<div><h3>Background</h3><div>Cooking with traditional fuels can lead to severe health issues caused by household air pollution, and can also affect gender equality and drive environmental degradation. In Nepal, despite government efforts to promote electric cooking, more than half of the population still uses traditional fuels, with electric cooking adoption remaining below 1%. Several of the barriers to and enablers of clean cooking vary geographically; however, few studies have considered spatial explicit information in planning national-scale transitions to clean cooking. In this study we provide a spatially explicit roadmap to estimate the required investments and benefits gained from the transition across Nepal.</div></div><div><h3>Methods</h3><div>This study uses geospatial modelling methods to evaluate strategies to achieve the Government of Nepal's vision for a national-scale transition to clean cooking. We integrate the open-source clean cooking geospatial assessment tool OnStove and a spatial multicriteria analysis model. With OnStove, we evaluate which cooking technologies and fuels maximise the net benefits of a clean-cooking transition across each km<sup>2</sup> of the region. With the multicriteria analysis, we weigh stakeholder preferences and prioritise areas of action where policy should be implemented. We used the most up-to-date geospatial data to the year 2023, such as the High Resolution Settlement Layer, Open Street Maps’ road networks, the Global Human Settlement Layer, NASA/USGS forest cover maps, and Facebook's Relative Wealth Index, among others. We also relied on data from the Nepal Oil Corporation, the Nepal Electricity Agency, the Central Bureau of Statistic's 2021 national census, and the Alternative Energy Promotion Center. We evaluate four scenarios capturing advances on clean cooking policy up to the year 2022, current market inefficiencies, and the potential effects of new policies for clean-cooking transition in Nepal.</div></div><div><h3>Findings</h3><div>Our results show that transitional and clean cooking technologies provide higher net benefits than traditional options everywhere across Nepal in all scenarios. Our net-benefit analysis shows that around 9563 deaths could be averted yearly if benefits and externalities were perceived and valued correctly. Furthermore, substantial benefits could be achieved in regard to greenhouse gas emissions avoidance, time saved, and health-cost reductions. Our results also show that the current subsidy strategy from the Government of Nepal is well aligned with the benefits achieved under a cost–benefit analysis. In this context, electric cooking can bring the highest benefits to the largest part of the population. The analysis showed how high subsidies for liquefied petroleum gas in Nepal can present trade-offs with energy security and independence, and how this could be avoided by transferring part of the subsidy to cover differentiated electric cooking tariffs. Accountin
{"title":"Achieving Nepal's clean cooking ambitions: an open source and geospatial cost–benefit analysis","authors":"Camilo Ramirez MSc , Babak Khavari PhD , Alicia Oberholzer MSc , Bhoj Raj Ghimire PhD , Bhogendra Mishra PhD , Santiago Sinclair-Lecaros MSc , Dimitris Mentis PhD , Anobha Gurung PhD , Dilip Khatiwada PhD , Francesco Fuso Nerini PhD","doi":"10.1016/S2542-5196(24)00209-2","DOIUrl":"10.1016/S2542-5196(24)00209-2","url":null,"abstract":"<div><h3>Background</h3><div>Cooking with traditional fuels can lead to severe health issues caused by household air pollution, and can also affect gender equality and drive environmental degradation. In Nepal, despite government efforts to promote electric cooking, more than half of the population still uses traditional fuels, with electric cooking adoption remaining below 1%. Several of the barriers to and enablers of clean cooking vary geographically; however, few studies have considered spatial explicit information in planning national-scale transitions to clean cooking. In this study we provide a spatially explicit roadmap to estimate the required investments and benefits gained from the transition across Nepal.