Projected heat-related mortality under climate change in the metropolitan area of Skopje.

BACKGROUND: Excessive summer heat is a serious environmental health problem in Skopje, the capital and largest city of the former Yugoslav Republic of Macedonia. This paper attempts to forecast the impact of heat on mortality in Skopje in two future periods under climate change and compare it with a historical baseline period. METHODS: After ascertaining the relationship between daily mean ambient air temperature and daily mortality in Skopje, we modelled the evolution of ambient temperatures in the city under a Representative Concentration Pathway scenario (RCP8.5) and the evolution of the city population in two future time periods: 2026-2045 and 2081-2100, and in a past time period (1986-2005) to serve as baseline for comparison. We then calculated the projected average annual mortality attributable to heat in the absence of adaptation or acclimatization during those time windows, and evaluated the contribution of each source of uncertainty on the final impact. RESULTS: Our estimates suggest that, compared to the baseline period (1986-2005), heat-related mortality in Skopje would more than double in 2026-2045, and more than quadruple in 2081-2100. When considering the impact in 2081-2100, sampling variability around the heat-mortality relationship and climate model explained 40.3 and 46.6 % of total variability. CONCLUSION: These results highlight the importance of a long-term perspective in the public health prevention of heat exposure, particularly in the context of a changing climate.

The public health impacts of climate change in the former Yugoslav Republic of Macedonia.

Projected climatic changes for the former Yugoslav Republic of Macedonia for the period 2025-2100 will be most intense in the warmest period of the year with more frequent and more intense heat-waves, droughts and flood events compared with the period 1961-1990. The country has examined their vulnerabilities to climate change and many public health impacts have been projected. A variety of qualitative and quantitative methodologies were used in the assessment: literature reviews, interviews, focus groups, time series and regression analysis, damage and adaptation cost estimation, and scenario-based assessment. Policies and interventions to minimize the risks and development of long-term adaptation strategies have been explored. The generation of a robust evidence base and the development of stakeholder engagement have been used to support the development of an adaptation strategy and to promote adaptive capacity by improving the resilience of public health systems to climate change. Climate change adaptation has been established as a priority within existing national policy instruments. The lessons learnt from the process are applicable to countries considering how best to improve adaptive capacity and resilience of health systems to climate variability and its associated impacts.

Ambient maximum temperature as a function of Salmonella food poisoning cases in the Republic of Macedonia.

BACKGROUND: Higher temperatures have been associated with higher salmonellosis notifications worldwide. AIMS: The objective of this paper is to assess the seasonal pattern of Salmonella cases among humans. MATERIAL AND METHODS: The relationship between ambient maximum temperature and reports of confirmed cases of Salmonella in the Republic of Macedonia and Skopje during the summer months (i.e. June, July, August and September) beginning in 1998 through 2008 was investigated. The monthly number of reported Salmonella cases and ambient maximum temperatures for Skopje were related to the national number of cases and temperatures recorded during the same timeframe using regression statistical analyses. The Poisson regression model was adapted for the analysis of the data. RESULTS: While a decreasing tendency was registered at the national level, the analysis for Skopje showed an increasing tendency for registration of new salmonella cases. Reported incidents of salmonellosis, were positively associated (P<0.05) with temperature during the summer months. By increasing of the maximum monthly mean temperature of 1° C in Skopje, the salmonellosis incidence increased by 5.2% per month. CONCLUSIONS: THE INCIDENCE OF SALMONELLA CASES IN THE MACEDONIAN POPULATION VARIES SEASONALLY: the highest values of the Seasonal Index for Salmonella cases were registered in the summer months, i.e. June, July, August and September.