Exposure to heatwaves may result in adverse human health impacts. Heat alerts in South Africa are currently based on defined temperature-fixed threshold values for large towns and cities. However, heat-health warning systems (HHWS) should incorporate metrics that have been shown to be effective predictors of negative heat-related health outcomes. This study contributes to the development of a HHWS for South Africa that can potentially minimize heat-related mortality. Distributed lag nonlinear models (DLNM) were used to assess the association between maximum and minimum temperature and diurnal temperature range (DTR) and population-adjusted mortality during summer months, and the effects were presented as incidence rate ratios (IRR). District-level thresholds for the best predictor from these three metrics were estimated with threshold regression. The mortality dataset contained records of daily registered deaths (n = 8,476,532) from 1997 to 2013 and data for the temperature indices were for the same period. Maximum temperature appeared to be the most statistically significant predictor of all-cause mortality with strong associations observed in 40 out of 52 districts. Maximum temperature was associated with increased risk of mortality in all but three of the districts. Our results also found that heat-related mortality was influenced by regional climate because the spatial distribution of the thresholds varied according to the climate zones across the country. On average, districts located in the hot, arid interior provinces of the Northern Cape and North West experienced some of the highest thresholds compared to districts located in temperate interior or coastal provinces. As the effects of climate change become more significant, population exposure to heat is increasing. Therefore, evidence-based HHWS are required to reduce heat-related mortality and morbidity. The exceedance of the maximum temperature thresholds provided in this study could be used to issue heat alerts as part of effective heat health action plans.
Niger is afflicted with high rates of poverty, high fertility rates, frequent environmental crises, and climate change. Recurrent droughts and floods have led to chronic food insecurity linked to poor maternal and neonatal nutrition outcomes in vulnerable regions. We analyzed maternal and neonatal nutrition trends and subnational variability between 2000 and 2021 with a focus on the implementation of policies and programs surrounding two acute climate shocks in 2005 and 2010. We used four sources of data: (a) national household surveys for maternal and newborn nutritional indicators allowing computation of trends and differences at national and regional levels; (b) document review of food security reports; (c) 30 key informant interviews and; (d) one focus group discussion. Many food security policies and nutrition programs were enacted from 2000 to 2020. Gains in maternal and neonatal nutrition indicators were more significant in targeted vulnerable regions of Maradi, Zinder, Tahoua and Tillabéri, from 2006 to 2021. However, poor access to financial resources for policy execution and suboptimal implementation of plans have hindered progress. In response to the chronic climate crisis over the last 20 years, the Nigerien government and program implementers have demonstrated their commitment to reducing food insecurity and enhancing resilience to climate shocks by adopting a deliberate multisectoral effort. However, there is more that can be achieved with a continued focus on vulnerable regions to build resilience, targeting high risk populations, and investing in infrastructure to improve health systems, food systems, agriculture systems, education systems, and social protection.
Climate change and its corollaries suggest that urban planning tools and strategies need to integrate adaptation and resilience approaches into urban development. This study aims to inform decision makers and the scientific community of the importance of appropriating data on urban adaptation and resilience strategies in the city of N’Djamena. After sampling 519 city dwellers, oriented questionnaires and focus groups were used to collect socio-demographic parameters, major climate risks, their impacts on urban issues and the urban resilience strategies employed. The various exposure and impact indices were used to identify and prioritize climate risks and urban exposure issues with the populations concerned. The study highlighted three major climatic hazards, namely, flooding, heat waves and strong winds, and their impact on social and community facilities, the living environment and human health. Ten vulnerability factors have been identified, of which the intrinsically geophysical factors are most familiar to the city’s population. The principal component analysis (PCA) illustrates ten (10) strategies for adaptation and resilience to urban climate risks. To meet the climatic challenges in urban areas, this study makes several short-, medium- and long-term recommendations to decision makers.
As found in the health studies literature, the levels of climate association between epidemiological diseases have been found to vary across regions. Therefore, it seems reasonable to allow for the possibility that relationships might vary spatially within regions. We implemented the geographically weighted random forest (GWRF) machine learning method to analyze ecological disease patterns caused by spatially non-stationary processes using a malaria incidence dataset for Rwanda. We first compared the geographically weighted regression (WGR), the global random forest (GRF), and the geographically weighted random forest (GWRF) to examine the spatial non-stationarity in the non-linear relationships between malaria incidence and their risk factors. We used the Gaussian areal kriging model to disaggregate the malaria incidence at the local administrative cell level to understand the relationships at a fine scale since the model goodness of fit was not satisfactory to explain malaria incidence due to the limited number of sample values. Our results show that in terms of the coefficients of determination and prediction accuracy, the geographical random forest model performs better than the GWR and the global random forest model. The coefficients of determination of the geographically weighted regression (R2), the global RF (R2), and the GWRF (R2) were 4.74, 0.76, and 0.79, respectively. The GWRF algorithm achieves the best result and reveals that risk factors (rainfall, land surface temperature, elevation, and air temperature) have a strong non-linear relationship with the spatial distribution of malaria incidence rates, which could have implications for supporting local initiatives for malaria elimination in Rwanda.
The climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to gain a more holistic understanding of the relationship between diarrhoea in young children and climate variability in a system stressed by water scarcity. METHODS: Using a mixed-methods approach, we explored diarrhoeal disease incidence in children under 5 years between 2010 to 2019 in Cape Town, primarily in the public health system through routinely collected diarrhoeal incidence and weather station data. We developed a negative binomial regression model to understand the relationship between temperature, precipitation, and relative humidity on incidence of diarrhoea with dehydration. We conducted in-depth interviews with stakeholders in the fields of health, environment, and human development on perceptions around diarrhoea and health-related interventions both prior to and over the drought, and analysed them through the framework method. RESULTS: From diarrhoeal incidence data, the diarrhoea with dehydration incidence decreased over the decade studied, e.g. reduction of 64.7% in 2019 [95% confidence interval (CI): 5.5-7.2%] compared to 2010, with no increase during the severe drought period. Over the hot dry diarrhoeal season (November to May), the monthly diarrhoea with dehydration incidence increased by 7.4% (95% CI: 4.5-10.3%) per 1 °C increase in temperature and 2.6% (95% CI: 1.7-3.5%) per 1% increase in relative humidity in the unlagged model. Stakeholder interviews found that extensive and sustained diarrhoeal interventions were perceived to be responsible for the overall reduction in diarrhoeal incidence and mortality over the prior decade. During the drought, as diarrhoeal interventions were maintained, the expected increase in incidence in the public health sector did not occur. CONCLUSIONS: We found that that diarrhoeal incidence has decreased over the last decade and that incidence is strongly influenced by local temperature and humidity, particularly over the hot dry season. While climate change and extreme weather events especially stress systems supporting vulnerable populations such as young children, maintaining strong and consistent public health interventions helps to reduce negative health impacts.
The unsustainable expansion of cities is generating urban heat islands (UHIs) by exchanging (trading) vegetation cover (green) for built impervious surfaces which is associated with heat-related health risks, globally. This phenomenon is exacerbated by climate change and anthropogenic activities like urban population growth, particularly in African cities. This study explores the spatio-temporal trends of land surface temperature (LST), land use land cover (LULC) and their economic and health risks in the Greater Accra Metropolitan Area (GAMA) of Ghana, from 1991 to 2021. We extracted LST/LULC information from Landsat datasets to perform change analysis, alongside an online survey across 56 communities on how LST relates to economic and human health risks perceptions of residents. The results show urbanization of GAMA is trading greens for heated surfaces, impacting communities’ health risks. While the built environment grew (8.6%), the vegetation cover declined (2.5%) and the mean LST rose (0.8 degrees C) in 25 years. A 30 degrees C LST corresponds to the point of inflexion of exchanging green vegetative cover for heated built surfaces. The forest community of Kisseman, the populous community of Dansoman and the harbour city of Tema corresponded to the first, fourth and fifth LST quintiles, changing at -0.05 degrees C, 0.06 degrees C and 0.164 degrees C per year. The common health risks include discomfort from heavy sweating, headaches, dehydration, thirst and skin rashes. These results call for climate action and green spatial planning through urban forestry and environmentalism in GAMA. For urban resilience and sustainable cities, we advocate green-cooling multi-purpose housing, roads, and industrial infrastructure.
Informal settlements in South Africa are facing diverse challenges such as land inaccessibility for food produc-tion, poverty, unemployment, malnutrition, and climate change attributing to food insecurity. This paper considered income sources, employment status, household food budget, agricultural production, and anthro-pometrics as indicators in reviewing the status of this study area. Evaluating geographic dimensions of food accessibility and acceptability locally whilst subsequently determining measures that will promote viable land utilisation options as an intervention within this peri-urban township food environment, required a systematic approach. A general household survey measuring factors contributing to food access was used also evaluating production and consumption patterns of adaptable indigenous crops (n = 200 households). Anthropometric data measured body mass index (BMI) kg/m2, waist circumference (WC) and waist to height ratio (WHtR) to determine levels of malnutrition and health risk factors. Supporting data included a survey from local street vendors and spaza shop owners (n = 25) to determine food items that were frequently accessible and consumed, then compared with the national urban food basket. Land ecotope data was collected to determine if the soil type/s, soil texture, and planting depth are appropriate for effective crop yields in the study area. Secondary data were sourced from the Geographic Information System (GIS) utilised by municipal services and national sta-tistical data. The survey indicated that more than 67.0% of informal dwellers were unemployed and survived on a highly restricted household food budget ( Despite considerable progress made over the past 20 years in reducing the global burden of malaria, the disease remains a major public health problem and there is concern that climate change might expand suitable areas for transmission. This study investigated the relative effect of climate variability on malaria incidence after scale-up of interventions in western Kenya. METHODS: Bayesian negative binomial models were fitted to monthly malaria incidence data, extracted from records of patients with febrile illnesses visiting the Lwak Mission Hospital between 2008 and 2019. Data pertaining to bed net use and socio-economic status (SES) were obtained from household surveys. Climatic proxy variables obtained from remote sensing were included as covariates in the models. Bayesian variable selection was used to determine the elapsing time between climate suitability and malaria incidence. RESULTS: Malaria incidence increased by 50% from 2008 to 2010, then declined by 73% until 2015. There was a resurgence of cases after 2016, despite high bed net use. Increase in daytime land surface temperature was associated with a decline in malaria incidence (incidence rate ratio [IRR] = 0.70, 95% Bayesian credible interval [BCI]: 0.59-0.82), while rainfall was associated with increased incidence (IRR = 1.27, 95% BCI: 1.10-1.44). Bed net use was associated with a decline in malaria incidence in children aged 6-59 months (IRR = 0.78, 95% BCI: 0.70-0.87) but not in older age groups, whereas SES was not associated with malaria incidence in this population. CONCLUSIONS: Variability in climatic factors showed a stronger effect on malaria incidence than bed net use. Bed net use was, however, associated with a reduction in malaria incidence, especially among children aged 6-59 months after adjusting for climate effects. To sustain the downward trend in malaria incidence, this study recommends continued distribution and use of bed nets and consideration of climate-based malaria early warning systems when planning for future control interventions. Climate services for health can facilitate health resilience and adaptation to climate change, particularly if they are well-calibrated to promote wellness and save lives. In this study, the status of climate services for health in South Africa’s Agincourt sub-district, Mpumalanga province, was assessed. A qualitative case study methodology encompassing multiple methods of data collection was used. The results show that climate services for health in the Agincourt sub-district, albeit essential, are fragmented and underdeveloped. Scientifically informed heathealth services are non-existent. Notwithsatnding this gap, healthcare and allied professionals are aware of the importance of climate services for health. The main barrier to climate services delivery is the paucity of interagency coordination; for example, coordination to plan and respond to climate-health information between the South African Weather Services and the Departments of Health and Education is lacking. Inclusive climate services for health are essential for positive prevention and treatment outcomes. Future studies must provide an investment case for climate services for health, demonstrating the benefits of acting and the costs of inaction. BACKGROUND: The increased frequency of climate induced natural disasters has exacerbated the risks of malnutrition in the already vulnerable regions. This study was aimed at exploring the effects of Cyclone Idai on nutrition outcomes of women of child-bearing age and children under 5 years. METHOD: The household-based cross-sectional study was conducted in Eastern Zimbabwe. Data were collected through face-to-face interviews to determine food consumption score (FCS) and household dietary diversity (HDDS), minimum dietary diversity for women (MDD-W) and minimum dietary diversity for children (MDD-C). Severity of Cyclone Idai was grouped into five categories based on the extent of damage to infrastructure and loss of human lives. Association between continuous and categorical variables was tested using Pearson correlation test and Chi square test, respectively. Linear and binary logistic regression was performed to investigate determinants of food security. RESULTS: A total of 535 households were interviewed. There was a significant correlation between severity of Cyclone Idai and MDD-W (p = 0.011), HDDS (p = 0.018) and FCS (p = 0.001). However, severity of Cyclone Idai was not a determinant of any nutrition outcome, but gender of household head was a negative predictor of HDDS (β = - 0.734, p = 0.040), and marital status of household head was a positive predictor (β = 0.093, p = 0.016) of FCS. CONCLUSION: The findings provide a good baseline to inform future programming of food aid activities during disasters. More so, our findings call for evidence-based policies regarding composition of a food aid basket and targeting of beneficiaries. The main strength of this study is that it is the first to investigate the effects of cyclones on food and nutrition security indicators and is based on a large sample size thus making our results generalisable. As global average temperatures rise, so does the frequency and intensity of El Nino-induced droughts, which in turn threaten the reliability of hydropower. 1.4 billion people live in countries where hydropower constitutes more than a quarter of the electricity production and which have experienced El Nino droughts, meaning many more power outages can be expected around the world. Little research has been conducted on the impact of power outages on mental health. This study takes Zambia as its case study to examine the impact that El Nino droughts have had on the lives of householders connected to a highly hydropower-dependant electricity grid, and includes the impact it has had on their physical and self-reported mental health. Using 54 online responses to a survey, we found that the greatest impacts of outages spoiled food, compromised entertainment, compromised ability to work and limitation in cooking options. More than a fifth of respondents reported experiencing self-reported depression to a major degree or all of the time due to power outages, with individuals writing their own responses that they felt debilitated, experienced reduced communication and reduced activities, and stress. Using Bayesian inference, we found that changes in sleeping patterns arising from power outages was a statistically significant predictor of self-reported depression. 63% of surveyed households were willing to pay approximately USD 0.10/kWh as of the end of 2019, about double the tariff that they did, to ensure reliable electricity supply. Household income was a statistically significant predictor of willingness to pay more. Climate change poses numerous threats to human life, including physical and mental health, the environment, housing, food security, and economic growth. People who already experience multidimensional poverty with the disparity in social, political, economic, historical, and environmental contexts are more vulnerable to these impacts. The study aims to identify the role of climate change in increasing multidimensional inequalities among vulnerable populations and analyze the strengths and limitations of South Africa’s National Climate Change Adaptation Strategy. A systematic review was applied, and literature from Google, Google Scholar, and PubMed, as well as relevant gray literature from 2014-2022 were reviewed. Out of 854 identified sources, 24 were included in the review. Climate change has exacerbated multidimensional inequalities among vulnerable populations in South Africa. Though the National Climate Change Adaptation Strategy has paid attention to health issues and the needs of vulnerable groups, the adaptation measures appear to focus less on mental and occupational health. Climate change may play a significant role in increasing multidimensional inequalities and exacerbating health consequences among vulnerable populations. For an inclusive and sustainable reduction in inequalities and vulnerabilities to the impact of climate change, community-based health and social services should be enhanced among vulnerable populations. BACKGROUND: Ethiopia has seen an increase in the number of internally displaced persons (IDPs) due to conflict and violence related to border-based disputes and climate change. This study examines the insecurities experienced by IDPs in the Burayu camp and how they navigate and challenge them. Violence and insecurity have daunted Ethiopian regions for decades, violated children’s rights, and impeded the achievement of the United Nation’s sustainable development goals related to children, such as good healthcare and mental health, quality education, clean water, and sanitation. The deteriorating security concerns in Ethiopia could also expose IDP children to poor health outcomes associated with a lack of access to healthcare services. METHODS: This was an exploratory qualitative case study guided by intersectionality theoretical lens to explore the forms of insecurities perceived and experienced by IDPs in Ethiopia. Participants were selected using a purposeful sampling approach. We interviewed 20 children, 20 parents or guardians, and 13 service providers. Interviews were audio recorded and transcribed verbatim in Afan Oromo, then translated into English. We used NVivo 12 qualitative data analysis software to analyze data following Braun & Clarke’s approach to thematic data analysis. RESULTS: The participants reported that IDP children in Burayu town faced many challenges related to poor socioeconomic conditions that exposed them to several insecurities and negatively affected their well-being. They reported inadequate access to clothing and shelter, clean water, sanitary facilities, food, and adequate healthcare due to financial barriers, lack of drugs, and quality of care. Our data analysis shows that socioeconomic and contextual factors intersect to determine the health and well-being of children in the Ethiopian IDP camp studied. The children experienced insecurities while navigating their daily lives. This is compounded by institutional practices that shape gender relations, income status, and access to healthcare, education, and food. These deficiencies expose children to traumatic events that could decrease future livelihood prospects and lead to compromised mental health, rendering them susceptible to prolonged post-traumatic stress disorder and depression. Results are presented under the following topics: (1) basic needs insecurity, (2) healthcare insecurity, (3) academic insecurity, (4) economic insecurity, (5) food insecurity, and (6) physical and mental health insecurity. CONCLUSION: Successful relocation and reintegration of IDPs would help to alleviate both parent and child post-conflict stressors. Managing and following up on economic reintegration efforts is needed in both the short and long term. Such measures will help to achieve goals for specific projects attached to donor support outcomes, consequently enabling social support and conflict resolution management efforts. Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso. METHODS: In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area. FINDINGS: Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]). INTERPRETATION: Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. FUNDING: Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation. Heat stress is a harmful physical hazard in many occupational settings. However, consequences of occupational heat exposure among workers in a sugarcane factory in Ethiopia are not well characterized. This study aimed to assess the level of occupational heat exposure-related symptoms and contributing factors. In this cross-sectional study, five workstations were selected for temperature measurement. Heat stress levels were measured using a wet-bulb globe temperature index meter. A stratified random sampling technique was used to select 1,524 participants. Heat-related symptoms were assessed using validated questionnaires. The level of occupational heat exposure was 72.4% (95% CI: 70.2%-74.8%), while 71.6% (95% CI: 69.3%-74.9%) of participants experienced at least one symptom related to heat stress. The most common heat-related symptoms were swelling of hands and feet (78%), severe thirst (77.8%) and dry mouth (77.4%). The identified risk factors were a lack of reflective shields (AOR: 2.20, 95% CI: 1.53, 3.17), not-enclosed extreme heat sources (AOR: 1.76, 95% CI: 1.23, 2.51), a lack of access to shade (AOR: 9.62, 95% CI: 6.20, 14.92), and inappropriate protective clothing provision (AOR: 1.58, 95% CI: 1.27, 2.71). The burden of occupational heat exposure and heat-induced symptoms was high. Lack of reflective shields, the absence of enclosed extreme heat sources, a lack of access to shade, and inappropriate protective clothing provision were considerable attributes of heat stress. Therefore, the use of mechanical solutions to stop heat emissions at their sources and the key factors identified were areas for future intervention. The Harmattan, a dry, northeasterly trade wind, transports large quantities of Saharan dust over the Sahelian region during the dry season (December-March). Studies have shown that bacterial meningitis outbreaks in Sahelian regions show hyper-endemic to endemic levels during high-dust months. We examine the (a) seasonality and intraseasonal variability of dust, climate, and meningitis and the (b) quantitative relationships between various dust proxies with meningitis lags of 0-10 weeks in Senegal from 2012 to 2017. The results show that the onset of the meningitis season occurs in February, roughly 2 months after the dusty season has begun. The meningitis season peaks at the beginning of April, when northeasterly wind speeds and particulate matter (PM) are relatively high, and the meningitis season ends near the end of June, when temperature and humidity rise and northeasterly wind speeds decline. Furthermore, we find that Senegal’s relatively high humidity year-round may help slow the transmission of the infection, contributing to a lower disease incidence than landlocked countries in the meningitis belt. Lastly, our results suggest the desert dust may have a significant impact on the onset to the peak of the meningitis season in Senegal, particularly at the 0-2 and 10-week lag, whether that be directly through biological processes or indirectly through changes in human behavior. PM and visibility, however, are not in phase with aerosol optical depth throughout the year and consequently show different relationships with meningitis. This study further exemplifies the critical need for more PM, meteorological, and meningitis measurements in West Africa to further resolve these relationships. Sub-Saharan Africa is often presented as the continent most vulnerable to climatic change with major repercussions for food systems. Coupled with high rates of population growth, continued food insecurity and malnutrition, thus the need to enhance food production across the continent is seen as a major global imperative. We argue here, however, that current models of agricultural development in Eastern Africa frequently marginalise critical smallholder knowledge from the process of future agricultural design due to a lack of a methodological tools for engagement. This paper addresses this by outlining a potential means to capture and share locally produced agronomic information on a large scale. We report on a ‘Citizen Science’ pilot study that worked with smallholder farmers in Elgeyo-Marakwet County, Western Kenya, to co-design a mobile application using the well-developed Sapelli platform that easily allows farmers to identify, record and geolocate cropping patterns and challenges at multiple stages in the agricultural calendar using their own understanding. The pilot project demonstrated the technical and epistemological benefits of co-design, the abilities of smallholder farmers to co-design and use smartphone applications, and the potential for such technology to produce and share valuable agricultural and ecological knowledge in real time. Proof-of-concept data illustrates opportunities to spatially and temporally track and respond to challenges related to climate, crop disease and pests. Such work expounds how smallholder farmers are a source of largely untapped ecological and agronomic expert knowledge that can, and should, be harnessed to address issues of future agricultural resilience and food system sustainability. Millions of dollars have been spent in fighting malaria in Namibia. However, malaria remains a major public health concern in Namibia, mostly in Kavango West and East, Ohangwena and Zambezi region. The primary goal of this study was to fit a spatio-temporal model that profiles spatial variation in malaria risk areas and investigate possible associations between disease risk and environmental factors at the constituency level in highly risk northern regions of Namibia. METHODS: Malaria data, climatic data, and population data were merged and Global spatial autocorrelation statistics (Moran’s I) was used to detect the spatial autocorrelation of malaria cases while malaria occurrence clusters were identified using local Moran statistics. A hierarchical Bayesian CAR model (Besag, York and Mollie’s model “BYM”) known to be the best model for modelling the spatial and temporal effects was then fitted to examine climatic factors that might explain spatial/temporal variation of malaria infection in Namibia. RESULTS: Average rainfall received on an annual basis and maximum temperature were found to have a significant spatial and temporal variation on malaria infection. Every mm increase in annual rainfall in a specific constituency in each year increases annual mean malaria cases by 0.6%, same to average maximum temperature. The posterior means of the time main effect (year t) showed a visible slightly increase in global trend from 2018 to 2020. CONCLUSION: The study discovered that the spatial temporal model with both random and fixed effects best fit the model, which demonstrated a strong spatial and temporal heterogeneity distribution of malaria cases (spatial pattern) with high risk in most of the Kavango West and East outskirt constituencies, posterior relative risk (RR: 1.57 to 1.78). This study examined the spatio-temporal dynamics of malaria epidemiological patterns considering environmental(vegetation, water bodies, slope, elevation) and climatic factors (rainfall, temperature and relative humidity) in Ondo State, Nigeria, from 2013 to 2017 using ArcGIS 10.4 and QGIS software. The factors influencing malaria were studied using a multi-criteria analysis (Analytical Hierarchical Process-AHP). The trend analysis revealed an increase in cases over time, indicating a significant increase in the occurrence of malaria in all study areas. The most important climatic variable impacting malaria transmission in the study was temperature. Nevertheless, other environmental and climatic factors causing transmission include vegetation, water bodies, slopes, elevation, rainfall, and relative humidity. With the exception of Okitipupa, the study identified high-risk locations (vulnerable areas/hot spots) in almost all of the local government areas, while Ondo East, Akure South, Akoko South West, and Owo are the most vulnerable areas. The findings reveal that the malaria incidence is high in the developed LGAs having more towns where temperature is higher due to several anthropogenesis activities, high population and increased land-use. Thus, in-depth epidemiological studies on malaria should be undertaken in Ondo State and other regions of Nigeria considering environmental factors impacting malaria incidence as this will enable one to ascertain the major factors influencing the disease, thereby taking adequate measures to curb the increase in incidence. Introduction: Safe and easily accessible drinking water service generates substantial benefits for public health and the economy. Approximately 10% of the global burden of disease worldwide could be prevented with improved access to drinking water. The death of similar to 30% of children younger than 5 years in developing countries is attributable to inadequate access to improved drinking water. Despite the presence of abundant water sources in Ethiopia, uneven distribution and waste pollution coupled with unprecedented population growth, rapid urbanization, and climate change are hindering the country’s ability to maintain the balance between the demand and supply of accessible and improved drinking water services. The importance of up-to-date evidence for actions regarding the distribution of access to improved drinking water services is indicated by the Ethiopian Ministry of Water and Energy. Therefore, this study aimed to explore the spatial distribution and determinants of limited access to improved drinking water service among households in Ethiopia. Methods: This study used the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). The data were weighted using sampling weight to restore the representativeness and to obtain valid statistical estimates. After excluding ineligible households, a total weighted sample of 5,760 households was included in the final analysis. The analysis was performed using STATA version 14.2, ArcGIS Pro, and SaTScan version 10.1 software. To find significant determinants with limited access to improved drinking water service, we used a multilevel logistic regression model. A P-value of Results: This study found that in Ethiopia, 16.1% (95% CI: 15.2, 17.1) of households have limited access to improved drinking water services. The spatial distribution of households with limited access was identified to be clustered across a few regions of the country (Moran’s I = 0.17, p-value < 0.01). The most likely significant primary clusters with highly limited access were seen in the Somali region (RR = 4.16, LLR = 162.8), the border between Amhara and Afar region (RR = 4.74, LLR = 41.6), the border between Oromia and Afar region (RR = 5.21, LLR = 13.23), and the northeastern Tigray region (RR = 2.52, LLR = 9.87). The wealth index, the age of household head, residence, and region were significantly associated with limited access to improved drinking water service. A high rate of limited access to improved drinking water service is predicted in the southwestern part of Gambella, the northeastern part of Oromia, the southwestern part of South Nation Nationalities and Peoples' region, and part of the Oromia region that surrounds Addis Ababa. Conclusion: Limited access to improved drinking water service in Ethiopia varies across regions, and inequality in the service provision exists in the country. Prioritization and extra level of efforts should be made by concerned government and non-government organizations as well as other stakeholders for those underprivileged areas and groups of the population as they are found in the study.
Beliefs form the fabric of every society. Likewise, there are socio-cultural beliefs that people hold as causes of climate risk. This paper sought to identify the socio-cultural beliefs on drought among crop farmers in Talensi, Ghana and how these provide insights for environmental management, social vulnerability, early warning systems and coping and adaptation. The selection of Talensi District was appropriate because it is one of the agrarian districts located in drought prone zone of Ghana. The study was designed following the case study approach. A total of 69 participants were selected through purposive sampling to participate in key informant interviews and focus group discussions conducted across nine (9) communities. The study found that manifestation of bad and/or indecent behavioural practices; performance and/or non-performance of traditional rites; presence and behaviour peculiar animals; and magical conjurations and incantations by spiritualists, diviners and soothsayers were the significant socio-cultural beliefs accounting for drought. The study concludes that the socio-cultural beliefs of the local people are their social-cultural capital and this asset is a useful gamut in explaining the social vulnerability; development of early warning drought systems; and selection of coping and adaptation strategies in Talensi District. A major recommendation is that individuals and institutions with expertise in technical and scientific early warning drought information should be circumspect in not adopting a judgmental approach when they are communicating and disseminating risk information, to the detriment of indigenous knowledge. BACKGROUND: This study aimed to examine the spatial variations in malaria hotspots along Dilla sub-watershed in western Ethiopia based on environmental factors for the prevalence; and compare the risk level along with districts and their respective kebele. The purpose was to identify the extent of the community’s exposure to the risk of malaria due to their geographical and biophysical situations, and the results contribute to proactive interventions to halt the impacts. METHODS: The descriptive survey design was used in this study. Ethiopia Central Statistical Agency based meteorological data, digital elevation model, and soil and hydrological data were integrated with other primary data such as the observations of the study area for ground truthing. The spatial analysis tools and software were used for watershed delineation, generating malaria risk map for all variables, reclassification of factors, weighted overlay analysis, and generation of risk maps. RESULTS: The findings of the study reveal that the significant spatial variations in magnitudes of malaria risk have persisted in the watershed due to discrepancy in their geographical and biophysical situations. Accordingly, significant areas in most of the districts in the watershed are characterized by high and moderate in malaria risks. In general, out of the total area of the watershed which accounts 2773 km2, about 54.8% (1522km2) identified as high and moderate malaria risk area. These areas are explicitly identified and mapped along with the districts and kebele in the watershed to make the result suitable for planning proactive interventions and other decision making. CONCLUSIONS: The research output may help the government and humanitarian organizations to prioritize the interventions based on identified spatial situations in severity of malaria risks. The study was aimed only for hotspot analysis which may not provide inclusive account for community’s vulnerability to malaria. Thus, the findings in this study needs to be integrated with the socio-economic and other relevant data for better malaria management in the area. Therefore, future research should comprehend the analysis of vulnerability to the impacts of malaria through integrating the level of exposure to the risk, for instance identified in this study, with factors of sensitivity and adaptation capacity of the local community. The spatial and seasonal distribution, abundance, and infection rates of human schistosomiasis intermediate host snails and interactions with other freshwater snails, water physicochemical parameters, and climatic factors was determined in this study. A longitudinal malacology survey was conducted at seventy-nine sites in seven districts in KwaZulu-Natal province between September 2020 and August 2021. Snail sampling was done simultaneously by two trained personnel for fifteen minutes, once in three months. A total of 15,756 snails were collected during the study period. Eight freshwater snails were found: Bulinus globosus (n = 1396), Biomphalaria pfeifferi (n = 1130), Lymnaea natalensis (n = 1195), Bulinus tropicus (n = 1722), Bulinus forskalii (n = 195), Tarebia granifera (n = 8078), Physa acuta (n = 1579), and Bivalves (n = 461). The infection rates of B. globosus and B. pfeifferi are 3.5% and 0.9%, respectively. In our study, rainfall, pH, type of habitats, other freshwater snails and seasons influenced the distribution, abundance, and infection rates of human schistosomiasis intermediate host snails (p-value < 0.05). Our findings provide useful information which can be adopted in designing and implementing snail control strategies as part of schistosomiasis control in the study area.
The study evaluates the performance of the Conformal Cubic Atmospheric Model (CCAM) when simulat-ing an urban heat island (UHI) over the city of eThekwini, located along the southeast coast of South Africa. The CCAM is applied at a grid length of 1 km on the panel with eThekwini, in a stretched-grid mode. The CCAM is coupled to the urban climate model called the Australian Town Energy Budget (ATEB). The ATEB incorporates measured urban parameters in-cluding building characteristics, emissions, and albedo. The ATEB incorporates the land-cover boundary conditions obtained from the Moderate Resolution Imaging Spectroradiometer (MODIS) satellite. The CCAM configuration applied realistically captured the orientation of the city and land-cover types. Simulations of meteorological variables such as temperatures and longwave radiation reproduced the spatial distribution and intensity of the UHI. Results show that the UHI is stronger during summer and weaker in all other seasons. The UHI developed because of natural factors (e.g., distribution of longwave radia-tion) and human factors (e.g., urban expansion, an increase in anthropogenic emissions, and additional heating). Because of the city’s location along the coast, the UHI simulation could be weakened by atmospheric circulations resulting from land and sea breezes. Mitigation methods such as applying reflective paints and revegetation of the city may increase albedo and latent heat fluxes but reduce the sensible heat fluxes and weaken the UHI. However, the UHI may not be completely elimi-nated since natural factors and emissions constantly influence its development. SIGNIFICANCE STATEMENT: The outcome of this study could be particularly valuable for municipalities in their disaster management planning since the occurrence of UHIs can cause heat-related diseases such as heatstrokes and even fatalities, especially for the elderly, in cities. Increases in temperatures also lead to higher demand for air condi-tioners, which in the long term lead to higher demand and pressure on the electricity grid system as well as increased costs for the individual. As higher temperatures increase heatwave events, increases in anthropogenic emissions also re-sult in degraded air quality that impacts health. UHIs impact human lives and can cause deterioration in health when individuals experience high temperatures in summer. Warmer temperatures also reduce energy demand (and in the long term assist with global environmental restoration). Simulium damnosum s.l., the most important vector of onchocerciasis in Africa, is a complex of sibling species described on the basis of differences in their larval polytene chromosomes. These (cyto) species differ in their geographical distributions, ecologies and epidemiological roles. In Togo and Benin, distributional changes have been recorded as a consequence of vector control and environmental changes (e.g. creation of dams, deforestation), with potential epidemiological consequences. We review the distribution of cytospecies in Togo and Benin and report changes observed from 1975 to 2018. The elimination of the Djodji form of S. sanctipauli in south-western Togo in 1988 seems to have had no long-term effects on the distribution of the other cytospecies, despite an initial surge by S. yahense. Although we report a general tendency for long-term stability in most cytospecies’ distributions, we also assess how the cytospecies’ geographical distributions have fluctuated and how they vary with the seasons. In addition to seasonal expansions of geographical ranges by all species except S. yahense, there are seasonal variations in the relative abundances of cytospecies within a year. In the lower Mono river, the Beffa form of S. soubrense predominates in the dry season but is replaced as the dominant taxon in the rainy season by S. damnosum s.str. Deforestation was previously implicated in an increase of savanna cytospecies in southern Togo (1975-1997), but our data had little power to support (or refute) suggestions of a continuing increase, partly because of a lack of recent sampling. In contrast, the construction of dams and other environmental changes including climate change seem to be leading to decreases in the populations of S. damnosum s.l. in Togo and Benin. If so, combined with the disappearance of the Djodji form of S. sanctipauli, a potent vector, plus historic vector control actions and community directed treatments with ivermectin, onchocerciasis transmission in Togo and Benin is much reduced compared with the situation in 1975. Increasing frequencies of climate change-induced extreme weather events like prolonged droughts pose signif-icant challenges for small-scale subsistence farmers in sub-Saharan Africa, who rely on the yearly harvest by more than 80 % of their nutritional needs. However, we do not have a good understanding of yield estimates at the field and household level (with a mean field size of < 2 ha) to understand nutritional priorities in vulnerable communities due to their scarcity in the literature, particularly yield estimates that do not require re-collection of in-situ data. Statistical models for estimating regional food crop yields based on high-resolution satellite data at the field level may provide better insights into how to address health risks such as child malnutrition. Especially in low-resource contexts, where the burden is greatest and expected to worsen in future climate projections. Our study developed crop-specific, satellite-based yield models using a novel three-year data set of in-situ yield measurements as exemplified for a rural region in Burkina Faso. The aim of the model is to reduce the need for in -situ field data collection while still assuring accurate yield estimates at the field level. The model employed LASSO regression and was based on monthly vegetation index composites from Sentinel-2 and weekly accu-mulated Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) rainfall data. Our yield modeling results showed that there was less overfitting when there was more training data over three years that demonstrated a wider range of yields, which also led to better model fits. R2 values ranged from 0.62 (Maize) to 0.3 (Sorghum) for the three-year yield models, with normalized root mean square error (nRMSE) values ranging from 12 % -16 %. An additional plausibility check confirmed the validity of our models, as we compared the magnitude of our yield estimation with national yield statistics for Burkina Faso. We demonstrated that our models based on three years of in-situ data may capture some of the inter-annual variability in yields, which could be a step toward minimizing the necessity for in-situ measurements in the future. Our advances in pre-dicting yield estimates at the field level enable a linkage between household-level yields, socioeconomic in-dicators, nutritional status of children, and the health status of the household members. A further application is linking high-resolution yield data to farmers' productivity losses from increasing heat under climate change.
The impacts of climate change and environmental predictors on malaria epidemiology remain unclear and not well investigated in the Sub-Sahara African region. This study was aimed to investigate the nonlinear effects of climate and environmental factors on monthly malaria cases in northwest Ethiopia, considering space-time interaction effects. The monthly malaria cases and populations sizes of the 152 districts were obtained from the Amhara public health institute and the central statistical agency of Ethiopia. The climate and environmental data were retrieved from US National Oceanic and Atmospheric Administration. The data were analyzed using a spatiotemporal generalized additive model. The spatial, temporal, and space-time interaction effects had higher contributions in explaining the spatiotemporal distribution of malaria transmissions. Malaria transmission was seasonal, in which a higher number of cases occurred from September to November. The long-term trend of malaria incidence has decreased between 2012 and 2018 and has turned to an increased pattern since 2019. Areas neighborhood to the Abay gorge and Benshangul-Gumuz, South Sudan, and Sudan border have higher spatial effects. Climate and environmental predictors had significant nonlinear effects, in which their effects are not stationary through the ranges of values of variables, and they had a smaller contributions in explaining the variabilities of malaria incidence compared to seasonal, spatial and temporal effects. Effects of climate and environmental predictors were nonlinear and varied across areas, ecology, and landscape of the study sites, which had little contribution to explaining malaria transmission variabilities with an account of space and time dimensions. Hence, exploring and developing an early warning system that predicts the outbreak of malaria transmission would have an essential role in controlling, preventing, and eliminating malaria in areas with lower and higher transmission levels and ultimately lead to the achievement of malaria GTS milestones. Due to the need to continuously monitor and understand the thermal environment and its socioeconomic implications, this study used remotely sensed data to analyze thermal comfort variation in LCZs, including along the rural to urban gradient of the eThekwini Municipality in KwaZulu-Natal province of South Africa. LCZs were mapped using multi-temporal and multi-spectral Landsat 8 and Landsat 9 data using the approach by World Urban Database and Access Portal Tools (WUDAPT), while thermal data were used to retrieve land surface temperatures (LSTs). Data for training classification of LCZs and accuracy assessment were digitized from GoogleEarth guided by knowledge gained and data collected during a field survey in March 2022 as well as pre-existing maps. LCZs were mapped using the random forest classifier in SAGA GIS software while a single channel algorithm based on band 10 was used to compute LST for different scenes. The LSTs were adjusted and further used to derive thermal comfort based on the Universal Thermal Comfort Index (UTCI) categories as an indicator for outdoor thermal comfort on the extremely low- and extremely high-temperature periods in the cool and hot seasons, respectively. LCZs were mapped with high accuracy (overall accuracy of 90.1% and kappa of 0.88) while inter-class separability was high (>1.5) for all LCZ pairs. Built-up LCZs dominate the eastern parts of the municipality, signifying the influence of the sea on development within the area. Average LST was coolest in the dense forest, open low-rise and water LCZs in the cool and hot seasons, respectively. The compact high-rise LCZ was the warmest in both the hot (36 degrees C) and the cool (23 degrees C) seasons. The sea sands were among coolest regions in both seasons due to their high water content, attributed to their high water table and close proximity to the ocean. There was no thermal stress during the cool season, while most areas recorded moderate to strong heat stress in the hot season. Some areas in the densely built-up LCZs recorded very strong heat stress in the hot season. The findings suggest that policies and strategies should enhance heat mitigation capacities in strong-heat-stress areas during the hot season. Municipal authorities and citizens must work together to build strategies to minimize temperature extremes and associated socioeconomic pressures. Urban development policies, plans and strategies should consider implications on the thermal environment as well as the value of conservation of LCZs with high-heat mitigation value such as dense forests and expansion of built-up LCZs with low-heat absorption levels such as open low-rise. The study was based mainly on remotely sensed temperatures with some ground data used to validate results, which may limit the assessment. Overall, the study provides insights towards achievement of global sustainable and climate-smart development targets. Care provision is a key component of women’s time use with implications for the health and wellbeing of children. Shifting labor demands resulting from weather shocks may imply that women in developing countries have less time for care provision, potentially affecting their children’s nutrition. Nonetheless, a broad literature focusing on the indirect impacts of climate change on child nutrition has yet to explore the mechanisms whereby this occurs, and whether mothers’ time use is one of these mechanisms. Using the Uganda National Panel Survey, a unique data set that gathers data on farming activities, time use, and anthropometric measures, I analyze how rainfall variability affects mother’s time use and whether time use is a mechanism whereby rainfall variability affects child nutrition in the short run (measured as weight-for-age and weight-for-height Z-scores). My results show that increased rainfall variability in the last month decreases mothers’ time share in other household-related activities (e.g., fetching water), while it increases the probability of child wasting. Moreover, using mediation analysis, I find that none of the mothers’ time-use variables appears to be a mediating factor between rainfall variability and child nutrition. These results suggest that mothers adjust their time use due to rainfall variability without jeopardizing their children’s nutritional levels. Sustainable management of groundwater resources in geological transition zones (GTZ) is essential due to their complex geology, increasing population, industrialization, and climate change. Groundwater quality monitoring and assessment represent a viable panacea to this problem. Therefore, there is a great need to investigate groundwater resources in terms of their chemistry and pollution to ascertain their quality and implement robust pollution abatement strategies. This study focused on the characterization of groundwater in a typical geological transition zone in northeastern Nigeria. Eighty-seven (87) groundwater samples were collected from dug wells and boreholes during the 2017 dry season. pH, conductivity, and total dissolved solids (TDS) were measured in situ using a multiparameter probe, while major cations and anions were measured using atomic absorption spectrometry and ion chromatography, respectively. Data were analyzed using descriptive statistics, principal component analysis (PCA), water quality index, and standard hydrochemical plots. TDS ranged between 95 and 1154 mg L(-1) in basement terrains and between 49 and 1105 in sedimentary areas. pH ranged between 6.8 and 7.7 mg L(-1) in basement terrains and between 5.0 and 6.5 in sedimentary areas, suggesting a moderately acidic to alkaline low mineralized groundwater. Calcium (2.6-128.0 mg L(-1)) was the dominant cation in the basement areas, suggesting silicate weathering/dissolution, while sodium (1.9-106.0 mg L(-1)) dominated the sedimentary zones due to base exchange reactions. The PCA analysis suggests that mineral dissolution (mostly silicate weathering) controls the hydrochemistry of the basement aquifers, while ion exchange and albite weathering, with some influence of anthropogenic factor, control the sedimentary aquifers. The water quality index revealed that the basement setting was predominated by poor to unsuitable groundwater, while the sedimentary terrain was characterized by potable groundwater. The dominant hydrochemical facie in the basement areas was Ca(2+)-(Mg(2+))-HCO(3)(-) characteristic of recharge meteoric water. The Na(+)- (K(+))-HCO(3)(-) facie characterized the sedimentary zones, indicative of cation exchange reactions, while the mixed water facie typifies the geological contact zones. The shallow nature of the basement groundwaters makes them more susceptible to geogenic and anthropogenic pollution compared to the sandstone aquifers. However, the basement aquifers have better irrigation indices (Kelly ratio and soluble sodium percent) as compared to the sandstone aquifers, which exhibit poor Kelly ratios (< 1) and soluble sodium percent (> 50) ratings. Results from the study clearly highlight the poor-unsuitable groundwater quality in parts of the studied GTZ and can be very instrumental to the policymakers in implementing sustainable water treatment strategies and cleaner production technologies in GTZ to forestall the incidence of water-related diseases. BACKGROUND: Ambient heat exposure is increasing due to climate change and is known to affect the health of pregnant and postpartum women, and their newborns. Evidence for the effectiveness of interventions to prevent heat health outcomes in east Africa is limited. Codesigning and integrating local-indigenous and conventional knowledge is essential to develop effective adaptation to climate change. METHODS: Following qualitative research on heat impacts in a community in Kilifi, Kenya, we conducted a two-day codesign workshop to inform a set of interventions to reduce the impact of heat exposure on maternal and neonatal health. Participants were drawn from a diverse group of purposively selected influencers, implementers, policy makers, service providers and community members. The key domains of focus for the discussion were: behavioral practices, health facilities and health system factors, home environment, water scarcity, and education and awareness. Following the discussions and group reflections, data was transcribed, coded and emerging intervention priorities ranked based on the likelihood of success, cost effectiveness, implementation feasibility, and sustainability. RESULTS: Twenty one participants participated in the codesign discussions. Accessibility to water supplies, social behavior-change campaigns, and education were ranked as the top three most sustainable and effective interventions with the highest likelihood of success. Prior planning and contextualizing local set-up, cross-cultural and religious practices and budget considerations are important in increasing the chances of a successful outcome in codesign. CONCLUSION: Codesign of interventions on heat exposure with diverse groups of participants is feasible to identify and prioritize adaptation interventions. The codesign workshop was used as an opportunity to build capacity among facilitators and participants as well as to explore interventions to address the impact of heat exposure on pregnant and postpartum women, and newborns. We successfully used the codesign model in co-creating contextualized socio-culturally acceptable interventions to reduce the risk of heat on maternal and neonatal health in the context of climate change. Our interventions can be replicated in other similar areas of Africa and serve as a model for co-designing heat-health adaptation. Extreme events like flooding, droughts and heatwave are among the factors causing huge socio-economic losses to Cameroonians. Investigating the potential response of rainfall and temperature extremes to global warming is therefore critically needed for tailoring and adjusting the country’s policies. Recent datasets have been developed for this purpose within the Coordinated Output for Regional Evaluations (CORDEX-CORE) initiative, at similar to 25 km grid spacing. These regional climate models were used to dynamically downscaled four global climate models participating in the Coupled Model Intercomparison Project phase 5 (CMIP5), under the optimistic and pessimistic representative concentration pathways (RCPs) 2.6 and 8.5, respectively. These models were employed in this study for characterizing the response of Cameroon’s extreme precipitation and temperature events to global warming, using seven indices defined by the Expert Team on Climate Change Detection and Indices. Under global warming, the maximum number of consecutive dry (wet) days’ is expected to increase (decrease). However, the annual total rainfall amount is expected to increase, mainly due to the intensification of very wet days and daily rainfall intensity. Furthermore, the temperature-based indices reveal an increase (decrease) in the total annual hot (cold) days, and overall, changes intensify with increased radiative forcing. The high-mitigated low-emission pathway RCP2.6 features attenuated changes, and even sometimes adapts to reverse the sign of changes. Designing reliable policies to limit the risks associated with the above changes is required, as their socio-economic consequences are likely to include food insecurity, heat-related illness, population impoverishment, price rises and market instability. BACKGROUND: Diarrheal illnesses are a long-standing public health problem in developing countries due to numerous sanitation issues and a lack of safe drinking water. Floods exacerbate public health issues by spreading water-borne infectious diseases such as diarrhea through the destruction of sanitation facilities and contamination of drinking water. There has been a shortage of studies regarding the magnitude of diarrheal disease in flood-prone areas. Therefore, this research aimed to evaluate the prevalence of diarrheal disease and its predictors among under-five children living in flood-prone localities in the south Gondar zone of Northwest Ethiopia. METHOD: A community-based cross-sectional research was carried out in flood-prone villages of the Fogera and Libokemkem districts from March 17 to March 30, 2021. Purposive and systematic sampling techniques were used to select six kebeles and 717 study units, respectively. Structured and pretested questionnaires were used to collect the data. A multivariable analysis was performed to determine the predictors of diarrheal disease, with P-value <0.05 used as the cut-off point to declare the association. RESULT: The prevalence of a diarrheal disease among under-five children was 29.0%. The regular cleaning of the compound [AOR: 2.13; 95% CI (1.25, 3.62)], source of drinking water [AOR: 2.36; 95% CI: (1.26, 4.41)], animal access to water storage site [AOR: 3.04; 95% CI: (1.76, 5.24)], vector around food storage sites [AOR: 9.13; 95% CI: (4.06, 20.52)], use of leftover food [AOR: 4.31; 95% CI: (2.64, 7.04)], and fecal contamination of water [AOR: 12.56; 95% CI: (6.83, 23.20)] remained to have a significant association with diarrheal diseases. CONCLUSION: The present study found that the prevalence of the diarrheal disease among under-five children was high. Routine compound cleaning, the source of drinking water, animal access to a water storage site, vectors near food storage sites, consumption of leftover food, and fecal contamination of water were significant predictors of diarrheal disease. Therefore, it is advised to provide improved water sources, encourage routine cleaning of the living area, and offer health education about water, hygiene, and sanitation.
Introduction: Climate change alters environmental and climatic conditions, leading to expansion or contraction and possible shifts in the geographical distribution of vectors that transmit diseases. Bulinus globosus and Biomphalaria pfeifferi are the intermediate host snails for human schistosomiasis in KwaZulu-Natal (KZN) province, South Africa.Methods: Using the Maximum entropy (MaxEnt) model, we modelled the current and future distribution of human schistosomiasis intermediate host snails in KZN using two representation concentration pathways (RCP4.5 and RCP8.5) for the year 2085. Thirteen and ten bioclimatic variables from AFRICLIM were used to model the habitat suitability for B. globosus and B. pfeifferi, respectively. The Jack-knife test was used to evaluate the importance of each bioclimatic variable.Results: Mean temperature warmest quarter (BIO10, 37.6%), the number of dry months (dm, 32.6%), mean diurnal range in temperature (BIO2, 10.8%), isothermality (BIO3, 6.7%) were identified as the top four bioclimatic variables with significant contribution to the model for predicting the habitat suitability for B. globosus. Annual moisture index (mi, 34%), mean temperature warmest quarter (BIO10, 21.5%), isothermality (BIO3, 20.5%), and number of dry months (dm, 7%) were identified as the four important variables for the habitat suitability of B. pfeifferi. Area under the curve for the receiving operating characteristics was used to evaluate the performance of the model. The MaxEnt model obtained high AUC values of 0.791 and 0.896 for B. globosus and B. pfeifferi, respectively. Possible changes in the habitat suitability for B. globosus and B. pfeifferi were observed in the maps developed, indicating shrinkage and shifts in the habitat suitability of B. pfeifferi as 65.1% and 59.7% of the current suitable habitats may become unsuitable in the future under RCP4.5 and RCP8.5 climate scenarios. Conversely, an expansion in suitable habitats for B. globosus was predicted to be 32.4% and 69.3% under RCP4.5 and RCP8.5 climate scenarios, with some currently unsuitable habitats becoming suitable in the future.Discussion: These habitat suitability predictions for human schistosomiasis intermediate host snails in KZN can be used as a reference for implementing long-term effective preventive and control strategies for schistosomiasis. Few studies examined the association between prenatal long-term ambient temperature exposure and stillbirth and fewer still from developing countries. Rather than ambient temperature, we used a human thermophysiological index, Universal Thermal Climate Index (UTCI) to investigate the role of long-term heat stress exposure on stillbirth in Ghana. METHODS: District-level monthly UTCI was linked with 90,532 stillbirths of 5,961,328 births across all 260 local districts between 1(st) January 2012 and 31(st) December 2020. A within-space time-series design was applied with distributed lag nonlinear models and conditional quasi-Poisson regression. RESULTS: The mean (28.5 ± 2.1 °C) and median UTCI (28.8 °C) indicated moderate heat stress. The Relative Risks (RRs) and 95% Confidence Intervals (CIs) for exposure to lower-moderate heat (1st to 25th percentiles of UTCI) and strong heat (99th percentile) stresses showed lower risks, relative to the median UTCI. The higher-moderate heat stress exposures (75th and 90th percentiles) showed greater risks which increased with the duration of heat stress exposures and were stronger in the 90th percentile. The risk ranged from 2% (RR = 1.02, 95% CI 0.99, 1.05) to 18% (RR = 1.18, 95% CI 1.02, 1.36) for the 90th percentile, relative to the median UTCI. Assuming causality, 19 (95% CI 3, 37) and 27 (95% CI 3, 54) excess stillbirths per 10,000 births were attributable to long-term exposure to the 90th percentile relative to median UTCI for the past six and nine months, respectively. Districts with low population density, low gross domestic product, and low air pollution which collectively defined rural districts were at higher risk as compared to those in the high level (urban districts). DISCUSSION: Maternal exposure to long-term heat stress was associated with a greater risk of stillbirth. Climate change-resilient interventional measures to reduce maternal exposure to heat stress, particularly in rural areas may help lower the risk of stillbirth. The African Niger Delta is among the world’s most important wetlands in which the ecological effects of intensive oil exploitation and global change are not well documented. We characterized the seasonal dynamics and pollution with total-petroleum-hydrocarbons (TPHs), heavy-metals (HMs) and nutrient-loads in relation to climate-driven variables. High TPH concentrations up to 889 mg/L and HMs up to 13.119 mg/L were found in water samples, with pronounced spatio-temporal variation throughout the year. HM pollution index and contamination factor indicate serious ecological and human health hazards, especially for Cd, Cu, Hg, and Ni. Significant differences in TPHs/HMs were observed between sites and seasons, with correlations between TPHs-HMs, and climate-variables and TPHs-HMs. Nutrient levels, turbidity, salinity, temperature, and SO(4)(2-) were high and interlinked with the variability of TPHs/HMs being greatest during wet season. These findings suggest an urgent need for improved pollution control in the Niger Delta taking into account the observed spatio-temporal variation and the exacerbation of effects in light of climate change. Given the high levels of contamination, further assessments of exposure effects and bioaccumulation in biota should include future climate change scenarios and effects on humans who intensively depend on the system for drinking water, food supply and livelihood. Climate change is associated with adverse mental and emotional health outcomes. Social and economic factors are well-known drivers of mental health, yet comparatively few studies examine the social and economic pathways through which climate change affects mental health. There is additionally a lack of research on climate change and mental health in sub-Saharan Africa. This qualitative study aimed to identify potential social and economic pathways through which climate change impacts mental and emotional wellbeing, focusing on a vulnerable population of Kenyan smallholder farmers living with HIV. We conducted in-depth, semi-structured interviews with forty participants to explore their experience of climate change. We used a thematic analytical approach. We find that among our study population of Kenyan smallholder farmers living with HIV, climate change is significantly affecting mental and emotional wellbeing. Respondents universally report some level of climate impact on emotional health including high degrees of stress; fear and concern about the future; and sadness, worry, and anxiety from losing one’s home, farm, occupation, or ability to support their family. Climate-related economic insecurity is a main driver of emotional distress. Widespread economic insecurity disrupts systems of communal and family support, which is an additional driver of worsening mental and emotional health. Our study finds that individual adaptive strategies used by farmers in the face of economic and social volatility can deepen economic insecurity and are likely insufficient to protect mental health. Finally, we find that agricultural policies can worsen economic insecurity and other mental health risk factors. Our proposed conceptual model of economic and social pathways relevant for mental health can inform future studies of vulnerable populations and inform health system and policy responses to protect health in a changing climate. The design of appropriate adaptation strategies to the impacts of climate change requires a contextual study of local perceptions due to the non-homogeneity of climate in a given agro-ecological area. The research objective of the current study aims to examine the evolution of climate parameters from 1983 to 2019 linked to the perceptions of local populations and appropriate adaptation measures in the Belabo-Diang Communal Forest of Cameroon. The methodological approach includes collecting and analyze climate data from 1983 to 2019; and surveying existing local perceptions and adaptive strategies among 540 households using semi-structured questionnaires. A significant increase in temperature of about 1 °C over 36 years (1983-2019) and a non-significant decrease in precipitation (95.36 mm) over the same period were observed. Local perceptions related to climate change vary according to the sector of activity and are mainly associated with more heat in the dry season (90%), late onset of rains (84%), drought recurrence (82%), less rainfall during the year (80%), and increase in the duration of drought (80%). For 82-100% of households, according to the activity sector, no appropriate adaptation measures to climate change were applied depending on activities. The adaptation measures used by less than 0-20% of respondents, include mainly the abandonment or change of activity, and modification of the agricultural calendar. With the lack of appropriate and adequate adaptation measures by the riparian populations, this study appears necessary to inform policy-makers of the need to develop and implement more appropriate strategies to enable the riparian people living in forest area of Cameroon to better adapt to these effects of climate changes. Zoonotic diseases negatively impact pastoral communities in Ethiopia. In addition to impacts on human health, the interaction between people, livestock and environment which is so fundamental to the pastoralist way of life, means zoonoses pose additional challenges to social bonds and protection networks. These challenges are compounded by adverse impacts from climate change, poor health care services, market problems and cultural practices that increase pastoralists’ vulnerability to zoonotic diseases. This research adopted a grounded theory approach and attempted to capture the perception of Hamer and Dassenetch pastoralists on zoonotic diseases and rangeland health through focus group discussions and key informant interviews. Involved in the research were human and animal health experts, and woreda (Woreda is a third level of administrative unit in Ethiopia following region and zone) level government officials. Thematic framework analysis was used to analyse the data. Zoonotic diseases are a significant public health concern and have a substantial economic burden on local livelihoods. Poor access to human and livestock health services contributed towards the widespread transmission of zoonotic pathogens. In most cases, pastoralists were aware of the possibility of zoonotic disease transmission from livestock to humans and were cognizant of infections contracted from animals. However, the level of risk perception from zoonotic diseases and the subsequent measures of protection was poor. In almost all cases, despite pastoralists’ awareness of zoonotic diseases, they did not consider zoonoses as harmful to human health as they are to animals. It was evident that the burden of zoonotic diseases was high in livestock camps away from settlements in Hamer while for Dassenetch the resettlement clusters created a conducive environment for transmission. This research underscored the importance of engaging with local communities on the risk implications of zoonotic diseases including those related to their food habits and practices. Ongoing climate changes are likely to impact household food security in rural households that depend on rainfed subsistence agriculture. This paper investigates the relationship between summer climate variability and household food security in rural Mpumalanga, South Africa. We used a household panel data set nested in the Agincourt Health and Socio-Demographic Surveillance System, together with rainfall and temperature data for the summer periods 2006-07 to 2018-19 from three weather stations that surround the study area. We quantified the variability of rainfall using coefficient of variation and the standardised rainfall anomaly index, while temperature variability was reflected by the standardised temperature anomaly. In addition, the Mann-Kendall analysis was applied to detect temporal trends in rainfall and temperature. Longitudinal models accounting for socioeconomic and climate factors were used to estimate the relationship between weather and climate. The results reveal significant impact on food security from high inter-annual rainfall variability through fluctuations in food consumption, dietary diversity, and the experience of hunger. This study offers significant insights on how dietary diversity, food availability and overall food security are positively associated with greater average rainfall through subsistence agriculture as a livelihood strategy. These insights have important implications by suggesting seasonal forecasts to predict periods of potential food insecurity in local communities and can guide government policy and interventions to lessen food insecurity in rural areas. Heat exposure in pregnancy is associated with a range of adverse health and wellbeing outcomes, yet research on the lived experience of pregnancy in high temperatures is lacking. We conducted qualitative research in 2021 in two communities in rural Kilifi County, Kenya, a tropical savannah area currently experiencing severe drought. Pregnant and postpartum women, their male spouses and mothers-in-law, community health volunteers, and local health and environment stakeholders were interviewed or participated in focus group discussions. Pregnant women described symptoms that are classically regarded as heat exhaustion, including dizziness, fatigue, dehydration, insomnia, and irritability. They interpreted heat-related tachycardia as signalling hypertension and reported observing more miscarriages and preterm births in the heat. Pregnancy is conceptualised locally as a ‘normal’ state of being, and women continue to perform physically demanding household chores in the heat, even when pregnant. Women reported little support from family members to reduce their workload at this time, reflecting their relative lack of autonomy within the household, but also potentially the ‘normalisation’ of heat in these communities. Climate change risk reduction strategies for pregnant women in low-resource settings need to be cognisant of local household gender dynamics that constrain women’s capacity to avoid heat exposures. Airborne fungal spores and pollen (aerospora), synergistic with air pollution, are key triggers of allergic respiratory diseases. Effective diagnosis and treatment requires up-to-date location-specific knowledge on the temporal variability of aerospora types and levels. Johannesburg is the largest city in South Africa and has grown substantially in three decades, with changes in ground cover, population density and air pollution, yet until now, no continuous aerospora sampling has occurred. We present a daily two-year (August 2019-July 2021) aerospora assemblage for Johannesburg and explore temporal characteristics of 13 dominant aerospora in relation to daily meteorological variables (pressure, rainfall, relative humidity, temperature and wind characteristics). February-July, July-September and January-July represent high-risk periods for fungal spores [(Alternaria alternata (Fries. ex Keissler), Ascospores, Aspergillus niger (Van Tieghem), Penicillium chrysogenum (Thom), Cladosporium graminum (Corda), Epicoccum nigrum (Link), Helminthosporium solani (Durieu and Montagne) Nigrospora sphaerica (Saccardo ex. Mason), Smuts Ustilago nuda (Jensen ex. Rostrup) and Torula herbarum (Link)], trees (Cupressus, Morus and Platanus) and grass (Poaceae), respectively. Using a generalised additive model, results show that daily meteorological characteristics explained 7-32% of daily aerospora variability, with the largest effect on tree pollen. Rainfall, relative humidity and temperature influenced daily fungal spore and Poaceae counts, with moderate/low rainfall (< 20 mm), higher/mid-ranging relative humidity (similar to 40-60%) and temperatures of similar to 15-20 degrees C associated with higher counts during high-risk periods. Rainfall predominantly influenced tree counts during high-risk periods, with higher counts occurring on low rainfall (<10 mm) days. These results update the aerospora profile of Johannesburg, South Africa, providing important information to inform allergy care.
Child growth failure, as indicated by low height-for-age z-scores (HAZ), is an important metric of health, social inequality, and food insecurity. Understanding the environmental pathways to this outcome can provide insight into how to prevent it. While other studies have examined the environmental determinants of HAZ, there is no agreed upon best-practices approach to measure the environmental context of this outcome. From this literature, we derive a large set of potential environmental predictors and specifications including temperature and precipitation levels, anomalies, and counts as well as vegetation anomalies and trends, which we include using linear, nonlinear, and interactive specifications. We compare these measures and specifications using four rounds of DHS survey data from Burkina Faso and a large set of fixed effects regression models, focusing on exposures from the time of conception through the second year of life and relying on joint hypothesis tests and goodness-of-fit measures to determine which approach best explains HAZ. Our analysis reveals that nonlinear and interactive transformations of climate anomalies, as opposed to climate levels or vegetation indices, provide the best explanation of child growth failure. These results underline the complex and nonlinear pathways through which climate change affects child health and should motivate climate-health researchers to more broadly adopt measures and specifications that capture these pathways. The number of malaria cases worldwide has increased, with over 241 million cases and 69,000 more deaths in 2020 compared to 2019. Burkina Faso recorded over 11 million malaria cases in 2020, resulting in nearly 4,000 deaths. The overall incidence of malaria in Burkina Faso has been steadily increasing since 2016. This study investigates the spatiotemporal pattern and environmental and meteorological determinants of malaria incidence in Burkina Faso. METHODS: We described the temporal dynamics of malaria cases by detecting the transmission periods and the evolution trend from 2013 to 2018. We detected hotspots using spatial scan statistics. We assessed different environmental zones through a hierarchical clustering and analyzed the environmental and climatic data to identify their association with malaria incidence at the national and at the district’s levels through generalized additive models. We also assessed the time lag between malaria peaks onset and the rainfall at the district level. The environmental and climatic data were synthetized into indicators. RESULTS: The study found that malaria incidence had a seasonal pattern, with high transmission occurring during the rainy seasons. We also found an increasing trend in the incidence. The highest-risk districts for malaria incidence were identified, with a significant expansion of high-risk areas from less than half of the districts in 2013-2014 to nearly 90% of the districts in 2017-2018. We identified three classes of health districts based on environmental and climatic data, with the northern, south-western, and western districts forming separate clusters. Additionally, we found that the time lag between malaria peaks onset and the rainfall at the district level varied from 7 weeks to 17 weeks with a median at 10 weeks. Environmental and climatic factors have been found to be associated with the number of cases both at global and districts levels. CONCLUSION: The study provides important insights into the environmental and spatiotemporal patterns of malaria in Burkina Faso by assessing the spatio temporal dynamics of Malaria cases but also linking those dynamics to the environmental and climatic factors. The findings highlight the importance of targeted control strategies to reduce the burden of malaria in high-risk areas as we found that Malaria epidemiology is complex and linked to many factors that make some regions more at risk than others. Evidence on the trends of the proportion of malaria infections detected by routine passive case detection at health facilities is important for public health decision making especially in areas moving towards elimination. The objective was to assess nine years of trends on clinical malaria infections detected at health facility and its associated climate factors, in the water resource development set up of Wonji sugar estate, Oromia, Ethiopia. Retrospective data were collected from malaria-suspected patient recording logbook at Wonji sugar factory’s primary hospital. Monthly average meteorological data were obtained from the estate meteorological station. Data were collected from April through June 2018 and January 2022. The data were analyzed using Stata version 16.0 software for Chi-square and regression analysis. Over the last nine years, 34,388 cases were legible for analysis with complete data. Of these, 11.75% (4039/34388) were positive for clinical malaria. Plasmodium vivax test positivity was the highest proportion (8.2%, n = 2820) followed by Plasmodium falciparum (3.48%, n = 1197) and mixed infections (P. falciparum and P. vivax, 0.06%, n = 21). The odds of being positive for malaria was highest in males (AOR = 1.46; 95%CI = 1.36-1.52; P < 0.001) compared to females and in older individuals of above 15 years old (AOR = 4.55, 95%CI = 4.01-5.17, P < 0.001) followed by school-aged children (5-15 years old) (AOR = 2.16; 95%CI = 1.88-2.49, P < 0.001). There was no significant variation in the proportion of malaria-positive cases in the dry and wet seasons (P = 0.059). Malaria test positivity rates were associated with average monthly rainfall (AdjIRR = 1.00; 95%CI = 1.00-1.001, P < 0.001) while negatively associated with average monthly minim temperature (adjIRR = 0.94; 95%CI = 0.94-0.95; P < 0.001) and average monthly relative humidity (adjIRR = 0.99, 95%CI = 0.99-1.00, P = 0.023). There was year-round malaria transmission, adults especially males and school children frequently tested malaria positive. Hence, alternative vector management tools like larval source management have to be deployed besides ITNs and IRS in such water development areas to achieve the malaria elimination goal.
INTRODUCTION: Understanding the specific geospatial variations in childhood stunting is essential for aligning appropriate health services to where new and/or additional nutritional interventions are required to achieve the Sustainable Development Goals (SDGs) and national targets. OBJECTIVES: We described local variations in the prevalence of childhood stunting at the second administrative level and its determinants in Nigeria after accounting for the influence of geospatial dependencies. METHODS: This study used the 2018 national Nigeria Demographic and Health Survey datasets (NDHS; N = 12,627). We used a Bayesian geostatistical modelling approach to investigate the prevalence of stunting at the second administrative level and its proximal and contextual determinants among children under five years of age in Nigeria. RESULTS: In 2018, the overall prevalence of childhood stunting in Nigeria was 41.5% (95% credible interval (CrI) from 26.4% to 55.7%). There were striking variations in the prevalence of stunting that ranged from 2.0% in Shomolu in Lagos State, Southern Nigeria to 66.4% in Biriniwa in Jigawa State, Northern Nigeria. Factors positively associated with stunting included being perceived as small at the time of birth and experience of three or more episodes of diarrhoea in the two weeks before the survey. Children whose mothers received a formal education and/or were overweight or obese were less likely to be stunted compared to their counterparts. Children who were from rich households, resided in households with improved cooking fuel, resided in urban centres, and lived in medium-rainfall geographic locations were also less likely to be stunted. CONCLUSION: The study findings showed wide variations in childhood stunting in Nigeria, suggesting the need for a realignment of health services to the poorest regions of Northern Nigeria. Cyclone Idai in 2019 was one of the worst tropical cyclones recorded in the Southern Hemisphere. The storm caused catastrophic damage and led to a humanitarian crisis in Mozambique. The affected population suffered a cholera epidemic on top of housing and infrastructure damage and loss of life. The housing and infrastructure damage sustained during Cyclone Idai still has not been addressed in all affected communities. This is of grave concern because storm damage results in poor housing conditions which are known to increase the risk of malaria. Mozambique has the 4th highest malaria prevalence in sub-Saharan Africa and is struggling to control malaria in most of the country. We conducted a community-based cross-sectional survey in Sussundenga Village, Manica Province, Mozambique in December 2019-February 2020. We found that most participants (64%) lived in households that sustained damage during Cyclone Idai. The overall malaria prevalence was 31% measured by rapid diagnostic test (RDT). When controlling for confounding variables, the odds of malaria infection was nearly threefold higher in participants who lived in households damaged by Cyclone Idai nearly a year after the storm. This highlights the need for long-term disaster response to improve the efficiency and success of malaria control efforts. Environmental pollution arises from the myriad of chemicals in current and historic applications. In Nigeria, the fate of pollutants among other factors relies on water runoffs with pollution implications on the flooded environment. In addition, there is a need for applications of pesticides against disease vectors in a flood-prone environment, therefore increasing pollution complications in the environment. Literature information is missing regarding the levels and public health risk implications of contaminants such as heavy metals and organochlorine pesticide (OCP) residues in groundwater and residential soils within the selected flood-prone residential locations in Lagos, Nigeria. This study was hence targeted at examining the levels and health risks of heavy metals and OCP residues in residential soils and groundwater sources of the targeted environment. Seven heavy metals comprising Cd, Zn, Fe, Pb, Cu, Ni, and Co were detected in the water samples with high concentrations of iron (mean = 22,000 mg/kg) and Zn (mean = 810 mg/kg). Only Fe (mean = 5.8 mu g/L) and Zn (mean = 2.6 mu g/L) were detected in the groundwater samples. Fifteen OCP residues were observed in the soil samples within the concentration range of 7.9 to 13 (mean = 11) mg/kg while seven OCP residues were reported in the groundwater samples within the concentration range of 0.19 to 0.35 (mean = 0.24) mg/kg. There was a concern about high contamination of dieldrin and heptachlor epoxide in the groundwater sources with concentrations exceeding the WHO (2017) drinking water guideline. A significant Pearson correlation (< 0.05) was obtained for endrin and endosulfan I in water and soil samples indicating potential contamination of groundwater from soil sources. The diagnostic ratio indicated possible applications of endosulfan and some other OCP residues. Overall, our data indicated low health risk implications for all the targeted contaminants. We recommend continuous investigation of newly listed priority chemicals such as dicofol and more public engagement on the implication of environmental pollution and health impacts of regulated chemicals.
During public health crises, people living with HIV (PLWH) may become disengaged from care. The goal of this study was to understand the impact of the COVID-19 pandemic and recent flooding disasters on HIV care delivery in western Kenya. We conducted ten individual in-depth interviews with HIV providers across four health facilities. We used an iterative and integrated inductive and deductive data analysis approach to generate four themes. First, increased structural interruptions created exacerbating strain on health facilities. Second, there was increased physical and psychosocial burnout among providers. Third, patient uptake of services along the HIV continuum decreased, particularly among vulnerable patients. Finally, existing community-based programs and teleconsultations could be adapted to provide differentiated HIV care. Community-centric care programs, with an emphasis on overcoming the social, economic, and structural barriers will be crucial to ensure optimal care and limit the impact of public health disruptions on HIV care globally. Seasonal shifts in community-level agricultural production and their impact on the severity of the annual hunger season and household coping behaviors are important themes in climate change-health research. The relationship between seasonal variability, childbearing, and reproductive health, however, is less well understood. In this research, we combine detailed, spatially referenced Performance Monitoring for Action (PMA) data collected for Burkina Faso in 2017 and 2018 and a community-specific measure of seasonal agricultural quality to assess the relationship between seasonal agricultural variation and individual-level fertility and two dimensions of reproductive health: contraceptive use and pregnancy. We also incorporate data related to the family planning service environment. Results from cross-sectional regression models indicate that a better than average agricultural season might increase contraceptive use among all women, and analyses of monthly behaviors during and just after the growing season suggest that better than average growing season conditions might actually reduce contraceptive use among women who have no children or who are in their prime childbearing years. The results therefore indicate that women who are building their families might be less likely to use contraception and are perhaps more interested in timing births to occur following better than average growing seasons. Exposure to singular or overlapping external shocks, such as rainfall extremes, armed conflict, and COVID-19, may catalyze a shift in gendered power dynamics within affected households as they cope with associated threats to their safety and livelihoods. Despite evidence that women are disproportionately affected by such shocks, little scientific work has assessed the separate and combined impacts of these three external shocks on women’s lives. In this study, we examined the distinct and overlapping associations between extreme events-growing season rainfall anomalies, armed conflict during the growing season, and COVID-19-and women’s daily decision-making power in Burkina Faso. We employed longitudinal survey data from IPUMS Performance Monitoring for Action (PMA), a complex and spatially referenced dataset. These data were collected from a population-representative sample of women of reproductive age (15-49 years) in Burkina Faso across two timepoints: 2019/2020 (December 2019-February 2020) and 2020/2021 (December 2020-March 2021). PMA data from Burkina Faso contain detailed questions on women’s sociodemographic characteristics, health, and household dynamics. We spatially linked these data with (1) external rainfall data, (2) armed conflict event data, and (3) PMA coronavirus-specific follow-up survey data (containing COVID-19 knowledge and prevention behaviors) collected in June and July of 2020. Using log-binomial general estimating equation (GEE) models, we examined the relationship between extreme events-wetter-than-usual growing season, armed conflict (that resulted in at least one death), and COVID-19-and increased daily decision-making power among women. We found strong and significant associations between experiencing a wetter-than-usual growing season (i.e., greater than 1 standard deviation above 10-year mean) and women being less likely to have increased daily decision-making power in the household compared those experiencing usual rainfall during the growing season [prevalence ratio (PR): 0.70, 95% confidence interval (CI): 0.56, 0.87]. Similarly, residing in an area that was more affected by the COVID-19 pandemic (i.e., where 80% or more of respondents in the community reported staying home to avoid COVID-19) was also associated with women being less likely to have increased daily decision-making power in the household [PR: 0.75, 95% CI: 0.61, 0.91]. We did not observe any significant association between armed conflict and increased daily decision-making among women [PR: 1.15, 95% CI: 0.84, 1.57]. These trends indicate that women’s decision-making power within partnerships may be negatively impacted by certain household shocks. Centering women (and other marginalized and vulnerable communities) in the leadership, implementation, and as key beneficiaries of crisis response efforts may be an effective strategy to combat some of these constraints on women’s decision-making and even empower them within their households and communities. Infectious diseases are emerging at an unprecedented rate while food production intensifies to keep pace with population growth. Large-scale irrigation schemes have the potential to permanently transform the landscape with health, nutritional and socio-economic benefits; yet, this also leads to a shift in land-use patterns that can promote endemic and invasive insect vectors and pathogens. The balance between ensuring food security and preventing emerging infectious disease is a necessity; yet the impact of irrigation on vector-borne diseases at the epidemiological, entomological and economic level is uncertain and depends on the geographical and climatological context. Here, we highlight the risk factors and challenges facing vector-borne disease surveillance and control in an emerging agricultural ecosystem in the lower Shire Valley region of southern Malawi. A phased large scale irrigation programme (The Shire Valley Transformation Project, SVTP) promises to transform over 40,000 ha into viable and resilient farmland, yet the valley is endemic for malaria and schistosomiasis and experiences frequent extreme flooding events following tropical cyclones. The latter exacerbate vector-borne disease risk while simultaneously making any empirical assessment of that risk a significant hurdle. We propose that the SVTP provides a unique opportunity to take a One Health approach at mitigating vector-borne disease risk while maintaining agricultural output. A long-term and multi-disciplinary approach with buy-in from multiple stakeholders will be needed to achieve this goal. Climate change and extreme weather conditions remain major threats to the attainment of well-being outcomes such as food security in sub-Saharan Africa. Thus, it is critical to identify and promote resilient value chains in order to ensure food security in the wave of extreme weather conditions such as drought. This study seeks to evaluate the effects of participating in indigenous chicken markets on smallholder farmers’ food and nutrition security in terms of household dietary diversity score. Cross-sectional data collected from 215 randomly selected farmers in Chiredzi and Mwenezi districts, Zimbabwe was used in this study. The endogenous treatment effect model was employed to determine the effects of market participation on household dietary diversity score. The findings showed that 76% of interviewed farmers participated in indigenous chicken markets. On average, participating in indigenous chicken markets increases the likelihood of having a higher household dietary diversity score by about 60%. This suggests that engagement in indigenous chicken value chain strengthens smallholder farmers’ resilience through attainment of food and nutrition security. Therefore, investment in capacity building of smallholder farmers to engage in indigenous chicken value chains should be prioritised and to support market engagement, indigenous chicken production contract arrangements with private firms should be promoted. We reflect on our fieldwork experience from the Climate Heat Maternal and Neonatal Health Africa (CHAMNHA) project in Kilifi, Kenya, which focused on studying the effects of extreme heat on women during pregnancy, delivery and the post-partum period. We describe the ethical and practical challenges encountered, highlighting valuable lessons learned. We propose potential solutions to address issues concerning the reciprocity of vulnerable participants and the provision of childcare and food for accompanying children. Further, we address challenges related to engaging specific participants, interview cancellations attributed to extreme temperatures and discuss the perpetuation of inequalities by ethics and academic institutions. With the anticipated increase in research at the intersection of climate change-induced heat exposure and its impacts on human populations, research institutions and ethics committees in low- and middle-income countries are responsible for instituting guidelines that account for the risks for the subjects under study and the field researchers. Mwenezi district is a drought prone area characterised by high temperatures, droughts, rainfall deficit, crop failures and chronic food deficiencies. Rainfed agriculture can no longer be sustained without any innovations. The study explored the impacts of climate change on household food security among the vulnerable populations of Matande communal lands, Mwenezi district in Zimbabwe. The study is guided by the Sustainable Livelihoods Framework (SLF). An exploratory sequential research design was adopted, and a total of 78 respondents were selected from the population of 371 households using purposive and cluster sampling techniques. Data collection was triangulated through the use of household survey, focus group discussions, key informant interviews and observations. The thematic approach and SPSS software were used to analyse qualitative and quantitative data, respectively. Results demonstrated that climate change propelled increases of pests and diseases for both livestock and crops, reduction of meals uptake per day, biodiversity loss and dwindled crop production. Livestock increases were recorded despite the changing climate shows a nexus with food insecurity. The research called for the adoption of drought-tolerant crops, capacity building through climate change resilience programmes, livestock centric in diversification, improved formal markets for livestock and tapping of underground water for irrigation and other purposes to complement existing water bodies to prevent them drying up early. CONTRIBUTION: There is deepening aridification in Mwenezi district because of climate change resulting in the continuous obliteration for the worst of agro-ecological regions iv and v reclassified into a and b. This confirmed the heterogeneity of various climatic conditions and variability within the same geographical context. However, vulnerability continues to be generalised into regions. The study investigates the impacts of climate change typical to Matande communal lands with the view to generate knowledge relevant to review adaptation practices specific to the researched area in order to escalate community resilience. Seasonal floods pose a commonly-recognised barrier to women’s access to maternal services, resulting in increased morbidity and mortality. Despite their importance, previous GIS models of healthcare access have not adequately accounted for floods. This study developed new methodologies for incorporating flood depths, velocities, and extents produced with a flood model into network- and raster-based health access models. The methodologies were applied to the Barotse Floodplain to assess flood impact on women’s walking access to maternal services and vehicular emergency referrals for a monthly basis between October 2017 and October 2018. METHODS: Information on health facilities were acquired from the Ministry of Health. Population density data on women of reproductive age were obtained from the High Resolution Settlement Layer. Roads were a fusion of OpenStreetMap and data manually delineated from satellite imagery. Monthly information on floodwater depth and velocity were obtained from a flood model for 13-months. Referral driving times between delivery sites and EmOC were calculated with network analysis. Walking times to the nearest maternal services were calculated using a cost-distance algorithm. RESULTS: The changing distribution of floodwaters impacted the ability of women to reach maternal services. At the peak of the dry season (October 2017), 55%, 19%, and 24% of women had walking access within 2-hrs to their nearest delivery site, EmOC location, and maternity waiting shelter (MWS) respectively. By the flood peak, this dropped to 29%, 14%, and 16%. Complete inaccessibility became stark with 65%, 76%, and 74% unable to access any delivery site, EmOC, and MWS respectively. The percentage of women that could be referred by vehicle to EmOC from a delivery site within an hour also declined from 65% in October 2017 to 23% in March 2018. CONCLUSIONS: Flooding greatly impacted health access, with impacts varying monthly as the floodwave progressed. Additional validation and application to other regions is still needed, however our first results suggest the use of a hydrodynamic model permits a more detailed representation of floodwater impact and there is great potential for generating predictive models which will be necessary to consider climate change impacts on future health access. Climate change impacts on the transmission and epidemics of vector-borne diseases (VBDs), hence an understanding of the institutional determinants that influence the response of national health systems is important. This study explored how institutional determinants influence health outcomes of malaria and bilharzia using the case study of Gwanda district, Zimbabwe, in the advent of climate change. Qualitative data were collected using in-depth interviews from representatives of public and private institutions; and organisations involved in the prevention and control of malaria and bilharzia. Results from the study showed that the Ministry of Health and Child Care of Zimbabwe and other relevant government ministries and departments involved in environmental and social issues, constituted the primary network in the control and prevention of malaria and bilharzia. Non-governmental organisations (NGOs) formed the secondary network that mainly mobilized resources or complimented the primary networks in the delivery of services. It was noted that there was an institutional structure primarily responsible for responding to malaria and bilharzia but it was not adequately prepared to address climate change-induced VBDs changes. Based on our findings, a framework for reducing vulnerability and enhancing resilience among populations affected by VBDs in the context of climate change was developed. PurposeThe adverse impacts of climate change coupled with rapid informal urbanization in the Southern African region are increasing the vulnerability of already sensitive population groups. Consequently, these urban regions are highly vulnerable to urban heat island effects and heatwaves due to exogenous and endogenous factors. While the dynamic interplay between the built environment, climate and response strategies is known, this paper highlights the lived experience of informal settlement residents. It presents work from a project undertaken in Melusi, an informal settlement in Tshwane, South Africa, as a multi-disciplinary project focusing on improving the local resilience to climate change associated heat stress.Design/methodology/approachFollowing a mixed method approach, a semi-structured observational analysis of the spatial layout and material articulation of selected dwellings along with the continuous monitoring and recording of their indoor environments were undertaken.FindingsThe paper presents the research results in terms of the dwelling characteristics, as spatial and material-use strategies and documented heat stress exposure in these structures. The findings highlight that informal dwellings perform poorly in all cases due to endogenous factors and that inhabitants experience extreme heat stress conditions for between 6 and 10 h daily during the peak summer period.Originality/valueCurrently, there are little empirical data on the heat stress residents living in informal settlements in Southern Africa are experiencing. This article provides insight into the indoor environments of informal dwellings and hopes to contribute future guidelines or heat health policies. Climate change and global warming have led to an increased incidence of flooding across the world. Against the backdrop of the recent devastating floods in the Kwazulu-Natal province of South Africa, this paper explores psychotraumatology of natural disasters. In particular, we explore the impact of internal migration in South Africa, as well as apartheid spatial planning and inequality on the consequences of the flooding. We also focus on the psychotraumatology resulting from flooding, in general, and in particular on the victims of the flooding in the KwaZulu-Natal province of South Africa. We conclude that the psychopathological consequences of such natural disasters are ignored even though they seriously affect the people concerned. The development of specific trainings for psychologists in psychotraumatology and the care of victims should be a priority in the future. (c) 2022 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Climate change poses a significant threat to various sectors, including agriculture, affecting men and women unevenly. Although gender-based perceptions of climate change have been studied, there remains a gap in understanding how these perceptions influence the adoption of adaptation strategies among men and women smallholder farmers in the production of leguminous crops in sub-Saharan Africa. This study investigated the gender differences in the adoption of climate change adaptation strategies among bean and cowpea farmers in Ghana. The findings revealed that socioeconomic and institutional factors significantly influenced the choice of adaptation strategies, with notable differences between men and women. Higher levels of education, farming experience, marital status, access to credit, and education determined the choice of adaptation strategies. On the other hand, women farmers, despite having lower levels of formal education, showed a higher utilization of extension services, possibly due to targeted efforts to reach out to more women farmers. Larger households were less likely to adopt mixed cropping and changing cropping patterns, while married individuals were less likely to use crop rotation. Training and access to credit significantly increased the likelihood of adopting crop rotation, changing cropping patterns, and using improved seeds. The study also found that [f]armers perceptions of the impacts of dry spells and delayed onset of rains influenced the use of climate change adaptation strategies. Furthermore, farmers who participated in climate change planning were more likely to use diverse adaptation strategies, underscoring the importance of a locally focused, inclusive planning process. However, gender differences were observed in the determinants of the use of these strategies. For instance, while access to extension services was found to be more influential for women, men’s decisions were more influenced by their marital status, access to credit, and education. Policy makers and local institutions need to encourage and facilitate farmers’ involvement in climate change planning processes to enable designing of effective, context-relevant, inclusive, and sustainable climate change adaptation strategies. Distinct differences in the factors underlying the use of adaptation strategies by men and women demand creation of and implementation of gender-sensitive programs that effectively reach and benefit both women and women. Affecting millions of individuals yearly, malaria is one of the most dangerous and deadly tropical diseases. It is a major global public health problem, with an alarming spread of parasite transmitted by mosquito (Anophele). Various studies have emerged that construct a mathematical and statistical model for malaria incidence forecasting. In this study, we formulate a generalized linear model based on Poisson and negative binomial regression models for forecasting malaria incidence, taking into account climatic variables (such as the monthly rainfall, average temperature, relative humidity), other predictor variables (the insecticide-treated bed-nets (ITNs) distribution and Artemisinin-based combination therapy (ACT)) and the history of malaria incidence in Dakar, Fatick and Kedougou, three different endemic regions of Senegal. A forecasting algorithm is developed by taking the meteorological explanatory variable Xj at time t-?j, where t is the observation time and ?j is the lag in Xj that maximizes its correlation with the malaria incidence. We saturated the rainfall in order to reduce over-forecasting. The results of this study show that the Poisson regression model is more adequate than the negative binomial regression model to forecast accurately the malaria incidence taking into account some explanatory variables. The application of the saturation where the over-forecasting was observed noticeably increases the quality of the forecasts. The study of the impacts and drivers of climate change adaptation should consider gender (in)equality and women’s participation, as they both play pivotal roles. However, research on gender aspects of climate change adaptation has been limited. This study assesses gender dimensions of adaptation to climate change and de-terminants of smallholder farmers’ adaptation strategies in Adwa district, Tigray, Ethiopia. Drawing on house-hold surveys, key informant interviews, and focus group discussions carried out in 2017, the study found that climate change had more severe impacts on female-headed households than on male-headed households. This was due to women’s lack of resource access and control, lack of income and technology use, and high depen-dence on natural resources. Major climate change adaptation measures identified in the study area included adjustment of planting dates, crop varieties, water harvesting practices, soil and water conservation, irrigation, seasonal migration, diversifying income sources, and agricultural inputs. Rates and extent of adaptation varied by gender. As indicated by multivariate probit analysis, major determinants of farmers’ adaptation choices included agro-ecology; gender, age, education, family size, farm size, non-farm income, livestock; access to in-formation, extension services, and credit; and distance to market center. Study findings suggest that policy-makers should consider differences between female-and male-headed families in their access to land, information, income, extension services, technologies, and other resources. By doing so, climate change adap-tation practices may be broadened and sustainable development promoted. Extant research has linked flooding with mental distress (MD) among flood-prone populations, but the mechanisms underlying this association remain largely unknown. This paper examines the association of flood stressors with MD among households in flood-prone communities in Ghana and estimates whether flood risk perceptions mediated the association. The study involved 767 household heads aged >= 20 years [mean = 47.3 +/- 13.7); males = 61.4%]. Flood stressors were assessed using a 15-item Flood Stress-related Scale, while the Kessler Psychological Distress Scale (K10) was used to assess MD. Linear regression-based mediation analysis using Hayes’ PROCESS macro was performed to assess the indirect effect of flood stressors with MD through flood risk perceptions. After adjusting for potential confounders, flood stressors were significantly linked with higher risks of MD (beta = .060-.080, p < .001). The mediation and bootstrapping analyses suggested that flood health risk perception partially mediated and accounted for 26.7% of the relationship between flood stressors and MD (direct effect: beta = .060, Boots 95%CI: .041-.079; indirect effect: beta = .022, Boots 95%CI: .015-.031; total effect: beta = .082, Boots 95%CI: .063-.101). The link between flood stressors and MD risk is explained partially by flood health risk perception. Knowledge of households' flood risk perception is therefore critical for effectively managing the effects of flood stressors on MD. Policy Highlights center dot The mechanisms underlying flood stressors-mental distress (MD) association remain largely unknown. center dot Flood stressors were significantly associated with higher risks of MD. center dot Flood stressors and MD risk linkage was partially explained by the health-related risk perception. center dot Timely psychological interventional services to flood-prone households via improvement in their health-risk perceptions is desirable.
