Climate Change and Health: Impacts Across Social Determinants in Kenyan Agrarian Communities

Abstract

Climate change is a global crisis that disproportionately affects vulnerable agrarian communities, exacerbating food insecurity and health risks. This qualitative study explored the relationship between climate change and health in the following two rural sub-counties of Kilifi County, Kenya: Ganze and Magarini. In fall 2023, we conducted 16 focus group discussions with adolescent girls (14–17), young adults (18–30), and older adults (31+). Thematic analysis revealed that climate change adversely affects health through key social determinants, including economic instability, environmental degradation, limited healthcare access, food insecurity, and disrupted education. Participants reported increased food scarcity, disease outbreaks, and reduced access to medical care due to droughts and floods. Economic hardship contributed to harmful survival strategies, including transactional sex and school dropout among adolescent girls. Mental health concerns, such as stress, substance use, and suicidal ideation, were prevalent. These findings highlight the wide-ranging health impacts of climate change in agrarian settings and the urgent need for comprehensive, community-informed interventions. Priorities should include improving nutrition, reproductive and mental health services, infectious disease prevention, and healthcare access.

1. Introduction

Climate change is increasingly recognized as a major threat to global health, affecting communities in complex and far-reaching ways. One of the most visible impacts is displacement, which often leads to increased vulnerability to violence [1]. Rising temperatures are also linked to heightened emotional distress and aggression, which can escalate into physical violence and even homicide [2,3,4]. Women and girls are especially at risk, facing greater exposure to gender-based violence during and after climate-related crises [5,6,7]. Beyond violence, climate change worsens the spread of diseases and strains already limited healthcare resources. In the aftermath of climate disasters, there is often a surge in waterborne illnesses, respiratory problems, and outbreaks of vector-borne diseases like malaria and yellow fever, particularly across parts of Africa [8,9]. These health risks are intensified by disrupted access to clean water, sanitation, and food [1,10].

Climate-related disasters also undermine food systems, reducing the availability, diversity, and nutritional value of food. These pressures increase the risk of undernutrition, particularly among vulnerable populations [11,12]. Economic hardship, caused by frequent and severe weather events, further drives food insecurity. Displacement during climate disasters exacerbates these challenges, leaving communities without stable access to healthcare, shelter, or income [13]. Ultimately, climate change is linked to a wide range of health issues, including infectious disease, undernutrition, violence, and mental health challenges.

Climate change is manifesting increasingly through extreme weather events such as heatwaves, heavy precipitation, floods, and droughts that are becoming more frequent and extreme [1]. Rural and agrarian residents are disproportionately vulnerable to these climate extremes due to their heavy reliance on rain-fed agriculture, limited access to infrastructure, and deprived adaptive capacity [14]. In agrarian settings, shifts in the timing and intensity of rains disrupt planting seasons, reduce crop yields, and erode food security. At the same time, floods and storms can destroy fields and livestock, obliterating accumulated livelihoods over the years [14]. In low-income, agriculture-dependent regions like sub-Saharan Africa, small-scale farmers, many of whom are already living in poverty, bear the brunt of climate change [15]. By mid-century, crop yields in southern Africa are projected to drop by around 18 percent, averaging about a 22 percent decline across all of sub-Saharan Africa, with reductions exceeding 30 percent in South Africa and Zimbabwe [15].

Kenya is a clear example of this vulnerability to extreme weather. Most of its farmers are small-scale farmers who rely heavily on two main rainy seasons. But in recent decades, these rains have become increasingly unpredictable and intense, making it harder for communities to plan and thrive [16]. Kilifi County, in particular, has undergone increasing frequency of droughts and flash floods, contributing to one of the highest under-five undernutrition rates in the country, with 20 percent of children underweight [17]. Coupled with poor road networks, limited infrastructure, and lack of formal water storage, these climatic stressors have culminated in food insecurity, income loss, and elevated health risks [17].

This work is grounded in the intersectional adaptation of the Social Determinants of Health framework to examine how structural inequities amplify climate health vulnerabilities [18]. Climate change acts as an amplifier of preexisting social and economic inequities, affecting the social determinants of health. These determinants can cause feedback loops that perpetuate cycles of vulnerability; poverty reduces educational attainment, limiting capacity to adopt adaptive behaviors, thereby sustaining cycles of illness and economic instability [19]. Likewise, environmental stressors erode social cohesion, weakening community networks vital for resilience and further perpetuating systemic inequalities [20]. These intersecting vulnerabilities fall most heavily on women and children, who face gender- and age-based inequities that magnify their exposure to climate-related risks [21]. For instance, in agrarian settings, climate-driven crop failures deepen household poverty, which often pushes families to remove daughters from school, forcing early marriage or unpaid domestic labor [22]. These shifts perpetuate intergenerational educational deficits, as girls who marry before age 18 complete significantly fewer years of schooling and are less likely to enroll their own children [23]. Concurrently, women and girls take on expanded burdens of water and fuel collection which heightens their risk of injury, exhaustion, and psychosocial stress [24].

