Impact of climate change on community health and resilience in Ethiopia: A review article

Abstract

BACKGROUND:

Drought is a serious issue which might be caused by climate change that could create famine and health problems. Drought reduces air quality, increases fungal infestation, reduces people hand washing, affects mental health, leads to malnutrition by decreasing agricultural production, and increases diseases transmitted by insects. This study aimed to determine and describe community health status through building drought resilience in Ethiopia.

METHODS:

This review was conducted based on the available peer-reviewed articles that were published from January 2004 to December 2018 Online databases from PubMed, MEDLINE, Scopus, EMBASE and Google Scholar were searched for studies related to the building drought and community health resilience at different regions of Ethiopia that were published in English language. The search was made by using “Emergency disaster”, “prevention”, “preparedness”, “response”, “recovery”, “drought”, “food insecurity”, “coping strategies” and “drought health policy” as keywords.

RESULTS:

Most of the reviewed articles deal with the impact of climate change on the human health in relation to food security. The associated factors of the impact of drought on food security is basically due to lack of irrigation and farmland, the scarcity of water due to the direct effect of drought, flood, severe soil erosion, livestock dispossession, family size of the household and literacy of the households. Various coping strategies were employed by the households to alleviate the high and continued food insecurity problem such as reducing the number and amount of meal, scrounging cash and grain, searching for off-farm and non-farm jobs, getting food aid, vending of livestock, and partake in food for work programs.

CONCLUSION:

The findings explored components of the coping strategies to the building resilience create fruitful health conditions for the food insecure household. The effect of agricultural support services as reliance’s on drought and community health situation was regarded as a positive outcome. Moreover, the means to get adequate food security strategies in all regions of Ethiopia should be designed. Furthermore, future researches are recommended for finding the best building strategies for each region of Ethiopia.

Keywords

Community drought Ethiopia health resilience

1. Introduction

Climate change is a real phenomenon globally that creates a severe burden on the environment, health-related issues, socioeconomic aspects and other direct or indirect risks to the human being and other living species [1, 2]. Although the impacts of climate change are still being disputed, it is likely to include rigorous consequence of intense-weather conditions that include heat waves, ocean acidification and species disappearance, droughts, and famine [2]. Yet, the rise of temperature will affect the agricultural sector which has a main effect on food security and bring more saddle on humans that might increase the risk of water, food, and vector-borne diseases such as typhoid, giardiasis, and malaria [2, 3]. As a result of such conditions, climate change and human health have a multidimensional relationship [2]. Both political and societal priority should be given to tackle and manage the causes of climate change and act to alleviate its possible impacts [1]. Thus, resilience is one of the main strategies for the management of climate change. Resilience is described as the capability of the exposure of a community or society to hazards to challenge, take up, and accommodate to and recuperate from its effects in a suitable and well-organized approach through safeguarding and re-establishing of its fundamental compositions and functions [3].

Global climate change effect has vital undesirable outcomes on environmental safety on top of social welfare, inconsistency, and trans-boundary relocations, particularly in arid areas. The intense of these alterations, however, is adequate to let the transformations of land use, which are susceptible to the occurrence of droughts and create confronts to disaster management [4] The consequence of the drier situation in the region induces disasters that lead to doubt in the local water [4] and food security. In Africa, for instance, there were about 14.4 million individuals who were destitute over 3.3 million tons of food deficit as a result of drought in 2002/03 [5]. In particular, the malnutrition effect attains 40% of the population in the Horn of Africa that make a total of 3.2 million needy on food support as a result of anthropogenic climate change-related impact [5], which cost the lives of 36,000 annually in 2000 based on the World Health Organization (WHO) report [6]. This shows how Africa is more vulnerable to climate change as compared with the other parts of the world. Food insecurity caused by climate change, such as droughts and probably floods continues to be a major challenge facing the world today. Apart from impacts of drought and flood, other determinants of food insecurity, such as unpredictable food price changes associated with or without climate change, poverty, inequality and weak governance are the main associated factors [6, 7, 8].