This article addresses how African states respond to climate crisis, arguing that, beyond the agency and impact of climate phenomena such as drought and cyclones, they are active participants in the production of climate disasters and emergencies, mostly through infrastructural processes that affect land and resource use, and subsequently livelihoods. To demonstrate this, it uses the cases of the drought in southwestern Angola and cyclones in northern and central Mozambique, where such climate phenomena have exposed ‘fatal architectures’ that have dramatically raised the toll of climate victims and refugees. Both extractivist, agro-industrial and hydroelectric projects, as well as other, more deferred infrastructural designs (roads, communication networks, etc.) have challenged the traditional agency and resilience of local communities. Such new infrastructural projects also illustrate how certain perceived long-term solutions to address the climate crisis with industrial and energy reconversion towards greener energies can still become fatal architectures in the context of climate emergencies. Ce texte traite de la maniere dont les etats africains repondent a la crise climatique, en soutenant que, au-dela de l’impact des phenomenes climatiques tels que la secheresse et les cyclones, les Etats participent activement a la production de catastrophes et d’urgences climatiques, principalement par le biais de processus infrastructurels qui affectent l’utilisation des terres et des ressources et, par consequent, les moyens de subsistance. Pour illustrer son propos, l’auteur s’appuie sur les exemples de la secheresse dans le sud-ouest de l’Angola et des cyclones dans le nord et le centre du Mozambique, ou ces phenomenes climatiques ont mis en evidence des << architectures fatales >> qui ont considerablement alourdi le bilan des victimes du changement climatique et des refugies. C’est le cas des projets extractivistes, agro-industriels et hydroelectriques, ainsi que des projets d’infrastructure plus differes (tels que les routes et les reseaux de communication) qui ont bouleverse le pouvoir d’action et la resilience traditionnels des communautes locales. Lorsqu’il s’agit de faire face a la crise climatique par une reconversion industrielle et energetique tournee vers des energies plus vertes, ces exemples de nouveaux projets d’infrastructure illustrent egalement comment certaines solutions percues comme etant a long terme peuvent malgre tout devenir des architectures fatales dans des contextes d’urgence climatique. Este texto aborda a forma como os Estados africanos respondem a crise climatica, com o argumento de que, para alem da agencia e do impacto de fenomenos climaticos tais como as secas e os ciclones, os Estados sao participantes ativos na producao de desastres e emergencias climaticas, em particular atraves de processos infraestruturais que afetam o uso da terra e dos recursos e, em ultima instancia, os modos de vida locais. Para ilustrar o argumento, invoco os casos da seca no sudoeste de Angola e dos ciclones no norte e centro de Mocambique, onde estes fenomenos climaticos expuseram “arquiteturas fatais” que aumentaram dramaticamente o numero de vitimas e refugiados do clima. e o caso de projetos extrativistas, agroindustriais e hidoreletricos, bem como de outros projetos infra-estruturais mais difusos (estradas, redes de comunicacao, etc.), que desafiaram a agencia tradicional e a resiliencia das comunidades locais. Estes casos de novos projetos infra-estruturais tambem nos recordam como certas solucoes percebidas como sendo de longo prazo no que diz respeito a enfrentar a crise climatica atraves da reconversao industrial e energetica para energias mais verdes ainda podem se tornar arquiteturas fatais em contextos de emergencia climatica. The global climate has changed, and there are concerns about the effects on both humans and the environment, necessitating more research for improved adaptation. In this study, we analyzed extreme temperature and rainfall events and projected future climate change scenarios for the coastal Savannah agroecological zone (CSAZ) of Ghana. We utilized the ETCCDI, the RClimDex software (version 1.0), the Mann-Kendall test, Sen’s slope estimator, and standardized anomalies to analyze homogeneity, trends, magnitude, and seasonal variations in temperature (T-max and T-min) and rainfall datasets for the zone. The SDSM was also used to downscale future climate change scenarios based on the CanESM2 (RCP 2.6, 4.5, and 8.5 scenarios) and HadCM3 (A2 and B2 scenarios) models for the zone. Model performance was evaluated using statistical methods such as R-2, RMSE, and PBIAS. Results revealed more changepoints in T-min than in T-max and rainfall. Results again showed that the CSAZ has warmed over the last four decades. The SU25, TXn, and TN90p have increased significantly in the zone, and the opposite is the case for the TN10p and DTR. Spatially varied trends were observed for the TXx, TNx, TNn, TX10p, TX90p, and the CSDI across the zone. The decrease in RX1day, RX5day, SDII, R10, R95p, and R99p was significant in most parts of the central region compared to the Greater Accra and Volta regions, while the CDD significantly decreased in the latter two regions than in the former. The trends in CWD and PRCPTOT were insignificant throughout the zone. The overall performance of both models during calibration and validation was good and ranged from 58-99%, 0.01-1.02 degrees C, and 0.42-11.79 degrees C for R-2, RMSE, and PBIAS, respectively. T-max is expected to be the highest (1.6 degrees C) and lowest (-1.6 degrees C) across the three regions, as well as the highest (1.5 degrees C) and lowest (-1.6 degrees C) for the entire zone, according to both models. T-min is projected to be the highest (1.4 degrees C) and lowest (-2.1 degrees C) across the three regions, as well as the highest (1.4 degrees C) and lowest (-2.3 degrees C) for the entire zone. The greatest (1.6 degrees C) change in mean annual T-max is expected to occur in the 2080s under RCP8.5, while that of the T-min (3.2 degrees C) is expected to occur in the 2050s under the same scenario. Monthly rainfall is expected to change between -98.4 and 247.7% across the three regions and -29.0 and 148.0% for the entire zone under all scenarios. The lowest (0.8%) and highest (79%) changes in mean annual rainfall are expected to occur in the 2030s and 2080s. The findings of this study could be helpful for the development of appropriate adaptation plans to safeguard the livelihoods of people in the zone. This article explores the experiences of local Black African women in adapting to flood impacts within the Durban metropolitan area. The article is premised on the realisation that women and men experience climate change differently, as persisting gendered inequities affect women’s adaptive capacity to climate change impacts. The study adopted a qualitative approach to research. Twenty-five local Black African women from four localities in Durban and five key informants from eThekwini municipality participated in the study through semi-structured interviews and focus group discussions. A qualitative content analysis approach was employed to elicit analytical themes and interpretations from the interview manuscripts in light of the research questions and the study’s contexts. Findings from the study show that despite the experiences of poverty, lack of access to information, and persistent gender inequity in the study’s contexts, the women’s situated knowledge and agency have transformed lives and livelihoods and increased climate resilience and overall well-being. We conclude that a much more appropriate and intentional approach to local Black women’s adaptation needs can yield much more effective, successful, equitable, and long-term climate change adaptation. The scale of climate migration across the Global South is expected to increase during this century. By 2050, millions of Africans are likely to consider, or be pushed into, migration because of climate hazards contributing to agricultural disruption, water and food scarcity, desertification, flooding, drought, coastal erosion, and heat waves. However, the migration-climate nexus is complex, as is the question of whether migration can be considered a climate change adaptation strategy across both the rural and urban space. Combining data from household surveys, key informant interviews, and secondary sources related to regional disaster, demographic, resource, and economic trends between 1990 and 2020 from north central and central dryland Namibia, we investigate (i) human migration flows and the influence of climate hazards on these flows and (ii) the benefits and dis-benefits of migration in supporting climate change adaptation, from the perspective of migrants (personal factors and intervening obstacles), areas of origin, and areas of destination. Our analysis suggests an increase in climate-related push factors that could be driving rural out-migration from the north central region to peri-urban settlements in the central region of the country. While push factors play a role in rural-urban migration, there are also several pull factors (many of which have been long-term drivers of urban migration) such as perceived higher wages, diversity of livelihoods, water, health and energy provisioning, remittances, better education opportunities, and the exchange of non-marketed products. Migration to peri-urban settlements can reduce some risks (e.g. loss of crops and income due to climate extremes) but amplify others (e.g. heat stress and insecure land tenure). Adaptation at both ends of the rural-urban continuum is supported by deeply embedded linkages in a model of circular rural-urban-rural migration and interdependencies. Results empirically inform current and future policy debates around climate mobilities in Namibia, with wider implications across Africa. Malaria epidemics result from extreme precipitation and flooding, which are increasing with global climate change. Local adaptation and mitigation strategies will be essential to preventing excess morbidity and mortality. METHODS: We investigated the spatial risk of malaria infection at multiple timepoints after severe flooding in rural western Uganda employing longitudinal household surveys measuring parasite prevalence and leveraging remotely-sensed information to inform spatial models of malaria risk in the three months after flooding. RESULTS: We identified clusters of malaria riskemerging in areas that (i) showed the greatest changes in NDVI from pre- to post-flood and (ii) residents were displaced for longer periods of time and had lower access to long-lasting insecticidal nets, both of which were associated with a positive malaria rapid diagnostic test result. The disproportionate risk persisted despite a concurrent chemoprevention program that achieved high coverage. CONCLUSIONS: The findings enhance our understanding not only of the spatial evolution of malaria risk after flooding, but also in the context of an effective intervention. The results provide a “proof-of-concept” for programs aiming to prevent malaria outbreaks after flooding using a combination of interventions. Further study of mitigation strategies – and particularly studies of implementation – is urgently needed. In 2021, Nigeria witnessed a severe cholera outbreak that affected Borno state, in which more than 1,600,000 internally displaced persons (IDPs) resided at the time. This rapid appraisal explored factors that facilitate the recurrence of cholera outbreaks in sites hosting IDPs in Northeast Nigeria. Semi-structured interviews were conducted with water, sanitation, and hygiene (WASH), management, and healthcare personnel working in 10 displacement camps in Borno state. The interviews were complemented by transect walks and field observations, measurements of free residual chlorine levels, and publicly available data published by the International Organization for Migration Displacement Tracking Matrix. The recurrence of cholera outbreaks appears to be facilitated by substantial interactions between IDPs and host communities, and suboptimal WASH services in camps. Of particular concern, IDP camps are exposed to extreme weather-related events that damage facilities and subsequently affect WASH practices. WASH services in camps may likewise be severely hindered by an influx of new arrivals. In conclusion, we emphasize the importance of expanding WASH activities to host communities and developing site-specific WASH interventions and chlorination targets. Practical recommendations are needed for the prevention and control of outbreaks following extreme weather-related events and population influxes. BACKGROUND: Essential health services can be disrupted due to several naturally occurring public health emergencies such as drought, flood, earthquake and outbreak of infectious diseases. However, little evidence exists on the status of essential health services delivery under the effect of drought and food insecurity. North-east Uganda is severely affected by prolonged drought that significantly affected the livelihood of the residents. Therefore, we aimed to determine the current status of essential health services and quality improvement (QI) actions in health facilities in north-east Uganda. METHODS: We used a descriptive cross-sectional study design to assess the availability of essential health service and quality improvement activities in drought and food insecurity affected districts of north-east Uganda. We included a total of 150 health facilities from 15 districts with proportionated multistage sampling method. We interviewed health facilities’ managers and services focal persons using structured questionnaire and observation checklist. We used a descriptive statistic to analyze the data with SPSS version 22. RESULTS: A few health facilities (8.7%) had mental health specialist. There was also lack of capacity building training on essential health services. Considerable proportion of health facilities had no non-communicable diseases (38.3%), mental health (47.0%), and basic emergency obstetric care (40.3%) services. Stock out of essential medicines were observed in 20% of health facilities. There was lack of supportive supervision, and poor documentation of QI activities. CONCLUSION: Essential health service and QI were suboptimal in drought and food insecure emergency affected districts. Human resource deployment (especially mental health specialist), provision of capacity building training, improving non-communicable diseases, mental health and basic emergency obstetric care services are required to improve availability of essential health services. Supporting supply chain management to minimize stock out of medicines, and promoting QI activities are also vital to assure quality of health service in drought and food insecurity affected districts in north-Eastern Uganda. Ethiopia has a history of climate related malaria epidemics. An improved understanding of malaria-climate interactions is needed to inform malaria control and national adaptation plans. METHODS: Malaria-climate associations in Ethiopia were assessed using (a) monthly climate data (1981-2016) from the Ethiopian National Meteorological Agency (NMA), (b) sea surface temperatures (SSTs) from the eastern Pacific, Indian Ocean and Tropical Atlantic and (c) historical malaria epidemic information obtained from the literature. Data analysed spanned 1950-2016. Individual analyses were undertaken over relevant time periods. The impact of the El Niño Southern Oscillation (ENSO) on seasonal and spatial patterns of rainfall and minimum temperature (Tmin) and maximum temperature (Tmax) was explored using NMA online Maprooms. The relationship of historic malaria epidemics (local or widespread) and concurrent ENSO phases (El Niño, Neutral, La Niña) and climate conditions (including drought) was explored in various ways. The relationships between SSTs (ENSO, Indian Ocean Dipole and Tropical Atlantic), rainfall, Tmin, Tmax and malaria epidemics in Amhara region were also explored. RESULTS: El Niño events are strongly related to higher Tmax across the country, drought in north-west Ethiopia during the July-August-September (JAS) rainy season and unusually heavy rain in the semi-arid south-east during the October-November-December (OND) season. La Niña conditions approximate the reverse. At the national level malaria epidemics mostly occur following the JAS rainy season and widespread epidemics are commonly associated with El Niño events when Tmax is high, and drought is common. In the Amhara region, malaria epidemics were not associated with ENSO, but with warm Tropical Atlantic SSTs and higher rainfall. CONCLUSION: Malaria-climate relationships in Ethiopia are complex, unravelling them requires good climate and malaria data (as well as data on potential confounders) and an understanding of the regional and local climate system. The development of climate informed early warning systems must, therefore, target a specific region and season when predictability is high and where the climate drivers of malaria are sufficiently well understood. An El Niño event is likely in the coming years. Warming temperatures, political instability in some regions, and declining investments from international donors, implies an increasing risk of climate-related malaria epidemics. Climate change may impact human health through the influence of weather on environmental transmission of diarrhea. Previous studies have found that high temperatures and heavy precipitation are associated with increased diarrhea prevalence, but the underlying causal mechanisms have not been tested and validated. We linked measurements of Escherichia coli in source water (n = 1673), stored drinking water (n = 9692), and hand rinses from children <2 years old (n = 2634) with publicly available gridded temperature and precipitation data (at ≤0.2 degree spatial resolution and daily temporal resolution) by the GPS coordinates and date of sample collection. Measurements were collected over a 3-year period across a 2500 km(2) area in rural Kenya. In drinking water sources, high 7-day temperature was associated with a 0.16 increase in log(10) E. coli levels (p < 0.001, 95% CI: 0.07, 0.24), while heavy 7-day total precipitation was associated with a 0.29 increase in log(10) E. coli levels (p < 0.001, 95% CI: 0.13, 0.44). In household stored drinking water, heavy 7-day precipitation was associated with a 0.079 increase in log(10) E. coli levels (p = 0.042, 95% CI: 0.07, 0.24). Heavy precipitation did not increase E. coli levels among respondents who treated their water, suggesting that water treatment can mitigate effects on water quality. On child hands, high 7-day temperature was associated with a 0.39 decrease in log(10) E. coli levels (p < 0.001, 95% CI: -0.52, -0.27). Our findings provide insight on how climate change could impact environmental transmission of bacterial pathogens in Kenya. We suggest water treatment is especially important after heavy precipitation (particularly when preceded by dry periods) and high temperatures.
The circulation of both West Nile Virus (WNV) and Chikungunya Virus (CHIKV) in humans and animals, coupled with a favorable tropical climate for mosquito proliferation in Zambia, call for the need for a better understanding of the ecological and epidemiological factors that govern their transmission dynamics in this region. This study aimed to examine the contribution of climatic variables to the distribution of Culex and Aedes mosquito species, which are potential vectors of CHIKV, WNV, and other arboviruses of public-health concern. Mosquitoes collected from Lusaka as well as from the Central and Southern provinces of Zambia were sorted by species within the Culex and Aedes genera, both of which have the potential to transmit viruses. The MaxEnt software was utilized to predict areas at risk of WNV and CHIKV based on the occurrence data on mosquitoes and environmental covariates. The model predictions show three distinct spatial hotspots, ranging from the high-probability regions to the medium- and low-probability regions. Regions along Lake Kariba, the Kafue River, and the Luangwa Rivers, as well as along the Mumbwa, Chibombo, Kapiri Mposhi, and Mpika districts were predicted to be suitable habitats for both species. The rainfall and temperature extremes were the most contributing variables in the predictive models. In many parts of the world, human losses to disasters have been on the increase during the past three decades. This has slowed down the human development process. In an attempt to curb disaster impact, the world adopted an action-oriented Sendai Framework for Disaster Risk Reduction (SFDRR) in 2015. Target A of the SFDRR seeks to substantially reduce disaster mortalities by 2030. This study contributes to the SFDRR by bringing in disaster-disaggregated mortality data to assess the progress of Zimbabwe’s commitment in attaining Target A. The data came from the Zimbabwe National Statistics Agency, the Traffic Safety Council of Zimbabwe, the Department of Civil Protection and the EM-DAT database. To anal-yse the data, we conducted 3-year and 5-year moving averages for a period of thirty years to frame a holistic picture of the disaster mortalities in Zimbabwe. We also applied the methodology developed by the Open-Ended Intergovernmental Expert Working Group to determine the mortality rates for the overall and individual disaster type. Results clearly showed that Zimbabwe is making progress in reduc-ing disaster mortalities despite a few spikes across its range of disasters. Major deaths were caused by drought, diarrhoea, malaria and tropical cyclones. Therefore, Zimbabwe needs to invest in drought mon-itoring and mitigation, cyclone forecasting and early warnings, and the surveillance and prevention of diarrhoeal diseases and malaria in order to substantially reduce the disaster mortality by the year 2030.(c) 2023 Elsevier Ltd. All rights reserved. Climate variability and extremes adversely affect the livestock sector by reducing pasture availability, polluting and depleting water resources, aggravating livestock diseases, and distorting the production systems. The cu-mulative effect of climate variability undermines the adaptive capacity of pastoralists and worsens food inse-curity. This study assesses the impact of climate variability and the determinants of pastoralists and agro-pastoralists adaptation strategies in Yabello and Arero Districts, southern Ethiopia. Accordingly, data were collected from randomly selected 296 sample households using a questionnaire survey. Data were also gathered from a purposively selected key informants and focus group discussion participants. Areal gridded dikadal rainfall and temperature data were collected from the National Meteorological Institute. Descriptive statistics and multinomial logistic regression data analysis methods were used. The results show that all seasons were significantly warming, while rainfall declined at various degrees and the distribution was highly variable across the study period. The ever rising minimum and maximum temperature and the erratic nature of rainfall has undermined the availability of pasture and water resources, especially during drought years resulting in the prevalence of livestock diseases. The age of the household head, poor access to information, lack of credit and saving services, limited knowledge, and erratic rainfall were found to be the determinant factors in the choice of adaptation options to climate variability and extremes. The study also found that lack of appropriate intervention and support mechanisms by government and non-government actors as well as the reluctance of pastoralists and agro-pastoralists to accept the stakeholders’ advice were the barriers to climate variability adaptation. Thus, it is clear that pastoralists’ and agro-pastoralists’ livelihood is at risk for climate variability and extremes and hence, requires context specific adaptive capacity building intervention that ranges from awareness creation to strengthening basic infrastructures and rangeland management. Prolonged exposure to high temperatures can cause heat-related illnesses and accelerate death, especially in the elderly. We developed a locally-appropriate Healthy Environment Assessment Tool, or ‘HEAT’ tool, to assess heat-health risks among communities. HEAT was co-developed with stakeholders and practitioners/professionals from the Rustenburg Local Municipality (RLM), a setting in which heat was identified as a risk in an earlier study. Feedback was used to identify vulnerable groups and settings in RLM, consider opportunities and barriers for interventions, and conceptualize a heat-health vulnerability assessment tool for a heat-resilient town. Using information provided by the RLM Integrated Development Plan, the HEAT tool was applied in the form of eight indicators relating to heat-health vulnerability and resilience and areas were evaluated at the ward level. Indicators included population, poverty, education, access to medical facilities, sanitation and basic services, public transport, recreation/community centres, and green spaces. Out of 45 wards situated in the municipality, three were identified as critical risk (red), twenty-eight as medium-high risk (yellow), and six as low risk (green) in relation to heat-health vulnerability. Short-term actions to improve heat health resilience in the community were proposed and partnerships between local government and the community to build heat health resilience were identified. BACKGROUND: Sub-Saharan Africa (SSA) has one of the highest prevalence of malnutrition among children under 5 in the world. It is also the region most vulnerable to the adverse effect of climate change, and the one that records the most armed conflicts. The chains of causality suggested in the literature on the relationship between climate change, armed conflict, and malnutrition have rarely been supported by empirical evidence for SSA countries. METHODS: This study proposes to highlight, under the hypothesis of spatial non-stationarity, the influence of climatic variations and armed conflicts on malnutrition in children under 5 in Ethiopia, Kenya, and Nigeria. To do this, we use spatial analysis on data from Demographic and Health Surveys (DHS), Uppsala Conflict Data Program Georeferenced Event Dataset (UCDP GED), Climate Hazards center InfraRed Precipitation with Station data (CHIRPS) and Moderate Resolution Imaging Spectroradiometer (MODIS). RESULTS: The results show that there is a spatial autocorrelation of malnutrition measured by the prevalence of underweight children in the three countries. Also, local geographically weighted analysis shows that armed conflict, temperature and rainfall are positively associated with the prevalence of underweight children in localities of Somali in Ethiopia, Mandera and Turkana of Wajir in Kenya, Borno and Yobe in Nigeria. CONCLUSION: In conclusion, the results of our spatial analysis support the implementation of conflict-sensitive climate change adaptation strategies. Temperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique. METHODS: We used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial-temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors. RESULTS: A total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37-5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01-1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61-0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30-2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014-1.054]) and having electricity (0.979 [0.967-0.992]) and sharing toilet facilities (0.957 [0.924-0.991]) significantly reduced malaria risk. CONCLUSION: Our current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths. It is now clear that anthropogenic climate change is having a negative impact on human health. In this paper, we provide the first comprehensive assessment of the impact of climatic stressors on child health in Burkina Faso. We undertake a rigorous empirical analysis of the impact of climate and weather shocks on mortality, stunting (height-for-age Z-score) and wasting (weight-for-age Z-score), using Demographic and Health Surveys, combined with high-resolution meteorological data, controlling for household and individual covariates. We find robust evidence that both lifetime and short-term exposure to high temperatures and droughts have a negative impact on child health, as do increased temperature anomalies during crop seasons, suggesting a link between climate and health through domestic food production. Income and household wealth, access to electricity, sanitation and a health facility for childbirth negate some adverse impacts of climate change. Combining our econometric estimates with updated CMIP6 scenarios, we compute policy-relevant projections of future child health. Our results show that future warming is projected to significantly increase child mortality, and share of underweight and stunted children, in all but the Paris Agreement scenario. Given the links between health, a key element of human capital, and economic growth, our findings and projections provide yet more evidence of the importance of a rapid reduction in global emissions combined with adaptation funding, if lower-income countries are to achieve poverty reduction and increasing prosperity. Residents of informal settlements in Sub-Sahara Africa (SSA) are vulnerable to the health impacts of climate change. Little is known about the knowledge, attitudes and practices (KAP) of inhabitants of informal settlements in SSA regarding climate change and its health impacts. The aim of this study was to investigate how inhabitants of an informal settlement in SSA experience climate change and its health impacts and assess related knowledge, attitudes and practices. The study was conducted in Mukuru informal settlement in Nairobi City County, Kenya. METHODS: A cross-sectional study was conducted in September 2021 using a structured, semi-closed KAP questionnaire. Inclusion criteria were ≥ 18 years of age and living in one of the three main sections in Mukuru: Kwa Njenga, Kwa Reuben or Viwandani. By spinning a pen at the geographic centre of each section, a random direction was selected. Then, in every second household one individual was interviewed, creating a representative mix of ages and genders of the local community. To assess participant characteristics associated with climate change knowledge multivariable logistic regression was used. Thematic content analysis was performed for qualitative responses. RESULTS: Out of 402 study participants, 76.4% (n = 307) had heard of climate change before the interview, 90.8% (n = 365) reported that climate change was affecting their community, and 92.6% (n = 372) were concerned with the health-related impact of climate change. Having lived in Mukuru for more than 10 years and living in a dwelling close to the riverside were factors significantly associated with having heard of climate change before (aOR 3.1, 95%CI 1.7 – 5.8 and aOR 2.6, 95%CI 1.1 – 6.1, respectively) and experiencing a climate change related impact on the community (aOR 10.7, 95%CI 4.0 – 28.4 and aOR 7.7; 95%CI 1.7 – 34.0, respectively). Chronic respiratory conditions, vector-borne diseases, including infectious diarrhoea, malnutrition and cardiovascular diseases were identified by respondents as climate related health risks. CONCLUSIONS: Most respondents were knowledgeable about climate change and were experiencing its (health-related) impact on their community. This study provides insights which may prove useful for policy makers, intervention planners and researchers to work on locally adapted mitigation and adaption strategies. Populations that are reliant on subsistence farming are particularly vulnerable to climatic effects on crop yields. However, empirical evidence on the role of the timing of exposure to crop yield deficits in early-life development is limited. We examined the relationship between child survival and annual crop yield reductions at different stages of early-life development in a subsistence farming population in Burkina Faso. Using shared frailty Cox proportional hazards models adjusting for confounders, we analyzed 57,288 children under 5 years of age followed by the Nouna Health and Demographic Surveillance System (1994-2016) in relation to provincial food-crop yield levels experienced in 5 nonoverlapping time windows (12 months before conception, gestation, birth-age 5.9 months, ages 6.0 months-1.9 years, and ages 2.0-4.9 years) and their aggregates (birth-1.9 years, first 1,000 days from conception, and birth-4.9 years). Of the nonoverlapping windows, point estimates were largest for child survival related to food-crop yields for the time window of 6.0 months-1.9 years: The adjusted mortality hazard ratio was 1.10 (95% confidence interval: 1.03, 1.19) for a 90th-to-10th percentile yield reduction. These findings suggest that child survival in this setting is particularly vulnerable to cereal-crop yield reductions during the period of nonexclusive breastfeeding. Floods are increasing in frequency and may increase the risk for experiencing emotional distress, anxiety, depression and PTSD. The aim of this study was to determine the extent of damage, loss, injury and death resulting from floods that occurred in and around the city of Durban, South Africa, in April 2022, and associated changes in mental health pre- to post-floods in a low-income setting. Seventy-three women between the ages of 18 and 45, residing in flood affected, low-income settings, were interviewed prior to the floods occurring. Mental health measures were repeated with 69 of the 73 women during the post-flood interview along with a questionnaire measuring flood-related exposures. Loss of infrastructure (lacked access to drinking water, electricity, fresh food, could not travel to work, had to stay in a shelter and could not get hold of friends or family) was a predictor of post-flood change in levels of emotional distress and anxiety. Higher levels of prior trauma exposure were associated with higher post-flood levels of emotional distress. Higher pre-flood food insecurity was also associated with higher post-flood anxiety. Women affected by poverty, food insecurity and a history of trauma are vulnerable to the additive adverse mental health effects of floods. Proactive approaches to diminishing the impact of floods on the livelihood of women is needed and post-flood relieve efforts may be more affective if they are enhanced by providing mental health support. ObjectiveIncreasingly unpredictable shifts in climate are triggering public health crises globally. Southern Madagascar is particularly vulnerable to climate impacts, despite contributing to only 0.2% of global emissions. Though endemic in Madagascar, climate impacts such as below average rainfall have increased the severity of droughts, putting over half of the population in southern regions at risk of being food insecure in 2022. The following review examines: How can interventions surrounding the current food emergency in southern Madagascar center community-based knowledge in their strategies? Through a social-ecological approach, this review aims to holistically discuss the complexity of the climate and food crises in this region, which is a topic that has not been widely covered in published review articles thus far.MethodsWe took a comprehensive and social-ecological approach by analyzing research pertaining to the impacts of colonial history, politics, economy, and culture on the current climate, ecology, and food systems of southern Madagascar.Main findingsMany current strategies to mitigate climate impacts and food security fail to incorporate community-based knowledge, leading to inequitable and ineffective interventions. Researchers who prioritize historical and cultural context illustrate how local knowledge may serve as a protective factor against climate impacts.ConclusionsAs climate shifts exacerbate public health crises, aid organizations must center community perspectives in their interventions to foster equitable and sustainable outcomes. The promise of a healthier, more comfortable, and more productive way of life has fueled a rapid technological transition, and a regenerative built environment has emerged as the tagline to denote the recent sustainable development. In the built environment, the regenerative paradigm has emerged as a transformative approach that goes beyond mere sustainability, aiming to restore, renew, and enhance the ecosystems affected by human activities. However, the concept of the regenerative paradigm and its potential to foster sustainable development has been understudied in recent time. Therefore, this paper explores how we can transform the built environment in the face of the present impacts of climate change using a new regenerative paradigm concept. The objectives of the study are: (i) to explore the predictors of climate change, (ii) to determine the negative impacts of environmental issues on inhabitants’ health, and (iii) to explore adaptive climate change strategies for Nigeria’s regenerative built environment. The study sample consisted of 235 stratified respondents’ opinions from within the built environment in southwestern Nigeria collected via a self-administered questionnaire. The collected quantitative data was analysed using SPSS (version 22) logistic regression analysis. The major results of the analysis revealed: (i) the ten most important predictors of climate change indicators, (ii) the existence of negative consequences of the impacts of climate change on inhabitants’ health in southwestern regions of Nigeria, and (iii) a significant (p & LE; 0.05) in all regenerative factors: planting native species has the highest & beta; coefficient of 0.499, followed by the biophilic approach (0.494), the establishment of a city’s tree canopy (0.467), the creation of a green functional green space (0.436), the use of smart landscaping techniques (0.388), and the development of a healthy watershed (0.314). This indicates that to have a regenerative built environment it is essential to create a functional green space, plant native species, establish a city’s tree canopy, create a healthy watershed, and render a biophilic approach. The study’s recommendations include urgent action to integrate climate change interventions into the decision-making processes, initiatives, and development plans of the Nigerian government. This integration should prioritize sustainable practices within the built environment, considering the regenerative paradigm’s potential to address climate change impact effectively. On the climate-health issue, studies have already attempted to understand the influence of climate change on the transmission of malaria. Extreme weather events such as floods, droughts, or heat waves can alter the course and distribution of malaria. This study aims to understand the impact of future climate change on malaria transmission using, for the first time in Senegal, the ICTP’s community-based vector-borne disease model, TRIeste (VECTRI). This biological model is a dynamic mathematical model for the study of malaria transmission that considers the impact of climate and population variability. A new approach for VECTRI input parameters was also used. A bias correction technique, the cumulative distribution function transform (CDF-t) method, was applied to climate simulations to remove systematic biases in the Coupled Model Intercomparison Project Phase 5 (CMIP5) global climate models (GCMs) that could alter impact predictions. Beforehand, we use reference data for validation such as CPC global unified gauge-based analysis of daily precipitation (CPC for Climate Prediction Center), ERA5-land reanalysis, Climate Hazards InfraRed Precipitation with Station data (CHIRPS), and African Rainfall Climatology 2.0 (ARC2). The results were analyzed for two CMIP5 scenarios for the different time periods: assessment: 1983-2005; near future: 2006-2028; medium term: 2030-2052; and far future: 2077-2099). The validation results show that the models reproduce the annual cycle well. Except for the IPSL-CM5B model, which gives a peak in August, all the other models (ACCESS1-3, CanESM2, CSIRO, CMCC-CM, CMCC-CMS, CNRM-CM5, GFDL-CM3, GFDL-ESM2G, GFDL-ESM2M, inmcm4, and IPSL-CM5B) agree with the validation data on a maximum peak in September with a period of strong transmission in August-October. With spatial variation, the CMIP5 model simulations show more of a difference in the number of malaria cases between the south and the north. Malaria transmission is much higher in the south than in the north. However, the results predicted by the models on the occurrence of malaria by 2100 show differences between the RCP8.5 scenario, considered a high emission scenario, and the RCP4.5 scenario, considered an intermediate mitigation scenario. The CanESM2, CMCC-CM, CMCC-CMS, inmcm4, and IPSL-CM5B models predict decreases with the RCP4.5 scenario. However, ACCESS1-3, CSIRO, NRCM-CM5, GFDL-CM3, GFDL-ESM2G, and GFDL-ESM2M predict increases in malaria under all scenarios (RCP4.5 and RCP8.5). The projected decrease in malaria in the future with these models is much more visible in the RCP8.5 scenario. The results of this study are of paramount importance in the climate-health field. These results will assist in decision-making and will allow for the establishment of preventive surveillance systems for local climate-sensitive diseases, including malaria, in the targeted regions of Senegal. Although vulnerability assessments have been widely conducted along the coast of Ghana, they have not focused on the factors contributing to social vulnerability of households and communi-ties to disaster risks. Using an indicator-based approach, this study examines the social factors that affect the exposure, sensitivity and adaptive capacity of households and communities in the Volta estuary, Ghana. Results indicate that all the communities within the study area were ex-posed to climate change related hazards. However, two communities, Azizanya in Ada East Dis-trict and Fuveme in Anloga District, were highly exposed with unweighted indexes of 0.50 and 0.76, respectively. Sensitivity among communities was generally high ranging from 0.00 to 0.87 due to several social factors including low household income, high number of children and aged at home, and lack of social amenities such as roads, health facilities, markets, and schools. The communities recorded high adaptive capacity and were able to withstand the ravages of the ocean and the river system. Households and communities developed various adaptation measures such as relocation to nearby communities or higher grounds, open spaces and packing of their be-longings on higher objects such as tables, whiles government actions included occasional dredg-ing and constructions of sea defense structures. An integrated, multi-stakeholder approach in-volving government, non-governmental community-based organisations, communities, house-holds, and other stakeholders is proposed to design and implement a comprehensive disaster management plan to combat climate change related coastal disasters. The study explored the challenges urbanites faced due to climate change and the COVID-19 pandemic. Urban vulnerability ills such as food insecurity, poverty and malnutrition have increased as climate change and COVID-19 jointly affect societies. Urban residents have resorted to urban farming and street vending as coping strategies. COVID-19 protocols and strategies for social distancing have compromised the urban poor livelihoods. Due to lockdown protocols such as curfew, closure of businesses, and the limited number of people doing certain activities, the urban poor often compromised lockdown rules to earn a living. The study used document analysis to gather data on climate change and poverty amidst the COVID-19 pandemic. Academic journals, newspaper articles, books and information from various reliable websites were used for data collection. Content and thematic analysis were used to analyse data, while data triangulation from various sources enhanced data reliability and trustworthiness. The study found that climate change increased food insecurity in urban areas. Low agricultural output and climate change impacts compromised food availability and affordability for urbanites. The COVID-19 protocols increased financial constraints on urbanites as lockdown restrictions negatively impacted income from formal and informal jobs. The study recommends looking beyond the virus for prevention strategies to improve poor peoples’ livelihoods. Countries must develop response strategies to cushion the urban poor from climate change and the COVID-19 impact. Developing countries are urged to sustainably adapt to climate change through scientific innovation to promote people’s livelihoods. In Sub-Saharan Africa, many cities are facing an increased risk of heat due to climate change and rapid urbanization. This poses a particular threat in areas with limited adaptive capacity. However, there is a lack of comprehensive heat risk assessment in the region, possibly due to the absence of high-resolution weather data. This study aims to address this gap by proposing and demonstrating a methodology for mapping high-risk areas in a tropical humid city, specifically focusing on Lagos, Nigeria. The approach utilises advanced numerical modelling techniques and open-source geospatial data. The urbanised Weather Research and Forecasting (WRF) model is employed to simulate Humidex-based heat stress during a specific heatwave event in March 2020. Open-source high resolution geospatial datasets were used to assess heat exposure and vulnerability. The urban areas were classified based on the Local Climate Zone (LCZ) scheme. Spatial analysis techniques, including Moran’s I test and Optimized Hot Spot Analysis (OHSA), were used to identify spatial clustering patterns and hot spots of heat risk areas. Moreover, using Gi* statistics in OHSA, the risk layer was categorised into hot, cold, and non-significant spots at various levels of significance (90 %, 95 %, and 99 %). Mapping the hot spots at the highest confidence level of 99 % identified Critical Heat Risk Zones (CHRZ), covering an area of approximately 423 km2. The results showed significant heat risk in highly urbanised LCZs. Further investigation indicated that the largest proportion of highrisk zones corresponded to densely populated and highly urbanised LCZs- LCZ3 (59 %), LCZ 6(21 %), and LCZ 7 (17 %). Notably, these areas coincide with two well-known slums in Lagos, emphasizing the need for targeted interventions and planning measures in these areas. The findings highlight the magnitude and extent of heat risk within the city and emphasize the urgent need for targeted climate change adaptation and mitigation strategies in the identified high-risk zones. This article assesses how adaptation governance within the eThekwini (Durban) metropolitan municipality, KwaZulu-Natal Province of South Africa, addresses the vulnerability and adaptation of black African women to flood impacts within the municipality. The article argues that there is an intersectional lens through which black local women’s experiences of vulnerability to the impact of climate change disasters need to be understood and addressed. Qualitative research methodologies were employed to collect data through semi-structured interviews and focus group discussions with local black African women from four areas in Durban who have experienced frequent floods over the past years. Personnel from eThekwini municipality’s Environmental Planning and Climate Protection Department and Disaster Management Department were also interviewed. The feminist political ecology perspective was used to unpack the nuances in power relations that engendered black African women’s vulnerability and adaptation to flood impacts within the municipality. The study’s findings revealed that the overall vulnerability experiences of black African women in Durban are shaped by factors relating to the lack of an ‘intentionally gendered’ approach to adaptation governance in the municipality. Adopting an intentional approach to adaptation governance is essential to inform policies responding to local black Africans’ vulnerability and adaptation experiences within the study’s context. BACKGROUND: Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. OBJECTIVE: The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. METHODS: Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. RESULTS: Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ≥25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. CONCLUSIONS: During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities. Global climate change is affecting water resources and other aspects of life in many countries. Rainfall is the most significant climate element affecting the livelihood and well-being of the majority of Ethiopians. Rainfall variability has a great impact on agricultural production, water supply, transportation, the environment, and urban planning. Because all agricultural activities and subsequent national crop production hinge on the amount and distribution of rainfall, accurate monthly and seasonal predictions of this rainfall are vital for agricultural planning. Rainfall prediction is also useful for governmental, non-governmental, and private agencies in making long-term decisions and planning in numerous areas such as farming, early warning of potential hazards, drought mitigation, disaster prevention, and insurance policy. Artificial Intelligence (AI) has been widely used in almost every area, and rainfall prediction is one of them. In this study, we attempt to investigate the use of AI-based models to predict monthly rainfall at 92 Ethiopian meteorological stations. The applicability of Artificial Neural Networks (ANNs) and Adaptive Neuro-Fuzzy Inference System (ANFIS) models in predicting long-term monthly precipitation was investigated using geographical and periodicity component (longitude, latitude, and altitude) data collected from 2011 to 2021. The experimental results reveal that the ANFIS model outperforms the ANN model in all assessment criteria across all testing stations. The Nash-Sutcliffe efficiency coefficients were 0.995 for ANFIS and 0.935 for ANN over testing stations. Three concurrent global environmental trends are particularly apparent: human population growth, urbanization, and climate change. Especially in countries such as Ethiopia in the Global South, all three are impacted by, and in turn have bearing upon, social justice and equity. Combined, these spatial and social factors reduce wellbeing, leading to increasing urgency to create urban environments that are more livable, resilient, and adaptive. However, the impacts on, and of, non-human urban residents, particularly on the ecosystem services they provide, are often neglected. We review the literature using the One Health theoretical framework and focusing on Ethiopia as a case-study. We argue for specific urban strategies that benefit humans and also have spillover effects that benefit other species, and vice versa. For example, urban trees provide shade, clean the air, help combat climate change, create more livable neighborhoods, and offer habitat for many species. Similarly, urban neighborhoods that attract wildlife have characteristics that also make them more desirable for humans, resulting in improved health outcomes, higher livability, and enhanced real-estate values. After summarizing the present state of knowledge about urban ecology, we emphasize components relevant to the developing world in general and pre- COVID-19 pandemic Ethiopia in particular, then expand the discussion to include social justice and equity concerns in the built environment. Prior to the ongoing civil war, Ethiopia was beginning to invest in more sustainable urbanization and serve as a model. Especially in light of the conflict and pandemic, much more will need to be done. Water pollution is a major issue in Ghana with direct impacts on human health. However, the underlying drivers of exposure and risks are not comprehensively explored and understood, while the diseases continue posing huge burdens. The key question addressed is: what are the key drivers influencing the water-health nexus, particularly water-borne disease risks in the Odaw River basin, Ghana? Multiple approaches were integrated: qualitative system dynamic modeling and urban land-use change assessment. Multi-level stakeholder participation, including household surveys, focus group discussions, and workshops were employed in developing and identifying indicators and feedback loops. The results revealed that communities have access to water and sanitation, but water-borne diseases are still prevalent. Flooding influenced by poor land use planning and solid waste disposal are key risk factors, contributing to water pollution and disease outbreaks. The major land-use change is the conversion of natural to built-up areas, resulting in decreased urban vegetation cover and increased soil sealing, partly contributing to flood risk. Complex linkages and multiple feedback loops between land use, flooding, water pollution, and water-borne disease risks were identified. In addition to supplying safe drinking water and sanitation, multi-sectoral collaborations are required to co-design and implement integrated interventions, including flood risk reduction, urban land use plans, and improved waste management to reduce disease risks and promote health. Heat stress is an important threat for human health and urban areas are affected at higher rates compared to rural environments. Additionally, climate change will increase the vulnerability towards urban heat stress in the future. Current high-resolution urban heat stress assessments are limited in time and space due to the high computational costs. In this paper, the UrbClim numerical model is used to simulate urban heat accurately at a fast rate and high spatial resolution for the cities of Johannesburg and Ekurhuleni, South Africa. Using detailed terrain information, (future) urban heat stress assessments are provided at 30 m resolution for both city agglomerations, while meter-scale simulations are executed for a selection of neighborhoods. These model simulations are evaluated using an extensive monitoring campaign in which the local community was heavily engaged. Distinct spatial differences in the urban heat island effect are observed, with greatest heat stress in areas with high building densities and low vegetation numbers. These areas are often characterized by lower socio-economic living conditions. The meter-scale analysis further shows the importance of shade provided by vegetation to lower heat stress in both present and future climate. These assessments offer assistance in the design of climate-resilient urban planning strategies. The vulnerable populations in the protracted humanitarian crisis in South Sudan are faced with constrained access to health services and frequent disease outbreaks. Here, we describe the experiences of emergency mobile medical teams (eMMT) assembled by the World Health Organization (WHO) South Sudan to respond to public health emergencies. Interventions: the eMMTs, multidisciplinary teams based at national, state and county levels, are rapidly deployed to conduct rapid assessments, outbreak investigations, and initiate public health response during acute emergencies. The eMMTs were deployed to locations affected by flooding, conflicts, famine, and disease outbreaks. We reviewed records of deployment reports, outreach and campaign registers, and analyzed the key achievements of the eMMTs for 2017 through 2020. Achievements: the eMMTs investigated disease outbreaks including cholera, measles, Rift Valley fever and coronavirus disease (COVID-19) in 13 counties, conducted mobile outreaches in emergency locations in 38 counties (320,988 consultations conducted), trained 550 healthcare workers including rapid response teams, and supported reactive measles vaccination campaigns in seven counties [148,726, (72-125%) under-5-year-old children vaccinated] and reactive oral cholera vaccination campaigns in four counties (355,790 vaccinated). The eMMT is relevant in humanitarian settings and can reduce excess morbidity and mortality and fill gaps that routine health facilities and health partners could not bridge. However, the scope of the services offered needs to be broadened to include mental and psychosocial care and a strategy for ensuring continuity of vaccination services and management of chronic conditions after the mobile outreach is instituted. Introduction: Secondary sex ratio is the number of live male births per 100 female births. In humans, the primary sex ratio, which is the sex ratio at conception, is expected to be 1:1 in natural populations based on the law of independent assortment of the X and Y chromosomes. This is not the case with the sex ratio at birth as it is largely affected by various social and cultural practices that it tends to bias towards one sex, with profound implications for population and demographic dynamics. Materials and Methods: We collected retrospective data of records of live births from three Southwestern Nigerian states, covering 10 years. The data were obtained from different Hospitals/Birth Centres from three states, i.e., Lagos, Ondo and Osun, between 2006 and 2017. Data analysis was performed to determine the monthly, quarterly, yearly and seasonal variation in sex ratios. Chi-square analysis was used to determine the significance of differences in sex ratios at P < 0.05. Results: Annual average sex ratios of 99.7, 105.6 and 106.0 were obtained for Lagos, Osun and Ondo, respectively, while the pooled data had a sex ratio of 104.2, indicating male preponderance. Sex ratios differ significantly according to season. Differences in sex ratio were significant during the dry season in Lagos and Osun states and in Ondo during the rainy season. Conclusions: Sex ratios from Southwest Nigeria are as diverse as other populations, with ratios ranging between 99.7 and 106.0.
Droughts are slow-onset disasters with devastating impacts that can last for months and even years. The poorest communities are usually the hardest hit by droughts. In the Androy region of Madagascar, droughts are a constant major handicap for agriculture and farming which are the two main local economic activities. Human vulnerability to droughts differs according to age, sex, and physical conditions. The precariousness of the situation of Antandroy women caused by droughts motivated the choice of this study, which sought to understand the factors behind women’s vulnerability to this risk. To study these factors, documents on gender, vulnerability, droughts and the Androy region were collected and analysed. We then conducted interviews and a survey to understand the Antandroy’s living conditions. Several factors lead to women’s high degree of vulnerability, such as the particular climate of Androy, household’s size, duties, difficulties faced by the agricultural production, early marriage, migration and low educational levels. To contribute to the reduction of their vulnerability to droughts, Antandroy women should reinforce their adaptability by developing income-generating activities in diversified sectors, using varied seeds and protecting the environment, with the definitive eradication of slash-and burn cultivation and bushfires. Exposure to heat and heatwaves are associated with mortality and may amplify morbidities. In a climate change context, projections suggest temperatures will likely rise in the foreseeable future. Our paper assesses the current knowledge on human health effects of heat exposure and gathered local knowledge of heat-health effects in a rural area of the Agincourt sub-district of South Africa. Existing, peer-reviewed published literature on heat effects on human health as well as heat-health indicators was reviewed. Interviews and structured observations to collect data on heat effects on human health in Agincourt sub-district were conducted. The Lancet Countdown heat-related indicators were applied as a framework against which to discuss our findings. A total of 93 participants who lived in Agincourt sub-district for 5 years and more were interviewed. Participants reported that temperatures, especially summertime temperatures, had been rising over the past years. Health effects of heat were deemed more apparent in relation to morbidity. Heatwaves were not easily comprehensible as singular ‘events’, and their effects were poorly understood. The population groups disproportionately affected by heat included infants, the elderly, those living with disability and outdoor workers. High ambient temperatures were deemed to be associated with reduced labour productivity of outdoor workers. Community-level perceptions of heat impacts on health were mainly related to illnesses and diseases, with no understanding of mortality risk. Future health awareness campaigns that encompass the full range of heat-health impacts are essential to reduce vulnerability, morbidity, and mortality. Our study provided location-specific, qualitative, and indicator-aligned data for a geographic area expected to undergo significant heat stress in the future. The study findings have significant research, policy, and practice implications in similar resource-limited settings. This paper investigates the impact of timeline-bound fetal exposure to drought shocks on birth outcomes in rural Sierra Leone. We link repeated cross-section birth record data across 11 years from the Sierra Leone Demographic and Health Surveys to district-level geolocation precipitation data from the University of Delaware weather repository. The methodology uses spatial distribution of precipitation across districts to identify the impacts of extreme droughts on birth outcomes. This study reinforces both harvest and direct gestation as maternal nutrition pathways for the impact of drought shocks on birth outcomes. Results also show that adverse in utero shock impacts are concentrated among poorer households and may be mitigated by antenatal care services. Background Household water security encompasses water-related factors that pose threats to public health at the household level. It presents a reliable access to water in sufficient quantity and quality towards meeting basic human needs. This study assessed the dynamics of seasonal variations in household water security and the association between household water security and diarrheal disease across dry and wet seasons in an urban settlement in Southwest Nigeria. Methods A panel study design was employed to study 180 households selected using a multistage sampling technique. The selected households were studied during dry and rainy seasons. Household water security was assessed through the application of the all or none principle to 9 indicators associated with household water security. The intensity of water insecurity was also assessed using the nine indicators. The higher the number of indicators a household failed, the higher the intensity of household water insecurity. The association between the intensity of household water insecurity and the burden of diarrheal disease across the seasons was assessed using the Mantel-Haenszel test. Results No household was water-secure in both dry and rainy seasons; however, the intensity of insecurity was more pronounced during the dry season compared with the rainy season. Ninety households (52.0%), had water insecurity intensity scores above fifty percentiles during the dry season while 21 (12.1%) households had a water insecurity score above the 50th percentile during raining season, p < 0.001. The burden of diarrheal disease was significantly higher among households with a water insecurity intensity score above the 50th percentile, 9 (8.1%) compared to households with a water insecurity intensity score below the 50th percentile 7 (3.0%), p = 0.034. There was no statistically significant association between the intensity of water insecurity and diarrheal disease burden across the dry and rainy seasons, p = 0.218. Conclusion The high burden of household water insecurity deserves concerted efforts from all concerned stakeholders, a panacea to an important health threat in the developing world.
BACKGROUND: Weather fluctuation affects the incidence of malaria through a network of causuative pathays. Globally, human activities have ultered weather conditions over time, and consequently the number of malaria cases. This study aimed at determining the influence of humidity, temperature and rainfall on malaria incidence in an inland (Muyuka) and a coastal (Tiko) settings for a period of seven years (2011-2017) as well as predict the number of malaria cases two years after (2018 and 2019). METHODS: Malaria data for Muyuka Health District (MHD) and Tiko Health District (THD) were obtained from the Regional Delegation of Public Health and Tiko District Health service respectively. Climate data for MHD was obtained from the Regional Delegation of Transport while that of THD was gotten from Cameroon Development Coorporation. Spearman rank correlation was used to investigate the relationship between number of malaria cases and the weather variables and the simple seasonal model was used to forecast the number of malaria cases for 2018 and 2019. RESULTS: The mean monthly rainfall, temperature and relative humidity for MHD were 200.38 mm, 27.05(0)C, 82.35% and THD were 207.36 mm, 27.57 °C and 84.32% respectively, with a total number of malaria cases of 56,745 and 40,160. In MHD, mean yearly humidity strongly correlated negatively with number of malaria cases (r = - 0.811, p = 0.027) but in THD, a moderate negative yearly correlation was observed (r = - 0.595, p = 0.159). In THD, the mean seasonal temperature moderately correlated (r = 0.599, p = 0.024) positively with the number of malaria cases, whereas MHD had a very weak negative correlation (r = - 0.174, p = 0.551). Likewise mean seasonal rainfall in THD moderately correlated (r = - 0.559, p = 0.038) negatively with malaria cases, contrary to MHD which showed a very weak positive correlation (r = 0.425, p = 0.130). The simple seasonal model predicted 6,842 malaria cases in Muyuka, for 2018 and same number for 2019, while 3167 cases were observed in 2018 and 2848 in 2019. Also 6,738 cases of malaria were predicted for MHD in 2018 likewise 2019, but 7327 cases were observed in 2018 and 21,735 cases in 2019. CONCLUSION: Humidity is the principal climatic variable that negatively influences malaria cases in MHD, while higher seasonal temperatures and lower seasonal rain fall significantly increase malaria cases in THD. BACKGROUND: The expected increase in heat in The Gambia is one of the most significant health threats caused by climate change. However, little is known about the gendered dynamics of exposure and response to heat stress, including women’s perceived health risks, their adaptation strategies to heat, and their perceptions of climate change. This research project aims to answer the question of whether and how pregnant farmers in The Gambia perceive and act upon occupational heat stress and its health impacts on both themselves and their unborn children, against the backdrop of current and expected climatic changes. METHOD: In-depth semi-structured interviews were conducted with 12 women who practice subsistence farming and were either pregnant or had delivered within the past month in West Kiang, The Gambia. Participants were selected using purposive sampling. Translated interview transcripts were coded and qualitative thematic content analysis with an intersectional lens was used to arrive at the results. RESULTS: All women who participated in the study experience significant heat stress while working outdoors during pregnancy, with symptoms often including headache, dizziness, nausea, and chills. The most common adaptive techniques included resting in the shade while working, completing their work in multiple shorter time increments, taking medicine to reduce symptoms like headache, using water to cool down, and reducing the amount of area they cultivate. Layered identities, experiences, and household power structures related to age, migration, marital situation, socioeconomic status, and supportive social relationships shaped the extent to which women were able to prevent and reduce the effects of heat exposure during their work whilst pregnant. Women who participated in this study demonstrated high awareness of climate change and offered important insights into potential values, priorities, and mechanisms to enable effective adaptation. CONCLUSION: Our findings reveal many intersecting social and economic factors that shape the space within which women can make decisions and take adaptive action to reduce the impact of heat during their pregnancy. To improve the health of pregnant working women exposed to heat, these intersectionalities must be considered when supporting women to adapt their working practices and cope with heat stress. OBJECTIVE: Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. DESIGN: We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0-36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0-27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. SETTING: Northern Kenya, June-July 2019. PARTICIPANTS: Daasanach pastoralist households (n 136) from seven communities. RESULTS: In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. CONCLUSIONS: These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access. BACKGROUND: Ethiopia’s exposure to the El Niño drought (2015-2016) resulted in high malnutrition, internally displaced people, and epidemics of communicable diseases, all of which strained the health system. The drought was especially challenging for mothers and children. We aimed to identify salient factors that can improve health system resilience by exploring the successes and challenges experienced by a community-based health system during the drought response. METHODS: We collected data via key informant interviews and focus group discussions to capture diverse perspectives across the health system (eg, international, national, district, facility, and community perspectives). Data were collected from communities in drought-affected regions of: 1) Somali, Sitti Zone, 2) Hawassa, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), and 3) Tigray, Eastern Zone. Data were analysed using a deductive-inductive approach using thematic content analysis applied to a conceptual framework. RESULTS: A total of 94 participants were included (71 from the communities and 23 from other levels). Key themes included the importance of: 1) organized community groups linked to the health system, 2) an effective community health workforce within strong health systems, 3) adaptable human resource structures and service delivery models, 4) training and preparedness, and 5) strong government leadership with decentralized decision making. CONCLUSIONS: The results of this study provide insights from across the health system into the successes and challenges of building resilience in community-based health systems in Ethiopia during the drought. As climate change exacerbates extreme weather events, further research is needed to understand the determinants of building resilience from a variety of shocks in multiple contexts, especially focusing on harnessing the power of communities as reservoirs of resilience. Cardiovascular diseases (CVDs) have a high disease burden both globally and in South Africa. They have also been found to be temperature-sensitive globally. The association between temperature and CVD morbidity has previously been demonstrated, but little is known about it in South Africa. It is important to understand how changes in temperature in South Africa will affect CVD morbidity, especially in rural regions, to inform public health interventions and adaptation strategies. This study aimed to determine the short-term effect of apparent temperature (T(app)) on CVD hospital admissions in Mopani District, Limpopo province, South Africa. A total of 3124 CVD hospital admissions records were obtained from two hospitals from 1 June 2009 to 31 December 2016. Daily T(app) was calculated using nearby weather station measurements. The association was modelled using a distributed lag non-linear model with a negative binomial regression over a 21-day lag period. The fraction of morbidity attributable to non-optimal T(app), i.e., cold (6-25 °C) and warm (27-32 °C) T(app) was reported. We found an increase in the proportion of admissions due to CVDs for warm and cold T(app) cumulatively over 21 days. Increasing CVD admissions due to warm T(app) appeared immediately and lasted for two to four days, whereas the lag-structure for the cold effect was inconsistent. A proportion of 8.5% (95% Confidence Interval (CI): 3.1%, 13.7%) and 1.1% (95% CI: -1.4%, 3.5%) of the total CVD admissions was attributable to cold and warm temperatures, respectively. Warm and cold T(app) may increase CVD admissions, suggesting that the healthcare system and community need to be prepared in the context of global temperature changes. BACKGROUND: Stunting is impaired linear growth of children: they experience stunting in the first 1000 days after conception and is an indication of chronic malnutrition. Children under the age of two are regarded as the most vulnerable to malnutrition due to their rapid growth and greater exposure to infectious disease. OBJECTIVE: To assess the magnitude and associated factors of stunting among 6 to 23-month-old children in drought-vulnerable kebeles of the Demba Gofa district, southern Ethiopia. METHODS: A community-based cross-sectional study was conducted from February to March 2021. Systematic random sampling was used to select pairs of mothers/caregivers with children aged 6 to 23 months. A semistructured questionnaire and anthropometric measurement were used to collect the data. The data were checked coded and entered into Epi-data version 3.1 and exported to SPSS for Windows version 20.0 for analysis. Simple and multivariable linear regressions were conducted. The level of significance was declared at 95% CI and p-value < 0.05. RESULTS: The magnitude of stunting in the study area was 79(21.82%). Household dietary diversity [β = 0.217, 95% CI, 0.093-0.342], early initiation of complementary feeding [β = 0.444, 95% CI, 0.344-0.543], frequency of breastfeeding within 24 h [β = 0.217, 95% CI, 0.179-0.263] and child eating animal source food [β = 0.351, 95% CI, 0.196-0.506] were positively significant predictors of child height/length-for-age (HAZ). CONCLUSION: The extent of stunting in the study area is relatively lower than that in regional and national reports, but one out of five children were still stunted. Therefore, health education on infant and young child feeding practices should be provided to mothers to reduce the problem.
BACKGROUND: In malaria endemic countries, seasonal malaria chemoprevention (SMC) interventions are performed during the high malaria transmission in accordance with epidemiological surveillance data. In this study we propose a predictive approach for tailoring the timing and number of cycles of SMC in all health districts of Mali based on sub-national epidemiological surveillance and rainfall data. Our primary objective was to select the best of two approaches for predicting the onset of the high transmission season at the operational scale. Our secondary objective was to evaluate the number of malaria cases, hospitalisations and deaths in children under 5 years of age that would be prevented annually and the additional cost that would be incurred using the best approach. METHODS: For each of the 75 health districts of Mali over the study period (2014-2019), we determined (1) the onset of the rainy season period based on weekly rainfall data; (ii) the onset and duration of the high transmission season using change point analysis of weekly incidence data; and (iii) the lag between the onset of the rainy season and the onset of the high transmission. Two approaches for predicting the onset of the high transmission season in 2019 were evaluated. RESULTS: In the study period (2014-2019), the onset of the rainy season ranged from week (W) 17 (W17; April) to W34 (August). The onset of the high transmission season ranged from W25 (June) to W40 (September). The lag between these two events ranged from 5 to 12 weeks. The duration of the high transmission season ranged from 3 to 6 months. The best of the two approaches predicted the onset of the high transmission season in 2019 to be in June in two districts, in July in 46 districts, in August in 21 districts and in September in six districts. Using our proposed approach would prevent 43,819 cases, 1943 hospitalisations and 70 deaths in children under 5 years of age annually for a minimal additional cost. Our analysis shows that the number of cycles of SMC should be changed in 36 health districts. CONCLUSION: Adapting the timing of SMC interventions using our proposed approach could improve the prevention of malaria cases and decrease hospitalisations and deaths. Future studies should be conducted to validate this approach. INTRODUCTION: Despite the implementation of control strategies at the national scale, the malaria burden remains high in Mali, with more than 2.8 million cases reported in 2019. In this context, a new approach is needed, which accounts for the spatio-temporal variability of malaria transmission at the local scale. This study aimed to describe the spatio-temporal variability of malaria incidence and the associated meteorological and environmental factors in the health district of Kati, Mali. METHODS: Daily malaria cases were collected from the consultation records of the 35 health areas of Kati’s health district, for the period 2015-2019. Data on rainfall, relative humidity, temperature, wind speed, the normalized difference vegetation index, air pressure, and land use-land cover were extracted from open-access remote sensing sources, while data on the Niger River’s height and flow were obtained from the National Department of Hydraulics. To reduce the dimension and account for collinearity, strongly correlated meteorological and environmental variables were combined into synthetic indicators (SI), using a principal component analysis. A generalized additive model was built to determine the lag and the relationship between the main SIs and malaria incidence. The transmission periods were determined using a change-point analysis. High-risk clusters (hotspots) were detected using the SatScan method and were ranked according to risk level, using a classification and regression tree analysis. RESULTS: The peak of the malaria incidence generally occurred in October. Peak incidence decreased from 60 cases per 1000 person-weeks in 2015, to 27 cases per 1000 person-weeks in 2019. The relationship between the first SI (river flow and height, relative humidity, and rainfall) and malaria incidence was positive and almost linear. A non-linear relationship was found between the second SI (air pressure and temperature) and malaria incidence. Two transmission periods were determined per year: a low transmission period from January to July-corresponding to a persisting transmission during the dry season-and a high transmission period from July to December. The spatial distribution of malaria hotspots varied according to the transmission period. DISCUSSION: Our study confirmed the important variability of malaria incidence and found malaria transmission to be associated with several meteorological and environmental factors in the Kati district. The persistence of malaria during the dry season and the spatio-temporal variability of malaria hotspots reinforce the need for innovative and targeted strategies. INTRODUCTION: Malaria is a life-threatening acute febrile illness which is affecting the lives of millions globally. Its distribution is characterized by spatial, temporal, and spatiotemporal heterogeneity. Detection of the space-time distribution and mapping high-risk areas is useful to target hot spots for effective intervention. METHODS: Time series cross sectional study was conducted using weekly malaria surveillance data obtained from Amhara Public Health Institute. Poisson model was fitted to determine the purely spatial, temporal, and space-time clusters using SaTScan™ 9.6 software. Spearman correlation, bivariate, and multivariable negative binomial regressions were used to analyze the relation of the climatic factors to count of malaria incidence. RESULT: Jabitenan, Quarit, Sekela, Bure, and Wonberma were high rate spatial cluster of malaria incidence hierarchically. Spatiotemporal clusters were detected. A temporal scan statistic identified 1 risk period from 1 July 2013 to 30 June 2015. The adjusted incidence rate ratio showed that monthly average temperature and monthly average rainfall were independent predictors for malaria incidence at all lag-months. Monthly average relative humidity was significant at 2 months lag. CONCLUSION: Malaria incidence had spatial, temporal, spatiotemporal variability in West Gojjam zone. Mean monthly temperature and rainfall were directly and negatively associated to count of malaria incidence respectively. Considering these space-time variations and risk factors (temperature and rainfall) would be useful for the prevention and control and ultimately achieve elimination. BACKGROUND: Diarrhea remains a significant public health problem and poses a considerable financial burden on Ghana’s health insurance scheme. In order to prioritize district-level hotspots of diarrhea incidence for effective targeted interventions, it is important to understand the potential drivers of spatiotemporal patterns of diarrhea. We aimed to identify the spatiotemporal heterogeneity of diarrhea incidence in Ghana and explore how meteorological and socio-demographic factors influence the patterns. METHODS: We used monthly district-level clinically diagnosed diarrhea data between 2012 and 2018 obtained from the Centre for Health Information and Management of the Ghana Health Services. We utilized a hierarchical Bayesian spatiotemporal modeling framework to evaluate potential associations between district-level monthly diarrhea incidence and meteorological variables (mean temperature, diurnal temperature range, surface water presence) and socio-demographic factors (population density, Gini index, District League Table score) in Ghana. In addition, we investigated whether these associations were consistent across the four agro-ecological zones. RESULTS: There was considerable spatial heterogeneity in diarrhea patterns across the districts, with clusters of high diarrhea risk areas mostly found in the transition and savannah zones. The average monthly temporal patterns of diarrhea revealed a weak biannual seasonality with major and minor peaks in June and October, respectively, coinciding with the major and minor rainy seasons. We found a significant association between both meteorological and socio-demographic factors and diarrhea risk, but the strength and direction of associations differed across the four agro-ecological zones. Surface water presence demonstrated consistently positive, while diurnal temperature range and population density demonstrated consistently negative associations with diarrhea both overall and across the agro-ecological zones. CONCLUSIONS: Although overall diarrhea incidence is declining in Ghana, our results revealed high-risk districts that could benefit from district-specific tailored intervention strategies to improve control efforts. Ghana health sector policy-makers can use these results to assess the effectiveness of ongoing interventions at the district level and prioritize resource allocation for diarrhea control. Malaria is a major public health problem especially in Africa where 94% of global malaria cases occur. Malaria prevalence and mortalities are disproportionately higher among children. In 2019, children accounted for 67% of malaria deaths globally. Recently, climatic factors have been acknowledged to influence the number and severity of malaria cases. Plasmodium falciparum-the most deadly malaria parasite, accounts for more than 95% of malaria infections among children in Ghana. Using the 2017 Ghana Demographic Health Survey data, we examined the local variation in the prevalence and climatic determinants of child malaria. The findings showed that climatic factors such as temperature, rainfall aridity and Enhanced Vegetation Index are significantly and positively associated with Plasmodium falciparum malaria prevalence among children in Ghana. However, there are local variations in how these climatic factors affect child malaria prevalence. Plasmodium falciparum malaria prevalence was highest among children in the south western, north western and northern Ghana. BACKGROUND: The health effects of climate change have been found to be a global concern for the last 2 centuries. However, the effect of climate variability on diarrhoea among under-five-year-old children is perhaps undocumented or otherwise unknown. The aim of the present study was to determine the effect of climate variability on diarrhoea among children under 5 years of age. METHODS: A community-based longitudinal study was conducted over 8 repeated visits from June 2016 to May 2018 at the Kersa Demographic Surveillance and Health Research Center. A total of 500 randomly selected households and their 48 improved water sources were included in the survey from 3 agro-ecological zones, the rural and urban areas of the study area. Data was collected on household characteristics, diarrhoea, WASH practices, water quality and quantity in households, and improved water sources. A structured pre-tested questionnaire, an observational check list and laboratory tests were used for data collection. The data was entered into Epi Data Version 3.01 and transferred to Stata Version 12 for analysis. Multilevel mixed-effect Poisson regression was used to determine the relationship between predictors and outcome variables. A P-value of less than .05 was the cut-off point for statistically significant. RESULTS: The prevalence of diarrhoea in 2 weeks among children under 5 years of age was 17.2% (95% CI: 15.8-19.71). Rainfall, E. coli contamination of drinking water at the source and in the home, 20 L of water consumption per capita per day, sharing water sources with animals and home water treatment by residents of the mid- and lowlands were all predictors of diarrhoea. The space-time scan statistic confirmed that child diarrhoea had random variation in both space and time. CONCLUSION: Climate variability has influenced the prevalence of diarrhoea among under-five-year-old children. Climate-resilient measures should be taken to reduce the burden of diarrhoea in the community. Background Panel data indicate that nonpregnant women’s dietary diversity fluctuates across climatic seasons in low- and middle-income countries. The natural day-to-day variability in food group consumption during gestation is unknown. Objectives A longitudinal study was conducted among pregnant women enrolled in the Micronutriments pour la Sante de la Mere et de l’Enfant study 3 randomized controlled efficacy trial [i.e., daily fortified balanced energy-protein supplement and an iron-folic acid (IFA) tablet compared with an IFA tablet only] to investigate the number of 24-hour recalls required to estimate usual prenatal food group (FG) diversity and the seasonality of pregnant women’s dietary diversity in Hounde, Burkina Faso. Methods FG consumption was assessed twice weekly by qualitative, list-based, 24-hour recalls among 1757 pregnant women (892 control, 865 intervention). The number of days needed to estimate a woman’s usual prenatal 10-point FG diversity score was calculated using the within-subject coefficient of variation. Regression models, including truncated Fourier series, were fitted to assess seasonal variations in the FG diversity score and the probability of reaching Minimum Dietary Diversity for Women (MDD-W; i.e., >= 5 FGs). Results The monthly mean FG scores (<5 FGs) and MDD-W prevalence (<45%) were low. Five list-based recalls allowed observed FG diversity to lie within 15% of the true mean in 90% of the estimations (mean +/- SD, 40.4 +/- 20.7 recalls per woman). Both the FG diversity score and prevalence achieving MDD-W showed responsiveness to seasonal variations, with peaks at the end of the dry season (i.e., April or May) and troughs in the rainy season (i.e., August). Conclusions Five list-based recalls are sufficient to estimate usual FG diversity during gestation, although intra-annual seasonal patterns did modestly affect the FG diversity score and MDD-W prevalence. Thus, timing of repeated dietary surveys is critical to ensure nonbiased inferences of change and trends in Burkina Faso. This trial was registered at clinicaltrials.gov as NCT 03533712.
BACKGROUND AND OBJECTIVES: Over centuries, Ethiopia has experienced severe famines and periods of serious drought, and malnutrition remains a major public health problem. The aims of this study were to estimate seasonal variations in child stunting and wasting, and identify factors associated with both forms of child malnutrition in drought-prone areas. METHODS: This cohort study was conducted among a random sample of 909 children in rural southern Ethiopia. The same children were followed for 1 year (2017-2018) with quarterly repeated measurements of their outcomes: height-for-age and weight-for-height indices (Z-scores). Linear regression models were used to analyse the association between both outcomes and baseline factors (eg, household participation in a social safety net programme and water access) and some time-varying factors (eg, household food insecurity). RESULTS: Child wasting rates varied with seasonal household food insecurity (ᵪ(2) (trend) = 15.9, p=0.001), but stunting rates did not. Household participation in a social safety net programme was associated with decreased stunting (p=0.001) and wasting (p=0.002). In addition to its association with decreased wasting (p=0.001), protected drinking water access enhanced the association between household participation in a social safety net programme and decreased stunting (p=0.009). Absence of a household latrine (p=0.011), lower maternal education level (p=0.001), larger family size (p=0.004) and lack of non-farming income (p=0.002) were associated with increased child stunting. CONCLUSIONS: Seasonal household food insecurity was associated with child undernutrition in rural Ethiopia. Strengthening community-based food security programmes, such as the Ethiopian social safety net programme, could help to reduce child undernutrition in drought-prone areas. Improving clean water access and sanitation could also decrease child undernutrition.Key terms: Z-scores; Social safety net program; Water access. The deprived area of the Metzinger Valley in the city of Mahajanga has many healthcare concerns due to repeated flooding during the rainy season. Improving this health situation requires a better knowledge of the pathogens present in this area and of the risk factors favoring their propagation. The aim of this study was to analyze the relationship between the household socioeconomic status and the presence of parasites in the faeces of children between 1 and 10 years of age in order to determine the risk factors for intestinal parasitosis. The study included 746 children, of whom 30% were infected with parasites. Entamoeba coli, a good indicator of environmental fecal contamination, was the most prevalent parasite with an observation frequency of 16.7% followed by Giardia lamblia with a prevalence of 10%. For helminths, Trichuris and Ascaris were the most prevalent respectively 5.4% and 1.8%. A large heterogeneity in the prevalence of parasites was observed from one neighborhood to another. However, multivariate analysis showed that these differences were not related to environmental factors or household structure, but rather to the economic level of the family, the education level of the mother as well as the age of the child. For example, the prevalence of Giardia decreased from 23.5% to 8% for children of mothers with little education to those with higher education, respectively. For E. coli, the prevalence is higher among poor households and school-aged children. In the frame of IRCOD project, mothers are being sensitized to hygiene and risk factors for transmission by intestinal parasites and the present study proposes a multidimensional approach as an assessment tool. Smallholder irrigation schemes (SISs) have been portrayed as a panacea to climate change adaptation. However, there is an emerging discourse that established schemes are becoming vulnerable to increased climate variability and change, particularly increased water stress. This paper reviews the existing knowledge on risks of climate change and variability in water supply in smallholder irrigation farming in Zimbabwe. In addition, this paper highlights adaptation options to climate change in SISs. Data for this review were collected systematically from peer-reviewed and published literature. The literature used for this study showed that SISs in Zimbabwe are beset with water stress, competing water needs and the outbreak of pests and diseases, which have been related with climate change and variability. Climate change is making Zimbabwe more arid through decreasing precipitation and warming. Droughts and floods are increasing in frequency and severity. Damage by floods is increasing exponentially, impacting environments, ecological systems and national economies. Climate change affects SISs’ productivity and decimates the livelihoods of scheme farmers. The review suggests that there is a need for increased adsorptive, adoptive and transformational capacity for SISs to obtain a new state of resilience from adverse effects of increased climate variability and change. This review recommends understanding and prioritizing solutions to vulnerability to climate change in SISs. Developing-country households are facing an increasingly challenging set of shocks-including climate, economic, political, and health shocks-that in combination present a novel threat to their livelihoods and well-being, and thus to international development progress. There is a growing need to strengthen the evidence base for interventions and programming approaches that bolster households’ resilience to such shocks. In response, this paper documents an impact evaluation of the USAID-funded “Pastoralist Areas Resilience Improvement and Market Expansion” (PRIME) project implemented from 2012 to 2017 in one of the most shock-prone areas of the world, the drylands of Ethiopia. The project’s overall goal was to reduce poverty and hunger by enhancing households’ ability to recover from recurring climate shocks and their downstream economic impacts. As it were, soon after its inception, the drylands were hit by an exceptionally harsh and prolonged shock, a series of multiple, back-to-back, severe droughts. The droughts led to a sharp drop in households’ well-being, measured here by their food security. Using Difference-in-Difference Propensity Score Matching (DID-PSM) in one of the first causal resilience evaluations, this paper demonstrates that, nevertheless, the project’s resilience-strengthening interventions had a positive impact on their ability to recover, slowing the decline in food security considerably. Delving deeper into how this impact was achieved, the paper finds that two programming approaches optimized resilience impacts. First, “Comprehensive Resilience Programming”, whereby interventions spanning multiple sectors were implemented simultaneously in the same geographical areas, made a major difference. Second, while interventions were mainly implemented at a systems-level (e.g., establishing veterinary pharmacies), many households made the decision to actively participate in them. The paper finds that the impact on their resilience was far greater when they did so. The lessons for future resilience projects are that (1) greater impacts can be achieved by taking advantage of the synergies induced when interventions are layered cross-sectorally, and (2) projects with systems-level interventions should pro-actively plan for the direct participation of households so they can take full advantage of their benefits and thereby achieve greater resilience to shocks. The paper also offers some lessons for future resilience impact evaluations. Typhoid fever is a major cause of illness and mortality in low- and middle-income settings. We investigated the association of typhoid fever and rainfall in Blantyre, Malawi, where multi-drug-resistant typhoid has been transmitting since 2011. Peak rainfall preceded the peak in typhoid fever by approximately 15 weeks [95% confidence interval (CI) 13.3, 17.7], indicating no direct biological link. A quasi-Poisson generalised linear modelling framework was used to explore the relationship between rainfall and typhoid incidence at biologically plausible lags of 1-4 weeks. We found a protective effect of rainfall anomalies on typhoid fever, at a two-week lag (P = 0.006), where a 10 mm lower-than-expected rainfall anomaly was associated with up to a 16% reduction in cases (95% CI 7.6, 26.5). Extreme flooding events may cleanse the environment of S. Typhi, while unusually low rainfall may reduce exposure from sewage overflow. These results add to evidence that rainfall anomalies may play a role in the transmission of enteric pathogens, and can help direct future water and sanitation intervention strategies for the control of typhoid fever. This study assessed the process contributions to life cycle impacts of six developed municipal solid waste management (MSWM) options (A1-A6) for Harare. Results show that waste collection contributes to increased acidification, eutrophication and global warming of 0.012, 0.0002 and 0.065 species.yr respectively as well as human health impact potential of 34 DALYs across all the MSWM options. Anaerobic digestion contributed to increased acidification, eutrophication and global warming impact potentials of 0.053, 0,008 and 0.043 species.yr respectively and 52 DALYs under MSWM options A3 to A6. Overall, incineration performed better than landfilling. The recovery of 20% of the recoverable materials for reuse and recycle under MSWM options A5 and A6 contributes to impacts reductions of -0.05, -0.004 and -0.26 species.yr with regards to acidification, eutrophication and global warming respectively and -56 DALYs with regards to human health. Therefore, strategies earmarked at reducing the positive contributions need to be developed. Malaria is the cause of nearly half a million deaths worldwide each year, posing a great socioeconomic burden. Despite recent progress in understanding the influence of climate on malaria infection rates, climatic sources of predictability remain poorly understood and underexploited. Local weather variability alone provides predictive power at short lead times of 1-2 months, too short to adequately plan intervention measures. Here, we show that tropical climatic variability and associated sea surface temperature over the Pacific and Indian Oceans are valuable for predicting malaria in Limpopo, South Africa, up to three seasons ahead. Climatic precursors of malaria outbreaks are first identified via lag-regression analysis of climate data obtained from reanalysis and observational datasets with respect to the monthly malaria case count data provided from 1998-2020 by the Malaria Institute in Tzaneen, South Africa. Out of 11 sea surface temperature sectors analyzed, two regions, the Indian Ocean and western Pacific Ocean regions, emerge as the most robust precursors. The predictive value of these precursors is demonstrated by training a suite of machine-learning classification models to predict whether malaria case counts are above or below the median historical levels and assessing their skills in providing early warning predictions of malaria incidence with lead times ranging from 1 month to a year. Through the development of this prediction system, we find that past information about SST over the western Pacific Ocean offers impressive prediction skills (~80% accuracy) for up to three seasons (9 months) ahead. SST variability over the tropical Indian Ocean is also found to provide good skills up to two seasons (6 months) ahead. This outcome represents an extension of the effective prediction lead time by about one to two seasons compared to previous prediction systems that were more computationally costly compared to the machine learning techniques used in the current study. It also demonstrates the value of climatic information and the prediction framework developed herein for the early planning of interventions against malaria outbreaks. Feco-orally transmitted infectious diseases are common in Nigeria where the potable water access is poor. In the south-western Nigerian Ibadan metropolis, supply of municipal water is meagre as residents depend on household wells and boreholes. The likelihood of fecal contamination of household water sources in Ibadan was examined longitudinally to quantify and understand its impact. Well and borehole water samples aseptically collected from 96 households in Ibadan were assessed for total heterotrophic counts (THCs), total coliform counts (TCCs) and total Escherichia coli counts (TECs) using a pour plate technique. E. coli were identified by uidA and whole-genome sequencing using Illumina technology, whereas virulence factors were predicted using VirulenceFinder. There was season-independent abundance of THC and TCC in the well and borehole with a significant recovery of E. coli in the wells during the wet season compared to the dry season (P = 0.0001). Virulence genes associated with pathogenic E. coli were identified in 13 (52%) strains with one E. coli each classified as extra-intestinal E. coli, avian pathogenic E. coli and enteroaggregative E. coli. High heterotrophic and coliform counts, with rainfall-driven E. coli contamination revealed that the water sources evaluated in this study are unfit for consumption. Global heating is considered one of the greatest threats to human health and well-being. Supporting human resilience to heating threats is imperative, but under-investigated. In response, this article reports a study that drew together results from quantitative data on perceptions of thermal comfort and mechanisms for coping with thermal discomfort among 406 households in a study in Giyani, Limpopo province. Indoor dwelling and outdoor temperatures were also analysed. Most participants perceived their dwellings to be too hot when it was hot outdoors. People relied on recommended heat health actions such as sitting outdoors in the shade or opening windows. While this agency is meaningful, resilience to climate change requires more than personal action. In light of the climate threats and climate-related disaster risks facing South Africa, an all-encompassing approach, including education campaigns, climate-proofed housing, access to basic services, and financial considerations that will help support resilient coping among South Africans, is urgently required. The uncertainty that the COVID-19 pandemic has brought demonstrates that income redistribution and traditional debt relief mechanisms are insufficient to meet public spending needs, mitigate external debt, and comply with the UN’s Sustainable Development Goals (SDGs), which aim to reduce multilateral debt to sustainable levels. Also, West African countries have focused their attention on the long-term fight against poverty and inequality and strengthening their social programs, especially in primary health care and macroeconomic stability. However, for more than a decade, the developing and least developed countries of West Africa have faced rapidly weakening macroeconomic conditions, combining several interrelated crises such as the sharp decline in oil prices, volatile financial markets and tourism disruptions, a global recession, the crisis of climate change, and shortages of food and energy, along with the economic contraction of COVID-19. Data from these countries show that health spending increases economic growth, minimizes infant mortality rates, and reduces debt. Furthermore, increasing government spending efficiency reduces the total debt and improves the health sector, in particular. The water, energy, land and food (WELF) nexus has been touted as a cross-sectoral systems approach that presents an opportunity to address the grand challenges related to poverty, unemployment, inequality and climate change, especially in the global South. However, as with any other developmental approach, the WELF nexus needs to mainstream gender, which often lies at the heart of poverty, unemployment, and inequality in sub-Saharan Africa. Access to water, energy, land and food is gendered, and so are livelihood strategies and climate change responses. Inequitable access to these resources, gender inequalities, socio-economic vulnerability and cultural norms contribute to women’s susceptibility to the impacts of climate change and limit their ability to harness opportunities arising from it. Reducing women’s vulnerability to the impacts of climate change in SSA and improving equity in natural resource access and resource use efficiencies will require transformation of gender relations and the active participation of both men and women in decision-making processes. Moreover, policies and interventions that cater to the WELF nexus need be updated to be more gender-aware and sensitive, as this will also contribute to addressing Sustainable Development Goal 5, in addition to Goals 1, 2, 6, 7, and 15. Three Coupled Model Intercomparison Project 5 (CMIP5) models that simulated the G4 experiment of the Geoengineering Model Intercomparison Project (GeoMIP) were used to investigate the impact of stratospheric aerosol injection (SAI) on combined temperature and precipitation extremes in Africa that can have greater negative impacts on human and the environment than individual rainfall or temperature extremes. The examined compound extremes included the dry (R(warm׀dry) and R(cold׀dry)) and wet (R(warm׀wet) and R(cold׀wet)) modes assessed during the injection (SAI, 2050-2069) and post-injection (postSAI, 2070-2089) periods compared with the historical period (1986-2005). We found a significant projected change in the occurrence of both wet and dry modes during SAI and postSAI related to the historical period. The magnitude and sign of this change depend on the season and the geographical location. During the SAI and postSAI, the wet (R(warm׀wet) and R(cold׀wet)) modes are projected to be significantly lower while the dry modes are noted to increase in a large part of African continent depending on the season and the geographical location and may consequently leads to an increase of the droughts prone areas. The termination effect is noted to reduce the occurrence of dry modes, which may reduce the potential negative effects of the injection after halting. As the effect may vary from one region to another and according to the season, it suggested assessing the key sector impacts of SAI. Thus, this change in dry modes due to SAI could affect all activities which depend on water resources such as water supply, agriculture and food production, energy demand, and production with adverse effects on health, security, and sustainable development, but this needs to be assessed and quantified at regional scales. Climate and other environmental factors continue to play important contributions on the livelihoods of communities all over the world. Their influence during historical periods and the roles they played remain under-reported. The main objective of this review is to investigate the climatological conditions during the time of the invasion of early European settlers in Southern Africa in the 19th and early 20th centuries. It establishes the possible relationships between climate variability and historical conflicts and wars, famines, disease pandemics, and the migration of African people to towns in search of sustainable and predictable livelihoods away from unreliable agriculture. A qualitative analysis of published peer reviewed literature in the form of reports, papers, and books was used in this review. At least 60 literature items were reviewed in this paper. There is a relationship between climate variability and the historical events of the 19th and early 20th centuries. Tribal conflicts and most of the wars between the settlers and the African people for land coincided with periods of droughts. Drought were key causes of famines, instabilities, and land degradation in the region. This study highlights the influence of environmental conditions on socio-economic conditions as the world enters an era of climate change and urbanization in developing countries, particularly in Africa. It shows that the hardships caused by environmental conditions have the potential to destabilize societies. Water is the key limiting factor in socioeconomic and ecological development, but it is adversely affected by climate change. The novel virtual water (VW) concept and water, energy, food, biodiversity, and human health (WEFBH) nexus approach are powerful tools to assess the sustainability of a region through the lens of climate change. Climate change-related challenges and water are complex and intertwined. This paper analyzed the significant WEFBH sectors using the multicriteria decision-making (MCDM) and analytic hierarchy process (AHP) model. The AHP model demonstrated quantitative relationships among WEFBH nexus sustainability indicators in the Greater Horn of Africa countries. Besides, the net VW imports and water footprints of major staple crops were assessed. The composite WEFBH nexus indices varied from 0.10 to 0.14. The water footprint of crops is increasing period by period. The results also revealed that most countries in the study area are facing WEFBH domains unsustainability due to weak planning or improper management strategies. The strong policy constancy among the WEFBH sector is vital for dissociating the high-water consumption from crop production, energy, environmental, and human health system. Thus, this study enhances insights into the interdependencies, interconnectedness, and interactions of sectors thereby strengthening the coordination, complementarities, and synergies among them. To attain sustainable development, we urgently call all public and private entities to value the amount of VW used in their daily activities and design better policies on the complex WEFBH nexus and future climate change. Urban water security is of critical global and local importance. Across many parts of low- and middle-income countries, urban water security either remains elusive or is becoming stressed. Rapid urbanisation and climate change are two key drivers of resource insecurity and at the forefront of urban water discourse. However, there are manifold and complex socio-political processes functioning alongside these megatrends that are often underemphasised. Drawing on three urban case studies in Ethiopia, we highlight these structural issues and the need for their continued consideration to fully understand and address urban water insecurity. Household water-use surveys, semi-structured interviews and participatory exercises with community residents, stakeholders and informal water vendors were used as part of a mixed-method approach in three urban areas. We found that government-managed urban water supplies were intermittent and unsafe, resulting in economic, health and time-use burdens for households, and that the socio-political dimensions reproducing urban water insecurity have historical roots. We argue that the uncertainty of climate change and unprecedented urbanisation do not offer sufficient explanation for why urban water insecurity persists. Moreover, we call for caution in only employing these narratives, to avoid obscuring deeply rooted challenges within socio-political systems. We call for socio-political processes to continue to be a central component of future interventions that seek to improve urban water insecurity. This paper explores the role of decentralised community-based care systems in achieving sustainable healthcare in resource-poor areas. Based on case studies from Sierra Leone, Madagascar, Uganda and Ethiopia, the paper argues that a community-based system of healthcare is more effective in the prevention, early diagnosis, and primary care in response to the zoonotic and infectious diseases associated with extreme weather events as well as their direct health impacts. Community-based systems of care have a more holistic view of the determinants of health and can integrate responses to health challenges, social wellbeing, ecological and economic viability. The case studies profiled in this paper reveal the importance of expanding notions of health to encompass the whole environment (physical and social, across time and space) in which people live, including the explicit recognition of ecological interests and their interconnections with health. While much work still needs to be done in defining and measuring successful community responses to health and other crises, we identify two potentially core criteria: the inclusion and integration of local knowledge in response planning and actions, and the involvement of researchers and practitioners, e.g., community-embedded health workers and NGO staff, as trusted key interlocuters in brokering knowledge and devising sustainable community systems of care. Intersectoral collaborations are an integral component of the prevention and control of diseases in a complex health system. On the one hand, One Health (OH) is promoting the establishment of intersectoral collaborations for prevention at the human-animal-environment interface. On the other hand, operationalising OH can only be realized through intersectoral collaborations. This work contributes to broadening the knowledge of the process for operationalising OH by analysing the governance structures behind different initiatives that tackle health problems at the human-animal-environment interface. The cases taken as examples for the analysis are the control and response to rabies and avian influenza under “classical OH”, and the management of floods and droughts for insights into “extended OH”. Data from Ghana and India were collected and compared to identify the key elements that enable ISC for OH. Despite the case studies being heterogeneous in terms of their geographic, economic, social, cultural, and historical contexts, strong similarities were identified on how intersectoral collaborations in OH were initiated, managed, and taken to scale. The actions documented for rabies prevention and control were historically based on one sector being the leader and implementer of activities, while avian influenza management relied more on intersectoral collaborations with clearly defined sectoral responsibilities. The management of the impact of flood and droughts on health provided a good example of intersectoral collaborations achieved by sectoral integration; however, the human health component was only involved in the response stage in the case of Ghana, while for India, there were broader schemes of intersectoral collaborations for prevention, adaptation, and response concerning climate change and disaster. Weather, climate, and climate change are affecting human health, with scientific evidence increasing substantially over the past two decades, but with very limited research from low- and middle-income countries. The health effects of climate change occur mainly because of the consequences of rising temperatures, rising sea levels, and an increase in extreme weather events. These exposures interact with demographic, socio-economic, and environmental factors, as well as access to and the quality of health care, to affect the magnitude and pattern of risks. Health risks are unevenly distributed around the world, and within countries and across population groups. Existing health challenges and inequalities are likely to be exacerbated by climate change. This narrative review provides an overview of the health impacts of weather, climate, and climate change, particularly on vulnerable regions and populations in sub-Saharan Africa and South Asia, and discusses the importance of protecting human health in a changing climate; such measures are critical to reducing poverty and inequality at all scales. Three case summaries from the INDEPTH Health and Demographic Surveillance Systems highlight examples of research that quantified associations between weather and health outcomes. These and comparable surveillance systems can provide critical knowledge to increase resilience and decrease inequalities in an increasingly warming world. There is potential for increased pesticide-related adverse health outcomes in the agricultural sector linked to adaptive increases in pesticide use necessitated, in part, by climate change-related increases in pest populations. To understand the role of adaptation practices in pesticide use and health risks, this study assessed Zimbabwean smallholder cotton farmers’ adaptive responses linked to their climate change perceptions. In depth interviews were conducted with 50 farmers who had been growing cotton for at least 30 years. The study identified farmers’ adaptation practices that increased their pesticide use, as well as those that presented opportunities for reducing pesticide use through non-pesticide-dependent adaptation pathways. The findings show that due to perceived climate change impacts, such as a shorter growing season, farmers were adopting a range of adaptive practices. These included changes in pest management practices, such as increasing pesticide spraying frequencies due to keeping ratoon crops, which were increasing farmers’ overall pesticide use. Such incremental adaptive practices are potentially maladaptive, as they may increase farmers’ pesticide-related health risks. Other practices, however, such as reducing cotton acreage and diversifying crops, resulting in transformational adaptation, suggest the existence of opportunities for decreasing overall pesticide use or totally eliminating pesticides from the farming system. In most sub-Saharan African countries, staple cereal grains harbor many fungi and some produce mycotoxins that negatively impact health and trade. Maize and three small grain cereals (sorghum, pearl millet, and finger millet) produced by smallholder farmers in Zimbabwe during 2016 and 2017 were examined for fungal community structure, and total aflatoxin (AF) and fumonisin (FM) content. A total of 800 maize and 180 small grain samples were collected at harvest and during storage from four agroecological zones. Fusarium spp. dominated the fungi associated with maize. Across crops, Aspergillusflavus constituted the main Aspergillus spp. Small grain cereals were less susceptible to both AF and FM. AF (52%) and FM (89%) prevalence was higher in maize than in small grains (13-25% for AF and 0-32% for FM). Less than 2% of small grain samples exceeded the EU regulatory limit for AF (4 µg/kg), while <10% exceeded the EU regulatory limit for FM (1000 µg/kg). For maize, 28% and 54% of samples exceeded AF and FM Codex guidance limits, respectively. Higher AF contamination occurred in the drier and hotter areas while more FM occurred in the wetter year. AF exposure risk assessment revealed that small grain consumption posed low health risks (≤0.02 liver cancer cases/100,000 persons/year) while maize consumption potentially caused higher liver cancer rates of up to 9.2 cases/100,000 persons/year depending on the locality. Additionally, FM hazard quotients from maize consumption among children and adults were high in both years, but more so in a wet year than a dry year. Adoption of AF and FM management practices throughout the maize value chain coupled with policies supporting dietary diversification are needed to protect maize consumers in Zimbabwe from AF- and FM-associated health effects. The higher risk of health burden from diseases associated with elevated concentration of mycotoxins in preferred maize during climate change events can be relieved by increased consumption of small grains.
The prevalence of food insecurity is much higher in East Africa than in other parts of the world. Climate change and associated variability are important contributors to food insecurity in the region. Using primary data collected in 2018/19 from Ethiopia, Kenya and Tanzania, this study examines the links between the prevalence of household food insecurity (the access to food dimension) and vulnerability to climate change in East Africa. The Household Food Insecurity Access Scale (HFIAS) was constructed to measure the prevalence of household food insecurity, and an ordered probit econometrics model was used to investigate the factors affecting the prevalence rates. The aggregate results show that 52% of the total sampled households in the region were food-secure; 15% and 26% were mildly food-secure and moderately food-insecure, respectively; and the remaining 7% were severely food-insecure. The ordered probit results suggest that exposure to climate change extremes and crop losses caused by these extremes significantly contribute to the prevalence of food insecurity across countries in East Africa. The results also indicate that households’ adaptive capacity plays a significant role in reducing the prevalence of food insecurity. The demographic/human, social, financial, physical, and natural assets/capital of the household also play a significant role in reducing household-level food insecurity in Ethiopia, Kenya, and Tanzania. INTRODUCTION: Reunion Island is a French overseas department characterized by a tropical climate with 2 distinct seasons. While the prevalence of asthma among adults in Reunion Island is close to that in mainland France, mortality and hospitalization rates are twice as high. To date, however, no epidemiological studies have evaluated the influence of environmental factors in asthma exacerbations in Reunion Island. METHODS: From January 2010 to June 2013, 1157 residents of Saint-Denis visited the emergency rooms of the Centre hospitalier universitaire site Nord de Saint-Denis for asthma. After exclusion of children under the age of 3, 864 visits were analyzed. These were correlated with the following daily factors: pollens and molds, meteorological parameters (temperature, precipitation levels, humidity and relative humidity levels, wind), pollutants (sulfur dioxide (SO(2)), nitrogen oxide (NO(x)), and the fine particles PM(10) and PM(2.5)), and the influenza virus. The correlation between these factors was evaluated using the DLNM and GO-GARCH models. RESULTS: Of the 864 analyzed visits, 532 were by pediatric patients (aged 3 to 16 years) and 332 by adult patients (aged over 16 years). In adults, pollens positively correlated with asthma exacerbations were Urticaceae, Oleaceae, Moraceae, and Chenopodiaceae. In children, these were Urticaceae, Oleaceae, Poaceae, and Myrtaceae. Molds positively correlated with asthma exacerbations in adults were ascospores and basidiospores. Only basidiospores were positively correlated with exacerbations in children. Temperature was positively correlated with exacerbations in both adults and children. The pollutants PM(10) and NO(x) were positively correlated with exacerbations in children. Influenza epidemics were strongly correlated with exacerbations in both adults and children. CONCLUSION: Our analysis shows that in Reunion Island, asthma is exacerbated by pollens (Urticaceae, Oleaceae, Moraceae, Chenopodiaceae in adults; Urticaceae, Oleaceae, Poaceae, Myrtaceae in children), molds (ascospores and basidiospores in adults; basidiospores in children), temperature, influenza, and the pollutants PM(10) and NO(x) (in children). In recent years, walkability is increasingly integrated into sustainability strategies, considering its many health and environmental benefits. Besides, thermal comfort also has been progressively promoted as a critical measure for pedestrian comfort and wellbeing. Despite the relevance of the two concepts, few studies combined them in a comprehensive model. This study considers thermal comfort in assessing walkability by developing a new measurement tool, the Street Walkability and Thermal Comfort Index (SWTCI), which focuses on comfort facilities and Physiological Equivalent Temperature (PET), at the street scale. The applied point system method requires combining a questionnaire survey, observations, and in situ measurements (air temperature, wind velocity, and relative humidity). The questionnaire survey (330 responders) measured 21 street design indicators’ importance, using a five-point Likert scale ranging from 1 (least important) to 5 (very important). The observation technique seeks to evaluate every pedestrian comfort indicator score (Si(s)). The in situ measurements permit Envi-met’s calibrated data validation and getting the mean radian temperature (T(mrt)). Those were considered in the PET’s calculation using Rayman software. Three distinct streets have been chosen in Annaba city, Algeria, within the Mediterranean climate (Csa). The results show that the SWTCI achieves its highest score on the three streets when the thermal perception is neutral (20 < PET <26), and its lowest score, with a warm thermal sensation (28 < PET < 31). Despite the divergence in PET values, the highest score of SWTCI was 33%, reflecting a low comfort quality and minimal pedestrian facilities. Applying the SWTCI method can transform uncomfortable streets into an ideal walkable and pleasant path by finding the problems and proposing improvements.