Despite this growing body of evidence linking severe weather events and adverse health outcomes, most research remains quantitative, leaving a critical gap in our understanding of how individuals and communities personally experience these changes [25,26]. Emerging qualitative studies have started to illuminate these lived realities, particularly within the Kenyan context, highlighting how climate events like prolonged droughts and floods affect people’s daily lives [27,28]. Yet, more in-depth exploration is needed, especially concerning the unique experiences of those most impacted by severe weather. Capturing these perspectives is essential to fully understanding how climate change affects health and well-being in climate-vulnerable communities.

Through qualitative data collection, this study explores the connections between climate change and health in two agrarian communities in Kilifi, Kenya. By focusing on lived experiences during droughts and floods, the study seeks to uncover how climate stressors affect food security, economic stability, access to healthcare, and overall well-being. Unlike studies relying on aggregate data, this qualitative approach captures the context specific mechanisms through which communities perceive and adapt to climate change. The value of this study is in the ability to uncover possible pathways as well as intersectional vulnerabilities that quantitative studies may miss. Increasingly erratic rainfall and prolonged droughts in Kenya disrupt agriculture impacting community health. Gaining a deeper understanding of how health is affected by these changes can provide critical insights for designing responsive interventions that help communities better withstand and recover from the effects of extreme weather events.

2. Materials and Methods

2.1. Study Design

We conducted a qualitative research study utilizing focus group discussions in two rural areas, Ganze and Magarini, sub-counties of Kilifi County, Kenya, to explore the health impacts of climate change in these rural communities. This study employed a community-based participatory research approach in which all aspects of the study were jointly conducted between investigators from LVCT Health (Kenya) and St. Catherine University (USA) referred to as the study team from here forward. Additionally, the study proposal was presented to Kilifi County administration to ensure that research outcomes aligned with local policy and climate change and violence prevention programming priorities. Continuous engagement with Kilifi County policymakers in gender, agriculture, and climate change sectors was prioritized to enhance ownership of study findings and facilitate their translation into policy and practice. Details of the study team engagement with local stakeholders have been previously published [29].

2.2. Study Site

The research was conducted in the Ganze and Magarini Sub-Counties of Kilifi County, Kenya. Kilifi County has a population of 1.4 Million and covers an area of over 12 million square kilometers [30]. About 90% of Kilifi, a typical coastal smallholder farming community, depends on rain-fed agriculture as a primary source of livelihood. This agriculture sector employs more than half the County population, and earnings contribute to about 52.7% of the average household income [30].

Over the past decade, the rainy seasons have become increasingly unpredictable, marked by droughts and floods, decreasing crop yields, depleting water sources, and exacerbating food insecurity [30]. The population’s health outcomes are generally poor, partly due to poverty and limited health infrastructure. There is also a high prevalence of violence against women, with six out of every ten households in Kilifi County experiencing domestic violence [31,32], which has increased during the COVID pandemic.

2.3. Study Population and Sampling Procedures

Adolescent girls, women, and men were recruited using criterion sampling to capture a wide range of experiences. We employed a community engaged recruitment strategy in collaboration with locally respected focal persons who were trusted community members identified through our research partner LVCT health. Focal persons played a central role in the recruitment process by identifying potential participants who met the study criteria, initiating introductions to establish trust within the community, and connecting interested individuals with our research coordinator for formal enrollment and scheduling of focus group discussions. Existing participants were encouraged to refer others within their networks who met the inclusion criteria. Following the initial recruitment phase, snowball sampling was utilized to identify and recruit additional participants. This community-centered recruitment process ensured the study included diverse voices and experiences from the rural community.

At each study site, there were two groups with adolescent girls (14 to 17 years), two with younger women (18–30 years), two with older women (30+ years), one with younger men (18–30 years), and one with older men (30+ years), for a total of 16 focus groups. The age brackets employed in this study were designed to align with both demographic conventions and the study’s focus on gendered violence, which disproportionately affects women and girls aged 15–49 [33]. Adolescents were grouped separately to acknowledge their unique developmental experiences and to foster a safe space for discussion among peers, as power dynamics with older participants could inhibit openness. For adults, the division between younger (18–30) and older (31+) participants reflects distinct life-stage experiences such as caring for young children versus older dependents and mitigates potential power imbalances that might arise in mixed-age groups. This stratification ensured that shared social contexts and lived experiences were prioritized within each focus group, enabling richer, more nuanced dialogue.

