Heat-health risk knowledge, perceptions, adaptation, and challenges in Mozambique: insights from community members and health professionals

Intro: Extreme heat is increasing across Mozambique, yet evidence on how heat is perceived, experienced, and how it impacts communities and key sectors remains limited. Methods: This exploratory study examines heat-health risk knowledge and perceptions, occupational and healthcare challenges, and adaptation strategies in Maputo City and Matola Municipality, the country’s largest urban area. Using a purposive sampling approach, we conducted 95 structured surveys between January and April 2023 (56 community members (C); 39 health professionals (H)), combining closed- and open-ended questions. These perspectives offer insight into local heat risks from key actors positioned to recognize and respond to heat risks, providing essential initial evidence to inform heat preparedness and policy in Mozambique. Data were analysed using descriptive statistics, non-parametric group comparison tests and ordinal logistic regression, and inductive thematic analysis for open-ended responses. Results: Nearly all participants (98%) perceived that extreme heat had increased in recent years and viewed it as a severe public health threat, with most rating the risk at the maximum level (10/10). Most respondents perceived themselves as “very much” vulnerable to heat (C: 55%, H: 39%), primarily due to health impacts and inadequate housing and work conditions contributing to high exposure. Heat was reported to affect healthcare delivery through increased patient load, equipment failures, and difficulties in storing medicines, as well as reducing labour productivity due to physical and mental fatigue. Although 94% reported receiving heat warnings, participants emphasized that warnings do not consistently reach vulnerable groups and called for more community-based dissemination. Conclusion: Extreme heat is already affecting daily life and healthcare services in urban Mozambique. Building resilience will require low-cost, equitable adaptation measures, strengthened health system preparedness, and coordinated institutional responses as heatwaves intensify. In data-scarce settings, frontline community and health-system perspectives are particularly valuable to understand local heat-health risks.