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Bonell A, Sonko B, Badjie J, Samateh T, Saidy T, Sosseh F, Sallah Y, Bajo K, Murray KA, Hirst J, Vicedo-Cabrera A, Prentice AM, Maxwell NS, Haines A. Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study. Lancet Planet Health 2022; 6:e968-e976. [PMID: 36495891 PMCID: PMC9756110 DOI: 10.1016/s2542-5196(22)00242-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus. METHODS We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain. FINDINGS Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase. INTERPRETATION Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions. FUNDING The Wellcome Trust.
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Affiliation(s)
- Ana Bonell
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Bakary Sonko
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Jainaba Badjie
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Tida Samateh
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Tida Saidy
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Fatou Sosseh
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yahya Sallah
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kebba Bajo
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kris A Murray
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia; Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Jane Hirst
- Nuffield Department of Women's and Reproductive Health and the George Institute for Global Health, University of Oxford, Oxford, UK
| | - Ana Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Andrew M Prentice
- Medical Research Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Neil S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, UK
| | - Andy Haines
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
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Bajo K. Equipment costs. The neonatal intensive care unit and the modern obstetric unit. Clin Perinatol 1983; 10:175-87. [PMID: 6851387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In summary, the cost of equipment depends on a plethora of factors. In purchasing equipment, while cost is a major consideration, it should not be the sole determinant. Other major concerns include prepurchase evaluation opportunity, repair capabilities, breakdown frequency, capability for emergency repair, self-monitoring systems built into equipment, personnel education on the use of the equipment, other services offered by the company, trade-in capability, reliability of the company, and restrictions established by the Hospital's Standardization committee. The Emergency Care Research Institute is considered to be the "consumer's guide" for sophisticated hospital equipment and issues a publication called Health Devices, which reviews the results of their findings. Also the Medical Device Register is a single source of information on medical equipment and suppliers.
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