Climate Heat And Maternal and Neonatal Health in Africa

The CHAMNHA project contains four work packages (WPs) related to climate change and maternal/newborn health. In epidemiological studies (WP 1), we analysed pre-existing datasets of daily activities in women after birth in Burkina Faso. We found a relation between extreme temperatures and a reduced time spent on breast-feeding, but relation to time working or time spent in childcare (Part C, BMJ Open). We also explored the Swedish Birth Register dataset using high resolution temperature and a pollution exposure map for Sweden. We did not find a relation between temperature and preterm birth in Sweden, despite the high-quality data, using comparison methods to assess temperature effects (De Bont et al. 2022). We further analysed air pollution and preterm birth. We found a relation between tropospheric ozone and pre-term birth in Sweden, after adjusting for temperature. This is a new finding as previous studies of pollution impacts on birth outcomes have focused on particles of solids or liquids that are in the air (Aziz N et al, submitted to Environment International). Using a dataset of hospital-births in Soweto, South Africa, we found a relation between high temperature in the first weeks of pregnancy and increased risk of maternal hypertension. (Published in Environmental Research). Further, high ambient temperatures was associated with stillbirth and preterm birth. Novel evidence regarding individual effect modifiers of the temperature-birth outcome relationship (women living with HIV are more at risk of heat-related preterm birth), show different effects of high temperature on death before or during delivery. (Effects of ambient temperature on stillbirth and preterm birth in Soweto, South Africa: A case-crossover analysis, to be submitted). In accordance with this, when we explored a hospital birth dataset from Gambia, we found that high temperatures were associated with increased risk of on death before or during delivery (Paper in progress). Finally, using birth information collected for the ALERT study on newborn health from Benin, Uganda, Tanzania and Malawi, we are exploring data on neonatal health and climate to be presented in future papers. In WP2 we explored lived experience of heat in pregnant women, women after delivery and newborns. Based on field work in Kenya and Burkina Faso we found a relation between extreme heat and the health and wellbeing of pregnant women in Kilifi, Kenya. Women attribute a range of symptoms to heat exposure, including dizziness, skin conditions and hypertension. The impact of heat is made worse by lack of opportunity to reduce the workload for the pregnant women. The impact of heat is also made worse by the current drought in Kenya that reduces access to household water. Papers were based on the field work in Kenya including qualitative analyses (Scorgie F et al. (2023), Lusambili et al. (2023)). A work regarding the health and wellbeing of pregnant women in Burkina Faso is ongoing (Kadio K et al, currently under review and Kouanda et al, in preparation; Impact of heat on maternal and neonatal health services in Burkina Faso). In WP3 we developed and accessed interventions to reduce the impacts of heat on mothers and babies. Behaviour change interventions with interviews, videos and illustrations used in discussions, reduced the adverse health impacts on MNH. The interventions were developed using a co-design process with local communities (Lusambili et al (2023); Kadio et al. (2023), Seni et al in preparation). CHAMNHA contributed to a briefing note on co-design in climate and health studies, an outcome of the workshop at Sustainability Research and Innovation Congress (SRI) in 2022 coordinated with other Belmont funded projects. The assessment of the feasibility of the interventions is being finalised in 2024. In Kenya data on post-intervention measures has been completed and analysed. The intervention was well received and changes in behaviour reduced the heat risks. In Burkina Faso, field work to assess the feasibility of the intervention was only possible in one site that is currently being analysed. In WP4 we submitted policy briefs (Climate change and child health: Public health measures are needed to protect the health of current and future generations) as well as 3 videos based on field work in Kilifi Kenya related to MNH, also available on internet. We performed climate analyses and estimated the impact of climate change on heat related child mortality attributable in Africa, by quantifying the additional present (1995 – 2019, NAT-HIST) health burden attributable to observed climate change and future burdens up to 2050 (Env. Research Letters). We further developed a model to estimate the heat-related burden of birth outcomes in Africa (still birth, preterm birth) where we will estimate the burden attributable to anthropogenic observed warming and future climate change.

Outcomes of CHAMNHA include results of epidemiological analyses on high quality datasets that quantify ambient temperature effects on a range of Maternal and Neonatal Health (MNH) outcomes, among these the frequency of stillbirth, preterm birth and hypertension in pregnancy. Field work with qualitative research in two sites in Burkina Faso and one site in Kenya describe how the communities perceive extreme heat. In co-design workshops the outcome was to develop interventions to change the behavior and reduce heat impacts on maternal and newborn health. Quantitative and qualitative research found that extreme hot weather was associated with adverse outcomes on a range of important events in maternal and neonatal health including: stillbirth, premature birth, skin rashes, breastfeeding and infant care, neonatal dehydration and nutrition, maternal wellbeing, maternal hypertension, and access to maternal health services. Qualitative research describes the lived experience of pregnant and post-partum women dealing with extreme heat. We found that heat affected the choice of delivery place and frequency of antenatal care visits, because women may walk long distances to arrive at health facilities. This severely affects care for their neonate who is carried on the back. Interventions, including behaviour change, climate services, cooling, planting trees to provide shadow, encouraging breastfeeding and drinking water were suggested to mitigate extreme heat impacts on pregnant women and neonates in community settings and health facilities. We have produced more than 18 journal papers as well as fact sheets and policy briefs.

CHAMNHA is a Belmont Forum project with the following partners: University of Oslo, Norway; Karolinske Institutet, Sweden; London School of Hygiene and Tropical Medicine, UK; University of Leeds UK; University of Washington, US. Heat exposure complicates Maternal and Neonatal Health (MNH), increasing risk for MN disease. Few studies have assessed these impacts in sub-Saharan Africa (SSA), where MN deaths are frequent, and health systems have low adaptive capacity and access to services that is increasingly disrupted by climate events. CHAMNHA is the largest heat impact and MNH intervention study in SSA. A transdisciplinary team from 3 continents, spanning the natural, health and social sciences will address gaps around heat and MNH in SSA, employing qualitative and quantitative methods, implementation and evaluation science, and climate impact methods. WP1 will quantify impacts of heat on MNH outcomes, using trial data, birth cohorts and other sources from SSA, Scandinavia and characterize sub-groups at high-risk. In WP2, we will document practices relating to heat exposure in pregnant women and neonates in Burkina Faso and Kenya. In conjunction with pregnant women and family, we will co-design community- and facility-based interventions, such as improving preparedness for heat, e.g. through warning systems; changing behaviors and health worker practices to reduce heat impacts on MNH; training birth companions and traditional birth attendants on heat reduction during childbirth; and promoting breastfeeding and optimised hydration for women and neonates. WP3 will test the acceptability, feasibility and effectiveness of selected interventions using a randomized design (Kenya) and pre-post study design (Burkina Faso). In WP4, building on established collaborations with stakeholders, ministries of health and WHO, we will translate research findings into recommendations for improved MNH practice, adaptation planning, and national and international policies.