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Nepal is a country economically dependent on climate-sensitive industries. It is highly vulnerable to the environmental, social, economic and health impacts of climate change. The objective of this study is to explore community perceptions of climate variability and human health risks. In this letter, we present a cross sectional study conducted between August 2013 and July 2014 in the Tanahu district of Nepal. Our analysis is based on 258 face-to-face interviews with household heads utilizing structured questionnaires. Over half of the respondents (54.7%) had perceived a change in climate, 53.9% had perceived an increase in temperature in the summer and 49.2% had perceived an increase in rainfall during the rainy season. Half of the respondents perceived an increase in the number of diseases during the summer, 46.5% perceived an increase during the rainy season and 48.8% during winter. Only 8.9% of the respondents felt that the government was doing enough to prevent climate change and its impact on their community. Belonging to the Janajati (indigenous) ethnic group, living in a pakki, super-pakki house and belonging to poor or mid-level income were related to higher odds of perceiving climate variability. Illiterates were less likely to perceive climate variability. Respondents living in a pakki house, super-pakki, or those who were poor were more likely to perceive health risks. Illiterates were less likely to perceive health risks.
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Environ. Res. Lett. 10 (2015) 034007 doi:10.1088/1748-9326/10/3/034007
LETTER
Climate change and adverse health events: community perceptions
from the Tanahu district of Nepal
Shiva Raj Mishra
1
, Parash Mani Bhandari
2
, Rita Issa
3
, Dinesh Neupane
4
, Swadesh Gurung
5
and
Vishnu Khanal
1
1
Nepal Development Society, Chitwan, Nepal
2
Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
3
University College London, UK
4
Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
5
Ipas, Kathmandu, Nepal
E-mail: shivarajmishra@gmail.com,parashmanibhandari@gmail.com,ritaissa88@gmail.com,neupane.dinesh@gmail.com,
grgswadesh@gmail.com and khanal.vishnu@gmail.com
Keywords: climate change, perception, health, Nepal, disease, variability
Abstract
Nepal is a country economically dependent on climate-sensitive industries. It is highly vulnerable to
the environmental, social, economic and health impacts of climate change. The objective of this study
is to explore community perceptions of climate variability and human health risks. In this letter, we
present a cross sectional study conducted between August 2013 and July 2014 in the Tanahu district of
Nepal. Our analysis is based on 258 face-to-face interviews with household heads utilizing structured
questionnaires. Over half of the respondents (54.7%) had perceived a change in climate, 53.9% had
perceived an increase in temperature in the summer and 49.2% had perceived an increase in rainfall
during the rainy season. Half of the respondents perceived an increase in the number of diseases
during the summer, 46.5% perceived an increase during the rainy season and 48.8% during winter.
Only 8.9% of the respondents felt that the government was doing enough to prevent climate change
and its impact on their community. Belonging to the Janajati (indigenous) ethnic group, living in a
pakki, super-pakki house and belonging to poor or mid-level income were related to higher odds of
perceiving climate variability. Illiterates were less likely to perceive climate variability. Respondents
living in a pakki house, super-pakki, or those who were poor were more likely to perceive health risks.
Illiterates were less likely to perceive health risks.
Introduction
Nepal is diverse in its geography, ecosystemand culture.
As a country economically dependent on climate-
sensitive industries such as agriculture, forestry and
ecotourism, it ranks 14th in the world when assessing
for vulnerability to climate change [1]. Since 1975, the
temperature of the country has risen 1.8 °C, with an
average annual increase of 0.06 °C [2]. This may have
detrimental effects [3]. The environmental, social and
economic impacts of climate change are rst and most
strongly felt by communities who live in ecologically
fragile areas [4]. Such communities often depend on
local natural resources for survival. Assessing these
communitiesperception and response to climate
variabilitysuch as short to medium term uctuations
in climate statecan identify early coping mechanisms
that are adopted to mitigate the worst of climate change.
Climate change is arguably the biggest current
threat to public health, contributing to the global bur-
den of disease and premature death [5]. Variant cli-
mate patterns and global warming will alter the
pattern and prevalence of infectious and vector-borne
diseases [6]. Disease burden may also increase as a
result of climate change related migration of reservoir
hosts [7]. Additionally, climate variability will lead to a
resurgence and increased endemicity of tropical dis-
eases [6]. Globally, an estimated 166 000 deaths result
from change in climate annually, relative to the aver-
age baseline measurements between 19611990 [8].
Diarrhea, the leading cause of under-ve deaths in
developing countries, is estimated to increase by 25%
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by 2020. Furthermore, annually, 5.5 million disability
adjusted life years (DALYs) can be attributed to cli-
mate change [9]. An earlier study reported ve cate-
gories of health outcomes which are most likely to be
affected by climate change: temperature-related mor-
bidity and mortality; health effects of extreme weather
events (storms, tornadoes, hurricanes, and precipita-
tion extremes); air-pollution-related health effects;
water-borne and food-borne diseases; and vector-
borne and rodent-borne diseases [10].
In Southeast Asia, including Nepal, there is a like-
lihood of increased epidemics of malaria, dengue,
other vector-borne diseases and climate-change
attributed diarrhea [1113]. As a result of rising global
temperatures, rainfall is predicted to increase, thereby
increasing the likelihood of ooding. Droughts and
ooding will result in declining crop yields and sub-
sequent malnutrition in this region [13]. Additionally,
Nepal is vulnerable to ooding, mudslides and glacier
lake outbursts secondary to the melting Himalayan
glaciers, which will lead to uctuations in the quality
and quantity of water, available land mass and envir-
onmental safety [14]. Few studies have explored the
spatial correlation between climate change and health
outcomes [1517]. Little is known about perceptions
of climate variability and subsequent health risks in
Nepal, particularly amongst the most at-risk commu-
nities. The following questions are explored in this
study:
(i) What are local perceptions of climate varia-
bility; what form does climate variability take? (ii) does
the local community perceive changes in patterns and
burden of disease?
