• Energy Research

La dengue est liée au changement climatique dans les pays tropicaux et subtropicaux, notamment en République démocratique populaire lao (Laos) et en Thaïlande. La connaissance de ces problèmes et les mesures préventives peuvent affecter l'incidence et le risque d'épidémie de dengue. Par conséquent, la présente étude a été menée pour déterminer les connaissances, les attitudes et les pratiques (cap) parmi les communautés urbaines et rurales et les responsables gouvernementaux sur le changement climatique et la dengue au Laos et en Thaïlande. Une enquête transversale sur le changement climatique et la dengue a été menée auprès de 360 ménages au Laos (180 urbains et 180 ruraux), 359 ménages en Thaïlande (179 urbains et 180 ruraux) et 20 représentants du gouvernement (10 dans chaque pays) à l'aide de questionnaires structurés. L'analyse des données a été entreprise en utilisant des méthodes descriptives, l'analyse en composantes principales (ACP), le test du Chi carré ou le test exact de Fisher (le cas échéant) et la régression logistique. Des différences significatives entre les communautés sélectionnées dans les deux pays ont été trouvées en termes d'âge, de niveau d'éducation, de statut socio-économique, de niveau d'attitude face au changement climatique et de niveau de cap de la dengue (P < 0,05 ; IC à 95 %). Dans l'ensemble, le cap des participants sur le changement climatique et la dengue était faible, à l'exception du niveau d'attitude pour la dengue dans les deux pays. Le niveau de sensibilisation des responsables gouvernementaux à la relation climatique avec la dengue était également faible. Dans les ménages laotiens, les connaissances des participants sur le changement climatique et la dengue étaient significativement associées au niveau d'éducation et au statut socio-économique (SSE) (P < 0,01). Leurs attitudes à l'égard du changement climatique et de la dengue étaient associées au niveau d'éducation et à l'utilisation d'Internet (P < 0,05). Les pratiques liées au changement climatique des ménages étaient associées au SSE (P < 0,01) et les pratiques liées à la dengue étaient associées au niveau d'éducation, au SSE, à l'expérience antérieure de la dengue et à l'utilisation d'Internet (P < 0,01). En Thaïlande, les connaissances des participants sur le changement climatique étaient associées au niveau d'éducation et au SSE (P < 0,01). Leurs attitudes à l'égard du changement climatique étaient associées au statut de résidence (urbain/rural) et à l'utilisation d'Internet (P < 0,05) ; les pratiques liées au changement climatique étaient associées au niveau d'éducation et au SSE (P < 0,05). Les connaissances liées à la dengue des participants étaient associées au SSE et à l'expérience antérieure de la dengue (P < 0,05) ; les attitudes et les pratiques liées à la dengue des participants étaient associées au niveau d'éducation (P < 0,01). Les résultats appellent à des programmes de sensibilisation intégrés et urgents pour augmenter les niveaux de cap concernant l'adaptation au changement climatique, l'atténuation et la prévention de la dengue afin d'améliorer la santé et le bien-être des populations de ces deux pays et des pays similaires où la dengue est endémique. El dengue está relacionado con el cambio climático en países tropicales y subtropicales como la República Democrática Popular Lao (Laos) y Tailandia. El conocimiento sobre estos problemas y las medidas preventivas pueden afectar la incidencia y el riesgo de brote de dengue. Por lo tanto, el presente estudio se realizó para determinar el conocimiento, las actitudes y las prácticas (CAP) entre las comunidades urbanas y rurales y los funcionarios gubernamentales sobre el cambio climático y el dengue en Laos y Tailandia. Se realizó una encuesta Cap transversal sobre el cambio climático y el dengue en 360 hogares en Laos (180 urbanos y 180 rurales), 359 hogares en Tailandia (179 urbanos y 180 rurales) y 20 funcionarios gubernamentales (10 en cada país) utilizando cuestionarios estructurados. El análisis de datos se realizó utilizando métodos descriptivos, análisis de componentes principales (PCA), prueba de Chi-cuadrado o prueba exacta de Fisher (según corresponda) y regresión logística. Se encontraron diferencias significativas entre las comunidades seleccionadas en ambos países en términos de edad de los participantes del hogar, nivel de educación, nivel socioeconómico, nivel de actitud ante el cambio climático y nivel Cap de dengue (P < 0,05; IC del 95%). En general, la Cap de los participantes sobre el cambio climático y el dengue fue baja, excepto el nivel de actitud para el dengue en ambos países. El nivel de conciencia entre los funcionarios gubernamentales con respecto a la