJ ET
BT 26.250 208.310 Td /F1 9.8 Tf  [(Available at : https://www.euro.who.int/__data/assets/pdf_file/0012/120090/190810_EN_Russia_wildfire_advisory.pdf)] TJ ET
BT 26.250 188.905 Td /F1 9.8 Tf  [(153.)] TJ ET
BT 48.974 188.905 Td /F1 9.8 Tf  [(WHO Regional Office for Europe \(2010b\) Climate change, extreme weather events and public health-meeting report. )] TJ ET
BT 26.250 177.000 Td /F1 9.8 Tf  [(Available at: https://www.euro.who.int/__data/assets/pdf_file/0011/144389/e95103.pdf)] TJ ET
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Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(24)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 44.977 577.500 732.023 re W n
0.271 0.267 0.267 rg
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q
15.000 44.977 577.500 732.023 re W n
0.271 0.267 0.267 rg
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BT 48.974 622.833 Td /F1 9.8 Tf  [(Cook A, Watson J, van Buynder P, Robertson A, Weinstein P. \(2008\) 10th anniversary review: natural disasters and their )] TJ ET
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BT 26.250 485.691 Td /F1 9.8 Tf  [(167.)] TJ ET
BT 48.974 485.691 Td /F1 9.8 Tf  [(IPCC \(2007\) Climate Change 2007: Synthesis Report. Contribution of Working Groups I, II and III to the Fourth )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, Pachauri, R.K and Reisinger, A. )] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(\(eds.\)]. IPCC, Geneva, Switzerland.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(168.)] TJ ET
BT 48.974 442.476 Td /F1 9.8 Tf  [(ALNAP \(2011\) Humanitarian action in drought-related emergencies. Available at: https://www.alnap.org/pool/files/alnap-)] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(lessons-drought.pdf)] TJ ET
BT 26.250 411.167 Td /F1 9.8 Tf  [(169.)] TJ ET
BT 48.974 411.167 Td /F1 9.8 Tf  [(Kustner HG, Whitehorn R, Wittmer H, Hignett VM, Rawlinson JL, Raubenheimer WJ, van der Merwe CA. \(1984\) Weight-)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(for-height nutrition surveys in rural Kwazulu and Natal, July 1983. South African medical journal = Suid-Afrikaanse tydskrif vir )] TJ ET
BT 26.250 387.357 Td /F1 9.8 Tf  [(geneeskunde 65 \(12\), 470-474.)] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(170.)] TJ ET
BT 48.974 367.953 Td /F1 9.8 Tf  [(CDC \(2011\) Notes from the field: malnutrition and mortality--southern Somalia, July 2011. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 356.048 Td /F1 9.8 Tf  [(Report \(MMWR\) 60 \(30\), 1026-1027.)] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(171.)] TJ ET
BT 48.974 336.643 Td /F1 9.8 Tf  [(CDC \(1991\) Nutritional assessment of children in drought-affected areas--Haiti, 1990. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 324.738 Td /F1 9.8 Tf  [(Report \(MMWR\) 40 \(13\), 222-225.)] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(172.)] TJ ET
BT 48.974 305.334 Td /F1 9.8 Tf  [(Patel M. \(1994\) An examination of the 1990-91 famine in Sudan. Disasters 18 \(4\), 313-331.)] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(173.)] TJ ET
BT 48.974 285.929 Td /F1 9.8 Tf  [(Ezra M, Kiros GE. \(2000\) Household vulnerability to food crisis and mortality in the drought-prone areas of northern )] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(Ethiopia. Journal of Biosocial Science 32 \(3\), 395-409.)] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(174.)] TJ ET
