Shuaib Lwasa

Vulnerability of indigenous health to climate change: a case study of Uganda's Batwa Pygmies.

The potential impacts of climate change on human health in sub-Saharan Africa are wide-ranging, complex, and largely adverse. The regions Indigenous peoples are considered to be at heightened risk given their relatively poor health outcomes, marginal social status, and resource-based livelihoods; however, little attention has been given to these most vulnerable of the vulnerable. This paper contributes to addressing this gap by taking a bottom-up approach to assessing health vulnerabilities to climate change in two Batwa Pygmy communities in rural Uganda. Rapid Rural Appraisal and PhotoVoice field methods complemented by qualitative data analysis were used to identify key climate-sensitive, community-identified health outcomes, describe determinants of sensitivity at multiple scales, and characterize adaptive capacity of Batwa health systems. The findings stress the importance of human drivers of vulnerability and adaptive capacity and the need to address social determinants of health in order to reduce the potential disease burden of climate change.

Community vulnerability to the health effects of climate change among indigenous populations in the Peruvian Amazon: a case study from Panaillo and Nuevo Progreso

This paper presents the results of an exploratory study working with two Amazonian communities in Peru to identify key climate-related health risks from the perspective of local residents, and characterize how these risks are experienced and managed. The work adopts a vulnerability-based approach and utilizes participatory methodologies to document and examine local perspectives on vulnerability and adaptive capacity. Thirty nine community members were engaged in participatory photography (photovoice), and rapid rural appraisal workshops were conducted with a total 40 participants. Contextual information was obtained from 34 semi-structured interviews with key informants and participant observation during fieldwork. Three climate-related health risks were identified by the communities as pressing issues (food insecurity, water insecurity, and vector-borne disease), all of which are climate-dependent and reported to be being affected by observed changes in climatic conditions. Sensitivity to these risks is high due to social and economic disadvantages which force people to live in suboptimal conditions, partake in dangerous activities, and engage in unhealthy behaviors. Traditional approaches to health and strong social networks are important in moderating health risks, but are placed under increasing stress in the context of local social and economic changes due to larger scale influences, including resource development, deforestation, and changing social relations.

Boost resilience of small and mid-sized cities

Smaller settlements are growing faster than megacities — and they need more protection from extreme events, write Joern Birkmann and colleagues.

A systematic review of research on climate change adaptation policy and practice in Africa and South Asia deltas

Recent years have witnessed a rapid increase in scholarship on adaptation to climate change. Peer-reviewed literature, governmental communiqués and reports are increasingly reporting formulated and implemented climate change adaptation policies, strategies and plans of action. A large part of this literature describes general policy strategies, while there is limited published work on adaptation interventions at the local scale. The generality of adaptation is not only limited to strategies but also in terms of coverage of regions believed to be highly vulnerable to the effects of climate change. Among such climate change “hotspots” where understanding on adaptation is limited are river deltas. Herein, this paper synthesizes selected literature on adaptation policy and practice in river deltas located in Africa and South Asia. A systematic review methodology was used to scan online knowledge portals for published papers and also unpublished government documents. The review characterizes the state of adaptation policy in African and South Asian deltas and identifies future research priorities targeting climate change adaptation in large delta regions.

Climate change, equity and the Sustainable Development Goals: an urban perspective

Climate change is acknowledged as the largest threat to our societies in the coming decades, potentially affecting large and diverse groups of urban residents in this century of urbanization. As urban areas house highly diverse people with differing vulnerabilities, intensifying climate change is likely to shift the focus of discussions from a general urban perspective to who in cities will be affected by climate change, and how. This brings the urban equity question to the forefront. Here we assess how climate change events may amplify urban inequity. We find that heatwaves, but also flooding, landslides, and even mitigation and adaptation measures, affect specific population groups more than others. As underlying sensitivity factors we consistently identify socioeconomic status and gender. We synthesize the findings with regard to equity types – meaning outcome-based, process-oriented and context-related equity – and suggest solutions for avoiding increased equity and justice concerns as a result of climate change impacts, adaptation and mitigation.

The burden and determinants of self-reported acute gastrointestinal illness in an Indigenous Batwa Pygmy population in southwestern Uganda.

Acute gastrointestinal illness (AGI) is an important public health priority worldwide. Few studies have captured the burden of AGI in developing countries, and even fewer have focused on Indigenous populations. This study aimed to estimate the incidence and determinants of AGI within a Batwa Pygmy Indigenous population in southwestern Uganda. A retrospective cross-sectional survey was conducted in January 2013 via a census of 10 Batwa communities (n = 583 participants). The AGI case definition included any self-reported symptoms of diarrhoea or vomiting in the past 2 weeks. The 14-day prevalence of AGI was 6·17% [95% confidence interval (CI) 4·2-8·1], corresponding to an annual incidence rate of 1·66 (95% CI 1·1-2·2) episodes of AGI per person-year. AGI prevalence was greatest in children aged <3 years (11·3%). A multivariable mixed-effects logistic regression model controlling for clustering at the community level indicated that exposure to goats [odds ratio (OR) 2·6, 95% CI 1·0-6·8], being a child aged <3 years (OR 4·8, 95% CI 1·2-18·9), and being a child, adolescent or senior Batwa in the higher median of wealth (OR 7·0, 95% CI 3·9-9·2) were significantly associated with having AGI. This research represents the first Indigenous community-census level study of AGI in Uganda, and highlights the substantial burden of AGI within this population.

