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Mother carrying a young child on her back, shown from behind, in green fields in Sierra Leone. Credit: Annie Spratt, Unsplash.

CHAMNHA

Understanding how climate change will affect maternal and neonatal health in sub-Saharan Africa.

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About

CHAMNHA is a three-year inter-disciplinary research project funded by the Belmont Forum that will quantify the risks from heat on maternal and neonatal health, document behaviour and develop interventions to reduce the impact of current climate risks and future climate change. The consortium includes research partners in the UK, Burkina Faso, Kenya, South Africa, Sweden, Norway, and the US.

Research

The CHAMNHA research programme has five research streams to develop evidence on the management of heatwaves and for adaptation in health systems in sub-Saharan Africa. The research will focus on the development of low-cost interventions to reduce the burden of heat-related conditions on maternal and newborn health.

About us
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Project rationale

Heatwaves are expected to increase in number and intensity in the coming years due to climate change. African countries are likely to be particularly affected by the health impacts of heatwaves.

Vision and activities

CHAMNHA will generate new knowledge on protecting the health of mothers and babies from heatwaves as these increase in frequency and intensity. The CHAMNHA project will quantify the burden of disease resulting from heat stress during pregnancy and in the neonatal period; generate evidence on effective, acceptable and feasible heat interventions within African contexts; and facilitate adaptation planning to improve preparedness and reduce the impacts of extreme heat on Maternal and neonatal health (MNH) in sub-Saharan Africa.

The project has five work streams.

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Hands of mother on sleeping newborn
Research
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Epidemiological analyses

We are undertaking systematic reviews and secondary analyses of survey and health data to quantify the impact of high temperature on adverse maternal and newborn outcomes, and to investigate the factors that affect these risks.

We have three main research questions:

  • What are the impacts of extreme hot weather on maternal, perinatal, and newborn health outcomes?
  • Is there a threshold above which action should be taken to protect maternal and newborn health?
  • Do certain maternal characteristics or comorbidities increase risk of adverse maternal outcomes during exposure to extreme heat?

Our initial secondary data analyses include:

  • A ground-breaking analysis of the relationship between heat stress and preterm birth using longitudinal data from the Swedish Pregnancy Register, the Swedish National Patient Register, and Statistics Sweden, and geocoded data on temperature and air pollution. In this cohort study we will test different case definitions for heat stress using data available on temperature and investigate the short term, longer term and medium terms effects of heat stress on preterm births
  • Using a data from a cohort of approximately 830 pregnant or postpartum women in Burkina Faso, an analysis of the relationship between extreme temperature and women’s activities patterns, maternal mental health, maternal functioning, hypertension and breastfeeding practices
  • Using meteorological and medical data on 59000 deliveries from South Africa, an investigation of the effects of high temperature, for different time lags, on a broad range of health outcomes including duration of labour, maternal infections, eclampsia/pre-eclampsia, and newborn dehydration.

We are looking for new datasets and collaboration. Please contact us if you have a suitable dataset for this type of analysis.

Publications

Our collaborator Prof Matthew Chersich has recently published a systematic review on the association between high temperature and stillbirths, low birth weight and preterm births. Read the publication.

Qualitative studies of heat and behaviour
Front of Kaya Maternity Unit, Kaya, Burkina Faso

In the first year of CHAMNHA, we will be carrying out parallel qualitative studies in Burkina Faso and Kenya to examine how exposure to extreme heat during pregnancy and in the postpartum is viewed by a range of stakeholders, and the extent to which they view it as a priority for intervention. Using a combination if individual in-depth interviews, key informant interviews, and focus group discussions, these studies will engage with pregnant and postpartum women, elderly female relatives, male partners, healthcare workers, government representatives and community leaders, among others. We will ask how women identify discomfort from heat in their neonates, understand their neonate’s fluid and nutritional needs, and formulate strategies to cool them down. We will also explore women’s own cooling behaviours and general resilience to heat stress.

In Burkina Faso, we are particularly interested to document how heat stress affects women’s utilisation of antenatal care and postnatal care, and how the health system copes with demand during periods of extreme heat, when power outages are more common. Using a co-design approach involving potential beneficiaries and local stakeholders, we will identify feasible and acceptable facility-based heat-health interventions to reduce the risk of heat stress for pregnant and postpartum women and neonates in this setting.

In Kenya, the co-design process will focus on identifying potential community-based interventions that may help to shore up resilience to heat stress for this population, such as the creation of cooler spaces in the community for pregnant women to use, and the use of existing Community Health Volunteers to monitor heat stress and disseminate heat ‘alerts’ to pregnant and postpartum women.

Implementation and evaluation

Research on designing and implementing interventions will begin in 2021.

Climate services
Tsangatsini Dispensary Maternity Unit, Kenya

Annual and seasonal temperatures are increasing across the African continent. We are analysing present-day extreme temperature events over sub-Saharan Africa and projecting their change through to 2050. We are linking changes in the climate to Maternal and Neonatal Health risks.

We are investigating which heat metrics are most relevant to capture health-related risks in sub-Saharan Africa. We are using a range of observational datasets and climate model projections to provide a range of plausible scenarios for future increases in temperature extremes.

Linking to climate projects

Climate change adaptation planning

There are a range of intervention strategies to reduce the impact of heat risks and these need to be incorporated within national adaptation planning for climate change. We are undertaking research to understand how to improve decision-making on heat-health risks.

Publications
Publications
Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis
Chersich Matthew Francis, Pham Minh Duc, Areal Ashtyn, Haghighi Marjan Mosalam, Manyuchi Albert, Swift Callum P et al.
2020
BMJ 2020; 371:m3811