Burden of infant mortality associated with flood in 37 African countries

Floods are becoming more frequent and severe in the context of climate change, with major impacts on human health. However, their effect on infant mortality remains unknown, particularly in low- and middle-income countries. We conducted a sibling-matched case-control study using individual-level data from Demographic and Health Surveys in Africa during 1990-2020. Individual flood experience was determined by matching the residential coordinates with flood events from the Dartmouth Flood Observatory database. Using data from 514,760 newborns, we found increased risks of infant mortality associated with flood exposure across multiple periods, with the risks remaining elevated for up to four years after the flood event. Overall, flood exposure was associated with 3.42 infant deaths per 1000 births in Africa from 2000 to 2020, approximately 1.7 times the burden associated with life-period exposure. This multi-country study in Africa provides novel evidence that flood events may increase infant mortality risk and burden, even over years after exposure.