Country-level impact of climate change on maternal and newborn health

Abstract

Background: Evidence connecting extreme heat to maternal and newborn health outcomes is needed at country level, especially in tropical areas. DHIS2 (District Health Information Software 2) collects aggregated population health data by health zone in the Democratic Republic of the Congo (DRC). Methods: Drawing from DHIS2 records of 22<middle dot>7 million DRC births 2018-2023, spatio-temporal modeling assessed associations between maternal mortality, stillbirth, and neonatal mortality and same-month, remotely sensed temperature, precipitation, anomalous high temperature (>95th percentile), and anomalous heavy precipitation (>95th percentile), controlling for month, year, remoteness, and health zone. Findings: Temperatures > 34 degrees C and anomalous heavy precipitation were strongly associated with increases in same-month stillbirth and maternal mortality and less strongly associated with neonatal mortality. The stillbirth rate rose by 2<middle dot>3/1,000 births for every degree increase above 34 degrees C (95% CI: 1<middle dot>9; 2<middle dot>5) or by 5<middle dot>9/1,000 births in months > 95th percentile (32<middle dot>9 degrees C; 95% CI: 5<middle dot>1; 6<middle dot>7). Maternal mortality rose by 27<middle dot>3 deaths/100,000 live births for every degree increase above 34 degrees C (95% CI: 19<middle dot>1; 35<middle dot>7) or by 95<middle dot>3 deaths/100,000 live births in months > 95th percentile (95% CI: 71<middle dot>3; 119<middle dot>4). Months with anomalous heavy precipitation were associated with an increase of 5<middle dot>4 stillbirths/1,000 births (95% CI: 4<middle dot>8; 6<middle dot>2) and with 120 maternal deaths/100,000 live births (95% CI: 100<middle dot>9; 139<middle dot>5). Interpretation: DHIS2 data offer a readily available opportunity to assess associations between climate and country-level population health outcomes. Further work is needed to hone and evaluate effective approaches that protect mothers and newborns in the face of projected warming and rainfall changes. Risk-based planning, geographic targeting, and stakeholder coordination will support appropriate, context-specific responses.