Decision making in the built environment as a public health intervention for malaria control in a changing climate

The overarching goal of the proposed proposal is building and validating transdisciplinary knowledge on climate-health-built environment connections that can be linked to the risk of malaria transmission in a changing climate. The specific objectives associated with this goal are: 1) conducting stakeholder engagement and participatory research with communities to understand local, place-based climate-related health threats and develop effective adaptation and mitigation strategies that focus on community resilience; 2) assessing potential impacts of future compounding and cascading climate change events and hazards on malaria over different timescales; 3) performing intersectional analyses to better understand differential Malaria, existing and compounding vulnerabilities, and the impacts of climate change experienced by vulnerable populations; 4) Exploring the potential direct or indirect health co-benefits, risks, or unintended consequences / maladaptive response of climate change mitigation and adaptation measures, and; 5) developing and validating a decision support framework that can be used to evaluate how the design aspects of the physical and built environment (urban, indoor, outdoor) could help mitigate climate change, support adaptation measures, and improve malaria prevention. Climate change impacts on vector-borne disease transmission and the climate vulnerability of marginalized communities across the globe is a growing concern (CDC, 2022; Rocklöv and Dubrow, 2020; Thompson and Stanberry, 2022; Sutherst, 2004). Climate change-related extreme heat and flooding cause an increased risk of vector-borne diseases, resulting in overburdening of under-resourced healthcare sectors in resource-constrained contexts. Increasing global temperatures allows mosquitoes to encroach into new areas and increase the transmission of parasites. Plastic pollution, open sewers, and stagnant storm water interact with changes in rainfall intensity to create breeding sites for vector mosquitoes (Landrigan et al, 2023; Kumar et al, 2021). Higher night-time temperatures coupled with inadequate building cooling and ventilation drive occupants to avoid bed nets and/ or, open windows, and spend time or sleep outside during prime mosquito-biting hours. Recognizing these risks and developing suitable built-environment responses will help reduce malaria transmission. The adverse impacts of climate on health have been acknowledged (Woodward, 2014; Campbell-Lendrum, 2023; Patz and Olson. 2006; Romanello et al., 2023), particularly dynamics of vector-borne diseases (Lafferty, 2009; Caminade, 2019; Williams, 2021). More data is needed on how the built environment contributes to the incidence of Malaria in a changing climate. The term “built environment” as used in this proposal refers to human-made or modified physical areas such as our homes, communities, schools, workplaces, parks/recreational areas, business areas, water and sanitation systems, and transportation systems (Younger, 2008). These vary in size from smaller rural to peri-urban and large-scale urban areas. The built environment has also been linked to changes in the environment that directly or indirectly influence the incidence and distribution of vector-borne diseases (Rocklöv et al., 2022; Shenton et al., 2019; Obonyo et al., 2019). Our proposed research will deepen the understanding of the intersection of gender, access, and interventional design. There are significant gaps in our understanding of how sex, gender roles and poverty intersect to create gender-specific vulnerabilities. We will explore the impact of gender norms and associated gender inequities such as education levels, access to economic assets, and access to and use of malaria prevention strategies. Our proposed research will address these intersectional challenges from a transdisciplinary approach, engaging academic and non-academic expertise. Malaria transmission risks are multifaceted. Urban political ecology studies on public health issues in cities underscore the need to broaden understanding of and solutions to such health issues beyond technocentric approaches (Moore, 2011; Robbins and Miller, 2013) and to consider the socio-political and the spatial dimensions that equally shape the risk factors (Ferring and Hausermann, 2019; Connolly et al., 2021). At the same time, these risk factors can be observed at different scales (Wolf, 2016). The multi-scale aspects address translational science challenges that have been articulated by the WHO/UN-HABITAT Multi-sectoral Working Group on malaria (co-chaired by Mbazazi, a senior personnel in this proposal). Using comparative case studies from the participating regions, the project team will derive research insights and address transdisciplinary methodological gaps at the nexus of climate change mitigation and adaptation, the built environment, and malaria’s impacts on human health. Specifically, our Belmont Forum project will develop a novel transdisciplinary methodology drawing from convergent approaches in global comparative research for understanding both common drivers and context-specific processes that can catalyze progress toward a climate-smart, malaria-free building sector. This methodology will leverage GCSE’s extensive network of subject matter experts. Existing approaches will be tailored to our projects through hosting 6 actionable knowledge workshops. Penn State and GCSE will host the kick-off workshop. Ardhi University will host the second workshop in Tanzania. During the second year, project team members will take turns to host stakeholder engagement workshops in Panama, Mozambique, and Nigeria. These will mirror the event in Tanzania. Penn State will leverage institutional resources to host a convening event for the broader community of stakeholders in public health responses to malaria in a changing climate. The investigators will also build on primary data from previous research efforts. For example, Obonyo, Mhina, and Madivate have collected data from households impacted by recent extreme weather events in Florida and selected coastal communities in Mozambique and Tanzania as part of a Belmont Forum Disaster Risk Reduction project that seeks to advance the resilience of low-income housing. Kibe, Mulure, and Mutunga have led malaria research efforts in Kenya. Anyanwu and Adetoun have findings from previous research efforts in Nigeria. Young has extensive community engagement experiences in Panama. The selected test beds have varied malaria transmission risks across many dimensions of complexity. In addition to climate, hydrology, ecology, and other biophysical factors, these include human and technology factors. This project offers an opportunity to leverage, improve, and apply actionable knowledge methodologies across these dimensions; and to use this actionable knowledge to generate transdisciplinary insights on built environment-related malaria prevention strategies.