Our Common Future Under Climate Change

International Scientific Conference 7-10 JULY 2015 Paris, France

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Thursday 9 July - 15:00-16:30 UPMC Jussieu - ROOM 107 - Block 24/34

3321 (b) - Health Responses

Parallel Session

Lead Convener(s): D. Campbell-Lendrum (World Health Organization, Geneva, Switzerland)

Convener(s): R. Sauerborn (Heidelberg University, Heidelberg, Germany), S. Paz (University of Haifa, Haifa, Israel), L.P. Briguglio (University of Malta, Msida, Malta)


Opening presentation

A. Haines (London School of Hygiene and Tropical Medicine, London , United Kingdom)

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Opening presentation
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Impacts of Climate Change on Vector Borne Diseases in the Mediterranean Basin - Implications for Preparedness and Adaptation Policy

S. Paz (University of Haifa, Haifa, Israel), M. Negev, (University of Haifa, Haifa, Israel), M. Green (University of Haifa, Haifa, Israel)

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Impacts of Climate Change on Vector Borne Diseases in the Mediterranean Basin - Implications for Preparedness and Adaptation Policy

S. Paz (1) ; M. Negev, (2) ; M. Green (2)
(1) University of Haifa, Geography and Environmental Studies, Haifa, Israel; (2) University of Haifa, School of public health, Haifa, Israel

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The Mediterranean region is vulnerable to climatic changes. A warming trend exists with an increase in warm days and nights, longer and warmer summers, an increase in the frequency and the severity of heat waves and a reduction in rainfall amounts. Therefore, it is expected that vector-borne diseases (VBD) in the region will be influenced by climate change since the ecology, development, behaviour, and survival of insects and the transmission dynamics of the diseases they transmit are strongly influenced by climatic factors (especially temperature, rainfall, and humidity). The same factors also play a crucial role in the survival and transmission rate of the pathogens.

The main parameter that affects the rate of multiplication in the insect is temperature. When the temperature increases, it tends to cause an upsurge in the growth rates of mosquito populations, decrease the interval between blood meals, shorten the incubation time from infection to infectiousness in mosquitoes and accelerate the virus evolution rate.

Most cities in the Mediterranean are densely populated. Air conditioning is used, but as part of the local mentality windows remain open for most of the hot months. Many activities, particularly social gatherings, occur in outdoor locations such as shaded balconies and outdoor restaurants - all ideal for contact with the vector.

For some disease emergence in the Mediterranean basin (i.e. West Nile virus) the linkage with climate change was proved recently; for others (such as dengue) the risk for local transmission is real.

Consequently, adaptation and preparation for changing patterns of VBD distribution is crucial for the Mediterranean countries.

We analyzed nine representative Mediterranean countries and found that they have started to prepare for this threat, but the preparation levels among them differ greatly. Policy mechanisms at the regional level are limited, and depend on international organizations.

The Mediterranean countries should enhance collaboration in order to address cross-border aspects of vector transmission since the vectors of infectious diseases know no political borders.

Based on the Mediterranean Action Plan (MAP)’s success in advancing national legislation and regional cooperation, we suggest that this existing framework will address the risk of VBD transmission.

Regional-level policy mechanisms should include: monitoring and surveillance systems, capacity building in and across environment and health sectors, and stakeholder awareness and participation. Regional vector management should be advanced by the Mediterranean countries before the VBD develop into regional outbreaks.


A vulnerability/resilience framework approach

L. P. Briguglio (University of Malta, Msida, Malta), S. Moncada (University of Malta, Msida, Malta)

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A vulnerability/resilience framework approach

LP. Briguglio (1) ; S. Moncada (2)
(1) University of Malta, Islands and Small States Institute, Msida, Malta; (2) University of Malta, Institute for european studies, Msida, Malta

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The presentation will draw on the literature on the health impacts of climate change, and will re-position the arguments in a vulnerability/resilience framework. It will be argued that many communities are located in territories that are inherently prone to being negatively affected by global warming in terms of health and this will have major negative impacts on human capital in these territories. This will be the vulnerability side of the argument. The resilience side of the argument will relate to what can be done, policy-wise, to strengthen the ability of communities to evade health problems and survive, recover from, and even possibly improve their health condition, in the face of global warming. These could include adaptation and mitigation measures. The outcome of inherent vulnerability and policy induced resilience could result in a net strengthening of human capital.


Adaptation to potential shifts in malaria breeding sites: larvicide application in SubSaharan Africa, guided by risk maps based on remote sensing

I. Traore (Centre de Recherche en Santé de Nouna, Nouna, Region Boucle du Mouhoun, Burkina Faso), A. Sié, (Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso), V. Machault (Laboratoire d'Aérologie, Toulouse, France), C. Vignolles (CNES, Toulouse, France), R. Sauerborn (Heidelberg University, Heidelberg, Germany), P. Dambach (Heidelberg University, Heidelberg, Germany), N. Becker (German Mosquito Control Association, Heidelberg, Germany)

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Adaptation to potential shifts in malaria breeding sites: larvicide application in SubSaharan Africa, guided by risk maps based on remote sensing

