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Climate change impact on malnutrition and child health in South Asia

Overview

Leader Yukiko Wagatsuma (University of Tsukuba)
Researcher Taiichi Hayashi (Kyoto University), David Sack (The Johns Hopkins University), Md. Harunor Rahid (Graduate School of Comprehensive Human Sciences, University of Tsukuba)
Term July 2014 - March 2015
Research Outline

Climate change is one of the defining challenges of the century and increasingly recognized as a public health policy. Previous studies reported the relationship between the increased risk of infections and climate related disasters. Many countries have a high burden of climate-sensitive diseases, but public health capability to respond is not always optimal. Major diseases that are sensitive to climate change often become serious among vulnerable population. Household food security and maternal malnutrition are known to be linked with child mortality and growth. Low birth weight (LBW; <2,500g) is a major determinant of mortality, morbidity and disability in neonates, infancy and childhood and has long term impact on health outcomes in adult life. The prevalence of LBW is estimated to be 16% worldwide with a range of 3-40% and occurs mostly in developing countries. The incidence of LBW in Bangladesh, predominantly the result of intrauterine growth restriction, is one of the highest in the world. This study aims to describe the impact of meteorological factors related to maternal and child malnutrition and child growth using a large birth cohort following 5,000 pregnancy mothers and their newborns in Bangladesh. The results would contribute an new evidence on vicious cycle of poverty and malnutrition, and facilitate policies how to mitigate the impact of climate change among vulnerable population.

Report

Leader Yukiko Wagatsuma (University of Tsukuba)
Researcher Taiichi Hayashi (Kyoto University), David Sack (The Johns Hopkins University), Md. Harunor Rahid (Graduate School of Comprehensive Human Sciences, University of Tsukuba)
Term July 2014 - March 2015
Achievements Outline

Climate change is one of the defining challenges of the century and increasingly recognized as a public health policy. Many countries have a high burden of climate-sensitive diseases, but public health capability to respond is not always optimal. Household food security and maternal malnutrition are known to be linked with child mortality and growth. Low birth weight is a major determinant of mortality, morbidity and disability in neonates, infancy and childhood and has long term impact on health outcomes in adult life. This study aims to describe the impact of meteorological factors related to maternal and child malnutrition and child growth using a large birth cohort following 5,000 pregnancy mothers and their newborns in Bangladesh. The results would contribute to evidences on vicious cycle of poverty and malnutrition, and facilitate policies how to mitigate the impact of climate change among vulnerable population.

Activity Contents

Activity Contents (Concrete Event and Result of Research, etc.)
Data analysis from a large birth cohort study was conducted. Symposium and Seminars to disseminate the results and have interactions among researchers were held during the term proposed through this program.
・ USJI Week 2015(Washington DC、February 23, 2015)
Session ”Challenges against poverty, malnutrition and infectious diseases”
Presentation1: Malaria research in Bangladesh (David Sack, Johns Hopkins University) Presentation2: Climate change impact on health (Yukiko Wagatsuma, University of Tsukuba)
Presentation3: Malnutrition and child health (Harunur Rashid, University of Tsukuba)
・ 2014 Global Health Workshop, organized by the Association of Pacific Rim Universities(Taipei, September 26, 2014)
Presentation: Fetal growth and development: a life-course approach to health(Yukiko Wagatsuma, University of Tsukuba)
・ Tsukuba Global Science Week 2014 “Solutions to Global Issues”(Tsukuba, September 29, 2014)
Presentation1:Temperature during pregnancy influences birth size (Miki Kagami, University of Tsukuba)
Presentation2:The early marriage and maternal health care utilization in rural Bangladesh(Md. Harunor Rashid, University of Tsukuba

Policy Paper

Leader Yukiko Wagatsuma (University of Tsukuba)
Researcher Taiichi Hayashi (Kyoto University), David Sack (The Johns Hopkins University), Md. Harunor Rahid (Graduate School of Comprehensive Human Sciences, University of Tsukuba)
Term July 2014 - March 2015
Title Challenges against poverty, malnutrition and infectious diseases

