Climate change and global child health: what can paediatricians do?

The effect of extreme weather events on child nutrition and health

This study traces the causal effects of extreme weather events on nutritional and health outcomes among rural children in Uganda using four waves of individual child survey data (2009–2014). A simultaneous regression model was applied for causal inference while also accounting for households’ adaptive responses. The study finds the evidence of a significant negative relationship between extreme weather events and availability of calories and nutrients for children. In particular, droughts reduced calorie, protein and zinc supply, and overall diet diversity by 67%, 37%, 28% and 30%, respectively. We further traced the effects of this reduced calorie and nutrient availability on child health indicators. A 10% decrease in zinc supply decreased height-for-age z-scores (HAZ) by around 0.139 - 0.164 standard deviations (SD), and increased probability of stunting ranging from 3.1 to 3.5 percentage points. Both boys and girls HAZ and stunting rates were sensitive to nutrient inadequacies. Different coping and adaptation strategies significantly influenced rural households’ ability to safeguard children’s nutrition and health against the effects of extreme weather. The findings of this study provide specific insights for building ex-ante resilience against extreme weather events, particularly when compared to ex-post, unsustainable, and often costlier relief actions.

The impact of climate change and biodiversity loss on the health of children: An ethical perspective

The reality of human induced climate change is no longer in doubt, but the concerted global action required to address this existential crisis remains inexcusably inert. Together with climate change, biodiversity collapse is increasingly driving the emergence and spread of infectious diseases, the consequences of which are inequitable globally. Climate change is regressive in its nature, with those least responsible for destroying planetary health at greatest risk of suffering the direct and indirect health consequences. Over half a billion of the world's children live in areas vulnerable to extreme weather events. Without immediate action, the health of today's children and future generations will be compromised. We consider the impact of biodiversity collapse on the spread of infectious diseases and outline a duty of care along a continuum of three dimensions of medical ethics. From a medical perspective, the first dimension requires doctors to serve the best interests of their individual patients. The second dimension considers the public health dimension with a focus on disease control and cost-effectiveness. The neglected third dimension considers our mutual obligation to the future health and wellbeing of children and generations to come. Given the adverse impact of our ecological footprint on current and future human health, we have a collective moral obligation to act.

Global child health in higher education in Germany: a mixed-methods study

Background

Germany has an ambitious global health strategy, yet its universities provide few opportunities for global child health researchers. Improved understanding of the reasons and the academic role of global child health is needed.

Objective

The objective of this study is to offer insights into Germany’s academic global child health landscape by describing the actors and their priorities in research and education and by analysing perceived barriers and opportunities.

Methods

We used a sequential exploratory mixed-method design. Participants were selected purposively to represent German global child health academics. Information was gathered first from a 33-item online survey and from interviews conducted four to six months post-survey. Surveys were analysed descriptively. A joint thematic approach using content analysis was used to analyse interview transcripts.

Results

Four categories emerged: training and professional orientation; professional realities; representation and advocacy, and barriers. Of the 20 survey participants (median [IQR] age 55 years [17], five female), seven agreed to be interviewed. Research experiences abroad shaped individuals’ career choices in global child health. They engaged in global child health education, primary health care and access to health services, frequently in clinical and humanitarian settings, but spent little time on global child health-related activities. Participants were active and valued in international networks and keen to extend their activities. Yet they felt under-represented academically and reported multiple structural and individual barriers in Germany. They perceived a lack of leadership positions, career paths, funding opportunities, and institutional and project support which limits academic advancement.

Conclusions

Germany’s global child health experts are motivated to engage with global child health-related topics but face difficulties in advancing academically. Academic actors may need to intensify research and training efforts in order to expand global child health’s scientific base in Germany.

Climate advocacy among Italian pediatric pulmonologists: A national survey on the effects of climate change on respiratory allergies

Climate change (CC) is expected to negatively impact respiratory health due to air pollution and increased aeroallergen exposure. Children are among the most vulnerable populations due to high ventilation rates, small peripheral airways, and developing respiratory and immunological systems. To assess the current knowledge among Italian pediatric pulmonologists on the potential effects of CC on pediatric respiratory allergic diseases, a national survey was launched online from February 2020 to February 2021. The members of the Italian Pediatric Respiratory Society (SIMRI) were contacted by email and 117 questionnaires were returned (response rate 16.4%). 72.6% of respondents were females, 53.8% were academic pediatricians, 42.7% had been working >10 years. Most of the participants were aware of the potential health effects of CC and stated that they had noticed an increase in the incidence (90.6%) and severity (67.5%) of allergic respiratory diseases among their patients. About 61% and 41% of participants respectively felt that there had been an increase in the number of children sensitized to pollen and molds. When applying latent class analysis to identify the features characterizing participants with greater awareness and knowledge of CC-related health effects, two classes were identified: almost 60% of the participants were labeled as "poor knowledge" and those with greater awareness were older, had longer work experience, and were those using the Internet to gather information about CC. There is urgent need to increase pediatricians' awareness of the detrimental effects of CC on children's respiratory health and integrate them in the educational programs of healthcare professionals.

