analysis critical literature review

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Literature reviews: criticality.

• Criticality

Express Critical Analysis

The literature review of a dissertation should include critical analysis. You cannot simply juxtapose the literature you find: you have to  evaluate and draw conclusions from it.  

Paragraph level  

Try expressing your voice in each paragraph of your literature review. Write strong paragraphs. In strong paragraphs your voice can be heard in the topic sentence, development (where you analyse and compare/contrast the sources, sometimes as individual pieces, sometimes in a synthesis) and, even more easily, in the concluding sentence, where you present the "therefore" of the paragraph. 

How to express criticality at the paragraph level:  

Identify the significance of the sources, and why the points they are making are relevant  

Make connections between the sources 

Compare and contrast sources, literatures  

Accept/adopt points made by the sources, with reasons  

Reject the points made by the sources, with reasons (e.g., limitations in the methodology; out of date; limited scope; geographical delimitation) 

Indicate the position you are taking in your own work on the theories and concepts presented by the sources 

Show how limitations in the existing literature create a research gap for you 

Organise the materials, synthesising them in an original way, that sheds new light on the topic.  

To find out more about paragraph writing, check out the Assignment Writing Guides.

Literature review level 

Try to take ownership of the literature review. Remember the purposes of the review (providing background on the subject you are researching and identifying a gap in the existing literature on this subject). Thus, throughout the review:   

Identify the key themes relevant to your subject matter  

Identify the most logical and effective order for your themes 

Relate the sources back to the dissertation's research question 

Shed new light on the topic 

Draw conclusions on the existing literature  

Identify gaps in the literature  

Your literature review should present an argument (which you can recap in the concluding paragraph of the literature review). For instance, 

"The literature says/illustrates/reveals that... there are debates in the literature as of... it can be understood from the literature that... however, there are gaps in the literature... the literature does not specifically address (specific sector/location/population)... there is a lack of independent/recent studies on...  therefore in order to answer the research question(s) (you can repeat the question) this dissertation uses method xyz, as illustrated in the next section (if applicable)". 

Manchester University’s  academic phrase bank  is a great resource for learning new words and phrases. 

Extra Resources

For extra help with all aspects of study skills including how to undertake literature reviews, appointments are available with learning advisors on Engage. 

Appointments are also available with an Academic Engagement Librarian to discuss any issues you might be having with research.

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How to Write a Literature Review

• 5. Critically Analyze and Evaluate
• Literature Reviews: A Recap
• Reading Journal Articles
• Does it Describe a Literature Review?
• 1. Identify the Question
• 2. Review Discipline Styles
• Searching Article Databases
• Finding Full-Text of an Article
• Citation Chaining
• When to Stop Searching
• 4. Manage Your References

Critically analyze and evaluate

Tip: read and annotate pdfs.

• 6. Synthesize
• 7. Write a Literature Review

Ask yourself questions like these about each book or article you include:

• What is the research question?
• What is the primary methodology used?
• How was the data gathered?
• How is the data presented?
• What are the main conclusions?
• Are these conclusions reasonable?
• What theories are used to support the researcher's conclusions?

Take notes on the articles as you read them and identify any themes or concepts that may apply to your research question.

This sample template (below) may also be useful for critically reading and organizing your articles. Or you can use this online form and email yourself a copy .

• Sample Template for Critical Analysis of the Literature

Opening an article in PDF format in Acrobat Reader will allow you to use "sticky notes" and "highlighting" to make notes on the article without printing it out. Make sure to save the edited file so you don't lose your notes!

Some Citation Managers like Mendeley also have highlighting and annotation features.Here's a screen capture of a pdf in Mendeley with highlighting, notes, and various colors:

Screen capture from a UO Librarian's Mendeley Desktop app

• Learn more about citation management software in the previous step: 4. Manage Your References
• << Previous: 4. Manage Your References
• Next: 6. Synthesize >>
• Last Updated: May 3, 2024 5:17 PM
• URL: https://researchguides.uoregon.edu/litreview

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In This Article Expand or collapse the "in this article" section Literature Reviews

Introduction, what is a literature review.

• Literature Reviews for Thesis or Dissertation
• Stand-alone and Systemic Reviews
• Purposes of a Literature Review
• Texts on Conducting a Literature Review
• Identifying the Research Topic
• The Persuasive Argument
• Searching the Literature
• Creating a Synthesis
• Critiquing the Literature
• Building the Case for the Literature Review Document
• Presenting the Literature Review

Related Articles Expand or collapse the "related articles" section about

About related articles close popup.

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• Higher Education Research
• Meta-Analysis and Research Synthesis in Education
• Methodologies for Conducting Education Research
• Mixed Methods Research
• Philosophy of Education
• Politics of Education
• Qualitative Data Analysis Techniques

Other Subject Areas

Forthcoming articles expand or collapse the "forthcoming articles" section.

• Black Women in Academia
• Girls' Education in the Developing World
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Literature Reviews by Lawrence A. Machi , Brenda T. McEvoy LAST REVIEWED: 27 October 2016 LAST MODIFIED: 27 October 2016 DOI: 10.1093/obo/9780199756810-0169

Literature reviews play a foundational role in the development and execution of a research project. They provide access to the academic conversation surrounding the topic of the proposed study. By engaging in this scholarly exercise, the researcher is able to learn and to share knowledge about the topic. The literature review acts as the springboard for new research, in that it lays out a logically argued case, founded on a comprehensive understanding of the current state of knowledge about the topic. The case produced provides the justification for the research question or problem of a proposed study, and the methodological scheme best suited to conduct the research. It can also be a research project in itself, arguing policy or practice implementation, based on a comprehensive analysis of the research in a field. The term literature review can refer to the output or the product of a review. It can also refer to the process of Conducting a Literature Review . Novice researchers, when attempting their first research projects, tend to ask two questions: What is a Literature Review? How do you do one? While this annotated bibliography is neither definitive nor exhaustive in its treatment of the subject, it is designed to provide a beginning researcher, who is pursuing an academic degree, an entry point for answering the two previous questions. The article is divided into two parts. The first four sections of the article provide a general overview of the topic. They address definitions, types, purposes, and processes for doing a literature review. The second part presents the process and procedures for doing a literature review. Arranged in a sequential fashion, the remaining eight sections provide references addressing each step of the literature review process. References included in this article were selected based on their ability to assist the beginning researcher. Additionally, the authors attempted to include texts from various disciplines in social science to present various points of view on the subject.

Novice researchers often have a misguided perception of how to do a literature review and what the document should contain. Literature reviews are not narrative annotated bibliographies nor book reports (see Bruce 1994 ). Their form, function, and outcomes vary, due to how they depend on the research question, the standards and criteria of the academic discipline, and the orthodoxies of the research community charged with the research. The term literature review can refer to the process of doing a review as well as the product resulting from conducting a review. The product resulting from reviewing the literature is the concern of this section. Literature reviews for research studies at the master’s and doctoral levels have various definitions. Machi and McEvoy 2016 presents a general definition of a literature review. Lambert 2012 defines a literature review as a critical analysis of what is known about the study topic, the themes related to it, and the various perspectives expressed regarding the topic. Fink 2010 defines a literature review as a systematic review of existing body of data that identifies, evaluates, and synthesizes for explicit presentation. Jesson, et al. 2011 defines the literature review as a critical description and appraisal of a topic. Hart 1998 sees the literature review as producing two products: the presentation of information, ideas, data, and evidence to express viewpoints on the nature of the topic, as well as how it is to be investigated. When considering literature reviews beyond the novice level, Ridley 2012 defines and differentiates the systematic review from literature reviews associated with primary research conducted in academic degree programs of study, including stand-alone literature reviews. Cooper 1998 states the product of literature review is dependent on the research study’s goal and focus, and defines synthesis reviews as literature reviews that seek to summarize and draw conclusions from past empirical research to determine what issues have yet to be resolved. Theoretical reviews compare and contrast the predictive ability of theories that explain the phenomenon, arguing which theory holds the most validity in describing the nature of that phenomenon. Grant and Booth 2009 identified fourteen types of reviews used in both degree granting and advanced research projects, describing their attributes and methodologies.

Bruce, Christine Susan. 1994. Research students’ early experiences of the dissertation literature review. Studies in Higher Education 19.2: 217–229.

DOI: 10.1080/03075079412331382057

A phenomenological analysis was conducted with forty-one neophyte research scholars. The responses to the questions, “What do you mean when you use the words literature review?” and “What is the meaning of a literature review for your research?” identified six concepts. The results conclude that doing a literature review is a problem area for students.

Cooper, Harris. 1998. Synthesizing research . Vol. 2. 3d ed. Thousand Oaks, CA: SAGE.

The introductory chapter of this text provides a cogent explanation of Cooper’s understanding of literature reviews. Chapter 4 presents a comprehensive discussion of the synthesis review. Chapter 5 discusses meta-analysis and depth.

Fink, Arlene. 2010. Conducting research literature reviews: From the Internet to paper . 3d ed. Los Angeles: SAGE.

The first chapter of this text (pp. 1–16) provides a short but clear discussion of what a literature review is in reference to its application to a broad range of social sciences disciplines and their related professions.

Grant, Maria J., and Andrew Booth. 2009. A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal 26.2: 91–108. Print.

DOI: 10.1111/j.1471-1842.2009.00848.x

This article reports a scoping review that was conducted using the “Search, Appraisal, Synthesis, and Analysis” (SALSA) framework. Fourteen literature review types and associated methodology make up the resulting typology. Each type is described by its key characteristics and analyzed for its strengths and weaknesses.

Hart, Chris. 1998. Doing a literature review: Releasing the social science research imagination . London: SAGE.

Chapter 1 of this text explains Hart’s definition of a literature review. Additionally, it describes the roles of the literature review, the skills of a literature reviewer, and the research context for a literature review. Of note is Hart’s discussion of the literature review requirements for master’s degree and doctoral degree work.

Jesson, Jill, Lydia Matheson, and Fiona M. Lacey. 2011. Doing your literature review: Traditional and systematic techniques . Los Angeles: SAGE.

Chapter 1: “Preliminaries” provides definitions of traditional and systematic reviews. It discusses the differences between them. Chapter 5 is dedicated to explaining the traditional review, while Chapter 7 explains the systematic review. Chapter 8 provides a detailed description of meta-analysis.

Lambert, Mike. 2012. A beginner’s guide to doing your education research project . Los Angeles: SAGE.

Chapter 6 (pp. 79–100) presents a thumbnail sketch for doing a literature review.

Machi, Lawrence A., and Brenda T. McEvoy. 2016. The literature review: Six steps to success . 3d ed. Thousand Oaks, CA: Corwin.

The introduction of this text differentiates between a simple and an advanced review and concisely defines a literature review.

Ridley, Diana. 2012. The literature review: A step-by-step guide for students . 2d ed. Sage Study Skills. London: SAGE.

In the introductory chapter, Ridley reviews many definitions of the literature review, literature reviews at the master’s and doctoral level, and placement of literature reviews within the thesis or dissertation document. She also defines and differentiates literature reviews produced for degree-affiliated research from the more advanced systematic review projects.

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Literature reviews - research guide

• Critical reading and analysis
• Literature reviews home
• Planning your Review & EBP
• Searching for literature
• Managing your results
• Writing your review
• Systematic literature reviews

Critical reading & analysis

• Critical reading
• Analysing sources

Author analysis

• Journal analysis
• Note taking

A critical reader:​ ​

• Does not believe everything they read​ ​
• Questions what they read​ ​
• Rereads if necessary​ ​
• Understands the influence of style​ ​
• Analyses arguments​ ​
• Discounts arguments that are unsupported or based on faulty reasoning

When reading critically, focus on the purpose of your literature review:

• Think about what you expect from the article or chapter, before reading it
• Skim the abstract, headings, conclusion, and the first sentence of each paragraph
• Focus on the arguments presented rather than facts
• Take notes as you read and start to organise your review around themes and ideas
• Consider using a table, matrix or concept map to identify how the different sources relate to each other
• Note four to six points for each study that summarises the main points and conclusions
• Be as objective as possible

Critical appraisal

Critical appraisal is the process of carefully and syst ematically examining research to judge its credibility, its value and its relevance in a specific context.

The aim of critical appraisal is to understand the strengths, weaknesses, and potential for bias in the research. Validity, applicability, and clinical importance should be considered during critical appraisal to ensure that research evidence is used reliably and efficiently and false conclusions are not drawn.

Why do we need to critically appraise the literature?

