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BackgroundExtreme weather is a recognised risk factor for stillbirth and preterm birth, disrupts women’s access to healthcare during pregnancy and childbirth, and negatively affects the care of newborns. Reliable and accessible heat and weather warning systems are key in alerting individuals to undertake protective measures. There is a notable gap in understanding how women and caregivers in rural East Africa perceive and utilize weather information. We investigated community members’ heat and weather warning information-seeking behaviour, identified available sources, assessed their reliability and utility, and examined their influence on behaviour. SettingsOur research was conducted in rural Kilifi County in Kenya’s coastal region. The area experiences temperatures exceeding 23°C throughout the year, with extended periods of extreme temperatures [> 40°C] and long and severe droughts. MethodsWe conducted in-depth interviews [IDI] with pregnant and postpartum women [n = 21] and held six focus group discussions [FGDs] involving mothers-in-law and community health volunteers [CHVs]. The data were analysed in NVivo 12 using both inductive and deductive approaches. ResultsWe found significant gaps concerning pregnant and post-partum women, and their caregivers, having timely access to weather forecasts and heat information from health or meteorological authorities. Information on heat and weather warnings is disseminated through various channels, including television, radio, mobile phones, and word of mouth, which are facilitated by community influencers such as CHVs and local chiefs. Indigenous methods of weather forecasting, such as cloud observation, consulting local “rainmakers”, and studying the behavioural patterns of amphibians, are employed in conjunction with warnings from the Kenyan Meteorological Department (KMD). Barriers to accessing weather information include the cost of television and smartphones and a lack of segmented information in local languages. ConclusionsNational and county meteorological services need to enhance public participation, communication, and the delivery of heat and weather information to guide community-level response measures and individual behaviour change. They should also collaborate with health professionals to address heat risks for vulnerable groups. Further research is needed to empower indigenous weather predictors with modern weather information and revise national policies to deliver tailored messages to vulnerable populations like pregnant and postpartum women. 

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. 

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. 

Climate change is likely to have wide-ranging impacts on maternal and neonatal health in Africa. Populations in low-resource settings already experience adverse impacts from weather extremes, a high burden of disease from environmental exposures, and limited access to high-quality clinical care. Climate change is already increasing local temperatures. Neonates are at high risk of heat stress and dehydration due to their unique metabolism, physiology, growth, and developmental characteristics. Infants in low-income settings may have little protection against extreme heat due to housing design and limited access to affordable space cooling. Climate change may increase risks to neonatal health from weather disasters, decreasing food security, and facilitating infectious disease transmission. Effective interventions to reduce risks from the heat include health education on heat risks for mothers, caregivers, and clinicians; nature-based solutions to reduce urban heat islands; space cooling in health facilities; and equitable improvements in housing quality and food systems. Reductions in greenhouse gas emissions are essential to reduce the long-term impacts of climate change that will further undermine global health strategies to reduce neonatal mortality.