The impact of extreme weather events on the mental health of vulnerable populations in Africa (The WEMA project): a study protocol

The WEMA study protocol outlines a transdisciplinary research initiative in Burkina Faso, Kenya, Mozambique, and South Africa that integrates systematic reviews, secondary data analysis, cross-sectional surveys, and participatory qualitative methods to investigate the impact of extreme weather events on common mental disorders among vulnerable African populations and inform climate adaptation policies.

The Gist

Imagine the Earth's climate as a giant, old house that is starting to fall apart. The roof leaks when it rains too hard, the walls crack during heatwaves, and the foundation shakes during storms. For a long time, we've been worried about how this "house" damage hurts our physical bodies—like getting sick from the cold or injured by falling debris.

But this new study, called WEMA, is asking a question we haven't asked enough: How does living in a crumbling house hurt our minds?

Here is a simple breakdown of what the researchers are planning to do, using everyday analogies.

1. The Big Problem: The "Storm" in Our Heads

Climate change is making extreme weather (like massive floods, cyclones, and heatwaves) happen more often and more violently. In Africa, where many people are already struggling with poverty or lack of resources, these storms hit the hardest.

While we know storms can wash away homes, this study looks at what they wash away inside us: our peace of mind. The researchers want to understand how these disasters trigger Common Mental Disorders (CMDs) like depression, anxiety, and PTSD (Post-Traumatic Stress Disorder). Think of it like this: if a flood destroys your kitchen, you can rebuild it. But if the flood leaves you feeling hopeless, scared, and unable to sleep, that "emotional damage" is much harder to fix.

2. The Four-Part Detective Mission

The researchers are acting like a team of detectives in four different countries: South Africa, Kenya, Mozambique, and Burkina Faso. They are using four different tools to solve the mystery:

• Tool 1: The "Time Travel" Book (Literature Review)
  Before they start, they will read every existing book and article written about weather and mental health in Africa. It's like checking the library to see what clues others have already found, so they don't have to reinvent the wheel.

• Tool 2: The "Weather Diary" (Secondary Data Analysis)
  They will look at old records from hospitals and weather stations. Imagine looking at a diary that says, "On this day, it rained 10 inches, and on that day, 50 people went to the hospital feeling depressed." They will use math to see if there is a direct link between the rain and the sadness.

• Tool 3: The "Snapshot" Survey (Prevalence Study)
  This is the big fieldwork. The team will visit two groups of people in each country:

  • Group A: People whose homes were flooded or who were displaced by storms.
  • Group B: People who live nearby but weren't hit by the storm.

  They will ask both groups questions about their mental health. It's like taking a photo of two groups of people to see if the group that got wet is feeling more anxious than the group that stayed dry. They are specifically looking at adults (18+), leaving children out to protect them from being re-traumatized by the questions.

• Tool 4: The "Story Circle" (Digital Storytelling)
  This is the most creative part. Instead of just filling out a checklist, the researchers will invite 10 people from each community to a workshop. They will teach them how to make short, 2-to-6-minute videos (digital stories) using their phones, photos, and voices.

  Imagine sitting around a campfire where people don't just say, "I was sad." Instead, they show you a video of their flooded street, play the sound of the rain, and tell you, "This is how the water made me feel like I was drowning in fear." This captures the feeling of the experience, not just the numbers.

3. Why This Matters

Right now, if a house floods, we send in a plumber to fix the pipes. But if the people inside are having panic attacks, we often don't know how to help them because we don't have the data.

This study is trying to build a blueprint for the future. By combining the hard numbers (the "how many") with the personal stories (the "how it feels"), the team hopes to:

• Prove to governments that climate change is a mental health crisis, not just a physical one.
• Help doctors and leaders create better support systems for people after a storm.
• Ensure that when the next big flood comes, communities aren't just given food and water, but also the emotional support they need to heal.

The Bottom Line

The WEMA project is a bridge. It connects the science of weather with the science of the human mind. It's about realizing that when the climate breaks, our minds break too, and we need to fix both to help vulnerable communities survive and thrive.

Technical Summary

Based on the study protocol provided, here is a detailed technical summary of the WEMA project ("The impact of extreme weather events on the mental health of vulnerable populations in Africa").

1. Problem Statement

• Context: Climate change is increasing the frequency and intensity of Extreme Weather Events (EWEs) such as storms, cyclones, flooding, and heavy rainfall. These events disproportionately affect vulnerable populations in resource-limited settings.
• The Gap: While the physical health impacts of EWEs are documented, the specific effects on mental health in Africa are under-researched. Existing literature is scarce, with only one published study on cumulative disaster and depression in South Africa. Most global studies on climate and mental health are quantitative and lack African context.
• The Burden: Common Mental Disorders (CMDs) like depression, anxiety, and PTSD are a leading cause of disability. In Low-and-Middle-Income Countries (LMICs), 76–85% of those with severe mental disorders receive no treatment.
• Objective: The WEMA study aims to generate evidence on the direct effects of EWEs on CMDs in four African countries (Burkina Faso, Kenya, Mozambique, and South Africa) to inform policy and locally relevant interventions.

