• Integrated, transdisciplinary approach: SPRINGS links behavioural, hydrometeorological, microbial water-quality and health data within a common framework across high-, middle- and low-income settings to identify shared versus context-specific risks and adaptation needs.
• Pathogen-specific focus: Target pathogens are Campylobacter, rotavirus, Cryptosporidium and Giardia, which are expected to respond differently to climate pressures. Prospective environmental testing and disease surveillance are under way in Tanzania and Italy, with Ghana and Romania following.
• Climate downscaling for health: Applying large ensembles of downscaled climate models and tailoring outputs for health-relevant decision making in each case-study context.
• Water-quality modelling under climate change: An extended model predicts microbiological water quality under changing climate in Ghana, with Romania in development; the approach captures peak contamination during climate shocks. Flooding hotspots are mapped using hydrological/hydraulic modelling adapted to data-poor catchments, combined with remote sensing and field data.
• Diarrhoeal-disease modelling: Two complementary approaches advance the field. A top-down statistical model quantifies historical burdens, identifies climate-sensitive indicators and projects future prevalence. A bottom-up agent-based model simulates disease emergence from behaviour and human–animal–environment interactions, enabling identification of intervention thresholds. Together these forecasts can strengthen surveillance, target vulnerable populations, improve outbreak preparedness and provide quantitative inputs for prioritising behavioural, environmental and public-health interventions.
• Integrated surveillance & QMRA: Implementing prospective, pathogen-specific environmental and disease surveillance at each site. In parallel, developing quantitative microbial risk-assessment (QMRA) tools for catchments, surface waters and wells to guide water-safety planning, surveillance and intervention prioritisation.
• Climate-resilient water-safety plans: Through stakeholder engagement, participatory mapping and downscaled climate information (including flood-risk hotspots), identifying climate-sensitive hazards and system vulnerabilities. Ongoing microbial monitoring across climatic conditions will strengthen hazard assessment and surveillance design.
• Prioritising adaptation across sectors: Developing an HTA-based framework to compare adaptation and mitigation options for diarrhoeal disease under climate change. A scoping review of interventions is complete, and workshops have elicited preferences and values from health-sector stakeholders—an under-explored area.
