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A vulnerability assessment in Chikwawa, Malawi

Malaria, diarrheal diseases and bilharzia may become more prevalent in southern Malawi as a result of climate change. In Chikwawa District a vulnerability assessment was used to identify measures to protect subsistence farmers against these and other climate-sensitive diseases.

Approximately half of Malawi’s 17 million people live in poverty and the vast majority engage in subsistence farming, making them particularly vulnerable to the effects of climate variability and change. Changes in temperature and precipitation patterns are already undermining agricultural productivity and, as a consequence, the country’s fragile food security. They also influence the prevalence of climate-sensitive diseases, such as malaria and bilharzia, which account for a large part of the disease burden among poor, rural Malawians.

A Vulnerability and Adaptation Assessment in cotton farming communities in the south of the country


In the coming years these climate trends are likely to intensify, with particularly detrimental effects for households which rely on traditional farming techniques. In late 2014 German Development Cooperation, in cooperation with the international NGO Concern International and the Great Lakes Cotton Company, undertook a Vulnerability and Adaptation Assessment (V&A) aimed at identifying and assessing the climate-related vulnerabilities facing smallholder cotton farmers in seven villages in Chikwawa District in southern Malawi. The results of the assessment were used to inform the design of an 18-month project aimed at improving residents’ ability to identify and prevent climate-sensitive diseases, mainly through hygiene measures.

Precarious lives: reduced harvests, food insecurity and vulnerable housing

El Niño - Harvest after flooding and drought
El Niño – Harvest after flooding and drought

Nearly all of the 158 surveyed households rely on subsistence farming for their livelihoods and about one-third of them live solely off their own farmed produce. Many report reduced harvests and loss of crops due to late and erratic rainfall, droughts, and strong winds which shift valuable top soil. Almost half of households experienced food insecurity in the previous six months and a quarter of these experienced severe food insecurity, with children skipping meals every month. An overdependence on maize as the main staple food, and on rain (rather than irrigation) to grow crops, means that food insecurity is likely to increase in the future as a result of climate change. In addition, the great majority of families live in mud houses and have roofs of thatched grass, neither of which properly protect them and their possessions against storms and floods, such as those which affected more than a million people – including some of the project beneficiaries – in southern Malawi in 2014-2015.

Malaria tops the list of common illnesses, but some Malawians don’t know how to prevent it or cannot afford mosquito nets

Agricultural productivity suffers when household members fall ill and are unable to work in the fields. Malaria affects more men, women and children than any other illness, while lymphatic filariasis, another mosquito-borne parasitic disease, is fairly common among men. Both are examples of climate-sensitive diseases which are likely to become more prevalent with changes in temperature and precipitation. Although residents can easily recognise the symptoms of malaria, there are gaps in their knowledge about its causes, prevention and treatment. For example, while three-quarters of respondents know that malaria is transmitted by mosquito bites, almost two in ten people did not know its cause. And although most people know that sleeping under an insecticide-treated mosquito net can help to prevent malaria, more than one in ten did not. Worryingly, the majority of those who do not sleep regularly under a mosquito net report that it is because they cannot afford one. In addition, few people were aware of other ways to prevent malaria, such as destroying mosquito breeding grounds and using mosquito repellant.

A lack of adequate water and sanitation contributes to the disease burden

Other commonly reported illnesses, including diarrhea and bilharzia, can be traced to the fact that many households do not have ready access to clean water or basic sanitation facilities. As a result, they cannot consistently practice behaviours, such as washing hands with soap after using the toilet, which would prevent them from falling ill. Only a handful of surveyed households have improved latrines with concrete slabs and hand washing facilities, while more than three quarters have pit latrines. Open defecation is practiced by 15 percent of the population. And while the vast majority of households can access an improved water source within a 30 minute walk from their homes, because of problems with salinity and long lines some continue to collect and use river water which puts them at high risk of disease.

More needs to be done to reach women with information about climate change and health

The assessment also revealed that there are differences in men’s and women’s access to information about climate change and health. Men are much more likely than women to have heard of climate change, with radio being the most trusted source of information. Men also have more contact with agricultural extension workers, the majority of whom are male. By contrast, and due to prevailing gender norms, women spend much of their time taking care of the household and their social contacts are primarily limited to family members, friends and neighbours. The study therefore concluded that efforts to improve residents’ ability to identify and prevent climate-sensitive diseases need to focus particular attention on providing information through channels which are accessible to women.

Deepen people’s knowledge about the causes of climate-sensitive diseases, and how to prevent them

Many residents underestimate their risk of contracting malaria, diarrhea and bilharzia and are often unaware of the effectiveness of preventive actions, such as using mosquito nets and consistently practicing hand-washing. The assessment recommended that adaptive measures should aim to deepen people’s understanding of the causes of common climate-sensitive diseases and how to prevent them, including actions that can be taken at both household and community level. How this was done is described in a separate case study.

Related materials and useful tools

© GIZ/ Global Programme Adaptation to climate change in the health sector
© GIZ/Claudia Aguirre
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