Ethiopia is challenged by both social and natural crisis. It is estimated that 85% of the Ethiopian population lives under the international poverty line [9] with human development index (HDI) of 0.406, which stands 9 ${}^{\rm th}$ from last out of 177 countries [10]. The occurrence of excessive climate changes in forms of droughts and floods has a long history in the context of Ethiopia. Between 1999 and 2004, Ethiopia has experienced at least one major drought which distress greater than half of all households; whereas a total of eight main droughts, of which five of them caused famine, since the early 1980s [6] and six major floods occurred over the last three decades, specifically in 1988, 1993, 1994, 1995, 1996, and 2006 [6, 11]. The last drought-driven flood disasters in 2006 confront the lives of about 700 human and 3600 cattle in Dire Dawa, South Omo and West Shewa. Moreover, this disaster displaces more than 35,000 individuals and led to the impact of water- and vector-borne diseases for over 200,000 people from the three regions [12]. Such climate change threatens the health of human and well-being significantly in a variety of ways even in the developed countries [13] in association with disease burden, risk of disasters and malnutrition [14]. For instance, it affect the distribution, survival, and behavior of mosquitoes, ticks and rodents that transmit disease in addition to affecting the quality of water and food [13]. The possible climate change influence includes burden of vector-borne infection such as Lyme disease due to ticks; water-related infection that induces diarrhea, intestinal illness, and blood-stream infections; food-related infection that increases the growth of pathogens such as the incidence of Salmonella exposure with infection and gastrointestinal outbreaks; asthma; Chronic Obstructive Pulmonary Disease; disability as the result of floods, and malnutrition [13]. Therefore, building community resilience is a vital part of the response to climate change.

El Nino drought crisis that occurred in 2016 was the major one affecting the livelihood of Ethiopians. Hence, the provision of food and water aids was decisive for some months as a result of the most horrible drought that was seen in 50 years history [15]. The incidence of drought increment is considered as one of the most imperative threats in the 21 ${}^{\rm st}$ century that brought momentous effects on food security due to the impact of climate change [16]. According to the International Aid Agencies, only in 2016, a minimum of 15 million people from some areas of the country was destitute to humanitarian aid as food insecurity had attained to an emergency stage [10, 15, 17]. The drought has affected not only humans but also numerous livestock. As a result, over half a million livestock were died while almost four-fold more were severely affected. Moreover, the “survived livestock” were dehydrated and being significantly valueless as compared to healthy animals, which made the livestock herders empty pocket to purchase some food items for their family units [15, 17]. According to the Famine Early Warning Systems Network (FEWSNET) report, the circumstance was similar to the 1980s famine, which takes the lives of almost one million people [15]. Consequently, the level of the humanitarian support in 2016 was surpassed any levels observed in the last 12 years. Above all, an intensive research is needed to solve these frequent droughts driven food insecurity in Ethiopia.

On top of this, in 2017 the El Nino episode significantly affected the normal weather patterns in Ethiopia that shortens the agricultural GDP of the country by 13.6% [18]. This circumstance, in turn, aggravates the food insecurity that made new threats to emerge in 2017 [19]. As a result, the need for emergency food assistance was raised to 8.5 million from August to December 2017 of which 3.3 million dwell only in Ethio-Somali region [19]. Therefore, the aim of this study was to describe the impact of climate change on community health status through building drought resilience in Ethiopia.

2. Materials and methods

This review was conducted based on the available peer-reviewed articles published from January 2004 to December 2018. The authors used databases from PubMed, MEDLINE, Scopus, EMBASE and Google Scholar that were published in English language. The search was made by using “Emergency disaster”, “prevention”, “preparedness”, “response”, “recovery”, “drought”, “food insecurity”, “coping strategies” and “drought health policy” as keywords.

2.1 Data extraction

The reviewed articles were selected based on the inclusion criteria and the authors’ independently extracted the necessary points from each article including the names of articles’ first author with the publication year, the purpose, design, sample size and sampling techniques, issues reported about the building drought and community health resilience according to the PRISMA Checklists (Fig. 1).

Figure 1.

Flow diagram of the study selection process.