2.4. Data Collection

In Fall 2023, we conducted 16 single-session 90-min focus group discussions in Ganze and Magarini of Kilifi County, Kenya. There were a total of eight focus groups in Ganze and eight in Magarini, all conducted in October. We utilized a semi-structured interview guide to ensure consistency across all focus group discussions while allowing the flexibility to explore emergent topics. Prior to data collection, the guides were refined based on pilot feedback to better elicit participants’ experiences. The final discussion guides were designed to facilitate in-depth conversations about the health impacts, lived experiences, and perceptions related to climate events. Discussions focused on understanding the specific health challenges that arose during and after severe floods and droughts.

Recognizing the power dynamics between university researchers and local research assistants and study participants, the research assistants, who facilitated the focus group discussions, were community members from areas in which the research was conducted. Research assistants had 5 years of experience in qualitative research and were fluent in Kiswahili and at least one of the local languages of the study areas to facilitate discussions. To address concerns related to the differences in positionality, the study PI from LVCT Health was the direct contact for the local RAs, and senior researchers from LVCT Health provided training to RAs. Research assistants received comprehensive instruction on research ethics, confidentiality, and the study’s objectives and research questions. Additionally, research assistants received specific guidance on ethical considerations, such as obtaining informed consent, ensuring the privacy and confidentiality of participants, and addressing any potential risks or sensitive topics that may arise during data collection. Cultural sensitivity training was provided to ensure sensitivity to discussion about violence and to promote understanding and respect for local customs, traditions, and gender dynamics prevalent in the rural community of Kilifi. Discussions were conducted in Kiswahili, were transcribed verbatim and then translated into English. In addition to facilitating the sessions, research assistants also documented contextual observations to supplement the transcripts. Identifiable information was removed during transcription to ensure participant privacy and data protection.

Adult participants were given KES 1000 (approximately USD 7 equivalent) for their participation and transportation costs. Adolescent participants were provided refreshments during the focus group discussions, as well as menstrual pads, and their parents were given 500 Kenyan Shillings (approximately USD 3 equivalent) to cover transportation to and from the focus group discussions.

2.5. Data Analysis

A thematic analysis was utilized to explore health impacts associated with severe weather events. This analysis allowed for a nuanced understanding of the social and environmental determinants of health during extreme weather events. Initially, all team members independently read each of the 16 transcripts multiple times to familiarize themselves with participant experiences and perspectives. Through this process of immersion, initial codes were generated directly from the text using participants’ own language where possible.

The team collaboratively reviewed and discussed preliminary codes, refining them through iterative discussions and pilot coding. Subthemes were constructed by identifying recurring patterns in the data, grouping related codes, and examining how they interconnected within and across transcripts. Relationships among subthemes were identified through constant comparative analysis, where the team assessed how different codes co-occurred, diverged, or built upon one another. A comprehensive codebook was then developed, containing broad themes, subthemes, and representative patterns across the transcripts. NVivo™ 15 software [34] was used to organize the codebook and facilitate coding, allowing for systematic categorization of participant responses.

The research team independently coded each transcript using the finalized codebook. Coding discrepancies were discussed in team meetings and resolved through consensus. Thematic saturation was determined by tracking the emergence of new codes and themes across transcripts and confirming that no additional insights were arising in later interviews. This was assessed both within the full dataset and across demographic strata to ensure consistency in saturation. This iterative, collaborative process ensured consistency and rigor in the analysis. The final coding results revealed overarching themes and subthemes that illustrate how climate change is impacting health in agrarian Kenyan communities.

2.6. Ethical Approval

Ethical considerations were prioritized, with informed consent obtained from all participants and additional parental consent for adolescent girls under age 18. After reviewing the study consent forms with locally trained research assistants, the participants gave written consent to participate in the focus groups. Ethical approval to conduct this study was obtained from the University Institutional Review Board (IRB) (P#1930) and the AMREF Health Africa Ethics and Scientific Review Committee (ESRC P1488/2023). A research permit from the National Council of Science and Technology (NACOSTI) was also secured. Additionally, we received county approval from Kilifi County to conduct the study.

3. Results

A total of 155 individuals participated in the focus group discussions. The majority (87.1%) resided on farms, with most (78.7%) using their farms primarily for family sustenance. A smaller proportion (25.2%) relied on their farms for income generation. Educational attainment varied across the population. Over half (52.9%) of the participants had completed primary school as their highest level of education. For a detailed breakdown of the study population’s demographics, please refer to

Table 1. Demographic characteristics of the study population.

