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Global Conversations: Climate Change Multiplies Health Risks, A Call to Action on Extreme Weather Effects

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By Davidson Ndyabahika, Johanna Blomgren and Julius T. Mugaga

Experts have urged urgent action to mitigate the health risks of climate change. The 2023 global conversation, on Climate Change and Health highlighted the need for transformational action in every sector to protect people’s health from climate change.

Held on September 5, 2023 the virtual seminar, organized by the Centre of Excellence for Sustainable Health (CESH), a collaboration between Makerere University and the Karolinska Institutet that aims to increase capacity and spur action to advance the agenda for sustainable health drew over 230 attendees from all over the world. It placed emphasis on mitigating the effects of extreme weather, such flooding.

A more recent research study by CESH defines Sustainable health as a multisectoral area for study, research, and practice towards improving health and well-being for all while staying within planetary boundaries.

In its 2023 report, the Intergovernmental Panel on Climate Change (IPCC) notes that global terrestrial, freshwater, and ocean ecosystems have already been affected by climate change, along with the associated losses and costs. It predicts that heavy rainfall and flooding events are expected to worsen and occur more frequently in the majority of regions of Africa, Asia, North America, and Europe by 1.5°C global warming (high confidence).

The 2023 IPCC report identifies barriers that prevent people and society from implementing climate-resilient behaviors. Financial limitations, conflicts with the SDGs, inequalities, institutional, economic, and social hurdles, as well as dispersed strategies, are a few of these. The panel equally agree that if global warming exceeds 1.5 °C and the SDGs are not adequately progressed, chances for climate-resilient development would be considerably more limited.

Now, during the seminar, the panel, by consensus agreed that climate change is critical citing that such conversations on critical factors in relation to the climate and health crisis are not only timely but necessary.

Climate change impacts the social determinants of health, which include excellent health and wellbeing, by causing decreased food output, low fishing yields, flooding, and infrastructure damage, according to Daniel Helldén, a PhD student at KI Department of Global Public Health.

“The future emission scenarios are dire. What is becoming more and more clear is that climate change is a generational issue. Children born today will continue to bear the biggest burden of climate change impact,” said Helldén.

Dr. Mugume Isaac Amooti, the Director of Weather Forecasting Services at the Uganda National Meteorological Authority (UNMA), emphasized the importance of considering both long-term averages and unprecedented weather events driven by climate change. These events are thought extreme only when they exceed past records. He noted for instance that in Uganda; “The widespread flooding brought on by heavy and frequent precipitation is what we are seeing in Uganda, particularly in the cities. However, we are witnessing heat waves and cold waves at different times of the year.”

A profile of panelist, Dr. Mugume Isaac Amooti, Director, Weather Forecasting Services, Uganda National Meteorological Authority (UNMA).
A profile of panelist, Dr. Mugume Isaac Amooti, Director, Weather Forecasting Services, Uganda National Meteorological Authority (UNMA).

Although there isn’t a clear pattern in Sweden’s precipitation, Dr. Johanna Sörensen of Lund University in Sweden said that forecasts suggest that rainfall may increase by the end of the century. Given the flooding problems that already present, this, she says is something to worry about. “Flooding is increasing not only because of climate change but also even more that we construct the cities more densely and we construct buildings and industries on lowly areas that we used not to do in the past which is of course not a good idea.”

A profile of panelist, Dr. Johanna Sörensen, Associate Senior Lecturer, Division of Water Resources Engineering, Faculty of Engineering (LTH), Lund University, Sweden.
A profile of panelist, Dr. Johanna Sörensen, Associate Senior Lecturer, Division of Water Resources Engineering, Faculty of Engineering (LTH), Lund University, Sweden.

Dr. Tamer Rabie, a lead health specialist at the World Bank Group, notes that risks are amplified by climate change, which therefore has an intensified negative impact. He points out, for instance, that in order to comprehend how climate change and changes in temperature and precipitation patterns will affect health, it is critical to view climate change as a risk multiplier.

