Assessing community adaptation for health risks associated with flood-induced waterborne disease outbreaks in Kampala City

Abstract

Kampala City, Uganda, faces substantial health risks stemming from frequent outbreaks of waterborne diseases induced by flooding. This study addressed the escalating vulnerability of poor urban communities to health risks associated with flooding, which is exacerbated by inadequate drainage systems, rapid urbanization, and limited adaptive capacities. This study evaluated community adaptation and the effectiveness of coping strategies in mitigating health risks linked to flood-induced waterborne diseases in Kampala City. A mixed-method research approach was employed, incorporating a case study and cross-sectional survey conducted in the three flood- prone parishes of Bwaise III, Kisenyi II, and Kamwokya III. Quantitative data were gathered through 370 household surveys, and qualitative insights were obtained from six focus group discussions. The findings revealed that flood events significantly increased health risks, particularly the spread of waterborne diseases, such as diarrhea, typhoid, and dysentery. Mental health risks were significantly associated with divisions and parishes (χ ² = 13.63, p = 0.001 for anxiety/stress; χ ² = 12.53, p = 0.002 for depression; x² = 17.195, p = 0.001 for post-traumatic stress disorder by marital status). Mortality and injury risks were also strongly linked to sociodemographic factors (χ ² = 23.98, p = 0.001 for drowning; x² = 63.11, p = 0.001 for deaths across divisions; χ ² = 64.485, p = 0.001 at the parish level). High exposure to contaminated flood water and hazardous chemicals resulted in widespread skin allergies (reported by up to 87% of the respondents in Kisenyi III). A general linear model confirmed that marital status, household size, education, and income significantly influenced community adaptation (p < 0.05). Multiple linear regression analysis revealed that elevating home structures negatively influenced adaptation (β = –0.082, p < 0.05), whereas community education, organized training programs, community-led flood mitigation projects, and coordination with local authorities positively influenced adaptation (β values ranging from 0.121 to 0.189, all p < 0.05). This study underscores the urgent need for integrated urban flood management and public health policies that prioritize community adaptation and adaptation in informal settlements. Enhancing community-based disaster risk reduction frameworks, integrating flood health adaptation planning, and improving coordination among local governments, health, and environmental agencies are crucial for reducing vulnerability and promoting sustainable urban health. This underscores the necessity for integrated risk reduction and adaptation strategies, public health interventions, and climate adaptation policies tailored to the specific conditions of impoverished urban communities.