2.2 Results identification

Twenty different studies conducted in Ethiopia and published between 2004 and 2018 were selected for this review (Table 1). Among those studies, most of them 8 (40%) were from the Southern Ethiopia [20, 21, 22, 23, 24, 25, 26, 27] followed by 3 (15%) from Eastern Ethiopia [28, 29, 30] and the other 2 (10%) each from Northern Ethiopia [31, 32], Northwest Ethiopia [33, 34] and national level study on Ethiopia [35, 36]. Almost 25% of the sample sizes of the selected studies were conducted in 2011 that consists of 19,459 (4.9%) participants [20, 21, 23, 27, 37] and 20% of the studies were selected from 2009 [28, 33, 35, 38] with a sample size of 1780 (0.44%) and from 2014 [30, 34, 36, 39] with a total participants of 3362 (0.93%). The majority of the participants were drawn from the study conducted in 2008 [25] with total participants of 362,940 (93.13%).

Table 1
Study setting, design, purpose, sampling technique, selection criteria and sample size of climate change, community health and building drought resilience in Ethiopia

Ref. No.	Authors’ name and publication year	Study setting	Purpose of the study	Study design	Sampling technique	Selection criteria	Sample size
[20]	Regassa, 2011	Southern Ethiopia	Examining the coping strategies of small holder farmers’ to sustained household food insecurity and hunger	Community based cross-sectional survey	Two-stage probability	All kebeles	614 households
[21]	Regassa and Stoecker, 2011	Southern Ethiopia	Determining the prevalence of household food insecurity and hunger	Cross-sectional survey	Multi-stage sampling	Rural households	1094 rural households
[22]	Sinaga et al., 2015	Southern Ethiopia	Assessing the effectiveness of population, health and environment approach to attain family planning	Comparative cross-sectional survey	Simple random sampling	Married women (15–49 age)	962 married women
[23]	Mekennen and Worku, 2011a	Southern Ethiopia	Evaluating the determinants of fertility in rural area	Retrospective study	Probability proportional method	Reproductive age women	9996 women
[24]	Regassa and Stoecker, 2012	Southern Ethiopia	Examining the nutritional status of mothers	Cross-sectional survey	Multi-stage sampling	Child under 24 months	1094 households
[25]	Fantahun et al., 2008	Southern Ethiopia	Exploring the pattern of adult (15–64 years) mortality	Retrospective study	Case-control	Adults (15–64 years)	367,940 individuals
[26]	Debela et al., 2015	Southern Ethiopia	Examining the associated factors and the perception of historic climate change on local agriculture	Cross-sectional survey	Multi-stage sampling	20 pastoral/ agro-pastoral associations	480 farm households
[27]	Mekonnen and Worku, 2011b	Southern Ethiopia	Examining the determinants of contraceptive and unmet need	Cross-sectional survey	Systematic random sampling	Married women (15–49 age)	5746 married women
[28]	Bogale and Shimelis, 2009	Eastern Ethiopia	Determining the socio-economic factors influencing household food insecurity	Cross-sectional survey	Two-stage Random Sampling	10 kebeles from rural households	1094 rural households
[29]	Mesfin et al., 2015	Eastern Ethiopia	Examining the prevalence and determinant factors of thinness	Cross-sectional survey	WHO standard procedures	School aged children (5–14 years)	206 school aged children
[30]	Nigatu et al., 2014	Eastern Ethiopia	Assessing university students knowledge, understanding and perception towards the impact of climate change on health	Cross-sectional survey	Two-stage Systematic sampling	Haramaya university health sciences students	327 students
[31]	Meze-Hausken, 2004	Northern Ethiopia	Examining peoples’ perception of climate change and variability and drought frequency and comparing to rainfall variability	Community based cross-sectional survey	Purposive sampling	Local farmers and pastoralists	104 farmers and pastoralists

Majority of the studies were used cross-sectional study design, which accounts 17 (85%) while two studies (10%) used longitudinal and only one (5%) study used retrospective study design (Table 1). Most of the study participants were selected from the rural areas in the study settings. Regarding the sampling techniques, majority of the studies used either multi or two -stage sampling techniques, which account 5 (25%) and 3 (15%) respectively. One study used both systematic and purposive sampling techniques while 3 (15%) used systematic random sampling techniques. Only one case-control study was used. The studies were described using different analysis techniques such as bi- and multi-variate logistic regression (Table 2). The overall results and conclusion are summarized in Table 2.