While climate change is a global challenge, its impact is generally felt in local communities, particularly cities. The impact of climate change in urban settings is exacerbated by the built environment, high energy usage, air pollution and urbanisation, among other factors. Due to urbanisation, more children will be born and raised, or migrate to live in cities. Children in cities are vulnerable to the impact of climate change due to their physiology and developmental needs. City authorities are expected to utilise their constitutional and legislative powers in climate governance to protect children from the impact of climate change. The central inquiry of this article is to explore how city-level climate law and policy protects children in the context of climate change. Using Kenya and South Africa, as key examples, it illustrates that cities have constitutional powers and legislative authority to plan, implement and govern in certain climate-related functional areas and that could be leveraged to ensure the protection of children. The discussion of cities, children’s rights and climate change governance has global significance given the trends of urban growth in the present and coming decade. Research on climate change and human population growth has focused mainly on how population size affects greenhouse gas emissions. Much less is known about how changes in temperature and precipitation, and corresponding socioeconomic impacts, influence population growth despite plausible rationale for such effects. We examine this relationship using birth histories from 1982 through 2017 in 23 sub-Saharan African countries, combined with high-resolution historical climate records. Our analyses show that exposure to climatic variability is associated with changes in the probability of childbearing, at least in the short run. Women exposed to spells of above-average temperatures and below-average precipitation experience significant reductions in the probability of fertility in the subsequent year. The association between precipitation anomalies and birth rates is particularly robust, though the estimated magnitude of effects is modest. We find substantively meaningful variation in both temperature and precipitation effects between demographic groups and across countries. Our results underscore the need to consider changes in fertility among the adaptive strategies households will employ in the face of environmental change. They also highlight the need to incorporate feedbacks between climate and fertility in models of population change and greenhouse gas emissions. IMPORTANCE: Extreme precipitation, including heavy rains and flooding, is associated with poor health outcomes mediated in part by decreases in income and food production. However, the association between heavy rains and HIV burden is unknown. OBJECTIVE: To investigate the association between heavy rainfall, HIV prevalence, and HIV transmission risk over a 12-year span in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional population-based study, using data collected from the 2005-2017 Demographic and Health Surveys, was conducted in 21 countries in sub-Saharan Africa and analyzed from July 29, 2021, to June 14, 2022. EXPOSURES: Heavy rainfall was defined based on the extent to which annual rainfall deviated from the historical average (standardized precipitation index ≥1.5) at the enumeration area level. MAIN OUTCOMES AND MEASURES: HIV, self-reported sexually transmitted infections (STIs), and number of sexual partners. RESULTS: The study included 288 333 participants aged 15 to 59 years; 172 344 were women (59.8%), and 183 378 were married (63.6%). Mean (SD) age was 31.9 (10.0) years. Overall, 42.4% of participants were exposed to at least 1 year of heavy rainfall in the past 10 years. Each year of heavy rainfall was associated with 1.14 (95% CI, 1.11-1.18) times the odds of HIV infection and 1.11 (95% CI, 1.07-1.15) times the odds of an STI in the past 12 months. There was also an association between heavy rainfall and the reported number of sexual partners (incident rate ratio, 1.12; 95% CI, 1.10-1.15). The odds were greater for the association between heavy rainfall and HIV prevalence and STIs among participants aged older than 20 years and participants in rural areas. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that heavy rainfall was associated with a higher HIV burden in sub-Saharan Africa. The association between heavy rainfall and STIs and number of sexual partners suggests that an increase in the risk of sexual transmission is a plausible mechanism for the observed findings around HIV prevalence. Heavy rainfall could also worsen food insecurity, increasing the risk of transactional sex, or cause damage to public health infrastructure, reducing access to STI education, HIV testing, and treatment. INTRODUCTION: Climate change is a global public health emergency with implications for access to care and emergency care service disruptions. The African continent is particularly vulnerable to climate-related extreme weather events due to an already overburdened health system, lack of early warning signs, poverty, inadequate infrastructure, and variable adaptive capacity. Emergency care services are not only utilized during these events but also threatened by these hazards. Considering that the effects of climate change are expected to increase in intensity and prevalence, it is increasingly important for emergency care to prepare to respond to the changes in presentation and demand. The aim of this study was to perform a scoping review of the available literature on the relationship between climate change and emergency care on the African continent. METHODS: A scoping review was completed using five databases: Pubmed, Web of Science, GreenFILE, Africa Wide Information, and Google Scholar. A ‘grey’ literature search was done to identify key reports and references from included articles. Two independent reviewers screened articles and a third reviewer decided conflicts. A total of 1,382 individual articles were initially screened with 17 meeting full text review. A total of six articles were included in the final analysis. Data from four countries were represented including Uganda, Ghana, Tanzania, and Nigeria. RESULTS: Analysis of the six articles yielded three key themes that were identified: climate-related health impacts that contribute to surges in demand and resource utilization, opportunities for health sector engagement, and solutions to improve emergency preparedness. Authors used the outcomes of the review to propose 10 recommendations for decision-makers and leaders. DXDISCUSSION: Incorporating these key recommendations at the local and national level could help improve preparedness and adaptation measures in highly vulnerable, populated areas on the African continent. INTRODUCTION: Climate change exacerbates existing sociopolitical and economic vulnerabilities, undermining livelihoods, inflating the risk of conflict, and making it difficult for people to remain stable. In 2019, around 25 million new displacements occurred due to natural disasters. This review aims to summarize the existing evidence regarding the impact of climate change on the health of African immigrants. METHODS: Nine databases were systematically searched using a strategy developed in collaboration with a subject librarian. Potentially relevant articles were identified, screened, and reviewed by at least two reviewers, with a third reviewer resolving conflicts where necessary. Data were extracted from relevant articles using a standardized form. RESULTS: Seven studies (three cross-sectional, two qualitative, one cohort, and one need assessment report) were identified; they included different categories of African migrants and reported on various aspects of health. The included articles report on climate change, e.g., flooding, drought, and excess heat, resulting in respiratory illness, mental health issues, malnutrition, and premature mortality among African immigrants. CONCLUSION: This review suggests climate change adversely affects the physical, mental, and social health of African immigrants. It also highlights a knowledge gap in evidence related to the impact of climate change on the health of African immigrants. Africa is predicted to be the region most affected by climate change and water is one of the sectors with anticipated severe impacts. Innovations in this sector are being promoted as part of the adaptation solutions to this problem. In this paper, we use available data on water-related climate change adaptation technological developments to examine the degree to which the vulnerability to climate change in the water sector is motivating these innovations. Using pooled data for African countries between 1990 and 2016, we estimate the relationship between climate-induced vulnerability in the water sector and water-related innovations, controlling for country size and proxies for technology transfer environment, institutional and regulatory quality, knowledge base, and research and development activity. Data on innovative activity shows evidence of over-dispersion; thus we use the negative binomial distribution with robust standard errors for estimation of our model. We find evidence that countries most exposed to water stress are innovating at lower rates. Though counterintuitive, this result is explained by the fact that such vulnerable countries also tend to have little research and development infrastructure needed to develop the kind of high quality innovations that usually necessitate patenting. Our result suggests that African countries experiencing water stress may need to reconsider priorities in the design of water-related adaptation to climate change. We also find that a country’s knowledge base and openness to trade are important determinants of adaptation technologies in the water sector. (C) 2021 Elsevier Ltd. All rights reserved. Vulnerability to climate change and variability impacts has been identified as a major cog in the wheel of both livelihood and resilience, particularly in vulnerable groups in rural areas. This study aims to assess genders’ vulnerability dimension to climate change and variability in REDD + (Reducing Emission from Deforestation and Forest Degradation+) piloted site/clusters, Cross River State, Nigeria. Data were proportionately collected from selected 200 respondents on gender disaggregated level using questionnaires. The assessment adopted the sustainable livelihood approach (livelihood vulnerability index) and compared the results with the IPCC vulnerability standard of exposure, sensitivity and adaptive capacity weighted mean. The results revealed a significant difference in the vulnerability dimension of both women and men disaggregated levels (LVI: men 0.509, women 0.618). The women category was more vulnerable to six out of seven major components of LVI assessed: (livelihood strategies (0.646), social networks (0.364), water (0.559), health (0.379), food and nutrition (0.507), and natural hazards and climate variability (0.482), while men only vulnerable to socio-demographic major component (0.346). Vulnerability indices also showed women to be more exposed (0.482), and sensitive (0.489) with the least adaptive capacities (0.462) to the climate change and variability impacts. Overall, on the IPCC-LVI index, women are more vulnerable (0.0098) to climate change and variability impacts than men (-0.0093). The study recommends that the women’s category resilience and adaptive capacity should be empowered in adaptation projects in climate change such as REDD + (Reducing Emissions from Deforestation and Forest Degradation+) to reduce their vulnerability to impacts of climate change and variability in the context of exposure, sensitivity, and adaptive capacities. This will be instrumental in formulating policies to address the specific needs of gender categories in reducing vulnerability to climate change and variability. This pragmatic approach may be used to monitor gender vulnerability dimension, and livelihood enhancement and evaluate potential climate change adaptation programs. Additionally, the introduction of IPCC-LVI as a baseline instrument will enhance information on gender resilience and adaptive capacity for policy effectiveness in a data-scarce region particularly Africa. Climate change will put millions more people in Africa at risk of food and nutrition insecurity by 2050. Integrated assessments of food systems tend to be limited by either heavy reliance on models or a lack of information on food and nutrition security. Accordingly, we developed a novel integrated assessment framework that combines models with in-country knowledge and expert academic judgement to explore climate-smart and nutrition-secure food system futures: the integrated Future Estimator for Emissions and Diets (iFEED). Here, we describe iFEED and present its application in Malawi, South Africa, Tanzania and Zambia. The iFEED process begins with a participatory scenario workshop. In-country stakeholders identify two key drivers of food system change, and from these, four possible scenarios are defined. These scenarios provide the underlying narratives of change to the food system. Integrated modeling of climate change, food production and greenhouse gas emissions is then used to explore nutrition security and climate-smart agriculture outcomes for each scenario. Model results are summarized using calibrated statements-quantitative statements of model outcomes and our confidence in them. These include statements about the way in which different trade futures interact with climate change and domestic production in determining nutrition security at the national level. To understand what the model results mean for food systems, the calibrated statements are expanded upon using implication statements. The implications rely on input from a wide range of academic experts-including agro-ecologists and social scientists. A series of workshops are used to incorporate in-country expertise, identifying any gaps in knowledge and summarizing information for country-level recommendations. iFEED stakeholder champions help throughout by providing in-country expertise and disseminating knowledge to policy makers. iFEED has numerous novel aspects that can be used and developed in future work. It provides information to support evidence-based decisions for a climate-smart and nutrition-secure future. In particular, iFEED: (i) employs novel and inclusive reporting of model results and associated in-country food system activities, with comprehensive reporting of uncertainty; (ii) includes climate change mitigation alongside adaptation measures; and (iii) quantifies future population-level nutrition security, as opposed to simply assessing future production and food security implications. PURPOSE OF REVIEW: The aim of this review is to summarize and provide clear insights into studies that evaluate the interaction between air pollution, climate, and health in North Africa. RECENT FINDINGS: Few studies have estimated the effects of climate and air pollution on health in North Africa. Most of the studies highlighted the evidence of the link between climate and air pollution as driving factors and increased mortality and morbidity as health outcomes. Each North African country prioritized research on a specific health factor. It was observed that the health outcome from each driving factor depends on the studied area and data availability. The latter is a major challenge in the region. As such, more studies should be led in the future to cover more areas in North Africa and when more data are available. Data availability will help to explore the applicability of different tools and techniques new to the region. This review explores studies related to climate and air pollution, and their possible impacts on health in North Africa. On one hand, air quality studies have focused mainly on particulate matter exceedance levels and their long-term exposure impacts, namely, morbidity and mortality. The observed differences between the various studies are mainly due to the used exposure-response function, the studied population, background emissions, and natural emission from the Sahara Desert that characterize the region. On the other hand, climate studies have focused primarily on the impact of heat waves, vector-borne disease, and mental disorders. More than half of these studies have been on leishmaniasis disease. The review revealed unbalanced and insufficient research on health impacts from air pollution episodes and climate extremes across the region. In the past two decades, several studies on arsenic (As) occurrence in the environment, particularly in surface and groundwater systems have reported high levels of As in some African countries. Arsenic concentrations up to 10,000 mu g/L have been reported in surface water systems, caused by human activities such as mining, industrial effluents, and municipal solid waste disposals. Similarly, concentrations up to 1760 mu g/L have been reported in many groundwater systems which account for approximately 60% of drinking water demand in rural Africa. Naturally, As is mobilized in groundwater systems through weathering processes and dissolution of As bearing minerals such as sulfides (pyrite, arsenopyrite, and chalcopyrite), iron oxides, other mineralized granitic and gneissic rocks, and climate change factors triggering As release in groundwater. Recently, public health studies in some African countries such as Tanzania and Ethiopia have reported high levels of As in human tissues such as toenails as well as in urine among pregnant women exposed to As contaminated groundwater, respectively. In urine, concentrations up to 150 mu g/L were reported among pregnant women depending on As contaminated drinking water within Geita gold mining areas in the north-western part of Tanzania. However, the studies on As occurrence, and mobilization in African water systems, as well as related health effects are limited, due to the lack of awareness. The current study aims to gather information on the occurrence of As in different environmental compartments, its spatial variability, public health problems and the potential remediation options of As in water sources. The study also aims at creating awareness of As contamination in Africa and its removal using locally available materials. The current and projected warming of the earth is unequivocal with humans playing a strong role as both perpetrators and victims. The warming on the African continent is projected to be greater than the global average with an increased average temperature of 3–6°C by the end of the century under a high Representative Concentration Pathway. In Africa, the Sub-Saharan region is identified as the most vulnerable to the changing climate due to its very low capacity to adapt to or mitigate climate change. While it is common to identify studies conducted to assess how climate change independently impacts water, land, or food resources, very limited studies have sought to address the interlinkages, synergies, and trade-offs existing between climate change, water, land, and food (WLF) resources as a system in Sub-Saharan Africa (SSA). The climate change and WLF security nexus, therefore, seeks to address this shortfall in literature and subsequently serve as a relevant source of information for decision-making and policy implementation concerning climate change mitigation and adaptation. In this study, 41 relevant studies were selected from Web of Science, Google Scholar, ResearchGate, and institutional websites. We provide information on the independent relationships between climate change and WLF resources, and further discuss the existing inter-linkages between climate change and the WLF security in SSA using the nexus approach, with recommendations on how decision making and policy implementations should be done using the climate change and WLF security nexus approach. In Africa, water resources pervade multiple sustainable development goals (SDGs), which mainly focus on eliminating poverty (SDG 1) and hunger (SDG 2), promoting good health and well-being (SDG 3) and supporting clean water and sanitation (SDG 6). Africa’s water scarcity problems have been worsened by population growth and climate change. Agriculture is the largest consumer of water in Africa, and a clear understanding of the water-food nexus is necessary to effectively alleviate water-related pressures on food security. Water footprint (WF) accounts and decompositions provide insights into water management planning for policy-makers. We investigated the WF of food consumption from 2000 to 2018 in 23 African countries and used the logarithmic mean Divisia index (LMDI) to decompose its driving forces into consumption structure, per capita food consumption, water intensity and population effect. The WF of food consumption increased from 609.8 km(3) in 2000 to 1212.9 km(3) in 2018, with an average annual growth rate of 3.7%. The population effect contributed most to this change (64.6%), followed by per capita food consumption (28.3%) and consumption structure (7.1%). Cereals (46.7%) and livestock (24.4%) were the major contributors to the increase in the total WF. Our findings highlight that controlling population growth and improving water efficiency are effective measures to relieve water-related pressures on food consumption. However, a healthy dietary structure must also be promoted because Africa’s current dietary energy level is below the global average. Moreover, nine countries in the research area have an inadequate supply of dietary energy; this will inevitably drive the WF of food, as calories increase and diets change. This study is helpful for understanding the water-food nexus in Africa and provides strategies to conserve water and enhance food production. The changing climate has negatively impacted food systems by affecting rainfall patterns and leading to drought, flooding, and higher temperatures which reduce food production. This study examined the ability of communities to cope with food insecurity due to the changing climate in the Serere and Buyende districts, which are two different agro-ecological zones of Uganda. We administered 806 questionnaires to households, a sample size which was determined using Yamane’s formula, with the snowball sampling method used to select the households. The questionnaire sought information, including that regarding the respondents’ resources, the effects of climate change on households, and the coping mechanisms employed to reduce the impact of climate change on food security. The data collected was coded and analyzed using the statistical package for the social sciences (SPSS). Agriculture was found to be the main source of income for 42.4% of male adults and 41.2% of female adults in Serere. In Buyende, 39.9% of males and 33.7% of females rely on selling animal, poultry, and food crops. Aggregate results further showed that 58.3% of females and 42.2% of the males from both districts had suffered from the impacts of climate change, and that the effects were more evident between March and May, when communities experienced crop failure. The study further found that the percentage of households who had three meals a day was reduced from 59.7% to 43.6%, while the number of households with no major meals a day increased from 1.3% to 1.6%. We also found that 34.3% of households reported buying food during periods of crop failure or food scarcity. Moreover, despite reporting an understanding of several coping mechanisms, many households were limited in their ability to implement the coping mechanisms by their low incomes. This reinforced their reliance on affordable mechanisms, such as growing drought-resistant crops (32.7%), rearing drought-resistant livestock breeds (26.1%), and reducing the number of meals a day (14.5%), which are mechanisms that are insufficient for solving all the climate-related food insecurity challenges. We recommend that the government intervenes by revising policies which help farmers cope with the negative effects of climate change, promoting the sensitization of farmers to employing the coping mechanisms, and subsidizing agricultural inputs, such as resistant varieties of crops, for all to afford. Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population’s interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs’ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants’ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels. This paper uses dozens of large-scale household surveys to measure average changes in fertility following hundreds of droughts, floods, earthquakes, tropical cyclones, other storms, and epidemics in Africa between 1980 and 2016. Droughts are the largest and longest-lasting type of disaster on average, and fertility decreases by between 3.5 and 6.8 percent in the five years after droughts. Fertility changes are smaller or less clear after other types of disasters. Comparisons between countries, rather than within countries, drive these findings. There is substantial geographic heterogeneity in the direction and magnitude of the changes in fertility after disasters, driven by characteristics of the disasters and survey respondents. Fertility decreases especially after more recent droughts and in areas prone to drought. Fertility also decreases after longer floods. Fertility decreases after epidemics for women near the start and end of their childbearing careers, but increases for women in their late twenties and early thirties. Greenland and Robins Government departments use the air quality index (AQI) to inform the public about how unhealthy the air is now or may become in the future. As the AQI increases, so do the health threats. It is a daily air quality index that is used to report on air quality. In addition, a measure of how air pollution impacts one’s health over a limited period of time. The AQI was created to assist people in understanding how local air quality affects their health. Therefore, the aim of the study was to assess 1-day air quality of 253 towns in Nigeria, thereby determining the health threat in these towns. The data was collected from the Tutiempo Network’s regular data set by the EPA Environmental Protection Agency. Data on all of the major pollutants (O-3, PM2.5, PM10, CO, NO, SO2) was collected and statistical analysis was performed. Kura (Kano State), a town in northern Nigeria, recorded the highest level of 184, while Idiroko, a border town (Nigeria-Benin Republic) in Ogun State, had the least value of 41. Kura was portrayed as unhealthy, while Idiroko was portrayed as healthy, implying that Idiroko air poses little to no danger, while Kura air showed that certain people of the general public, as well as members of sensitive groups, could encounter more severe health effects. The 1-day AQI is slightly elevated, which may contribute to climate change and the radiation budget. This means that efforts should be made to reduce the potential health risks posed by pollutants. Climate change (CC) is a global phenomenon that impacts several aspects of human existence. The Sustainable Development Goal 13 implores stakeholders to take action to mitigate the effects of CC. However, its impact on health, particularly primary health care, has not been thoroughly studied. Here, we share anecdotal experiences of the impact of CC on health and primary care presentations in Kano, Northwest, Nigeria. We observed consistent clinical presentations logically associated with high temperatures and excessive flooding in certain months of the year. Presentations range from skin and water-borne diseases to malnutrition and stress-related disorders. Our experience in Kano, Nigeria could be a valuable exposition of the diversity of the impact of CC on primary health care presentation in Africa, considering geographical and cultural differences. It also exposes the paucity of data regarding the impact of CC on primary care activities in Africa.Contribution: In conclusion, CC has potential impacts on primary health care and practice. The full implications of CC on this vital level of care will require future research (quantitative and qualitative studies). This will help strategic intervention planning by stakeholders. Environmental health-related risks are becoming a primary concern in Nigeria, with diverse environmental problems such as air pollution, water pollution, oil spillage, deforestation, desertification, erosion, and flooding (due to inadequate drainage systems) caused mostly by anthropogenic activities. This paper reviews the pre-existing and current environmental health problems, proffer future research and needs, policy needs, and recommendations necessary to mitigate Nigeria’s environmental health situation. Data from the Institute of Health Metric and Evaluation on Global Burden of Disease (GBD) was used to ascertain the causes of Death and Disability-adjusted Life Years (DALYs) in Nigeria from 2007-2017 and published literatures where reviewed. According to the world health data report, most of the highest-ranked causes of DALYs in Nigeria are related to environmental risk factors. The lower respiratory infection associated with air pollution has advanced from the 4(th) in 2007 to the highest ranked cause of death in 2017. Other predominant causes of death associated with environmental risk factors include chronic respiratory diseases, cardiovascular diseases, enteric infections, diarrheal diseases, communicable, maternal, neonatal, and nutritional disease, which has resulted in approximately 800 thousand deaths and 26 million people living with DALYs per annum in Nigeria. Major environmental risk factors include household air pollution, ambient air pollution, water, sanitation, and hygiene (WaSH), which shows a prolonged but progressive decline. In contrast, ambient particulate matter pollution, ambient ozone pollution, and lead exposure show a steady rise associated with death and DALYs in Nigeria, indicating a significant concern in an environmental health-related risk situation. Sustaining a healthy environment is critical in improving the quality of life and the span of a healthy life. Therefore, environmentally sustainable development policies and practices should be essential to the population and policymakers for a healthy life. To limit global temperature increases to ‘well below 2 degrees C’, it is necessary that current national commitments to reduce emissions are increased, and these commitments are implemented. The identification of local develop-ment benefits from climate change mitigation is a possible motivating factor to achieve this. However, there is a lack of practical examples of how climate change mitigation and development priorities can be integrated in national planning processes, particularly in low-and middle-income countries. This work considers two ques-tions i) What are the factors that have to be considered when developing a plan integrating GHG reductions with local development goals?; and ii) How do you structure a process to reach a consensus about the plan itself?. It does this by conceptualising the integration of climate mitigation and development benefits as a policy intervention. As a case study, a national planning process that integrated climate change mitigation with improvements to air quality and human health in Nigeria is conceptualised, ex-post, as an intervention theory model. The key factors iden-tified include the importance of tailoring the planning process to the national context of how development priorities are identified and then used in the allocation of national budgets. In particular, assessments undertaken within the planning process, of emission reductions, and development of implementation pathways provided necessary information on how climate mitigation actions contribute to national development priorities. Addi-tionally, the importance of structuring these assessments within a planning processes that also engaged key stakeholders to allow the information produced by the assessments to be informed, and acted upon, by those responsible for mitigation in each key sector is also highlighted. Finally, approaches for the use of intervention theory as a conceptual framework to design a planning process, ex-ante, are discussed, to further optimise the integration of development priorities into climate change planning. Purpose The purpose of this study is to unravel the changing nature of climate change impact on the food and human security sector of the Nigerian State. Design/methodology/approach This study is an in-depth case study that involves the use of both quantitative and qualitative data. Statistical data on climate variability in Nigeria obtained from reliable databases were use in the making of analysis. Also, data derived from semi-structure interviews and special reports from International Non-governmental organizations on the subject matter were also used in the study. The findings of the study were based on an in-depth analysis of both primary and secondary sources of data. The secondary data were derived from existing published academic works. The primary data was developed using qualitative data that were collected from January to November, 2018 to 2019 in the different regions of Nigeria. For the South East, primary data was collected from Abakaliki, Ebonyi State. In the South-South, primary data was collected from Asaba, Delta State. In the South West, primary data was collected from Barutin, Kwara State. In the North East, primary data was collected from Maiduguri, while in North West, data was collected from Gusau, Zamfara State. In the North Central, data was collected from Markurdi, Benue State. During the data collection, 48 semi-structured Key Informant Interviews (KIIs) were carried out in the six selected research areas that represented their geo-political zones. Six Focus Group Discussions (FGDs) were carried out, one for each of these six selected cities. Each of the Focus Group Discussions comprised between five and seven respondents. The idea of KIIs and FGDs is to allow the respondents to freely express their ideas comprehensively. Again, in other to get varied forms of responses, the respondents are mainly farmers however, a number of NGOs, civil servants, fertilizer sellers, government officials, transporters and aged men and women/retirees. It should be noted that the respondents cut across male and female gender of all ages and ethnic configuration. The respondents were also randomly selected through social networking. To avoid having people of similar The KIIs were three academics; two community leaders; two small scale fish farmers; rice, cassava, fish, livestock and crop farmers. All KIIs ad TIs were transcribed and analysed using thematic content analysis. Findings The findings revealed that climate change has negatively affected food security in Nigeria. it has also led to continuous armed confrontations over natural resources thereby undermining human security in the country. Originality/value This study is 100% original and can be assessed through turn it in evaluation. The enormous effects of food insecurity have worsened in Nigeria and are further heightened by internal conflicts combined with ongoing climate change impacts such as drought and floods. Moreover, food availability is affected by economic challenges especially a weakening of foreign exchange and fiscal revenues, which has reduced the rate of food importation and increased local prices. Furthermore, the geometric increase in population especially in the last five decades has placed enormous pressure on the limited food resources, making it more challenging for agricultural and food systems to sustainably meet local food needs. Put together, these indices are contributing significantly to undernourishment. The huge local legume resources if properly harnessed can contribute toward addressing food insecurity. However, most of the legumes are included in the United Nations’ Food and Agriculture Organization list of underutilized crops. Also, there is an over-reliance on food high in calorie in Nigeria, which is discouraged by nutritionists worldwide. Plant-based protein from legumes is necessary for effective metabolism and human wellbeing. This work highlights the benefits of the sustainable utilization of neglected and underutilized legume resources in Nigeria. The work discusses potential solutions for food insecurity as well as avenues for improving human nutrition and wellbeing. Access to water, sanitation, and hygiene (WASH)-including drainage-services-is essential for public health and socio-economic development, but access remains inadequate and inequitable in low- to middle-income countries such as South Africa. In South Africa, rural areas and small towns generally depend on a limited and climate-sensitive economic base (e.g., farming), and they have a limited capacity and are located in areas where transport challenges can increase WASH access risks. Climate change shifts hydrological cycles, which can worsen WASH access and increase susceptibility to the interlinked impacts of droughts and flooding in already vulnerable regions. We adopted a transdisciplinary approach to explore the needs, barriers, and vulnerabilities with respect to WASH in rural areas and small towns in South Africa-using two case studies to explore climate risk and vulnerability assessment (CRVA) in one rural village in the northern Limpopo province and a small town in the Western Cape province. This holistic approach considered natural (environment and climate) and socio-economic (economic, social, governance, and political) factors and how they interplay in hampering access to WASH. Extreme weather events characterized by frequent and intense droughts or floods aggravate surface and groundwater availability and damage water infrastructure while threatening agriculture-dependent livelihoods. The lack of reliable transport infrastructure increases risks posed by flooding as roads to vital supplies are prone to damage. High inequality linked to rising unemployment and the Apartheid legacy of a segregated service delivery system result in inequitable access to WASH services. The intertwined ways in which natural elements and historical, social, economic, governance, and policy aspects are changing in South Africa increase WASH vulnerability in rural areas and small towns. The changes in climatic conditions and their associated impacts are contributing to a worsening of existing gender inequalities and a heightening of women’s socioeconomic vulnerabilities in South Africa. Using data collected by research methods inspired by the tradition of participatory appraisals, we systematically discuss the impacts of climate change on marginalized women and the ways in which they are actively responding to climate challenges and building their adaptive capacity and resilience in the urban areas of KwaZulu-Natal, South Africa. We argue that changes in climate have both direct and indirect negative impacts on women’s livelihoods and well-being. Less than one-half (37%) of the women reported implementing locally developed coping mechanisms to minimize the impacts of climate-related events, whereas 63% reported lacking any form of formal safety nets to deploy and reduce the impacts of climate-induced shocks and stresses. The lack of proactive and gender-sensitive local climate change policies and strategies creates socioeconomic and political barriers that limit the meaningful participation of women in issues that affect them and marginalize them in the climate change discourses and decision-making processes, thereby hampering their efforts to adapt and reduce existing vulnerabilities. Thus, we advocate for the creation of an enabling environment to develop and adopt progendered, cost-effective, transformative, and sustainable climate change policies and adaptation strategies that are responsive to the needs of vulnerable groups (women) of people in society. This will serve to build their adaptive capacity and resilience to climate variability and climate change-related risks and hazards. Social vulnerability indices (SVI) can predict communities’ vulnerability and resilience to public health threats such as drought, food insecurity or infectious diseases. Parity has yet to be investigated as an indicator of social vulnerability in young women. We adapted an SVI score, previously used by the US Centre for Disease Control (CDC), and calculated SVI for young urban South African women (n = 1584; median age 21.6, IQR 3.6 years). Social vulnerability was more frequently observed in women with children and increased as parity increased. Furthermore, young women classified as socially vulnerable were 2.84 times (95% CI 2.10-3.70; p < 0.001) more likely to report household food insecurity. We collected this information in 2018-2019, prior to the current global COVID-19 pandemic. With South Africa having declared a National State of Disaster in March 2020, early indicators suggest that this group of women have indeed been disproportionally affected, supporting the utility of such measures to inform disaster relief efforts.
There are many climatic changes facing South Africa which already have, or are projected to have, a detrimental impact on human health. Here the risks to health due to several alterations in the climate of South Africa are considered in turn. These include an increase in ambient temperature, causing, for example, a significant rise in morbidity and mortality; heavy rainfall leading to changes in the prevalence and occurrence of vector-borne diseases; drought-associated malnutrition; and exposure to dust storms and air pollution leading to the potential exacerbation of respiratory diseases. Existing initiatives and strategies to prevent or reduce these adverse health impacts are outlined, together with suggestions of what might be required in the future to safeguard the health of the nation. Potential roles for the health and non-health sectors as well as preparedness and capacity development with respect to climate change and health adaptation are considered. BACKGROUND: Climate change presents an unprecedented and urgent threat to human health and survival. South Africa’s health response will require a strong and effective intersectoral organisational effort. AIM: Exploratory interview outcomes are used to advance practice and policy recommendations, as well as for broad input in the development of a draft national framework for a health risk and vulnerability assessment (RVA) for national departments. SETTING: Nationally in South Africa. METHOD: Twenty key expert interviews were conducted with South African experts in the field of climate change and health. Interview data was analysed by means of thematic content analysis. RESULTS: Findings suggest that previously poor communities are most at risk to the impacts of climate change on health, as well as those with underlying medical conditions. Climate change may also serve as a catalyst for improving the healthcare system overall and should serve as the conduit to do so. A draft climate change and health RVA should take into account existing frameworks and should be implemented by local government. It is also critical that the health and health system impacts from climate change are well understood, especially in light of the plans to implement the (South African) National Health Insurance (NHI) scheme. CONCLUSION: Practice and policy initiatives should be holistic in nature. Consideration should be given to forming a South African National Department of Climate Change, or a similar coordinating body between the various national departments in South Africa, as health intercepts with all other domains within the climate change field. Children spend a significant proportion of their time at school and in school buildings. A healthy learning environment that supports children should be thermally conducive for learning and working. Here, we aimed to study the relations between indoor classroom temperatures and learner absenteeism as a proxy for children’s health and well-being. This one-year prospective study that spanned two calendar years (from June 2017 to May 2018) entailed measurement of indoor classroom temperature and relative humidity, calculated as apparent temperature (Tapp) and collection of daily absenteeism records for each classroom in schools in and around King Williams Town, Eastern Cape province, South Africa. Classroom characteristics were collected using a standardized observation checklist. Mean indoor classroom temperature ranged from 11 to 30 °C, while mean outdoor temperature ranged from 6 °C to 31 °C during the sample period. Indoor classroom temperatures typically exceeded outdoor temperatures by 5 °C for 90% of the study period. While multiple factors may influence absenteeism, we found absenteeism was highest at low indoor classroom Tapp (i.e., below 15 °C). Absenteeism decreased as indoor Tapp increased to about 25 °C before showing another increase in absenteeism. Classroom characteristics differed among schools. Analyses of indoor classroom temperature and absenteeism in relation to classroom characteristics showed few statistically significant relations-although not exceptionally strong ones-likely because of the multiple factors that influence absenteeism. However, given the possible relationship between indoor temperature and absenteeism, there is a learning imperative to consider thermal comfort as a fundamental element of school planning and design. Furthermore, additional research on factors besides temperature that affect learner absenteeism is needed, especially in rural areas. Pneumonia is a leading cause of hospitalization in South Africa. Climate change could potentially affect its incidence via changes in meteorological conditions. We investigated the delayed effects of temperature and relative humidity on pneumonia hospital admissions at two large public hospitals in Limpopo province, South Africa. Using 4062 pneumonia hospital admission records from 2007 to 2015, a time-varying distributed lag non-linear model was used to estimate temperature-lag and relative humidity-lag pneumonia relationships. Mean temperature, relative humidity and diurnal temperature range were all significantly associated with pneumonia admissions. Cumulatively across the 21-day period, higher mean daily temperature (30 °C relative to 21 °C) was most strongly associated with a decreased rate of hospital admissions (relative rate ratios (RR): 0.34, 95% confidence interval (CI): 0.14-0.82), whereas results were suggestive of lower mean daily temperature (12 °C relative to 21 °C) being associated with an increased rate of admissions (RR: 1.27, 95%CI: 0.75-2.16). Higher relative humidity (>80%) was associated with fewer hospital admissions while low relative humidity (<30%) was associated with increased admissions. A proportion of pneumonia admissions were attributable to changes in meteorological variables, and our results indicate that even small shifts in their distributions (e.g., due to climate change) could lead to substantial changes in their burden. These findings can inform a better understanding of the health implications of climate change and the burden of hospital admissions for pneumonia now and in the future.
In 2018, 70% of global fatalities due to pneumonia occurred in about fifteen countries, with Tanzania being among the top eight countries contributing to these deaths. Environmental and individual factors contributing to these deaths may be multifaceted, but they have not yet been explored in Tanzania. Therefore, in this study, we explore the association between climate change and the occurrence of pneumonia in the Tanga Region, Tanzania. A time series study design was employed using meteorological and health data of the Tanga Region collected from January 2016 to December 2018 from the Tanzania Meteorological Authority and Health Management Information System, respectively. The generalized negative binomial regression technique was used to explore the associations between climate indicators (i.e., precipitation, humidity, and temperature) and the occurrence of pneumonia. There were trend differences in climate indicators and the occurrence of pneumonia between the Tanga and Handeni districts. We found a positive association between humidity and increased rates of non-severe pneumonia (incidence rate ratio (IRR) = 1.01; 95% CI: 1.01-1.02; p ≤ 0.05) and severe pneumonia (IRR = 1.02; 95% CI: 1.01-1.03; p ≤ 0.05). There was also a significant association between cold temperatures and the rate of severe pneumonia in Tanga (IRR = 1.21; 95% CI: 1.11-1.33; p ≤ 0.001). Other factors that were associated with pneumonia included age and district of residence. We found a positive relationship between humidity, temperature, and incidence of pneumonia in the Tanga Region. Policies focusing on prevention and control, as well as promotion strategies relating to climate change-related health effects should be developed and implemented. Togo, in west Africa, is vulnerable to the impacts of climate change, but has made a negligible contribution to causing it. Togo ratified the Paris Agreement in 2017, committing to submit Nationally Determined Contributions (NDCs) that outline Togo’s climate change mitigation commitment. Togo’s capital, Lomé, as well as other areas of Togo have ambient air pollutant levels exceeding World Health Organisation guidelines for human health protection, and 91 % of Togolese households cook using solid biomass, elevating household air pollution exposure. In Togo’s updated NDC, submitted in 2021, Togo acknowledges the importance and opportunity of achieving international climate change mitigation targets in ways that improve air quality and achieve health benefits for Togo’s citizens. The aim of this work is to evaluate priority mitigation measures in an integrated assessment of air pollutant, Short-Lived Climate Pollutant (SLCP) and Greenhouse Gas (GHG) emissions to identify their effectiveness in simultaneously reducing air pollution and Togo’s contribution to climate change. The mitigation assessment quantifies emissions for Togo and Grand Lomé from all major source sectors for historical years between 2010 and 2018, for a baseline projection to 2030 and for mitigation scenarios evaluating ten mitigation measures. The assessment estimates that Togo emitted ~21 million tonnes of GHG emissions in 2018, predominantly from the energy and Agriculture, Forestry and Other Land Use sectors. GHG emissions are projected to increase 42 % to 30 million tonnes in 2030 without implementation of mitigation policies and measures. The implementation of the ten identified priority mitigation measures could reduce GHG emissions by ~20 % in 2030 compared to the baseline, while SLCPs and air pollutants were estimated to be reduced more, with a more than 75 % reduction in black carbon emissions in 2030. This work therefore provides a clear pathway by which Togo can reduce its already small contribution to climate change while simultaneously achieving local benefits for air quality and human health in Togo and Grand Lomé. BACKGROUND: Climate change is expected to decrease food security globally. Many Indigenous communities have heightened sensitivity to climate change and food insecurity for multifactorial reasons including close relationships with the local environment and socioeconomic inequities which increase exposures and challenge adaptation to climate change. Pregnant women have additional sensitivity to food insecurity, as antenatal undernutrition is linked with poor maternal-infant health. This study examined pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda. Specific objectives were to characterize: 1) sensitivities to climate-associated declines in food security for pregnant Indigenous women; 2) women’s perceptions of climate impacts on food security during pregnancy; and 3) changes in food security and maternal-infant health over time, as observed by women. METHODS: Using a community-based research approach, we conducted eight focus group discussions-four in Indigenous Batwa communities and four in non-Indigenous communities-in Kanungu District, Uganda, on the subject of climate and food security during pregnancy. Thirty-six women with ≥1 pregnancy participated. Data were analysed using a constant comparative method and thematic analysis. RESULTS: Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe. CONCLUSIONS: Programs promoting women’s adaptive capacity to climate change are required to improve food security for pregnant women and maternal-infant health. These interventions are particularly needed in Indigenous communities, which often face underlying health inequities. However, resiliency among mothers was strong and, with supports, they can reduce food security challenges in a changing climate. BACKGROUND: Vulnerabilities of men and women to adverse health effects due to weather variability and climate change are not equal. Uganda was among the countries in the world most affected by extreme weather events during the last decade. However, there is still limited gendered empirical evidence on the links between weather variability and health and the possible pathways through which these health effects occur. Therefore, this study analyses the effect of weather variability on illness, and the extent to which water collection ‘time burden’ mediates the relationship between weather anomalies and illness among men and women of working age in Uganda. The study also quantifies the health inequalities to be eliminated if resources are equalized. METHODS: Socioeconomic, health and time use data were obtained from the World Bank Living Standards Measurement Studies – Integrated Surveys on Agriculture (LSMS -ISA), combined with high resolution remotely-sensed weather data. Two-parts and non-linear decomposition regression analysis were used on the national representative pooled dataset from the four household survey waves collected between 2009 to 2014, comprising a total of 22,469 men and women aged between 15 and 64 years. RESULTS: Empirical results show that low rainfall below the long-term mean increased the likelihood of illness by at least 8 and 6 percentage points for women and men, respectively. The indirect effect of low rainfall on illness through water access pathway was estimated at 0.16 percentage points in women. Decomposition results reveal that health inequalities among women and men would have been narrowed by 27-61%, if endowments were equalized. CONCLUSIONS: Strategies that promote women empowerment (such as education, labor force participation, access to financial services and clean water), health adaptation and time poverty reduction strategies (such as rain water harvesting and improved access to quality health care) would reduce gender-based health inequalities in Uganda despite changing climatic conditions. An adequate supply of energy, micronutrients and macronutrients is essential to achieve food and nutrition security to prevent malnutrition. Socio-economic, political, and climatic events, however, can affect the supply of food and nutrients. We assessed country-level supply trends of food and nutrients and their sources within the context of policy changes and political, socio-economic and climatic events from 1961 to 2013 in Zambia. Due to the lack of national food consumption data, food supply data from the FAO food balance sheets, matched to food composition tables, were used to estimate the energy, macronutrient and micronutrient content of 264 food items available to Zambia. We calculated historical nutrient supplies based on demographic characteristics and population-level dietary requirements. Results showed that Zambia was nutrition insecure from 1961 to 2013 for key micronutrients vitamin A, folate, riboflavin, vitamin B12, calcium, zinc, iron, and energy-deficient from the late-1980s. The diet has not substantially changed over time, with maize being the dominant food source. However, refined energy-dense food has steadily increased in the diet coupled with a reduction in fibre. These nutrient supply and dietary pattern trends coincide with specific socio-economic, policy, political, and climatic events from the 1970s to the early-mid 2000s, such as population growth, maize subsidy and crop diversification policies, regime change and drought. This study shows how policy, political and climatic events have been central features shaping nutrient supplies and the consequences for nutrition security. The study provides a context to inform future food policies to improve food and nutrition security. BACKGROUND: Some latrines remain unused even under conditions of high coverage in rural areas of low- and middle-income countries. Not much is known on household latrine use in the long term in the absence of an intervention. The current work assesses drivers and barriers to sustained use of a ventilated improved pit latrine (Blair VIP) design where it originated and how rural households adapt it to climate change. METHODS: A mixed methods study was conducted from November 2020 to May 2021 among rural households of Mbire district, Zimbabwe. A cross sectional survey of 238 households with Blair ventilated improved pit (BVIP) latrines was conducted using a questionnaire and a latrine observation checklist. Data were analysed using logistic regression. Qualitative data were collected using six focus groups among house heads and analysed by thematic analysis. RESULT: The latrine has perceived health, non-health and hygiene benefits for its sustained use. However, there are design, environmental and social barriers. The quantitative study indicated that determinants of latrine use were contextual (individual and household levels) and technology (individual level) factors. Focus groups indicated that latrine use was influenced by social, technology and contextual factors at multiple level factors. Interplay of factors influenced the intention to adapt the BVIP latrine to climate change. Local climate change adaptation strategies for the latrine were odour and erosion control, construction of the conventional latrine design and raised structures. CONCLUSION: The conventional BVIP latrine design is durable and relatively resilient to climate change with high local household use. High construction cost of the latrine causes households to build incomplete and poor quality designs which affect odour and fly control. These are barriers to sustained latrine use. The government should implement the new sanitation policy which considers alternative sanitation options and offer community support for adapting sanitation to climate change. 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. This study was conducted on Manoka Island (Littoral Region of Cameroon) with the aim of analyzing climate change vulnerability and local adaptation strategies based on the local community’s perceptions and biophysical evidence. We used household surveys, focus group discussions, field observation, GIS, and remote sensing to collect data on variables of exposure, sensitivity, and adaptive capacity. Historical changes in rainfall and temperature, mangrove cover, and the occurrence of extreme climatic events were used as indicators of exposure. Property losses and income structure were used as indicators of sensitivity, while human, natural, social, financial, and physical assets represented adaptive capacity. 89 households were interviewed in the nine settlements of the island. Results show that Manoka Island is experiencing irregular rainfall patterns (with average annual values deviating from the mean by -1.9 to +1.8 mm) and increasing temperature (with annual values deviating from the mean by -1.2 to +3.12). The dynamics of the coastline between 1975 and 2017 using EPR show average setbacks of more than ±3 m/year, with erosion levels varying depending on the period and location. The number of households perceiving extreme climatic events like seasonal variability, flood, and rain storm was higher. From respondents’ perception, housing and health are the sectors most affected by climate change. The reported high dependence of households on fishing for income, their overall low livelihood diversification, and their poor access to climate information reported by 65% of respondents portray their poor adaptive capacity. Local response initiatives are ineffective and include among others constructing buildings on stilts and using car wheels to counter the advancement of seawater inland. The study concludes that households on Manoka Island are vulnerable to the impacts of climate change. Income diversification, mangrove reforestation, the development of sustainable supply chains for wood fuel, and sustainable fish smoking devices are the main pathways for adaptation planning in this area. BACKGROUND: Epidemiological data of heart failure (HF) decompensation from the northern hemisphere suggests higher rates during winter. OBJECTIVES: We aimed to explore the seasonal variation in decompensated HF admission and mortality rates in a country with equatorial climate. METHODS: We conducted a retrospective cross-sectional study by chart review of the admission, discharge registries and patient files from 2016 to 2018 in the cardiology unit of the Yaound?? Central Hospital, Cameroon. Data was collected on HF morbidity and mortality from the registers and patients’ files. Corresponding seasonal climatic data was obtained from the meteorology office of the Cameroonian ministry of transports. Analysis of variance and Chi-square test were respectively used to compare the continuous and categorical data between across seasons. Correlation between continuous data was assess with the Spearman correlation. RESULTS: Decompensated HF accounted for 636 (36.2%) out 1755 cardiology unit admission and an 18% lethality rate. Decompensated HF admission, mortality and lethality rates were respectively 38.2%, 6.7% and 17.9% higher during the long rainy season (all P values >0.05). We observed a borderline-to-significant inverse linear continuous correlation between monthly temperatures and admission rate (r=-0.301; P=0.070), lethality rate (r=-0.361; P=0.030) and mortality rate (r=-0.385; P=0.020). There was no significant difference of the distribution of precipitating factors between seasons. CONCLUSION: Although statistically insignificant, decompensated HF admissions and mortality increase in rainy season where the temperature is lower in an equatorial climate. This study assessed the perceived causes, indicators and impacts of climate change by disaggregating farmers in to adaptor and non-adaptor groups in Goat based agro-pastoral livelihood zone of Ethiopia. The collected quantitative and qualitative data were analysed in descriptive statistics, linear regression, anomaly index, Likert rating scale and conceptual narrations. The findings demonstrated that an increasing temperature and a decreasing rainfall trends were perceived by farmers across the study decades. Higher deforestation rate, rash natural resource exploitation, poor soil and water management rehearses and alarming population growth in descending order were identified as climate change causes. Livestock and crop yield decline, livestock/human diseases epidemics and death, as well as recurrent conflicts due to grazing land were its associated impacts. The status and nature of climate change causes, indicators and impacts were however significantly diverse within similar awareness groups. To mitigate its adverse impacts, the farmers were thus applied livestock, crop and non-agriculture related adaptation strategies. Shortage of finance and eligible household labor combined with the absence of climate related information, training and extension services were hindered farmers to take any measure to the climate change. Therefore, to encourage the farmers’ responsiveness, the finding underlines the importance of supplying applicable as well as legitimate natural resource exploitation system, followed by access to climate related information, awareness rising trainings, credit and input delivery services at local and community level. This study explores the perceived influence of climate change on the health of Hamer pastoralists and their livestock in south-western Ethiopia. A combination of focus group discussions and key informant interviews were conducted with Hamer communities as well as local health workers, animal health workers and non-governmental organisation (NGO) staff. Thematic framework analysis was used to analyse the data. Reductions in rangeland, erratic rainfall, recurrent droughts and loss of seasonality were perceived to be the biggest climate challenges influencing the health and livelihoods of the Hamer. Communities were travelling greater distances to access sufficient grazing lands, and this was leading to livestock deaths and increases in ethnic violence. Reductions in suitable rangeland were also precipitating disease outbreaks in animals due to increased mixing of different herds. Negative health impacts in the community stemmed indirectly from decreases in livestock production, uncertain crop harvests and increased water scarcity. The remoteness of grazing lands has resulted in decreased availability of animal milk, contributing to malnutrition in vulnerable groups, including children. Water scarcity in the region has led to utilisation of unsafe water sources resulting in diarrhoeal illnesses. Further, seasonal shifts in climate-sensitive diseases such as malaria were also acknowledged. Poorly resourced healthcare facilities with limited accessibility combined with an absence of health education has amplified the community’s vulnerability to health challenges. The resilience and ambition for livelihood diversification amongst the Hamer was evident. The introduction of camels, increase in permanent settlements and new commercial ideas were transforming their livelihood strategies. However, the Hamer lack a voice to express their perspectives, challenges and ambitions. There needs to be collaborative dynamic dialogue between pastoral communities and the policy-makers to drive sustainable development in the area without compromising the values, traditions and knowledge of the pastoralists. Climate change has become a global phenomenon, but its impact is unevenly distributed among regions, economic classes, age classes and genders. Gender is among the factors that influence the perception and adaptation of smallholder farmers to the impacts of climate change. This study assessed the level of gender vulnerability, perception and adaptation options against climate change in the rural areas of Meta District, eastern Ethiopia. Data were collected from 193 respondents through household survey, focus group discussions (FGD) and key informant interviews. Long-term climate data (1990-2019) were acquired from the National Meteorological Agency (NMA) of Ethiopia. Integrated vulnerability assessment method through the construction of indices from selected indicators of climate change was used to describe vulnerability. A multivariate probit model (MVP) was employed to identify factors affecting the choice of adaptation options to climate change. Climate data analysis showed that long-term annual, belg (short rainy season from February-April) and kiremt (long rainy season from June-September) seasonal rainfall had high variability with a coefficient of variation of 37.7%, 42.5% and 34.4%, respectively. Approximately 90% of male- and 74% of female-headed households perceived declining and erratic rainfall and rising temperature over time in their locality in the last three decades. The lower perception of women implies that they had less access to climate information and lack awareness, which constrains their adaptation against the impacts of climate change. The likelihood of household heads adopting soil and water conservation (SWC) practices, adjusting planting dates and use of drought-tolerant varieties was 77.2%, 56.9% and 53.9%, respectively. Women were more vulnerable, with a vulnerability index (VI) of – 0.138, to climate change than men (VI = 0.009) in the study area. These findings necessitate the formulation and implementation of gender-sensitive and context-specific policies that provide poor female farmers with the opportunities to diversify their livelihood with non-farm income. Moreover, non-formal trainings and better extension services are needed to enhance the perception of climate change and the use of adaptation practices to improve resilience against climate change. The Ethiopian Rift Valley (ERV) is characterized by arid and semi-arid climate with groundwater as the most important water resource used for drinking and irrigation purposes. However, in the region, people are suffering from severe water scarcity exacerbated by climate effect. Besides water availability, endemic water quality issues are critical and affect the suitability of the water and human health risks. The present study evaluates the suitability of groundwater for drinking and agricultural purposes in the Ziway Lake Basin (ZLB) of the ERV. Groundwater used for drinking contains multiple inorganic contaminants in levels that surpass the World Health Organization recommended limits. The most frequent of these violations were for Na+, K+, HCO3-, F- and few samples for Mn, As, U, Pb and Mo. The modeled Drinking Water Quality Index (DWQI) values of the groundwater show wide variation ranging from 12.7 (Excellent category) to 714 (Unsuitable category) with mean value of 94. Likewise, Irrigation Water Quality Index (IWQI) computed by considering EC, SAR, Na%, RSC and PI of the groundwater varies from 13.2 to 520 with a mean value of 106. Both DWQI and IWQI values suggest that groundwater is generally of Excellent quality for drinking and irrigation use in the headwater regions of the ZLB and progressively becomes extremely Unsuitable toward the rift floor. The exceptionally high DWQI values to the west of Lake Ziway is mainly associated with the co-occurrence of multiple toxic elements from a groundwater from the Quaternary sediments and rhyolitic volcanic aquifers. Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders. Climate change is a global threat, affecting the food security and food sovereignty of many depending on agriculture for their livelihoods. This is even more pronounced in Kenya, given their over-reliance on rain-fed crops and the frequency of floods and droughts in the country. Through qualitative interviews, this study set out to establish how climate change not only affects the food security, production and consumption of rural women farmers in Kakamega County, Kenya, but their response to climate shocks. Using resilience theory as a lens, we established that women use different pathways to mitigate the effects of climate change on their livelihoods. The study found that initially women adopt coping strategies that are reactive and not sustainable, but soon adapted their farming strategies, using their indigenous knowledge to exercise some control over both their food security and food sovereignty. Besides this, they use their human and social capital to expand their networks of support. By linking up to other organizations and gaining access to government support, they are able to challenge patriarchal relations that perpetuate poverty and inequality and bring about more transformative and sustainable responses to climate change. The climate is changing, and such changes are projected to cause global increase in the prevalence and geographic ranges of infectious diseases such as anthrax. There is limited knowledge in the tropics with regards to expected impacts of climate change on anthrax outbreaks. We determined the future distribution of anthrax in Kenya with representative concentration pathways (RCP) 4.5 and 8.5 for year 2055. Ecological niche modelling (ENM) of boosted regression trees (BRT) was applied in predicting the potential geographic distribution of anthrax for current and future climatic conditions. The models were fitted with presence-only anthrax occurrences (n = 178) from historical archives (2011-2017), sporadic outbreak surveys (2017-2018), and active surveillance (2019-2020). The selected environmental variables in order of importance included rainfall of wettest month, mean precipitation (February, October, December, July), annual temperature range, temperature seasonality, length of longest dry season, potential evapotranspiration and slope. We found a general anthrax risk areal expansion i.e., current, 36,131 km(2), RCP 4.5, 40,012 km(2), and RCP 8.5, 39,835 km(2). The distribution exhibited a northward shift from current to future. This prediction of the potential anthrax distribution under changing climates can inform anticipatory measures to mitigate future anthrax risk. Climate change-induced crises can aggravate intimate partner violence (IPV); the loss of income when weather affects the agricultural industry can exacerbate violence at home. In Kenya, climate change has increased precipitation during the rainy season and raised temperatures during the dry season, resulting in floods and droughts. For 75% of Kenyans, agricultural activities are their primary source of income. This research aims to assess patterns in IPV and severe weather events (SWE). We examined Integrated Public Use Microdata Series-Demographic Health Survey (IPUMS-DHS) data from 2008 and 2014 for IPV severity and frequency. We used Emergency Events Database (EM-DAT) data along with GPS coordinates to identify SWEs (defined as any flood >10 days) by county in Kenya. Overall, women were more likely to experience IPV if their spouse worked in agriculture (Odds Ratio (OR) = 1.22, 95% Confidence Interval (CI): 1.10-1.36). There was a 60% increase in the odds of reporting IPV in counties that experienced an SWE as compared to counties that did not experience an SWE (OR = 1.60, 95% CI: 1.35-1.89). This analysis further supports the growing body of research that suggests a relationship between climate change-related weather events and violence against women. Studies have looked into how environmental and climate covariates affect under-and over-nutrition, but little is known about the spatial distribution of different forms of malnutrition in Kenya and whether there are locations that suffer from double-burden of malnutrition. This research quantifies spatial variations and estimates how climatic and environmental factors affect under-and over-nutrition among women in Kenya. This enables us to determine if the patterns in which these factors affect the malnutrition indicators are similar and whether there are overlaps in the spatial distributions. The study used data from the Demographic and Health Survey, which included cross-sectional data on malnutrition indicators as well as some climate and environmental variables. A multicategorical response variable that classified the women into one of four nutritional classes was generated from the body mass index (BMI) of the women, and a Bayesian geoadditive regression model with an estimate based on the Markov chain Monte Carlo simulation technique was adopted. Findings show that women in Turkana, Samburu, Isiolo, Baringo, Garissa, and West Pokot counties are more likely to be underweight than women in other counties while being overweight is prevalent in Kirinyag’a and Kitui counties. Obesity is prevalent in Kirinyag’a, Lamu, Kiambu, Murang’a, and Taita Taveta counties. The study further shows that as mean temperature and precipitation increase, the likelihood of being underweight reduces. The chances of being underweight are lower among literate women [OR: 0.614; 95% CrI: 0.513,0.739], married women [OR: 0.702; 95% CrI: 0.608,0.819] and those from rich households [OR: 0.617; 95% CrI: 0.489,0.772], which is not the case for overweight and obesity. The generated spatial maps identify hot spots of the double burden of malnutrition that can assist the government and donor agencies in channeling resources efficiently. Acute malnutrition affects a sizeable number of young children around the world, with serious repercussions for mortality and morbidity. Among the top priorities in addressing this problem are to anticipate which children tend to be susceptible and where and when crises of high prevalence rates would be likely to arise. In this article, we highlight the potential role of conflict and climate conditions as risk factors for acute malnutrition, while also assessing other vulnerabilities at the individual- and household-levels. Existing research reflects these features selectively, whereas we incorporate all the features into the same study. The empirical analysis relies on integration of health, conflict, and environmental data at multiple scales of observation to focuses on how local conflict and climate factors relate to an individual child’s health. The centerpiece of the analysis is data from the Demographic and Health Surveys conducted in several different cross-sectional waves covering 2003-2016 in Kenya, Nigeria, and Uganda. The results obtained from multi-level statistical models indicate that in Kenya and Nigeria, conflict is associated with lower weight-for-height scores among children, even after accounting for individual-level and climate factors. In Nigeria and Kenya, conflict lagged 1-3 months and occurring within the growing season tends to reduce WHZ scores. In Uganda, however, weight-for-height scores are primarily associated with individual-level and household-level conditions and demonstrate little association with conflict or climate factors. The findings are valuable to guide humanitarian policymakers and practitioners in effective and efficient targeting of attention, interventions, and resources that lessen burdens of acute malnutrition in countries prone to conflict and climate shocks. Hunger and inadequate nutrition are ongoing concerns in rural Malawi and are exemplified in traditional proverbs. Traditional proverbs and common expressions offer insight into commonly held truths across societies throughout sub-Saharan Africa. Strong oral traditions allow community beliefs embodied in proverbs to be passed down from generation to generation. In our qualitative study, we conducted 8 individual and 12 focus group interviews with a total of 83 participants across two districts in rural central Malawi with the aim of soliciting context-specific details on men and women’s knowledge, attitudes and practices related to nutrition, gender equality and women’s empowerment. Each interview began by asking participants to share common proverbs related to nutrition. Our qualitative analysis, informed by an indigenous-based theoretical framework that recognises and centres African indigenous knowledge production, yielded six themes: ‘a black dog enters the home’, ‘don’t stay with your hands hanging’, ‘a man is at the stomach’, ‘showers have fallen’, ‘we lack peace in our hearts’ and ‘the hunger season’. Traditional proverbs can provide insight into the underlying causes of hunger and malnutrition. Physicians, nurses and other allied health professionals around the world have a role to play in addressing hunger and malnutrition, which have been exacerbated by climate change. We have an ethical duty to educate ourselves and others, and change our behaviours, to mitigate the root causes of climate change, which are contributing to food insecurity and resultant poor health outcomes in countries like Malawi. Erratic temperatures and precipitation influence nutrition, human capital investment, and living standards, particularly for children. This study investigates the effect of climate change (changes in the monthly maximum average near-surface temperature and total monthly precipitation) on children’s health outcomes, particularly stunting and underweight, in Nigeria. We combine Living Standards Measurement Study -Integrated Surveys on Agriculture (LSMS-ISA) data with high resolution gridded climate data. We find that the rise in temperature is associated with higher levels of stunting – even more so in rural areas. The paper’s findings highlight the need for climate-friendly policies to mitigate the long-term effect of climate change on malnourishment. Without such policies, climate change could reverse years of progress in lowering children’s malnutrition. There is evidence that Nigeria is already experiencing environmental challenges attributed to climate change (CC) and its impacts. This has clearly highlighted the need for knowledge-based strategies to help plan adequate mitigation and adaptation measures for the country. One of the basic requirements to ensure such strategies is the development of a database of national CC research. This will aid in the assessment of past and present scientific publications from which directions for future study can be mapped. The present study used standard, systematic, and bibliographic literature reviews to analyse the trend, focus, spatial variability, and effectiveness of published research on CC impacts in Nigeria. Four thematic areas of CC impact research were defined: Agriculture, Environment, Human and Multi-disciplinary study. A total of 701 articles were found to be relevant and the review shows that CC impacts and adaptations in the literature vary across research categories and locations. The period between 2011 (68 studies) and 2015 (80 studies) showed a tremendous rise in CC impact research with a peak in 2014 (84 studies). Studies in the agriculture category had the highest publications in 23 States of Nigeria. The review revealed three research gaps: (1) lack of research that investigated the magnitude of present and potential future impacts in the aquatic environment (2) little attention on CC impacts and adaptation in the Northern regions of Nigeria (3) absence of study investigating the effects of multiple variables of CC at the same time. The findings suggest that it would be useful to advance CC research in Nigeria beyond perceptive approaches to more quantitative ones. This is particularly important for highly vulnerable animals, crops, locations, and for better planning of adaptation strategies. In the third week of January 2022, the southern districts of Malawi were hit by Cyclone Ana. The worst affected areas were Chikwawa and Nsanje. Four weeks following Cyclone Ana, a rather smaller cyclone, Dumako, hit the same areas, causing more damage. The Partners in Health or Abwenzi Pa Za Umoyo, an international humanitarian nongovernmental organisation that provides primary health care (PHC), organised teams to join Chikwawa District Council – Health, providing PHC assistance in the most affected district (Chikwawa); these teams were joined by three senior residents in family medicine from Kamuzu University of Health Sciences.Contribution: From the experiences of the interventions reported here, it was learnt that a multidisciplinary team of PHC providers is the key to the success of the emergency PHC programmes in times of natural disasters. While immediate PHC may be important at the actual time of disaster, it was learnt that PHC is also very important for continuation of care for chronic conditions, antenatal clinics and other clinics that are interrupted by the disaster. The experiences emphasised the importance of involving the PHC physicians and other PHC cadres in planning PHC programmes in natural disaster-prone areas. Sun protection has become crucial due to the effects of climate change that has resulted in effects such as extremely high temperatures. Early exposure of children to ultraviolet rays (UVR) makes them vulnerable to developing sun-related diseases later in life. Sun protection through clothing is the most affordable option to use for many people. The study assessed the awareness of sun protection for pre-school children among parents, and awareness of retailers about children’s clothing with sun-protective finishes. This exploratory and descriptive study was conducted to describe the prevailing awareness of sun-protective clothing using a questionnaire that was hand-delivered by children to their parents. A target convenience sample was selected with 20 children in each of four pre-schools from the four administrative regions of Eswatini. A research assistant interviewed managers of purposefully selected retail outlets on whether managers are aware of clothing for children with sun-protective finishes. Results showed that a majority of parents were not aware of the need to protect their children against sun exposure. Those parents who were aware mainly used clothing as a preventative measure against sun exposure. Parents, who viewed sun exposure as a health hazard, were likely to be aware of sun-protective clothing and accessories. Thus, these parents generally selected garments made from light-coloured cotton fabric. Only one retail outlet stocked merchandise with specialised tags for sun-protective clothing. In conclusion, most parents were not aware of the effects of sun exposure and the hazards associated with prolonged exposure to the sun. Only one retail outlet stocked merchandise with sun-protective finishes. The recommendation is to introduce educational programmes in schools and for consumers on protecting children against sun exposure. Climate change has been identified as one of the leading threats to human health in Southern Africa. Climate change-induced natural disasters often leave behind a trail of destruction characterized by multidimensional losses such as loss of infrastructure, physical health, and psychological health. Adolescents are among the most vulnerable groups during and after a natural disaster. This article presents findings of a research whose aim was to establish cyclone Idai-related losses and postdisaster coping strategies among adolescent survivors. Based on qualitative data collected from 15 participants in the Odzi community of Manicaland Province in Zimbabwe, the article reveals that participants experienced diverse disaster-related losses, such as loss of independence and sense of control over their lives and general life satisfaction. The study notes that the impact of disaster-related losses had a toll on adolescents’ psychological, social, and physical well-being. From the study, it is established that in the aftermath of natural disasters, adolescents adopted two-pronged coping strategies, namely, personal coping strategies that include positive thinking and self-talk, and the utilization of social support such as instrumental and counseling support. This study suggests, among other recommendations, school-based training to equip adolescents with personal coping strategies. INTRODUCTION: Climate change-related extreme weather events have increased in frequency and intensity, threatening people’s health, particularly in places with weak health systems. In March 2019, Cyclone Idai devastated Mozambique’s central region, causing infrastructure destruction, population displacement, and death. We assessed the impact of Idai on maternal and child health services and recovery in the Sofala and Manica provinces. METHODS: Using monthly district-level routine data from November 2016 to March 2020, we performed an uncontrolled interrupted time series analysis to assess changes in 10 maternal and child health indicators in all 25 districts before and after Idai. We applied a Bayesian hierarchical negative binomial model with district-level random intercepts and slopes to estimate Idai-related service disruptions and recovery. RESULTS: Of the 4.44 million people in Sofala and Manica, 1.83 (41.2%) million were affected. Buzi, Nhamatanda, and Dondo (all in Sofala province) had the highest proportion of people affected. After Idai, all 10 indicators showed an abrupt substantial decrease. First antenatal care visits per 100,000 women of reproductive age decreased by 23% (95% confidence interval [CI]=0.62, 0.96) in March and 11% (95% CI=0.75, 1.07) in April. BCG vaccinations per 1,000 children under age 5 years declined by 21% (95% CI=0.69, 0.90) and measles vaccinations decreased by 25% (95% CI=0.64, 0.87) in March and remained similar in April. Within 3 months post-cyclone, almost all districts recovered to pre-Idai levels, including Buzi, which showed a 22% and 13% relative increase in the number of first antenatal care visits and BCG, respectively. CONCLUSION: We found substantial health service disruptions immediately after Idai, with greater impact in the most affected districts. The findings suggest impressive recovery post-Idai, emphasizing the need to build resilient health systems to ensure quality health care during and after natural disasters. INTRODUCTION: During a disaster, comprehensive, accurate, timely, and standardized health data collection is needed to improve patient care and support effective responses. In 2017, the World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) as an international standard for data collection in the context of disasters and public health emergencies. The EMT MDS was formally activated for the first time in 2019 during the response to Cyclone Idai in Mozambique. STUDY OBJECTIVE: The aim of this study was to analyze data collected through the EMT MDS during Cyclone Idai of 2019 and to identify the benefits of and opportunities for its future use. METHODS: The EMT MDS was used for data collection. All 13 international EMTs deployed from March 27 through July 12 reported data in accordance with the EMT MDS form. The collected data were analyzed descriptively. RESULTS: A total of 18,468 consultations, including delivery of 94 live births, were recorded. For children under-five and those five-years and older, the top five reasons for consultation were minor injuries (4.5% and 10.8%, respectively), acute respiratory infections ([ARI] 12.6% and 4.8%, respectively), acute watery diarrhea (18.7% and 7.7%, respectively), malaria (9.2% and 6.1%, respectively), and skin diseases (5.1% and 3.1%, respectively). Non-disaster-related health events accounted for 84.7% of the total health problems recorded. Obstetric care was among the core services provided by EMTs during the response. CONCLUSION: Despite of challenges, the EMT MDS reporting system was found to support the responses and coordination of EMTs. The role of the Mozambican Ministry of Health (MOH), its cooperation with EMTs, and the dedicated technical support of international organizations enabled its successful implementation. On March 15, 2019, Cyclone Idai made landfall near the port city of Beira in central Mozambique causing significant casualties and serious damage to infrastructure. The Emergency Medical Team Type 2 – Italy Regione Piemonte (EMT2-ITA) was deployed approximately two weeks after the disaster to support the country in need, providing essential medical and surgical care.The EMT2-ITA staff was composed of 77 team members including two rotations and integrating local staff. A total of 1,121 patients (1,183 triage admissions) were treated during the 27 days of field hospital activity; among all the admissions, only few cases (17; 1%) were directly or indirectly attributed to the disaster event. Only three cases of cholera were confirmed and transferred to one of the treatment centers set up in Beira. The EMT2-ITA performed a total of 62 surgical operations (orthopedic, gynecological, general, and plastic surgery), of which more than one-half were elective procedures.The objective of this manuscript is to report the mission of the EMT2-ITA in Mozambique, raising interesting points of discussion regarding the impact of timing on the mission outcomes, the operational and clinical activities in the field hospital, and the great importance to integrate local staff into the team. Beira, the biggest city of Mozambique’s Sofala province, was struck by Cyclone Idai on 14 March 2019, with devastating impacts. The floods along with the cyclone destroyed road infrastructure and health facilities and disrupted primary health care (PHC) service delivery. In addition, destruction of farmland and food stocks resulted in malnutrition; the abundance of water fostered the reproduction of mosquitos, exacerbating the burden of malaria; and problems with water and sanitation led to epidemics of cholera. The exact role and contribution of human-induced climate change is very difficult to quantify, but there is little doubt that climate change is driving more frequent and severe cyclones, such as Idai. Considering the current climatic changes, it is expected that climate hotspots such as Beira will only experience more frequent extreme weather events. In these settings, with high risks but low adaptive capacity, dedicated efforts are required to strengthen PHC with a focus on preparedness for disasters. This should entail community awareness and education, strengthening infrastructure and service provision, as well as collaboration with important stakeholders across other sectors.Contribution: Using a case study approach, this article contributes climate resilient PHC for better preparedness to service continuity. The impact of climate change is a global threat, and its effect is more pronounced in developing countries. It is vital to link physical data analysis with endogenous knowledge and practices of farmers to strengthen their adaptive capacity. This study was conducted to explore spatial variability and temporal trends of temperature and rainfall in association with farmers’ perceptions and their adaptation strategies in Southwest Ethiopia. Daily rainfall and temperature data of twelve weather stations were collected from the National Meteorological Agency of Ethiopia for the period 1983 to 2016. Farmers’ perceptions about climate change and its impact and their adaptation strategies were assessed through a survey. Spatial variability and temporal trends of rainfall and temperature were analyzed using ArcGIS and R software. Sen’s slope estimator and Mann-Kendall’s trend tests were used to detect the magnitude and statistical significance of changes in rainfall and temperature. Spatial analysis of rainfall showed high variability over the region. There were no consistent and significant temporal trends of annual and seasonal rainfall of the area. Significant and upward trends of annual maximum and minimum temperatures were reported for all stations. Accordingly, annual maximum and minimum temperatures were increased by 0.71 and 0.65 degrees C, respectively, over the period 1983 to 2016. Farmers had a good awareness of climate change and its impact. Adaptation strategies used by farmers included soil and water conservation practices (66.21%), crop diversification (62.16%), modifying planting date (42.56%), agroforestry practices (35.13%), use of drought-tolerant variety (33.95%), use of early maturing crop (27.03%), and livelihood diversification (25.42%). As most of these adaptation strategies were familiarized by a small number of farmers, further effort is needed to identify factors limiting the adoption of these strategies. Furthermore, additional planned strategies and supports that widen available options at the farmers’ disposal should be introduced to strengthen their adaptive capacity. BACKGROUND: The recent research recommendations on the adaptations of poor are toward local specific investigations, aimed at a comprehensive understanding of the adaptation strategies through in-depth analysis of the status, and the explicit on how climate and non-climate global change processes constrain the inherent strategies. Intent to this idea, we have designed this study to assess the small-scale farmers’ adaptation and coping strategies in southwestern Ethiopia. METHODS: The agroecology approach steered in case-study design was used for the conceptual and analytical framework. The data collected from 335 households were analyzed for descriptive and multivariate analysis of variance and substantiated by qualitative data obtained through focused group discussion, interview, and observations. RESULTS: The significant differences were observed in the watershed among households in the case studies on their adoption of the identified adaptation and coping strategies. The sustainability of preferred strategies was different along case studies, solely determined by the impact magnitude of the adaptations constraining factors. Although free ecosystem-based strategies become less practical and replacing by new strategies in the watershed, the processes were gradual, internal to the community and managed through adaptive learning in the highland. However, the paths were perceived as toward maladaptive, resulted by the state interventions which disrupted free adaptations, deteriorated adaptive learning of the community, and shaped the adaptation responses toward the interventions in the kolla agroecology. CONCLUSIONS: The study implies that the situations of households’ adaptation strategies are beyond the reflections of their respective production ecology, designated within climate variability in the previous studies. The structural land use dynamics and associated resource tenure insecurity have greater constraining effects on the strategies than the impacts of climate variability in the kolla. Thus, subsequent research interested in such contexts, and any plan for the development interventions should (re)consider the impacts of non-climate national/and global environmental change in shaping the adaptation and coping strategies of the local community. Maize is a major staple and plays an essential role in food and nutrition security in Sub-Saharan Africa (SSA). Conservation agriculture (CA), a climate-smart agriculture practise based on minimum soil disturbance, crop residue retention, and crop diversification, has been widely advocated but without extensive research on the impact it may have on maize nutrient composition, and food and nutrition security. This study assessed the grain yield, macro- and micronutrient mineral content, and nutrient yield of eight maize varieties grown in Malawi, and how these are affected by CA practises over two seasons. The minerals were analysed by inductively coupled plasma (ICP) coupled to optical emission spectroscopy (OES) and to mass spectroscopy (MS). Grain yield and Se content differed among the varieties, while C, N, Fe, K, Mg, Mn, P, and Zn were similar. The local variety Kanjerenjere showed lowest grain and nutrient yields. The open-pollinated varieties (OPVs) concentrated more minerals than the F1 hybrids, but the latter showed higher yields for both grain and nutrients. Typical consumption of the eight maize varieties could fully meet the protein and Mg dietary reference intake (DRIs) of Malawian children (1-3 years), as well as Mg and Mn needs of adult women (19-50 years), but their contribution to dietary requirements was low for Fe (39-41%) and K (13-21%). The trials showed that CA increased grain yield (1.2- to 1.8-fold) and Se content (1.1- to 1.7-fold), but that it had no effect on C, K, Mg, P, and Zn, and that N (1.1- to 1.2-fold), Mn (1.1- to 1.8-fold), and Fe (1.3- to 3.4-fold) were reduced. The high increase in grain yield under CA treatments resulted in increased yields of protein and Se, no effect on the yields of K, Mg, Mn, P, Zn, and reduced Fe yield. Conservation agriculture could contribute in reducing the risk of Se deficiency in Malawian women and children but exacerbates the risk of Fe deficiency. A combination of strategies will be needed to mitigate some of the foreseen effects of climate change on agriculture, and food and nutrition security, and improve nutrient intake. Considering the feasibility and effectiveness of adaptation options is essential for guiding responses to climate change that reduce risk. Here, we assessed the feasibility of adaptation options for the African context. Using the Global Adaptation Mapping Initiative, a stocktake of adaptation-related responses to climate change from the peer-reviewed literature in 2013–2020, we found 827 records of adaptation actions in Africa. We categorised and evaluated 24 adaptation options and for each option, six dimensions of feasibility were considered: economic, environmental, social, institutional, technological, and evidence of effectiveness. Over half (51%) of all adaptation actions were reported in the food sector where sustainable water management (SWM) was the most reported option. The fewest actions were reported for cities (5%). The majority of actions (53%) were recorded in just six countries: Ghana, Ethiopia, Kenya, Tanzania, Nigeria and South Africa. Encouragingly, effectiveness was assessed as medium or high for 95% of adaptation options. However, no options had high feasibility on any other dimension. Technological and institutional factors present major barriers to implementation. Crop management, SWM, sustainable agricultural practices, agroforestry, livelihood diversification, ecosystem governance and planning, health governance and planning, infrastructure and built environment, all had moderate feasibility across three or more dimensions. Human migration has low feasibility but high potential for risk reduction. Major knowledge gaps exist for environmental feasibility, for assessing adaptation limits at increasing levels of climate hazard, for economic trade-offs and synergies, and for Central and Northern Africa. Our results highlight sectors where enablers for adaptation can be increased. Future assessments can apply the method established here to extend findings to other national and local levels. Global demand for agricultural products continues to grow. However, efforts to boost productivity exacerbate existing pressures on nature, both on farms and in the wider landscape. There is widespread appreciation of the critical need to achieve balance between biodiversity and human well-being in rural tropical crop production landscapes, that are essential for livelihoods and food security. There is limited empirical evidence of the interrelationships between natural capital, the benefits and costs of nature and its management, and food security in agricultural landscapes. Agroforestry practices are frequently framed as win-win solutions to reconcile the provision of ecosystem services important to farmers (i.e., maintaining soil quality, supporting pollinator, and pest control species) with nature conservation. Yet, underlying trade-offs (including ecosystem disservices linked to pest species or human-wildlife conflicts) and synergies (e.g., impact of ecosystem service provision on human well-being) are seldom analysed together at the landscape scale. Here, we propose a systems model framework to analyse the complex pathways, with which natural capital on and around farms interacts with human well-being, in a spatially explicit manner. To illustrate the potential application of the framework, we apply it to a biodiversity and well-being priority landscape in the Southern Agricultural Growth Corridor of Tanzania, a public-private partnership for increasing production of cash and food crops. Our framework integrates three main dimensions: biodiversity (using tree cover and wildlife as key indicators), food security through crop yield and crop health, and climate change adaptation through microclimate buffering of trees. The system model can be applied to analyse forest-agricultural landscapes as socio-ecological systems that retain the capacity to adapt in the face of change in ways that continue to support human well-being. It is based on metrics and pathways that can be quantified and parameterised, providing a tool for monitoring multiple outcomes from management of forest-agricultural landscapes. This bottom-up approach shifts emphasis from global prioritisation and optimisation modelling frameworks, based on biophysical properties, to local socio-economic contexts relevant in biodiversity-food production interactions across large parts of the rural tropics. The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women’s workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers’ time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana’s Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women’s productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature. In low- and middle-income countries, food insecurity (FI) is a living reality for many households, particularly among the most vulnerable groups. The burden of household FI in Mozambique and how FI and coping strategies relate to perceived health are unknown. This study investigated the lived experiences and coping strategies of food-insecure households, along with their perceived health. Altogether, 16 in-depth interviews were performed, audio-recorded, and transcribed verbatim. A qualitative content analysis was carried out and five themes emerged: lived experiences of FI, coping strategies used in situations of FI, food choices, climate change and food security, and FI and perceived health. A wide range of lived experiences and coping strategies were reported, including cooking whatever is available, skipping meals, receiving money or food from friends and relatives, eating unsafe and low-quality foods, taking on additional work, cooking least-preferred foods, and having a monotonous and less-nutritious diet. Furthermore, the participants reported emotional distress, anxiety and depression, substance use, and other negative health outcomes. Some had diagnoses of hypertension, diabetes or HIV/AIDS. The findings suggest the need for employment creation and women’s empowerment, as well as the implementation of appropriate policies and programmes to alleviate household FI. BACKGROUND: Depression has substantial and enduring impacts for adolescents, particularly those living in poverty. Yet, evidence on its determinants in low-income countries remains scarce. We examined the social determinants of depressive symptoms for Tanzanian adolescents. METHODS: We used cross-sectional data for 2458 adolescents (aged 14-19), to describe associations with depressive symptoms within and across five domains-demographic, economic, neighbourhood, environmental and social-cultural-using linear mixed models. We estimated depressive symptoms using the 10-item Centre for Epidemiological Studies Depression Scale, which ranges from 0 to 30 and increases with additional symptoms. RESULTS: Factors associated with depressive symptoms in the fully adjusted models included experiencing five or more household economic shocks (β=2.40; 95% CI 1.48 to 3.32), experiencing droughts/floods (β=0.76; 95% CI 0.36 to 1.17), being in a relationship (β=1.82; 95% CI 1.30 to 2.33), and having moderate (β=1.26; 95% CI 0.80 to 1.71) or low (β=2.27; 95% CI 1.81 to 2.74) social support. Exclusive schooling was protective compared with being engaged in both school and paid work (β=1.07; 95% CI 0.05 to 2.61) and not engaged in either (β=0.73; 95% CI 0.24 to 1.22). Household size and relationship status were more important factors for girls, while employment status, and extreme precipitation were more important for boys. CONCLUSION: Mental health is associated with determinants from multiple domains. Results suggest that environmental shocks related to climate change contribute to poor mental health in adolescents, highlighting an important area for intervention and research. African pastoralists are undergoing significant changes in livelihood strategies, from predominantly mobile pastoralism to agro-pastoralism in which both livestock raising and cultivation of crops are practiced, to agropastoralism combined with wage labor and petty trade. These changes often result in fixed settlements or a process known as sedentarization. Previous research indicates that sedentarization and increased climate variability are prominent forces shaping livelihood opportunities and constraints in East Africa, but the effects of these co-occurring processes have yet to be investigated. This paper develops theory, using qualitative data collected in Morogoro and Tanga Regions of Tanzania, explaining the relationships between climate variability, pastoral sedentarization, livelihood outcomes, and resulting nutritional status. We observed that the co-occurring processes of increased climate variability and sedentarization among pastoralists in these regions have dramatic impacts on communities’ economic prosperity, health status, and nutritional outcomes. Due to risks associated with climate and sedentarization, land tenure policies that allow continued practice of highly mobile livelihood strategies, namely, legal recognition of collective land rights, should be adopted. Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages. In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity’s effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making. There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground. Lassa fever is a longstanding public health concern in West Africa. Recent molecular studies have confirmed the fundamental role of the rodent host (Mastomys natalensis) in driving human infections, but control and prevention efforts remain hampered by a limited baseline understanding of the disease’s true incidence, geographical distribution and underlying drivers. Here, we show that Lassa fever occurrence and incidence is influenced by climate, poverty, agriculture and urbanisation factors. However, heterogeneous reporting processes and diagnostic laboratory access also appear to be important drivers of the patchy distribution of observed disease incidence. Using spatiotemporal predictive models we show that including climatic variability added retrospective predictive value over a baseline model (11% decrease in out-of-sample predictive error). However, predictions for 2020 show that a climate-driven model performs similarly overall to the baseline model. Overall, with ongoing improvements in surveillance there may be potential for forecasting Lassa fever incidence to inform health planning. OBJECTIVE: To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). METHODS: This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. RESULTS: A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. CONCLUSIONS: The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect. Heatwaves can have severe impacts on human health extending from illness to mortality. These health effects are related to not only the physical phenomenon of heat itself but other characteristics such as frequency, intensity, and duration of heatwaves. Therefore, understanding heatwave characteristics is a crucial step in the development of heat-health warning systems (HHWS) that could prevent or reduce negative heat-related health outcomes. However, there are no South African studies that have quantified heatwaves with a threshold that incorporated a temperature metric based on a health outcome. To fill this gap, this study aimed to assess the spatial and temporal distribution and frequency of past (2014 – 2019) and future (period 2020 – 2039) heatwaves across South Africa. Heatwaves were defined using a threshold for diurnal temperature range (DTR) that was found to have measurable impacts on mortality. In the current climate, inland provinces experienced fewer heatwaves of longer duration and greater intensity compared to coastal provinces that experienced heatwaves of lower intensity. The highest frequency of heatwaves occurred during the austral summer accounting for a total of 150 events out of 270 from 2014 to 2019. The heatwave definition applied in this study also identified severe heatwaves across the country during late 2015 to early 2016 which was during the strongest El Niño event ever recorded to date. Record-breaking global temperatures were reported during this period; the North West province in South Africa was the worst affected experiencing heatwaves ranging from 12 to 77 days. Future climate analysis showed increasing trends in heatwave events with the greatest increases (80%-87%) expected to occur during summer months. The number of heatwaves occurring in cooler seasons is expected to increase with more events projected from the winter months of July and August, onwards. The findings of this study show that the identification of provinces and towns that experience intense, long-lasting heatwaves is crucial to inform development and implementation of targeted heat-health adaptation strategies. These findings could also guide authorities to prioritise vulnerable population groups such as the elderly and children living in high-risk areas likely to be affected by heatwaves. Climate change is likely to have wide-ranging impacts on maternal and neonatal health in Africa. Populations in low-resource settings already experience adverse impacts from weather extremes, a high burden of disease from environmental exposures, and limited access to high-quality clinical care. Climate change is already increasing local temperatures. Neonates are at high risk of heat stress and dehydration due to their unique metabolism, physiology, growth, and developmental characteristics. Infants in low-income settings may have little protection against extreme heat due to housing design and limited access to affordable space cooling. Climate change may increase risks to neonatal health from weather disasters, decreasing food security, and facilitating infectious disease transmission. Effective interventions to reduce risks from the heat include health education on heat risks for mothers, caregivers, and clinicians; nature-based solutions to reduce urban heat islands; space cooling in health facilities; and equitable improvements in housing quality and food systems. Reductions in greenhouse gas emissions are essential to reduce the long-term impacts of climate change that will further undermine global health strategies to reduce neonatal mortality. Extreme heat shocks are increasingly linked to poor economic and health outcomes. This paper constructs hour-degree bins of temperature exposure to assess the effects of extreme heat on early child nutrition, a health outcome correlated with educational attainment and income in adulthood. Linking 15 rounds of repeated cross-section data from five West African countries to geo-coded weather data, we find that extreme heat exposure increases the prevalence of both chronic and acute malnutrition. We find that a 2 degrees C rise in temperature will increase the prevalence of stunting by 7.4 percentage points, reversing the progress made on improving nutrition during our study period. In the coming few decades, projected increases in global temperature and humidity are generally expected to exacerbate human exposure to climate extremes (e.g., humid-heat and rainfall extremes). Despite the growing risk of humid-heat stress (measured by wet-bulb temperature), it has received less attention in East Africa, where arid and semi-arid climatic conditions prevail. Moreover, no consensus has yet been reached across models regarding future changes in rainfall over this region. Here, we screen Global Climate Models (GCMs) from CMIP5 and CMIP6 and use, for boundary conditions, simulations from only those GCMs that simulate successfully recent climatic trends. Based on these GCMs and Regional Climate Model (RCM) simulations, we project that annual mean temperature is likely to rise by 2 celcius toward midcentury (2021-2050) at a faster rate than the global average (about 1.5 celcius), under the RCP8.5 and SSP5-8.5 scenarios, associated with more frequent and severe climate extremes. In particular, low-lying regions in East Africa will be vulnerable to severe heat stress, with an extreme wet-bulb temperature approaching or exceeding the US National Weather Service’s extreme danger threshold of 31 celcius. On the other hand, population centers in the highlands of Ethiopia will receive significantly more precipitation during the autumn season and will see more extreme rainfall events, with implications for flooding and agriculture. The robustness of these results across all GCM and RCM simulations, and for both of CMIP5 and CMIP6 frameworks (CMIP: Coupled Model Inter-comparison Project) supports the reliability of these future projections. Our simulations of near-term climate change impacts are designed to inform the development of sound adaptation strategies for the region. Countries with abundant solar radiation have the potential to invest in simple technologies for deactivation of many bacteria and viruses in medical solid waste. In addition to the traditional Infection and Prevention Control (IPC) measures, these simple technologies contribute to better protection of health care workers in countries with compromised solid management schemes. Monitoring of temperature, relative humidity and ultraviolet inside containers soundly designed to collect disposal infectious waste illustrated to deactivate several viruses and bacteria. Casanova et al., 2010, used some surrogate viruses to overcome the challenges of working with SARS-CoV, concluded that by temperature above 40 °C most of viruses become below levels of detection after 90 min. Here we are proposing a model of a simple transparent container almost 200 L in volume that allow solar energy to be accumulated inside. In summer conditions in the testing site, temperature inside the container reached above 50 °C when the ambient air temperature was around 30 °C. The container was built using epoxy glass to guarantee maximum heat penetration. Actual temperature measurement inside the container was measured in real time against ambient air temperature. We present a mathematical model for predication of maximum temperature at different positions inside the container and their relation to different ambient air temperature scenarios. The mathematical formulas used are based on the conservation laws and a good agreement of a full month of field measurements were obtained. Even in winter conditions in many of developing countries air temperature can maintain levels above 20 °C, which will produce temperature around 30 °C and viruses can reach levels below detection limit in maximum 3 h. The goal of this article is to consider data solutions to investigate the differential pathways that connect climate/weather variability to child health outcomes. We apply several measures capturing different aspects of climate/weather variability to different time periods of in utero exposure. The measures are designed to capture the complexities of climate-related risks and isolate their impacts based on the timing and duration of exposure. Specifically, we focus on infant birth weight in Mali and consider local weather and environmental conditions associated with the three most frequently posited potential drivers of adverse health outcomes: disease (malaria), heat stress, and food insecurity. We focus this study on Mali, where seasonal trends facilitate the use of measures specifically designed to capture distinct aspects of climate/weather conditions relevant to the potential drivers. Results indicate that attention to the timing of exposures and employing measures designed to capture nuances in each of the drivers provides important insight into climate and birth weight outcomes, especially in the case of factors impacted by precipitation. Results also indicate that high temperatures and low levels of agricultural production are consistently associated with lower birth weights, and exposure to malarious conditions may increase likelihood of nonlive birth outcomes. More recurrent heat waves and extreme ozone (O(3)) episodes are likely to occur during the next decades and a key question is about the concurrence of those hazards, the atmospheric patterns behind their appearance, and their joint effect on human health. In this work, we use surface maximum temperature and O(3) observations during extended summers in two cities from Morocco: Casablanca and Marrakech, between 2010 and 2019. We assess the connection between these data and climate indices (North Atlantic Oscillation (NAO), Mediterranean Oscillation (MO), and Saharan Oscillation (SaO)). We then identify concurrent heat waves and O(3) episodes, the weather type behind this concurrence, and the combined health risks. Our findings show that the concurrence of heat waves and O(3) episodes depends both on the specific city and the large-scale atmospheric circulation. The likely identified synoptic pattern is when the country is under the combined influence of an anticyclonic area in the north and the Saharan trough extending the depression centered in the south. This pattern generates a warm flow and may foster photochemical pollution. Our study is the first step toward the establishment of an alert system. It will help to provide recommendations for coping with concurrent heat waves and air pollution episodes. The increasing number and complexity of urban risk and disasters have a significant bearing on the emotional and mental wellbeing of those who are exposed and hamper their responses. Nevertheless, current discourses and approaches to increase resilience tend to focus on broader socio-economic, physical and environmental systems. This reflects a failure by the academic and practitioner communities to consider the potential contribution of human interior dimensions in adaptation planning. Concomitantly, a growing body of knowledge highlights the need to bridge the gap between internal and external (systems) approaches for achieving sustainable transformations. Against this background, this article aims to increase knowledge on the operationalization of such more integrative approaches in marginal settings. Based on a case study of a flood adaptation project in Kibera, Kenya, we assess the need and potential ways to address interior dimensions in the context of project planning, design and implementation. We show how the integration of such dimensions occurs in existing adaptation projects and why this matters. On this basis, we provide methodological and operational recommendations regarding ways to support more integrative approaches that bridge subjective, intersubjective, objective and interobjective perspectives to support transformation. Urban floods have long-term mental health implications, yet this subject remains largely neglected in flood-related studies. This paper examines the psychological distress (PD) of adults exposed to floods in Ghana. Cross-sectional data involving 767 flood-prone community-dwelling household heads aged ≥20 years were analyzed [mean = 47.3 years (SD = 13.7); males = 61.4%]. We used the Exposure to Flood-related Events Scale, and PD was assessed with the Kessler Psychological Distress Scale (K10). Ordinary Least Squares (OLS) regressions evaluated crude and adjusted associations of flood exposure with PD. The mean scores of PD (37[SD = 8]) and exposure to flood events (6[SD = 3]) significantly varied by age and sex (p < .05). After full adjustment for potential confounders, exposure to flood events was significantly and positively associated with PD index in the total sample (β = 0.030; p < .005), among male participants (β = 0.019; p < .05) and female participants (β = 0.048; p < .001). Furthermore, age-wise analysis revealed significant association of flood exposure with PD in young adults (β = 0.033; p < .001) but not in older adults (β = 0.048; p = .062). Exposure to floods increased the risk of PD. Policy and public health efforts to manage PD should include selective flood reduction interventions, including land use regulations and sustained public education.