Our ndings are useful to guide climate change
policy for at-risk communities. Utilizing local peoples
perception and coping strategies is essential if inter-
ventions are to be well targeted and well placed. Such
data gathered amongst the most vulnerable commu-
nities are useful for the implementation of wider
national and international policy and strategy.
Materials and methods
We performed a cross sectional study in the Tanahu
district of Nepal. This district is located in the central
hilly region of the country. It covers an area of
1546 km
2
and has a population of 323 228 [18]. The
district is at an elevation of 3402134 m above sea
level. The climate is tropical and sub-tropical, and the
temperature ranges from 5 °C to 48 °C [19].
This study was conducted in the Bhimad village
which was purposefully selected as a place where the
Terai plain meets the hills. The village is orientated to
commerce and tourism. This Village Development
Committee (VDC; the lowest administrative unit in
Nepal [20]) has a total of 2191 households and is
inhabited by 8414 people [18].
Study samples were drawn using proportionate
stratied random sampling. A comprehensive list of
households was obtained from the ofce of the VDC
and the existing administrative division of wards was
used to stratify the VDC into 9 strata. Samples were
selected in proportion to the population size of each
strata using systematic random sampling. Heads of
respective households were selected for face-to-face
interviews. If the head of the household was not pre-
sent at the time of the interview, the eldest person from
the same house was selected for the interview. We
selected 258 households, considering a 5 percent
allowable error. This is based on a similar study com-
pleted in Bangladesh, which found that 80% of
respondents perceived increased summer tempera-
tures, a decrease in rainfall and warmer winters (21).
The study questionnaire was prepared in considera-
tion with previous works for reference [2124]. Earlier
studies on perceptions of climate change have used a
ve point Likert scale, with a scale of 1 to 5 to denote
perceptions of climate variability. However, these did
not go so far as to measure what factors were attributed
to variability (22). In our study, we used a similar
approach with additional exposure variablese.g. per-
ception of climate variability, health riskmeasured
dichotomously (yesand no). By calculating such
variables, a new dimension is added to the existing lit-
erature. Prior to interviewing the 258 household heads,
the questionnaire was pre-tested among 20 household
heads in Nayapati VDC, Kathmandu, Nepal. The study
tool assessed an individuals: i) socio-demographic fac-
tors (age, sex, ethnicity, educational status, type of
family, type of house, main source of income and area
of cultivable land owned by the family) ii) perception of
climate variability over the past ve years, and iii) per-
ception of health risks. Demographic characteristics
were gathered through direct questioning and house-
hold observation. We further used classications from
the 2008 Household Budget Survey to identify house
types (25). A super-pakki house is dened as the house
in which both the walls and the roof are built in perma-
nent materials, such as cement, concrete and bricks. A
pakki house is a house where either wall or roof is built
in permanent materials and the other is built in tempor-
ary materials. A Kachhi house is one where both walls
and roof are built in temporary materials, such as mud,
straw, bamboo or plastic.
Respondents were asked whether they had experi-
enced, observed or witnessed given climate-change
related indicators. Three options provided to the
respondent were yes,noand do not know. Total
scores for climate variability and health risks were cal-
culated. Perception of climate variability was indicated
if the total score was greater than the median. The fol-
lowing questions were asked to the respondents to
measure the perception of climate variability:
1. Have you perceived a change in the degree of
hotness during the summer?
2
Environ. Res. Lett. 10 (2015) 034007 S R Mishra et al
2. Have you perceived a change in the degree of
coldness during the winter?
3. Have you perceived change in the amount of
rainfall during the rainy season?
We further tested whether respondents had a per-
ception of a change in disease occurrence. The per-
ceived human health risk was indicated if the
perceived health risk score was greater than the med-
ian. The following questions were asked to measure
the perception of health risks:
1. Have you perceived a change in the occurrence of
disease during the summer?
2. Have you perceived a change in the occurrence of
disease during the winter?
3. Have you perceived a change in the occurrence of
disease during the rainy season?
Data was entered into EpiData 3.1 and analyzed
using SPSS Version 17 (SPSS Inc., Chicago). We
considered all variables used in bivariate analysis for
multiple logistic regressions to control for confound-
ing [26].
This study was conducted from August 2013 to
July 2014 and the participantsenrollment was active
from March to May 2014. The study protocol was
approved by the Institutional Review Board (IRB) at
the Institute of Medicine, Tribhuvan University,
Nepal. Permission for conducting the study was also
obtained from the VDC ofce. We obtained written
informed consent from each household head after
explaining the rationale of the study. We ensured the
condentiality and anonymity of participants.
Respondents were informed of the right not to answer
any of the asked questions or leave the interview with-
out reason. A few of the respondents could not read or
write and provided verbal consent for interview.
Results
Characteristics of the respondents
Of the 258 participants, 74.4% were female and 86.8%
were aged 24 years or older. When asked about the size
of family, 53.9% reported to be living in nuclear
families. Agriculture was the main source of income
for 33.6% of the households questioned, followed by
foreign remittance at 28.3% of households. In terms of
economic status, 15.5% self-rated as poor, and 76%
as middle income. 27.1% percent were illiterate and
43.4% had a basic education (table not shown).
Perception of climate change and health risks
Over half of respondents had perceived a change in
climate (54.7%). A total of 53.9% perceived an
increase in hotness in the summer and 49.2% had
perceived an increase in rainfall during the rainy
season. Similarly, 50.0% had perceived an increase in
the number of diseases during the summer, 46.5%
perceived this increase during the rainy season and
48.8% during the winter (gure 1).
When asked about changes in local climate, 31.4%
noted an increase in wind velocity during the summer,
43.4% said rainfall during the summer was adequate,
though 5.8% had seen a spring dry up over the
preceding ve years (table not shown).