</div></div><div><h3>Methods</h3><div>This study uses geospatial modelling methods to evaluate strategies to achieve the Government of Nepal's vision for a national-scale transition to clean cooking. We integrate the open-source clean cooking geospatial assessment tool OnStove and a spatial multicriteria analysis model. With OnStove, we evaluate which cooking technologies and fuels maximise the net benefits of a clean-cooking transition across each km<sup>2</sup> of the region. With the multicriteria analysis, we weigh stakeholder preferences and prioritise areas of action where policy should be implemented. We used the most up-to-date geospatial data to the year 2023, such as the High Resolution Settlement Layer, Open Street Maps’ road networks, the Global Human Settlement Layer, NASA/USGS forest cover maps, and Facebook's Relative Wealth Index, among others. We also relied on data from the Nepal Oil Corporation, the Nepal Electricity Agency, the Central Bureau of Statistic's 2021 national census, and the Alternative Energy Promotion Center. We evaluate four scenarios capturing advances on clean cooking policy up to the year 2022, current market inefficiencies, and the potential effects of new policies for clean-cooking transition in Nepal.</div></div><div><h3>Findings</h3><div>Our results show that transitional and clean cooking technologies provide higher net benefits than traditional options everywhere across Nepal in all scenarios. Our net-benefit analysis shows that around 9563 deaths could be averted yearly if benefits and externalities were perceived and valued correctly. Furthermore, substantial benefits could be achieved in regard to greenhouse gas emissions avoidance, time saved, and health-cost reductions. Our results also show that the current subsidy strategy from the Government of Nepal is well aligned with the benefits achieved under a cost–benefit analysis. In this context, electric cooking can bring the highest benefits to the largest part of the population. The analysis showed how high subsidies for liquefied petroleum gas in Nepal can present trade-offs with energy security and independence, and how this could be avoided by transferring part of the subsidy to cover differentiated electric cooking tariffs. Accountin","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e754-e765"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00172-4
Richard M Oxborough PhD , Karen L Figueroa Chilito MSc , Filemon Tokponnon PhD , Louisa A Messenger PhD
Mass distribution of insecticide-treated nets (ITNs) has been a key factor in reducing malaria cases and deaths in sub-Saharan Africa. A shortcoming has been the over-reliance on pyrethroid insecticides, with more than 2·13 billion pyrethroid ITNs (PY ITNs) distributed in the past two decades, leading to widespread pyrethroid resistance. Progressive changes are occurring, with increased deployment of more effective pyrethroid-chlorfenapyr (PY-CFP) or pyrethroid-piperonyl butoxide (PY-PBO) ITNs in areas of pyrethroid resistance. In 2023, PY-PBO ITNs accounted for 58% of all ITNs shipped to sub-Saharan Africa. PY-PBO and PY-CFP ITNs are 30–37% more expensive than standard PY ITNs, equating to an additional US$132–159 million required per year in sub-Saharan Africa to fund the shift to more effective ITNs. Several countries are withdrawing or scaling back indoor residual spraying (IRS) programmes to cover the shortfall, which is reflected by the number of structures sprayed by the US President's Malaria Initiative decreasing by 30% from 5·67 million (2021) to 3·96 million (2023). Benin, located in West Africa, is a prime example of a country that ceased IRS in 2021 after 14 years of annual spraying. Our economic evaluation indicates that IRS in Benin cost $3·50 per person protected per year, around five times more per person protected per year compared with PY-PBO ($0·73) or PY-CFP ITNs ($0·76). Although costly to implement, a major advantage of IRS is the portfolio of at least three chemical classes for prospective resistance management. With loss of synergy to PBO developing rapidly, there is the danger of over-reliance on PY-CFP ITNs. As gains in global malaria control continue to reverse each year, current WHO projections estimate that key 2030 malaria incidence milestones will be missed by a staggering 89%. This Personal View explores contemporary malaria vector control trends in sub-Saharan Africa and cost implications for improved disease control and resistance management.
