While the heat wave impacts on public health have been widely addressed in developed countries especially after the intense event over West Europe during summer 2003, no effort has been made to detect them and evaluate their impacts in least developed countries, and especially Africa where the climate is warmer and adaptation capacities are low. Over West Africa preliminary interviews, climate and epidemiologic analyses show however that this problem is emerging. Moreover climate projections in this area indicate that such events should increase in frequency and intensity in the near future. However these climate models display huge biases in their mean state over this region, and recent studies highlighted large radiative and low-level temperature biases. In order to provide robust information on the future evolution of heat waves, it is necessary to reduce as much as possible these biases. Starting from this context, the main objective of ACASIS is to set-up a pre-operational heat wave warning system over West Africa tailored to health risks of the population living in this region. This is a demonstration project focused on Senegal and Burkina where national weather services have already started developing products dedicated to weather/climate and health relationships, and where several health and demographic observatories have been operating for up to several decades. Based on qualified meteorological, climate and demographic data bases, firstly, the dynamics of the heat wave events and their atmospheric patterns will be determined, as well as their evolution over the last decades. Their predictability at short and medium ranges will be evaluated on ensembles of multi-models forecasts outputs. On a longer time scale, control simulations and climate scenarios of the CMIP5/AR5 database will be analysed and the simulated future evolution and associated uncertainty of these events will be evaluated. More precisely the processes at the origin of model radiative biases will be examined and reduced as much as possible. In parallel, epidemiologic studies associated with interviews will be conducted in the health and demographic sites in Senegal and Burkina in order to evaluate the physiologic and social vulnerability of the African population to high temperature extremes. It will allow to define tailored bio-meteorological indicators to be used in the warning system. From these outcomes and by implementing downscaling to link the synoptic scale of the heat waves to local bio-meteorological indicators, we will set-up a demonstration warning system on a “testbed” platform named MISVA, already implemented as the result of a prior collaboration between Meteo-France, OMP and ANACIM, the meteorological agency of Senegal. Based on the interviews, and with the setting of several workshops with stakeholders and public institutions, we will be able to provide specific recommendations associated to these warnings. An implementation in the Meteo-France operational system at the end of the project or after might be possible. To carry on this project, a pluri-disciplinary consortium has been set-up gathering climatologists, physical processes specialists, meteorologists, biostatisticians, demographers, socio-economists, epidemiologists, geographers, and operational meteorological agencies. It will work through a close collaboration between French and African teams where young African researchers will be highly involved.

Changemaker objective: To implement & evaluate a sustainable health intervention program on health, nutrition, & environmental outcomes for the primary prevention of adolescent obesity & related non-communicable diseases (NCDs) together with adolescents in three rapidly urbanizing cities in Burkina Faso, Kenya, Tanzania. Background: There is an increasing epidemic of adolescent obesity that can contribute to adult obesity, morbidity & NCDs in a broader sense. Sustainable health interventions in urban low- and middle-income countries are critical in addressing lifestyle factors that contribute to obesity, diabetes & hypertension in later life, such as unhealthy dietary habits, inactivity & sedentary behaviors while shaping urban environments. Considering obesity is a complex issue that is influenced by wide range of interconnected factors, such as policy, environment, social, economic, cultural, behavioral, commercial, & biological determinants, a whole-systems approach that converges multiple sectors (i.e., health, education, environment, and agriculture) and stakeholders (i.e., adolescents, caregivers, staff, local government, communities, policymakers & implementers) are needed for obesity prevention in LMICs. Our strategy: Four evidence-based strategies, which will be adapted to context through a co-design process: 1) urban farming in schools with satellite farms and organic waste composting, 2) sustainable health modules for classrooms, 3) linking to healthcare workers through health talks using motivational interviewing techniques and 4) WHO Best Buys: Mass media campaign. Our evaluation: 3 cluster-RCTs in secondary schools, within the framework of urban Health & Demographic Surveillance Systems, implementation, process evaluation & cost-effective evaluation. Our expected results: Evidence of how to implement and scale a sustainable health intervention. Estimate a mean difference in BMI of 0.175 which could lead to reduction of 5% in the prevalence of obesity.

Noncommunicable diseases (NCDs) are a major public health problem, resulting in over 70% of global deaths each year; the majority (85%) of deaths occur in low-and middle-income countries. While cost-effective, evidence-based best practices are available, implementation of these interventions has remained a critical challenge, particularly ones targeted at promoting health behaviors among adolescents and youth. Despite the importance, few studies have been undertaken to identify the facilitators and barriers to the implementation of evidence-based interventions that promote healthy behaviors among adolescents and youth in sub-Saharan Africa (SSA). "Reducing nutrition-related noncommunicable diseases in adolescence and youth: From nutrition literacy to fluency" will take a major step towards improving the implementation of evidence-based interventions – nutrition education and SSB policy - that promote healthy behaviors among adolescents and youth in SSA to reduce the impact of NCDs. With the use of a multi-disciplinary approach, innovative design, and cutting-edge tools, the proposed project aims to establish a global alliance to prevent and reduce nutrition-related NCDs among adolescence and youth in SSA region, by shaping individuals’ health behaviors through nutrition literacy and fluency, assessing the impact and performance of the nutrition-related policy and promotion programs, and providing flexible, cost-effective, scalable, reliable, secure and easy-to-use tools. The establishment of an Africa Think Tank for Adolescents and Youth Health, and annual forums will help facilitate continuous engagement with key stakeholders to enhance buy-in, acceptance and relevance of the project outputs. Ultimately, the expected wider effects of this project include improved NCD prevention policy adoption and implementation, improved policies and evidence-informed decision making amongst key stakeholders, and ultimately decreased avoidable mortality due to NCDs.