Indoor Temperatures in Low Cost Housing in Johannesburg, South Africa

Container buildings used for residential and business purposes in Johannesburg, South Africa and potential heat-related health risks

Background

Outdoor and indoor air temperature affects human health and wellbeing. Climate change projections suggest that global temperatures will continue to increase, and this poses a threat to health. Buildings (for housing and business purposes) that can protect humans from the adverse effects of temperature are essential, especially in the context of climate change.

Method

In this cross-sectional study, we measured the indoor temperature inside shipping containers comprising a seven-storey block of apartments and businesses in Johannesburg, South Africa for 14 days. We assessed indoor temperature and relative humidity; evaluated measured temperatures in relation to thresholds known to be associated with adverse health risks; and sought to understand heat-health perceptions and symptoms of people living and working in shipping container units.

Results

Median indoor apparent temperature (AT) (a combination of temperature and relative humidity) was 16°C with values ranging from 6°C (observed at 8:00) to 42°C (observed at 17:00). Insulated units had temperatures between 2°C and 9°C cooler than the uninsulated unit. Heat-health risks from AT exposure were likely in all units, although there was variation in the number of occurrences that AT measurements exceeded the four symptom bands of caution, extreme caution, danger and extreme danger. Indoor AT was found to be 7°C higher on average when compared to outdoor AT. Some participants believed that their units were hot during hot weather and most people opened windows or did nothing during hot weather. Few participants reported experiencing adverse heat-health impacts, except for experiencing headaches (58%) and feeling tired or weak (40%).

Conclusion

Residents, tenants, or business owners using shipping containers should consider insulation installation and adequate windows/air conditioning for ventilation, especially in hot climates. Further research and awareness regarding heat-health risks of living or working in these spaces is needed.

Impact of climate change on maternal health outcomes: An evidence gap map review

Climate change poses unique challenges to maternal well-being and increases complications during pregnancy and childbirth globally. This evidence gap map (EGM) aims to identify gaps in existing knowledge and areas where further research related to climate change and its impact on maternal health is required. The following databases were searched individually from inception to present: Medline, EMBASE, and Global Health via OVID; Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost; Scopus; and organizational websites. In this EGM, we integrated 133 studies published in English, including qualitative, quantitative, reviews and grey literature that examined the impact of climate change on maternal health (women aged 15-45). We used Covidence to screen studies and Evidence for Policy and Practice Information (Eppi reviewer)/Eppi Mapper software to generate the EGM. Data extraction and qualitative appraisal of the studies was done using critical appraisal tools. The study protocol was registered in International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) # INPLASY202370085. Out of 133 included studies, forty seven studies were of high quality, seventy nine moderate equality and seven low quality. This EGM found notable gaps in the literature regarding the distribution of research across regions. We found significant research in North America (51) and Asia (40 studies). However, Africa and the Caribbean had fewer studies, highlighting potential disparities in research attention and resources. Moreover, while the impact of extreme heat emerged as a prominent factor impacting maternal well-being, there is a need for further investigation into other climate-related factors such as drought. Additionally, while preterm stillbirth and maternal mortality have gained attention, there is an overlook of malnutrition and food insecurity indicators that require attention in future research. The EGM identifies existing research gaps in climate change and maternal health. It emphasizes the need for global collaboration and targeted interventions to address disparities and inform climate-responsive policies.

Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil

Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017-2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens - especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.

Cold housing environments: defining the problem for an appropriate policy response

Researchers across disciplines are increasing attention to cold housing environments. Public health, environmental and social sciences, architecture, and engineering each define and measure cold housing environments differently. Lack of standardisation hinders our ability to combine evidence, determine prevalence, understand who is most at risk--and to formulate policy responses. We conducted a systematic, cross-disciplinary review of literature to document the measures used. We examined benefits and limitations of each approach and propose a conceptualisation of cold housing: where temperature is too low to support optimal health and wellbeing of inhabitants, measured using one or a combination of economic, 'objective', or subjective approaches. More accurate data on home temperatures for all population groups, combined with an understanding of factors leading to cold homes, will enable appropriate policy response to reduce adverse health effects and costs. Policies targeting better building standards and energy subsidies both improve temperature conditions in housing environments.

Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework

Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures. Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be co-designed and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent.

