Research project launched to help prevent heatwave deaths

Public health experts at universities, hospitals and non-government organisations in Karachi have launched a collaborative research project, HEAT, to suggest and evaluate ways to reduce deaths caused by extreme heat exposure (temperatures over 37°C).

The project has been undertaken in view of the blistering heatwave in Karachi in June 2015, which triggered a healthcare emergency. Extreme temperatures over a five-day period led to record hospital admissions and resulted in hundreds of preventable deaths.

HEAT (Heat Emergency Awareness and Treatment) will see researchers from the Aga Khan University, the Johns Hopkins University, the World Health Organisation and the Aman Foundation come together to test whether novel community-based and hospital-specific interventions can prevent fatalities attributed to heat stroke and heat exhaustion.

Researchers from the four organisations have jointly developed the research study designed to generate knowledge through two interventions: a community-based programme among 16,000 people living in a low-income locality in Korangi, in eastern Karachi; and a clinical intervention in major hospitals of the city.

In HEAT’s community-based arm of the project, researchers will use Aman Foundation’s operations and infrastructure in Korangi to disseminate health education messages through community leaders, bulk text messages, tele-health systems and special information sessions in schools and mosques.

Community health workers hailing from the area will monitor the public’s recall of measures to counter diseases caused by extreme heat (EH) and will also evaluate the effectiveness of these campaigns by tracking data on hospital admissions and deaths. The most effective measures will then be implemented in the same community through a pilot project ahead of the next summer in 2018.

In the hospital-based component of the project, researchers will build capacity among emergency department physicians on the management of heat emergencies. Trainings will revolve around issues such as emergency department preparedness as well as key skills such as rapid cooling, triage and resuscitation.

Eventually, evidence from the emergency room will be used to develop a focused guideline to improve the treatment of EH illnesses. Once protocols are prepared, further training sessions will be held in four major hospitals in the city.    

Health awareness and evidence-based strategies represent a vital step in tackling EH illnesses caused by heat waves, says Dr Nadeem Ullah Khan, associate professor in emergency medicine at the AKU. 

Inadequate awareness about early signs of EH conditions in 2015 prevented people from implementing simple, yet effective preventive measures against heat exposure at home. As this influx of patients with advanced symptoms arrived at hospitals, already overwhelmed ER doctors lacked a precise protocol to treat these illnesses. 

Dr Khan adds that EH diseases need special attention, as besides being life-threatening themselves, they can also increase the danger posed by cardiopulmonary (heart and lung) and cerebrovascular diseases like stroke, which are common in South Asian countries. 

“Our intervention aims to tackle heat exposure at the earliest stages through a range of preventive measures. Lower hospital admissions mean that doctors trained under HEAT can focus on treating the most severe cases of heat exposure.” 

Goal 13 of the Sustainable Development Goals places special emphasis on preparedness for climate-related disasters. HEAT’s objectives will inform efforts under target 13.1, which specifically requires countries to strengthen their resilience and adaptive capacity to climate-related hazards and natural disasters.

In the long-term, Dr Khan believes that findings from the study can be used to strengthen public health systems in other cities in the developing world and contribute towards developing a global response to weather emergencies caused by climate change.

HEAT’s principal investigator (PI) is Dr Junnaid Razzak, professor of Emergency Medicine at the Johns Hopkins University. Dr Nadeem Ullah Khan, Dr Uzma Rahim Khan and Dr Shahan Waheed from the AKU’s Department of Emergency Medicine are co-PIs on the project.

The Aman Foundation has been running a community health programme in Ibrahim Hyderi, Korangi, since 2012. It runs a clinic in the area and its team of 50 community health workers serves the health needs of 100,000 people.