Household heads were asked for the necessity and
adequacy of both personal and government efforts in
mitigating climate change and its impact on the com-
munity. 3 in 10 respondents agreed that personal
effort was essential for climate change mitigation.
Only 8.9% felt that the government was doing enough
(gure 2).
Being a female (aOR = 1.780, 95% CI (0.991;
3.200)), belonging to the Janajati (indigenous) ethnic
group (aOR = 2.492, 95% CI (1.293; 4.801)), living in
apakki (aOR = 3.662, 95% CI (1.3889.663)), super-
pakki house (aOR = 5.862, 95% CI (2.119; 16.218)), or
belonging to poor (aOR = 9.187, 95% CI
(1.80846.675)) and those with mid-level income
(aOR = 5.193, 95% CI (1.34220.098)) were related to
higher odds of perceiving climate variability. The illit-
erate were less likely to perceive climate variability
(aOR = 0.410, 95% CI (0.1900.884)) (table 1).
Respondents living in a pakki house (aOR = 2.907,
95% CI (1.1657.256)), super-pakki (aOR = 4.833,
95% CI (1.84412.672)), and being poor (aOR =
5.163, 95% CI (1.13823.416)) were more likely to
perceive health risks. The illiterate were less likely to
perceive health risks (aOR = 0.320, 95% CI
(0.1500.684)) (table 2).
Discussion and conclusions
Whilst this is the rst study to report community
perception of climate variability and health risks in
Nepal, a number of limitations need to be considered.
Firstly, all respondentsperception of climate varia-
bility and health risks were measured from proxy
indicators. Secondly, this study surveyed a large
number of households in a single village of a mid-hill
district of Nepal. Due to coverage of such a small study
area, extrapolation of the ndings to other parts of the
country may be limited. Finally, measuring perception
of climate variability and health risks is difcult. The
responses recorded through indicators may suffer
recall bias, and be subject to personal judgment [21].
Nevertheless, the ndings of this study reect the
communitiesview on climate change and health, and
will be important while launching programs to
mitigate future adverse events.
Data conrm that Nepal has experienced a mea-
surable change in climate, particularly in precipitation
patterns and heat stress [1517]. Our study ndings
3
Environ. Res. Lett. 10 (2015) 034007 S R Mishra et al
show these objective ndings are reected in sub-
jective measurements of climate change at a commu-
nity level. A signicant proportion of respondents
have a clear perception of climate variability, most
notably through increased summer temperatures,
higher wind velocity and increased rainfall during the
rainy season.
People falling under the Janajati (indigenous)
group were found to have higher odds of perceiving
climate variability. This observed association could be
accounted for their close relationship with and reli-
ance upon environmental resources for survival. An
earlier similar study conducted among indigenous
people in Nigeria [27]reects these ndings, stating
that over a few decades, 73% had experienced rising
temperatures, 83.5% had expressed a decrease in rain-
fall and 75% had said the environment is becoming
drier to the point of affecting human comfort. Our
study found association between economic level and
perception of climate variability and health risks.
Those with lower economic level depend on natural
resources such as forest, grassland and wetland [28],
thus they are supposed to perceive climate variability
and disease occurrence more compared to people of
higher economic level. Education was positively asso-
ciated with perception of climate variability and health
risks. Literacy of the effects of climate change can be
instrumental in achieving better adaptation at com-
munity level. Further research is needed to shed light
on our speculations.
Compared to a similar study in Bangladesh [21], a
smaller percentage of our research community per-
ceived climate variability. Such differences may be an
accurate perception due to oods and heat waves
being more common in Bangladesh than in Nepal. In
an another study in Nepal, 73.2% of people believed
that the weather was getting warmer, 67.2% believed
that the onset of summer and monsoon had advanced
during the last 10 years; furthermore, 46% believed
that there was less snow on mountains than before and
70% felt that water sources were drying up [29]. Again,
variation in results may be due to inherent differences
in the study location.
Table 1. Factors associated with perception of climate variability.
Variables OR (95% CI) aOR (95% CI)
Age 0.674
<20 years 1
2045 years 1.175 (0.4802.875)
>45 years 1.439 (0.5573.718)
Sex 0.054
Male 1
Female 1.780 (0.9913.200)
Ethnicity 0.000 0.000
Brahmin/
Chhetri
11
Janajati 2.476
a
(1.3384.580) 2.492
a
(1.2934.801)
Dalit 0.763 (0.3521.653) 0.608 (0.2611.414)
Type of family 0.577
Nuclear 1
Joint 0.817(0.4941.351)
Extended 1.562(0.3377.242)
Education 0.197 0.066
Educated 1 1
Literate 0.998 (0.5481.818) 0.725 (0.3701.422)
Illiterate 0.601 (0.3091.170) 0.410
a
(0.1900.884)
Source of
income
0.063
Agriculture 1
Skilled 1.863
a
(1.0843.202)
Labor 1.073 (0.3833.003)
House type 0.019 0.003
Kachha 11
Pakki 2.071 (0.9204.660) 3.662
a
(1.3889.663)
Super-pakki 2.950
a
(1.3686.362) 5.862
a
(2.11916.218)
Economic level 0.096 0.027
Poor 2.400 (0.5819.908) 9.187
a
(1.80846.675)
Mid-level
income
3.589 (0.98313.100) 5.193
a
(1.34220.098)
Rich 1 1
a
p < 0.05, statistically signicant at 95% CI.
Table 2. Factors associated with perception of health risks.
