CHAMNHA: Climate, heat and maternal and neonatal health in Africa

在撒哈拉以南非洲（SSA），热浪的频率和强度都有所增加，并将在未来几十年内升级。热浪对健康构成重大威胁，特别是对弱势群体，如社会经济资源有限或应对热应激的生理能力受损的群体。孕妇和新生儿（出生后<28天）有一系列独特的健康脆弱性，特别是在低收入和中低收入国家，那里的怀孕和分娩往往非常不稳定。热暴露使孕产妇和新生儿健康（MNH）复杂化，增加了孕产妇出血和败血症、早产、低出生体重和新生儿脱水的风险。很少有研究评估撒哈拉以南非洲的这些影响，那里孕产妇和新生儿死亡频繁，设施室内温度高，卫生系统适应能力低，获得服务的机会越来越多地受到气候事件的干扰。拟议的研究（CHAMNHA）由来自三大洲的跨学科团队领导，跨越自然，健康和社会科学，并将与利益相关者合作，采用定性和定量方法，实施和评估科学以及气候影响方法，解决SSA中热量和MNH的关键知识差距。该项目分为三个工作包（WP）。WP 1将使用来自SSA，挪威和瑞典的试验数据，出生队列和其他数据来源量化热暴露对MNH结果的影响。我们将描述这些影响，并确定高风险的子群体。在WP 2中，定性研究将记录与布基纳法索和肯尼亚孕妇和新生儿热暴露有关的看法和当地做法。然后，我们将与孕妇、男性伴侣和卫生工作者一起，共同设计基于社区和设施的干预措施，例如通过预警系统改善对高温的准备;改变行为和卫生工作者的做法，以减少高温对产妇和新生儿的影响;培训分娩伴侣和传统助产士在分娩期间减少热量;促进母乳喂养和优化妇女和新生儿的水合作用。WP 3将使用随机设计（肯尼亚）和前后研究设计（布基纳法索）测试选定干预措施的可接受性、可行性和有效性。在WP 4中，我们将在与利益相关者、卫生部和世卫组织建立的合作基础上，将研究结果转化为改进卫生部门MNH实践的建议，以及国家适应规划，以减少气候变化对MNH当前和未来的影响。

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 haemorrhage 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 work packages (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 behaviours 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 on MNH