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Global heating is considered one of the greatest threats to human health and well-being. Supporting human resilience to heating threats is imperative, but under-investigated. In response, this article reports a study that drew together results from quantitative data on perceptions of thermal comfort and mechanisms for coping with thermal discomfort among 406 households in a study in Giyani, Limpopo province. Indoor dwelling and outdoor temperatures were also analysed. Most participants perceived their dwellings to be too hot when it was hot outdoors. People relied on recommended heat health actions such as sitting outdoors in the shade or opening windows. While this agency is meaningful, resilience to climate change requires more than personal action. In light of the climate threats and climate-related disaster risks facing South Africa, an all-encompassing approach, including education campaigns, climate-proofed housing, access to basic services, and financial considerations that will help support resilient coping among South Africans, is urgently required.

Prolonged exposure to high temperatures can cause heat-related illnesses and accelerate death, especially in the elderly. We developed a locally-appropriate Healthy Environment Assessment Tool, or ‘HEAT’ tool, to assess heat-health risks among communities. HEAT was co-developed with stakeholders and practitioners/professionals from the Rustenburg Local Municipality (RLM), a setting in which heat was identified as a risk in an earlier study. Feedback was used to identify vulnerable groups and settings in RLM, consider opportunities and barriers for interventions, and conceptualize a heat-health vulnerability assessment tool for a heat-resilient town. Using information provided by the RLM Integrated Development Plan, the HEAT tool was applied in the form of eight indicators relating to heat-health vulnerability and resilience and areas were evaluated at the ward level. Indicators included population, poverty, education, access to medical facilities, sanitation and basic services, public transport, recreation/community centres, and green spaces. Out of 45 wards situated in the municipality, three were identified as critical risk (red), twenty-eight as medium-high risk (yellow), and six as low risk (green) in relation to heat-health vulnerability. Short-term actions to improve heat health resilience in the community were proposed and partnerships between local government and the community to build heat health resilience were identified.

Climate change threatens the health and well-being of populations. We conducted a risk assessment of two climate-related variables (i.e., temperature and rainfall) and associated water, sanitation and hygiene (WASH)-related exposures and vulnerabilities for people living in Mopani District, Limpopo province, South Africa. Primary and secondary data were applied in a qualitative and quantitative assessment to generate classifications of risk (i.e., low, medium, or high) for components of hazard/threat, human exposure, and human vulnerability. Climate-related threats were likely to impact human health due to the relatively high risk of waterborne diseases and WASH-associated pathogens. Vulnerabilities that increased the susceptibility of the population to these adverse outcomes included environmental, human, physical infrastructure, and political and institutional elements. People of low socio-economic status were found to be least likely to cope with changes in these hazards. By identifying and assessing the risk to sanitation services and water supply, evidence exists to inform actions of government and WASH sector partners. This evidence should also be used to guide disaster risk reduction, and climate change and human health adaptation planning.

Children spend a significant proportion of their time at school and in school buildings. A healthy learning environment that supports children should be thermally conducive for learning and working. Here, we aimed to study the relations between indoor classroom temperatures and learner absenteeism as a proxy for children’s health and well-being. This one-year prospective study that spanned two calendar years (from June 2017 to May 2018) entailed measurement of indoor classroom temperature and relative humidity, calculated as apparent temperature (Tapp) and collection of daily absenteeism records for each classroom in schools in and around King Williams Town, Eastern Cape province, South Africa. Classroom characteristics were collected using a standardized observation checklist. Mean indoor classroom temperature ranged from 11 to 30 °C, while mean outdoor temperature ranged from 6 °C to 31 °C during the sample period. Indoor classroom temperatures typically exceeded outdoor temperatures by 5 °C for 90% of the study period. While multiple factors may influence absenteeism, we found absenteeism was highest at low indoor classroom Tapp (i.e., below 15 °C). Absenteeism decreased as indoor Tapp increased to about 25 °C before showing another increase in absenteeism. Classroom characteristics differed among schools. Analyses of indoor classroom temperature and absenteeism in relation to classroom characteristics showed few statistically significant relations—although not exceptionally strong ones—likely because of the multiple factors that influence absenteeism. However, given the possible relationship between indoor temperature and absenteeism, there is a learning imperative to consider thermal comfort as a fundamental element of school planning and design. Furthermore, additional research on factors besides temperature that affect learner absenteeism is needed, especially in rural areas.