Climate change is one of the defining challenges of the century and increasingly recognized as a public health policy. Previous studies reported the relationship between the increased risk of infections and climate related disasters. Many countries have a high burden of climate-sensitive diseases, but public health capability to respond is not always optimal. Major diseases that are sensitive to climate change often become serious among vulnerable population. Household food security and maternal malnutrition are known to be linked with child mortality and growth. Low birth weight (LBW; <2,500g) is a major determinant of mortality, morbidity and disability in neonates, infancy and childhood and has long term impact on health outcomes in adult life. The prevalence of LBW is estimated to be 16% worldwide with a range of 3-40% and occurs mostly in developing countries. The incidence of LBW in Bangladesh, predominantly the result of intrauterine growth restriction, is one of the highest in the world. This study aims to describe the impact of meteorological factors related to maternal and child malnutrition and child growth using a large birth cohort following 5,000 pregnancy mothers and their newborns in Bangladesh. The results would contribute to evidences on vicious cycle of poverty and malnutrition, and facilitate policies how to mitigate the impact of climate change among vulnerable population.

 

  1. The Influence of Climatic Variability on Diarrheal Diseases

Introduction Diarrheal disease remains a remarkable factor that causes significant mortality annually, especially in developing countries. It is also anticipated that the global warming may further accelerate the increasing trend of epidemics in near future. Thus, it becomes more and more important to clarify the dynamics that control the epidemic of diarrheal diseases.

Objectives We aim to assess the impact of local and global climatic variability on diarrheal diseases.

Methods Diarrheal surveillance data used were daily diarrheal patient numbers from ICDDR,B Dhaka Hospital for over 22 years (1980-2001). Time scales of meteorological elements used were diurnal, intra-seasonal, seasonal and inter-annual variations. Lag-correlation and time-series regression models were used to assess an effect of meteorological phenomenon on the epidemiology of diarrheal diseases.

Results We identified several local, regional and global environmental factors that affect the epidemic peak of diarrheal patients. Regional climatologic and hydrological environmental factors associated with the late rainy epidemic correlate with regional anomalous atmospheric circulation patterns, i.e., stronger than normal local Hadley circulation, and stranger than normal Tibetan High. It indicates that El Niño/Southern Oscillation (ENSO) mode maturing in the preceding winter significantly correlates with the epidemics.

Conclusion The winter El Niño affects the epidemic in Dhaka in late rainy season, through the suppression of western North Pacific rainfall and the resultant anomalous South Asian monsoon circulation.

  1. The Effect of Meteorological Factors on Fetal Growth

Introduction In the last decade, extreme weather events happened in various areas of the world. Many places recorded extremely hot summer in 2010. It has been concerned about the adverse effects of climate change on human health both directly and indirectly. Hajat et al. showed evidence of increased mortality in association with hot and cold weather [1]. Every person is at risk of climate change, and children are more vulnerable than adults to health risk from exposure to environmental hazards [2]. Low birth weight (LBW) is defined as a birth of less than 2500g and is a major determinant of mortality and morbidity in neonates, infancy and childhood. The incidence of LBW in the world is 16%, and most of LBW infants are born in developing countries [3]. Some studies reported seasonal variation of birth weight and length [4-7]. Murray et al. suggested that the relationship between lower birth weight and exposure to low winter temperature during mid-gestation [7]. However, it has not been certain whether which meteorological element has an effect upon birth weight and length. If meteorological elements have influence on fetal development, climate change will be a burden to fetus. The aim of this study is to examine whether temperature during pregnancy has an influence on fetal growth.

Materials and Methods

Study Area and Population Matlab is situated 50 km southeast of Dhaka, the capital city of Bangladesh. The area is a typical rural area of Bangladesh. The International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) has maintained a registration system of birth, death and migrations in Matlab Health and Demographic Surveillance (HDSS) site since 1966. In 2001, ICDDR, B and collaborative partners initiated the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study. It was a set of randomized trials that would improve maternal nutritional status through supplementation. Approximately 5,000 of pregnant women who lived in the area were recruited as early as 8 weeks of gestation from November 2001 to October 2003. This study used fetal growth data of 3,267 livebirth singleton infants. The study had fetal size parameters such as birth weight, birth length, head circumference (HC) and abdominal circumference (AC). HC and AC were measured by ultrasound at 14, 19 and 30 weeks of gestation. Mothers’ weight and height were also measured when they enrolled in the study, and the information such as age, parity and education status were collected. We also obtained meteorological data that included daily maximum and minimum temperatures, temperatures of every three hours, daily hours of sunlight, relative humidity and precipitation (every three hours) from 2001 to 2004, observed at Changpur observatory site of Bangladesh Meteorological Department.