Temperature and indoor environments

From the thermodynamic perspective, the term temperature is clearly defined for ideal physical systems: A unique temperature can be assigned to each black body via its radiation spectrum, and the temperature of an ideal gas is given by the velocity distribution of the molecules. While the indoor environment is not an ideal system, fundamental physical and chemical processes, such as diffusion, partitioning equilibria, and chemical reactions, are predictably temperature-dependent. For example, the logarithm of reaction rate and equilibria constants are proportional to the reciprocal of the absolute temperature. It is therefore possible to have non-linear, very steep changes in chemical phenomena over a relatively small temperature range. On the contrary, transport processes are more influenced by spatial temperature, momentum, and pressure gradients as well as by the density, porosity, and composition of indoor materials. Consequently, emergent phenomena, such as emission rates or dynamic air concentrations, can be the result of complex temperature-dependent relationships that require a more empirical approach. Indoor environmental conditions are further influenced by the thermal comfort needs of occupants. Not only do occupants have to create thermal conditions that serve to maintain their core body temperature, which is usually accomplished by wearing appropriate clothing, but also the surroundings must be adapted so that they feel comfortable. This includes the interaction of the living space with the ambient environment, which can vary greatly by region and season. Design of houses, apartments, commercial buildings, and schools is generally utility and comfort driven, requiring an appropriate energy balance, sometimes considering ventilation but rarely including the impact of temperature on indoor contaminant levels. In our article, we start with a review of fundamental thermodynamic variables and discuss their influence on typical indoor processes. Then, we describe the heat balance of people in their thermal environment. An extensive literature study is devoted to the thermal conditions in buildings, the temperature-dependent release of indoor pollutants from materials and their distribution in the various interior compartments as well as aspects of indoor chemistry. Finally, we assess the need to consider temperature holistically with regard to the changes to be expected as a result of global emergencies such as climate change.

Waste Disposal Practices in Low-Income Settlements of South Africa

Domestic solid waste is rapidly increasing due to accelerated population growth and urbanization. Improper waste disposal poses potential health risks and environmental concerns. Here, we investigated waste disposal practices in relation to household/dwelling characteristics in South African low-income communities. Data for 2014 to 2019 from a community-orientated primary care program were analyzed using logistic regression. Families who reported living in a shack were more likely to dump waste in the street. Households who reported using non-electric sources of fuel for heating/cooking, those who lacked proper sanitation, and those who did not have access to piped water inside the dwelling were more likely to dispose of waste by dumping it in the street/in the yard or burying it. Families living in low-income settlements are at risk of solid waste exposure and this situation is exacerbated by poor access to piped water, proper sanitation, and electricity.

Major climate change-induced risks to human health in South Africa

There are many climatic changes facing South Africa which already have, or are projected to have, a detrimental impact on human health. Here the risks to health due to several alterations in the climate of South Africa are considered in turn. These include an increase in ambient temperature, causing, for example, a significant rise in morbidity and mortality; heavy rainfall leading to changes in the prevalence and occurrence of vector-borne diseases; drought-associated malnutrition; and exposure to dust storms and air pollution leading to the potential exacerbation of respiratory diseases. Existing initiatives and strategies to prevent or reduce these adverse health impacts are outlined, together with suggestions of what might be required in the future to safeguard the health of the nation. Potential roles for the health and non-health sectors as well as preparedness and capacity development with respect to climate change and health adaptation are considered.

Emerging climate change-related public health challenges in Africa: A case study of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania

Heat has the potential to become one of the most significant public health impacts of climate change in the coming decades. Increases in temperature have been linked to both increasing mortality and morbidity. Cities have been recognized as areas of particular vulnerability to heat's impacts on health, and marginalized groups, such as the poor, appear to have higher heat-related morbidity and mortality. Little research has examined the heat vulnerability of urban informal settlements residents in Africa, even though surface temperatures across Africa are projected to increase at a rate faster than the global average. This paper addresses this knowledge gap through a mixed-methods analysis of the heat-health vulnerability of informal settlement residents in Dar es Salaam, Tanzania. The heat exposure, sensitivity and adaptive capacity of informal settlement residents were assessed through a combination of climate analyses, semi-structured interviews with local government actors and informal settlement residents, unstructured interviews with health sector respondents, a health impacts literature review, and a stakeholder engagement workshop. The results suggest that increasing temperatures due to climate change will likely be a significant risk to human health in Dar es Salaam, even though the city does not reach extreme temperature conditions, because informal settlement residents have high exposure, high sensitivity and low adaptive capacity to heat, and because the heat-health relationship is currently an under-prioritized policy issue. While numerous urban planning approaches can play a key role in increasing the resilience of citizens to heat, Dar es Salaam's past and current growth and development patterns greatly complicate the implementation and enforcement of such approaches. For African cities, the findings highlight an urgent need for more research on the vulnerability and resilience of residents to heat-health impacts, because many African cities are likely to present similar characteristics to those in Dar es Salaam that increase resident's vulnerability.

Environmental Comfort as a Sustainable Strategy for Housing Integration: The AURA 1.0 Prototype for Social Housing

The AURA 1.0 prototype is a sustainable social housing proposal, designed by the University of Seville and built for the first Latin American edition of the prestigious Solar Decathlon competition. Different conditioning strategies were integrated into this prototype, optimized for a tropical climate, and focused on contributing positively to the health of the most humble people in society. In this moment, in which a large part of the world population is confined to their homes due to the Covid-19 pandemic, we have the opportunity (and the obligation) to reconsider the relationship between architecture and medicine or in other words, between the daily human habitat and health. For this reason, this analysis of aspects derived from the interior conditioning of the homes is carried out. The main objective of the Aura proposal is to be able to extract data through a housing monitoring system, which allows us to transfer some design strategies to the society to which is a case study, in order to promote environmental comfort and, therefore, people’s health. The AURA 1.0 prototype develops flexible and adaptable living spaces, with a high environmental quality, in order to maintain the variables of temperature, relative humidity and natural lighting within a range of comfort required by the rules of the event. To achieve this end, the prototype develops an architectural proposal that combines passive and active conditioning strategies, using construction qualities and typical costs of social housing. These strategies allowed the project to achieve the first prize in the Comfort Conditions test. So, this paper presents an appropriate and tested solution that can satisfy comfortability and health of residents who live in social housing while maintaining low energy consumption.

Dwelling Characteristics Influence Indoor Temperature and May Pose Health Threats in LMICs

Background:

Shelter and safe housing is a basic human need that brings about a sense of ownership, self-sufficiency, and citizenship. Millions of people around the world live in inadequate dwellings in unhealthy areas, such as urban slums. These dwellings may experience indoor temperatures that impact inhabitants’ health. Indoor dwelling temperatures vary depending on many factors including geographic location, such as inland versus coastal. In an era of climate change, understanding how dwelling characteristics influence indoor temperature is important, especially in low- and middle-income countries, to protect health.

Objective:

To assess indoor temperature in low-cost dwellings located in a coastal setting in relation to dwelling characteristics.

Methods:

Indoor temperature and relative humidity loggers were installed from 1 June 2017 to 15 May 2018 in 50 dwellings in two settlements in a coastal town on the east coast of South Africa. Ambient outdoor temperature data were obtained from the national weather service, indoor temperature data were converted into apparent temperature, and heat index calculations were made to consider possible heat-health risks. A household questionnaire and dwelling observation assessment were administered. A mixed-effects linear regression model was constructed to consider the impact of dwelling characteristics on indoor apparent temperature.

Findings:

Among 17 dwellings with all data sets, indoor temperatures were consistently higher than, and well correlated (r = 0.92) with outdoor temperatures. Average differences in indoor and outdoor temperatures were about 4°C, with statistically significant differences in percentage difference of indoor/outdoor between seasons (p < 0.001). Heat indices for indoor temperatures were exceeded mostly in summer, thereby posing possible health risks. Dwellings with cement floors were statistically significantly cooler than any other floor type across all seasons.

Conclusions:

Low-cost dwellings experienced temperatures indoors higher than outdoor temperatures in part due to floor type. These results help inform interventions that consider housing and human health (n = 289).