As disasters increase in frequency and magnitude with adverse effects on population health, governments will be forced to implement disaster risk management policies that may include forced relocation. Ineffective public consultation has been cited as one reason for failure of these policies. Using the deliberative polling method, this study assessed the capacity of rural communities to participate in flood risk management policy priority setting and the impact of providing accurate and balanced information on policies by comparing pre-and post -deliberation data. The study also assessed the level of trust on whether government and community would use the results of this study. Results indicated strong community support for policy options to reduce vulnerability in communities and strong resistance to relocation. As all the top five ranked policy options were concerned with population pressure, gender, and social service issues, which are all conceptually considered social determinants of a healthy community, this study concludes that public health considerations are central to flood risk policy development and implementation. The study revealed high levels of trust in government and the community relating to flood risk management, which policymakers in low-to-middle income countries can capitalise on for meaningful community consultation for effective disaster risk management. Recurrent floods have become a major problem in the transboundary Lower Mono River catchment of Togo and Benin, causing more damage and loss of life than any other disaster in the area. The level of understanding about floods and their management can be as diverse as the groups within the communities and thus can present a variety of perspectives. People tend to perceive flood risk and management differently due to their proximity to flood-prone areas and their level of vulnerability as well as their capacity to adapt. Therefore, this study explores the specific perspectives of local communities and experts on floods in the transboundary Mono catchment, which can help to inform better adaptation strategies according to the contexts of each community. We conducted series of focus groups discussions (FGDs) using the Actors, Resources, Dynamics, and Interactions (ARDI) framework to develop mental models of flood management. This approach allowed us to identify the causes and impact of flooding in the area, and to describe the actors and effects of flood events on the main natural resources as well as the dynamics and interactions that drive change and influence flood management in the study area. The results indicate that the perceptions of local communities and experts show both similarities and differences. These differences include (1) perceptions of relevant direct actors, (2) perceptions of resources at stake, and (3) actor-specific resource utilization. Considering these dissimilar views between expert and local community knowledge systems appears to be an important contributing factor to improving flood mitigation efforts in the catchment. Adapting risk communication and measures taken for flood management in accordance with the perceptions of affected communities could greatly increase success, with positive long-term effects for the involved institutions and communities regarding mutual trust-building. Flooding is one of the most destructive climatic hazards which has affected agricultural activities in the world, especially Sub-Saharan Africa. This article investigated the impact of the recurrent annual floods on food production and how subsistent farmers have adapted to resultant food insecurity in the Sudan Savannah agroecological zone of Ghana. The specific objectives of the study were to understand the nature of flooding (frequency, period and extent of coverage of flood water), how the perennial floods contribute to food insecurity, how farmers adapt to it to contribute towards policy development on flood control and improve food security. Primary data were collected using questionnaires, interviews, focus group discussions and field observation. Secondary data were obtained from documents and reports from NADMO and MOFA. The questionnaires were analyzed using Statistical Package for Social Science and the focus group discussions, interviews, and fieldwork were analyzed manually using content analysis. The findings show that the study areas experience floods every year. Between 2007 and 2018, eleven floods event occurred in the study communities. The floods usually occur around August and September when rainfall is torrential coupled with overflow from the spillage of the Bagre dam upstream. The flooding has resulted in a decline in food production among subsistent farmers. As a result, households in study communities are food insecure. Farmers have learned to cope with floods/food insecurity by engaging in alternative livelihoods such as flood recession farming, dry season farming, petty trading. They have also employed other means such as rationings of food and social networks cope with food insecurity. In all these strategies, women play a critical role as they are largely in charge of food preparation and dishing. The study recommends strengthening of the alternative livelihoods, introduction of short maturing crop varieties, sensitisation of women on the preparation of healthy meals. This research reviews climate change, flood disasters impacts and food security nexus in northern Ghana. The impacts of climate change include flood disasters which in turn affect food production with subsequent impact on food security. While climate change impact can be positive in some regions, it can be negative in other regions as it could lead to excess or lack of water, which negatively affects food production. Most especially, flood disasters have reportedly become frequent with devastating consequences on food production. Literature further suggests that the frequency of floods and their impacts have the potential to increase in the future. Floods inundate farms, pastures and livestock, which could subsequently reduce crop yields and animal production. Floods also destroys physical infrastructure and disrupts socio-economic activities which are linked to agriculture sector and could affect food production. This eventually decreases food availability, accessibility, utilization, and stability in the region. Northern Ghana has experienced flood disasters with increased frequency, which are related to climate change impacts. Although there is research on climate change, flood disasters, and food security issues in northern Ghana, the literature thus far indicates no clear focus of studies that focuses on the nexus of climate change, flood disasters, and food security of the study site. Thus, this research seeks to review the nexus of climate change, and flood disaster impacts on food security in northern Ghana with their implications on food security in the region. This study has two main research objectives. The first objective of this research is to identify and understand the potential impacts of climate change and flood disasters on food production in the study site. The second research objective is to explain the connection between climate change and flood disasters and the implications of this relationship on food security in the study site. This review study focuses on climate change, flood disasters, and food production to understand the critical impacts of climate change and flood disasters on food security in the northern part of Ghana. The aim of this research is to contribute to literature and discussion of the nexus of climate change, flood disaster impacts and food security sub-Saharan Africa. In sub-Saharan Africa, land cover change, expansion of hydropower infrastructure, and increased flooding complicate country-level efforts to meet the Sustainable Development Goal target concerning access to safe water. The Water, Energy and Food (WEF) nexus approach recognises that addressing these complex challenges requires cross-sectoral analyses at multiple scales. Building on such an approach, our study examined the interrelationships between land cover change, dam-related flooding and access to safe water via a national-level spatial analysis with local case studies in Malawi and Ghana. Our assessment of the water-food interactions found that areas of overlap between water points and cropland increased from 2000 to 2020 for both countries at national scale, but overlap extent varied greatly depending on the land cover product used. Local-scale exploration of water point installation patterns in Zomba, Malawi confirmed this pattern, highlighting increasing non-governmental funding of borehole installation programmes. Our assessment of water-energy interactions found that flooding mediated by hydropower dams increased for the White Volta Basin in Ghana, thereby increasing inundation of groundwater points. Local-scale focus group discussions revealed flooding resulted in contaminated water sources and high risk of injury or drowning whilst fetching water. Overall, our study highlights how socio-economic drivers are bringing water points, flooding and cropland into closer proximity, requiring flood mitigation measures at water points and agro-chemical management to minimise potential water quality impacts. Given differences between land cover products, we recommend more robust integration of existing land cover products to better monitor these phenomena. BACKGROUND: The ability of disaster response, preparedness, and mitigation efforts to assess the loss of physical accessibility to health facilities and to identify impacted populations is key in reducing the humanitarian consequences of disasters. Recent studies use either network- or raster-based approaches to measure accessibility in respect to travel time. Our analysis compares a raster- and a network- based approach that both build on open data with respect to their ability to assess the loss of accessibility due to a severe flood event. As our analysis uses open access data, the approach should be transferable to other flood-prone sites to support decision-makers in the preparation of disaster mitigation and preparedness plans. METHODS: Our study is based on the flood events following Cyclone Idai in Mozambique in 2019 and uses both raster- and network-based approaches to compare accessibility to health sites under normal conditions to the aftermath of the cyclone to assess the loss of accessibility. Part of the assessment is a modified centrality indicator, which identifies the specific use of the road network for the population to reach health facilities. RESULTS: Results for the raster- and the network-based approaches differed by about 300,000 inhabitants (~ 800,000 to ~ 500,000) losing accessibility to healthcare sites. The discrepancy was related to the incomplete mapping of road networks and affected the network-based approach to a higher degree. The modified centrality indicator allowed us to identify road segments that were most likely to suffer from flooding and to highlight potential backup roads in disaster settings. CONCLUSIONS: The different results obtained between the raster- and network-based methods indicate the importance of data quality assessments in addition to accessibility assessments as well as the importance of fostering mapping campaigns in large parts of the Global South. Data quality is therefore a key parameter when deciding which method is best suited for local conditions. Another important aspect is the required spatial resolution of the results. Identification of critical segments of the road network provides essential information to prepare for potential disasters. Flood-induced fatalities are among the more poorly reported effects of flood disasters in many developing countries because of poor data inventory and management. Specific objectives of this study are to assess the spatial and temporal variations in flood fatalities in Nigeria, the most populous country in Africa. The study explored available datasets from the National (Nigerian) Meteorological and Emergency Management Agencies as well as those from the Dartmouth Flood Observatory (DFO) at the University of Colorado Boulder and complemented those with scattered reports from Nigerian newspapers to achieve the stated objectives. Using a mix of statistical and geographical information analysis approaches, the study showed that most of Nigeria is vulnerable to flood, given the nature of the dominant climate that often results in “medium” to “high” rainfall intensity (i.e., rainfall 5 38.1-50.1 mm or > 50.1 mm in 24 h, respectively), inadequate settlement planning/land-use and land-cover management, and dam failure. Analysis of the frequency of the flood-fatality relationship indicates an increase in flood fatalities by 4.7% relative to flood cases between 1985 and 2017. The study complemented the results with information from newspapers and some other non-peer-reviewed documents (especially reports from relevant agencies) and revealed the need for a better flood information management system in the country, especially since the national database and DFO records were not the same. The study concluded that flood fatalities are on the increase but are poorly reported. It thus recommends improved information systems for flood and other disasters and their fatalities in the country. Rural isolation can limit access to basic services and income-generating opportunities. Among some communities, rainfall induced flooding can cause increased uncertainty where first-mile transportation infrastructure is limited. In Rwanda, this challenge is apparent, where 90% of the population below the poverty line live in rural areas that are typically mountainous with frequent flooding – events that may be increasing in frequency and severity as the climate changes. To reduce these transportation barriers, the non-profit organization Bridges to Prosperity (B2P) plans to construct hundreds of trailbridges in Rwanda between 2018 and 2023. This scale of rural infrastructure services presents an opportunity for experimental investigation of the effects of these new trailbridges on economic, health, agricultural and education outcomes in rural communities. In this paper, we present a cohort study evaluating the potential community benefits of rural trailbridges – including economic, health and social outcomes for Rwandan communities experiencing environmental change. We examined households living near 12 trailbridge sites and 12 comparison sites over February 2019-March 2020. We found that labor market income increased by 25% attributable to the trailbridges. We did not observe any significant effects on agricultural income, education or health outcomes, however given the small sample and short duration of this study we anticipate observing additional outcomes within the recently started 200 site, 4 year trial. The urban poor in cities of developing countries tend to be the most affected by climate change. This is because of the intersection of their socio-economic characteristics and the hazardous bio-physical environments they inhabit, which usually have limited social services. This study, conducted through interviews with 320 residents of Bauleni and Misisi residential areas of Lusaka, applied the concept of intersectionality to investigate climate risk and social vulnerabilities in informal settlements of Lusaka. The study was based on both quantitative and qualitative data. Quantitative data was analysed using the two-sample proportions Z test and descriptive statistics with the aid of Minitab 17 statistical package, while qualitative data was analysed using thematic analysis with the aid of a qualitative data analysis software called QDA miner. The respondents identified floods, diseases and crime as the major social and climatic risks. Apart from flooding and crime, the risks were not perceived to affect the value of housing in the study sites. This was due to a lack of affordable housing alternatives for the urban poor. The social and climatic risks had differentiated effects on women, men and children. Housing property owners and tenants continue to reside in the risky environments because of the lower cost of land, low cost of living and proximity to the city’s central business district. The study recommends that policy measures aimed at improving informal settlements residents’ well-being should be directed at improving their ability to adjust to and recover from impacts of the climatic disasters and reducing social vulnerabilities. Nairobi’s settlements are vulnerable to urban flooding exacerbated by anthropogenic factors. Households living in flood-prone areas suffer perennially. However, little scientific evidence exists on the relationship between impacts of flooding and coping strategies in Nairobi’s settlements. In this study, primary data was obtained through ground-truth surveys and administration of questionnaires to 310 households in Nairobi’s crowded informal settlements of Mathare Kosovo and Kibera Mashimoni. Information captured included their bio-data, knowledge and perception of flooding, socio-economic, susceptibility and recovery indicators. Secondary data was mainly from literature review. The findings of the canonical correlation revealed that an insignificant relationship of 0.2964 and 0.2503 existed between flooding impacts and coping strategies adopted by households and communities respectively. Floods caused inaccessibility of houses, workplaces and schools, damages to settlements infrastructure, drowning, diseases and displacement of residents. The indirect impacts were loss of livelihoods, environmental degradation, loss of manhours in traffic jams and economic loss. This study is novel in that it provides empirical scientific evidence on the nexus between impacts of flooding and coping strategies in an urban settlement. It augments existing literature on flood risks in urban settlements. It also provides an entry point for policy and decision makers such as scientists, private sector leaders, urban planners and government technocrats to make informed policy guidelines and intervention strategies. With heat stress as a notable climate-related challenge in Africa, the need to limit heat exposure and enhance adaptation becomes important. Behavioural responses and heat-resistant characteristics of residential buildings are key aspects of exposure and adaptation to heat stress. We report a study that investigates heat exposure and adaptation responses across two neighbourhoods of different socio-economic status in Akure, Nigeria. The study involved a survey of 70 residents in each of the neighbourhoods. The study shows differences and commonalities in personal behavioural responses to heat stress, further revealing that education (p < 0.000), household income (p < 0.001) and gender (p < 0.002) were significant predictors of behavioural responses. Heat-resistant features in dwellings in both neighbourhoods were also identified. The poorer neighbourhood was more disadvantaged in this regard as their housing features did not completely prevent heat exposure. People in the richer neighbourhood, much more than the poorer one, were able to include features such as A/C, ceramic tiles, shady plants to cope with heat. These findings highlight intra-urban inequality in heat exposure and adaptation. They show the need for initiatives towards improved awareness and comprehensive retrofitting of dwellings to enhance their heat-resistant capacity.A
The disruptions of anthropogenic climate change are increasingly severe. People living in sub-Saharan Africa are especially exposed to these risks, and amongst them young people. It is well established that climate disruptions have the potential to halt education, displace populations, and wreck infrastructure. This rigorous literature review focuses on climate change in the landlocked East African country of Uganda, demographically the world’s third youngest country, where young people struggle to get by due to insufficient work opportunities. Extended to other countries in the Eastern and Central African region, the review considers what is known about the intersection of youth livelihoods and climate change; young people’s susceptibility to climate disruption due to limited resources and livelihood options; and the constraints around their responses. The review findings suggest the need for substantial youth informed interventions to bolster young people’s economic resilience and adaptive capacity given the worsening climate change and prolonged population growth. Climate change presents significant threats to human health, especially for low-income urban communities in the Global South. Despite numerous studies of heat stress, surprisingly little is known about the temperatures actually encountered by people in their homes, or the benefits of affordable adaptations. This paper examines indoor air temperature measurements gathered from 47 living rooms within eight low-income communities of Accra and Tamale, Ghana. Using multiple temperature indices and a tiered analysis, we evaluate indoor temperature variations linked to roof type, ceiling insulation, presence of fans, and tree shade, for different housing types and locations. Our data reveal indoor temperatures in the range 22.4 degrees C to 45.9 degrees C for Accra, and 22.2 degrees C to 43.0 degrees C in Tamale. Using dummy regression analysis, we find that tree shade reduces the number of very hot days (>40 degrees C) and nights (>30 degrees C) by about 12 and 15 d per year, respectively. Building materials also strongly moderate indoor temperatures but in opposing ways: rooms with traditional mud walls and thatch roofs are on average 4.5 degrees C cooler than rooms in concrete block houses with uninsulated metal roofs during the day but are 1.5 degrees C warmer at night; rooms with ceiling insulation are on average 6.9 degrees C cooler in the day but 1.4 degrees C warmer at night. We conclude that sub-daily data are necessary for reporting extreme indoor temperatures, and that trade-offs between minimum and maximum temperatures require interventions to be assessed carefully before attempting to counter extreme heat inside homes. Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures. Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be co-designed and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent. Although mixed methods research proves significant in understanding complex social phenomenon, inadequate research has explored its utility in heat exposure studies. The convergent mixed methods analysis comprising 320 surveys and two focus group interviews were used to evaluate the social impacts of occupational heat stress on Ghanaian mineworkers to enlighten policy choices for the purpose of complementarity. The study contributes to mixed methods study by affirming the practical use of between-method triangulation and complementarity. The merged quantitative and qualitative results also showed adequate corroboration and complementarity between both data, to illustrate the social impacts of work-related heat stress on mining workers as heat-related comorbidity, productive capacity loss, anxiety, slow pace of work, and inadequate social well-being. The mixed methods results would inform policy options on the health and safety of work settings, managing occupational heat stress, and adaptation guidelines in the mining industry. As global temperatures continue to rise unabated, episodes of heat-related catastrophes across the world have intensified. In Kenya, heatwave phenomena and their associated impacts are ignored and neglected due to several reasons, including unreliable and inconsistent weather datasets and heatwave detection metrics. Based on CHIRTS satellite infrared estimates and station blended temperature, this study investigated the spatiotemporal distribution of the heatwave events over Kenya during 1987-2016 using the Heatwave Magnitude Index daily (HWMId). The results showed that contrary to the absence of heatwave records in official national and international disaster database about Kenya, the country experienced heatwaves ranging from less severe (normal) to deadly (super-extreme) between 1987 and 2016. The most affected areas were located in the eastern parts of the country, especially in Garissa and Tana River, and in the west-northern side around the upper side of Turkana county. It was also found that the recent years’ heatwaves were more severe in magnitude, duration, and spatial extent. The highest magnitude of the heatwaves was recorded in 2015 (HWMId = 22.64) while the average over the reference period is around 6. CHIRTS and HWMId were able to reveal and capture most critical heatwave events over the study period. Therefore, they could be used respectively as data source and detection metrics, for heatwaves disaster emergency warning over short period as well as for long-term projection to provide insight for adaptation strategies. The ability of poor urban populations in developing countries to adapt to rapid increase in surface temperature and likely health effect of a 1.5 °C increase in global temperature is uncertain. Rapid urbanization and poor socio, economic, and technological development may increase heat vulnerabilities of poor urban populations in tropical cities. This study examines the thermal perception of urban populations in Ibadan, south western Nigeria, and sociodemographic characteristics of individuals that influence thermal perception, self-reported health effects, and coping strategies to heat stress using a purposefully designed questionnaire and interviews with aged individuals in the five local government areas of Ibadan metropolis. Differences in sociodemographic characteristics of respondents such as inequalities in monthly income, occupation, ethnicity, housing characteristics, and length of stay in Ibadan significantly influence thermal perception, self-reported health effects of heat exposure, and coping strategies adopted. Perceived thermal conditions reported were warmer temperatures during the day and night (43.75%), warmer day-time temperatures (40.25%), and warmer night-time temperatures (16%). Dehydration and sweating (56%): heat rash, heat exhaustion, headaches, sleep disturbances and dehydration (15.25%), and sleep disturbance and sweating (12.25%) were major combinations of self-reported health effects. Other effects include fainting, diarrhea, raised blood pressure, and restlessness. Temperature variations (minimum and maximum) examined from 1971 to 2018 shows that warmer conditions are being experienced in Ibadan. Increased heat-health awareness and urban designs that respond to people’s thermal perception should be encouraged in developing thermally comfortable environments in Ibadan. The Sahelian zone of Senegal experienced heat waves in the previous decades, such as 2013, 2016 and 2018 that were characterised by temperatures exceeding 45°C for up to 3 successive days. The health impacts of these heat waves are not yet analysed in Senegal although their negative effects have been shown in many countries. This study analyses the health impacts of observed extreme temperatures in the Sahelian zone of the country, focusing on morbidity and mortality by combining data from station observation, climate model projections, and household survey to investigate heat wave detection, occurrence of climate-sensitive diseases and risk factors for exposure. To do this, a set of climatic (temperatures) and health (morbidity, mortality) data were collected for the months of April, May and June from 2009 to 2019. These data have been completed with 1246 households’ surveys on risk factor exposure. Statistical methods were used to carry out univariate and bivariate analyses while cartographic techniques allowed mapping of the main climatic and health indicators. The results show an increase in temperatures compared to seasonal normal for the 1971-2000 reference period with threshold exceedances of the 90th percentiles (42°C) for the maxima and (27°C) the minima and higher temperatures during the months of May and June. From health perspective, it was noted an increase in cases of consultation in health facilities as well as a rise in declared morbidity by households especially in the departments of Kanel (17.7%), Ranérou (16.1 %), Matam (13.7%) and Bakel (13.7%). The heat waves of May 2013 were also associated with cases of death with a reported mortality (observed by medical staff) of 12.4% unequally distributed according to the departments with a higher number of deaths in Matam (25, 2%) and in Bakel (23.5%) than in Podor (8.4%) and Kanel (0.8%). The morbidity and mortality distribution according to gender shows that women (57%) were more affected than men (43%). These health risks have been associated with a number of factors including age, access to drinkable water, type of fuel, type of housing and construction materials, existence of fan and an air conditioner, and health history.The heat wave recurrence has led to a frequency in certain diseases sensitive to rising temperatures, which is increasingly a public health issue in the Sahelian zone of Senegal. Climate change poses a major threat to the future of today’s youth. Globally, young people are at the forefront of climate change activism. Their ability to engage, however, depends on the level of knowledge of climate change and concern about the topic. We sought to examine levels of knowledge and concerns about climate change among youth in South Africa, and their experiences of heat exposure. Ten questions on climate change knowledge, concerns and experiences were nested within a cross-sectional survey conducted in a cluster randomised trial among 924 secondary school learners in 14 public schools in low-income Western Cape areas. Learners’ mean age was 15.8 years and they were predominately female. While 72.0% of respondents knew that climate change leads to higher temperatures, only 59.7% agreed that human activity is responsible for climate change, and 58.0% believed that climate change affects human health. Two thirds (68.7%) said that climate change is a serious issue and 65.9% indicated action is needed for prevention. Few learners indicated climate change events had affected them, although many reported difficulties concentrating during hot weather (72.9%). Female learners had lower knowledge levels than male learners, but more frequent heat-related symptoms. Learners scoring high on knowledge questions expressed the most concern about climate change and had the highest heat impacts. Many youth seem unaware that climate change threatens their future. Heat-related symptoms are common, likely undermining educational performance, especially as temperatures escalate. More is needed to mainstream climate change into South African school curricula. Increasing air temperature coupled with high humidity due to ongoing climate change across most parts of South Africa is likely to induce and intensify heat exposure, particularly in densely populated areas. The adverse health implications, including heatstroke, are expected to be common and more severe during extreme heat and heat wave events. The present study was carried out to examine heat stress conditions and long-term trends in South Africa. The study aimed to identify geographical locations exposed to elevated heat stress based on over two decades of hourly ground-based data. Selected heat stress indicators were calculated based on Steadman’s apparent temperature (AT in degrees C). The trends in AT were assessed based on the non-parametric Mann-Kendall (MK) trend test at 5% significance level. Positive trends were detected in 88% of the selected weather stations except in Welkom-FS, Ficksburg-FS, Langebaanweg-WC, Lambertsbaai Nortier-WC, Skukuza-MP, and Thabazimbi-LP. Approximately 47% of the detected positive trends are statistically significant at 5% significant level. Overall, high climatological annual median (ATmed) values (>32 degrees C) were observed at 42 stations, most of which are in low altitude regions, predominately along the coastlines. The hottest towns with ATmed values in the danger category (i.e., 39-50 degrees C) were found to be Patensie-EC (41 degrees C), Pietermaritzburg-KZN (39 degrees C), Pongola-KZN (39 degrees C), Knysna-WC (39 degrees C), Hoedspruit-LP (39 degrees C), Skukuza-MP (45 degrees C), and Komatidraai-MP (44 degrees C). The results provide insight into heat stress characteristics and pinpoint geographical locations vulnerable to heat stress conditions at the community level in South Africa. Such information can be useful in monitoring hotspots of heat stress and contribute to the development of local heat-health adaptation plans. Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22-43 weeks’ gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017-June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low and high temperatures were defined as the 5th and 95th percentiles of daily mean temperature, respectively. Of 7986 women included, 844 (10.6%) had a hypertensive disorder of which 432 (51.2%) had high blood pressure/hypertension/gestational hypertension and 412 (48.8%) had pre-eclampsia/eclampsia/HELLP. High temperature in early pregnancy was associated with an increased risk of pre-eclampsia/eclampsia/HELLP. High temperature (23 °C vs 18 °C) in the third and fourth weeks of pregnancy posed the greatest risk, with hazard ratios of 1.76 (95% CI 1.12-2.78) and 1.79 (95% CI 1.19-2.71), respectively. Whereas, high temperatures in mid-late pregnancy tended to protect against pre-eclampsia/eclampsia/HELLP. Low temperature (11°) during the third trimester (from 29 weeks’ gestation) was associated with an increased risk of high blood pressure/hypertension/gestational hypertension, however the strength and statistical significance of low temperature effects were reduced with model adjustments. Our findings support the hypothesis that high temperatures in early pregnancy increase risk of severe hypertensive disorders, likely through an effect on placental development. This highlights the need for greater awareness around the impacts of moderately high temperatures in early pregnancy through targeted advice, and for increased monitoring of pregnant women who conceive during periods of hot weather. Both climate change and rapid urbanization accelerate exposure to heat in the city of Kampala, Uganda. From a network of low-cost temperature and humidity sensors, operational in 2018-2019, we derive the daily mean, minimum and maximum Humidex in order to quantify and explain intra-urban heat stress variation. This temperature-humidity index is shown to be heterogeneously distributed over the city, with a daily mean intra-urban Humidex Index deviation of 1.2 degrees C on average. The largest difference between the coolest and the warmest station occurs between 16:00 and 17:00 local time. Averaged over the whole observation period, this daily maximum difference is 6.4 degrees C between the warmest and coolest stations, and reaches 14.5 degrees C on the most extreme day. This heat stress heterogeneity also translates to the occurrence of extreme heat, shown in other parts of the world to put local populations at risk of great discomfort or health danger. One station in a dense settlement reports a daily maximum Humidex Index of >40 degrees C in 68% of the observation days, a level which was never reached at the nearby campus of the Makerere University, and only a few times at the city outskirts. Large intra-urban heat stress differences are explained by satellite earth observation products. Normalized Difference Vegetation Index has the highest (75%) power to predict the intra-urban variations in daily mean heat stress, but strong collinearity is found with other variables like impervious surface fraction and population density. Our results have implications for urban planning on the one hand, highlighting the importance of urban greening, and risk management on the other hand, recommending the use of a temperature-humidity index and accounting for large intra-urban heat stress variations and heat-prone districts in urban heat action plans for tropical humid cities. Over the past years, cities have become more prone to extreme and frequent heatwaves. In this regard, urban form plays an important role and several typomorphological classifications have been developed to describe the urban form characteristics that can exacerbate heat stress and influence people’s health and comfort negatively (i.e. the environmental dimension of heat-stress resilience). Nevertheless, evidence from past heatwave disasters indicates that other urban form characteristics, not included in existing typomorphological classifications, can significantly affect heat-stress resilience by influencing the conditions of social interaction and the state of social ties and solidarities in urban neighborhoods (i.e. the social dimension). Therefore, this paper proposes a broader approach combining the aforementioned environmental and social dimensions in the classification of urban form types; and demonstrates its application in a real-world case by developing a data-driven typomorphological classification that complements existing ones with the missing social dimension. The results showed the possi-bility of numerically identifying neighborhood types that, through distinct urban form characteristics, have different potentials for enhancing the social dimension of heat-stress resilience. This has direct planning and design relevance as the quantifiable characteristics of these types can be translated into guidelines/rules and incorporated into local regulations/codes. Heat stress-related illness attributed to the changing climate, particularly the more frequent extreme high temperatures, is becoming a theme of public concern, especially in the most vulnerable regions, such as the African continent. Knowledge of the existing research directions and gaps on heat stress and human health is vital for informing future strategic research foci capable of influencing policy development, planning, adaptation, and mitigation efforts. In this regard, a bibliometric analysis was conducted, with an emphasis on Africa, to assess regional research contributions to heat stress impacts on human health. The goals of the study were to review publication growth and patterns of the scientific publications and to identify key players (especially collaborating institutions and countries) and the evolution of research themes on the African continent, while paying attention to global trends and emergent hot topics and methodology of heat stress research. Using the Web of Science (WoS) and Scopus core collection databases, a structured keyword search was undertaken, which yielded 463 and 58 research publications from around the world and Africa, respectively. The retrieved scientific documents, published between 1968 and 2020, were analyzed and visualized using a bibliometric analysis technique and the VOSviewer software tool. The results indicate low statistics and slow scientific growth in publication output, with the highest peak having been reached in 2018, resulting in 13 scientific publications. While global research collaborations are successfully reflected in the literature, there is a considerable gap in understanding heat stress and related collaborations between African countries and international institutions. The review study has identified key opportunities that can benefit Africa through the expansion of the scope of heat stress and human health research on the continent. These opportunities can be achieved by closing the following research gaps: (1) vulnerability assessments within demographic classes, such as the elderly, (2) personal exposure and associated risks, (3) Urban Heat Island (UHI) evaluation for urban environments, and (4) heat adaptation research, which will enable informed and targeted preventive actions that will limit future heat health impacts. The authors opine that the pursuit of such studies will be most impactful if the current knowledge gaps are bridged through transdisciplinary research supported by local, regional, and international collaborators. Climate change and expected weather patterns in the long-term threaten the livelihood inside oases settlements in arid lands, particularly under the recurring heat waves during the harsh months. This paper investigates the impact of climate change on the outdoor thermal comfort within a multifamily housing neighborhood that is considered the most common residential archetype in Algerian Sahara, under extreme weather conditions in the summer season, in the long-term. It focuses on assessing the outdoor thermal comfort in the long-term, based on the Perceived Temperature index (PT), using simulation software ENVI-met and calculation model RayMan. Three different stations in situ were conducted and combined with TMY weather datasets for 2020 and the IPCC future projections: A1B, A2, B1 for 2050, and 2080. The results are performed from two different perspectives: to investigate how heat stress evolution undergoes climate change from 2020 till 2080; and for the development of a mathematical algorithm to predict the outdoor thermal comfort values in short-term, medium-term and long-term durations. The results indicate a gradual increase in PT index values, starting from 2020 and progressively elevated to 2080 during the summer season, which refers to an extreme thermal heat-stress level with differences in PT index averages between 2020 and 2050 (+5.9 degrees C), and 2080 (+7.7 degrees C), meaning no comfortable thermal stress zone expected during 2080. This study gives urban climate researchers, architects, designers and urban planners several insights into predicted climate circumstances and their impacts on outdoor thermal comfort for the long-term under extreme weather conditions, in order to take preventive measures for the cities’ planning in the arid regions. BACKGROUND: Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus. METHODS: We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain. FINDINGS: Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase. INTERPRETATION: Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions. FUNDING: The Wellcome Trust.
Indoor thermal comfort is essential for occupants’ well-being, productivity, and efficiency. Global climate change is leading to extremely high temperatures and more intense solar radiation, especially in hot, humid areas. Passive cooling is considered to be one of the environmental design strategies by which to create indoor thermal comfort conditions and minimize buildings’ energy consumption. However, little evidence has been found regarding the effect of passive cooling on the thermal comfort of historical buildings in hot-dry or hot-humid areas. Therefore, we explored the passive cooling features (north-south orientation, natural ventilation, window shading, and light color painted walls) applied in historic residential buildings in Zanzibar and evaluated the residents’ thermal responses and comfort perception based on questionnaires and field surveys. The results showed that the average predicted mean votes (PMVs) were 1.23 and 0.85 for the two historical case study buildings; the average predicted percentages of dissatisfaction (PPD) were 37.35% and 20.56%, respectively. These results indicate that the thermal conditions were not within the acceptable range of ASHRAE Standard 55. Further techniques, such as the use of lime plaster, wash lime, and appropriate organization, are suggested for the improvement of indoor thermal comfort in historical buildings in Zanzibar. This study provides guidelines to assist architects in designing energy-efficient residential buildings, taking into account cultural heritage and thermal comfort in buildings. Nearly 1 billion people live without electricity at home. Energy poverty limits their ability to take autonomous actions to improve air circulation and the cooling of their homes. It is therefore important that electricity-access planners explicitly evaluate the current and future air circulation and cooling needs of energy-poor households, in addition to other basic energy needs. To address this issue, we combine climate, socio-economic, demographic and satellite data with scenario analysis to model spatially explicit estimates of potential cooling demand from households that currently lack access to electricity. We link these demand factors into a bottom-up electrification model for sub-Saharan Africa, the region with the world’s highest concentration of energy poverty. Accounting for cooling needs on top of baseline household demand implies that the average electrification investment requirements grow robustly (a scenario mean of 65.5% more than when considering baseline household demand only), mostly due to the larger generation capacity needed. Future climate change could increase the investment requirements by an additional scenario mean of 4%. Moreover, the share of decentralised systems as the lowest-cost electrification option falls by a scenario mean 4.5 percentage points of all new connections. The crucial determinants for efficient investment pathways are the adoption and use of cooling appliances, the extent of climate change, and the baseline electricity demand. Our results call for a more explicit consideration of climate-adaptative energy needs by infrastructure planners in developing countries. Extreme weather events are major causes of loss of life and damage infrastructure worldwide. High temperatures cause heat stress on humans, livestock, crops and infrastructure. Heat stress exposure is projected to increase with ongoing climate change. Extremes of temperature are common in Africa and infrastructure is often incapable of providing adequate cooling. We show how easily accessible cooling technology, such as evaporative coolers, prevent heat stress in historic timescales but are unsuitable as a solution under climate change. As temperatures increase, powered cooling, such as air conditioning, is necessary to prevent overheating. This will, in turn, increase demand on already stretched infrastructure. We use high temporal resolution climate model data to estimate the demand for cooling according to two metrics, firstly the apparent temperature and secondly the discomfort index. For each grid cell we calculate the heat stress value and the amount of cooling required to turn a heat stress event into a non heat stress event. We show the increase in demand for cooling in Africa is non uniform and that equatorial countries are exposed to higher heat stress than higher latitude countries. We further show that evaporative coolers are less effective in tropical regions than in the extra tropics. Finally, we show that neither low nor high efficiency coolers are sufficient to return Africa to current levels of heat stress under climate change. Investigating the effects of the increased global warming through the lens of the Paris agreements would be of particular importance for Central African countries, which are already experiencing multiple socio-political and socio-economic constraints, but are also subject to severe natural hazards that interact to limit their adaptive capacity and thus increase their vulnerability to the adverse effects of climate change. This study explores changes in heat stress and the proportion of population at risk of discomfort over Central Africa, based on an ensemble-mean of high-resolution regional climate model simulations that cover a 30-year period, under 1.5, 2 and 3 °C Global Warming Levels (GWLs). The heat index was computed according to Rothfusz’s equation, while the discomfort index was obtained from Thom’s formula. The results show that throughout the year but with a predominance from March to August, the spatial extent of both heat and discomfort categories is projected to gradually increase according to the considered GWLs (nearly threefold for an increasing warming thresholds from 1.5 to 3 °C). As these heat conditions become more frequent, they lead to the emergence of days with potentially dangerous heat-related risks, where almost everyone feels discomfort due to heat stress. It thus appears that the majority of populations living in countries located along the Atlantic coast and in the northern and central part of the study area are likely to be more vulnerable to certain health problems, which could have repercussions on the socio-economic development of the sub-region through decreased workers’ productivity and increased cooling degree days. Overall, these heat-related risks are more extended and more frequent when the GWL reaches 2 °C and above. Objectives Folate is an essential nutrient fundamental to human growth and development. Human milk maintains high folate content across the maternal folate status range, suggesting buffering of milk folate with prioritized delivery to milk at the expense of maternal depletion. We investigated whether and how the extent of this buffering may diminish under prolonged nutritional and/or disease stress, while taking into consideration infants’ varying vulnerability to malnutrition-related morbidity/mortality. Methods A cross-sectional study analyzed milk specimens from northern Kenyan mothers (n = 203), surveyed during a historic drought and ensuing food shortage. Multiple regression models for folate receptor-alpha (FOLR1) in milk were constructed. Predictors included maternal underweight (BMI < 18.5), iron-deficiency anemia (hemoglobin 5 mg/L), folate deficiency (hyperhomocysteinemia, homocysteine >12 or 14 mu mol/L), inflammation (serum C-reactive protein >5 mg/L), infant age and sex, and mother-infant interactions. Results In adjusted models, milk FOLR1 was unassociated with maternal underweight, iron-deficiency anemia and inflammation. FOLR1 was positively associated with maternal folate deficiency, and inversely associated with infant age. There was interaction between infant age and maternal underweight, and between infant sex and maternal folate deficiency, predicting complex changes in FOLR1. Conclusions Our results suggest that mothers buffer milk folate against their own nutritional stress even during a prolonged drought; however, the extent of this buffering may vary with infant age, and, among folate-deficient mothers, with infant sex. Future research is needed to better understand this variability in maternal buffering of milk folate and how it relates to folate status in nursing infants. Pastoralists in East Africa are among the world’s most vulnerable communities to climate change, already living near their upper thermal limits and engaging in a climate-sensitive livelihood in a climate change global hot spot. Pregnant women and children are even more at risk. Here, we report the findings of a study characterizing Samburu pastoralist women’s experiences of severe drought and outcomes in their children (N = 213, 1.8-9.6 y). First, we examined potential DNA methylation (DNAm) differences between children exposed to severe drought in utero and same-sex unexposed siblings. Next, we performed a high-dimensional mediation analysis to test whether DNAm mediated associations of exposure to severe drought with body weight and adiposity. DNAm was measured using the Infinium MethylationEPIC BeadChip array. After quality control; batch, chip, and genomic inflation corrections; covariate adjustment; and multiple testing correction, 16 CpG sites were differentially methylated between exposed and unexposed children, predominantly in metabolism and immune function pathways. We found a significant indirect effect of drought exposure on child body weight through cg03771070. Our results are the first to identify biological mediators linking severe drought to child growth in a low-income global hot spot for climate change. A better understanding of the mechanisms underlying the association between drought exposure and child growth is important to increasing climate change resilience by identifying targets for intervention. There is growing evidence that early life conditions are important for outcomes during adolescence, including cognitive development and education. Economic conditions at the time children enter school are also important. We examine these relationships for young adolescents living in a low-income drought-prone pastoral setting in Kenya using historical rainfall patterns captured by remote sensing as exogenous shocks. Past rainfall shocks measured as deviations from local long-term averages have substantial negative effects on the cognitive development and educational achievement of girls. Results for the effects of rainfall shocks on grades attained, available for both girls and boys, support that finding. Consideration of additional outcomes suggests the effects of rainfall shocks on education are due to multiple underlying mechanisms including persistent effects on the health of children and the wealth of their households, underscoring the potential value of contemporaneous program and policy responses to such shocks. Each year there are over 300 natural disasters globally with millions of victims that cost economic losses near USD$100 billion. In the context of climate change, an emerging literature linking extreme weather events to HIV infections suggests that efforts to control the HIV epidemic could be under threat. We used Demographic and Health Survey (DHS) data collected during the 2015-2016 harsh drought that affected several areas of Malawi to provide new evidence on the effect of an unanticipated economic shock on sexual behaviours of young women and men. We find that amongst women employed in agriculture, a six-months drought doubles their likelihood of engaging in transactional sex compared to women who were not affected by the drought and increases their likelihood of having a sexually transmitted infections (STI) by 48% in the past twelve months. Amongst men employed outside of agriculture, drought increases by 50% the likelihood of having a relationship with a woman engaged in transactional sex. These results suggest that women in agriculture experiencing economic shocks as a result of drought use transactional sex with unaffected men, i.e. men employed outside agriculture, as a coping mechanism, exposing themselves to the risk of contracting HIV. The effect was especially observed among non-educated women. A single drought in the last five years increases HIV prevalence in Malawi by around 15% amongst men and women. Overall, the results confirm that weather shocks are important drivers of risky sexual behaviours of young women relying on agriculture in Africa. Further research is needed to investigate the most adequate formal shock-coping strategies to be implemented in order to limit the negative consequences of natural disasters on HIV acquisition and transmission. The effects of adverse prenatal conditions are not only experienced over the life course but can be passed on intergenerationally. The present study took advantage of a natural experiment from three drought periods of 1981/82, 1987/88, and 1992/93 that occurred in Malawi with varying severity and used data from a randomized clinical trial (RCT), conducted between 2011-2015 (Protocol #NCT01239693). The present study aimed to assess the effect of the interactions between maternal exposure to drought in early life and prenatal supplementation with a novel supplement [small quantity (SQ), lipid-based nutrient supplement (LNS)], the standard of care prenatal supplement [iron-folic acid or IFA], or a close substitute of the standard of care [multiple micronutrients or MMN], on subsequent infant birth outcomes. During data analysis, ordinary least squares were used to run multiple regressions. The regression results were as follows. When there was no maternal exposure to drought, SQ-LNS compared to IFA appeared to improve subsequent infant birth outcomes for length-for-age Z score or LAZ (0.403 standard deviation (SD), Confidence interval CI [0.099, 0.708]), for subsequent infant weight-for-age Z score or WAZ (0.372 SD, CI [0.053, 0.691]), and for imputed infant birthweight or BTW (125.900 g, CI [2.901, 248.899]). In conclusion, the results show a pattern emerging whereby some positive associations can be observed, specifically, when maternal non-drought exposure variables and the SQ-LNS variable interact. Their combined effects on subsequent infant birth outcomes notably subsequent infant LAZ, subsequent infant WAZ, and subsequent infant imputed BWT appear to be positive. INTRODUCTION: Over the past 30 years, south-central Somalia, Puntland (north-east) and Somaliland (north-west) have experienced recurring drought- and conflict-related crises. By the end of 2018, the number of internally displaced persons (IDPs) in the region had reached 2.6 million; most were displaced to larger towns under government control, where humanitarian assistance was more accessible. Understanding the drivers of crisis-related displacement can provide insight into how responses can best manage and respond to displacement to prevent downstream morbidity and mortality. We aimed to explore the temporal patterns and crisis-related risk factors for population displacement in Somalia from 2016 to 2018, a period of severe drought. METHODS: We conducted an ecological study of secondary panel data stratified by district and month. The study population included all people in the region from 2016 to 2018. The outcome was defined as the number of new out-migrating internally displaced persons (IDPs) per district-month. Exposure variables included armed conflict, rainfall, food insecurity and food security services. Lags at one, two and three months were generated to explore possible delayed effects. All univariate and multivariate analyses were conducted using negative binomial regression models with mixed effects incorporating the district as a random effect. RESULTS: From 2016 to 2018, the proportion of IDPs increased from 9% to 25% in Somalia, Puntland and Somaliland. We observed strong associations between IDP out-migration rate and failed rains at a three-month lag, food insecurity at a one-month lag, and the presence of therapeutic food services with no lag. IDP out-migration rate was not associated with armed conflict intensity, and cash- and rations-based food security services. DISCUSSION: This study identified temporal, and socially and biologically plausible associations between key crisis-related risk factors and displacement in Somalia. The findings suggest a sequence of events spanning a few months, where failed rains and consequent food insecurity likely prompted early population out-migration to larger urban centers where humanitarian services were more accessible. The presence of therapeutics-based food security services could represent a more general correlate of crisis severity and the decision to migrate. In 2015, South Africa experienced one of the worst (El Ni??o-induced) droughts in 35 years. This affected economic activities, individual and community livelihoods and wellbeing especially in rural communities in northern KwaZulu-Natal. Drought’s direct and indirect impacts on public health require urgent institutional responses, especially in South Africa’s stride to eliminate HIV as a public health threat by 2030 in line with the UNAIDS goals. This paper draws on qualitative data from interviews and policy documents to discuss how the devastating effect of the 2015 drought experience in the rural Hlabisa sub-district of uMkhanyakude, a high HIV prevalence area, imposes an imperative for more proactive institutional responses to drought and other climate-related events capable of derailing progress made in South Africa’s HIV/AIDS response. We found that drought had a negative impact on individual and community livelihoods and made it more difficult for people living with HIV to consistently engage with care due to economic losses from deaths of livestock, crop failure, food insecurity, time spent in search of appropriate water sources and forced relocations. It also affected government institutions and their interventions. Interviewed participants’ reflections on drought-related challenges, especially those related to institutional and coordination challenges, showed that although current policy frameworks are robust, their implementation has been stalled due to complex reporting systems, and inadequate interdepartmental collaboration and information sharing. We thus argue that to address the gaps in the institutional responses, there is a need for more inclusive systems of drought-relief implementation, in which government departments, especially at the provincial and district levels, work with national institutions to better share data/information about drought-risks in order to improve preparedness and implementation of effective mitigation measures. In 2015 and 2016, South Africa experienced a severe drought resulting in water restrictions and food price inflation. A year later, while the proportion of food secure households remained constant, the proportion of those experiencing severe food insecurity increased. This paper investigates the socio-economic determinants of increasing food insecurity during and after the drought. Two cross-sectional household surveys were carried out in the district of iLembe in November 2016 and 2017. Household food insecurity was measured using the Coping Strategies Index. The results indicated changes in socio-economic determinants of food insecurity over time, with the poorest households experiencing the worst levels of food insecurity. After the drought, having a child under-five years was positively associated with food insecurity, while being located in a rural area was negatively associated. Policies that limit household vulnerability to price inflation, and interventions that protect poorer households from the effects of drought should be considered. The 2015 El Nin & SIM;o-triggered drought in Southern Africa caused widespread economic and livelihood disruption in South Africa, imposing multiple physical and health challenges for rural populations including people living with HIV (PLHIV). We examined the economic, social and demographic impacts of drought drawing on 27 in-depth interviews in two cohorts of PLHIV in Hlabisa, uMkhanyakude district, KwaZulu-Natal. Thematic analysis revealed how drought enforced soil water depletion, dried-up rivers, and dams culminated in a continuum of events such as loss of livestock, reduced agricultural production, and insufficient access to water and food which was understood to indirectly have a negative impact on HIV treatment adherence. This was mediated through disruptions in incomes, livelihoods and food systems, increased risk to general health, forced mobility and exacerbation of contextual vulnerabilities linked to poverty and unemployment. The systems approach, drawn from interview themes, hypothesises the complex pathways of plausible networks of impacts from drought through varying socioeconomic factors, exacerbating longstanding contextual precarity, and ultimately challenging HIV care utilisation. Understanding the multidimensional relationships between climate change, especially drought, and poor HIV care outcomes through the prism of contextual vulnerabilities is vital for shaping policy interventions. BACKGROUND: Climate-induced disruptions like drought can destabilize household and community livelihoods, particularly in low- and middle-income countries. This qualitative study explores the impact of severe and prolonged droughts on gendered livelihood transitions, women’s social and financial wellbeing, and sexual and reproductive health (SRH) outcomes in two Zambian provinces. METHODS: In September 2020, in-depth interviews (n = 20) and focus group discussions (n = 16) with 165 adult women and men in five drought-affected districts, as well as key informant interviews (n = 16) with civic leaders and healthcare providers, were conducted. A team-based thematic analysis approach, guided by the Framework Method, was used to code transcript text segments, facilitating identification and interpretation of salient thematic patterns. RESULTS: Across districts, participants emphasized the toll drought had taken on their livelihoods and communities, leaving farming households with reduced income and food, with many turning to alternative income sources. Female-headed households were perceived as particularly vulnerable to drought, as women’s breadwinning and caregiving responsibilities increased, especially in households where women’s partners out-migrated in search of employment prospects. As household incomes declined, women and girls’ vulnerabilities increased: young children increasingly entered the workforce, and young girls were married when families could not afford school fees and struggled to support them financially. With less income due to drought, many participants could not afford travel to health facilities or would resort to purchasing health commodities, including family planning, from private retail pharmacies when unavailable from government facilities. Most participants described changes in fertility intentions motivated by drought: women, in particular, expressed desires for smaller families, fearing drought would constrain their capacity to support larger families. While participants cited some ongoing activities in their communities to support climate change adaptation, most acknowledged current interventions were insufficient. CONCLUSIONS: Drought highlighted persistent and unaddressed vulnerabilities in women, increasing demand for health services while shrinking household resources to access those services. Policy solutions are proposed to mitigate drought-induced challenges meaningfully and sustainably, and foster climate resilience. The assessment of the vulnerability to drought hazards in smallholder farming systems dependent on rain-fed agriculture has recently gained global popularity, given the need to identify and prioritize climate hotspots for climate adaptation. Over the past decade, numerous studies have focused on vulnerability assessments with respect to drought and other meteorological hazards. Nonetheless, less research has focused on applying common measurement frameworks to compare vulnerability in different communities and the sources of such vulnerability. Yet, the crucial question remains: who is more vulnerable and what contributes to this vulnerability? This article is a case study for assessing the vulnerability to drought of smallholder farmers in two wards in Chivi district, Masvingo Province, Zimbabwe. This study is timely, as climate change is increasingly affecting populations dependent on rainfed agriculture. This assessment has been conducted by calculating the Livelihood Vulnerability Index (LVI) and Livelihood Vulnerability Index of the Intergovernmental Panel on Climate Change (LVI-IPCC). This empirical study used data from 258 households from the two wards and triangulated it through Key Informant Interviews and Focus Group Discussions. To calculate the LVI, twenty-six subcomponents made up of seven major components, including socio-demographic variables; livelihood strategies; social capital; access to food, health, and water; and exposure to drought, were considered. To calculate the LVI-IPCC, we combined the three contributing factors of vulnerability (exposure, sensitivity, and adaptive capacity). Our results indicate that the LVI forward 14 is statistically higher than for ward 19 (F = 21.960; p <= 0.01) due to high exposure to drought, food insecurity, and compromised social networks. Concerning the LVI-IPCC, ward 14 was significantly more vulnerable to the impacts of drought than ward 19 (F = 7.718; p <= 0.01). Thus, reducing exposure to drought through early warning systems, building diversified agricultural systems, and social networks are of high priority to reduce the vulnerability of the farmers.
Climate change-induced extreme weather events such as drought have occurred with increasing frequency and intensity in Zimbabwe over the past 30 years bringing about pressure on communally owned water resources. Using the Zimbabwe Vulnerability Assessment Committee 2020 survey of rural households in Zimbabwe, this study assesses the impact of drought shock on the occurrence of water point violence. The impact of self-reported drought shock on the likelihood of occurrence of social conflict in the form of water point violence is subject to confounding due to selection bias. Using the doubly robust inverse probability weighted regression adjustment to account for confounding, we investigate gender dimensions of the impact of drought on inducing water point violence in rural Zimbabwe. The study offers three major findings. First, drought shock is associated with increased household propensity to experience water point violence. Second, the severity of the drought shock impact increases the probability of the household experiencing water point violence. Third, drought shock-induced water point violence is only statistically valid for households where the water-fetcher is a woman or girl. The results suggest that the impact of drought shocks on water point violence is gendered and disadvantages women and girls more than men and boys. INTRODUCTION: Zimbabwe experienced the negative effects of the devastating cyclone Idai which affected several districts in the country, and the drought due to low rainfall that has affected the whole country. As a result of these catastrophes, the food and nutrition security situation in the country has deteriorated. For this reason, we carried out a rapid assessment of the health facilities in 19 sampled high global acute malnutrition and high food insecurity districts from the ten provinces of Zimbabwe to ascertain the preparedness of the facilities to respond to drought effects. METHODS: we conducted a rapid nutritional assessment in 19 purposely selected districts with highest rates of global acute malnutrition from the 10 provinces of Zimbabwe. From these districts, we selected a district hospital and a rural health facility with high number of acute malnutrition cases. We adapted and administered the WHO recommended checklist (Multi-Cluster/Sector Initial Rapid Assessment (MIRA) as the assessment tool. We used STATA to generate frequencies, and proportions. RESULTS: about 94% (16/19) of the districts had less than 50% health workers trained to manage acute malnutrition. A total of 26% (5/19) of the district hospitals and 32% (6/19) of the primary health care facilities were not admitting according to integrated management of acute malnutrition (IMAM) protocol. Twelve districts (63%) had none of their staff trained in infant and young child feeding (IYCF), 58% (11/19) had no staff trained in growth monitoring and 63% (12/19) of the districts had no trained staff in baby friendly hospital initiative (BFHI). A total of 60% of the provinces did not have combined mineral vitamin mix stocks, 80% had no resomal stocks, 20% did not have micronutrient powder stocks and 30% had no ready to use supplementary food stocks in all their assessed facilities. Fifty percent (50%) of the health facilities were not adequately stocked with growth monitoring cards. Manicaland had the least (20%) number of health facility with a registration system to notify cases of malnutrition. CONCLUSION: we concluded that the Zimbabwe health delivery system is not adequately prepared to respond to the effects of the current drought as most health workers had inadequate capacity to manage acute malnutrition, the nutrition surveillance was weak and inadequate stocks of commodities and anthropometric equipment was noted. Following this, health workers from six of ten provinces were trained on management of acute malnutrition, procurement of some life -saving therapeutic and supplementary foods was done. We further recommend food fortification as a long-term plan, active screening for early identification of malnutrition cases and continuous training of health workers. Droughts are associated with several health effects and Africa is uniquely vulnerable. Despite this, there has been no previous review of the literature on the health effects of drought in Africa. This study systematically reviewed the epidemiological research on the association between drought and adverse health effects in Africa (2012-2019). A total of fifteen articles were included in the review after screening 1922 published (peer-reviewed) and unpublished articles. These studies were all conducted in 9 Sub-Saharan African countries. The drought-related health effects identified were on adverse nutritional health (n = 8) including malnutrition resulting in reduced body size and wasting, stunting and underweight, mortality from food insecurity, anaemia from food insecurity and nutrition-related disability from food insecurity; drought and diseases due to microbial contamination of water (n = 6) including cholera, diarrhoeal diseases, scabies, vector-borne diseases and malaria-related mortality; and drought and health behaviours (n = 1) including HIV prevention and care behaviours. The study found limited evidence of a high prevalence of malnutrition, an increased prevalence of anaemia, cholera, scabies, dengue and an increased incidence in child disabilities during periods of drought. Additionally, there was limited evidence on improved child nutritional health with improved water and sanitation access, and an increased prevalence of child wasting, stunting and underweight in drought-prone areas. No evidence of drought on other health outcomes was found. However, all the studies had more than one limitation including weak study design, a lack of comparison to a drought period, uncertainty on the onset and end of drought, lack of control for confounding, presence of contextual factors, weak outcome and/or exposure measure, small sample size and lack of generalizability. This review found weak evidence for all health outcomes measured but highlights key areas for further research and contextual factors which need to be considered for interventions. Droughts are associated with poor health outcomes and disruption of public health programming. Data on the association between drought and HIV testing and transmission risk behaviors are limited. We combined data from Demographic and Health Surveys from 10 high HIV prevalence sub-Saharan African countries with a high-resolution measure of drought. We estimated the association between drought and recent HIV testing, report of condomless sex, and number of sexual partners in the last year. Respondents exposed to drought were less likely to have an HIV test and more likely to have condomless sex, although effect sizes were small. We found evidence for effect modification by sex and age for the association between drought and HIV testing, such that the negative association between drought and HIV testing was strongest among men (marginal risk ratio [mRR] 0.92, 95% CI 0.89-0.95) and adolescents (mRR 0.90, 95% CI 0.86-0.93). Drought may hinder HIV testing programs in countries with high HIV prevalence. Climate change is directly and indirectly linked to human health, including through access to treatment and care. Our systematic review presents a systems understanding of the nexus between drought and antiretroviral therapy (ART) adherence in HIV-positive individuals in the African setting. Narrative synthesis of 111 studies retrieved from Web of Science, PubMed/MEDLINE, and PsycINFO suggests that livelihoods and economic conditions, comorbidities and ART regimens, human mobility, and psychobehavioural dispositions and support systems interact in complex ways in the drought-ART adherence nexus in Africa. Economic and livelihood-related challenges appear to impose the strongest impact on human interactions, actions, and systems that culminate in non-adherence. Indeed, the complex pathways identified by our systems approach emphasise the need for more integrated research approaches to understanding this phenomenon and developing interventions. Objectives This study of Samburu pastoralists (Kenya) employs a same-sex sibling design to test the hypothesis that exposure in utero to severe drought and maternal psychosocial stress negatively influence children’s growth and adiposity. As a comparison, we also hypothesized that regional climate contrasts would influence children’s growth and adiposity based on ecogeographical patterning. Materials and Methods Anthropometric measurements were taken on Samburu children ages 1.8-9.6 years exposed to severe drought in utero and younger same-sex siblings (drought-exposed, n = 104; unexposed, n = 109) in two regions (highland, n = 128; lowland, n = 85). Mothers were interviewed to assess lifetime and pregnancy-timed stress. Results Drought exposure associated to lower weight-for-age and higher adiposity. Drought did not associate to tibial growth on its own but the interaction between drought and region negatively associated to tibial growth in girls. In addition, drought exposure and historically low rainfall associated to tibial growth in sensitivity models. A hotter climate positively associated to adiposity and tibial growth. Culturally specific stressors (being forced to work too hard, being denied food by male kin) associated to stature and tibial growth for age. Significant covariates for child outcomes included lifetime reported trauma, wife status, and livestock. Discussion Children exposed in utero to severe drought, a hotter climate, and psychosocial stress exhibited growth differences in our study. Our results demonstrate that climate change may deepen adverse health outcomes in populations already psychosocially and nutritionally stressed. Our results also highlight the value of ethnography to identifying meaningful stressors. This paper evaluates the short-term health effects of in utero drought shock using repeated cross-section household data on Malawi. The main finding reveals that the effects of in utero harvest variability caused by rainfall shocks on child growth indices are driven by the deleterious effects of negative rainfall deviations, namely droughts. Negative rainfall deviation during the agricultural season prior to the gestational period of a child leads to a 21.8 per cent average local level reduction in age-standardized height scores, with the counterpart positive rainfall deviation having no apparent effect. The paper also uses harvest and consumption patterns to establish an important link between early-life malnutrition and growth serving as a precursor for the fetal period programming hypothesis in the literature. The direct impact of embryonic period shocks on growth provides supportive evidence on potential interaction between nutritional and environmental pathways. Extreme Temperature Events (ETEs), including heatwaves, warm spells, cold waves and cold spells, have disastrous impacts on human health and ecosystems. The frequency, intensity, and duration of ETEs is projected to increase due to climate change. However, very little research has been done on ETEs in South Africa, and only a few attempts have been made to identify and examine trends. Currently, ten known publications have examined ETEs across South Africa, the majority of which use the South African Weather Service (SAWS) climate database as the primary source. The general findings indicate that the incidence and duration of extreme warm temperatures are increasing, while cold extremes are decreasing. However, inconstancies exist in the indices used to identify ETEs, selection of meteorological stations, study period, and statistical methods used to examine trends. We review the methodological approaches to define ETEs, the extreme temperature indices adopted, the selection of meteorological stations, study periods, data quality and homogeneity, statistical trend analysis, and results. From these, we propose an approximate number of stations to adequately portray temperature variability on a national and regional level. Finally, we reflect on projections of ETEs under current climate change conditions, and the implications of cold and warm ETEs in a South African context. According to the Intergovernmental Panel on Climate Change (IPCC), the global mean temperature is expected to increase from 1.4°C to 5.8°C by 2100. The implications will be particularly significant in urban areas as indoor and outdoor comfort levels will be disrupted, leading to significant health impacts. One of the expected impacts is indoor overheating, as it has been identified as one of the major causes of thermal discomfort and is directly linked to the potential increase in mortality levels in the future. This paper focuses on the potential implications of increased overheating hours on human health in an old low-income residential neighborhood. We study the effect of three main factors: population coping capacity, building thermal performance, and human physiological response to heat exposure. This is achieved by examining an old low-income neighborhood in Cairo, Egypt, whose residents have limited cooling systems access. Results indicate higher overheating risks in older buildings with a projected increase of 18% in indoor temperature and higher health risks, especially for elderly residents. The study’s findings can be considered a starting point to examine the relationship between exposure duration, indoor air temperature range, and potential health risks for vulnerable urban communities with limited access to cooling mechanisms such as AC units. BACKGROUND: Temperature and precipitation are known to affect Vibrio cholerae outbreaks. Despite this, the impact of drought on outbreaks has been largely understudied. Africa is both drought and cholera prone and more research is needed in Africa to understand cholera dynamics in relation to drought. METHODS: Here, we analyse a range of environmental and socioeconomic covariates and fit generalised linear models to publicly available national data, to test for associations with several indices of drought and make cholera outbreak projections to 2070 under three scenarios of global change, reflecting varying trajectories of CO(2) emissions, socio-economic development, and population growth. RESULTS: The best-fit model implies that drought is a significant risk factor for African cholera outbreaks, alongside positive effects of population, temperature and poverty and a negative effect of freshwater withdrawal. The projections show that following stringent emissions pathways and expanding sustainable development may reduce cholera outbreak occurrence in Africa, although these changes were spatially heterogeneous. CONCLUSIONS: Despite an effect of drought in explaining recent cholera outbreaks, future projections highlighted the potential for sustainable development gains to offset drought-related impacts on cholera risk. Future work should build on this research investigating the impacts of drought on cholera on a finer spatial scale and potential non-linear relationships, especially in high-burden countries which saw little cholera change in the scenario analysis. Chronic seasonal crop and livestock loss due to heat stress and rainfall shortages can pose a serious threat to human health, especially in Sub-Saharan Africa where subsistence and small-scale farming dominate. Young children are particularly susceptible to undernutrition when households experience food insecurity because nutritional deficiencies affect their growth and development. The increase in the frequency of extreme climate events, including droughts, can potentially pose serious health impacts on children. However, the evidence is inconclusive and rather limited to small-scale local contexts. Furthermore, little is known about the differential impacts of droughts on the health of population subgroups. This study contributes to the literature by using data from three nationwide Demographic and Health Surveys (DHS) for Ethiopia conducted in 2005, 2011 and 2016 (n = 21,551). Undernutrition, measured as stunting and wasting among children under five, is used as a health indicator. Droughts are identified using the Standardized Precipitation Evapotranspiration Index (SPEI), a multi-scalar drought index. This study found that drought exposure during the main agricultural season (meher) increased the risk of both chronic undernutrition (stunting) and acute undernutrition (wasting) among under-five children in Ethiopia, however, the impacts vary with population subgroups. Boys, children born to uneducated mothers, and those living in the rural area and whose households are engaged in agricultural activities were more likely to be affected. This suggests that nutritional intervention should target these particularly vulnerable groups of the population. (C) 2021 Elsevier Ltd. All rights reserved. A healthy and a dignified life experience requires adequate water, sanitation, and hygiene (WaSH) coverage. However, inadequate WaSH resources remain a significant public health challenge in many communities in Southern Africa. A systematic search of peer-reviewed Researchs from 2010 -May 2022 was undertaken on Medline, PubMed, EbscoHost and Google Scholar from 2010 to May 2022 was searched using combinations of predefined search terms with Boolean operators. Eighteen peer-reviewed articles from Southern Africa satisfied the inclusion criteria for this review. The general themes that emerged for both barriers and facilitators included geographical inequalities, climate change, investment in WaSH resources, low levels of knowledge on water borne-diseases and ineffective local community engagement. Key facilitators to improved WaSH practices included improved WaSH infrastructure, effective local community engagement, increased latrine ownership by individual households and the development of social capital. Water and sanitation are critical to ensuring a healthy lifestyle. However, many people and communities in Southern Africa still lack access to safe water and improved sanitation facilities. Rural areas are the most affected by barriers to improved WaSH facilities due to lack of WaSH infrastructure compared to urban settings. Our review has shown that, the current WaSH conditions in Southern Africa do not equate to the improved WaSH standards described in SDG 6 on ensuring access to water and sanitation for all. Key barriers to improved WaSH practices identified include rurality, climate change, low investments in WaSH infrastructure, inadequate knowledge on water-borne illnesses and lack of community engagement. Flooding is the most frequent natural hazard globally, but evidence of its impact on domestic water point contamination remains limited. This study aimed to assess dam-related flooding’s impact on microbiological contamination of rural water points and to evaluate agreement of satellite-derived flood maps with ground-based observations of water point flooding. Fieldwork took place in two Ghanaian districts frequently flooded following dam overspill. Fifty-seven water points were tested for bacterial parameters during and immediately after flooding. Forty water points were resampled in the dry season, with the remainder having run dry. Ground-based observations of flooding were compared with three satellite-derived flood maps. Boreholes were less contaminated than wells or surface waters (geometric mean E. coli = 20.2, 175.6, and 590.7 cfu/100 ml, respectively). Among groundwater points, a Wilcoxon signed-rank test indicated significantly greater median E. coli and thermotolerant coliform contamination during flooding (p = 0.025 and p < 0.001, respectively), but Shigella, salmonella, and intestinal enterococci counts were not significantly different between seasons. In contrast, among surface water points, E. coli, Shigella, and Salmonella counts were significantly greater in dry season samples (p < 0.005 for all parameters), possibly reflecting a "concentration" effect. Satellite-derived flood maps had no or low agreement with ground-based observations of water point flooding. Although groundwater quality deteriorated during and after flooding, surface waters were the most microbiologically contaminated in both seasons. The greatest public health risk thus occurred where households switched to surface water collection during or following flood season. Flood risk should be assessed before borehole installation and existing flood-prone boreholes remediated to mitigate population exposure to contaminated water.
Floods affect the human security conditions of floodplain residents. The aim of this paper is to explore how residents of the Tana River Delta in Kenya become flood insecure. This paper utilises assemblage theory, particularly the principles of rhizomatic multiplicity to explain the concept of becoming flood insecure. It combines these rhizomatic multiplicity principles with disruptions to the pillars of human security which are becoming afraid, becoming wanting and becoming undignified and their composite conditions of human insecurity to create an analytical framework with which to understand becoming flood insecure. The study sources its data from Focus Group Discussions in 10 sampled villages in the Tana River Delta. The results reveal that becoming flood insecure is a rhizomatic multiplicity and that the pillars and conditions of human security that comprise it are heterogenous and interconnected. The results reveal the conditions of human insecurity in the Tana River Delta as personal, food, water, fuel, housing, health, environment, and political. They also reveal that while children become more flood insecure, they are also the most adaptive. Additionally, the results show that there are transitory conditions of human insecurity, food, housing health, to which people attempt to find local solutions and redundant conditions of human insecurity, political, health, water, personal and environment, to which people cannot find local solutions and public action is required. Leptospirosis is a waterborne zoonosis (60,000 infections and 1 million deaths annually). Knowledge about the disease in the urban context is surprisingly rare, especially in Africa. Here, we provide the first study of leptospires in waters within an African city. A simple centrifugation-based method was developed to screen waterborne leptospires from remote or poorly areas. Major ions, trace elements, stable isotopes and pathogenic Leptospira were then seasonally investigated in 193 water samples from three neighborhoods of Cotonou (Benin) with different socio-environmental and hydrographic characteristics. Firstly, no leptospire was detected in tap waters. Secondly, although surface contamination cannot be excluded, one groundwater well was found leptospire positive. Thirdly, pathogenic Leptospira mainly contaminated surface waters of temporary and permanent ponds (9.5% and 27.3% of total prevalence, respectively). Isotopic signatures suggest that leptospires occurred in pond waters formed at the beginning of the rainy season following low to moderate rainfall events. Nevertheless, Leptospira-containing waters possess physico-chemical characteristics that are similar to the spectrum of waters sampled throughout the three sites, thus suggesting that Cotonou waters are widely compatible with Leptospira survival. The frequent contact with water exposes Cotonou inhabitants to the risk of leptospirosis which deserves more attention from public health authorities. BACKGROUND: Floods are the most frequently occurring natural disaster and constitute a significant public health risk. Several operational satellite-based flood detection systems quantify flooding extent, but it is unclear how far the choice of satellite-based flood product affects the findings of epidemiological studies of associated public health risks. Few studies of flooding’s health impacts have used mixed methods to enrich understanding of these impacts. This study therefore aims to evaluate the relationship between two satellite-derived flood products with outpatient attendance and diarrhoeal disease in northern Ghana, identifying plausible reasons for observed relationships via qualitative interviews. METHODS: A convergent parallel mixed methods design combined an ecological time series with focus group discussions and key informant interviews. Through an ecological time series component, monthly outpatient attendance and diarrhoea case counts from health facilities in two flood-prone districts for 2016-2020 were integrated with monthly flooding map layers classified via the Moderate Resolution Imaging Spectroradiometer (MODIS) and Landsat satellite sensors. The relationship between reported diarrhoea and outpatient attendance with flooding was examined using Poisson regression, controlling for seasonality and facility catchment population. Four focus group discussions with affected community members and four key informant interviews with health professionals explored flooding’s impact on healthcare delivery and access. RESULTS: Flooding detected via Landsat better predicted outpatient attendance and diarrhoea than flooding via MODIS. Outpatient attendance significantly reduced as LandSat-derived flood area per facility catchment increased (adjusted Incidence Rate Ratio = 0.78, 95% CI: 0.61-0.99, p < 0.05), whilst reported diarrhoea significantly increased with flood area per facility catchment (adjusted Incidence Rate Ratio = 4.27, 95% CI: 2.74-6.63, p < 0.001). Key informants noted how flooding affected access to health services as patients and health professionals could not reach the health facility and emergency referrals were unable to travel. CONCLUSIONS: The significant reduction in outpatient attendance during flooding suggests that flooding impairs healthcare delivery. The relationship is sensitive to the choice of satellite-derived flood product, so future studies should consider integrating multiple sources of satellite imagery for more robust exposure assessment. Health teams and communities should plan spatially targeted flood mitigation and health system adaptation strategies that explicitly address population and workforce mobility issues.
Climate change threatens the health and well-being of populations. We conducted a risk assessment of two climate-related variables (i.e., temperature and rainfall) and associated water, sanitation and hygiene (WASH)-related exposures and vulnerabilities for people living in Mopani District, Limpopo province, South Africa. Primary and secondary data were applied in a qualitative and quantitative assessment to generate classifications of risk (i.e., low, medium, or high) for components of hazard/threat, human exposure, and human vulnerability. Climate-related threats were likely to impact human health due to the relatively high risk of waterborne diseases and WASH-associated pathogens. Vulnerabilities that increased the susceptibility of the population to these adverse outcomes included environmental, human, physical infrastructure, and political and institutional elements. People of low socio-economic status were found to be least likely to cope with changes in these hazards. By identifying and assessing the risk to sanitation services and water supply, evidence exists to inform actions of government and WASH sector partners. This evidence should also be used to guide disaster risk reduction, and climate change and human health adaptation planning. This longitudinal flood-relief study assessed the impact of the March 2019 Cyclone Idai flood event on E. coli contamination of hand-pumped boreholes in Mulanje District, Malawi. It established the microbiological water-quality safety of 279 community supplies over three phases, each comprising water-quality survey, rehabilitation and treatment verification monitoring. Phase 1 contamination three months after Idai was moderate, but likely underestimated. Increased contamination in Phase 2 at 9 months and even greater in Phase 3, a year after Idai was surprising and concerning, with 40% of supplies then registering E. coli contamination and 20% of supplies deemed ‘unsafe’. Without donor support for follow-up interventions, this would have been missed by a typical single-phase flood-relief activity. Contamination rebound at boreholes successfully treated months earlier signifies a systemic problem from persistent sources intensified by groundwater levels likely at a decade high. Problem extent in normal, or drier years is unknown due to absence of routine monitoring of water point E. coli in Malawi. Statistical analysis was not conclusive, but was indicative of damaged borehole infrastructure and increased near-borehole pit-latrine numbers being influential. Spatial analysis including groundwater flow-field definition (an overlooked sector opportunity) revealed ‘hit-and-miss’ contamination of safe and unsafe boreholes in proximity. Hydrogeological control was shown by increased contamination near flood-affected area and in more recent recharge groundwater otherwise of good quality. Pit latrines are presented as credible e-coli sources in a conceptual model accounting for heterogeneous borehole contamination, wet season influence and rebound behavior. Critical to establish are groundwater level – flow direction, hand-pump plume draw, multiple footprint latrine sources – ‘skinny’ plumes, borehole short-circuiting and fast natural pathway (e.g. fracture flow) and other source influences. Concerted WASH (Water, Sanitation and Hygiene) sector investment in research and policy driving national water point based E. coli monitoring programs are advocated. BACKGROUND: Malaria epidemics are a well-described phenomenon after extreme precipitation and flooding, which account for nearly half of global disasters over the past two decades. Yet few studies have examined mitigation measures to prevent post-flood malaria epidemics. METHODS: We conducted an evaluation of a malaria chemoprevention program implemented in response to severe flooding in western Uganda. Children ≤12 years of age from one village were eligible to receive 3 monthly rounds of dihydroartemisinin-piperaquine (DP). Two neighboring villages served as controls. Malaria cases were defined as individuals with a positive rapid diagnostic test result as recorded in health center registers. We performed a difference-in-differences analysis to estimate changes in the incidence and test positivity of malaria between intervention and control villages. RESULTS: A total of 554 children received at least one round of chemoprevention with 75% participating in at least two rounds. Compared to control villages, we estimated a 53.4% reduction (aRR 0.47, 95% CI 0.34 – 0.62, p<.01) in malaria incidence and a 30% decrease in the test positivity rate (aRR=0.70, CI 0.50 - 0.97, p=0.03) in the intervention village in the six months post-intervention. The impact was greatest among children receiving the intervention, but decreased incidence was also observed in older children and adults (aRR=0.57, CI 0.38-0.84, p<.01). CONCLUSIONS: Three rounds of chemoprevention with DP delivered under pragmatic conditions reduced the incidence of malaria after severe flooding in western Uganda. These findings provide a proof-of-concept for the use of malaria chemoprevention to reduce excess disease burden associated with severe flooding.
Climate changes in the eastern part of Sahelian regions will induce an increase in rainfalls and extreme climate events. In this area, due to the intense events and floods, malaria transmission, a climate sensitive disease, is thus slowly extending in time to the drought season and in areas close to the border of the desert. Vectors can as well modify their area of breeding. Control programs must be aware of these changes to adapt their strategies. Water scarcity is a global challenge, yet existing responses are failing to cope with current shocks and stressors, including those attributable to climate change. In sub-Saharan Africa, the impacts of water scarcity threaten livelihoods and wellbeing across the continent and are driving a broad range of adaptive responses. This paper describes trends of water scarcity for Africa and outlines climate impacts on key water-related sectors on food systems, cities, livelihoods and wellbeing, conflict and security, economies, and ecosystems. It then uses systematic review methods, including the Global Adaptation Mapping Initiative, to analyse 240 articles and identify adaptation characteristics of planned and autonomous responses to water scarcity across Africa. The most common impact drivers responded to are drought and participation variability. The most frequently identified actors responding to water scarcity include individuals or households (32%), local government (15%) and national government (15%), while the most common types of response are behavioural and cultural (30%), technological and infrastructural (27%), ecosystem-based (25%) and institutional (18%). Most planned responses target low-income communities (31%), women (20%), and indigenous communities (13%), but very few studies target migrants, ethnic minorities or those living with disabilities. There is a lack of coordination of planned adaptation at scale across all relevant sectors and regions, and lack of legal and institutional frameworks for their operation. Most responses to water scarcity are coping and autonomous responses that showed only minor adjustments to business-as-usual water practices, suggesting limited adaptation depth. Maladaptation is associated with one or more dimension of responses in almost 20% of articles. Coordinating institutional responses, carefully planned technologies, planning for projected climate risks including extension of climate services and increased climate change literacy, and integrating indigenous knowledge will help to address identified challenges of water scarcity towards more adaptive responses across Africa. Droughts are associated with several societal ills, especially in developing economies that rely on rainfed agriculture. Recently, researchers have begun to examine the effect of droughts on the risk of Intimate-Partner Violence (IPV), but so far this work has led to inconclusive results. For example, two large recent studies analyzed comparable data from multiple sub-Saharan African countries and drew opposite conclusions. We attempt to resolve this apparent paradox by replicating previous analyses with the largest data set yet assembled to study drought and IPV. Integrating the methods of previous studies and taking particular care to control for spatial autocorrelation, we find little association between drought and most forms of IPV, although we do find evidence of associations between drought and women’s partners exhibiting controlling behaviors. Moreover, we do not find significant heterogeneous effects based on wealth, employment, household drinking water sources, or urban-rural locality. Pastoral women in the semi-arid rangelands of East Africa are significantly burdened by the vulnerability to and responsibility for responding to changing climates. Consequently, understanding how adaptation and coping strategies impact pastoral women’s well-being is critical for supporting the climate resilience of communities and the landscapes on which they rely. We used a household survey, guided by a multi-dimensional framework of well-being, to investigate how the use of drought-related coping and adaptation strategies by Samburu households influenced livestock loss and women’s well-being in northern Kenya. Coping and adaptation strategies predicted numerous social-cognitive components of well-being, although not livestock loss. We conjecture these results are a product of a gendered division of labor within households and the community. We argue that interventions aimed at supporting drought resilience must consider the gendered implications of climate response strategies, multiple indicators for evaluation, and the influence of community and place. Protracted and prolonged droughts lead to famine and substantial decline in agricultural productivity that contribute to food insecurity and hunger in sub-Saharan Africa which needs to explore the risk coping strategies to better target risk mitigation. The main research question of this paper was to analyze ex-post coping strategies and their determinants in rural Ethiopia. We use a cross-section data collected in 2013 from vulnerable rural households in Rayitu district, Bale Zone of Oromia Regional State. Using population-proportionate to size (PPS) sampling technique, a total number of 1,402 households in the district participated in this study. The data were analyzed using a three-stage least squares (3SLS) method. Our analysis confirms that rural households in Rayitu district experience drought and are vulnerable to the consequences of shocks. As a response, rural households adopt interdependent risk coping strategies. This supports the notion of addressing the problem of risk through integrated rural development strategies (and policies) to help the poor to improve the vulnerability to shock and help to escape out of poverty. In addition, we found that the risk coping strategies that households adopt are influenced by the resource holdings and income levels of the rural households, their access to product and financial market, and their socio-demographic characteristics. Hence, we argue that strategies and interventions to improve the livelihood of the poor and to support the vulnerable ones should be targeted to fit to the needs and priorities of households. BACKGROUND: Ethiopia is a Sub-Saharan country with very high neonatal mortality rates, varying across its regions. The rate of neonatal mortality reduction in Ethiopia is slow, and Ethiopia may not meet the third United Nations sustainable development target by 2030. This study aimed to investigate the spatial variations and contributing factors for neonatal mortality rates in Ethiopia. METHODS: We analysed data from the 2016 Ethiopian Demographic and Health Survey (EDHS), which used a two-stage cluster sampling technique with a census enumeration area as primary and households as secondary sampling units. A Bayesian spatial logistic regression model using the Stochastic Partial Differential Equation (SPDE) method was fitted accounting for socio-economic, health service-related and geographic factors. RESULTS: Higher neonatal mortality rates were observed in eastern, northeastern and southeastern Ethiopia, and the Somali region had higher risks of neonatal mortality. Neonates from frequently drought-affected areas had a higher mortality risk than less drought-affected areas. Application of traditional substances on the cord increased the risk of neonatal mortality (Adjusted Odds Ratio (AOR) = 2.07, 95% Credible Interval (CrI): 1.12 to 4.30) and getting health facility delivery services had a lower odds of neonatal mortality (AOR = 0.60, 95% CrI: 0.37, 0.98). CONCLUSIONS: Residing in drought-affected areas, applying traditional substances on the umbilical cord and not delivering at health facilities were associated with a higher risk of neonatal mortality. Policy-makers and resource administrators at different administrative levels could leverage the findings to prioritise and target areas identified with higher neonatal mortality rates. BACKGROUND: Globally, understanding spatial analysis of malnutrition is increasingly recognized. However, our knowledge on spatial clustering of malnutrition after controlling for known risk factors of malnutrition such as wealth status, food insecurity, altitude and maternal characteristics is limited from Ethiopia. Previous studies from southern Ethiopia have shown seasonal patterns of malnutrition, yet they did not evaluate spatial clustering of malnutrition. OBJECTIVE: The aim of this study was to assess whether child stunting and maternal malnutrition were spatially clustered in drought-prone areas after controlling for previously known risk factors of malnutrition. METHODS: We used a community-based cohort study design for a one-year study period. We used SaTScan software to identify high rates of child stunting and maternal malnutrition clustering. The outcome based was the presence or absence of stunting and maternal malnutrition ([BMI] <18.5 kg/m(2)). We controlled for previously known predictors of child stunting and maternal malnutrition to evaluate the presence of clustering. We did a logistic regression model with declaring data to be time-series using Stata version 15 for further evaluation of the predictors of spatial clustering. RESULTS: The crude analysis of SaTScan showed that there were areas (clusters) with a higher risk of stunting and maternal malnutrition than in the underlying at risk populations. Stunted children within an identified spatial cluster were more likely to be from poor households, had younger and illiterate mothers, and often the mothers were farmers and housewives. Children identified within the most likely clusters were 1.6 times more at risk of stunting in the unadjusted analysis. Similarly, mothers within the clusters were 2.4 times more at risk of malnutrition in the unadjusted analysis. However, after adjusting for known risk factors such as wealth status, household food insecurity, altitude, maternal age, maternal education, and maternal occupation with SaTScan analysis, we show that child stunting and maternal malnutrition were not spatially clustered. CONCLUSION: The observed spatial clustering of child stunting and maternal malnutrition before controlling for known risk factors for child stunting and maternal malnutrition could be due to non-random distribution of risk factors such as poverty and maternal characteristics. Moreover, our results indicated the need for geographically targeted nutritional interventions in a drought-prone area.
Evidence on the potential for agricultural intensification to improve nutrition has grown considerably. While small-scale irrigation is a key factor driving agricultural intensification in sub-Saharan Africa, its impact on nutrition has not yet been thoroughly explored. In this study, we assess the impact of adoption of small-scale irrigation in Ethiopia and Tanzania on household and women’s dietary diversity, as well as children’s nutrition. We use two rounds of primary data collected from irrigators and nonirrigators in Ethiopia and Tanzania. We used a panel fixed effects econometric approach to control for observed household, women and children specific characteristics as well as observed and unobserved time-invariant confounding factors. The results show that among Ethiopian households who reported having faced drought, women in irrigating households have higher Women’s Dietary Diversity Score (WDDS) compared to women in nonirrigating households. In Tanzania, women in irrigating households have higher WDDS compared to nonirrigators and the impact of irrigation on WDDS more than doubles among households facing drought. In addition, among Tanzanian households who reported having faced a drought shock, irrigating households have higher Household Dietary Diversity Score compared to nonirrigators. Children in irrigating households in Ethiopia have weight-for-height z-scores (WHZ) that are 0.87 SDs higher, on average, than WHZ of children in nonirrigating households. In Tanzania, irrigation leads to higher WHZ-scores in children under-five among households who reported having experienced a drought in the 5 years preceding the survey. The study shows small-scale irrigation has a strong effect on households’ economic access to food and on nutritional outcomes of women and children. Globally, drought impacts more people than any other natural hazard. However, drought is also the most complex natural hazard, and its impacts are not evenly distributed across the landscape or among human populations. Just as the impacts of drought vary, so do the coping strategies used by people during drought. The research to-date on drought coping strategies in Sub-Saharan Africa are highly quantitative, focused on top-down interventions, and do not emphasize individual perceptions, experience, and autonomous decision-making when coping with drought. This paper aims to fill these gaps by examining the human experience of coping with drought through narratives from farmers in Burat and Kinna, Isiolo County, Kenya. This paper highlights (1) their perceived impacts of drought, and (2) the various coping strategies used. A total of 83 interviews were conducted in 20 households. Results found that the perceived impacts of drought were decreased agricultural productivity, livestock hunger, death, and relocation, a lack of water in rivers, human hunger and disease, and violent conflict. The strategies for coping with drought included changing agricultural practices, adopting irrigation, relying on aid, charcoal burning, casual labor, livelihood diversification, and others. Importantly, these coping strategies can be classified into four categories: livelihood diversification, longer-term livelihood strategies, short-term coping activities, and erosive coping strategies. This research contributes to the effort to better document and understand farmers? perceptions and strategies to cope with drought through qualitative research methods and from the perspective of the individual smallholder farmer, which is important for making context-specific policy and project recommendations aimed at smallholder farmers. Over the last decades, increased emission of greenhouse gases has led to hot weather extremes, heavy precipitation and worsening of agricultural and ecological droughts. Although Africa’s contribution to climate change is minimal, the continent is especially vulnerable to its effects. This report aims to describe the effect of climate change leading to drought in Kilifi County, Kenya, and the communities’ experiences of this effect on food availability. During their community rotation, residents from a university in Nairobi, Kenya, evaluated changes in weather patterns and nutrition indicators in Kilifi County and conducted focus group discussions (FGDs) with community members and health care stakeholders to explore challenges in access to adequate nutrition and possible local solutions. Kilifi County has one of the highest rates of undernutrition in Kenya, with one in five under-5 children being underweight. County data showed that rainfall in the last 4 years has become increasingly unpredictable, resulting in reduced household milk production, one of the indicators of nutrition security. Three major themes emerged from the FGDs: lack of food variety, collapse of drought mitigating projects and increasing poverty levels. Possible solutions to these problems include promoting alternatives to the current diet that are culturally sensitive and adaptable to recent climate changes, ensuring continuity of agricultural and financial support projects and improved local leadership and governance. Given the crucial role of climate in malaria transmission, many mechanistic models of malaria represent vector biology and the parasite lifecycle as functions of climate variables in order to accurately capture malaria transmission dynamics. Lower dimension mechanistic models that utilize implicit vector dynamics have relied on indirect climate modulation of transmission processes, which compromises investigation of the ecological role played by climate in malaria transmission. In this study, we develop an implicit process-based malaria model with direct climate-mediated modulation of transmission pressure borne through the Entomological Inoculation Rate (EIR). The EIR, a measure of the number of infectious bites per person per unit time, includes the effects of vector dynamics, resulting from mosquito development, survivorship, feeding activity and parasite development, all of which are moderated by climate. We combine this EIR-model framework, which is driven by rainfall and temperature, with Bayesian inference methods, and evaluate the model’s ability to simulate local transmission across 42 regions in Rwanda over four years. Our findings indicate that the biologically-motivated, EIR-model framework is capable of accurately simulating seasonal malaria dynamics and capturing of some of the inter-annual variation in malaria incidence. However, the model unsurprisingly failed to reproduce large declines in malaria transmission during 2018 and 2019 due to elevated anti-malaria measures, which were not accounted for in the model structure. The climate-driven transmission model also captured regional variation in malaria incidence across Rwanda’s diverse climate, while identifying key entomological and epidemiological parameters important to seasonal malaria dynamics. In general, this new model construct advances the capabilities of implicitly-forced lower dimension dynamical malaria models by leveraging climate drivers of malaria ecology and transmission. In this paper, we present a nonlinear deterministic mathematical model for malaria transmission dynamics incorporating climatic variability as a factor. First, we showed the limited region and nonnegativity of the solution, which demonstrate that the model is biologically relevant and mathematically well-posed. Furthermore, the fundamental reproduction number was determined using the next-generation matrix approach, and the sensitivity of model parameters was investigated to determine the most affecting parameter. The Jacobian matrix and the Lyapunov function are used to illustrate the local and global stability of the equilibrium locations. If the fundamental reproduction number is smaller than one, a disease-free equilibrium point is both locally and globally asymptotically stable, but endemic equilibrium occurs otherwise. The model exhibits forward and backward bifurcation. Moreover, we applied the optimal control theory to describe the optimal control model that incorporates three controls, namely, using treated bed net, treatment of infected with antimalaria drugs, and indoor residual spraying strategy. The Pontryagin’s maximum principle is introduced to obtain the necessary condition for the optimal control problem. Finally, the numerical simulation of optimality system and cost-effectiveness analysis reveals that the combination of treated bed net and treatment is the most optimal and least-cost strategy to minimize the malaria. BACKGROUND: High altitude settings in Eastern Africa have been reported to experience increased malaria burden due to vector habitat expansion. This study explored possible associations between malaria test positivity rates and its predictors including malaria control measures and meteorological factors at a high-altitude, low malaria transmission setting, south of Mount Kilimanjaro. METHODS: Malaria cases reported at the Tanganyika Plantation Company (TPC) hospital’s malaria registers, meteorological data recorded at TPC sugar factory and data on bed nets distributed in Lower Moshi from 2009 to 2018 were studied. Correlation between bed nets distributed and malaria test positivity rates were explored by using Pearson correlation analysis and the associations between malaria test positivity rates and demographic and meteorological variables were determined by logistic regression and negative binomial regression analyses, respectively. RESULTS: Malaria cases reported at TPC hospital ranged between 0.48 and 2.26% per year and increased slightly at the introduction of malaria rapid diagnostic tests. The risk of testing positive for malaria were significantly highest among individuals aged between 6 and 15 years (OR = 1.65; 1.65 CI = 1.28-2.13; p = 0.001) and 16-30 years (OR = 1.49; CI = 1.17-1.89; p = 0.001) and when adjusted for age, the risk were significantly higher among male individuals when compared to female individuals (OR = 1.54; 1.00-1.31; p = 0.044). Malaria test positivity rates were positively associated with average monthly minimum temperatures and negatively associated with average monthly maximum temperatures (incidence rate ratio (IRR) = 1.37, 95% confidence interval (CI) = 1.05-1.78, p = 0.019 and IRR = 0.72, 95% CI = 0.58-0.91, p = 0.005, respectively). When analysed with one month lag for predictor variables, malaria test positivity rates were still significantly associated with average monthly minimum and maximum temperatures (IRR = 1.67, 95% CI = 1.28-2.19, p = 0.001 and IRR = 0.68, 95% CI = 0.54-0.85, p = 0.001, respectively). Average monthly rainfall and relative humidity with or without a one month lag was not associated with malaria test positivity rates in the adjusted models. Explopring possible associations between distribution of long-lasting insecticidal nets, (LLINs) and malaria test positivity rates showed no apparent correlation between numbers of LLINs distributed in a particular year and malaria test positivity rates. CONCLUSION: In Lower Moshi, the risk of being tested positive for malaria was highest for older children and male individuals. Higher minimum and lower maximum temperatures were the strongest climatic predictors for malaria test positivity rates. In areas with extensive irrigation activity as in Lower Moshi, vector abundance and thus malaria transmission may be less dependent on rainfall patterns and humidity. Mass distribution of LLINs did not have an effect in this area with already very low malaria transmission. BACKGROUND: Climate variables impact human health and in an era of climate change, there is a pressing need to understand these relationships to best inform how such impacts are likely to change. OBJECTIVES: This study sought to investigate time series of daily admissions from two public hospitals in Limpopo province in South Africa with climate variability and air quality. METHODS: We used wavelet transform cross-correlation analysis to monitor coincidences in changes of meteorological (temperature and rainfall) and air quality (concentrations of PM(2.5) and NO(2)) variables with admissions to hospitals for gastrointestinal illnesses including diarrhoea, pneumonia-related diagnosis, malaria and asthma cases. We were interested to disentangle meteorological or environmental variables that might be associated with underlying temporal variations of disease prevalence measured through visits to hospitals. RESULTS: We found preconditioning of prevalence of pneumonia by changes in air quality and showed that malaria in South Africa is a multivariate event, initiated by co-occurrence of heat and rainfall. We provided new statistical estimates of time delays between the change of weather or air pollution and increase of hospital admissions for pneumonia and malaria that are addition to already known seasonal variations. We found that increase of prevalence of pneumonia follows changes in air quality after a time period of 10 to 15 days, while the increase of incidence of malaria follows the co-occurrence of high temperature and rainfall after a 30-day interval. DISCUSSION: Our findings have relevance for early warning system development and climate change adaptation planning to protect human health and well-being. Studies about the impact of future climate change on diseases have mostly focused on standard Representative Concentration Pathway climate change scenarios. These scenarios do not account for the non-linear dynamics of the climate system. A rapid ice-sheet melting could occur, impacting climate and consequently societies. Here, we investigate the additional impact of a rapid ice-sheet melting of Greenland on climate and malaria transmission in Africa using several malaria models driven by Institute Pierre Simon Laplace climate simulations. Results reveal that our melting scenario could moderate the simulated increase in malaria risk over East Africa, due to cooling and drying effects, cause a largest decrease in malaria transmission risk over West Africa and drive malaria emergence in southern Africa associated with a significant southward shift of the African rain-belt. We argue that the effect of such ice-sheet melting should be investigated further in future public health and agriculture climate change risk assessments. In the last decade, many malaria-endemic countries, like Zambia, have achieved significant reductions in malaria incidence among children <5 years old but face ongoing challenges in achieving similar progress against malaria in older age groups. In parts of Zambia, changing climatic and environmental factors are among those suspectedly behind high malaria incidence. Changes and variations in these factors potentially interfere with intervention program effectiveness and alter the distribution and incidence patterns of malaria differentially between young children and the rest of the population. We used parametric and non-parametric statistics to model the effects of climatic and socio-demographic variables on age-specific malaria incidence vis-à-vis control interventions. Linear regressions, mixed models, and Mann-Kendall tests were implemented to explore trends, changes in trends, and regress malaria incidence against environmental and intervention variables. Our study shows that while climate parameters affect the whole population, their impacts are felt most by people aged ≥5 years. Climate variables influenced malaria substantially more than mosquito nets and indoor residual spraying interventions. We establish that climate parameters negatively impact malaria control efforts by exacerbating the transmission conditions via more conducive temperature and rainfall environments, which are augmented by cultural and socioeconomic exposure mechanisms. We argue that an intensified communications and education intervention strategy for behavioural change specifically targeted at ≥5 aged population where incidence rates are increasing, is urgently required and call for further malaria stratification among the ≥5 age groups in the routine collection, analysis and reporting of malaria mortality and incidence data.
