The Different Effects of Climate Extremes on Physiological Health Among Agroecology and Conventional Smallholder Rice Farmers

Abstract

As climate change increases temperatures and the frequency of extreme heat events, farm workers are among the most affected. Because of the nature of the work, farmers working at hot temperatures may experience physiological changes in their body such as increases in body temperature, blood pressure, and heart rate, as well as leading to intolerance of blood glucose and blood cholesterol. This study speculates that extreme heat hazards may lead to incidence of heat-related diseases among farmers in the workplace and other metabolic disorders. The purpose of this study is to determine the potential health effects of heat exposure between agroecology and conventional rice farmers. This study recruited 33 agroecology and 25 conventional rice farmers in the northern state of peninsular Malaysia. The adapted questionnaire was used to obtain the respondent's background information. Also, the environmental and physiological measurements were carried out to determine the heat stress index (HSI) and physiological strain index (PSI). The HSI was monitored by using WetBulb globe temperature meter, whereas the physiological parameters were assessed by using thermometer, blood pressure monitor, and blood cholesterol/glucose monitor kit. The study shows that there is a significant difference between HSI, blood pressure, and blood glucose levels among organic and conventional farmers. Both groups of farmers also have a significant association between blood glucose and blood pressure. The findings of this study suggest that pesticide use can act as a synergistic effect, resulting in more significant health effects for those who were exposed to heat in their work environment. Given the impact of climate change on the agriculture sector, the disparity in the heat-related health effects between pesticides used and nonpesticides used farming community may serve as a critical factor to consider while implementing the workplace heat stress program in the agricultural industry.

Introduction

In 2016, the contribution of agriculture, forestry and fisheries sectors gross domestic product (GDP) amounted to 8.9% of the total GDP of Malaysia. Of this, the palm oil industry was the most significant contributor to agricultural GDP at RM41.9b (40.2%), while paddy contributed only RM2.4b (2.3%).¹ Despite the marginal economic contribution, rice is an essential crop to study given its status as a staple food for many Malaysian households. In 2013, Malaysia's agricultural sector employed >1.6 million workers, contributing >23% of total export earnings and 7.2% of Malaysia's GDP.² Among others, rice cultivation is mainly contributed by smallholder farmers who work significantly to the economic well-being of rural communities.³

Exposure to extreme heat stress is a growing concern for agricultural health due to global climate change, particularly in tropical developing countries. Malaysia is well known for its climate that is hot and humid, where farmers perform arduous work continuously under extreme weather conditions. The situation is worsening due to their farming methods that involve the use of primitive equipment and hard manual labor conducted in full sunshine under hot and humid conditions. Work on monitoring the impact of heat on farm workers is still dearth, recognizing that they are the most vulnerable population suffering from an acute and chronic heat-related disease.⁴ Heat exposure can lead to the occurrence of heat stress in which the body fails to control its internal temperature. Exposure to heat over a long time will eventually lead to the presence of heat-related symptoms such as heat rash, heat cramps, heat exhaustion, and heatstroke. Also, heat exposure can be affected by metabolic heat, environmental heat, and personal protective equipment (PPE) worn. Therefore, the human body experiences subtle physiological changes while being exposed to extreme temperature to maintain homeostasis of the body.

The essential difference between agroecology and conventional farming is that conventional agriculture relies on chemical intervention to fight pests and weeds and provide plant nutrition. In contrast, agroecology farming focuses primarily on land cultivation and growth of crops using techniques such as crop rotation, compost, and green manure. Although both farming groups are exposed to extreme temperatures equally, conventional farmers have been assumed to have increased health risks compared with farmers in agroecology. When working in the field at extreme temperatures, the farmer's body would sweat to cool down the body temperature. At the same time, pesticide residues in the body would increase heat absorption faster than cold skin through their hot, sweaty skin.⁵ In other words, heat exposure would act as a synergistic effect leading to increased body temperature, which subsequently increases the absorption of pesticides into the body and, therefore, increases the potential for chronic health risks from heat and pesticide exposure.⁶

Agroecology farmers, in contrast, were known throughout their farming activities for avoiding the use of synthetic and harmful pesticides. Therefore, agroecology farmers are assumed to have been prevented from the possible synergistic effects of heat- and pesticide-induced health risks. Although farmers from both farming systems experience heat-related disease when working under extreme temperatures, there were different levels of subsequent health risks among these farming groups. This study aimed to determine the effects of heat exposure on health among agroecology and conventional smallholder rice farmers by comparing their physiological parameters (core body temperature, blood pressure, heart rate, blood glucose, and blood cholesterol level) and examine their heat stress index (HSI) and physiological strain index (PSI), respectively.

