Article Category:
Research Article

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

Francesco Vladimiro Segala Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro,” Bari, Italy;

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Edoardo Occa Doctors with Africa CUAMM, Maputo, Mozambique;

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Elsa Chambisse Doctors with Africa CUAMM, Maputo, Mozambique;

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Francesco Cavallin Independent Statistician, Solagna, Italy;

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Rumela Cobre Doctors with Africa CUAMM, Maputo, Mozambique;

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Giorgia Gelfi Doctors with Africa CUAMM, Maputo, Mozambique;

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Vitor Laguessa Doctors with Africa CUAMM, Maputo, Mozambique;

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Jose Moniz Doctors with Africa CUAMM, Maputo, Mozambique;

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Abdul Chorai Doctors with Africa CUAMM, Maputo, Mozambique;

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Ketan Chitnis UNICEF Mozambique, Maputo, Mozambique;

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Claudia Marotta Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;

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Inusso Chuau UNICEF Mozambique, Maputo, Mozambique;

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Angelo Ghelardi UNICEF Mozambique, Maputo, Mozambique;

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Aida Mahomed UNICEF Mozambique, Maputo, Mozambique;

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Giovanni Putoto Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy;

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Manuel Aly Mussa Nucleo de Investigaçao Operacional del Pemba (NIOP), Pemba, Mozambique

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Annalisa Saracino Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro,” Bari, Italy;

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Francesco Di Gennaro Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro,” Bari, Italy;

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DOI:
https://doi.org/10.4269/ajtmh.24-0423
Volume/Issue:
Volume 112: Issue 2
Page(s):
331–336
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ABSTRACT.

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.

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Author Notes

Financial support: All study activities were conducted within the framework of the UNICEF-CUAMM (University College for Aspiring Missionary Doctors) program “Support Adoption of Key Behaviors to Prevent Covid-19, Cholera, Malaria, Malnutrition, and Improve Access to Services in Cabo Delgado.” No additional funds were required for the performance of the study.

Disclosures: The data collection for this study was realized in the framework of activities for the program “Support Adoption of Key Behaviors to Prevent Covid-19, Cholera, Malaria, Malnutrition, and Improve Access to Services in Cabo Delgado.” This project operates under a framework agreement involving CUAMM, UNICEF, the Mozambique government, and a specific agreement with the Cabo Delgado province permitting the execution of all study activities. Participation was voluntary, anonymous, and uncompensated. Aggregated data at the family-unit level were collected anonymously.

Authors’ contributions: F. V. Segala, E. Occa, F. Di Gennaro, and C. Marotta contributed to study concept and design. E. Chambisse, R. Cobre, G. Gelfi, V. Laguessa, J. Moniz, A. Chorai, I. Chuau, A. Ghelardi, A. Mahomed, and M. A. Mussa contributed to patient inclusion and data collection. F. Cavallin and F. V. Segala cleaned the data, and F. Cavallin contributed to the statistical analysis. F. V. Segala, E. Occa, F. Di Gennaro, C. Marotta, G. Putoto, and F. Cavallin interpreted the data. F. V. Segala, F. Cavallin, and E. Occa drafted the manuscript. F. Di Gennaro, A. Ghelardi, A. Saracino, G. Putoto, and K. Chitnis critically revised the manuscript. All authors approved the final manuscript.

Current contact information: Francesco Vladimiro Segala, Annalisa Saracino, and Francesco Di Gennaro, Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro,” Bari, Italy, E-mails: fvsegala@gmai.com, annalisa.saracino@uniba.it, and francesco.digennaro1@uniba.it. Edoardo Occa, Elsa Chambisse, Rumela Cobre, Giorgia Gelfi, Vitor Laguessa, Jose Moniz, and Abdul Chorai, Doctors with Africa CUAMM, Maputo, Mozambique, E-mails: e.occa@cuamm.org, e.chambisse@cuamm.org, r.cobre@cuamm.org, g.gelfi@cuamm.org, v.laguessa@cuamm.org, j.moniz@cuamm.org, and a.chorai@cuamm.org. Francesco Cavallin, Independent Statistician, Solagna, Italy, E-mail: cescocava@libero.it. Ketan Chitnis, Inusso Chuau, Anelo Ghelardi, and Aida Mahomed, UNICEF Mozambique, Maputo, Mozambique, E-mails: kchitnis@unicef.org, ichuau@unicef.org, aghelardi@unicef.org, and amahomed@unicef.org. Claudia Marotta and Giovanni Putoto, Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy, E-mails: marotta.claudia@gmail.com and g.putoto@cuamm.org. Manuel Aly Mussa, Nucleo de Investigaçao Operacional del Pemba (NIOP), Pemba, Mozambique, E-mail: alymussamanuel@yahoo.com.br.

Address correspondence to Francesco Vladimiro Segala, University of Bari “Aldo Moro,” Piazza Umberto i n. 1, 70121 Bari, Italy. E-mail: fvsegala@gmail.com
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
26 Jun 2024
|
Accepted:
12 Aug 2024
|
Published Online:
19 Nov 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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