A profile of Dr. Tamer Samah Rabie, Lead Health Specialist, World Bank's Health, Nutrition, and Population Global Practice.
A profile of Dr. Tamer Samah Rabie, Lead Health Specialist, World Bank’s Health, Nutrition, and Population Global Practice.

Dr. Tamer, also the architect of the World Bank’s global Health-Climate and Environment Program (H-CEP), underscored three pathways through which climate change impacts health: direct effects, indirect effects, and those mediated by ecosystems. Some of the direct pathways include issues like increased temperatures likely to lead to heat waves, heat-related illnesses, worsened non-communicable diseases, and increase in the risk of events like traumatic injuries.

According to Dr. Tamer, ecosystem-mediated risks include vector-borne diseases (like Malaria and Dengue), foodborne illnesses, and waterborne diseases (like Cholera). These risks are closely tied to how health outcomes are influenced by the ecosystem. Additionally, indirect health impacts encompass mental health due to population displacements, as well as malnutrition resulting from shifts in food production and overall food systems.

“We have done estimates in the World Bank that show that extreme weather events and climate change will lead to pushing nearly 132 million people into extreme poverty by 2030. If you look at the health impacts within those figures and the main drivers, we are seeing that nearly 44 million out of those 132 will be pushed into extreme poverty by 2030 if we don’t take any action today,” Dr. Tamer.

According to Dr. Tamer, the World Bank has conducted climate and health vulnerability assessments specifically looking at the cost of inaction moving into the 2030s and 2050s using information that relates to malaria, dengue, diarrhea, stunting in children, heat related illnesses, floods, among others.

“What we are seeing is that on average, countries will be losing anywhere between 1-5% of their GDP as a result of not really addressing the climate crisis, not being able to address these impacts that we are talking about, and obviously not investing enough into the health systems to be able to be more resilient,” Dr. Tamer noted during the webinar.

According to Dr. Sara Gabrielsson, an Associate Senior Lecturer in Sustainability Science at Lund University’s Centre for Sustainability Studies (LUCSUS), addressing immediate health risks involves containing flooding, which is just one aspect of climate change-related challenges like sea level rise and drought.

A profile of Dr. Sara Gabrielsson, Lecturer and Researcher, Lund University Centre for Sustainability Studies (LUCSUS).
A profile of Dr. Sara Gabrielsson, Lecturer and Researcher, Lund University Centre for Sustainability Studies (LUCSUS).

She highlights the connection between various deadly diseases like dengue, typhoid, trachoma, and cholera among others to this issue. During a crisis like flooding, treatment for these diseases she notes often takes a backseat due to the overwhelming health burdens that arise.

“There is death from drowning or direct injury from debris in these very storm surges, but then we also have the issue of just water sitting, waiting in water for longer periods, leading to lots of infections, urine-tract infections, vaginal infections, skin diseases, hypothermia, lots of those kinds of things, but also vector-borne diseases, and especially malaria, which is, of course, one big thing here,” Dr. Gabrielsson opines.

She adds that flooding brings problems like contaminated drinking water, leading to chronic diarrhea and malnutrition. Additionally, damaged sanitation facilities force people into open defecation, exposing them to harmful bacteria and further risk of chronic diarrhea.

“These immediate health risks are just the beginning. Moving into long-term risks, flooding severely impacts the availability of clean water for basic hygiene. As we’ve learned from COVID, hygiene is paramount for health. Insufficient handwashing and personal hygiene can breed disease. We need proper hygiene for preparing food, tending to babies, managing menstrual health, and more. Without it, there’s increased exposure to harmful bacteria, compounded by the use of inadequate sanitation systems, resulting in outbreaks of various diseases,” observed Gabrielsson.

