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Climate change, driven primarily by greenhouse gas emissions from the Global North, is increasing the frequency and intensity of tropical cyclones in Mozambique. After Cyclones Idai and Kenneth in 2019, Cabo Delgado experienced its most severe cholera outbreak in decades. This study explores the factors associated with the prevalence of acute watery diarrhea (AWD) and cholera among people exposed to both climate disasters and armed conflicts in Mozambique. This cross-sectional, community-based study assessed the prevalence and predictors of cholera and AWD in Cabo Delgado Province. Trained community health workers conducted a structured face-to-face survey in December 2023. Associations between variables were investigated using the χ2 test or Fisher's exact test, and a logistic regression model identified independent risk factors for cholera-like events. The study included 1,615 households and 8,366 people from six districts of Cabo Delgado Province. Children under 14 years old comprised 88% of the population, and 37.9% of households included internally displaced people. Overall, 4.3% of households experienced AWD or cholera within 3 months. Multivariable analysis identified factors associated with AWD, including study district (P <0.0001), overcrowding (P = 0.02), access to safe water (P <0.0001), and handwashing (P = 0.004). Among people exposed to climate disasters, factors associated with cholera or AWD were overcrowding and lack of access to safe water and handwashing facilities. These findings can guide policymakers in designing targeted climate adaptation interventions.

Introduction: Climate change is contributing to increase the frequency and severity of climate disasters in Mozambique, leading, since 2019, to extensive damage to infrastructure and displacement 1.3 million people. Aim of this study is to evaluate baseline preparedness to vector-borne and water-borne infections among households and internally displaced people exposed to climate disasters in Mozambique., Methods: This was a cross-sectional, community-based survey assessing the preparedness to infectious diseases outbreaks among people exposed to climate disasters in six districts in Mozambique. Structured form was delivered via face-to-face between October 15th and November 7th, 2022. Study outcome was defined as a seven-point score of preparedness to infectious disease outbreaks. Multivariable analysis of the score was conducted using Conway-Maxwell-Poisson regression., Results: This study included 2,140 households and 11,239 people, with IDPs accounting for 30% of them. Overall, 1,186 (55.4%) households were overcrowded. Median score of preparedness was 3 points (IQR 2-4). At multivariable analyses, districts with low preparedness were Montepuez and Mueda. Higher preparedness was associated with family planning (p < 0.0001), access to primary education for all children living in the household (p < 0.001) and possession of a birth certificate for all children aged < 5y (p < 0.0001), while preparedness was heterogeneous among the districts (p < 0.05). Households composed by IDPs were not associated with a lower preparedness score., Conclusions: In climate-vulnerable communities in Mozambique, households practicing family planning, providing access to primary education and birth certificate for all children were less vulnerable to water-borne and vector-borne infectious disease outbreaks. Being family planning and childcare primarily performed by women, our findings can inform policymakers and practitioners on the importance of addressing women to mitigate the impact of climate disasters and reduce the risk of infectious disease outbreaks., (© 2024. The Author(s).)