Periodic Reporting for period 1 - HIGH Horizons (Heat Indicators for Global Health (HIGH Horizons): monitoring, Early Warning Systems and health facility interventions for pregnant and postpartum women, infants and young children and health workers)
Période du rapport: 2022-09-01 au 2024-02-29
HIGH Horizons addresses key knowledge gaps around the quantification and monitoring of direct and indirect impacts of heat exposure on maternal, newborn and child health. With heat adaptation interventions such as modifications to health facilities (e.g. passive cooling systems, reflective white paint on the roofs,…) and effective messaging through smartphones to accompany heat stress notifications to pregnant and postpartum women and mothers of infants, the burden of adverse health outcomes may be reduced.
Using systematic reviews, analyses of heat impacts on maternal, newborn and child health outcomes, and data science predictive modelling on maternal and newborn health data from Sweden, Italy, Greece, Kenya and South Africa, HIGH Horizons will increase our understanding of the relationships between heat and maternal, newborn and child health outcomes and inform testing and selection of global, EU and national indicators as well as cut-off thresholds for the EWS, stratified by risk groups. Specific biomarkers are measured among pregnant women and their infants in a prospective mother-child birth cohort in Greece to better understand the role of heat exposures on adverse health effects. Through a smartphone app (ClimApp-MCH), this EWS delivers notifications and setting-specific messages, co-designed locally. The app will be evaluated among 600 mothers and infants in Sweden, South Africa and Zimbabwe, from pregnancy through 12 months of infant age. The HIGH Horizons project will document the impact of heat exposure on health worker wellbeing, health, productivity and on the quality of care provided. Modifications to health facilities are co-designed and modelled to reduce heat exposure for health workers and to limit facility-generated carbon emissions. Health worker outcomes and facility emissions are compared before and after the mitigation and adaptation interventions of which the cost-effectiveness is evaluated.
Using systematic reviews, analyses of heat impacts on maternal, newborn and child health outcomes, and data science predictive modelling on maternal and newborn health data from Sweden, Italy, Greece, Kenya and South Africa, HIGH Horizons will increase our understanding of the relationships between heat and maternal, newborn and child health outcomes and inform testing and selection of global, EU and national indicators as well as cut-off thresholds for the EWS, stratified by risk groups. Specific biomarkers are measured among pregnant women and their infants in a prospective mother-child birth cohort in Greece to better understand the role of heat exposures on adverse health effects. Through a smartphone app (ClimApp-MCH), this EWS delivers notifications and setting-specific messages, co-designed locally. The app will be evaluated among 600 mothers and infants in Sweden, South Africa and Zimbabwe, from pregnancy through 12 months of infant age. The HIGH Horizons project will document the impact of heat exposure on health worker wellbeing, health, productivity and on the quality of care provided. Modifications to health facilities are co-designed and modelled to reduce heat exposure for health workers and to limit facility-generated carbon emissions. Health worker outcomes and facility emissions are compared before and after the mitigation and adaptation interventions of which the cost-effectiveness is evaluated.
RP1
Population-level heat-health indicators
* Cross-country data analyses conducted of the association between heat exposure and maternal and newborn health outcomes using several heat metrics based on datasets from Greece, Italy, Kenya, South Africa, and Sweden
* Systematic review and meta-analysis conducted on high temperature exposure in pregnancy and adverse maternal and neonatal outcomes
* Ongoing process to identify population-level indicators to track and monitor the impacts of extreme heat on maternal, newborn and child health, through scoping meetings with the Expert Group and national workshops in South Africa and Zimbabwe
Early Warning System
* EWS prototype developed for individualized heat stress warnings for protecting pregnant and postpartum women, infants and health workers
* Selection of predictive heat warning thresholds & co-design of locally-appropriate messages for the EWS
Integrated adaptation-mitigation interventions
* Thermal exposure assessed in maternity wards in South Africa, Sweden and Zimbabwe
* Health worker baseline assessment conducted in the hot season in Zimbabwe and South Africa
* Carbon emissions measured at health facilities in Kenya, South Africa and Zimbabwe
* CARBOMICA developed, a resource optimisation tool for modelling of alternative mitigation interventions
Shaping policy
* Relevant stakeholders at global, country and local level identified and engaged with outreach and networking ongoing
Biological and thermal physiological pathways of heat effects
* Mother-child cohort study protocol developed and recruitment of cohort started in Greece
Population-level heat-health indicators
* Cross-country data analyses conducted of the association between heat exposure and maternal and newborn health outcomes using several heat metrics based on datasets from Greece, Italy, Kenya, South Africa, and Sweden
