IHACC Uganda - Summary of Emerging Research Results

Indigenous Health Adaptation to Climate Change (IHACC) - Uganda Summary of emerging research results By: IHACC-Uganda

INDIGENOUS

HEALTH adaptation to

CLIMATE

CHANGE

Climate Change and Indigenous Peoples

Climate change has been identified as one of the greatest health threats this century, and health systems will have to adapt. Adaptation is particularly important for Indigenous peoples who are expected to be among the most affected by climate change. Despite this, there is limited understanding of the health dimensions of climate change and opportunities for adaptation among Indigenous populations, and a significant deficit in focus on Indigenous populations in adaptation planning.

The Indigenous Health Adaptation to Climate Change (IHACC) project was established in 2011 as a multinational interdisciplinary research team from Canada, Uganda and Peru to develop an understanding of the health dimensions of climate change for Indigenous populations. IHACC seeks to identify and characterize the vulnerability of Indigenous communities to the health effects of climate change, and how to use this understanding to identify and evaluate opportunities for adaptation. This summary report provides an overview of IHACC and presents some of the emerging results from Uganda.

What is the Indigenous Health and Adaptation to Climate Change (IHACC) research project?

IHACC was developed as an interdisciplinary project, and the team is composed of epidemiologists, human and health geographers, climate modelers, medical doctors, and policy makers. The team has expertise in a diversity of research approaches, including participatory communitybased adaptation research, quantitative/qualitative survey design, epidemiologic analysis, climate and biophysical system modeling, and scenarios analysis.

Research Objectives

The overall objective of IHACC is to apply scientific and Indigenous Knowledge to empower remote Indigenous populations to adapt to the health effects of climate change. Key research components of the project include:

1. Advancing knowledge:

- Quantitative characterization of health vulnerability to climate change - Qualitative characterization of health systems and vulnerability - Estimating future vulnerability - Evaluating adaptation success & opportunities 2. Shaping policy & informing practice - Knowledge translation - Knowledge communication - Mainstreaming adaptation 3. Training & networking - Graduate training - Partner training - Promoting networking

The overall objective of IHACC is to apply scientific and Indigenous Knowledge to empower remote Indigenous populations to adapt to the health effects of climate change.

Photo by IHACC

IHACC is developing the first systematically and comparatively collected dataset on climaterelated health outcomes in Uganda.

Photo by Lea Berrang Ford

IHACC Research Methods

The first three years of IHACC have focused on documenting exposure, sensitivity and adaptive capacity to key climate-related health risks (food & water security, vector-borne disease). In all regions, a standardized longitudinal survey has been used to collect baseline data on the incidence and prevalence of food insecurity, selfreported acute gastrointestinal illness (AGI), vector-borne disease, fever, and associated risk factors. Sampling has taken place across seasons given the hypothesized seasonal determining factors, with >4000 questionnaires administered. Surveying has been accompanied by the collection of anthropometric data and finger-prick testing for malaria. IHACC is developing the first systemically and comparatively collected dataset on climate-related health outcomes in Uganda and Peru, while the AGI and longitudinal components of the Arctic surveys have not previously been conducted.

Qualitative research has sought to document local and traditional knowledge to describe the climate-related risks of focus, characterize the experience of different health outcomes, identify coping mechanisms, and examine determinants of adaptive capacity. Qualitative projects are ongoing and have included extensive indepth semi-structured interviews across the regions, focus groups, photo voice, and risk ranking exercises. IHACC has begun to generate early data to support estimates of future vulnerability. This has involved students and staff in each region assembling qualitative and quantitative data to climate projections for key health priorities and downscaled for each region. In all three regions, a strong emphasis has been put on engaging community members in the research, through participatory research methods, results dissemination events and consultations.

Research Partnerships

IHACC currently partners with, among others, the 10 Batwa settlements within Kanungu District Local Government, Makerere University, the Batwa Development Programme (BDP), the Bwindi Community Hospital (BCH), the District of Kanungu, and the Ministry of Health/ Uganda National Health Research Organization (UNHRO).