Links between heat exposure and congenital anomalies have not been explored in detail despite animal data and other strands of evidence that indicate such links are likely. We reviewed articles on heat and congenital anomalies from PubMed and Web of Science, screening 14,880 titles and abstracts in duplicate for articles on environmental heat exposure during pregnancy and congenital anomalies. Thirteen studies were included. Most studies were in North America (8) or the Middle East (3). Methodological diversity was considerable, including in temperature measurement, gestational windows of exposure, and range of defects studied. Associations were detected between heat exposure and congenital cardiac anomalies in three of six studies, with point estimates highest for atrial septal defects. Two studies with null findings used self-reported temperature exposures. Hypospadias, congenital cataracts, renal agenesis/hypoplasia, spina bifida, and craniofacial defects were also linked with heat exposure. Effects generally increased with duration and intensity of heat exposure. However, some neural tube defects, gastroschisis, anopthalmia/microphthalmia and congenital hypothyroidism were less frequent at higher temperatures. While findings are heterogenous, the evidence raises important concerns about heat exposure and birth defects. Some heterogeneity may be explained by biases in reproductive epidemiology. Pooled analyses of heat impacts using registers of congenital anomalies are a high priority.

Background: Measuring national progress towards the Sustainable Development Goals (SDGs) enables the identification of gaps which need to be filled to end poverty, protect the planet and improve lives. Progress is typically calculated using indicators stemming from published methodologies. South Africa tracks progress towards the SDGs at a national scale, but aggregated data may mask progress, or lack thereof, at local levels. Objective: To assess the progress towards achievement of the SDGs in four low-income, rural villages (Giyani) in South Africa and to relate the findings to national SDG indicators. Methods: Using data from a cross-sectional environmental health study, the global indicator framework for the SDGs was applied to calculate indicators for Giyani. Local progress towards SDG achievement was compared with national progress, to contextualize and supplement national scale tracking. Findings: Village scores were mostly in line with country scores for those indices which were computable, given the available data. Low data availability prevented a complete local progress assessment. Higher levels of poverty prevail in the study villages compared to South Africa as a whole (17.7% compared to 7.4%), high unemployment (49.0% compared to 27.3%) and lack of access to information via the Internet (only 4.2% compared to 61.8%) were indicators in the villages identified as falling far short of the South African averages. Conclusions: Understanding progress towards the SDGs at a local scale is important when trying to unpack national progress. It shines a light upon issues that are not picked up by national composite assessments yet require most urgent attention. Gaps in data required to measure progress towards targets represents a serious stumbling block, preventing the creation of a true reflection of local and national scale progress.

There are many climatic changes facing South Africa which already have, or are projected to have, a detrimental impact on human health. Here the risks to health due to several alterations in the climate of South Africa are considered in turn. These include an increase in ambient temperature, causing, for example, a significant rise in morbidity and mortality; heavy rainfall leading to changes in the prevalence and occurrence of vector-borne diseases; drought-associated malnutrition; and exposure to dust storms and air pollution leading to the potential exacerbation of respiratory diseases. Existing initiatives and strategies to prevent or reduce these adverse health impacts are outlined, together with suggestions of what might be required in the future to safeguard the health of the nation. Potential roles for the health and non-health sectors as well as preparedness and capacity development with respect to climate change and health adaptation are considered.