BT 48.974 254.619 Td /F1 9.8 Tf  [(Kumar S, Bhawani L. \(2005\) Managing child malnutrition in a drought affected district of Rajasthan--a case study. Indian )] TJ ET
BT 26.250 242.715 Td /F1 9.8 Tf  [(journal of public health 49 \(4\), 198-206.)] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(175.)] TJ ET
BT 48.974 223.310 Td /F1 9.8 Tf  [(Singh MB, Lakshminarayana J, Fotedar R. \(2008\) Chronic energy deficiency and its association with dietary factors in )] TJ ET
BT 26.250 211.405 Td /F1 9.8 Tf  [(adults of drought affected desert areas of Western Rajasthan, India. Asia Pacific journal of clinical nutrition 17 \(4\), 580-585.)] TJ ET
BT 26.250 192.000 Td /F1 9.8 Tf  [(176.)] TJ ET
BT 48.974 192.000 Td /F1 9.8 Tf  [(Mahapatra A, Geddam JJ, Marai N, Murmu B, Mallick G, Bulliyya G, Acharya AS, Satyanarayana, K. \(2000\) Nutritional )] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(status of preschool children in the drought affected Kalahandi district of Orissa. Indian Journal of Medical Research 111, 90-94.)] TJ ET
BT 26.250 160.691 Td /F1 9.8 Tf  [(177.)] TJ ET
BT 48.974 160.691 Td /F1 9.8 Tf  [(Katona-Apte J, Mokdad A. \(1998\) Malnutrition of children in the Democratic People's Republic of North Korea. Journal of )] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(Nutrition 128 \(8\), 1315-1319.)] TJ ET
BT 26.250 129.381 Td /F1 9.8 Tf  [(178.)] TJ ET
BT 48.974 129.381 Td /F1 9.8 Tf  [(Soekirman \(2001\) Food and nutrition security and the economic crisis in Indonesia. Asia Pacific journal of clinical nutrition )] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(10 Suppl, S57-61.)] TJ ET
BT 26.250 98.072 Td /F1 9.8 Tf  [(179.)] TJ ET
BT 48.974 98.072 Td /F1 9.8 Tf  [(Block SA, Kiess L, Webb P, Kosen S, Moench-Pfanner R, Bloem MW, Timmer CP. \(2004\) Macro shocks and micro )] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(outcomes: child nutrition during Indonesia's crisis. Economics & Human Biology 2 \(1\), 21-44.)] TJ ET
BT 26.250 66.762 Td /F1 9.8 Tf  [(180.)] TJ ET
BT 48.974 66.762 Td /F1 9.8 Tf  [(Arlappa N, Venkaiah K, Brahmam G N V. \(2011\) Severe drought and the vitamin A status of rural pre-school children in )] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(India. Disasters, 35 \(3\), 577-86.)] TJ ET
Q
q
15.000 44.977 577.500 732.023 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(424.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(159.)] TJ ET
BT 48.974 748.071 Td /F1 9.8 Tf  [(Wright J, Ford H. \(1992\) Another African disaster. BMJ 305, 1479-1480.)] TJ ET
BT 26.250 728.667 Td /F1 9.8 Tf  [(160.)] TJ ET
BT 48.974 728.667 Td /F1 9.8 Tf  [(NETL \(2009\). Impact of drought on US steam electric power plant cooling water intakes and related water resource )] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(management issues. National Energy Technology Laboratory. Available at: )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(https://www.evs.anl.gov/pub/doc/NETL_final_drought_impacts.pdf)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(161.)] TJ ET
BT 48.974 685.452 Td /F1 9.8 Tf  [(L�tard V, Flandre H, Lepeltier S. \(2004\) Rapport d� information. La France et les Francais face � la canicule: les lecons )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(d�une crises. S�nat No. 195. Available at: https://www.senat.fr/rap/r03-195/r03-1951.pdf)] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(162.)] TJ ET