Critical appraisal is necessary to:

• Assess benefits and strengths for research against flaws and weaknesses
• Decide whether studies have been undertaken in a way that makes their findings reliable
• Make sense of the result
• Know what these results mean in the context of the clinical decision being made
• Assess the usefulness of  the evidence for clinical decisions

Elements of sources

• Abstract: this is what the author wants the reader to take away from their article - what is the starting point? ​ ​
• Introduction:  provides background and a starting point - how does it guide the reader?​ ​
• Materials and methods:  often overlooked but very important - is the methodology understandable, reproducible, direct and robust?
• What do the tables, figures and legends actually report? ​ ​
• What do you think the data means? Decide before reading the discussion​.
• Discussion:  author draws conclusions – how does this correlate with your conclusions?

Evaluation of sources

Consider the following criteria:

• Is the source up-to-date?​
• Does it consider the latest research on your topic?​
• Is the article relevant to your topic?​
• Is the research methodology comprehensively described?​
• Does the work ultimately contribute in any significant way to an understanding of the subject?
• How reputable is the source?​
• Is the source peer-reviewed?​
• What is the source's impact factor ?
• Is the author from a reputable institution?​
• Have you seen the author cited in other sources?​
• Does the data support the conclusions drawn?​
• Are the author's opinions and conclusions convincing? 
• Are the author's arguments supported by evidence (primary material, case studies, narratives, statistics, recent findings)?​ ​
• Is the article properly referenced?​
• What is the purpose of the article and its intended audience?​
• Can you detect any bias in the content?​
• Is the reporting objective?​
• Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Which of the author's arguments are most/least convincing?​ ​
• Were the objectives achieved? ​ ​
• Hypotheses tested? ​ ​
• How do these results relate to other studies you have found?​ ​
• Do the authors openly discuss any limitations of their study?​ ​
• What else needs be studied in the future?

Interpretation

• Read critically​ ​
• Note 2-4 bullet points for each study that summarises the main points and conclusions​ ​
• Use matrix to analyse findings, relevance and importance of each text​ ​
• Draw attention to studies that are important, influential or that bring a new understanding or method of studying your area of research
• Literature Analysis Worksheet
• Literature Review Matrix

Databases such as Scopus and Web of Science can be used to:

• Locate the papers of a specific author
• Compare the research output of more than one author

The h -index

The h -index is a metric that allows you to compare the publications or research output of authors. This metric is calculated by determining the number of articles (n) written by an author, in the database, that have received the same number or more (n) citations over time. The h -index is a useful metric for comparing rates of publication, as the value is not skewed by a single highly cited paper, nor by a large number of poorly cited papers.

• The h -index is not a static value – if discussing an author’s h-index, you need to specify the date on which the h -index was calculated.
• The h -index is also calculated by other databases/resources and may vary from the h -index given by Scopus – if discussing an author’s h -index, you need to specify the source of the h-index.

See the example below of how an author's  h -index may appear in Scopus.

To locate papers of an author in  Scopus :

• Go to the default Scopus search screen and select Authors tab.
• Enter the author details and affiliation (university). Only include author surname for a comprehensive search. If the author has a common surname, include the first name's initial only.
• The author’s details and the documents that they have written, and which are indexed by Scopus, will be retrieved. Click on the author’s name to see a full list of their publications.

The information about the author will also tell you:

• How many of their publications have been indexed by Scopus
• How many times their publications have been cited
• Which of their publications are most highly cited
• Who they have co-authored papers with
• Their publication and citation trends for the past nine years
• Their h -index

See the Scopus resources below for more help:

• How to search for authors by topic
• How to assess an author's impact
• How to keep track of an author
• How to create citation overviews in Scopus

Web of Science Core Collection

To locate papers of an author in Web of Science Core Collection (WoS CC):

• Go to the default WoS CC search screen and select Researchers tab.
• Enter the author's surname and first name's initial.

The author’s details and the papers that they have written, and which are indexed by WoS CC, will be retrieved. Click on the Publications tab to see a full list of their publications.

• How many of their publications have been indexed by WoS CC

The author's citation report will tell you:

The Measuring research quality and impact guide has more detailed information on author analytics:

• Measuring research quality and impact

Source/journal analysis

Databases such as Scopus and Web of Science  (including CAB Abstracts ) can be used to determine the quality of journals in a discipline or field of research. For more information on journal analytics, please see the relevant section of our guide on Measuring Research Quality & Impact:

• Journal quality & impact (in Measuring research quality & impact guide)

Taking clear, legible notes will help to focus your critical reading and analysis of your literature review sources. When taking notes, avoid plagiarism by:

•  Keeping track of the difference between information from your sources and from your own ideas
•  Providing clear references, including page numbers

Note taking methods

Some effective methods of note-taking include:

• Outlining method. Use headings, sub-headings and bullet points to organize topics
• Cornell method. Use two columns - in one column write your summary of the authors' conclusions and evidence, and in the other column write down your own analysis and other comments
• Charting method. Create a list of topics or points you want to write about - use a column for each one. As you read, add references and make notes in the appropriate column
• Sentence method. Simply write down new ideas and bits of information as a numbered  sentence
• Mapping method. Write down key concepts and terms, with related ideas radiating out from these

You may consider using the matrix below for your note taking and analysis:

Critical reading & analysis checklist

• Does your literature review highlight flaws, gaps, or shortcomings of specific texts or groups of texts?
• Have you identified areas that have not yet been researched or have not yet been researched sufficiently?
• Does the literature demonstrate a change over time or recent developments that make your research relevant now?
• Are you able to discuss research methods used to study this topic and/or related topics?
• Can you clearly state why your research is necessary?
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• Last Updated: Mar 8, 2024 1:16 PM
• URL: https://libguides.murdoch.edu.au/LitReview

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• Writing Tips

Critical Analysis in a Literature Review

3-minute read

• 29th June 2015

A literature review is vital to any in-depth research , providing a foundation your work will build upon. Familiarizing yourself with the existing literature allows you to identify current debates in the field, ensuring that your work is up-to-date and addresses significant questions.

But a good literature review will require reading critically. This means deciding whether you agree or disagree with certain viewpoints, arguments and theories, rather than simply describing them.

It also requires being able to spot the flaws and strengths of particular studies, which can in turn help when developing your own ideas. To make sure you do this effectively, it’s worth looking for the following things.

1. Overgeneralizations

One common issue in research is the scope of its application, especially when dealing with limited sample sizes or when a study is generalized too broadly.

The conclusions of a psychological study conducted with all male participants, for instance, may not be applicable in the same way to female subjects.

2. Methodological Limitations

When writing a literature review, ask yourself whether the methods used for particular studies were appropriate.

For example, whether the study used a quantitative, qualitative or mixed-methods research design can make a big difference to the conclusions reached.

3. How Well Explained is the Research?

When reading for a critical literature review, it is important to consider how well written the studies you examine are.

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Does the author explain their methods? Is enough detail provided for any experiments to be replicated? Are sampling, data collection and analysis techniques clearly identified? Does the conclusion follow from the results?

Asking these and similar questions will help you discern between good and bad research.

4. Identify Biases

Another important factor is to consider whether implicit biases might have influenced the research.

The term “confirmation bias,” for example, refers to the tendency to focus on evidence which supports one’s existing beliefs, which can lead to overlooking alternative hypotheses.

5. Challenge Your Own Assumptions

If you come across a study which seems to oppose your hypothesis, consider whether it presents good counterarguments to your own position. If it does, ask yourself whether this affects how you conduct the rest of your research.

The final point here is important because conducting a literature review serves two purposes . The finished literature review will help your reader to understand the background of your research, so critical analysis helps to clarify what your work contributes to the debate.

But comparing different studies and theories for a literature review will also help you to develop a research approach. The better your critical analysis, then, the better prepared you’ll be.

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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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Systematic Reviews

• Types of Literature Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

• Planning Your Systematic Review
• Database Searching
• Creating the Search
• Search Filters and Hedges
• Grey Literature
• Managing and Appraising Results
• Further Resources

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Chaos to Clarity: Structuring Your Literature Review Format

Master literature review format! Learn key sections, effective citation & analysis tips to write a strong academic review.

Ever wondered how to dive into a mountain of books and articles and come up with something that not just makes sense but shines new light on a topic? What if there was a way to neatly tie together all that information, spot what’s missing, and maybe even pave the way for discoveries? 

That’s what you are going to learn in this article, literature reviews—a place where chaos meets order, and where your insights could set the stage for the next big thing. Let’s break down the literature review format , your essential guide to properly writing a literature review.

Dissecting Literature Review Format 

There are 6 main sections to make a note of while writing a literature review. Those are:

The Introduction Section

Topic background, conceptual framework.

• Synthesis and Evaluation in Literature Reviews
• Conclusion for Your Literature Review
• Reference List in Your Literature Review

Also Read: Essential Components of a Literature Review

The introduction of your literature review is where you set the stage for the entire document. It’s your first opportunity to engage your readers and provide a clear blueprint of what your review will cover and why it matters. This section does more than merely introduce the topic; it establishes the context, defines the scope, and outlines the purpose and objectives of your literature review.

Things to keep in mind while writing an introduction:

• Craft a compelling opening
• Establish the Context and Justification
• Define the Scope and Objectives
• Lay out the Structure
• Give an overview of the Structure

The “Topic Background” section of a literature review serves as the cornerstone for understanding the evolution and current state of the subject matter. It is divided into two crucial sub-sections: Historical Context and Current State of the Topic . 

Delving into these areas provides you with a comprehensive backdrop against which the literature review is framed, enriching the reader’s understanding of why the topic is of interest and what has influenced its development to the current state.

Historical Context

The Historical Context is fundamental in setting the stage for the entire literature review. This section is not just a chronology of events or developments; it’s a curated narrative that highlights the key milestones and turning points that have significantly impacted the topic. 

By examining the historical evolution, the review establishes a timeline of how understanding and perspectives have shifted over the years.

Summary Of Key Historical Developments

This involves identifying and summarizing the major breakthroughs, shifts in thinking, or seminal works that have shaped the topic. It’s important to focus on developments that have a direct relevance to the current understanding and state of the subject. For example, if the topic is about the evolution of renewable energy technologies, this part would outline the initial discovery and use of renewable sources, significant technological innovations, and pivotal policy decisions that have influenced the field.

Relevance Of Historical Context To The Topic

After outlining the key historical developments, it’s crucial to connect these events to the present topic. This means discussing how past events have laid the groundwork for current theories, practices, or debates within the field. It involves analyzing the impact of historical milestones on the subject matter, and explaining how they have contributed to current knowledge, challenges, and research questions. This section makes it clear why understanding history is essential for anyone researching or studying the topic today.

Current State Of The Topic

Moving from the historical context, the review transitions to the present with the Current State of the Topic. This part assesses the latest research, trends, debates, and technological advancements that define the subject area at the moment.

Current Trends Or Updates

Here, the focus shifts to what is happening in the field right now. This could include recent research findings, emerging theories, new methodologies, or the latest technological innovations. The aim is to provide a snapshot of the current research landscape, identifying what themes, questions, or problems are being actively explored. For instance, in the context of digital marketing, this might involve discussing the rise of artificial intelligence in customer relationship management or the impact of social media trends on marketing strategies.

Impact Of These Trends On The Subject Matter

The final step is to assess the implications of these current trends for the topic. This includes considering how recent developments have advanced the field, the challenges they present, and the opportunities they open up for future research. It’s about connecting the dots between what’s happening now and what it means for the subject area moving forward. This not only helps to frame the research questions that the literature review will address but also sets the stage for identifying gaps in the current knowledge, thereby guiding the direction of future studies.

Also Read: What is a literature review? Get the concept and start using it

When doing a literature review, it’s essential to lay a solid foundation for your exploration through a well-defined conceptual framework. This framework acts as a compass, guiding your review’s direction by establishing the key concepts, theories, and perspectives that underpin your topic. 

Definitions And Descriptions

Before diving into the depths of your literature review, it’s crucial to start with the basics. This means clearly identifying and defining the key concepts related to your topic. Think of this as setting the stage for your readers, ensuring they have a clear understanding of the fundamental terms and ideas you will be exploring.

Key Concepts Related To The Topic

Begin by listing the essential concepts central to your review. These are the building blocks of your topic, the terms that will repeatedly appear throughout your exploration. 

Detailed Definitions And Their Relevance

Once you’ve identified these concepts, provide precise and comprehensive definitions for each. Don’t hesitate to explore different dimensions or interpretations of these terms, as this can enrich your readers’ understanding. More importantly, discuss why these concepts are crucial to your review. How do they shape the scope of your exploration? How do they relate to each other and to the broader topic? This step ensures that your readers are not just familiar with the terms but also understand their significance within your review’s context.

