McGill University, Department of Geography, Burnside Hall Building, Room 705, 805 Sherbrooke Street West, Montreal, Quebec H3A 0B9, Canada.
University of Guelph, School of Population Medicine, Ontario Veterinary College, Guelph, Ontario, N1G 2W1, Canada.
Soc Sci Med. 2017 Aug;187:39-48. doi: 10.1016/j.socscimed.2017.06.021. Epub 2017 Jun 19.
Maternal and newborn health disparities and the health impacts of climate change present grand challenges for global health equity, and there remain knowledge gaps in our understanding of how these challenges intersect. This study examines the pathways through which mothers are affected by seasonal and meteorological factors in sub-Saharan Africa in general, and Kanungu District (Uganda), in particular. We conducted a community-based study consisting of focus group discussions with mothers and interviews with health care workers in Kanungu District. Using a priori and a posteriori coding, we found a diversity of perspectives on the impacts of seasonal and weather exposures, with reporting of more food available in the rainy season. The rainy season was also identified as the period in which women performed physical labour for longer time periods, while work conditions in the dry season were reported to be more difficult due to heat. The causal pathways through which weather and seasonality may be affecting size at birth as reported by Kanungu mothers were consistent with those most frequently reported in the literature elsewhere, including maternal energy balance (nutritional intake and physical exertion output) and seasonal illness. While both Indigenous and non-Indigenous mothers described similar pathways, however, the severity of these experiences differed. Non-Indigenous mothers frequently relied on livestock assets or opportunities for less taxing physical work than Indigenous women, who had fewer options when facing food shortages or transport costs. Findings point to specific entry points for intervention including increased nutritional support in dry season periods of food scarcity, increased diversification of wage labour opportunities, and increased access to contraception. Interventions should be particularly targeted towards Indigenous mothers as they face greater food insecurity, may have fewer sources of income, and face greater overall deprivation than non-Indigenous mothers.
孕产妇和新生儿健康差距以及气候变化对健康的影响给全球健康公平带来了巨大挑战，我们在理解这些挑战如何相互交织方面仍存在知识差距。本研究考察了季节性和气象因素如何影响撒哈拉以南非洲的母亲，特别是乌干达卡农古区的母亲。我们在卡农古区进行了一项基于社区的研究，包括与母亲进行焦点小组讨论和与卫生保健工作者进行访谈。通过预先和事后编码，我们发现了对季节性和天气暴露影响的多样性观点，报告称雨季有更多的食物。雨季也是女性进行长时间体力劳动的时期，而旱季的工作条件因炎热而被报告为更加困难。卡农古区母亲报告的天气和季节性可能影响出生体重的因果途径与文献中其他地方最常报告的途径一致，包括母婴能量平衡（营养摄入和体力消耗）和季节性疾病。尽管土著和非土著母亲描述了类似的途径，但这些经历的严重程度不同。非土著母亲经常依赖牲畜资产或从事比土著妇女更少体力劳动的机会，而土著妇女在面临粮食短缺或交通成本时选择较少。研究结果指出了具体的干预切入点，包括在食物短缺的旱季增加营养支持、增加工资劳动机会的多样化以及增加获得避孕措施的机会。干预措施应特别针对土著母亲，因为她们面临更大的粮食不安全，可能收入来源较少，并且总体贫困程度高于非土著母亲。