Materials and Methodology

This is a cross-sectional study conducted at the northern state of Peninsular Malaysia. Both conventional and agroecology smallholder rice farmers are working on the same season of paddy growing season and sharing a similar climate condition. Inclusion criteria were to only recruit male and smallholder farmers who work at either agroecology or conventional rice farming. Also, farmers aged between 20 and 60 years, have >3 months of farming experience, and not consume alcohol or any other medications (such as diuretics and angiotensin-converting enzyme inhibitors) that can minimize heat tolerance and increase the risk of heat-related illness. A total of 33 agroecology and 25 conventional paddy farmers who fulfilled these inclusive criteria were randomly recruited to participate in this study.

Study instrument I—questionnaire

A self-administered questionnaire was used to examine the sociodemographical background of the study respondents. The purpose of this questionnaire enables us to cross-tabulate and compare both demographical information of both groups in this study. Therefore, the survey contained information such as age, gender, ethnicity, marital status, educational level, body mass index (BMI), and smoking habit.

Study instrument II—WetBulb globe temperature meter (Model: QUESTemp °36 thermal environment)

WetBulb globe temperature (WBGT) (Model: QUESTemp °36 thermal environment) was used to measure the heat stress in direct sunlight, considering temperature, humidity, wind speed, sun angle, and cloud cover (solar radiation). By using tripod mounting, it connected to the three sensors: each sensor installed at 0.1, 1.1, and 1.7 m, respectively. It was placed at the center of the farmland throughout the 8 hours working period. Based on the value obtained, HSI, therefore, is calculated by considering air temperature and relative humidity to examine how hot the human body felt when exposed to warm weather temperatures. When the HSI is high, humans can experience heat stress, which can lead to particularly dangerous conditions in which people can be harmed from being too warm and unable to cool themselves properly.

Study instrument III—body physiological monitoring

After 8 hours of working time under full sunshine, physiological parameters and climatic conditions were recorded. Core body temperature, blood pressure and heart rate, blood glucose, and cholesterol level are the physiological parameters used in this study. In this section, thermometer (Model: OMRON MC-510 Gentle Temperature) has been used to measure core body temperature, and blood pressure and heart rate were measured using Model: OMRON T3. In this study, the PSI was estimated after the measurement to determine the heat strain felt by rice farmers by integrating the core body temperature and heart rate components. Next, a drop of 0.7 μL of capillary blood was drawn by finger pricking on farmers with permission and consent, wherein the level of an individual's glucose and cholesterol was assessed by using blood cholesterol and glucose level monitor (Model: Cofoe Medical).

Result

From January to February 2019, a total of 33 agroecology rice farmers and 25 conventional rice farmers were recruited. The sociodemographical background of the study population was tabulated, as given in Table 1.

Table 1.

Respondents' Sociodemographic Information (N = 58)

Sociodemographic information	Agroecology smallholder rice farmers (n = 33) (%)	Conventional smallholder rice farmer (n = 25) (%)
Age(years)
20–30	12 (36.4)	4 (16.0)
31–40	11 (33.3)	5 (20.0)
41–50	4 (12.1)	6 (24.0)
51–60	6 (18.2)	10 (40.0)
Race
Malay	24 (72.7)	25 (100.0)
Chinese	3 (9.1)	—
Indian	1 (3.0)	—
Others	5 (15.2)	—
Status
Single	14 (42.4)	6 (24.0)
Married	19 (57.6)	19 (76.0)
Education
Primary school	1(3.0)	2 (8.0)
Secondary school	11 (33.3)	22 (88.0)
Certificate/diploma/degree	21 (63.6)	1 (4.0)
BMI
Underweight	1 (3.0)	1 (4.0)
Normal	20 (60.6)	13 (52.0)
Overweight	9 (27.3)	9 (36.0)
Obese	3 (9.1)	2 (8.0)
Smoking status
Yes	22 (66.7)	21 (84.0)
No	11 (33.3)	4 (16.0)

BMI, body mass index.