Table 1, continued
Ref. No.	Authors’ name and publication year	Study setting	Purpose of the study	Study design	Sampling technique	Selection criteria	Sample size
[32]	Haidar et al., 2005	Northern Ethiopia	Determining associated factors of childhood under nutrition	Cross-sectional survey	Systematic sampling	Four rural villages	144 households
[33]	Alene and Worku, 2009	Northwest Ethiopia	Investigating the Women and other social groups perceptions on the prevailing population pressures	Cross-sectional survey	Multistage cluster-sampling	15–49 years age women	3,512 women
[34]	Geremew et al., 2014	Northwest Ethiopia	Assessing the level of traditional cooking energy sources utilization and its correlates	Community based cross-sectional survey	Systematic and purposive sampling	All kebeles	423 households
[35]	Tadele and Manyena, 2009	Ethiopia	Assessing the resilience of disaster affected communities using the hyogo framework for action (2005–2015)	Cross-sectional survey	Non-intervention approach	Disaster resilience through capacity building	Institute
[36]	Hagos et al., 2014	Ethiopia	Assessing the outcomes of weather variables on child under nutrition and the variations of the three agro-ecologies	Longitudinal panel study	Panel data regression	Data for the period of 1996, 1998, 1998, 2000- and 2004	Rainfall data on for the period of 1996–2004
[37]	Belachew et al., 2011	Southwest Ethiopia	Determining the association between adolescent food insecurity, school absenteeism and educational achievement	Five year longitudinal family study	Stratified random sampling	Adolescents (13–17 years) in 2009	2100 adolescents
[38]	Abaya et al., 2009	Western Ethiopia	Assessing the knowledge base of managing strategies that minimize flood-related health risks	Community based cross-sectional survey	Purposing sampling	Government and non-government organizations	35 flood victims in itang woreda
[39]	Birhane et al., 2014	Central Ethiopia	Examining the urban population food insecurity condition	Community based cross-sectional survey	Three-stage sampling	Urban population	550 households

Table 2

Analysis and overall finding of climate change, community health and building drought resilience in Ethiopia

Authors’ name and publication year	Results	Conclusion	Analysis	Ref. No.
Regassa, 2011	The households’ food insecurity was reported as 54.1% and about 28.8% facing mild to severe level.	There was relatively high level of household food insecurity that was induced due to climate change. As a result, the households employ various coping strategies to solve the food insecurity situation such as reducing the number and amount of meals.	Multivariate analysis	[20]
Regassa and Stoecker, 2011	About 17.7% of the households were classified as food secured based on household food insecurity access scale while 6.8%, 27.7% and 47.8% of the households were mild, moderately and severely food insecure. On the other hand, 29.0% and 5.6% of the households were facing moderate and severe household hunger based on the household hunger scale.	Smallholder farming households suffering food insecurity in which majority of them facing mild to severe food insecurity and hunger for longer period of time.	Bivariate logistic regression	[21]
Sinaga et al., 2015	There was a better integration of family planning, health and environmental issues into the grassroots level interventions in the population, health and environment (PHE) woreda that has high contraceptive prevalence rate (78%) through using students as a medium for reaching parents on family planning.	In married women and their respective husbands, the combination of PHE has affirmative outcomes in family planning activities.	Descriptive statistics and multivariable logistic regression	[22]
Mekennen and Worku, 2011a	The presence of small number of children was correlated to the incidence of late marriage, women with formal education, living in food secured and absence of child death experience. Women who have no formal education had 1.24 times more children in contrast to those who accomplished secondary and above level of education.	Women who have complete at least secondary school play an important role towards the management of their fertility, which has an impact on the economy of household.	Bi-variate and multivariate regression model	[23]
Regassa and Stoecker, 2012	Woman’s age, breast feeding period, educational status, land size, andliving in food secured household could predict the maternal malnutrition.	Maternal malnutrition is a critical difficulty in the study area.	Multivariable logistic regression	[24]
Fantahun et al., 2008	Adult mortality due to communicable diseases show a modest reduction trend; it shows significantly higher rate in rural areas that is related to poor economic status, lack of women’s decision-making, and lack of education in a household.	The risk of mortality can be increased due to different factors such as lack of education, low economic status, social disadvantage and communicable diseases.	Poisson regression model	[25]
Debela et al., 2015	Climate change and its negative impact on agriculture were perceived by the majority (96%) of the participants as it has a significant risk towards their prospect livelihoods and economic development.	The perception level of smallholders were influenced by their age, level of education, livestock asset, access to climate information.	Proc Survey logistic Logistic	[26]
Mekonnen and Worku, 2011b	The prevalence rate of current contraceptive use among married women was 25.4% while unmet need of contraceptive was 52.4%.	An improved level of education is crucial for the use of contraceptive.	Logistic regression model	[27]
Bogale and Shimelis, 2009	The size of the family, annual income, amount of credit received, access to irrigation, household head age, size of the farmland, and livestock possessed were among the determinants of household food insecurity.	The situation of improving the household food security requires building assets, advancing the rural financial market functioning, and encouraging the utilization of family planning.	A binary logit model