Theoretical Perspectives

With the key concepts clearly defined, it’s time to frame your literature review within relevant theoretical perspectives. This is where you align your exploration with existing theories, models, or frameworks that provide insights into your topic.

Important Theories Related To The Topic

Identify the theories that are foundational to your topic. These could range from well-established theories that have long guided research in your field to more contemporary models that offer new insights. For example, a review of organizational behavior might draw on theories of motivation, leadership styles, and organizational culture.

Evaluation Of These Theories And Their Influence On The Topic

After pinpointing the relevant theories, critically assess their contributions to the topic. Consider questions like: How have these theories shaped understanding of the topic? What insights do they offer, and where do they fall short? Are there controversies or debates surrounding these theories? This evaluation not only deepens your review’s analytical depth but also positions your work within the larger academic conversation.

Synthesis And Evaluation In Literature Reviews

The “Synthesis and Evaluation” section is where your literature review truly comes to life. Here, you’re not just summarizing what others have said; you’re weaving together diverse strands of research to present a cohesive picture of the topic at hand.

Comparison And Contrast Of Sources

Synthesizing the literature involves more than listing findings from various studies; it’s about drawing connections between them, highlighting areas of agreement and dispute, and weaving these into a narrative that adds depth and breadth to your understanding of the topic.

Comparative Analysis

Start by grouping your sources based on similarities in their findings, methodologies, or theoretical approaches. This clustering will help you identify trends and common themes across the literature. For example, if several studies have found similar outcomes under comparable conditions, these findings can be grouped to strengthen a particular argument or observation about the topic.

Contrasts Or Conflicts Among Sources

Equally important is the identification of discrepancies in the literature. Do some studies present findings that directly contradict others? Are there differences in how researchers have interpreted similar data? Highlighting these conflicts is crucial, as it can indicate areas where the topic is still evolving or where further research is needed. It also shows your ability to critically engage with the material, a hallmark of scholarly rigor.

Analysis Of Gaps In Literature

One of your primary tasks in the synthesis and evaluation section is to identify what’s missing in the current body of research. This requires a critical eye and a deep understanding of both your topic and the broader field in which it resides.

Identification Of Research Gaps

As you comb through the literature, ask yourself: What questions remain unanswered? Are there underexplored areas or populations? Perhaps certain methodologies have been overlooked, or theoretical perspectives have not been considered. Pinpointing these gaps is not a mere exercise in academic critique; it’s a vital step in advancing knowledge within the field.

Implications Of These Gaps For Future Research

Highlighting gaps in the literature sets the stage for future studies. It’s where you, as the reviewer, can suggest new research directions that could fill these voids or further explore the topic. Discussing the implications of these gaps not only enriches your review but also contributes to the ongoing scholarly conversation. 

Conclusion For Your Literature Review

The conclusion of your literature review is where you bring together all the strands of your argument, synthesizing the insights gained and highlighting the significance of your findings. It’s not just a summary of what has been discussed; it’s an opportunity to underscore the relevance of the review, reflect on the broader implications of your synthesis and evaluation, and suggest directions for future research. 

Summary Of Key Points

Start your conclusion by succinctly summarizing the main points and findings of your review. This isn’t about rehashing every detail but rather about distilling the essence of your exploration. Highlight the critical trends, themes, and conflicts you’ve uncovered, and remind your readers of the significance of these discoveries.

Relevance And Implications Of The Literature For The Topic

Next, focus on the relevance and implications of your findings. This involves stepping back to consider the bigger picture—how does your literature review contribute to the understanding of your topic? Discuss the impact of the trends and gaps you’ve identified on the field, and elaborate on how your synthesis of the literature advances or enriches existing knowledge.

Reflection On The Research Process

Reflecting on the research process itself can provide valuable insights. Consider discussing the challenges you encountered in navigating the literature, such as dealing with conflicting findings or the scarcity of research on certain aspects of your topic. 

Directions For Future Research

One of the most critical aspects of your conclusion is to suggest directions for future research. Be as precise as possible, whether suggesting new methodologies, theoretical frameworks, or specific topics that warrant deeper investigation.

Final Thoughts

End your conclusion with a strong closing statement that reiterates the value of your literature review. Emphasize the importance of continued research on your topic and the potential it holds for advanced understanding within your field. A compelling conclusion reaffirms the significance of your work, leaving your readers with a clear sense of its contribution and the urgent need for further exploration.

Reference List In Your Literature Review

The Reference List is the backbone of your literature review, providing a comprehensive compilation of all the sources you’ve cited throughout your exploration. It’s not merely a formality but a crucial component that lends credibility and rigor to your work.

Importance Of Accuracy And Consistency

The cornerstone of a reliable Reference List is accuracy and consistency in citation style. Whether you’re adhering to APA , MLA , Chicago , or another academic citation format, it’s vital to apply the rules with precision. This includes correctly formatting author names, publication dates, titles, and publication details. 

Organizing Your References

While different citation styles have their own rules for listing references, organizing them in a way that enhances readability and accessibility is universally beneficial. Alphabetical order by the author’s last name is the most common method, as it allows readers to easily locate sources.

Comprehensive Coverage

Your Reference List should be exhaustive, including every work you’ve cited in your review. This extends beyond journal articles and books to encompass reports, conference papers, online resources, and any other materials that have informed your analysis.

The Value Of Annotations

While not always required, providing brief annotations for key sources can add tremendous value to your Reference List. An annotated bibliography offers a succinct summary of each source’s main arguments, methodologies, and findings, as well as its relevance to your literature review.

Digital Accessibility

In today’s digital age, considering the accessibility of your referenced works can greatly enhance the utility of your Reference List. Whenever possible, include Digital Object Identifiers (DOIs) or stable URLs for online sources, ensuring readers can directly access the materials. 

Also read: What Is A DOI? Exploring The Purpose And Importance

Reflecting On Ethical Scholarship

Finally, your Reference List is a reflection of ethical scholarship. By accurately citing all the sources that have informed your work, you’re honoring the intellectual property of other researchers and upholding the academic community’s standards of integrity and respect. 

Crafting a meticulous Reference List is an essential aspect of your literature review that underscores the credibility, depth, and ethical foundation of your research. By adhering to the principles of accuracy, comprehensiveness, and accessibility, you not only facilitate further inquiry but also pay homage to the collective endeavor of knowledge advancement in your field.

Related Article: Navigating the AMA Citation Format: Best Tips for Referencing

In conclusion, writing a literature review involves meticulous structuring, beginning with an engaging introduction that sets the stage, followed by a detailed exploration of the topic’s background, including its historical context and current state. 

A robust conceptual framework lays the groundwork for analysis, leading to a critical synthesis and evaluation of relevant literature. 

The conclusion ties together the review’s key findings and implications, while the reference list meticulously catalogs all cited works. Mastering each section ensures a comprehensive and insightful review, essential for advancing academic understanding and contributing to scholarly discussions.

Related Article: Preliminary Literature Review: A Guide for Effective Research

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About Sowjanya Pedada

Sowjanya is a passionate writer and an avid reader. She holds MBA in Agribusiness Management and now is working as a content writer. She loves to play with words and hopes to make a difference in the world through her writings. Apart from writing, she is interested in reading fiction novels and doing craftwork. She also loves to travel and explore different cuisines and spend time with her family and friends.

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Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review

• Substantive Review
• Published: 20 May 2024

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• Joanne H. Hunt   ORCID: orcid.org/0000-0002-6230-841X 1 ,
• Holly L. Peay 2 &
• Gail E. Henderson 3  

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In 2022, 54% of 1.5 million children (age 0–14) living with HIV had access to anti-retroviral medication (ART). Adherence to ART for pregnant or breastfeeding HIV + women is critical for maintaining their personal health and to prevent mother-to-child-transmission (MTCT). For HIV + infants, adherence is essential to establish early viremic control and is contingent on caregiver administration. We conducted a scoping review to systematically identify and categorize the influences on ART adherence for pregnant or breastfeeding HIV + women and their HIV + infants. We searched databases in June 2023 and employed the Social-Ecological Model (SEM) to organize facilitators and barriers to adherence referenced in published articles. All articles published before 2016 were excluded due to updated guidelines from WHO on MTCT and ART. Our analysis included 52 articles. 50/52 took place in Africa and used cross-sectional and mixed-methods design. Barriers to adherence for pregnant or breastfeeding HIV + women included maternal education, self-efficacy, social support, and social/economic context. Barriers to infant adherence included development, nutrition, age of treatment initiation, disclosure, and ART side effects. Additional facilitators and barriers to adherence are presented at family, extra-familial, and socio-cultural SEM levels. Stigma was the most salient barrier referenced across the entire continuum of HIV care and all SEM levels. This review revealed a dearth of literature focusing on HIV + infants who are dependent on their caregivers for ART adherence and lack of a standard adherence measure. We identified multi-leveled influences on adherence impacting both the mother and infant and are amenable to public health intervention.

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Acknowledgements

The authors acknowledge the adults and children living with HIV who provided the data reviewed in this study.

GH and HP were funded through a grant from the Early-treated Perinatally HIV-infected Individuals: Improving Children’s Actual Life (EPIICAL) consortium.

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Hunt, J.H., Peay, H.L. & Henderson, G.E. Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04373-4

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The implications of using maternity care deserts to measure progress in access to obstetric care: a mixed-integer optimization analysis

• Meghan E. Meredith 1 ,
• Lauren N. Steimle 1 &
• Stephanie M. Radke 2  

BMC Health Services Research volume  24 , Article number:  682 ( 2024 ) Cite this article

Metrics details

Lack of access to risk-appropriate maternity services, particularly for rural residents, is thought to be a leading contributor to disparities in maternal morbidity and mortality. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access.

We formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women who lack access to obstetric care. We define regions with a lack of access as either maternity care deserts, designated by the March of Dimes to be counties with no obstetric care facility or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey.

Out of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both maternity care desert and further than 50 miles from CCO services. Our optimization analysis suggests that at least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. However, the expansion of 8 facilities would ensure all women in Georgia live within 50 miles of CCO services.

Conclusions

Current measures of access to obstetric care may not be sufficient for evaluating access and planning action toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to meet obstetric care needs.

Peer Review reports

The maternal mortality rate in the United States (U.S.), 32.9 deaths per 100,000 live births as of 2021, is the highest among developed countries and has increased by 89% since 2018 [ 1 , 2 ]. There is evidence that upwards of 80% of maternal deaths in the U.S. are preventable [ 3 ]. Among the factors contributing to the maternal mortality crisis in the U.S. is a lack of access to risk-appropriate care and an undersupply of maternal healthcare providers [ 2 ].

Rural access to obstetric services has been declining in recent years. Over half of rural counties did not have a facility offering obstetric services in 2014, and this number grew by 2.7% from 2014 to 2018 [ 4 ]. Administrators cite financial concerns, shortages of obstetric professionals, and low volume as reasons for closing their obstetric units [ 5 , 6 ]. Lack of access to obstetric services is associated with adverse maternal outcomes, adverse neonatal outcomes, and prenatal stress [ 7 , 8 , 9 , 10 , 11 ]. Recent findings suggest a lack of access and disparities in geographic access will persist unless facility-level infrastructure is expanded [ 12 ]. However, geographic access to obstetric care is measured in several ways, which causes uncertainty about how to optimally invest in infrastructure to expand access. One common measure of access in the academic literature and news media is the maternity care desert, as defined by the March of Dimes [ 13 , 14 ]. The March of Dimes categorizes counties with a lack of access to care (no hospital or birth center offering obstetric care and no obstetric providers) as maternity care deserts. As of 2022, more than 2.2 million reproductive-aged women in the U.S. live in maternity care deserts [ 15 ]. Studies have shown that pregnant women who live in maternity care deserts have higher rates of infant and maternal mortality [ 16 , 17 ]. However, the maternity care deserts access measure does not necessarily reflect distance to care because counties differ in size and some pregnant women within a county may live close to an obstetric facility in a neighboring county. Other studies have measured geographic access as driving time to the nearest facility offering obstetric services at different levels of care [ 12 , 18 ] and distance to the nearest facility offering critical care obstetric (CCO) services [ 19 , 20 ] as key measures for quantifying potential access.

In contrast to these existing studies that measure current levels of access, we considered the implications of using these metrics as key performance indicators for tracking improvements in access to obstetric care. In particular, we asked: what is required for states to reduce the number of women who lack access to obstetric care, as defined by two different access to care measures? To answer this question, we considered the implications of expanding access to care through facility expansions by drawing upon mathematical optimization . Optimization is a mathematical science that is widely used to identify the ideal solution while considering the complex interactions and constraints within a system [ 21 ]. The specific type of optimization modeling framework, facility location modeling, has often been used to evaluate the ideal placement of healthcare facilities to ensure proper coverage of a patient population [ 22 , 23 , 24 ]. A comprehensive review of healthcare facility location modeling is provided by Admadi-Javid et al. [ 25 ].

