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Abstract ObjectiveTo understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi. DesignQualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16). SettingsWe conducted our research in Kilifi County in Kenya’s Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C. Data analysisData were analyzed in NVivo 12, using both inductive and deductive approaches. ResultsHigh ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate’s skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as “having no peace”. Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care. ConclusionsHigh ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings. 

Objective:Although extreme heat can impact the health of anyone, certain groups are disproportionately affected. In urban settings, cooling centers are intended to reduce heat exposure by providing air-conditioned spaces to the public. We examined the characteristics of populations living near cooling centers and how well they serve areas with high social vulnerability. Methods:We identified 1402 cooling centers in 81 US cities from publicly available sources and analyzed markers of urban heat and social vulnerability in relation to their locations. Within each city, we developed cooling center access areas, defined as the geographic area within a 0.5-mile walk from a center, and compared sociodemographic characteristics of populations living within versus outside the access areas. We analyzed results by city and geographic region to evaluate climate-relevant regional differences. Results:Access to cooling centers differed among cities, ranging from 0.01% (Atlanta, Georgia) to 63.2% (Washington, DC) of the population living within an access area. On average, cooling centers were in areas that had higher levels of social vulnerability, as measured by the number of people living in urban heat islands, annual household income below poverty, racial and ethnic minority status, low educational attainment, and high unemployment rate. However, access areas were less inclusive of adult populations aged ≥65 years than among populations aged <65 years. Conclusion:Given the large percentage of individuals without access to cooling centers and the anticipated increase in frequency and severity of extreme heat events, the current distribution of centers in the urban areas that we examined may be insufficient to protect individuals from the adverse health effects of extreme heat, particularly in the absence of additional measures to reduce risk. 

BackgroundAmbient heat exposure is increasing due to climate change and is known to affect the health of pregnant and postpartum women, and their newborns. Evidence for the effectiveness of interventions to prevent heat health outcomes in east Africa is limited. Codesigning and integrating local-indigenous and conventional knowledge is essential to develop effective adaptation to climate change. MethodsFollowing qualitative research on heat impacts in a community in Kilifi, Kenya, we conducted a two-day codesign workshop to inform a set of interventions to reduce the impact of heat exposure on maternal and neonatal health. Participants were drawn from a diverse group of purposively selected influencers, implementers, policy makers, service providers and community members. The key domains of focus for the discussion were: behavioral practices, health facilities and health system factors, home environment, water scarcity, and education and awareness. Following the discussions and group reflections, data was transcribed, coded and emerging intervention priorities ranked based on the likelihood of success, cost effectiveness, implementation feasibility, and sustainability. ResultsTwenty one participants participated in the codesign discussions. Accessibility to water supplies, social behavior-change campaigns, and education were ranked as the top three most sustainable and effective interventions with the highest likelihood of success. Prior planning and contextualizing local set-up, cross-cultural and religious practices and budget considerations are important in increasing the chances of a successful outcome in codesign. ConclusionCodesign of interventions on heat exposure with diverse groups of participants is feasible to identify and prioritize adaptation interventions. The codesign workshop was used as an opportunity to build capacity among facilitators and participants as well as to explore interventions to address the impact of heat exposure on pregnant and postpartum women, and newborns. We successfully used the codesign model in co-creating contextualized socio-culturally acceptable interventions to reduce the risk of heat on maternal and neonatal health in the context of climate change. Our interventions can be replicated in other similar areas of Africa and serve as a model for co-designing heat-health adaptation. 

Abstract As the impacts of climate change increasingly and disproportionately affect indigenous peoples, equitable approaches to regional climate change adaptation must center the voices, needs, and priorities of Indigenous communities. Although the tribal climate change principles identify actionable recommendations to address the unique needs of Indigenous peoples in the contexts of climate change adaptation efforts undertaken at the Federal level in the United States (U.S.), there has yet to be exploration of how such principles might be applied at the regional level. Through semi-structured qualitative interviews with 18 representatives from inter-Tribal organizations and non-Tribal organizations engaged in regional climate adaptation in the U.S. Pacific Northwest, this research sought to describe challenges faced by, and opportunities available to, non-Tribal entities when engaging with Tribes on regional climate adaptation initiatives. All respondents reported high levels of motivation to work with Tribes on climate adaptation and identified several perceived benefits of integrating Tribal partnerships and indigenous ways of knowing into regional climate adaptation initiatives. Respondents underscored the need for strong, trusted relationships that respect the sovereignty and priorities of Tribal nations to guide engagement. However, non-Tribal organizations’ own capacity constraints, perceived Tribal capacity constraints, and institutional cultures rooted in colonialism and structural racism were discussed as obstacles to meaningful engagement. As such, we identify an urgent need to prioritize sustained investments in both Tribal and non-Tribal actors’ partnership capacities and climate change adaptation capabilities to place Indigenous voices and needs at the forefront of regional climate change adaptation planning and implementation. 

Heat is a dangerous hazard that causes acute heat illness, chronic disease exacerbations, adverse pregnancy outcomes, and a range of injuries. Risks are highest during extreme heat events (EHEs), which challenge the capacity of health systems and other critical infrastructure. EHEs are becoming more frequent and severe, and climate change is driving an increasing proportion of heat-related mortality, necessitating more investment in health protection. Climate-resilient health systems are better positioned for EHEs, and EHE preparedness is a form of disaster risk reduction. Preparedness activities commonly take the form of heat action plans (HAPs), with many examples at various administrative scales. HAP activities can be divided into primary prevention, most important in the pre-event phase; secondary prevention, key to risk reduction early in an EHE;and tertiary prevention, important later in the event phase. After-action reports and other postevent evaluation activities are central to adaptive management of this climate-sensitive hazard. 

Herein, a new protocol for rapid synthesis of α,β-unsaturated epoxy ketones utilizing a bifunctional sulfonium/phosphonium ylide is described. This approach comprises two sequential chemoselective reactions between sulfonium and phosphonium ylides and two distinct aldehydes, which allows for the rapid construction of a variety of unsymmetric α,β-unsaturated epoxy ketones. This methodology allows the rapid construction of the core reactive functionality of a family of lipid peroxidation products, the epoxyketooctadecenoic acids, but can be further broadly utilized as a useful synthon for the synthesis of natural products, particularly those derived from oxidized fatty acids. Accordingly, a protocol utilizing this approach to synthesize the epoxyketooctadecenoic acid family of molecules is described.