Malaria is a critical health issue across the world and especially in Africa. Studies based on dynamical models helped to understand inter-linkages between this illness and climate. In this study, we evaluated the ability of the VECTRI community vector malaria model to simulate the spread of malaria in Cameroon using rainfall and temperature data from FEWS-ARC2 and ERA-interim, respectively. In addition, we simulated the model using five results of the dynamical downscaling of the regional climate model RCA4 within two time frames named near future (2035-2065) and far future (2071-2100), aiming to explore the potential effects of global warming on the malaria propagation over Cameroon. The evaluated metrics include the risk maps of the entomological inoculation rate (EIR) and the parasite ratio (PR). During the historical period (1985-2005), the model satisfactorily reproduces the observed PR and EIR. Results of projections reveal that under global warming, heterogeneous changes feature the study area, with localized increases or decreases in PR and EIR. As the level of radiative forcing increases (from 2.6 to 8.5 W.m(-2)), the magnitude of change in PR and EIR also gradually intensifies. The occurrence of transmission peaks is projected in the temperature range of 26-28 °C. Moreover, PR and EIR vary depending on the three agro-climatic regions of the study area. VECTRI still needs to integrate other aspects of disease transmission, such as population mobility and intervention strategies, in order to be more relevant to support actions of decision-makers and policy makers. 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. Non-typhoidal Salmonella (NTS) ranks first among causes of bloodstream infection in children under five years old in the Democratic Republic of Congo and has a case fatality rate of 15%. Main host-associated risk factors are Plasmodium falciparum malaria, anemia and malnutrition. NTS transmission in sub-Saharan Africa is poorly understood. NTS bloodstream infections mostly occur during the rainy season, which may reflect seasonal variation in either environmental transmission or host susceptibility. We hypothesized that environment- and host-associated factors contribute independently to the seasonal variation in NTS bloodstream infections in children under five years old admitted to Kisantu referral hospital in 2013-2019. We used remotely sensed rainfall and temperature data as proxies for environmental factors and hospital data for host-associated factors. We used principal component analysis to disentangle the interrelated environment- and host-associated factors. With timeseries regression, we demonstrated a direct association between rainfall and NTS variation, independent of host-associated factors. While the latter explained 17.5% of NTS variation, rainfall explained an additional 9%. The direct association with rainfall points to environmental NTS transmission, which should be explored by environmental sampling studies. Environmental and climate change may increase NTS transmission directly or via host susceptibility, which highlights the importance of preventive public health interventions. BACKGROUND: Internally displaced persons fleeing their homes due to conflict and drought are particularly at risk of morbidity and mortality from diarrhoeal diseases. Regular handwashing with soap (HWWS) could substantially reduce the risk of these infections, but the behaviour is challenging to practice while living in resource-poor, informal settlements. To mitigate these challenges, humanitarian aid organisations distribute hygiene kits, including soap and handwashing infrastructure. Our study aimed to assess the effect of modified hygiene kits on handwashing behaviours among internally displaced persons in Moyale, Ethiopia. METHODS: The pilot study evaluated three interventions: providing liquid soap; scented soap bar; and the inclusion of a mirror in addition to the standard hygiene kit. The hygiene kits were distributed to four study arms. Three of the arms received one of the interventions in addition to the standard hygiene kit. Three to six weeks after distribution the change in behaviour and perceptions of the interventions were assessed through structured observations, surveys and focus group discussions. RESULTS: HWWS was rare at critical times for all study arms. In the liquid soap arm, HWWS was observed for only 20% of critical times. This result was not indicated significantly different from the control arm which had a prevalence of 17% (p-value = 0.348). In the mirror and scented soap bar intervention arms, HWWS prevalence was 11 and 10%, respectively. This was indicated to be significantly different from the control arm. Participants in the focus group discussions indicated that liquid soap, scented soap bar and the mirror made handwashing more desirable. In contrast, participants did not consider the soap bar normally distributed in hygiene kits as nice to use. CONCLUSION: We found no evidence of an increased prevalence of handwashing with soap following distribution of the three modified hygiene kits. However, our study indicates the value in better understanding hygiene product preferences as this may contribute to increased acceptability and use among crisis-affected populations. The challenges of doing research in a conflict-affected region had considerable implications on this study’s design and implementation. TRIAL REGISTRATION: The trial was registered at www.ClinicalTrials.gov 6 September 2019 (reg no: NCT04078633 ). BACKGROUND: Environmental Enteric Dysfunction (EED) is a chronic intestinal inflammatory disorder of unclear aetiology prevalent amongst children in low-income settings and associated with stunting. We aimed to characterise development of EED and its putative risk factors amongst rural Kenyan infants. METHODS: In a birth cohort study in Junju, rural coastal Kenya, between August 2015 and January 2017, 100 infants were each followed for nine months. Breastfeeding status was recorded weekly and anthropometry monthly. Acute illnesses and antibiotics were captured by active and passive surveillance. Intestinal function and small intestinal bacterial overgrowth (SIBO) were assessed by monthly urinary lactulose mannitol (LM) and breath hydrogen tests. Faecal alpha-1-antitrypsin, myeloperoxidase and neopterin were measured as EED biomarkers, and microbiota composition assessed by 16S sequencing. FINDINGS: Twenty nine of the 88 participants (33%) that underwent length measurement at nine months of age were stunted (length-for-age Z score <-2). During the rainy season, linear growth was slower and LM ratio was higher. In multivariable models, LM ratio, myeloperoxidase and neopterin increased after cessation of continuous-since-birth exclusive breastfeeding. For LM ratio this only occurred during the rainy season. EED markers were not associated with antibiotics, acute illnesses, SIBO, or gut microbiota diversity. Microbiota diversified with age and was not strongly associated with complementary food introduction or linear growth impairment. INTERPRETATION: Our data suggest that intensified promotion of uninterrupted exclusive breastfeeding amongst infants under six months during the rainy season, where rainfall is seasonal, may help prevent EED. Our findings also suggest that therapeutic strategies directed towards SIBO are unlikely to impact on EED in this setting. However, further development of non-invasive diagnostic methods for SIBO is required. FUNDING: This research was funded in part by the Wellcome Trust (Research Training Fellowship to RJC (103376/Z/13/Z)). EPKP was supported by the MRC/DfID Newton Fund (MR/N006259/1). JAB was supported by the MRC/DFiD/Wellcome Trust Joint Global Health Trials scheme (MR/M007367/1) and the Bill & Melinda Gates Foundation (OPP1131320). HHU was supported by the NIHR Oxford Biomedical Research Centre (IS-BRC-1215-20008).
Precision health mapping is a technique that uses spatial relationships between socio-ecological variables and disease to map the spatial distribution of disease, particularly for diseases with strong environmental signatures, such as diarrhoeal disease (DD). While some studies use GPS-tagged location data, other precision health mapping efforts rely heavily on data collected at coarse-spatial scales and may not produce operationally relevant predictions at fine enough spatio-temporal scales to inform local health programmes. We use two fine-scale health datasets collected in a rural district of Madagascar to identify socio-ecological covariates associated with childhood DD. We constructed generalized linear mixed models including socio-demographic, climatic and landcover variables and estimated variable importance via multi-model inference. We find that socio-demographic variables, and not environmental variables, are strong predictors of the spatial distribution of disease risk at both individual and commune-level (cluster of villages) spatial scales. Climatic variables predicted strong seasonality in DD, with the highest incidence in colder, drier months, but did not explain spatial patterns. Interestingly, the occurrence of a national holiday was highly predictive of increased DD incidence, highlighting the need for including cultural factors in modelling efforts. Our findings suggest that precision health mapping efforts that do not include socio-demographic covariates may have reduced explanatory power at the local scale. More research is needed to better define the set of conditions under which the application of precision health mapping can be operationally useful to local public health professionals. Faecal pathogens can be introduced into surface water through open defecation, illegal disposal and inadequate treatment of faecal sludge and wastewater. Despite sanitation improvements, poor countries are progressing slowly towards the United Nation’s Sustainable Development Goal 6 by 2030. Sanitation-associated pathogenic contamination of surface waters impacted by future population growth, urbanization and climate change receive limited attention. Therefore, a model simulating human rotavirus river inputs and concentrations was developed combining population density, sanitation coverage, rotavirus incidence, wastewater treatment and environmental survival data, and applied to Uganda. Complementary surface runoff and river discharge data were used to produce spatially explicit rotavirus outputs for the year 2015 and for two scenarios in 2050. Urban open defecation contributed 87%, sewers 9% and illegal faecal sludge disposal 3% to the annual 15.6 log(10) rotavirus river inputs in 2015. Monthly concentrations fell between -3.7 (Q5) and 2.6 (Q95) log(10) particles per litre, with 1.0 and 2.0 median and mean log(10) particles per litre, respectively. Spatially explicit outputs on 0.0833 × 0.0833° grids revealed hotspots as densely populated urban areas. Future population growth, urbanization and poor sanitation were stronger drivers of rotavirus concentrations in rivers than climate change. The model and scenario analysis can be applied to other locations. Climate variability is expected to increase the risk of diarrhea diseases, a leading cause of child mortality and morbidity in Sub-Saharan Africa (SSA). The risk of diarrhea is more acute when populations have poor access to improved water and sanitation. This study seeks to determine individual and joint effects of climate variation, water supply and sanitation on the occurrence of diarrhea among children under five in SSA using multilevel mixed-effect Poisson regression including cross-level interaction. We merged 57 Demographic and Health Surveys (DHS) from 25 SSA countries covering the period 2000-2019 with climatic data from the DHS geolocation databases. The results of the research indicate that 77.7% of the variation in the occurrence of diarrhea in Sub-Saharan households is due to climatic differences between clusters. Also, a household residing in a cluster with a high incidence of diarrhea is 1.567 times more likely to have diarrhea cases than a household from a cluster with a low incidence. In addition, when average temperature and rainfall increase, households using unimproved sanitation or unimproved water have more cases of diarrhea. For SSA, the results of the multilevel analysis suggest the adoption at both levels; macro (national) and micro (household), of climate change adaption measures in the water sector to reduce the prevalence of diarrhea. Temperature constrains the transmission of many pathogens. Interventions that target temperature-sensitive life stages, such as vector control measures that kill intermediate hosts, could shift the thermal optimum of transmission, thereby altering seasonal disease dynamics and rendering interventions less effective at certain times of the year and with global climate change. To test these hypotheses, we integrated an epidemiological model of schistosomiasis with empirically determined temperature-dependent traits of the human parasite Schistosoma mansoni and its intermediate snail host (Biomphalaria spp.). We show that transmission risk peaks at 21.7 °C (T (opt) ), and simulated interventions targeting snails and free-living parasite larvae increased T (opt) by up to 1.3 °C because intervention-related mortality overrode thermal constraints on transmission. This T (opt) shift suggests that snail control is more effective at lower temperatures, and global climate change will increase schistosomiasis risk in regions that move closer to T (opt) Considering regional transmission phenologies and timing of interventions when local conditions approach T (opt) will maximize human health outcomes. The incidence of most diseases varies greatly with seasons, and global climate change is expected to increase its risk. Predictive models that automatically capture trends between climate and diseases are likely to be beneficial in minimizing disease outbreaks. Machine learning (ML) predictive analytic tools have been popularized across many health-care applications, however the optimal task performance of such ML tools largely depends on manual parameter tuning and calibration. Such manual tuning significantly limits the full potential of ML methods, especially for high-dimensional and complex task domains, as typified by real-world health-care application data-sets. Additionally, the inaccessibility of many health-care data-sets compounds innate problems of method comparison, predictive accuracy and the overall advancement of ML based health-care applications. In this study we investigate the impact of Relevance Estimation and Value Calibration, an evolutionary parameter optimization method applied to automate parameter tuning for comparative ML methods (Deep learning and Support Vector Machines) applied to predict daily diarrhoea cases across various geographic regions. Data-augmentation is also used to complement real-world noisy, sparse and incomplete data-sets with synthetic data-sets for training, validation and testing. Results support the efficacy of evolutionary parameter optimization and data synthesis to boost predictive accuracy in the given task, indicating a significant prediction accuracy boost for the deep-learning models across all data-sets. Water pollution had become a major problem due to its negative impact on the human health. Effects of humaninduced actions on groundwater quality were examined in this study. The physicochemical, heavy metals and microbial parameters of groundwater, sampled during the two major climatic periods in Nigeria, were measured according to APHA approved procedures. Results obtaned from laboratory tests revealed that anthropogenic IP: 14.98.160.66 On: Fri, 01 Jul 2022 12:43:29 activities had substantial effect on the groundwater quality. The groundwater TDS, nitrate, BOD, chloride and phosphate concentrations varied from 23.93 to 42.32 mg/L, 0.54 to 2.16 mg/L, 2.23 to 4.72 mg/L, 10.78 to Delivered by Ingenta 19.15 mg/L, and 0.22 to 0.36 mg/L respectively. Likewise, Cd concentration fluctuated between 0 and 0.001 mg/L, Cu varied between 0 and 0.149 mg/L, Fe varied between 0 and 0.293 mg/L, Pb varied between 0 to 0.105 mg/mL, Zn varied between from 0 and 0.768 mg/L, while Ni fluctuated between 0 and 0.001 mg/L. The findings revealed that areas with poor sanitary situations had poor groundwater quality, compared to the areas with improved sanitary situations. Regarding the microbial population, the highest Total Bacteria and Fungi Counts recorded in the groundwater were 1.11 x 102 cfu/mL and 1.23 x 102 cfu/mL respectively. Similarly, the highest recorded Enterobacterial spp., Staphylococus arurius, E. coli, Proteus spp. and Shegeela spp. populations were 26.22 x 102 cfu/mL, 1.23 x 102 cfu/mL, 0.41 MPN/100 mL, 0.12 cfu/ml and 0.30 x 102 cfu/mL respectively. Although, the groundwater physicochemical parameters and heavy metals concentrations were within safe drinking water limits; the groundwater was largely contaminated with pathogenic microorganisms, mostly during the rainy season. This work reports control strategies of the water quality in the city of Souk-Ahras (east Algeria). With the recent development, rapid population growth, and the consequences of climate change, the capacity of water supply reserves becomes more unpredictable in the long term. This has drastically affected the distributed water quantity. A correlation between bacteriological water analysis and the analysis of pollution indicative physicochemical parameters is developed to replace the slow bacteriological analysis, which takes more than two days, by directly accessible physicochemical analysis to anticipate the case-onset of waterborne diseases. A good correlation is found between different combinations of physicochemical pollution parameters: (Turbidity, Nitrates); (Turbidity, Active chlorine) (nitrates, active chlorine); (Ammonium, Chlorine) and (Turbidity, Ammonium) with Spearman rank coefficients of 0.8657, -0.8602 and -0.8531 -0.8227 et 0.7957 respectively. Besides, long term analysis (over several years) revealed a high correlation of more than 0.92 between the analysis of pollution indicative physicochemical parameters and bacteriological analysis. The EPANET software is used to simulate the hydraulic behaviour of the network system over an extended period within pressurized and pressure-deficient conditions. The simulation results of several supply scenarios of daily drinking water pressure in the city center area show that 62% of drinking water distribution system is supplied with a steep slope (80 m), 10% with unsatisfactory pressure and only 23% with acceptable pressure (1-80 m). Therefore, the high working pressure at the mesh, and the interruptions of the water supply are factors that can lead to the occurrence of cross-connection cases. This diagnosis of the defects in the water supply system is combined with a statistical data analysis of physicochemical parameters to set up an effective sampling strategy that takes into account the frequency of analysis and the areas at risk to prevent the risk of waterborne diseases. In this article we draw on an interdisciplinary study on drinking water quality in Maputo, the capital of Mozambique, to examine the nature, scale, and politics of waterborne diseases. We show how water contamination and related diseases are discursively framed as household risks, thereby concealing the politics of uneven exposure to contaminated water and placing the burden of being healthy on individuals. In contrast, we propose that uneven geographies of waterborne diseases are best understood as the product of Maputo’s urban metabolism, in which attempts at being sanitary and healthy are caught up in relations of power, class, and variegated citizenship. Waterborne diseases are the result of complex and fragmented circulations and intersections of (waste)waters, generated by uneven urban development, heterogeneous infrastructure configurations, and everyday practices to cope with basic service deficits, in conjunction with increasing climatic variability. The latrine-from which ultimately contamination and diseases spread-is an outcome of these processes, rather than the site to be blamed. This article also advances an interdisciplinary framework for analyzing urban metabolism and deepening its explanatory potential. It serves as a demonstration of how interdisciplinary approaches might be taken forward to generate new readings of more-than-human metabolic processes at distinct temporal and spatial scales. Africa has historically seen several periods of prolonged and extreme droughts across the continent, causing food insecurity, exacerbating social inequity and frequent mortality. A known consequence of droughts and their associated risk factors are infectious disease outbreaks, which are worsened by malnutrition, poor access to water, sanitation and hygiene and population displacement. Cholera is a potential causative agent of such outbreaks. Africa has the highest global cholera burden, several drought-prone regions and high levels of inequity. Despite this, research on cholera and drought in Africa is lacking. Here, we review available research on drought-related cholera outbreaks in Africa and identify a variety of potential mechanisms through which these outbreaks occurred, including poor access to water, marginalization of refugees and nomadic populations, expansion of informal urban settlements and demographic risks. Future climate change may alter precipitation, temperature and drought patterns, resulting in more extremes, although these changes are likely to be spatially heterogeneous. Despite high uncertainty in future drought projections, increases in drought frequency and/or durations have the potential to alter these related outbreaks into the future, potentially increasing cholera burden in the absence of countermeasures (e.g. improved sanitation infrastructure). To enable effective planning for a potentially more drought-prone Africa, inequity must be addressed, research on the health implications of drought should be enhanced, and better drought diplomacy is required to improve drought resilience under climate change. BACKGROUND: Climate and environmental factors could be one of the primary factors that drive malaria transmission and it remains to challenge the malaria elimination efforts. Hence, this study was aimed to evaluate the effects of meteorological factors and topography on the incidence of malaria in the Boricha district in Sidama regional state of Ethiopia. METHODS: Malaria morbidity data recorded from 2010 to 2017 were obtained from all public health facilities of Boricha District in the Sidama regional state of Ethiopia. The monthly malaria cases, rainfall, and temperature (minimum, maximum, and average) were used to fit the ARIMA model to compute the malaria transmission dynamics and also to forecast future incidence. The effects of the meteorological variables and altitude were assessed with a negative binomial regression model using R version 4.0.0. Cross-correlation analysis was employed to compute the delayed effects of meteorological variables on malaria incidence. RESULTS: Temperature, rainfall, and elevation were the major determinants of malaria incidence in the study area. A regression model of previous monthly rainfall at lag 0 and Lag 2, monthly mean maximum temperature at lag 2 and Lag 3, and monthly mean minimum temperature at lag 3 were found as the best prediction model for monthly malaria incidence. Malaria cases at 1801-1900 m above sea level were 1.48 times more likely to occur than elevation ≥ 2000 m. CONCLUSIONS: Meteorological factors and altitude were the major drivers of malaria incidence in the study area. Thus, evidence-based interventions tailored to each determinant are required to achieve the malaria elimination target of the country. BACKGROUND: During the last two decades, researchers have suggested that the changes of malaria cases in African highlands were driven by climate change. Recently, a study claimed that the malaria cases (Plasmodium falciparum) in Oromia (Ethiopia) were related to minimum temperature. Critics highlighted that other variables could be involved in the dynamics of the malaria. The literature mentions that beyond climate change, trends in malaria cases could be involved with HIV, human population size, poverty, investments in health control programmes, among others. METHODS: Population ecologists have developed a simple framework, which helps to explore the contributions of endogenous (density-dependent) and exogenous processes on population dynamics. Both processes may operate to determine the dynamic behaviour of a particular population through time. Briefly, density-dependent (endogenous process) occurs when the per capita population growth rate (R) is determined by the previous population size. An exogenous process occurs when some variable affects another but is not affected by the changes it causes. This study explores the dynamics of malaria cases (Plasmodium falciparum and Plasmodium vivax) in Oromia region in Ethiopia and explores the interaction between minimum temperature, HIV, poverty, human population size and social instability. RESULTS: The results support that malaria dynamics showed signs of a negative endogenous process between R and malaria infectious class, and a weak evidence to support the climate change hypothesis. CONCLUSION: Poverty, HIV, population size could interact to force malaria models parameters explaining the dynamics malaria observed at Ethiopia from 1985 to 2007. BACKGROUND: Informed decision making is underlined by all tiers in the health system. Poor data record system coupled with under- (over)-reporting of malaria cases affects the country’s malaria elimination activities. Thus, malaria data at health facilities and health offices are important particularly to monitor and evaluate the elimination progresses. This study was intended to assess overall reported malaria cases, reporting quality, spatiotemporal trends and factors associated in Gedeo zone, South Ethiopia. METHODS: Past 8 years retrospective data stored in 17 health centers and 5 district health offices in Gedeo Zone, South Ethiopia were extracted. Malaria cases data at each health center with sociodemographic information, between January 2012 and December 2019, were included. Meteorological data were obtained from the national meteorology agency of Ethiopia. The data were analyzed using Stata 13. RESULTS: A total of 485,414 suspected cases were examined for malaria during the previous 8 years at health centers. Of these suspects, 57,228 (11.79%) were confirmed malaria cases with an overall decline during the 8-year period. We noted that 3758 suspected cases and 467 confirmed malaria cases were not captured at the health offices. Based on the health centers records, the proportions of Plasmodium falciparum (49.74%) and P. vivax (47.59%) infection were nearly equivalent (p = 0.795). The former was higher at low altitudes while the latter was higher at higher altitudes. The over 15 years of age group accounted for 11.47% of confirmed malaria cases (p < 0.001). There was high spatiotemporal variation: the highest case record was during Belg (12.52%) and in Dilla town (18,150, 13.17%, p < 0.001) which is located at low altitude. Monthly rainfall and minimum temperature exhibited strong associations with confirmed malaria cases. CONCLUSION: A notable overall decline in malaria cases was observed during the eight-year period. Both P. falciparum and P. vivax were found at equivalent endemicity level; hence control measures should continue targeting both species. The noticed under reporting, the high malaria burden in urban settings, low altitudes and Belg season need spatiotemporal consideration by the elimination program.
Background: In Gabon, a new national malaria control policy was implemented in 2003. It resulted in a decrease in the number of malaria cases in the country. In March 2020, the disruption of routine health services due to the COVID-19 pandemic has led to an increase in cases and deaths due to malaria. However, in Franceville, south-east Gabon, no data on malaria cases recorded before, during and after the COVID-19 epidemic has been published. Thus, the objective of this study was to determine the epidemiological characteristics of malaria in Franceville from 2019 to 2021. Methods: A retrospectively study of malaria cases was performed at the Hopital de l’Amitie Sino-Gabonaise (HASG). Information regarding age, gender, malaria diagnosis by microscopy and hematology cell count were collected from laboratory registers from June 2019 to December 2021. Malaria data were analyzed and correlated with seasonal variations. Results: The data of 12,695 febrile patients were collected from the laboratory registers of the HASG, among which 4252 (33.5%) patients were found positive for malaria. The malaria prevalence was 37.5% in 2020 year. This prevalence was highest compared to the 2019 (29.6%) and 2021 (31.5%) year (p < 0.001). During the short rainy season (October to December), a large increase in malaria cases was observed all three year, from 2019 to 2021 (p > 0.05). Conclusion: The prevalence of malaria in Franceville was very high during COVID-19 pandemic. It is therefore necessary to strengthen existing interventions and implement more effective interventions. Background: This study investigated malaria transmission under various contrasting settings in the Central Region, a malaria endemic region in Ghana. Methods: This cross-sectional study was carried out in five randomly selected districts in the Central Region of Ghana. Three of the districts were forested, while the rest was coastal. Study participants were selected to coincide with either the regular rainy or dry season. From each study site, hospital attendees were randomly selected with prior consent. Consciously, study participants were selected in both rainy (September and October, 2020) and dry (November and December, 2020) seasons. Clinical data for each patient was checked for clinical malaria suspicion and microscopic confirmation of malaria. Using SPSS Version 24 (Chicago, IL, USA), bivariate analysis was done to determine the association of independent variables (ecological and seasonal variations) with malaria status. When the overall analysis did not yield significant association, further statistical analysis was performed after stratification of variables (into age and gender) to determine whether any or both of them would significantly associate with the dependent variable. Results: Of the 3993 study participants, 62.5% were suspected of malaria whereas 38.2% were confirmed to have clinical falciparum malaria. Data analysis revealed that in both rainy and dry seasons, malaria cases were significantly higher in forested districts ) than coastal districts (x2 = 217.9 vs x2 = 50.9; p < 0.001). Taken together, the risk of malaria was significantly higher in the dry season (COR = 1.471, p < 0.001) and lower in coastal zones (COR = 0.826, p = 0.007). There was significant reduced risk of participants aged over 39 years of malaria (COR=0.657, p < 0.001). Whereas, in general patients between 10 and 19 years were insignificantly less likely to have malaria (COR = 0.911, p = 0.518) compared to participants aged less than < 10 years, the reverse was observed in coastal districts where patients less than 10 years of age in coastal districts were less likely to have malaria (COR=2.440, p = 0.003). In general, gender did not associate with malaria, but when stratified by study district, the risk of female gender to malaria was significantly higher in Agona Swedru (COR = 5.605, p < 0.001), Assin central (COR = 2.172, p < 0.001), Awutu Senya (COR = 2.410, p < 0.001) and Cape Coast (COR = 3.939, p < 0.001) compared to Abura-Asebu-Kwamankese. Conclusion: This study demonstrated that the predictors of malaria differ from one endemic area to another. Therefore, malaria control interventions such as distribution of long-lasting insecticide treated bed nets, residual spraying with insecticide and mass distribution of antimalaria prophylaxis must be intensified in forested districts in all seasons with particular attention on females. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. CC_BY_NC_ND_4.0
The Greater Accra Region is the smallest of the 16 administrative regions in Ghana. It is highly populated and characterized by tropical climatic conditions. Although efforts towards malaria control in Ghana have had positive impacts, malaria remains in the top five diseases reported at healthcare facilities within the Greater Accra Region. To further accelerate progress, analysis of regionally generated data is needed to inform control and management measures at this level. This study aimed to examine the climatic drivers of malaria transmission in the Greater Accra Region and identify inter-district variation in malaria burden. Monthly malaria cases for the Greater Accra Region were obtained from the Ghanaian District Health Information and Management System. Malaria cases were decomposed using seasonal-trend decomposition, based on locally weighted regression to analyze seasonality. A negative binomial regression model with a conditional autoregressive prior structure was used to quantify associations between climatic variables and malaria risk and spatial dependence. Posterior parameters were estimated using Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. A total of 1,105,370 malaria cases were recorded in the region from 2015 to 2019. The overall malaria incidence for the region was approximately 47 per 1000 population. Malaria transmission was highly seasonal with an irregular inter-annual pattern. Monthly malaria case incidence was found to decrease by 2.3% (95% credible interval: 0.7-4.2%) for each 1 °C increase in monthly minimum temperature. Only five districts located in the south-central part of the region had a malaria incidence rate lower than the regional average at >95% probability level. The distribution of malaria cases was heterogeneous, seasonal, and significantly associated with climatic variables. Targeted malaria control and prevention in high-risk districts at the appropriate time points could result in a significant reduction in malaria transmission in the Greater Accra Region. Malaria remains a serious public health challenge in Ghana including the Greater Accra Region. This study aimed to quantify the spatial, temporal and spatio-temporal patterns of malaria in the Greater Accra Region to inform targeted allocation of health resources. Malaria cases data from 2015 to 2019 were obtained from the Ghanaian District Health Information and Management System and aggregated at a district and monthly level. Spatial analysis was conducted using the Global Moran’s I, Getis-Ord Gi*, and local indicators of spatial autocorrelation. Kulldorff’s space-time scan statistics were used to investigate space-time clustering. A negative binomial regression was used to find correlations between climatic factors and sociodemographic characteristics and the incidence of malaria. A total of 1,105,370 malaria cases were reported between 2015 and 2019. Significant seasonal variation was observed, with June and July being the peak months of reported malaria cases. The hotspots districts were Kpone-Katamanso Municipal District, Ashaiman Municipal Districts, Tema Municipal District, and La-Nkwantanang-Madina Municipal District. While La-Nkwantanang-Madina Municipal District was high-high cluster. The Spatio-temporal clusters occurred between February 2015 and July 2017 in the districts of Ningo-Prampram, Shai-Osudoku, Ashaiman Municipal, and Kpone-Katamanso Municipal with a radius of 26.63 km and an relative risk of 4.66 (p < 0.001). Malaria cases were positively associated with monthly rainfall (adjusted odds ratio [AOR] = 1.01; 95% confidence interval [CI] = 1.005, 1.016) and the previous month's cases (AOR = 1.064; 95% CI 1.062, 1.065) and negatively correlated with minimum temperature (AOR = 0.86, 95% CI = 0.823, 0.899) and population density (AOR = 0.996, 95% CI = 0.994, 0.998). Malaria control and prevention should be strengthened in hotspot districts in the appropriate months to improve program effectiveness.
Whilst climate change is expected to tremendously influence the regional transmission of malaria, the available data reveal conflicting results. This study provides contextual evidence. We adopted multi-scale geographically weighted regression (MGWR) modelling approach. AICc and local r(2) were used to evaluate performance of the MGWR.. The MGWR analysis showed that LST (beta = -0.667), maximum temperature (beta = -0.507), mean temperature (beta = -0.480), and distance from streams (beta = -0.487) were negatively associated with malaria prevalence. However, enhanced vegetation index correlated positively with malaria prevalence (beta = 0.663). Our results may be important for public health interventions. Malaria has a significant impact on the lives of many in Ghana. It is one of the key causes of mortality and morbidity, resulting in 32.5% of outpatient visits and 48.8% of under 5-year-old hospital admissions. Future climate change may impact on this risk. This study aims at estimating the impact of climate variables and health facilities on malaria prevalence in Ghana using regional data from January 2012 to May 2017. This study links data at a regional level on malaria cases with weather data to evaluate the impact that changes in weather may have on malaria prevalence in Ghana. The results of fixed-effect modelling show that the maximum temperature has a statistically significant negative impact on malaria in the context of Ghana, and rainfall with a lag of two months has a positive statistically significant impact. Adapting to climate change in Ghana requires a better understanding of the climate-malaria relationship and this paper attempts to bridge this gap. CONTEXT: In Mali, malaria transmission is seasonal, exposing children to high morbidity and mortality. A preventative strategy called Seasonal Malaria Chemoprevention (SMC) is being implemented, consisting of the distribution of drugs at monthly intervals for up to 4 months to children between 3 and 59 months of age during the period of the year when malaria is most prevalent. This study aimed to analyze the evolution of the incidence of malaria in the general population of the health districts of Kati, Kadiolo, Sikasso, Yorosso, and Tominian in the context of SMC implementation. METHODS: This is a transversal study analyzing the routine malaria data and meteorological data of Nasa Giovanni from 2016 to 2018. General Additive Model (GAM) analysis was performed to investigate the relationship between malaria incidence and meteorological factors. RESULTS: From 2016 to 2018, the evolution of the overall incidence in all the study districts was positively associated with the relative humidity, rainfall, and minimum temperature components. The average monthly incidence and the relative humidity varied according to the health district, and the average temperature and rainfall were similar. A decrease in incidence was observed in children under five years old in 2017 and 2018 compared to 2016. CONCLUSION: A decrease in the incidence of malaria was observed after the SMC rounds. SMC should be applied at optimal periods. Malaria is among the greatest public health threats in Mozambique, with over 10 million cases reported annually since 2018. Although the relationship between seasonal trends in environmental parameters and malaria cases is well established, the role of climate in deviations from the annual cycle is less clear. To investigate this and the potential for leveraging inter-annual climate variability to predict malaria outbreaks, weekly district-level malaria incidence spanning 2010-2017 were processed for a cross-analysis with climate data. An empirical orthogonal function analysis of district-level malaria incidence revealed two dominant spatiotemporal modes that collectively account for 81% of the inter-annual variability of malaria: a mode dominated by variance over the southern half of Mozambique (64%), and another dominated by variance in the northern third of the country (17%). These modes of malaria variability are shown to be closely related to precipitation. Linear regression of global sea surface temperatures onto local precipitation indices over these variance maxima links the leading mode of inter-annual malarial variability to the El Nino-Southern Oscillation, such that La Nina leads to wetter conditions over southern Mozambique and, therefore, higher malaria prevalence. Similar analysis of spatiotemporal patterns of precipitation over a longer time period (1979-2019) indicate that the Subtropical Indian Ocean Dipole is both a strong predictor of regional precipitation and the climatic mechanism underlying the second mode of malarial variability. These results suggest that skillful malaria early warning systems may be developed that leverage quasi-predictable modes of inter-annual climate variability in the tropical oceans. Plain Language Summary Malaria is one of the main public health concerns in Mozambique, with millions of reported cases in the country each year. While malaria has been tied to monthly swings in rainfall and temperature, its relationship to year-to-year changes of the climate is less well known. We identified regions where local malaria cases varied together and found two main patterns: a main hotspot over the southern half of Mozambique, and a second hotspot over the northern third of the country. Rainfall drives both of these hotspots. We then tied these patterns to two natural climate phenomena, the El Nino-Southern Oscillation and the Subtropical Indian Ocean Dipole, both of which impact the climate of the region and help drive malaria prevalence. Our results suggest that it may be possible to take advantage of the predictability of these climate phenomena to improve public health planning both in Mozambique and more broadly. Introduction: Despite the recent progress in the malaria burden, climatic factors are important if the world will achieve the set target of its eradication. Hence, this study determined the impact of climatic conditions on childhood severe malaria in a tertiary health facility in northern Nigeria. Methodology: This was a retrospective descriptive study that involved children with severe malaria managed between July 2016 and August 2017. The diagnosis of severe malaria was according to the World Health Organization 2015 guidelines. We extracted relevant data from case records and obtained the weather information from the Nigerian Meteorological Agency and www.worldweatheronline.com. Data were entered in Microsoft Excel 2013 and analyzed with Statistical Package for the Social Sciences version 20. Results: A total of 483 cases of children with severe malaria were managed. The median age was 4.0 (2.5-8.0) years. Males were 261 (54.0%). In the wet season, 375 (77.6%) cases were recorded, while 108 (22.4%) cases occurred during the dry season. The odds of malaria occurring during the wet season were 2.057 (95% CI, 1.613-2.622). Temperature patterns were not related to malaria cases. Malaria cases showed significant moderate positive cross-correlation at 2- and 3-months lag for the rainfall pattern (best cross-correlation occurred at 3 months lag with a coefficient of 0.598, p = 0.045). Conclusion: This study demonstrated marked seasonality of childhood severe malaria infection with 77% of cases during the wet season. Malaria was associated with only rainfall at a 2 to 3 months lag amongst the climatic variables. We recommend the urgent implementation of seasonal malaria chemoprophylaxis. Several vector-borne diseases, such as malaria, are sensitive to climate and weather conditions. When unusual conditions prevail, for example, during periods of heavy rainfall, mosquito populations can multiply and trigger epidemics. This study, which consists of better understanding the link between malaria transmission and climate factors at a national level, aims to validate the VECTRI model (VECtor borne disease community model of ICTP, TRIeste) in Senegal. The VECTRI model is a grid-distributed dynamical model that couples a biological model for the vector and parasite life cycles to a simple compartmental Susceptible-Exposed-Infectious-Recovered (SEIR) representation of the disease progression in the human host. In this study, a VECTRI model driven by reanalysis data (ERA-5) was used to simulate malaria parameters, such as the entomological inoculation rate (EIR) in Senegal. In addition to the ERA5-Land daily reanalysis rainfall, other daily rainfall data come from different meteorological products, including the CPC Global Unified Gauge-Based Analysis of Daily Precipitation (CPC for Climate Prediction Center), satellite data from the African Rainfall Climatology 2.0 (ARC2), and the Climate Hazards InfraRed Precipitation with Station data (CHIRPS). Observed malaria data from the National Malaria Control Program in Senegal (PNLP/Programme National de Lutte contre le Paludisme au Senegal) and outputs from the climate data used in this study were compared. The findings highlight the unimodal shape of temporal malaria occurrence, and the seasonal malaria transmission contrast is closely linked to the latitudinal variation of the rainfall, showing a south-north gradient over Senegal. This study showed that the peak of malaria takes place from September to October, with a lag of about one month from the peak of rainfall in Senegal. There is an agreement between observations and simulations about decreasing malaria cases on time. These results indicate that the southern area of Senegal is at the highest risk of malaria spread outbreaks. The findings in the paper are expected to guide community-based early-warning systems and adaptation strategies in Senegal, which will feed into the national malaria prevention, response, and care strategies adapted to the needs of local communities. Malaria is a constant reminder of the climate change impacts on health. Many studies have investigated the influence of climatic parameters on aspects of malaria transmission. Climate conditions can modulate malaria transmission through increased temperature, which reduces the duration of the parasite’s reproductive cycle inside the mosquito. The rainfall intensity and frequency modulate the mosquito population’s development intensity. In this study, the Liverpool Malaria Model (LMM) was used to simulate the spatiotemporal variation of malaria incidence in Senegal. The simulations were based on the WATCH Forcing Data applied to ERA-Interim data (WFDEI) used as a point of reference, and the biased-corrected CMIP6 model data, separating historical simulations and future projections for three Shared Socio-economic Pathways scenarios (SSP126, SSP245, and SSP585). Our results highlight a strong increase in temperatures, especially within eastern Senegal under the SSP245 but more notably for the SSP585 scenario. The ability of the LMM model to simulate the seasonality of malaria incidence was assessed for the historical simulations. The model revealed a period of high malaria transmission between September and November with a maximum reached in October, and malaria results for historical and future trends revealed how malaria transmission will change. Results indicate a decrease in malaria incidence in certain regions of the country for the far future and the extreme scenario. This study is important for the planning, prioritization, and implementation of malaria control activities in Senegal. BACKGROUND: This study aimed to assess the seasonality of confirmed malaria cases in Togo and to provide new indicators of malaria seasonality to the National Malaria Control Programme (NMCP). METHODS: Aggregated data of confirmed malaria cases were collected monthly from 2008 to 2017 by the Togo’s NMCP and stratified by health district and according to three target groups: children < 5 years old, children ≥ 5 years old and adults, and pregnant women. Time series analysis was carried out for each target group and health district. Seasonal decomposition was used to assess the seasonality of confirmed malaria cases. Maximum and minimum seasonal indices, their corresponding months, and the ratio of maximum/minimum seasonal indices reflecting the importance of malaria transmission, were provided by health district and target group. RESULTS: From 2008 to 2017, 7,951,757 malaria cases were reported in Togo. Children < 5 years old, children ≥ 5 years old and adults, and pregnant women represented 37.1%, 57.7% and 5.2% of the confirmed malaria cases, respectively. The maximum seasonal indices were observed during or shortly after a rainy season and the minimum seasonal indices during the dry season between January and April in particular. In children < 5 years old, the ratio of maximum/minimum seasonal indices was higher in the north, suggesting a higher seasonal malaria transmission, than in the south of Togo. This is also observed in the other two groups but to a lesser extent. CONCLUSIONS: This study contributes to a better understanding of malaria seasonality in Togo. The indicators of malaria seasonality could allow for more accurate forecasting in malaria interventions and supply planning throughout the year.
BACKGROUND: Environmental factors such as temperature, rainfall, and vegetation cover play a critical role in malaria transmission. However, quantifying the relationships between environmental factors and measures of disease burden relevant for public health can be complex as effects are often non-linear and subject to temporal lags between when changes in environmental factors lead to changes in malaria incidence. The study investigated the effect of environmental covariates on malaria incidence in high transmission settings of Uganda. METHODS: This study leveraged data from seven malaria reference centres (MRCs) located in high transmission settings of Uganda over a 24-month period. Estimates of monthly malaria incidence (MI) were derived from MRCs’ catchment areas. Environmental data including monthly temperature, rainfall, and normalized difference vegetation index (NDVI) were obtained from remote sensing sources. A distributed lag nonlinear model was used to investigate the effect of environmental covariates on malaria incidence. RESULTS: Overall, the median (range) monthly temperature was 30 °C (26-47), rainfall 133.0 mm (3.0-247), NDVI 0.66 (0.24-0.80) and MI was 790 per 1000 person-years (73-3973). Temperature of 35 °C was significantly associated with malaria incidence compared to the median observed temperature (30 °C) at month lag 2 (IRR: 2.00, 95% CI: 1.42-2.83) and the increased cumulative IRR of malaria at month lags 1-4, with the highest cumulative IRR of 8.16 (95% CI: 3.41-20.26) at lag-month 4. Rainfall of 200 mm significantly increased IRR of malaria compared to the median observed rainfall (133 mm) at lag-month 0 (IRR: 1.24, 95% CI: 1.01-1.52) and the increased cumulative IRR of malaria at month lags 1-4, with the highest cumulative IRR of 1.99(95% CI: 1.22-2.27) at lag-month 4. Average NVDI of 0.72 significantly increased the cumulative IRR of malaria compared to the median observed NDVI (0.66) at month lags 2-4, with the highest cumulative IRR of 1.57(95% CI: 1.09-2.25) at lag-month 4. CONCLUSIONS: In high-malaria transmission settings, high values of environmental covariates were associated with increased cumulative IRR of malaria, with IRR peaks at variable lag times. The complex associations identified are valuable for designing strategies for early warning, prevention, and control of seasonal malaria surges and epidemics. BACKGROUND: There is concern in the international community regarding the influence of climate change on weather variables and seasonality that, in part, determine the rates of malaria. This study examined the role of sociodemographic variables in modifying the association between temperature and malaria in Kanungu District (Southwest Uganda). METHODS: Hospital admissions data from Bwindi Community Hospital were combined with meteorological satellite data from 2011 to 2014. Descriptive statistics were used to describe the distribution of malaria admissions by age, sex, and ethnicity (i.e. Bakiga and Indigenous Batwa). To examine how sociodemographic variables modified the association between temperature and malaria admissions, this study used negative binomial regression stratified by age, sex, and ethnicity, and negative binomial regression models that examined interactions between temperature and age, sex, and ethnicity. RESULTS: Malaria admission incidence was 1.99 times greater among Batwa than Bakiga in hot temperature quartiles compared to cooler temperature quartiles, and that 6-12 year old children had a higher magnitude of association of malaria admissions with temperature compared to the reference category of 0-5 years old (IRR = 2.07 (1.40, 3.07)). DISCUSSION: Results indicate that socio-demographic variables may modify the association between temperature and malaria. In some cases, such as age, the weather-malaria association in sub-populations with the highest incidence of malaria in standard models differed from those most sensitive to temperature as found in these stratified models. CONCLUSION: The effect modification approach used herein can be used to improve understanding of how changes in weather resulting from climate change might shift social gradients in health. BACKGROUND: Seasonal patterns of malaria cases in many parts of Africa are generally associated with rainfall, yet in the dry seasons, malaria transmission declines but does not always cease. It is important to understand what conditions support these periodic cases. Aerial moisture is thought to be important for mosquito survival and ability to forage, but its role during the dry seasons has not been well studied. During the dry season aerial moisture is minimal, but intermittent periods may arise from the transpiration of peri-domestic trees or from some other sources in the environment. These periods may provide conditions to sustain pockets of mosquitoes that become active and forage, thereby transmitting malaria. In this work, humidity along with other ecological variables that may impact malaria transmission have been examined. METHODS: Negative binomial regression models were used to explore the association between peri-domestic tree humidity and local malaria incidence. This was done using sensitive temperature and humidity loggers in the rural Southern Province of Zambia over three consecutive years. Additional variables including rainfall, temperature and elevation were also explored. RESULTS: A negative binomial model with no lag was found to best fit the malaria cases for the full year in the evaluated sites of the Southern Province of Zambia. Local tree and granary night-time humidity and temperature were found to be associated with local health centre-reported incidence of malaria, while rainfall and elevation did not significantly contribute to this model. A no lag and one week lag model for the dry season alone also showed a significant effect of humidity, but not temperature, elevation, or rainfall. CONCLUSION: The study has shown that throughout the dry season, periodic conditions of sustained humidity occur that may permit foraging by resting mosquitoes, and these periods are associated with increased incidence of malaria cases. These results shed a light on conditions that impact the survival of the common malaria vector species, Anopheles arabiensis, in arid seasons and suggests how they emerge to forage when conditions permit. The role of climate change on global malaria is often highlighted in World Health Organisation reports. We modelled a Zambian socio-environmental dataset from 2000 to 2016, against malaria trends and investigated the relationship of near-term environmental change with malaria incidence using Bayesian spatio-temporal, and negative binomial mixed regression models. We introduced the diurnal temperature range (DTR) as an alternative environmental measure to the widely used mean temperature. We found substantial sub-national near-term variations and significant associations with malaria incidence-trends. Significant spatio-temporal shifts in DTR/environmental predictors influenced malaria incidence-rates, even in areas with declining trends. We highlight the impact of seasonally sensitive DTR, especially in the first two quarters of the year and demonstrate how substantial investment in intervention programmes is negatively impacted by near-term climate change, most notably since 2010. We argue for targeted seasonally-sensitive malaria chemoprevention programmes. BACKGROUND: Malaria epidemics are increasing in East Africa since the 1980s, coincident with rising temperature and widening climate variability. A projected 1-3.5 °C rise in average global temperatures by 2100 could exacerbate the epidemics by modifying disease transmission thresholds. Future malaria scenarios for the Lake Victoria Basin (LVB) are quantified for projected climate scenarios spanning 2006-2100. METHODS: Regression relationships are established between historical (1995-2010) clinical malaria and anaemia cases and rainfall and temperature for four East African malaria hotspots. The vector autoregressive moving average processes model, VARMAX (p,q,s), is then used to forecast malaria and anaemia responses to rainfall and temperatures projected with an ensemble of eight General Circulation Models (GCMs) for climate change scenarios defined by three Representative Concentration Pathways (RCPs 2.6, 4.5 and 8.5). RESULTS: Maximum temperatures in the long rainy (March-May) and dry (June-September) seasons will likely increase by over 2.0 °C by 2070, relative to 1971-2000, under RCPs 4.5 and 8.5. Minimum temperatures (June-September) will likely increase by over 1.5-3.0 °C under RCPs 2.6, 4.5 and 8.5. The short rains (OND) will likely increase more than the long rains (MAM) by the 2050s and 2070s under RCPs 4.5 and 8.5. Historical malaria cases are positively and linearly related to the 3-6-month running means of monthly rainfall and maximum temperature. Marked variation characterizes the patterns projected for each of the three scenarios across the eight General Circulation Models, reaffirming the importance of using an ensemble of models for projections. CONCLUSIONS: The short rains (OND), wet season (MAM) temperatures and clinical malaria cases will likely increase in the Lake Victoria Basin. Climate change adaptation and mitigation strategies, including malaria control interventions could reduce the projected epidemics and cases. Interventions should reduce emerging risks, human vulnerability and environmental suitability for malaria transmission. 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. Dengue Fever (DF) is an important arthropod-borne viral infection that has repeatedly occurred as outbreaks in eastern and northeastern Ethiopia since 2013. A cross-sectional epidemiological outbreak investigation was carried out from September to November 2019 on febrile patients (confirmed malaria negative) who presented with suspected and confirmed DF at both public and private health facilities in Gewane District, Afar Region, northeastern Ethiopia. Entomological investigation of containers found in randomly selected houses belonging to DF-positive patients was undertaken to survey for the presence of Aedes larvae/pupae. A total of 1185 DF cases were recorded from six health facilities during the 3-month study period. The mean age of DF cases was 27.2 years, and 42.7% of cases were female. The most affected age group was 15−49 years old (78.98%). The total case proportions differed significantly across age groups when compared to the population distribution; there were approximately 15% and 5% higher case proportions among those aged 15−49 years and 49+ years, respectively. A total of 162 artificial containers were inspected from 62 houses, with 49.4% found positive for Aedes aegypti larva/pupae. Aedes mosquitoes were most commonly observed breeding in plastic tanks, tires, and plastic or metal buckets/bowls. World Health Organization entomological indices classified the study site as high risk for dengue virus outbreaks (House Index = 45.2%, Container Index = 49.4%, and Breteau Index = 129). Time series climate data, specifically rainfall, were found to be significantly predictive of AR (p = 0.035). Study findings highlight the importance of vector control to prevent future DF outbreaks in the region. The scarcity of drinking water and microclimatic conditions may have also contributed to the occurrence of this outbreak. Dengue fever is a systemic viral infection of epidemic proportions in tropical countries. The incidence of dengue fever is ever increasing and has doubled over the last few decades. Estimated 50million new cases are detected each year and close to 10000 deaths occur each year. Epidemics are unpredictable and unprecedented. When epidemics occur, health services are over whelmed leading to overcrowding of hospitals. At present there is no evidence that dengue epidemics can be predicted. Since the breeding of the dengue mosquito is directly influenced by environmental factors, it is plausible that epidemics could be predicted using weather data. We hypothesized that there is a mathematical relationship between incidence of dengue fever and environmental factors and if such relationship exists, new cases of dengue fever in the succeeding months can be predicted using weather data of the current month. We developed a mathematical model using machine learning technique. We used Island wide dengue epidemiology data, weather data and population density in developing the model. We used incidence of dengue fever, average rain fall, humidity, wind speed, temperature and population density of each district in the model. We found that the model is able to predict the incidence of dengue fever of a given month in a given district with precision (RMSE between 18- 35.3). Further, using weather data of a given month, the number of cases of dengue in succeeding months too can be predicted with precision (RMSE 10.4-30). Health authorities can use existing weather data in predicting epidemics in the immediate future and therefore measures to prevent new cases can be taken and more importantly the authorities can prepare local authorities for outbreaks. Dengue contributes a significant burden on global public health and economies. In Africa, the burden of dengue virus (DENV) infection is not well described. This review was undertaken to determine the prevalence of dengue and associated risk factors. A literature search was done on PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases to identify articles published between 1960 and 2020. Meta-analysis was performed using a random-effect model at a 95% confidence interval, followed by subgroup meta-analysis to determine the overall prevalence. Between 1960 and 2020, 45 outbreaks were identified, of which 17 and 16 occurred in East and West Africa, respectively. Dengue virus serotype 1 (DENV-1) and DENV-2 were the dominant serotypes contributing to 60% of the epidemics. Of 2211 cases reported between 2009 and 2020; 1954 (88.4%) were reported during outbreaks. Overall, the prevalence of dengue was 29% (95% CI: 20-39%) and 3% (95% CI: 1-5%) during the outbreak and non-outbreak periods, respectively. Old age (6/21 studies), lack of mosquito control (6/21), urban residence (4/21), climate change (3/21), and recent history of travel (3/21) were the leading risk factors. This review reports a high burden of dengue and increased risk of severe disease in Africa. Our findings provide useful information for clinical practice and health policy decisions to implement effective interventions. Human vulnerability to disasters poses a significant concern to water resources management. The present study examined the factors influencing the occurrence of flooding, risk and management strategies in Lagos, Nigeria. A set of questionnaires was administered to 400 respondents in four randomly selected settlements in Lagos State based on perception and observation methods. Descriptive and multivariate statistics and cartographic mapping techniques were employed for data analysis. The result indicates that the majority of the respondents live in a rented room and parlor. The significant flood risks include poor sanitation, a breeding site for mosquitoes, water contamination/waterborne diseases, and mental stress. Factors analysis explains 74.62% of the variance, indicating anthropogenic, natural, and institutional factors influencing flooding in the study area. The dominant flood management measures are clearance of drains, environmental sanitation, public awareness, training/education, while the significant steps taken by the government to ameliorate flooding challenges in the area include awareness, early warning, and education. The study concluded that there exists a significant difference in the factors influencing flooding across the settlements based on the ANOVA result given as: (DWSD F = 19.661, p < 0.05; RI = 41.104, p < 0.05; WIC = 18.123, p < 0.05; HWL = 37.481, p < 0.05; SD = 10.294, p < 0.05). The study contributes to knowledge using cartographic techniques to map the risks of flooding for easy understanding. The study has potential policy implications for planning and interventions in areas vulnerable areas. The study recommended monitoring of construction activities, enforcement of building codes, awareness campaigns, and early warning flood technology for sustainable flood management in the area.
Despite the long-lasting and widespread drought in the Sahel, flood events did punctuate in the past. The concern about floods remains dwarf on the international research and policy agenda compared to droughts. In this paper, we elucidate that floods in the Sahel are now becoming more frequent, widespread, and more devastating. We analyzed gridded daily rainfall data over the period 1981-2020, used photographs and satellite images to depict flood areas and threats, compiled and studied flood-related statistics over the past two decades, and supported the results with peer-reviewed literature. Our analysis revealed that the timing of the maximum daily rainfall occurs from the last week of July to mid-August in the Eastern Sahel, but from the last week of July to the end of August in the Western Sahel. In 2019 and 2020, flash and riverine floods took their toll in Sudan and elsewhere in the region in terms of the number of affected people, direct deaths, destroyed and damaged houses and croplands, contaminated water resources, and disease outbreaks and deaths. Changes in rainfall intensity, human interventions in the physical environment, and poor urban planning play a major role in driving catastrophic floods. Emphasis should be put on understanding flood causes and impacts on vulnerable societies, controlling water-borne diseases, and recognizing the importance of compiling relevant and reliable flood information. Extreme rainfall in this dry region could be an asset for attenuating the regional water scarcity status if well harvested and managed. We hope this paper will induce the hydroclimate scholars to carry out more flood studies for the Sahel. It is only then encumbered meaningful opportunities for flood risk management can start to unveil. The study examined the effect of heat stress on the well-being of outdoor workers and their coping strategies. A cross-sectional survey study was conducted between September 2019 and December 2019 to collect data from outdoor workers including hawkers and traffic wardens from 13 urban areas (N = 322) and analyzed using SPSS v.23. The results of the study show that most of the outdoor workers were in a good health state based on their self-health assessment. However, the respondents expressed concerns and symptoms of heat stress including heat cramps, heat exhaustion, heat stroke and sleep disorders. The findings also show that male outdoor workers were 1.3 times more likely than females to be affected by heat stress. Respondents in their 20s were more likely to be affected by heat stress, as a result of temperatures and humidity conditions, than those in their 30s (OR = 0.389, CI = 0.158-0962) and 40s (OR = 0.395, CI = 0.147-1.063). Coping strategies identified include the use of breathable cotton attires, drinking a lot of water, hiding under shades and reducing outdoor activity intermittently. The 2019 and 2020 sporadic outbreaks of yellow fever (YF) in Sub-Saharan African countries had raised a lot of global health concerns. This article aims to narratively review the vector biology, YF vaccination program, environmental factors and climatic changes, and to understand how they could facilitate the reemergence of YF. This study comprehensively reviewed articles that focused on the interplay and complexity of YF virus (YFV) vector diversity/competence, YF vaccine immunodynamics and climatic change impacts on YFV transmission as they influence the 2019/2020 sporadic outbreaks in Sub-Saharan Africa (SSA). Based on available reports, vectorial migration, climatic changes and YF immunization level could be reasons for the re-mergence of YF at the community and national levels. Essentially, the drivers of YFV infection due to spillover are moderately constant. However, changes in land use and landscape have been shown to influence sylvan-to-urban spillover. Furthermore, increased precipitation and warmer temperatures due to climate change are likely to broaden the range of mosquitoes’ habitat. The 2019/2020 YF outbreaks in SSA is basically a result of inadequate vaccination campaigns, YF surveillance and vector control. Consequently, and most importantly, adequate immunization coverage must be implemented and properly achieved under the responsibility of the public health stakeholders. BACKGROUND: Malaria has continued to be a life-threatening disease among under-five children in sub-Saharan Africa. Recent data indicate rising cases in Rwanda after some years of decline. We aimed at estimating the spatial variations in malaria prevalence at a continuous spatial scale and to quantify locations where the prevalence exceeds the thresholds of 5% and 10% across the country. We also consider the effects of some socioeconomic and climate variables. METHODS: Using data from the 2014-2015 Rwanda Demographic and Health Survey, a geostatistical modeling technique based on stochastic partial differential equation approach was used to analyze the geospatial prevalence of malaria among under-five children in Rwanda. Bayesian inference was based on integrated nested Laplace approximation. RESULTS: The results demonstrate the uneven spatial variation of malaria prevalence with some districts including Kayonza and Kirehe from Eastern province; Huye and Nyanza from Southern province; and Nyamasheke and Rusizi from Western province having higher chances of recording prevalence exceeding 5%. Malaria prevalence was found to increase with rising temperature but decreases with increasing volume for rainfall. The findings also revealed a significant association between malaria and demographic factors including place of residence, mother’s educational level, and child’s age and sex. CONCLUSIONS: Potential intervention programs that focus on individuals living in rural areas, lowest wealth quintile, and the locations with high risks should be reinforced. Variations in climatic factors particularly temperature and rainfall should be taken into account when formulating malaria intervention programs in Rwanda. BACKGROUND: Floods have affected 2.3 billion people worldwide in the last 20 years, and are associated with a wide range of negative health outcomes. Climate change is projected to increase the number of people exposed to floods due to more variable precipitation and rising sea levels. Vulnerability to floods is highly dependent on economic wellbeing and other societal factors. Therefore, this systematic review synthesizes the evidence on health effects of flood exposure among the population of sub-Saharan Africa. METHODS: We systematically searched two databases, Web of Science and PubMed, to find published articles. We included studies that (1) were published in English from 2010 onwards, (2) presented associations between flood exposure and health indicators, (3) focused on sub-Saharan Africa, and (4) relied on a controlled study design, such as cohort studies, case-control studies, cross-sectional studies, or quasi-experimental approaches with a suitable comparator, for instance individuals who were not exposed to or affected by floods or individuals prior to experiencing a flood. RESULTS: Out of 2306 screened records, ten studies met our eligibility criteria. We included studies that reported the impact of floods on water-borne diseases (n = 1), vector-borne diseases (n = 8) and zoonotic diseases (n = 1). Five of the ten studies assessed the connection between flood exposure and malaria. One of these five evaluated the impact of flood exposure on malaria co-infections. The five non-malaria studies focused on cholera, scabies, taeniasis, Rhodesian sleeping sickness, alphaviruses and flaviviruses. Nine of the ten studies reported significant increases in disease susceptibility after flood exposure. CONCLUSION: The majority of included studies of the aftermath of floods pointed to an increased risk of infection with cholera, scabies, taeniasis, Rhodesian sleeping sickness, malaria, alphaviruses and flaviviruses. However, long-term health effects, specifically on mental health, non-communicable diseases and pregnancy, remain understudied. Further research is urgently needed to improve our understanding of the health risks associated with floods, which will inform public policies to prevent and reduce flood-related health risks. 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. Background: Environmentally related morbidity and mortality still remain high worldwide, although they have decreased significantly in recent decades. This study aims to forecast malaria epidemics taking into account climatic and spatio-temporal variations and therefore identify geo-climatic factors predictive of malaria prevalence from 2001 to 2019 in the Democratic Republic of Congo. Methods: This is a retrospective longitudinal ecological study. The database of the Directorate of Epidemiological Surveillance including all malaria cases registered in the surveillance system based on positive blood test results, either by microscopy or by a rapid diagnostic test for malaria was used to estimate malaria morbidity and mortality by province of the DRC from 2001 to 2019. The impact of climatic factors on malaria morbidity was modeled using the Generalized Poisson Regression, a predictive model with the dependent variable Y the count of the number of occurrences of malaria cases during a period of time adjusting for risk factors. Results: Our results show that the average prevalence rate of malaria in the last 19 years is 13,246 (1,178,383−1,417,483) cases per 100,000 people at risk. This prevalence increases significantly during the whole study period (p < 0.0001). The year 2002 was the most morbid with 2,913,799 (120,9451−3,830,456) cases per 100,000 persons at risk. Adjusting for other factors, a one-day in rainfall resulted in a 7% statistically significant increase in malaria cases (p < 0.0001). Malaria morbidity was also significantly associated with geographic location (western, central and northeastern region of the country), total evaporation under shelter, maximum daily temperature at a two-meter altitude and malaria morbidity (p < 0.0001). Conclusions: In this study, we have established the association between malaria morbidity and geo-climatic predictors such as geographical location, total evaporation under shelter and maximum daily temperature at a two-meter altitude. We show that the average number of malaria cases increased positively as a function of the average number of rainy days, the total quantity of rainfall and the average daily temperature. These findings are important building blocks to help the government of DRC to set up a warning system integrating the monitoring of rainfall and temperature trends and the early detection of anomalies in weather patterns in order to forecast potential large malaria morbidity events.
BACKGROUND: Malaria is a global burden in terms of morbidity and mortality. In the Democratic Republic of Congo, malaria prevalence is increasing due to strong climatic variations. Reductions in malaria morbidity and mortality, the fight against climate change, good health and well-being constitute key development aims as set by the United Nations Sustainable Development Goals (SDGs). This study aims to predict malaria morbidity to 2036 in relation to climate variations between 2001 and 2019, which may serve as a basis to develop an early warning system that integrates monitoring of rainfall and temperature trends and early detection of anomalies in weather patterns. METHODS: Meteorological data were collected at the Mettelsat and the database of the Epidemiological Surveillance Directorate including all malaria cases registered in the surveillance system based on positive blood test results, either by microscopy or by a rapid diagnostic test for malaria, was used to estimate malaria morbidity and mortality by province of the DRC from 2001 to 2019. Malaria prevalence and mortality rates by year and province using direct standardization and mean annual percentage change were calculated using DRC mid-year populations. Time series combining several predictive models were used to forecast malaria epidemic episodes to 2036. Finally, the impact of climatic factors on malaria morbidity was modeled using multivariate time series analysis. RESULTS: The geographical distribution of malaria prevalence from 2001 and 2019 shows strong disparities between provinces with the highest of 7700 cases per 100,000 people at risk for South Kivu. In the northwest, malaria prevalence ranges from 4980 to 7700 cases per 100,000 people at risk. Malaria has been most deadly in Sankuru with a case-fatality rate of 0.526%, followed by Kasai (0.430%), Kwango (0.415%), Bas-Uélé, (0.366%) and Kwilu (0.346%), respectively. However, the stochastic trend model predicts an average annual increase of 6024.07 malaria cases per facility with exponential growth in epidemic waves over the next 200 months of the study. This represents an increase of 99.2%. There was overwhelming evidence of associations between geographic location (western, central and northeastern region of the country), total evaporation under shelter, maximum daily temperature at two meters altitude and malaria morbidity (p < 0.0001). CONCLUSIONS: The stochastic trends in our time series observed in this study suggest an exponential increase in epidemic waves over the next 200 months of the study. The increase in new malaria cases is statistically related to population density, average number of rainy days, average wind speed, and unstable and intermediate epidemiological facies. Therefore, the results of this research should provide relevant information for the Congolese government to respond to malaria in real time by setting up a warning system integrating the monitoring of rainfall and temperature trends and early detection of anomalies in weather patterns.
Eswatini is on the brink of malaria elimination and had however, had to shift its target year to eliminate malaria on several occasions since 2015 as the country struggled to achieve its zero malaria goal. We conducted a Bayesian geostatistical modeling study using malaria case data. A Bayesian distributed lags model (DLM) was implemented to assess the effects of seasonality on cases. A second Bayesian model based on polynomial distributed lags was implemented on the dataset to improve understanding of the lag effect of environmental factors on cases. Results showed that malaria increased during the dry season with proportion 0.051 compared to the rainy season with proportion 0.047 while rainfall of the preceding month (Lag2) had negative effect on malaria as it decreased by proportion - 0.25 (BCI: - 0.46, - 0.05). Night temperatures of the preceding first and second month were significantly associated with increased malaria in the following proportions: at Lag1 0.53 (BCI: 0.23, 0.84) and at Lag2 0.26 (BCI: 0.01, 0.51). Seasonality was an important predictor of malaria with proportion 0.72 (BCI: 0.40, 0.98). High malaria rates were identified for the months of July to October, moderate rates in the months of November to February and low rates in the months of March to June. The maps produced support-targeted malaria control interventions. The Bayesian geostatistical models could be extended for short-term and long-term forecasting of malaria supporting-targeted response both in space and time for effective elimination. A counterargument to the importance of climate change for malaria transmission has been that regions where an effect of warmer temperatures is expected, have experienced a marked decrease in seasonal epidemic size since the turn of the new century. This decline has been observed in the densely populated highlands of East Africa at the center of the earlier debate on causes of the pronounced increase in epidemic size from the 1970s to the 1990s. The turnaround of the incidence trend around 2000 is documented here with an extensive temporal record for malaria cases for both Plasmodium falciparum and Plasmodium vivax in an Ethiopian highland. With statistical analyses and a process-based transmission model, we show that this decline was driven by the transient slowdown in global warming and associated changes in climate variability, especially ENSO. Decadal changes in temperature and concurrent climate variability facilitated rather than opposed the effect of interventions. BACKGROUND: Malaria is a serious public health problem of most developing countries, including Ethiopia. The burden of malaria is severely affecting the economy and lives of people, particularly among the productive ages of rural society. Thus, this study was targeted to analyze the past five-year retrospective malaria data among the rural setting of Maygaba town, Welkait district, northwest Ethiopia. METHODS: The study was done on 36,219 outpatients attending for malaria diagnosis during January 2015 to 2019. Data was extracted from the outpatient medical database. Chi-square (χ (2)) test and binary logistic regression model were used to analyze the retrospective data. Statistical significance was defined at p < 0.05. RESULTS: Of 36,219 outpatients examined, 7,309 (20.2%) malaria-positive cases were reported during 2015-2019. There was a fluctuating trend in the number of malaria-suspected and -confirmed cases in each year. Male slide-confirmed (61.4%, N = 4,485) were significantly higher than females (38.6%, N = 2,824) (p < 005). Plasmodium falciparum and Plasmodium vivax were the dominant parasites detected, which accounted for 66.1%; N = 4832, 33.9%; N = 2477, respectively. Despite the seasonal abundance of malaria cases, the highest prevalence was recorded in autumn (September to November) in the study area. Binary logistic regression analysis revealed that statistically significant associations were observed between sexes, interseasons, mean seasonal rainfall, and mean seasonal temperature with the prevalence of P. vivax. However, P. falciparum has shown a significant association with interseasons and mean seasonal temperature. CONCLUSIONS: Although the overall prevalence of malaria was continually declined from 2015-2019, malaria remains the major public health problem in the study area. The severe species of P. falciparum was found to be the dominant parasite reported in the study area. A collaborative action between the national malaria control program and its partners towards the transmission, prevention, and control of the two deadly species is highly recommended.
Background. In Sub-Saharan African countries, malaria is a leading cause of morbidity and mortality. In Ethiopia, malaria is found in three-fourths of its land mass with more than 63 million people living in malaria endemic areas. Nowadays, Ethiopia is implementing a malaria elimination program with the goal of eliminating the disease by 2030. To assist this goal, the trends of malaria cases should be evaluated with a function of time in different areas of the country to develop area-specific evidence-based interventions. Therefore, this study was aimed at analysing a five year trend of malaria in Nirak Health Center, Abergele District, Northeast Ethiopia, from 2016 to 2020. Methods. A retrospective study was conducted at Nirak Health Center, Abergele District, Northeast Ethiopia from February to April 2021. Five-year (2016 to 2020) retrospective data were reviewed from the malaria registration laboratory logbook. The sociodemographic and malaria data were collected using a predesigned data collection sheet. Data were entered, cleaned, and analysed using SPSS version 26. Results. In the five-year period, a total of 19,433 malaria suspected patients were diagnosed by microscopic examination. Of these, 6,473 (33.3%) were positive for malaria parasites. Of the total confirmed cases, 5,900 (91.2%) were P. falciparum and 474 (7.2%) were P. vivax. Majority of the cases were males (62.2%) and in the age group of 15-45 years old (52.8%). The findings of this study showed an increasing trend in malaria cases in the past five years (2016-2020). The maximum number of confirmed malaria cases reported was in the year 2020, while the minimum number of confirmed malaria cases registered was in 2016. Regarding the seasonal distribution of malaria, the highest number of malaria cases (55.2%) was observed in Dry season (September to January) and also the least (15.9%) was observed in Autumn (March to May) replaced by the least (21.6%) was observed in Rainy season (June to August), that is, the major malaria transmission season in Ethiopia and the least (15.9%) was observed in autumn (March to May). Conclusion. The trends of malaria in Nirak Health Center showed steadily increasing from the year 2016-2020, and the predominant species isolated was P. falciparum. This showed that the malaria control and elimination strategy in the area were not properly implemented or failed to achieve its designed goal. Therefore, this finding alarms the local governments and other stack holders urgently to revise their intervention strategies and take action in the locality. BACKGROUND: Land use change has increasingly been expanding throughout the world in the past decades. It can have profound effects on the spatial and temporal distribution of vector borne diseases like malaria through ecological and habitat change. Understanding malaria disease occurrence and the impact of prevention interventions under this intense environmental modification is important for effective and efficient malaria control strategy. METHODS: A descriptive ecological study was conducted by reviewing health service records at Abobo district health office. The records were reviewed to extract data on malaria morbidity, mortality, and prevention and control methods. Moreover, Meteorological data were obtained from Gambella region Meteorology Service Center and National Meteorology Authority head office. Univariate, bivariate and multivariate analysis techniques were used to analyze the data. RESULTS: For the twelve-year time period, the mean annual total malaria case count in the district was 7369.58. The peak monthly malaria incidence was about 57 cases per 1000 people. Only in 2009 and 2015 that zero death due to malaria was recorded over the past 12 years. Fluctuating pattern of impatient malaria cases occurrence was seen over the past twelve years with an average number of 225.5 inpatient cases. The data showed that there is a high burden of malaria in the district. Plasmodium falciparum (Pf) was a predominant parasite species in the district with the maximum percentage of about 90. There was no statistically significant association between season and total malaria case number (F(3,8): 1.982, P:0.195). However, the inter-annual total case count difference was statistically significant (F(11,132): 36.305, p < 0001). Total malaria case count had shown two months lagged carry on effect. Moreover, 3 months lagged humidity had significant positive effect on total malaria cases. Malaria prevention interventions and meteorological factors showed statistically significant association with total malaria cases. CONCLUSION: Malaria was and will remain to be a major public health problem in the area. The social and economic impact of the disease on the local community is clearly pronounced as it is the leading cause of health facility visit and admission including the mortality associated with it. Scale up of effective interventions is quite important. Continuous monitoring of the performance of the vector control tools needs to be done.
BACKGROUND: Rainfall is one of the climate variables most studied as it affects malaria occurrence directly. OBJECTIVE: This study aimed to describe how monthly rainfall variability affects malaria incidence in different years. METHODS: A total of 7 years (2013/14-2019/20) retrospective confirmed and treated malaria cases in Gondar Zuria district were used for analysis in addition to five (2013/14-2017/18) years retrospective data from Dembia district. RESULTS: The annual rainfalls in the study years showed no statistically significant difference (p = 0. 78). But, variations in rainfalls of the different months (p = 0.000) of the different years were the source of variations for malaria count (incidences) in the different years. Malaria was transmitted throughout the year with the highest peak in November (mean count = 1468.7 ± 697.8) and followed by May (mean count = 1253.4 ± 1391.8), after main Kiremt/Summer and minor Bulg/Spring rains respectively. The lowest transmission was occurred in February (338 ± 240.3) when the rivers were the only source of mosquito vectors. Year 2013/14 (RF = 2351.12 mm) and 2019/20 (RF = 2278.80 mm) with no statistically significant difference (p = 0.977) in annual rainfalls produced 10, 702 (49.2%) and 961 (20%) malaria counts for the Bulg (spring) season respectively due to 581.92 mm (24.8%) higher total Bulg/Spring rain in 2013/14 compared to 124.1 mm (5.45%) in 2019/20. Generally, above normal rainfalls in Bulg/Spring season increased malaria transmission by providing more aquatic habitats supporting the growth of the immature stages. But heavy rains in Summer/Kiremt produced low malaria counts due to the high intensity of the rainfalls which could kill the larvae and pupae. Spearman’s correlation analysis indicated that the mean rainfalls of current month (RF) (0 lagged month) (P = 0.025), previous month (RF1) (1 month lagged) (p = 0.000), before previous months (RF2) (2 months lagged) (p = 0.001) and mean RF + RF1 + RF2 (P = 0.001) were positive significantly correlated with mean monthly malaria counts compared to negative significant correlations for temperature variables. Temperature variables negative correlations were interpreted as confounding effects because decreased malaria counts in dry months were due to a decrease in rainfalls. Conclusion: rainfall distribution in different months of a year affects malaria occurrences. Exposure of humans to high concentrations of PM2.5 has adverse effects on their health. Researchers estimate that exposure to particulate matter from fossil fuel emissions accounted for 18% of deaths in 2018-a challenge policymakers argue is being exacerbated by the increase in the number of extreme weather events and rapid urbanization as they tinker with strategies for reducing air pollutants. Drawing on a number of ensemble machine learning methods that have emerged as a result of advancements in data science, this study examines the effectiveness of using ensemble models for forecasting the concentrations of air pollutants, using PM2.5 as a representative case. A comprehensive evaluation of the ensemble methods was carried out by comparing their predictive performance with that of other standalone algorithms. The findings suggest that hybrid models provide useful tools for PM2.5 concentration forecasting. The developed models show that machine learning models are efficient in predicting air particulate concentrations, and can be used for air pollution forecasting. This study also provides insights into how climatic factors influence the concentrations of pollutants found in the air. Dust storms are meteorological hazards associated with several adverse health impacts including eye irritations, respiratory and cardiovascular disorders, and vehicular road accidents due to poor visibility. This study investigated relations between admissions from a large, public hospital that serves people living in Northern Cape and Free State provinces, South Africa during 2011 to 2017, and meteorological variables (temperature and air quality) during two dust storms, one in October 2014 (spring) and the second in January 2016 (summer), identified from the media as no repository of such events exists for South Africa. Distributed nonlinear lag analysis and wavelet transform analysis were applied to explore the relationships between hospital admissions for respiratory and cardiovascular diseases, eye irritation, and motor vehicle accidents; maximum temperature, and two air quality ‘proxy measures,’ aerosol optical depth and angstrom ngstrom exponent, were used as ground-based air quality data were unavailable. Eye irritation was the most common dust-related hospital admission after both dust storm events. No statistically significant changes in admissions of interest occurred at the time of the two dust storm events, using either of the statistical methods. Several lessons were learnt. For this type of study, ground-based air quality and local wind data are required; alternative statistical methods of analysis should be considered; and a central dust storm repository would help analyze more than two events. Future studies in South Africa are needed to develop a baseline for comparison of future dust storm events and their impacts on human health. This review highlights the importance of air quality in the African urban development process. We address connections between air pollution and (a) rapid urbanization, (b) social problems, (c) health impacts, (d) climate change, (e) policies, and (f) new innovations. We acknowledge that air pollution levels in Africa can be extremely high and a serious health threat. The toxic content of the pollution could relate to region-specific sources such as low standards for vehicles and fuels, cooking with solid fuels, and burning household waste. We implore the pursuit of interdisciplinary research to create new approaches with relevant stakeholders. Moreover, successful air pollution research must regard conflicts, tensions, and synergies inherent to development processes in African municipalities, regions, and countries. This includes global relationships regarding climate change, trade, urban planning, and transportation. Incorporating aspects of local political situations (e.g., democracy) can also enhance greater political accountability and awareness about air pollution. The vegetation burning caused by wildfires can release significant quantities of aerosols and toxic chemicals into the atmosphere and result in health risk. Among these emitted pollutants, Benzo(a)pyrene (BaP), the most toxic congener of 16 parent PAHs (polycyclic aromatic hydrocarbons), has received widespread concerns because of its carcinogenicity to human health. Efforts have been made to investigate the environmental and health consequences of wildfire-induced BaP emissions in Africa. Still, uncertainties remain due to knowledge and data gaps in wildfire incidences and biomass burning emissions. Based on a newly-developed BaP emission inventory, the present study assesses quantitatively the BaP environment cycling in Africa and its effects on other continents from 2001 to 2014. The new inventory reveals the increasing contribution of BaP emission from African wildfires to the global total primarily from anthropogenic sources, accounting for 48% since the 2000 s. We identify significantly higher BaP emissions and concentrations across sub-Saharan Africa, where the annual averaged BaP concentrations were as high as 5-8 ng/m(3). The modeled BaP concentrations were implemented to estimate the lifetime cancer risk (LCR) from the inhalation exposure to BaP concentrations. The results reveal that the LCR values in many African countries exceeded the acceptable risk level at 1 × 10(-6), some of which suffer from very high exposure risk with the LCR>1 × 10(-4). We show that the African BaP emission from wildfires contributed, to some extent, BaP contamination to Europe as well as other regions, depending on source proximity and atmospheric pathways under favorable atmospheric circulation patterns. Objective Respiratory viruses are the most important cause of lower respiratory tract infections (LRTI) in children. Meteorological factors can influence viral outbreaks. The objective of this study was to determine the association between climate variables and respiratory virus detection. Methods Multicenter prospective 1-year surveillance was conducted among children hospitalized for LRTI in Tunisia. Nasopharyngeal aspirates were tested by direct immunofluorescence assay (DIFA) for the detection of respiratory syncytial virus (RSV); adenovirus (AdV); influenza virus (IFV) A and B; and parainfluenza virus 1, 2, and 3 (PIV1/2/3). Samples were further analyzed by reverse-transcription polymerase chain reaction for the detection of human metapneumovirus (hMPV). Monthly meteorological data were determined by consulting the National Institute of Meteorology and the World Weather Online Meteorological Company websites. Pearson’s correlation tests were used to determine the statistical association between the detection of respiratory viruses and climatic characteristics. Results Among 572 patients, 243 (42.5%) were positive for at least one virus. The most frequently detected viruses by DIFA were RSV (30.0%), followed by IFVA (3.8%), IFVB (3.5%), PIV (0.9%), and AdV (0.9%). HMPV was detected in 13 RSV-negative samples (3.3%). Dual infections were detected in seven cases (1.2%). Monthly global respiratory viruses and RSV detections correlated significantly with temperature, rainfall, cloud cover, wind speed, wind temperature, and duration of sunshine. Monthly IFV detection significantly correlated with rainfall, wind speed, wind temperature, and duration of sunshine. HMPV detection significantly correlated with temperature and wind temperature. Conclusion Respiratory viral outbreaks are clearly related to meteorological factors in Tunisia. Since the outbreak of COVID-19, its effects on different aspects of life have been subject to much research, including food security, a domain that has been of special concern in many low-income countries. Ethiopia has been facing many challenges related to food security for decades via drought, famine, and conflict. Within this context, this case study assessed the impact of the COVID-19 pandemic on food security in Ethiopia. Results show that the ongoing pandemic has negatively impacted different regions and at-risk groups in a heterogeneous manner. This has been mainly through disruptions in the Ethiopian food value chain and the relative failure of social security programmes to address the losses generated by COVID-19. The population in the capital city, Addis Ababa, was able to maintain the same level of food security despite income losses caused by the COVID-19 pandemic. However, at-risk groups such as refugees, internally displaced persons (IDPs), and conflict affected regions were seen to suffer significantly from food insecurity exacerbated by COVID-19. Furthermore, this paper particularly emphasizes the importance of considering contextual factors other than COVID-19, such as conflicts or climate change, when discussing the state of food security in Ethiopia. The African Sahel countries are inherently fragile, environmentally insecure and economically weak. This paper underscores the compounded impacts brought about by the COVID-19 pandemic on resource supply security and, hence, the long-term development of the region. It outlines the Sahel-specific COVID-19 scenario by firstly highlighting the underlying vulnerabilities and later linking the health sector outcomes to increased political instability and environmental insecurity, particularly the deterioration of food security. In this sense, this paper shows from a region-wide perspective how COVID-19 in the Sahel is associated with enlarged sociopolitical developmental perils. Lower remittance sent by expatriates, violent conflicts, increased cross-border terrorism and migration, discriminant mobility restrictions of people and goods, weak national healthcare infrastructures, bottlenecks in international aid, pressures on the education system and recent climate extremes are some revealing examples of aggravators of the impacts on the supply of vital resources, such as food. This paper also shows the importance of considering the close interlinks between health, food and political stability in the Sahel. There is a paramount need for more comprehensive approaches linking human health to other sectors, and for re-considering local sustainable agriculture. To avoid prolonged or recurrent humanitarian crises, the Sahel countries need to strengthen response capacities through public sector-led responses. Examples of these responses include reinforced national disaster programs for the vulnerable, support to sustainable agriculture and food markets, improved performance and communication of public sector relief, state-based cooperation, building of regional alliances and peacemaking efforts. The aim of this study is to simulate the impact of mineral dust emissions from the Sahel-Saharan zone on temperature extremes over the Sahel. To achieve this goal, we performed two numerical simulations: one with the standard version of the regional climate model RegCM4 (no dust run) and another one with the same version of this model incorporating a dust module (dust run). The difference between both versions of the model allowed to isolate the impacts of mineral dust emissions on temperature extremes. The results show that the accumulation of mineral dust into the atmosphere leads to a decrease of the frequency of warm days, very warm days, and warm nights over the Sahel. This decrease is higher during the MAM (March-April-May) and JJA (June-July-August) periods especially in the northern and western parts of the Sahel. The impact of the mineral dust emissions is also manifested by a decrease of the frequency of tropical nights especially during MAM in the northern Sahel. When considering the warm spells, mineral particles tend to weaken them especially in MAM and JJA in the northern Sahel. To estimate the potential impacts of the mineral dust accumulation on heat stress, the heat index and the humidex are used. The analysis of the heat index shows that the dust impact is to reduce the health risks particularly in the northern Sahel during the MAM period, in the western Sahel during JJA, and in the southern and the northeastern parts of the Sahel during the SON (September-October-November) period. As for the humidex, it is characterized by a decrease especially in the northern Sahel for all seasons. This reduction of the occurrence of thermal extremes may have a positive effect on the energy demand for cooling and on global health. However, the accumulation of dust particles in the atmosphere may also increase the meningitis incidence and prevalence. BACKGROUND: Onchocerciasis is a neglected tropical filarial disease transmitted by the bites of blackflies, causing blindness and severe skin lesions. The change in focus for onchocerciasis management from control to elimination requires thorough mapping of pre-control endemicity to identify areas requiring interventions and to monitor progress. Onchocerca volvulus nodule prevalence in sub-Saharan Africa is spatially continuous and heterogeneous, and highly endemic areas may contribute to transmission in areas of low endemicity or vice-versa. Ethiopia is one such onchocerciasis-endemic country with heterogeneous O. volvulus nodule prevalence, and many districts are still unmapped despite their potential for onchocerciasis transmission. METHODOLOGY/PRINCIPLE FINDINGS: A Bayesian geostatistical model was fitted for retrospective pre-intervention nodule prevalence data collected from 916 unique sites and 35,077 people across Ethiopia. We used multiple environmental, socio-demographic, and climate variables to estimate the pre-intervention prevalence of O. volvulus nodules across Ethiopia and to explore their relationship with prevalence. Prevalence was high in southern and northwestern Ethiopia and low in Ethiopia’s central and eastern parts. Distance to the nearest river (RR: 0.9850, 95% BCI: 0.9751-0.995), precipitation seasonality (RR: 0.9837, 95% BCI: 0.9681-0.9995), and flow accumulation (RR: 0.9586, 95% BCI: 0.9321-0.9816) were negatively associated with O. volvulus nodule prevalence, while soil moisture (RR: 1.0218, 95% BCI: 1.0135-1.0302) was positively associated. The model estimated the number of pre-intervention cases of O. volvulus nodules in Ethiopia to be around 6.48 million (95% BCI: 3.53-13.04 million). CONCLUSIONS/SIGNIFICANCE: Nodule prevalence distribution was correlated with habitat suitability for vector breeding and associated biting behavior. The modeled pre-intervention prevalence can be used as a guide for determining priorities for elimination mapping in regions of Ethiopia that are currently unmapped, most of which have comparatively low infection prevalence. Malaria is a severe public health problem in the Amhara region, Ethiopia. A retrospective study was conducted to model and interpret the effects of climate variability and environmental factors on the monthly malaria surveillance data of 152 districts in the region. The data were analyzed using the Bayesian generalized Poisson spatiotemporal model. Malaria incidence had significant seasonal, temporal, and spatial variations in the region. The risk of malaria incidence was decreased by 24% per 100 m increase in altitude. Monthly minimum temperature decreases the risk of malaria by 2.2% per a 1 °C increment. The risk of malaria transmission was increased by 8% per 100 mm rise in the total monthly rainfall of districts. Besides, long-lasting insecticidal net coverage significantly reduces malaria risk by a factor of 0.8955. The finding suggests that malaria transmission was higher in northern and western districts. Hence, concerned bodies should consider seasonal, temporal, and spatial variations and effects of climate and environmental factors for intervention and elimination. Background: Insecticide treated bed nets (ITN) are considered a core malaria vector control tool by the WHO and are the main contributor to the large decline in malaria burden in sub-Saharan Africa over the past 20 years, but they are less effective if they are not broadly and regularly used. ITN use may depend on factors including temperature, relative humidity, mosquito density, seasonality, as well as ideational or psychosocial factors including perceptions of nets and perceptions of net use behaviours.Methods: A cross-sectional household survey was conducted as part of a planned randomized controlled trial in Magoe District, Mozambique. Interviewers captured data on general malaria and ITN perceptions including ideational factors related to perceived ITN response efficacy, self-efficacy to use an ITN, and community norms around ITN using a standardized questionnaire. Only households with sufficient ITNs present for all children to sleep under (at least one ITN for every two children under the age of five years) were eligible for inclusion in the study. Additional questions were added about seasonality and frequency of ITN use.Results: One-thousand six hundred sixteen mother-child dyads were interviewed. Responses indicated gaps in use of existing nets and net use was largely independent of ideational factors related to ITNs. Self-reported ITN use varied little by season nor meaningfully when different methods were used to solicit responses on net use behaviour. Mothers’ perceived response efficacy of ITNS was negatively associated with net use (high perceived response efficacy reduced the log-odds of net use by 0.27 (95% CI – 0.04 to – 0.51), implying that stronger beliefs in the effectiveness of ITNs might result in reduced net use among their children.Conclusions: In this context, ITN use among children was not clearly related to mothers’ ideational factors measured in the study. Scales used in solicitation of ideation around ITN use and beliefs need careful design and testing across a broader range of populations in order to identify ideational factors related to ITN use among those with access. Malaria is a major public health concern in tropics and subtropics. Accurate malaria prediction is critical for reporting ongoing incidences of infection and its control. Hence, the purpose of this investigation was to evaluate the performances of different models of predicting malaria incidence in Marodijeh region, Somaliland. The study used monthly historical data from January 2011 to December 2020. Five deterministic and stochastic models, i.e. Seasonal Autoregressive Moving Average (SARIMA), Holt-Winters’ Exponential Smoothing, Harmonic Model, Seasonal and Trend Decomposition using Loess (STL) and Artificial Neural Networks (ANN), were fitted to the malaria incidence data. The study employed Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Absolute Percentage Error (MAPE) and Mean Absolute Scaled Error (MASE) to measure the accuracy of each model. The results indicated that the artificial neural network (ANN) model outperformed other models in terms of the lowest values of RMSE (39.4044), MAE (29.1615), MAPE (31.3611) and MASE (0.6618). The study also incorporated three meteorological variables (Humidity, Rainfall and Temperature) into the ANN model. The incorporation of these variables into the model enhanced the prediction of malaria incidence in terms of achieving better prediction accuracy measures (RMSE = 8.6565, MAE = 6.1029, MAPE = 7.4526 and MASE = 0.1385). The 2-year generated forecasts based on the ANN model implied a significant increasing trend. The study recommends the ANN model for forecasting malaria cases and for taking the steps to reduce malaria incidence during the times of year when high incidence is reported in the Marodijeh region. In the Maasai Steppe, public health and economy are threatened by African Trypanosomiasis, a debilitating and fatal disease to livestock (African Animal Trypanosomiasis -AAT) and humans (Human African Trypanosomiasis-HAT), if not treated. The tsetse fly is the primary vector for both HAT and AAT and climate is an important predictor of their occurrence and the parasites they carry. While understanding tsetse fly distribution is essential for informing vector and disease control strategies, existing distribution maps are old and were based on coarse spatial resolution data, consequently, inaccurately representing vector and disease dynamics necessary to design and implement fit-for-purpose mitigation strategies. Also, the assertion that climate change is altering tsetse fly distribution in Tanzania lacks empirical evidence. Despite tsetse flies posing public health risks and economic hardship, no study has modelled their distributions at a scale needed for local planning. This study used MaxEnt species distribution modelling (SDM) and ecological niche modeling tools to predict potential distribution of three tsetse fly species in Tanzania’s Maasai Steppe from current climate information, and project their distributions to midcentury climatic conditions under representative concentration pathways (RCP) 4.5 scenarios. Current climate results predicted that G. m. morsitans, G. pallidipes and G swynnertoni cover 19,225 km2, 7,113 km2 and 32,335 km2 and future prediction indicated that by the year 2050, the habitable area may decrease by up to 23.13%, 12.9% and 22.8% of current habitable area, respectively. This information can serve as a useful predictor of potential HAT and AAT hotspots and inform surveillance strategies. Distribution maps generated by this study can be useful in guiding tsetse fly control managers, and health, livestock and wildlife officers when setting surveys and surveillance programs. The maps can also inform protected area managers of potential encroachment into the protected areas (PAs) due to shrinkage of tsetse fly habitats outside PAs. In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs’ perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts. This study used a mixed-methods research design to examine the sensitivity of vector-borne disease (VBD) patterns to the changes in rainfall and temperature trends. The research focused on malaria in Masvingo Province, Zimbabwe. The study interfaced the climate action, health and sustainable cities and communities with sustainable development goals (SDGs). Historical climate and epidemiological data were used to compute the correlations and determine the possible modifications of disease patterns. Clustered random and chain-referral sampling approaches were used to select study sites and respondents. Primary data were gathered through a questionnaire survey (n = 191), interviews and focus group discussions, with Mann-Kendal trend tests performed using XLSTAT 2020. The results show a positive correlation between malaria prevalence rates and temperature-related variables. A decline in precipitation-related variables, specifically mean monthly precipitation (MMP), was associated with an increase in malaria prevalence. These observations were confirmed by the views of the respondents, which show that climate change has a bearing on malaria spatial and temporal dynamics in Masvingo Province. The study concludes that climate change plays a contributory role in VBD dynamics, thereby impeding the attainment of the 2030 Agenda for Sustainable Development, especially SDG 3, which deals with health. The study recommends further research into appropriate adaptation mechanisms to increase the resilience of rural and urban communities against the negative transmutations associated with weather and climatic pressures. BACKGROUND: Understanding the response of vector habitats to climate change is essential for vector management. Increasingly, there is fear that climate change may cause vectors to be more important for animal husbandry in the future. Therefore, knowledge about the current and future spatial distribution of vectors, including ticks (Ixodida), is progressively becoming more critical to animal disease control. METHODS: Our study produced present (2018) and future (2050) bont tick (Amblyomma hebraeum) niche models for Mashonaland Central Province, Zimbabwe. Specifically, our approach used the Ensemble algorithm in Biomod2 package in R 3.4.4 with a suite of physical and anthropogenic covariates against the tick’s presence-only location data obtained from cattle dipping facilities. RESULTS: Our models showed that currently (the year 2018) the bont tick potentially occurs in 17,008 km(2), which is 60% of Mashonaland Central Province. However, the models showed that in the future (the year 2050), the bont tick will occur in 13,323 km(2), which is 47% of Mashonaland Central Province. Thus, the models predicted an ~ 13% reduction in the potential habitat, about 3685 km(2) of the study area. Temperature, elevation and rainfall were the most important variables explaining the present and future potential habitat of the bont tick. CONCLUSION: Results of our study are essential in informing programmes that seek to control the bont tick in Mashonaland Central Province, Zimbabwe and similar environments. Glossina morsitans is a vector for Human African Trypanosomiasis (HAT), which is mainly distributed in sub-Saharan Africa at present. Our objective was to project the historical and future potentially suitable areas globally and explore the influence of climatic factors. The maximum entropy model (MaxEnt) was utilized to evaluate the contribution rates of bio-climatic factors and to project suitable habitats for G. morsitans. We found that Isothermality and Precipitation of Wettest Quarter contributed most to the distribution of G. morsitans. The predicted potentially suitable areas for G. morsitans under historical climate conditions would be 14.5 million km(2), including a large area of Africa which is near and below the equator, small equatorial regions of southern Asia, America, and Oceania. Under future climate conditions, the potentially suitable areas are expected to decline by about -5.38 ± 1.00% overall, under all shared socioeconomic pathways, compared with 1970-2000. The potentially suitable habitats of G. morsitans may not be limited to Africa. Necessary surveillance and preventive measures should be taken in high-risk regions. Genetic evolution of Rift Valley fever virus (RVFV) in Africa has been shaped mainly by environmental changes such as abnormal rainfall patterns and climate change that has occurred over the last few decades. These gradual environmental changes are believed to have effected gene migration from macro (geographical) to micro (reassortment) levels. Presently, 15 lineages of RVFV have been identified to be circulating within the Sub-Saharan Africa. International trade in livestock and movement of mosquitoes are thought to be responsible for the outbreaks occurring outside endemic or enzootic regions. Virus spillover events contribute to outbreaks as was demonstrated by the largest epidemic of 1977 in Egypt. Genomic surveillance of the virus evolution is crucial in developing intervention strategies. Therefore, we have developed a computational tool for rapidly classifying and assigning lineages of the RVFV isolates. The computational method is presented both as a command line tool and a web application hosted at https://www.genomedetective.com/app/typingtool/rvfv/ . Validation of the tool has been performed on a large dataset using glycoprotein gene (Gn) and whole genome sequences of the Large (L), Medium (M) and Small (S) segments of the RVFV retrieved from the National Center for Biotechnology Information (NCBI) GenBank database. Using the Gn nucleotide sequences, the RVFV typing tool was able to correctly classify all 234 RVFV sequences at species level with 100% specificity, sensitivity and accuracy. All the sequences in lineages A (n = 10), B (n = 1), C (n = 88), D (n = 1), E (n = 3), F (n = 2), G (n = 2), H (n = 105), I (n = 2), J (n = 1), K (n = 4), L (n = 8), M (n = 1), N (n = 5) and O (n = 1) were also correctly classified at phylogenetic level. Lineage assignment using whole RVFV genome sequences (L, M and S-segments) did not achieve 100% specificity, sensitivity and accuracy for all the sequences analyzed. We further tested our tool using genomic data that we generated by sequencing 5 samples collected following a recent RVF outbreak in Kenya. All the 5 samples were assigned lineage C by both the partial (Gn) and whole genome sequence classifiers. The tool is useful in tracing the origin of outbreaks and supporting surveillance efforts.Availability: https://github.com/ajodeh-juma/rvfvtyping. BACKGROUND: Despite global intervention efforts, malaria remains a major public health concern in many parts of the world. Understanding geographic variation in malaria patterns and their environmental determinants can support targeting of malaria control and development of elimination strategies. METHODS: We used remotely sensed environmental data to analyze the influences of environmental risk factors on malaria cases caused by Plasmodium falciparum and Plasmodium vivax from 2014 to 2017 in two geographic settings in Ethiopia. Geospatial datasets were derived from multiple sources and characterized climate, vegetation, land use, topography, and surface water. All data were summarized annually at the sub-district (kebele) level for each of the two study areas. We analyzed the associations between environmental data and malaria cases with Boosted Regression Tree (BRT) models. RESULTS: We found considerable spatial variation in malaria occurrence. Spectral indices related to land cover greenness (NDVI) and moisture (NDWI) showed negative associations with malaria, as the highest malaria rates were found in landscapes with low vegetation cover and moisture during the months that follow the rainy season. Climatic factors, including precipitation and land surface temperature, had positive associations with malaria. Settlement structure also played an important role, with different effects in the two study areas. Variables related to surface water, such as irrigated agriculture, wetlands, seasonally flooded waterbodies, and height above nearest drainage did not have strong influences on malaria. CONCLUSION: We found different relationships between malaria and environmental conditions in two geographically distinctive areas. These results emphasize that studies of malaria-environmental relationships and predictive models of malaria occurrence should be context specific to account for such differences. Aims: This study examines the dynamics of malaria as influenced by meteorological factors in French Guiana from 2005 to 2019. It explores spatial hotspots of malaria transmission and aims to determine the factors associated with variation of hotspots with time. Methods: Data for individual malaria cases came from the surveillance system of the Delocalized Centers for Prevention and Care (CDPS) (n = 17) from 2005-2019. Meteorological data was acquired from the NASA Goddard Earth Sciences Data and Information Services Center (GES DISC) database. The Box-Jenkins autoregressive integrated moving average (ARIMA) model tested stationarity of the time series, and the impact of meteorological indices (issued from principal component analysis-PCA) on malaria incidence was determined with a general additive model. Hotspot characterization was performed using spatial scan statistics. Results: The current sample includes 7050 eligible Plasmodium vivax (n = 4111) and Plasmodium falciparum (n = 2939) cases from health centers across French Guiana. The first and second PCA-derived meteorological components (maximum/minimum temperature/minimum humidity and maximum humidity, respectively) were significantly negatively correlated with total malaria incidence with a lag of one week and 10 days, respectively. Overall malaria incidence decreased across the time series until 2017 when incidence began to trend upwards. Hotspot characterization revealed a few health centers that exhibited spatial stability across the entire time series: Saint Georges de l’Oyapock and Antecume Pata for P. falciparum, and Saint Georges de l’Oyapock, Antecume Pata, Régina and Camopi for P. vivax. Conclusions: This study highlighted changing malaria incidence in French Guiana and the influences of meteorological factors on transmission. Many health centers showed spatial stability in transmission, albeit not temporal. Knowledge of the areas of high transmission as well as how and why transmission has changed over time can inform strategies to reduce the transmission of malaria in French Guiana. Hotspots should be further investigated to understand other influences on local transmission, which will help to facilitate elimination. Using new satellite data from the European Space Agency’s Sentinel-5P system, this article investigates the spatial and temporal dynamics of vehicular traffic congestion, air pollution, and the distributional impacts on vulnerable populations in Dar es Salaam, Tanzania. The metro region’s rapid growth in vehicle traffic exceeds road network capacity, generating congestion, transport delays, and air pollution from excess fuel use. Dangerously high pollution levels from tailpipe emissions put the health of vulnerable residents at risk, calling for the need to adopt continuous air-quality monitoring and effective pollution control. Our results highlight significant impacts of seasonal weather and wind-speed factors on the spatial distribution and intensity of air pollution from vehicle emissions, which vary widely by area. In seasons when weather factors maximize pollution, the worst exposure occurs along the wind path of high-traffic roadways. The study identifies priority areas for reducing congestion to yield the greatest exposure reduction for young children and the elderly in poor households. This new research direction, based only on the use of free global information sources with the same coverage for all cities, offers metropolitan areas in developing regions the opportunity to benefit from the rigorous analyses traditionally limited to well-endowed cites in developing countries. Externalities, such as air pollution and increased occupational hazards, resulting from global trends in climate change, rapid industrialization, and rapidly increasing populations are raising global concerns about the associated health risks. The Global Environmental and Occupational Health Hub for Eastern Africa was established to address some of these problems at national and regional levels through focused training and applied research that would yield evidence supporting policies and investments to mitigate risks of increasing environmental threats throughout the Eastern African region. Emphasis has been placed on air pollution, a leading risk factor for global mortality, accounting for over 7 million premature deaths or 8.7% of the 2017 global mortality burden. Despite the enormous disease burden that air pollution causes, global investment in air pollution monitoring and research capacity building in low-middle and middle-income countries have been inadequate. This study outlines the activities the Hub has undertaken in planning for and carrying out its initial capacity building and building its primary research programs and identifies central lessons that can inform other large global research partnerships. BACKGROUND: The application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described. METHODS: We used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality. RESULTS: The incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at ∼30 episodes per 100 child-years in children aged 7-15 months, with substantial variation in incidence between sites. A significant burden was also seen in children 0-6 months of age, higher than other viral etiologies with the exception of rotavirus. Children with adenovirus 40/41 diarrhea were more likely to have a fever than children with norovirus, sapovirus, and astrovirus (adjusted odds ratio [aOR], 1.62; 95% CI, 1.16-2.26) but less likely than children with rotavirus (aOR, 0.66; 95% CI, 0.49-0.91). Exclusive breastfeeding was strongly protective against adenovirus 40/41 diarrhea (hazard ratio, 0.64; 95% CI, 0.48-0.85), but no other risk factors were identified. The seasonality of adenovirus 40/41 diarrhea varied substantially between sites and did not have clear associations with seasonal variations in temperature or rainfall. CONCLUSIONS: This study supports the situation of adenovirus 40/41 as a pathogen of substantial importance, especially in infants. Fever was a distinguishing characteristic in comparison to other nonrotavirus viral etiologies, and promotion of exclusive breastfeeding may reduce the high observed burden in the first 6 months of life. CONTEXT: Tropical areas and small islands are identified as highly vulnerable to climate change, and already experiencing shifts in their temperature distribution. However, the knowledge on the health impacts of temperatures under tropical marine climate is limited. We explored the influence of temperature on mortality in four French overseas regions located in French Guiana, French West Indies, and in the Indian Ocean, between 2000 and 2015. METHOD: Distributed lag non-linear generalized models linking temperature and mortality were developed in each area, and relative risks were combined through a meta-analysis. Models were used to estimate the fraction of mortality attributable to non-optimal temperatures. The role of humidity was also investigated. RESULTS: An increased risk of mortality was observed when the temperature deviated from median. Results were not modified when introducing humidity. Between 2000 and 2015, 979 deaths [confidence interval (CI) 95% 531:1359] were attributable to temperatures higher than the 90th percentile of the temperature distribution, and 442 [CI 95% 178:667] to temperature lower than the 10th percentile. DISCUSSION: Heat already has a large impact on mortality in the French overseas regions. Results suggest that adaptation to heat is relevant under tropical marine climate. Stillbirths and complications from preterm birth are two of the leading causes of neonatal deaths across the globe. Lower- to middle-income countries (LMICs) are experiencing some of the highest rates of these adverse birth outcomes. Research has suggested that environmental determinants, such as extreme heat, can increase the risk of preterm birth and stillbirth. Under climate change, extreme heat events have become more severe and frequent and are occurring in differential seasonal patterns. Little is known about how extreme heat affects the risk of preterm birth and stillbirth in LMICs. Thus, it is imperative to examine how exposure to extreme heat affects adverse birth outcomes in regions with some of the highest rates of preterm and stillbirths. Most of the evidence linking extreme heat and adverse birth outcomes has been generated from high-income countries (HICs) notably because measuring temperature in LMICs has proven challenging due to the scarcity of ground monitors. The paucity of health data has been an additional obstacle to study this relationship in LMICs. In this study, globally gridded meteorological data was linked with spatially and temporally resolved Demographic and Health Surveys (DHS) data on adverse birth outcomes. A global analysis of 14 LMICs was conducted per a pooled time-stratified case-crossover design with distributed-lag nonlinear models to ascertain the relationship between acute exposure to extreme heat and PTB and stillbirths. We notably found that experiencing higher maximum temperatures and smaller diurnal temperature range during the last week before birth increased the risk of preterm birth and stillbirth. This study is the first global assessment of extreme heat events and adverse birth outcomes and builds the evidence base for LMICs. This document provides meteorological information for climate change adaptation, weather disaster risk reduction, and climate resilient development in Nigeria. The document is published yearly. South African Air Quality Information System (SAAQIS) is a web based interactive air quality information system which seeks to provide the state of air quality information to citizens, and it is a research portal for strengthening policy development related to air quality issues. The Fire Danger Index (FDI) uses 5 categories to rate the fire danger represented by colour codes [Blue (insignificant) (0-20), Green (low) (21-45), Yellow (moderate) (46-60), Orange (high) (61-75) and Red (extremely high) (75<)]. Each of the danger rating is accompanied by precaution statement.
