Interdisciplinary Collaboration in Co-designing Complex Multi-Level, Multi-Component, Heat Adaptation Interventions to Reduce Heat Impacts on Pregnant Women and Infants

Background
High ambient temperatures in pregnancy are directly and indirectly affecting adverse birth outcomes and pregnancy-related complications, while poorly ventilated and hot health facilities raise infection rates, impaired health worker performance and care quality. Addressing these risks requires co-designed, interdisciplinary heat adaptation interventions at individual, community, facility, and policy levels. We describe the process and outcomes of co-designing multi-level heat adaptation interventions in rural Zimbabwe.

Methods
Following mixed-methods formative assessments, including surveys, qualitative inquiries, and continuous temperature monitoring, we conducted four codesign workshops with stakeholders (Figure 1). All workshops used small-group activities, plenary sessions, and formal ranking tools, with data transcribed, coded, and ranked based on success likelihood, cost-effectiveness, implementation feasibility, and sustainability. We used the Power-Interest-Matrix framework in a participatory stakeholder mapping workshop to identify stakeholders of each codesign workshop.

Results
A total of 105 stakeholders participated in the co-design, and prioritised behavioural, health systems, building modifications and nature-based solutions. Behavioural interventions included hydration and cooling strategies, light clothing, heat illness self-monitoring, and frequent breastfeeding for infants. Health system interventions involved cooler-time antenatal care scheduling (e.g. early mornings), investments in human resources, health posts, cooler waiting mothers' homes, health facility green-zones and guidelines for managing heat exposure and training care providers (Figure 1). Built environment interventions at health facilities aimed to reduce indoor temperatures through blinds, reflective paint, and indigenous thatching designs, and health facilities upgraded for better ventilation and cooling. Nature-based solutions involved non-timber community woodland management, and planting trees to improve thermal comfort. Policy actions incorporated heat adaptation guidelines in facilities and rural planning. Resilience measures include drilling boreholes for potable water, food support, and cash transfers.

Discussion and conclusion
By integrating behavioural changes, health system improvements, built environment modifications, nature-based solutions, and policy actions, the study showcases the complexity of heat-related challenges. The process identified critical needs, set technical benchmarks, and engaged local knowledge systems, fostering community capacity and ownership. The outcomes demonstrate the utility of co-design in resource-limited settings and offer a scalable model for other regions, highlighting the necessity of technically sound, culturally grounded, and interdisciplinary approaches in developing scalable heat adaptation strategies.