Use of adaptive measures to reduce the impact of climate change on the health sector in Bangladesh
Author(s)Kabir, Md Iqbal
Contributor(s)University of Newcastle. Faculty of Health & Medicine, School of Medicine and Public Health
thesis by publication
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AbstractResearch Doctorate - Doctor of Philosophy (PhD)
This thesis by publication is composed of an overview on climate change and health, brief literature review, rationale, objectives, five published papers, and a final chapter providing a conclusion and recommendations. At the time of submission, four papers have been published and a further paper has been accepted to peer reviewed journals. Chapter 1 provides an overview of climate change and health, a brief literature review of climate change and its impact on health, the global perspective of climate change and human health, and health consequences of climate change in Bangladesh. It also describes the rationale for conducting this study; and presents research questions, objectives, and a statement regarding ethical approval. Chapter 2 (Paper 5), reports a primary analytic assessment of the climate change risks to health in Bangladesh. The title of the paper is "Climate Change and Health: Burden of Bangladesh", published in the <i>Asian-Pacific Newsletter on Occupational Health and Safety</i> 2011, 18 (1):14-16 from the University of Helsinki, Finland. A comprehensive summary of the epidemiological evidence of climate sensitive health outcomes and particularly vulnerable groups has also been presented here. It showed the health effects stemming from climate change, distribution of diseases, and the Government cost estimates for the possible additional health burdens of climate change in Bangladesh. The total costs for climate attributed diseases were estimated to be US $2.8 billion by 2021. Chapter 3 (Paper 4), makes an attempt to highlight the negative impacts of changing climate on health and establish the need for linking climate change and health adaptation with sustainable development. This paper titled "Climate Change and Health Adaptation for sustainable development" was published in <i>Journal of Development Management and Communication</i> 2014, 1 (3):258-264 from Joypur, India. The adverse effects of climate change will mostly be seen in Least Developed Countries, which are already burdened with world’s most prominent climate sensitive health challenges. The shift of Millennium Development Goals to Sustainable Development Goals demands planned adaptive strategies to face these challenges. Chapter 4 (Paper 2), “Knowledge and perception about climate change and health: findings from a baseline survey among vulnerable communities in Bangladesh” has been submitted to <i>BMC Public Health</i>. This is a cross-sectional survey, undertaken among 6720 households of 224 enumeration areas of rural villages geographically distributed in seven vulnerable districts of Bangladesh. The study revealed that the majority of the participants (54.2%) have had knowledge about climate change from some source but 45.8% did not (p< 0.001). Among the knowledgeable participants (n=3645), the majority felt excessive temperature as the change of climate (83.2%). Among the respondents 94.5% perceived change in climate and extreme weather events. Most of them (91.9%) observed change in rainfall pattern in the last 10 years and 97.8% people think their health care expenditure increased after the extreme weather events. Age, educational qualification, monthly income, and occupation were significantly associated with the knowledge of climate change (p<0.001). The most influential factor was the level of education to understand climate change and its impact on health. Chapter 5 (Paper 3), titled: “Climate change and health in Bangladesh: A baseline survey” has been accepted by the <i>Global Health Action</i> (in press). This chapter provides information on potential climate change impact on health, magnitude of climate sensitive diseases and baseline scenarios of health systems to climate variability and change. The majority of the respondents (n=6750) were low income vulnerable group (60% farmer or day labourer) with an average of 30 years stay in their locality. Most of them (96%) faced extreme weather events, 45% of people became homeless and displaced for a mean duration of 38 days in the last 10 years. Almost all of the respondents (97.8%) believe that health care expenditure increased after the extreme weather events. Mean annual total health care expenditure was 6,555 Bangladeshi Taka (1 USD = 77 BDT in 2015) and exclusively out-of-pocket of the respondents. Incidence of dengue was 1.29 (95% CI 0.65 – 2.56) and malaria 13.86 (95% CI 6.00 – 32.01) per 1,000 adult population for 12 months preceding the data collection. Incidence of diarrhoea and pneumonia among under 5 children of the households for the preceding month was 10.3% (95% CI 9.16 – 11.66) and 7.3% (95% CI 6.35 – 8.46), respectively. The findings of this survey showed that there is a potential risk of climate change on human health in Bangladesh. The magnitude of malaria, dengue, childhood diarrhoea and pneumonia was high among the vulnerable communities. Chapter 6 (Paper 1), deals with the child-centred adaptive measures for climate change and health adaptation. The paper “Child centred approach to climate change and health adaptation through schools in Bangladesh: a cluster randomised intervention trial” published in <i>PLoS One</i> 2015, 10(8):e0134993. This cluster randomized intervention trial involved 60 schools throughout Bangladesh, with 3293 secondary school students participating. The objective of this study was to test the effectiveness of the school manual developed by the Government of Bangladesh in increasing the knowledge level of the school children about climate change and health adaptation. A total of 1515 students from 30 intervention schools received the intervention through classroom training based on the school manual and 1778 students of the 30 control schools did not get the manual but a leaflet on climate change and health issues. Six months later, a post-intervention test of the same questionnaire used in the pre-test was performed at both intervention and control schools. The pre and post test scores were analysed along with the demographic data by using random effects model. The intervention group had a 17.42% (95% CI: 14.45 to 20.38, P=<0.001) higher score in the post-test after adjusting for pre-test score and other covariates in a multi-level linear regression model. These results suggest that school-based intervention for climate change and health adaptation is effective for increasing the knowledge level of school children. Chapter 7 provides conclusion and recommendations that summarizes the key results of the research and demonstrates how the original research aims were achieved. The thesis concludes with a discussion of the implications of the research and directions for further research.