Table 2, continued
Authors’ name and publication year	Results	Conclusion	Analysis	Ref. No.
Mesfin et al., 2015	About 11.6% and 2% thinness and low BMI was reported among school children, respectively. The risk of such children that feel hunger at school was 1.55 times as high as those who didn’t. Mothers aged $\geqslant$ 35 born children has 30% less risk to develop thinness as compared to younger mothers.	Under acute nutritional stress was observed over 10% of school children in the form of thinness. Hence, widespread school health program such as providing free meals at school should be integrated as nutritional intervention.	Logistic regression model	[29]
Nigatu et al., 2014	Over 75% students have awareness about the impact of climate change on health in which females show slightly higher rates than males.	An inclusive curriculum about the impact of climate change on health benefits health science students.	Bivariate logistic regression	[30]
Meze-Hausken, 2004	Regional climate change was observed among farmers, pastoralists, and local authorities. Hence, farmers changed their farming strategies by using drought-resist crops and those which can be harvested shortly.	Weather and climate change requires a wider study of the socioeconomic, cultural and environmental conditions experienced by the affected people.	Statistical analysis of rainfall chronologies	[31]
Haidar et al., 2005	The under nutrition overall prevalence rate as described by stunting, underweight and wasting was 44.5%, 25.0% and 9.0%, respectively in which female-head households showed the higher proportion.	The nutrition condition of households can be invalidated by improving the resources of household through accessing irrigation and launching of income generating livelihood alternatives.	Descriptive, bivariate, and multivariate logistic regression	[32]
Alene and Worku, 2009	Women who were asked about how many children they needed, over two-thirds had given no thought to the number of children they should have in their lifetime.	Fast growing population has its own negative connotations towards the achievement for various goals in terms of the political, economic, and social advancement.	Descriptive analysis	[33]
Geremew et al., 2014	95% of households who were less knowledgeable about the negative impact of health and environmental utilize the traditional energy for cooking.	Due to poor knowledge and belief, majority of households exercise traditional energy for cooking.	Logistic regression	[34]
Tadele and Manyena, 2009	In order to reduce the incidence of disaster and its impact to the society, proper evaluation and activity towards holistic and integrated approach for capacity building is essential.	Capacity building is the basis to build the community, resilience and organize in collaboration with donors on top of the government agencies.	Not mentioned	[35]
Hagos et al., 2014	The overall average prevalence of stunting, underweight, and wasting was 55.2%, 42.5%, and 10.1%, respectively over the study period.	The disparity in child stunting and underweight is predicted due to the effect of rainfall and temperature.	Panel regression	[36]
Belachew et al., 2011	About 33% and 17.8% of adolescents were recognized as school absenteeism with food insecure and food secure, respectively.	Poor education achievement and school absenteeism were the direct outcomes of food insecure households’ adolescents.	Regression analysis	[37]
Abaya et al., 2009	The occurrence of flood frequent and its prevalence is rising through time due to change of climate and land use, predominantly deforestation. Such conditions brought its own impact to health death such as death, injuries, crop damage and subsequent malnutrition, and water-borne diseases like malaria and diarrhea.	Unavailability of flood-specific policy, poor risk evaluation, and slow institutional capacity were identified as the main issue to cope-up with a new strategy.	Content analysis	[38]
Birhane et al., 2014	About 75% and 23% of households were food insecure and in stage of hunger, respectively. The coping strategies used include meal size reduction and changing to poor quality or using cheaper food types.	Household food insecurity is becoming common to both rural and urban settings and the incidence is high among those with low-income and illiterate households.	Univariate and bivariate analysis

