The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis
Abstract
:1. Introduction
2. Methods
2.1. Eligibility Criteria and Rationale
- (1)
- Published between the years 2012 and 2022, to focus on contemporary data.
- (2)
- Academic peer-reviewed articles to ensure academic rigor.
- (3)
- Published in English, as this is the most widely used language for international research publishing.
- (4)
- Full article availability.
- (5)
- Reported at least one impact of climate change on health service(s) in a low- or middle-income country.
2.2. Search Strategy
2.3. Selection of Studies
2.4. Data Extraction
2.5. Thematic Analysis
2.6. Risk of Bias Assessment
3. Results
3.1. Articles Identified
3.2. Study Descriptions
3.3. Risk of Bias Assessment
3.4. Climate Impacts
3.5. Health Services
3.6. Service Delivery
3.6.1. Hospitalization
3.6.2. Health Care Accessibility
3.6.3. Family Planning and Mental Health Services
3.6.4. Preventive Services
3.7. Human Resources
3.8. Health Finance
3.8.1. Government Health Expenditures
3.8.2. Out-of-Pocket Payments (OOP)
3.9. Leadership or Governance
3.10. Healthcare Products and Technologies
3.11. Climate Change Impact Assessment Framework
4. Discussion
4.1. A Lack of Evidence in LMICs
4.2. Direct versus Indirect Policy Impact and Responsible Innovation
4.3. Early Warning Systems
4.4. Climate Change and Mental Health
4.5. The Role of the Healthcare Professional
4.6. Cost
4.7. Appetite for Action
4.8. Strengths and Limitations
- *
- This systematised literature review offers a robust and reliable overview of the current state of play in climate change and research on access to health services.
- *
- To the best knowledge of the authors, this is the first study of its kind on this topic.
- *
- The research was undertaken using two databases. Despite these being extensive resources, by not including more databases, the authors may have omitted some important papers.
- *
- Due to resource availability, not all analysis steps were performed by two reviewers.
- *
- Many of the studies contained in this systematic review did not control for other factors in the research setting, which could include conflict, health service fragility, socioeconomic factors, or chronic under-investment in health systems in LMICs.
5. Conclusions and Future Research
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Climate Change | Health Services | LMIC | |
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Google search |
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Synonyms |
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Emtree |
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MeSH |
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Search 1: | Climate variability, greenhouse effect, meteorological phenomena, ecological and environmental phenomena, climate change, global warming |
Search 2: | General medical service, medical commission, health practice, hospital medical system, emergency health service, rescue personnel, medical service, health service, medical information system, emergency medical service communication systems, emergency medical services, pharmaceutical services, clinical laboratory service, reproductive health services, health care costs, delivery of healthcare, patient care management, hospital medical system |
Search 3: | Lower middle income countr *, Low income countr * Middle-income country *, Middle-income economy countr *, Low-income economy countr *, Developing country *, Least developed countr *, Less developed countr *, Underdeveloped nation *, Underdeveloped countr *, Developing nation *, Less developed nation *, Third world countr * World Bank’s list of LMICs (The full list of countries is available in the appendix figure…) |
Search 4: | S1 AND S2 AND S3 |
Study Title | Type of Study | Year of Publication | Geographical Interest | N | Participants | Method | Climate Change Focus |
---|---|---|---|---|---|---|---|
Schnitter et al. [12] | World Health Organisation (WHO) assessment | 2018 | Dominica | N/A | A group of climate and health experts, as well as representatives of NGOs and government agencies | Secondary research | General |
Stewart-Ibarra et al. [13] | Qualitative description | 2019 | Dominica Barbados | 73 | Stakeholder—public decision-makers, practitioners from the climate and health sectors at the regional level | In-depth interviews, survey, workshop. | Extreme weather—drought |
Lowe et al. [25] | Modelling study—quantitative study | 2018 | Barbados | N/A | No participants | Distributed lag nonlinear models (DLNMs) coupled with a mixed-model framework. | Extreme weather—drought and meteorological—rainfall |
McIver et al. [14] | Review of vulnerability and adaptation assessment to climate change—secondary research | 2014 | Kiribati | N/A | A group of climate and health experts, as well as representatives of Non-Governmental Organisations (NGOs) and government agencies | Secondary research | General |
