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

撒哈拉以南非洲(SSA)的热浪频率和强度有所增加，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)有一组独特的健康脆弱性，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危险。热暴露使母亲和新生儿健康(MNH)复杂化，增加了母亲出血和败血症、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，设施经历室内高温，卫生系统的适应能力较低，获得服务的机会越来越多地受到气候事件的干扰。这项拟议的研究(CHAMNHA)由一个来自三大洲的跨学科团队领导，横跨自然、健康和社会科学，将与利益攸关方合作，利用定性和定量方法、实施和评估科学以及气候影响方法，解决有关SSA热能和MNH的关键知识差距。该项目分为三个工作包(WP)。WP1将利用来自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结局的影响。我们将描述这些影响的特征，并确定处于高风险的子群体。在WP2中，定性研究将记录布基纳法索和肯尼亚对孕妇和新生儿热暴露的看法和当地做法。然后，我们将与孕妇、男性合作伙伴和卫生工作者共同设计以社区和设施为基础的干预措施，例如通过警报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对MNH的高温影响；培训产伴和传统助产士在分娩期间减少热量；以及促进母乳喂养和妇女和新生儿的最佳补水。WP3将使用随机设计(肯尼亚)和研究前设计(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WP4中，我们将在与利益攸关方、卫生部和世卫组织已建立的合作的基础上，将研究结果转化为建议，以改进卫生部门的卫生保健做法，并制定国家适应规划，以减少气候变化对卫生保健工作目前和未来的影响

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