Systematic Review of Climate-Change Interventions to Improve Child Health

Abstract

Background: Climate change is the "… single biggest health threat facing humanity" according to the World Health Organization, and children under five years old bear an estimated 88% of the additional disease burden. Changing temperature and rainfall patterns have increased heat-related illnesses, vector-borne diseases and adverse birth outcomes, while exacerbating food insecurity leading to malnutrition. Air pollution has adverse impacts on birth outcomes and respiratory health in children. Many interventions have been introduced to reduce the harm of climate change on child-health outcomes, but few have been assessed scientifically. We did a systematic review to synthesise the available evidence on tested interventions to improve child health in response to the impacts of climate change. 

Methods: We searched PubMed, Medline, Embase and Google Scholar for relevant literature published up to 14 March 2024. We included all study types published in English that evaluated a 2 child health outcome in response to a climate change intervention. We identified the target populations, outcome measures and descriptions of the interventions. We applied the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence of each study, excluding reviews. 

Results: Of 4381 records identified, 58 met the eligibility criteria. The quality of evidence was predominantly moderate to very low. Interventions addressed health outcomes relating to: environmental factors: (i) heat (n = 16), (ii) water, sanitation, and hygiene (n = 3), (iii) food insecurity and undernutrition (n = 4), (iv) disasters and extreme weather (n = 6); and specific health issues: (v) respiratory illness (n = 5), (vi) mental health (n = 2), and (vii) vector-borne diseases (n = 6). The co-benefits of mitigation on child health outcomes was studied in 17 papers. Heat-related morbidity was reduced via maternity ward relocation and preseason high school sports guidelines. Low birth weight was reduced via cash transfers to pregnant women, rainwater collection, and green space. Childhood underweight was improved via household-level livelihood diversification. Respiratory outcomes were improved via retrofitting buildings with insulation and administering pneumococcal conjugate vaccines. Malaria incidence and mortality was reduced via insecticide treated nets, indoor residual spraying, and artemisinin combination therapy. Classroom-based sessions related to climate change increased mental wellbeing, as well as knowledge of climate risks and adaptation behaviours. Overall, reports of mitigation policies consistently found cobenefits in improving infant mortality, respiratory outcomes, adverse birth outcomes, and life years lost. 

Findings: Current global evidence of which interventions are successful is scarce, heterogenous, and of inconsistent quality. A robust scientific demonstration of effectiveness is needed for child health interventions within climate change policies to ensure they are effective.

Keywords: climate change, child health, interventions, policy, children's health, heat, WASH, disasters, extreme weather, mitigation, adaptation, respiratory, food insecurity, malnutrition, vector-borne disease, mental health