Variables OR (95% CI) aOR (95% CI)
Age 0.601
<20 years 1
20-45 years 1.336 (0.5463.266)
>45 years 1.596 (0.6184.124)
Sex 0.199
Male 1
Female 1.454 (0.8222.573)
Ethnicity 0.008 0.006
Brahmin/
Chhetri
11
Janajati 1.900
a
(1.0423.464) 1.805(0.950 3.430)
Dalit 0.750 (0.3571.574) 0.596 (0.2641.346)
Type of family 0.86
Nuclear 1
Joint 0.987 (0.5991.625)
Extended 1.518 (0.3287.035)
Educational
status
0.058 0.011
Educated 1 1
Literate 0.880 (0.4831.604) 0.651(0.335 1.264)
Illiterate 0.477
a
(0.2450.928) 0.320
a
(0.1500.684)
Source of
income
0.116
Agriculture 1
Skilled 1.662 (0.9752.832)
Labor 0.883 (0.3172.463)
Type of house 0.038 0.005
Kachha 11
Pakki 1.804 (0.8263.941) 2.907
a
(1.1657.256)
Super-pakki 2.560
a
(1.2235.359) 4.833
a
(1.84412.672)
Economic level 0.155 0.098
Poor 1.833 (0.4966.778) 5.163
a
(1.13823.416)
Mid-level
income
2.723 (0.8398.835) 3.384 (0.98211.655)
Rich 1 1
a
p < 0.05, statistically signicant at 95% CI.
4
Environ. Res. Lett. 10 (2015) 034007 S R Mishra et al
At present, there are few studies reporting a cor-
relation between climate change and diseases occur-
rence in Nepal. An earlier study reported a 1 °C
increase in minimum and mean temperatures and
increased malaria incidence by 27% [30]. Public per-
ception of climate change is not new to literature
[2124]; however, further analysis exploring pre-
dictors of climate variability and health risks have not
been reported before. Our study format and ndings
can benet further research in the eld to link sub-
jective and objective measures of climate change.
Furthermore, our study pointed out strong evidence
to support climate variability in Nepal. Perception of
climate variability and diseases occurrence were pre-
dicted by a number of factors, including socio-demo-
graphic (ethnicity, education, house type) and
economic level. The literature states that voluntary
mitigation and adaptation is often the result of per-
ception of climate variability [31]. In the light of this
evidence, better awareness activities about climate
variability and associated human health risks can
yield better adaptation and mitigation practices in
Nepal. Our ndings can particularly be of higher
importance to the National Adaptation Program of
Actions 2010(32) and the Local Adaptation Plan of
Action National Framework 2011launched by the
Ministry of Science, Technology and Environment
[33]. These two frameworks are keys to successfully
adapting to and mitigating climate change in Nepal.
As measures to address and mitigate climate change
receive increasing priority, our data outcomes are
valuable: to assist policy makers in mapping commu-
nity vulnerability to climate change and adverse
health outcomes, and to better direct the design of
community based mitigation and adaptation strate-
gies in Nepal and beyond.
Data accessibility
Data will be made available upon the approval from
Institutional Review Board of Institute of Medicine.
Figure 1. Perception of climate variability and disease occurrence.
Figure 2. Attitude towards climate change.
5
Environ. Res. Lett. 10 (2015) 034007 S R Mishra et al
Acknowledgments
The authors wish to thank the study participants for
contributing their valuable support, time and
responses. We appreciate the help of the Community
Health Diagnosis-Bhimad team. The authors thank
Department of Community Medicine and Public
Health, the Institute of Medicine Nepal, and the
Bhimad Village Development Committee ofce for
their support during the research.
Competing Interest
The authors declare no competing interests.
Authors Contribution
SRM conceived the research work. PMB coordi-
nated the eld level data collection. SRM and SG car-
ried out the data analysis. SRM wrote the draft of the
manuscript. VK, RI and DN contributed in the litera-
ture review, interpretation of results and manuscript
revision. All the authors contributed in the revision of
the paper and agreed on the nal manuscript.
References
[1] Kreft S and Eckstein D 2014 Global Climate Risk Index 2014
(Bonn: Germanwatch e.V.) http://germanwatch.org/en/
download/8551.pdf
[2] Shrestha A, Budhathoki K, Shrestha R and Adhikari R 2004
Bathymetric survey of Tsho Rolpa Glacier Lake2002 Hydrol-
ogy J. SOHAM 1135
[3] Kim K H, Kabir E and Ara Jahan S 2014 A review of the
consequences of global climate change on human health
J. Environ. Sci. Health C32 299318
[4] Lama S and Devkota B 2009 Vulnerability of mountain
communities to climate change and adaptation strategies
J. Agric. Environ. 10 7683
[5] IPCC Climate Change 2007 Synthesis Report. Contribution of
Working Groups I, II and III to the Fourth Assessment Report of
the Intergovernmental Panel on Climate Change (Cambridge:
Cambridge University Press)
[6] Haines A, Kovats R S, Campbell-Lendrum D and Corvalan C
2006 Climate change and human health: impacts, vulnerability
and public health Public Health 120 58596
[7] Hales S, Kovats S and Woodward A 2000 What El Niño can tell
us about human health and global climate change Glob.