In this article, we characterized access to obstetric care using existing access measures and evaluated these existing measures by determining how many facilities are needed to provide a sufficient level of access according to these measures. We focused on the tate of Georgia because Georgia has one of the highest rates of maternal mortality in the U.S. – almost twice as high as the national rate [ 26 ]. As of 2019 more than 75% of Georgia’s 159 counties had no hospital or birth center offering obstetric care [ 15 ]. Georgia does have a set of Regional Perinatal Centers whose mission is to coordinate access to optimal and risk-appropriate maternal and infant care [ 27 ]. Georgia is taking multiple initiatives to improve obstetric outcomes, including extending Medicaid coverage, introducing quality improvement initiatives, verifying levels of maternal care in Georgia hospitals, and expanding home visiting in rural counties [ 28 ].

First, we characterized regions in Georgia that lack access to obstetric care using two commonly used measures in the literature: (1) the March of Dimes maternity care desert measure [ 15 ] and (2) regions that are further than 50 miles from the closest facility that provides CCO services. Upon defining a region as lacking access or not, we reported the total number of reproductive-aged women who lack access to obstetric care according to each measure. Finally, we analyzed how many facilities would be needed in the state of Georgia to reduce the number of reproductive-aged women who lack access to obstetric care by 50% and 100%.

The goal of this study is to characterize regions defined to have a lack of access to obstetric care based on two existing measures of access and to determine the facility interventions required to improve access according to these measures. We hypothesized that obstetric facility expansion policies focused on reducing maternity care deserts alone are impractical and could have negative consequences and policies focusing on reducing distance to CCO services alone are not aligned with risk-appropriate care for the majority of pregnancies, revealing the need for new measures of geographic access to high-quality, risk-appropriate care which can be used as targets for policy intervention.

Data sources

First, we collected data to infer the geographic distribution of obstetric healthcare facilities and providers, as well as the geographic distribution of subpopulations and communities that would demand obstetric services. The data sources used are described below.

Location of facilities providing obstetric care

We included obstetric facilities in Georgia that are classified as birth centers, or Perinatal Care Level 1, 2, or 3 hospitals according to the public records from Georgia’s Department of Public Health from 2017 [ 27 ]. The address of each obstetric facility was verified by the study team by cross-referencing with Google Maps, and the latitude and longitude of each obstetric facility were located using Python’s geopy package [ 29 ].

Location of demand for obstetric care

To estimate the demand for obstetric care access, we used data from the American Community Survey (ACS) which provides population estimates for age and sex groups. We used the 2017 ACS 5-year estimates of the population of reproductive-aged women (18–44) in each census block group, which we assumed is proportional to the demand for obstetric care in each block group. We used 5-year estimates because they are the most reliable and they are collected for all small geographies including census block groups. To estimate the location of this demand, we used the latitude and longitude of center of population of each census block group as reported by the U.S. Census Bureau in 2010 to be consistent with the census block groups used for the population estimates data from 2017 [ 30 ].

Distance to obstetric care

We calculated the distance between each obstetric facility and each obstetric care demand point using Great Circle distance [ 29 ] in miles between the coordinates of each facility and each census block group center of population. Great Circle distance is the direct distance between two points accounting for the curvature of the earth and is commonly used to estimate access to healthcare [ 31 , 32 ].

Measures of obstetric access

We then determined which census block groups lack access to obstetric care according to the measures outlined below.

Maternity care desert

We considered the March of Dimes definition of a maternity care desert which is defined to be a county that has zero hospitals or birth centers offering obstetric services and zero obstetric providers [ 15 ]. Because maternity care deserts are defined at the county level and the distance measure is defined at the census block group level, we deemed any census block group in a maternity care desert county to be a maternity care desert census block group. Our study team validated Georgia maternity care deserts based on our data against the March of Dimes maternity care deserts dashboard and found they were consistent [ 33 ].

Distance to critical care obstetric (CCO) hospital

We evaluated the distance from the center of population of each census block group to its nearest facility offering CCO services. In line with previous studies [ 20 ], we characterized hospitals as offering CCO services if they are designated as Perinatal Care Level 3 obstetric hospitals. We refer to birth centers and Level 1 and 2 obstetric hospitals collectively as “lower-level” hospitals. These lower-level hospitals provide basic and specialty obstetric care but do not provide CCO services. We referred to public reporting from Georgia’s Department of Public Health to characterize each hospital’s level of care [ 27 ]. We then evaluated whether the census block group population center is within the pre-specified distance threshold of 50 miles. A 50-mile threshold is commonly used because it approximates the farthest distance most people appear willing to travel for specialized medical care, and it estimates the widely accepted “Golden Hour.” The “Golden Hour” stems from trauma care, where it is thought that critically injured patients have better outcomes if they receive definitive care within an hour of their injuries [ 34 ]. This 50-mile threshold has been commonly used to estimate access to obstetric care [ 19 , 20 ], although it has not been validated for obstetric care [ 35 , 36 ].

Evaluation metrics

Using the measures above, we characterized each census block group as either having access to obstetric care or lacking access to obstetric care.

Characterization of lack of access to obstetric care

First, we characterized the number of census block groups that lacked access to obstetric care according to different measures of access (i.e., maternity care desert, >50 miles from CCO services, and both a maternity care desert and >50 miles from CCO services). Additionally, we characterized the demographics of the populations within the census block groups that lacked access to obstetric care according to different measures of access.

Other measures of access to obstetric care

We characterized the distribution of distance to the closest obstetric facility for different measures of access to obstetric care. We further characterized distance to care by level of care, calculating the distance to the closest facility offering Level 1, 2, and 3 care.

Evaluating the need for facility expansion to improve access

We considered how many new facilities would hypothetically be needed to reduce the number of reproductive-aged women who lack access to obstetric care by 50% and 100%. To do so, we use a mathematical optimization model drawing from the facility location literature (see Appendix). This optimization model determined the optimal placement of new obstetric facilities to minimize the number of reproductive-aged women living in deserts. This model unrealistically assumed that we could readily build obstetric facilities anywhere we wanted. We revisit this assumption in the discussion.

We considered both measures of access to obstetric care in our optimization models. First, we investigated the number of new obstetric facilities that would hypothetically be required to reduce the number of women in maternity care deserts by a given percentage. To do so, we formulated a mathematical optimization model that minimized the total number of reproductive-aged women who live in maternity care deserts by introducing at most X new obstetric hospitals. This model returned the optimal location of these X new facilities. Here, X is a parameter that was varied to analyze the change in the number of reproductive-aged women living in maternity care deserts as more facilities are introduced. We also investigated the number of existing lower-level obstetric facilities that would need to be upgraded to provide CCO services to reduce the number of women living further than 50 miles from a CCO facility by a given percentage. We formulated a second mathematical optimization model that minimized the total number of reproductive-aged women living further than 50 miles from CCO services by optimally choosing at most X existing lower-level obstetric hospitals to upgrade to provide CCO services.

Figure  1 shows the regions that lack access to obstetric care according to the two access measures. In Georgia, 83 hospitals offer obstetric services. 56 counties are deemed to be maternity care deserts, which contain a combined 524 census blocks. In comparison, 650 census block groups from 53 counties are further than 50 miles to CCO services.

Table  1 shows that out of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 reproductive-aged women (7.9%) live more than (>) 50 miles from CCO services, and 38,202 (2.0%) live in both maternity care deserts and >50 miles from CCO services.

In Georgia, 14.8% of people do not have insurance and 14.9% of people have Medicaid. These proportions are higher for people who live in regions characterized as maternity care deserts (16.9%, 21.1%), >50 miles from CCO services (17.2%, 20.4%), and regions designated as both (18.4%, 22.8%). Also, in Georgia, 16.9% of people have an income below the federal poverty line. This proportion is higher in regions characterized as maternity care deserts (23.7%), > 50 miles from CCO services (23.4%), and regions designated as both (25.1%).

Current state of lack of access to obstetric care in Georgia. The shaded regions represent census block group that are ( A ) Maternity Care Deserts, ( B ) >50 miles from critical care obstetric (CCO) services, ( C ) both Maternity Care Deserts and >50 miles from CCO services

Table  2 shows the number of reproductive-aged women who live within the specified distance from obstetric services for each level of care. Of the 104,158 reproductive-aged women who live in maternity care deserts, 63% are within 50 miles of CCO services, 97% are within 50 miles of Level 2 care, and 100% are within 50 miles of an obstetric care facility. Of the 150,563 reproductive-aged women who live >50 miles from CCO services, 98% are within 50 miles of Level 2 care, 100% are within 50 miles of an obstetric care facility, and 75% do not live in a maternity care desert. Of the 1,806,150 reproductive-aged women who do not live in maternity care deserts, 93% are within 50 miles of CCO services. Similarly, of the 1,759,745 women who are within 50 miles of CCO services, 96% live in a county with an obstetric care facility.

Responsiveness to interventions

Figure  2 shows the results of our optimization analysis. To hypothetically reduce the number of reproductive-aged women living in maternity care deserts by at least 50%, 16 new obstetric hospitals would be required in counties that are currently maternity care deserts. This would be an increase of 19% over the 83 current number of facilities offering obstetric services and would reduce the number of reproductive-aged women living in maternity care deserts from 104,158 to 51,477. To eliminate maternity care deserts in Georgia, 56 new obstetric hospitals would be required (a 67% increase in obstetric facilities; one facility for each county that is currently a maternity care desert).

The number of obstetric facilities needed to be expanded to reduce the number of reproductive-aged (RA) women who lack access to obstetric care by 50% and 100% according to two measures of access

Our optimization analysis shows that to reduce the number of reproductive-aged women living 50 miles from CCO services by at least 50% (from 150,563 to 57,338 reproductive-aged women) it would require upgrading 2 obstetric facilities to offer CCO services. To eliminate all census block groups that are >50 miles from CCO services, a minimum of 8 facilities would need to be upgraded to offer CCO services.

Figure  3 shows how many facilities are needed to reduce the number of reproductive-aged women to a specified level. The number of reproductive-aged women living in maternity care deserts does not decrease significantly with each expanded obstetric unit. In contrast, a small number of expanded CCO services dramatically reduces the number of reproductive-aged women living further than 50 miles from CCO services.

The number of obstetric care facilities needed to reduce the number of reproductive-aged (RA) women who lack access to obstetric care according to two measures of access

Access to care is an important dimension to consider in the context of the maternal health crisis in the U.S. Our study analyzed the implications of using existing measures of access to obstetric care as key performance indicators to evaluate and track improvements in access.

In this paper, we analyzed two current measures of obstetric access, including the popular maternity care deserts measure. Maternity care deserts are counties in which there are no obstetric providers or obstetric care facilities. This measure has been widely used in both academic literature and popular media, and it has drawn widespread attention to the lack of access to obstetric care in the U.S. Consistent with the March of Dimes report, we found that 5.5% of reproductive-aged women in Georgia live in the 56 counties designated as maternity care deserts (more than the national average, 3.5%) [ 15 ]. We found that 7.9% of reproductive-aged women live further than 50 miles from CCO services, which is less than a study using 2015 data which found that 10.2% of reproductive-aged women live further than 50 miles from CCO services [ 20 ]. This difference may be due to a difference in distance metrics or the procedures for identifying the locations and levels of obstetric hospitals. We additionally found that 2.0% of reproductive-aged women live in regions that are both maternity care deserts and further than 50 miles from CCO services.

In our analysis, we considered the hypothetical implications of using current access measures to inform facility expansions, with the goal of evaluating these measures without concern for costs or workforce barriers. Our optimization model showed that eliminating maternity care deserts in Georgia would require at least 56 new obstetric hospitals. Doing so would increase the number of obstetric hospitals in Georgia by 67%, from 83 to 139. In contrast, ensuring all reproductive-age women in Georgia live within 50 miles of CCO services would require upgrading at least 8 existing lower-level hospitals to provide CCO services. Thus, these different measures of access imply very different strategies to expand access and very different estimates of how many obstetric facilities of different levels are needed in a geographic region.

Our findings suggest that additional tools are needed to provide estimates of how many facilities of each level of care are needed and can be sustained in a geographic region. Ideally, the number of facilities, their level of care designations, and coordination should promote optimal pregnancy outcomes. Access to obstetric care has been identified as an important opportunity to improve maternal outcomes and disparities, as rural residence has been associated with a greater probability of severe maternal morbidity and mortality [ 10 ], and maternity care deserts associated with higher rates of preterm birth, infant mortality, low birth weight, and maternal mortality [ 16 , 17 , 37 ].

