Climate change (CC) constitutes one of the greatest threats to human health, and requires political awareness for effective and efficient adaptation planning. This study identified the perceptions of climate change and health adaptation (CC&H) among relevant stakeholders, decision-makers, and policymakers (SDPs) in Burkina Faso (BF) by determining their perceptions of CC, of related health risks and vulnerabilities, and of CC impacts on agriculture and food security. We carried out 35 semi-structured, qualitative in-depth interviews with SDPs, representing national governmental institutions, international organizations, and civil society organizations. The interviews were analyzed using content analysis. SDPs shared similar perceptions of CC and concurred with three ideas (1) CC is a real and lived experience in BF; (2) the population is aware of climatic changes in their environment; (3) CC is intertwined with the agricultural and economic development of the country. SDPs identified biodiversity loss, floods, droughts, and extreme heat as posing the highest risk to health. They elaborated five exposure pathways that are and will be affected by CC: water quality and quantity, heat stress, food supply and safety, vector borne diseases, and air quality. In conclusion, SDPs in Burkina Faso are highly aware of CC hazards, relevant health exposure pathways, and their corresponding health outcomes. Mental health and the interplay between social factors and complex health risks constitute perception gaps. SDPs perceived CC&H risks and vulnerabilities align with current evidence.
Climate change is projected to induce extreme and irregular rainfall patterns in the West African Sahel region, affecting household food security and income. Children are among the worst affected population groups. Previous studies focusing on rainfall irregularities in specified periods have revealed how child health and nutritional status are impacted, especially in rural settings. However, the aggregated effect of rainfall over a lifetime on chronic child undernutrition remains poorly understood. We conducted a multilevel regression using a 2017 household survey from rural Burkina Faso containing 12 919 under-five-year-old children and their corresponding household rainfall data. The rainfall data originated from the Climate Hazards Infrared Precipitation with Stations monthly dataset with a native resolution of 4.8 km (0.05 degrees). We show that an increase in rainfall below 75 mm monthly average tends to produce poor nutritional outcomes (regression coefficient = -0.11***; 95% CI = -0.13, -0.10; p < 0.001) in rural Burkina Faso children. We found a consistent negative relationship between different sex and household wealth groups, but not age groups. Vulnerable younger children were more affected by the adverse effects of increased rainfall, while older children seemed to handle it better. Our methodological approach tracing the impact of rainfall over children's lifetimes makes a meaningful contribution to the portfolio of tools for studying the complex relationship between climate change and health outcomes. Our work confirms that rainfall is a risk factor for chronic child undernutrition, highlighting the need for adaptation strategies that boost household and community resilience to counteract the harmful impacts of climate change on child nutritional status.
West African countries, such as Burkina Faso are particularly vulnerable to an array of health impacts due to climate change. Consequently, Burkina Faso has drafted and implemented adaptation plans and programmes, with varying levels of success. This exploratory qualitative study examines the institutional barriers faced by policymakers in this process, particularly in the health system of concern. We applied in-depth interviews with policymakers, using framework analysis. We identified the barriers to implementing climate change and health programmes and categorized the barriers according to the Framework to diagnose barriers to climate change adaptation. Policymakers identified eight interconnected barriers through the framework: Four barriers in the management phase (insufficient financial resources, frequent turnover, policy-politics disconnect /weak structural support, unsustainable programming), three in the planning phase (heft of bureaucracy/lack of political will, diverging development priorities, insufficient cooperation), one in the larger context of Burkina Faso’s environment (national security). The respondents mentioned no barriers in the understanding phase. These barriers are indicative of weak institutional support systems and limited resource allocation to climate and health work in Burkina Faso.
Home gardening is promoted as an adaptation strategy to ameliorate the increasing food insecurity from climate change impacts among subsistence farming families in rural sub-Saharan Africa. Yet, the geographic distribution of home gardens, their setup, management, and the effects on nutrition outcomes have not been fully described. This scoping review aimed to map and synthesize recent evidence on home gardening for two exemplar countries: Burkina Faso and Kenya. Between June and August 2020, we searched, screened, and extracted evidence about home garden projects in both countries, following the PRISMA guidelines for scoping reviews. Peer-reviewed scientific publications, and gray literature in English and French that reported about subsistence horticulture in rural settings of Burkina Faso or Kenya were included. The characteristics of the documents and the data pertaining to our research objectives were extracted into predefined spreadsheets. The data were synthesized in the form of a narrative review. Our search yielded 949 documents, of which 20 documents were included in the synthesis (Burkina Faso: 8, Kenya: 12). While the gardens varied in composition and size, the majority provided green leafy vegetables and indigenous horticultural crops. The challenges for successful home garden implementation comprised unfavorable climatic conditions, access to and affordability of inputs, water and land, and lack of know-how. We identified trends for improved food security, diet quality, and nutritional status among the target populations. This scoping review found that there is limited evidence on home garden practices in rural Burkina Faso and Kenya. To enhance the sustainability of home gardens, research and resources should he invested in codesigning context-specific home gardening projects. Pending rigorous impact evaluation, home gardens appear to be a promising tool for climate change adaptation while simultaneously improving food security and the nutritional situation among women and young children in these two exemplar countries of sub-Saharan Africa.
