The effect of extreme precipitation on the use of maternal healthcare services in Malawi.

In the recent IPCC Report [1], Malawi has been designated as one of the most vulnerable countries to climate change. With many low-lying regions, unpaved roads, and poor building infrastructure, flooding and heavy precipitation, in particular, are considerable threats to population health. Between 1991 and 2020, more than 3.5 million people were exposed to flooding in Malawi, with 935 deaths due to flooding, mudslides, disease, and injury [2]. In addition to these direct impacts on individual health, precipitation events can severely disrupt access to and provision of medical care. In 2023, Cyclone Freddy affected the operation of 79 healthcare facilities [3], some of which were forced to close for months.

As there is no systematic data collection on the nature of these disruptions, the magnitude of their consequences is unknown. However, given that such extreme precipitation events are expected to become more common, that impact is expected to become worse in the coming decades. Using facility-specific data on antenatal care (ANC) service provision in Malawi [4], coupled with ERA5 reanalysis data [5], we use regression analyses to characterize the historic relationship between precipitation and healthcare access. We then use downscaled CMIP6 projections [6] to estimate the future impact. Under Shared Socio-economic Pathway 5.85, we estimate that 54,800 ANC appointments will be affected between 2025 and 2060, due to precipitation. That represents 0.2% of projected births in Malawi. However, this belies significant regional and temporal variation: in regions in the South or bordering Lake Malawi, up to 1 in 40 of all appointments could be affected annually. In a country with already-high maternal and neonatal mortality, such disruptions could increase barriers to care and worsen health outcomes.

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2. World Bank. (2024). Malawi - Climate and Health Vulnerability Assessment. https://hdl.handle.net/10986/41847.

3. Lutala, P., & Makwero, M. (2023). Cyclone Freddy in Malawi: Reflections from a primary care perspective. Afr. J. Prim. Health Care Fam. Med., 15(1), 1–2

4. Malawi HMIS. (2022). Malawi Health Management Information System. https://dhis2.health.gov.mw/.

5. Hersbach, H., et al. (2020). The ERA5 global reanalysis. Q. J. R. Meteorol. Soc., 146(730), 1999–2049.

6. Gergel, D., et al (2022). ClimateImpactLab/DownscaleCMIP6: v1.0.0. https://doi.org/10.5281/zenodo.6403794.