{"title":"Malaria vector control in sub-Saharan Africa: complex trade-offs to combat the growing threat of insecticide resistance","authors":"Richard M Oxborough PhD , Karen L Figueroa Chilito MSc , Filemon Tokponnon PhD , Louisa A Messenger PhD","doi":"10.1016/S2542-5196(24)00172-4","DOIUrl":"10.1016/S2542-5196(24)00172-4","url":null,"abstract":"<div><div>Mass distribution of insecticide-treated nets (ITNs) has been a key factor in reducing malaria cases and deaths in sub-Saharan Africa. A shortcoming has been the over-reliance on pyrethroid insecticides, with more than 2·13 billion pyrethroid ITNs (PY ITNs) distributed in the past two decades, leading to widespread pyrethroid resistance. Progressive changes are occurring, with increased deployment of more effective pyrethroid-chlorfenapyr (PY-CFP) or pyrethroid-piperonyl butoxide (PY-PBO) ITNs in areas of pyrethroid resistance. In 2023, PY-PBO ITNs accounted for 58% of all ITNs shipped to sub-Saharan Africa. PY-PBO and PY-CFP ITNs are 30–37% more expensive than standard PY ITNs, equating to an additional US$132–159 million required per year in sub-Saharan Africa to fund the shift to more effective ITNs. Several countries are withdrawing or scaling back indoor residual spraying (IRS) programmes to cover the shortfall, which is reflected by the number of structures sprayed by the US President's Malaria Initiative decreasing by 30% from 5·67 million (2021) to 3·96 million (2023). Benin, located in West Africa, is a prime example of a country that ceased IRS in 2021 after 14 years of annual spraying. Our economic evaluation indicates that IRS in Benin cost $3·50 per person protected per year, around five times more per person protected per year compared with PY-PBO ($0·73) or PY-CFP ITNs ($0·76). Although costly to implement, a major advantage of IRS is the portfolio of at least three chemical classes for prospective resistance management. With loss of synergy to PBO developing rapidly, there is the danger of over-reliance on PY-CFP ITNs. As gains in global malaria control continue to reverse each year, current WHO projections estimate that key 2030 malaria incidence milestones will be missed by a staggering 89%. This Personal View explores contemporary malaria vector control trends in sub-Saharan Africa and cost implications for improved disease control and resistance management.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e804-e812"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00202-X
Jie Ban PhD , Kailai Lu MSc , Yuanyuan Liu , Jiawei Zang MSc , Zhen Zhou MSc , Can Zhang PhD , Zhao Liu PhD , Jianbin Huang PhD , Yidan Chen PhD , Prof Xuejie Gao PhD , Prof Ying Xu PhD , Prof Can Wang PhD , Prof Wenjia Cai PhD , Prof Peng Gong PhD , Prof Yong Luo PhD , Prof Tiantian Li PhD
Background
Climate-change-induced extreme precipitation events have attracted global attention; however, the associated excess deaths burden has been insufficiently explored and remains unclear.
Methods
We first defined an extreme precipitation event for each county when the daily total precipitation exceeded the county-specific 99·5th percentile of the daily precipitation from 1986 to 2005; then we estimated the associations between extreme precipitation events and cause-specific deaths in 280 Chinese counties using a two-stage time-series model. Second, we projected the excess deaths related to extreme precipitation events by combining the bias-corrected multi-model precipitation predictions derived under different combined emission-population scenarios of three representative concentration pathways (RCPs; RCP2·6, RCP4·5, and RCP8·5) and three shared socioeconomic pathways (SSP2, a business-as-usual scenario) populations (S1, low fertility rate; S2, medium fertility rate; and S3, high fertility rate). We quantified the climate and population contributions to the changes of future excess deaths nationwide and by climatic zones.
Findings
Compared with the non-extreme precipitation days, the percentage increase of deaths associated with exposure to extreme precipitation days is 13·0% (95% CI 7·0–19·3) for accidental cause, 4·3% (2·0–6·6) for circulatory disease, and 6·8% (2·8–10·9) for respiratory disease. The number of annual average excess deaths related to extreme precipitation events during 1986–2005 was 2644 (95% CI 1496–3730) for accidental cause, 69 (33–105) for circulatory disease, and 181 (79–279) for respiratory disease. In the 2030s, the total number of excess deaths of these three causes will increase by 1244 (43%), 1756 (61%), and 2008 (69%) under RCP2·6, RCP4·5, and RCP8·5 scenarios combined with a medium-fertility-rate population (SSP2-S2), respectively, but will decrease by 3% under RCP2·6–SSP2-S2 and increase by 25% under RCP8·5–SSP2-S2 in the 2090s. Humid and water-limited regions in subtropical, middle-temperate, and plateau climate zones will face highly increased risks. Climate and population factors contributed disproportionally among the five climate zones.
Interpretation
This study is the largest integrated projection exploring the disease burden associated with extreme precipitation events. The excess deaths will be amplified by climate and population changes. Improving mitigation and adaptation capacities is crucial when responding to precipitation extremes.
Funding
National Natural Science Foundation of China and Wellcome Trust.