As the epidemiological transition progresses throughout sub-Saharan Africa, life lived with diseases is an increasingly important part of a population’s burden of disease. The burden of disease of climate-sensitive health outcomes is projected to increase considerably within the next decades. Objectively measured, reliable population health data is still limited and is primarily based on perceived illness from recall. Technological advances like non-invasive, consumer-grade wearable devices may play a vital role in alleviating this data gap and in obtaining insights on the disease burden in vulnerable populations, such as heat stress on human cardiovascular response. The overall goal of this study is to investigate whether consumer-grade wearable devices are an acceptable, feasible and valid means to generate data on the individual level in low-resource contexts. Three hundred individuals are recruited from the two study locations in the Nouna health and demographic surveillance system (HDSS), Burkina Faso, and the Siaya HDSS, Kenya. Participants complete a structured questionnaire that comprises question items on acceptability and feasibility under the supervision of trained data collectors. Validity will be evaluated by comparing consumer-grade wearable devices to research-grade devices. Furthermore, we will collect demographic data as well as the data generated by wearable devices. This study will provide insights into the usage of consumer-grade wearable devices to measure individual vital signs in low-resource contexts, such as Burkina Faso and Kenya. Vital signs comprising activity (steps), sleep (duration, quality) and heart rate (hr) are important measures to gain insights on individual behavior and activity patterns in low-resource contexts. These vital signs may be associated with weather variables-as we gather them from weather stations that we have setup as part of this study to cover the whole Nouna and Siaya HDSSs-in order to explore changes in behavior and other variables, such as activity, sleep, hr, during extreme weather events like heat stress exposure. Furthermore, wearable data could be linked to health outcomes and weather events. As a result, consumer-grade wearables may serve as a supporting technology for generating reliable measurements in low-resource contexts and investigating key links between weather occurrences and health outcomes. Thus, wearable devices may provide insights to better inform mitigation and adaptation interventions in these low-resource settings that are direly faced by climate change-induced changes, such as extreme weather events.
In 2017, diarrheal diseases were responsible for 606 024 deaths in Sub-Saharan Africa. This situation is due to domestic and recreational use of polluted surface waters, deficits in hygiene, access to healthcare and drinking water, and to weak environmental and health monitoring infrastructures. Escherichia coli (E. coli) is an indicator for the enteric pathogens that cause many diarrheal diseases. The links between E. coli, diarrheal diseases and environmental parameters have not received much attention in West Africa, and few studies have assessed health risks by taking into account hazards and socio-health vulnerabilities. This case study, carried out in Burkina Faso (Bagre Reservoir), aims at filling this knowledge gap by analyzing the environmental variables that play a role in the dynamics of E. coli, cases of diarrhea, and by identifying initial vulnerability criteria. A particular focus is given to satellite-derived parameters to assess whether remote sensing can provide a useful tool to assess the health hazard. Samples of surface water were routinely collected to measure E. coli, enterococci and suspended particulate matter (SPM) at a monitoring point (Kapore) during one year. In addition, satellite data were used to estimate precipitation, water level, Normalized Difference Vegetation Index (NDVI) and SPM. Monthly epidemiological data for cases of diarrhea from three health centers were also collected and compared with microbiological and environmental data. Finally, semi-structured interviews were carried out to document the use of water resources, contact with elements of the hydrographic network, health behavior and condition, and water and health policy and prevention, in order to identify the initial vulnerability criteria. A positive correlation between E. coli and enterococci in surface waters was found indicating that E. coli is an acceptable indicator of fecal contamination in this region. E. coli and diarrheal diseases were strongly correlated with monsoonal precipitation, in situ SPM, and Near Infra-Red (NIR) band between March and November. Partial least squares regression showed that E. coli concentration was strongly associated with precipitation, Sentinel-2 reflectance in the NIR and SPM, and that the cases of diarrhea were strongly associated with precipitation, NIR, E. coli, SPM, and to a lesser extent with NDVI. Moreover, E. coli dynamics were reproduced using satellite data alone, particularly from February to mid-December (R2 = 0.60) as were cases of diarrhea throughout the year (R2 = 0.76). This implies that satellite data could provide an important contribution to water quality monitoring. Finally, the vulnerability of the population was found to increase during the rainy season due to reduced accessibility to healthcare and drinking water sources and increased use of water of poor quality. During this period, surface water is used because it is close to habitations, easy to use and free from monetary or political constraints. This vulnerability is aggravated by marginality and particularly affects the Fulani, whose concessions are often close to surface water (river, lake) and far from health centers.