Other partners have supported the implementation of research activities. These include the Uganda Wildlife Authority (http://www.ugandawildlife.org), the Gorilla Clinic operated by Conservation Through Public Health (CTPH) (http://www.ctph.org), and personnel from health centers spread throughout Kanungu.

The overall coordination of IHACC is based at McGill University in Canada, while Makerere University in Uganda and Cayetano University in Peru coordinate regional teams respectively.

In Uganda, IHACC has trained and engaged 18 community members in data collection and survey administration who have worked since inception.

In close collaboration with BDP, IHACC has implemented some early adaptation projects. These adaptations include distribution of treated mosquito nets to all Batwa households, distribution of flyers and explanations about early findings of the research, and the construction of water projects in two of the settlements, Kihembe and Rulangara.

Emerging Results Food Security

We have applied a modified USDA food security survey to participants. In Uganda, there is limited research on food systems and food security among the Batwa, and a key focus has been to quantify and describe the level and determinants of food security and examine the composition of Batwa diet. In food security surveys conducted in 2013, 99% of households were classified as food insecure.

Over half of all households were classified as severely food insecure. This is to our knowledge the highest rate of food insecurity in the published literature. Fewer than 10% of households report eating meat on a regular basis, with posho and plantain comprising the majority of the diet. Notably, preliminary analyses identified very few significant predictors of food security. This work highlights the homogeneity of food insecurity among the Batwa, a factor likely to exacerbate vulnerability to the impacts of climate change on food systems.

Water Security

In Uganda, data from the 2013 January census survey have been analyzed for acute gastrointestinal illness (AGI). Out of the 583 Batwa surveyed, the overall 14day prevalence of AGI was 6.2%, which results in a 1.66 episodes per person-year incidence rate. In one month we would expect to see 52 new cases of AGI within the 10 communities. AGI was greatest among children below the age of 3, particularly among girls, and greater among women than men. The Batwa experience a high severity of AGI, wtih episodes of vomiting lasting an average of 2.8 days and for diarrhea, an average of 4.5 days. Exposure to goats may be a risk factor, possibly for children in particular. Though seasonal analyses are not complete, early data indicate that AGI prevalence is higher during the rainy season. Preliminary water quality data suggest a seasonal relationship for water turbidity and temperature.

Male

IHACC has not found evidence of seasonality of food insecurity using quantitative surveys. Further research will following up on these results with qualitative analysis of food security experiences.

Female

Proportion of AGI cases by sex among Batwa of Kanungu District, January 2013

Prevalence of AGI (%)

Preliminary findings from the food security work indicate that household food systems and food security are influenced by adoption of farming practices. Given the slow transition from forest hunter gatherers to settled farming communities, household food systems appear to be influenced by market-based access to food and or food donations. Analysis of the determinants of food security in households of Batwa will take into consideration household provisioning, market-based foods and food donations.

61%

39%

12 10 8 6 4 2 0

0-3 yrs

4-12 yrs 13-34 yrs 35+ yrs

Prevalence of AGI by age among Batwa of Kanungu District, January 2013

In food security surveys conducted in 2013, 99% of households were classified as food insecure. Over half of all households were severely food insecure.

Photo by IHACC

Malaria prevalence during the high season, in January 2013, was 4.1% among Batwa over 5 years old.

Photo by Lea Berrang Ford

Emerging Results (continued) Health systems

A literature review has been conducted and a paper titled ‘Understanding Uganda’s health system in the context of climate change preparedness and response: challenges and opportunities’ has been written pending review and publication by IHACC. With specific reference to the Batwa in Kanungu district, all the settlements and health facilities in the district have been mapped in order to assess how they access the formal health care system.

Preliminary findings show that the Batwa have access to a well-organised community health insurance scheme called e-Quality implemented by BCH and co-funded by BDP and Batwa themselves. The insurance scheme seems to be operating well and could be an adaptation strategy in case of increased disease prevalence due to climate change. For example, feedback from focus group discussions (FGDs) and key informants suggest that the scheme has raised a sense of awareness and health seeking behaviour among Batwa communities. At the household and individual level the Batwa appear keen to acquire an insurance card and to use it when they have a health problem.

