Climate change and health in urban informal settlements in low- and middle-income countries – a scoping review of health impacts and adaptation strategies

Figures & data

Table 1. Search terms used in PubMed, Embase and Cochrane

Category	PubMed, Embase and Cochrane Search Strategy
Climate Change	(‘climate change’ OR ‘climate variabil*’ OR ‘global warming’ OR ‘greenhouse effect*’ OR ‘greenhouse gas emission*’ OR GHGE OR ‘heat wave*’ OR heatwave* OR ‘high temperature*’ OR drought* OR flood* OR ‘climate induced’ OR ‘climate related disaster*’ OR ‘storm*’ OR ‘typhoo*’ OR ‘hurricane*’ OR ‘cyclone*’ OR ‘sea level rise*’)
Informal Settlements	(slum* OR settlement*)
Health	(health* OR well-being OR wellbeing OR prevalence OR incidence OR risk OR rate OR mortality OR morbidity OR obesity OR malnutrition OR malnour* OR overweight OR over-weight OR underweight OR under-weight OR nutrient OR iron OR iodine OR ‘vitamin d’ OR ‘vitamin b12’ OR calcium OR ‘vitamin a’ OR zinc OR magnesium OR deficien* OR shortage* OR value* OR anemia OR anaemia OR hypertension OR ‘blood pressure’ OR BP OR stroke OR diabetes OR ICH OR ‘heart disease’ OR CKD OR ‘kidney disease’ OR chronic OR cardiovascular OR cardio-vascular OR malaria OR dengue OR vector OR cholera OR cancer)

Figure 1. PRISMA 2009 flow diagram of the literature selection process. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 6(7): e10000

Figure 2. Provides an overview of the publication types, methods, and data sources used in the studies

Figure 3. The distribution of geographical focus of the identified papers

Table 2. Search terms used in web of science

Category	Web of Science Search Strategy
Climate Change	(‘climate change’ OR ‘climate variabil*’ OR ‘global warming’ OR ‘greenhouse effect*’ OR ‘heat wave*’ OR heatwave* OR drought* OR flood* OR ‘climate induced’ OR ‘climate related disaster*’ OR ‘storm*’ OR ‘typhoo*’ OR ‘hurricane*’ OR ‘cyclone*’ OR ‘sea level rise*’)
Informal Settlements	(slum* OR settlement*)
Health	(mortality OR morbidity OR obesity OR malnutrition OR malnour* OR overweight OR over-weight OR underweight OR under-weight OR nutrient OR iron OR iodine OR ‘vitamin d’ OR ‘vitamin b12’ OR calcium OR ‘vitamin a’ OR zinc OR magnesium OR anemia OR anaemia OR hypertension OR ‘blood pressure’ OR stroke OR diabetes OR ICH OR ‘heart disease’ OR CKD OR ‘kidney disease’ OR chronic OR cardiovascular OR cardio-vascular OR malaria OR dengue OR vector OR cholera OR cancer)

