Research Outputs

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Impacts of heat exposure in utero on longterm health and social outcomes: a systematic review
(BioMed Central (BMC), 2024) Norris, Shane; Brink, Nicholas; Lakhoo, Darshnika P.; Solarin, Ijeoma; Maimela, Gloria; von Dadelszen, Peter; Chersich, Matthew F.
Background: Climate change, particularly global warming, is amongst the greatest threats to human health. While short-term effects of heat exposure in pregnancy, such as preterm birth, are well documented, long-term effects have received less attention. This review aims to systematically assess evidence on the long-term impacts on the foetus of heat exposure in utero. Methods: A search was conducted in August 2019 and updated in April 2023 in MEDLINE(PubMed). We included studies on the relationship of environmental heat exposure during pregnancy and any long-term outcomes. Risk of bias was assessed using tools developed by the Joanna-Briggs Institute, and the evidence was appraised using the GRADE approach. Synthesis without Meta-Analysis (SWiM) guidelines were used. Results: Eighteen thousand six hundred twenty one records were screened, with 29 studies included across six outcome groups. Studies were mostly conducted in high-income countries (n=16/25), in cooler climates. All studies were observational, with 17 cohort, 5 case-control and 8 cross-sectional studies. The timeline of the data is from 1913 to 2019, and individuals ranged in age from neonates to adults, and the elderly. Increasing heat exposure during pregnancy was associated with decreased earnings and lower educational attainment (n=4/6), as well as worsened cardiovascular (n=3/6), respiratory (n=3/3), psychiatric (n=7/12) and anthropometric (n=2/2) outcomes, possibly culminating in increased overall mortality (n=2/3). The effect on female infants was greater than on males in 8 of 9 studies differentiating by sex. The quality of evidence was low in respiratory and longevity outcome groups to very low in all others. Conclusions Increasing heat exposure was associated with a multitude of detrimental outcomes across diverse body systems. The biological pathways involved are yet to be elucidated, but could include epigenetic and developmental perturbations, through interactions with the placenta and inflammation. This highlights the need for further research into the long-term effects of heat exposure, biological pathways, and possible adaptation strategies in studies, particularly in neglected regions. Heat exposure in-utero has the potential to compound existing health and social inequalities. Poor study design of the included studies constrains the conclusions of this review, with heterogenous exposure measures and outcomes rendering comparisons across contexts/studies difficult.
Nexus between summer climate variability and household food security in rural Mpumalanga Province, South Africa
(2023-09) Rusere, Farirai; Hunter, Lori ; Collinson, Mark; Twine, Wayne
Ongoing climate changes are likely to impact household food security in rural households that depend on rainfed subsistence agriculture. This paper investigates the relationship between summer climate variability and household food security in rural Mpumalanga, South Africa. We used a household panel data set nested in the Agincourt Health and Socio-Demographic Surveillance System, together with rainfall and temperature data for the summer periods 2006-07 to 2018-19 from three weather stations that surround the study area. We quantified the variability of rainfall using coefficient of variation and the standardised rainfall anomaly index, while temperature variability was reflected by the standardised temperature anomaly. In addition, the Mann-Kendall analysis was applied to detect temporal trends in rainfall and temperature. Longitudinal models accounting for socioeconomic and climate factors were used to estimate the relationship between weather and climate. The results reveal significant impact on food security from high inter-annual rainfall variability through fluctuations in food consumption, dietary diversity, and the experience of hunger. This study offers significant insights on how dietary diversity, food availability and overall food security are positively associated with greater average rainfall through subsistence agriculture as a livelihood strategy. These insights have important implications by suggesting seasonal forecasts to predict periods of potential food insecurity in local communities and can guide government policy and interventions to lessen food insecurity in rural areas.

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