BT 48.974 654.143 Td /F1 9.8 Tf  [(Van Vliet M, Yearsley J, Ludwig F, V�gele S, Lettenmaier D, Kabat P. \(2012\) Vulnerability of US and European electricity )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(supply to climate change. Nature Climate Change.)] TJ ET
BT 26.250 622.833 Td /F1 9.8 Tf  [(163.)] TJ ET
BT 48.974 622.833 Td /F1 9.8 Tf  [(Cook A, Watson J, van Buynder P, Robertson A, Weinstein P. \(2008\) 10th anniversary review: natural disasters and their )] TJ ET
BT 26.250 610.929 Td /F1 9.8 Tf  [(long-term impacts on the health of communities. Journal of Environmental Monitoring 10, 167-175.)] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(164.)] TJ ET
BT 48.974 591.524 Td /F1 9.8 Tf  [(Ding Y, Hayes M, Widhalm M. \(2010\) Measuring economic impacts of drought: a review and discussion. Disaster )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(Prevention and Management 20 \(4\), 434 � 446.)] TJ ET
BT 26.250 560.214 Td /F1 9.8 Tf  [(165.)] TJ ET
BT 48.974 560.214 Td /F1 9.8 Tf  [(UNDRR \(2012\) United Nations Office for Disaster Risk Reduction. Hyogo Framework for Action 2005-2015. Building the )] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(Resilience of Nations and Communities to Disasters. Available at: https://www.unisdr.org/we/coordinate/hfa)] TJ ET
BT 26.250 528.905 Td /F1 9.8 Tf  [(166.)] TJ ET
BT 48.974 528.905 Td /F1 9.8 Tf  [(UNISDR \(2009\) Drought risk reduction framework and practices: contributing to the implementation of the Hyogo )] TJ ET
BT 26.250 517.000 Td /F1 9.8 Tf  [(Framework for Action. United Nations International Strategy for Disaster Reduction, Geneva, and National Drought Mitigation )] TJ ET
BT 26.250 505.095 Td /F1 9.8 Tf  [(Center, Lincoln. Available at: https://www.unisdr.org/files/11541_DroughtRiskReduction2009library.pdf)] TJ ET
BT 26.250 485.691 Td /F1 9.8 Tf  [(167.)] TJ ET
BT 48.974 485.691 Td /F1 9.8 Tf  [(IPCC \(2007\) Climate Change 2007: Synthesis Report. Contribution of Working Groups I, II and III to the Fourth )] TJ ET
BT 26.250 473.786 Td /F1 9.8 Tf  [(Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, Pachauri, R.K and Reisinger, A. )] TJ ET
BT 26.250 461.881 Td /F1 9.8 Tf  [(\(eds.\)]. IPCC, Geneva, Switzerland.)] TJ ET
BT 26.250 442.476 Td /F1 9.8 Tf  [(168.)] TJ ET
BT 48.974 442.476 Td /F1 9.8 Tf  [(ALNAP \(2011\) Humanitarian action in drought-related emergencies. Available at: https://www.alnap.org/pool/files/alnap-)] TJ ET
BT 26.250 430.572 Td /F1 9.8 Tf  [(lessons-drought.pdf)] TJ ET
BT 26.250 411.167 Td /F1 9.8 Tf  [(169.)] TJ ET
BT 48.974 411.167 Td /F1 9.8 Tf  [(Kustner HG, Whitehorn R, Wittmer H, Hignett VM, Rawlinson JL, Raubenheimer WJ, van der Merwe CA. \(1984\) Weight-)] TJ ET
BT 26.250 399.262 Td /F1 9.8 Tf  [(for-height nutrition surveys in rural Kwazulu and Natal, July 1983. South African medical journal = Suid-Afrikaanse tydskrif vir )] TJ ET
BT 26.250 387.357 Td /F1 9.8 Tf  [(geneeskunde 65 \(12\), 470-474.)] TJ ET
BT 26.250 367.953 Td /F1 9.8 Tf  [(170.)] TJ ET
BT 48.974 367.953 Td /F1 9.8 Tf  [(CDC \(2011\) Notes from the field: malnutrition and mortality--southern Somalia, July 2011. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 356.048 Td /F1 9.8 Tf  [(Report \(MMWR\) 60 \(30\), 1026-1027.)] TJ ET