However, the maternity care desert measure is inherently dependent on the number and size of counties in a state and fails to account for actual distance to healthcare facilities. Counties were determined by territories and states without standardization, resulting in high variability in the number and size of counties across states [ 38 ]. For example, Georgia has the second most counties of any state (159), only behind Texas (254), although Georgia is the 8th most populated state in the U.S. and 24th largest by area. Thus, this measure may encourage a large number of obstetric units in Georgia simply because Georgia has a large number of counties, despite the fact that 82% of reproductive-aged women who live in maternity care deserts in Georgia live within 25 miles of an obstetric hospital.

Considering these measures of access alone to inform facility expansion could lead to unintended negative consequences. We showed that it would require a 67% increase in the number of obstetric hospitals to ensure no reproductive-aged women live in maternity care deserts in Georgia. Even if the economic forces would allow for so many obstetric facilities, a maternal healthcare system with that many obstetric facilities could have unintended negative consequences due to the dilution of volume across many low-volume rural hospitals, which are known to be associated with poor pregnancy outcomes [ 39 , 40 , 41 , 42 ]. Moreover, staffing this many units would likely be very expensive and challenging given that there are already obstetric workforce shortages in Georgia [ 43 ].

While distance to CCO services could be a useful measure of access, this measure alone neither considers whether there are other nearby facilities that offer potentially sufficient lower-levels of obstetric care nor coordination between lower-level and CCO facilities. Additionally, the threshold of 50 miles to CCO services has not been validated in obstetrics [ 35 , 36 ], nor does it account for transportation factors that influence actual driving time. Thus, there are a variety of limitations in using existing measures of access alone to inform the number of facilities that are needed in a geographic region. Our findings motivate the need for nuanced access to obstetric care measures that are capable of evaluating and planning action toward the reduction of lack of access, and new approaches to estimate the optimal number of facilities of different levels of care that are necessary and sustainable within a geographic region. Future work may consider other measures of access or access expansion interventions that incorporate home visits, telemedicine, and transportation programs.

Our study is not without limitations. We use facility and population data from 2017 because the most recent publicly available data on obstetric facilities was published by the Georgia Department of Public Health in 2017. Because of the age of our data, some obstetric hospitals may have closed, opened, and merged since 2017. The Georgia Hospital Association reports that 13 hospitals in Georgia have closed since 2013 (as of November 2022) [ 44 ]. The only obstetric hospital that closed was Wellstar Atlanta Medical Center, which closed in November 2022. This hospital was 1 mile from the Atlanta Region’s Regional Perinatal Center which provides CCO services. Moreover, we found that our models’ determination of maternity care deserts was consistent with the March of Dimes maternity care deserts dashboard [ 33 ]. We expect that even with some facility closures or expansions of obstetric services at existing hospitals, our conclusion that the maternity care deserts measure is not a practical performance indicator of improvements to access to obstetric care still holds. Also, we did not account for geographical barriers or traffic when calculating distance from the centroid of a census block group when computing whether the group is further than 50 miles from CCO services, and we did not account for measurement errors in the ACS. We did not account for other important barriers to access, such as transportation disadvantage and insurance coverage. We also did not account for out-of-state hospitals that offer obstetric services that could provide care to pregnant people in Georgia. Finally, our analysis only considered potential access. Future work may investigate the impact of facility expansion on realized access to care, especially considering some patients prefer to bypass local hospitals to receive care elsewhere [ 45 , 46 ].

Our findings suggest that the current measures of obstetric access, while useful for capturing certain dimensions of the maternal healthcare system, may not be useful for estimating the optimal number, designations, and coordination of obstetric care within a geographic region. Specifically, while maternity care deserts are associated with increased rates of maternal mortality [ 16 ], this measure is not a practical performance indicator of improvements to access to obstetric care. Thus, there is a need for tools that can track improvements and inform the appropriate number of obstetric care facilities that are needed in a geographic region to improve access to high-quality, risk-appropriate care, and ultimately improve obstetric outcomes. In addition, future work may examine how to optimally balance the cost and outcomes of expanding care, considering the trade-offs between increased access and loss of quality due to dilution and staffing issues, and incorporating alternate access expansion strategies such as home visits, telemedicine, and transportation programs.

Data availability

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Acknowledgements

The authors would like to thank Hengyi Hu and Abel Sapirstein for their assistance with the data collection and Dr. Debra Kane for her thoughtful comments throughout the analysis.

Research reported in this publication was supported in part by Imagine, Innovate and Impact (I3) from the Emory School of Medicine, Georgia Tech, by the Georgia CTSA NIH award (UL1-TR002378; Steimle) and by the National Science Foundation under grant number DGE-2039655 (Meredith); any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation. This research was also supported by the Harold R. and Mary Anne Nash endowment to the Georgia Tech H. Milton Stewart School of Industrial and Systems Engineering.

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Meredith, M.E., Steimle, L.N. & Radke, S.M. The implications of using maternity care deserts to measure progress in access to obstetric care: a mixed-integer optimization analysis. BMC Health Serv Res 24 , 682 (2024). https://doi.org/10.1186/s12913-024-11135-4

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Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review

• Hao-Ran Wang 1 , 2 ,
• Tao Liu 1 , 2 ,
• Xiang Gao 1 , 2 ,
• Hong-Bin Wang 1 , 2 &
• Jian-Hua Xiao   ORCID: orcid.org/0000-0003-1109-9133 1 , 2  

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West Nile virus (WNV), the most widely distributed flavivirus causing encephalitis globally, is a vector-borne pathogen of global importance. The changing climate is poised to reshape the landscape of various infectious diseases, particularly vector-borne ones like WNV. Understanding the anticipated geographical and range shifts in disease transmission due to climate change, alongside effective adaptation strategies, is critical for mitigating future public health impacts. This scoping review aims to consolidate evidence on the impact of climate change on WNV and to identify a spectrum of applicable adaptation strategies.

We systematically analyzed research articles from PubMed, Web of Science, Scopus, and EBSCOhost. Our criteria included English-language research articles published between 2007 and 2023, focusing on the impacts of climate change on WNV and related adaptation strategies. We extracted data concerning study objectives, populations, geographical focus, and specific findings. Literature was categorized into two primary themes: 1) climate-WNV associations, and 2) climate change impacts on WNV transmission, providing a clear understanding. Out of 2168 articles reviewed, 120 met our criteria. Most evidence originated from North America (59.2%) and Europe (28.3%), with a primary focus on human cases (31.7%). Studies on climate-WNV correlations ( n  = 83) highlighted temperature (67.5%) as a pivotal climate factor. In the analysis of climate change impacts on WNV ( n  = 37), most evidence suggested that climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Although few studies directly addressed the implementation of adaptation strategies for climate-induced disease transmission, the proposed strategies ( n  = 49) fell into six categories: 1) surveillance and monitoring (38.8%), 2) predictive modeling (18.4%), 3) cross-disciplinary collaboration (16.3%), 4) environmental management (12.2%), 5) public education (8.2%), and 6) health system readiness (6.1%). Additionally, we developed an accessible online platform to summarize the evidence on climate change impacts on WNV transmission ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

Conclusions

This review reveals that climate change may affect the transmission and distribution of WNV, but the literature reflects only a small share of the global WNV dynamics. There is an urgent need for adaptive responses to anticipate and respond to the climate-driven spread of WNV. Nevertheless, studies focusing on these adaptation responses are sparse compared to those examining the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, along with more comprehensive evidence synthesis, is needed to inform effective policy responses tailored to local contexts.

West Nile virus (WNV), the most widely distributed flavivirus globally, is a significant mosquito-borne virus [ 1 ]. It was first isolated in 1937 from the blood of a febrile woman in the West Nile region of Uganda. The earliest reported outbreaks occurred in the 1950s near Haifa, Israel [ 2 ]. Since the 1950s, WNV outbreaks have primarily occurred in Israel and various African countries [ 3 , 4 ]. However, the epidemiology of WNV appears to have shifted since the 1990s due to the globalization of human trade and travel [ 1 ]. WNV was first detected in New York City in 1999 and subsequently spread rapidly throughout the entire Western Hemisphere, including the United States (US), Canada, and Argentina [ 5 , 6 , 7 ]. Concurrently, epidemic activity increased in Europe, the Middle East, and Russia [ 3 , 4 , 8 ]. In 2018, Europe experienced an unprecedented WNV epidemic, with human cases exceeding 1900, seven times higher than in previous seasons [ 9 ]. In 2020, locally transmitted human cases of WNV were reported for the first time in the Netherlands and Germany [ 10 , 11 ]. Evidence suggests interactive WNV cycles on all continents except Antarctica [ 1 ].

The establishment of ongoing WNV transmission relies on the interactions among the virus, vectors, hosts, and environmental factors [ 12 ]. WNV can infect a wide range of vertebrate species, including most mammals, birds, and some reptiles and amphibians [ 13 , 14 ]. Birds, serving as the primary amplifying hosts, play a crucial role in WNV proliferation. While humans and horses are susceptible to WNV, they are considered dead-end hosts [ 15 ]. In humans, WNV often results in asymptomatic or mild illness, but approximately 1 in 150 cases progress to neuroinvasive disease, potentially leading to encephalitis or death [ 16 ]. The primary vectors for WNV transmission are mosquitoes, particularly those belonging to the Culex genus. Mosquito bites are responsible for the vast majority of human WNV infections, although the virus can also spread through blood transfusions, organ transplantations, and potentially breastfeeding [ 17 ]. Given that WNV is transmitted by mosquitoes, its distribution depends on environmental conditions and is susceptible to the impacts of climate change [ 18 ]. For example, higher temperatures can accelerate viral replication, shorten the extrinsic incubation period in mosquitoes, promote vector abundance, enhance transmission efficiency, expand the suitability of vector habitats, and increase the probability of avian migration across regions [ 19 , 20 ]. Additionally, precipitation patterns have a significant impact on mosquito breeding and abundance, thus affecting the spread and geographical distribution of WNV [ 18 ].

The current body of evidence strongly indicates that climate change directly impacts the spread and proliferation of vector-borne illnesses, including WNV [ 21 ]. Numerous studies have demonstrated that areas vulnerable to WNV transmission could expand or shift due to climate elements. This encompasses projecting future global climate change scenarios, examining how vector species respond to environmental shifts in laboratory settings, and conducting field research in regions where outbreaks occur. There is some evidence of WNV emerging or re-emerging in high-latitude regions and at the edges of current endemic zones [ 22 , 23 , 24 , 25 , 26 ]. For example, in North America, the suitable range for WNV is projected to extend northward and to higher altitudes by 2050 and 2080, potentially leading to new infections in both native and non-native species [ 22 ]. In Europe, increased WNV cases and new outbreak locations are predicted under future climate scenarios, especially at the margin of current transmission areas [ 23 ]. In South America, high risk areas for WNV might shift between 2046–2065 and 2081–2100, with more pronounced changes under high greenhouse gas emission scenarios, potentially altering the current WNV distributions in some countries (e.g., parts of Bolivia, Paraguay, and Brazil) [ 24 ]. Moreover, existing surveillance data support the overall trend of heightened WNV risk due to climate change. For instance, in the Powder River Basin of Montana and Wyoming, US, the WNV mortality rate in the wild bird population was significantly higher in 2003 (the sixth most sweltering summer historically) than in 2004 and 2005 [ 25 ]. In Germany, the extreme heat in the summer of 2018 (the second most sweltering and desiccated summer historically) theoretically played a pivotal role in reducing the average extrinsic incubation period in mosquitoes, resulting in rapid viral amplification and increased transmission risks to vertebrate hosts [ 26 ]. However, the impact of climate change on WNV distribution may vary geographically, and some areas may see a decrease in cases. For example, while Keyel et al. predicted a general increase in WNV cases in 2021, a subsequent study indicated that future cases may decrease in areas outside the boundaries of the original study area in New York [ 27 , 28 ].

While efforts to mitigate climate change are essential to reduce CO 2 emissions and lessen potential future impacts, there is an increasing need to focus on adaptation strategies as well. These include various short-term measures at different levels to address the immediate effects of climate change [ 29 ]. Adaptation approaches aim to enhance resilience in health systems, preparing them to manage and minimize the health consequences of climate change [ 29 ]. Given the commitments countries have made to the Paris Agreement and Sustainable Development Goals, along with the growing global evidence base for climate change's impact on disease spread, nations have begun developing and implementing policy responses as components of national climate adaptation plans [ 30 ]. Insights into the expected magnitude of climate change impacts on WNV and associated adaptive responses can help inform best practices to mitigate public health impacts from the climate-induced spread of disease.