Way forward

Dr. Sörensen, from a Swedish standpoint, proposes proactive steps to mitigate flooding. These include slowing down water flow, discouraging construction in flood-prone zones, and avoiding building in areas prone to heavy rain. She points out that in cities like Mumbai and Gothenburg, there has been a concerning trend of construction in flood-prone regions. Dr. Sörensen emphasizes the importance of adapting solutions for creating greener, more sustainable cities. “In China, they call it a sponge city. It’s like a sponge—you fill it up with water during rainfall and then use it later for various purposes. Utilizing vegetation and water storage helps retain water and slow down its flow in urban areas. Green spaces in cities are crucial for health, well-being, and providing shade, especially during heatwaves,” she says.

Dr. Johanna Sörensen.
Dr. Johanna Sörensen.

In Uganda, Dr. Mugume notes that the government has invested in weather monitoring infrastructure, including the three weather radars, which are strategically spread across the country to enable UNMA to monitor weather at any part of the country.

“With this technology, we can now offer more precise and timely services, ensuring our communities respond effectively. Weather and climate forecasts range from hourly to seasonal projections. Shorter forecasts tend to be more accurate, although longer ones still fall within manageable limits. For instance, our seasonal forecast accuracy in Uganda is at 90%, aligning with National Development Plan 3. We collaborate with development partners to fine-tune these forecasts.”

For Dr. Gabrielsson, preparedness is key, especially for the 2.2 billion people worldwide relying on sanitation systems, many of whom live in rapidly urbanizing areas and unplanned settlements.

Unfortunately, these systems often lack proper management, leading to health risks. In urban settings, she says, the spread of sludge from these systems can have widespread health implications. To address this, there’s a pressing need to prioritize climate-resilient sanitation systems. Historically, the sanitation sector has been under-prioritized, resulting in insufficient funding and political attention. Without a one-size-fits-all solution due to diverse living habits, cultural considerations become paramount. A gender-responsive approach is crucial, as women are primarily responsible for WASH (Water, Sanitation, and Hygiene) practices.

Dr. Sara Gabrielsson.
Dr. Sara Gabrielsson.

“It involves recognizing the unique needs of different groups, such as refugees, the elderly, disabled individuals, children, and menstruating individuals. Climate-resilient wash infrastructure requires community responsibility, government policy, and financial support. For instance, in flood-prone areas like the Amazon Basin, sanitation facilities are designed to align with local livelihoods, incorporating features like composting latrines that produce manure for farming and collecting rainwater for handwashing. This approach ensures environmental safety and sustainable practices,” she observes.

Dr. Gabrielsson emphasizes the importance of cultural acceptance in encouraging people’s dedication to upholding basic sanitation and hygiene practices, particularly in the face of flooding. “Another example I presented is a UNICEF-supported toilet in Bangladesh. It’s elevated with precast concrete rings to prevent flooding, sealed with concrete mortar for contamination prevention, and reinforced to withstand heavy rain and wind. This design was developed in close consultation with local communities, ensuring cultural acceptance and affordability. The goal is to create facilities that people actually want to use, which is why it’s crucial to integrate natural and social sciences for effective solutions.”

The World Bank has substantially supported action on climate change, including both adaptation and mitigation initiatives. Dr. Tamer says over $2.2 billion has been set aside as of today for climate-related health interventions, especially in South Asia and sub-Saharan Africa. Significant assistance has also been given to assist tiny island states in managing the effects of climate change, particularly extreme events.

In Yemen, the World Bank has sponsored efforts to put in place electronic early warning systems for real-time health data and policy response due to outbreaks of diseases including cholera and malaria. In Madagascar, the World Bank has funded work combining climate and nutrition programming.  The World Bank worked with the government of Ghana to create long-lasting vaccine delivery networks.

