Twabi Hussein H, Jafali James, Mndala Leonard, Riches Jennifer, Monk Edward J M, Phiri Deborah, Makuluni Regina, Gadama Luis, Kachale Fannie, Bilesi Rosemary, Mbewe Malangizo, Likaka Andrew, Chapuma Chikondi, Kumwenda Moses, Maseko Bertha, Ndamala Chifundo, Kuyere Annie, Munthali Laura, Henrion Marc Y R, Msefula Chisomo, Lissauer David, Odland Maria Lisa
Kamuzu University of Health Sciences, Blantyre, Malawi.
Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
PLOS Glob Public Health. 2024 Aug 28;4(8):e0003565. doi: 10.1371/journal.pgph.0003565. eCollection 2024.
Climate change poses a significant threat to women's health in sub-Saharan Africa, yet the impact of climate change on maternal health is rarely reported in the region. Using an existing Maternal Surveillance Platform (MATSurvey), we estimated the immediate impact of Cyclone Freddy on maternal health care service indicators in Malawi. We analysed facility-level data for pregnant women up to 42 weeks post-partum using the national MATSurvey database. We compared incidences of service utilisation before (1 January to 19 February 2023) and after (20 February to 30 March 2023) the cyclone using a negative binomial regression approach. Between 1 January and 30 March 2023, a total of 37,445 live births, 50,048 antenatal clinic attendances, 23,250 postnatal clinic attendances, 84 maternal deaths, and 1,166 neonatal deaths were recorded by 33 facilities in the MatSurvey database. There was an immediate reduction in service utilisation in the post-cyclone period, including the postnatal attendance per week (pre-cyclone median: 355.0 [IQR 279.0-552.0], post-cyclone median: 261.0 [IQR 154.3-305.5], RR 0.56 [95% CI 0.44-0.71, p <0.001]) and the antenatal attendance per week (pre-cyclone median: 860.0 [IQR 756.5-1060.0], post-cyclone median: 656.5 [IQR 486.5-803.3], RR 0.66 [95% CI 0.55-0.78, p <0.001]). Stratified analyses by geographical zones revealed a stronger reduction in postnatal clinic attendance in the Southwest (RR 0.50 [95% CI 0.29-0.85, p = 0.010]) and the North (RR 0.29 [95% CI 0.15-0.56, p <0.001]). Cyclone Freddy resulted in an immediate decline in utilisation of maternal health services in cyclone-affected regions in Malawi. We observe evidence of catastrophic climate events impacting on the healthcare of women and their babies. Policymakers, researchers, and health systems need to ensure that essential women's health services are maintained during these events and improve measures to support service resilience in the face of climate change.
气候变化对撒哈拉以南非洲地区妇女的健康构成了重大威胁，但该地区很少报告气候变化对孕产妇健康的影响。我们利用现有的孕产妇监测平台（MATSurvey），估计了热带气旋弗雷迪对马拉维孕产妇保健服务指标的直接影响。我们使用国家MATSurvey数据库分析了产后42周内孕妇的机构层面数据。我们采用负二项回归方法比较了气旋发生前（2023年1月1日至2月19日）和气旋发生后（2023年2月20日至3月30日）服务利用的发生率。在2023年1月1日至3月30日期间，MatSurvey数据库中的33个机构记录了总共37445例活产、50048次产前门诊就诊、23250次产后门诊就诊、84例孕产妇死亡和1166例新生儿死亡。气旋过后，服务利用立即减少，包括每周的产后就诊次数（气旋前中位数：355.0[四分位间距279.0 - 552.0]，气旋后中位数：261.0[四分位间距154.3 - 305.5]，相对风险0.56[95%置信区间0.44 - 0.71，p<0.001]）和每周的产前就诊次数（气旋前中位数：860.0[四分位间距756.5 - 1060.0]，气旋后中位数：656.5[四分位间距486.5 - 803.3]，相对风险0.66[95%置信区间0.55 - 0.78，p<0.001]）。按地理区域进行的分层分析显示，西南部（相对风险0.50[95%置信区间0.29 - 0.85，p = 0.010]）和北部（相对风险0.29[95%置信区间0.15 - 0.56，p<0.001]）的产后门诊就诊次数减少更为明显。热带气旋弗雷迪导致马拉维受气旋影响地区的孕产妇保健服务利用立即下降。我们观察到有证据表明灾难性气候事件正在影响妇女及其婴儿的医疗保健。政策制定者、研究人员和卫生系统需要确保在这些事件期间维持基本的妇女保健服务，并改进措施以提高面对气候变化时服务的恢复力。
