Effects of ambient heat exposure on risk of all-cause mortality in children younger than 5 years in Africa: a pooled time-series analysis

IF 24.1 1区 医学 Q1 ENVIRONMENTAL SCIENCES Lancet Planetary Health Pub Date : 2024-09-01 DOI:10.1016/S2542-5196(24)00160-8
Chloe Brimicombe PhD , Katharina Wieser BSc , Tobias Monthaler BSc , Prof Debra Jackson PhD , Jeroen De Bont PhD , Prof Matthew F Chersich PhD , Prof Ilona M Otto PhD
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Abstract

Background

Reducing child mortality is a Sustainable Development Goal, and climate change constitutes numerous challenges for Africa. Previous research has shown an association between leading causes of child mortality and climate change. However, few studies have examined these effects in detail. We aimed to explore the effects of ambient heat on neonate, post-neonate, and child mortality rates.

Methods

For this pooled time-series analysis, health data were obtained from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Health and Demographic Surveillance System. We included data from 29 settlements from 13 countries across Africa, collected via monthly surveys from Jan 1, 1993, to Dec 31, 2016. Climate data were obtained from ERA5, collected from Jan 1, 1991, to Dec 31, 2019. We pooled these data for monthly mean daily maximum wet bulb globe temperature (WBGT) and downscaled to geolocations. Due to data heaping, we pooled our health data on a monthly temporal scale and a spatial scale into six different climate regions (ie, Sahel [ie, Burkina Faso and northern Ghana], Guinea [ie, southern Ghana, Côte d'Ivoire, and Nigeria], Senegal and The Gambia, eastern Africa [ie, Kenya, Malawi, Tanzania, Mozambique, and Uganda], South Africa, and Ethiopia). Our outcomes were neonate (ie, younger than 28 days), post-neonate (ie, aged 28 days to 1 year), and child (ie, older than 1 year and younger than 5 years) mortality. To assess the association between WBGT and monthly all-cause mortality, we used a time-series regression with a quasi-Poisson, polynomial-distributed lag model.

Findings

Between Jan 1, 1993, and Dec 31, 2016, there were 44 909 deaths in children younger than 5 years across the 29 sites in the 13 African countries: 10 078 neonates, 14 141 post-neonates, and 20 690 children. We observed differences in the association of heat with neonate, post-neonate, and child mortality by study region. For example, for Ethiopia, the relative risk ratio of mortality at the 95th percentile compared with median heat exposure during the study period was 1·14 (95% CI 1·06–1·23) for neonates, 0·99 (0·90–1·07) for post-neonates, and 0·79 (0·73–0·87) for children. Across the whole year, there was a significant increase in the relative risk of increased mortality for children in eastern Africa (relative risk 1·27, 95% CI 1·19–1·36) and Senegal and The Gambia (1·11, 1·04–1·18).

Interpretation

Our results show that the influence of extreme heat on mortality risk in children younger than 5 years varies by age group, region, and season. Future research should explore potentially informative ways to measure subtleties of heat stress and the factors contributing to vulnerability.

Funding

EU Horizons as part of the Heat Indicators for Global Health (HIGH) Horizons project.

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环境热暴露对非洲 5 岁以下儿童全因死亡风险的影响:汇总时间序列分析。
背景:降低儿童死亡率是一项可持续发展目标,而气候变化给非洲带来了诸多挑战。以往的研究表明,儿童死亡的主要原因与气候变化有关。然而,很少有研究对这些影响进行详细研究。我们旨在探讨环境温度对新生儿、新生儿后期和儿童死亡率的影响:在这项汇总时间序列分析中,健康数据来自国际人口及其健康状况评估网络(INDEPTH)的健康与人口监测系统。我们纳入了来自非洲 13 个国家 29 个定居点的数据,这些数据是通过 1993 年 1 月 1 日至 2016 年 12 月 31 日的月度调查收集的。气候数据来自ERA5,收集时间为1991年1月1日至2019年12月31日。我们汇集了这些数据的月平均日最大湿球温度(WBGT),并对地理位置进行了降尺度处理。由于数据堆积,我们按月时间尺度和空间尺度将健康数据汇集到六个不同的气候区域(即萨赫勒[即布基纳法索和加纳北部]、几内亚[即加纳南部、科特迪瓦和尼日利亚]、塞内加尔和冈比亚、非洲东部[即肯尼亚、马拉维、坦桑尼亚、莫桑比克和乌干达]、南非和埃塞俄比亚)。我们的研究结果是新生儿(即小于 28 天)、新生儿后(即 28 天至 1 岁)和儿童(即 1 岁以上 5 岁以下)死亡率。为了评估 WBGT 与每月全因死亡率之间的关系,我们采用了准泊松、多项式分布滞后模型进行时间序列回归:1993年1月1日至2016年12月31日期间,13个非洲国家的29个地点共有44 909名5岁以下儿童死亡:其中新生儿 10 078 例,新生儿后 14 141 例,儿童 20 690 例。我们观察到,不同研究地区的高温与新生儿、新生儿后期和儿童死亡率的关系存在差异。例如,在埃塞俄比亚,与研究期间的热暴露中位数相比,第 95 百分位数的新生儿死亡率的相对风险比为 1-14 (95% CI 1-06-1-23),新生儿后死亡率的相对风险比为 0-99 (0-90-1-07),儿童死亡率的相对风险比为 0-79 (0-73-0-87)。从全年来看,东非(相对风险 1-27,95% CI 1-19-1-36)、塞内加尔和冈比亚(1-11,1-04-1-18)的儿童死亡率相对风险显著增加:我们的研究结果表明,极端高温对 5 岁以下儿童死亡风险的影响因年龄组、地区和季节而异。未来的研究应探索潜在的信息方法,以测量热应激的微妙性和导致脆弱性的因素:作为全球健康热指标(HIGH)地平线项目一部分的欧盟地平线项目。
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来源期刊
CiteScore
28.40
自引率
2.30%
发文量
272
审稿时长
8 weeks
期刊介绍: The Lancet Planetary Health is a gold Open Access journal dedicated to investigating and addressing the multifaceted determinants of healthy human civilizations and their impact on natural systems. Positioned as a key player in sustainable development, the journal covers a broad, interdisciplinary scope, encompassing areas such as poverty, nutrition, gender equity, water and sanitation, energy, economic growth, industrialization, inequality, urbanization, human consumption and production, climate change, ocean health, land use, peace, and justice. With a commitment to publishing high-quality research, comment, and correspondence, it aims to be the leading journal for sustainable development in the face of unprecedented dangers and threats.
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