Climate change and HIV/AIDS represent two of the greatest threats to human health in the 21st century. However, limitations in understanding the complex relationship between these syndemics continue to constrain advancements in the prevention and management of HIV/AIDS in the context of a rapidly changing climate. Here, we present a conceptual framework that identifies four pathways linking climate change with HIV/AIDS transmission and health outcomes: increased food insecurity, increased prevalence of other infectious diseases, increased human migration, and erosion of public health infrastructure. This framework is based on an in-depth literature review in PubMed and Google Scholar from June 6 to June 27, 2019. The pathways linking climate change with HIV transmission and health outcomes are complex with multiple interacting factors. Food insecurity emerged as a particularly important mediator by driving sexual risk-taking behaviours and migration, as well as by increasing susceptibility to infections that are common among people living with HIV (PLWHIV). Future interventions should focus on decreasing carbon dioxide emissions globally and increasing education and investment in adaptation strategies, particularly in those areas of sub-Saharan Africa and southeast Asia heavily impacted by both HIV and climate change. Environmentally sustainable interventions such as urban gardening and investing in sustainable agriculture technologies also have significant health co-benefits that may help PLWHIV adapt to the environmental consequences of climate change. The increasing distribution and prevalence of fasciolosis in both human and livestock are concerning. Here, we examine the various types of factors influencing fasciolosis transmission and burden and the interrelations that may exist between them. We present the arsenal of molecules, ‘adjusting’ capabilities and parasitic strategies of Fasciola to infect. Such features define the high adaptability of Fasciola species for parasitism that facilitate their transmission. We discuss current environmental perturbations (increase of livestock and land use, climate change, introduction of alien species and biodiversity loss) in relation to fasciolosis dynamics. As Fasciola infection is directly and ultimately linked to livestock management, living conditions and cultural habits, which are also changing under the pressure of globalization and climate change, the social component of transmission is also discussed. Lastly, we examine the implication of increasing scientific and political awareness in highlighting the current circulation of fasciolosis and boosting epidemiological surveys and novel diagnostic techniques. From a joint perspective, it becomes clear that factors weight differently at each place and moment, depending on the biological, environmental, social and political interrelating contexts. Therefore, the analyses of a disease as complex as fasciolosis should be as integrative as possible to dissect the realities featuring each epidemiological scenario. Such a comprehensive appraisal is presented in this review and constitutes its main asset to serve as a fresh integrative understanding of fasciolosis. Global food insecurity concerns due to climate change, emphasizes the need to focus on the sensitivity of sorghum to climate change and potential crop improvement strategies available, which is discussed in the current review to promote climate-smart agriculture. Climate change effects immensely disturb the global agricultural systems by reducing crop production. Changes in extreme weather and climate events such as high-temperature episodes and extreme rainfalls events, droughts, flooding adversely affect the production of staple food crops, posing threat to ecosystem resilience. The resulting crop losses lead to food insecurity and poverty and question the sustainable livelihoods of small farmer communities, particularly in developing countries. In view of this, it is essential to focus and adapt climate-resilient food crops which need lower inputs and produce sustainable yields through various biotic and abiotic stress-tolerant traits. Sorghum, “the camel of cereals”, is one such climate-resilient food crop that is less sensitive to climate change vulnerabilities and also an important staple food in many parts of Asia and Africa. It is a rainfed crop and provides many essential nutrients. Understanding sorghum’s sensitivity to climate change provides scope for improvement of the crop both in terms of quantity and quality and alleviates food and feed security in future climate change scenarios. Thus, the current review focused on understanding the sensitivity of sorghum crop to various stress events due to climate change and throws light on different crop improvement strategies available to pave the way for climate-smart agriculture. Background: Africa is facing the triple burden of communicable diseases, non-communicable diseases (NCDs), and nutritional disorders. Multilateral institutions, bilateral arrangements, and philanthropies have historically privileged economic development over health concerns. That focus has resulted in weak health systems and inadequate preparedness when there are outbreaks of diseases. This review aims to understand the politics of disease control in Africa and global health diplomacy’s (GHD’s) critical role. Methods: A literature review was done in Medline/PubMed, Web of Science, Scopus, Embase, and Google scholar search engines. Keywords included MeSH and common terms related to the topics: “Politics,” “disease control,” “epidemics/ endemics,” and “global health diplomacy” in the “African” context. The resources also included reports of World Health Organization, United Nations and resolutions of the World Health Assembly (WHA). Results: African countries continue to struggle in their attempts to build health systems for disease control that are robust enough to tackle the frequent epidemics that plague the continent. The politics of disease control requires the crafting of cooperative partnerships to accommodate the divergent interests of multiple actors. Recent outbreaks of COVID-19 and Ebola had a significant impact on African economies. It is extremely important to prioritize health in the African development agendas. The African Union (AU) should leverage the momentum of the rise of GHD to (i) navigate the politics of global health governance in an interconnected world(ii) develop robust preparedness and disease response strategies to tackle emerging and reemerging disease epidemics in the region (iii) address the linkages between health and broader human security issues driven by climate change-induced food, water, and other insecurities (iv) mobilize resources and capacities to train health officials in the craft of diplomacy. Conclusion: The AU, Regional Economic Communities (RECs), and African Centres for Disease Control should harmonize their plans and strategies and align them towards a common goal that integrates health in African development agendas. The AU must innovatively harness the practice and tools of GHD towards developing the necessary partnerships with relevant actors in the global health arena to achieve the health targets of the Sustainable Development Goals. Climatic change will have an impact on production and release of pollen, with consequences for the duration and magnitude of aeroallergen seasonal exposure and allergic diseases. Evaluations of pollen aerobiology in the southern hemisphere have been limited by resourcing and the density of monitoring sites. This review emphasizes inconsistencies in pollen monitoring methods and metrics used globally. Research should consider unique southern hemisphere biodiversity, climate, plant distributions, standardization of pollen aerobiology, automation, and environmental integration. For both hemispheres, there is a clear need for better understanding of likely influences of climate change and comprehending their impact on pollen-related health outcomes. Seasonality is a critical source of vulnerability across most human activities and natural processes, including the underlying and immediate drivers of acute malnutrition. However, while there is general agreement that acute malnutrition is highly variable within and across years, the evidence base is limited, resulting in an overreliance on assumptions of seasonal peaks. We review the design and analysis of 24 studies exploring the seasonality of nutrition outcomes in Africa’s drylands, providing a summary of approaches and their advantages and disadvantages. Over half of the studies rely on two to four time points within the year and/or the inclusion of time as a categorical variable in the analysis. While such approaches simplify interpretation, they do not correspond to the climatic variability characteristic of drylands or the relationship between climatic variability and human activities. To better ground our understanding of the seasonality of acute malnutrition in a robust evidence base, we offer recommendations for study design and analysis, including drawing on participatory methods to identify community perceptions of seasonality, use of longitudinal data and panel analysis with approaches borrowed from the field of infectious diseases, and linking oscillations in nutrition data with climatic data. Ethiopia is experiencing an increasing frequency and intensity of slow-onset and acute disasters caused by climate change, with significant health impacts. Understanding and addressing these impacts involves trade-offs, which are central to effective priority setting in health and overarching efforts to meet the Sustainable Development Goals. Despite minimal historic greenhouse gas emissions, Ethiopia has been at the forefront of climate action since launching the Climate-Resilient Green Economy (CRGE) in 2011, a low-carbon development strategy. To learn from the Ethiopian approach, this paper examines to what extent health has been integrated into the CRGE. We found that the early years of the CRGE prioritized developing the financial basis of the green economy, while the health impacts of climate change have only been tentatively considered to date and remain detached from broader health strategies. Further analysis of climate adaptation measures, “health co-benefits,” and reducing specific vulnerabilities of the health sector could help improve health and build climate resilience. In the next century, global warming, due to changes in climatic factors, is expected to have an enormous influence on the interactions between pathogens and their hosts. Over the years, the rate at which vector-borne diseases and their transmission dynamics modify and develop has been shown to be highly dependent to a certain extent on changes in temperature and geographical distribution. Schistosomiasis has been recognized as a tropical and neglected vector-borne disease whose rate of infection has been predicted to be elevated worldwide, especially in sub-Saharan Africa; the region currently with the highest proportion of people at risk, due to changes in climate. This review not only suggests the need to develop an efficient and effective model that will predict Schistosoma spp. population dynamics but seeks to evaluate the effectiveness of several current control strategies. The design of a framework model to predict and accommodate the future incidence of schistosomiasis in human population dynamics in sub-Saharan Africa is proposed. The impact of climate change on schistosomiasis transmission as well as the distribution of several freshwater snails responsible for the transmission of Schistosoma parasites in the region is also reviewed. Lastly, this article advocates for modelling several control mechanisms for schistosomiasis in sub-Saharan Africa so as to tackle the re-infection of the disease, even after treating infected people with praziquantel, the first-line treatment drug for schistosomiasis. Throughout much of the African continent, healthcare systems are already strained in their efforts to meet the needs of a growing population using limited resources. Climate change threatens to undermine many of the public health gains that have been made in this region in the last several decades via multiple mechanisms, including malnutrition secondary to drought-induced food insecurity, mass human displacement from newly uninhabitable areas, exacerbation of environmentally sensitive chronic diseases, and enhanced viability of pathogenic microbes and their vectors. We reviewed the literature describing the various direct and indirect effects of climate change on diseases with cutaneous manifestations in Africa. We included non-communicable diseases such as malignancies (non-melanoma skin cancers), inflammatory dermatoses (i.e. photosensitive dermatoses, atopic dermatitis), and trauma (skin injury), as well as communicable diseases and neglected tropical diseases. Physicians should be aware of the ways in which climate change threatens human health in low- and middle-income countries in general, and particularly in countries throughout Africa, the world’s lowest-income and second most populous continent. Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized. Despite being one of the continents with the least greenhouse gas emissions, no continent is being struck as severely by climate change (CC) as Africa. Mosquito-borne diseases (MBD) cause major human diseases in this continent. Current knowledge suggests that MBD range could expand dramatically in response to CC. This study aimed at assessing the relationship between CC and MBD in Africa. Methods For this purpose, a systematic peer review was carried out, considering all articles indexed in PubMed, Scopus, Embase and CENTRAL. Search terms referring to MBD, CC and environmental factors were screened in title, abstract and keywords.Results A total of twenty-nine studies were included, most of them on malaria (61%), being Anopheles spp. (61%) the most commonly analyzed vector, mainly in Eastern Africa (48%). Seventy-nine percent of these studies were based on predictive models. Seventy-two percent of the reviewed studies considered that CC impacts on MBD epidemiology. MBD prevalence will increase according to 69% of the studies while 17% predicted a decrease. MBD expansion throughout the continent was also predicted. Most studies showed a positive relationship between observed or predicted results and CC. However, there was a great heterogeneity in methodologies and a tendency to reductionism, not integrating other variables that interact with both the environment and MBD. In addition, most results have not yet been tested. A global health approach is desirable in this kind of research. Nevertheless, we cannot wait for science to approve something that needs to be addressed now to avoid greater effects in the future. While the global response to climate change has been scant and uncoordinated, especially with regard to providing adequate water resources for the most improvised, water scarcity has become an increasingly neglected phenomenon in rural areas. The long-term imbalance resulting from the water demand exceeding the available water resources has been identified in the literature, with the majority of rural dwellers negatively affected by water scarcity. Using a scoping review technique to explore the nexus between climate change and water-security realities in view of coping and planning mechanisms in the South African context, 246,443 articles published between 2010 and 2019 were collated and reviewed in a bid to ascertain the state of knowledge, study, and focus on the coping and planning strategies adopted by rural communities in the face of climate change-induced water insecurity in South Africa. The identified gaps in the literature indicate the omission of spatial planning principles in responding to water-scarcity issues. This review concludes that, although policy research that links the impacts of climate change in rural communities exists, stronger focus on the quality and quantity issues in the implementation of water-security matters is critical. Hence, the impact of climate change on climate-sensitive supplies available in these rural areas as well as the consequent coping and planning alternatives for rural communities require a more robust policy and spatial research. Thus, as rural communities deal with the impacts of climate change, implementation cycles of water-security measures need to be ensured along with further integration of spatial planning issues in rural areas. Hence, a deeper engagement with spatial planning issues is needed, in order to further mitigate and address the impacts of climate change on water security in rural areas. BACKGROUND: Mosquito-borne viral infections have in recent years, become a public health threat globally. This review aimed to provide an overview of the ecological and epidemiological profiles of mosquito-borne viral infections in the Democratic Republic of the Congo (DRC). METHODS: A search of literature was conducted using Google Scholar, PubMed and the WHO website using the following keywords: “Democratic Republic of the Congo”, “Zaire”, “Belgian Congo” and either of the following: “mosquito-borne virus”, “arbovirus”, “yellow fever”, “dengue”, “chikungunya”, “West Nile”, “Rift Valley fever”, “O’nyong’nyong”, “Zika”, “epidemiology”, “ecology”, “morbidity”, “mortality”. Published articles in English or French covering a period between 1912 and October 2018 were reviewed. RESULTS: A total of 37 articles were included in the review. The findings indicate that the burden of mosquito-borne viral infections in DRC is increasing over time and space. The north-western, north-eastern, western and central regions have the highest burden of mosquito-borne viral infections compared to south and eastern highland regions. Yellow fever, chikungunya, dengue, Zika, Rift Valley fever, West Nile and O’nyong’nyong have been reported in the country. These mosquito-borne viruses were found circulating in human, wildlife and domestic animals. Yellow fever and chikungunya outbreaks have been frequently reported. Aedes aegypti and Ae. simpsoni were documented as the main vectors of most of the mosquito-borne viral infections. Heavy rains, human movements, forest encroachment and deforestation were identified as drivers of mosquito-borne viruses occurrence in DRC. CONCLUSIONS: Mosquito-borne viral infections are becoming common and a serious public health problem in DRC. In the current context of climate change, there is urgent need to improve understanding on ecological and epidemiology of the diseases and strengthen surveillance systems for prompt response to epidemics in DRC. East Africa is highly affected by neglected tropical diseases (NTDs), which are projected to be exacerbated by climate change. Consequently, understanding what research has been conducted and what knowledge gaps remain regarding NTDs and climate change is crucial to informing public health interventions and climate change adaptation. We conducted a systematic scoping review to describe the extent, range, and nature of publications examining relationships between NTDs and climatic factors in East Africa. We collated all relevant English and French publications indexed in PubMed(®), Web of Science™ Core Collection, and CAB Direct(©) databases published prior to 2019. Ninety-six publications were included for review. Kenya, Tanzania, and Ethiopia had high rates of publication, whereas countries in the Western Indian Ocean region were underrepresented. Most publications focused on schistosomiasis (n = 28, 29.2%), soil-transmitted helminthiases (n = 16, 16.7%), or human African trypanosomiasis (n = 14, 14.6%). Precipitation (n = 91, 94.8%) and temperature (n = 54, 56.3%) were frequently investigated climatic factors, whereas consideration of droughts (n = 10, 10.4%) and floods (n = 4, 4.2%) was not prominent. Publications reporting on associations between NTDs and changing climate were increasing over time. There was a decrease in the reporting of Indigenous identity and age factors over time. Overall, there were substantial knowledge gaps for several countries and for many NTDs. To better understand NTDs in the context of a changing climate, it would be helpful to increase research on underrepresented diseases and regions, consider demographic and social factors in research, and characterize how these factors modify the effects of climatic variables on NTDs in East Africa. PURPOSE OF REVIEW: The purpose of this review is to describe the combined impacts of the nutrition transition and climate change in Nigeria and analyze the country’s national food-related policy options that could support human and planetary health outcomes. RECENT FINDINGS: This paper uses a food systems framework to analyze how the nutrition transition and climate change interact in Nigeria affecting both diets and the double burden of malnutrition, resulting in what has been termed the syndemic. Interactions between climate change and the nutrition transition in Nigeria are exacerbating diet-related inequities and will continue to do so if food systems continue on their current trajectory and without significant transformation. Siloed policy actions that attempt to mitigate one aspect of food system risk can create a negative feedback loop in another aspect of the food system. Our analysis finds that Nigeria has five national policies that include actionable steps to address food system insufficiencies; however, each of these policies is constrained by the boundaries of singular nutrition, climate change, and agricultural objectives. The country should consider a coherent policy environment that explicitly identifies and links underlying systemic and institutional drivers between climate change and malnutrition that simultaneously and comprehensively address both human and planetary health outcomes of food systems. The systemic and institutional outcomes of this emerging syndemic-undernutrition, obesity, and climate change-are inexorably linked. Nigeria lacks a coherent policy environment taking on this challenging syndemic landscape. The analysis in this paper highlights the need for Nigeria to prioritize their national nutrition and agricultural and climate policies that uncouple feedback loops within food systems to address climate change and malnutrition in all its forms. Mesquite (Prosopis juliflora (Sw.) DC), is an medium-sized tree (family Fabaceae, subfamily Mimosoideae), that has been intorcuded around the world. It is a noxious invasive species in Africa, Asia, and the Arabian Peninsula and a source of highly allergenic pollen in. The present article reviews the adverse allergenic effects of P. juliflora pollen on human and animal health. Several studies have diagnosed that allergenic pollens from Prosopis spp. can provoke respiratory problems. Prosopis pollen extracts have 16 allergenic components of which nine proteins were recognized as major allergens with some of them showing cross-reactivity. Clinically, understanding Prosopis pollen production, flowering seasonality, pollen load, and dispersal in the atmosphere are important to avoid allergic consequences for local inhabitants. Climate change and other pollution can also help to further facilitate allergenic issues. Furthermore, we document other human and animal health problems caused by invasive Prosopis trees. This includes flesh injuries, dental and gastric problems, and the facilitation of malaria. This review summarizes and enhances the existing knowledge about Prosopis flowering phenology, aeroallergen, and other human and animal health risks associated with this noxious plant. Sub-Saharan Africa (SSA) has been identified by the Intergovernmental Panel on Climate Change (IPCC) as being the most vulnerable region to climate change impacts. A major concern is the increase in extreme weather events (EWE) such as storms, floods, droughts, heatwaves, wildfires, and landslides in SSA and their potential to affect the health and well-being of children and adolescents. The objective of this systematic review is to examine the direct and indirect impacts of EWE on the mental health of children and adolescents living in SSA, in order to inform protective adaptation strategies and promote resilience. A meta-analysis will not be possible, since the assumption is that limited studies have been published on the EWE-associated mental health impacts on children and adolescents living in SSA and that those studies that are available are heterogenous. There is acknowledgement in the global literature of the need to highlight child and adolescent mental health more prominently in climate change health strategies and policies. It is vital that adaptation strategies are informed by research on risk prevention and promotion of resilience to ensure the mental health of children and adolescents is protected. The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk – the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are “win-win situation” from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin. Climate change strongly impacts the agricultural sector in West Africa, threatening food security and nutrition, particularly for populations with the least adaptive capacity. Little is known about national climate change policies in the region. This systematic review identifies and analyses climate change policy documents in all 16 West African countries: (1) What are the existing climate change adaptation policies publicly available? (2) Which topics are addressed? (3) How are agriculture and food security framed and addressed? Following PRISMA guidelines, PubMed and Google scholar as key databases were searched with an extensive grey literature search. Keywords for searches were combinations of “Africa”, “Climate Change”, and “National Policy/Plan/Strategy/Guideline”. Fifteen countries have at least one national policy document on climate change in the frame of our study. Nineteen policy documents covered seven key sectors (energy, agriculture, water resources, health, forestry, infrastructure, and education), and eight thematic areas (community resilience, disaster risk management, institutional development, industry development, research and development, policy making, economic investment, and partnerships/collaboration). At the intersection of these sectors/areas, effects of changing climate on countries/populations were evaluated and described. Climate change adaptation strategies emerged including development of local risk/disaster plans, micro-financing and insurance schemes (public or private), green energy, and development of community groups/farmers organizations. No clear trend emerged when analysing the adaptation options, however, climate change adaptation in the agriculture sector was almost always included. Analysing agriculture, nutrition, and food security, seven agricultural challenges were identified: The small scale of West African farming, information gaps, missing infrastructure, poor financing, weak farmer/community organizations, a shifting agricultural calendar, and deteriorating environmental ecology. They reflect barriers to adaptation especially for small-scale subsistence farmers with increased climate change vulnerabilities. The study has shown that most West African countries have climate change policies. Nevertheless, key questions remain unanswered, and demand for further research, e.g., on evaluating the implementation in the respective countries, persists. BACKGROUND: Both the World Health Organization and the Intergovernmental Panel on Climate Change project that malnutrition will be the greatest contributor to climate change-associated morbidity and mortality. Although there have been several studies that have examined the potential effects of climate change on human health broadly, the effects on malnutrition are still not well understood. We conducted a systematic review investigating the role of three climate change proxies (droughts, floods, and climate variability) on malnutrition in children and adults. METHODS AND FINDINGS: We identified 22 studies examining the effects of droughts, floods, and climate variability on at least one malnutrition metric. We found that 17 out of 22 studies reported a significant relationship between climate change proxies and at least one malnutrition metric. In meta-analysis, drought conditions were significantly associated with both wasting (Odds Ratio [OR] 1.46, 95% Confidence Interval [CI] 1.05-2.04) and underweight prevalence (OR 1.46, 95% CI 1.01-2.11). CONCLUSIONS: Given the long-term consequences of malnutrition on individuals and society, adoption of climate change adaptation strategies such as sustainable agriculture and water irrigation practices, as well as improving nutritional interventions aimed at children aged 1-2 years and older adults, should be prioritised on global policy agendas in the coming years. Research on climate change mitigation and adaptation is pressing in order to understand its implications and risks in different urban areas. It is especially critical for those who face high degrees of urban inequality in the context of an uneven state presence. This paper is an explorative and investigative study which uses Cairo as a case. The focus of the study is on mapping state and private sector efforts in mitigating climate change issues, specifically for vulnerable groups who have limited access to public services. The study adopted an investigative approach where a literature search and bibliometric mapping were used to identify the gap in knowledge in the field of architecture and urban climate change mitigation and adaptation, followed by a field survey which included conducting interviews and questionnaires with different stakeholders from the public and private sector to investigate the link between the efforts for climate change mitigation. The explorative part of the study concluded that there is a huge knowledge gap in the Middle East and in Egypt when it comes to research efforts related to climate change with a focus on the built environment. The results of the investigative part of this study revealed that-apart from already limited efforts on ground-there is no synchronization in efforts between the public and private sector. Climate change issues are still not a priority when poverty, economy, and health are still a prime concern and take precedence over climate change. There is uneven presence of public efforts for climate change adaptation and mitigation. The efforts that do exist in the public sphere are self-help unorganized work (efforts) conducted by the civil society. Extreme cold events (“cold waves”) have disastrous impacts on ecosystem and human health. Evidence shows that these events will still occur under current increasing mean temperatures. Little research has been done on extreme cold events, especially in developing countries such as South Africa. These events pose a significant threat due to the low adaptive capacity, urgent development needs and relatively inadequate infrastructure in South Africa. This study presents annual and seasonal, spatial and temporal trend analyses of extreme cold temperature events for the period 1960-2016. We apply the World Meteorological Organisation Commission for Climatology and Indices Expert Team on Sector-Specific Climate Indices (ET-SCI) to South Africa for the first time, with comparison to the World Meteorological Organisation Expert Team on Climate Change Detection (ETCCDI) indices previously used in South Africa. The extreme cold indices are calculated using the RClimDex and ClimPACT, respectively. Trends were calculated using the non-parametric Mann-Kendall test, Spearman Rank Correlation Coefficient and Sen’s slope estimates. A decreasing trend is found for annual cold spell duration and cold wave frequency, at rates of 0.10 days.day(-1) and 0.02 events.day(-1), respectively. Seasonally, coldest day temperatures increased in autumn, with increases of 0.02 degrees C.day(-1) for the period 1960-2016. Regionally, increasing trends in annual cold spell duration days were evident in stations located in the Western Cape, Eastern Cape, North-West Province, at a rate of 0.03 days.day(-1). Increasing trends in cold waves were observed for stations in Northern Cape, Gauteng, KwaZulu-Natal and the Eastern Cape Province, at a rate of 0.01 events.day(-1). These results contribute to the awareness and recognition of the incidence and duration of cold extreme events in South Africa, seeing that studies suggest that anomalously cold events may persist in a warming world. Frameworks for understanding well-being play an important role in designing and evaluating climate change adaptation intervention and policy. To be effective, frameworks must capture the complexities of the social, ecological, and cultural contexts specific to vulnerable social groups. This study explores the concept of well-being from the perspective of pastoral women in Northern Kenya, a social group highly vulnerable to the impacts of climate change. Data were collected using semi-structured interviews and a novel participatory group ranking activity. Analysis using the WeD Framework for well-being highlights key components from the perspective of Samburu women and underscores the importance of understanding the interaction between these components. We discuss the theoretical implications of these interactions for future use of the WeD framework and practical implications for the design and evaluation of climate change adaptation intervention and policy. Although there is a large and growing literature on anticipated climate change impacts on health, we know very little about the linkages between differentiated vulnerabilities to climate extremes and adverse physical and mental health outcomes. In this paper, we examine how recurrent flooding interacts with gendered vulnerability, social differentiation, and place-related historical and structural processes to produce unequal physical and mental health outcomes. We situated the study in Old Fadama, Ghana, using a Photovoice approach (n = 20) and theoretical concepts from political ecologies of health and feminist political ecology. Overall, the study revealed several adverse physical and mental health impacts of flooding, with vulnerability differentiated based particularly on gender and age, but also housing, class, and income. Our findings suggest the need for greater attentiveness to social differentiation in scholarship involving political ecologies of health. The paper builds on the health and place literature by linking the social and contextual to the medical. Despite the direct linkage between climate change and social work practice, the involvement of social workers in addressing climate change issues remains discouraging. This is attributed to lack of exposure in climate change issues during training as social workers leading to lack of adequate tools for social workers to integrate climate change issues into their day-to-day interventions with clients. This paper is aimed at providing guidelines for social work practice in mainstreaming the participation of rural women in the climate change discourse. Social workers and rural women are absent from climate change interventions at professional, practice and personal levels. The precarious impacts of climate change manifesting through floods, droughts, water scarcity, depletion of the natural resource base, cyclones and heat waves disproportionally affect women particularly those in rural communities. Women’s vulnerability to climate change is emanating from exclusion in climate change decision-making processes, cultural norms and patterns which confines them to household responsibilities, lack of adaptive capacity, low literacy levels, patriarchal dominance and high poverty levels. As such, social workers are required to enhance social change, through empowerment and liberation of women to participate in discussions on climate change like men. A model is presented based on experiences in southern Africa to provide some guidance for social workers on how best to mainstream gender dimensions in climate change interventions. This would foster social and environmental justice, social resilience, equal participation in the climate change discourse, capacity building and adaptive capacity for rural women. The Urban Heat Island effect has been the focus of several studies concerned with the effects of urbanisation on human and ecosystem health. Humidity, however, remains much less studied, although it is useful for characterising human thermal comfort, the Urban Dryness Island effect and vegetation development. Furthermore, variability in microscale climate due to differences in land cover is increasingly crucial for understanding urbanisation effects on the health and wellbeing of living organisms. We used regression analysis to investigate the spatial and temporal dynamics of temperature, humidity and heat index in the tropical African city of Kampala, Uganda. We gathered data during the wet to dry season transition from 22 locations that represent the wide range of urban morphological differences in Kampala. Our analysis showed that the advancement of the dry season increased variability of climate in Kampala and that the most built-up locations experienced the most profound seasonal changes in climate. This work stresses the need to account for water availability and humidity to improve our understanding of human and ecosystem health in cities. BACKGROUND: Zoonoses pose major threats to the health of humans, domestic animals and wildlife, as seen in the COVID-19 pandemic. Zoonoses are the commonest source of emerging human infections and inter-species transmission is facilitated by anthropogenic factors such as encroachment and destruction of wilderness areas, wildlife trafficking and climate change. South Africa was selected for a ‘One Health’ study to identify research priorities for control of zoonoses due to its complex disease burden and an overstretched health system. METHODS: A multidisciplinary group of 18 experts identified priority zoonotic diseases, knowledge gaps and proposed research priorities for the next 5 y. Each priority was scored using predefined criteria by another group of five experts and then weighted by a reference group (n=28) and the 18 experts. RESULTS: Seventeen diseases were mentioned with the top five being rabies (14/18), TB (13/18), brucellosis (11/18), Rift Valley fever (9/11) and cysticercosis (6/18). In total, 97 specific research priorities were listed, with the majority on basic epidemiological research (n=57), such as measuring the burden of various zoonoses (n=24), followed by 20 on development of new interventions. The highest research priority score was for improving existing interventions (0.77/1.0), followed by health policy and systems research (0.72/1.0). CONCLUSION: Future zoonotic research should improve understanding of zoonotic burden and risk factors and new interventions in public health. People with limited rural services, immunocompromised, in informal settlements and high-risk occupations, should be the highest research priority. INTRODUCTION: Sub-Saharan Africa has the largest number of people with HIV, one of the most severe burdens of adverse birth outcomes globally and particular vulnerability to climate change. We examined associations between seasonality and adverse birth outcomes among women with and without HIV in a large geographically representative birth outcomes surveillance study in Botswana from 2015 to 2018. METHODS: We evaluated stillbirth, preterm delivery, very preterm delivery, small for gestational age (SGA), very SGA, and combined endpoints of any adverse or severe birth outcome. We estimated the risk of each outcome by month and year of delivery, and adjusted risks ratios (ARRs) of outcomes during the early wet (1 November-15 January), late wet (16 January-31 March) and early dry (1 April-15 July) seasons, compared with the late dry (16 July-31 October) season. Analyses were conducted overall and separately by HIV status. RESULTS: Among 73 178 women (24% with HIV), the risk of all adverse birth outcomes peaked in November-January and reached low points in September. Compared with the late dry season, the ARRs for any adverse birth outcome were 1.03 (95% CI 1.00 to 1.06) for the early dry season, 1.08 (95% CI 1.04 to 1.11) for the early wet season and 1.07 (95% CI 1.03 to 1.10) for the late wet season. Comparing the early wet season to the late dry season, we found that ARRs for stillbirth and very preterm delivery were higher in women with HIV (1.23, 95% CI 0.96 to 1.59, and 1.33, 95% CI 1.10 to 1.62, respectively) than in women without HIV (1.07, 95% CI 0.91 to 1.26, and 1.19, 95% CI 1.04 to 1.36, respectively). CONCLUSIONS: We identified a modest association between seasonality and adverse birth outcomes in Botswana, which was greatest among women with HIV. Understanding seasonal patterns of adverse birth outcomes and the role of HIV status may allow for mitigation of their impact in the face of seasonal extremes related to climate change. Enteric infections and water-related illnesses are more frequent during times of relative water abundance, especially in regions that experience bimodal rainfall patterns. However, it is unclear how seasonal changes in water availability and drinking water source types affect enteric infections in young children. This study investigated seasonal shifts in primary drinking water source type and the effect of water source type on enteric pathogen prevalence in stool samples from 404 children below age 5 in rural communities in Limpopo Province, South Africa. From wet to dry season, 4.6% (n = 16) of households switched from a source with a higher risk of contamination to a source with lower risk, with the majority switching to municipal water during the dry season. In contrast, 2.6% (n = 9) of households switched from a source with a lower risk of contamination to a source with higher risk. 74.5% (n = 301) of the total households experienced interruptions in their water supply, regardless of source type. There were no significant differences in enteric pathogen prevalence between drinking water sources. Intermittent municipal water distribution and household water use and storage practices may have a larger impact on enteric infections than water source type. The limited differences in enteric pathogen prevalence in children by water source could also be due to other exposure pathways in addition to drinking water, for example through direct contact and food-borne transmission. The present study analyses changes in the timing and duration of the hot days season over the Middle East and North Africa region from 1970 to 2099 using model simulations of 11 regional models from the Coordinated Regional Climate Downscaling Experiment under the RCP8.5 scenario. In general, a non-symmetrical lengthening of the hot days season is projected, with a tendency to extend more into spring than into autumn. By the end of the century and the RCP8.5 scenario, Western Africa and the Persian Gulf display a hot days season starting 60 days earlier than in the historical period (1970-1999) (May vs. July, respectively). Southernmost latitudes are the most affected by a later retreat of the hot days season, of up to 60 days with respect to the historical period (October vs. August). The length of the extreme season is projected to increase between 100 and 120 days for the southernmost latitudes and the Persian Gulf resulting in nearly four more months with hot days conditions. Climate risks and vulnerability continue to disproportionately affect the urban poor given their constrained adaptive capacity. This paper examines the urban poor’s perceptions and vulnerability to climate change in Kampala. Data was collected from a proportionate sample of 534 respondents drawn from households that were randomly selected from the city’s informal settlements and interviewed using a structured questionnaire. Six focus group discussions and 15 key informant interviews were conducted whose participants were purposively selected because of their knowledge and experiences. Quantitative data was analyzed using chi-square tests while content analysis was used to analyze qualitative data from key informant interviews and focus group discussions. A total of 96.6% of the households were aware of climate change, mainly perceived as rising temperatures and reduction in rainfall. Floods (53.4%) and droughts (27%) were the most commonly experienced climate risks, with the former considered more frequent and severe. Perceptions and vulnerability to climate risk varied with incomes, education level, marital status, main occupation, housing conditions and length of stay. Individuals with less wealth and education, employed in informal business and having insecure housing tenure were most vulnerable to flooding than they are to drought. The sensitivity of the urban poor communities is heightened by ecosystem degradation, poor access to urban infrastructure, utilities and services. With socio-economic attributes highly associated to climate change vulnerabilities, incorporating social dimensions and exchange of information between the vulnerable communities, planners and decision makers is necessary to inform the city’s adaptation policy and building long-term urban resilience. Partnerships are necessary between the urban authorities, communities, civil society and donors/financiers to improve housing and livelihoods in slums settlements. At the same time, strengthening co-production of climate information services, building climate change awareness, restoration of critical ecosystems and a broader inclusive adaptation planning are avenues for building resilient urban poor communities. Climate variability and change (CVC) affect many economic sectors including agriculture. In order to alleviate the negative impact of CVC on food production, farmers must adopt a range of strategies. However, the strategies will be less effective if farmers’ perceptions on CVC are not considered. This study therefore, examined the perceptions of commercial farmers on CVC and their adaptation strategies to the perceived impacts. It used a cross-sectional survey involving 365 farmers in the intensive farming region of Zimbabwe. Results showed that farmers’ perceptions on increasing temperatures and decreasing rainfall amounts were cognate with climate data from the meteorological office. The findings also demonstrated that farmers were well aware of the CVC impacts on their livelihoods. These include increases in the frequency and severity of drought, and a shortening of the length of the rainy season. However, the most significant changes were observed among the natural and economic capitals including soil salinization, reduction in grazing pastures, fodder and crop yields in addition to increases in food prices. In response to the perceived impacts of local CVC, the farmers were adopting crop and land use management strategies that include planting rotation, cultivating short-season varieties and drought tolerant crops, crop and farm diversification, intensified irrigation, agroforestry, soil moisture conservation and mixed farming. The study concludes that farmers are active observers of local CVC. Therefore, they should modify their agricultural calendar and diversify their farming systems so as to better meet current and future risks from CVC. A common problem that arises in extreme value theory when dealing with several variables (such as weather or meteorological) is to find an appropriate method to assess their joint or conditional multivariate extremal dependence behaviour. The method for choosing an appropriate threshold in peaks-over threshold approach is also another problem of endless debate. In this era of climate change and global warming, extreme temperatures accompanied by heat waves and cold waves pose serious economic and health challenges particularly in small economies or developing countries like South Africa. The present study attempts to address these problems, in particular, to deal with and capture dependencies in extreme values of two variables, by applying bivariate conditional extremes modelling with a time-varying threshold to Limpopo province’s monthly maximum temperature series. Limpopo and North West provinces are the two hottest provinces in South Africa characterised by heat waves and the present study is carried out in the Limpopo province at Mara, Messina, Polokwane and Thabazimbi meteorological stations for the period 1994-2009. With the aim to model extremal dependence of maximum temperature at these four meteorological stations, two modelling approaches are applied: bivariate conditional extremes model and time-varying threshold. The latter approach was used to capture the climate change effects in the data. The main contribution of this paper is in combining these two approaches in bivariate extremal dependence modelling of maximum temperature extremes in the Limpopo province of South Africa. The findings of the study revealed both significant positive and negative extremal dependence in some pairs of meteorological stations. Among the major findings were the significant strong positive extremal dependence of Thabazimbi on high-temperature values at Mara and the strong negative extremal dependence of Polokwane on high-temperature values at Messina. The findings of this study play an important role in revealing information useful to meteorologists, climatologists, agriculturalists, and planners in the energy sector among others. Climate change is expected to increase the prevalence of water-borne diseases especially in developing countries. Climate-resilient drinking water supplies are critical to protect communities from faecal contamination and thus against increasing disease risks. However, no quantitative assessment exists for the impacts of short-term climate variability on faecal contamination at different drinking water sources in developing countries, while existing understanding remains largely conceptual. This critical gap limits the ability to predict drinking water quality under climate change or to recommend climate-resilient water sources for vulnerable communities. This study aims to provide such quantitative understanding by investigating the relationships between faecal contamination and short-term climate variability across different types of water sources. We collected a novel dataset with over 20 months’ monitoring of weather, Escherichia coli (E. coli) and total coliforms, at 233 different water sources in three climatically different regions in Tanzania. We then took a rigorous statistical analysis with Bayesian hierarchical models, to relate both contamination occurrence and amount to climate variability. The model results explained the temporal variability in drinking water faecal contamination using climate predictors, and also revealed the climate sensitivity of faecal contamination for individual water sources. We found that: a) short-term climate variability and baseline contamination levels can explain about half the observed variability in faecal contamination (R(2) ? 0.44); b) increased contamination was most consistently related to recent heavy rainfall and high temperature across different water sources; c) unimproved water sources such as the unprotected dug wells have substantially higher climate sensitivity. Based on these results, we can expect substantial increases in drinking water contamination risks across tropical Sub-Saharan Africa and South-East Asian developing countries under a warmer climate, which highlight the urgent need of protecting vulnerable communities from the severe climate impacts. In early 2019, following the 2015-2016 severe drought, the provinces of Sofala and Cabo Delgado, Mozambique, were hit by Cyclones Idai and Kenneth, respectively. These were the deadliest and most destructive cyclones in the country’s history. Currently, these two provinces host tens of thousands of vulnerable households due to the climatic catastrophes and the massive influx of displaced people associated with violent terrorist attacks plaguing Cabo Delgado. The emergence of the COVID-19 pandemic added a new challenge to this already critical scenario, serving as a real test for Mozambique’s public health preparedness. On the planetary level, Mozambique can be viewed as a ‘canary in the coal mine’, harbingering to the world the synergistic effects of co-occurring anthropogenic and natural disasters. Herein, we discuss how the COVID-19 pandemic has accentuated the need for an effective and comprehensive public health response in a country already deeply impacted by health problems associated with natural disasters and population displacement. Disaster planning for slow-onset city-wide shocks will be become increasingly necessary, particularly as cities face increasingly severe climate hazards. This paper provides unique insight into the disaster planning and management that was undertaken by the City of Cape Town government in response to its most severe hydrological drought on record. It describes how risk was understood and why decisions were made on key elements of the plan, including trigger points, risk prioritisation and mitigation, and the location and design of points of distribution of water rations for the public. Reflecting upon the authors’ experience and interviews with senior City officials who worked on the drought disaster planning and response, the paper extracts five key lessons learnt that have since been applied during the COVID-19 pandemic: (i) the need for cross-functional planning and response skills, (ii) the need for integrated, up-to-date and scale-appropriate data; (iii) the importance of scenario-based simulations, communication and rapid costing to enable the rapid scaling-up of a response; (iv) the value of being able to use outsourced expert capacity effectively; and (v) the application of previously used disaster management and planning experience to build resilience in cities. These lessons, captured in a visual framework, help reflect on capabilities required for responding to future city-scale disasters. The paper provides an informative case study for other cities and risk managers, and will be particularly useful for global South contexts that face drought and other slow-onset disasters, most recently illustrated by the COVID-19 pandemic. Migration is often considered a form of climate change adaptation by which individuals, households, and communities seek to reduce the risks associated with climate change. In this study, we examine first-time seasonal migration out of a village in North-Western Burkina Faso to neighbouring countries, triggered by more irregular rainfall patterns. Through a set of 52 qualitative interviews, we analyse the perceptions of migrants themselves as well as the sending community regarding migration consequences. Men migrated in the off-season, whereas women stayed behind. Most migrant men and wives of migrants perceive migration to have negative consequences for their socio-economic situation and their health. Despite this, a lack of options and deteriorating environmental conditions might force the men to move again. We interpreted the range of narratives provided by women and men against the background of the scientific literature on migration as climate change adaptation. While migration could be beneficial, this study challenges the notion of migration as an effective adaptation strategy for people in climate-vulnerable settings, who lack other options. 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. Rift Valley Fever (RVF) is a zoonotic disease whose outbreak results in heavy economic and public health burdens. In East Africa, RVF is mainly experienced in arid and semi-arid areas predominantly inhabited by the pastoralists. These areas experience sudden, dramatic epidemics of the disease at intervals of approximately 10 years, associated with widespread flooding and the resultant swarms of mosquitoes. Pastoralists’ indigenous knowledge and experience of RVF is critical for public health interventions targeting prevention and control of RVF. The study adopted a descriptive cross-sectional design combining both quantitative and qualitative methods of data collection. A total of 204 respondents participated in questionnaire survey and 15 key informants and 4 focus group discussions were interviewed and conducted respectively. In addition, secondary data mainly journal publications, books, policy documents and research reports from conferences and government departments were reviewed. Findings indicated that the Somali pastoralists possess immense knowledge of RVF including signs and symptoms, risk factors, and risk pathways associated with RVF. Ninety eight percent (98%) of respondents identified signs and symptoms such as bloody nose, diarrhea, foul smell and discharge of blood from the orifices which are consistent with RVF. Heavy rains and floods (85%) and sudden emergence of mosquito swarms (91%) were also cited as the major RVF risk factors while mosquito bites (85%), drinking raw milk and blood (78%) and contact with animal fluids during mobility, slaughter and obstetric procedures (77%) were mentioned as the RVF entry risk pathways. Despite this immense knowledge, the study found that the pastoralists did not translate the knowledge into safer health practices because of the deep-seated socio-cultural practices associated with pastoralist production system and religious beliefs. On top of these practices, food preparation and consumption practices such as drinking raw blood and milk and animal ritual sacrifices continue to account for most of the mortality and morbidity cases experienced in humans and animals during RVF outbreaks. This article concludes that pastoralists’ indigenous knowledge on RVF has implications on public health delivery approaches. Since the pastoralists’ knowledge on RVF was definitive, integrating the community into early warning systems through training on reporting mechanisms and empowering the nomads to use their mobile phone devices to report observable changes in their livestock and environment could prove very effective in providing information for timely mobilization of public health responses. Public health advocacy based on targeted and contextually appropriate health messaging and disseminated through popular communication channels in the community such as the religious leaders and local radio stations would also be needed to reverse the drivers of RVF occurrence in the study area. OBJECTIVE: The aim of this study is to find the most suitable heat wave definition among 15 different ones and to evaluate its impact on total, age-, and gender-specific mortality for Bandafassi, Senegal. METHODS: Daily weather station data were obtained from Kedougou situated at 17 km from Bandafassi from 1973 to 2012. Poisson generalized additive model (GAM) and distributed lag non-linear model (DLNM) are used to investigate the effect of heat wave on mortality and to evaluate the nonlinear association of heat wave definitions at different lag days, respectively. RESULTS: Heat wave definitions, based on three or more consecutive days with both daily minimum and maximum temperatures greater than the 90th percentile, provided the best model fit. A statistically significant increase in the relative risk (RRs 1.4 (95% Confidence Interval (CI): 1.2-1.6), 1.7 (95% CI: 1.5-1.9), 1.21 (95% CI: 1.08-1.3), 1.2 (95% CI: 1.04-1.5), 1.5 (95% CI: 1.3-1.8), 1.4 (95% CI: 1.2-1.5), 1.5 (95% CI: 1.07-1.6), and 1.5 (95% CI: 1.3-1.8)) of total mortality was observed for eight definitions. By using the definition based on the 90th percentile of minimum and maximum temperature with a 3-day duration, we also found that females and people aged ? 55 years old were at higher risks than males and other different age groups to heat wave related mortality. CONCLUSION: The impact of heat waves was associated with total-, age-, gender-mortality. These results are expected to be useful for decision makers who conceive of public health policies in Senegal and elsewhere. Climate parameters, including temperatures and humidity, could be used to forecast heat wave risks as an early warning system in the area where we conduct this research. More broadly, our findings should be highly beneficial to climate services, researchers, clinicians, end-users and decision-makers. Natural hazards like floods and droughts affect many aspects of life. The study in particular examined the impacts of droughts on under-five mortality rate in Southern Africa, adjusting for gross domestic product (GDP) and literacy rate. Despite drought and child mortality being key public health concerns in Southern Africa over the past few decades, there have hardly been any studies examining the relationships between them. The study used publicly available data from 1980 to 2012. The Standard Precipitation Index (SPI) was calculated for 3-, 6-, 9-, and 12-monthly time scales for ten southern African countries. The wetter and drier states are represented by positive and negative SPI values, respectively. SPI, GDP, and literacy rate were considered for predicting child mortality rate using both Multiple Linear Regression techniques and nonlinear methods (Generalized Additive Model), on a leave-one-year-out cross validation approach for model evaluation. Child mortality increased as the drought worsened for five countries in this region, namely Angola, Malawi, Mozambique, Namibia, and Zambia. We found that child mortality can be predicted with a high degree of accuracy using three predictor variables-drought index, GDP and literacy rate. Statistical modelling based on early warning system can complement regional capacities for drought response systems to increase child survival rate in drought-prone areas Understanding the regional impact of future climate change is one of the major global challenges of this century. This study investigated possible effects of climate change on malaria in West Africa in the near future (2006-2035) and the far future (2036-2065) under two representative concentration pathway (RCP) scenarios (RCP4.5 and RCP8.5), compared to an observed evaluation period (1981-2010). Projected rainfall and temperature were obtained from the coordinated regional downscaling experiment (CORDEX) simulations of the Rossby Centre Regional Atmospheric regional climate model (RCA4). The malaria model used is the Liverpool malaria model (LMM), a dynamical malaria model driven by daily time series of rainfall and temperature obtained from the CORDEX data. Our results highlight the unimodal shape of the malaria prevalence distribution, and the seasonal malaria transmission contrast is closely linked to the latitudinal variation of the rainfall. Projections showed that the mean annual malaria prevalence would decrease in both climatological periods under both RCPs but with a larger magnitude of decreasing under the RCP8.5. We found that the mean malaria prevalence for the reference period is greater than the projected prevalence for 6 of the 8 downscaled GCMs. The study enhances understanding of how malaria is impacted under RCP4.5 and RCP8.5 emission scenarios. These results indicate that the southern area of West Africa is at most risk of epidemics, and the malaria control programs need extra effort and help to make the best use of available resources by stakeholders. Climate change and variability influence temperature and rainfall, which impact vector abundance and the dynamics of vector-borne disease transmission. Climate change is projected to increase the frequency and intensity of extreme climate events. Mosquito-borne diseases, such as dengue fever, are primarily transmitted by Aedes aegypti mosquitoes. Freshwater availability and temperature affect dengue vector populations via a variety of biological processes and thus influence the ability of mosquitoes to effectively transmit disease. However, the effect of droughts, floods, heat waves, and cold waves is not well understood. Using vector, climate, and dengue disease data collected between 2013 and 2019 in Kenya, this retrospective cohort study aims to elucidate the impact of extreme rainfall and temperature on mosquito abundance and the risk of arboviral infections. To define extreme periods of rainfall and land surface temperature (LST), we calculated monthly anomalies as deviations from long-term means (1983-2019 for rainfall, 2000-2019 for LST) across four study locations in Kenya. We classified extreme climate events as the upper and lower 10% of these calculated LST or rainfall deviations. Monthly Ae. aegypti abundance was recorded in Kenya using four trapping methods. Blood samples were also collected from children with febrile illness presenting to four field sites and tested for dengue virus using an IgG enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). We found that mosquito eggs and adults were significantly more abundant one month following an abnormally wet month. The relationship between mosquito abundance and dengue risk follows a non-linear association. Our findings suggest that early warnings and targeted interventions during periods of abnormal rainfall and temperature, especially flooding, can potentially contribute to reductions in risk of viral transmission. The lack of empirical evidence on the effect of heat exposure on the health and safety, productivity, psychological behaviour and social well-being outcomes of small- and large-scale mining workers in Africa has derailed concrete policy directions and interventions. An explanatory cross-sectional survey involving 320 small- and large-scale mining workers was used to assess this research gap. A path analysis was used to model health and safety, productivity, psychological behaviour and social well-being as a function of heat exposure, mediated and moderated by adaptation strategies and barriers, while controlling for age, gender, level of education, years of working experience and workplace environment. Significant direct adverse effects of heat exposure on mining workers’ health and safety, productivity and psychological behaviour outcomes were found. Using a pick-a-point approach, significant difference was found in simple slopes (SS) for heat exposure on adaptation strategies at medium level of barriers and a trend toward significance at the high level of barriers. Except for health and safety outcomes, there were significant conditional indirect effects of heat exposure on the performance outcomes at the medium and high levels of barriers to adaptation strategies. However, there was no evidence of mediated-moderation for heat exposure and health and safety, productivity, psychological behaviour and social well-being outcomes. We have provided empirical evidence to establish heat exposure effect on key performance outcomes of mining workers to initiate and guide the formulation of heat exposure management policies. OBJECTIVES: This study compared the prevalence of concentrated urine (urine specific gravity ?1.021), an indicator of hypohydration, across Tsimane’ hunter-forager-horticulturalists living in hot-humid lowland Bolivia and Daasanach agropastoralists living in hot-arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. METHODS: This study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane’ households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). RESULTS: The prevalence of hypohydration among Tsimane’ men (50.0%) and women (54.0%) was substantially higher (P?
Climate change-induced extreme weather events have been at their worst increase in the past decade (2010-2020) across Africa and globally. This has proved disruptive to global socio-economic activities. One of the challenges that has been faced in this regard is the increased coastal flooding of cities. This study examined the trends and impacts of coastal flooding in the Western Cape province of South Africa. Making use of archival climate data and primary data from key informants and field observations, it emerged that there is a statistically significant increase in the frequency of flooding and consequent human and economic losses from such in the coastal cities of the province. Flooding in urban areas of the Western Cape is a factor of human and natural factors ranging from extreme rainfall, usually caused by persistent cut off-lows, midlatitude cyclones, cold fronts and intense storms. Such floods become compounded by poor drainage caused by vegetative overgrowth on waterways and land pollution that can be traced to poor drainage maintenance. Clogging of waterways and drainage systems enhances the risk of flooding. Increased urbanisation, overpopulation in some areas and non-adherence to environmental laws results in both the affluent and poor settling on vulnerable ecosystems. These include coastal areas, estuaries, and waterways, and this worsens the risk of flooding. The study recommends a comprehensive approach to deal with factors that increase the risk of flooding as informed by the provisions of both the Sustainable Development Goals framework and the Sendai Framework for Disaster Risk Reduction 2015-2030 in a bid to de-risking human settlement in South Africa. Forced displacement and resettlement is a pervasive challenge being contemplated across the social sciences. Scholarly literature, however, often fails to engage complexities of power in understanding socio-environmental interactions in resettlement processes. Addressing Zimbabwe’s Tokwe-Mukosi flood disaster resettlement, we explore hegemonic uses of state power during the pre- and post-flood induced resettlement processes. We examine how state power exercised through local government, financial, and security institutions impacts community vulnerabilities during forced resettlement processes, while furthering capitalist agendas, drawing insights from analysing narratives between 2010 and 2021. Concerns abound that multiple ministries, the police, and the army undermined displaced people’s resilience, including through inadequate compensation, with state institutions neglecting displaced communities during encampment by inadequately meeting physical security, health, educational, and livestock production needs. We explore how forcibly resettling encamped households to a disputed location is not only an ongoing perceived injustice regionally but also a continuing reference point in resettlement discussions countrywide, reflecting concerns that land use and economic reconfigurations in resettlement can undermine subsistence livelihoods while privileging certain values and interests over others. Policy lessons highlight the need for reviewing disaster management legislation, developing compensation guidelines and reviewing encampment practices. Analytically, lessons point to how state power may be studied in relation to perspectives on the destruction of flood survivors’ connections to place, people and livelihoods, underscoring the critical need for theorising the relationships between power dynamics and diverse experiences around displacement. Many occupational settings located outdoors in direct sun, such as open cut mining, pose a health, safety, and productivity risk to workers because of their increased exposure to heat. This issue is exacerbated by climate change effects, the physical nature of the work, the requirement to work extended shifts and the need to wear protective clothing which restricts evaporative cooling. Though Ghana has a rapidly expanding mining sector with a large workforce, there appears to be no study that has assessed the magnitude and risk of heat exposure on mining workers and its potential impact on this workforce. Questionnaires and temperature data loggers were used to assess the risk and extent of heat exposure in the working and living environments of Ghanaian miners. The variation in heat exposure risk factors across workers’ gender, education level, workload, work hours, physical work exertion and proximity to heat sources is significant (p<0.05). Mining workers are vulnerable to the hazards of heat exposure which can endanger their health and safety, productive capacity, social well-being, adaptive capacity and resilience. An evaluation of indoor and outdoor Wet Bulb Globe Temperature (WBGT) in the working and living environment showed that mining workers can be exposed to relatively high thermal load, thus raising their heat stress risk. Adequate adaptation policies and heat exposure management for workers are imperative to reduce heat stress risk, and improve productive capacity and the social health of mining workers.
Climate extreme events have significant impacts on the livelihoods of smallholder women farmers. The aim of the present study is to investigate the coping and adaptation measures that women farmers use to respond to specific climate extreme events. The data for the study comes from 187 smallholder women farmers from Upper West region of Ghana. The study employed the Bivariate Probit model in the empirical analysis. The results revealed that membership of farmer-based organizations and the use of climate information were the key factors which influenced women farmers’ coping strategies against climate extreme events. Women farmers’ adaptation measures were mainly influenced by access to credit. The key policy variable that influenced both coping and adaptation measures of women farmers was access to agricultural extension services. The study recommends that policy should focus on the promotion of specific coping and adaptation interventions against climate extreme events among women farmers. Policy should create enabling environment for the establishments of farmer-based organizations, increase women farmers’ contact with women agricultural extension officers and remove institutional barriers that impede access to credit and the use of climate information.Climate extreme events have significant impacts on the livelihoods of smallholder women farmers. The aim of the present study is to investigate the coping and adaptation measures that women farmers use to respond to specific climate extreme events. The data for the study comes from 187 smallholder women farmers from Upper West region of Ghana. The study employed the Bivariate Probit model in the empirical analysis. The results revealed that membership of farmer-based organizations and the use of climate information were the key factors which influenced women farmers’ coping strategies against climate extreme events. Women farmers’ adaptation measures were mainly influenced by access to credit. The key policy variable that influenced both coping and adaptation measures of women farmers was access to agricultural extension services. The study recommends that policy should focus on the promotion of specific coping and adaptation interventions against climate extreme events among women farmers. Policy should create enabling environment for the establishments of farmer-based organizations, increase women farmers’ contact with women agricultural extension officers and remove institutional barriers that impede access to credit and the use of climate information. Environmental change and climate-related disasters are an under-examined factor impacting women’s health, globally. Drawing on ecofeminist theory, we conduct analyses examining if the HIV burden among women is higher in nations that experience suffering from droughts. Specifically, we posit that droughts, which typically impact more people and for greater lengths of time than other climate-related disasters, have a unique impact on women’s vulnerability to HIV/AIDS. We use a cross-national dataset of less-developed countries and ordinary least squares (OLS) regression to explore and compare relationships between suffering from drought and total HIV prevalence and suffering from drought and women’s proportion of HIV cases. Overall, the results demonstrate that while droughts have an inconsistent impact on total HIV prevalence, suffering from drought significantly increases the proportion of HIV cases among women in comparison to men, net of the impact of common economic, social, cultural, and political predictors. The findings suggest that suffering from drought differentially impacts women’s health in less-developed countries, where a number of mechanisms, such as transactional sex or displacement, likely underlie the associations identified. Climate change is a threat to food security. Wild-harvested food plants (WFPs) are important for the diets of millions of people and contribute to food security, especially in rural and low-income communities, but little is known about climate change risk to WFPs. Using species distribution models, we examined climate change risk to 1190 WFP species used by 19 native language groups in southern Africa. We project that 60% of species will experience an increase (40% a decrease) in range extent within southern Africa by 2060-2080 under a low warming scenario (Representative Concentration Pathway (RCP) 2.6), while range reductions for 66% of species are projected under a high warming scenario (RCP 8.5). Decreases in geographic range are projected for > 70% of WFP species traditionally used by some language groups. Loss of suitable climatic conditions is projected to decrease WFP species richness most in north-eastern southern Africa-with losses of > 200 species-while increases in species richness are projected in the south and east of South Africa. Availability of WFP species for food security during lean times is also projected to change. In south-eastern South Africa, local diversity of WFPs is projected to increase, while maize and sorghum yields decrease. However, this potential WFP nutritional safety net may be lost in central parts of the region, where declines in both crop yield and WFPs are projected. By looking beyond conventional crops to the exceptional diversity of WFPs, this research helps understanding linkages between WFPs, traditional knowledge, food security and climate change adaptation. Extreme climate change is posing an increasing threat to human welfare across countries. Specifically, the devastating floods coupled with the looming spectre of drought are argued to explain cross-country differences in food security. While the debate continues and uncertainties about the precise influence of climate change on food security linger, the question of whether climate change plays a pivotal role in increased hunger and food insecurity across countries remains unanswered. This study presented new evidence of the role of climate change in Africa’s food security. We utilised the Mann-Kendall test and Sen’s slope estimator to analyse climate change trends. We also employed the pooled mean group technique and the Dumitrescu-Hurlin panel causality test to investigate the effect of climate change on food security in 15 African countries between 1970 and 2016. Our empirical findings revealed three things. First, rainfall plays a decisive role in Africa’s food security when examined broadly. However, the significance of the effect of rainfall varied substantially across the 15 countries. Second, we find no robust impact of temperature on food security in the long run. However, the short-run results showed that extreme temperatures impede food security, with varying magnitudes across countries. Third, except for rainfall, a bidirectional causality exists between food security and temperature in Africa. Given the risks associated with rain-fed agriculture, we argue that African countries need to limit their dependence on rain-fed agriculture to boost food production. Climate drives population dynamics through multiple mechanisms, which can lead to seemingly context-dependent effects of climate on natural populations. For climate-sensitive diseases, such as dengue, chikungunya, and Zika, climate appears to have opposing effects in different contexts. Here we show that a model, parameterized with laboratory measured climate-driven mosquito physiology, captures three key epidemic characteristics across ecologically and culturally distinct settings in Ecuador and Kenya: the number, timing, and duration of outbreaks. The model generates a range of disease dynamics consistent with observed Aedes aegypti abundances and laboratory-confirmed arboviral incidence with variable accuracy (28-85% for vectors, 44-88% for incidence). The model predicted vector dynamics better in sites with a smaller proportion of young children in the population, lower mean temperature, and homes with piped water and made of cement. Models with limited calibration that robustly capture climate-virus relationships can help guide intervention efforts and climate change disease projections. In this project we consider the ways that different livelihood strategies impact the climate-health linkage. Specifically, we build on knowledge of livestock mobility in the Sahel and use remotely sensed-based measures of waterholes with health survey data to investigate the linkages between child health outcomes related to food security. We focus on the landscape characteristics relevant to limitedly studied, but highly climate-vulnerable populations, pastoralists and agro-pastoralists in the Sahel. We combine remotely sensed-based data on surface waterholes and spatially referenced health survey data and use flexible regression modeling techniques to uncover the quantitative relationship between waterhole depth and a child’s height-for-age z-score (HAZ). The results suggest that the water depth level of nearby waterholes does indeed impact a child’s HAZ, even after accounting for other environmental factors. This relationship is impacted, however, by the livelihood practices of the area as well as by the source of household drinking water. We examine the relationships between climatic conditions, breastfeeding behavior, and maternal time use in Ethiopia. Infant feeding practices are important predictors of child nutrition that may be affected by a number of factors including mother’s time engaging in agricultural labor, food security, cultural beliefs, and antenatal care. We use panel data from the Living Standards Measurement Study to investigate linkages between climatic conditions during a child’s first year of life and year prior to birth and duration of exclusive breastfeeding. We then explore one potential mechanism: women’s agricultural labor. Results indicate that rainfall during the primary agricultural season-kiremt-in a child’s first year of life plays an important role in duration of exclusive breastfeeding. Experiencing 25 cm of average monthly kiremt rainfall, versus 5 cm, is associated with a 20-percentage-point decrease in the likelihood of being exclusively breastfed for the recommended six months. More kiremt rainfall is associated with a greater number of days that women spend planting and harvesting, and at high levels of rainfall women with infants do not engage in significantly fewer days of agricultural labor than those without infants. Lastly, we find that during the year before birth, greater rainfall during kiremt as well as the dry season is associated with a lower likelihood of six months of exclusive breastfeeding, potentially due to the early introduction of complementary foods. Our findings indicate that agricultural labor demands may in part drive breastfeeding behaviors, leading to “sub-optimal” feeding practices in the short-term, but resulting in improved household food security in the longer-term. Climate change is a global problem, which affects the various geographical regions at different levels. It is also associated with a wide range of human health problems, which pose a burden to health systems, especially in regions such as Africa. Indeed, across the African continent public health systems are under severe pressure, partly due to their fragile socioeconomic conditions. This paper reports on a cross-sectional study in six African countries (Ghana, Nigeria, South Africa, Namibia, Ethiopia, and Kenya) aimed at assessing their vulnerabilities to climate change, focusing on its impacts on human health. The study evaluated the levels of information, knowledge, and perceptions of public health professionals. It also examined the health systems’ preparedness to cope with these health hazards, the available resources, and those needed to build resilience to the country’s vulnerable population, as perceived by health professionals. The results revealed that 63.1% of the total respondents reported that climate change had been extensively experienced in the past years, while 32% claimed that the sampled countries had experienced them to some extent. Nigerian respondents recorded the highest levels (67.7%), followed by Kenya with 66.6%. South Africa had the lowest level of impact as perceived by the respondents (50.0%) when compared with the other sampled countries. All respondents from Ghana and Namibia reported that health problems caused by climate change are common in the two countries. As perceived by the health professionals, the inadequate resources reiterate the need for infrastructural resources, medical equipment, emergency response resources, and technical support. The study’s recommendations include the need to improve current policies at all levels (i.e., national, regional, and local) on climate change and public health and to strengthen health professionals’ skills. Improving the basic knowledge of health institutions to better respond to a changing climate is also recommended. The study provides valuable insights which may be helpful to other nations in Sub-Saharan Africa. Climate change is predicted to adversely affect agricultural yields, particularly in African countries such as Ethiopia, where crop production relies heavily on environmental factors such as rainfall and temperature. However, there have only been a limited number of studies on the effects of climate change dynamics on food security in Africa, particularly at the household level. We therefore analyzed local climatic changes, the status of household food security, climate-related causes of food insecurity, food security determinants, and the adaptation strategies of local farmers. Three decades meteorological data were analyzed. A total of 185 farmers were selected using simple random sampling and interviewed, together with focus groups. Data were analyzed using the descriptive and inferential statistics were used together with the logit regression model. Climate change over the last three decades was found to have a negative impact the food security status of households. Crop production was constrained by poor rainfall, severe erosion, and increases in temperature. The unpredictability of rainfall, pests, and diseases were also contributing factors. Using the calorie intake approach, 60.5% of sampled respondents were found to be food insecure. Analysis using the logistic regression model showed that age and family size, as well as the amount of cultivated land and rainfall, were the significant (p < .05) factors influencing household food security status. A large proportion (69.8%) of farmers were incorporating adapting strategies into farm management including improved use of crop varieties and livestock production, in addition to income diversification. Taken together, these findings show that improving climate change awareness, facilitating the participation of female-led households in income generation, and strengthening existing adaptation measures have positive impacts on food security. Heatwaves pose a serious threat to human health worldwide but remain poorly documented over Africa. This study uses mainly the ERA5 dataset to investigate their large-scale drivers over the Sahel region during boreal spring, with a focus on the role of tropical modes of variability including the Madden-Julian Oscillation (MJO) and the equatorial Rossby and Kelvin waves. Heatwaves were defined from daily minimum and maximum temperatures using a methodology that retains only intraseasonal scale events of large spatial extent. The results show that tropical modes have a large influence on the occurrence of Sahelian heatwaves, and, to a lesser extent, on their intensity. Depending on their convective phase, they can either increase or inhibit heatwave occurrence, with the MJO being the most important of the investigated drivers. A certain sensitivity to the geographic location and the diurnal cycle is observed, with nighttime heatwaves more impacted by the modes over the eastern Sahel and daytime heatwaves more affected over the western Sahel. The examination of the physical mechanisms shows that the modulation is made possible through the perturbation of regional circulation. Tropical modes thus exert a control on moisture and the subsequent longwave radiation, as well as on the advection of hot air. A detailed case study of a major event, which took place in April 2003, further supports these findings. Given the potential predictability offered by tropical modes at the intraseasonal scale, this study has key implications for heatwave risk management in the Sahel. Individuals living in every region of the world are increasingly vulnerable to negative health outcomes due to extreme heat exposure. Children, in particular, may face long-term consequences associated with heat stress that affect their educational attainment and later life health and well-being. Retrospective individual-level analyses are useful for determining the effects of extreme heat exposure on health outcomes. Typically, future risk is inferred by extrapolating these effects using future warming scenarios that are applied uniformly over space and time without consideration of topographical or climatological gradients. We propose an alternative approach using a stochastic weather generator. This approach employs a 1 degrees C warming scenario to produce an ensemble of plausible future weather scenarios, and subsequently a distribution of future health risks. We focus on the effect of global warming on fetal development as measured by birth weight in Ethiopia. We demonstrate that predicted changes in birth weight are sensitive to the evolution of temperatures not quantified in a uniform warming scenario. Distributions of predicted changes in birth weight vary in magnitude and variability depending on geographic and socioeconomic region. We present these distributions alongside results from the uniform warming scenario and discuss the spatiotemporal variability of these predicted changes. Lokoja, the capital of Kogi State, Nigeria, experiences seasonal flooding with devastating consequences on the people and the natural and built environments. In contrast with developed countries, researchers and flood managers in Nigeria have largely ignored Participatory Geographic Information System, which integrates the perceptions and experiences of the people affected by flood events with technical, conventional methods, as a flood management strategy, with flood managers employing a reactive, top-bottom post-flood strategy of relief and rescue. This study employed PGIS to conduct a vulnerability assessment in Lokoja as a pre-flood strategy that involves the communities. Datasets utilized include Landsat imageries, DEM, and soil samples. Spatial multi criteria evaluation using the analytical hierarchy process was employed to analyze flood parameters determined through community participation to evaluate vulnerability while consistency ratio was also calculated to ensure that the comparison of criteria made was consistent. Results revealed that elevation is the most important factor, and land use, among other parameters of flood vulnerability. Out of a total area of 6, 258 Ha, 4, 445 Ha are highly vulnerable and 1, 815 Ha being moderately vulnerable. Comparison consistency ratio was determined to be 0.08 which is acceptable. Based on the results, this study concludes that the perception of affected communities can complement conventional flood research for a more effective response and mitigation strategy. The research therefore recommends the integration of geospatial techniques and participatory approaches for flood vulnerability studies for a proactive, bottom-up approach to flood management. For two decades, the flood risk has become a challenge for all authorities in the world. However, its mitigation can be conducted through structural and non-structural measures. The non-structural measures include the flood risk assessment and management, the evacuating process during the flood, and land use management. This case study used HEC-RAS and HEC-LifeSim models to assess the potential flood risk, Mohammedia (Morocco), associated with Malleh dam rupture. The HEC-RAS2D Hydraulic model was calibrated for one flood and its sensitivity to the Manning was analysed. Thus, the potential life loss simulation was conducted using the socio-economic and Hydraulic data using HEC-LifeSim according to two alternatives of the evacuation process. The results showed that traffic management during floods decreases the probability of life loss. Overall results showed that the city is vulnerable to the disaster simulated in terms of road network capacity that can be used for the evacuation process. Flood is one of life-threatening events in different parts of Ethiopia. The causes of flood might vary from place to place, for instance, rates of deforestation, agricultural expansion, urbanization, wetland drainage, climate change, siltation of river bed, and several other types of land use change might be the cause for flood in different rivers banks. This study aims to assess, investigate, and design suitable river training works on lower Kulfo river reach. The study reach has been seriously affected by extreme floods due to the above reasons. For minimizing the loss due to flood, and to use the advantage of flood for different developmental activities various flood control measures should be adopted. The flood control measures which should more correctly be termed as “flood management” can be planed either through structural engineering measures or non-structural measures. Structural measures comprise retarding structures which store flood water, channel improvements which increase flood-carrying capacity of the river, embankments, and levees which keep the waterway from flood-prone area, detention basin which retards and absorbs most of the floodwater. Within the identified 6 km reach, field investigation including secondary data collection has been done to predict the flood extent using 1D hydrodynamic model, HECRAS and HEC Geo RAS. Estimated flood depth and extent helped us in fixing the dimension of different river training structures selected. The modelling result indicates a maximum channel bed flood depth of 4.3 m and flood plain flood depth 2.3 m obtained using a 100-year return flow. Analysis of soil samples indicates that the lower reach of Kulfo river is gravel and sand dominated meandering river, with estimated scour depth up to 3.41 m along the river course. Levees have been designed in conjunction with Groynes to protect the Upstream farm located at the prison and upper part of the Limat households. Frequent floods happening near both bridges shall be reduced by using Guide banks without influencing the bridges and diversion structures. Consideration is given for the ecosystem to stay in equilibrium, by providing suitable outer slopes so that plantation is possible on the top and side slope of the levees and guide banks. INTRODUCTION: In 2016-18, the Democratic Republic of São Tomé and Príncipe suffered a necrotic skin infection epidemic. METHODS: A surveillance system was established after increased hospitalisations for this infection. Microbiology results were available for samples analysed in December 2016 and March 2017 using whole genome sequencing and metagenomics. Negative binomial regression was used to study the association of weather conditions with monthly case counts in a time-series analysis. RESULTS: From October 2016 to October 2018, the epidemic cumulative attack rate was 1.5%. The first peak lasted 5 months, accounting for one-third of total cases. We could not conclusively identify the aetiological agent(s) due to the country’s lack of microbiology capacity. Increased relative humidity was associated with increased monthly cases (incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.09), and higher precipitation in the previous month with a higher number of cases in the following month (months with 0-49 mm rainfall compared with months with 50-149 mm and ?150 mm: IRR 1.44, 95 % CI 1.13-1.78 and 1.50, 95% CI 1.12-1.99, respectively). DISCUSSION: This epidemic was favoured by increased relative humidity and precipitation, potentially contributing to community-based transmission of ubiquitous bacterial strains superinfecting skin wounds. FUNDING: World Health Organization Regional Office for Africa, Ministry of Health. Small-scale inland capture fisheries provide an important source of nutritious food, employment and income to millions of people in developing countries, particularly in rural environments where limited alternatives exist. However, the sector is one of most under-valued fisheries sectors and is increasingly experiencing environmental change. This study adopts a Sustainable Livelihoods Approach and investigates how important a fluctuating inland fishery is to livelihoods, and how local perceptions on challenges corresponds to global evidence. Through an innovative participatory method; photovoice, the lived experiences and perceptions of fishers are depicted. The findings illuminate the valuable role of the sector to food and nutrition security and the complex nexus with vulnerability to climate change. The study responds to the call for more local level assessments of the impacts of climate change on inland fisheries in data-limited environments, and the value of the sector in underpinning the Sustainable Development Goals. 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. Exposure to drought is on the increase, also in sub-Saharan Africa. Even so, little attention has been paid to what supports youth resilience to the stressors associated with drought. In response, this article reports a secondary analysis of qualitative data generated in a phenomenological study with 25 South African adolescents (average age 15.6; majority Sepedi-speaking) from a drought-impacted and structurally disadvantaged community. The thematic findings show the importance of personal, relational, and structural resources that fit with youths’ sociocultural context. Essentially, proactive collaboration between adolescents and their social ecologies is necessary to co-advance socially just responses to the challenges associated with drought. Gender-sensitive and gender-responsive approaches are important to increase adaptive capacity in a changing climate given the gendered nature of exposure levels to climate shocks. Nonetheless, knowledge and perception of the public to climate change influence behavioural intention to adapt. While literature is replete with public perception and adaptation strategies to climate change, there is a dearth of information exploring the influence of gender on climate change knowledge. This paper employs quantitative and qualitative data to examine the influence of gender on knowledge in climate trends in Beitbridge Rural District, Zimbabwe, using questionnaire surveys. This survey tool consisted of demographic questions on gender and other variables. Our results indicate that compared to women, actual knowledge of trends in selected variables of climate change was higher among men. Furthermore, male respondents had higher self-evaluated knowledge on climate trends compared to female participants. We recommend gender disaggregated data in the vulnerability and adaptation assessments and the education, training and awareness sections of the National Communications to the United Nations Convention on Climate Change. BACKGROUND: In the Republic of Congo, hot temperature and seasons distortions observed may impact the development of malaria parasites. We investigate the variation of malaria cases, parasite density and the multiplicity of Plasmodium falciparum infection throughout the year in Brazzaville. METHODS: From May 2015 to May 2016, suspected patients with uncomplicated malaria were enrolled at the Hôpital de Mfilou, CSI « Maman Mboualé», and the Laboratoire National de Santé Publique. For each patient, thick blood was examined and parasite density was calculated. After DNA isolation, MSP1 and MSP2 genes were genotyped. RESULTS: A total of 416, 259 and 131 patients with suspected malaria were enrolled at the CSI «Maman Mboualé», Hôpital de Mfilou and the Laboratoire National de Santé Publique respectively. Proportion of malaria cases and geometric mean parasite density were higher at the CSI «Maman Mboualé» compared to over sites (P-value <0.001). However the multiplicity of infection was higher at the Hôpital de Mfilou (P-value <0.001). At the Laboratoire National de Santé Publique, malaria cases and multiplicity of infection were not influenced by different seasons. However, variation of the mean parasite density was statistically significant (P-value <0.01). Higher proportions of malaria cases were found at the end of main rainy season either the beginning of the main dry season at the Hôpital de Mfilou and the CSI «Maman Mboualé»; while, lowest proportions were observed in September and January and in September and March respectively. Higher mean parasite densities were found at the end of rainy seasons with persistence at the beginning of dry seasons. The lowest mean parasite densities were found during dry seasons, with persistence at the beginning of rainy seasons. Fluctuation of the multiplicity of infection throughout the year was observed without significance between seasons. CONCLUSION: The current study suggests that malaria transmission is still variable between the north and south parts of Brazzaville. Seasonal fluctuations of malaria cases and mean parasite densities were observed with some extension to different seasons. Thus, both meteorological and entomological studies are needed to update the season's periods as well as malaria transmission intensity in Brazzaville.