	Adolescent Girls (14–17) N = 36 (%)	Younger Women (18–30) N = 41 (%)	Older Women (31+) N = 39 (%)	Younger Men (18–30) N = 20 (%)	Older Men (31+) N = 19 (%)	Total N = 155 (%)
Mean Age (years)	15.0	23.0	63.4	22.2	42.1	33.1
Marital Status
Married	N/A	13 (31.7)	30 (76.9)	3 (15.0)	17 (89.5)	63 (52.9)
Never married		19 (46.3)	2 (5.1)	15 (75.0)	1 (5.3)	37 (31.1)
Divorced		0	2 (5.1)	0	0	2 (1.2)
Widowed		1 (2.4)	4 (10.3)	0	0	5 (4.2)
Live-in partner		7 (17.1)	0	0	1(5.3)	8 (6.7)
Unknown		1 (2.4)	1 (2.6)	2 (10.0)		4 (3.4)
Current or Highest Level of Education
None	0	1 (2.4)	6 (15.4)	0	0	7 (4.5)
Primary	26 (72.2)	19 (46.3)	30 (76.9)	1 (5.0)	6 (31.6)	82 (52.9)
Secondary (high school)	10 (27.8)	18 (43.9)	1 (2.6)	16 (80.0)	9 (47.4)	54 (34.8)
Associate/university/college	0	3 (7.3)	1 (2.6)	3 (15.0)	4 (21.1)	11 (7.1)
Unknown	0	0	1 (2.6)	0	0	1 (0.6)
Live on Farm
Yes	35 (97.2)	30 (73.2)	37 (94.9)	17 (85.0)	17 (89.5)	136 (87.1)
No	1 (2.8)	10 (24.4)	2 (5.1)	3 (15.0)	2 (10.5)	18 (11.6)
Unknown	0	1 (2.4)	0	0	0	1 (0.6)
Work Outside Home
Yes	0	12 (31.7)	16 (41.0)	5 (25.0)	13 (68.4)	46 (29.8)
No	35 (100)	26 (63.4)	14 (35.9)	15 (75.0)	6 (31.6)	96 (61.9)
Unknown		3 (7.3)	9 (23.1)			12 (7.7)
Family Use Farm to Make Money
Yes	3 (8.3)	8 (19.5)	19 (48.7)	2 (10.0)	7 (36.8)	39 (25.2)
No	32 (88.9)	31 (75.6)	19 (48.7)	18 (90.0)	12 (63.2)	112 (72.3)
Unknown	1 (2.8)	2 (4.9)	1 (2.6)	0	0	4 (2.6)
Family Use Farm to Feed Household
Yes	32 (88.9)	26 (63.4)	36 (92.3)	12 (60.0)	16 (84.2)	122 (78.7)
No	2 (5.6)	12 (31.7)	2 (5.1)	8 (40.0)	3 (15.8)	27 (17.4)
Unknown	2 (5.6)	3 (7.3)	1 (2.6)	0	0	6 (3.9)
Drinking Water Source
Public well	7 (19.4)	5 (12.2)	7 (17.9)	7 (35.0)	9 (47.4)	35 (22.6)
Public tap	14 (38.9)	24 (58.5)	15 (38.5)	10 (50.0)	3 (15.8)	66 (42.6)
Natural source (steam, river, spring)	7 (19.4)	9 (22.0)	4 (10.3)	1 (5.0)	1 (5.3)	22 (14.2)
Piped into dwelling	6 (16.7)	3 (7.3)	12 (30.8)	2 (10.0)	6 (31.6)	29 (18.7)
Unknown	2 (5.6)	0	1 (2.6)	0	0	3 (1.9)

.

The focus group discussions revealed that climate change exacerbates health vulnerabilities through multiple social determinants, including economic stability, access to healthcare, the physical environment, education, food security, and social context. Participants described these impacts as deeply interrelated and widespread.

Table 2. Pathways linking climate change to health outcomes through social determinants.

Determinant of Health	Climate-Driven Effects	Health Outcomes
Economic Stability	- Food insecurity due to crop/livestock loss and inflation - Job loss and income instability - Transactional sex as survival strategy	- Malnutrition - Early pregnancy - HIV/STIs - Alcohol abuse
Neighborhood/Physical Environment	- Drought and water scarcity - Flooding and stagnant water - Damaged roads limiting access to care	- Malaria - Cholera - Delayed treatment and care
Healthcare Access and Quality	- Long distances to health facilities - Inadequate facility resources and medicine - Lack of transportation money	- Untreated illness - Poor maternal and child health
Education	- School dropout due to pregnancy or family need	- Compromised long-term well-being
Social and Community Context	- Gendered labor burdens (e.g., walking long distances for food/water) - Stigma for young pregnant girls - Lack of community support	- Suicide risk - Mental distress - Forced early marriage
Food Security and Nutrition	- Loss of diverse crops (e.g., cassava and sweet potatoes) - Increased reliance on processed foods	- Malnutrition - Poor maternal/child nutrition

shows the climate-related health outcomes related to the social determinants as described by study participants.

