Health care needs survey to improve preparedness of community outreach clinics after severe flooding in Mulanje district, Malawi

Résumé

Due to the rising impact of climate change, Malawi has increasingly experienced extreme weather events in the last decade, including flooding that resulted in large-scale displacement of vulnerable populations. In response, the Ministry of Health and partners set up outreach clinics at camps for displaced persons. However, little is known about health care needs of the affected populations. We conducted a cross-sectional survey among individuals aged ≥18 years utilizing health services at mobile outreach clinics at 7 campsites in Mulanje district, set up after flooding caused by cyclone Freddy (2023). We describe demographic characteristics, prevalence of self-reported acute and chronic conditions, depression (PHQ-9 tool), intimate partner violence (IPV) and health service satisfaction. Of 341 participants surveyed, median age was 32 (IQR 23-47) years, and 80.1% were female. Fifty-eight percent were displaced persons, the rest resided close to the camps. Compared to non-displaced residents, displaced individuals significantly more frequently had: no formal education (32.5% vs. 15.3%; p < 0.001); worse self-reported health (41.6% vs. 23.6%; p < 0.001) and respiratory illness (31.0% vs. 20.1%; p = 0.025). They had similar prevalence of chronic heart disease or hypertension (23.9% vs. 20.1%; p = 0.415) and unknown HIV status (1.0% vs. 4.2%; p = 0.163), but lower prevalence of disabilities (5.6% vs. 11.8%; p = 0.039). Similar proportions in both groups screened positive for depression (53.5% vs. 56.3%, p = 0.598; 95.7% had minimal/mild depression symptoms) and IPV (78.2% vs 70.8%, p = 0.225), but sexual violence prevalence was higher in displaced persons (34.5% vs 21.4%, p = 0.225). Low satisfaction with health services was uncommon (11.7%) and significantly associated with male sex and a positive depression score. After severe flooding, mobile outreach clinics were frequented by displaced persons and nearby residents, unable to reach their regular health facility. Given high rates of acute illnesses, chronic conditions, depression and IPV, outreach clinics in these settings require multidisciplinary teams with diverse skills to meet the health needs of the attending population.

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