Smallholder farmers who participated in this study are at the age of 20 to 69 years, with a young adult handling 36.4% of agroecology farming at the age of 20 to 30 years, and 40% of adults manage conventional farming at the age of 51 to 60 years. At least 57.6% of agroecology farmers are married, and 63.3% of them received higher education training up to degree levels. About 76% of conventional farmers were married, and 88% of them attended high school levels. Besides, 66.7% and 52% of agroecology and conventional farmers are smokers, but none of them reported to be alcoholic. Overall, 60.6% of agroecology smallholder rice farmers and 52% of conventional rice farmers were recorded to have healthy BMI.

HSI of agroecology and conventional smallholder rice farmers

As given in Table 2, Mann–Whitney U-test was used to compare the median difference of HSI among agroecology and conventional smallholder rice farmers. The result shows that there is a significant difference (p < 0.001) of HSI among agroecology and conventional smallholder rice farmers. Conventional rice farmers perceived higher heat stress than agroecology rice farmers.

Table 2.

Heat Stress Index Among Agroecology and Conventional Smallholder Rice Farmers (N = 58)

Group	Median (IQR)^a	Z-statistics	p
Agroecology farmer (n = 33)	34.00 (5)	−5.134	<0.001^b
Conventional farmer (n = 25)	36.00 (5)	−5.134	<0.001^b

Mann–Whitney U-test.

p-Value is significant at 0.001.

Physiological parameters (blood pressure, heart rate, core body temperature, blood glucose level, and blood cholesterol level) among agroecology and conventional smallholder rice farmers

Next, blood pressure (systolic and diastolic), body temperature, heart rate, blood glucose, and blood cholesterol level were compared between both groups of smallholder rice farmers. As given in Table 3, blood pressure and blood glucose level show that there was a significant difference (p < 0.05) between both groups of smallholder rice farmers. However, no significant differences (p > 0.05) of body temperature, heart rate, and blood cholesterol levels were shown between both groups of the farming community.

Table 3.

Comparison of the Physiological Parameters Among Agroecology and Conventional Smallholder Rice Farmers (N = 58)

	Agroecology smallholder rice farmers (n = 33)	Conventional smallholder rice farmer (n = 25)	t^a/Z^b	p
Blood pressure systolic (mean ± SD)	123.27 ± 14.69	142.20 ± 16.50	−4.608	<0.001^**
Blood pressure diastolic (mean ± SD)	75.48 ± 9.65	87.48 ± 13.93	−3.873	<0.001^**
Core body temperature (mean ± SD)	38.35 ± 0.99	38.560 ± 0.85	−0.841	0.404
Heart rate (mean ± SD)	85.88 ± 12.15	92.00 ± 16.82	−1.610	0.113
Blood glucose level (median, IQR)	5.50, 2.05	6.20, 2.85	−2.830	0.005^*
Blood cholesterol level (mean ± SD)	4.63 ± 0.58	4.75 ± 0.78	−0.704	0.484

Independent t-test.

Mann–Whitney U-test.

p-Value is significant at 0.005 level.

p-Value is significant at 0.001 level.

PSI among agroecology and conventional smallholder rice farmers

Next, blood pressure (systolic and diastolic), body temperature, and PSI were calculated based on core body temperature, and heart rate is tabulated in Table 4. An independent t-test was used to compare the PSI among agroecology and conventional rice farmers. Nevertheless, no significant difference (p > 0.05) was found between the PSI for agroecology rice farmers and conventional rice farmers.

Table 4.

Physiological Strain Index Among Agroecology and Conventional Smallholder Rice Farmers (N = 58)

Group	Median (SD)^a	t-statistics	p
Agroecology farmer (n = 33)	3.73 (1.72)	0.456	0.65
Conventional farmer (n = 25)	3.52 (1.74)	0.456	0.65

Independent t-test.

Relationship between HSI, blood pressure, blood glucose, and blood cholesterol level among agroecology and conventional smallholder rice farmers

In this context, logistic regression was conducted to determine the relationship between HSI, blood pressure, blood glucose, and blood cholesterol level among agroecology and conventional smallholder rice farmers. This regression was performed to examine the variation in the measured physiological parameters (HSI, blood pressure, blood glucose, and blood cholesterol level), cause variation under the condition of using pesticide (conventional farmers) or not using pesticide (agroecology farmer).