INTRODUCTION: To investigate total annual precipitation, precipitation anomaly and aridity index in relation to linear growth in children under 5 in Uganda and quantify the mediating role of crop yield. METHODS: We analysed data of 5219 children under 5 years of age who participated in the 2016 Uganda Demographic and Health Survey. Annual crop yield in kilograms per hectare for 42 crops at a 0.1° (~10 km at the equator) spatial resolution square grid was obtained from the International Food Policy Research Institute. Normalised rainfall anomaly and total precipitation were derived from the African Rainfall Estimation Algorithm Version 2 product. Linear regression models were used to associate total annual precipitation and anomalies with height-for-age z-scores and to explore the mediating role of crop yield qualitatively. The intervening effects were quantitatively estimated by causal mediation models. RESULTS: Twenty-nine per cent of children were stunted (95% CI 28% to 31%). After adjusting for major covariates, higher total annual precipitation was significantly associated with increasing height-for-age z-scores. At the mean, an increase of 1 standard deviation in local annual rainfall was associated with a 0.07-point higher z-score. Aridity index and precipitation anomaly were not associated with height-for-age z scores in altitude-adjusted models. Crop yields of nuts, seeds, cereals and pulses were significant mediating factors. For instance, 38% of the association between total annual precipitation with height-for-age z-scores can be attributed to the yield of sesame seeds. CONCLUSIONS: Higher total annual precipitation at the village-level was significantly associated with higher height-for-age z-scores among children in Uganda. This association can be partially explained by higher crop yield, especially from seeds and nuts. This study suggests that more attention should be paid to villages with lower annual rainfall amounts to improve water availability for agriculture. In Somalia, challenges related to energy access is influenced by both weather and climate extremes and associated conflict. The objective of this article is to gain an improved understanding of these risks and challenges, which are faced by the most vulnerable populations in the country. In particular, cooking energy-related challenges faced by households affected by weather and climate extremes and conflicts include protection risks, malnutrition, health risks, environmental degradation and heightened tension and conflict between social groups. Interventions to address these issues should focus on both fuel supply and fuel demand as well as on improving the livelihoods of affected populations. In the aftermath of an extreme weather event it is recommended that assessments of the energy needs of all affected populations, including both hosts and Internally Displaced People (IDPs), be conducted. Post-disaster support should include the promotion of energy-efficient technologies for cooking as well as alternative sources of fuel where available, including non-wood based renewable energy. The implementation of a field inventory to assess the status of natural resources in areas vulnerable to climate impacts could help to determine woody biomass trends and enable the development of ecosystem restoration plans. These could include provisions for the establishment of woodlots and agro-forestry, thus building resilience to environmental degradation while maintaining woody biomass resources in and around displacement camps. Interventions should also be designed jointly with partners, and activities should be conflict-sensitive to ensure an enhanced state of resiliency and preparedness among vulnerable populations. Low-cost houses make up the majority of the homes in townships (racially segregated areas which are usually underdeveloped) in South Africa and there has been limited research on the indoor temperatures experienced by residents of these homes. As a developing nation the price and availability of construction materials, often takes precedence over the potential thermal efficiency of the house. Occupants of low-cost houses are particularly vulnerable to climatic changes which may increase the likelihood of exposure to extreme temperatures in South Africa. This study focused on the relationship between indoor and ambient temperature in two study areas namely; Kathorus in Gauteng and Wakkerstroom in Mpumalanga. Three housing types were included in the study (government funded apartheid era houses, government funded post-apartheid houses and informal houses (shacks)). Temperature data loggers were installed in each home, in each area, from June 2017 to July 2018. Ambient temperature data were collected for the period June 2017 to July 2018. The houses studied were built with different materials which affect their thermal efficiency. The study also included semi-structured interviews where occupant’s perspectives on housing could be surveyed. Household temperatures in Kathorus and Wakkerstroom, both in the warmer and colder months fluctuated substantially throughout the day. There was an 8 °C, 9 °C and 14 °C fluctuations in daily indoor temperatures of apartheid-era, post-apartheid and shacks houses, and daily outdoor fluctuations of 5-15 °C, with higher fluctuations measured in Wakkerstroom. Generally, ambient and indoor temperatures were correlated but showed high variability. Indoor data for the winter months were less well correlated. Data showed that residents are subjected to extreme temperatures and these are expected to increase. The householder’s perceptions of thermal comfort were often not related to indoor temperature readings but to behavioural changes including the use of warm clothes and wood burning stoves. The study’s findings suggest that a majority of low-cost houses are thermally inefficient especially for those built in the post-apartheid era and shacks. With these houses showing a clear link between ambient and indoor temperature fluctuations. The occupants of these homes are poor and vulnerable to health risks which could be exacerbated by temperature fluctuations. Small changes such as installation of ceilings and use of insulation could make a large difference in these houses. Previous studies that observed the fact that Middle Palaeolithic sites mainly were concentrated in arid and semi-arid areas in Africa and Southwest Asia, concluded that climate factors determined the distribution patterns. We argue that biological factors could have been equally important. In present-day sub-Saharan Africa, mosquito borne diseases and especially falciparum malaria have a serious impact on human populations. This study was aimed to investigate the possible former effect of falciparum malaria on Middle Palaeolithic site distribution patterns and explain why ancient humans avoided the humid areas in the tropical and subtropical regions. It was found that the early human settlements situated in those regions of Africa and Southwest Asia where the potential annual development period of falciparum parasites was short in the mosquitoes, the area was not too humid, and the potential falciparum malaria incidence values were low or moderate. In the Indian Peninsula, precipitation played a less significant role in determining human settlements. The number of the months when the extrinsic development of Plasmodium falciparum parasites was possible showed the strongest structural overlap with the modelled malaria incidences according to the spatial occurrence of the Middle Paleolithic archaeological sites in the case of Africa and in Southwest Asia. In the Indian Peninsula, climatic factors showed the strongest structural overlap with the modelled malaria incidences according to the occurrence patterns of the Middle Palaeolithic archaeological sites. According to the World Health Organization, about 20 million people are infected with Hepatitis E every year. In 2015, there were 44,000 deaths due to HEV infection worldwide. Food, water and climate are key factors that affect the outbreak of Hepatitis E. This paper presents an ensemble learning model for Hepatitis E prediction by studying the correlation between historical epidemic cases of hepatitis E and environmental factors (water quality and meteorological data). Environmental factors include many features, and ones that are most relevant to HEV are selected and input into the ensemble learning model composed by Gradient Boosting Decision Tree (GBDT) and Random Forest for training and prediction. Three indicators, root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE), are used to evaluate the effectiveness of the ensemble learning model against the classical time series prediction model. It is concluded that the ensemble learning model has a better prediction effect than the classical model, and the prediction effectiveness can be improved by exploiting water quality and meteorological factors (radiation, air pressure, precipitation). Drought is a major challenge threatening agricultural productivity in uMsinga. The occurrence of drought is expected to increase in coming decades, intensifying in severity, duration and the way people are affected by drought. The objective of this study is to understand small-scale farmers’ and rural communities’ perceptions of drought, its environmental and socio-economic impacts, adaptive and mitigation measures at household level and their satisfaction with the government’s role in drought management in the community. The study utilized a combination of quantitative and qualitative research methods, in the form of questionnaires, focus groups and key informant interviews. The sample size for the research study was 180 respondents for the questionnaire component and a total of 30 respondents for the focus groups and key informant interviews. The results show that increased levels of poverty, food insecurity and increased migration were the main socio-economic impacts perceived by respondents. Water scarcity, crop failure, forest degradation and an increase in average temperatures were perceived by respondents as the main environmental impacts caused by drought in uMsinga. Respondents perceived drought as a serious threat to agricultural production and adopted various indigenous adaptive strategies. A majority of respondents adopted a reactive approach to drought management, and therefore did not adopt many mitigation measures. Globally, studies have shown that diurnal changes in weather conditions and extreme weather events have a profound effect on mortality. Here, we assessed the effect of apparent temperature on all-cause mortality and the modifying effect of sex on the apparent temperature-mortality relationship using mortality and weather data archived over an eleven-year period. An overdispersed Poisson regression and distributed lag nonlinear models were used for this analysis. With these models, we analysed the relative risk of mortality at different temperature values over a 10-day lag period. By and large, we observed a nonlinear association between mean daily apparent temperature and all-cause mortality. An assessment of different temperature values over a 10-day lag period showed an increased risk of death at the lowest apparent temperature (18°C) from lag 2 to 4 with the highest relative risk of mortality (RR?=?1.61, 95% CI: 1.2, 2.15, p value?=?0.001) occurring three days after exposure. The relative risk of death also varied between males (RR?=?0.31, 95% CI: 0.10, 0.94) and females (RR?=?4.88, 95% CI: 1.40, 16.99) by apparent temperature and lag. On the whole, males are sensitive to both temperature extremes whilst females are more vulnerable to low temperature-related mortality. Accordingly, our findings could inform efforts at reducing temperature-related mortality in this context and other settings with similar environmental and demographic characteristics. INTRODUCTION: Bacterial meningitis still constitutes an important threat in Africa. In the meningitis belt, a clear seasonal pattern in the incidence of meningococcal disease during the dry season has been previously correlated with several environmental parameters like dust and sand particles as well as the Harmattan winds. In parallel, the evidence of seasonality in meningitis dynamics and its environmental variables remain poorly studied outside the meningitis belt. This study explores several environmental factors associated with meningitis cases in the Democratic Republic of Congo (DRC), central Africa, outside the meningitis belt area. METHODS: Non-parametric Kruskal-Wallis’ tests were used to establish the difference between the different health zones, climate and vegetation types in relation to both the number of cases and attack rates for the period 2000-2018. The relationships between the number of meningitis cases for the different health zones and environmental and socio-economical parameters collected were modeled using different generalized linear (GLMs) and generalized linear mixed models (GLMMs), and different error structure in the different models, i.e., Poisson, binomial negative, zero-inflated binomial negative and more elaborated multi-hierarchical zero-inflated binomial negative models, with randomization of certain parameters or factors (health zones, vegetation and climate types). Comparing the different statistical models, the model with the smallest Akaike’s information criterion (AIC) were selected as the best ones. 515 different health zones from 26 distinct provinces were considered for the construction of the different GLM and GLMM models. RESULTS: Non-parametric bivariate statistics showed that there were more meningitis cases in urban health zones than in rural conditions (?2 = 6.910, p-value = 0.009), in areas dominated by savannah landscape than in areas with dense forest or forest in mountainous areas (?2 = 15.185, p-value = 0.001), and with no significant difference between climate types (?2 = 1.211, p-value = 0,449). Additionally, no significant difference was observed for attack rate between the two types of heath zones (?2 = 0.982, p-value = 0.322). Conversely, strong differences in attack rate values were obtained for vegetation types (?2 = 13.627, p-value = 0,001) and climate types (?2 = 13.627, p-value = 0,001). This work demonstrates that, all other parameters kept constant, an urban health zone located at high latitude and longitude eastwards, located at low-altitude like in valley ecosystems predominantly covered by savannah biome, with a humid tropical climate are at higher risk for the development of meningitis. In addition, the regions with mean range temperature and a population with a low index of economic well-being (IEW) constitute the perfect conditions for the development of meningitis in DRC. CONCLUSION: In a context of global environmental change, particularly climate change, our findings tend to show that an interplay of different environmental and socio-economic drivers are important to consider in the epidemiology of bacterial meningitis epidemics in DRC. This information is important to help improving meningitis control strategies in a large country located outside of the so-called meningitis belt. Yellow Fever (YF) is an arbovirus endemic in tropical regions of South America and Africa and it is estimated to cause 78,000 deaths a year in Africa alone. Climate change may have substantial effects on the transmission of YF and we present the first analysis of the potential impact on disease burden. We extend an existing model of YF transmission to account for rainfall and a temperature suitability index and project transmission intensity across the African endemic region in the context of four climate change scenarios. We use these transmission projections to assess the change in burden in 2050 and 2070. We find disease burden changes heterogeneously across the region. In the least severe scenario, we find a 93.0%[95%CI(92.7, 93.2%)] chance that annual deaths will increase in 2050. This change in epidemiology will complicate future control efforts. Thus, we may need to consider the effect of changing climatic variables on future intervention strategies. Climate change and air pollution are two independent risk factors to cardiovascular diseases (CVD). Few studies investigated their interaction and potential effect modification of one another in developing countries. Individual level CVD hospital admission (ICD10: I00-I99) data for 1 January 2011 to 31 October 2016 were obtained from seven private hospitals in Cape Town. NO(2), SO(2), PM(10), temperature and relative humidity data were obtained from the South African Weather Services and the City of Cape Town. A case-crossover epidemiological study design and conditional logistic regression model were applied. Various cut-off values were applied to classify cold and warm days. In total, 54,818 CVD hospital admissions were included in the study. In general, on warm and cold days the 15-64 years old group was more at risk for CVD hospitalization with increasing air pollution levels compared to all ages combined or the ??65 years old group. Females appeared to be more at risk than males with increasing PM(10) levels. In contrast, males were more vulnerable to the effects of NO(2) and SO(2) than females. The study showed the modification effect of temperature on air pollution associated with CVD hospital admissions. The consideration of such interaction will help in policy making and public health interventions dealing with climate change-related health risks. This paper examines the relationship between weather conditions and child nutrition in Ethiopia. We link data from four rounds of the Ethiopia Demographic and Health Survey to high-resolution climate data to measure exposure to rainfall and temperature in utero and during early life. We then estimate a set of multivariate regression models to understand how weather conditions impact child stunting, an indicator of sustained early life undernutrition. We find that greater rainfall during the rainy seasons in early life is associated with greater height for age. In addition, higher temperatures in utero, particularly during the first and third trimesters, and more rainfall during the third trimester, are positively associated with severe stunting, though stunting decreases with temperature in early life. We find potential evidence for a number of pathways underlying the weather-child nutrition relationship including agricultural livelihoods, heat stress, infectious disease transmission, and women’s time use during pregnancy. These findings illuminate the complex pathways through which climate change may influence child health and should motivate additional research focused on identifying the causal mechanisms underlying these links. BACKGROUND: Between 2014 and 2017, successive cholera epidemics occurred in South Sudan within the context of civil war, population displacement, flooding, and drought. We aim to describe the spatiotemporal and molecular features of the three distinct epidemic waves and explore the role of vaccination campaigns, precipitation, and population movement in shaping cholera spread in this complex setting. METHODS: In this descriptive epidemiological study, we analysed cholera linelist data to describe the spatiotemporal progression of the epidemics. We placed whole-genome sequence data from pandemic Vibrio cholerae collected throughout these epidemics into the global phylogenetic context. Using whole-genome sequence data in combination with other molecular attributes, we characterise the relatedness of strains circulating in each wave and the region. We investigated the association of rainfall and the instantaneous basic reproduction number using distributed lag non-linear models, compared county-level attack rates between those with early and late reactive vaccination campaigns, and explored the consistency of the spatial patterns of displacement and suspected cholera case reports. FINDINGS: The 2014 (6389 cases) and 2015 (1818 cases) cholera epidemics in South Sudan remained spatially limited whereas the 2016-17 epidemic (20?438 cases) spread among settlements along the Nile river. Initial cases of each epidemic were reported in or around Juba soon after the start of the rainy season, but we found no evidence that rainfall modulated transmission during each epidemic. All isolates analysed had similar genotypic and phenotypic characteristics, closely related to sequences from Uganda and Democratic Republic of the Congo. Large-scale population movements between counties of South Sudan with cholera outbreaks were consistent with the spatial distribution of cases. 21 of 26 vaccination campaigns occurred during or after the county-level epidemic peak. Counties vaccinated on or after the peak incidence week had 2·2 times (95% CI 2·1-2·3) higher attack rates than those where vaccination occurred before the peak. INTERPRETATION: Pandemic V cholerae of the same clonal origin was isolated throughout the study period despite interepidemic periods of no reported cases. Although the complex emergency in South Sudan probably shaped some of the observed spatial and temporal patterns of cases, the full scope of transmission determinants remains unclear. Timely and well targeted use of vaccines can reduce the burden of cholera; however, rapid vaccine deployment in complex emergencies remains challenging. FUNDING: The Bill & Melinda Gates Foundation. BACKGROUND: As global progress to reduce malaria transmission continues, it is increasingly important to track changes in malaria incidence rather than prevalence. Risk estimates for Africa have largely underutilized available health management information systems (HMIS) data to monitor trends. This study uses national HMIS data, together with environmental and geographical data, to assess spatial-temporal patterns of malaria incidence at facility catchment level in Uganda, over a recent 5-year period. METHODS: Data reported by 3446 health facilities in Uganda, between July 2015 and September 2019, was analysed. To assess the geographic accessibility of the health facilities network, AccessMod was employed to determine a three-hour cost-distance catchment around each facility. Using confirmed malaria cases and total catchment population by facility, an ecological Bayesian conditional autoregressive spatial-temporal Poisson model was fitted to generate monthly posterior incidence rate estimates, adjusted for caregiver education, rainfall, land surface temperature, night-time light (an indicator of urbanicity), and vegetation index. RESULTS: An estimated 38.8 million (95% Credible Interval [CI]: 37.9-40.9) confirmed cases of malaria occurred over the period, with a national mean monthly incidence rate of 20.4 (95% CI: 19.9-21.5) cases per 1000, ranging from 8.9 (95% CI: 8.7-9.4) to 36.6 (95% CI: 35.7-38.5) across the study period. Strong seasonality was observed, with June-July experiencing highest peaks and February-March the lowest peaks. There was also considerable geographic heterogeneity in incidence, with health facility catchment relative risk during peak transmission months ranging from 0 to 50.5 (95% CI: 49.0-50.8) times higher than national average. Both districts and health facility catchments showed significant positive spatial autocorrelation; health facility catchments had global Moran’s I?=?0.3 (p <?0.001) and districts Moran’s I?=?0.4 (p <?0.001). Notably, significant clusters of high-risk health facility catchments were concentrated in Acholi, West Nile, Karamoja, and East Central – Busoga regions. CONCLUSION: Findings showed clear countrywide spatial-temporal patterns with clustering of malaria risk across districts and health facility catchments within high risk regions, which can facilitate targeting of interventions to those areas at highest risk. Moreover, despite high and perennial transmission, seasonality for malaria incidence highlights the potential for optimal and timely implementation of targeted interventions. Natural environmental disasters in the developing countries of West Africa are at alarming rate which necessitate the investigation of long-term trend of rainfall and temperature. Current variation, trends of temperature, and rainfall across Nigeria were investigated using parametric and non-parametric statistical tools. Meteorological data obtained from the Nigeria Meteorological Agency in Lagos, Nigeria, from 1970 to 2010 were used for this analysis. Seasonal and annual trends of maximum temperature, minimum temperature, and rainfall were carried out using Mann-Kendall and Sen’s slope methods. Long-term linear regression of these meteorological variables was analyzed across eighteen locations in the country. Spatial distribution of seasonal trends of these variables was also estimated for the four seasons in Nigeria. The result of the linear regression on temperatures and rainfall showed increasing trends in most of the locations across the country. Similarly, Mann-Kendall and Sen’s slope analysis showed a significant increasing trend in most areas across the country. Consequently, recent phenomena of environmental hazard such as an outbreak of airborne diseases and flooding leading to the collapse of buildings and various environmental disasters can be linked to the observed result. BACKGROUND: In malaria endemic areas, identifying spatio-temporal hotspots is becoming an important element of innovative control strategies targeting transmission bottlenecks. The aim of this work was to describe the spatio-temporal variation of malaria hotspots in central Senegal and to identify the meteorological, environmental, and preventive factors that influence this variation. METHODS: This study analysed the weekly incidence of malaria cases recorded from 2008 to 2012 in 575 villages of central Senegal (total population approximately 500,000) as part of a trial of seasonal malaria chemoprevention (SMC). Data on weekly rainfall and annual vegetation types were obtained for each village through remote sensing. The time series of weekly malaria incidence for the entire study area was divided into periods of high and low transmission using change-point analysis. Malaria hotspots were detected during each transmission period with the SaTScan method. The effects of rainfall, vegetation type, and SMC intervention on the spatio-temporal variation of malaria hotspots were assessed using a General Additive Mixed Model. RESULTS: The malaria incidence for the entire area varied between 0 and 115.34 cases/100,000 person weeks during the study period. During high transmission periods, the cumulative malaria incidence rate varied between 7.53 and 38.1 cases/100,000 person-weeks, and the number of hotspot villages varied between 62 and 147. During low transmission periods, the cumulative malaria incidence rate varied between 0.83 and 2.73 cases/100,000 person-weeks, and the number of hotspot villages varied between 10 and 43. Villages with SMC were less likely to be hotspots (OR?=?0.48, IC95%: 0.33-0.68). The association between rainfall and hotspot status was non-linear and depended on both vegetation type and amount of rainfall. The association between village location in the study area and hotspot status was also shown. CONCLUSION: In our study, malaria hotspots varied over space and time according to a combination of meteorological, environmental, and preventive factors. By taking into consideration the environmental and meteorological characteristics common to all hotspots, monitoring of these factors could lead targeted public health interventions at the local level. Moreover, spatial hotspots and foci of malaria persisting during LTPs need to be further addressed. TRIAL REGISTRATION: The data used in this work were obtained from a clinical trial registered on July 10, 2008 at www.clinicaltrials.gov under NCT00712374. Background: despite the increase in malaria control and elimination efforts, weather patterns and ecological factors continue to serve as important drivers of malaria transmission dynamics. This study examined the statistical relationship between weather variables and malaria incidence in Abuja, Nigeria. Methodology/Principal Findings: monthly data on malaria incidence and weather variables were collected in Abuja from the year 2000 to 2013. The analysis of count outcomes was based on generalized linear models, while Pearson correlation analysis was undertaken at the bivariate level. The results showed more malaria incidence in the months with the highest rainfall recorded (June-August). Based on the negative binomial model, every unit increase in humidity corresponds to about 1.010 (95% confidence interval (CI), 1.005-1.015) times increase in malaria cases while the odds of having malaria decreases by 5.8% for every extra unit increase in temperature: 0.942 (95% CI, 0.928-0.956). At lag 1 month, there was a significant positive effect of rainfall on malaria incidence while at lag 4, temperature and humidity had significant influences. Conclusions: malaria remains a widespread infectious disease among the local subjects in the study area. Relative humidity was identified as one of the factors that influence a malaria epidemic at lag 0 while the biggest significant influence of temperature was observed at lag 4. Therefore, emphasis should be given to vector control activities and to create public health awareness on the proper usage of intervention measures such as indoor residual sprays to reduce the epidemic especially during peak periods with suitable weather conditions. While food insecurity is a persistent public health challenge, its long-term association with depression at a national level is unknown. We investigated the spatial heterogeneity of food insecurity and its association with depression in South Africa (SA), using nationally-representative panel data from the South African National Income Dynamics Study (years 2008-2015). Geographical clusters (“hotpots”) of food insecurity were identified using Kulldorff spatial scan statistic in SaTScan. Regression models were fitted to assess association between residing in food insecure hotspot communities and depression. Surprisingly, we found food insecurity hotspots (p?
BACKGROUND: Malaria continues to be a disease of massive burden in Africa, and the public health resources targeted at surveillance, prevention, control, and intervention comprise large outlays of expense. Malaria transmission is largely constrained by the suitability of the climate for Anopheles mosquitoes and Plasmodium parasite development. Thus, as climate changes, shifts in geographic locations suitable for transmission, and differing lengths of seasons of suitability will occur, which will require changes in the types and amounts of resources. METHODS: The shifting geographic risk of malaria transmission was mapped, in context of changing seasonality (i.e. endemic to epidemic, and vice versa), and the number of people affected. A published temperature-dependent model of malaria transmission suitability was applied to continental gridded climate data for multiple future AR5 climate model projections. The resulting outcomes were aligned with programmatic needs to provide summaries at national and regional scales for the African continent. Model outcomes were combined with population projections to estimate the population at risk at three points in the future, 2030, 2050, and 2080, under two scenarios of greenhouse gas emissions (RCP4.5 and RCP8.5). RESULTS: Estimated geographic shifts in endemic and seasonal suitability for malaria transmission were observed across all future scenarios of climate change. The worst-case regional scenario (RCP8.5) of climate change predicted an additional 75.9 million people at risk from endemic (10-12 months) exposure to malaria transmission in Eastern and Southern Africa by the year 2080, with the greatest population at risk in Eastern Africa. Despite a predominance of reduction in season length, a net gain of 51.3 million additional people is predicted be put at some level of risk in Western Africa by midcentury. CONCLUSIONS: This study provides an updated view of potential malaria geographic shifts in Africa under climate change for the more recent climate model projections (AR5), and a tool for aligning findings with programmatic needs at key scales for decision-makers. In describing shifting seasonality, it was possible to capture transitions between endemic and epidemic risk areas, to facilitate the planning for interventions aimed at year-round risk versus anticipatory surveillance and rapid response to potential outbreak locations. BACKGROUND: The individual effects of biological constituents of particulate matter (PM) such as fungal spores, on lung function in children are not well known. This study investigated the seasonal short-term effect of daily variation in Alternaria and Cladosporium fungal spores on lung function in schoolchildren. METHODS: This panel study evaluated 313 schoolchildren in informal settlements of the Western Cape of South Africa, exposed to spores of two commonly encountered fungi, Alternaria and Cladosporium species. The children provided forced-expiratory volume in 1-s (FEV(1)) and peak-expiratory flow (PEF) measurements thrice daily for two consecutive school-weeks in summer and winter. Daily PM(10) levels, from a stationary ambient air quality monitor and fungal spore levels using spore traps were measured in each study area throughout the year. The effects of Alternaria and Cladosporium spores, on lung function were analysed for lag periods up to five-days, adjusting-for PM(10), other pollen exposures, study area, and other host and meteorological factors. Same-day exposure-response curves were computed for both fungal species. RESULTS: There was more variability in Alternaria spores level with noticeable peaks in summer. There were consistent lag-effects for Alternaria on PEF compared to Cladosporium, with the largest PEF deficit observed in winter (mean deficit: 13.78 L/min, 95%CI: 24.34 to -3.23 L/min) per 10spores/m(3) increase in Alternaria spores on lag day-2. Although there were no observable lag-effects for Alternaria and Cladosporium on FEV(1), same-day effects of Cladosporium spores on FEV(1) was present across both seasons. Threshold effects of Alternaria on both PEF and FEV(1) deficits were apparent at levels of 100 spores/m(3), but could not be explored for Cladosporium beyond the levels observed during the study. CONCLUSION: The study provides evidence for the independent effects of daily exposure to ambient fungal spores of Alternaria and Cladosporium on lung function deficits, more especially in winter for PEF. This study was conducted to evaluate seasonal patterns of household food insecurity, dietary diversity, and household characteristics on wasting and stunting among children in households followed for 1 year in the drought-prone areas of Sidama, Ethiopia. A cohort study design was employed. Data were collected on the pre-harvest season (March and June) and post-harvest season (September and December) of 2017. We studied 935 children aged 6 to 47 months. At four seasons over a year, we had 3,449 observations from 897 households and 82% (2,816) (95% CI: 80.3-82.9) were food in-secured households. Severe food insecurity was higher in the pre-harvest (March; food scarcity season) which was 69% as compared to 50% of September (P < .001). From 3,488 observations, 44% (1,533) (95% CI: 42.3-45.6) of children were stunted. Stunting showed seasonal variations with 38% (95% CI: 34.7-41.0) in March and 49% (95% CI: 45.8-52.5) in December. Six percent (95% CI: 5.0-6.6) of children were wasted, with higher prevalence in March (8%) as compared to 3% of September (P < .001). Moreover, household characteristics such as poverty level, education, occupation and the household food insecurity and dietary diversity were associated with subsequent wasting and stunting.
With the focus on post-disaster relief provision in Johannesburg following the 2016 floods, this article explores how South African local government and non-governmental actors conceive of compounding vulnerability and conflict within urban disaster governance. It reveals the diverse strategies employed to navigate violent conflict in the cyclical experience of disaster and reconstruction that the predominantly migrant population experiences in the Setswetla informal settlement. Rendered visible in moments of disaster and recovery are the spatial politics and multi-dimensional nature of conflict that unfold across various levels of urban governance and in the affected community and effectively construct a disaster citizenship that makes risk reduction and community cohesion impossible in the eyes of disaster managers. Based on a set of expert interviews, this research integrates conflict and disaster studies to shed light on how the conflict-disaster interface materializes, and is operationalized, in urban settings. This article is protected by copyright. All rights reserved. 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.
We combine data from the 2006 and 2011 Uganda Demographic and Health Surveys (UDHS) with rainfall data and two waves of the Ugandan National Household Survey (UNHS) to study patterns in child weight, as measured by weight-for-height z scores (WHZ), among 3492 rural children below age 5 in Uganda. We focus on rainfall as a nutrition driver along agriculture and disease pathways. We find a positive and significant association between crop yield and WHZ, but the magnitude of this association diminishes as we control for covariates, especially the use of productivity-enhancing agricultural inputs. We find diarrheal disease to have a negative and significant association with WHZ, and modifying effects of social and environmental factors along the disease pathway. Contemporaneous rainfall is associated with a lower likelihood of diarrheal disease in areas with excess rainfall and a higher likelihood of diarrheal disease in rainfall deficit areas. Our findings reinforce calls for targeted and situation-sensitive policies to promote child nutrition. Global climate change makes extreme precipitation events likely to become more frequent and intense in large parts of Africa. We study the effect of rainfall shocks on intimate partner violence in sub-Saharan Africa. The analysis shows the presence of spatial autocorrelation in rainfall shocks, which compromises the exogeneity of rainfall shocks in many applications. We correct for the autocorrelation using spatial polynomials. In particular, we use three different estimation strategies. We first use the complete cross-sectional sample to analyze whether recent droughts are correlated with respondents’ experience with intimate partner violence during the last year. We then use the nine countries with repeated surveys to construct a repeated cross-section analysis at the grid level. Finally, we use event history analysis on a time series constructed from the information provided by the abused women about when the violence first took place. We find no robust evidence that droughts increase intimate partner violence. Potential explanations are that the rainfall shocks do not affect spouses’ power, or that the slow onset of the droughts allows for a calmer response to the crisis. We contribute to the wider literature on climate and conflict as many of the mechanisms, economic and psychological, that link climate to violence apply to both intimate partner violence and organized violence. The number of dengue fever incidence and its distribution has increased considerably in recent years in Africa. However, due to inadequate research at the continental level, there is a limited understanding regarding the current and future spatial distribution of the main vector, the mosquitoAedes aegypti, and the associated dengue risk due to climate change. To fill this gap we used reported dengue fever incidences, the presence of Ae. aegypti, and bioclimatic variables in a species distribution model to assess the current and future (2050 and 2070) climatically suitable areas. High temperatures and with high moisture levels are climatically suitable for the distribution of Ae. aegypti related to dengue fever. Under the current climate scenario indicated that 15.2% of the continent is highly suitable for dengue fever outbreaks. We predict that climatically suitable areas for Ae. aegypti related to dengue fever incidences in eastern, central and western part of Africa will increase in the future and will expand further towards higher elevations. Our projections provide evidence for the changing continental threat of vector-borne diseases and can guide public health policy decisions in Africa to better prepare for and respond to future changes in dengue fever risk. BACKGROUND: Agriculture represents the mainstay of African economies and livestock products are essential to the human population’s nutritional needs. However, in many developing countries, including Ghana, livestock production fails to meet demand due to population growth and negative effects of climate change. One of the challenges to production is livestock loss affecting farmers. However, despite stressful events experienced, livestock farmers’ mental health is poorly documented. This study aims to identify the root causes of livestock losses and their influence on pastoralists’ mental health. METHODS: We conducted a mixed methods study in two districts in the Northern and Southern Belts of Ghana. Using the Depression Anxiety and Stress Scale-21 and guided interviews, we collected quantitative and qualitative data from 287 livestock farmers and 24 key-informants respectively. Mental health scores were categorized using standard guidelines. We evaluated the factors that explained variations in mental wellbeing using general linear models (??=?0.05). RESULTS: About 85% (240/287) of the livestock farmers lost cattle within 1 year. Of these, 91% lost cattle to animal diseases, 50% to theft and 27% to pasture shortages. Qualitative findings reveal that due to poor access to veterinary services, farmers treat livestock diseases themselves with drugs from unregulated sources and often sell diseased cows for meat to recover losses. Findings showed that 60% of livestock farmers had poor mental health. Of those, 72% were depressed, 66% anxious and 59% stressed. Mental wellbeing was negatively associated with the number of adverse events experienced, proportion of livestock lost to most of the major loss factors, emotional attachment to livestock and self-reported physical illnesses in farmers, but positively associated with increasing herd size [F (8,278)?=?14.18, p?
Mali aims to reach the pre-elimination stage of malaria by the next decade. This study used functional regression models to predict the incidence of malaria as a function of past meteorological patterns to better prevent and to act proactively against impending malaria outbreaks. All data were collected over a five-year period (2012-2017) from 1400 persons who sought treatment at Dangassa’s community health center. Rainfall, temperature, humidity, and wind speed variables were collected. Functional Generalized Spectral Additive Model (FGSAM), Functional Generalized Linear Model (FGLM), and Functional Generalized Kernel Additive Model (FGKAM) were used to predict malaria incidence as a function of the pattern of meteorological indicators over a continuum of the 18 weeks preceding the week of interest. Their respective outcomes were compared in terms of predictive abilities. The results showed that (1) the highest malaria incidence rate occurred in the village 10 to 12 weeks after we observed a pattern of air humidity levels >65%, combined with two or more consecutive rain episodes and a mean wind speed <1.8 m/s; (2) among the three models, the FGLM obtained the best results in terms of prediction; and (3) FGSAM was shown to be a good compromise between FGLM and FGKAM in terms of flexibility and simplicity. The models showed that some meteorological conditions may provide a basis for detection of future outbreaks of malaria. The models developed in this paper are useful for implementing preventive strategies using past meteorological and past malaria incidence.
Energy-poor households in Africa’s burgeoning urban informal settlements are especially likely to suffer from heatwaves because of thermally inefficient dwellings and lack of affordable cooling options. This study utilised a controlled experiment to assess the effectiveness of passive cooling through specially formulated paints (cool coatings) in standard informal structures. The test structures were built to simulate typical shack dwellings in South Africa’s urban informal settlements. Results showed that the mean daily maximum temperatures of the coated structure were up to 4.3 degrees C lower than those in the uncoated structure. The same cooling trend was observed for the minimum daily temperatures, which were lower by an average of 2.2 degrees C. Besides, the annual frequency of maximum temperature exceedances beyond the critical heat stroke value of 40 degrees C dropped from 19% for the uncoated structure to 1% for the coated structure. These temperature differences were found to be statistically and subjectively significant, implying that cool coatings may be effective in promoting thermal comfort and climate resilience in poor urban communities. It is recommended that governmental authorities and relevant role players invest in the production and assisted application of cool coatings in urban informal settlements. The interventions promise hope of reduced energy burden on poor households and could be implemented in parallel with ongoing efforts focused on the design and implementation of low-cost, durable and thermally comfortable houses for indigent communities. Ultimately, the endeavours could be a potential policy change to assist in expanding poor households’ access to alternative and green energy resources. INTRODUCTION: The negative effects of climate change affect community subsistence models, thus determining an increase in social conflicts, a loosening of social capital, an increase in the incidence of traumas and diseases, and a push for migration. AIM: This exploratory research compares the perception of climate change, as well as the reduction of social capital and mental health, in two groups of migrants arriving in Italy from African countries with high or extreme vulnerability to climate change. METHODS: The perception of climate change and the degree of social capital were assessed with a semi-structured interview. The psychological condition was investigated through a clinical psychological interview and tests. RESULTS: The group of migrants coming from countries with extreme exposure to climate change perceive greater vulnerability of their country and reports a greater loss of social capital. The level of education does not seem to affect the ability to perceive climate change. In the entire sample, there is a strong correlation between the perception of change and the loss of social capital, and between the loss of social capital and emotional disorders. CONCLUSIONS: The study suggests that actions to preserve the social capital of a community strongly exposed to climate change can mitigate the impact of change on mental health. The duration and intensity of future heat waves are analyzed for 53 cities in the Middle East and the North Africa (MENA) region for the 21st century under two different scenarios (RCP4.5 and RCP8.5). A consistent approach is carried out using data from 13 Regional models within the framework of the Coordinated Regional Climate Downscaling Experiment (CORDEX). By the end of the century, 80% of the most populated MENA cities are expected to be at least 50% of the days under heat wave conditions during the warm season. In addition, the mean and maximum intensity of the heat waves will also increase. Changes in the duration and intensity of heat waves have shown to be negatively correlated. Therefore, the vulnerability of the MENA cities to future heat waves was determined using a cumulative index (CI) that takes into account both duration and intensity. This CI indicates that Middle East and the eastern part of Africa will suffer the most unfavorable temperature conditions in the future. Assuming no intervention trough adaptation/mitigation strategies, these results, together with the particular properties of the MENA region, such as aridity or lack of precipitation, make it likely that the area will be affected by disease or famine. Malaria is a Plasmodium parasitic disease transmitted by infected female Anopheles mosquitoes. Climatic factors, such as temperature, humidity, rainfall, and wind, have significant effects on the incidence of most vector-borne diseases, including malaria. The mosquito behavior, life cycle, and overall fitness are affected by these climatic factors. This paper presents the results obtained from investigating the optimal control strategies for malaria in the presence of temperature variation using a temperature-dependent malaria model. The study further identified the temperature ranges in four different geographical regions of sub-Saharan Africa, suitable for mosquitoes. The optimal control strategies in the temperature suitable ranges suggest, on average, a high usage of both larvicides and adulticides followed by a moderate usage of personal protection such as bednet. The average optimal bednet usage mimics the solution profile of the mosquitoes as the mosquitoes respond to changes in temperature. Following the results from the optimal control, this study also investigates using a temperature-dependent model with insecticide-sensitive and insecticide-resistant mosquitoes the impact of insecticide-resistant mosquitoes on disease burden when temperature varies. The results obtained indicate that optimal bednet usage on average is higher when insecticide-resistant mosquitoes are present. Besides, the average bednet usage increases as temperature increases to the optimal temperature suitable for mosquitoes, and it decreases after that, a pattern similar to earlier results involving insecticide-sensitive mosquitoes. Thus, personal protection, particularly the use of bednets, should be encouraged not only at low temperatures but particularly at high temperatures when individuals avoid the use of bednets. Furthermore, control and reduction of malaria may be possible even when mosquitoes develop resistance to insecticides. Environmental water quality issues have dominated global discourse and studies over the past five decades. Significant parameters of environmental water quality include changes in biological and physical parameters. Some of the biological parameters of significance include occurrence of enteric viruses. Enteric viruses can affect both human and animal’s health by causing diseases such as gastrointestinal and respiratory infections. In this study, the relationship between the occurrence of enteric viruses with reference to adenoviruses and enteroviruses and the physical water quality characteristics was assessed from water samples collected from Lake Victoria (LV) in Kenya. In order to understand the dynamics of season driven enteric viruses’ contamination of the lake waters, we additionally analysed seasonal behavior of the lake’s catchment area in terms of rainfall effects. Physical quality parameters were measured on-site while viral analysis was carried out by molecular methods using the nested polymerase chain reaction (nPCR). From 216 samples that were analysed for viral contamination, enteric viral genomes were discovered in 18 (8.3%) of the samples. Out of half of the samples (108) collected during the rainy season, enteric viral genomes were detected in 9.26% (10) while 8 (7.41%) samples tested positive from the other half of the samples (108) collected during the dry season. There was, however, no significant correlation noted between the physical water quality characteristics and the enteric viruses’ occurrence. Neither wet season nor dry season was significantly associated with the prevalence of the viruses. In Lake Victoria waters, most of the samples had an average of physical water quality parameters that were within the range accepted by the World Health Organization (WHO) for surface waters with exemption of turbidity which was above the recommended 5 NTU as recorded from some sampling sites. Continuous and long-term surveillance of the lake water to accurately monitor the contaminants and possible correlation between chemical, physical, and biological characteristics is recommended. This would be important in continuous understanding of the hydrological characteristics changes of the lake for proper management of its quality with reference to the WHO standards. A multiple varied-sampling approach in different geographical regions during different seasons is recommended to establish the geographical distribution and relatedness to seasonal distribution patterns of the viruses. The data generated from this study will be useful in providing a basis for assessment of seasonally driven fecal pollution load of the lake and enteric virus contamination for proper management of the sanitary situation around the lake. Thermal comfort plays a main role in encouraging people to use outdoor spaces, specifically in hot arid and humid climates. The reconciliation of climatic aspects during the urban design phase is limited in implementation, due to the need for multidisciplinary collaboration between desperate scientific fields of climatology, urban planning, and urban environmental modelling. This paper aims to create an integrated interface between the microclimate, outdoor thermal comfort, and design guidelines. The investigation combines subjective and objective approaches, including on-site field measurements, a structured questionnaire using the seven-point American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE 55) thermal sensation votes, and a correlation study of these votes and the microclimatic parameters. Pedestrian thermal comfort was then examined under six shading scenarios, addressing the form and opening of shading devices using computational fluid dynamics. Modelling is based on four dependent variables: wind velocity, ventilation flow rate, air temperature, and the physiological equivalent temperature (PET) index. Findings indicate that the form and location of apertures of the shading devices were the dominant factors in achieving thermal comfort on the urban scale, and led to a reduction in air temperature and a physiological equivalent temperature of 2.3-2.4 degrees C. Subjective votes indicate that people who live in hot arid climates have a wider range of adaptation and tolerance to local climatic conditions Accordingly, a psychometric chart, for the case study outdoor thermal comfort was developed. In this study, we examine the concepts of spatial dependence and spatial heterogeneity in the effect of macro-level and micro-level factors on stunting among children aged under five in Uganda. We conducted a cross-sectional analysis of 3624 Ugandan children aged under five, using data from the 2016 Ugandan Demographic and Health Survey. Multilevel mixed-effect analysis, spatial regression methods and multi-scale geographically weight regression (MGWR) analysis were employed to examine the association between our predictors and stunting as well as to analyse spatial dependence and variability in the association. Approximately 28% of children were stunted. In the multilevel analysis, the effect of drought, diurnal temperature and livestock per km(2) on stunting was modified by child, parent and household factors. Likewise, the contextual factors had a modifiable effect on the association between child’s sex, mother’s education and stunting. The results of the spatial regression models indicate a significant spatial error dependence in the residuals. The MGWR suggests rainfall and diurnal temperature had spatial varying associations with stunting. The spatial heterogeneity of rainfall and diurnal temperature as predictors of stunting suggest some areas in Uganda might be more sensitive to variability in these climatic conditions in relation to stunting than others. Pastoralism is widely practiced in arid lands and is the primary means of livelihood for approximately 268 million people across Africa. Environmental, interpersonal, and transactional variables such as vegetation and water availability, conflict, ethnic tensions, and private/public land delineation influence the movements of these populations. The challenges of climate change and conflict are widely felt by nomadic pastoralists in Somalia, where resources are scarce, natural disasters are increasingly common, and protracted conflict has plagued communities for decades. Bereft of real-time data, researchers and programmatic personnel often turn to post hoc analysis to understand the interaction between climate, conflict, and migration, and design programs to address the needs of nomadic pastoralists. By designing an Agent-Based Model to simulate the movement of nomadic pastoralists based on typologically-diverse, historical data of environmental, interpersonal, and transactional variables in Somaliland and Puntland between 2008 and 2018, this study explores how pastoralists respond to changing environments. Through subsequent application of spatial analysis such as choropleth maps, kernel density mapping, and standard deviational ellipses, we characterize the resultant pastoralist population distribution in response to these variables. Outcomes demonstrate a large scale spatio-temporal trend of pastoralists migrating to the southeast of the study area with high density areas in the south of Nugaal, the northwest of Sool, and along the Ethiopian border. While minimal inter-seasonal variability is seen, multiple analyses support the consolidation of pastoralists to specifically favorable regions. Exploration of the large-scale population, climate, and conflict trends allows for cogent narratives and associative hypotheses regarding the pastoralist migration during the study period. While this model produces compelling associations between pastoralist movements and terrestrial and conflict variables, it relies heavily on assumptions and incomplete data that are not necessarily representative of realities on the ground. Given the paucity of data regarding pastoralist decision-making and migration, validation remains challenging. A deterministic mathematical model for brucellosis that incorporates seasonality on direct and indirect transmission parameters for domestic ruminants, wild animals, humans, and the environment was formulated and analyzed in this paper. Both analytical and numerical simulations are presented. From this study, the findings show that variations in seasonal weather have the great impact on the transmission dynamics of brucellosis in humans, livestock, and wild animals. Thus, in order for the disease to be controlled or eliminated, measures should be timely implemented upon the fluctuation in the transmission of the disease. OBJECTIVES: Modelling and assessing the loss of geographical accessibility is key to support disaster response and rehabilitation of the healthcare system. The aim of this study was therefore to estimate postdisaster travel times to functional health facilities and analyse losses in accessibility coverage after Cyclones Idai and Kenneth in Mozambique in 2019. SETTING: We modelled travel time of vulnerable population to the nearest functional health facility in two cyclone-affected regions in Mozambique. Modelling was done using AccessMod V.5.6.30, where roads, rivers, lakes, flood extent, topography and land cover datasets were overlaid with health facility coordinates and high-resolution population data to obtain accessibility coverage estimates under different travel scenarios. OUTCOME MEASURES: Travel time to functional health facilities and accessibility coverage estimates were used to identify spatial differences between predisaster and postdisaster geographical accessibility. RESULTS: We found that accessibility coverage decreased in the cyclone-affected districts, as a result of reduced travel speeds, barriers to movement, road constraints and non-functional health facilities. In Idai-affected districts, accessibility coverage decreased from 78.8% to 52.5%, implying that 136?941 children under 5 years of age were no longer able to reach the nearest facility within 2?hours travel time. In Kenneth-affected districts, accessibility coverage decreased from 82.2% to 71.5%, corresponding to 14?330 children under 5 years of age having to travel >2?hours to reach the nearest facility. Damage to transport networks and reduced travel speeds resulted in the most substantial accessibility coverage losses in both Idai-affected and Kenneth-affected districts. CONCLUSIONS: Postdisaster accessibility modelling can increase our understanding of spatial differences in geographical access to care in the direct aftermath of a disaster and can inform targeting and prioritisation of limited resources. Our results reflect opportunities for integrating accessibility modelling in early disaster response, and to inform discussions on health system recovery, mitigation and preparedness. BACKGROUND: Climate change is predicted to impact the transmission dynamics of vector-borne diseases. Tsetse flies (Glossina) transmit species of Trypanosoma that cause human and animal African trypanosomiasis. A previous modelling study showed that temperature increases between 1990 and 2017 can explain the observed decline in abundance of tsetse at a single site in the Mana Pools National Park of Zimbabwe. Here, we apply a mechanistic model of tsetse population dynamics to predict how increases in temperature may have changed the distribution and relative abundance of Glossina pallidipes across northern Zimbabwe. METHODS: Local weather station temperature measurements were previously used to fit the mechanistic model to longitudinal G. pallidipes catch data. To extend the use of the model, we converted MODIS land surface temperature to air temperature, compared the converted temperatures with available weather station data to confirm they aligned, and then re-fitted the mechanistic model using G. pallidipes catch data and air temperature estimates. We projected this fitted model across northern Zimbabwe, using simulations at a 1 km × 1 km spatial resolution, between 2000 to 2016. RESULTS: We produced estimates of relative changes in G. pallidipes mortality, larviposition, emergence rates and abundance, for northern Zimbabwe. Our model predicts decreasing tsetse populations within low elevation areas in response to increasing temperature trends during 2000-2016. Conversely, we show that high elevation areas (> 1000 m above sea level), previously considered too cold to sustain tsetse, may now be climatically suitable. CONCLUSIONS: To our knowledge, the results of this research represent the first regional-scale assessment of temperature related tsetse population dynamics, and the first high spatial-resolution estimates of this metric for northern Zimbabwe. Our results suggest that tsetse abundance may have declined across much of the Zambezi Valley in response to changing climatic conditions during the study period. Future research including empirical studies is planned to improve model accuracy and validate predictions for other field sites in Zimbabwe. It is often difficult to define the relationship and the influence of climate on the occurrence and distribution of disease. To examine this issue, the effects of climate indices on the distributions of malaria and meningitis in Nigeria were assessed over space and time. The main purpose of the study was to evaluate the relationships between climatic variables and the prevalence of malaria and meningitis, and develop an early warning system for predicting the prevalence of malaria and meningitis as the climate varies. An early warning system was developed to predetermine the months in a year that people are vulnerable to malaria and meningitis. The results revealed a significant positive relationship between rainfall and malaria, especially during the wet season with correlation coefficient R-2 >= 60.0 in almost all the ecological zones. In the Sahel, Sudan and Guinea, there appears to be a strong relationship between temperature and meningitis with R-2 > 60.0. In all, the results further reveal that temperatures and aerosols have a strong relationship with meningitis. The assessment of these initial data seems to support the finding that the occurrence of meningitis is higher in the northern region, especially the Sahel and Sudan. In contrast, malaria occurrence is higher in the southern part of the study area. We suggest that a thorough investigation of climate parameters is critical for the reallocation of clinical resources and infrastructures in economically underprivileged regions. BACKGROUND: Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30?years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda. METHODS: Times-series data on malaria cases (2011-2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period. RESULTS: Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases. CONCLUSIONS: Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones. Climate change is a serious challenge to human existence. It threatens efforts towards the attainment of sustainable development goals and aggravates conditions that lead to health inequities and inequalities for vulnerable populations. The study aimed to investigate knowledge and adaptation to climate change among people in Ghana. A nationally representative survey of Ghanaian adults (N?=?674) was conducted from August 1, 2019, to December 31, 2019. Results showed that 43.9% of the respondents understood the meaning of climate change. Respondents perceived the causes of climate change to include burning of fossil fuel, deforestation, natural events such as ocean currents, carbon emission from vehicles and industries, agricultural emissions of nitrous oxide from fertilizers, and an act of God. About 53.1% and 41% of the male and female respondents, respectively, had an encounter with climate change-induced natural disasters. About two out of five respondents (43%) were either afraid or confused about climate change. Distilled or maintained public drainage from waste (30.2%) and clearing drains (25.6%) was the leading adaptation strategies towards climate change-induced natural disasters. Training (30.1%), national radio (27.7%), and television (19.1%) were the preferred leading methods for receipt of global warming information. These findings provide useful insights for policy directions. The government of Ghana and other stakeholders should develop a communication strategy to increase and sustain publicity and education on climate change to the citizenry. Lassa fever (LF) is increasingly recognised as an important rodent-borne viral haemorrhagic fever presenting a severe public health threat to sub-Saharan West Africa. In 2017-18, LF caused an unprecedented epidemic in Nigeria and the situation was worsening in 2018-19. This work aims to study the epidemiological features of epidemics in different Nigerian regions and quantify the association between reproduction number (R) and state rainfall. We quantify the infectivity of LF by the reproduction numbers estimated from four different growth models: the Richards, three-parameter logistic, Gompertz and Weibull growth models. LF surveillance data are used to fit the growth models and estimate the Rs and epidemic turning points (?) in different regions at different time periods. Cochran’s Q test is further applied to test the spatial heterogeneity of the LF epidemics. A linear random-effect regression model is adopted to quantify the association between R and state rainfall with various lag terms. Our estimated Rs for 2017-18 (1.33 with 95% CI 1.29-1.37) was significantly higher than those for 2016-17 (1.23 with 95% CI: (1.22, 1.24)) and 2018-19 (ranged from 1.08 to 1.36). We report spatial heterogeneity in the Rs for epidemics in different Nigerian regions. We find that a one-unit (mm) increase in average monthly rainfall over the past 7 months could cause a 0.62% (95% CI 0.20%-1.05%)) rise in R. There is significant spatial heterogeneity in the LF epidemics in different Nigerian regions. We report clear evidence of rainfall impacts on LF epidemics in Nigeria and quantify the impact. Pastoralist communities all over Africa have been facing a variety of social and economic problems, as well as climate risks and hazards for many years. They have also been suffering from climate change and extreme events, along with a variety of weather and climate threats, which pose many challenges to herders. On the one hand, pastoralist communities have little influence on policy decisions; however, on the other hand, they suffer to a significant extent from such policies, which limit their options for sustainable development and poverty alleviation. Also, the socio-cultural legacy of herders, and their role in food security and provision of ecosystem services, as well as their efforts towards climate change adaptation, are little documented, particularly in Eastern and Southern African countries. There is a perceived need for international studies on the risks and impacts of climate change and extreme events on the sustainability of pastoralist communities in Africa, especially in eastern and southern Africa. Based on the need to address this research gap, this paper describes the climate change risks and challenges that climate threats pose to the sustainability and livelihoods of pastoralist communities in eastern and southern Africa. Also, it discusses the extent to which such problems affect their wellbeing and income. Additionally, the paper reports on the socioeconomic vulnerability indices at country-level; identifies specific problems pastoralists face, and a variety of climate adaptation strategies to extreme events through field survey among pastoralist communities in a sample of five countries, namely Ethiopia, Kenya, Malawi, Uganda, and Zimbabwe. The study has shown that the long-term sustainability of the livelihoods of pastoral communities is currently endangered by climate change and the risks and hazards it brings about, which may worsen poverty among this social group. The study suggests that a more systematic and structured approach is needed when assessing the climate vulnerability of individual pastoral communities, since this may help in designing suitable disaster risk reduction strategies. Moreover, the paper shows that it is also necessary to understand better the socio-ecological systems (SES) of the various communities, and how their livelihoods are influenced by the changing conditions imposed by a changing climate. Measles is a major cause of child mortality in sub-Saharan Africa. Current immunization strategies achieve low coverage in areas where transmission drivers differ substantially from those in high-income countries. A better understanding of measles transmission in areas with measles persistence will increase vaccination coverage and reduce ongoing transmission. We analysed weekly reported measles cases at the district level in Niger from 1995 to 2004 to identify underlying transmission mechanisms. We identified dominant periodicities and the associated spatial clustering patterns. We also investigated associations between reported measles cases and environmental drivers associated with human activities, particularly rainfall. The annual and 2-3-year periodicities dominated the reporting data spectrum. The annual periodicity was strong with contiguous spatial clustering, consistent with the latitudinal gradient of population density, and stable over time. The 2-3-year periodicities were weaker, unstable over time and had spatially fragmented clustering. The rainy season was associated with a lower risk of measles case reporting. The annual periodicity likely reflects seasonal agricultural labour migration, whereas the 2-3-year periodicity potentially results from multiple mechanisms such as reintroductions and vaccine coverage heterogeneity. Our findings suggest that improving vaccine coverage in seasonally mobile populations could reduce strong measles seasonality in Niger and across similar settings. Estimating the epidemic potential of vector-borne diseases, along with the relative contribution of underlying mechanisms, is crucial for animal and human health worldwide. In West African Sahel, several outbreaks of Rift Valley fever (RVF) have occurred over the last decades, but uncertainty remains about the conditions necessary to trigger these outbreaks. We use the basic reproduction number (R(0)) as a measure of RVF epidemic potential in northern Senegal, and map its value in two distinct ecosystems, namely the Ferlo and the Senegal River delta and valley. We consider three consecutive rainy seasons (July-November 2014, 2015 and 2016) and account for several vector and animal species. We parametrize our model with estimates of Aedes vexans arabiensis, Culex poicilipes, Culex tritaeniorhynchus, cattle, sheep and goat abundances. The impact of RVF virus introduction is assessed every week over northern Senegal. We highlight September as the period of highest epidemic potential in northern Senegal, resulting from distinct dynamics in the two study areas. Spatially, in the seasonal environment of the Ferlo, we observe that high-risk locations vary between years. We show that decreased vector densities do not greatly reduce R(0) and that cattle immunity has a greater impact on reducing transmission than small ruminant immunity. The host preferences of vectors and the temperature-dependent time interval between their blood meals are crucial parameters needing further biological investigations. BACKGROUND: The effects of food insecurity linked to climate change will be exacerbated in subsistence communities that are dependent upon food systems for their livelihoods and sustenance. Place-and community-based forms of surveillance are important for growing an equitable evidence base that integrates climate, food, and health information as well as informs our understanding of how climate change impacts health through local and Indigenous subsistence food systems. METHODS: We present a case-study from southwestern Uganda with Batwa and Bakiga subsistence communities in Kanungu District. We conducted 22 key informant interviews to map what forms of monitoring and knowledge exist about health and subsistence food systems as they relate to seasonal variability. A participatory mapping exercise accompanied key informant interviews to identify who holds knowledge about health and subsistence food systems. Social network theory and analysis methods were used to explore how information flows between knowledge holders as well as the power and agency that is involved in knowledge production and exchange processes. RESULTS: This research maps existing networks of trusted relationships that are already used for integrating diverse knowledges, information, and administrative action. Narratives reveal inventories of ongoing and repeated cycles of observations, interpretations, evaluations, and adjustments that make up existing health and subsistence food monitoring and response. These networks of local health and subsistence food systems were not supported by distinct systems of climate and meteorological information. Our findings demonstrate how integrating surveillance systems is not just about what types of information we monitor, but also who and how knowledges are connected through existing networks of monitoring and response. CONCLUSION: Applying conventional approaches to surveillance, without deliberate consideration of the broader contextual and relational processes, can lead to the re-marginalization of peoples and the reproduction of inequalities in power between groups of people. We anticipate that our findings can be used to inform the initiation of a place-based integrated climate-food-health surveillance system in Kanungu District as well as other contexts with a rich diversity of knowledges and existing forms of monitoring and response. OBJECTIVE: The weather-related conditions change the ecosystem and pose a threat to social, economic and environmental development. It creates unprecedented or unanticipated human health problems in various places or times of the year. Africa is the world’s second largest and most populous continent and has relatively changeable weather conditions. The present study aims to investigate the impact of weather conditions, heat and humidity on the incidence and mortality of COVID-19 pandemic in various regions of Africa. MATERIALS AND METHODS: In this study, 16 highly populated countries from North, South, East, West, and Central African regions were selected. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization. The daily temperature and humidity figures were obtained from the weather web “Time and Date”. The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of “Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)” in the African region, from Feb 14 to August 2, 2020. RESULTS: In African countries, the daily basis mean temperature from Feb 14, 2020 to August 2, 2020 was 26.16±0.12°C, and humidity was 57.41±0.38%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.192, p<0.001) and deaths (r= -0.213, p<0.001). Similarly, a significant inverse correlation was found between temperature and the number of cases (r= -0.25, p<0.001) and deaths (r=-0.18, p<0.001). Furthermore, the regression results showed that with 1% increase in humidity the number of cases and deaths was significantly reduced by 3.6% and 3.7% respectively. Congruently, with 1°C increase in temperature, the number of cases and deaths was also significantly reduced by 15.1% and 10.5%, respectively. CONCLUSIONS: Increase in relative humidity and temperature was associated with a decrease in the number of daily cases and deaths due to COVID-19 pandemic in various African countries. The study findings on weather events and COVID-19 pandemic have an impact at African regional levels to project the incidence and mortality trends with regional weather events which will enhance public health readiness and assist in planning to fight against this pandemic.
Continental-scale models of malaria climate suitability typically couple well-established temperature-response models with basic estimates of vector habitat availability using rainfall as a proxy. Here we show that across continental Africa, the estimated geographic range of climatic suitability for malaria transmission is more sensitive to the precipitation threshold than the thermal response curve applied. To address this problem we use downscaled daily climate predictions from seven GCMs to run a continental-scale hydrological model for a process-based representation of mosquito breeding habitat availability. A more complex pattern of malaria suitability emerges as water is routed through drainage networks and river corridors serve as year-round transmission foci. The estimated hydro-climatically suitable area for stable malaria transmission is smaller than previous models suggest and shows only a very small increase in state-of-the-art future climate scenarios. However, bigger geographical shifts are observed than with most rainfall threshold models and the pattern of that shift is very different when using a hydrological model to estimate surface water availability for vector breeding. Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas. Background: Malaria remains a global challenge with approximately 228 million cases and 405,000 malaria-related deaths reported in 2018 alone; 93% of which were in sub-Saharan Africa. Aware of the critical role than environmental factors play in malaria transmission, this study aimed at assessing the relationship between precipitation, temperature, and clinical malaria cases in East Africa and how the relationship may change under 1.5 C and 2.0 C global warming levels (hereinafter GWL1.5 and GWL2.0, respectively). Methods: A correlation analysis was done to establish the current relationship between annual precipitation, mean temperature, and clinical malaria cases. Differences between annual precipitation and mean temperature value projections for periods 2008-2037 and 2023-2052 (corresponding to GWL1.5 and GWL2.0, respectively), relative to the control period (1977-2005), were computed to determine how malaria transmission may change under the two global warming scenarios. Results: A predominantly positive/negative correlation between clinical malaria cases and temperature/precipitation was observed. Relative to the control period, no major significant changes in precipitation were shown in both warming scenarios. However, an increase in temperature of between 0.5 C and 1.5 C and 1.0 C to 2.0 C under GWL1.5 and GWL2.0, respectively, was recorded. Hence, more areas in East Africa are likely to be exposed to temperature thresholds favourable for increased malaria vector abundance and, hence, potentially intensify malaria transmission in the region. Conclusions: GWL1.5 and GWL2.0 scenarios are likely to intensify malaria transmission in East Africa. Ongoing interventions should, therefore, be intensified to sustain the gains made towards malaria elimination in East Africa in a warming climate. BACKGROUND: Infection by hepatitis E virus (HEV) can cause a high burden of morbidity and mortality in countries with poor access to clean water and sanitation. Our study aimed to investigate the situation of HEV infections in the Central African Republic (CAR). METHODS: A retrospective analysis of the blood samples and notification forms collected through the national yellow fever (YF) surveillance program, but for which a diagnosis of YF was discarded, was carried out using an anti-HEV IgM ELISA and a HEV-specific RT-PCR. RESULTS: Of 2883 YF-negative samples collected between January 2008 and December 2012, 745 (~?26%) tested positive by at least either of the 2 tests used to confirm HEV cases. The results revealed that the CAR was hit by a large HEV outbreak in 2008 and 2009. The results also showed a clear seasonal pattern with correlation between HEV incidence and rainfall in Bangui. A phylogenetic analysis showed that the circulating strains belonged to genotypes 1e and 2b. CONCLUSIONS: Overall, this study provides further evidences that HEV can be a significant cause of acute febrile jaundice, particularly among adults during rainy season or flood, in a country from Sub-Saharan Africa. Somalia, Kenya and Ethiopia, situated in the Horn of Africa, are highly vulnerable to climate change, which manifests itself through increasing temperatures, erratic rains and prolonged droughts. Millions of people have to flee from droughts or floods either as cross-border refugees or as internally displaced persons (IDPs). The aim of this study was to identify knowledge status and gaps regarding public health consequences of large-scale displacement in these countries. After a scoping review, we conducted qualitative in-depth interviews during 2018 with 39 stakeholders from different disciplines and agencies in these three countries. A validation workshop was held with a selection of 13 interviewees and four project partners. Malnutrition and a lack of vaccination of displaced people are well-known challenges, while mental health problems and gender-based violence (GBV) are less visible to stakeholders. In particular, the needs of IDPs are not well understood. The treatment of mental health and GBV is insufficient, and IDPs have inadequate access to essential health services in refugee camps. Needs assessment and program evaluations with a patients’ perspective are either lacking or inadequate in most situations. The Horn of Africa is facing chronic food insecurity, poor population health and mass displacement. IDPs are an underserved group, and mental health services are lacking. A development approach is necessary that moves beyond emergency responses to the building of long-term resilience, the provision of livelihood support and protection to reduce displacement by droughts. There is an urgent need to map the geographic location of climate change risks and vulnerability, especially for cities in sub-Saharan Africa, which are experiencing the greatest urban development challenges and vulnerability to climate change impacts. The aim of this study is to investigate current and projected future heat risk, expressed as a heat stress exposure index using high-resolution climate change projections, and a social vulnerability index, to identify areas of potential future heat stress risk in the Durban (eThekwini) metropolitan area, South Africa. Additionally, this is the first study to use high-resolution downscaled climate change projections under Representative Concentration (RCP) 8.5, to construct the heat exposure index using apparent temperature and increases in minimum temperature and a social vulnerability index, using demographic and socio-economic census and land use data to, derived from principal component analysis (PCA) to spatially characterize heat stress within a South African city. Results show that while heat stress is not a current concern, it is projected to increase and become a future concern, mainly as a function of social vulnerability due to household demographic and infrastructural characteristics, and will be experienced in both the rural and inner-city areas of the metro. This study contributes a heat risk framework to identify locations for specific research and adaptation activities on heat stress risk and for urban planning in sub-Saharan African cities, which are characterized by both rural and urban contexts, to address climate change adaptation targeting and priority setting. BACKGROUND: Malaria is a mosquito-borne infectious disease known to cause significant numbers of morbidities and mortalities across the globe. In Ethiopia, its transmission is generally seasonal and highly unstable due to variations in topography and rainfall patterns. Studying the trends in malaria in different setups is crucial for area-specific evidence-based interventions, informed decisions, and to track the effectiveness of malaria control programs. The trend in malaria infections in the area has not been documented. Hence, this study aimed to assess the five-year trend in microscopically confirmed malaria cases in Dembecha Health Center, West Gojjam Zone, Amhara national regional state, Ethiopia. METHODS: A health facility-based retrospective study was conducted in Dembecha Health Center from February to April 2018. All microscopically confirmed malaria cases registered between 2011/12 and 2015/16 were carefully reviewed from laboratory record books and analyzed accordingly. RESULTS: A total of 12,766 blood films were requested over the last five years at Dembecha Health Center. The number of microscopically confirmed malaria cases was 2086 (16.34%). The result showed a fluctuating yet declining trend in malaria infections. The highest number of cases was registered in 2012/13, while the lowest was in 2015/16. Males and age groups >20 constituted 58.9% and 44.2% of the patients, respectively, being the hardest hit by malaria in the area. Malaria existed in almost every month and seasons. Plasmodium falciparum was the predominant species. The highest peak of malaria infections was observed in the late transition (October-December) 799 (38.3%) and early transition (May-June) 589 (28.2%) seasons. CONCLUSION: Although the results indicate a fluctuating yet declining trend, the prevalence of confirmed malaria cases in the area remains alarming and indicates a major public health burden. Therefore, close monitoring and intervention measures to control malaria infections in the area and also to tackle the dominant species, Plasmodium falciparum, are necessitated accordingly. Flash flood is an extreme flooding event which is quick, short-lived, hazardous phenomena having negative environmental and socio-economic impacts. Flood risk management is essential to reduce the effects of flood on human lives and livelihoods. The main goals of this research were flash flood risk analysis and risk quantification in terms of land use land cover using geo-spatial technology in Shewa Robit town. In the present study, elevation, slope, drainage density, distance from river, NDVI, land use land cover, topographic wetness index and curvature were used as parameters determining flash flood risk. To realize these research objectives, all these data were reclassified in to five classes and different weights for each of them was assigned using analytic hierarchy process. Weighted Sum Overlay (WSO) analyses of ARC GIS software was employed to produce flood vulnerability map. Then, the accuracy of generated flood risk map was validated using historical flood data. According to the result, about 3.08%, 14.62% and 20.66% of Shewa Robit town are at a very high, high and moderate flash flood risk, respectively. In addition to this, flood risk was also quantified in terms of land use land cover. The result indicates that the settlement land use is the most vulnerable with an estimated area of 12.01 ha, 99.57 ha and 174.16 ha in very high, high and moderate risk classes. The outcome of the study will be applicable in flood hazard management and mitigation strategies. Available guidance to mitigate health risks from exposure to freshwater harmful algal blooms (HABs) is largely derived from temperate ecosystems. Yet in tropical ecosystems, HABs can occur year-round, and resource-dependent populations face multiple routes of exposure to toxic components. Along Winam Gulf, Lake Victoria, Kenya, fisher communities rely on lake water contaminated with microcystins (MCs) from HABs. In these peri-urban communities near Kisumu, we tested hypotheses that MCs exceed exposure guidelines across seasons, and persistent HABs present a chronic risk to fisher communities through ingestion with minimal water treatment and frequent, direct contact. We tested source waters at eleven communities across dry and rainy seasons from September 2015 through May 2016. We measured MCs, other metabolites, physicochemical parameters, chlorophyll a, phytoplankton abundance and diversity, and fecal indicators. We then selected four communities for interviews about water sources, usage, and treatment. Greater than 30% of source water samples exceeded WHO drinking water guidelines for MCs (1?g/L), and over 60% of source water samples exceeded USEPA guidelines for children and immunocompromised individuals. 50% of households reported sole use of raw lake water for drinking and household use, with alternate sources including rain and boreholes. Household chlorination was the most widespread treatment utilized. At this tropical, eutrophic lake, HABs pose a year-round health risk for fisher communities in resource -limited settings. Community-based solutions and site-specific guidance for Kisumu Bay and similarly impacted regions is needed to address a chronic health exposure likely to increase in severity and duration with global climate change. BACKGROUND: Over the past four decades, drought episodes in the Eastern Mediterranean Region (EMR) of the of the World Health Organization (WHO) have gradually become more widespread, prolonged and frequent. We aimed to map hotspot countries and identified key strategic actions for health consequences. METHODS: We reviewed scientific literature and WHO EMR documentation on trends and patterns of the drought health consequences from 1990 through 2019. Extensive communication was also carried out with EMR WHO country offices to retrieve information on ongoing initiatives to face health consequences due to drought. An index score was developed to categorize countries according vulnerability factors towards drought. RESULTS: A series of complex health consequences are due to drought in EMR, including malnutrition, vector-borne diseases, and water-borne diseases. The index score indicated how Afghanistan, Yemen and Somalia are “hotspots” due to poor population health status and access to basic sanitation as well as other elements such as food insecurity, displacement and conflicts/political instability. WHO country offices effort is towards enhancing access to water and sanitation and essential healthcare services including immunization and psychological support, strengthening disease surveillance and response, and risk communication. CONCLUSIONS: Drought-related health effects in the WHO EMR represent a public health emergency. Strengthening mitigation activities and additional tailored efforts are urgently needed to overcome context-specific gaps and weaknesses, with specific focus on financing, accountability and enhanced data availability. Although only a small proportion of the landmass of South Africa is classified as high risk for malaria, the country experiences on-going challenges relating to malaria outbreaks. Climate change poses a growing threat to this already dire situation. While considerable effort has been placed in public health campaigns in the highest-risk regions, and national malaria maps are updated to account for changing climate, malaria cases have increased. This pilot study considers the sub-population of South Africans who reside outside of the malaria area, yet have the means to travel into this high-risk region for vacation. Through the lens of the governmental “ABC of malaria prevention”, we explore this sub-population’s awareness of the current boundaries to the malaria area, perceptions of the future boundary under climate change, and their risk-taking behaviours relating to malaria transmission. Findings reveal that although respondents self-report a high level of awareness regarding malaria, and their boundary maps reveal the broad pattern of risk distribution, their specifics on details are lacking. This includes over-estimating both the current and future boundaries, beyond the realms of climate-topographic possibility. Despite over-estimating the region of malaria risk, the respondents reveal an alarming lack of caution when travelling to malaria areas. Despite being indicated for high-risk malaria areas, the majority of respondents did not use chemoprophylaxis, and many relied on far less-effective measures. This may in part be due to respondents relying on information from friends and family, rather than medical or governmental advice. Wildfires are an important ecological threat in Cote d’Ivoire with the northern half the most affected zone. This study assessed farmers’ perception of wildfire occurrence in the N’Zi River Watershed and compared this perception to remotely sensed fire data trends. To this end, 259 farmers were individually interviewed and 18 farmers were involved in three focus group discussions in three agro-ecological zones. A combination of descriptive statistics and regression analysis was used for data analysis. Results showed that 78.75% of farmers observed the upward trend in the annual wildfire activity identified by remote sensing data during 2001-2016. Most of the respondents identified hunting (65.83%), farm establishment (50%) and firebreaks establishment (46.67%) as main causes of wildfires. The perceived impacts of wildfires included immediate crop burning, crop growth delaying, mid-term post-fire crop destruction, destruction of material goods and loss of human life. Local population developed endogenous strategies to cope with this scourge. Amongst identified coping strategies, firebreaks establishment and maintenance around new clearings and farms and prohibition of fire-hunting during the dry season were highlighted. Therefore, policies and institutions that support local wildfires management initiatives must take advantage of the strong community knowledge and networks to strengthen their effectiveness and sustainability. When drought hits water-scarce regions, there are significant repercussions for food and water security, as well as serious issues for the stability of broader social and environmental systems. To mitigate these effects, environmental monitoring and early warning systems aimed at detecting the onset of drought conditions can facilitate timely and effective responses from government and private sector stakeholders. This study uses multistage, participatory research methods across more than 135 interviews, focus groups, and workshops to assess extant climatic, agricultural, hydrological, and drought monitoring systems; key cross-sector drought impacts; and drought monitoring needs in four countries in the Middle East and North Africa (MENA) region: Morocco, Tunisia, Lebanon, and Jordan. This extensive study of user needs for drought monitoring across the MENA region is informing and shaping the ongoing development of drought early warning systems, a composite drought indicator (CDI), and wider drought management systems in each country. Overarching themes of drought monitoring needs include technical definitions of drought for policy purposes; information-sharing regimes and data-sharing platforms; ground-truthing of remotely sensed and modeled data; improved data quality in observation networks; and two-way engagement with farmers, organizations, and end-users of drought monitoring products. This research establishes a basis for informing enhanced drought monitoring and management in the countries, and the broad stakeholder engagement can help foster the emergence of effective environmental monitoring coalitions. Increasing population and economic growth has intensified water supply pressure on the Olifants River Basin causing it to become water-stressed. Climate change is expected to aggravate existing water supply challenges in the basin if urgent interventions are not implemented. This study evaluates the impacts of climate change on water availability and demand in the Olifants River Basin of South Africa, and assesses to what extent a combination of management strategies can mitigate current and longer term impacts using the Water Evaluation and Planning (WEAP) model. The results demonstrated by the two projected climate change scenarios (RCP4.5 and RCP8.5) showed a rise in temperature of approximately 1 degrees C-4 degrees C, and a decrease in precipitation of 5%-30%, as compared to the baseline climate of 1976-2005. Results also showed that pressure on water supply due to increased economic activities and a decline in streamflow will increase unmet water demand by 58% and 80% for the mid and end century periods respectively. Results further revealed that the combination of management measures proposed by decision makers is expected to decrease future unmet water demand from 1006MCM to 398MCM, 1205MCM to 872MCM and 1251MCM to 940MCM for reference, RCP4.5 and RCP 8.5 scenario respectively. The study therefore concludes that the combination of management strategies provides a much better and more efficient solution to water scarcity issues in the basin, compared to a reliance on a single strategy. There is potential for increased pesticide-related adverse health outcomes in the agricultural sector linked to adaptive increases in pesticide use necessitated, in part, by climate change-related increases in pest populations. To understand the role of adaptation practices in pesticide use and health risks, this study assessed Zimbabwean smallholder cotton farmers’ adaptive responses linked to their climate change perceptions. In depth interviews were conducted with 50 farmers who had been growing cotton for at least 30 years. The study identified farmers’ adaptation practices that increased their pesticide use, as well as those that presented opportunities for reducing pesticide use through non-pesticide-dependent adaptation pathways. The findings show that due to perceived climate change impacts, such as a shorter growing season, farmers were adopting a range of adaptive practices. These included changes in pest management practices, such as increasing pesticide spraying frequencies due to keeping ratoon crops, which were increasing farmers’ overall pesticide use. Such incremental adaptive practices are potentially maladaptive, as they may increase farmers’ pesticide-related health risks. Other practices, however, such as reducing cotton acreage and diversifying crops, resulting in transformational adaptation, suggest the existence of opportunities for decreasing overall pesticide use or totally eliminating pesticides from the farming system. Climatic variability affects many underlying determinants of child malnutrition, including food availability, access, and utilization. Evidence of the effects of changing temperatures and precipitation on children’s nutritional status nonetheless remains limited. Research addressing this knowledge gap is merited given the shortand long-run consequences of malnutrition. We address this issue by estimating the effects of temperature and precipitation anomalies on the weight and wasting status of children ages 0-59 months across 18 countries in sub-Saharan Africa. Linear regression models show that high temperatures and low precipitation are associated with reductions in child weight, and that high temperatures also lead to increased risk of wasting. We find little evidence of substantively meaningful differences in these effects across sub-populations of interest. Our results underscore the vulnerability of young children to climatic variability and its second-order economic and epidemiological effects. The study also highlights the corresponding need to design and assess interventions to effectively mitigate these impacts. Climate change in South Africa remains an issue of socio-economic and environmental concern. An increase in frequency and intensity of climatic events pose significant threats to biophysical and socio-economic aspects, namely food security, water resources, agriculture, biodiversity, tourism, and poverty. In order to counteract the socio-economic and environmental concerns pertaining to issues of climate change, emergent insights on climate change strategies suggest that building resilience in human and environmental systems is an ideal way of combating dynamic environmental conditions and future uncertainties. Using the qualitative secondary data approach, this article evaluates whether vulnerable communities in uMkhanyakude District Municipality can become resilient to the implications of climate change. UMkhanyakude District Municipality is predominantly rural and one of the most impoverished districts in KwaZulu-Natal, with the majority of socially and economically marginalised individuals and households experiencing more severe impacts as a result of climate change compared to those in urban areas. Data was analysed using content analysis and a concise summary of the biophysical and socio-economic aspects is presented. This research suggests that building resilience to climate change is possible when bottom-up, proactive and systematic measures are taken to manage vulnerable areas such as those in uMkhanyakude District Municipality. It recommends that social impact assessments (SIA) be conducted to assist in terms of assessing social consequences that are likely to follow from policy actions. BACKGROUND: The World Health Organization (WHO) promotes long-lasting insecticidal nets (LLIN) and indoor residual house-spraying (IRS) for malaria control in endemic countries. However, long-term impact data of vector control interventions is rarely measured empirically. METHODS: Surveillance data was collected from paediatric admissions at Tororo district hospital for the period January 2012 to December 2019, during which LLIN and IRS campaigns were implemented in the district. Malaria test positivity rate (TPR) among febrile admissions aged 1 month to 14 years was aggregated at baseline and three intervention periods (first LLIN campaign; Bendiocarb IRS; and Actellic IRS?+?second LLIN campaign) and compared using before-and-after analysis. Interrupted time-series analysis (ITSA) was used to determine the effect of IRS (Bendiocarb?+?Actellic) with the second LLIN campaign on monthly TPR compared to the combined baseline and first LLIN campaign periods controlling for age, rainfall, type of malaria test performed. The mean and median ages were examined between intervention intervals and as trend since January 2012. RESULTS: Among 28,049 febrile admissions between January 2012 and December 2019, TPR decreased from 60% at baseline (January 2012-October 2013) to 31% during the final period of Actellic IRS and LLIN (June 2016-December 2019). Comparing intervention intervals to the baseline TPR (60.3%), TPR was higher during the first LLIN period (67.3%, difference 7.0%; 95% CI 5.2%, 8.8%, p?<?0.001), and lower during the Bendiocarb IRS (43.5%, difference -?16.8%; 95% CI -?18.7%, -?14.9%) and Actellic IRS (31.3%, difference -?29.0%; 95% CI -?30.3%, -?27.6%, p?<?0.001) periods. ITSA confirmed a significant decrease in the level and trend of TPR during the IRS (Bendicarb?+?Actellic) with the second LLIN period compared to the pre-IRS (baseline?+?first LLIN) period. The age of children with positive test results significantly increased with time from a mean of 24 months at baseline to 39 months during the final IRS and LLIN period. CONCLUSION: IRS can have a dramatic impact on hospital paediatric admissions harbouring malaria infection. The sustained expansion of effective vector control leads to an increase in the age of malaria positive febrile paediatric admissions. However, despite large reductions, malaria test-positive admissions continued to be concentrated in children aged under five years. Despite high coverage of IRS and LLIN, these vector control measures failed to interrupt transmission in Tororo district. Using simple, cost-effective hospital surveillance, it is possible to monitor the public health impacts of IRS in combination with LLIN. Despite improvements to global economic conditions, child undernourishment has increased in recent years, with approximately 7.5% of children suffering from wasting. Climate change is expected to worsen food insecurity and increase potential threats to nutrition, particularly in low-income and lower-middle income countries where the majority of undernourished children live. We combine anthropometric data for 192,000 children from 30 countries in Sub-Saharan Africa with historical climate data to directly estimate the effect of temperature on key malnutrition outcomes. We first document a strong negative relationship between child weight and average temperature across regions. We then exploit variation in weather conditions to statistically identify the effects of increased temperatures over multiple time scales on child nutrition. Increased temperatures in the month of survey, year leading up to survey and child lifetime lead to meaningful declines in acute measures of child nutrition. We find that the lifetime-scale effects explain most of the region-level negative relationship between weight and temperature, indicating that high temperatures may be a constraint on child nutrition. We use CMIP5 local temperature projections to project the impact of future warming, and find substantial increases in malnutrition depending on location: western Africa would see a 37% increase in the prevalence of wasting by 2100, and central and eastern Africa 25%. BACKGROUND: Climate change is a significant threat to the health of the Ghanaian people. Evidence abounds in Ghana that temperatures in all the ecological zones are rising, whereas rainfall levels have been generally reducing and patterns are increasingly becoming erratic. The study estimated the impact of climate variation between seasons on biochemical markers of kidney disease. METHODS: This study conveniently recruited 50 apparently healthy peasant farmers and hawkers at Wa in the Upper West Region of Ghana. A pre-study screening for hepatitis A and C, Diabetes mellitus, hypertension was done. Serum creatinine and urea levels were analyzed to rule out kidney preexisting kidney disease. Baseline data was collected by estimating urea, creatinine, sodium, potassium, eGFR (estimated glomerular filtration rate) as well as for hemoglobin (Hb) and hematocrit (Hct) concentrations. Anthropometric data such as height, weight and blood pressure were measured by trained personnel. The study participants were closely followed and alerted deep in the dry season for the second sampling (urea, creatinine, hemoglobin, hematocrit, blood pressure, anthropometry). RESULTS: This study recruited more males (58.82%) than females (41.15%), majority (52.92%) of which were aged 25-29?years with the youngest being 22?years and the eldest being 35?years. The study found body mass index (p?<?0.001), systolic blood pressure (p?=?0.019), creatinine (p?<?0.001), urea (p?=?0.013) and eGFR (p?<?0.001) to be significantly influenced by climate change. Stage 1 hypertension was predominant among the study participants during the dry season, 8 (15.69%) than was observed during the rainy season, 4 (7.84%) nonetheless the number of participants with normal BMI rose from 49.02% in the rainy season to 62.75% during the dry reason. Additionally, the study observed that the impact of climate change on systolic blood pressure and urea varied based on age and sex. CONCLUSION: This study revealed that climatic changes cause variations in various biochemical parameters used to assess kidney function. Public health education on climatic changes and its implication including precautionary measures should be done among inhabitants of Wa and its environs to reduce its effect. Additionally, appropriate dietary patterns should also be advised to avoid the development of non-communicable diseases such as hypertension and obesity that are known principal causes of Chronic Kidney Disease (CKD). Global warming is a serious threat to human existence. The relatively higher level of global warming in recent times poses higher health risks to humans, both directly and indirectly. The aim of the study was to investigate public knowledge of global warming and its effects on human health. A nationally representative survey of Ghanaian adults (N = 1130) was conducted from November 1, 2018 to February 28, 2019. Results show that 84.4% of the respondents understood the meaning of global warming. Respondents’ perceived causes of global warming include natural processes, deforestation, act of the gods, burning of fossil fuel, and carbon dioxide (CO(2)) emission from vehicles and industries. The majority of the respondents (83.4%) indicated that global warming has an impact on human health, while 8.5% indicated that it does not. Majority (78.6%) of the respondents are willing to support efforts to reduce the intensity of global warming. Television (19.1%) and social media (18.6%) were the leading preferred methods for receipt of global warming information. These findings provide useful insights for policy directions. The Government of Ghana and other stakeholders in health should develop a communication strategy to increase and sustain publicity and education of the citizenry on global warming.The relative effect of climate variability on malaria incidence after scale-up of interventions in Western Kenya: A time-series analysis of monthly incidence data from 2008 to 2019
The missing links in climate services for health and heat-health services: Examining climate-heat services in peri-urban districts in South Africa
The relationship between climate change induced natural disasters and selected nutrition outcomes: A case of Cyclone Idai, Zimbabwe
The impact of power outages on households in Zambia
The implications of climate change on health among vulnerable populations in South Africa: A systematic review
The forms and adverse effects of insecurities among internally displaced children in Ethiopia
The effect of extreme temperature and precipitation on cause-specific deaths in rural Burkina Faso: A longitudinal study
The burdens of occupational heat exposure-related symptoms and contributing factors among workers in sugarcane factories in Ethiopia: Heat stress wet bulb globe temperature meter
Temporal relationships between Saharan dust proxies, climate, and meningitis in Senegal
Tanapox, South Africa, 2022
Supporting the capacities and knowledge of smallholder farmers in Kenya for sustainable agricultural futures: A citizen science pilot project
Spatio-temporal analysis of malaria incidence and its risk factors in North Namibia
Spatio-temporal analysis of environmental and climatic factors impacts on malaria morbidity in Ondo State, Nigeria
Spatial distribution and determinants of limited access to improved drinking water service among households in Ethiopia based on the 2019 Ethiopian mini demographic and health survey: Spatial and multilevel analyses
Socio-cultural beliefs on drought in Talensi Ghana: Insights for environmental management, social vulnerability, early warning systems and coping and adaptation
Spatial analysis of malaria hotspots in dilla sub-watershed: Western Ethiopia
Spatial and seasonal distribution of human schistosomiasis intermediate host snails and their interactions with other freshwater snails in 7 districts of Kwazulu-Natal province, South Africa
Simulation of the ethekwini heat island in South Africa
Seasonal variations and other changes in the geographical distributions of different cytospecies of the Simulium damnosum complex (diptera: Simuliidae) in Togo and Benin
Satellite-based multi-annual yield models for major food crops at the household field level for nutrition and health research: A case study from the Nouna Hdss, Burkina Faso
Seasonal and spatial variations of malaria transmissions in Northwest Ethiopia: Evaluating climate and environmental effects using generalized additive model
Remote sensing-based outdoor thermal comfort assessment in local climate zones in the rural-urban continuum of Ethekwini municipality, South Africa
Rainfall, mothers’ time use, and child nutrition: Evidence from rural Uganda
Quality and hydrochemical assessment of groundwater in geological transition zones: A case study from N.E. Nigeria
Process and outputs from a community codesign workshop on reducing impact of heat exposure on pregnant and postpartum women and newborns in Kilifi, Kenya
Projected changes in extreme rainfall and temperature events and possible implications for Cameroon’s socio-economic sectors
Prevalence of diarrheal disease and associated factors among under-five children in flood-prone settlements of Northwest Ethiopia: A cross-sectional community-based study
Predicted changes in habitat suitability for human schistosomiasis intermediate host snails for modelled future climatic conditions in Kwazulu-Natal, South Africa
Prenatal exposure to long-term heat stress and stillbirth in Ghana: A within-space time-series analysis
Pollution of the Niger Delta with total petroleum hydrocarbons, heavy metals and nutrients in relation to seasonal dynamics
Pathways from climate change to emotional wellbeing: A qualitative study of Kenyan smallholder farmers living with HIV
Perception and adaptation strategies of forest dwellers to climate variability in the tropical rainforest in Eastern Cameroon: The case of the inhabitants of the Belabo-diang Communal Forest
One health insights into pastoralists’ perceptions on zoonotic diseases in Ethiopia: Perspectives from South Omo Zone of SNNP Region
Nexus between summer climate variability and household food security in rural Mpumalanga Province, South Africa
Mothers get really exhausted! The lived experience of pregnancy in extreme heat: Qualitative findings from Kilifi, Kenya
Meteorological influences on airborne pollen and spores in Johannesburg (Gauteng), South Africa
Measuring the environmental context of child growth in Burkina Faso
Malaria in Burkina Faso: A comprehensive analysis of spatiotemporal distribution of incidence and environmental drivers, and implications for control strategies
Malaria positivity rate trend analysis at water resources development project of wonji sugar estate Oromia, Ethiopia
Mapping local variations and the determinants of childhood stunting in Nigeria
Long-lasting household damage from cyclone Idai increases malaria risk in rural western Mozambique
Levels and health risks of heavy metals and organochlorine pesticide residues in soil and drinking water of flood-prone residential area of Lagos, Nigeria
Interruptions to HIV care delivery during pandemics and natural disasters: A qualitative study of challenges and opportunities from frontline healthcare providers in western Kenya
Investigating seasonal agriculture, contraceptive use, and pregnancy in Burkina Faso
Investigating the impacts of rainfall, armed conflict, and COVID-19 shocks on women’s household decision-making among partnered women in Burkina Faso
Integrating vector control within an emerging agricultural system in a region of climate vulnerability in southern Malawi: A focus on malaria, schistosomiasis, and arboviral diseases
Indigenous chicken market participation and smallholder farmers’ well-being outcomes in Chiredzi and Mwenezi districts of Zimbabwe
In our own eyes: Ethical dilemmas and insights encountered by researchers conducting qualitative research in high ambient temperatures in Kilifi, Kenya
Impacts of climate change on household food security in matande communal lands, Mwenezi District in Zimbabwe
Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse floodplain, Zambia
Health institutional dynamics in the management of malaria and bilharzia in Zimbabwe in the advent of climate change: A case study of Gwanda District
Ground-level documentation of heat stress exposure and response strategies in informal settlements in Tshwane, South Africa
Global warming and psychotraumatology of natural disasters: The case of the deadly rains and floods of April 2022 in South Africa
Gendered perceptions and adaptations to climate change in Ghana: What factors influence the choice of an adaptation strategy?