Table 3. Characteristics of the original articles

Author (year)	Study site	Climate exposure	Health effect	Outcome measures	Adaptations	Recommendations
Original research articles
Bambrick H. et al. (2015)	Shashemene (Ethiopia)	Climate change(not specified)	Indirect effects: Food insecurity and malnutrition CDS: Changes to infectious disease transmission e.g. diarrhea, typhoid, and malaria	Identification of climate-sensitive health conditions and the local hazards that may affect the informal urban communities	* Improved sanitation and water supply * Vaccination	Research: Local research to inform national policy Research taking community needs into consideration.
Contreras C. et al. (2018)	Lima (Peru)	Flooding	Indirect effects: Mental Health: depression and domestic violence	Prevalence of depression and domestic violence. Persons accepting the accompaniment to government services	Elements of the intervention (1) screening for depression and domestic violence, (2) children’s activities to strengthen social and emotional skills and diminish stress, (3) participatory theater activities to support conflict resolution and community resilience, and (4) community health worker (CHW) accompaniment to government health services.	N/A
Egondi T. et al. (2015)	Nairobi (Kenya)	Temperature variation, heat waves, and cold spells	Direct effect: Years of Life Lost	Association of temperature and Years of Life Lost	* Improvement of housing conditions and building standards * Create awareness of the dangers of extreme temperatures	Research: Individual level studies to establish vulnerable groups and help in designing adaptive strategies.
Egondi T. et al. (2012)	Nairobi (Kenya)	Temperature and rainfall	Direct effects: Mortality	Association of temperature, rainfall, and mortality	* Proper housing and clothing	Research: Epidemiologic studies that incorporate archived climatological and environmental data in modeling specific health outcomes in vulnerable populations
Khan M. et al. (2014)	Dhaka(Bangladesh)	Flooding	Indirect effects: Poor mental well-being, malnutrition CDS: diarrhea and gastric disease NCD: High blood pressure, diabetes, heart disease	Affected by flood/stagnant water. Health problems. Urban/rural impact	* Hand washing with soap, proper disposal of fecal material, and the use of modern toilets	Policy: Availability of essential equipment e.g. power generators and water pumps Allocation of alternative less vulnerable settlement areas
Knowlton K. et al. (2014)	Ahmedabad (India)	Heat waves	N/A	N/A	* Community outreach to build public awareness* Early warning systems and weather forecasting *Capacity building among health care professionals	Policy: A seven-phase model described in the article can be used as a template for developing other adaptation projects for extreme weather events in lower-resource settings
Toan D. et al. (2014)	Hanoi (Vietnam)	Climate change (not specified)	Illness (not specified) CDS: Emerging diseases (dengue, Japanese encephalitis)	Perceptions and knowledge of climate change and health. Perceived illness among family members	N/A	Policy: Make use of community groups as climate change communication channels Research: Studies where perceptions are checked against real health data could provide more precision
Tran K. et al. (2013)	Ahmedabad (India)	Extreme heat	Direct effects: Heat-related symptoms, Heat-related illness	Self-reported heat-related illness and heat-related symptoms at the individual level	* Inform people about the dangers of extreme heat * Capacity building among health care professionals and CHW	Research: Future research should assess exposure-outcome associations and focus on intervention implementation and evaluation
Vellingiri S. et al. (2020)	Ahmedabad (India)	Temperature	Direct effect: Heat-related illness	Temperatures in intervention and nonintervention homes	Selected cool roof technologies can reduce indoor temperatures	Research: Future studies with larger sample sizes and better research designs
Reviews, Commentaries, View-Points, and Editorials
Corburn J. et al. (2017)	N/A	Climate change (not specified)	Health (not specified)	Health benefits of slum upgrading	Improved flood control by upgrading of infrastructure and housing	Policy: Having a supportive state policy framework can enhance long-term impacts from slum upgrading upon population health
Munslow B. et al. (2010)	Asia	Climate change (various)	Health (not specified)	N/A	* Early warning systems * Disaster preparedness	Policy: Creation of multi stakeholder partnerships
Scovronick N. et al. (2015)	N/A	Climate change (various)	Health (various)	N/A	* Land access and provision of infrastructure * Ecosystem protection	Research: The article provides an overview of study designs that have been used for research in informal settlements and only require moderate data inputs Lack of data might hinder future research
Sverdlik A. (2011)	N/A	Climate change (various)	Health (various)	N/A	* Improvement of housing conditions and building standards	Policy: Low-income groups may require special assistanceResearch: Evaluate the pathways between climate change and NCDs
Commentaries and editorials
Patrick R. et al. (2016)	N/A	Climate change (various)	Health (various)	N/A	* Urban food production to reduce heat, food insecurity and GHE	Policy: Promoting citizen participation in decisions about the future of the global food system
Ramin B. (2009)	Africa	Climate change (various)	Health (various)	N/A	N/A	Policy: taking into account climate change and urbanization when planning public health interventionsResearch: research focused on climate-change related health outcomes among slum dwellers

*Suggested/proposed adaptation strategy, not investigated in the article