After working at the farmland under extreme temperatures for the same period of work, conventional farmers reported to have 3.89 times higher odds of prehypertension and 15 times higher odds of hypertension than agroecology farmers. In terms of blood glucose, conventional farmers have 13.75 times higher odds of reporting prediabetes and 5.56 times higher odds of reporting diabetes than agroecology farmers after working under extreme temperatures at the farmland for the equal working duration. Lastly, in terms of blood cholesterol, conventional farmers have 1.4 times higher odds of reporting high cholesterol than agroecology farmers after working under extreme temperatures at the farmland for an equal working duration.

As given in Table 5, the conventional rice farmers have relatively higher blood pressure and blood glucose than agroecology rice farmers. For blood pressure, they were the majority in the range of hypertension (stage 1), the adjusted odds ratio was 35.62 with a p-value of 0.018. On the contrary, blood cholesterol and HSI did not show a significant relationship between the agroecology and conventional rice farmers.

Table 5.

Heat Stress Index, Blood Pressure, Blood Glucose, and Blood Cholesterol Level Among Agroecology and Conventional Smallholder Rice Farmers (N = 58)

	Crude OR (95% CI)^a	Adjusted OR^b	p
Blood pressure
Normal	1.00	1.00	0.127
Prehypertension	3.89 (0.904–16.72)	22.31	0.036^*
Hypertension (Stage 1)	15.0 (3.153–71.367)	35.62	0.018^*
Hypertension (Stage 2)	—	—	—
Blood glucose
Normal	1.00	1.00	0.063
Prediabetes	13.75 (2.86–66.03)	18.74	0.024^*
Diabetes	5.56 (1.37–22.56)	15.31	0.684
Blood cholesterol
Normal	1.00	1.00	—
High cholesterol	1.4 (0.375–5.48)	—	—
Heat stress index
Some discomfort	1.00	1.00	—
Great discomfort	—	—	–

Simple logistic regression.

Multiple logistic regression; method = enter; R² = 0.533.

DV = pesticide usage, where 1 = use pesticide in the farm (conventional farmer), 0 = not use pesticide in the farm (agroecology farmer).

CI, confidence interval; OR, odds ratio.

Discussion

Rural households are particularly vulnerable to this heat shock arising from the extreme temperature in developing countries. For example, Malaysia located in the tropical region where climate change will be more pronounced, and the livelihoods of rural smallholder farmers are more dependent on subsistence farming. To evaluate agricultural health mitigation measures during the climate change scenario, it is, therefore, essential to understand how the health effect of these farmers responds to higher temperatures.

Subjects' background information

This research consists of 33 agroecology farmers and 25 conventional smallholder rice farmers whose farmlands are located in the Peninsular Malaysia's northern state. The age of the farmers was between 20 and 60 years old, where agroecology farmers are mostly at the age of 20–40 years, and most of the conventional farmers are at the age of 41–60 years. The ages are essential as it was suggested in the past that young adults have better heat dissipation than middle-aged and older adults, which causes lower sweat production that leads to the heat being trapped more in the body.⁷ Thus, this condition makes middle-aged and older adults more vulnerable to experience a more significant level of heat strain, particularly among conventional farmers in this study.

In terms of education level, most of the agroecology farmers (63.6%) received higher education, such as certificate, diploma, and degree, whereas most conventional farmers (88.0%) only obtained secondary school education. Education disparity may explain the levels of perceiving heat and performing pesticide management among these farming communities. Most farmers were in the range of healthy BMI. This could be one of the health indicators as people who are overweight and obese are more likely to have slow metabolism due to the subcutaneous adipose tissue that hinders heat loss to maintain normothermia.⁸ Since most of the farmers are smokers, smoking can be one of the contributing factors of heat-related health effects because nicotine can increase the physiological strain of smokers.⁹ On another note, nicotine present in cigarettes could enhance local and systemic catecholamine releases and it may increase the heart rate and blood pressure.¹⁰

HSI of organic and conventional paddy farmers

HSI was obtained by measuring six parameters of a thermal environment: WBGTout, wet bulb temperature, dry bulb temperature, globe temperature, relative humidity, and air movement. The indices were categorized based on the Canada humidex range, which considers both temperature and relative humidity. In this context, Humidex was used by combining the effect of heat and humidity effect to explain how hot the weather feels to the average person.

