Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework.
Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework.
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DOI：
10.1002/ijgo.14381
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发表时间：
2023-02
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妊娠和分娩期间的解剖、生理和社会文化变化增加了妇女和新生儿对环境高温的脆弱性。高温会压倒孕妇的体温调节机制，特别是在分娩期间，导致脱水和内分泌功能障碍，并损害胎盘功能。临床后遗症包括高血压疾病、妊娠期糖尿病、早产和死产。环境温度高会增加感染率，并影响卫生工作者的表现和医疗保健寻求。随着气候变化和有限的资源，气温上升加剧了人们的担忧。我们提出了一个包含四个方面的适应框架。首先，行为变化，如减少怀孕期间的工作量和使用低成本喷水。第二，卫生系统干预措施包括以现有社区外展为中心的早期预警系统；热-健康指标跟踪；补充水和监测分娩期间与热有关的条件。建筑改造、被动和主动冷却系统以及基于自然的解决方案可以降低设施中的温度。最后，结构性干预和气候融资至关重要。整套干预措施需要与受影响的社区共同设计和共同提供，并利用现有的妇幼保健平台，这是在成本效益和热模拟权衡之后理想的选择。强有力的应用研究将为非洲各地针对孕妇的项目奠定基础。充足的研究和气候融资现在迫在眉睫。高温会增加不良妊娠结局的发生率。非洲妇女处于高危状态，需要行为、卫生系统、建筑环境和结构性干预。
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. High temperatures increase rates of adverse pregnancy outcomes. Women in Africa are at high risk, and require behavioral, health‐system, built‐environment, and structural interventions.