Background: Global climate change poses grave risks to population health, especially in low- and middle-income countries (LMICs). It both threatens the sustainability of nascent epidemiological transitions and raises prospects for counter transitions driven by indirect climate impacts on mortality, such as those from reemerging infectious diseases and by direct impacts of extreme climatic events. Objective: We investigate how the relationship between climate and mortality has changed as Antananarivo, Madagascar, progressed through the stages of the epidemiological transition, focusing on enteric infection mortality in children under 5. Methods: Using death registration, precipitation, and temperature time series data spanning over four decades, we model the climate–cause-specific mortality relationships during each stage of the epidemiological transition using generalized additive models. Results: While we find that enteric infection mortality has become less sensitive to low rainfall, higher temperatures, and climate extremes overall, it has become somewhat more sensitive to heavy rainfall. Mortality from remaining causes exhibits little climatic variation. Conclusions: While we find that childhood enteric infection mortality has become less sensitive to low rainfall and higher temperatures, it has become more sensitive to heavy rainfall. Mortality from other causes has also become less sensitive to high temperatures but has become slightly more sensitive to heavy rainfall while significantly more sensitive to low temperatures. Contribution: This is the first multidecade climate–mortality study of a city in sub-Saharan Africa out-side of South Africa.

中文翻译：

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气候变化和健康转型：来自马达加斯加塔那那利佛的证据（作者：Jordan Klein、Anjarasoa Rasoanomenjanahary）


背景：全球气候变化对人口健康构成严重风险，特别是在低收入和中等收入国家（LMIC）。它既威胁到新生流行病学转变的可持续性，又增加了由气候对死亡率的间接影响（例如重新出现的传染病和极端气候事件的直接影响）驱动的反转变的前景。目标：我们调查随着马达加斯加塔那那利佛经历流行病学转变阶段，气候与死亡率之间的关系如何变化，重点关注 5 岁以下儿童的肠道感染死亡率。方法：使用死亡登记、降水量和温度时间序列数据跨越四十年，我们使用广义相加模型对流行病学转变每个阶段的气候-原因-特定死亡率关系进行建模。结果：虽然我们发现肠道感染死亡率对低降雨量、高温和极端气候的总体敏感性降低，但对强降雨变得更加敏感。其他原因造成的死亡率几乎没有随气候变化而变化。结论：虽然我们发现儿童肠道感染死亡率对低降雨量和高温变得不太敏感，但对强降雨变得更加敏感。其他原因造成的死亡对高温的敏感度也降低了，但对强降雨的敏感度稍高，而对低温的敏感度则明显更高。贡献：这是第一个针对南非以外撒哈拉以南非洲城市的数十年气候死亡率研究。