Predictors of Cholera and Acute Watery Diarrhea among Climate-Vulnerable People Living in Cabo Delgado, Mozambique: A Cross-Sectional Study

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.