I. Traore (1) ; A. Sié, (2) ; V. Machault (3) ; C. Vignolles (4) ; R. Sauerborn (5) ; P. Dambach (5) ; N. Becker (6)
(1) Centre de Recherche en Santé de Nouna, Service Formation Recherche et Communication, Nouna, Region Boucle du Mouhoun, Burkina Faso; (2) Centre de Recherche en Santé de Nouna, Direction, Nouna, Burkina Faso; (3) Laboratoire d'Aérologie, Toulouse, France; (4) CNES, Toulouse, France; (5) Heidelberg University, Institute of public health, Heidelberg, Germany; (6) German Mosquito Control Association, Heidelberg, Germany

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Climate change is likely to lead to shifting patterns of temporal and spatial distribution of many vector borne diseases, such as malaria. Firstly, this could lead to new areas becoming suitable for malaria transmission, particularly in higher altitudes and latitudes. Secondly we could observe epidemic patterns of malaria transmission and thirdly within the area of current endemicity, we could see e.g. a prolongation of the transmission period and a change in the productivity of breeding sites.

In Sub-Saharan Africa, significant progress has been made in providing access to bed-nets impregnated with insecticides and in offering subsidized, but still expensive malaria treatment. Both control measures are likely to have less than optimal effectiveness: Health care seeking drops drastically in the high transmission /high agricultural work season due to high time costs of farmers and an ebb in household cash resources before the next harvest. Second, many farmers sleep in makeshift straw huts in the midst of their fields and are thus not protected by bed nets. Unfortunately the third pillar of control, blocking larval production in breeding sites through applying larvicides, has hardly been used for malaria control. Larviciding was abandoned due to the large biological side effect of the then used DDT. However, biological larvicides, derived from Bti (Bacillus thuringiensis israeliensis) and others have been developed in the meantime. They have been effectively applied for decades in high and middle-income countries in larval control programs without showing any adverse human or biodiversity side effects. In Africa however, larviciding is largely absent in malaria control. This is generally attributed to the perceived high costs of biological larvicides and the high cost of treating all breeding sites around human settlements every two weeks during the rainy season.

We developed and validated a technique using SPOT-5 satellite images to predict which breeding sites would carry Anopheles larvae and at which larval productivity. The remote sensing predictions were tested and validated with field entomological and ecological data until a high degree of agreement was achieved. We used this novel technique to test two separate hypothesis that (i) applying larvicides is a cost-effective measure for malaria control, compared to currently applied control measures; and (ii) that it makes cost-effectiveness sense to apply the larvicides only to the breeding sites with the highest larval productivity.

We present first cost and effectiveness results of a three-armed cluster-randomized trial with three arms: (i) larvicidal treatment of all breeding sites within a radius of 1,5 km of the village borders; (ii) larvicidal treatment of only those 50% of breeding sites which are identified and validated as high-productivity sites: and (iii) control clusters of villages with no larvicide application of any kind. All study  arms receive the current national routine malaria control measures.

The results show that larvicidal treatment is highly effective both in larvae removal for 2 weeks under field conditions and to significantly reduce adult mosquito abundance in reference villages. First cost data indicate that the costs of locally adapted larviciding compare favorably to those of impregnated bed nets and that the targeted 50% larvicidal intervention is about 35% less costly. Analysis of data on the effect of malaria transmission to children under five years is under way.


The Effect of Training on Health: Biogas Development Interventions to Enhance Health Resilience to Climate Change in Informal Urban Settlements in Ethiopia

S. Moncada (University of Malta, Msida, Malta), H. Bambrick (University of Western Sydney, Penrith, Australia)

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The Effect of Training on Health: Biogas Development Interventions to Enhance Health Resilience to Climate Change in Informal Urban Settlements in Ethiopia

S. Moncada (1) ; H. Bambrick (2)
(1) University of Malta, Institute for european studies, Msida, Malta; (2) University of Western Sydney, School of Medicine, Penrith, Australia

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This paper measures the impact of community-level Overseas Development Assistance (ODA) on public health, specifically focusing on the provision of training. It is often the case that biogas programmes do not include any training component accompanying the intervention, believed to be either too expensive or simply overlooked. However, improved sanitation facilities do not automatically translate into better health standards, unless increased awareness and education can support behavioural changes to ensure long-lasting development.

The context of this research is an informal urban settlement in Ethiopia, characterised by extreme poverty, poor sanitation and exposure to climate-sensitive risks, where a biogas sanitation project funded by ODA was implemented in 2013. The development intervention included environmental and sanitation training, provided to 45 heads of the 200 beneficiary households of the project. Quasi-experimental techniques with propensity score matching methods are applied using two waves of panel data, generated from a dedicated survey conducted among all the households.

The study finds that training, provided within the biogas and sanitation development intervention, had positive effects on a number of health indicators including self-assessed health and lower use of contaminated water from the river. Although training beneficiaries carries additional costs during implementation, the benefits are significant, suggesting long-term behavioural changes. Participants who live closer to the biogas facilities enjoyed further health benefits, reinforcing arguments for the scaling-up of biogas development and sanitation interventions inclusive of training in informal urban settlements to enhance health resilience to climate change.