Contemporary prioritization in Canada of investigative pursuits on emerging human and animal diseases under climate change scenarios indicated that WNV is a disease requiring primary attention [ 31 , 32 ]. Since the Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report in 2007, the health impacts of climate change have garnered significant research focus [ 33 ]. This attention has increased further following the Fifth Assessment Report in 2014 and the 2015 Lancet Commission on Climate Change and Health, leading to a growth in the number of related publications [ 34 , 35 ]. In addition to highlighting the impacts of climate change, these articles also emphasize to some degree specific interventions or policy responses within defined countries and regions. To our knowledge, a comprehensive review of the global impacts and adaptation responses related to climate change and WNV has not been conducted. Such a review is necessary to consolidate existing evidence, explore how climate change influences the spread of WNV, and identify the most effective strategies for developing adaptation policies.

In summary, this scoping review aims to address two core questions:

What types of evidence exist regarding the impact of climate change on the global transmission of WNV?

What adaptation measures have been proposed or implemented in response to climate change?

Our primary focus is to elucidate the climatic drivers of WNV to better inform these strategies. This approach is intended to serve as a foundation for future research that may delve into comprehensive public health policies and adaptation measures.

Protocol and registration

We used a scoping review methodology to select studies for inclusion in this synthesis. Our review followed an established protocol, guided by the PRISMA Scoping Review Extension (PRISMA-SCR) and published scoping review methodology [ 36 , 37 , 38 ]. It was registered with the OSF Registries ( https://osf.io/9j2as ) on December 25, 2023, to ensure transparency [ 39 , 40 ].

Search strategy

We conducted systematic searches across four databases—PubMed (MEDLINE), Web of Science, Scopus, and EBSCOhost—to identify relevant peer-reviewed publications on climate change and WNV between January 2007 and December 2023 without imposing language restrictions. Our literature searches employed terminology related to climate change and the diseases of interest. Terms for climate change were taken from the search strategy used in Sweileh’s (2020) bibliometric analysis of climate change and health publications: “climat* Change” OR “global warming” OR “changing climate” OR “climate variability” OR “greenhouse gas” OR “rising temperature” OR “extreme weather” OR “greenhouse effect” [ 41 ]. Disease-specific terms included were: “West Nile virus” OR “WNV host” OR “WNV vector”. Full search strategies for each database are provided in supplementary materials (Additional file 1 ).

This search strategy was designed to comprehensively capture all original studies examining the associations between meteorological, climatological, ecological, or environmental change factors and the transmission dynamics, outbreaks, risks, or adaptations of WNV. By conducting systematic searches across key databases, supplemented by targeted topic strings, our strategy ensures reproducibility and effectively summarizes contemporary evidence illuminating the connections between WNV and climate amidst escalating changes.

Eligibility criteria

The criteria for including and excluding articles in our analysis are outlined in Table  1 . We examined literature since 2007 to capture research conducted after the IPCC Fourth Assessment Report’s release, representing a milestone driving expanded climate-health investigations [ 33 , 41 ]. Focusing on this period enhances relevance and rigor by concentrating on studies consciously examining climate-related impacts during intensifying change. Further augmenting stringency, we concentrated solely on original quantitative and qualitative investigations published in English-language peer-reviewed academic journals. Together these boundaries help systematically extract recent high-quality evidence elucidating shifting WNV transmission dynamics amidst climate change while delineating adaptations instituted since an authoritative global assessment.

Screening and study selection

We used the systematic review software NoteExpress 3.8.0.9455 (Beijing Aegean Sea Software Company, Beijing, China) to implement standardized screening and selection procedures. Two independent reviewers carried out an initial screening of titles and abstracts to filter articles that met basic eligibility criteria, with a third reviewer resolving any discrepancies. Subsequently, these two reviewers conducted full-text evaluations of the retained articles to ensure compliance with all inclusion criteria as outlined in the predefined protocol. Any disputes again triggered third-reviewer arbitration to achieve consensus.

Data extraction

We used a predefined covidence data extraction framework to systematically characterize key article features including 1) identifiers like title, author(s), and year; 2) specific objectives, study populations, WNV research priority (primary/secondary), and geographic focus; and 3) findings of the paper, such as nature of the evidence for climate change impacts on disease emergence, transmission or spread and/or policy responses, interventions or adaptations [ 42 , 43 ].

We categorized the geographic focus of articles into six regions: North America, South America, Europe, Africa, Asia, and Oceania, with multi-regional studies classified as global. The study populations analyzed included humans, mosquitoes, birds, and horses. Investigations encompassing more than one species were labeled as ‘multiple species’, and studies that did not specify their focus were marked as ‘unspecified’. The central disease under investigation in all articles was WNV. Articles primarily focused on WNV dynamics were categorized under ‘primary’ interest level, while those analyzing WNV in conjunction with other vector-borne diseases were deemed of ‘secondary’ interest.

The findings of the paper regarding evidence or arguments presented on the impacts of climate change (including extreme weather, rising temperatures, and/or climate variability) on WNV emergence, transmission, or spread were recorded. To clearly understand the impacts of climate change on WNV, articles were grouped into two main categories: 1) climate-WNV associations, and 2) climate change impacts on WNV, as categorized by Kulkarni et al. in their study of the impact of climate change on global malaria and dengue fever [ 38 ]. The articles defined as climate-WNV associations mainly refer to the impacts of climatic and seasonal factors (e.g. temperature, precipitation, and seasonal variations) on WNV transmission and spread within a certain time frame. Articles defined as climate change impacts on WNV are further categorized into two types: those with clear evidence of climate change or climate anomalies during the study period affecting WNV transmission and spread, and those with projections of future WNV transmission and spread under climate change scenarios.

The findings of the paper pertaining to evidence for policy responses, interventions, or adaptive measures addressing the impacts of climate change on disease emergence, transmission, or spread were documented. Specifically, the nature of the evidence or arguments presented regarding policy measures, interventions, and/or adaptations to mitigate the effects of climate change on the emergence, propagation, or spread of WNV were recorded. The United Nations Environmental Program (UNEP) handbook on methodologies for assessing climate change impacts and adaptation strategies outlines a typology of adaptation measures to safeguard human health from climate change [ 44 ]. These encompassed five categories of measures: (1) surveillance and monitoring, (2) infrastructure development, (3) public education, (4) technology or engineering strategies, and (5) medical interventions. The content of the article on adaptation strategies is categorized according to the UNEP manual and in the context of the WNV case.

Quality assessment of included literature

The quality of the included articles was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool [ 45 ]. All selected studies were scored using the 10 quality control items suggested by the tool. A score of one was awarded for each item fulfilled while a zero score was awarded for each unmet item. Score aggregates were generated and studies were classified as either low (0–3), moderate (4–6), or high (7–10) quality.

Web development

Most reviews traditionally present evidence in a tabular format, which consumes a considerable portion of the article’s space and often hinders easy navigation through the key information [ 36 , 38 ]. In this study, we used the R Shiny interactive web application framework to develop an online-accessible website that presents evidence on the impact of climate change on WNV transmission and dissemination [ 46 ]. This website allows visitors to query and download information on the effects of climate change on WNV transmission and spread at any time and from any location. This method provides a novel way to access and understand the synthesized evidence in a clearer and more convenient manner.

Characteristics of included studies

Initially, 2168 articles were retrieved from four databases: Web of Science, PubMed, Scopus, and EBSCOhost. After removing 896 duplicates, 1272 articles remained (Fig. 1 ). Following title and abstract screening, 1068 articles were excluded as irrelevant, leaving 204 for full-text review. This resulted in 105 articles meeting inclusion criteria, focusing on the association between climate/weather and WNV or its transmission due to climate changes.

Flowchart diagram illustrating the article search and selection process

To comprehensively cover literature on the impact of climate change on WNV, we used specific search terms based on key themes from prior studies [ 37 , 38 ]. Although these terms helped in retrieving targeted and relevant literature, their specificity might have restricted the scope, possibly excluding significant studies that broader terms could have included. Hence, the reviewers recommended 36 relevant articles, which we screened and retained 15 articles according to the inclusion criteria.

The comprehensive review included 120 studies divided into two categories: 83 studies focused on the associations between climate/weather and WNV, and 37 studies examined the impacts of climate change on WNV transmission. All the reviewed evidence and related adaptation responses are available for exploration and download through a dedicated Shiny web application ( https://2xzl2o-neaop.shinyapps.io/WNVScopingReview/ ).

Publication year

The number of published studies on climate change and WNV has increased over time, with a sharp rise observed after 2013 (Fig.  2 ). Regarding the temporal distribution of relevant literature, two key observations can be made.

Distribution of the publication years in all articles included from 2007 to 2023

First, only 26 articles were published between 2007 and 2012, of which 21 articles focused on the associations between climate/weather [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] and 5 articles examined the impacts of climate change on WNV [ 25 , 68 , 69 , 70 , 71 ]. The earliest study on climate/weather factors and WNV, published in 2007, analyzed the association between precipitation and human WNV incidence in the US during 2002–2004. The first article on the impacts of climate change on WNV, published in 2007, investigated WNV prevalence in wild Greater Sage-Grouse populations across Montana and Wyoming during 2003–2005. The relatively small number of studies before 2013 indicates that relevant research was still in its infancy stage.

Second, most studies on this topic ( n  = 94) emerged after 2013, corresponding to the release of the IPCC Fifth Assessment Report in 2014 and the Lancet Commission on Climate and Health in 2015 [ 34 , 35 ]. As authoritative reviews synthesizing the state-of-the-art science on anthropogenic climate change and its health consequences, these landmark reports have stimulated new research assessing climate impacts on infectious diseases like WNV.

Study location

The geographical distribution of study locations examined in the articles is shown in Fig.  3 . The most frequently studied region was North America, representing 59.2% of articles ( n  = 71). Within North America, 53 articles focused on the US [ 25 , 27 , 28 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 68 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], 17 on Canada [ 31 , 32 , 63 , 64 , 69 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 ], and 1 covered the entire continent [ 22 ]. Europe was the second most studied region, accounting for 28.3% of articles ( n  = 34) [ 23 , 26 , 65 , 70 , 71 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 ]. The other world regions assessed were Asia ( n  = 4; 3.3%) [ 66 , 146 , 147 , 148 ], Africa ( n  = 4; 3.3%) [ 67 , 149 , 150 , 151 ], South America ( n  = 2; 1.7%) [ 24 , 152 ], and Oceania ( n  = 1; 0.8%) [ 153 ]. Only 4 articles (3.3%) [ 51 , 154 , 155 , 156 ] included multiple global regions and were classified as the “global” studies.

Geographical distribution of the study areas in all articles included from 2007 to 2023

Research on WNV has focused on two regions, North America and Europe, which corresponds to the high incidence and disease burden from epidemics reported in these two regions over the past two decades. In the US, between 2007 and 2022, there were 32,600 confirmed or suspected human WNV cases reported to the Centers for Disease Control and Prevention, particularly concentrated in California, Colorado, and Texas [ 157 ]. WNV remains the leading cause of mosquito-borne disease in the US, accounting for 83.0% of the reported cases in 2020 [ 158 ]. In Canada, since the virus's emergence in 2001, there have been over 5000 lab-confirmed human cases, with around 20.0% of patients experiencing neurological complications [ 159 , 160 ]. Additionally, it is estimated that up to 27,000 cases may have gone unreported, given the largely asymptomatic nature of WNV infection [ 160 ]. Similarly severe WNV outbreaks have hit Europe in recent years — its 2018 epidemic exceeded 1900 confirmed human cases, surpassing all previous years in scale and distribution [ 161 ]. The heavy health and economic toll has reasonably triggered intensive research interests in examining environmental risk factors such as climate change. Study interests and public health priorities understandably tend to align with acute epidemic events and tangible disease burden.

Research on WNV in regions like Asia, Africa, South America, and Oceania has been comparatively sparse. This imbalance may stem from various factors, such as a lower prioritization due to limited epidemiological data and clinical cases, often attributed to suboptimal surveillance systems. Additionally, the allocation of public health resources in these regions might be challenged by competing health issues, alongside barriers to conducting coordinated multi-national research. For example, in South America, inconsistencies between actual and reported WNV cases arise from symptomatic similarity with other arboviruses and limitations in differential laboratory diagnostics [ 24 ]. Moreover, mild and self-resolving cases may remain undocumented. Meanwhile, more severe cases can also be under-diagnosed, owing to a lack of accessible healthcare facilities and logistical constraints on sample transportation and testing [ 12 ].

