Impact of community education on heat-related health outcomes and heat literacy among low-income communities in Karachi, Pakistan: a randomised controlled trial

Abstract

BackgroundExtreme heat exposure is a growing public health concern. In this trial, we tested the impact of a community health worker (CHW) led heat education programme on all-cause mortality, unplanned hospital visits and changes in knowledge and practices in Karachi, Pakistan.MethodsThe Heat Emergency Awareness and Treatment trial was a community-based, open-label, two-group, unblinded cluster-randomised controlled trial that implemented a CHW-led educational intervention between March and May 2018 in Karachi, Pakistan. We randomly assigned (1:1) 16 clusters, each with ~185 households or 1000 population, to the intervention or usual care (control group). We collected data on all-cause mortality, unplanned hospital visits, evidence of heat illness through surveillance and a knowledge and practice survey during the summer months of 2017 (preintervention) and 2018 (postintervention).FindingsWe recruited 18 554 participants from 2991 households (9877 individuals (1593 households) in the control group and 8668 individuals (1398 households) in the intervention group). After controlling for temporal trends, there was a 38% (adjusted OR 0.62, 95% CI 0.49 to 0.77) reduction in hospital visits for any cause in the intervention group compared with the control group. In addition, there was an improvement in many areas of knowledge and practices, but there was no significant difference in all-cause mortality.InterpretationA CHW-led community intervention was associated with decreased unscheduled hospital visits, improved heat literacy and practices but did not impact all-cause mortality. CHWs could play an essential role in preparing communities for extreme heat events.Trial registration numberNCT03513315.

Attribution of 2022 early-spring heatwave in India and Pakistan to climate change: lessons in assessing vulnerability and preparedness in reducing impacts

“…At least four people found dead on the streets in the city of Nagpur in India, in April 2022, were suspected to be heat stroke-related fatalities (Mascarenhas 2022). The urban heat island effect, which can exacerbate heat by up to 12 • C locally, also contributes to the exposure risk among the urban poor (Razzak et al 2022). For peri-urban residents, the risk of exposure is largely due to the long-distance commute to work by foot, two-wheelers or public transportation, thus limiting their options to mitigate (Bakhsh et al 2016).…”

Heat stress: adaptation measures in South African informal settlements

“…This has implications for practitioners and policymakers to develop multifaceted heat healthresponse strategies for Southern African informal settlements. This will require more holistic and integrated response measures that (1) improve the building stock, (2) create public cooling zones, (3) establish and grow vegetation coverage, (4) ensure accessibility to potable water during crises and (5) develop awareness campaigns and training programmes to promote behaviour changes and community response strategies during heatwave events (Cheung & Jim 2018;Kapwata et al 2018;Liang et al 2014;Razzak et al 2022).…”

“…As noted by Kimemia et al (2020) these higher temperatures have adverse physiological impacts ranging from mild effects (discomfort and loss in efficiencies) to much larger health impacts (heat cramps, heat syncope and heat stroke). Other impacts as also include increased occurrence of violent behaviour (Chersich et al 2019), loss of livelihoods and employment opportunities (Adegun & Ayoola 2022;Razzak et al 2022), and adverse changes in the local ecology (Kotharkar et al 2018).…”

“…Although highly visible events typically capture public attention, heat stress events are often under-represented (Eckstein et al 2021), with little done to address them (Baruti & Johansson 2020). Yet the impacts of higher temperatures and heat stress exposure present economic costs (Razzak et al 2022), increased negative health implications (Wright et al 2021) and have adverse effects on inhabitants' wellbeing (Chersich et al 2019). This paper considers heat stress exposure in a South African informal settlement and reports on the efficacy of using two building-related adaptation measures to lower heat stress exposure under current and future 2100 climate scenarios.…”

Ground-level documentation of heat stress exposure and response strategies in informal settlements in Tshwane, South Africa

“…These higher temperatures ultimately affect the user wellbeing causing heat cramps, exhaustion, heat syncope, heat strokes and potentially death (Kimemia et al, 2020). It specifically affects vulnerable individuals such as children, the elderly and pregnant women (Razzak et al, 2022;Roos et al, 2021).…”