Generalized linear models to forecast malaria incidence in three endemic regions of Senegal
Gender dimensions of climate change adaptation in Tigray, Ethiopia
Flood stressors and mental distress among community-dwelling adults in Ghana: A mediation model of flood-risk perceptions
Fatal architectures and death by design: The infrastructures of state-sponsored climate disasters in Angola and Mozambique
Extreme temperature and rainfall events and future climate change projections in the coastal Savannah agroecological zone of Ghana
Exploring black African women’s experiences of vulnerability and adaptation to flood impacts in the Ethekwini Metropolitan Municipality, Kwazulu-natal, South Africa
Exploring the benefits and dis-benefits of climate migration as an adaptive strategy along the rural-peri-urban continuum in Namibia
Evolution of spatial risk of malaria infection after a pragmatic chemoprevention program in response to severe flooding in rural Western Uganda
Environmental, social, and WASH factors affecting the recurrence of cholera outbreaks in displacement camps in Northeast Nigeria: A rapid appraisal
Essential health services delivery and quality improvement actions under drought and food insecurity emergency in north-east Uganda
El Niño and other climatic drivers of epidemic malaria in Ethiopia: New tools for national health adaptation plans
Effects of high temperature and heavy precipitation on drinking water quality and child hand contamination levels in rural Kenya
Ecological niche modeling of aedes and culex mosquitoes: A risk map for chikungunya and west nile viruses in Zambia
Disaster mortalities and the sendai framework target A: Insights from Zimbabwe
Determinants of the choice of adaptation strategies to climate variability and extremes among pastoralist and agro-pastoralist households in Yabello and Arero districts, Southeast Ethiopia
Developing a healthy environment assessment tool (heat) to address heat-health vulnerability in South African towns in a warming world
Climate variability, armed conflicts and child malnutrition in sub-saharan Africa: A spatial analysis in Ethiopia, Kenya and Nigeria
Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016-2018: A spatial temporal analysis
Climate, weather and child health in Burkina Faso
Climate change and health risks in Mukuru informal settlement in Nairobi, Kenya – knowledge, attitudes and practices among residents
Child survival and annual crop yield reductions in rural Burkina Faso: Critical windows of vulnerability around early-life development
Change in emotional distress, anxiety, depression and PTSD from pre- to post-flood exposure in women residing in low-income settings in South Africa
Centering community-based knowledge in food security response and climate resilience in southern Madagascar
Built environment transformation in Nigeria: The effects of a regenerative framework
Bias-corrected CMIP5 projections for climate change and assessments of impact on malaria in Senegal under the vectri model
Assessment of social factors that promote the vulnerability of communities to coastal hazards in the volta estuary in Ghana
Assessing climate change and urban poverty in the context of the COVID-19 lockdowns: Rethinking personality and societal challenges in Zimbabwe
Assessing heat risk in a sub-saharan African humid city, Lagos, Nigeria, using numerical modelling and open-source geospatial socio-demographic datasets
Assessing local government’s response to black women’s vulnerability and adaptation to the impacts of floods in the context of intersectionality: The case of eThekwini metropolitan municipality, South Africa
Assessing the effect of extreme weather on population health using consumer-grade wearables in rural Burkina Faso: Observational panel study
Artificial intelligence models for prediction of monthly rainfall without climatic data for meteorological stations in Ethiopia
Why urban ecology matters in Ethiopia
Water and health nexus-land use dynamics, flooding, and water-borne diseases in the Odaw River Basin, Ghana
Urban heat in Johannesburg and Ekurhuleni, South Africa: A meter-scale assessment and vulnerability analysis
Use of mobile medical teams to fill critical gaps in health service delivery in complex humanitarian settings, 2017-2020: A case study of South Sudan
Trends and seasonal variations in human secondary sex ratio in southwest Nigeria: A 10-year survey
The vulnerability of Antandroy women to droughts in Ambovombe Androy (Madagascar)
The self-reported human health effects associated with heat exposure in Agincourt sub-district of South Africa
The impact of timing of in utero drought shocks on birth outcomes in rural households: Evidence from Sierra Leone
The effects of seasonal variations on household water security and burden of diarrheal diseases among under 5 children in an urban community, southwest Nigeria
The effect of climatic factors on the number of malaria cases in an inland and a coastal setting from 2011 to 2017 in the equatorial rain forest of Cameroon
The challenges of working in the heat whilst pregnant: Insights from Gambian women farmers in the face of climate change
The co-occurrence of water insecurity and food insecurity among Daasanach pastoralists in northern Kenya
The contribution of community health systems to resilience: Case study of the response to the drought in Ethiopia
The association between apparent temperature and hospital admissions for cardiovascular disease in Limpopo province, South Africa
Stunting and associated factors among 6-23 month old children in drought vulnerable kebeles of Demba Gofa district, southern Ethiopia
Sub-national tailoring of seasonal malaria chemoprevention in Mali based on malaria surveillance and rainfall data
Spatio-temporal variability of malaria incidence in the health district of Kati, Mali, 2015-2019
Spatio-temporal variation of malaria incidence and risk factors in West Gojjam zone, northwest Ethiopia
Spatiotemporal patterns of diarrhea incidence in Ghana and the impact of meteorological and socio-demographic factors
Spatial analysis of climatic factors and Plasmodium falciparum malaria prevalence among children in Ghana
Seasonal variability influence on the prevalence of diarrhoea among under-five-year-old children in Kersa district, eastern Ethiopia: A community-based longitudinal study
Seasonality and day-to-day variability of dietary diversity: Longitudinal study of pregnant women enrolled in a randomized controlled efficacy trial in rural Burkina Faso
Seasonality and predictors of childhood stunting and wasting in drought-prone areas in Ethiopia: A cohort study
Risk factors for intestinal parasite portage in an informal suburb on the west coast of Madagascar
Risks of climate change on future water supply in smallholder irrigation schemes in Zimbabwe
Recovering from severe drought in the drylands of Ethiopia: Impact of comprehensive resilience programming
Rainfall anomalies and typhoid fever in Blantyre, Malawi
Process contributions to life cycle impacts of municipal solid waste management options in Harare, Zimbabwe
Predicting malaria outbreaks from sea surface temperature variability up to 9 months ahead in Limpopo, South Africa, using machine learning
Potentially pathogenic Escherichia coli from household water in peri-urban Ibadan, Nigeria
Perceptions of thermal comfort and coping mechanisms related to indoor and outdoor temperatures among participants living in rural villages in Limpopo province, South Africa
Health and climate change urban profiles: Kisumu county
Today & Tomorrow impact case study: flexibility in funding a ‘game changer’ for cyclone-ravaged Madagascar
National Adaptation Plans (NAPs) and Vulnerability and Adaptation Assessments (VAA) in Uganda
Cholera in Lusaka
Malaria, mental disorders, immunity and their inter-relationships – A cross sectional study in a household population in a health and demographic surveillance site in Kenya
Fiscal space policies for sustainable development and debt relief: Empirical analysis in West African countries
Gender perspectives of the water, energy, land, and food security nexus in sub-Saharan Africa
Implication of stratospheric aerosol geoengineering on compound precipitation and temperature extremes in Africa
Influence of climate on conflicts and migrations in southern Africa in the 19th and early 20th centuries
Insights on water and climate change in the Greater Horn of Africa: Connecting virtual water and water-energy-food-biodiversity-health nexus
Socio-political processes must be emphasised alongside climate change and urbanisation as key drivers of urban water insecurity
Towards sustainable community-based systems for infectious disease and disaster response; lessons from local initiatives in four African countries
Intersectoral collaboration shaping One Health in the policy agenda: A comparative analysis of Ghana and India
Weather, climate, and climate change research to protect human health in sub-Saharan Africa and South Asia
Climate change, pesticides and health: Considering therisks and opportunities of adaptation for Zimbabwean smallholder cotton growers
Prevalence of aflatoxin- and fumonisin-producing fungi associated with cereal crops grown in Zimbabwe and their associated risks in a climate change scenario
Prevalence of household food insecurity in East Africa: Linking food access with climate vulnerability
Asthma exacerbations in reunion island: Environmental factors
The Street Walkability and Thermal Comfort Index (SWTCI): A new assessment tool combining street design measurements and thermal comfort
Leveraging city-level climate change law and policy for the protection of children
Climate anomalies and birth rates in sub-Saharan Africa
Analysis of heavy rainfall in sub-saharan Africa and HIV transmission risk, HIV prevalence, and sexually transmitted infections, 2005-2017
Climate change and emergency care in Africa: A scoping review
Climate change and African migrant health
Innovation and adaptation to climate change: Evidence from the water sector in Africa
Livelihood vulnerability index: Gender dimension to climate change and variability in REDD
A new integrated assessment framework for climate-smart nutrition security in sub-saharan Africa: The integrated future estimator for emissions and diets (ifeed)
A review on climate, air pollution, and health in North Africa
Arsenic in Africa: Potential sources, spatial variability, and the state of the art for arsenic removal using locally available materials
Climate change, land, water, and food security: Perspectives from Sub-Saharan Africa
Drivers of the increasing water footprint in Africa: The food consumption perspective
Examining the ability of communities to cope with food insecurity due to climate change
Family physician perceptions of climate change, migration, health, and healthcare in Sub-Saharan Africa: An exploratory study
Fertility following natural disasters and epidemics in Africa
Use of verbal autopsy for establishing causes of child mortality in camps for internally displaced people in Mogadishu, Somalia: A population-based, prospective, cohort study
Air quality index: A case of 1-day monitoring in 253 Nigerian urban and suburban towns
Climate change and primary health care in Sahelian Kano, Nigeria
Environmental health situation in Nigeria: Current status and future needs
Integration of climate change mitigation and sustainable development planning: Lessons from a national planning process in Nigeria
The impact of climate change on food and human security in Nigeria
The place of neglected and underutilized legumes in human nutrition and protein security in Nigeria
Water, sanitation, and hygiene vulnerability among rural areas and small towns in South Africa: Exploring the role of climate change, marginalization, and inequality
Climate-urban nexus: A study of vulnerable women in urban areas of Kwazulu-Natal Province, South Africa
Social vulnerability, parity and food insecurity in urban South African young women: The healthy life trajectories initiative (HeLTI) study
Major climate change-induced risks to human health in South Africa
Climate change and health within the South African context: A thematic content analysis study of climate change and health expert interviews
Classroom temperature and learner absenteeism in public primary schools in the Eastern Cape, South Africa
Lagged association between climate variables and hospital admissions for pneumonia in South Africa
Analysis of pneumonia occurrence in relation to climate change in Tanga, Tanzania
Integrated climate change and air pollution mitigation assessment for Togo
Seasonality, climate change, and food security during pregnancy among indigenous and non-indigenous women in rural Uganda: Implications for maternal-infant health
Health gender gap in Uganda: Do weather effects and water play a role?
Evolution of energy and nutrient supply in Zambia (1961-2013) in the context of policy, political, social, economic, and climatic changes
Drivers and barriers to sustained use of blair ventilated improved pit latrine after nearly four decades in rural Zimbabwe
Climate change, health risks, and vulnerabilities in Burkina Faso: A qualitative study on the perceptions of national policymakers
Every drop matters: Combining population-based and satellite data to investigate the link between lifetime rainfall exposure and chronic undernutrition in children under five years in rural Burkina Faso
Institutional barriers to climate change and health adaptation in Burkina Faso
Home gardening in sub-Saharan Africa: A scoping review on practices and nutrition outcomes in rural Burkina Faso and Kenya
Feasibility, acceptability and validation of wearable devices for climate change and health research in the low-resource contexts of Burkina Faso and Kenya: Study protocol
Climate change vulnerability assessment in mangrove-dependent communities of Manoka Island, littoral region of Cameroon
Seasonal variation of decompensated heart failure admissions and mortality rates in sub-Saharan Africa, Cameroon
Causes, indicators and impacts of climate change: Understanding the public discourse in Goat based agro-pastoral livelihood zone, Ethiopia
Examining local perspectives on the influence of climate change on the health of Hamer pastoralists and their livestock in Ethiopia
Gendered vulnerability, perception and adaptation options of smallholder farmers to climate change in eastern Ethiopia
Application of multi-hydrochemical indices for spatial groundwater quality assessment: Ziway lake basin of the Ethiopian rift valley
Maternal time use drives suboptimal complementary feeding practices in the El Niño-affected eastern Ethiopia community
Building resilience: The gendered effect of climate change on food security and sovereignty in Kakamega-Kenya
Modeling the potential future distribution of anthrax outbreaks under multiple climate change scenarios for Kenya
Kenyan women bearing the cost of climate change
Spatial location, temperature and rainfall diversity affect the double burden of malnutrition among women in Kenya
Conflict and climate factors and the risk of child acute malnutrition among children aged 24-59 months: A comparative analysis of Kenya, Nigeria, and Uganda
A black dog enters the home: Hunger and malnutrition in Malawi
Climate change and child malnutrition: A Nigerian perspective
Systematic review of climate change impact research in Nigeria: Implication for sustainable development
Experiences from Cyclone Anna and Cyclone Dumako: A short report
Awareness and clothing selection to mitigate the effect of ultraviolet light on pre-school children in Eswatini
Cyclone Idai-related losses and the coping strategies of adolescent survivors in the Odzi community of Manicaland Province, Zimbabwe
Maternal and child health care service disruptions and recovery in Mozambique after Cyclone Idai: An uncontrolled interrupted time series analysis
First activation of the who emergency medical team minimum data set in the 2019 response to tropical Cyclone Idai in Mozambique
Italian field hospital experience in Mozambique: Report of ordinary activities in an extraordinary context
How did primary health care in Beira experience Cyclone Idai?
Spatial variability and temporal trends of climate change in southwest Ethiopia: Association with farmers’ perception and their adaptation strategies
Local adaptation and coping strategies to global environmental changes: Portraying agroecology beyond production functions in southwestern Ethiopia
Conservation agriculture affects grain and nutrient yields of maize (zea mays l.) and can impact food and nutrition security in sub-Saharan Africa
Feasibility assessment of climate change adaptation options across Africa: An evidence-based review
A framework to assess forest-agricultural landscape management for socioecological well-being outcomes
Climate change, women’s workload in smallholder agriculture, and embodied political ecologies of undernutrition in northern Ghana
Coping strategies for household food insecurity, and perceived health in an urban community in southern Mozambique: A qualitative study
Exploring multilevel social determinants of depressive symptoms for Tanzanian adolescents: Evidence from a cross-sectional study
Increased climate variability and sedentarization in Tanzania: Health and nutrition implications on pastoral communities of Mvomero and Handeni districts, Tanzania
The mental health outcomes of food insecurity and insufficiency in West Africa: A systematic narrative review
The impact of food insecurity on mental health in Africa: A systematic review
Maasai women hearing voices: Implications for global mental health
Geographical drivers and climate-linked dynamics of Lassa fever in Nigeria
A feasibility study of the use of Umbiflow™ to assess the impact of heat stress on fetoplacental blood flow in field studies
An analysis of past and future heatwaves based on a heat-associated mortality threshold: Towards a heat health warning system
How climate change may threaten progress in neonatal health in the African region
Heat exposure and child nutrition: Evidence from West Africa
Near-term regional climate change in east Africa
Utilization of greenhouse effect for the treatment of COVID-19 contaminated disposable waste – A simple technology for developing countries
Exploring strategies for investigating the mechanisms linking climate and individual-level child health outcomes: An analysis of birth weight in Mali
Concurrent heat waves and extreme ozone (o(3)) episodes: Combined atmospheric patterns and impact on human health
Activating transformation: Integrating interior dimensions of climate change in adaptation planning
Flood exposure and psychological distress among Ghanaian adults in flood-prone settings
A deliberative rural community consultation to assess support for flood risk management policies to strengthen resilience in Malawi
Comparing expert and local community perspectives on flood management in the lower Mono River catchment, Togo and Benin
Adaptation to perennial flooding and food insecurity in the Sudan savannah agroecological zone of Ghana
Climate change, flood disaster risk and food security nexus in Northern Ghana
Growing spatial overlap between dam-related flooding, cropland and domestic water points: A water-energy-food nexus management challenge in Malawi and Ghana
Assessing road criticality and loss of Healthcareibility during floods: The case of Cyclone Idai, Mozambique 2019
An evaluation of flood fatalities in Nigeria
Engineering environmental resilience: A matched cohort study of the community benefits of trailbridges in rural Rwanda
In the intersection of climate risk and social vulnerabilities: A case of poor urbanites in Lusaka, Zambia
Nexus between flooding impacts and coping strategies in Nairobi’s settlements
Between the rich and poor: Exposure and adaptation to heat stress across two urban neighbourhoods in Nigeria
Climate change and young people in Uganda: A literature review
Monitoring and moderating extreme indoor temperatures in low-income urban communities
Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework
Mixed methods study into social impacts of work-related heat stress on Ghanaian mining workers: A pragmatic research approach
Heatwaves in Kenya 1987-2016: Facts from CHIRTS high resolution satellite remotely sensed and station blended temperature dataset
Urban thermal perception and self-reported health effects in Ibadan, south west Nigeria
Heat waves and health risks in the northern part of Senegal: Analysing the distribution of temperature-related diseases and associated risk factors
Climate change knowledge, concerns and experiences in secondary school learners in South Africa
Characteristics and long-term trends of heat stress for South Africa
Ambient temperature during pregnancy and risk of maternal hypertensive disorders: A time-to-event study in Johannesburg, South Africa
Lack of vegetation exacerbates exposure to dangerous heat in dense settlements in a tropical African city
Combining environmental and social dimensions in the typomorphological study of urban resilience to heat stress
A literature review of the impacts of heat stress on human health across Africa
Prediction of climate change effect on outdoor thermal comfort in arid region
Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in the Gambia, West Africa: An observational cohort study
Evaluation of passive cooling and thermal comfort in historical residential buildings in Zanzibar
The role of residential air circulation and cooling demand for electrification planning: Implications of climate change in sub-Saharan Africa
Heat stress in Africa under high intensity climate change
Potential impact of 1.5, 2 and 3°C global warming levels on heat and discomfort indices changes over Central Africa
Characterizing the extent human milk folate is buffered against maternal malnutrition and infection in drought-stricken northern Kenya
Epigenetic mechanisms underlying the association between maternal climate stress and child growth: Characterizing severe drought and its impact on a Kenyan community engaging in a climate change-sensitive livelihood
Rainfall shocks, cognitive development and educational attainment among adolescents in a drought-prone region in Kenya
From a drought to HIV: An analysis of the effect of droughts on transactional sex and sexually transmitted infections in Malawi
A conceptual framework of the impact of maternal early life drought exposure on newborn size in Malawi
Exploring the temporal patterns and crisis-related risk factors for population displacement in Somalia (2016-2018)
Institutional responses to drought in a high HIV prevalence setting in rural South Africa
Socio-economic determinants of increasing household food insecurity during and after a drought in the District of iLembe, South Africa
Economic, social and demographic impacts of drought on treatment adherence among people living with HIV in rural South Africa: A qualitative analysis
Burnt by the scorching sun: Climate-induced livelihood transformations, reproductive health, and fertility trajectories in drought-affected communities of Zambia
Mapping and managing livelihoods vulnerability to drought: A case study of Chivi District in Zimbabwe
Drought and social conflict in rural Zimbabwe: Does the burden fall on women and girls?
Enhancing capacity of Zimbabwe’s health system to respond to climate change induced drought: A rapid nutritional assessment
The adverse health effects associated with drought in Africa
Drought, HIV testing, and HIV transmission risk behaviors: A population-based study in 10 high HIV prevalence countries in Sub-Saharan Africa
Exploring linkages between drought and HIV treatment adherence in Africa: A systematic review
Drought, psychosocial stress, and ecogeographical patterning: Tibial growth and body shape in Samburu (Kenyan) pastoralist children
Malnutrition pathway for the impact of in utero drought shock on child growth indicators in rural households
Extreme Temperature Events (ETEs) in South Africa: A review
Passive survivability under extreme heat events: The case of AlDarb Al Ahmar, Cairo
Exploring relationships between drought and epidemic cholera in Africa using generalised linear models
Seasonal droughts and the risk of childhood undernutrition in Ethiopia
Barriers and facilitators to water, sanitation and hygiene (wash) practices in southern Africa: A scoping review
Impact of flooding on microbiological contamination of domestic water sources: A longitudinal study in northern Ghana
Becoming flood insecure: Lessons from village level experiences in Tana Delta, Kenya
Pathogenic Leptospira and water quality in African cities: A case study of Cotonou, Benin
Dam-mediated flooding impact on outpatient attendance and diarrhoea cases in northern Ghana: A mixed methods study
Applying a wash risk assessment tool in a rural south African setting to identify risks and opportunities for climate resilient communities
Acute health risks to community hand-pumped groundwater supplies following cyclone Idai flooding
Dihydroartemisinin-piperaquine chemoprevention and malaria incidence after severe flooding: Evaluation of a pragmatic intervention in rural Uganda
Malaria transmission in Sahelian African regions, a witness of climate changes
Understanding responses to climate-related water scarcity in Africa
Re-examining the effects of drought on intimate-partner violence
Pastoral coping and adaptation climate change strategies: Implications for women’s well-being
Drought, hunger and coping mechanisms among rural household in Southeast Ethiopia
Bayesian spatial analysis of factors influencing neonatal mortality and its geographic variation in Ethiopia
Spatial variation of child stunting and maternal malnutrition after controlling for known risk factors in a drought-prone rural community in southern Ethiopia
Irrigation improves weight-for-height z-scores of children under five, and women’s and household dietary diversity scores in Ethiopia and Tanzania
Coping with drought: Narratives from smallholder farmers in semi-arid Kenya
Climate change poses a threat to nutrition and food security in Kilifi County, Kenya
Inference and dynamic simulation of malaria using a simple climate-driven entomological model of malaria transmission
Modeling and optimal control analysis for malaria transmission with role of climate variability
Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi
Exploring rural hospital admissions for diarrhoeal disease, malaria, pneumonia, and asthma in relation to temperature, rainfall and air pollution using wavelet transform analysis
Impact of an accelerated melting of Greenland on malaria distribution over Africa
Climate change and the dynamics of age-related malaria incidence in Southern Africa
Malaria metrics distribution under global warming: Assessment of the vectri malaria model over Cameroon
Environmental determinants of E. coli, link with the diarrheal diseases, and indication of vulnerability criteria in tropical West Africa (Kapore, Burkina Faso)
Direct association between rainfall and non-typhoidal Salmonella bloodstream infections in hospital-admitted children in the Democratic Republic of Congo
An exploratory pilot study of the effect of modified hygiene kits on handwashing with soap among internally displaced persons in Ethiopia
Cessation of exclusive breastfeeding and seasonality, but not small intestinal bacterial overgrowth, are associated with environmental enteric dysfunction: A birth cohort study amongst infants in rural Kenya
Socio-demographic, not environmental, risk factors explain fine-scale spatial patterns of diarrhoeal disease in Ifanadiana, rural Madagascar
Modelling rotavirus concentrations in rivers: Assessing Uganda’s present and future microbial water quality
Climate variability, water supply, sanitation and diarrhea among children under five in Sub-Saharan Africa: A multilevel analysis
Interventions can shift the thermal optimum for parasitic disease transmission
Predicting disease outbreaks with climate data
Comprehensive assessment of the effect of various anthropogenic activities on the groundwater quality
Control strategies to improve the low water quality of Souk-Ahras city
The urban metabolism of waterborne diseases: Variegated citizenship, (waste)water flows, and climatic variability in Maputo, Mozambique
Drought-related cholera outbreaks in Africa and the implications for climate change: A narrative review
Effects of rainfall, temperature and topography on malaria incidence in elimination targeted district of Ethiopia
Epidemic malaria dynamics in Ethiopia: The role of self-limiting, poverty, HIV, climate change and human population growth
Past eight-year malaria data in Gedeo zone, southern Ethiopia: Trend, reporting-quality, spatiotemporal distribution, and association with socio-demographic and meteorological variables
Epidemiology of malaria from 2019 to 2021 in the southeastern city of Franceville, Gabon
Ecological and seasonal variations and other factors associated with clinical malaria in the central region of Ghana: A cross-sectional study
A Bayesian spatio-temporal analysis of malaria in the Greater Accra Region of Ghana from 2015 to 2019
Distribution and risk factors of malaria in the greater Accra region in Ghana
Bio-climatic impact on malaria prevalence in Ghana: A multi-scale spatial modeling
Estimating the impact of temperature and rainfall on malaria incidence in Ghana from 2012 to 2017
Evolution of malaria incidence in five health districts, in the context of the scaling up of seasonal malaria chemoprevention, 2016 to 2018, in Mali
Interannual climate variability and malaria in Mozambique
Impact of climatic variables on childhood severe malaria in a tertiary health facility in northern Nigeria
Assessment of climate-driven variations in malaria transmission in Senegal using the vectri model
Malaria in Senegal: Recent and future changes based on bias-corrected CMIP6 simulations
Seasonality of confirmed malaria cases from 2008 to 2017 in Togo: A time series analysis by health district and target group
Associations between environmental covariates and temporal changes in malaria incidence in high transmission settings of Uganda: A distributed lag nonlinear analysis
Do socio-demographic factors modify the effect of weather on malaria in Kanungu District, Uganda?
Impact of aerial humidity on seasonal malaria: An ecological study in Zambia
Near-term climate change impacts on sub-national malaria transmission
Forecasting the potential effects of climate change on malaria in the Lake Victoria basin using regionalized climate projections
Climate factors and dengue fever in Burkina Faso from 2017 to 2019
Epidemiological, entomological, and climatological investigation of the 2019 dengue fever outbreak in Gewane District, afar region, north-east Ethiopia
An accurate mathematical model predicting number of dengue cases in tropics
Dengue virus infection and associated risk factors in Africa: A systematic review and meta-analysis
Factors influencing the occurrence of flooding, risk and management strategies in Lagos, Nigeria
Debilitating floods in the Sahel are becoming frequent
Climate change-mediated heat stress vulnerability and adaptation strategies among outdoor workers
Incidence, drivers and global health implications of the 2019/2020 yellow fever sporadic outbreaks in Sub-Saharan Africa
Geostatistical modeling of malaria prevalence among under-five children in Rwanda
Epidemiology of floods in sub-saharan Africa: A systematic review of health outcomes
Impact of seasonal malaria chemoprevention on prevalence of malaria infection in malaria indicator surveys in Burkina Faso and Nigeria
Extending seasonal malaria chemoprevention to five cycles: A pilot study of feasibility and acceptability in Mangodara District, Burkina Faso
Geo-climatic factors of malaria morbidity in the Democratic Republic of Congo from 2001 to 2019
Forecasting malaria morbidity to 2036 based on geo-climatic factors in the Democratic Republic of Congo
Bayesian geostatistical modeling to assess malaria seasonality and monthly incidence risk in Eswatini
Malaria trends in Ethiopian highlands track the 2000 ‘slowdown’ in global warming
Seasonal profile and five-year trend analysis of malaria prevalence in Maygaba Health Center, Welkait District, Northwest Ethiopia
Malaria threatens to bounce back in Abergele District, northeast Ethiopia: Five-year retrospective trend analysis from 2016-2020 in Nirak Health Center
Burden of malaria, impact of interventions and climate variability in western Ethiopia: An area with large irrigation based farming
Description of malaria epidemics and normal transmissions using rainfall variability in Gondar Zuria highland District, Ethiopia
Modelling and forecasting temporal PM2.5 concentration using ensemble machine learning methods
Exploring meteorological conditions and human health impacts during two dust storm events in Northern Cape Province, South Africa: Findings and lessons learnt
Air quality in Africa: Public health implications
Effects of African bap emission from wildfire biomass burning on regional and global environment and human health
Correlation between children respiratory virus infections and climate factors
Impact of COVID-19 on food security in Ethiopia
From scenario to mounting risks: COVID-19’s perils for development and supply security in the Sahel
Potential dust induced changes on the seasonal variability of temperature extremes over the Sahel: A regional climate modeling study
Geospatial modeling of pre-intervention nodule prevalence of Onchocerca volvulus in Ethiopia as an aid to onchocerciasis elimination
Effects of climate variability and environmental factors on the spatiotemporal distribution of malaria incidence in the Amhara national regional state, Ethiopia
Ideational factors and their association with insecticide treated net use in Magoe District, Mozambique
Evaluation of prediction models for the malaria incidence in Marodijeh region, Somaliland
Potential impacts of climate change on geographical distribution of three primary vectors of African Trypanosomiasis in Tanzania’s Maasai Steppe: G. m. morsitans, G. pallidipes and G. swynnertoni
Uganda mountain community health system-perspectives and capacities towards emerging infectious disease surveillance
Interfacing vector-borne disease dynamics with climate change: Implications for the attainment of SDGs in Masvingo city, Zimbabwe
Climate change diminishes the potential habitat of the bont tick (Amblyomma hebraeum): Evidence from Mashonaland Central Province, Zimbabwe
Projecting the potential distribution of Glossina morsitans (Diptera: Glossinidae) under climate change using the maxent model
Genomic surveillance of Rift Valley fever virus: From sequencing to lineage assignment
Remote sensing of environmental risk factors for malaria in different geographic contexts
Spatio-temporal dynamics of Plasmodium falciparum and Plasmodium vivax in French Guiana: 2005-2019
Spatiotemporal analysis of traffic congestion, air pollution, and exposure vulnerability in Tanzania
The GEOHealth hub for eastern Africa: Contributions and lessons learned
Burden, clinical characteristics, risk factors, and seasonality of Adenovirus 40/41 diarrhea in children in eight low-resource settings
Influence of temperature on mortality in the French overseas regions: A pledge for adaptation to heat in tropical marine climates
Extreme heat, preterm birth, and stillbirth: A global analysis across 14 lower-middle income countries
Climate change, adaptation and infectious diseases surveillance – Policy Brief
Mozambique Country Climate and Development Report
South Africa Lancet Countdown on Health and Climate Change Data Sheet 2023
Sierra Leone Lancet Countdown on Health and Climate Change Data Sheet 2023
Nigeria Lancet Countdown on Health and Climate Change Data Sheet 2023
Kenya Lancet Countdown on Health and Climate Change Data Sheet 2023
Listening to Communities is Key to Preparing for the Public Health Implications of El Niño in Zambia
Improving clean water provision and nutrition through drought anticipation measures in Kenya
Improving clean water provision and nutrition through drought anticipation measures in Kenya
Next generation chlorine dispensers for safe water, delivering a climate-health solution at scale
Developing a climate-resilient workforce through the establishment of Zambia’s first-ever Family Medicine program
CARBOMICA: a carbon mitigation and resource allocation modelling tool for the healthcare sector in East Africa
Developing early warning, alert and response systems (EWARS) to combat climate-sensitive diseases in Ethiopia
Engaging across sectors in six cities to realise health benefits of action on air pollution
Preventing climate-driven outbreaks of malaria through scalable and cost effective Seasonal Malaria Chemoprevention programs in Africa
Nature exclosures for carbon sequestration to generate revenue, rehabilitate nature and improve agricultural yields in the highlands of Ethiopia
Drought risk management and mitigation strategy 2022-2032
Regenerating rainforests by listening to communities: A planetary health approach to the climate and nature crisis in Madagascar
Bringing health into climate policy-making in Accra using the WHO Urban Health Initiative model-process
World Malaria Report 2022
Risk Information Exchange (RiX)
From Pollution to Solution in Africa’s Cities: The case for investing in air pollution and climate change together
Perspective climatique – Madagascar
Bulletin Climat-Santé – Madagascar
Climate and Health Bulletin – Nigeria
Seasonal Climate Prediction – Nigeria
Air Quality Information System – South Africa
Fire Danger Index – South Africa
The synergistic relationship between climate change and the HIV/AIDS epidemic: A conceptual framework
Towards the comprehension of fasciolosis (re-)emergence: An integrative overview
Sorghum mitigates climate variability and change on crop yield and quality
Politics of disease control in Africa and the critical role of global health diplomacy: A systematic review
Global climate change and pollen aeroallergens: A southern hemisphere perspective
How seasonality of malnutrition is measured and analyzed
Climate change risks to human development in sub-Saharan Africa: A review of the literature
Climate change and health in Ethiopia: To what extent have the health dimensions of climate change been integrated into the climate-resilient green economy?
The effect of climate change and the Snail-Schistosome Cycle in transmission and bio-control of Schistosomiasis in Sub-Saharan Africa
The effects of climate change on human health in Africa, a dermatologic perspective: A report from the International Society of Dermatology Climate Change Committee
The epidemiology of skin cancer and public health strategies for its prevention in Southern Africa
The impact of climate change on mosquito-borne diseases in Africa
Scoping the nexus between climate change and water-security realities in rural South Africa
Mosquito-borne viral diseases in the Democratic Republic of the Congo: A review
Neglected tropical diseases in the context of climate change in East Africa: A systematic scoping review
Nutrition transition and climate risks in Nigeria: Moving towards food systems policy coherence
Invasive Mesquite (Prosopis juliflora), an allergy and health challenge
Impact of extreme weather events on Sub-Saharan African child and adolescent mental health: A protocol for a systematic review
Impacts of climate change on the public health of the Mediterranean Basin population – Current situation, projections, preparedness and adaptation
Climate change policies in 16 West African countries: A systematic review of adaptation with a focus on agriculture, food security, and nutrition
A systematic review and meta-analysis assessing the impact of droughts, flooding, and climate variability on malnutrition
The practice and politics of urban climate change mitigation and adaptation efforts: The case of Cairo
Trend analysis of cold extremes in South Africa: 1960-2016
The good life in the face of climate change: Understanding complexities of a well-being framework through the experience of pastoral women
Stressed, anxious, and sick from the floods: A photovoice study of climate extremes, differentiated vulnerabilities, and health in Old Fadama, Accra, Ghana
Social work empowerment model for mainstreaming the participation of rural women in the climate change discourse
Spatiotemporal dynamics of urban climate during the wet-dry season transition in a tropical African city
Research priorities for control of zoonoses in South Africa
Seasonality of adverse birth outcomes in women with and without HIV in a representative birth outcomes surveillance study in Botswana
Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa
Projected changes in the season of hot days in the Middle East and North Africa
Perceptions and vulnerability to climate change among the urban poor in Kampala City, Uganda
Perceived impacts of climate variability and change: An exploration of farmers’ adaptation strategies in Zimbabwe’s intensive farming region
Modelling temperature extremes in the Limpopo province: Bivariate time-varying threshold excess approach
Modelling the influence of short-term climate variability on drinking water quality in tropical developing countries: A case study in Tanzania
Natural disasters, population displacement and health emergencies: Multiple public health threats in Mozambique
Managing city-scale slow-onset disasters: Learning from Cape Town’s 2015-2018 drought disaster planning
Is migration an effective adaptation to climate-related agricultural distress in sub-Saharan Africa?
Indoor temperature variability in the Sahel: A pilot study in Ouagadougou, Burkina Faso
Indigenous knowledge of Rift Valley Fever among Somali nomadic pastoralists and its implications on public health delivery approaches in Ijara sub-County, North Eastern Kenya
Impact of different heat wave definitions on daily mortality in Bandafassi, Senegal
Impact of droughts on child mortality: A case study in Southern African countries
Impact of future climate change on malaria in West Africa
Impact of recent climate extremes on mosquito-borne disease transmission in Kenya
Heat exposure effect on Ghanaian mining workers: A mediated-moderation approach
Hydration in relation to water insecurity, heat index, and lactation status in two small-scale populations in hot-humid and hot-arid environments
Flooding trends and their impacts on coastal communities of Western Cape Province, South Africa
Forced displacement: Critical lessons in the protracted aftermath of a flood disaster
Estimating the magnitude and risk associated with heat exposure among Ghanaian mining workers
Do women farmers cope or adapt to strategies in response to climate extreme events? Evidence from rural Ghana
Drought and disproportionate disease: An investigation of gendered vulnerabilities to HIV/AIDS in less-developed nations
Climate change risk to southern African wild food plants
Climate change: A friend or foe to food security in Africa?
Climate predicts geographic and temporal variation in mosquito-borne disease dynamics on two continents
Climate variability and health in extremely vulnerable communities: Investigating variations in surface water conditions and food security in the West African Sahel
Climatic conditions and infant care: Implications for child nutrition in rural Ethiopia
Climate change and health preparedness in Africa: Analysing trends in six African countries
Climate change impacts on household food security and adaptation strategies in southern Ethiopia
Atmospheric tropical modes are important drivers of Sahelian springtime heatwaves
Can we advance individual-level heat-health research through the application of stochastic weather generators?
Assessment of flood vulnerability in some communities in Lokoja, Kogi State, Nigeria, using Participatory Geographic Information Systems
Application of HEC-RAS and HEC-LifeSim models for flood risk assessment
Application of hydrodynamic models for designing structural measures for river flood mitigation: The case of Kulfo River in southern Ethiopia
A large epidemic of a necrotic skin infection in the Democratic Republic of São Tomé and Principe: An epidemiological study
A photovoice assessment for illuminating the role of inland fisheries to livelihoods and the local challenges experienced through the lens of fishers in a climate-driven lake of Malawi
Women’s vulnerability to climate-related risks to household water security in Centre-East, Burkina Faso
Youth resilience to drought: Learning from a group of South African adolescents
A gendered lens to self-evaluated and actual climate change knowledge
Variation of prevalence of malaria, parasite density and the multiplicity of Plasmodium falciparum infection throughout the year at three different health centers in Brazzaville, Republic of Congo
Village-level climate and weather variability, mediated by village-level crop yield, is associated with linear growth in children in Uganda
Uncovering the challenges of domestic energy access in the context of weather and climate extremes in Somalia
The three little houses: A comparative study of indoor and ambient temperatures in three low-cost housing types in Gauteng and Mpumalanga, South Africa
The potential impacts of climate factors and malaria on the Middle Palaeolithic population patterns of ancient humans
The prediction of hepatitis E through ensemble learning
The impacts of drought and the adaptive strategies of small-scale farmers in uMsinga, KwaZulu-Natal, South Africa
The influence of apparent temperature on mortality in the Kintampo health and demographic surveillance area in the middle belt of Ghana: A retrospective time-series analysis
The environmental drivers of bacterial meningitis epidemics in the Democratic Republic of Congo, central Africa
The effect of climate change on yellow fever disease burden in Africa
Temperature as a modifier of the effects of air pollution on cardiovascular disease hospital admissions in Cape Town, South Africa
Stunted from the start: Early life weather conditions and child undernutrition in Ethiopia
Successive epidemic waves of cholera in South Sudan between 2014 and 2017: A descriptive epidemiological study
Spatial-temporal patterns of malaria incidence in Uganda using HMIS data from 2015 to 2019
Spatio-temporal variation and trends of long-term meteorological variables in Nigeria
Spatio-temporal variation of malaria hotspots in Central Senegal, 2008-2012
Statistical modelling of the effects of weather factors on Malaria occurrence in Abuja, Nigeria
Spatial clustering of food insecurity and its association with depression: A geospatial analysis of nationally representative South African data, 2008-2015
Shifting transmission risk for malaria in Africa with climate change: A framework for planning and intervention
Short term seasonal effects of airborne fungal spores on lung function in a panel study of schoolchildren residing in informal settlements of the Western Cape of South Africa
Seasonal variation of household food insecurity and household dietary diversity on wasting and stunting among young children in a drought prone area in South Ethiopia: A cohort study
Risk, vulnerability and pragmatic inevitability: The conflict-disaster nexus in urban governance in Johannesburg
Saharan sand and dust storms and neonatal mortality: Evidence from Burkina Faso
Rainfall and child weight in Uganda
Rainfall shocks and intimate partner violence in sub-Saharan Africa
Present and future climatic suitability for dengue fever in Africa
Poor mental health of livestock farmers in Africa: A mixed methods case study from Ghana
Predicting Malaria transmission dynamics in Dangassa, Mali: A novel approach using functional generalized additive models
Passive cooling for thermal comfort in informal housing
Perception of climate change, loss of social capital and mental health in two groups of migrants from African countries
Persistent heat waves projected for Middle East and North Africa by the end of the 21st century
Optimal control and temperature variations of malaria transmission dynamics
Occurrence of enteric viruses in surface water and the relationship with changes in season and physical water quality dynamics
Outdoor thermal comfort: Coupling microclimatic parameters with subjective thermal assessment to design urban performative spaces
Multilevel and spatial analyses of childhood malnutrition in Uganda: Examining individual and contextual factors
Modeling pastoralist movement in response to environmental variables and conflict in Somaliland: Combining agent-based modeling and geospatial data
Modeling the impact of seasonal weather variations on the infectiology of brucellosis
Modelling geographical accessibility to support disaster response and rehabilitation of a healthcare system: An impact analysis of cyclones Idai and Kenneth in Mozambique
Modelling the impact of climate change on the distribution and abundance of tsetse in Northern Zimbabwe
Malaria and meningitis under climate change: Initial assessment of climate information service in Nigeria
Malaria patterns across altitudinal zones of Mount Elgon following intensified control and prevention programs in Uganda
Knowledge, attitude, and adaptation to climate change in Ghana
Large-scale Lassa fever outbreaks in Nigeria: Quantifying the association between disease reproduction number and local rainfall
Introducing experiences from African pastoralist communities to cope with climate change risks, hazards and extremes: Fostering poverty reduction
Investigating persistent measles dynamics in Niger and associations with rainfall
It’s risky to wander in September: Modelling the epidemic potential of Rift Valley fever in a Sahelian setting
Integrating climate in Ugandan health and subsistence food systems: Where diverse knowledges meet
Impact of weather conditions on incidence and mortality of COVID-19 pandemic in Africa
Incorporating hydrology into climate suitability models changes projections of malaria transmission in Africa
Impact of extreme weather conditions on healthcare provision in urban Ghana
Impact of 1.5 (o)C and 2 (o)C global warming scenarios on malaria transmission in East Africa
Hepatitis E virus outbreak associated with rainfall in the Central African Republic in 2008-2009
Health status and health care needs of drought-related migrants in the Horn of Africa-A qualitative investigation
Heat stress risk and vulnerability under climate change in Durban metropolitan, South Africa – Identifying urban planning priorities for adaptation
Five-year trend analysis of malaria prevalence in Dembecha Health Center, West Gojjam Zone, northwest Ethiopia: A retrospective study
Flash flood risk assessment using geospatial technology in Shewa Robit town, Ethiopia
Harmful algal blooms threaten the health of peri-urban fisher communities: A case study in Kisumu Bay, Lake Victoria, Kenya
Health consequences of drought in the WHO Eastern Mediterranean Region: Hotspot areas and needed actions
Exploring public awareness of the current and future malaria risk zones in South Africa under climate change: A pilot study
Exploring wildfire occurrence: Local farmers’ perceptions and adaptation strategies in central Cote d’Ivoire, West Africa
Drought monitoring in the Middle East and North Africa (MENA) region: Participatory engagement to inform early warning systems
Climate change impact on water availability in the olifants catchment (South Africa) with potential adaptation strategies
Climate change, pesticides and health: Considering the risks and opportunities of adaptation for Zimbabwean smallholder cotton growers
Climate variability and child nutrition: Findings from sub-Saharan Africa
Building resilience to climate change in vulnerable communities: A case study of uMkhanyakude district municipality
Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012-2019
Characterizing the contribution of high temperatures to child undernourishment in Sub-Saharan Africa
Climate change causes changes in biochemical markers of kidney disease
An assessment of public knowledge and potential health impacts of global warming in Ghana
Health and Climate Change Urban Profiles: Kisumu county
Health and Climate Change Urban Profiles: Accra
KMD Maproom (Kenya)
One Health stakeholder and institutional analysis in Kenya
Plan D’actions Du Senegal (2006- 2020) pour la Mise en Place du Cadre National pour les Services Climatologiques (CNSC)
Bulletin de Surveillance de la Qualité de l’air Madagascar
Madagascar Maproom
Vigilance météorologique Madagascar
Vigilance Cyclones Tropicaux Madagascar
Madagascar: Health and Climate Change Country Profile 2022
ANACIM Maproom (Senegal)
Climate Change Adaptation through Implementation of Climate-resilient Water Safety Planning in Tanzania
UNFCCC NDC Registry
Shifting Risks of Malaria in Southern Africa: A Regional Analysis
Plague in a Changing Environment: A Literature Review for Madagascar
Malaria Early Warning in Ethiopia: A Roadmap for Scaling to the National Level
Climate Risk Profile: Guinea
Effects Of Climate Change On The Social & Environmental Determinants Of Health In Africa: What Can Communities Do To Strengthen Their Climate Resilience?
Climate And Health Consortium For Africa: Roundtable Discussion
Health and Environment Joint Interventions in Africa: Third Interministerial Conference On Health And Environment In Africa, Libreville, Gabon 6–9 November 2018
Strategic Action Plan to Scale Up Health and Environment Interventions in Africa 2019–2029
Framework for Scaling Up Investments in Priority Health and Environment Interventions: Third Interministerial Conference On Health And Environment In Africa Libreville, Gabon 6–9 November 2018
The Libreville Declaration on Health and Environment in Africa: 10 years on, 2008 – 2018
Third Inter-ministerial Conference On Health And Environment In Africa: Conference Proceedings and Outcomes
Assessment of Climate Change-related Risks and Vulnerabilities in the Health Sector in Togo
Togo Plan National d’Adaptation du Secteur de la Santé aux Effets des Changements Climatiques (PNAS))
Tanzania: Health National Adaptation Plan to Climate Change in Tanzania 2018 – 2023
Plan d’Action National d’Adaptation du Secteur Santé au Changement Climatique à Madagascar
Ethiopia National Health Adaptation Plan to Climate Change 2018-2020
SIDS Dynamic Data Dashboard on Health and Climate Change
Looking back: Documenting lessons learned from a climate and health project in Ethiopia
Using climate information to predict and control meningitis epidemics in West Africa
Improving malaria evaluation and planning with enhanced climate services in East Africa
Healthy Futures Atlas: A publicly available resource for evaluating climate change risks on water-related and vector-borne disease in eastern Africa
Forecasting malaria transmission: finding the basis for making district scale predictions in Uganda
Mapping and modelling plague in Uganda to improve health outcomes
EPIDEMIA: integrating climate information and disease surveillance for malaria epidemic forecasting in Ethiopia
Working with communities in East Africa to manage diarrhoeal disease and dengue risk in a changing climate
Madagascar Climate and Health Working Group
Long-term climate and health collaboration in Ethiopia to improve forecasting of malaria outbreaks
Heat stress risk and vulnerability under climate change in Durban metropolitan, South Africa—identifying urban planning priorities for adaptation
Characteristics and thermodynamics of Sahelian heatwaves analysed using various thermal indices
Barriers to occupational heat stress risk adaptation of mining workers in Ghana
Investigating climate suitability conditions for malaria transmission and impacts of climate variability on mosquito survival in the humid tropical region: A case study of Obafemi Awolowo University Campus, Ile-Ife, south-western Nigeria
Exploring the association between childhood diarrhea and meteorological factors in Southwestern Ethiopia
Evaluation of heat stress impacts and adaptations: Perspectives from smallholder rural farmers in Bawku East of Northern Ghana
Emerging climate change-related public health challenges in Africa: A case study of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania
Drought and illness among young children in Uganda, 2009-2012
Diagnosis of meteorological factors associated with recent extreme rainfall events over Burundi
Determinants of Plasmodium falciparum multiplicity of infection and genetic diversity in Burkina Faso
Coping through a drought: The association between child nutritional status and household food insecurity in the district of iLembe, South Africa
Childhood malaria case incidence in Malawi between 2004 and 2017: Spatio-temporal modelling of climate and non-climate factors
Biting rates and relative abundance of Simulium flies under different climatic conditions in an onchocerciasis endemic community in Ghana
Assessing the interaction of land cover/land use dynamics, climate extremes and food systems in Uganda
Assessing vulnerability of horticultural smallholders’ to climate variability in Ghana: Applying the livelihood vulnerability approach
Are we ready for it? Health systems preparedness and capacity towards climate change-induced health risks: Perspectives of health professionals in Ghana
A study protocol to determine heat-related health impacts among primary schoolchildren in South Africa
A protocol for an observational cohort study of heat strain and its effect on fetal wellbeing in pregnant farmers in The Gambia
A 7-year trend of malaria at primary health facilities in northwest ethiopia
Twenty-First Century Projected Changes in Extreme Temperature over Côte d’Ivoire (West Africa)
Water as destiny – The long-term impacts of drought in sub-Saharan Africa
Understanding the impacts of short-term climate variability on drinking water source quality: Observations from three distinct climatic regions in Tanzania
Understanding disaster resilience in communities affected by recurrent drought in Lesotho and Swaziland-A qualitative study
Time series non-Gaussian Bayesian bivariate model applied to data on HMPV and RSV: A case of Dadaab in Kenya
The water-energy-food nexus as a tool to transform rural livelihoods and well-being in southern Africa
The role of social networks in building adaptive capacity and resilience to climate change: A case study from northern Ghana
The logic model for Uganda’s health sector preparedness for public health threats and emergencies
The incidence of skin cancer in relation to climate change in South Africa
The gender dynamics of climate change on rural women’s agro-based livelihoods and food security in rural Zimbabwe: Implications for green social work
Temporal, spatial, and household dynamics of Typhoid fever in Kasese district, Uganda
Ten years malaria trend at Arjo-Didessa sugar development site and its vicinity, Southwest Ethiopia: A retrospective study
Survey-based data on food security, nutrition and agricultural production shocks among rural farming households in northern Uganda
Strategies for coping and adapting to flooding and their determinants: A comparative study of cases from Namibia and Zambia
Spatiotemporal characterisation and risk factor analysis of malaria outbreak in Cabo Verde in 2017
Spatio-temporal dynamics of malaria expansion under climate change in semi-arid areas of Ethiopia
Spatio-temporal analysis of association between incidence of malaria and environmental predictors of malaria transmission in Nigeria
Socio-economic and institutional drivers of vulnerability to climate change in urban slums: The case of Accra, Ghana
Socio-economic, infrastructural and health-related risk factors associated with adverse heat-health effects reportedly experienced during hot weather in South Africa
Socio-political drivers and consequences of landslide and flood risk zonation: A case study of Limbe city, Cameroon
Socioeconomic and environmental factors associated with malaria hotspots in the Nanoro demographic surveillance area, Burkina Faso
Socio-ecological vulnerability to climate change/variability in central rift valley, Ethiopia
Short-term association between ambient temperature and homicide in South Africa: A case-crossover study
Seasonality of antenatal care attendance, maternal dietary intake, and fetal growth in the VHEMBE birth cohort, South Africa
Seasonality of childhood tuberculosis cases in Kampala, Uganda, 2010-2015
Seasonal distribution and seven year trend of malaria in North West Tigrai: 2012-2018, Ethiopia; 2019
Role of climatic factors in the incidence of dengue in Port Sudan City, Sudan
Rainfall trends and malaria occurrences in Limpopo Province, South Africa
Predicting malaria cases using remotely sensed environmental variables in Nkomazi, South Africa
Predicting the direct and indirect impacts of climate change on malaria in coastal Kenya
Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: A retrospective cohort study
Performance evaluation of a potential component of an early flood warning system-A case study of the 2012 flood, Lower Niger River Basin, Nigeria
Nutritional status of children aged 0-60 months in two drought-prone areas of Ethiopia
Mortality impact of low annual crop yields in a subsistence farming population of Burkina Faso under the current and a 1.5 degrees C warmer climate in 2100
Modelled and observed mean and seasonal relationships between climate, population density and malaria indicators in Cameroon
Malaria in Burkina Faso (West Africa) during the twenty-first century
Malaria smear positivity among Kenyan children peaks at intermediate temperatures as predicted by ecological models
Localised human thermal discomfort assessment using high temporal resolution meteorological data: A case of University of Zimbabwe
Linking water quality monitoring and climate-resilient water safety planning in two urban drinking water utilities in Ethiopia
Land fragmentation, climate change adaptation, and food security in the Gamo Highlands of Ethiopia
Influence of meteorological parameters in the seasonality of influenza viruses circulating in Northern Cameroon
In pursuit of livelihood sustainability and drought resilience: The human dimension of drought-adaptation in the Maasai pastoralists coupled socio-ecological systems across Kajiado County, Kenya
Impacts of flooding on drinking water access in Dar es Salaam, Tanzania: Implications for the Sustainable Development Goals
Hydrological hazards in Vhembe district in Limpopo Province, South Africa
How violence against women and girls undermines resilience to climate risks in Chad
Hunger, nutrition, and precipitation: Evidence from Ghana and Bangladesh
Household air pollution mitigation with integrated biomass/cookstove strategies in Western Kenya
Groundwater and resilience to drought in the Ethiopian highlands
Health vulnerability to flood-induced risks of households in flood-prone informal settlements in the coastal city of Mombasa, Kenya
Gender dimension of vulnerability to climate change and variability: Empirical evidence of smallholder farming households in Ghana
Gender, social capital and adaptive capacity to climate variability: A case of pastoralists in arid and semi-arid regions in Kenya
Gendered perception and vulnerability to climate change in urban slum communities in Accra, Ghana
From rain to famine: Assessing the utility of rainfall observations and seasonal forecasts to anticipate food insecurity in East Africa
Flood governance for resilience in cities: The historical policy transformations in Dakar’s suburbs
Examining climate change and food security in Ghana through an intersectional framework
Evaluating local vulnerability and organisational resilience to frequent flooding in Africa: The case of Northern Cameroon
Establishing the nexus between climate change adaptation strategy and smallholder farmers’ food security status in South Africa: A bi-casual effect using instrumental variable approach
Epidemiology of enteric viruses in children with gastroenteritis in Ogun State, Nigeria
Environmental temperature and case fatality of patients with Ebola virus disease in Sierra Leone and Liberia, 2014-2015: A retrospective cohort study
Entomological assessment of dengue virus transmission risk in three urban areas of Kenya
El Nino-Southern oscillation and under-5 diarrhea in Botswana
Ecological vulnerability indicators to drought: Case of communal farmers in Eastern Cape, South Africa
Droughts, livelihoods, and human migration in northern Ethiopia
Dynamical malaria forecasts are skillful at regional and local scales in Uganda up to 4 months ahead
Drought and child undernutrition in Ethiopia: A longitudinal path analysis
Distinct climate influences on the risk of typhoid compared to invasive non-typhoid Salmonella disease in Blantyre, Malawi
Differences of rainfall-malaria associations in lowland and highland in Western Kenya
Determinants of adaptation choices to climate change in agro-pastoral dry lands of Northeastern Amhara, Ethiopia
Complex interactions between climate change, sanitation, and groundwater quality: A case study from Ramotswa, Botswana
Conceptualizations of climate-related health risks among health experts and the public in Ghana
Conserving resources during chronic disaster: Impacts of religious and meaning-focused coping on Botswana drought survivors
Communities’ perceptions of health hazards induced by climate change in Mount Darwin district, Zimbabwe
Community-based surveillance of unaccompanied and separated children in drought-affected northern Ethiopia
Climatic factors in relation to diarrhoea hospital admissions in rural Limpopo, South Africa
Climate change-induced impacts on smallholder farmers in selected districts of Sidama, Southern Ethiopia
Climate change and healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region, South Africa
Climate change impacts on the distribution of venomous snakes and snakebite risk in Mozambique
Climate change adaptation strategies in response to food insecurity: The paradox of improved potato varieties adoption in eastern Ethiopia
Characterizing the spatial determinants and prevention of malaria in Kenya
Cash transfers enable households to cope with agricultural production and price shocks: Evidence from Zambia
Bayesian conditional autoregressive models to assess spatial patterns of diarrhoea risk among children under the age of 5 years in Mbour, Senegal
Bringing the state back in to humanitarian crises response: Disaster governance and challenging collaborations in the 2015 Malawi flood response
Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016-2017
Assessing the role of climate factors on malaria transmission dynamics in South Sudan
Analysis of gender vulnerability to climate-related hazards in a rural area of Ethiopia
Agricultural investments and hunger in Africa modeling potential contributions to SDG2 – Zero hunger
Adaptation to flooding, pathway to housing or ‘wasteful expenditure’? Governance configurations and local policy subversion in a flood-prone informal settlement in Cape Town
After the flames then what? Exploring the linkages between wildfires and household food security in the northern savannah of Ghana
A quantitative analysis of socio-economic determinants influencing crop drought vulnerability in sub-saharan Africa
A dynamical and zero-inflated negative binomial regression modelling of malaria incidence in Limpopo Province, South Africa
A high-frequency mobile phone data collection approach for research in social-environmental systems: Applications in climate variability and food security in sub-Saharan Africa
A One Health perspective to identify environmental factors that affect Rift Valley fever transmission in Gezira state, Central Sudan
Welfare effects of weather variability: Multi-country evidence from Africa south of the Sahara
Using smartphone technology to reduce health impacts from atmospheric environmental hazards
Utilizing remote sensing at a subsistence farming level to explore child undernutrition in the context of climate change
Vulnerability of HIV/AIDS orphans to floods in Malawi
Urban climate change, livelihood vulnerability and narratives of generational responsibility in Jinja, Uganda
Understanding weather and hospital admissions patterns to inform climate change adaptation strategies in the healthcare sector in Uganda
The consequences of relocating in response to drought: Human mobility and conflict in contemporary Kenya
Temporal patterns of anthrax outbreaks among livestock in Lesotho, 2005-2016
The 2015-2016 malaria epidemic in Northern Uganda; What are the implications for malaria control interventions?
Spatio-temporal dynamic of malaria in Ouagadougou, Burkina Faso, 2011-2015
Spatio-temporal heterogeneity of malaria morbidity in Ghana: Analysis of routine health facility data
Sensitivity of vegetation to climate variability and its implications for malaria risk in Baringo, Kenya
Responses to climate variability in urban poor communities in Pietermaritzburg, KwaZulu-Natal, South Africa
Quantifying trade-offs between future yield levels, food availability and forest and woodland conservation in Benin
Psychological distance of climate change and mental health risks assessment of smallholder farmers in northern Ghana: Is habituation a threat to climate change?
Preliminary investigation of flooding problems and the occurrence of kidney disease around Hadejia-Nguru wetlands, Nigeria and the need for an ecohydrology solution
Plant phenology supports the multi-emergence hypothesis for Ebola spillover events
Perceptions of climate change and occupational heat stress risks and adaptation strategies of mining workers in Ghana
Modelling trends of climatic variability and malaria in Ghana using vector autoregression
Mapping malaria risk using geographic information systems and remote sensing: The case of Bahir Dar City, Ethiopia
Mapping potential Anopheles gambiae s.l. larval distribution using remotely sensed climatic and environmental variables in Baringo, Kenya
Malaria transmission trends and its lagged association with climatic factors in the highlands of Plateau State, Nigeria
Land use and ambient air quality in Bahir Dar and Hawassa, Ethiopia
Investigation of a scabies outbreak in drought-affected areas in Ethiopia
Is ambient heat exposure levels associated with miscarriage or stillbirths in hot regions? A cross-sectional study using survey data from the Ghana Maternal Health Survey 2007
Interactions between climatic changes and intervention effects on malaria spatio-temporal dynamics in Uganda
Influence of climatic factors on malaria epidemic in Gulu District, Northern Uganda: A 10-Year retrospective study
Impacts of climate variability and food price volatility on household income and food security of farm households in East and West Africa
Impact of the 2013 floods on the incidence of malaria in Almanagil Locality, Gezira State, Sudan
Impact of weather conditions on atopic dermatitis prevalence in Abuja, Nigeria
Impact evaluation of malaria control interventions on morbidity and all-cause child mortality in Mali, 2000-2012
Health risk perceptions and local knowledge of water-related infectious disease exposure among Kenyan wetland communities
Family planning and resilience: Associations found in a population, health, and environment (PHE) project in western Tanzania
Exploring the influence of daily climate variables on malaria transmission and abundance of anopheles arabiensis over Nkomazi local municipality, Mpumalanga Province, South Africa
Experience and future perceived risk of floods and diarrheal disease in urban poor communities in Accra, Ghana
Evaluating efficacy of landsat-derived environmental covariates for predicting malaria distribution in rural villages of Vhembe District, South Africa
Emotional and cognitive factors influencing flood preparedness in Dire Dawa town, Ethiopia
Effect of agronomic practices and weather conditions on mycotoxins in maize: A case study of subsistence farming households in Zimbabwe
Ecological distribution and population dynamics of Rift Valley fever virus mosquito vectors (Diptera, Culicidae) in Senegal
Ecological niche modeling of Aedes mosquito vectors of chikungunya virus in southeastern Senegal
Dominant malaria vector species in Nigeria: Modelling potential distribution of Anopheles gambiae sensu lato and its siblings with MaxEnt
Drought and flood risk, impacts and adaptation options for resilience in rural communities of Uganda
Diversity within village institutions and its implication for resilience in the context of climate change in Cameroon
Disaster preparedness and response capacity of regional hospitals in Tanzania: A descriptive cross-sectional study
Climate variability, perceptions and political ecology: Factors influencing changes in pesticide use over 30 years by Zimbabwean smallholder cotton producers
Climate, birth weight, and agricultural livelihoods in Kenya and Mali
Climate change and occupational heat stress risks and adaptation strategies of mining workers: Perspectives of supervisors and other stakeholders in Ghana
Climate change and vulnerability discourse by students at a South African university
Climate change impact on water resources in the Awash basin, Ethiopia
Climate change and African trypanosomiasis vector populations in Zimbabwe’s Zambezi Valley: A mathematical modelling study
Cattle and rainfall affect tick abundance in central Kenya
Challenges of DHS and MIS to capture the entire pattern of malaria parasite risk and intervention effects in countries with different ecological zones: The case of Cameroon
Biodiversity pattern of mosquitoes in southeastern Senegal, epidemiological implication in arbovirus and malaria transmission
Awareness of environmental change, climate variability, and their role in prevalence of mosquitoes among urban dwellers in southern Ghana
Association between precipitation and diarrheal disease in Mozambique
Assessment of risk, vulnerability and adaptation to climate change by the health sector in Madagascar
Assessing vulnerability and coping capacities of rural women to drought: A case study of Zvishavane District, Zimbabwe
Assessing drought vulnerability and adaptation among farmers in Gadaref region, Eastern Sudan
Assessing impacts of seasonal climate variability on maize yield in Kenya
Annual crop-yield variation, child survival, and nutrition among subsistence farmers in Burkina Faso
Analysis of air quality in Dire Dawa, Ethiopia
Aeroallergens in north-central Nigeria
Agricultural diversification as an important strategy for achieving food security in Africa
A political economy analysis of decision-making on natural disaster preparedness in Kenya
A detailed study of climate change and some vulnerabilities in Indian Ocean: A case of Madagascar island
Whether weather matters: Evidence of association between in utero meteorological exposures and foetal growth among Indigenous and non-Indigenous mothers in rural Uganda
Vulnerability to drought and food price shocks: Evidence from Ethiopia
Weather extremes and household welfare in rural Kenya
Using rainfall and temperature data in the evaluation of national malaria control programs in Africa
Using remote sensing environmental data to forecast malaria incidence at a rural district hospital in Western Kenya
Urban settlements’ vulnerability to flood risks in African cities: A conceptual framework
Trichuris trichiura infection and its relation to environmental factors in Mbeya region, Tanzania: A cross-sectional, population-based study
The long road to elimination: Malaria mortality in a South African population cohort over 21 years
The effects of adaptation to climate change on income of households in rural Ethiopia
The complex interplay between everyday risks and disaster risks: The case of the 2014 cholera pandemic and 2015 flood disaster in Accra, Ghana
Temporal distribution of gastroenteritis viruses in Ouagadougou, Burkina Faso: Seasonality of rotavirus
Temporal dynamic of malaria in a suburban area along the Niger River
Temporal genetic differentiation in Glossina pallidipes tsetse fly populations in Kenya
Temporal variation in confirmed diagnosis of fever-related malarial cases among children under-5 years by community health workers and in health facilities between years 2013 and 2015 in Siaya County, Kenya
Surveillance of vector-borne infections (chikungunya, dengue, and malaria) in Bo, Sierra Leone, 2012-2013
Studies on sand fly fauna and ecological analysis of Phlebotomus orientalis in the highland and lowland foci of kala-azar in northwestern Ethiopia
Spatiotemporal transmission and socio-climatic factors related to paediatric tuberculosis in north-western Ethiopia
Spatiotemporal variability of drinking water quality and the associated health risks in southwestern towns of Ethiopia
Spatial determinants of Ebola virus disease risk for the West African epidemic
Rural household vulnerability to climate risk in Uganda
Seasonal Pattern of Mycobacterium ulcerans, the causative agent of Buruli Ulcer, in the environment in Ghana
Reprint of “Modelling the influence of temperature and rainfall on malaria incidence in four endemic provinces of Zambia using semiparametric poisson regression”
Relationship between meteorological variables/dust and the number of meningitis cases in Burkina Faso
Rainfall variability and floods occurrence in the city of Bamenda (Northwest of Cameroon)
Quality and dissemination of information from a drought early warning system in Karamoja sub-region, Uganda
Quantifying and predicting the contribution of sea-level rise to shoreline change in Ghana: Information for coastal adaptation strategies
Prenatal temperature shocks reduce cooperation: Evidence from public goods games in Uganda
Prevalence and seasonal transmission of schistosoma haematobium infection among school-aged children in Kaedi town, southern Mauritania
Prediction of future malaria hotspots under climate change in sub-saharan Africa
Population-level estimates of the proportion of Plasmodium vivax blood-stage infections attributable to relapses among febrile patients attending Adama Malaria Diagnostic Centre, East Shoa zone, Oromia, Ethiopia
Modeling the risk of transmission of schistosomiasis in Akure North Local Government Area of Ondo State, Nigeria using satellite derived environmental data
Model-driven engineering and creative arts approach to designing climate change response system for rural Africa: A Case study of Adum-Aiona community in Nigeria
Micro-spatial distribution of malaria cases and control strategies at ward level in Gwanda District, Matabeleland South, Zimbabwe
Malaria incidence during early childhood in rural Burkina Faso: Analysis of a birth cohort protected with insecticide-treated mosquito nets
Malaria incidence trends and their association with climatic variables in rural Gwanda, Zimbabwe, 2005-2015
Malaria mortality characterization and the relationship between malaria mortality and climate in Chimoio, Mozambique
Malaria risk in young male travellers but local transmission persists: A case-control study in low transmission Namibia
Longitudinal survey on the distribution of Biomphalaria sudanica and B. choanomophala in Mwanza region, on the shores of Lake Victoria, Tanzania: Implications for schistosomiasis transmission and control
Malaria incidence among children less than 5 years during and after cessation of indoor residual spraying in Northern Uganda
Long-term climate data description in Ethiopia
Local-level climate change adaptation decision-making and livelihoods in semi-arid areas in Zimbabwe
Living with drought in South Africa: Lessons learnt from the recent El Nino drought period
Joint Bayesian modeling of time to malaria and mosquito abundance in Ethiopia
Is living in a gas-flaring host community associated with being hypertensive? Evidence from the Niger Delta Region of Nigeria
Interacting effects of land use and climate on rodent-borne pathogens in central Kenya
Interactions between intervention packages, climatic risk, climate change and food security in mixed crop-livestock systems in Burkina Faso
Infrastructure mitigates the sensitivity of child growth to local agriculture and rainfall in Nepal and Uganda
Institutional challenges to climate change adaptation: A case study on policy action gaps in Uganda
Indoor temperatures in low cost housing in Johannesburg, South Africa
Indoor temperatures in patient waiting rooms in eight rural primary health care centers in northern South Africa and the related potential risks to human health and wellbeing
Influence of meteorological variables on diversity and abundance of mosquito vectors in two livestock farms in Ibadan, Nigeria: Public health implications
Impacts of supplemental irrigation as a climate change adaptation strategy for maize production: a case of the Eastern Cape Province of South Africa
How seasonality and weather affect perinatal health: Comparing the experiences of indigenous and non-indigenous mothers in Kanungu district, Uganda
Human migration, climate variability, and land degradation: Hotspots of socio-ecological pressure in Ethiopia
Hindrances to adaptation to water insecurity under climate variability in peri-urban Ghana
Household cereal crop harvest and children’s nutritional status in rural Burkina Faso
Heat effects of ambient apparent temperature on all-cause mortality in Cape Town, Durban and Johannesburg, South Africa: 2006-2010
Habitat preference and seasonal dynamics of Phlebotomus orientalis in urban and semi-urban areas of Kala-azar endemic district of Kafta Humera, northwest Ethiopia
Excess burden of non-communicable disease years of life lost from heat in rural Burkina Faso: A time series analysis of the years 2000-2010
Exogenous factors matter when interpreting the results of an impact evaluation: a case study of rainfall and child health programme intervention in Rwanda
Effects of flood irrigation on the risk of selected zoonotic pathogens in an arid and semi-arid area in the eastern Kenya
Effects of irrigation and rainfall on the population dynamics of Rift Valley fever and other arbovirus mosquito vectors in the epidemic-prone Tana River County, Kenya
Effect of climatic variability on childhood diarrhea and its high risk periods in northwestern parts of Ethiopia
Effect of climatic variability on malaria trends in Baringo County, Kenya
Effect of climate on incidence of respiratory syncytial virus infections in a refugee camp in Kenya: A non-Gaussian time-series analysis
Drought and child mortality: a meta-analysis of small-scale surveys from Ethiopia
Ecological niche modeling for filoviruses: A Risk map for Ebola and Marburg Virus Disease Outbreaks in Uganda
Distribution and abundance of key vectors of Rift Valley fever and other arboviruses in two ecologically distinct counties in Kenya
Development agents and their role in cushioning the pastoralists of Isiolo Central Sub-County, Kenya, against negative effects of climate variability
Defying the odds: Climate variability, asset adaptation and food security nexus in the delta state of Nigeria
Constraints to climate change adaptation among cassava women farmers: Implications for agricultural transformation and food security in Ebonyi State, Nigeria
Community perceptions on outdoor malaria transmission in Kilombero Valley, Southern Tanzania
Comparison of malaria simulations driven by meteorological observations and reanalysis products in Senegal
Comparison of the spatial patterns of schistosomiasis in Zimbabwe at two points in time, spaced twenty-nine years apart: is climate variability of importance?
Climatic variables and malaria morbidity in mutale local municipality, South Africa: A 19-year data analysis
Climate impact on malaria in northern Burkina Faso
Climate influence on emerging risk areas for Rift Valley fever epidemics in Tanzania
Climate change and variability impacts on agricultural production and livelihood systems in western Tanzania
Climate change adaptation: a panacea for food security in Ondo State, Nigeria
Chikungunya virus seroprevalence and associated factors among hospital attendees in two states of southwest Nigeria: A preliminary assessment
Cassava production as a climate change adaptation strategy in Chilonga Ward, Chiredzi District, Zimbabwe
Challenges and opportunities for mainstreaming climate change adaptation into WaSH development planning in Ghana
Building climate change resilience through adaptation in smallholder farming systems in semi-arid Zimbabwe
Building resilience to food insecurity in rural communities: Evidence from traditional institutions in Zimbabwe
Can smallholder farmers adapt to climate variability, and how effective are policy interventions? Agent-based simulation results for Ethiopia
Associations between meteorological parameters and influenza activity in a subtropical country: Case of five sentinel sites in Yaounde-Cameroon
Assessment of climate-driven variations in malaria incidence in Swaziland: Toward malaria elimination
Association between childhood diarrhoeal incidence and climatic factors in urban and rural settings in the health district of Mbour, Senegal
Assessing realtionship between selected climate variables, human diseases and crop production using ARDL approach- the example of Ondo state, Nigeria
Assessing climate driven malaria variability in Ghana using a regional scale dynamical model
Anaemia among children in a drought affected community in south-central Ethiopia
Air pollution-related health and climate benefits of clean cookstove programs in Mozambique
Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at Kinshasa University clinics, Democratic Republic of Congo (DRC)
Adapting to climate change for food security in the Rift Valley dry lands of Ethiopia: Supplemental irrigation, plant density and sowing date
A prospective cohort study on ambient air pollution and respiratory morbidities including childhood asthma in adolescents from the Western Cape Province: Study protocol
A weather-based prediction model of malaria prevalence in Amenfi West District, Ghana
Vulnerability to climate change and adaptation strategies of local communities in Malawi: Experiences of women fish-processing groups in the Lake Chilwa Basin
Vulnerability to the health effects of climate variability in rural southwestern Uganda
Water resources transfers through southern African food trade: Water efficiency and climate signals
Vector competence of Aedes aegypti in transmitting Chikungunya virus: Effects and implications of extrinsic incubation temperature on dissemination and infection rates
Use patterns of natural resources supporting livelihoods of smallholder communities and implications for climate change adaptation in Zimbabwe
Trauma unit attendance: Is there a relationship with weather, sporting events and week/ month-end times? An audit at an urban tertiary trauma unit in Cape Town
Understanding women’s needs for weather and climate information in agrarian settings: The case of Ngetou Maleck, Senegal
To what extent does climate explain variations in reported malaria cases in early 20th century Uganda?
The relationship between carbon dioxide and agriculture in Ghana: a comparison of VECM and ARDL model
The relative contribution of climate variability and vector control coverage to changes in malaria parasite prevalence in Zambia 2006-2012
Sustainable smallholder poultry interventions to promote food security and social, agricultural, and ecological resilience in the Luangwa Valley, Zambia
Temperature changes, household consumption, and internal migration: Evidence from Tanzania
Socioeconomic assessment of flooding among farm households in Anambra state, Nigeria
Sources and seasonal variation of coliform bacteria abundance in groundwater around the slopes of Mount Meru, Arusha, Tanzania
Space-time mapping of wasting among children under the age of five years in Somalia from 2007 to 2010
Social capital, trust, and adaptation to climate change: Evidence from rural Ethiopia
Securing well-being with the advent of climate hazards: Case of forest-dependent communities in a landscape in the Congo Basin
Severe flooding and Malaria transmission in the Western Ugandan Highlands: Implications for disease control in an era of global climate change
Seasonal variation of food security among the Batwa of Kanungu, Uganda
Seasonality in diabetes in Yaounde, Cameroon: A relation with precipitation and temperature
Seasonal Variation in Biting Rates of Simulium damnosum sensu lato, Vector of Onchocerca volvulus, in Two Sudanese Foci
Seasonal and geographic variation of pediatric malaria in Burundi: 2011 to 2012
Risk of intestinal parasitic infections in people with different exposures to wastewater and fecal sludge in Kampala, Uganda: A cross-sectional study
Remotely sensed environmental conditions and Malaria mortality in three Malaria endemic regions in Western Kenya
Resilience of the poorest: Coping strategies and indigenous knowledge of living with the floods in Northern Namibia
Review of meningitis surveillance data, upper West Region, Ghana 2009-2013
Rift Valley fever vector diversity and impact of meteorological and environmental factors on Culex pipiens dynamics in the Okavango Delta, Botswana
Rainfall variation and child health: effect of rainfall on diarrhea among under 5 children in Rwanda, 2010
Random forest variable selection in spatial malaria transmission modelling in Mpumalanga Province, South Africa
Perceptions of climate change and the potential for adaptation in a rural community in Limpopo Province, South Africa
Piped water consumption in Ghana: A case study of temporal and spatial patterns of clean water demand relative to alternative water sources in rural small towns
Modelling the influence of temperature and rainfall on malaria incidence in four endemic provinces of Zambia using semiparametric Poisson regression
Misfortunes never come singly: structural change, multiple shocks and child malnutrition in rural Senegal
Mapping as a tool for predicting the risk of anthrax outbreaks in Northern Region of Ghana
Malaria and large dams in sub-Saharan Africa: Future impacts in a changing climate
Local conditions of drought-related violence in sub-Saharan Africa: the role of road and water infrastructures
Knowledge, experiences and training needs of health professionals about disaster preparedness and response in Southwest Ethiopia: A cross sectional study
Lay knowledge and management of malaria in Baringo county, Kenya
Influenza activity in Kenya, 2007-2013: Timing, association with climatic factors, and implications for vaccination campaigns
Indigenous environmental indicators for malaria: A district study in Zimbabwe
Impacts of climate change on water resources in Malawi
Household’s socio-economic factors influencing the level of adaptation to climate variability in the dry zones of Eastern Kenya
Heat exposure on farmers in northeast Ghana
Forecasting paediatric malaria admissions on the Kenya Coast using rainfall
Frequency and extent of employing food insecurity coping strategies among rural households: Determinants and implications for policy using evidence from Swaziland
Fishers’ perceptions of climate change, impacts on their livelihoods and adaptation strategies in environmental change hotspots: A case of Lake Wamala, Uganda
Factors affecting rural households’ resilience to food insecurity in Niger
Farmers’ perception and adaptation practice to climate variability and change: A case study of the Vea catchment in Ghana
Evaluating the impact and uncertainty of reservoir operation for malaria control as the climate changes in Ethiopia
Environmental predictors of stunting among children under-five in Somalia: Cross-sectional studies from 2007 to 2010
Environmental change and Rift Valley fever in eastern Africa: Projecting beyond HEALTHY FUTURES
El Nino-based malaria epidemic warning for Oromia, Ethiopia, from August 2016 to July 2017
Effects of climatological parameters in modeling and forecasting seasonal influenza transmission in Abidjan, Cote d’Ivoire
Effects of drought on child health in Marsabit District, Northern Kenya
Effects of regional climate variability on the prevalence of diseases and their economic impacts on households in the Lake Victoria basin of Western Kenya
Effect of temperature and relative humidity on the development times and survival of Synopsyllus fonquerniei and Xenopsylla cheopis, the flea vectors of plague in Madagascar
Ecological niche modelling of Rift Valley fever virus vectors in Baringo, Kenya
Economic impacts of climate change on cereal production: Implications for sustainable agriculture in northern Ghana
Drivers of rural-urban interdependence and their contributions to vulnerability in food systems in Nigeria – a framework
Dynamic risk model for Rift Valley fever outbreaks in Kenya based on climate and disease outbreak data
Determinants of climate change awareness level in upper Nyakach Division, Kisumu County, Kenya
Clinical malaria transmission trends and its association with climatic variables in Tubu Village, Botswana: A retrospective analysis
Climate variability and educational attainment: Evidence from rural Ethiopia
Climate change/variability and schistosomiasis transmission in Ga district, Ghana
Climate change influences potential distribution of infected Aedes aegypti co-occurrence with dengue epidemics risk areas in Tanzania
Climate change perception and choice of adaptation strategies: Empirical evidence from smallholder farmers in east Ethiopia
Climate change threats to two low-lying South African coastal towns: Risks and perceptions
Climate change and rural communities in Ghana: Social vulnerability, impacts, adaptations and policy implications
Cholera in Cameroon, 2000-2012: Spatial and temporal analysis at the operational (health district) and sub climate levels
Assessing comorbidity and correlates of wasting and stunting among children in Somalia using cross-sectional household surveys: 2007 to 2010
Assessing temporal associations between environmental factors and malaria morbidity at varying transmission settings in Uganda
Assessing the effects of air temperature and rainfall on malaria incidence: An epidemiological study across Rwanda and Uganda
Adaptation of agriculture to climate change in semi-arid Borena, Ethiopia
A policy review of synergies and trade-offs in South African climate change mitigation and air pollution control strategies
A gender approach to understanding the differentiated impact of barriers to adaptation: Responses to climate change in rural Ethiopia
A gendered analysis of perception and vulnerability to climate change among smallholder farmers: The case of Same District, Tanzania
Use of prospective hospital surveillance data to define spatiotemporal heterogeneity of malaria risk in coastal Kenya
Triggering of stroke by ambient temperature variation: a case-crossover study in Maputo, Mozambique
The role of small scale sand dams in securing water supply under climate change in Ethiopia
The potential role of neglected and underutilised crop species as future crops under water scarce conditions in sub-Saharan Africa
The influence of environmental factors on childhood fever during the rainy season in an African city: A multilevel approach in Dakar, Senegal
The impact of flooding on people living with HIV: a case study from the Ohangwena Region, Namibia
The association of weather variability and under five malaria mortality in KEMRI/CDC HDSS in Western Kenya 2003 to 2008: A time series analysis
Temperature variation and heat wave and cold spell impacts on years of life lost among the urban poor population of Nairobi, Kenya
Spatiotemporal analysis of climate variability impacts on malaria prevalence in Ghana
Seasonal associations of climatic drivers and malaria in the highlands of Ethiopia
Satellite based assessment of hydroclimatic conditions related to cholera in Zimbabwe
Research on emissions, air quality, climate, and cooking technologies in Northern Ghana (REACCTING): Study rationale and protocol
Rainfall variability and violence in rural Kenya: Investigating the effects of drought and the role of local institutions with survey data
Perception of climate change and its impact by smallholders in pastoral/agropastoral systems of Borana, South Ethiopia
Multilevel analysis of trachomatous trichiasis and corneal opacity in Nigeria: The role of environmental and climatic risk factors on the distribution of disease
Mapping and modelling the geographical distribution and environmental limits of podoconiosis in Ethiopia
Long-run relative importance of temperature as the main driver to malaria transmission in Limpopo Province, South Africa: A simple econometric approach
Malaria-associated morbidity during the rainy season in Saharan and Sahelian zones in Mauritania
Knowledge, perception and practices about malaria, climate change, livelihoods and food security among rural communities of central Tanzania
Local and participatory approaches to building resilience in informal settlements in Uganda
Influenza seasonality in Madagascar: The mysterious African free-runner
Impact of climate and mosquito vector abundance on sylvatic arbovirus circulation dynamics in Senegal
Impact of climate change on staple food crop production in Nigeria
How do rainfall variability, food security and remittances interact? The case of rural Mali
Households’ perception and livelihood vulnerability to climate change in a coastal area of Akwa Ibom State, Nigeria
Exploring climate change impacts and adaptation options for maize production in the Central Rift Valley of Ethiopia using different climate change scenarios and crop models
Evaluation of climate change impacts and adaptation measures for maize cultivation in the western Uganda agro-ecological zone
El Nino-southern oscillation and cassava production in Tanzania and Brazil
Drought adaptation and coping strategies among the Turkana pastoralists of northern Kenya
Drought risk during the early growing season in Sahelian Sudan
Determinants of food security under changing land-use systems among pastoral and agro-pastoral households in eastern Ethiopia
Demonstration of successful malaria forecasts for Botswana using an operational seasonal climate model
Determinants of adoption of climate-smart push-pull technology for enhanced food security through integrated pest management in eastern Africa
Correlation of climate variability and malaria: A retrospective comparative study, Southwest Ethiopia
Climate change, fish catch and premix fuel supply to fishermen for sustainable livelihoods of coastal people in the central region of Ghana
Climate change trends and environmental impacts in the Makonde Communal Lands, Zimbabwe
Climate change induced occupational stress and reported morbidity among cocoa farmers in South-Western Nigeria
Climate change and health vulnerability in informal urban settlements in the Ethiopian Rift Valley
Classical swine fever changes the way farmers value pigs in South Africa
Climate and socioeconomic influences on interannual variability of cholera in Nigeria
Childhood diarrhea exhibits spatiotemporal variation in northwest Ethiopia: A SaTScan spatial statistical analysis
Bialaba migrants from the Northern of Benin to Nigeria, in search of productive land-insights for living with climate change
Building climate change resilience through bottom-up adaptation to flood risk in Warri, Nigeria
Building resilience to climate change impacts after the 2011 flood disaster at the University of Ibadan, Nigeria
Barriers to climate change adaptation: Evidence from northeast Ghana in the context of a systematic literature review
Assessing the relationship between environmental factors and malaria vector breeding sites in Swaziland using multi-scale remotely sensed data
Assessing the social vulnerability to malaria in Rwanda
Assessing barriers to adaptation to climate change in coastal Tanzania: Does where you live matter?
Assessing the bio-psychosocial correlates of flood impacts in coastal areas of Lagos, Nigeria
Assessing the impact of global changes on the surface water resources of southwestern Nigeria
Analyzing the relationship between objective-subjective health status and public perception of climate change as a human health risk in Coastal Tanzania
An analysis of climatic impacts and adaptation strategies in Tanzania
An assessment of adaptation planning for flood variability in the Okavango Delta, Botswana
Adaptation to climate change and resettlement in Rwanda
A spatial analysis of climate-related child malnutrition in the Lake Victoria basin
A review of climate change impacts on water resources in East Africa
Zoom in at African country level: Potential climate induced changes in areas of suitability for survival of malaria vectors
Water and climate variability in developing countries: The case of Uganda
Weather and child health in rural Nigeria
Vulnerability modeling for sub-Saharan Africa: An operationalized approach in Malawi
Vulnerability to flood-induced public health risks in Sudan
Vector competence of Aedes aegypti populations from Kilifi and Nairobi for dengue 2 virus and the influence of temperature
Visualizing the uncertainty in the relationship between seasonal average climate and malaria risk
University students as recipients of and contributors to information on climate change: Insights from South Africa and implications for well-being
The role of livestock diversification in ensuring household food security under a changing climate in Borana, Ethiopia
The impact of climate change on meningitis in northwest Nigeria: An assessment using CMIP5 climate model simulations
The effect of season and temperature variation on hospital admissions for incident stroke events in Maputo, Mozambique
Statistical modeling of the abundance of vectors of West African Rift Valley fever in Barkedji, Senegal
Small scale farmers’ vulnerability to climatic changes in southern Benin: The importance of farmers’ perceptions of existing institutions
Rift Valley Fever outbreaks in Mauritania and related environmental conditions
Relative undernourishment and food insecurity associations with Plasmodium falciparum among Batwa Pygmies in Uganda: Evidence from a cross-sectional survey
Rainfall-induced crop failure, food insecurity and out-migration in Same-Kilimanjaro, Tanzania
Perception and trends of associated health risks with seasonal climate variation in Oke-Ogun region, Nigeria
Occurrence of rift valley fever in cattle in Ijara district, Kenya
National policy response to climate change in South Africa
Managing environmental risk in presence of climate change: The role of adaptation in the Nile Basin of Ethiopia
Leptospira interrogans at the human-wildlife interface in northern Botswana: A newly identified public health threat
Local communities vulnerability to climate change and adaptation strategies in Bukavu in DR Congo
Knowledge and perceptions about the health impact of climate change among health sciences students in Ethiopia: A cross-sectional study
Impacts of climate change and variability on cattle production in southern Ethiopia: Perceptions and empirical evidence
Impacts of flooding on coastal fishing folks and risk adaptation behaviours in Epe, Lagos State
Identifying secure and low carbon food production practices: A case study in Kenya and Ethiopia
Human health impacts in a changing South African climate
Growing population and ecosystem change increase human schistosomiasis around Lake Malawi
Gauging the impact of climate change on food crops production in Mauritius An econometric approach
Extreme weather and civil war: Does drought fuel conflict in Somalia through livestock price shocks?
Farmer portfolios, strategic diversity management and climate-change adaptation – implications for policy in Vietnam and Kenya
Extreme vulnerability of smallholder farmers to agricultural risks and climate change in Madagascar
Effects of climatic conditions on the biting density and relative abundance of Simulium damnosum complex in a rural Nigerian farm settlement
Ecological niche and potential distribution of Anopheles arabiensis in Africa in 2050
Determinants of climate change adaptation strategies used by fish farmers in Epe local government area of Lagos State, Nigeria
Current level and correlates of traditional cooking energy sources utilization in urban settings in the context of climate change and health, northwest Ethiopia: A case of Debre Markos town
Compound vulnerabilities: The intersection of climate variability and HIV/AIDS in northwestern Tanzania
Climate change, crop production and child under nutrition in Ethiopia; a longitudinal panel study
Climate influences on meningitis incidence in northwest Nigeria
Climate change and cerebrospinal meningitis in the Ghanaian meningitis belt
Climate change and internal migration intentions in the forest-savannah transition zone of Ghana
Climate change and occupational health: A South African perspective
Assessing indigenous knowledge systems and climate change adaptation strategies in agriculture: A case study of Chagaka Village, Chikhwawa, Southern Malawi
Analysis of institutional mechanisms that support community response to impacts of floods in the middle-zambezi river basin, Zimbabwe
Anopheles arabiensis seasonal densities and infection rates in relation to landscape classes and climatic parameters in a Sahelian area of Senegal
Air temperature, relative humidity, climate regionalization and thermal comfort of Nigeria
A spatial analysis of population dynamics and climate change in Africa: Potential vulnerability hot spots emerge where precipitation declines and demographic pressures coincide
A non-stationary relationship between global climate phenomena and human plague incidence in Madagascar
Linking population, fertility, and family planning with adaptation to climate change: Perspectives from Ethiopia
Climate change is likely to worsen the public health threat of diarrheal disease in Botswana
Adapting agriculture to climate change in Kenya: Household strategies and determinants
National level organisational responses to climate change adaptation: A case study of Malawi
Critical review of research literature on climate-driven malaria epidemics in sub-Saharan Africa
Vulnerability of indigenous health to climate change: A case study of Uganda’s Batwa Pygmies
Weather and mortality: A 10 year retrospective analysis of the Nouna Health and Demographic Surveillance System, Burkina Faso
Time-series analysis of weather and mortality patterns in Nairobi’s informal settlements
The impact of housing type on temperature-related mortality in South Africa, 1996-2015
Prevalence of malaria infection in Butajira area, south-central Ethiopia
Regime shifts and heterogeneous trends in malaria time series from Western Kenya Highlands
Modeling the influence of local environmental factors on malaria transmission in Benin and its implications for cohort study
Impact of climate change on children’s health in Limpopo Province, South Africa
Climate variability and environmental stress in the Sudan-Sahel zone of West Africa
Climate change and risk projection: Dynamic spatial models of Tsetse and African Trypanosomiasis in Kenya
Climate change and urban children’s health: A case study of Ibadan south west local goverment, Nigeria
Changes in malaria morbidity and mortality in Mpumalanga Province, South Africa (2001-2009): A retrospective study
A time series analysis of weather variability and all-cause mortality in the Kasena-Nankana Districts of Northern Ghana, 1995-2010
Absence of dry season Plasmodium parasitaemia, but high rates of reported acute respiratory infection and diarrhoea in preschool-aged children in Kaedi, southern Mauritania
Why analyze mental models of local climate change? A case from southern Mozambique
Vulnerability and adaptation to food insecurity and poverty in Kenya
Ties Between Air Quality and Climate Change in South Africa and their Impact on Human Health
The costs of climate change: A study of cholera in Tanzania
Surveillance of vector populations and malaria transmission during the 2009/10 El Nino event in the western Kenya highlands: Opportunities for early detection of malaria hyper-transmission
The Nigeria high glycemic index starchy foods, obesity, and the environment
Short term effect of rainfall on suspected malaria episodes at Magaria, Niger: A time series study
Smallholders adaptation to climate change in Mali
Seasonal trends in epidemiological and entomological profiles of malaria transmission in North Central Nigeria
Raised temperatures over the Kericho tea estates: Revisiting the climate in the East African highlands malaria debate
Modeling the relationship between precipitation and malaria incidence in children from a holoendemic area in Ghana
Impact of drought on the spatial pattern of transmission of Schistosoma haematobium in coastal Kenya
Health care waste management in Cameroon: A case study from the Southwestern Region
Health officials’ perceptions of and preparedness for the impacts of climate variability on human health in the Somali region of Ethiopia
Geo-additive modelling of malaria in Burundi
Distribution and faunal richness of Cladocera in western Uganda crater lakes
Climatic variables and malaria transmission dynamics in Jimma town, South West Ethiopia
Climate change and vector-borne diseases: An economic impact analysis of malaria in Africa
Climate change and vunerability of fish farmers in Southwestern Nigeria
Agriculture and food systems in sub-Saharan Africa in a 4 degrees C+ world
Mainstreaming climate adaptation into development assistance: Rationale, institutional barriers and opportunities in Mozambique
Chronic diseases, climate change and complexity: The hidden connections
Vulnerability to epidemic malaria in the highlands of Lake Victoria basin: The role of climate change/variability, hydrology and socio-economic factors
Transmission intensity and drug resistance in malaria population dynamics: Implications for climate change
Seasonal pattern of hospitalization from acute respiratory infections in Yaounde, Cameroon
Seasonal patterns of cardiovascular disease mortality of adults in Burkina Faso, West Africa
Robust negative impacts of climate change on African agriculture
Model variations in predicting incidence of Plasmodium falciparum malaria using 1998-2007 morbidity and meteorological data from south Ethiopia
Livelihood diversification in tropical coastal communities: A network-based approach to analyzing ‘livelihood landscapes’
Heat impact on schoolchildren in Cameroon, Africa: Potential health threat from climate change
Climate indices, rainfall onset and retreat, and malaria in Nigeria
Climate not to blame for African civil wars
Climate change and altitudinal structuring of malaria vectors in south-western Cameroon: Their relation to malaria transmission
Bayesian modelling of the effect of climate on malaria in Burundi
Adapting to climate change: Agricultural system and household impacts in East Africa
Participatory planning, justice, and climate change in Durban, South Africa
Warming increases the risk of civil war in Africa
The income-climate trap of health development: A comparative analysis of African and Non-African countries
The Indian Ocean Dipole and malaria risk in the highlands of western Kenya
Spatial and temporal distribution of the malaria mosquito Anopheles arabiensis in northern Sudan: Influence of environmental factors and implications for vector control
Modelling malaria incidence with environmental dependency in a locality of Sudanese savannah area, Mali
Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003-2006: Analysis of a time series
Increased risk of diarrhoeal diseases from climate change: Evidence from urban communities supplied by groundwater in Uganda
Impact of drainage networks on cholera outbreaks in Lusaka, Zambia
Human vulnerability to climate variability in the Sahel: Farmers’ adaptation strategies in northern Burkina Faso
Food insecurity and HIV/AIDS in low-income households in urban Zimbabwe
Climate impacts on environmental risks evaluated from space: A conceptual approach to the case of Rift Valley Fever in Senegal
Climate change impact on SWAT simulated streamflow in western Kenya
Assessment of the impact of climate shifts on malaria transmission in the Sahel
Adaptation to climate change in Ethiopia and South Africa: Options and constraints
A ricardian analysis of the distribution of climate change impacts on agriculture across agro-ecological zones in Africa
Vulnerability to episodes of extreme weather: Butajira, Ethiopia, 1998-1999
Unjust waters: Climate change, flooding and the urban poor in Africa
Using spatial information technologies as monitoring devices in international watershed conservation along the Senegal River Basin of West Africa
South African crop farming and climate change: An economic assessment of impacts
Spatial prediction of Plasmodium falciparum prevalence in Somalia
Relationships between climate and year-to-year variability in meningitis outbreaks: A case study in Burkina Faso and Niger
Schistosomiasis transmission at high altitude crater lakes in Western Uganda
Malaria and pond-based rainwater harvesting linkages in the fringes of central highland Ethiopia
Livelihoods, vulnerability and adaptation to climate change in Morogoro, Tanzania
Effective livelihood adaptation to climate change disturbance: Scale dimensions of practice in Mozambique
Effectiveness of malaria control during changing climate conditions in Eritrea, 1998-2003
Climate change impacts on agro-ecosystem sustainability across three climate regions in the maize belt of South Africa
Addressing diarrhea prevalence in the West African Middle Belt: Social and geographic dimensions in a case study for Benin
A spatially explicit assessment of current and future hotspots of hunger in Sub-Saharan Africa in the context of global change
Tectonics, orbital forcing, global climate change, and human evolution in Africa: Introduction to the African paleoclimate special volume
Changing household responses to drought in Tharaka, Kenya: Vulnerability, persistence and challenge
The quest for safe drinking water: An example from Guinea-Bissau (West Africa)
Trauma and posttraumatic stress disorder in a rural primary care population in South Africa
Views from the vulnerable: Understanding climatic and other stressors in the Sahel
Prevalence of urban malaria and assocated factors in Gondar Town, Northwest Ethiopia
Malaria mosquito control using edible fish in western Kenya: Preliminary findings of a controlled study
How is climate change perceived in relation to other socioeconomic and environmental threats in Nairobi, Kenya?
Climate prediction of El Ni–o malaria epidemics in north-west Tanzania
Climatic variables and transmission of falciparum malaria in New Halfa, eastern Sudan
Clinical symptoms, treatment and outcome of highlands malaria in Eldoret (2420 m a.s.l.) and comparison to malaria in hyper-immune population in endemic region of Southern Sudan
Astronomically forced climate change in the Kenyan Rift Valley 2.7-2.55 Ma: Implications for the evolution of early hominin ecosystems
A study of climate change and anthropogenic impacts in West Africa
Ghana: Health and Climate Change Country Profile
Kenya: Health and Climate Change Country Profile
South Africa: Health and Climate Change Country Profile
Tanzania: Health and Climate Change Country Profile
Ethiopia: Health and Climate Change Country Profile
The Pan African programme for public health adaptation to climate change: current status and perspectives
Climate Change and Health Risks in Senegal
Plan D’actions Du Senegal (2006- 2020) pour la Mise en Place du Cadre National pour les Services Climatologiques (CNSC)
The United Republic of Tanzania One Health Strategic Plan 2015 – 2020
Using satellites to find groundwater in Ethiopia
Rwanda’s new water supply policy and strategy addresses climate risks
Financing Climate Resilient Water and Sanitation and using Multiple User Systems in Madagascar
Heat acclimatization and vulnerabilities of people living in the Sahel: The case of Senegal
Too hot to handle? Heat resilience in urban South Sudan
Solar Powered Water Systems in Somaliland
Solar powered water supply for drought-prone communities in Uganda
Emerging climate change-related public health challenges in Africa: A case study of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania
Climate and Malaria in Africa: IRI Maproom
African Flood and Drought Monitor
Seasonal Climatic Suitability for Malaria Transmission in Tanzania
TMA Map Room
Tanzania Weather Bulletins