Dengue is now a major health concern in sub-Saharan Africa. Understanding the influence of local meteorological factors on the incidence of dengue is an important element for better prediction and control of this disease. This study aims to assess the impact of meteorological factors on dengue transmission in the central region of Burkina Faso. We analyzed the lagged effects of meteorological factors on the weekly incidence of dengue from 2017 to 2019 in the central region of Burkina Faso using a General Additive Model. The results show that maximum and minimum temperature, relative humidity, and wind speed have a significant non-linear effect on dengue cases in the region with 83% of case variance explained. The optimal temperature that increases dengue cases was 27°C to 32°C for the maximum temperature and 18°C to 20°C for the minimum temperature with a decrease beyond that. The maximum temperature shifted by six weeks had the best correlation with dengue incidence. The estimated number of dengue cases increases as the maximum relative humidity increases from 15 to 45% and then from 60 to 70%. In general, an increase in daily wind speed is estimated to decrease the number of daily dengue cases. The relationship between rainfall and dengue cases was not significant. This study provides local information about the effect of meteorological factors on dengue that should help improve predictive models of dengue cases in Burkina Faso and contribute to the control of this disease.
BACKGROUND: In 2012, the WHO issued a policy recommendation for the use of seasonal malaria chemoprevention (SMC) to children 3-59 months in areas of highly seasonal malaria transmission. Clinical trials have found SMC to prevent around 75% of clinical malaria. Impact under routine programmatic conditions has been assessed during research studies but there is a need to identify sustainable methods to monitor impact using routinely collected data. METHODS: Data from Demographic Health Surveys were merged with rainfall, geographical and programme data in Burkina Faso (2010, 2014, 2017) and Nigeria (2010, 2015, 2018) to assess impact of SMC. We conducted mixed-effects logistic regression to predict presence of malaria infection in children aged 6-59 months (rapid diagnostic test (RDT) and microscopy, separately). RESULTS: We found strong evidence that SMC administration decreases odds of malaria measured by RDT during SMC programmes, after controlling for seasonal factors, age, sex, net use and other variables (Burkina Faso OR 0.28, 95% CI 0.21 to 0.37, p<0.001; Nigeria OR 0.40, 95% CI 0.30 to 0.55, p<0.001). The odds of malaria were lower up to 2 months post-SMC in Burkina Faso (1-month post-SMC: OR 0.29, 95% CI 0.12 to 0.72, p=0.01; 2 months post-SMC: OR: 0.33, 95% CI 0.17 to 0.64, p<0.001). The odds of malaria were lower up to 1 month post-SMC in Nigeria but was not statistically significant (1-month post-SMC 0.49, 95% CI 0.23 to 1.05, p=0.07). A similar but weaker effect was seen for microscopy (Burkina Faso OR 0.38, 95% CI 0.29 to 0.52, p<0.001; Nigeria OR 0.53, 95% CI 0.38 to 0.76, p<0.001). CONCLUSIONS: Impact of SMC can be detected in reduced prevalence of malaria from data collected through household surveys if conducted during SMC administration or within 2 months afterwards. Such evidence could contribute to broader evaluation of impact of SMC programmes.
