title: Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study.
abstract: BACKGROUND
  Bangladesh is one of the countries in the world which is most prone to natural disasters. The overall situation is expected to worsen, since extreme weather and climate events (EWCE) are likely to increase in both frequency and intensity. Indirect consequences caused in the events' aftermath widen the range of possible adverse health outcomes.
  
  
  OBJECTIVE
  To assess the association of indirect consequences of EWCE and physical health.
  
  
  METHODS
  We used recent cross-sectional self-reported data from 16 coastal villages in Bangladesh. A total of 980 households were surveyed using a structured questionnaire. The outcome of physical health was categorized into three groups, reflecting the severity of reported diseases by the respective source of treatment as a proxy variable (hospital/clinic for severe disease, other source/no treatment for moderate disease, and no disease). The final statistical analysis was conducted using multinomial logistic regression.
  
  
  RESULTS
  Severe diseases were significantly associated with drinking water from open sources [odds ratio (OR): 4.26, 95% confidence interval (CI): 2.25-8.09] and tube wells (OR: 2.39, 95% CI: 1.43-4.01), moderate harm by river erosion (OR: 6.24, 95% CI: 2.76-14.11), food scarcity (OR: 1.98, 95% CI: 1.16-3.40), and the perception of increased employment problems (OR: 2.19, 95% CI: 1.18-4.07). Moderate diseases were significantly associated with moderate harm by river erosion (OR: 2.65, 95% CI: 1.28-5.48) and fully experienced food scarcity (OR: 1.75, 95% CI: 1.16-2.63). For both categories, women and the elderly had higher chances for diseases.
  
  
  CONCLUSIONS
  Indirect consequences of EWCE were found to be associated with adverse health outcomes. Basic needs such as drinking water, food production, and employment opportunities are particularly likely to become threatened by EWCE and, thus, may lead to a higher likelihood of ill-health. Intervention strategies should concentrate on protection and provision of basic needs such as safe drinking water and food in the aftermath of an event.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Beier
authors.affiliation: Unit of Epidemiology, Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brzoska
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany; mobarak.khan@uni-bielefeld.de.
authors.forename: Md Mobarak Hossain
authors.initials: MM
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D057231:Climate Change; D003430:Cross-Sectional Studies; D004190:Disasters; D004196:Disease Outbreaks; D060766:Drinking Water; D005191:Family Characteristics; D005260:Female; D055868:Floods; D005523:Food Supply; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D060766:Drinking Water
keywords: Bangladesh; climate change; coastal flooding; extreme weather and climate events; physical health