TECHNICAL REPORT understan CLIMATE CHANGE AND HEALTH IN MOZAMBIQUE: IMPACTS ON DIARRHEAL DISEASE AND MALARIA March 2018 This document was produced for review by the United States Agency for International Development. It was prepared by Chemonics for the ATLAS Task Order. This document was produced for review by the United States Agency for International Development. It was prepared by Chemonics International for the Climate Change Adaptation, Thought Leadership and Assessments (ATLAS) Task Order No. AID-OAA-I-14-00013, under the Restoring the Environment through Prosperity, Livelihoods and Conserving Ecosystems (REPLACE) IDIQ. Chemonics contact: Chris Perine, Chief of Party ([email protected]) Chemonics International Inc. 1717 H Street NW Washington, DC 20006 ATLAS reports and other products are available on the Climatelinks website: https://www.climatelinks.org/projects/atlas Cover Photo: Direct Relief, March 2016. Three boys test a new bed net provided through a partnership of the NGO Malaria Consortium and the Government of Mozambique. CLIMATE CHANGE AND HEALTH IN MOZAMBIQUE IMPACTS ON DIARRHEAL DISEASE AND MALARIA March 2018 Prepared for: United States Agency for International Development Climate Change Adaptation, Thought Leadership and Assessments (ATLAS) Prepared by: Fernanda Zermoglio (Chemonics International) Anna Steynor (Climate Systems Analysis Group of the University of Cape Town) Chris Jack (Climate Systems Analysis Group of the University of Cape Town) Izidine Pinto (Climate Systems Analysis Group of the University of Cape Town) Kris Ebi (University of Washington) Lindsay Allen (University of Washington) Colin Quinn (USAID) James Colborn This report is made possible by the support of the American people through the United States Agency for International Development (USAID). The contents of this report are the sole responsibility of the author or authors and do not necessarily reflect the views of USAID or the United States government. CONTENTS LIST OF FIGURES ························································································· II LIST OF TABLES ··························································································· V ACRONYMS ································································································· VI ACKNOWLEDGMENTS ················································································ VII EXECUTIVE SUMMARY ·················································································· 1 Objective of the study ...................................................................................................... 2 Geographic scope of study .............................................................................................. 3 Historical and future climate in Mozambique ................................................................... 3 Diarrheal disease and climate ......................................................................................... 4 Malaria and climate ......................................................................................................... 8 Using weather and climate information to improve health system resilience .................. 10 BACKGROUND ····························································································14 I. WEATHER, CLIMATE VARIABILITY, AND CLIMATE CHANGE IN MOZAMBIQUE ····················································································16 Weather and climate variability in Mozambique ............................................................. 16 Regional climatology ..................................................................................................... 19 Climatological differences: 1981–1999 and 2000–2014 ................................................. 26 Discussion ..................................................................................................................... 31 Climate change in Mozambique..................................................................................... 32 II. CURRENT AND FUTURE RISKS FROM DIARRHEAL DISEASE AND MALARIA ···························································································56 Diarrheal disease and weather associations .................................................................. 58 Diarrheal disease under a changing climate .................................................................. 76 Malaria and weather associations .................................................................................. 80 Malaria under a changing climate .................................................................................. 97 Discussion ..................................................................................................................... 98 III. USING WEATHER AND CLIMATE INFORMATION TO IMPROVE HEALTH SYSTEM RESILIENCE ········································································ 102 National response ....................................................................................................... 103 Recommendations....................................................................................................... 104 REFERENCES ···························································································· 109 CLIMATE CHANGE AND HEALTH IN MOZAMBIQUE| I LIST OF FIGURES Figure 1. Regional relationship between Incidence Rate Ratios and two climate variables ........ 6 Figure 2. Relationship between incidence rate ratios and six climate variables .......................... 9 Figure 3. Map of Mozambique showing the four regions discussed in this report ......................15 Figure 4. Pressure and air distribution over southern Africa during winter .................................17 Figure 5. Pressure distribution and movement of air masses over southern Africa during summer .....................................................................................................................................18 Figure 6. a) Average monthly rainfall, and maximum and minimum temperatures – southern region ........................................................................................................................................20 Figure 7. Annual mean total rainfall for each grid cell, 1981-2014 .............................................22 Figure 8. Average Monthly rainfall across Mozambique, 1981-2014 .........................................22 Figure 9. Effects of ENSO in Africa ...........................................................................................23 Figure 10. July–June rainfall anomalies between 1981–1999 and 2000–2014 ..........................24 Figure 11. Annual mean temperature for each grid cell, 1981–2014 .........................................25 Figure 12. Seasonal cycle of monthly mean temperature, 1981-2014 .......................................25 Figure 13. Mean temperature differences between (a) 1981–1999 and (b) 2000–2014 relative to 1981–2014 ................................................................................................................................26 Figure 14. Total average rainfall: (a) 1981–1999; (b) Difference between 1981–1999 and 2000– 2014 ..........................................................................................................................................27 Figure 15. Average consecutive dry days: (a) 1981-1999; (b) Difference for 1981–1999 and 2000–2014 ................................................................................................................................28 Figure 16. Average of rain days with rainfall above 20 mm: (a) 1981–1999; .............................29 Figure 17. Average rainfall intensity: (a) 1981–1999; (b) Difference between 1981–1999 and 2000–2014 ................................................................................................................................30 Figure 18. Average 5-day rainfall: (a) 1981–1999; (b) Difference between 1981–1999 and 2000– 2014 ..........................................................................................................................................31 Figure 19. Projected change in rainfall derived from Global Circulation Models under RCP 8.5 (worst-case scenario), 2046–2065 ............................................................................................37 Figure 20. Rainfall projections derived from the Self-Organizing Map-based Statistical Downscaling method under RCP 8.5 (worst-case scenario), 2046–2065 ..................................38 Figure 21. Projected changes in number of days exceeding 50 mm rainfall derived from Global Circulation Models (CMIP5), 2046–2065 ...................................................................................39 CLIMATE CHANGE AND HEALTH IN MOZAMBIQUE| II Figure 22. Projected changes in number of days exceeding 50 mm rainfall derived from downscaled data, 2046–2065 ...................................................................................................40 Figure 23. Future temperature projections derived from Global Circulation Models (CMIP5), 2046–2065 ................................................................................................................................41 Figure 24. Maximum temperature projections derived from downscaled data, 2046–2065 ........42 Figure 25. Projections of rain days above 1 mm derived from Global Circulation Models under RCP 8.5 (worst-case scenario), 2046–2065 ..............................................................................44