Developing Climate Change and Health Impact Monitoring through eHealth at the South East Asia Community Observatory and Health and Demographic Surveillance Site, Malaysia (CHIMES): A Mixed-Methods Study (Preprint)

Abstract

Malaysia will experience a surge in extreme heat, excessive rainfall, rainfall variability, dry spells, thunderstorms, and high winds. Additionally, climate change affects the destruction of coastal and mangrove forests, coral reef bleaching, and the extinction of marine species. All of these changes will also have an impact on the health of Malaysia’s population: heat-related mortality is projected, nutritional security will decline, and unusable land will necessitate migration. However, there are currently insufficient data to investigate the health effects of climate change on the Malaysian population and to better inform decision-making and intervention prioritization.

We will conduct a mixed-methods study to elucidate best practices for developing a South East Asia Community Observatory (SEACO) Health and Demographic Surveillance System (HDSS) that is equipped for climate change and health research, while simultaneously assessing the feasibility of community-based screening and measurements for climate-sensitive lung diseases, such as chronic obstructive pulmonary disease (COPD) and asthma.

Sensor-based measurements for climate change and health research on three different levels are introduced: consumer-grade wearable devices and smart spirometers on the individual-level, indoor temperature measurements on the home-based level, and 3D-printed weather stations on the community-based level. We will randomly sample n=120 of the SEACO HDSS population in the Segamat region of Malaysia, above the age of 18 years. Participants will wear a wrist-worn device that measures heart rate, daily activity, sleep, and blood oxygen levels 24 hours a day, seven days a week for three weeks, while an indoor temperature sensor is installed in their living room and 3D-printed weather stations provide outdoor measurements. Participants' potential for having a climate-sensitive lung illness will be assessed by a validated pre-screening questionnaire and a smart spirometer. A total of three study cycles of three weeks duration and covering n=40 study participants each will be conducted. Each study cycle will include at least n=10 participants with a high likelihood of having COPD or asthma.

This study will determine the best ways to develop a climate change and health research-ready SEACO HDSS using sensor-based measurements, including individual (wearable devices measuring activity, sleep, heart rate, oxygen saturation, and a spirometer for lung capacity assessment), home-based (indoor temperatures), and community measurements (3D-printed weather stations as a sustainable and inexpensive method to increase spatial and temporal coverage of weather and climate). Integrating climate-related data and reported and measured health status into the SEACO HDSS will help characterize objectively, people's activity levels and exposures in their homes using indoor measures, as well as outdoor measures from 3D-printed weather stations.

Our study will generate insights on how to strengthen research infrastructures like the SEACO HDSS with sensor-based devices to generate data relevant for climate change and health research in climate-vulnerable populations. To facilitate research and better decision-making for identifying priorities in adaptation and mitigation, we will focus on generating best practices, utilizing cost-effective data collection mechanisms of consumer-grade wearable devices, indoor temperature measurements, and 3D-printable weather stations.