HIGH Horizons - Protocol for population level heat-health impact study in Greece, Italy, Kenya, South Africa and Sweden

This study protocol falls within WP2 of HIGH Horizons (assessment of health impacts and facilities), task 2.1 (population-level impacts: measurement). Analyses of heat-health impacts and data science predictive modelling using population-level data from Sweden, Italy (Lazio region), Greece and data from health facilities in Kenya and South Africa (Gauteng province) underpin all other activities in HIGH Horizons. These analyses, along with systematic reviews, will inform testing and selection of global, EU and national indicators. Analyses will also inform cut-off thresholds for an Early Warning System (EWS), whereby a smartphone app (ClimApp-MCH) will deliver personalised warnings and context-specific messages, co-designed locally.

The aim of the epidemiological study is to generate evidence to inform the testing and selection of global, EU and national indicators of heat exposure on maternal, neonatal, and child health (MNCH), and to inform cut-off thresholds for a personalised early warning system for pregnant and postpartum women, infants and health workers.

The primary objectives of this study are:
1)    To quantify relationships between ambient temperature exposures and risk of adverse maternal, neonatal, and child health outcomes;
2)    To identify the relative temperature threshold(s) above which risk of an adverse outcome is increased;
3)    To determine valid and reliable heat indicators for assessing heat-MNCH impacts at population-level;
4)    To characterise groups of pregnant women and children at high risk of heat-related conditions;
5)    To determine if heat-MNCH associations vary by location, climate, facility, or quality of care, as the data allow.
Our secondary objectives are:
6)    To identify critical windows of susceptibility during gestation or during infancy and childhood; 
7)    To explore impacts of both acute and cumulative heat exposures.