A Life-Course Exposome for Maternal and Child Health: Linking Climate, Infection, Nutrition, and Health-Service Access

Changes in maternal and child health due to climate conditions frequently are cascading events. The impact of these factors may be cumulative, starting at pregnancy, through early childhood. This study compared these sequences of exposure and investigated if continuous care decreased the impact of these exposures. Explanatory sequential mixed methods design was followed in three districts of Bangladesh which were at risk due to climate change. A total of 480 pregnant women were included in the quantitative phase and 426 mother-child dyads were followed to 24 months. Information on the environment was combined with clinical information, nutrition data, infection history, and service-use data. Distributed-lag models were used as well as sequence analysis, mixed-effects regression, target-trial emulation and mediation analysis. Twenty-four mothers, partners and frontline health workers were recruited from different and contrasting exposure groups during the qualitative phase. Severe maternal complications (adjusted odds ratio 2.06, 95% confidence interval 1.11-3.82), preterm birth (1.89, 1.05-3.41) and adverse child health at 24 months (2.74, 1.55-4.86) were associated with compound climate, infection, nutrition, and service disruption. A continuum of services lowered the likelihood of negative outcomes for children from 28.7% to 20.1%. This was 12.3 percentage point absolute decline in the lowest socioeconomic group. Qualitative results indicated that transport problems, loss of income, food insecurity and missed referrals exacerbated the impact of short-term climate shocks to become long-term health risks. Climate policy should be integrated with maternal and child health and nutrition support and ongoing care.