{"title":"Projecting future excess deaths associated with extreme precipitation events in China under changing climate: an integrated modelling study","authors":"Jie Ban PhD , Kailai Lu MSc , Yuanyuan Liu , Jiawei Zang MSc , Zhen Zhou MSc , Can Zhang PhD , Zhao Liu PhD , Jianbin Huang PhD , Yidan Chen PhD , Prof Xuejie Gao PhD , Prof Ying Xu PhD , Prof Can Wang PhD , Prof Wenjia Cai PhD , Prof Peng Gong PhD , Prof Yong Luo PhD , Prof Tiantian Li PhD","doi":"10.1016/S2542-5196(24)00202-X","DOIUrl":"10.1016/S2542-5196(24)00202-X","url":null,"abstract":"<div><h3>Background</h3><div>Climate-change-induced extreme precipitation events have attracted global attention; however, the associated excess deaths burden has been insufficiently explored and remains unclear.</div></div><div><h3>Methods</h3><div>We first defined an extreme precipitation event for each county when the daily total precipitation exceeded the county-specific 99·5th percentile of the daily precipitation from 1986 to 2005; then we estimated the associations between extreme precipitation events and cause-specific deaths in 280 Chinese counties using a two-stage time-series model. Second, we projected the excess deaths related to extreme precipitation events by combining the bias-corrected multi-model precipitation predictions derived under different combined emission-population scenarios of three representative concentration pathways (RCPs; RCP2·6, RCP4·5, and RCP8·5) and three shared socioeconomic pathways (SSP2, a business-as-usual scenario) populations (S1, low fertility rate; S2, medium fertility rate; and S3, high fertility rate). We quantified the climate and population contributions to the changes of future excess deaths nationwide and by climatic zones.</div></div><div><h3>Findings</h3><div>Compared with the non-extreme precipitation days, the percentage increase of deaths associated with exposure to extreme precipitation days is 13·0% (95% CI 7·0–19·3) for accidental cause, 4·3% (2·0–6·6) for circulatory disease, and 6·8% (2·8–10·9) for respiratory disease. The number of annual average excess deaths related to extreme precipitation events during 1986–2005 was 2644 (95% CI 1496–3730) for accidental cause, 69 (33–105) for circulatory disease, and 181 (79–279) for respiratory disease. In the 2030s, the total number of excess deaths of these three causes will increase by 1244 (43%), 1756 (61%), and 2008 (69%) under RCP2·6, RCP4·5, and RCP8·5 scenarios combined with a medium-fertility-rate population (SSP2-S2), respectively, but will decrease by 3% under RCP2·6–SSP2-S2 and increase by 25% under RCP8·5–SSP2-S2 in the 2090s. Humid and water-limited regions in subtropical, middle-temperate, and plateau climate zones will face highly increased risks. Climate and population factors contributed disproportionally among the five climate zones.</div></div><div><h3>Interpretation</h3><div>This study is the largest integrated projection exploring the disease burden associated with extreme precipitation events. The excess deaths will be amplified by climate and population changes. Improving mitigation and adaptation capacities is crucial when responding to precipitation extremes.</div></div><div><h3>Funding</h3><div>National Natural Science Foundation of China and Wellcome Trust.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e723-e733"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00201-8
Prof Ding Ding PhD , Mengyun Luo PhD , Maria Florencia Petrelli Infante MSc , Lucy Gunn PhD , Deborah Salvo PhD , Belen Zapata-Diomedi PhD , Prof Ben Smith PhD , Prof William Bellew PhD , Prof Adrian Bauman PhD , Tracy Nau BSc , Binh Nguyen PhD
Active travel is a widely recognised strategy for promoting active living but its co-benefits beyond increasing physical activity, such as broader health, environmental, and social benefits, have rarely been synthesised. We conducted a systematic review to examine the co-benefits of active travel interventions. Following a preregistered protocol (PROSPERO CRD42022359059), we identified 80 studies for the search period from Jan 1, 2000, to Sept 13, 2022. Across studies, there was consistent evidence that active travel interventions offered co-benefits beyond physical activity. Particularly, 25 (71%) of 35 studies favoured improved safety outcomes, 20 (67%) of 30 showed improved health, 17 (85%) of 20 supported economic benefits, 16 (84%) of 19 highlighted improved transport quality, 12 (92%) of 13 showed environmental benefits, and four (80%) of five documented social benefits. Despite the overall low-certainty evidence, mostly limited by the quasi-experimental design and natural-experimental design of many of the studies, active travel interventions offer unique opportunities to engage stakeholders across sectors to jointly address major societal issues, such as physical inactivity, traffic safety, and carbon emissions. This evidence can inform the design, implementation, and evaluation of active travel interventions.