Zoonoses account for about 25% of the infectious disease burden in low-income countries Poverty might increase the risk for zoonotic disease where the active human--livestock and human--wildlife interfaces can increase the likelihood of disease transmission A combined disease burden exists for people in areas such as tropical and subtropical Africa, where there is likelihood of co-infection with zoonotic diseases and other pathogenic or infectious diseases, such as malaria, tuberculosis and HIV Many endemic zoonoses remain widely neglected in such settings, undetected and underreported, because their impacts are borne largely by impoverished and marginalized communities Here, Wernecke et al discuss how to 'prevent the next pandemic' by interrogating what is known about zoonotic diseases and how best one can break the chain of transmission

Sun protection behavior studies are almost exclusively carried out in populations with fair skin for the obvious reason that people with unpigmented skin are more susceptible to the health impacts of excess solar ultraviolet radiation exposure. In a dataset of 1271 Black South Africans, we analyzed factors related to sun protection applied when spending time outdoors including awareness of skin cancer, gender, age and Living Standards Measure (LSM) where 1-4 equate to the lowest, 5-7 intermediate and 8-10 the highest LSM status. The most important driver for Black South Africans to use sun protection was whether they were aware of skin cancer (OR: 2.6 for those who were aware versus those who were not, P

Background Exposure to high ambient temperatures during pregnancy may increase the risk of adverse pregnancy outcomes due to physiological and anatomical changes in pregnancy compromising the ability to thermoregulate. Methods A systematic review and meta-analysis of studies that assessed associations between ambient heat, and preterm birth, birth weight and stillbirths. Articles were identified through a search of Medline (PubMed) and Web of Science. Titles and abstracts were screened, eligible studies extracted and risk of bias assessed using the Joanna Briggs Institute appraisal tools. Results 14,880 records were screened and a total of 70 studies included. In 40 of 47 studies, preterm births were more frequent at higher than lower temperatures. In random effects meta-analysis, the odds of a preterm birth rose 1.05-fold per 1 °C increase in temperature (95%CI=1.03, 1.07), and 1.16 fold during heat waves (95%CI=1.10, 1.23). Reduced birth weight associated with higher temperature was found in in 18 of 28 studies, with considerable heterogeneity. Studies on stillbirths (n = 8) all showed temperature-stillbirth associations, with stillbirths increasing 1.05-fold per 1 °C rise in temperature (95%CI=1.01, 1.08). Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings. Conclusions As frequency of heat exposures is increasing, prevention for pregnant women during heat waves should become a standard aspect of heat adaptation. Key messages Increase in extreme temperature events may have major implications for child health unless much more is done to provide heat adaptation services for pregnant women. Links between socio-economic status and study outcomes suggest higher vulnerability for already disadvantaged groups.

Background. A changing climate is likely to have widespread and varying impacts on ecosystems and human health. South Africa (SA) is particularly vulnerable to the impacts of climate change, given the projected increases in temperature, and changes in the amount and patterns of rainfall. Moreover, SA’s vulnerability is exacerbated by extreme inequality and poverty. To prepare for the impacts of climate change and to ensure timeous adaptation, a perspective is given on essential heat and health research in the country. Objectives. To gather studies conducted by the South African Medical Research Council (SAMRC)’s Environment and Health Research Unit (EHRU) to illustrate the range of possible research key areas in the climate, heat and health domain and to present future research priorities. Methods. Studies conducted by the SAMRC’s EHRU were gathered and used to illustrate the range of possible research key areas in the climate, heat and health domain. Using national and international published and grey literature, and tapping into institutional research experiences, an overview of research findings to date and future research priorities were developed. Results. Heat and health-related research has focussed on key settings, for example, schools, homes and outdoor work places, and vulnerable groups such as infants and children, the elderly and people with pre-existing diseases. The need to address basic needs and services provision was emphasised as an important priority. Conclusions. High and low temperatures in SA are already associated with mortality annually; these impacts are likely to increase with a changing climate. Critical cross-sectoral research will aid in understanding and preparing for temperature extremes in SA.