relación climática con el dengue también fue bajo. En los hogares de Laos, el conocimiento de los participantes sobre el cambio climático y el dengue se asoció significativamente con el nivel de educación y el nivel socioeconómico (ses) (P < 0,01). Sus actitudes hacia el cambio climático y el dengue se asociaron con el nivel educativo y el uso de internet (P < 0.05). Las prácticas relacionadas con el cambio climático de los hogares se asociaron con el ses (P < 0,01) y las prácticas relacionadas con el dengue se asociaron con el nivel educativo, el ses, la experiencia previa con el dengue y el uso de Internet (P < 0,01). En Tailandia, el conocimiento de los participantes sobre el cambio climático se asoció con el nivel de educación y el ses (P < 0,01). Sus actitudes hacia el cambio climático se asociaron con el estado de residencia (urbano/rural) y el uso de Internet (P < 0.05); las prácticas relacionadas con el cambio climático se asociaron con el nivel educativo y el ses (P < 0.05). El conocimiento relacionado con el dengue de los participantes se asoció con el ses y la experiencia previa del dengue (P < 0,05); las actitudes y prácticas relacionadas con el dengue de los participantes se asociaron con el nivel educativo (P < 0,01). Los hallazgos exigen programas de concientización integrados que se necesitan con urgencia para aumentar los niveles de Cap con respecto a la adaptación al cambio climático, la mitigación y la prevención del dengue para mejorar la salud y el bienestar de las personas en estos dos países y en países similares donde el dengue es endémico. Dengue is linked with climate change in tropical and sub-tropical countries including the Lao People's Democratic Republic (Laos) and Thailand. Knowledge about these issues and preventive measures can affect the incidence and outbreak risk of dengue. Therefore, the present study was conducted to determine the knowledge, attitudes, and practices (KAP) among urban and rural communities and government officials about climate change and dengue in Laos and Thailand. A cross-sectional KAP survey about climate change and dengue were conducted in 360 households in Laos (180 urban and 180 rural), 359 households in Thailand (179 urban and 180 rural), and 20 government officials (10 in each country) using structured questionnaires. Data analysis was undertaken using descriptive methods, principal component analysis (PCA), Chi-square test or Fisher's exact test (as appropriate), and logistic regression. Significant differences among the selected communities in both countries were found in terms of household participant's age, level of education, socioeconomic status, attitude level of climate change and KAP level of dengue (P < 0.05; 95% CI). Overall, participants' KAP about climate change and dengue were low except the attitude level for dengue in both countries. The level of awareness among government officials regarding the climatic relationship with dengue was also low. In Lao households, participants' knowledge about climate change and dengue was significantly associated with the level of education and socioeconomic status (SES) (P < 0.01). Their attitudes towards climate change and dengue were associated with educational level and internet use (P < 0.05). Householders' climate change related practices were associated with SES (P < 0.01) and dengue related practices were associated with educational level, SES, previous dengue experience and internet use (P < 0.01). In Thailand, participants' knowledge about climate change was associated with the level of education and SES (P < 0.01). Their attitudes towards climate change were associated with residence status (urban/rural) and internet use (P < 0.05); climate change related practices were associated with educational level and SES (P < 0.05). Dengue related knowledge of participants was associated with SES and previous dengue experience (P < 0.05); participants' dengue related attitudes and practices were associated with educational level (P < 0.01). The findings call for urgently needed integrated awareness programs to increase KAP levels regarding climate change adaptation, mitigation and dengue prevention to improve the health and welfare of people in these two countries, and similar dengue-endemic countries. ترتبط حمى الضنك بتغير المناخ في البلدان الاستوائية وشبه الاستوائية بما في ذلك جمهورية لاو الديمقراطية الشعبية (لاوس) وتايلاند. يمكن أن تؤثر المعرفة بهذه القضايا والتدابير الوقائية على حدوث وخطر تفشي حمى الضنك. لذلك، أجريت هذه الدراسة لتحديد المعرفة والمواقف والممارسات (KAP) بين المجتمعات الحضرية والريفية والمسؤولين الحكوميين حول تغير المناخ وحمى الضنك في لاوس وتايلاند. وأجريت دراسة استقصائية مستعرضة للمعارف والمواقف والممارسات بشأن تغير المناخ وحمى