{"title":"The co-benefits of active travel interventions beyond physical activity: a systematic review","authors":"Prof Ding Ding PhD , Mengyun Luo PhD , Maria Florencia Petrelli Infante MSc , Lucy Gunn PhD , Deborah Salvo PhD , Belen Zapata-Diomedi PhD , Prof Ben Smith PhD , Prof William Bellew PhD , Prof Adrian Bauman PhD , Tracy Nau BSc , Binh Nguyen PhD","doi":"10.1016/S2542-5196(24)00201-8","DOIUrl":"10.1016/S2542-5196(24)00201-8","url":null,"abstract":"<div><div>Active travel is a widely recognised strategy for promoting active living but its co-benefits beyond increasing physical activity, such as broader health, environmental, and social benefits, have rarely been synthesised. We conducted a systematic review to examine the co-benefits of active travel interventions. Following a preregistered protocol (PROSPERO CRD42022359059), we identified 80 studies for the search period from Jan 1, 2000, to Sept 13, 2022. Across studies, there was consistent evidence that active travel interventions offered co-benefits beyond physical activity. Particularly, 25 (71%) of 35 studies favoured improved safety outcomes, 20 (67%) of 30 showed improved health, 17 (85%) of 20 supported economic benefits, 16 (84%) of 19 highlighted improved transport quality, 12 (92%) of 13 showed environmental benefits, and four (80%) of five documented social benefits. Despite the overall low-certainty evidence, mostly limited by the quasi-experimental design and natural-experimental design of many of the studies, active travel interventions offer unique opportunities to engage stakeholders across sectors to jointly address major societal issues, such as physical inactivity, traffic safety, and carbon emissions. This evidence can inform the design, implementation, and evaluation of active travel interventions.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e790-e803"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00203-1
Ronan Adler Tavella , Fernando Rafael de Moura , Simone Georges El Khouri Miraglia , Flavio Manoel Rodrigues da Silva Júnior
{"title":"A New Dawn for Air Quality in Brazil","authors":"Ronan Adler Tavella , Fernando Rafael de Moura , Simone Georges El Khouri Miraglia , Flavio Manoel Rodrigues da Silva Júnior","doi":"10.1016/S2542-5196(24)00203-1","DOIUrl":"10.1016/S2542-5196(24)00203-1","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e717-e718"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00208-0
Ana Bonell PhD , Prof Ana M Vicedo-Cabrera PhD , Giovenale Moirano PhD , Bakary Sonko BSc , David Jeffries PhD , Prof Sophie E Moore PhD , Prof Andy Haines F Med Sci , Prof Andrew M Prentice PhD , Prof Kris A Murray PhD
<div><h3>Background</h3><div>The intersecting crises of climate change, food insecurity, and undernutrition disproportionately affect children. Understanding the effect of heat on growth from conception to 2 years of age is important because of mortality and morbidity implications in the near term and over the life course.</div></div><div><h3>Methods</h3><div>In this secondary analysis, we used longitudinal pregnancy cohort data from the Early Nutrition and Immunity Development (ENID) randomised controlled trial in West Kiang, The Gambia, which occurred between Jan 20, 2010, and Feb 10, 2015. The ENID trial assessed micronutrient supplementation in the first 1000 days of life starting from 20 weeks’ gestation, during which anthropometric measurements were collected prospectively. We used multivariable linear regression to assess the effect of heat stress (defined by Universal Thermal Climate Index [UTCI]) on intrauterine growth restriction based on length-for-gestational age Z score (LGAZ), weight-for-gestational age Z score (WGAZ), and head circumference-for-gestational age Z score (HCGAZ) at birth, and assessed for effect modification of supplement intervention on the relationship between heat stress and infant anthropometry. We used multivariable, multilevel linear regression to evaluate the effect of heat stress on infant growth postnatally based on weight-for-height Z score (WHZ), weight-for-age Z score (WAZ), and height-for-age Z score (HAZ) from 0 to 2 years of age.