Little is known about levels of awareness and perceptions of skin cancer among Africans living in Africa. This study assessed skin cancer awareness among 1271 deeply pigmented South Africans. Participants (n = 642 males vs n = 629 females) were aware of skin cancer (79%) with more females than males being aware of skin cancer (P = 0.02). Majority of all participants had never checked their skin for signs or symptoms of skin cancer (90%). Palms of hands and soles of feet were the least recognized anatomic sites for skin cancer development, despite these sites being the common sites for acral lentiginous melanoma in individuals with deeply pigmented skin. Results suggest a need for targeted skin cancer awareness among population groups with dark skin on identification, screening, and early detection, professional training for healthcare personnel and content on skin cancer in deeply pigmented skin in medical curricula.

The DST/Mintek National Innovation Center, the Institute of Nanotechnology and Water – Water Node at the University of Johannesburg and the UNESCO SIMEV Chair, hosted by the European Institute of Membranes, joined hands to organize from 17 to 19 July 2019 the first workshop on membrane development and separation processes for water and air purification in South Africa. This booklet of abstracts gathers the detailed program with the contacts of all the speakers, with their short biography and abstracts.

In low-income communities, non-electric fuel sources are typically the main cause of Household Air Pollution (HAP). In Umlazi, a South African coastal, informal settlement, households use electric- and non-electric (coal, wood, gas, paraffin) energy sources for cooking and heating. The study aimed to determine whether respiratory ill health status varied by fuel type use. Using a questionnaire, respondents reported on a range of socio-demographic characteristics, dwelling type, energy use for cooking and heating as well as respiratory health symptoms. Multivariate Poisson regression was used to obtain the adjusted Odds Ratios (ORs) for the effects of electric and non-electric energy sources on prevalence of respiratory infections considering potential confounding factors. Among the 245 households that participated, Upper Respiratory Tract Infections (URTI, n = 27) were prevalent in respondents who used non-electric sources compared to electric sources for heating and cooking. There were statistically significant effects of non-electric sources for heating (adjusted OR = 3.6, 95% CI (confidence interval): 1.2&ndash, 10.1, p &lt, 0.05) and cooking (adjusted OR = 2.9, 95% CI: 1.1&ndash, 7.9, p &lt, 0.05) on prevalence of URTIs. There was a statistically significant effect of electric sources for heating (adjusted OR = 2.7, 95% CI: 1.1&ndash, 6.4, p &lt, 0.05) on prevalence of Lower Respiratory Tract Infections (LRTIs) but no evidence for relations between non-electric sources for heating and LRTIs, and electric or non-electric fuel use type for cooking and LRTIs. Energy switching, mixing or stacking could be common in these households that likely made use of multiple energy sources during a typical month depending on access to and availability of electricity, funds to pay for the energy source as well as other socio-economic or cultural factors. The importance of behaviour and social determinants of health in relation to HAP is emphasized.

Weather conditions, especially temperature and precipitation, play a critical role in shaping patterns of diarrhoeal diseases. They determine the frequency of outbreaks, and the spatial and seasonal distribution of cases. Not surprisingly, it is anticipated that the burden of diarrhoeal diseases will escalate with climate change, in tandem with gradual increments in mean temperatures, but also during episodic heatwaves. The degree and nature of this escalation will, however, vary with the mix of pathogens in an area, the quality of sanitation services, food hygiene regulations and their enforcement, and the age structure of the population, among other factors. Understanding these patterns can inform the design of measures to prevent and control heat-related diarrhoea. In this editorial, we sum evidence on the heat sensitivity of enteric infections in South Africa (SA) and other parts of sub-Saharan Africa (19 studies), drawing on articles located in a systematic review (methods detailed in Manyuchi et al. [1]), and consider the implications of these findings for control of diarrhoea in SA in the context of climate change.

