Climate stress, migration, and emotional dimensions of malaria vulnerability: a mixed-methods study in an urban informal settlement, South Africa

Abstract

Vulnerability to malaria in Thembelihle arises in a context of climatic instability, environmental degradation, and high mobility, which shape how residents interpret health risks. Erratic rainfall, flooding, and heat stress interact with inadequate drainage, stagnant water, and overcrowded conditions to heighten environmental exposure. Migrants arriving with prior experiences of climate shocks may carry emotional residues that influence local risk perception. This study examines how these structural and interpretive pressures intersect to shape malaria vulnerability in a non-endemic urban informal settlement. A convergent mixed-methods design was employed. Quantitative data were collected through a structured household survey of 150 residents, and qualitative insights were obtained from semi-structured interviews with key informants, including community leaders and sector experts. Composite indices were calculated to capture climate stress, migration factors, and vulnerability. Survey data were analysed in SPSS using descriptive statistics and Spearman’s rank correlations. Interview data were analysed thematically using ATLAS.ti.25. Respondents reported exposure to multiple environmental stressors, including heat, erratic rainfall, pollution, stagnant water, and inadequate services. A composite environmental hardship measure showed the strongest association with perceived malaria vulnerability. Qualitative findings indicate persistent fear, uncertainty, and heightened sensitivity to environmental cues. Migration histories linked to climate shocks contributed to a continuity of vulnerability, shaping how residents interpret local health risks. Malaria vulnerability emerges through intertwined material and interpretive processes, in which environmental conditions and prior experiences jointly shape perceived risk. Effective interventions should integrate environmental upgrading with community-responsive approaches that address both physical exposure and the broader social and perceptual dimensions of climate-sensitive health risks. These findings highlight the importance of integrating climate adaptation, urban planning, and public health strategies, while recognising the roles of mobility and prior climatic exposure in shaping vulnerability patterns across non-endemic urban settlements and in informing responsive, context-specific intervention design for equitable and sustainable health outcomes.