4. Economic Stability

Economic hardship was a recurring theme across all participant groups. Climate-related events such as droughts and floods have devastated livelihoods by destroying crops, killing livestock, and reducing opportunities for wage-earning activities. These disruptions have led to food scarcity and inflation, making basic necessities increasingly unaffordable for many families. Participants explained the economic strains faced as a result of climate change:

Because of the drought, the cows died… now, we only afford flour to make ugali. Our children don’t even know traditional foods anymore.

(Magarini Older Women)

If there is severe weather conditions, particularly droughts, it affects our crops that we planted. Maybe it had rained a little and we planted, then drought hit and the crops failed because of the sun. It is usually a difficult condition.

(Magarini Young Women)

In addition to crop failure and livestock loss, extreme weather patterns have limited income-generating activities especially for men by hindering mobility and trade.

Because of the heavy rains, men cannot go out to fend for themselves, that’s why the goods in the shops, including flour, are on high demand raising the price limits, forcing the young people to go look for opportunities to earn and be able to afford those expensive goods so as to beat the rising cost of living.

(Magarini Younger Men)

Those men, they… For floods lead to loss of job opportunities. This is because here in Garashi, men head lowlands where floods emanate to work because there are coconut plantations and a lot of economic activities [are] found there so when it floods they remain in their houses.

(Magarini Young Women)

Under these worsening economic conditions, adolescent girls and young women are pushed into transactional sex to meet their basic needs, including food, menstrual hygiene products, and school supplies. Transactional sex was consistently described as an act of desperation rather than choice.

It is brought about by the children asking you for something, for example she has asked you for pads but you say you don’t have money. She will get a man out there who will give her the money to go buy pads and that is why girls are getting pregnant early. It is because back at home there is nothing.

(Ganze Older Women)

If you don’t have sanitary pads, when you go home and your parents tell you they don’t have money, you might be forced to go and have sex with someone so they can give you that money.

(Ganze Adolescent Girls)

These testimonies illustrate how climate change exacerbates existing economic inequalities, forcing communities, particularly young women and girls, into harmful survival strategies.

5. Neighborhood and Physical Environment

Participants described significant degradation of the physical environment as a result of climate change, with direct and severe consequences for health. Recurrent flooding and prolonged droughts have contributed to critical water shortages, contamination of available water sources, and the accumulation of stagnant floodwaters. These conditions have created ideal environments for the spread of waterborne illnesses such as cholera and malaria. Participants linked heavy rainfall to disease outbreaks:

When there is heavy rainfall it causes outbreaks of diseases like cholera, especially among children, and that is because of the stagnant water, if I’m not wrong. So most of the children are affected by diseases when it is raining.

(Ganze, Younger Men)

Access to clean water has become increasingly difficult. As one younger woman described, people must now travel long distances for water, often competing with livestock for contaminated sources:

Climate change made people travel for long distances for water. Humans and livestock both needed water, but the water was contaminated. When humans consumed it, they would get illnesses like cholera. So there were many patients who had diarrhea. With so many patients, hospitals would lack medicine, and the patient would be forced to buy from a chemist, but they had no money.

(Ganze, Younger Women)

Infrastructure damage due to flooding further compounds these challenges. Participants reported that roads were frequently washed out or rendered impassable, disrupting both the transportation of medical supplies and access to healthcare services:

The roads get damaged, and it’s difficult for transportation to bring medicine from the dispensaries. Medications run out, and the roads are impassable. People in the community then lack access to the necessary medical supplies.

(Magarini, Older Women)

At the local hospital, there are medicines given to people who are unwell. But during floods, the roads are often impassable, which hinders the delivery of essential medication and supplies to keep us healthy. So, when the roads are destroyed due to heavy flooding, it becomes problematic.

(Magarini, Adolescent Girls)

These accounts reveal how the physical environment, already strained by poverty and under-resourced infrastructure, is further stressed by climate change, exacerbating existing barriers to clean water, disease prevention, and emergency healthcare access.

6. Healthcare Access and Quality

Access to healthcare services was hindered by both environmental and financial barriers. Flooded roads, long distances to health facilities, and lack of transportation funds were commonly reported. As one woman described, “The hospital usually doesn’t have enough drugs, and we don’t have money to buy them elsewhere.” (Magarini Younger Women). This lack of access significantly affected maternal health and care for children, especially during disease outbreaks.

When there are floods, the road to Kaya is affected because of floods, the only route that is used is the Marafa route. So in the past, if someone has a leg injury or has high blood pressure during floods there is only one passable route and also the hospital usually doesn’t have enough drugs to cater for everyone, as in, drugs for all illnesses, so you will be forced to take a motorbike which is also a problem if you don’t have money…. After crossing, you may not be able to return because it is flooded…you must get a vehicle or a motorcycle and that is difficult because there is no money.

(Magarini Younger Women)

During drought, people face challenges, especially if where I live is far, and the hospital is also far. You end up caressing the sick person, there are times when we’re told not to buy children’s medicine from shops, but because the hospital is far we just buy first, so that it might help and you find a way to reach the hospital.

