Structural heat adaptation and education in a rural setting of Pakistan: protocol for a randomised controlled trial.

INTRODUCTION: Pakistan is one of the countries most affected by climate change, where peak temperatures in certain areas frequently exceed 40°C. Despite evidence that vernacular designs and behavioural adjustments can reduce indoor temperatures, heat-adaptation efforts remain concentrated in urban or high-resource settings, with limited evidence for vulnerable rural populations in low- and middle-income countries, including Pakistan. METHODS AND ANALYSIS: This trial aims to evaluate the effectiveness of a comprehensive Resilience and Heat Adaptation Bundle (ReHAB) that integrates behavioural and structural interventions to reduce heat-related morbidity and mortality and improve internal ambient conditions in rural settings of Pakistan. This study is a prospective, cluster-randomised trial, comprising 22 clusters allocated to intervention and control arms in a 1:1 ratio. The ReHAB intervention combines community education and awareness with targeted structural improvements, including roof and wall treatments, enhanced shading, improved ventilation, sustainable energy installations and communal outdoor shelters. Health and behavioural data will be collected through household surveys, while wearable devices and environmental sensors will measure individual heat exposure and record indoor and outdoor thermal conditions. ETHICS AND DISSEMINATION: The study has received ethical approval from the Aga Khan University (AKU) (ref: 2025-11559-35625) and National Bioethics Committee (ref: 4-87/NBCR-1065/23/1736). Written informed consent will be obtained from all participants before enrolment. Referral pathways to healthcare facilities will be established to ensure timely management of complications. Findings will be disseminated through peer-reviewed publications, scientific conferences and engagement with policymakers and public health stakeholders. Results will also be shared with participants and communities through meetings and informal sessions to raise awareness and support evidence-based heat adaptation. TRIAL REGISTRATION NUMBER: NCT06983483.