Regional differences in climate, vector ecology, and host community characteristics contribute to variations in WNV transmission patterns and health impacts. For example, the primary vectors of WNV display distinct seasonality under varying climatic conditions [ 68 ]. Furthermore, viral strains may evolve different levels of pathogenicity in diverse host species and environmental settings [ 84 ]. Consequently, collaborative multi-regional research is essential to formulate prevention policies that are specifically tailored to different regions. Additionally, integrating knowledge and assessment tools is crucial to further understand the environmental and social factors driving WNV transmission.

Study population

The majority of research articles ( n  = 103; 85.8%) focused exclusively on WNV, its vectors, or hosts. The remaining 17 articles (14.2%) examined WNV in conjunction with other mosquito-borne diseases, such as dengue fever and Rift Valley fever. The most studied subject was human WNV cases (Fig.  4 ), examined in 31.7% of articles ( n  = 38) [ 23 , 27 , 47 , 48 , 52 , 53 , 54 , 56 , 58 , 59 , 62 , 66 , 71 , 73 , 78 , 82 , 83 , 90 , 96 , 98 , 102 , 109 , 118 , 122 , 124 , 125 , 126 , 128 , 130 , 131 , 132 , 133 , 134 , 135 , 140 , 143 , 145 , 148 ]. Mosquito vectors[ 49 , 55 , 57 , 61 , 65 , 68 , 69 , 72 , 74 , 80 , 84 , 87 , 88 , 91 , 92 , 93 , 95 , 97 , 101 , 103 , 105 , 107 , 108 , 110 , 111 , 116 , 121 , 127 , 129 , 136 , 139 , 144 , 150 , 152 , 153 , 155 ] and multi-species [ 22 , 26 , 28 , 51 , 60 , 64 , 67 , 70 , 75 , 76 , 77 , 79 , 81 , 86 , 94 , 99 , 100 , 106 , 117 , 119 , 123 , 141 , 142 , 146 ] were investigated in 36 (30.0%) and 24 (20.0%) studies, respectively. A smaller percentage of articles ( n  = 10, 8.3%) failed to specify the study population [ 24 , 31 , 32 , 51 , 112 , 113 , 120 , 151 , 154 , 156 ]. Limited studies focused solely on bird hosts ( n  = 7, 5.8%) [ 25 , 50 , 89 , 104 , 114 , 115 , 138 ] or equine hosts ( n  = 5, 4.2%) [ 63 , 85 , 137 , 147 , 149 ].

Distribution of the study populations in all articles included from 2007 to 2023

The majority of WNV research has focused on human infection. It's estimated that about 1 in 150 infected individuals develop a severe, long-lasting illness [ 162 ]. High incidence rates in humans have been linked to environmental factors such as extensive irrigated croplands and rural settings [ 54 ]. Mosquito vectors, particularly Culex species, play a crucial role in WNV transmission cycles, with their abundance influenced by factors like the urban heat island effect, the presence of water bodies, and the extent of irrigated farmland [ 54 , 129 ].

However, there is a significant gap in the number of animal-focused studies compared to human studies. In North America, over 28,000 equine cases of WNV have been reported since 1999 [ 163 ]. Additionally, in the US alone, the virus has impacted over 300 bird species, with estimated deaths in the millions [ 164 ]. Juvenile dispersing birds have been demonstrated to play a vital role in the long-distance dispersal and rapid spatial spread of introduced WNV strains across North America [ 165 ]. Given the importance of the role of animals in the transmission and evolution of WNV, there is a need to strengthen research on the impacts of climate change on the transmission and spread of WNV in animals.

Climate-WNV associations

Among the 83 articles examining climate/weather associations with WNV, temperature was the most studied factor ( n  = 56, 67.5%) [ 28 , 47 , 49 , 51 , 52 , 54 , 55 , 58 , 59 , 60 , 61 , 63 , 64 , 66 , 72 , 75 , 76 , 79 , 80 , 81 , 82 , 84 , 86 , 87 , 88 , 89 , 92 , 93 , 94 , 98 , 105 , 107 , 108 , 109 , 110 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 132 , 134 , 137 , 138 , 139 , 147 , 150 ]. All these studies showed increased WNV transmission probabilities or cases within certain temperature ranges. Precipitation was assessed in 34 studies (41.0%), with 13 showing a positive correlation, 13 indicating a negative correlation, 7 revealing mixed positive/negative correlations, and 1 indicating no correlation with WNV risk [ 28 , 47 , 48 , 52 , 53 , 54 , 55 , 58 , 63 , 67 , 72 , 77 , 79 , 81 , 82 , 86 , 87 , 88 , 92 , 93 , 98 , 105 , 109 , 110 , 125 , 126 , 128 , 131 , 136 , 137 , 139 , 146 , 149 , 150 ]. Drought events and warmer winters were investigated less frequently, in 8 (9.7%) [ 28 , 56 , 72 , 74 , 85 , 119 , 126 , 146 ] and 5 (6.0%) [ 50 , 65 , 83 , 92 , 106 ] studies, respectively. Four articles (4.8%) showed a correlation between humidity and WNV risk, with 3 [ 47 , 80 , 91 ] showing a positive correlation and 1 [ 119 ] showing a negative correlation. Nine studies (10.8%) found links between WNV activity and climate-driven seasonal shifts [ 57 , 61 , 62 , 73 , 78 , 90 , 95 , 96 , 133 ], while 2 (2.4%) reported increased transmission associated with flooding events [ 135 , 153 ]. Three studies (3.6%) reported the correlation between WNV risk and winds/hurricanes [ 91 , 97 , 119 ].

Temperature and WNV

Ambient temperature is a critical driver influencing WNV transmission through direct and indirect impacts on vectors and hosts [ 49 , 71 ]. Specifically, higher temperatures accelerate viral replication and shorten the incubation period in mosquitoes, fuel vector population growth, increase transmission efficiency, and expand vector habitat suitability [ 49 ]. In Israel, positive temperature anomalies were linked to greater mosquito abundance and ensuing human cases [ 66 ]. Similarly in Canada, higher mean temperatures are associated with increased Culex populations and elevated WNV infections [ 129 ]. Moreover, there is a trend towards increased risk around large metropolitan areas characterized by urban heat islands, for example in the United Kingdom [ 129 ]. Phenomena such as warm winters and hot summers due to increased temperatures have also contributed to the rise in WNV infection rates [ 50 , 65 , 83 , 106 ]. The mean temperature is a strong predictor of the presence of WNV in Culex mosquitoes, and this relationship is unimodal [ 76 ]. The optimal temperature range for WNV transmission is identified as 22.7–30.2 °C [ 75 ]. Outside this range, particularly at temperatures below 17.0 °C, vector competence significantly declines, reaching a relative risk near zero [ 76 ]. It is important to note that this lower temperature threshold can vary among different vector species. Moreover, extreme heat events may further amplify outbreak magnitude [ 65 , 66 ]. However, it is important to note that an increase in temperature does not necessarily mean an increase in disease incidence altogether. For example, temperatures above 30 °C reduced survival of  Culex tarsalis  and slowed the growth of WNV in Culex mosquito [ 166 ].

In addition, ambient temperature rise under climate change may indirectly alter WNV transmission by shifting bird host ecology and associated vector exposures. Models project warming could expand bird infection prevalence to higher latitudes as longer activity seasons enable more transmission events [ 114 ]. While temperature alone allows increased vector habitat suitability and viral replication at mid-range optima, cascading impacts on avian immunity, migration timing, vector-host overlaps, and habitat ranges could potentially override direct effects. For instance, warmer climates have prompted earlier nesting in British birds, potentially leading to offspring hatching during peak mosquito seasons, increasing young birds’ exposure to vectors [ 167 ]. This phenomenon is exemplified in Caillouët et al.’s study, which demonstrates how the end of the nesting season aligns with higher mosquito populations, potentially escalating WNV transmission risks during these periods [ 168 ].

Precipitation and WNV

The positive correlation between elevated rainfall pre-outbreak and intensified WNV vector abundance/infection has been well documented [ 47 , 125 , 126 ]. For example, a 10 cm rise in summer precipitation was associated with 0.39 more WNV-positive Culex mosquitoes per 1000 tested in South Africa [ 67 ]. In the US, every 1 cm precipitation increase was linked to a 15% greater WNV incidence [ 86 ]. In Australia and Srpska, flooding due to extreme precipitation events creates favorable conditions for WNV transmission, as waterlogged environments can support larger populations of waterbirds and mosquitoes, increasing the likelihood of virus spread [ 135 , 153 ]. However, precipitation effects on WNV vary across regions and timescales, likely due to place-based differences in viral strain, vector, and host ecology. For example, a negative correlation between total monthly precipitation and the number of WNV cases was observed in Europe [ 128 ]. Similarly, in years of increased human WNV incidence in Israel, there was a significant decrease in spring precipitation [ 146 ]. In America, extreme drought caused by extremely low precipitation is a potential amplifier of WNV virus transmission and can further increase the risk of WNV transmission [ 56 , 85 ]. The cause of this phenomenon may be related to the fact that below-average precipitation creates limited water resources for mosquitoes, thereby increasing close contact between hosts and infected mosquitoes at remaining water sources [ 169 ]. In addition, both positive and negative correlations of precipitation on WNV incidence have been observed in the eastern and western parts of the US at different time scales [ 53 , 82 ].

Humidity, wind speed and WNV

Humidity and wind speed play important and complex roles in WNV transmission dynamics, but the impacts vary widely across ecosystems. For instance, higher humidity increased the probability of human infection with WNV in the US [ 47 ], and positive correlations were found between soil moisture and vector indices [ 80 ]. However, a Greek study conversely found negative relative humidity-WNV case correlations [ 119 ]. A study in New York and Connecticut showed an inverse U-shaped relationship between soil moisture and WNV-infected mosquitoes, with high infection associated with drought, but also an increase associated with wetter conditions—both patterns can be present at the same time [ 27 ]. Meanwhile, wind may impact disease transmission by influencing mosquito movement. For example, low wind speeds were found to be associated with the capture of WNV-infected mosquitoes during the same week that human cases of WNV emerged in Greece [ 119 ]. This may be related to the fact that high wind speeds reduce the chances of a mosquito blood meal, thus reducing the chances of human WNV cases [ 119 ]. Additional hypotheses, including storm roles in bird migration contributing to WNV transmission [ 170 ], require further investigation.

Climate-driven seasonal shifts and WNV

Climate-driven seasonal shifts are also important factors influencing WNV spread and outbreak magnitudes. For example, Texan counties experience major spikes following wet springs and hot, dry summers [ 73 ]. In Suffolk County, warm and dry conditions in early spring have been shown to increase WNV infection in Culex mosquitoes [ 74 ]. Patterns of dry, hot temperatures following wet years also increase WNV infections [ 78 ]. Broader European analyses suggest that anomalous seasonal temperatures and dry winters exacerbate seasonal amplification and drive WNV outbreaks [ 133 ]. These climate-mediated seasonal effects likely arise through multiple mechanisms affecting vector reproduction, host immunity, viral replication rates, and transmission efficiency at different phases [ 170 ]. As climate change intensifies precipitation variability and seasonal temperature extremes, such seasonal shift tipping points may become more frequent. Therefore, improved surveillance programs that are responsive to emerging seasonal shifts remain essential for predicting and mitigating transmission at fine geographic and temporal scales.

While climatic factors have a significant impact on the spread and transmission of WNV, many other factors also influence the complexity of the transmission dynamics. Land use, global trade, bird migration patterns, landscape features, and socioeconomics also partially determine the geographic distribution of infections [ 50 , 80 , 86 ]. For example, areas with older infrastructure, lower incomes, high percentages of cropland, and large rural populations have more landscape features and environmental conditions favorable to vector habitat, which increases local WNV risk [ 54 , 80 ]. Therefore, operationalizing the “One Health” paradigm through collaborative surveillance, modeling, and mitigation across veterinary, human, wildlife and environmental health remains imperative for fully anticipating and responding to shifting WNV.

Climate change impacts on WNV

Among the 37 articles examining climate change impacts on WNV, the majority ( n  = 28; 75.7%) predicted the impact of climate change on WNV [ 22 , 23 , 24 , 27 , 31 , 32 , 69 , 70 , 99 , 100 , 101 , 102 , 103 , 104 , 111 , 112 , 113 , 114 , 115 , 116 , 141 , 142 , 143 , 145 , 151 , 152 , 155 , 156 ]. Specifically, high latitude regions, areas with immunocompromised populations, locations prone to extreme weather events, and marginalized communities were expected to be more affected [ 22 , 24 , 103 ]. Additionally, 8 articles (21.6%) provided substantial evidence that climatic variability phenomena have already affected the transmission and distribution of WNV during recent outbreaks [ 25 , 26 , 68 , 71 , 140 , 144 , 148 , 154 ]. Only 1 article (2.7%) focused on developing a national indicator framework for monitoring climate change impacts on infectious diseases [ 51 ].

