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Disproportionate climate burden of rising temperatures on low birth weight in Pakistan
Syeda H Fatima1,2, Corey J A Bradshaw1, Zulfiqar A Bhutta3
1Healthy Environment and Lives (HEAL) Global Research Centre, University of Canberra, Canberra, ACT, Australia.
Insights
Extreme heat significantly increases low birth weight in Pakistan, posing a major public health challenge. Targeted interventions are crucial to protect vulnerable pregnant women and newborns from rising temperatures.
Area of Science:
- Environmental Health
- Neonatal Health
- Climate Change Impacts
Background:
- Rising global temperatures exacerbate health burdens, disproportionately affecting pregnant women and newborns.
- Low birth weight (LBW) is a critical neonatal health issue in Pakistan, contributing to mortality and long-term health problems.
- Understanding the impact of extreme heat on LBW is vital for public health strategies.
Purpose of the Study:
- To assess the impact of extreme temperatures on low birth weight (LBW) in Pakistan.
- To identify high-risk subgroups and estimate the heat-attributable burden of LBW.
- To project future risks and develop a district-level heat vulnerability index.
Main Methods:
- A space-time series study analyzed nationally representative surveys (2008-2017) across Pakistan.
- Distributed-lag non-linear models in a generalized mixed-effects framework were used to assess temperature-LBW associations.
- Subgroup analyses examined factors like maternal education, wealth, residence, and air quality; a heat vulnerability index was constructed.
Main Results:
- The study included 85,017 participants, with 18.72% infants having LBW.
- Heat-related risks for LBW varied by province, with relative risks up to 1.91 at the 99th temperature percentile.
- Heat-attributable LBW cases were estimated at 1.24 million over the study period, with projections showing an increase by the 2060s.
Conclusions:
- Findings pinpoint Pakistan's districts most vulnerable to heat-related LBW.
- Key contributing factors and high-risk subgroups (e.g., those with less education, urban residents, exposed to air pollution) were identified.
- The study provides crucial insights for targeted interventions in resource-limited, high-risk settings facing rising temperatures.
Background:
Warming temperatures add to the global health burden, with disproportionate effects on pregnant women and newborns. Low birth weight is a major neonatal health issue in Pakistan, leading to neonatal mortality and impaired long-term health. We assessed the impact of extreme temperatures on low birth weight, identified high-risk subgroups, estimated the heat-attributable burden, projected future risks, and constructed a district-level heat vulnerability index.
Methods:
We conducted a space-time series study using nationally representative surveys from 2008 to 2017 across Pakistan's provinces. We modelled temperature-low-birth-weight associations with distributed-lag non-linear models in a generalised mixed-effects framework, with model averaging to address specification uncertainty. Subgroup analyses considered maternal education, household wealth, urban/rural residence, and air quality. We estimated heat-related population attributable fraction using observed temperature and projections under SSP2-4.5 and SSP5-8.5. Province-level risk estimates combined with district-level indicators, such as mean temperature, multidimensional poverty, and under-5 mortality, were used to develop the heat vulnerability index.
Results:
The study included 85,017 participants, with 15,920 (18.72%) infants identified as having low birth weight. Heat-related risks for low birth weight varied across provinces, with relative risks ranging from 1.47 (1.07-2.03, 95% confidence interval) to 1.91 (1.24-2.93) at the 99th percentile of temperature. The heat-related population attributable fraction ranged from 9.39% to 13.15%, translating to 1.24 million heat-related low-birth-weight cases over the study period. Projections indicate that heat-related population attributable fractions will increase by 8.43-10.20% by the 2060s. Subgroup analysis showed higher risk among women exposed to hazardous air pollution, those with less education, and urban residents. Women in southern Punjab, northern Baluchistan, and Sindh faced the highest risks.
Conclusions:
Our findings identify Pakistan's districts most vulnerable to heat-related low birth weight and highlight contributing factors. These insights can inform targeted interventions to mitigate risks. The study advances the understanding of the impacts of rising temperatures, particularly in resource-limited and high-risk settings.
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