(Ganze Older Women)

When there is heavy rainfall there will be someone in a remote location in the community who is using a motorbike as a means of transport so that they can get medication or access treatment. So the heavy rainfall can affect transportation and the time it takes to reach the hospital.

(Ganze Younger Men)

Another factor limiting access to healthcare was the cost of travel. With funds already scarce, those who fell ill often delayed going to the hospital because they could not afford the ride.

Let’s say, I live very far away; it’s costly to travel from there to here (the hospital). So, if I say I’m coming from there, it costs money. We have a saying here, “let me just check on them tomorrow to see if they’ll have improved.” It means I don’t have the money to get on a motorcycle to rush for quick treatment. I’ll have to attend to them at home and see if miracles will happen for them to recover. But you find someone delays coming to the hospital because of transport.

(Ganze Older Women)

Access to medication was limited because roads were damaged, which hindered delivery. On top of hospitals being located far, if participants did get the chance to get to a hospital, they were already at capacity, and resources were depleted after extreme weather events due to outbreaks of diseases.

When we look at malaria, it also affected many people. Those are the effects that we experience when there is a change in climate. When you go to hospital, the drugs are depleted or they are not enough because there is an outbreak of different diseases.

(Magarini Older Women)

I mean that at the local hospital, there are medicines given to people who are unwell. But during floods, the roads are often impassable, which hinders the delivery of essential medication and supplies to keep us healthy. So, when the roads are destroyed due to heavy flooding, it becomes problematic.

(Magarini Older Women)

7. Education

Climate change indirectly impacted educational continuity, particularly for girls. Early pregnancies often the result of transactional sex led to school dropouts and early marriages. The inability to afford sanitary pads was a significant barrier to continued education, leading some girls to seek support from older men, increasing their vulnerability to exploitation and disease.

Girls ask for pads, and if the parents can’t provide, they find a man to give them money. That’s how pregnancies happen.

(Ganze Older Women)

Drought caused our children to have childhood pregnancies and also early marriages, early marriages because you find a man has three or four daughters and he says these ones will not go to school, he looks for husbands for them and it is not young husbands of their age, old men who are even smelling of death, they are just left with a few days before they die.

(Magarini Older Women)

Adolescent Ganze girls emphasized the importance of schools and the resources they provide like giving pads to them. However, when schools are closed, girls need to find alternative means for menstrual supplies. There are organizations and people that provide menstrual supplies to females…“There’s another woman here in Ganze…, sometimes she distributes pads” (Ganze Adolescent Girls). Many times though, girls and young women are forced into transactional sex to receive money for their menstrual supplies.

During drought and you are on periods you tell your parent, “I need money to buy pads.” The parent says, “I don’t have money.” So, … you won’t know what to do then… you see a boy who tells you, “I love you and I want to sleep with you, I am ready to give you what you want.” You tell him all your problems and he gives you the money then he has sex with you then you get an early pregnancy.

(Magarini Adolescent Girls)

It is brought about by the children asking you for something, for example she has asked you for pads but you say you don’t have money. She will get a man out there who will give her the money to go buy pads and that is why girls are getting pregnant early. It is because back at home there is nothing.

(Ganze Older Women)

8. Social and Community Context

Climate change also had social consequences, including mental health stressors, strained family dynamics, and a weakening of community support systems. Participants reported that prolonged droughts, food insecurity, and economic instability had intensified psychological distress. Feelings of hopelessness, abandonment, and shame were common, with reports of substance abuse, gender-based violence, and suicide emerging as critical concerns.

Women frequently described being left to manage households alone when male partners abandoned their families during crises. This compounded the emotional and economic burden they carried.

During such droughts, women are always stressed, thinking about how to feed their children. They take on tough jobs like construction work. You’ll find a woman who recently gave birth already at a construction site, working for what? To earn money to use.

(Ganze, Older Women)

The stress was also acutely felt by men, who faced increasing pressure to provide for their families. This strain sometimes led to suicide.

The lack of job opportunities during climate change caused men to commit suicide. My husband has told me he has not gotten anything. Don’t say, “What kind of man are you?” You find that a man can kill himself because of those responsibilities it is also not his wish.

(Magarini, Older Women)

Alcohol use among men was described as both a symptom and driver of domestic tension. During periods of food scarcity, some men resorted to drinking as a form of escape. A woman explained:

During that drought, you could search for food and still not find any. A child saying, ‘I’m hungry,’ sleeps without eating. Even if you don’t have a problem yourself, you come home to a drunk husband. If you ask, he says he was given alcohol instead of buying food. He drinks so much, he doesn’t even realize.

(Ganze, Older Women)

The father comes home drunk at around 9 o’clock, and when he arrives, he will ask for food yet he brought nothing. So it becomes a difficult life with challenges that bring about the violence of beatings in the homes.