Statistical Analysis First, the fetal data were divided into three categories by season (dry and cold; October – February, hot; March – May, monsoon; June – September) and into 12 categories by month at birth, then comparisons among group mean birth weight or length were conducted to see seasonal and monthly difference. Then, we calculated daily mean temperature and 2-week moving average temperature. Lag-correlation analyses were used to examine the relationship between birth weight and 2-week average temperature at different time points of gestation during pregnancy. The relationship for birth length was tested in a similar manner. Multivariate regression analyses was conducted to examine the relationship between birth size and 2-week moving average temperature, adjusted by sex of newborn, parity, BMI and education of mothers.

Results Of 3,267 livebirth singleton infants, about 30% of them were LBW. The incidence of preterm birth was 7.9%. Mean BMI of mothers was 20.2. 31% were primigrava. About one-third of mothers had received no formal schooling, and 27% had been educated for less than 6 years.

There were significant seasonal variation in birth weight and birth length (P<0.001). Infants born in winter were significantly shorter than those born in other seasons, and infants born in January and December had the shortest mean birth length. Winter-born infants, especially born in January and December, had also lower mean birth weight. However, infants with the lowest mean birth weight were observed in June and July (monsoon season). Significant negative correlation was observed between birth length and mean temperature at the 8 week to 26 week of gestation. On the other hand, for birth weight, significant negative correlation with temperature was found from 26 week to 30 week of gestation. After adjusted by sex of infant, BMI, parity and education of mother, the relationship was no more significant for birth weight.

Discussion Our study showed that if temperature increased at the 1st and the 2nd trimester, birth length was shorter. This is the first study to report the effect of temperature on birth length. Birth weight and birth length were vary by season as several studies reported in previous studies [4-7]. Seasonal variation was explained in a simple manner for birth length (colder is shorter). However, there was no significant seasonal difference for birth weight. It might be explained that birth weight is more affected by other meteorological elements such as precipitation than birth length.

Conclusion Fetal growth and size at birth are related to a variety of socioeconomic, nutritional, and environment factors. Yet, based on our result, higher mean temperature during pregnancy has negative association with size at birth. Although absolute effect in size is small, this effect is for everyone and possibly continues until adulthood (the theory of fetal origins of adult diseases has been confirmed [8-9]).

References

[1] Hajat, S., Kovats, R. and Lachowycz, K. (2007) Heat-related and cold-related deaths in England and Wales: who is at risk? Occup Environ Med.64,93-100.

[2] Pronczuk, J. and Surdu, S. (2008) Children’s environmental health in the twenty-first century. Ann. N. Y. Acad. Sci. 1140, 143-154.

[3] United Nations Children’s Fund (UNICEF). (2009) The State of the world’s children special edition statistics tables. p.15.

[4] Wohlfahrt, J., Melbye, M., Christens, P., Anderson, A. and Hjalgrim, H. (1998) Secular and seasonal variation of length and weight at birth. The Lancet. 352, 1990

[5] McGrath, J., Keeping, D., Saha, S., Chant, D., Lieberman, D. and O’Callaghan, M. (2005) Seasonal fluctuations in birth weight and neonatal limb length; does prenatal vitamin D influence neonatal size and shape? Early Human Development. 81, 609-618.

[6] Chodic, G., Shalev, V., Goren, I. and Inskip, P. (2007) Seasonality in birth weight in Israel: new evidence suggests several global patterns and different etiologies. Ann Epidemiol. 17, 440-446.

[7] Murray, L., O’Reilly, D.,Betts, N., Patterson, C., Smith, G. and Evans, A. (2000) Season and outdoor ambient temperature: effect on birth weight. Obstet Gynecol. 96, 689-695.

[8] Flouris, A., Spiropoulos, Y., Sakellariou, G. and Koutedakis, Y. (2009) Effect of seasonal programming

on fetal development and longevity: links with environment temperature. Am.J.Hum.Biol.21,214-216.

[9] Barker DJP. Mothers, babies, and diseases in later life. (1994). London:BMJ Publishing Group.

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