The Three Little Houses: A Comparative Study of Indoor and Ambient Temperatures in Three Low-Cost Housing Types in Gauteng and Mpumalanga, South Africa

Low-cost houses make up the majority of the homes in townships (racially segregated areas which are usually underdeveloped) in South Africa and there has been limited research on the indoor temperatures experienced by residents of these homes. As a developing nation the price and availability of construction materials, often takes precedence over the potential thermal efficiency of the house. Occupants of low-cost houses are particularly vulnerable to climatic changes which may increase the likelihood of exposure to extreme temperatures in South Africa. This study focused on the relationship between indoor and ambient temperature in two study areas namely; Kathorus in Gauteng and Wakkerstroom in Mpumalanga. Three housing types were included in the study (government funded apartheid era houses, government funded post-apartheid houses and informal houses (shacks)). Temperature data loggers were installed in each home, in each area, from June 2017 to July 2018. Ambient temperature data were collected for the period June 2017 to July 2018. The houses studied were built with different materials which affect their thermal efficiency. The study also included semi-structured interviews where occupant's perspectives on housing could be surveyed. Household temperatures in Kathorus and Wakkerstroom, both in the warmer and colder months fluctuated substantially throughout the day. There was an 8 °C, 9 °C and 14 °C fluctuations in daily indoor temperatures of apartheid-era, post-apartheid and shacks houses, and daily outdoor fluctuations of 5-15 °C, with higher fluctuations measured in Wakkerstroom. Generally, ambient and indoor temperatures were correlated but showed high variability. Indoor data for the winter months were less well correlated. Data showed that residents are subjected to extreme temperatures and these are expected to increase. The householder's perceptions of thermal comfort were often not related to indoor temperature readings but to behavioural changes including the use of warm clothes and wood burning stoves. The study's findings suggest that a majority of low-cost houses are thermally inefficient especially for those built in the post-apartheid era and shacks. With these houses showing a clear link between ambient and indoor temperature fluctuations. The occupants of these homes are poor and vulnerable to health risks which could be exacerbated by temperature fluctuations. Small changes such as installation of ceilings and use of insulation could make a large difference in these houses.

The Epidemiology of Skin Cancer and Public Health Strategies for Its Prevention in Southern Africa

Skin cancer is a non-communicable disease that has been underexplored in Africa, including Southern Africa. Exposure to solar ultraviolet radiation (UVR) is an important, potentially modifiable risk factor for skin cancer. The countries which comprise Southern Africa are Botswana, Lesotho, Namibia, South Africa, and Swaziland. They differ in population size and composition and experience different levels of solar UVR. Here, the epidemiology and prevalence of skin cancer in Southern African countries are outlined. Information is provided on skin cancer prevention campaigns in these countries, and evidence sought to support recommendations for skin cancer prevention, especially for people with fair skin, or oculocutaneous albinism or HIV-AIDS who are at the greatest risk. Consideration is given to the possible impacts of climate change on skin cancer in Southern Africa and the need for adaptation and human behavioural change is emphasized.

Socio-economic, infrastructural and health-related risk factors associated with adverse heat-health effects reportedly experienced during hot weather in South Africa

INTRODUCTION

Poor urban communities are likely to bear the brunt of climate change impacts on health and well-being. The City of Johannesburg, South Africa, is predicted to experience an average increase in ambient temperature of 4°C by 2100. Focusing on the urban environment, this study aimed to determine socio-economic, infrastructural and health-related risk factors for heat-related adverse health effects.

METHODS

This was a cross-sectional study. Data of interest were collected using a pretested and validated questionnaire administered to parents of children attending schools participating in a school heat study. Information related to demographic, socio-economic and household-level determinants of health, which has an impact on the individual prevalence of adverse heat-health effects associated with hot weather, was collected for 136 households and 580 individuals.

RESULTS

Sweating (n = 208 individuals; 35%), headache and nausea (n = 111; 19%) and weakness, fatigue and dizziness (n = 87; 15%) were the most common heat-health effects reportedly experienced by individuals (n = 580) during hot weather. Individuals who suffered from hypertension (OR = 2.32, 95% CI: 1.34 - 4.05, p = 0.003) and individuals older than 60 years (OR = 1.81, 95% CI: 1.27-1.99, p < 0.001) compared to other age groups were more likely to experience 'any heat-health effects'. Living in government-sponsored detached housing and in houses with asbestos roofs were associated with an increase in reported experience of 'any heat-health effects' compared to living in other housing types.

