The goal of this clinical trial is to learn if infrastructure and equipment installed to cool homes reduce adverse health outcomes. The main questions it aims to answer are: What is the impact of the intervention on indoor heat stress? What is the impact of the intervention on personal exposure to heat stress? What is the impact of the intervention on health outcomes, including heart rate, and heart rate variability, and sleep quality? Participants will have cooling infrastructure and/or equipment installed in their home; have heat stress sensors installed inside and outside their home and wear personal heat stress monitors; allow some biological functions such as heat rate, heat rate variability, and sleep quality.
During the last two decades, nearly half a million people died each year from heat-related causes; climate change is expected to exacerbate the burden of adverse health outcomes. Heat stress has been associated with an increase in all-cause mortality, cardiovascular disease and mortality, chronic respiratory disease, lower respiratory infection, chronic kidney disease, diabetes, adverse pregnancy outcomes, and poor mental health. The investigators will to determine personal heat stress of low-income individuals who do not have access to air conditioning, evaluate the effectiveness, acceptability, feasibility, and scalability of building-level cooling strategies to reduce indoor heat stress among vulnerable individuals, and evaluate the impact of these interventions on heart rate. A disproportionate burden of heat-related death and disease is borne by low-income communities because they do not have access to cooling and suffer from comorbidities that exacerbate the adverse impacts of heat stress. South Asia faces the greatest current and predicted loss in disability-adjusted life years due to heat stress, and heat stress is particularly strong in informal settlements. As such, the investigators plan to conduct this study in informal settlements in Dhaka, Bangladesh. The overall hypothesis is that individuals who live in homes with corrugated iron roofs and walls are at elevated risk of heat stress and that it is possible to modify homes to prevent increases in heart rate associated with heat stress, ultimately reducing cardiovascular morbidity and mortality. The investigators will evaluate the impact of cooling infrastructure and/or equipment interventions on residents' heart rate (primary outcome), heart rate variability, sleep quality, self-reported thermal comfort, mental health, wellness, fatigue, and indoor thermal conditions (secondary outcomes).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
1,539
Infrastructure and/or equipment that cools the house in the hot season
International Centre for Diarrhoeal Disease Research, Bangladesh
Dhaka, Bangladesh
Heart rate
resting heart rate (beats per minute, bpm), where lower heart rate is better
Time frame: 0, 2, and 4 weeks
Heart rate variability
resting heart rate (beats per minute, bpm) variability, where higher variability is better
Time frame: 0, 2, and 4 weeks
Sleep quality
Self-reported sleep quality and number of minutes in rapid eye movement (REM), as recorded by a fitness watch, where more time in REM is better
Time frame: 0, 2, and 4 weeks
Irritability
Self-reported irritability, as measured by the Brief Irritability Test (BITe), where a lower score is better
Time frame: 0, 2, and 4 weeks
Environmental Symptoms
Environmental symptoms, as measured by the abbreviated environmental symptoms questionnaire, where a lower score is better
Time frame: 0, 2, and 4 weeks
Depression
Depression as measured by the Patient Health Questionnaire version with 8 questions (PHQ-8). A total PHQ-8 score of \>=7 indicated depression, \>= 10 indicates major depression and \>= 20 indicates severe depression.
Time frame: 0, 2, and 4 weeks
Anxiety
Anxiety, as measured by the Generalised Anxiety Disorder with 7 questions (GAD-7). A total GAD-7 score of \>= 8 indicates anxiety.
Time frame: 0, 2, and 4 weeks
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