الضنك في 360 أسرة معيشية في لاوس (180 في المناطق الحضرية و 180 في المناطق الريفية)، و 359 أسرة معيشية في تايلند (179 في المناطق الحضرية و 180 في المناطق الريفية)، و 20 مسؤولا حكوميا (10 في كل بلد) باستخدام استبيانات منظمة. تم إجراء تحليل البيانات باستخدام الأساليب الوصفية، وتحليل المكونات الرئيسية (PCA)، واختبار مربع كاي أو اختبار فيشر الدقيق (حسب الاقتضاء)، والانحدار اللوجستي. تم العثور على اختلافات كبيرة بين المجتمعات المختارة في كلا البلدين من حيث عمر المشارك في الأسرة، ومستوى التعليم، والوضع الاجتماعي والاقتصادي، ومستوى الموقف من تغير المناخ ومستوى المعرفة والتعلم والتعلم والتعلم من حمى الضنك (P < 0.05 ؛ 95 ٪ CI). بشكل عام، كانت المعارف والمواقف والممارسات للمشاركين حول تغير المناخ وحمى الضنك منخفضة باستثناء مستوى الموقف تجاه حمى الضنك في كلا البلدين. كما كان مستوى الوعي بين المسؤولين الحكوميين فيما يتعلق بالعلاقة المناخية مع حمى الضنك منخفضًا. في أسر لاو، كانت معرفة المشاركين حول تغير المناخ وحمى الضنك مرتبطة بشكل كبير بمستوى التعليم والوضع الاجتماعي والاقتصادي (P < 0.01). ارتبطت مواقفهم تجاه تغير المناخ وحمى الضنك بالمستوى التعليمي واستخدام الإنترنت (P < 0.05). ارتبطت الممارسات المتعلقة بتغير المناخ لدى الأسر بالخدمات الاجتماعية والاقتصادية (P < 0.01) وارتبطت الممارسات المتعلقة بحمى الضنك بالمستوى التعليمي، والخدمات الاجتماعية والاقتصادية، وتجربة حمى الضنك السابقة واستخدام الإنترنت (P < 0.01). في تايلاند، ارتبطت معرفة المشاركين بتغير المناخ بمستوى التعليم و SES (P < 0.01). ارتبطت مواقفهم تجاه تغير المناخ بوضع الإقامة (حضري/ريفي) واستخدام الإنترنت (P < 0.05 )؛ ارتبطت الممارسات المتعلقة بتغير المناخ بالمستوى التعليمي و SES (P < 0.05). ارتبطت معرفة المشاركين المتعلقة بحمى الضنك بالخدمات البيئية والاجتماعية وتجربة حمى الضنك السابقة (P < 0.05 )؛ وارتبطت مواقف المشاركين وممارساتهم المتعلقة بحمى الضنك بالمستوى التعليمي (P < 0.01). تدعو النتائج إلى برامج توعية متكاملة مطلوبة بشكل عاجل لزيادة مستويات المعارف والمواقف والممارسات فيما يتعلق بالتكيف مع تغير المناخ والتخفيف من آثاره والوقاية من حمى الضنك لتحسين صحة ورفاهية الناس في هذين البلدين، والبلدان الموبوءة بحمى الضنك المماثلة.

Aedes aegypti is the main vector of dengue globally. The variables that influence the abundance of dengue vectors are numerous and complex. This has generated a need to focus on areas at risk of disease transmission, the spatial-temporal distribution of vectors, and the factors that modulate vector abundance. To help guide and improve vector-control efforts, this study identified the ecological, social, and other environmental risk factors that affect the abundance of adult female and immature Ae. aegypti in households in urban and rural areas of northeastern Thailand. A one-year entomological study was conducted in four villages of northeastern Thailand between January and December 2019. Socio-demographic; self-reported prior dengue infections; housing conditions; durable asset ownership; water management; characteristics of water containers; knowledge, attitudes, and practices (KAP) regarding climate change and dengue; and climate data were collected. Household crowding index (HCI), premise condition index (PCI), socio-economic status (SES), and entomological indices (HI, CI, BI, and PI) were calculated. Negative binomial generalized linear models (GLMs) were fitted to identify the risk factors associated with the abundance of adult females and immature Ae. aegypti. Urban sites had higher entomological indices and numbers of adult Ae. aegypti mosquitoes than rural sites. Overall, participants’ KAP about climate change and dengue were low in both settings. The fitted GLM showed that a higher abundance of adult female Ae. aegypti was significantly (p < 0.05) associated with many factors, such as a low education level of household respondents, crowded households, poor premise conditions, surrounding house density, bathrooms located indoors, unscreened windows, high numbers of wet containers, a lack of adult control, prior dengue infections, poor climate change adaptation, dengue, and vector-related practices. Many of the above were also significantly associated with a high abundance of immature mosquito stages. The GLM model also showed that maximum and mean temperature with four-and one-to-two weeks of lag were significant predictors (p < 0.05) of the abundance of adult and immature mosquitoes, respectively, in northeastern Thailand. The low KAP regarding climate change and dengue highlights the engagement needs for vector-borne disease prevention in this region. The identified risk factors are important for the critical first step toward developing routine Aedes surveillance and reliable early warning systems for effective dengue and other mosquito-borne disease prevention and control strategies at the household and community levels in this region and similar settings elsewhere.