The findings of this study showed that there is significantly different HSI among conventional and agroecology farmers. In other words, conventional farmers perceived higher heat stress than agroecology farmers. The result obtained might be influenced by the clothing factors and PPE worn, especially among conventional farmers. This might be because conventional farmers wear double woven clothes, goggles, rubber gloves, and rubber boots to protect themselves while spraying pesticides to the crops. In other words, conventional farmers were more likely to experience heat stress than the agroecology farmers who only used long sleeve shirts and pants. Clothing can act as a barrier for heat transfer and evaporation from the surface of the skin that increases thermal insulation, thus leading to an increase in body temperature.¹¹ These environmental factors are among the contributing factors to heat discomforts, which lead to heat stress among conventional farmers.

Physiological parameters (blood pressure, heart rate, core body temperature, blood glucose level, and blood cholesterol level) among agroecology and conventional rice farmers

The findings of this study show that the average blood pressure and blood glucose level were higher among conventional farmers than among agroecology farmers. In this context, it is speculated that the usage of pesticides among conventional farmers in their farmland is one of the contributing factors that influence these metabolic outputs. Previous study¹² stated that pesticides such as polychlorinated biphenyls have a significant association with hypertension and elevation of blood pressure in an individual without hypertension, and it might be the contributing factor that regulates the changes in blood pressure. Other studies also found that organochlorine pesticides have a positive association with insulin resistance among nondiabetic respondents.¹³ This is crucial as insulin resistance occurs when too much insulin was produced by the beta cell in the pancreas, which causes hyperglycemia and leads to the high risk of getting type 2 diabetes.

Core body temperature, heart rate, and blood cholesterol level showed no significant difference between both groups of rice farmers. As for core body temperature and heart rate, the extreme weather during farming affected both. In response to the rise in core body temperature, heart rate usually increases because blood needs to be pumped to the rest of the body to dissipate energy from the body and maintain thermoregulation in the body. As consistent with previous study,¹⁴ there is no significant difference in blood cholesterol level and body temperature, however, other study showed that high-density lipoprotein (HDL) may be reduced in response to increase in ambient temperature.¹⁵ Since this study only measured the total cholesterol level, future research should monitor both the HDL and low-density lipoprotein (LDL) of the farmers to evaluate the influence of the increasing ambient temperature among farmers' metabolic health.

PSI among agroecology and conventional rice farmers

The PSI is calculated by combining the thermoregulatory (core body temperature) and cardiovascular system (heart rate) to measure the heat strain felt by the person exposed to scorching weather.¹⁶ Although agroecology farmers have higher PSI than conventional farmers, the result does not show any significant PSI difference between the two farmer groups.

Agroecology farming is more labor intensive than conventional farming, where agroecology farmers put in extra effort to maintain soil fertility and protect crops against pest and weed without using pesticides. In other words, agroecology farmers consume more energy that leads to an increase in their heart rate as the body needs to increase the cardiac output to deliver adequate blood flow to the muscles. Thus, it was necessary to deliver enough blood flow to meet the oxygen demand.¹⁷ This laborious process under the tropical environment slowly induces physiological changes to claim for metabolic heat strain and compensates for muscle activity. Thus, the metabolic heat load should be balanced by transferring heat from the body to the environment equally to maintain the ideal core body temperature. However, PSI increases when heat production increases with low heat loss, and this results in the rise in core body temperature. Since the heart rate and core body temperature are the key factors in determining the PSI, the increased in energy intake, metabolic heat strain and muscle activity among the farmers will consequently affect the PSI value.

Consistent with previous study,¹⁸ metabolic output showed no significant different from the heat wave effect among conventional farmers. This is because the load carrying operation (pesticide tank sprayer) has already affected their energy intake, metabolic heat strain and muscle activity during their daily exercise. This may influence the PSI values obtained by conventional paddy farmers. Even though both farming activities show different energy outputs from various types of farming activities performed by both groups of farmers, farmers did experience physiological strain when carrying out farming activities under the hot weather environment.