McMichael et al. [20] | Case study—qualitative study | 2021 | Fiji | N/A | Locals (residents in the village of Vunidogoloa) | In-depth interviews, group discussion | Extreme weather—water-level rises |
Abdullah et al. [34] | Perspective of case studies—qualitative study | 2019 | Bangladesh | 12 | Locals (residents, village doctors, and traditional birth attendants in Khaliajuri) | In-depth interviews, group discussion | Extreme weather—floods |
Kabir et al. [21] | Cross-sectional study—qualitative | 2016 | Bangladesh | 6720 | Locals (head of households—men) | In-depth interviews, group discussion | Extreme weather—floods, storms |
Haque et al. [22] | Cross-sectional study—mixed-method study | 2013 | Bangladesh | 450 | Locals | Interview, administered questionnaires. Literature review. | extreme weather—floods, storms |
Sahoo et al. [23] | Qualitative description | 2012 | India | 53 | Locals (people in Malkangiri and Khurda from various backgrounds, with a range of ages, genders, educational levels, and occupation) | In-depth interviews, group discussion, | General |
Malik et al. [26] | Quantitative study | 2012 | Pakistan | N/A | NO human participants | Climate change vulnerability index | General |
Aik et al. [27] | Time series analysis—quanititative study | 2020 | Singapore | N/A | No human participants | Time series analysis | Meteorological—relative humidity, increase in temperature and rainfall |
Van Minh et al. [15] | Cross-sectional descriptive study— mixed-method study | 2014 | Vietnam | 24 | Health experts, civic leaders (local representatives) | In-depth interviews, group discussion, self-administered questionnaires | Extreme weather—flood, storm |
Wu et al. [19] | Qualitative description | 2019 | China | 21 | Professionals (researchers, physicians, local officers, dispatches rescue experts) | In-depth interviews, report and thematic analysis | Extreme weather—flood |
Amstislavski et al. [24] | Correlational and time series analysis—quantitative study | 2013 | Russia | 370 | Locals (nomadic herders) | Clinical visits, record analysis, Spearman correlation—to measure the relation between temperature anomalies and the arrival of herders at Nes clinic. Piecewise regression | Meteorological—rise in temperature |
Lindvall et al. [16] | Qualitative description | 2020 | Ethiopia Kenya Somalia | 39 | Professionals (United Nations (UN) agencies, government ministries, Non-Governmental Organizations (NGOs), and regional leaders) | In-depth interviews, workshop, review of the published literature | Extreme weather—drought |
Haileselassie et al. [28] | Ecological study—quantitative study | 2022 | Ethiopia | N/A | No human participants | Report analysis on malaria morbidity, molarity and prevention, meteorological data collection, multivariate analysis | Meteorological—relative humidity, rainfall |
Rosen et al. [32] | Qualitative description | 2021 | Zambia | 181 | Locals (adults and women in drought-affected areas), health experts, civic leaders | In-depth interviews, focus group discussions | Extreme weather—drought |
Yiran et al. [33] | Qualitative description | 2017 | Ghana | 13 communities were involved—the exact number of participants was not specified | Locals professionals (people with different backgrounds, ranging from those who have experienced at least one of the hazards and/or have knowledge of climate change, community leaders, rich/poor, professionals, and educated/uneducated) | In-depth interviews, Group discussions | General |
Kendrovski et al. [17] | Vulnerability and adaptation assessment to climate change | 2014 | Macedonia | N/A | A group of climate and health experts, as well as representatives of NGOs and government agencies | Secondary research | General |
Duarte et al. [29] | Ecological Quantitative study | 2017 | Brazil | N/A | No human participants | Data collection—data was retrieved from the national hospital Information System of Brazil (he SUS), National Institute of Meteorology and the National Water Agency Multiple Poisson and negative binomial regression models were used. | Extreme weather- Flood |
Souza et al. [30] | Ecological quantitative study | 2012 | Brazil | N/A | No human participants | Data collection—daily data on admissions for respiratory diseases, precipitation, air temperature, humidity, and wind speed for the 2004–2008 period. Generalised linear models, with Poisson multiple regression | Meteorological changes in temperature, humidity, precipitation and wind speed |
Ebi et al. [18] | Mixed-method study | 2017 | Albania, Barbados, Bhutan, China, Fiji, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Philippines, Russian Federation, Tajikistan, and Uzbekistan | 19 | A group of climate and health experts, as well as representatives of NGOs and government agencies | In-depth interviews, focus groups, discussions, evaluating project reports of multinational health adaptation. project between 2008–2013 | General |
