CHAMNHA Climate, heat and maternal and neonatal health in Africa

The frequency and intensity of heat waves have increased in sub-Saharan Africa (SSA) and are set to escalate in the coming decades. Heatwaves present major health threats, especially for vulnerable population groups, such as those with limited socio-economic resources or compromised physiological ability to respond to heat stress. Pregnant women and neonates (<28 days after birth) have a unique set of health vulnerabilities, particularly in low- and lower-middle income countries (LLMICs), where pregnancy and childbirth are often highly precarious. Heat exposure complicates Maternal and Neonatal Health (MNH), increasing risks for maternal hemorrhage and sepsis, prematurity, low birth weight and neonatal dehydration. Few studies have assessed these impacts in sub-Saharan Africa, where maternal and neonatal deaths are frequent, facilities experience high indoor temperatures, health systems have low adaptive capacity and access to services is increasingly disrupted by climate events.

The proposed study (CHAMNHA) is led by a transdisciplinary team from 3 continents, spanning the natural, health and social sciences, and will address key knowledge gaps around heat and MNH in SSA in collaboration with stakeholders, employing qualitative and quantitative methods, implementation and evaluation science, and climate impact methods. The project is divided into three workpackages (WP). WP1 will quantify impacts of heat exposure on MNH outcomes, using trial data, birth cohorts and other data sources from SSA, Norway and Sweden. We will characterize these impacts and identify sub-groups at high-risk. In WP2, qualitative research will document perceptions and local practices relating to heat exposure in pregnant women and neonates in Burkina Faso and Kenya. Then, in conjunction with pregnant women, male partners and health workers, we will co-design community- and facility-based interventions, such as improving preparedness for heat, e.g. through warning systems; changing behaviors and health worker practices to reduce heat impacts on MNH; training birth companions and traditional birth attendants on heat reduction during childbirth; and promoting breastfeeding and optimised hydration for women and neonates. WP3 will test the acceptability, feasibility and effectiveness of selected interventions using a randomized design (Kenya) and pre-post study design (Burkina Faso). In WP4, building on established collaborations with stakeholders, ministries of health and WHO, we will translate research findings into recommendations for improved MNH practice in the health sector, and national adaptation planning to reduce the current and future impacts of climate change.

More targeted, evidence-based intervention in the neglected area of heat impacts will lead to social and economic benefits for women, children, their families and their communities through improved health and reduced household expenditure on medical care and lost income. If specific interventions we test in this study are found to be effective and feasible to implement, the translation of these findings into concrete policy and practice changes will also contribute to improving health and well-being in other population groups. The new epidemiological evidence will support WHO and the Institute of Health Metrics in the assessment of the burden of disease due to climate change.
This evidence could be used to increase the focus on MNH and climate change in the policy environment, and to support arguments for integration of heat interventions in existing health services. There is precedent for rapid action on evidence related to risk assessment in children that serves as a guide. For instance, evidence of foetal harms from maternal alcohol use became a central argument for stronger alcohol controls and the creation of public health messaging about the dangers of drinking during pregnancy. Better evidence on the impact of extreme heat on MNH will help guide appropriate policy in this area.
The most important potential beneficiaries of this research are pregnant women and neonates. Given stipulated causal pathways, a number of potential low-risk and low-cost interventions can be readily identified, including, for example, increased natural ventilation and cooling interventions in labour wards and community settings, prioritisation of hydration during labour and in neonates, heat 'counselling' by birth companions, educational interventions using social media alerts, and the setting of specific heat-warning thresholds and plans for pregnant women.
We will engage with Ministries of Health and Environment to facilitate this process. National and international policy-makers in LLMICs will benefit from practical implementation lessons and epidemiological evidence. The data are expected to demonstrate that the simplicity of the interventions means that training needs will be minimal and that no additional personnel will be needed - an important consideration in LLMIC settings.
We will ensure that our evidence is used beyond the study countries (Burkina Faso and Kenya) by engaging closely with regional networks to maximize impacts. The IRSS (Institute de Recherche en Sciences de la Sante, Burkina Faso) is a regional hub for global health research. In the final year, we will host a conference in IRSS for the regional health and climate stakeholders. We will also make use of the African networks for climate - including CLIM-DEV and the ACDI (African Climate and Development Institute) and also funded research projects that have African partners.