The influence of hydrometeorological variables on childhood diarrheal disease: A Planetary Health approach

Despite great reductions in the global burden of diarrheal disease, it remains a leading cause of mortality among children under five years old. Climate change threatens these gains, as extreme weather events such as floods, droughts, and heavy rainfall following dry periods are associated with increased risk. The impacts of climate change on childhood diarrheal disease burden depend on interactions between climate hazards, vulnerabilities, and pathogen exposures, although pathogen-specific impacts are not well understood. Improved understanding of how hydrometeorological factors influence pathogen-specific diarrheal disease is needed to predict future diarrheal disease risk and inform preventive action. The SPRINGS project (Supporting Policy Regulations and Interventions to Negate aggravated Global diarrheal disease due to future climate Shocks) brings together scientists from multiple disciplines to collaborate with communities, public authorities, and policymakers to address these challenges within a Planetary Health framework. The case study in Akuse, Ghana integrates epidemiology, environmental sampling, and weather data.  

This study aims to determine how hydrometeorological variables influence the incidence of medically-attended diarrheal disease among children under five in Akuse, Ghana. More specifically, this study aims to assess whether the influence of hydrometeorological variables on diarrhea is direct or acts through intermediate impacts on water quality and other water, sanitation and hygiene (WaSH) factors. By identifying climate-sensitive transmission pathways, this study will improve projections of future diarrheal disease risk and identify potential targets for intervention to mitigate the impact of climate change on diarrheal disease in this area in Ghana. 

This two-year epidemiological study employs a case-control study design, with a nested case-crossover study. Children under the age of five presenting to four selected health facilities with and without diarrheal disease will be recruited as cases and controls, respectively. Surveys administered by local nurses will collect data about individual- and household-level risk factors, including WASH conditions and animal ownership. In addition, stool samples will be collected to estimate the attributable incidence of diarrheal disease due to four key diarrheal pathogens: rotavirus, Campylobacter, Cryptosporidium, and Giardia. Local weather conditions during the study will be monitored by weather stations positioned near each health facility. Throughout the study, water samples will be collected from various sources in the study area to be tested for multiple water quality parameters, including the presence of the four diarrheal pathogens of interest. Additionally, anthropological research will improve the understanding of human behaviours and perceptions related to diarrheal disease risk and climate change in this area.  

By linking weather variability, environmental pathogen presence, WASH factors, and child health outcomes, this study illustrates how a Planetary Health approach can improve understanding of climate-sensitive diarrheal disease risk and provide evidence to inform adaptation strategies and child health interventions in Ghana.