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METS Newsletter May 2024

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The newly appointed CDC Uganda Country Director, Dr. Adetinuke Mary Boyd (7th from left) met with country implementing partner Executive Directors to get insights on ongoing projects, discussed leveraging of partnerships as well as strategizing for how best to strengthen health systems. Infectious Diseases Institute (IDI)-McKinnell Knowledge Centre, Makerere University, Kampala Uganda, East Africa.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS May 2024 Newsletter

  • Enhancing Response to Sexual and Gender-Based Violence
    • Responding to and preventing Sexual and Gender-Based Violence (SGBV) and Violence Against Children (VAC) are critical components of Uganda’s national HIV prevention program. METS developed a new app designed to improve support for SGBV survivors. This followed an assessment in December 2022, that revealed gaps in service access and coordination in Fort Portal and Kampala Regions.
    • The METS team, in collaboration with regional implementing partners, is scaling up the app’s use in pilot districts such as Masaka, Kiryandongo, Fort Portal, and Mubende. The team visited facilities and police stations to install the app and train selected focal persons on its use.
  • Assessing Readiness for Integrated HIV and NCD Care Services
    • METS supported the Ministry of Health to conduct a site readiness assessment for integrated delivery of HIV and Non-Communicable Diseases (NCD) services from 22nd to 26th April 2024, in collaboration with the US Centers for Disease Control and Prevention (CDC), and various implementing partners. The activity was conducted in selected health facilities in Acholi, Mubende, Kayunga, and Rwenzori regions to determine their feasibility for participating in a comprehensive NCD evaluation.
    • The 48 facilities visited have already integrated NCD services (mental Health, diabetes, and hypertension). Of these, 78% have integrated mental health services in their PMTCT clinics. 40% of the facilities have a dedicated NCD services physicians /doctor in the ART Clinic, 29% have doc have dedicated physicians in the PMTCT clinics. 90%. Most of the facilities have clinical and nurses in the ART than PMTCT facilities but more nurses offering NCD services in PMTCT sites.
  • Digitalizing the health sector through strategic partnerships
    • In collaboration with CDC and METS, the MoH organized a national Electronic Medical Records (EMR) stakeholders meeting to orient stakeholders on the national EMR agenda and transition towards a comprehensive digital health facility package. Key actions discussed included expanding the rollout of the EMR and Community Health Information System (eCHIS) and urging development partners to support prioritized health information and digital health investments.
    • The introduction of electronic medical records (EMRs) in health facilities aims to improve the quality of health service delivery by providing real-time accountability transparency, and traceability of medical supplies, monitoring health worker absenteeism, enhancing patient satisfaction through efficient care provision, reducing unnecessary or duplicate diagnostic tests, and offering easy access to management reports for decision-making. Additionally, EMRs will lay the foundation for the implementation of national health insurance.
  • UgandaEMR+ Implementation Showcased at Kisenyi HCIV
    • METS and Reach Out Mbuya (ROM) showcased the implementation of UgandaEMR+ to representatives from the USG and the Ministry of Health (MoH) at Kisenyi HCIV. The visit was aimed at providing a clear understanding of the system’s functionality at the health facility, which serves over 1,200 outpatients daily and supports over 1600 clients on ART.
    • Dr. Peter Akonyera, the ART Clinic In Charge shared positive end-user experiences, noting simplified data use and analysis, efficient data retrieval, and the system’s popularity among users despite existing challenges. He appreciated METS’ support in maintaining system synchronization. The data visualization tools have been particularly useful for clinicians to manage patient schedules and workload distribution effectively, ensuring timely and efficient healthcare delivery.
  • METS Showcases Research at INTEREST 2024 Conference in Benin
    • The International Conference on HIV Treatment, Pathogenesis, and Prevention Research (INTEREST) brought together global scientists to share cutting-edge knowledge in HIV diagnosis, treatment, and prevention. The conference also aimed to build a community of African physicians and scientists to develop local solutions for managing HIV and preventing its transmission.
    • METS submitted an abstract titled “Enhancing HIV Case Identification through a National HIV Testing Services (HTS) Continuous Quality Improvement” based on support to the Ministry of Health (MoH) in designing, implementing, and evaluating initiatives to increase the identification of HIV-positive clients, crucial for achieving the global target of 95% of people living with HIV (PLHIV) knowing their status.
  • Gallery
    • New CDC Director meets Country implementing partner Executive Directors
    • UgandaEMR+ support supervision at Kisenyi HCIV visit
    • EMR Stakeholders meeting
    • CBS guidelines meeting
    • INTEREST 2024 conference – Benin
    • Key Populations assessment – Ishaka district

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SIMCS-Trial Vacancy Announcement: Twenty-Five (25) Research Assistants

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An elevated shot of the School of Health Sciences and School of Medicine Building, College of Health Sciences (CHS), Makerere University. Mulago Campus, Kampala Uganda, East Africa.