Change Human Health 16677
[8] McMichael A J, Campbell-Lendrum D, Kovats R S,
Edwards S and Wilkinson P 2004 Comparative Quantication
of Health Risks: Global and Regional Burden of Disease due to
Selected Major Risk Factors (Geneva: World Health
Organization)
[9] World Health Organization 2002 The World Health Report
2002: Reducing Risks, Promoting Healthy Life (Geneva: World
Health Organization)
[10] Patz J A et al 2001 The potential health impacts of climate
variability and change for the United States. Executive
summary of the report of the health sector of the US National
Assessment J. Environ. Health 64 208
[11] Martens P et al 1999 Climate change and future populations at
risk of malaria Glob. Environ. Change 9S89107
[12] Bai L, Morton L C and Liu Q 2013 Climate change and
mosquito-borne diseases in China: a review Glob. Health 9:10
doi:10.1186/1744-8603-9-10
[13] Parry M L 2007 Climate change 2007: impacts Adaptation and
Vulnerability: Working Group II Contribution to the Fourth
Assessment Report of the IPCC Intergovernmental Panel on
Climate Change (Cambridge: Cambridge University Press)
[14] Barnett T P, Adam J C and Lettenmaier D P 2005 Potential
impacts of a warming climate on water availability in snow-
dominated regions Nature 438 3039
[15] Marahatta S, Dangol B S and Gurung G B 2009 Temporal and
Spatial Variability of Climate Change over Nepal (19762005)
(Kathmandu: Practical Action Nepal Ofce) http://
practicalaction.org/le/region_nepal/ClimateChange1976-
2005.pdf
[16] Bhandari G P, Gurung S, Dhimal M and Bhusal C L 2012
Climate change and occurrence of diarrheal diseases: evolving
facts from Nepal J. Nepal Health Res. Council 10 1816
[17] Pradhan B, Shrestha S, Shrestha R, Pradhanang S,
Kayastha B and Pradhan P 2013 Assessing climate change and
heat stress responses in the Tarai region of Nepal Indust. Health
51 10112
[18] Central Bureau of Statistics. National Population and Housing
Census. Kathmandu (Nepal): Central Bereau of Statistics 2011
[19] Central Bureau of Statistics 2012 District Pro le Tanahu
(Kathmandu: CBS)
[20] Poudel J P (ed) 2013 Demographic Pro le of Nepal, 2013/2014:
VDC and Municipality Population, Household and Population
by Sex: Ward Level (Kathmandu: Mega Research Centre and
Publication)
[21] Haque M A, Yamamoto S S, Malik A A and Sauerborn R 2012
Householdsperception of climate change and human health
risks: a community perspective Environmental Health: A
Global Access Science Source 11 1
[22] Devkota R P 2014 Climate change: trends and peoples
perception in Nepal J. Environ. Protection 2014 25565
[23] Akerlof K et al 2010 Public perceptions of climate change as a
human health risk: surveys of the United States, Canada and
Malta. International J. Environ. Res. Public Health 7
2559-606
[24] Semenza J C, Hall D E, Wilson D J, Bontempo B D,
Sailor D J and George L A 2008 Public perception of climate
change voluntary mitigation and barriers to behavior change
Am J. Preventive Med. 35 47987
[25] Nepal Rastra Bank 2008 Types of House (Dwelling Units)
(Kathmandu: Nepal Rastra Bank)
[26] Bursac Z, Gauss C H, Williams D K and Hosmer D W 2008
Purposeful selection of variables in logistic regression Source
Code for Biology and Medicine 317
[27] Ishaya S and Abaje I 2008 Indigenous peoples perception on
climate change and adaptation strategies in Jemaa local
government area of Kaduna State, Nigeria J. Geography Regio-
nal Planning 113843
[28] International Fund for Agricultural Development 2011 Rural
Poverty Report 2011 (Rome: IFAD)
[29] Chaudhary P and Bawa K S 2011 Local perceptions of climate
change validated by scientic evidence in the Himalayas
Biology Lett. 776770
[30] Dhimal M, OHara R B, Karki R, Thakur G D, Kuch U and
Ahrens B 2014 Spatio-temporal distribution of malaria and its
association with climatic factors and vector-control interven-
tions in two high-risk districts of Nepal Malaria J. 13 457
[31] Semenza J C, Ploubidis G B and George L A 2011 Climate
change and climate variability: personal motivation for
adaptation and mitigation Environ. Health 10 46
[32] Ministry of Science Technology and Environment 2010
National Adaptation Programmes of Action (NAPA)
(Kathmandu: Ministry of Environment)
[33] Ministry of Science Technology & Environment 2011 Local
Adaptation Plan of Action National Framework (LAPA) (Kath-
mandu: Government of Nepal)
6
Environ. Res. Lett. 10 (2015) 034007 S R Mishra et al
... For instance, in Ethiopia (Debela et al., 2015;Tesfaye and Seifu, 2016), Chile (Roco et al., 2015), Africa (Elum et al., 2017), Switzerland (Shi et al., 2015), Nigeria (Ayanlade et al., 2017), Tanzania (Below et al., 2015), and Romania (Bogdan et al., 2016), among others. In Nepal, numerous scholars have endeavored to assess the perceptions and understanding of local communities by documenting their experiences and adaptation strategies to climate change across various sectors and locations (Aryal et al., 2016;Devkota et al., 2017;Khanal and Kattel, 2017;Khanal et al., 2018a, b;Mishra et al., 2015;Poudel and Duex, 2017;Shrestha and Aryal, 2011;Sujakhu et al., 2016). However, limited literature focuses on the Terai (lowlands) region in terms of climate change, but this region is recognized as 'food basket' of the country and more than half of the country's population resides and has high pressure on balancing the infrastructure needs with food production and residential infrastructure. ...
... The increased infestation of pests and diseases, acute water shortages, changing rainfall patterns (for rain-fed agriculture), and increased flash floods contribute to the decline in agricultural production. These observations align with findings from other studies conducted in Nepal (Khanal and Kattel, 2017;Mishra et al., 2015;Paudel et al., 2020). The heightened impacts of climate change on agriculture in this region are likely to exacerbate the food security situation nationwide. ...
... First, we conducted a comprehensive search across 5 databases (Medline, CINAHL, Web of Science, ScienceDirect, and Embase), as well as Google and Google Scholar, for relevant studies conducted in LMICs, including Bangladesh. 15,18,[26][27][28] In the second stage, we listed the variables from the selected studies and assessed their availability in our survey, considering their statistical significance. Finally, the variables found statistically significant were included in the analysis. ...
... 14 The intensified occurrence of skin diseases may be linked to factors such as exposure to unsanitary conditions, compromised hygiene, and limited access to clean water sources in the aftermath of a disaster. 27,36 The rise in diarrhea cases could be attributed to contaminated water supplies, disrupted sanitation infrastructure, and challenges in maintaining proper hygiene practices during and after the disaster. 51 Furthermore, an increase in malnutrition rates is likely influenced by disrupted food supply chains, limited access to nutritious food, and the socio-economic fallout accompanying disasters. ...