</div></div><div><h3>Findings</h3><div>Complete data were available for 668 livebirth outcomes (329 [49%] female infants and 339 [51%] male infants). With each 1°C increase in mean daily maximum UTCI exposure, in the first trimester, we observed a reduction in WGAZ (–0·04 [95% CI –0·09 to 0·00]), whereas in the third trimester, we observed an increase in HCGAZ (0·06 [95% CI 0·00 to 0·12]), although 95% CIs included 0. Maternal protein-energy supplementation in the third trimester was associated with reduced WGAZ (–0·16 [–0·30 to –0·02]) with each 1°C increase in mean daily maximum UTCI exposure, while no effect of heat stress on WGAZ was found with either standard care (iron and folate) or multiple micronutrient supplementation. For the postnatal analysis, complete anthropometric data at 2 years were available for 645 infants (316 [49%] female infants and 329 [51%] male infants). Postnatally, heat stress effect varied by infant age, with infants aged 6–18 months being the most affected. In infants aged 12 months exposed to a mean daily UTCI of 30°C (preceding 90-day period) versus 25°C UTCI, we observed reductions in mean WHZ (–0·43 [95% CI –0·57 to –0·29]) and mean WAZ (–0·35 [95% CI –0·45 to –0·26]). We observed a marginal increase in HAZ with increasing heat stress exposure at age 6 months, but no effect at older ages.</div></div><div><h3>Interpretation</h3><div>Our results suggest that heat stress impacts prenatal and postnatal growth up to 2 years of age but sensitivity mig
背景：气候变化、粮食不安全和营养不良等危机相互交织，对儿童的影响尤为严重。了解热量对受孕至 2 岁儿童生长的影响非常重要，因为热量会在短期内和整个生命过程中对死亡率和发病率产生影响：在这项二次分析中，我们使用了来自冈比亚西基昂早期营养与免疫发展（ENID）随机对照试验的纵向孕期队列数据，该试验发生在 2010 年 1 月 20 日至 2015 年 2 月 10 日之间。ENID试验评估了从妊娠20周开始的生命最初1000天的微量营养素补充情况，在此期间对人体测量数据进行了前瞻性收集。我们采用多变量线性回归评估了热应激（以通用热气候指数[UTCI]定义）对宫内生长受限的影响，该影响基于出生时胎龄身长Z值（LGAZ）、胎龄体重Z值（WGAZ）和胎龄头围Z值（HCGAZ），并评估了补充剂干预对热应激与婴儿人体测量之间关系的影响修正。我们使用多变量、多层次线性回归法评估了热应激对婴儿出生后生长的影响，其依据是婴儿0至2岁期间的体重身高Z值（WHZ）、体重年龄Z值（WAZ）和身高年龄Z值（HAZ）：668 名活产婴儿（329 名[49%]女婴和 339 名[51%]男婴）的完整数据。UTCI日平均最高暴露温度每升高1°C，在妊娠的前三个月，我们观察到WGAZ下降（-0-04 [95% CI -0-09 to 0-00]），而在妊娠的后三个月，我们观察到HCGAZ上升（0-06 [95% CI 0-00 to 0-12]），尽管95% CI包括0.5°C。母体在妊娠三个月内补充蛋白质能量与日平均最高UTCI暴露温度每升高1°C，WGAZ降低（-0-16 [-0-30 to -0-02]）有关，而标准护理（铁和叶酸）或多种微量营养素补充均未发现热应激对WGAZ的影响。在产后分析中，645 名婴儿（316 名[49%]女婴和 329 名[51%]男婴）2 岁时的人体测量数据完整。产后热应激的影响因婴儿年龄而异，6-18 个月的婴儿受影响最大。在 12 个月大的婴儿中，暴露于 30°C 的日平均 UTCI（前 90 天期间）与 25°C 的 UTCI 相比，我们观察到平均 WHZ（-0-43 [95% CI -0-57 to -0-29]）和平均 WAZ（-0-35 [95% CI -0-45 to -0-26]）降低。我们观察到，在 6 个月大时，随着热应激暴露程度的增加，HAZ 略有增加，但在较大年龄时则没有影响：我们的研究结果表明，热应激会影响2岁以内的产前和产后生长，但敏感性可能因年龄而异。在地球迅速变暖的背景下，这些发现可能会对个人健康产生短期和长期影响，并对公共儿童健康产生近期和未来的影响：惠康基金会。
{"title":"Effect of heat stress in the first 1000 days of life on fetal and infant growth: a secondary analysis of the ENID randomised controlled trial","authors":"Ana Bonell PhD , Prof Ana M Vicedo-Cabrera PhD , Giovenale Moirano PhD , Bakary Sonko BSc , David Jeffries PhD , Prof Sophie E Moore PhD , Prof Andy Haines F Med Sci , Prof Andrew M Prentice PhD , Prof Kris A Murray PhD","doi":"10.1016/S2542-5196(24)00208-0","DOIUrl":"10.1016/S2542-5196(24)00208-0","url":null,"abstract":"<div><h3>Background</h3><div>The intersecting crises of climate change, food insecurity, and undernutrition disproportionately affect children. Understanding the effect of heat on growth from conception to 2 years of age is important because of mortality and morbidity implications in the near term and over the life course.