Relative Undernourishment and Food Insecurity Associations with Plasmodium falciparum Among Batwa Pygmies in Uganda: Evidence from a Cross-Sectional Survey

Although malnutrition and malaria co-occur among individuals and populations globally, effects of nutritional status on risk for parasitemia and clinical illness remain poorly understood. We investigated associations between Plasmodium falciparum infection, nutrition, and food security in a cross-sectional survey of 365 Batwa pygmies in Kanungu District, Uganda in January of 2013. We identified 4.1% parasite prevalence among individuals over 5 years old. Severe food insecurity was associated with increased risk for positive rapid immunochromatographic test outcome (adjusted relative risk [ARR] = 13.09; 95% confidence interval [95% CI] = 2.23–76.79). High age/sex-adjusted mid-upper arm circumference was associated with decreased risk for positive test among individuals who were not severely food-insecure (ARR = 0.37; 95% CI = 0.19–0.69). Within Batwa pygmy communities, where malnutrition and food insecurity are common, individuals who are particularly undernourished or severely food-insecure may have elevated risk for P. falciparum parasitemia. This finding may motivate integrated control of malaria and malnutrition in low-transmission settings.

Seasonal variation of food security among the Batwa of Kanungu, Uganda.

Objective Climate change is projected to increase the burden of food insecurity (FI) globally, particularly among populations that depend on subsistence agriculture. The impacts of climate change will have disproportionate effects on populations with higher existing vulnerability. Indigenous people consistently experience higher levels of FI than their non-Indigenous counterparts and are more likely to be dependent upon land-based resources. The present study aimed to understand the sensitivity of the food system of an Indigenous African population, the Batwa of Kanungu District, Uganda, to seasonal variation. Design A concurrent, mixed methods (quantitative and qualitative) design was used. Six cross-sectional retrospective surveys, conducted between January 2013 and April 2014, provided quantitative data to examine the seasonal variation of self-reported household FI. This was complemented by qualitative data from focus group discussions and semi-structured interviews collected between June and August 2014. Setting Ten rural Indigenous communities in Kanungu District, Uganda. Subjects FI data were collected from 130 Indigenous Batwa Pygmy households. Qualitative methods involved Batwa community members, local key informants, health workers and governmental representatives. Results The dry season was associated with increased FI among the Batwa in the quantitative surveys and in the qualitative interviews. During the dry season, the majority of Batwa households reported greater difficulty in acquiring sufficient quantities and quality of food. However, the qualitative data indicated that the effect of seasonal variation on FI was modified by employment, wealth and community location. Conclusions These findings highlight the role social factors play in mediating seasonal impacts on FI and support calls to treat climate associations with health outcomes as non-stationary and mediated by social sensitivity.

Urban Adaptation Planning and Governance: Challenges to Emerging Wisdom

Numerous recommendations are emerging to guide cities in developing risk assessments and climate adaptation plans. In some instances, these recommendations are appropriate. However, since many are drawn from traditional approaches to comprehensive planning and from climate mitigation programs, they often do not account for the unique challenges associated with urban adaptation or provide guidance that is sensitive to the distinctive social, cultural, institutional, and administrative characteristics of particular locales. In this paper, which captures a panel discussion convened at the Resilient Cities Congress 2010, expert practitioners and academics review emerging wisdom about best practices in adaptation planning, draw on their experience and research findings to challenge these assumptions, and show what we can learn about process and outcomes from cities at the forefront.

A Longitudinal Analysis of Mosquito Net Ownership and Use in an Indigenous Batwa Population after a Targeted Distribution.

Major efforts for malaria prevention programs have gone into scaling up ownership and use of insecticidal mosquito nets, particularly in sub-Saharan Africa where the malaria burden is high. Socioeconomic inequities in access to long lasting insecticidal nets (LLINs) are reduced with free distributions of nets. However, the relationship between social factors and retention of nets after a free distribution has been less studied, particularly using a longitudinal approach. Our research aimed to estimate the ownership and use of LLINs, and examine the determinants of LLIN retention, within an Indigenous Batwa population after a free LLIN distribution. Two LLINs were given free of charge to each Batwa household in Kanungu District, Uganda in November 2012. Surveyors collected data on LLIN ownership and use through six cross-sectional surveys pre- and post-distribution. Household retention, within household access, and individual use of LLINs were assessed over an 18-month period. Socioeconomic determinants of household retention of LLINs post-distribution were modelled longitudinally using logistic regression with random effects. Direct house-to-house distribution of free LLINs did not result in sustainable increases in the ownership and use of LLINs. Three months post-distribution, only 73% of households owned at least one LLIN and this period also saw the greatest reduction in ownership compared to other study periods. Eighteen-months post distribution, only a third of households still owned a LLIN. Self-reported age-specific use of LLINs was generally higher for children under five, declined for children aged 6–12, and was highest for older adults aged over 35. In the model, household wealth was a significant predictor of LLIN retention, controlling for time and other variables. This research highlights on-going socioeconomic inequities in access to malaria prevention measures among the Batwa in southwestern Uganda, even after free distribution of LLINs, and provides critical information to inform local malaria programs on possible intervention entry-points to increase access and use among this marginalized population.