Cities worldwide are facing ever-increasing pressure to develop mitigation strategies for all sectors to deal with the impacts of climate change. Cities are expected to house 70% of the world’s population by 2050, and developing related resilient health systems is a significant challenge. Because of their physical nature, cities’ surface temperatures are often substantially higher than that of the surrounding rural areas, generating the so-called Urban Heat Island (UHI) effect. Whilst considerable emphasis has been placed on strategies to mitigate against the UHI-associated negative health effects of heat and pollution in cities, mosquito-borne diseases have largely been ignored. However, the World Health Organization estimates that one of the main consequences of global warming will be an increased burden of mosquito-borne diseases, many of which have an urban facet to their epidemiology and thus the global population exposed to these pathogens will steadily increase. Current health mitigation strategies for heat and pollution, for example, may, however, be detrimental for mosquito-borne diseases. Implementation of multi-sectoral strategies that can benefit many sectors (such as water, labor, and health) do exist or can be envisaged and would enable optimal use of the meagre resources available. Discussion among multi-sectoral stakeholders should be actively encouraged.

Despite intensive research activity within the area of climate change, substantial knowledge gaps still remain regarding the potential future impacts of climate change on human health. A key shortcoming in the scientific understanding of these impacts is the lack of studies that are conducted in a coordinated and consistent fashion, producing directly comparable outputs. This Viewpoint discusses and exemplifies a bottom-up initiative generating new research evidence in a more coordinated and consistent way compared with previous efforts. It describes one of the largest model comparisons of projected health impacts due to climate change, so far. Yet, the included studies constitute only a selection of health impacts in a variety of geographical locations, and are therefore not a comprehensive assessment of all possible impact pathways and potential consequences. The new findings of these studies shed light on the complex and multidirectional impacts of climate change on health, where impacts can be both adverse or beneficial. However, the adverse impacts dominate overall, especially in the scenarios with more greenhouse gas forcing. Overall, the future population at risk of disease and incidence rates are predicted to increase substantially, but in a highly location-specific and disease-specific fashion. Greenhouse gas emission mitigation can substantially reduce risk and resultant morbidity and mortality. The potential positive impact of adaptation has not been included in the models applied, and thus remains a major source of uncertainty. This bottom-up initiative lays out a research strategy that brings more meaningful research outputs and calls for greater coordination of research initiatives across the health community.

The expansion in the geographical distribution of vector‐borne diseases is a much emphasized consequence of climate change, as are the consequences of urbanization for diseases that are already endemic, which may be even more important for public health. In this paper, we focus on dengue, the most widespread urban vector‐borne disease. Largely urban with a tropical/subtropical distribution and vectored by a domesticated mosquito, Aedes aegypti, dengue poses a serious public health threat. Temperature plays a determinant role in dengue epidemic potential, affecting crucial parts of the mosquito and viral life cycles. The urban predilection of the mosquito species will further exacerbate the impact of global temperature change because of the urban heat island effect. Even within a city, temperatures can vary by 10 °C according to urban land use, and diurnal temperature range (DTR) can be even greater. DTR has been shown to contribute significantly to dengue epidemic potential. Unraveling the importance of within‐city temperature is as important for dengue as for the negative health consequences of high temperatures that have thus far been emphasized, for example, pollution and heat stroke. Urban and landscape planning designed to mitigate the non‐infectious negative effects of temperature should additionally focus on dengue, which is currently spreading worldwide with no signs of respite.

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