Article
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Objectives The objective of this study was to explore the burden of disasters and adverse health outcomes during and following disasters in Bangladesh. Methods We analyzed 6 788 947 respondents’ data from a cross-sectional and nationally representative 2021 Bangladesh Disaster-related Statistics (BDRS). The key explanatory variables were the types of disasters respondents faced, while the outcome variables were the disease burden during and following disasters. Descriptive statistics were used to determine disease burden. A multilevel mixed-effects logistic regression model assessed the association between disease burden and disaster types, along with socio-demographic characteristics of respondents. ResultsNearly 50% of respondents experienced diseases during disasters, rising to 53.4% afterward. Fever, cough and diarrhea were prevalent during and after disasters, with increases in skin diseases, malnutrition, and asthma post-disaster. Vulnerable groups, such as children aged 0–4, hijra individuals, those with lower education, people with disabilities, and rural residents, especially in Chattogram, Rangpur, and Sylhet divisions, were most affected. Floods, cyclones, thunderstorms, and hailstorms significantly increased disease likelihood during and after disasters. Conclusions The study underscores the complex relationship between disasters and health outcomes in Bangladesh, stressing the need for targeted public health interventions, improved health care infrastructure, and evidence-based policies to mitigate disaster-related health risks.
... By taking action to address the health impacts of climate change, Nepal can help to protect the health and wellbeing of its citizens and build a more sustainable future for all. [80] ...
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Introduction Nepal witnessed a tumultuous journey over past two centuries, marked by significant political, social, and cultural shifts. From fighting British colonial encroachments in 1800s, the dynastic Rana regime (1846–1951), and democracy movements in the late 1950s, 1990s and 2000s, Nepal became a federal republic in 2008. The main objective of this review is to lay out an interpretative summary on Nepal’s epidemiological transition (includes general trends and disease specific topics) followed by discussion on health system development over key periods: historical period (–1950s), modern period (1950–1990), post-democracy (1991–2016), and post-federalization (2016–). Methods We conducted a scoping review of available literature using the Arksey and O’Malley framework to synthesize the key insights. Searches were performed in PubMed (via NLM), Embase and Google Scholar using a combination of search terms related to Nepal’s health system, epidemiological transition, disease burden and emerging health issues. A total of 1204 records were identified, of which 123 documents – including peer-reviewed articles, government reports and grey literature – met the inclusion criteria. Results Major advances in maternal and child health, nutritional health and reduction of infectious diseases have been observed in recent decades. The maternal mortality ratio (MMR) declined by 55% (1996–2016), and neonatal mortality halved (40 to 20 per 1000 live births) due to improved antenatal care, skilled birth attendance and family planning. Stunting rates fell from 66% (1996) to 25% (2022), yet rising non-communicable diseases (NCDs) pose new challenges. Communicable diseases, once dominant, have declined owing to expanded immunization and tuberculosis control. However, NCDs now account for over two thirds of deaths, driven by urbanization, ageing and lifestyle shifts. Health system gaps persist, with workforce shortages, rural–urban disparities and out-of-pocket health costs limiting access. Addressing rising health inequities, digital health innovations and service expansion is critical to achieving universal health coverage and sustaining Nepal’s health gains. Conclusions Nepal’s health care landscape has continuously evolved over the past centuries, coinciding with key demographic and political changes. Advances through innovation are necessary for the country’s overstretched health system to reduce the cost of health services whilst increasing quality and access.
... In Nepal, several studies have investigated people's perceptions of climate change, but they all have limitations. Some studies focused solely on perceptions without considering other factors [24][25][26], while others compared perceptions with a limited set of climate indicators [27][28][29][30][31]. None of these studies incorporated a comprehensive set of climate indicators along with people's perceptions. Instead, studies that included climatic data focused solely on annual mean, minimum, and maximum temperatures and precipitation amounts (detail summary of published literature in S1 Table) [17,[32][33][34][35][36][37][38][39]. ...
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The Hindu Kush Himalayan region is a global hotspot for climate change and highly vulnerable to its direct and indirect impacts. Understanding people’s perception of climate change is crucial for effective adaptation strategies. We conducted a study by using quantitative (Household survey, n = 660) and qualitative data collection tools (Focus group discussion, n = 12; In-depth interviews, n = 27) in central Nepal encompassing three altitudinal regions: Lowland (<1000 m amsl; Terai region), Midland (1000–1500 m amsl; hilly region) and Highland (1500–2100 m amsl; mountainous region). We analyzed 37 years (1981–2017) of climatic data from respective districts (Lowland: Chitwan, Dhading; Midland: Kathmandu, Lalitpur; Highland: Nuwakot, Rasuwa). People’s perception was compared with climate extreme indices measured along these regions and evaluated if they accurately recognized the impacts on the environment and human health. Our findings show significant climate changes, including rising summer temperature, region-specific winter temperatures and extended monsoon seasons in Nepal. Participants in our study accurately perceived these trends but misperceived heavy precipitation patterns. Reported impacts are rise in crop diseases, human diseases, vector expansion and climate induced disasters like floods, landslides, and water resource depletion, with perception accuracy varying by region. These insights highlight the importance of understanding regional and cross-regional perceptions in relation to climate data in order to develop tailored climate adaptation strategies. Policymakers can use this information to establish region-specific educational and communication initiatives, addressing communities’ distinctive vulnerabilities and needs across diverse landscapes. Such approaches can enhance equitable and effective climate resilience in subtropical to alpine regions.
... (Sloggy et al, 2022;Cho, 2017;Nash et al, 2019) Similarly, residents in regions where the local economy heavily relies on natural resources, such as agriculture, fishing, tourism, also demonstrate a greater understanding of climate change impacts on their wellbeing. (Armah et al, 2015;Mishra et al, 2015) While it may be difficult to make people believe the urgency of climate change, this evidence shows that perceived personal experiences can help enhance their understanding about the consequences of climate change, thereby motivating them to act on climate change. ...
