Assessing trends of heat waves and perception of people about health risks of heat wave in Nepal.

Research Report.

SUMMARY: The number of heat waves is increasing worldwide due to climate change and land-use development and especially urban areas magnify the effects of heat waves by concentrating heat emissions (and air pollution) from vehicles and by trapping and absorbing heat between buildings and the pavement. Global warming will unquestionably increase the impact of heat on individuals who work in already hot workplaces in hot climate areas. The increasing prevalence of this environmental health risk requires the improvement of assessment methods linked to meteorological data. Such new methods will help to reveal the size of the problem and design appropriate interventions at individual, workplace and societal level. The aim of this study was to assess the trend of heat waves and perception of people about associated health risks of heat wave in Nepal. A mixed method study with concurrent triangulation design was done. The trend of heat wave was assessed using secondary analysis of retrospective meteorological data of last 30 years whereas descriptive cross-sectional study was done to explore people's perceptions and behavioral responses towards extreme heat exposure in a warming climate. A qualitative study was also done to assess the current organizational policies on heat wave and to explore key informants' (health service providers, officials of the line ministries, employers etc.) recommendations for improvement. Meteorological data was collected using the pre-structured format from all the 40 meteorological stations of Nepal that have the record of the required climate variables of the given time range. For the cross-sectional study, face-to-face interview was done using questionnaire among 318 research participants in three districts. For the qualitative study, key informant interview was done among school teacher, organization manager, community leaders and farmers using key interview guideline. The questionnaire and guideline were developed after comprehensive review of literature on occupational heat exposure and expert review. Among 318 participants, from each 3 districts there were 106 participants selected, among them majority were male, 30-49 years and involved in labor activities. Most of them have secondary level of education. Most of participants were working on outdoor location. Furthermore, participants felt their working environment was hot but 30% participants were not using any kind of Personal Protective Equipment. 58% participants were suffered from any kind of heat related events, however, 80% participants were deprived from paid leave if suffered from heat related illness/sickness and 89% of participants felt there is increment in temperature every year. Despite the increasing heat related events such as heat waves are increasing in later days, awareness regarding heat waves and its consequences is not adequate enough among the people residing heat prone areas. Similarly, organization effort to combat with heat waves is not sufficient enough. Furthermore, heat related morbidity and mortality data need to be improved in terms of recording and reporting so that empirical relationship can be developed between trends of heat waves and heat related illness for evidence informed decision making in Nepal.