</div></div><div><h3>Methods</h3><div>In this secondary analysis, we used longitudinal pregnancy cohort data from the Early Nutrition and Immunity Development (ENID) randomised controlled trial in West Kiang, The Gambia, which occurred between Jan 20, 2010, and Feb 10, 2015. The ENID trial assessed micronutrient supplementation in the first 1000 days of life starting from 20 weeks’ gestation, during which anthropometric measurements were collected prospectively. We used multivariable linear regression to assess the effect of heat stress (defined by Universal Thermal Climate Index [UTCI]) on intrauterine growth restriction based on length-for-gestational age Z score (LGAZ), weight-for-gestational age Z score (WGAZ), and head circumference-for-gestational age Z score (HCGAZ) at birth, and assessed for effect modification of supplement intervention on the relationship between heat stress and infant anthropometry. We used multivariable, multilevel linear regression to evaluate the effect of heat stress on infant growth postnatally based on weight-for-height Z score (WHZ), weight-for-age Z score (WAZ), and height-for-age Z score (HAZ) from 0 to 2 years of age.</div></div><div><h3>Findings</h3><div>Complete data were available for 668 livebirth outcomes (329 [49%] female infants and 339 [51%] male infants). With each 1°C increase in mean daily maximum UTCI exposure, in the first trimester, we observed a reduction in WGAZ (–0·04 [95% CI –0·09 to 0·00]), whereas in the third trimester, we observed an increase in HCGAZ (0·06 [95% CI 0·00 to 0·12]), although 95% CIs included 0. Maternal protein-energy supplementation in the third trimester was associated with reduced WGAZ (–0·16 [–0·30 to –0·02]) with each 1°C increase in mean daily maximum UTCI exposure, while no effect of heat stress on WGAZ was found with either standard care (iron and folate) or multiple micronutrient supplementation. For the postnatal analysis, complete anthropometric data at 2 years were available for 645 infants (316 [49%] female infants and 329 [51%] male infants). Postnatally, heat stress effect varied by infant age, with infants aged 6–18 months being the most affected. In infants aged 12 months exposed to a mean daily UTCI of 30°C (preceding 90-day period) versus 25°C UTCI, we observed reductions in mean WHZ (–0·43 [95% CI –0·57 to –0·29]) and mean WAZ (–0·35 [95% CI –0·45 to –0·26]). We observed a marginal increase in HAZ with increasing heat stress exposure at age 6 months, but no effect at older ages.</div></div><div><h3>Interpretation</h3><div>Our results suggest that heat stress impacts prenatal and postnatal growth up to 2 years of age but sensitivity mig","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e734-e743"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00230-4
Joost D Piët , Amy Booth , Erik M Donker , Fabrizio de Ponti , Carlotta Lunghi , Elisabetta Poluzzi , Ben J A Janssen , SanYuMay Tun , Charlotte Bekker , Lorena Dima , João Costa , Mathilde Jalving , Thijs H Oude Munnink , Patricia M L A van den Bemt , Marc Labriffe , Tomás van Emden , Vera van Waardenburg , Robert Likic , Milan Richir , Michiel A van Agtmael , Jelle Tichelaar
{"title":"Environmentally sustainable prescribing: recommendations for EU pharmaceutical legislation","authors":"Joost D Piët , Amy Booth , Erik M Donker , Fabrizio de Ponti , Carlotta Lunghi , Elisabetta Poluzzi , Ben J A Janssen , SanYuMay Tun , Charlotte Bekker , Lorena Dima , João Costa , Mathilde Jalving , Thijs H Oude Munnink , Patricia M L A van den Bemt , Marc Labriffe , Tomás van Emden , Vera van Waardenburg , Robert Likic , Milan Richir , Michiel A van Agtmael , Jelle Tichelaar","doi":"10.1016/S2542-5196(24)00230-4","DOIUrl":"10.1016/S2542-5196(24)00230-4","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e715-e716"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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