Progress in understanding climate change's effects on children and youth

PURPOSE OF REVIEW

Climate change remains a major threat to the health and well-being of children globally. This article reviews the myriad health effects of climate change on children throughout their lives and discusses ways in which the general pediatrician can be an advocate for climate solutions.

RECENT FINDINGS

Rising atmospheric temperatures, increased air pollution, and destabilized weather patterns all lead to adverse health outcomes for children and adverse obstetric outcomes. However, the impact of climate change is not evenly distributed. Children living in poverty are more likely to be adversely impacted by the changing climate.

SUMMARY

Ongoing and emerging research suggests that children are particularly vulnerable to the effects of climate change. The primary care pediatrician is encouraged to see this irrefutable evidence as a call to action for advocacy on behalf of our patients and the planet.

Association between climate and infectious diseases among children in Varanasi city, India: A prospective cohort study

The effects of climate on infectious diseases could influence the health impacts, particularly in children in countries with the unfair socioeconomic conditions. In a prospective cohort of 461 children under 16-years-of-age in Varanasi city, India, the association of maximum-temperature (Tmax), relative humidity (RH), absolute humidity (AH), rainfall (RF), wind-speed (WS), and solar radiation (SLR) with prevalent infectious diseases (Diarrhea, Common cold and flu, Pneumonia, Skin-disease and Malaria, and Dengue) was examined using binomial-regression, adjusting for confounders and effect modifiers (socioeconomic-status; SES and child anthropometry), from January 2017 to January 2020. Attributable-fraction (AFx) was calculated due to each climate variable for each infectious disease. The result showed that each unit (1 °C) rise in Tmax was associated with an increase in diarrhea and skin-disease cases by 3.97% (95% CI: 2.92, 5.02) and 3.94% (95% CI: 1.67, 6.22), respectively, whereas, a unit decline in Tmax was associated with an increase in cold and flu cases by 3.87% (95% CI: 2.97, 4.76). Rise in humidity (RH) was associated with increase in cases of cold and flu by 0.73% (95% CI: 0.38, 1.08) and malaria (AH) by 7.19% (95% CI: 1.51, 12.87) while each unit (1 g/m³) decrease in humidity (AH) observed increase in pneumonia cases by 3.02% (95% CI: 0.75, 5.3). WS was positively associated with diarrhea (14.16%; 95% CI: 6.52, 21.80) and negatively with dengue (17.40%; 12.32, 22.48) cases for each unit change (kmph). RF showed marginal association while SLR showed no association at all. The combined AFx due to climatic factors ranged from 9 to 18%. SES and anthropometric parameters modified the climate-morbidity association in children with a high proportion of children found suffering from stunting, wasting, and underweight conditions. Findings from this study draw the attention of government and policymakers to prioritize effective measures for child health as the present association may increase disease burden in the future under climate-change scenarios in already malnourished paediatric population through multiple pathways.

Ethical considerations regarding the effects of climate change and planetary health on children

Climate change represents one of the most significant health challenges and global inequities of our generation. As a 'wicked' problem, climate change imposes an involuntary exposure on vulnerable individuals and societies that is regressive in its nature, with those least responsible for destroying planetary health at greatest risk of suffering the direct and indirect health consequences of unabated warming of the planet. The current and future generations of children are the most vulnerable population to suffer the effects of climate change. By 2030, there will be 131 000 additional child deaths each year if climate mitigation strategies are not enacted, driven by the synergy of an increasing burden of infectious diseases, food insecurity and political instability. Over half a billion of the world's children live in areas vulnerable to extreme weather events, and there is a pressing risk that our current lack of action to mitigate and adapt to climate change will result in today's children, and future generations, being the first to have poorer physical and mental health than previous generations - creating a significant intergenerational ethical dilemma. Child health-care professionals need to advocate for policies to address climate change that consider the complex health, planetary and ethical considerations necessary to solve the most significant risk to our children's health today. Without immediate action, the health of the current and future generations of children is perilous.

Global child health in Germany - Time for action

Child health is central to the SDG agenda. Universities in the UK and other European countries provide leadership in research and education for global child health to inform related policy and practice, but the German contribution is inadequate. German paediatricians and other child health professionals could make more substantial contributions to the debate at home and internationally, but lack opportunities for scholarship and research. We argue, that there is a momentum to advance global child health in academia and call on German universities to realise this potential.

