Climate change and health in Bangladesh: a baseline cross-sectional survey

Impact of climate change on vector-borne diseases: Exploring hotspots, recent trends and future outlooks in Bangladesh

Climate change is a significant risk multiplier and profoundly influences the transmission dynamics, geographical distribution, and resurgence of vector-borne diseases (VBDs). Bangladesh has a noticeable rise in VBDs attributed to climate change. Despite the severity of this issue, the interconnections between climate change and VBDs in Bangladesh have yet to be thoroughly explored. To address this research gap, our review meticulously examined existing literature on the relationship between climate change and VBDs in Bangladesh. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, we identified 3849 records from SCOPUS, Web of Science, and Google Scholar databases. Ultimately, 22 research articles meeting specific criteria were included. We identified that the literature on the subject matter of this study is non-contemporaneous, with 68% of studies investing datasets before 2014, despite studies on climate change and dengue nexus having increased recently. We pinpointed Dhaka and Chittagong Hill Tracts as the dengue and malaria research hotspots, respectively. We highlighted that the 2023 dengue outbreak illustrates a possible shift in dengue-endemic areas in Bangladesh. Moreover, dengue cases surged by 317% in 2023 compared to 2019 records, with a corresponding 607% increase in mortality compared to 2022. A weak connection was observed between dengue incidents and climate drivers, including the El Niño Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD). However, no compelling evidence supported an association between malaria cases, and Sea Surface Temperature (SST) in the Bay of Bengal, along with the NINO3 phenomenon. We observed minimal microclimatic and non-climatic data inclusion in selected studies. Our review holds implications for policymakers, urging the prioritization of mitigation measures such as year-round surveillance and early warning systems. Ultimately, it calls for resource allocation to empower researchers in advancing the understanding of VBD dynamics amidst changing climates.

The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis

Aim: The aim of this study was to assess the impact of climate change on health services as categorized by the WHO's Building Blocks for creating Climate-Resilient Health Systems. Objective: The objective was to conduct a systematized review of the published literature concerning the impact of climate change, using a thematic analysis approach to address our aim and identify areas for further research. Design: A search was conducted on 8 February 2022 using the Embase and PubMed research databases. Peer-reviewed scientific studies that were published in English from 2012 to 2022, which described at least one report concerning the impact of climate change on health services in LMICs, were included. Studies were organized based on their key characteristics, which included the date of publication, objective, method, limitations, participants, and geographical focus. The Mixed-Methods Appraisal Tool (MMAT) was used to assess the risk of bias in the included studies. Results: Twenty-three studies were included in this review. Five areas of health services which align with the WHO building blocks framework were impacted by climate change. These health service areas included: (1) Service Delivery, (2) Human Resources, (3) Health Finance, (4) Healthcare Products and Technology, and (5) Leadership and Governance. However, research concerning the impact of climate change on health information systems, which is part of the WHO building blocks framework, did not feature in our study. The climatic effects were divided into three themes: meteorological effects, extreme weather events, and general. The research in this study found that climate change had a detrimental impact on a variety of health services, with service delivery being the most frequently reported. The risk of bias varied greatly between studies. Conclusions: Climate change has negatively impacted health services in a variety of different ways, and without further actions, this problem is likely to worsen. The WHO building blocks have provided a useful lens through which to review health services. We built an aligned framework to describe our findings and to support future climate change impact assessments in this area. We propose that further research concerning the impact of climate change on health information systems would be valuable, as well as further education and responsible policy changes to help build resilience in health services affected by climate change.

Social vulnerability, impacts and adaptations strategies in the face of natural hazards: insight from riverine islands of Bangladesh

BACKGROUND

Bangladesh is one of the countries at risk of natural disasters due to climate change. In particular, inhabitants of its riverine islands (char) confront ongoing climatic events that heighten their vulnerability. This study aims to assess social vulnerability, impacts, and adaptation strategies to climate change in the riverine island areas of Bangladesh.