Also preliminary FGDs suggest that Batwa still cherish the traditional health systems characterised by selfmedication using herbs for common diseases like malaria.

This is enhanced by long-standing Batwa Indigenous Knowledge of a range of medicinal plants for various ailments. However, this is constrained by restrictions to forest access, competing western lifestyles, and a decline in the older generation of Batwa who possess the Indigenous Kwnowledge.

Malaria

Malaria was identified as a key climate-sensitive health priority during IHACC pilot research. Longitudinal health surveys have confirmed malaria rates to be lower than anticipated. Results from our January 2013 survey (high season for malaria) indicate that malaria point prevalence was 4.1% among participants over five years old. Low parasite prevalence suggests most Batwa lack acquired immunity to P. falciparum. Consequently, Batwa may have higher risk than other Ugandans for clinical illness with each infection. We are continuing to study the relationship between parasitemia and clinical malaria among the Batwa to understand disease burden. We investigated associations between P. falciparum malaria infection, nutrition, and food security, seeking to identify risk factors and characterize the distribution of malaria infection among Batwa. Early models indicate that malaria is higher among men, those that spend time in the forest, and in households that are severely food insecure. Where malnutrition and food insecurity are common, individuals who are especially undernourished or severely foodinsecure have higher risk for P. falciparum.

Evaluating Adaptation Success

In Uganda, the IHACC team has worked closely with BDP to identify priority communities for improvement of water quality systems. Supported by IHACC research and collaborations, BDP has completed installation of water systems in two communities, with IHACC facilitating qualitative assessment of the experience, and outcomes of these projects. Adaptation priorities for enhancing household food systems and security have

Evaluating Adaptation Success

been identified among the Batwa. IHACC is working with partners to initiate a series of activities that will promote enhanced food systems, targeting improved food security at the household level. Some of the Batwa settlements have ample arable land that is under-utilized for agriculture and food production. We envisage that training, piloting and demonstration of food production activities will potentially contribute to food security.

Next Research Steps

In Uganda, qualitative research during JuneAugust 2014 will follow-up on the results of quantitative analysis for AGI risk, with additional research on water quality planned for 2014. Food security data for Uganda are currently being analyzed. A qualitative analysis of household level food security and food system is underway to be analyzed over the next 1-2 years as a component of current and future vulnerabilities.

IHACC is currently funded by:

IHACC-Uganda Study Area

IHACC is working with partners to initiate a series of activities that will promote enhanced food systems, targeting improved food security at the household level.

Photo by Lea Berrang Ford

Key IHACC-Uganda Partners

IHACC Partners

Batwa Development Programme (BDP) Bwindi Community Hospital (BCH) Kanungu Local Government (KLG) Uganda National Health Research Organization (UNHRO)

Publications IHACC – Uganda Lewnard et al. (In press) Relative undernourishment and food insecurity associations with Plasmodium falciparum among Batwa pygmies in Uganda: evidence from a cross-sectional survey. American Journal of Tropical Medicine and Hygiene.

Berrang-Ford et al. (2012) Vulnerability of Indigenous health to climate change: a case study of Uganda’s Batwa pygmies. Social Science and Medicine. 75(6):1067-1077.

Namanya B. Didacus (2013) Malaria risk factors facing Uganda’s Batwa Populations. Africa Portal. Mach 26: 2013.

Namanya B. Didacus (2013) Community health insurance a policy option for climate change adaptation. Africa Portal. March 12: 2013.

IHACC project (2012) Indigenous Adaptation in a Changing Climate: Local Voices, Global Perspectives.

Harper, S.L. (2012) Managing Climate Change Impacts on Waterborne Disease in Uganda. Africa Portal. March 2012: 25.

Harper, S.L. (2012) Social Determinants of Health for Uganda’s Indigenous Batwa Population. Africa Portal. June 2012: 32.

For more information, visit: http://www.ihacc.ca Designed by Stephanie Austin Cover Photo by IHACC Photo Voice Any individuals shown in these photographs have provided consent for it to be used in IHACC publications.

2014