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Vulnerability and Adaptation to Extreme Heat in Odisha, India: A Community Based Comparative Study.

ABSTRACT: BACKGROUND:Extreme heat and heat illness are becoming very frequent in India. We aimed to identify the factors associated with heat illness and the coping practices among city dwellers of Odisha, India during the summer. METHODS:A cross-sectional study included 766 households (HHs) in twin cities of Odisha covering a population of 1099 (slum: 404 and non-slum: 695) in the year 2017. We collected information on sociodemographic, household characteristics, coping practices to heat and the heat illness history reported during the summer. Multivariate logistic regression accounting for clustering effects at the household and slum levels was used to identify the associated factors of heat illness after adjustment of other variables. RESULT:Nearly, 49% of the study participants were female and the mean age was 38.36 years (95% confidence interval (CI): 37.33-39.39 years). A significant difference of living environment was seen across the groups. More than two-thirds of the study participants at least once had heat illness. In the non-slum population, males (adjusted odds ratio (aOR): 3.56; 95% CI: 2.39-5.29), persons under medication (aOR: 3.09; 95% CI: 1.15-8.29), and chronic conditions had higher association with heat illness. Whereas, in the slum population, having a kitchen outside the home (aOR: 1.63; 95% CI: 1.02-3.96) and persons with chronic conditions were positively associated with heat illness. Use of cooling practices in slum areas reduced the risk of heat illness by 60%. CONCLUSION:Heat illness is associated with the living environment and physical health of the individuals. Identifying the vulnerable population and scaling up adaptive practices can strengthen the public health preparedness.

SUBMITTER: Swain S

PROVIDER: S-EPMC6950623 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Vulnerability and Adaptation to Extreme Heat in Odisha, India: A Community Based Comparative Study.

Swain Subhashisa S Bhattacharya Shreeporna S Dutta Ambarish A Pati Sanghamitra S Nanda Lipika L

International journal of environmental research and public health 20191212 24

<h4>Background</h4>Extreme heat and heat illness are becoming very frequent in India. We aimed to identify the factors associated with heat illness and the coping practices among city dwellers of Odisha, India during the summer.<h4>Methods</h4>A cross-sectional study included 766 households (HHs) in twin cities of Odisha covering a population of 1099 (slum: 404 and non-slum: 695) in the year 2017. We collected information on sociodemographic, household characteristics, coping practices to heat a ...[more]

PMID: 31842287

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Project description:Climate forecasts project further increases in extremely high-temperature events. These present threats to biodiversity, as they promote population declines and local species extinctions. This implies that ecological communities will need to rely more strongly on recovery processes, such as recolonization from a meta-community context. It is poorly understood how differences in extreme event intensity change the outcome of subsequent community reassembly and if such extremes modify the biotic environment in ways that would prevent the successful re-establishment of lost species. We studied replicated aquatic communities consisting of algae and herbivorous rotifers in a design that involved a control and two different heat wave intensity treatments (29°C and 39°C). Animal species that suffered heat-induced extinction were subsequently re-introduced at the same time and density, in each of the two treatments. The 39°C treatment led to community closure in all replicates, meaning that a previously successful herbivore species could not re-establish itself in the postheat wave community. In contrast, such closure never occurred after a 29°C event. Heat wave intensity determined the number of herbivore extinctions and strongly affected algal relative abundances. Re-introduced herbivore species were thus confronted with significantly different food environments. This ecological legacy generated by heat wave intensity led to differences in the failure or success of herbivore species re-introductions. Reassembly was significantly more variable, and hence less predictable, after an extreme heat wave, and was more canalized after a moderate one. Our results pertain to relatively simple communities, but they suggest that ecological legacies introduced by extremely high-temperature events may change subsequent ecological recovery and even prevent the successful re-establishment of lost species. Knowing the processes promoting and preventing ecological recovery is crucial to the success of species re-introduction programs and to our ability to restore ecosystems damaged by environmental extremes.

Project description:BackgroundExtreme heat poses current and future risks to human health. Heat vulnerability indices (HVIs), commonly developed using principal components analysis (PCA), are mapped to identify populations vulnerable to extreme heat. Few studies critically assess implications of analytic choices made when employing this methodology for fine-scale vulnerability mapping.ObjectiveWe investigated sensitivity of HVIs created by applying PCA to input variables and whether training input variables on heat-health data produced HVIs with similar spatial vulnerability patterns for Detroit, Michigan, USA.MethodsWe acquired 2010 Census tract and block group level data, land cover data, daily ambient apparent temperature, and all-cause mortality during May-September, 2000-2009. We used PCA to construct HVIs using: a) "unsupervised"-PCA applied to variables selected a priori as risk factors for heat-related health outcomes; b) "supervised"-PCA applied only to variables significantly correlated with proportion of all-cause mortality occurring on extreme heat days (i.e., days with 2-d mean apparent temperature above month-specific 95th percentiles).ResultsUnsupervised and supervised HVIs yielded differing spatial vulnerability patterns, depending on selected land cover input variables. Supervised PCA explained 62% of variance in the input variables and was applied on half the variables used in the unsupervised method. Census tract-level supervised HVI values were positively associated with increased proportion of mortality occurring on extreme heat days; supervised PCA could not be applied to block group data. Unsupervised HVI values were not associated with extreme heat mortality for either tracts or block groups.DiscussionHVIs calculated using PCA are sensitive to input data and scale. Supervised HVIs may provide marginally more specific indicators of heat vulnerability than unsupervised HVIs. PCA-derived HVIs address correlation among vulnerability indicators, although the resulting output requires careful contextual interpretation beyond generating epidemiological research questions. Methods with reliably stable outputs should be leveraged for prioritizing heat interventions. https://doi.org/10.1289/EHP4030.

