Maternal mental health and child development before and after an extreme cyclone in Malawi

Climate change is increasing the frequency and severity of cyclones and hurricanes, with the most severe impact occurring in low-resource settings. Women and children are among the most vulnerable to adverse health impacts of these severe weather events. Despite this, there is limited data on how cyclones and hurricanes impact maternal mental health or child development in low-resource settings.

We recruited pregnant women and their newborns into a prospective cohort study between 2018 and 2022 in Blantyre, Malawi and assessed maternal mental health, child development, and growth repeatedly from one to five years of age. Tropical Cyclone Freddy hit Blantyre on March 11, 2023, severely impacting our study site. We assessed the impact of cyclone exposure on study outcomes; maternal mental health, child neurodevelopment, and child growth, classifying measurements based on time since cyclone. We utilized generalized estimating equations logistic regression to estimate the effect of cyclone exposure on study outcomes.

A total of 858 mother-child dyads were enrolled in the follow up cohort. Of these 838 mothers had at least one mental health assessment, 802 children had neurodevelopmental assessments, and 844 children had growth measurements. Cyclone exposure was associated with an increased odds of stunting with risk rising both in the first six months (Odds Ratio (OR) = 3.40; 95% Confidence Interval (CI): 2.55-4.51) and more than six months after the event (OR = 6.05; 95% CI: 4.3-8.35), compared to pre-Cyclone exposure assessments. In contrast, the odds of maternal distress and developmental delay decreased during the first six months following Cyclone Freddy.

The effects of Cyclone Freddy on maternal and child health in Malawi are complex. Strengthening of maternal and child health resources may help mitigate post-disaster consequences and prevent long-term health problems.