Climate change and public health research ethics in low- and middle-income countries: A systematic literature review

Background: Climate change poses significant public health challenges, particularly in low- and middle-income countries (LMICs), where ethical considerations are critical for equitable research. This systematic review synthesizes existing knowledge on climate change, public health, and research ethics in LMICs to identify key themes and research gaps. Methods: A systematic search of PubMed and Medline (2001-2024) identified 643 articles, of which 86 met inclusion criteria. Studies were thematically synthesized, and keyword co-occurrence mapping and cluster analysis were used to explore associations between health and ethical themes. Data visualization, including keyword co-occurrence mapping and hierarchical clustering, was performed to highlight thematic associations and research gaps. Results: Out of 86 studies 53.48 % were were published after the year 2022. Research is predominantly focused on mortality, outbreaks, and epidemics, mostly associated in ethical contextss such as community rights and beneficence. Associations were strongest between "Rights and Liberties" and "Community Rights." However, ethical considerations were inconsistently integrated, with equity and justice particularly underrepresented in studies on non-communicable diseases and maternal health. Most of the studies relied on secondary data, reflecting gaps in localized, context-specific evidence. Geographically, South Asia and parts of Africa were represented, while Southeast Asia and Latin America were markedly underrepresented despite major climate-related health risks. Conclusion: This review highlights increasing research interests in climate change and health but identifies gaps in ethical frameworks and LMIC representation. Strengthening research agendas with context-specific ethical considerations and prioritizing vulnerable populations is essential for equitable health responses towards climate change in resource-limited settings.