Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the effect of high ambient temperature on pregnancy. A literature search was conducted in advance of the meeting to identify existing hypotheses and develop a series of questions and themes for discussion. Numerous hypotheses have been generated based on animal models and limited observational studies. There is growing evidence that pregnant women are able to appropriately thermoregulate; however, when exposed to extreme heat, there are a number of processes that may occur which could harm the mother or fetus including a reduction in placental blood flow, dehydration, and an inflammatory response that may trigger preterm birth. There is a lack of substantial evidence regarding the processes that cause heat exposure to harm pregnant women. Research is urgently needed to identify what causes the adverse outcomes in pregnancy related to high ambient temperatures so that the impact of climate change on pregnant women can be mitigated.

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Background: Alcohol plays a role at the different points in the natural history of HIV/AIDS: This article focuses on the health implications of harmful alcohol consumption in the era of antiretroviral therapy. Aim:To explore the role of alcohol in HIV disease progression, in order to improve HIV patient management and overall better HIV prognosis. Methods:An examination of studies pertaining to the behavioral, biological and bio-chemical aspects of alcohol consumption on the pathogenesis of HIV.Findings: Alcohol consumption impacts on HIV progression resulting in increased morbidity and mortality. Alcohol consumption reduces compliance with ARV regimens, resulting in additional premature mortality. Both alcohol and HIV modulate innate and adaptive immunity and alcohol consumption for HIV-positive individuals increases the likelihood of viral replication and leads to increased susceptibility to contract opportunistic infections and other co-morbid conditions. The situation is further compounded by drugs used for the treatment of the opportunistic infections and other co-morbid conditions and their potential interactions with alcohol. The liver also metabolizes both alcohol and ARV drugs and alcohol-related liver toxicity results in compromised liver function with ARVs not working optimally and an increased risk of serious toxicity from antiretroviral therapy.Discussion: Very diverse measures of alcohol consumption have been used in studies on interactions between alcohol and HIV, making it difficult to compare studies and draw definitive conclusions. It is essential to acquire clear evidence-based guidelines on alcohol consumption for HIV-positive patients and their health-care providers. The variables alcohol, HIV and ART and their myriad interactions have not been clearly delineated. The multiple effects from HIV, alcohol and ART may compound each other, making it difficult to disentangle presenting adverse reactions and specifically the associations with alcohol. Furthermore findings in this arena are particularly relevant for prevention and treatment of HIV in countries such as South Africa that have high HIV and alcohol health burdens and have committed to an extended ARV rollout.

Children (<5 years) are highly vulnerable during hot weather due to their reduced ability to thermoregulate. There has been limited quantification of the burden of climate change on health in sub-Saharan Africa, in part due to a lack of evidence on the impacts of weather extremes on mortality and morbidity. Using a linear threshold model of the relationship between daily temperature and child mortality, we estimated the impact of climate change on annual heat-related child deaths for the current (1995–2020) and future time periods (2020–2050). By 2009, heat-related child mortality was double what it would have been without climate change; this outweighed reductions in heat mortality from improvements associated with development. We estimated future burdens of child mortality for three emission scenarios (SSP119, SSP245 and SSP585), and a single scenario of population growth. Under the high emission scenario (SSP585), including changes to population and mortality rates, heat-related child mortality is projected to double by 2049 compared to 2005-2014. If 2050 temperature increases were kept within the Paris target of 1.5ºC (SSP119 scenario), approximately 4,000 – 6,000 child deaths per year could be avoided in Africa. The estimates of future heat-related mortality include the assumption of the significant population growth projected for Africa, and declines in child mortality consistent with Global Burden of Disease estimates of health improvement. Our findings support the need for urgent mitigation and adaptation measures that are focussed on the health of children.

ObjectiveTo examine the effects of high ambient temperature on infant feeding practices and childcare.DesignSecondary analysis of quantitative data from a prospective cohort study.SettingCommunity-based interviews in the commune of Bobo-Dioulasso, Burkina Faso. Exclusive breastfeeding is not widely practised in Burkina Faso.Participants866 women (1:1 urban:rural) were interviewed over 12 months. Participants were interviewed at three time points: cohort entry (when between 20 weeks’ gestation and 22 weeks’ postpartum), three and nine months thereafter. Retention at nine-month follow-up was 90%. Our secondary analysis focused on postpartum women (n=857).ExposureDaily mean temperature (°C) measured at one weather station in Bobo-Dioulasso. Meteorological data were obtained from publicly available archives (TuTiempo.net).Primary outcome measuresSelf-reported time spent breastfeeding (minutes/day), exclusive breastfeeding of infants under 6 months (no fluids other than breast milk provided in past 24 hours), supplementary feeding of infants aged 6–12 months (any fluid other than breast milk provided in past 24 hours), time spent caring for children (minutes/day).ResultsThe population experienced year-round high temperatures (daily mean temperature range=22.6°C–33.7°C). Breastfeeding decreased by 2.3 minutes/day (95% CI -4.6 to 0.04, p=0.05), and childcare increased by 0.6 minutes/day (0.06 to 1.2, p=0.03), per 1°C increase in same-day mean temperature. Temperature interacted with infant age to affect breastfeeding duration (p=0.02), with a stronger (negative) association between temperature and breastfeeding as infants aged (0–57 weeks). Odds of exclusive breastfeeding very young infants (0–3 months) tended to decrease as temperature increased (OR=0.88, 0.75 to 1.02, p=0.09). There was no association between temperature and exclusive breastfeeding at 3–6 months or supplementary feeding (6–12 months).ConclusionsWomen spent considerably less time breastfeeding (~25 minutes/day) during the hottest, compared with coolest, times of the year. Climate change adaptation plans for health should include advice to breastfeeding mothers during periods of high temperature.