(Magarini Young Women)

Among adolescent girls, the intersection of poverty, sexual violence, and social stigma created life-threatening vulnerabilities. Participants described how lack of access to basic items such as sanitary pads could lead girls into transactional sex, resulting in unplanned pregnancies, rejection, and suicidal ideation.

If you don’t have sanitary pads, when you go home and your parents tell you they don’t have money, you might be forced to go and have sex with someone so they can give you that money. Unfortunately, you might end up getting pregnant. If you pursue the person who impregnated you, they might deny it or threaten to kill you. When you go back home, your parents may also kick you out and this can lead a girl to commit suicide.

(Ganze, Adolescent Girls)

You tell your parents you’re pregnant, and they chase you away. The man who impregnated you threatens you. That’s how girls end their lives.

(Ganze, Adolescent Girls)

Access to basic resources such as water also placed a burden on women and girls, especially during droughts, further isolating them and limiting their time for school or rest.

When there is drought, there is a shortage of water. We have to go to the dams to fetch water, and it is very far.

(Ganze, Adolescent Girls)

Many women have to walk from here to places like Kakuhani to fetch water. The queue is long there because of the water scarcity. There is only one water point and many people rush there when they hear there is water.

(Magarini Young Women)

These narratives illustrate how climate change intensifies social stressors, amplifies gendered inequalities, and disrupts community cohesion. Mental health struggles, often invisible or stigmatized, are deeply rooted in structural and environmental hardships.

9. Food and Nutrition Security

Food insecurity emerged as a significant concern across all participant groups. Severe weather events, especially prolonged droughts and floods have destroyed farms, decimated livestock, and diminished access to traditional and nutrient-rich crops. As a result, many households relied on low-nutrient, processed alternatives such as refined flour, contributing to rising rates of malnutrition.

During drought, there’s no food. You eat porridge once a day. Babies become malnourished.

(Magarini, Younger Women)

During the drought, we often lack food, we sleep hungry, and our health is affected.

(Ganze, Adolescent Girls)

Climate-related stressors such as livestock deaths and failed crops have hampered local food systems and contributed to the erosion of traditional food knowledge. One older woman reflected:

For me, the drought affected me personally because I had banana plantations and cows, but now because the drought lasted long, the cows died. I could not afford to buy grass. Mine died. In terms of food, our young children don’t even know sweet potatoes or traditional foods. They’re used to us buying a packet of flour at two hundred shillings to make ugali. So you find they don’t even know these other foods.

(Magarini, Older Women)

Extreme weather has also affected livelihoods, limiting people’s ability to earn income and afford rising food prices. As one younger man explained:

Because of the heavy rains, men cannot go out to fend for themselves. That’s why the goods in the shops, including flour, are in high demand, raising the price limits. This forces young people to look for opportunities to earn just to afford those expensive goods.

(Magarini, Younger Men)

The compounding effects of food scarcity, poverty, and poor dietary quality are particularly devastating for children. Another participant described the nutritional toll on families:

Even with health, you will find if there is drought, there is lack of food at home. The children get kwashiorkor or become malnourished. Imagine somebody is supposed to eat in the morning, day, and evening, isn’t it? You eat in the evening only and it is a small cup of porridge and sleep with a baby this young. This baby doesn’t eat in the morning or during the day, just a small cup of porridge in the evening. This one will definitely become malnourished.

(Magarini, Younger Women)

These accounts illustrate how climate change by destabilizing food production, altering dietary practices, and deepening poverty has exacerbated food and nutrition insecurity in ways that intersect with health, gender, and generational disparities.

10. Discussion

Climate change in Kilifi County is causing disruptions across the social determinants of health with droughts and flooding impacting livelihoods, infrastructure, and community systems. Our focus-group findings reveal that climate-driven crop and livestock failures, water scarcity, and transportation interruptions exacerbate malnutrition, infectious disease outbreaks, and psychosocial stress, particularly among women and girls. These societal breakdowns spread across the following six key domains: economic stability, neighborhood and physical environment, healthcare access and quality, education, social and community context, food and nutrition security.

Our findings on economic instability from failed harvests mirror those in Turkana County, Kenya, where recurring droughts have forced pastoralist communities to adopt environmentally degrading survival tactics like charcoal burning [27]. Similarly, in Rwanda, studies highlight how climate-induced economic strain disrupts traditional livelihoods, pushing vulnerable groups into high-risk coping mechanisms [35]. These patterns align with broader trends observed across low- and middle-income countries, where extreme weather diminishes crop yields and informal labor opportunities, eroding economic stability [36]. In Kilifi, these disruptions deepen poverty and fuel a reliance on harmful coping mechanisms, particularly among adolescent girls, such as transactional sex, which heightens the risk of early pregnancy, HIV/STIs, and gender-based violence [37,38]. As in other drought-prone regions, girls are disproportionately burdened with securing household resources, often at the expense of their education, health, and autonomy [39], underscoring the cyclical nature of poverty and gender inequity in climate-vulnerable settings. While our study confirms the widespread economic and health impacts of climate change, it also adds nuance by revealing how Kilifi’s unique agrarian context intensifies these effects. The community’s reliance on rain-fed agriculture exacerbates food insecurity, an issue less pronounced in pastoralist communities where climate adaptation knowledge is more embedded. Additionally, Kilifi participants uniquely highlighted the role of disrupted social networks in worsening psychosocial stress, a health consequence less emphasized in the existing literature.