METHODS

A mixed-method approach incorporating qualitative and quantitative procedures was used on data collected from 180 households of riverine islands in Gaibandha, Bangladesh. The social vulnerability of riverine island communities was assessed based on their adaptation capacity, sensitivity, and exposure to climatic stressors.

RESULTS

The findings show that char dwellers' vulnerability, impacts, and adaptation capability to climate change vary significantly depending on their proximity to the mainland. Social vulnerability factors such as geographical location, fragile and low-grade housing conditions, illiteracy and displacement, climate-sensitive occupation and low-income level, and so on caused to the in-height vulnerability level of these particular areas. This study also displays that climate change and its associated hazards cause severe life and livelihood concerns for almost all households. In this case, the riverine dwellers employed several adaptation strategies to enhance their way of life to the disaster brought on changing climate. However, low education facilities, deficiency of useful information on climate change, poor infrastructure, and shortage of money are still the supreme hindrance to the sustainability of adaptation.

CONCLUSION

The findings underscore the importance of evaluating the susceptibility of local areas to climate change and emphasize the need for tailored local initiatives and policies to reduce vulnerability and enhance adaptability in communities residing in char households.

Human Exposure to Bats, Rodents and Monkeys in Bangladesh

Bats, rodents and monkeys are reservoirs for emerging zoonotic infections. We sought to describe the frequency of human exposure to these animals and the seasonal and geographic variation of these exposures in Bangladesh. During 2013-2016, we conducted a cross-sectional survey in a nationally representative sample of 10,002 households from 1001 randomly selected communities. We interviewed household members about exposures to bats, rodents and monkeys, including a key human-bat interface-raw date palm sap consumption. Respondents reported observing rodents (90%), bats (52%) and monkeys (2%) in or around their households, although fewer reported direct contact. The presence of monkeys around the household was reported more often in Sylhet division (7%) compared to other divisions. Households in Khulna (17%) and Rajshahi (13%) were more likely to report drinking date palm sap than in other divisions (1.5-5.6%). Date palm sap was mostly consumed during winter with higher frequencies in January (16%) and February (12%) than in other months (0-5.6%). There was a decreasing trend in drinking sap over the three years. Overall, we observed substantial geographic and seasonal patterns in human exposure to animals that could be sources of zoonotic disease. These findings could facilitate targeting emerging zoonoses surveillance, research and prevention efforts to areas and seasons with the highest levels of exposure.

Effects of climate-related risks and extreme events on health outcomes and health utilization of primary care in rural and remote areas: a scoping review

BACKGROUND

Rural populations are at risk of climate-related impacts due to ecological and geographical determinants, potentially leading to greater morbidity and health utilization. They are often highly dependent on primary care services. However, no rural- or primary care specific synthesis of these issues has ever been conducted. This review aimed to identify, characterize, and summarize existing research on the effects of climate-related events on utilization and health outcomes of primary care in rural and remote areas and identify related adaptation strategies used in primary care to climate-related events.

METHODS

A scoping review following PRISMA-ScR guidelines was conducted, examining peer-reviewed English-language articles published up to 31 October 2022. Eligible papers were empirical studies conducted in primary care settings that involved climate-related events as exposures, and health outcomes or utilization as study outcomes. Two reviewers independently screened and extracted relevant information from selected papers. Data were analysed using content analysis and presented using a narrative approach.

RESULTS

We screened 693 non-duplicate papers, of those, 60 papers were analysed. Climate-related events were categorized by type, with outcomes described in terms of primary, secondary, and tertiary effects. Disruption of primary care often resulted from shortages in health resources. Primary care may be ill-prepared for climate-related events but has an important role in supporting the development of community.

CONCLUSIONS

Findings suggest various effects of climate-related events on primary care utilization and health outcomes in rural and remote areas. There is a need to prepare rural and remote primary care service before and after climate-related events.

