Heat risk perceptions and limits to adaptation in urban Mozambique: insights from communities and health professionals

Extreme heat is an increasingly severe public health challenge worldwide, yet heat risks remain underexplored in low-income countries. This study is the first to examine heat risk knowledge, perceptions, challenges, and adaptation strategies in Mozambique, focusing on community members and health professionals in the urban agglomeration of Maputo and Matola City. We conducted a survey (N=95) that combined closed-ended questions with follow-up open-ended responses to explore participants' reasoning. Descriptive analyses of the quantitative data were performed, and open-ended responses were categorized based on emergent themes drawn from participants’ answers. Our results show that participants widely recognized heatwaves as a severe public health threat and a majority perceived themselves as vulnerable. They identified a wide range of common heat-related symptoms, vulnerable groups, and adaptation measures, although many noted barriers that limited their ability to implement common strategies. Respondents also reported persistent challenges to continue working during extreme heat, mentioning reasons such as impacts on health, mental strain, and overall reduced productivity. Specific healthcare challenges due to the heat were also reported, such as increased number of patients, equipment failures, and difficulities in storing medicines. Lastly, although most participants received heat alerts in advance of extreme heat, the messages were found to lack actionable guidance and not always reach all vulnerable groups effectively. In conclusion, our findings underscore the need to strengthen healthcare preparedness, as well as the development targeted interventions which take into account socio-economic disparities in adaptation to heat.