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This research explores Auckland residents' views regarding the information they receive about climate change and its impacts on human wellbeing. The main goal of this research is to assess their understanding of climate change, how much they understand its potential impacts, and the perceived urgency to mitigate the climate issues based on their current level of knowledge. Through qualitative methods, specifically the semi-structured interviews and thematic analysis, this research will identify the common themes and patterns in residents' perceptions on climate change. The research findings will be useful to improve the effectiveness of climate change communication strategies and increase public engagement on climate change adaptation. Introduction:
... According to Udmale et al. [62] and Menghistu et al. [14], farm households perceived that drought caused poor human health, which is consistent with the present finding. Similarly, a study conducted in Nepal by Mishra et al. [69] reveals that due to climate variability and droughts, 50% of the respondents perceived an increase in the number of diseases during the summer, 46.5% perceived an increase during the rainy season, and 48.8% during the winter. The drought also increased the number of children dropping out of school. ...
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Globally, drought is occurring more frequently today, which is considerably affecting rural households’ agricultural productivity and socioeconomic development. Understanding households’ perceptions of drought is thus important for resilience-building work because people act based on their views, and the resilience of people is tied to their views, knowledge, culture, and attitudes. This study analyses the rural households’ perceptions of drought occurrence and its influence on livelihood strategies in northeast Ethiopia. This was achieved through a mixed-methods approach with a concurrent research design. The quantitative data were collected from 354 randomly selected household heads, whereas the qualitative data were collected from purposefully selected household head focus group discussions (FGDs) and key informants. The quantitative data were analyzed using descriptive statistics, whereas the qualitative data were analyzed using thematic data analysis techniques. The results show that climate variability and drought occurrence were perceived by the households as decreasing rainfall, increasing temperature, variations in rainfall onset and cessation, variations in heat waves and cold waves, heavy rainfall events, changes in sporadic rain, a lesser coverage of clouds, and adverse weather events. Within the last 25 years, households have perceived the number of extreme, severe, or moderate droughts to be increasing. Household perceptions of temperature changes match meteorological records, but their perceptions of rainfall changes do not. The drought hampered income sources, brought food shortages, and threatened family well-being. It increased water stress, livestock morbidity and mortality, insect invasions, fire outbreaks, grazing resource depletion, abnormal migration, school dropout rates, and human health problems. The findings have important policy implications to mitigate drought risk, enhance drought adaptation, and develop pathways out of drought vulnerability, so it is worthwhile to harmonize the household perceptions with climate change policy.
... Again, while a large number of study participants had little to no formal education and were illiterate, all were able to confidently understand research assistant questions on climate change and comprehend the potentially relevant impacts on individual and household health. This data adds to, and is consistent with, several studies on the public perceptions of climate change and health in LMICs [28][29][30]. ...
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Liberia and other low and middle-income countries (LMICs) are particularly vulnerable to climate change. Yet, data on perceived risks of climate change among community residents in these countries are little known. We performed a cross-sectional survey of 800 households selected randomly through multistage cluster sampling from two regionally distinct areas of Liberia. A 91-item English survey was administered by trained research assistants verbally in the respondent’s preferred spoken language. Univariable comparison of climate related questions between the two regions was made by chi-squared analysis. Univariable and multivariable logistic regression modeling was performed to assess the association between known risks and the primary outcome of interest: a self-reported increase in health emergencies due to extreme heat, drought, flooding, wildfires, or other extreme weather events by climate change. Survey respondents were majority male (n = 461, 57.8%) with a mean age of 40.6 years (SD 14.7). Over 65% of households lived on less than 100 USD per month. A majority of respondents reported increased intensity of heat during the dry season (n = 408, 51.0%); increased intensity of rainfall during the rainy season (n = 433, 54.1%), and increased severity in endemic diseases (n = 401, 50.1%) over the past 5–10 years. In multivariable modeling, perceived water and food impacts (OR: 6.79, 95%CI 4.26–10.81; OR: 3.97, 95%CI 2.25–7.03, respectively), unemployment (OR: 3.52, 95%CI 1.89–6.56), and lack of electricity (OR: 2.04, 95%CI: 1.23–3.38) were the strongest predictors of perceived increased health emergencies due to climate change. A significant proportion of households across multiple Liberian communities have already felt the health effects of climate change. Focused efforts on mitigating individual and household risks associated with the increased health effects of climate change is essential.