Waiting for the wave, but missing the tide: Case studies of climate-related (im)mobility and health

Climate change amplifies health risks, including through the health impacts of climate-related displacement. Yet diverse mobility responses in a warming world can also provide a pathway for climate change adaptation. This article examines the connections between climatic and environmental change, human mobility and health. It presents case studies across three countries: Fiji, Bangladesh, and Burkina Faso. All case studies used qualitative methods, including semi-structured interviews, storytelling, and group discussions. The Fiji case study focuses on relocation of a coastal village exposed to erosion, flooding and saltwater intrusion; it highlights self-reported health risks and opportunities following relocation. The Bangladesh case study includes seven sites that variously experience flooding, cyclones and riverbank erosion; while residents use migration and mobility as a coping strategy, there are associated health risks, particularly for those who feel trapped in new sites of residence. The case study from a village in Burkina Faso examines seasonal labour migration to the Ivory Coast and Mali during times of drought and reduced agricultural productivity, and discusses health risks for men who migrate and for women who remain in sending communities. These case studies illustrate that there is no consistent figure that represents a 'climate migrant', 'climate refugee', or 'trapped' person. Accordingly, we argue that where planetary health looks to highlight 'waves' of climate displacement, it may miss the 'tide' of slower onset climatic changes and smaller-scale and diverse forms of (im)mobility. However, even where climate-related mobility is broadly adaptive - e.g. providing opportunities for livelihood diversification, or migration away from environmental risks - there can be health risks and opportunities that are shaped by socio-political contexts, access to healthcare, altered food sources, and living and working conditions. Responsive solutions are required to protect and promote the health of mobile populations in a warming world.

Impact of climate change on human health: evidence from riverine island dwellers of Bangladesh

This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers' health issues.

Climate change induced human displacement in Bangladesh: Implications on the livelihood of displaced riverine island dwellers and their adaptation strategies

In Bangladesh, many people are being displaced in riverine island (char) areas every year due to climate change and its associated natural catastrophes. This study intends to investigate the impact of climate change on internally displaced char people's lives and livelihoods along with local adaptation strategies and hindrances to the coping mechanism. Data have been collected from 280 internally displaced households in two sub-districts. A mixed-method approach has been considered combined with qualitative and quantitative methods. The results disclose that frequent flooding, riverbank erosion, and crop loss are the leading causes for relocation, and social relations are impeded in the new place of residence. Increasing summer and winter temperatures, recurrent flooding, severity of riverbank erosion, and expanding disease outbreaks are also important indicators of climate change identified by displaced people, which are consistent with observed data. This study also reveals that almost all households come across severe livelihood issues like food shortage, unemployment and income loss, and housing and sanitation problems due to the changing climate associated with disasters in the former and present places. In response to this, the displaced people acclimatize applying numerous adaptation strategies in order to boost the livelihood resilience against climate change. However, fragile housing, financial conditions, and lack of own land are still the highest impediments to the sustainability of adaptation. Therefore, along with the government, several organizations should implement a dynamic resettlement project through appropriate scrutiny to eradicate the livelihood complications of internally displaced people.

Mortality rate, carbon emissions, renewable energy and per capita income nexus in Sub-Saharan Africa

This study exclusively contributes to the health-environment discourse by using mortality rates, carbon emissions (proxy for environmental degradation), renewable energy and real per capita income to investigate these intrinsic relationships. This study uses an unbalanced sample of 47 Sub-Saharan African countries from 2005-2019 to reveal that: (1) both carbon emissions and renewable energy are associated with higher mortality rates; (2) real per capita income is associated with reducing mortality rates; (3) per capita income attenuates the effect of renewable energy on mortality rates, (4) persistency in mortalities exist; and (5) the health-environment-energy-income dynamics differ across income groups. Additionally, this study submits that the interaction of renewable energy and real per capita income dampens the positive effect of renewable energy on mortality rates and supports the argument that income levels lessen the extent of mortalities. Besides, these results vividly show that real per capita income reduces the devastating effect of renewable energy on infant and under-5 mortality rates from 0.942% to 0.09%, 2.42% to 0.55%, 1.04% to 0.09% and 2.8% to 0.64% for high and middle-income countries, respectively. This is a novel and significant contribution to the health-environment literature. Hence, real per capita income is a crucial determinant of mortality rate. Policy recommendations are discussed.

