Climate change, women, and children: Assessing health vulnerability, impacts, and adaptation in the Kavre district, Nepal
Creators: Tiwari, Ishwar
Publisher: name: University of Alberta Library
Year: 2024

<p>Nepal is ranked as one of the countries most vulnerable to climate change. Certain Nepalese subpopulations, including women and children, are at higher risk than others and may experience climate change impacts disproportionately due to socioeconomic disparities, gender roles, limited mobility and access to resources, physiological characteristics, and others. This thesis research qualitatively explored the women&#39;s lived experiences concerning climate change and quantitatively investigated the impacts of meteorological factors and air pollution exposure on adverse pregnancy outcomes (APO) and childhood infectious diseases in Kavre, Nepal.<br>
In Chapter II, we conducted a scoping review synthesizing evidence from recent South Asian studies on the relationship of meteorological factors and air pollution with women’s and children’s health. A research librarian executed the search on six databases for the period from January 2010 to May 2020. Two reviewers independently conducted title, abstract, and full-text screening. We extracted data from 42 studies. Most studies were based in India (23) and Bangladesh (14) and focused on meteorological factors (19) as the primary exposure. The impacts of extreme weather events, meteorological factors, and air pollution on children&#39;s health were the focus of 34 studies, and only eight focused on women&#39;s health. Undernutrition, acute respiratory infection (ARI), diarrheal diseases, low birthweight, and premature mortality were the main health focus in children and women. This study highlighted a gap in the geographic area of studies across regions and suggested opportunities for future work in climate change and women&#39;s and children&#39;s health.<br>
Chapter III included qualitative research exploring women&#39;s perspectives and lived experiences concerning climate change, its adverse impacts on agriculture and health and ongoing adaptation strategies. Eight focus group discussions and eight interviews were conducted using purposive and snowball recruitment. Interviews in the Nepali language, audio-recorded and transcribed verbatim in Nepali, and content analysis using NVivo 1.7. was conducted. Three primary topical areas appeared. The first topical area, &quot;When the weather changes, it gets very cold,&quot; captured participants&#39; perspectives on climate change. The second, ‘the unpredictability of weather,’ captured their lived experience related to climate change. The third, ‘acting locally,’ captured local-level actions to address impacts expected from climate change. These results can guide the development of interventions to address women&#39;s and children&#39;s needs and concerns. <br>
Chapter IV examined quantitative relationships between environmental exposures and APOs in Kavre, Nepal. Using a historical cohort study design, we conducted a secondary analysis of health facilities-based data. We linked health records to temperature, precipitation, and PM2.5 exposures for six months preceding each birth. A random intercept model was used to analyze birthweight. A composite APO outcome was analyzed using multivariable logistic regression. We observed that total precipitation (β: 0.17, 95% CI 0.01 to 0.33) positively affected birthweight in the wetter season. Negative effects for mean maximum (β: -33.37, 95% CI -56.68 to -10.06), mean (β: -32.35, 95% CI -54.44 to -10.27), and mean minimum temperature (β: -29.28, 95% CI -49.58 to -8.98) on birthweight was observed in the wetter season. Future studies should consider larger cohorts to explain these complex relationships in Nepal. <br>
Chapter V included an analysis of health facilities-based data using a historical cohort study design examining the association of meteorological and air pollution exposures with diarrhea and ARI. Daily temperature and precipitation were linked to health records for the two weeks preceding each recorded health outcome. For PM2.5, we linked health records to the month preceding each recorded health outcome. Multivariable logistic regression was used to analyze environmental exposures, diarrhea and ARI. We observed a positive effect of mean PM2.5 exposure on diarrhea [Adjusted Odds Ratio (AOR) 1.02, 95% CI 1.003 – 1.03]. The mean minimum temperature was positively associated with ARI (AOR 1.04; 95% CI 1.001 – 1.08). The findings from a stratified analysis showed that mean PM2.5 exposure positively affected diarrhea among urban residents (AOR 1.03, 95% CI 1.001 – 1.07) and in the wetter season (AOR 1.05, 95% CI 1.02 – 1.07). <br>
This thesis research emphasizes the need for collaborative efforts across local-level government and non-government stakeholders to address the impacts of climate change, including strengthening systems and protecting women&#39;s and children&#39;s health. Furthermore, the Government of Nepal must improve its climate infrastructure to enable the regular recording and capturing of environmental data.  </p>