Makerere University College of Health Sciences School of Medicine in collaboration with Baylor College of Medicine received funding from US National Institutes of Health – Fogarty International Center to carry out a study on “Development and evaluation of an information management and communication system for population-wide point of-care infant sickle cell disease screening (SIMCS-Trial)”. The program seeks to recruit 25 research assistants at its study sites. 

Roles and responsibilities  

  • Identify and screen participants for possible enrolment into the study according to the Study Protocol.
  • Obtain informed consent from caregivers of eligible participants as per protocol accordance with GCP and HSP principles.
  • Counsel and explain study procedures to the caregivers of study participants using the mobile app.
  • Enrol eligible participants into the study to meet the study accrual targets.
  • Complete study CRFs, correctly and accurately in compliance with trial procedures/ SOPs and GCP standards.
  • Ensure study participants’ safety and privacy, data integrity and confidentiality.
  • Participate in collection of appropriate study samples/specimens from the participants as per protocol and SOPs as well as performing the test.
  • Carry out any other duties as assigned by superiors in line with your work.

Required Qualification and experience 

  • A degree in any health-related discipline, and registered with the relevant national bodies.
  • Knowledge and familiarity with Microsoft word, Excel, PowerPoint and Access as well as basic internet applications 
  • Skills in using common relevant computer packages and mobile technology for data collection
  • Previous work in a research environment is added advantage.
  • Basic knowledge of clinical research regulatory procedures. 
  • Good Clinical Practice (GCP) training and Research Ethics training skills and knowledge
  • Excellent command of English (written and oral) as well as the local languages (Luganda or Lusoga)
  • Excellent interpersonal skills to develop relationships with participants.
  • Experience of living and or working both in urban and rural environment.
  • Team-working skills to work effectively as part of a multidisciplinary healthcare team 
  • Time management skills and ability to handle multiple tasks simultaneously.
  • Highly organized, detail-oriented and self-motivated/driven. 
  • Ability to handle multiple tasks simultaneously. 
  • Ability to professionally communicate in writing, verbally or other means deemed appropriate. 

Reports to: The SIMCS Co-Investigator/SIMCS Trial Coordinator 

Expected start date: July 2024

How to apply: 1-page type written application letter addressed to the Principal Investigator SIMCS Trial MakCHS SOM together with current CV, copies of academic certificates, and recommendation letters from two past employers should be e-mailed as ONE PDF DOCUMENT to makimpact22@gmail.com

Deadline for receiving applications: Friday 20th June 2024 at 5:00 pm

Only shortlisted candidates will be invited to the interview. 

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CTCA Call for Proposals: Enhance Tobacco Control Institutional Capacity in Africa

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Call for Proposals - Project Title: Enhance Tobacco Control Institutional Capacity in Africa; Grant #339. Deadline 30th June 2024, by 5pm EAT. The Centre for Tobacco Control in Africa (CTCA), School of Public Health, College of Health Sciences (CHS), Makerere University, Kampala Uganda, East Africa.

Project Title: Enhance Tobacco Control Institutional Capacity in Africa; Grant #339

Introduction:

The Centre for Tobacco Control in Africa (CTCA) received funding from the African Capacity Building Foundation (ACBF) for the 2024-2026 to implement a project on institutional capacity. The project investments are geared towards sustaining human resource capacity and knowledge generation to reduce use of all forms of tobacco products in Africa. Specifically, the project aims to:

  1. Enhance training opportunities for African governments and relevant actors in tobacco control in
    the continent
  2. Increase access to knowledge for guiding tobacco use prevention and control in Africa
  3. Reinforce the institutional development of CTCA for an optimal performance of its functions
    and processes.