3. Discussion

3.1 Health impact of climate change

The most decisive and intimidating confronts of the 21 ${}^{\rm st}$ century for policymakers is the issue of climate changes [40]. There is a debate among scientific and public groups on the direct and indirect effect of climate change on human health; however, as described in Table 3, various effects have been happened on the health of human and their safety due to drought, flood, and food insecurity [41]. Pre-existing psychological vulnerabilities such as depression and unpleasant life events can be depicted by climate change, which, in turn, fails to prepare satisfactorily for any preconditions for natural disaster [42]. On the other hand, those communities and individuals who are ready for extreme events that occur due to climate change experience minimal distress [42]. On such circumstances, electronic mass media utilization improves the understanding of change of climate on the impact of health [30]. These situations might affect the societal and economic arrangement towards strengthening once health. The potential impact of climate changes on health, in which Ethiopia is susceptible, was seriously addressed by policy-makers and health planners [30].

The incidence and amplified strength of unseasonal storms, drought, and flooding affected the hydrological cycles and rainfall variations have direct inference for the upcoming food availability [43]. The effect of climate change on child under nutrition across the three agro-ecologies of Ethiopia is clearly indicated [36]. The incidence of infectious diseases can be influenced due to climate change, which also influences the socio-demographic and/or environmental conditions of the society such as agricultural development, nutritional availability, and deforestation. On the other hand, there has been found that the effect of climate change expressed through changes in patterns, amount and duration of rainfall and variations of temperature conditions, which, in turn, mainly influences the health of under-five children as stunting and underweight in the three agro-ecologic zones in Ethiopia [36].

According to the study of Geremew et al., traditional biomass use reached 95% of households among those who have limited knowledge regarding the negative effect on human health and environment as they mostly use charcoal as the source of energy that causes deforestation [34]. Abaya and co-workers indicated that flood, which is one of the effects of climate change, was identified as it had a tremendous health impact in the studied area, Gambella, due to various reasons such as the absence of flood-specific policy, feeble institutional capability, and lack of risk consideration [38].

Table 3
Types of impacts of climate change on health

Climate change	Health impact	References
Drought	Child malnutrition, stunting, underweight, scarcity of water	[24, 30, 32, 36, 41, 43]
Flooding	Injuries, water-related infection such as diarrhea, vector-borne infection such as malaria and other infectious diseases, demolition of properties and crops that lead to food insecurity	[25, 38, 43]
Rainfall and temperature variation	Food-related issues such as malnutrition, underweight, stunted, wasting	[32, 36, 43]
Deforestation	Environmental pollution, psychological vulnerabilities such as exercising unpleasant life, depression	[34, 38, 42]

3.2 Effect of drought on food security and nutrition

The availability of food to households is seriously affected due to changes associated with rainfall and temperature variations, which, in turn, boosts the threats of child under nutrition [34]. Moreover, it predicts the disparity in child underweight and stunting as low quantity of rainfall influences crop production and accessibility (Table 3). According to the study by [39], for example, the overall average prevalence rate of under nutrition as indomitable by stunting, underweight and wasting in Ethiopia was 55.2%, 42.5%, and 10.1%, respectively [36]. A higher ratio of under nutrition was observed among female-headed households [32]. The overall prevalence rates of stunting, wasting and underweight were relatively higher in Ethiopia as compared to study conducted in Southwest Nigeria, Ile-Ife, which accounts 39.3%, 6.3% and 14.1%, respectively [44]. The nutritional status of children was affected by various reasons such as lack of irrigation and farmland, scarcity of water as the result of drought, high number of children in the households, insufficient dietary intake, livestock dispossession, unbalanced sharing of food within the household, incorrect eating customs of households, and poor child feeding performance [24, 32]. In general, the attempts undertaking to challenge under nutrition in conjunction with improving household food security was affected due to the change of climate.

Globally, natural disasters such as floods as a result of the occurrence of heavy rainfall are one of the most common and devastating disasters that cause extraordinary deaths, diseases such as malaria and diarrhea, and demolition of properties and crops [38]. Climate change and deforestation were the main causes for the frequent occurrence of floods. These conditions were frequently observed in developing countries like Ethiopia because of the insufficiency of disaster management and limited economic resources [38]. In resource-limited countries like Ethiopia, the deficiency of nutrition is the basic alarm of public health in school children [29]. As the result of under nutrition, one of the public health problems, the school children nutritional status indicates a range of 23–50% thinness prevalence in Ethiopia from different regions. According to the study conducted at Kersa, Eastern Ethiopia, by [29] over 10% of them was under acute nutritional pressure [29].