BT 26.250 336.643 Td /F1 9.8 Tf  [(171.)] TJ ET
BT 48.974 336.643 Td /F1 9.8 Tf  [(CDC \(1991\) Nutritional assessment of children in drought-affected areas--Haiti, 1990. Morbidity and Mortality Weekly )] TJ ET
BT 26.250 324.738 Td /F1 9.8 Tf  [(Report \(MMWR\) 40 \(13\), 222-225.)] TJ ET
BT 26.250 305.334 Td /F1 9.8 Tf  [(172.)] TJ ET
BT 48.974 305.334 Td /F1 9.8 Tf  [(Patel M. \(1994\) An examination of the 1990-91 famine in Sudan. Disasters 18 \(4\), 313-331.)] TJ ET
BT 26.250 285.929 Td /F1 9.8 Tf  [(173.)] TJ ET
BT 48.974 285.929 Td /F1 9.8 Tf  [(Ezra M, Kiros GE. \(2000\) Household vulnerability to food crisis and mortality in the drought-prone areas of northern )] TJ ET
BT 26.250 274.024 Td /F1 9.8 Tf  [(Ethiopia. Journal of Biosocial Science 32 \(3\), 395-409.)] TJ ET
BT 26.250 254.619 Td /F1 9.8 Tf  [(174.)] TJ ET
BT 48.974 254.619 Td /F1 9.8 Tf  [(Kumar S, Bhawani L. \(2005\) Managing child malnutrition in a drought affected district of Rajasthan--a case study. Indian )] TJ ET
BT 26.250 242.715 Td /F1 9.8 Tf  [(journal of public health 49 \(4\), 198-206.)] TJ ET
BT 26.250 223.310 Td /F1 9.8 Tf  [(175.)] TJ ET
BT 48.974 223.310 Td /F1 9.8 Tf  [(Singh MB, Lakshminarayana J, Fotedar R. \(2008\) Chronic energy deficiency and its association with dietary factors in )] TJ ET
BT 26.250 211.405 Td /F1 9.8 Tf  [(adults of drought affected desert areas of Western Rajasthan, India. Asia Pacific journal of clinical nutrition 17 \(4\), 580-585.)] TJ ET
BT 26.250 192.000 Td /F1 9.8 Tf  [(176.)] TJ ET
BT 48.974 192.000 Td /F1 9.8 Tf  [(Mahapatra A, Geddam JJ, Marai N, Murmu B, Mallick G, Bulliyya G, Acharya AS, Satyanarayana, K. \(2000\) Nutritional )] TJ ET
BT 26.250 180.096 Td /F1 9.8 Tf  [(status of preschool children in the drought affected Kalahandi district of Orissa. Indian Journal of Medical Research 111, 90-94.)] TJ ET
BT 26.250 160.691 Td /F1 9.8 Tf  [(177.)] TJ ET
BT 48.974 160.691 Td /F1 9.8 Tf  [(Katona-Apte J, Mokdad A. \(1998\) Malnutrition of children in the Democratic People's Republic of North Korea. Journal of )] TJ ET
BT 26.250 148.786 Td /F1 9.8 Tf  [(Nutrition 128 \(8\), 1315-1319.)] TJ ET
BT 26.250 129.381 Td /F1 9.8 Tf  [(178.)] TJ ET
BT 48.974 129.381 Td /F1 9.8 Tf  [(Soekirman \(2001\) Food and nutrition security and the economic crisis in Indonesia. Asia Pacific journal of clinical nutrition )] TJ ET
BT 26.250 117.477 Td /F1 9.8 Tf  [(10 Suppl, S57-61.)] TJ ET
BT 26.250 98.072 Td /F1 9.8 Tf  [(179.)] TJ ET
BT 48.974 98.072 Td /F1 9.8 Tf  [(Block SA, Kiess L, Webb P, Kosen S, Moench-Pfanner R, Bloem MW, Timmer CP. \(2004\) Macro shocks and micro )] TJ ET
BT 26.250 86.167 Td /F1 9.8 Tf  [(outcomes: child nutrition during Indonesia's crisis. Economics & Human Biology 2 \(1\), 21-44.)] TJ ET
BT 26.250 66.762 Td /F1 9.8 Tf  [(180.)] TJ ET
BT 48.974 66.762 Td /F1 9.8 Tf  [(Arlappa N, Venkaiah K, Brahmam G N V. \(2011\) Severe drought and the vitamin A status of rural pre-school children in )] TJ ET
BT 26.250 54.858 Td /F1 9.8 Tf  [(India. Disasters, 35 \(3\), 577-86.)] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(25)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 48.974 759.976 Td /F1 9.8 Tf  [(Gitau R, Makasa M, Kasonka L, Sinkala M, Chintu C, Tomkins A, Filteau S. \(2005\) Maternal micronutrient status and )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(drought of 2001-2002. Public health nutrition 8 \(7\), 837-843.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(182.)] TJ ET
