A time-stratified, case–crossover study of heat exposure and perinatal mortality from 16 hospitals in sub-Saharan Africa
Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum and intrapartum stillbirths, and deaths within 24 h after birth using a time-stratified case-crossover design. We observed an association between an increase from the 75th to the 99th percentile in mean temperature 1 week (lag 0-6 d) before childbirth and perinatal mortality (odds ratio (OR) = 1.34 (95% confidence interval (CI) 1.01-1.78)). The estimates for stillbirths were similarly positive, but CIs included unity: OR = 1.29 (95% CI 0.95-1.77) for all stillbirths, OR = 1.18 (95% CI 0.71-1.95) for antepartum stillbirths and OR = 1.64 (95% CI 0.74-3.63) for intrapartum stillbirths. The cumulative exposure-response curve suggested that the steepest slopes for heat for intrapartum stillbirths and associations were stronger during the hottest seasons. We conclude that short-term heat exposure may increase mortality risks, particularly for intrapartum stillbirths, raising the importance of improved intrapartum care.
Authors
- Jean‐Paul Dossou (ORCID: https://orcid.org/0000-0003-1681-2604)
- Andrea B. Pembe (ORCID: https://orcid.org/0000-0002-8090-3298)
- Hussein Kidanto (ORCID: https://orcid.org/0000-0001-9167-8068)
- Kristi Sidney Annerstedt (ORCID: https://orcid.org/0000-0002-8798-4027)
- Federica Nobile (ORCID: https://orcid.org/0000-0002-8040-8975)
- Massimo Stafoggia (ORCID: https://orcid.org/0000-0003-2843-2908)
- Peter Waiswa (ORCID: https://orcid.org/0000-0001-8221-902X)
- Chérie Part (ORCID: https://orcid.org/0000-0002-3281-1671)
- Claudia Hanson (ORCID: https://orcid.org/0000-0001-8066-7873)
- Petter Ljungman (ORCID: https://orcid.org/0000-0002-7815-2632)
- Effie Chipeta (ORCID: https://orcid.org/0000-0002-7925-3443)
- Nathalie Roos (ORCID: https://orcid.org/0000-0001-9752-2355)
- Lenka Beňová (ORCID: https://orcid.org/0000-0001-8595-365X)
- Jeroen de Bont (ORCID: https://orcid.org/0000-0001-9924-5961)
- Véronique Filippi (ORCID: https://orcid.org/0000-0003-1331-3391)
- Maria del Rosario Alsina
Institutions
- University of London (GB)
- Muhimbili University of Health and Allied Sciences (TZ)
- Kamuzu Central Hospital (MW)
- Karolinska Institutet (SE)
- London School of Hygiene & Tropical Medicine (GB)
- ASL Roma (IT)
- Glanrhyd Hospital (GB)
- Aga Khan University Nairobi (KE)
- Azienda Sanitaria Locale Roma 3 (IT)
- Makerere University (UG)
- Instituut voor Tropische Geneeskunde (BE)
Publication Details
- Journal
- Nature Medicine
- Published
- 2024-09-03
- DOI
- https://doi.org/10.1038/s41591-024-03245-7
- Citations
- 19
- Primary Topic
- Climate Change and Health Impacts
- Type
- article
- Field-Weighted Citation Impact
- 5.98
Funders
- Sight Research UK
- European Commission
- Karolinska Institutet
- Vetenskapsrådet
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd
- Natural Environment Research Council