BACKGROUND: Seasonal malaria chemoprevention (SMC) involves administering antimalarial drugs at monthly intervals during the high malaria transmission period to children aged 3 to 59 months as recommended by the World Health Organization. Typically, a full SMC course is administered over four monthly cycles from July to October, coinciding with the rainy season. However, an analysis of rainfall patterns suggest that the malaria transmission season is longer and starting as early as June in the south of Burkina Faso, leading to a rise in cases prior to the first cycle. This study assessed the acceptability and feasibility of extending SMC from four to five cycles to coincide with the earlier rainy season in Mangodara health district. METHODS: The mixed-methods study was conducted between July and November 2019. Quantitative data were collected through end-of-cycle and end-of-round household surveys to determine the effect of the additional cycle on the coverage of SMC in Mangodara. The data were then compared with 22 other districts where SMC was implemented by Malaria Consortium. Eight focus group discussions were conducted with caregivers and community distributors and 11 key informant interviews with community, programme and national-level stakeholders. These aimed to determine perceptions of the acceptability and feasibility of extending SMC to five cycles. RESULTS: The extension was perceived as acceptable by caregivers, community distributors and stakeholders due to the positive impact on the health of children under five. However, many community distributors expressed concern over the feasibility, mainly due to the clash with farming activities in June. Stakeholders highlighted the need for more evidence on the impact of the additional cycle on parasite resistance prior to scale-up. End-of-cycle survey data showed no difference in coverage between five SMC cycles in Mangodara and four cycles in the 22 comparison districts. CONCLUSIONS: The additional cycle should begin early in the day in order to not coincide with the agricultural activities of community distributors. Continuous sensitisation at community level is critical for the sustainability of SMC and acceptance of an additional cycle, which should actively engage male caregivers. Providing additional support in proportion to the increased workload from a fifth cycle, including timely remuneration, is critical to avoid the demotivation of community distributors. Further studies are required to understand the effectiveness, including cost-effectiveness, of tailoring SMC according to the rainy season. Understanding the impact of an additional cycle on parasite resistance to SPAQ is critical to address key informants’ concerns around the deviation from the current four-cycle policy recommendation.
Very little research has documented the exposure of populations in Africa to extreme heat. We measured indoor air temperature and humidity hourly for 13 months in seven houses of contrasted architecture and construction materials all in the northern neighbourhoods of Ouagadougou, Burkina Faso. These measurements are compared to air temperatures recorded at the synoptic weather station of Ouagadougou airport and to land surface temperature estimates from Landsat satellite images at seven dates with clear-sky conditions. The results reveal huge temperature differences (exceeding 10 degrees C) between houses, especially in the afternoon hours of the warmest season. Indoor temperature is also much more variable than land surface (outdoor) temperature in the same locations, as estimated by satellite imagery. Houses with greater thermal inertia smooth the afternoon temperature peak, reducing heat exposure. Heat stress bioindicators reveal that danger thresholds, while rarely reached in some houses, are frequently exceeded in others year round except for the core of the cold winter season (December and January). In spring, the hottest season, the danger threshold is almost permanently exceeded in these dwellings, exposing their inhabitants to significant heat stress. This pilot study shows the primary role of housing in modulating indoor temperature, raising questions of public health and habitability of Sahelian regions in a warming world. This issue will be of increasing importance with ongoing climate change, hence the need for further, more detailed instrumented campaigns in African settlements.
Variable climate conditions, resulting in periods of water scarcity and longer dry spells, or intense rainfall events, have serious implications for water and sanitation services. Climate change threatens to exacerbate these hazards, increasing risks to household water security, and associated impacts on health, wellbeing and livelihoods. These risks are not evenly distributed across individuals and communities, and there is a particular need to understand women’s vulnerabilities and responses to these risks due to disproportionate impacts of poor water and sanitation conditions. This study used mixed-methods data collection to assess how vulnerabilities to climate-related risks to household water security are produced and vary among women in the Centre-East region, Burkina Faso, as well as capacities to respond. Gendered water-related roles and norms were found to drive vulnerabilities for women in the case study site particularly related to increasingly inadequate water availability during the dry season. Other social differences such as Mossi and Peul ethnicity which influence ways of using water, also contributed to women’s differential vulnerability and capacities to respond. These findings show there is a need to consider how the development of ‘climate resilient’ water and sanitation services take social drivers of vulnerability into account.
West African populations are exposed to the longest and harshest dust storms on the planet, the Saharan sand and dust storms (SDS). Nonetheless, little is known about the effects of the severe storms on early-life health in West Africa. This study investigated the association of the risk of neonatal mortality, an indicator of the population’s early-life health, with potential prenatal and neonatal exposure to the Saharan SDS. Data on 30,552 under-five children from Burkina Faso’s 1993, 2003, and 2010 demographic and health surveys were matched to the particulate matters (PM) and terrestrial air temperature and precipitation forecasts. Exposure to dust events was measured by the number of days with average PM10 and PM2.5 concentrations above a series of threshold. Intensity-dependent patterns of associations between neonatal mortality and both prenatal and birth month exposure to dust events were identified. There was no association if average daily PM10 and PM2.5 levels were <60 and 30 ?g/m(3), respectively. However, strong associations, which increase almost linearly with the intensity of exposure, were identified when daily PM10 and PM2.5 levels ranged from 70 to 150 and from 40 to 70 ?g/m(3), respectively. At the higher PM levels, the association for the gestation period decreased, but that for the birth month remained mostly unresponsive to changes in the PM levels. Larger associations were identified when siblings were compared.