Climate Change and Childhood Respiratory Health: A Call to Action for Paediatricians

Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like carbon dioxide (CO2), nitrogen oxides (NOx) and black carbon are naturally occurring greenhouse gases. Air pollution may enhance the allergenicity of some plants and, also, has an adverse effect on respiratory health. Children are a uniquely vulnerable group that suffers disproportionately from CC burden. The increasing global warming related to CC has a big impact on plants' lifecycles, with earlier and longer pollen seasons, as well as higher pollen production, putting children affected by asthma and allergic rhinitis at risk for exacerbations. Extreme weather events may play a role too, not only in the exacerbations of allergic respiratory diseases but, also, in favouring respiratory infections. Even though paediatricians are already seeing the impacts of CC on their patients, their knowledge about CC-related health outcomes with specific regards to children's respiratory health is incomplete. This advocates for paediatricians' increased awareness and a better understanding of the CC impact on children's respiratory health. Having a special responsibility for children, paediatricians should actively be involved in policies aimed to protect the next generation from CC-related adverse health effects. Hence, there is an urgent need for them to take action and successfully educate families about CC issues. This paper aims at reviewing the evidence of CC-related environmental factors such as temperature, humidity, rainfall and extreme events on respiratory allergic diseases and respiratory infections in children and proposing specific actionable items for paediatricians to deal with CC-related health issues in their clinical practice.

Impact of Extreme Weather Events on Sub-Saharan African Child and Adolescent Mental Health: A Protocol for a Systematic Review

Sub-Saharan Africa (SSA) has been identified by the Intergovernmental Panel on Climate Change (IPCC) as being the most vulnerable region to climate change impacts. A major concern is the increase in extreme weather events (EWE) such as storms, floods, droughts, heatwaves, wildfires, and landslides in SSA and their potential to affect the health and well-being of children and adolescents. The objective of this systematic review is to examine the direct and indirect impacts of EWE on the mental health of children and adolescents living in SSA, in order to inform protective adaptation strategies and promote resilience. A meta-analysis will not be possible, since the assumption is that limited studies have been published on the EWE-associated mental health impacts on children and adolescents living in SSA and that those studies that are available are heterogenous. There is acknowledgement in the global literature of the need to highlight child and adolescent mental health more prominently in climate change health strategies and policies. It is vital that adaptation strategies are informed by research on risk prevention and promotion of resilience to ensure the mental health of children and adolescents is protected.

Risk factors for wheezing in primary health care settings in the tropics

BACKGROUND

The International Study of Wheezing in Infants (EISL) is a cross-sectional, population-based study, based on ISAAC (http://www.isaac.auckland.ac.nz). It uses a validated questionnaire on early wheezing and risk/protective factors.

OBJECTIVE

To apply the EISL questionnaire regarding wheezing events in 0- to 12-month-old infants with or without atopic background searching for risk factors in the tropics.

METHODS

The population was toddlers coming in for a checkup or 12-months' vaccination in primary health care clinics of a tropical city. Apart from child factors (eg, daycare attendance), we evaluated home factors (eg, air conditioning, bathroom, carpet, >6 persons, pollution) and mothers' factors (eg, education level, employment, cellphone). Data analysis was descriptive and case-control, with as cases atopic (AW) or non-atopic (NAW) wheezing children vs healthy controls. Wheezing-associated factors were evaluated using multivariate analysis, adjusted for the relation of AW/NAW with factors that were significant in prior univariate analysis.

RESULTS

The study included 999 toddlers. Any wheeze: 31.3%, recurrent wheeze (≥3 episodes): 12.1%. Major risk factors for AW (OR; 95%CI) included smoking (11.39; 2.36-54.99), common cold before 3 months of life (3.72; 2.59-5.36), mold (3.48; 2.28-5.30), kitchen indoors (2.40; 1.27-4.54), and pets (1.69; 1.09-2.62); breastfeeding was almost protective. For NAW, common cold and pets were risk factors, but cesarean section (0.44; 0.23-0.82), more than 1 sibling (0.33; 0.18-0.61), and breastfeeding for longer than 3 months (0.50; 0.28-0.91) were protective.

CONCLUSION

Wheezing is a health care burden. We found potential new risk factors for AW, some possibly unique for tropical climates. We suggest testing several hypotheses: could early AW be reduced in the tropics by attacking mold growth? Enhancing cooking place ventilation? Keeping pets outside? Or by postponing daycare attendance until after 4 months of age and avoiding (passive) smoking during pregnancy?