Food insecurity is the problem of both urban and rural regions in Ethiopia, which affects the health and physical growth of children and their intellectual capabilities [37, 39]. This result was in agreement with other African countries like in Osun State (Nigeria) where only 24.5% were food secured and 40.9% and 34.5% were moderately and severely food insecure, respectively [45]. Similarly, the food insecure households were 62%, 65%, 80% and 85% in Rakai (Uganda), Ile-Ife (Nigeria), Lushoto (Tanzania) and Wote (Kenya), respectively [45, 46]. On the contrary, the households’ food security level was relatively higher in Oyo State, Nigeria, which accounts for 58.1% and with lower level (13.6%) of food insecurity [47].

Even though the household food insecurity was high among low-income families, the condition was aggravated in those house heads that are illiterate and daily laborers. The Hyogo Framework for Action 2005–2015 has highlighted the means to build institutional capacity to avert, arrange and react towards disasters to augment the resilience of disaster pretentious communities [35]. Thus, policy-makers should work to consolidate the food market and produce an opportunity to recover the livelihood and acquisition of households [39].

3.3 Drought perception, adaptation, and food security

Drought and community health resilience in Ethiopia was explored and analyzed based on the results of different case studies, which uses various instruments to measure (Table 2). The various measurements of the studies includes 15% used survey questionnaire [26, 27, 38], and 5% of each studies used structured interview questionnaire [24], secondary recorded data [36], general interview questionnaire [39], and mixed data collection materials [34], while only one study (5%) did not use any questionnaire [35]. Eight of the studies explored the effect of family size on food security. Among them, for instance, the study conducted in Dire Dawa, Eastern Ethiopia pointed out that the adaptability of family planning utilization could improve the food security of the family along with advancing the practice of irrigation and utility of rural financial market [28]. As the result of such instances, the family size and annual income could be improved and the possible occurrence of hunger is reduced.

Perception levels towards climate change significantly influenced by different conditions among pastoral and agro-pastoral communities [26]. Such conditions include their educational level, age, access to information regarding climate, and the size of livestock they have. However, the size of the household, an income of the communities from farm or non-farm, and production system did not significantly affect their level of perception. It is obvious that lack of perception may bring threats to proper transition to cultivation and non-pastoral livelihoods. Alternatively, a frequent episode of drought and pestilence affects the adolescent food security and educational attainment. The impact of climate change towards health could be enhanced through the understanding and perception of individuals through developing awareness and facilitating interferences [30].

Adolescent school attendance and educational achi- evement are negatively correlated with household food insecurity, i.e., as the concern of food security improved; the school presence of adolescent could also be enhanced with higher educational achievement [37]. As a result, the integration of universal primary education attainment with the food insecure setting could ensure food security for the adolescents. Another study that was conducted in food insecure area indicates that woman’s age, educational status, breast-feeding duration, the size of the land they occupy, marital status, and intra-household food distribution significantly contribute to maternal malnutrition [24]. According to the study conducted by [39] food security could be affected by the income of household, the educational status, and employment condition of the family head. Moreover, the households use different survival approach to overcome hunger and the high price of food. These strategies include reducing the amount of meal size and changing to less expensive and compromised quality food types [20, 39].

3.4 Determinants of household food security

Food security is a wide-ranging concept, which covers matters associated with the nature, quality, and safety of the supplied food besides the issues of its access. One of the key necessities for health and life is the availability of adequate and quality food, which designates the household food security status [48]. Hence, a food secured household is the one that can obtain consistently food with an adequate amount and quality for all members of the households [48]. In developing countries, recently, the issue of population growth and change of climate along with the reduced extent of agricultural benefit have brought an undeviating and disappointing impact on the status of food security [49].

