Editing IPCC:AR6/WGII/Chapter-9 (section)

==== 9.10.3.4 Disease-specific Adaptations ====

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===== 9.10.3.4.1 Adaptation to prevent malaria =====

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Increasing distribution and coverage of long-lasting insecticide-treated bed nets, improved diagnostic tests and increasing health service access could mitigate the impacts of climate change on malaria if aligned with the predicted or actual burden of malaria ( ''medium confidence'' ) ( [[#Kienberger--2014|Kienberger and Hagenlocher, 2014]] ; [[#Thwing--2017|Thwing et al., 2017]] ). Understanding seasonal shifts in malaria transmission suitability as a result of climate change can guide more targeted seasonal public health responses and better planning for different types of management and control interventions based on the impact. For example, an increase in the number of months where climate conditions are suitable for mosquito survival will require public health responses for an extended period of time ( [[#Ryan--2020|Ryan et al., 2020]] ).

In malaria-endemic areas, repeated malaria infections can provide temporary immunity, which reduces new clinical cases ( [[#Laneri--2015|Laneri et al., 2015]] ; [[#Yamana--2016|Yamana et al., 2016]] ). Conversely, where people have little or no immunity, exposure to malaria can lead to epidemics ( [[#Semakula--2017a|Semakula et al., 2017a]] ; [[#Ryan--2020|Ryan et al., 2020]] ). Pregnant women and infants remain at risk of severe malaria, regardless of immunity status. Vector control and case management capacity should be rapidly scaled up in newly affected areas where risks for epidemics are high and populations are especially vulnerable. Poverty-alleviation initiatives underpin malaria control as the malaria burden is strongly tied to socioeconomic status ( [[#Huldén--2014|Huldén et al., 2014]] ; [[#Degarege--2019|Degarege et al., 2019]] ).

Contextualised risk studies on local drivers of transmission are still lacking and present a major gap in developing appropriate adaptation strategies ( ''high confidence'' ). Progress has been made identifying and ranking vulnerability and exposure indicators ( [[#Protopopoff--2009|Protopopoff et al., 2009]] ; [[#Onyango--2016a|Onyango et al., 2016a]] ), however, better linking of biophysical and socioeconomic determinants of risk in integrated assessment models is needed ( [[#Caminade--2019|Caminade et al., 2019]] ; [[#Zermoglio--2019|Zermoglio et al., 2019]] ), as are applied approaches to develop adaptation strategies for risk management ( [[#Leedale--2016|Leedale et al., 2016]] ; [[#Onyango--2016b|Onyango et al., 2016b]] ; [[#Sadoine--2018|Sadoine et al., 2018]] ).

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===== 9.10.3.4.2 Adaptation to reduce diarrhoeal disease =====

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Reducing pathogen concentrations in water and across food chains is fundamental for controlling diarrhoeal diseases ( [[#van%20den%20Berg--2019|van den Berg et al., 2019]] ). Diarrhoea prevention and treatment post-disaster, encompass social mobilisation campaigns, water treatment, enhanced surveillance, and vaccination and treatment centres for cholera ( [[#Cambaza--2019|Cambaza et al., 2019]] ) and typhoid ( [[#Neuzil--2019|Neuzil et al., 2019]] ).

Improved WASH requires robust water and sanitation infrastructure ( [[#Duncker--2017|Duncker, 2017]] ; [[#Kohlitz--2017|Kohlitz et al., 2017]] ; [[#Venema--2017|Venema and Temmer, 2017]] ) and technological adaptations (Gabert, 2016; [[#van%20Wyk--2017|van Wyk et al., 2017]] ), such as waterless on-site sanitation ( [[#Sutherland--2021|Sutherland et al., 2021]] ), diversification of water sources (e.g., rainwater harvesting ( [[#Lasage--2015|Lasage and Verburg, 2015]] ) and groundwater abstraction ( [[#MacDonald--2012|MacDonald et al., 2012]] )), and sharing of best practices across the continent ( [[#WASH%20Alliance%20International--2015|WASH Alliance International, 2015]] ; [[#Jack--2016|Jack et al., 2016]] ; see also [[#9.7.3|Section 9.7.3]] ; [[IPCC:Wg2:Chapter:Chapter-4|Chapter 4]] [[IPCC:Wg2:Chapter:Chapter-4#4.6.4|Section 4.6.4]] ). Hand hygiene can be improved through the creation of handwashing stations, increased access to soap and simple technologies such as the foot-operated Tippy taps ( [[#Coultas--2020|Coultas and Iyer, 2020]] ; [[#Mbakaya--2020|Mbakaya et al., 2020]] ).

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===== 9.10.3.4.3 Adaptation to reduce conditions related to heat exposure =====

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Reducing morbidity and mortality during extreme heat events requires changes in behaviour and health promotion initiatives, health system interventions and modifications to the built and natural environment. Health promotion initiatives include promoting adequate hydration and simple cooling measures, such as drinking cold liquids, water sprays and raising awareness of the symptoms and importance of heat stress, including heatstroke ( [[#Aljawabra--2018|Aljawabra and Nikolopoulou, 2018]] ). Adaptive measures are especially important for high-risk groups such as outdoor workers, the elderly, pregnant women and infants. Health systems interventions may include early warning systems, heat health regulation and health workers providing cooling interventions, such as supplying cool water or fans, during heat waves. Changes to the built environment include painting the roofs of houses white and improving ventilation during extreme heat ( [[#Codjoe--2020|Codjoe et al., 2020]] ), the use of insulation materials or altering the building materials used for the construction of housing to improve their ability to moderate indoor temperatures ( [[#Mathews--1995|Mathews et al., 1995]] ; [[#Makaka--2006|Makaka and Meyer, 2006]] ).

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===== 9.10.3.4.4 Adaptation to prevent malnutrition =====

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Transformative adaptation requires integration of resilience and mitigation across all parts of the food system including production, supply chains, social aspects and dietary choices ( [[#IPCC--2019a|IPCC, 2019a]] ). Adaptation to prevent malnutrition goes hand-in-hand with adaptation to prevent food insecurity, as is discussed in [[#9.8.3|Section 9.8.3]] ; [[IPCC:Wg2:Chapter:Chapter-5|Chapter 5]] [[IPCC:Wg2:Chapter:Chapter-5#5.12.5|Section 5.12.5]] .

Urban agriculture and forestry can improve nutrition and food security, household income and mental health of urban farmers while mitigating against some of the impacts of climate change, like flooding and landslides (by stabilising the soil and reducing runoff, for example), heat (by providing shade and through evapotranspiration) and diversifying food sources in case of drought ( [[#Zezza--2010|Zezza and Tasciotti, 2010]] ; [[#Lwasa--2014|Lwasa et al., 2014]] ; [[#Battersby--2020|Battersby and Hunter-Adams, 2020]] ).

The health sector needs to collaborate and coordinate adaptation activities with other sectors, as well as civil society and international agencies, to engage communities in health promotion ( [[#Irwin--2006|Irwin et al., 2006]] ; [[#Commission%20of%20Social%20Determinants%20of%20Health--2008|Commission of Social Determinants of Health, 2008]] ; [[#Braveman--2014|Braveman and Gottlieb, 2014]] ). The importance of social determinants of health, such as socioeconomic status, education and the physical environment in which people live and work and their consideration during development are highlighted in [[IPCC:Wg2:Chapter:Chapter-7|Chapter 7]] (see Sections 7.1.6; 7.4.2)

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