The impact of climate change on children's nutritional status in coastal Bangladesh

This paper studies the impact of climate change on the nutritional status of very young children between the ages of 0-3 years by using weather data from the last half century merged with rich information on child, mother, and household characteristics in rural coastal Bangladesh. We evaluate the health consequences of rising temperature and relative humidity and varying rainfall jointly employing alternate functional forms. Leveraging models that control for annual trends and location-specific seasonality, and that allow the impacts of temperature to vary non-parametrically while rainfall and humidity have flexible non-linear forms, we find that temperatures that exceed 25 °C (the "comfortable" benchmark) in the month of birth exert negative effects on children's nutritional status as measured by mid upper arm circumference. Humidity has a positive impact which persists when child, mother and household controls are included. We find that exposure to changing climate in utero also matters. Explanations for these results include consequences of weather fluctuations on the extent of pasture, cropland, and rainfed lands planted with rice and other crops, and on mother's age at first marriage. Our results underline that climate change has real consequences for the health of very young populations in vulnerable areas.

Lagged Association between Climate Variables and Hospital Admissions for Pneumonia in South Africa

Pneumonia is a leading cause of hospitalization in South Africa. Climate change could potentially affect its incidence via changes in meteorological conditions. We investigated the delayed effects of temperature and relative humidity on pneumonia hospital admissions at two large public hospitals in Limpopo province, South Africa. Using 4062 pneumonia hospital admission records from 2007 to 2015, a time-varying distributed lag non-linear model was used to estimate temperature-lag and relative humidity-lag pneumonia relationships. Mean temperature, relative humidity and diurnal temperature range were all significantly associated with pneumonia admissions. Cumulatively across the 21-day period, higher mean daily temperature (30 °C relative to 21 °C) was most strongly associated with a decreased rate of hospital admissions (relative rate ratios (RR): 0.34, 95% confidence interval (CI): 0.14–0.82), whereas results were suggestive of lower mean daily temperature (12 °C relative to 21 °C) being associated with an increased rate of admissions (RR: 1.27, 95%CI: 0.75–2.16). Higher relative humidity (>80%) was associated with fewer hospital admissions while low relative humidity (<30%) was associated with increased admissions. A proportion of pneumonia admissions were attributable to changes in meteorological variables, and our results indicate that even small shifts in their distributions (e.g., due to climate change) could lead to substantial changes in their burden. These findings can inform a better understanding of the health implications of climate change and the burden of hospital admissions for pneumonia now and in the future.

Climate change and child health: a scoping review and an expanded conceptual framework

Climate change can have detrimental effects on child health and wellbeing. Despite the imperative for a fuller understanding of how climate change affects child health and wellbeing, a systematic approach and focus solely on children (aged <18 years) has been lacking. In this Scoping Review, we did a literature search on the impacts of climate change on child health from January, 2000, to June, 2019. The included studies explicitly linked an alteration of an exposure to a risk factor for child health to climate change or climate variability. In total, 2970 original articles, reviews, and other documents were identified, of which 371 were analysed. Employing an expanded framework, our analysis showed that the effects of climate change on child health act through direct and indirect pathways, with implications for determinants of child health as well as morbidity and mortality from a range of diseases. This understanding can be further enhanced by using a broader range of research methods, studying overlooked populations and geographical regions, investigating the costs and benefits of mitigation and adaptation for child health, and considering the position of climate change and child health within the UN Sustainable Development Goals. Present and future generations of children bear and will continue to bear an unacceptably high disease burden from climate change.