It is thought that agriculture is the most vulnerable segment to change of climate as it directly affects the rainfall and temperature conditions, the two important natural segments of agricultural production inputs [20]. Furthermore, the change of climate influences agricultural production indirectly by manifestation and allocation of crop pests and diseases of livestock, the occurrence of undesirable weather conditions, shortage of water provisions and irrigation; and aggravating of harsh soil erosion [20]. Even though most of the developing countries have made a great effort to alleviate such problems, the occurrence of food insecurity and dilapidated food production per capital might linger the same or decline eventually [49]. Hence, household food insecurity stays as a key public health problem in Ethiopia, with households’ distress shortage of food.

It is important to realize the main determinants of food security at household levels, particularly in rural areas, to design suitable interferences to guarantee food security for households with food insecure [48, 49]. Household food security was determined with the household caloric achievement and there were various determinants that were recognized which intensify the food insecurity situation [50]. These determinants are deprived of farmlands and soil fertility, size of total cultivated land, use of farm input, number of oxen owned by the households, lower livestock productivity, frequently occurred drought, undeveloped farming technologies, low-input farming practices, poor infrastructural situation, off-farm income, family size as a result of family planning utilization, communicable diseases, age of household head, and level of education of the household heads [20, 21, 25, 27, 33, 48, 49, 50]. The combinations of such determinants have resulted in rigorous and rising difficulty of food insecurity at household level in Ethiopia [50]. The determinants described had in agreement with studies conducted in other African countries like Nigeria [45] and East Africa, namely Kenya, Uganda, and Tanzania [46].

Variety of coping strategies were practiced by the households to react against the high and continued food insecurity problem which includes reducing the number and amount of meal, scrounging cash and grain, searching for off-farm and non-farm jobs, getting food aid, vending of livestock, and partake in food for work programs [20, 45, 49]. Therefore, enhancements in all determinants are inevitably required to progress household food security by implementing the existing and new policies that significantly manipulate the food security and nutritional status of the community. Furthermore, supporting the households to get and use chemical fertilizer, dissemination of information to each household, increasing the possibility of getting an improved variety of crops, creating awareness to exercise the utilization of family planning, providing employment opportunities, and participating in income-generating activities can add value to households’ food security status [48].

4. Conclusion

Drought, flood, deforestation, and rainfall variation are among the important issues that are related to the change of climate, which counter act on the living standards of the societies, particularly the low- and middle-income countries as it affects their socio-economic conditions such as reduction of the agricultural production, the occurrence of infectious diseases, and malnutrition. In Ethiopia, such incidences are occurring now and then particularly in low land areas. The spread and quantity of rainfall is reduced in low land areas in Ethiopia, which have a direct effect on the availability of food to the households, which indirectly boosts the threats of under-five child nutrition.

Lack of irrigation and farmland, the scarcity of water due to the direct effect of drought, flood, severe soil erosion, livestock dispossession, family size of the household and literacy of the households are the most dominant determinants of food insecurity in developing countries. Improving the perception level towards climate change is crucial as it can significantly alter the attitude of individuals towards the environmental protection. Therefore, regional and national drought and community health resilience, and adequate food security strategies in all regions in Ethiopia should be designed accurately and effectively. The effect of agricultural support services as reliance’s on drought and community health situation was regarded as a positive outcome; however, it needs to be interpreted with precaution. In addition, great attention should be given to pregnant women and children who are living in vulnerable areas to drought and other condition. Further research to address the continuing effects of agricultural support services in order to improve the food security agenda in both health and drought policy as a combination and the underlying systemic mechanism leading to drought, climate change, and community health reliance should be conducted.

The role of policy-makers to improve the phenomena occurred due to the incidence of climate changes is unquestionable that needs an immediate effort to plan and implement a strategy to improve the health aspects of the community.

Footnotes

Acknowledgments

We acknowledged all persons who provided technical assistance in writing the manuscript.

Conflict of interest

We declare no conflicts of interest.

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Impact of climate change on community health and resilience in Ethiopia: A review article

Abstract

BACKGROUND:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Materials and methods

2.1 Data extraction

Table 1 Study setting, design, purpose, sampling technique, selection criteria and sample size of climate change, community health and building drought resilience in Ethiopia

3.1 Health impact of climate change

Table 3 Types of impacts of climate change on health

3.3 Drought perception, adaptation, and food security

3.4 Determinants of household food security

4. Conclusion

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Study setting, design, purpose, sampling technique, selection criteria and sample size of climate change, community health and building drought resilience in Ethiopia

Table 3
Types of impacts of climate change on health