BT 48.974 716.762 Td /F1 9.8 Tf  [(Cheung E, Mutahar R, Assefa F, Ververs M-T, Nasiri S M, Borrel A, Salama P. \(2003\) An epidemic of scurvy in )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Afghanistan: Assessment and response. Food and Nutrition Bulletin 24 \(3\): 247-255.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(183.)] TJ ET
BT 48.974 685.452 Td /F1 9.8 Tf  [(Kelly B, Lewin T, Stain H, Coleman C, Fitzgerald M, Perkins D, Carr V, Fragar L, Fuller J, Lyle D, Beard J. \(2011\) )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Determinants of mental health and well-being within rural and remote communities. Social Psychiatry and Psychiatric )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(Epidemiology 46: 1331-1342.)] TJ ET
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BT 26.250 759.976 Td /F1 9.8 Tf  [(181.)] TJ ET
BT 48.974 759.976 Td /F1 9.8 Tf  [(Gitau R, Makasa M, Kasonka L, Sinkala M, Chintu C, Tomkins A, Filteau S. \(2005\) Maternal micronutrient status and )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(drought of 2001-2002. Public health nutrition 8 \(7\), 837-843.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(182.)] TJ ET
BT 48.974 716.762 Td /F1 9.8 Tf  [(Cheung E, Mutahar R, Assefa F, Ververs M-T, Nasiri S M, Borrel A, Salama P. \(2003\) An epidemic of scurvy in )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Afghanistan: Assessment and response. Food and Nutrition Bulletin 24 \(3\): 247-255.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(183.)] TJ ET
BT 48.974 685.452 Td /F1 9.8 Tf  [(Kelly B, Lewin T, Stain H, Coleman C, Fitzgerald M, Perkins D, Carr V, Fragar L, Fuller J, Lyle D, Beard J. \(2011\) )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Determinants of mental health and well-being within rural and remote communities. Social Psychiatry and Psychiatric )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(Epidemiology 46: 1331-1342.)] TJ ET
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BT 48.974 759.976 Td /F1 9.8 Tf  [(Gitau R, Makasa M, Kasonka L, Sinkala M, Chintu C, Tomkins A, Filteau S. \(2005\) Maternal micronutrient status and )] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(drought of 2001-2002. Public health nutrition 8 \(7\), 837-843.)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(182.)] TJ ET
BT 48.974 716.762 Td /F1 9.8 Tf  [(Cheung E, Mutahar R, Assefa F, Ververs M-T, Nasiri S M, Borrel A, Salama P. \(2003\) An epidemic of scurvy in )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(Afghanistan: Assessment and response. Food and Nutrition Bulletin 24 \(3\): 247-255.)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(183.)] TJ ET
BT 48.974 685.452 Td /F1 9.8 Tf  [(Kelly B, Lewin T, Stain H, Coleman C, Fitzgerald M, Perkins D, Carr V, Fragar L, Fuller J, Lyle D, Beard J. \(2011\) )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Determinants of mental health and well-being within rural and remote communities. Social Psychiatry and Psychiatric )] TJ ET
BT 26.250 661.643 Td /F1 9.8 Tf  [(Epidemiology 46: 1331-1342.)] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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trailer
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