A Meta-Synthesis of Policy Recommendations Regarding Human Mobility in the Context of Climate Change

Changing mobility patterns combined with changes in the climate present challenges and opportunities for global health, requiring effective, relevant, and humane policy responses. This study used data from a systematic literature review that examined the intersection between climate change, migration, and health. The study aimed to synthesize policy recommendations in the peer-reviewed literature, regarding this type of environmental migration with respect to health, to strengthen the evidence-base. Systematic searches were conducted in four academic databases (PubMed, Ovid Medline, Global Health and Scopus) and Google Scholar for empirical studies published between 1990-2020 that used any study design to investigate migration and health in the context of climate change. Studies underwent a two-stage protocol-based screening process and eligible studies were appraised for quality using a standardized mixed-methods tool. From the initial 2425 hits, 68 articles were appraised for quality and included in the synthesis. Among the policy recommendations, six themes were discernible: (1) avoid the universal promotion of migration as an adaptive response to climate risk; (2) preserve cultural and social ties of mobile populations; (3) enable the participation of migrants in decision-making in sites of relocation and resettlement; (4) strengthen health systems and reduce barriers for migrant access to health care; (5) support and promote optimization of social determinants of migrant health; (6) integrate health into loss and damage assessments related to climate change, and consider immobile and trapped populations. The results call for transformative policies that support the health and wellbeing of people engaging in or affected by mobility responses, including those whose migration decisions and experiences are influenced by climate change, and to establish and develop inclusive migrant healthcare.

Toward the Development of an Integrated Climate-Sensitive Disease Surveillance in Southeast Asian Countries: A Situational Analysis

Changes in climatic conditions influence the transmission of water and/or vector-borne diseases. It is one of the reasons for the emergence and re-emergence of various infectious diseases. This case study documents the learnings from selected Southeast Asian countries that can be useful for developing integrated disease surveillance and early warning system for selected climate-sensitive diseases. Through informal key-informant interviews and site-visits to Sri Lanka, Bhutan, and Thailand, we studied the disease surveillance, meteorological surveillance and early warning systems. These leanings suggest that an integrated data sharing mechanism is essential for real-time disease prediction. Further, there is immense scope for developing mechanisms on the uniform in data collection, data processing and analysis. There is an urgent need for developing a multi-sectoral collaborative plan for the integration of surveillance for real-time prediction of climate-sensitive diseases.

Disaggregated level child morbidity in Bangladesh: An application of small area estimation method

Acute respiratory infection (ARI) and diarrhoea are two major causes of child morbidity and mortality in Bangladesh. National and regional level prevalence of ARI and diarrhoea are calculated from nationwide surveys; however, prevalence at micro-level administrative units (say, district and sub-district) is not possible due to lack of sufficient data at those levels. In such a case, small area estimation (SAE) methods can be applied by combining survey data with census data. Using an SAE method for the dichotomous response variable, this study aims to estimate the proportions of under-5 children experienced with ARI and diarrhoea separately as well as either ARI or diarrhoea within a period of two-week preceding the survey. The ARI and diarrhoea data extracted from Bangladesh Demographic and Health Survey 2011 are used to develop a random effect logistic model for each of the indicators, and then the prevalence is estimated adapting the World Bank SAE approach for the dichotomous response variable using a 5% sample of the Census 2011. The estimated prevalence of each indicator significantly varied by district and sub-district (1.4–11.3% for diarrhoea, 2.2–11.8% for ARI and 4.3–16.5% for ARI/diarrhoea at sub-district level). In many sub-districts, the proportions are found double of the national level. District and sub-district levels spatial distributions of the indicators might help the policymakers to identify the vulnerable disaggregated and remote hotspots. Particularly, aid industries can provide effective interventions at the highly vulnerable spots to overcome the gaps between micro and macro level administrative units.

The implications of population growth and climate change on sustainable development in Bangladesh

Bangladesh is characterised by its large population on a small land, rapid and unplanned urbanisation, rising urban inequalities, food and nutritional insecurity and lower level of resilience to climate change. These combined effects are major threats to food security of the country in the near future. This paper examined the implications of population growth and climate change on sustainable development of Bangladesh. This research was based on the analysis of chronological data and synthesis of literature on population growth, greenhouse gases emission, climate change, food security and sustainable development, mainly contextualised on Bangladesh. The analysis found that the population of Bangladesh has almost doubled between 1980 and 2015. The country shared around 2.2% (in 2013) of global population and contributed only 0.19% of global carbon dioxide emission. On the contrary, climate change is the biggest challenge for the country. An increase in temperature could decline rice and wheat production. Moreover, average monsoon rainfall would be increased as a result of increased temperature. The increase in temperature and rainfall may lead to early arrival and late departure of the monsoon season or an increase in mean daily rainfall intensity. Population growth and climate change have multiple implications on development. Therefore, sustainable development may be difficult to attain if climate change continues to jeopardise economic growth, environmental stability as well as the social progress of Bangladesh.