* Systematic review and meta-analysis conducted on high temperature exposure in pregnancy and adverse maternal and neonatal outcomes
* Ongoing process to identify population-level indicators to track and monitor the impacts of extreme heat on maternal, newborn and child health, through scoping meetings with the Expert Group and national workshops in South Africa and Zimbabwe
Early Warning System
* EWS prototype developed for individualized heat stress warnings for protecting pregnant and postpartum women, infants and health workers
* Selection of predictive heat warning thresholds & co-design of locally-appropriate messages for the EWS
Integrated adaptation-mitigation interventions
* Thermal exposure assessed in maternity wards in South Africa, Sweden and Zimbabwe
* Health worker baseline assessment conducted in the hot season in Zimbabwe and South Africa
* Carbon emissions measured at health facilities in Kenya, South Africa and Zimbabwe
* CARBOMICA developed, a resource optimisation tool for modelling of alternative mitigation interventions
Shaping policy
* Relevant stakeholders at global, country and local level identified and engaged with outreach and networking ongoing
Biological and thermal physiological pathways of heat effects
* Mother-child cohort study protocol developed and recruitment of cohort started in Greece
RP1
Although still work in progress HIGH Horizons has obtained three results which may have potential impact on end users and policy makers. Assessing the impact of these methods, products and policy recommendations is part of our work in the last stage of HIGH Horizons.
1. Population-level heat-health indicators. The process on selection of potential indicators to track and monitor the effects of heat exposure on maternal, newborn and child health outcomes has started. The Expert Group gathered by WHO discussed evidence-based findings, including a systematic review and data analyses by HIGH Horizons and their recommendations are taken forward by the HIGH Horizons team. The final set of indicators will be released in a joint WHO/UNFPA/UNICEF/WMO publication.
2. EWS prototype. The prototype of the ClimApp-MCH, the personalised and context-specific early warning system that HIGH Horizons will introduce and test in 600 pregnant and postpartum women and in 60 health workers in South Africa, Sweden and Zimbabwe, is ready. A demo video is available and all HIGH Horizons colleagues are asked to download the app and to test the ClimApp-MCH prototype and comment on it so that further improvements can be made. Heat health risk thresholds have been preliminarily identified.
3. CARBOMICA tool. This resource allocation tool supports health managers to improve health facilities’ carbon management efficacy and informs decision-makers in the strategic distribution of scarce resources towards decarbonizing health facilities. This tool has been tested in real-world to exemplify its utility in our ongoing efforts to make the CARBOMICA tool practical and user-friendly. The case study was Mt Darwin District Hospital, Zimbabwe, and showcases CARBOMICA’s ability to integrate diverse data sets and its proficiency in generating actionable insights from such data. The tool is being finetuned and will soon be used to identify a resource optimal package of mitigation interventions in the selected health facilities in Kenya, South Africa and Zimbabwe.
Although still work in progress HIGH Horizons has obtained three results which may have potential impact on end users and policy makers. Assessing the impact of these methods, products and policy recommendations is part of our work in the last stage of HIGH Horizons.
1. Population-level heat-health indicators. The process on selection of potential indicators to track and monitor the effects of heat exposure on maternal, newborn and child health outcomes has started. The Expert Group gathered by WHO discussed evidence-based findings, including a systematic review and data analyses by HIGH Horizons and their recommendations are taken forward by the HIGH Horizons team. The final set of indicators will be released in a joint WHO/UNFPA/UNICEF/WMO publication.
2. EWS prototype. The prototype of the ClimApp-MCH, the personalised and context-specific early warning system that HIGH Horizons will introduce and test in 600 pregnant and postpartum women and in 60 health workers in South Africa, Sweden and Zimbabwe, is ready. A demo video is available and all HIGH Horizons colleagues are asked to download the app and to test the ClimApp-MCH prototype and comment on it so that further improvements can be made. Heat health risk thresholds have been preliminarily identified.
3. CARBOMICA tool. This resource allocation tool supports health managers to improve health facilities’ carbon management efficacy and informs decision-makers in the strategic distribution of scarce resources towards decarbonizing health facilities. This tool has been tested in real-world to exemplify its utility in our ongoing efforts to make the CARBOMICA tool practical and user-friendly. The case study was Mt Darwin District Hospital, Zimbabwe, and showcases CARBOMICA’s ability to integrate diverse data sets and its proficiency in generating actionable insights from such data. The tool is being finetuned and will soon be used to identify a resource optimal package of mitigation interventions in the selected health facilities in Kenya, South Africa and Zimbabwe.