Title : Compounding crises: A mixed methods investigation of climate driven disruptions to maternal and child health in HIV affected populations across East Africa
Abstract:
Background: Climate change represents a critical and escalating public health emergency, increasingly manifesting as extreme heat and severe flooding. These environmental shocks disproportionately impact vulnerable demographics, yet the specific mechanisms and epidemiological scale of these disruptions on maternal and child health particularly within HIV-affected households remain under-quantified. Addressing this gap is essential for building equitable and resilient public health infrastructure in highly susceptible regions like East Africa.
Objective: To identify the qualitative mechanisms and quantitatively estimate the impact of extreme heat and flooding on pregnancy-related care disruption and child mortality among HIV-affected populations in East Africa.
Methods: This study employs a comprehensive mixed-methods design. The qualitative phase (Aim 1) analyzes 45 in-depth interviews with women in Rwanda to build a mechanistic framework detailing how climate shocks influence healthcare access, Antiretroviral Therapy (ART) adherence, food insecurity, and displacement-related stress. The quantitative phases (Aims 2 & 3) utilize an ecological case-crossover design integrating Demographic and Health Surveys (DHS) with geospatial climate data across East Africa. This spatial-epidemiological approach estimates the association between extreme weather (heat, flooding, and compounded events) and care disruption (using home birth as a proxy) as well as child mortality, explicitly evaluating whether these risks are amplified in HIV-affected households.
Anticipated Results: Qualitative findings are expected to outline a cascading framework where environmental shocks precipitate food insecurity and displacement, ultimately derailing ART adherence and maternal care access. Building on these mechanisms, geospatial quantitative modeling anticipates demonstrating a statistically significant increase in both home births and child mortality following acute heat and flooding events. Furthermore, we hypothesize that the magnitude of these adverse outcomes will be substantially higher in HIV-affected households compared to their non-affected counterparts.
Conclusion: By integrating localized, grounded qualitative insights with large-scale geospatial climate data, this research provides a vital data-driven approach to understanding climate-health intersections. The resulting mechanistic and epidemiological frameworks will inform targeted public health interventions and resilient healthcare policies, ensuring that climate adaptation strategies protect the most vulnerable maternal and child populations.
