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Climate-Resilient Sustainable Biomaterials for Global Health in Low-Resource Settings: A Scoping Review of Evidence, Gaps, and Engineering Priorities. v1
Summary
Researchers reviewed 57 studies on eco-friendly medical materials (like plant-based bandages and drug packaging) designed to replace plastics in poorer, hot-climate countries — but found a major blind spot: none of these materials were actually tested for how they hold up in real tropical conditions like extreme heat, humidity, or flooding. This matters because a "sustainable" bandage or medical device that breaks down too fast or fails in the field could put patients at risk, so before these green alternatives are rolled out widely, they need real-world testing in the places that need them most.
ABSTRACT Background Theconvergence of climate change, healthcare-associated plastic pollution, andpersistent health inequities in low- and middle-income countries (LMICs)necessitates transformative solutions. Sustainable biomaterials derived fromrenewable feedstocks offer a dual opportunity to reduce the environmentalfootprint of medical technologies while addressing LMIC health needs. However,the extent to which such materials have been engineered and validated for thespecific environmental conditions of tropical LMICs remains unknown. Methods FollowingPRISMA-ScR guidelines and Joanna Briggs Institute methodology, wesystematically searched PubMed, Embase, Scopus, and Web of Science forpeer-reviewed articles published between January 2014 and May 2026. GoogleScholar was used as a supplementary source, and reference lists of includedstudies were manually screened. Studies examining sustainable or bio-basedbiomaterials for health applications in low-resource settings were included.Data were charted and synthesized narratively. Results Thedatabase search identified 9,244 records. Following the removal of 1,685duplicates, 7,559 articles underwent screening. Of these, 300 articles wereassessed full-text, and 57 studies met the inclusion criteria (52reviews, 5 primary experimental studies). Cellulose- and chitosan-basedmaterials predominated (59.6% and 42.1% of studies, respectively), with primaryapplications in tissue engineering (35.1%), wound management (31.6%), and drugdelivery (29.8%). All studies claimed sustainability benefits; however,scalability and cost were among the most frequently reported implementationchallenges. Critically, none of the 57 studies explicitly reported biomaterialtesting under predefined tropical climate-resilience conditions, such as hightemperature (>40°C), high humidity (>70%), flooding simulation, orprolonged tropical storage. Research leadership was overwhelmingly concentratedin high-income countries (80.7% of lead authors), with only 8.8% LMIC-led and10.5% international collaborations. No field validation in tropical LMICsettings was reported. Conclusion Sustainablebiomaterials research for global health is expanding rapidly yet exhibits acritical evidence gap: the absence of climate resilience engineering. Thisdisconnect threatens the real-world viability of these technologies inclimate-vulnerable LMICs. Urgent investment is required in standardized climatestress testing protocols, LMIC-led research consortia, and interdisciplinaryapproaches to develop genuinely resilient health technologies. Keywords sustainablebiomaterials, climate-resilient materials, global health, low-resourcesettings, LMICs, eco-friendly engineering, bio-based polymers, circulareconomy, One Health