title: Climate change and health in Bangladesh: a baseline cross-sectional survey.
abstract: BACKGROUND
  Bangladesh is facing the unavoidable challenge of adaptation to climate change. However, very little is known in relation to climate change and health. This article provides information on potential climate change impact on health, magnitude of climate-sensitive diseases, and baseline scenarios of health systems to climate variability and change.
  
  
  METHODS
  A cross-sectional study using multistage cluster sampling framework was conducted in 2012 among 6,720 households of 224 rural villages in seven vulnerable districts of Bangladesh. Information was obtained from head of the households using a pretested, interviewer-administered, structured questionnaire. A total of 6,720 individuals participated in the study with written, informed consent.
  
  
  RESULTS
  The majority of the respondents were from the low-income vulnerable group (60% farmers or day labourers) with an average of 30 years' stay in their locality. Most of them (96%) had faced extreme weather events, 45% of people had become homeless and displaced for a mean duration of 38 days in the past 10 years. Almost all of the respondents (97.8%) believe that health care expenditure increased after the extreme weather events. Mean annual total health care expenditure was 6,555 Bangladeshi Taka (BDT) (1 USD=77 BDT in 2015) and exclusively out of pocket of the respondents. Incidence of dengue was 1.29 (95% CI 0.65-2.56) and malaria 13.86 (95% CI 6.00-32.01) per 1,000 adult population for 12 months preceding the data collection. Incidence of diarrhoea and pneumonia among under-five children of the households for the preceding month was 10.3% (95% CI 9.16-11.66) and 7.3% (95% CI 6.35-8.46), respectively.
  
  
  CONCLUSIONS
  The findings of this survey indicate that climate change has a potential adverse impact on human health in Bangladesh. The magnitude of malaria, dengue, childhood diarrhoea, and pneumonia was high among the vulnerable communities. Community-based adaptation strategy for health could be beneficial to minimise climate change attributed health burden of Bangladesh.
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.|National Institute of Preventive and Social Medicine, NIPSOM, Dhaka, Bangladesh.|Climate Change and Health Promotion Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh; mdiqbal.kabir@uon.edu.au.
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Kabir
authors.affiliation: School of Public Health and Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia.
authors.forename: Md Bayzidur
authors.initials: MB
authors.lastname: Rahman
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Smith
authors.affiliation: Health Communication Network, Dhaka, Bangladesh.
authors.forename: Mirza Afreen Fatima
authors.initials: MA
authors.lastname: Lusha
authors.affiliation: Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Abul Hasnat
authors.initials: AH
authors.lastname: Milton
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D057231:Climate Change; D003141:Communicable Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011203:Poverty; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D014887:Weather
keywords: Bangladesh; adaptation; climate change; health; household; vulnerable community