Leal Fet al. [31] | Comparative analysis—quantitative study | 2018 | Austria, Ethiopia, Malaysia, Uruguay, South-Eastern Austria, Douala, La Paz, Dar-es-Salaam | N/A | No human participants | Cross-comparison analysis and analysis | General |
Are there clear qualitative and quantitative research questions (or objectives *), or a clear mixed-methods question (or objective *)? | Do the collected data address the research question (objective)? E.g., consider whether the follow-up period is long enough for the outcome to occur (for longitudinal studies or study components) | Are the sources of qualitative data (archives, documents, informants, observations) relevant to the research question (objective)? | Is the process for analysing qualitative data relevant to the research question (objective)? | Has the researcher considered how the findings relate to the context, e.g., the setting, in which the data were Collected? | Do researchers take into account how their influence on participants may be affected by their findings? | Does coherence exist between qualitative data sources, collection, analysis, and interpretation? | |
Stewart-Ibarra et al. [13] | Yes | No | Yes | Yes | Yes | No | Yes |
McMichael et al. [20] | Yes | Yes | Yes | Yes | Yes | yes | Yes |
Abdullah et al. [50] | Yes | Yes | No | Yes | Yes | Yes | Yes |
Kabir et al. [21] | Yes | Yes | Yes | Yes | Yes | No | Yes |
Sahoo et al. [23] | Yes | Yes | Yes | Yes | Yes | No | Yes |
Wu et al. [19] | Yes | Yes | no | Yes | Yes | No | Yes |
Lindvall et al. [16] | Yes | No | Yes | Yes | Yes | No | Yes |
Rosen et al. [32] | Yes | Yes | No | Yes | Yes | No | Yes |
Yiran et al. [33] | Yes | Yes | Yes | Yes | Yes | No | Yes |
Is the sampling strategy relevant to the research question? | Is the sample representative of the target population? | Are the measurements appropriate? | Is statistical analysis appropriate to answer the research question? | |
Lowe et al. [25] | Yes | Yes | Yes | Yes |
Aik et al. [27] | Yes | Yes | Yes | Yes |
Amstislavski et al. [24] | Yes | Yes | Yes | Yes |
Haileselassie et al. [28] | Yes | Yes | Yes | yes |
Malik S et al. [26] | Yes | Yes | Yes | Yes |
Duarte et al. [29] | Yes | Yes | Yes | Yes |
Souza et al. [30] | Yes | Yes | Yes | |
Leal Fet al. [31] | Yes | Yes | Yes | Yes |
Is there an adequate rationale for using a mixed-methods design to address the research question? | Are the different components of the study effectively integrated to answer the research question? | Are the outputs of the integration of qualitative and quantitative components adequately interpreted? | Are divergences and inconsistencies between quantitative and qualitative results adequately addressed? | Do the different components of the study adhere to the quality criteria of each of the methods involved? | |
Haque et al. [22] | Yes | Yes | Yes | No | Yes |
Van Minh et al. [15] | Yes | Yes | Yes | No | Yes |
Ebi et al. [18] | No | Yes | Yes | No | Yes |
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Inclusion Criteria and Explanation | Exclusion Criteria |
---|---|
Studies published between the years 2012 and 2022 To ensure we identified contemporary data | Studies which were published before 2012 or after 2022 |
Studies which were published in English. English is the most widely used language in academic publications | Studies published in a language other than English. |
Accessible full articles To facilitate data analysis | Inaccessible full articles |
Studies that reported at least one impact of climate change on health service(s) in LMICs To align with the study objectives | Studies that did not report at least one impact of climate change on health service(s) in LMICs or studies which reported the impact of climate on a specific condition |
Academic peer-reviewed papers To ensure the studies were rigorous | Non-academic or non-peer-reviewed papers |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Naser, K.; Haq, Z.; Naughton, B.D. The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis. Int. J. Environ. Res. Public Health 2024, 21, 434. https://doi.org/10.3390/ijerph21040434
Naser K, Haq Z, Naughton BD. The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis. International Journal of Environmental Research and Public Health. 2024; 21(4):434. https://doi.org/10.3390/ijerph21040434
Chicago/Turabian StyleNaser, Kamar, Zaeem Haq, and Bernard D. Naughton. 2024. "The Impact of Climate Change on Health Services in Low- and Middle-Income Countries: A Systematised Review and Thematic Analysis" International Journal of Environmental Research and Public Health 21, no. 4: 434. https://doi.org/10.3390/ijerph21040434