Relationship between HSI, blood pressure, blood glucose, and blood cholesterol level among agroecology and conventional rice farmers

The association result shows that blood pressure, blood glucose level, and HSI have a significant association between pesticide and nonpesticides used by a group of farmers, except for blood cholesterol. Meanwhile, conventional paddy farmers have had predominant prehypertension, hypertension (Stage 1), and hypertension (Stage 2), whereas organic paddy farmers have been mostly categorized within the normal range of blood pressure. Physiologically, blood vessels expand during hot temperature to dissipate heat from the body.¹⁹ Besides, another study also suggests that increased blood pressure among conventional farmers may be due to pesticides used that could act as a surrogate factor in masking the effect of blood vessels on heat dissipation from the body. In line with the previous study,²⁰ conventional farmers in this study have 3.89-fold and 15-fold higher chance of getting prehypertension and hypertension compare to conventional farmers after working at extreme temperatures for equivalent working hours. In other words, pesticides might be the main factor for the elevation of blood pressure among conventional paddy farmers.

In terms of blood glucose, the result reported that prediabetes and diabetes were dominant among conventional paddy farmers as compared with organic paddy farmers. Conventional farmers have 13.75 times higher odds of reporting prediabetes and 5.56 times higher odds of reporting diabetes than organic farmers after working under extreme temperatures at the farmland for an equal working duration. Usage of pesticides among conventional farmers might be the main contributor that increase the blood glucose level as claimed by previous studies²¹^,²² that organophosphates could disrupt the glucose metabolism and increase the risk of getting type 2 diabetes. Besides, the study also showed that there was a positive correlation between malathion level and insulin resistance.²³ Insulin resistance can elevate the production of hepatic glucose, which was the cause of the occurrence of hyperglycemia, thus leading to the risk of getting type 2 diabetes.²⁴ In fact, apart from pesticide usage, heat exposure might also contribute to the elevation of blood glucose levels among both groups of rice farmers. A previous study²⁵ also suggests that acute exposure to heat stress increased the level of glucose and insulin by hepatic gluconeogenesis, which drives the increase of fasting plasma glucose.

Meanwhile, blood cholesterol level shows no significant association between agroecology and conventional farmers. Still, conventional farmers have 1.4 times higher odds of reporting high cholesterol than agroecology farmers after working under extreme temperatures at the farmland for the equal working duration. Even though past studies show no significant correlation between heat exposure and changes in blood cholesterol levels, the HDL and LDL increased and decreased, respectively, for each 5°C increase in mean ambient temperature.²⁶ Also, the usage of pesticides by conventional paddy farmers might contribute to the changes in blood cholesterol levels. HDL, which is good cholesterol, helps to remove other forms of cholesterol from the bloodstream and was significantly depressed when exposed to organophosphates pesticides. Nevertheless, blood cholesterol obtained in this study showed no significant association as total cholesterol was measured instead of HDL and LDL.

Conclusion

In conclusion, blood pressure, blood glucose, and HSI showed a significant difference between organic and conventional paddy farmers. However, the odds ratio of getting elevated blood pressure, blood glucose, and HSI was higher among conventional paddy farmers than among organic paddy farmers. The findings of this study show that the pesticide used may act as a synergistic effect that produces more significant health effects on those who were exposed to heat at their work environment. Thus, these findings can support proper managing of the pesticides used in the agriculture industry to fill the knowledge gaps between the occurrence of heat-related illness and other metabolic diseases with exposure to heat and pesticides.

This study is important as info about farmers' experiences regarding heat and climate change is a prerequisite and fundamental for policy-making strategies implementation to protect them from climate change. For instance, the difference of heat-related health effects among pesticide used and nonpesticide used farming communities could serve as an essential factor to consider while implementing workplace heat stress program in the agricultural industry. This preventive action can be made to mitigate or minimize the occurrence of heat-related illnesses and other metabolic diseases, such as diabetes and cardiovascular diseases. Given that total blood cholesterol levels have not shown any significant association between the pesticide and nonpesticide use group of farmers, this study suggests monitoring HDL and LDL in future research to further explore the potential metabolic health effects at physiological levels.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Acknowledgments

The authors thank Sri-Lovely Organic Farm and PACOS Trust, Sabah (Partners of Community Organisation) for their contributions and support to the project.

Funding Information

This study was funded by International Science Council (ISC) under 2018 Advanced Institute on Slow-Onset Climate Disasters (Al-SOCD)—Heat Stress Sensors, Early Warning and Information Technology Seed Grant Programme.