The CHAMNHA project: defining heat impacts on maternal and neonatal health and testing adaptive interventions in Burkina Faso and Kenya

Abstract

BACKGROUND AND AIM: Heat exposure increasingly threatens the health of pregnant women, foetuses and neonates, especially in low-resource settings. The CHAMNHA project documents the size and nature of these threats, pathways to impacts, and intervention effectiveness in Africa. METHODS: We assess heat impacts in pregnancy using systematic reviews and statistical modelling of existing data from birth registries and cohorts. These findings, together with multi-component qualitative enquiries will inform co-design and then testing of facility- and community-level interventions. RESULTS:More than 100 studies on heat exposure in pregnancy were located, demonstrating clear patterns of heat impacts, though methodological and statistical heterogeneity are considerable. Gaps in existing evidence are being addressed in time-series analyses of pregnancy outcomes and breastfeeding patterns in Burkina Faso and South Africa. While in Sweden, birth outcomes in a countrywide population-level database from 2014-2020 are being correlated with 1x1km2 grid exposure data. In qualitative research in urban Ouagadougou and rural sites in Burkina Faso and Kenya, pregnant women, male partners and other key informants have described multiple effects of heat on daily activities, and the health and wellbeing of pregnant women and neonates. In Burkina Faso women recounted a range of heat-related symptoms in themselves and their foetus, and obstacles that extreme heat poses to health facility access and care quality. For women in Kenya, heat exposure and water shortages are inextricably linked, and interventions addressing either hazard in isolation may have limited efficacy. Participatory workshops will advance data interpretation and intervention co-design. Interventions at facility-level in Burkina Faso and with community health workers in Kenya will be implemented and evaluated over nine months. CONCLUSIONS:The project heighten attention of policy makers and funders to the vulnerabilities of pregnant women to heat exposure and climate change, and the need for commensurate responses at multiple levels. KEYWORDS: Temperature, Female, Maternal health, neonates, time-series analysis