The association between temperature, rainfall and humidity with common climate-sensitive infectious diseases in Bangladesh

Bangladesh is one of the world's most vulnerable countries for climate change. This observational study examined the association of temperature, humidity and rainfall with six common climate-sensitive infectious diseases in adults (malaria, diarrheal disease, enteric fever, encephalitis, pneumonia and bacterial meningitis) in northeastern Bangladesh. Subjects admitted to the adult medicine ward of a tertiary referral hospital in Sylhet, Bangladesh from 2008 to 2012 with a diagnosis of one of the six chosen climate-sensitive infectious diseases were enrolled in the study. Climate-related data were collected from the Bangladesh Meteorological Institute. Disease incidence was then analyzed against mean temperature, humidity and average rainfall for the Sylhet region. Statistical significance was determined using Mann-Whitney test, Chi-square test and ANOVA testing. 5033 patients were enrolled (58% male, 42% female, ratio 1.3:1). All six diseases showed highly significant (p = 0.01) rises in incidence between the study years 2008 (540 cases) and 2012 (1330 cases), compared with no significant rise in overall all-cause hospital admissions in the same period (p = 0.19). The highest number of malaria (135), diarrhea (266) and pneumonia (371) cases occurred during the rainy season. On the other hand, the maximum number of enteric fever (408), encephalitis (183) and meningitis (151) cases occurred during autumn, which follows the rainy season. A positive (P = 0.01) correlation was observed between increased temperature and the incidence of malaria, enteric fever and diarrhea, and a negative correlation with encephalitis, meningitis and pneumonia. Higher humidity correlated (P = 0.01) with a higher number of cases of malaria and diarrhea, but inversely correlated with meningitis and encephalitis. Higher incidences of encephalitis and meningitis occurred while there was low rainfall. Incidences of diarrhea, malaria and enteric fever, increased with rainfall, and then gradually decreased. The findings support a relationship between weather patterns and disease incidence, and provide essential baseline data for future large prospective studies.

Right to health and social justice in Bangladesh: ethical dilemmas and obligations of state and non-state actors to ensure health for urban poor

Background

The world is urbanizing rapidly; more than half the world’s population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people’s rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens. The country is thus facing many issues that raise moral and ethical concerns.

Methods

A narrative literature review was conducted between October 2016 and November 2017 on issues related to social justice, health, and human rights in urban Bangladesh. The key questions discussed here are: i) ethical dilemmas and inclusion of the urban poor to pursue social justice; and ii) the ethical obligations and moral responsibilities of the state and non-state sectors in serving Bangladesh’s urban poor. Using a Rawlsian theory of equality of opportunity to ensure social justice, we identified key health-related ethical issues in the country’s rapidly changing urban landscape, especially among the poor.

Results

We examined ethical dilemmas in Bangladesh’s health system through the rural–urban divide and the lack of coordination among implementing agencies. The unregulated profusion of the private sector and immoral practices of service providers result in high out-of-pocket expenditures for urban poor, leading to debt and further impoverishment. We also highlight policy and programmatic gaps, as well as entry points for safeguarding the right to health for Bangladeshi citizens.

Conclusions

The urban health system in Bangladesh needs a reform in which state and non-state actors should work together, understanding and acknowledging their moral responsibilities for improving the health of the urban poor by engaging multiple sectors. The social determinants of health should be taken into account when formulating policies and programs to achieve universal health coverage and ensure social justice for the urban poor in Bangladesh.