2. Methodology

The study employs a transdisciplinary, mixed-methods approach integrating quantitative and qualitative data across four work packages (WPs).

Study Design & Settings

• Locations: Four sites with high climate vulnerability:
  • South Africa: eThekwini (Durban) and Hlabisa (KwaZulu-Natal).
  • Kenya: Mukuru Kwa Reuben (exposed) and Manyatta (control) in Nairobi/Kisumu.
  • Mozambique: Beira, Dondo, and Nhamatanda (Sofala province).
  • Burkina Faso: Nouna.
• Participants: Adults (18+ years) residing in the area for ≥6 months.
  • Exclusion: Pregnant women (last trimester) and post-partum women (≤3 months) to avoid confounding hormonal factors; minors (<18) excluded due to ethical concerns regarding re-traumatization without child psychologists.
  • Groups: Exposed (flooded homes/displaced) vs. Unexposed (similar demographics, no flooding).

Work Packages (WPs)

• WP1: Rapid Evidence Synthesis & Secondary Data Analysis

  • Literature Review: A PRISMA-guided rapid review of PubMed, PsycInfo, and Web of Science to synthesize existing evidence on EWEs and mental health in Sub-Saharan Africa.
  • Secondary Data Analysis: Utilization of Health and Demographic Surveillance System (HDSS) data.
    • Data Sources: Anonymized hospital records, verbal autopsies (ICD-10 codes F00-99 for mental health), and meteorological data (local stations + ERA-5 reanalysis).
    • Analysis: Time-series regression using Distributed Lag Non-Linear Models (DLNM) to assess temporal associations between temperature/precipitation and mental health-related mortality/morbidity over lag periods up to 30 days.

• WP2: Primary Data Collection (Prevalence & Lived Experience)

  • WP2.1: Cross-Sectional Prevalence Survey

    • Sampling: Random sampling of households in exposed and unexposed areas. Target sample: 833 individuals (417 per group), adjusted for design effects and non-response.
    • Tools: Structured questionnaires on tablets (REDCap).
    • Outcome Measures:
      • Depression: PHQ-9 (Cut-off ≥10).
      • Anxiety: GAD-7 (Cut-off ≥10).
      • PTSD: PCL-5 (Cut-off ≥31-33).
    • Confounders: Socio-economic status, food security (US module), alcohol use (AUDIT-C), drug use, HIV status, social support, self-efficacy, and adverse childhood experiences.
    • Statistical Analysis: Logistic regression to estimate Odds Ratios (OR) for CMDs, adjusted for confounders, followed by meta-regression to combine country-level estimates.

  • WP2.2: Digital Storytelling (DST)

    • Method: Participatory arts-based research.
    • Process: 10 Community-Based Co-Researchers (CBCRs) per site attend 5-day workshops to create 2–6 minute digital narratives about their lived experiences of EWEs and mental health.
    • Analysis: Two-stage thematic analysis. First, participatory analysis by CBCRs; second, in-depth thematic analysis by the research team using ATLAS.ti software.

3. Key Contributions

• Methodological Innovation: Combines rigorous quantitative epidemiology (DLNM, large-scale surveys) with participatory qualitative methods (Digital Storytelling) to capture both statistical trends and human narratives.
• Contextual Specificity: Focuses exclusively on Sub-Saharan Africa, addressing a critical geographic gap in climate-mental health literature.
• Community Engagement: Utilizes Community-Based Co-Researchers (CBCRs) not just as subjects, but as active agents in data generation, analysis, and intervention design.
• Control Group Design: Unlike many previous studies in the region, this protocol explicitly includes a matched unexposed control group to isolate the specific impact of flooding from background prevalence rates.

4. Results

• Status: As this is a study protocol, no empirical results (data findings) are yet available.
• Expected Outputs:
  • A systematic review synthesizing current evidence gaps.
  • Quantitative estimates of the association between EWEs and CMDs (Odds Ratios).
  • Prevalence rates of depression, anxiety, and PTSD in flood-exposed vs. unexposed populations.
  • Thematic insights from digital stories regarding the psychosocial mechanisms of climate trauma.
  • Policy briefs and intervention strategies co-designed with communities.

5. Significance

• Policy Impact: The study aims to bridge the gap between scientific evidence and policy, driving the development of climate adaptation strategies that specifically address mental health.
• Health Equity: By focusing on vulnerable populations (slum dwellers, rural communities, displaced persons), the research highlights and seeks to reduce health inequalities exacerbated by climate change.
• System Strengthening: Identifies gaps in existing health data systems (e.g., lack of mental health coding in mortality data) to improve future surveillance.
• Ethical Safeguards: The protocol includes a distress protocol with access to psychologists to manage re-traumatization, setting a standard for ethical research on sensitive trauma topics in LMICs.

Funding & Ethics: Funded by the Wellcome Trust (Award 228025/Z/23/Z). Approved by ethics committees in all four countries (KZN-BREC, CERS Burkina Faso, Amref ESRC Kenya, CNBS Mozambique).