Climate change is associated with shifts in global weather patterns, especially an increase in ambient temperature, and is deemed a formidable threat to human health. Skin cancer, a non-communicable disease, has been underexplored in relation to a changing climate. Exposure to solar ultraviolet radiation (UVR) is the major environmental risk factor for skin cancer. South Africa is situated in the mid-latitudes and experiences relatively high levels of sun exposure with summertime UV Index values greater than 10. The incidence of skin cancer in the population group with fair skin is considered high, with cost implications relating to diagnosis and treatment. Here, the relationship between skin cancer and several environmental factors likely to be affected by climate change in South Africa are discussed including airborne pollutants, solar UVR, ambient temperature and rainfall. Recommended strategies for personal sun protection, such as shade, clothing, sunglasses and sunscreen, may change as human behaviour adapts to a warming climate. Further research and data are required to assess any future impact of climate change on the incidence of skin cancer in South Africa.

Residential solid fuel combustion emission within low-income communities result in increased negative health impacts within these settlements. The Highveld is considered to be the industrial epicentre of South Africa as it houses 11 of the 13 coal-fired power stations situated within the country’s borders. The availability of low-cost coal within the area makes it the fuel of choice for heating and cooking purposes within low-income settlements. As a result residents of these settlements are continuously exposed to high concentrations of air pollutants. A paucity in data, on the impact of residential solid fuel combustion, exists since research is mainly focussed on industrial emission impacts. This paper aims to accurately quantify and characterise the mass concentrations of particulate matter experienced within both the indoor (PM4) and ambient (PM10, PM2.5) environments of KwaDela, a low-income settlement located on the South African Highveld. Furthermore, an attempt was made to link the indoor and ambient particulate mass concentrations, identify diurnal patterns and seasonal variations. KwaDela experiences high levels of particulate pollution, within both the indoor and ambient environment, as a result of domestic solid fuel combustion. Energy use varies seasonally with higher consumption of solid fuels during the winter leading to increased particulate loading. The concentrations of respirable particulate concentrations within the indoor environment are significantly higher than PM10 and PM2.5 experienced in the ambient environment. This indicates that the effect of respirable particulate matter, associated with solid fuel combustion in the indoor environment, has been underrepresented and thus its effect on health underreported.

The household combustion of solid fuels, for the purpose of heating and cooking, is an activity practiced by many people in South Africa. Air pollution caused by the combustion of solid fuels in households has a significant influence on public health. People mostaffected are those considered to be the poorest, living in low-income settlements, where burning solid fuel is the primary source of energy. Insufficient data has been collected in South Africa to quantify the concentrations of particulate emissions that peopleare exposed to, especially the respirable fraction, associated with the combustion of solid fuels. The aim of this paper is to gain an understanding of the particulate matter (PM) concentrations a person living in a typical household in a low income settlement in theSouth African Highveld is exposed to. It also seeks to demonstrate that the use of solid fuels in the household can lead to indoor air pollution concentrations reaching levels very similar to ambient PM concentrations, which could be well in excess of the NationalAmbient Air Quality Standards, representing a major national public health threat. A mobile monitoring station was used in KwaDela, Mpumalanga to measure both ambient particulate concentrations and meteorological conditions, while a range of dust/particulate monitors were used for indoor and personal particulate concentration measurements. Indoor and personal measurements are limited to the respirable fraction (PM4) as this fraction contributes significantly to the negative health impacts. The sampling for this case study took place from 7-19 August 2014. Highest particulate matter concentrations were evident during the early mornings and the early evenings, when solid fuel burning activities were at their highest. Indoor and personal daily average PM4 concentrations did not exceed the 24h National Ambient PM2.5 Standard of 65 μg/m3 nor did they exceed the 24h National Ambient PM10 Standard of 75 μg/ m3. The outdoor PM2.5 concentrations were found to be below the standards for the duration of the sampling period. The outdoor PM10 concentrations exceeded the standards for one day during the sampling period. Results indicate that, although people in KwaDelamay be exposed to ambient PM concentrations that can be non-compliant to ambient standards, the exposure to indoor air, where solid fuel is burnt, may be detrimental to their health.