Evidence of future climate change impacts on WNV

In the review, most evidence predicts that future climate change may affect the spread and distribution of WNV [ 22 , 23 , 24 , 111 , 114 , 151 , 155 , 156 ]. In North America, the projected climatic suitability range for WNV in 2050 and 2080 is expected to expand northward and into high-altitude areas, potentially leading to infections in novel and native hosts [ 22 ]. In Europe, studies project heightened WNV infection rates and new endemic areas under future climate scenarios, particularly at the margin of current transmission zones (e.g., eastern Croatia, northeastern and northwestern Turkey) [ 23 ]. Notably, recent evidence also confirms local transmissions as far north as Germany and the Netherlands, indicating an expansion of risk areas beyond those previously identified [ 10 , 11 ]. In South America, high-risk areas for WNV may shift between 2046–2065 and 2081–2100, becoming more pronounced under high greenhouse gas emission scenarios, potentially altering the current WNV distribution in some countries (e.g. parts of Bolivia, Paraguay, and Brazil) [ 24 ]. In Morocco, the suitable habitat range for  Cx. pipiens  is projected to expand into new central and southeastern areas by 2050, increasing the risk of WNV transmission [ 151 ].

Current evidence of climate change impacts on WNV

In addition to predictive studies on the future, existing evidence also demonstrates that climatic variability phenomena have already affected the transmission and distribution of WNV in some regions [ 25 , 26 , 144 , 148 ]. In the Powder River Basin of Montana and Wyoming in the US, WNV-related mortality rates in bird populations were significantly higher in 2003, the sixth warmest summer on record, than in 2004 and 2005, the 86th and 41st warmest, respectively [ 25 ]. Although this increase in mortality coincided with higher temperatures, it is crucial to consider that 2003 also marked a period of the virus’s initial introduction into the region. This introduction likely contributed significantly to the observed mortality rates, as populations are often most vulnerable when a pathogen first emerges. In Germany, the extreme heat of the summer of 2018 (the second hottest and most arid summer on record locally) was speculated to be an important reason for the decreased mean extrinsic incubation period values in mosquitoes, leading to rapid viral amplification and increased risk of transmission to vertebrate hosts [ 26 ]. Additionally, the detection of WNV-infected Uranotaenia unguiculata in northern Germany in 2016 presents another case of climate change driving the northward spread of mosquito species and WNV [ 144 ]. In Israel, an intense heat wave and a spike in summer temperatures were observed during WNV outbreaks [ 148 ].

The extent of climate change impacts on WNV transmission depends on local regional conditions, including population immunity levels and vector abundance [ 99 , 101 , 103 ]. In areas where comprehensive vaccination programs for animals susceptible to WNV, such as horses, are in place, alongside robust public health infrastructure and strong vector monitoring and control systems, the impact of WNV may be significantly mitigated or even negligible [ 103 ]. For example, predictions for the island scrub-jay in California showed that vaccinating ≥ 60 individuals during WNV outbreaks could decrease the risk from ≥ 22% to ≤ 5% [ 104 ]. Undoubtedly, strengthening broad-spectrum socioecological resilience through surveillance, preparedness, vector management, and medical capacity building remains paramount for sustainable health amidst climate and global change [ 101 ]. However, these anthropogenic measures require considerable regional coordination and resource mobilization, frequently lacking in disproportionately impacted communities. Therefore, actualizing equitable and adaptive WNV resilience necessitates comprehensively integrating climatological, environmental, veterinary, wildlife, genetic, immunological, and public health data into prediction frameworks and response protocols prioritizing vulnerable populations. International organizations must lead in facilitating such collaborative resilience measures globally.

Adaptation strategies to address climate-driven WNV transmission and spread

Among all 120 reviewed articles, 49 proposed or discussed adaptive strategies against WNV risks in response to climate change. These measures were categorized into six groups based on UNEP criteria and the case of WNV (Fig.  5 ) [ 44 ]: surveillance and monitoring ( n  = 19; 38.8%) [ 22 , 23 , 56 , 65 , 69 , 75 , 85 , 92 , 99 , 100 , 101 , 106 , 117 , 120 , 123 , 135 , 148 , 151 , 152 ]; predictive models ( n  = 9; 18.4%) [ 49 , 70 , 74 , 81 , 84 , 98 , 103 , 105 , 111 ]; cross-disciplinary/border cooperation ( n  = 8; 16.3%) [ 24 , 51 , 80 , 126 , 131 , 133 , 141 , 156 ]; environmental management ( n  = 6; 12.2%) [ 25 , 87 , 95 , 104 , 142 , 145 ]; health system preparation ( n  = 4; 8.2%) [ 27 , 57 , 102 , 121 ]; and public education ( n  = 3; 6.1%) [ 86 , 113 , 118 ]. A brief overview table of identified adaptation strategies is provided (Additional file 2 ), with details accessible on the project website under “Detailed adaptation strategies”.

Classification of 49 articles that proposed or discussed adaptive strategies against West Nile virus risks in response to climate change, divided into six categories based on United Nations Environmental Program criteria

Monitoring and surveillance

Most studies reviewed highlight that monitoring and surveillance are the most critical means of preventing and controlling the spread of WNV under climate change scenarios. Specifically, surveillance should concentrate on high-risk populations, vector populations, wildlife and domestic animals, migrating birds, and neglected areas. As Skaff et al. noted, identifying consistencies between highly susceptible communities and local climates approaching critical thermal thresholds can enhance infectious disease prevention efficacy amidst climate change [ 75 ]. Additionally, Semenza et al. recommended fortifying epidemiological monitoring for neuroinvasive diseases potentially indicative of WNV to expand healthcare provider awareness of clinical manifestations and strengthen diagnostic testing capabilities [ 23 ]. They also advised augmenting blood donation screening and transportation safeguards while at the same time accounting for climate change in formulating robust WNV contamination prevention protocols [ 23 ]. Moreover, numerous studies have suggested that a more granular analysis of meteorological and entomological factors could improve comprehension of intricate WNV transmission dynamics [ 31 , 56 , 65 , 101 , 106 , 151 , 152 ]. Concurrently, research and control programs must localize to maximize relevance for regional climate change impacts [ 101 ]. Furthermore, public health agencies and vector control teams should amplify efforts to continuously track distributions to minimize human infection risks [ 151 , 152 ]. Meanwhile, WNV surveillance systems should be strengthened with host monitoring and regular risk assessment, especially for rural livestock, long-distance migratory birds, and wildlife with high mobility [ 117 , 123 ]. Domestic livestock, particularly horses in high-risk areas, should be vaccinated to enhance their immunity and prevent mortality and morbidity [ 85 ]. Routine surveillance should also be conducted in neglected areas (e.g., areas thought not to be transmitted zones and poor areas) [ 22 ]. Based on the results of data analysis from surveillance and monitoring, preventive and control strategies need to be adjusted accordingly to cope with changing infectious diseases.

Predictive models

Beyond intensifying surveillance, advancing predictive models and early warning systems remain vital for honing outbreak preparedness and rapid response. Sophisticated predictive tools enabling localized risk projections and efficient resource allocation can dramatically amplify intervention impact [ 38 ]. Ideally, such systems would synthesize meteorological, biological, genetic, ecological, entomological, and epidemiological data for accurate emergence prediction across scales [ 49 , 70 , 74 , 81 , 84 , 103 , 105 , 111 ]. Developing predictive models by linking laboratory-observed environmental transmission patterns to actual transmission patterns is crucial to accurately predicting the impact of climate change on WNV and other vector-borne pathogens [ 49 ]. Most importantly, next-generation frameworks must address substantial knowledge gaps around viral evolution, vector-host mutations, species migration and adaptation capacity, infection-recovery dynamics, and anthropogenic environmental change impacts on virus shifting dynamics [ 70 , 103 , 111 ]. Advancing models encompassing this intrinsic biocomplexity and policy-environment feedback remains essential to preempt unprecedented post-climate change outbreaks through context-specific preparation and response. International alliances should prioritize pioneering these innovations in prediction science alongside flexible surveillance strengthening for integrated epidemic resilience. Beyond informing ongoing emergence, these efforts will uncover complex ecological interconnectivity in the face of convergence across climate and global changes.

Cross-disciplinary/border cooperation

As climate change accelerates, advanced WNV prevention and control requires integrating “One Health” approaches across human, veterinary, wildlife, and environmental health sectors. Multidisciplinary collaboration enables the holistic elucidation of shifting transmission dynamics for accurate risk prediction, alert activation, and adaptive response [ 126 , 133 ]. Specifically, increased data sharing between public health, vector control, and meteorological agencies, coupled with artificial intelligence integration, can exponentially improve monitoring sensitivity, early warning trigger development, and outbreak interception agility [ 24 , 80 ]. Additionally, transregional information exchange and coordination remain imperative for refining control strategies and resource allocation amidst climate and global change [ 156 ]. The 2018 European WNV emergency exemplified the superiority of integrated “One Health” surveillance, ensuring targeted data-driven countermeasures, bridging counties halted uncontrolled cross-border transmission [ 141 ]. Given the existential threat of vector-borne diseases necessitates all governmental and international institutions prioritizing and operationalizing such interdisciplinary preparedness and response architectures. This obligation will grow increasingly urgent as environments continue transforming unprecedentedly.

Other adaptive strategies

Of all the studies reviewed, there are fewer strategies related to public education, environmental management, and health system preparedness. However, adapting to the growing threat of WNV under climate change will require multifaceted strategies across environmental management, public awareness-raising, and health system preparedness. Effective environmental management to suppress vector populations, including the elimination of mosquito breeding grounds and the establishment of secondary conserved populations for possible vaccination, forms a crucial first line of defense against WNV [ 25 , 104 , 142 ]. However, this must be coupled with sustained public education campaigns to promote protective behaviors among individuals and vigilant surveillance efforts to enable early response [ 86 , 113 , 118 ]. Finally, health systems must enhance their capacity for detecting WNV outbreaks in vectors and hosts, allowing timely intervention measures, as well as boosting clinical diagnosis and treatment capacity [ 102 , 121 ].

Future work

While this review concentrated on the climatic aspects of WNV transmission, it sets the stage for subsequent in-depth analyses of adaptation strategies within the public health domain. Future studies could adopt a One Health approach or leverage the UNEP framework to explore diverse responses to WNV, thereby enriching the dialogue between climate science and public health policy.

Climate change may affect the transmission and distribution of WNV, with the extent of the impact depending on local and regional conditions. Surveillance and monitoring stand out as the most recommended adaptation tactics to address the spread of WNV under climate change scenarios. However, far fewer studies have explicitly focused on adaptation strategies than have investigated the impacts of climate change. Further research on the impacts of climate change and adaptation strategies for vector-borne diseases, as well as more comprehensive evidence synthesis, are needed to inform effective policy responses tailored to local contexts.

Our findings highlight the significant role of climate factors in the transmission dynamics of WNV. However, acknowledging the limitations of our focus, we propose future research to extensively explore adaptation strategies that address these climatic challenges. Such efforts would provide comprehensive insights that are crucial for the development of robust public health policies.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Abbreviations

• West Nile virus

Intergovernmental Panel on Climate Change

United Nations Environmental Program

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This work was supported by the National Natural Science Foundation of China (No.31802217).

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Department of Veterinary Surgery, Northeast Agricultural University, Harbin, 150030, Heilongjiang, People’s Republic of China

Hao-Ran Wang, Tao Liu, Xiang Gao, Hong-Bin Wang & Jian-Hua Xiao

Heilongjiang Key Laboratory for Laboratory Animals and Comparative Medicine, College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, Heilongjiang, People’s Republic of China

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HRW participated in the design, study selection, data extraction and analysis, and write-up of this study. TL, XG, and HBW participated in the design of this study and revised the manuscript. JHX participated in the revision of the manuscript. All authors approved the final version.

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Wang, HR., Liu, T., Gao, X. et al. Impact of climate change on the global circulation of West Nile virus and adaptation responses: a scoping review. Infect Dis Poverty 13 , 38 (2024). https://doi.org/10.1186/s40249-024-01207-2

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Received : 03 January 2024

Accepted : 17 May 2024

Published : 24 May 2024

DOI : https://doi.org/10.1186/s40249-024-01207-2

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