Project description:BACKGROUND:Multimorbidity, the coexistence of two or more chronic conditions is increasingly prevalent in primary care populations. Despite reports on its adverse impact on health outcomes, functioning and well-being, it's association with quality of life is not well known in low and middle income countries. We assessed the health-related quality of life (HRQoL) of primary care patients with multimorbidity and identified the influencing factors. METHODS:This cross-sectional study was done across 20 public and 20 private primary care facilities in Odisha, India. Data were collected from 1649 adult out-patients using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). HRQoL was assessed by the 12-item short-form health survey (SF-12). Both physical (PCS) and mental components scores (MCS) were calculated. Multiple regression analysis was performed to determine the association of HRQoL with socio-demographics, number, severity and typology of chronic conditions. RESULTS:Around 28.3% [95% CI: 25.9-30.7] of patients had multimorbidity. Mean physical component scope (PCS) and mental component score (MCS) of QoL in the study population was 43.56 [95% CI: 43.26-43.86] and 43.69 [95% CI: 43.22-44.16], respectively. Patients with multimorbidity reported poorer mean PCS [43.23, 95% CI: 42.62-43.84] and MCS [41.58, 95% CI: 40.74-42.43] compared to those without. After adjusting for other variables, morbidity severity burden score was found to be negatively associated with MCS [adjusted coefficient: -0.24, 95% CI -?0.41 to -?0.08], whereas no significant association was seen with PCS. Hypertension and diabetes with arthritis and acid peptic diseases were found to be negatively related with MCS. Within multimorbidity, lower education was inversely associated with mental QoL and positively associated with physical QoL score after adjusting for other variables. CONCLUSION:Our findings demonstrate the diverse negative effects of multimorbidity on HRQoL and reveal that apart from count of chronic conditions, severity and pattern also influence HRQoL negatively. Health care providers should consider severity as an outcome measure to improve QoL especially in individuals with physical multimorbidity. Given the differences observed between age groups, it is important to identify specific care needs for each group. Musculoskeletal clusters need prioritised attention while designing clinical guidelines for multimorbidity.

Project description:BackgroundLymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression.Methodology/principal findingsA lymphedema management program was implemented in Odisha State, India from 2007-2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value ?= 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions.Conclusions/significanceThese results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.

Project description:BackgroundIndia has been at the forefront of innovations around social accountability mechanisms in improving the delivery of public services, including health and nutrition. Yet little is known about how such initiatives are faring now that they are incorporated formally into government programmes and implemented at scale. This brings greater impetus to understand their effectiveness. This formative qualitative study focuses on how such mechanisms have sought to strengthen community-level nutrition and health services (the Integrated Child Development Services and the National Rural Health Mission) in the state of Odisha. It fills a gap in the literature on considering how such initiatives are running when institutionalised at scale. The primary research questions were 'what kinds of community level mechanisms are functioning in randomly selected villages in 3 districts of state of Odisha' and 'how are they perceived to function by their members and frontline workers'.MethodsThe study is based on focus group discussions with pregnant women and mothers of children below the age of 2 (n = 12) and with women's self-help groups (n = 12); interviews with frontline health workers (n = 24) and with members of community committees (n = 36). Interviews were analysed thematically using a priori coding derived from wider literature on key accountability themes.ResultsFour main types of community-based mechanisms were examined - Mothers committees, Jaanch committees, Village Health and Sanitation Committees and Self-Help Groups. The degree of their effectiveness varied depending on their ability to offer meaningful avenues for participation of their members and empower women for autonomous action. Notably, in most of these mechanisms community participation is very weak, with committees largely controlled by the frontline workers who are supposed to be held to account. However, self-help groups showed real levels of autonomy and collective power. Despite not having an explicit accountability role, these groups were nevertheless effective in advocating for better service delivery and the broader needs of their members to a level not seen in institutional committees.ConclusionsThe study points to the need for community-level mechanisms in India to adequately address issues of participation and empowerment of community members to be successful in contributing to service improvements in health and nutrition.

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Vulnerability and Adaptation to Extreme Heat in Odisha, India: A Community Based Comparative Study.

Publications

Vulnerability and Adaptation to Extreme Heat in Odisha, India: A Community Based Comparative Study.

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