In 2020, CTCA developed a Tobacco Control Research Agenda (TCRA) with the aim of providing a guide for generating local evidence to drive tobacco control policy formulation and implementation in Africa.

Therefore, CTCA with support from ACBF is seeking researchers across the African continent to be awarded 6 small grants of USD 5000 to implement research that aligns with the TCRA thematic areas below:

  1. Patterns and trends of tobacco use and exposure for all tobacco products including the new
    products at country and regional levels (sex, age, region, types of products, new products).
  2. Effects of tobacco use and exposure on sustainable development (poverty, education, culture, food security, environment, HIV, TB, reproductive health, NCDs).
  3. Tobacco use and populations at risk (youth, young adults, women/gender, elderly, residents
    of urban areas, miltary, prisoners, mental health patients, populations in low socio-economic
    dwellings like slums).
  4. Tobacco control policy research and analysis (smoke free, TAPS, GHWs, ceasation) of cost
    effectiveness, impact, drivers, enablers, innovation, challenges, communication and advocacy
    for tobacco control.
  5. Sociocultural context of tobacco use
  6. Tobacco industry and tobacco control policy
  7. Tobacco production, alternative livelihoods and environment (distribution, value chain,
    environmental impact, historical and determinants of tobacco production)
  8. The economics of tobacco and tobacco control (product, pricing, illicit tobacco trade,
    taxation)

The full research Agenda can be accessed in English and in French.

Submissions

We are pleased to invite submissions from researchers based in Africa. Successful proposals should align with any of the 8 thematic areas of the CTCA Research Agenda. Innovative proposals that address critical issues and contribute to evidence-based policy and practice in the respective areas to inform Tobacco control in Africa are particularly encouraged.

Requirements

These grants will fund work that relates to the CTCA Research Agenda. Activities will include
proposal development, data collection and analysis, report writing and dissemination. All research to be implemented will be approved by the institutional review board and published in peer reviewed journals. These grants are intended for; 1) Researchers based in Tobacco Control Programs/Response; 2) post graduate students who would like to complete their research projects aligned to this call and 3) early and middle career researchers. It is required that this research is executed, and the report completed within 12 months. The applicant should have a mentor in an established institution.

Eligibility

Eligibility is restricted to Africa-based researchers. This refers to individuals who are (a) currently studying at a university or research institute in Africa, and/or b) currently working within a university, research institute, or in tobacco control in Africa. All persons associated with tobacco industry will not be funded and therefore should not apply. Successful applicants will be required to sign a declaration of interest that they do not have any relationship with tobacco industry.

Evaluation criteria

Proposals will be reviewed by a group of experts and researchers. Projects will be assessed against six, equally weighted evaluation criteria:

  • Knowledge contribution in respect to policy, strategy, and evidence to answer local
    challenges:
    Does the study articulate the research gap? Does study make a significant
    contribution toward advancing knowledge in the tobacco control field? Does it answer
    new questions or introduce novel methods, measures, or tobacco control interventions? Is
    it aligned to the WHO FCTC and tobacco control local context requirements? Does the
    study add to the existing body of research?
  • Policy relevance: Will results from the research have generalizable implications? How,
    if at all, will the “lessons learned” have relevance beyond the study? Will the study
    outcomes influence decisions in tobacco control?
  • Technical design: Do the methods appropriately answer the objectives and the questions
    outlined in the proposal? Is the proposed study feasible in one year?
  • Project viability: Are there any other logistical or political obstacles that might threaten
    the completion of the study, for example, government authorization or Human Subjects
    review, civil strife, social cultural sensitivity?
  • Value of research: Is the cost of the study commensurate with the value of expected
    contributions to policy? Are the planned activities justified and coherent?
  • Ethics: Reviewers will consider whether there are any risks of harm to research
    participants, what the proposed risk mitigation strategies are, and how the possible
    benefits of the research compare to the possible harms.

Application Process

Apply HERE not later than 30th June 2024, by 5pm EAT. Applicants are required to provide a
recommendation/support letter from their supervisors or heads of department.

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