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This paper examines the crucial role of healthcare managers in Nepal in implementing climate-responsive policies to ensure sustainable and effective healthcare delivery amidst increasing climate related health risks. The study synthesizes existing literature on climate change impacts on healthcare systems, international and national climate policies in Nepal, and organizational actions for climate resilience. It highlights the responsibilities of healthcare managers in strategic leadership, risk assessment, capacity building, resource allocation, and collaboration. Climate change poses significant threats to Nepal's healthcare system, exacerbating existing vulnerabilities. Effective organizational actions, such as strengthening climate-resilient infrastructure, enhancing emergency preparedness, and integrating climate policies, are essential. Healthcare managers play a pivotal role in implementing these actions through strategic leadership, policy implementation, risk assessment, workforce training, and resource management. The review is limited by its reliance on existing literature and may not fully capture the nuances of on-the-ground challenges in Nepal. Future research should focus on empirical studies to assess the effectiveness of implemented strategies and identify best practices. Healthcare organizations in Nepal must prioritize climate-conscious policies and enhance collaboration between policymakers, healthcare professionals, and international organizations. Strengthening leadership in climate adaptation is essential for safeguarding public health and ensuring a sustainable healthcare system. This paper contributes to the understanding of how healthcare managers can effectively integrate climate resilience strategies in resource-constrained settings, providing insights for policymakers and healthcare institutions in Nepal and similar contexts. Key Words: climate change, healthcare management, climate resilience, policy implementation, emergency preparedness, sustainable healthcare
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Mitigating global climate change requires not only government action but also cooperation from consumers. Population-based, cross-sectional surveys were conducted among 1202 respondents in Portland OR and Houston TX between June and September 2007 regarding awareness, concern, and behavior change related to climate change. The data were subjected to both quantitative and qualitative analyses. Awareness about climate change is virtually universal (98% in Portland and 92% in Houston) with the vast majority reporting some level of concern (90% in Portland and 82% in Houston). A multivariate analysis revealed significant predictors of behavior change: individuals with heightened concern about climate change (p<0.001); respondents with higher level of education (p= 0.03); younger compared with older individuals (p<0.001); and Portlanders more likely to change behavior compared with Houstonians (p<0.001). Of those who changed behavior, 43% reported having reduced their energy usage at home, 39% had reduced gasoline consumption, and 26% engaged in other behaviors, largely recycling. Qualitative data indicate a number of cognitive, behavioral, and structural obstacles to voluntary mitigation. Although consumers are interested in global climate change-mitigation strategies and willing to act accordingly, considerable impediments remain. Government policy must eliminate economic, structural, and social barriers to change and advance accessible and economical alternatives. Individual-level mitigation can be a policy option under favorable contextual conditions, as these results indicate, but must be accompanied by mitigation efforts from industry, commerce, and government.
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Background Over the last decade, the incidence of confirmed malaria has declined significantly in Nepal. The aim of this paper is to assess the spatio-temporal distribution of malaria and its association with climatic factors and vector control interventions in two high-risk districts of Nepal. Methods Hotspot analysis was used to visualize the spatio-temporal variation of malaria incidence over the years at village level and generalized additive mixed models were fitted to assess the association of malaria incidence with climatic variables and vector control interventions. Results Opposing trends of malaria incidence were observed in two high-risk malaria districts of eastern and far-western Nepal after the introduction of long-lasting insecticidal nets (LLINs). The confirmed malaria incidence was reduced from 2.24 per 10,000 in 2007 to 0.31 per 10,000 population in 2011 in Morang district but increased from 3.38 to 8.29 per 10,000 population in Kailali district. Malaria hotspots persisted mostly in the same villages of Kailali district, whereas in Morang district malaria hotspots shifted to new villages after the introduction of LLINs. A 1[degree sign] C increase in minimum and mean temperatures increased malaria incidence by 27% (RR =1.27, 95% CI =1.12-1.45) and 25% (RR =1.25, 95% CI =1.11-1.43), respectively. The reduction in malaria incidence was 25% per one unit increase of LLINs (RR =0.75, 95% CI =0.62-0.92). The incidence of malaria was 82% lower in Morang than in Kailali district (RR =0.18, 95% CI =0.11-0.33). Conclusions The study findings suggest that LLIN coverage should be scaled up to entire districts rather than high-incidence foci only. Climatic factors should be considered for malaria micro-stratification, mosquito repellents should be prescribed for those living in forests, forest fringe and foothills and have regular visits to forests, and imported cases should be controlled by establishing fever check posts at border crossings.
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The impact of climate change has been significant enough to endanger human health both directly and indirectly via heat stress, degraded air quality, rising sea levels, food and water security, extreme weather events (e.g., floods, droughts, earthquakes, volcano eruptions, tsunamis, hurricanes, etc.), vulnerable shelter, and population migration. The deterioration of environmental conditions may facilitate the transmission of diarrhea, vector-borne and infectious diseases, cardiovascular and respiratory illnesses, malnutrition, etc. Indirect effects of climate change such as mental health problems due to stress, loss of homes, economic instability, and forced migration are also unignorably important. Children, the elderly, and communities living in poverty are among the most vulnerable of the harmful effects due to climate change. In this article, we have reviewed the scientific evidence for the human health impact of climate change and analyzed the various diseases in association with changes in the atmospheric environment and climate conditions.
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For policymakers -- Technical summary -- Assessment of observed changes and responses in natural and managed systems -- New assessment methods and the characterisation of future conditions -- Fresh water resources and their management -- Ecosystems, their properties, goods and services -- Food, fibre, and forest products -- Coastal systems and low-lying areas -- Industry, settlement and society -- Human health -- Africa -- Asia -- Australia and New Zealand -- Europe -- Latin America -- North America -- Polar regions (Arctic and Antarctic) -- Small islands -- Assessment of adaptation practices, options, constraints and capacity -- Inter-relationships between adaptation and mitigation -- Assessing key vulnerabilities and the risk from climate change -- Perspectives on climate change and sustainability -- Cross-chapter case studies.
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Global estimates of the potential impact of climate change on malaria transmission were calculated based on future climate scenarios produced by the HadCM2 and the more recent HadCM3 global climate models developed by the UK Hadley Centre. This assessment uses an improved version of the MIASMA malaria model, which incorporates knowledge about the current distributions and characteristics of the main mosquito species of malaria.The greatest proportional changes in potential transmission are forecast to occur in temperate zones, in areas where vectors are present but it is currently too cold for transmission. Within the current vector distribution limits, only a limited expansion of areas suitable for malaria transmission is forecast, such areas include: central Asia, North America and northern Europe. On a global level, the numbers of additional people at risk of malaria in 2080 due to climate change is estimated to be 300 and 150 million for P. falciparum and P. vivax types of malaria, respectively, under the HadCM3 climate change scenario. Under the HadCM2 ensemble projections, estimates of additional people at risk in 2080 range from 260 to 320 million for P. falciparum and from 100 to 200 million for P. vivax. Climate change will have an important impact on the length of the transmission season in many areas, and this has implications for the burden of disease. Possible decreases in rainfall indicate some areas that currently experience year-round transmission may experience only seasonal transmission in the future. Estimates of future populations at risk of malaria differ significantly between regions and between climate scenarios.