CONCLUSION

Heat-health awareness campaigns should target people suffering from pre-existing diseases and the elderly, as these groups are especially vulnerable to heat. Focus should also be given to appropriate roofing and insulation in government-sponsored housing since summertime temperatures are projected to increase.

Socioeconomic Status and Temporal Urban Environmental Change in Accra: a Comparative Analysis of Area-based Socioeconomic and Urban Environmental Quality Conditions Between Two Time Points

The influence of area-based socioeconomic (SE) conditions on environmental quality conditions has recently been reported showing the precise spatial relationship between area-based SE conditions and neighborhood environmental quality in an urban area in a low-income setting. Nonetheless, there is still a lack of understanding of the nature of the relationship on a temporal scale. This study aimed to investigate the dynamic temporal relationship between area-based SE conditions and urban environmental quality conditions over a decadal period in Accra, Ghana. The results showed that there were differences in environmental quality across the SE quintiles in space (with regard to per capita waste generation (p < 0.012), waste collection/clearing (p < 0.01), and waste deposition (p < 0.001) and that the urban environmental quality conditions had changed dramatically over the decade for most of the environmental variables (p < 0.001). Despite the enormous urban development initiatives, some of the environmental quality indicators (e.g., proportion of households without flush toilet/Water Closet, connection to central sewer p < 0.001) appeared to have worsened in the high class quintile, suggesting that a high proportion of households were without acceptable sanitation facilities. The study concludes that urban development in low-income countries will need to follow strictly international best practice by observing standardized building codes and guidelines, if progress should be made in meeting the Millennium Development Goals targets.

Climate change adaptation in South Africa: a case study on the role of the health sector

BACKGROUND

Globally, the response to climate change is gradually gaining momentum as the impacts of climate change unfold. In South Africa, it is increasingly apparent that delays in responding to climate change over the past decades have jeopardized human life and livelihoods. While slow progress with mitigation, especially in the energy sector, has garnered much attention, focus is now shifting to developing plans and systems to adapt to the impacts of climate change.

METHODS

We applied systematic review methods to assess progress with climate change adaptation in the health sector in South Africa. This case study provides useful lessons which could be applied in other countries in the African region, or globally. We reviewed the literature indexed in PubMed and Web of Science, together with relevant grey literature. We included articles describing adaptation interventions to reduce the impact of climate change on health in South Africa. All study designs were eligible. Data from included articles and grey literature were summed thematically.

RESULTS

Of the 820 publications screened, 21 were included, together with an additional xx papers. Very few studies presented findings of an intervention or used high-quality research designs. Several policy frameworks for climate change have been developed at national and local government levels. These, however, pay little attention to health concerns and the specific needs of vulnerable groups. Systems for forecasting extreme weather, and tracking malaria and other infections appear well established. Yet, there is little evidence about the country's preparedness for extreme weather events, or the ability of the already strained health system to respond to these events. Seemingly, few adaptation measures have taken place in occupational and other settings. To date, little attention has been given to climate change in training curricula for health workers.

CONCLUSIONS

Overall, the volume and quality of research is disappointing, and disproportionate to the threat posed by climate change in South Africa. This is surprising given that the requisite expertise for policy advocacy, identifying effective interventions and implementing systems-based approaches rests within the health sector. More effective use of data, a traditional strength of health professionals, could support adaptation and promote accountability of the state. With increased health-sector leadership, climate change could be reframed as predominately a health issue, one necessitating an urgent, adequately-resourced response. Such a shift in South Africa, but also beyond the country, may play a key role in accelerating climate change adaptation and mitigation.

Household Fuel Use for Heating and Cooking and Respiratory Health in a Low-Income, South African Coastal Community

In low-income communities, non-electric fuel sources are typically the main cause of Household Air Pollution (HAP). In Umlazi, a South African coastal, informal settlement, households use electric- and non-electric (coal, wood, gas, paraffin) energy sources for cooking and heating. The study aimed to determine whether respiratory ill health status varied by fuel type use. Using a questionnaire, respondents reported on a range of socio-demographic characteristics, dwelling type, energy use for cooking and heating as well as respiratory health symptoms. Multivariate Poisson regression was used to obtain the adjusted Odds Ratios (ORs) for the effects of electric and non-electric energy sources on prevalence of respiratory infections considering potential confounding factors. Among the 245 households that participated, Upper Respiratory Tract Infections (URTI, n = 27) were prevalent in respondents who used non-electric sources compared to electric sources for heating and cooking. There were statistically significant effects of non-electric sources for heating (adjusted OR = 3.6, 95% CI (confidence interval): 1.2⁻10.1, p < 0.05) and cooking (adjusted OR = 2.9, 95% CI: 1.1⁻7.9, p < 0.05) on prevalence of URTIs. There was a statistically significant effect of electric sources for heating (adjusted OR = 2.7, 95% CI: 1.1⁻6.4, p < 0.05) on prevalence of Lower Respiratory Tract Infections (LRTIs) but no evidence for relations between non-electric sources for heating and LRTIs, and electric or non-electric fuel use type for cooking and LRTIs. Energy switching, mixing or stacking could be common in these households that likely made use of multiple energy sources during a typical month depending on access to and availability of electricity, funds to pay for the energy source as well as other socio-economic or cultural factors. The importance of behaviour and social determinants of health in relation to HAP is emphasized.

Impacts of Climate Change on Health and Wellbeing in South Africa

Given its associated burden of disease, climate change in South Africa could be reframed as predominately a health issue, one necessitating an urgent health-sector response. The growing impact of climate change has major implications for South Africa, especially for the numerous vulnerable groups in the country. We systematically reviewed the literature by searching PubMed and Web of Science. Of the 820 papers screened, 34 were identified that assessed the impacts of climate change on health in the country. Most papers covered effects of heat on health or on infectious diseases (20/34; 59%). We found that extreme weather events are the most noticeable effects to date, especially droughts in the Western Cape, but rises in vector-borne diseases are gaining prominence. Climate aberration is also linked in myriad ways with outbreaks of food and waterborne diseases, and possibly with the recent Listeria epidemic. The potential impacts of climate change on mental health may compound the multiple social stressors that already beset the populace. Climate change heightens the pre-existing vulnerabilities of women, fishing communities, rural subsistence farmers and those living in informal settlements. Further gender disparities, eco-migration and social disruptions may undermine the prevention-but also treatment-of HIV. Our findings suggest that focused research and effective use of surveillance data are required to monitor climate change's impacts; traditional strengths of the country's health sector. The health sector, hitherto a fringe player, should assume a greater leadership role in promoting policies that protect the public's health, address inequities and advance the country's commitments to climate change accords.

Diarrhoeal Disease in Relation to Possible Household Risk Factors in South African Villages

Diarrhoeal disease is a significant contributor to child morbidity and mortality, particularly in the developing world. Poor sanitation, a lack of personal hygiene and inadequate water supplies are known risk factors for diarrhoeal disease. Since risk factors may vary by population or setting, we evaluated the prevalence of diarrhoeal disease at the household level using a questionnaire to better understand household-level risk factors for diarrhoea in selected rural areas in South Africa. In a sub-sample of dwellings, we measured the microbial quality of drinking water. One in five households had at least one case of diarrhoea during the previous summer. The most widespread source of drinking water was a stand-pipe (inside yard) (45%) followed by an indoor tap inside the dwelling (29%). Storage of water was common (97%) with around half of households storing water in plastic containers with an opening large enough to fit a hand through. After adjusting for confounders, the occurrence of diarrhoea was statistically significantly associated with sourcing water from an indoor tap (Adjusted Odds Ratio (AOR): 2.73, 95% CI: 2.73, 1.14–6.56) and storing cooked/perishable food in non-refrigerated conditions (AOR: 2.17, 95% CI: 2.17, 1.44–3.26). The highest total coliform counts were found in water samples from kitchen containers followed by stand-pipes. Escherichia coli were most often detected in samples from stand-pipes and kitchen containers. One in four households were at risk of exposure to contaminated drinking water, increasing the susceptibility of the study participants to episodes of diarrhoea. It is imperative that water quality meets guideline values and routine monitoring of quality of drinking water is done to minimise diarrhoea risk in relevant rural communities. The security of water supply in rural areas should be addressed as a matter of public health urgency to avoid the need for water storage.