The destruction of neighborhoods and the physical environment exacerbates disease and limits healthcare access. Climate-driven infrastructure degradation in Kilifi County, particularly roads and water systems, creates an environment rife for infectious disease outbreaks and restricts access to essential health services. Participants described how seasonal floods wash out unpaved roads and bridges, leaving communities isolated for days or weeks. These environmental changes depict patterns observed across sub-Saharan Africa: after heavy rains and flooding in eastern Uganda, for instance, deep ruts in roads formed new mosquito breeding sites, causing spikes in malaria incidence [40]. Likewise, analyses of cholera outbreaks in West Africa following ravine floods revealed a correlation between flood-induced water contamination and cholera cases [41,42].

As roads become impassable, healthcare access and quality is compromised. In Kilifi, participants reported delayed treatment for malaria and cholera, as well as interruption of routine maternal and child health services during peak flooding months. This was a challenge well documented in Uganda [40], Haiti [41], and Zambia [43], where weather-damaged infrastructure can severely limit healthcare access. During floods and droughts, clinics suffer supply shortages, staff absenteeism, and service suspensions, leaving pregnant women and young children without essential antenatal visits, immunizations, or emergency care. Community members contend with increased transportation costs or outright inability to reach clinics, coupled with the burden of weather-related illnesses and injuries. This barrier is well documented in low-resource settings: a study of rural Nigeria found that flood events reduced antenatal care utilization by over 20% due to impassable roads and forbidding terrain [43]. In Kenya, 11% of the population live more than two hours from the nearest health facility, with prolonged travel times during rainy seasons [44]. Together, these findings emphasize how Kilifi’s experience reflects a broader regional pattern of climate-induced healthcare disruptions where the fragile infrastructure compounds existing health vulnerabilities in agrarian communities.

Climate-related economic strain in Kilifi County impedes girls’ education through the following two primary pathways: increased household responsibilities and the prevalence of early pregnancies. Our findings confirm what other studies across rural Kenya have shown, that when families face income loss and crop failure, adolescent girls are often pulled out of school to take on domestic labor. Kilifi’s context presents important nuances that extend the current understanding on the impact of girls. The severity of crop failures due to extreme weather events accelerates the shift of girls’ labor from supplemental labor to primary household sustenance. Participants describe cases where young girls became the de facto head of the household during extreme weather events, which is a phenomenon less documented in previous studies. These patterns are consistent with broader evidence from western Kenya, where household duties are a leading cause of school dropout, with 42% of out-of-school girls citing domestic responsibilities such as childcare and housework [45,46]. Building on this, our study further highlights how early pregnancy and child marriage, often linked to transactional sex as a means of survival, are additional drivers of educational disruption. These survival strategies, rooted in economic desperation, compound girls’ vulnerability and reinforce cycles of poverty. Ultimately, these chronic interruptions to girls’ education deepen gender inequities and limit social and economic mobility, undermining broader development goals in climate-affected regions [47].

The mental health consequences of severe weather events in Kilifi County reveal both confirmations and additions to the existing climate health literature. While studies across sub-Saharan Africa have established links between climate change and psychological distress [48,49], our findings deepen this understanding by showing how Kilifi and other agrarian contexts shape these mental health impacts. Losing a season worth of crops accelerates mental deterioration, which is not fully documented in other studies. Kilifi women reported carrying the triple burden of economic provider, caregiver, and emotional anchor. In some instances, there is the added pressure of forced relocation, further disrupting the pre-existing social networks. Unlike pastoralist communities where the burden of survival post-extreme-weather event is shared [27], Kilifi shows a gendered impact which suggests that interventions may need to consider the unique contexts of agrarian communities. These findings collectively call for context-specific mental health approaches that account for the frequency of extreme weather events and support systems in agrarian communities.

Finally, our study revealed that severe weather has a large impact on food security and nutrition. Recurrent crop failures and market-driven food price inflation in Kilifi County have forced households to rely increasingly on cheap, low-nutrient staples such as maize flour and cassava at the expense of diverse, micronutrient-rich foods. The shift to low-nutrient staples during droughts has been documented across sub-Saharan Africa, with stunting rates rising notably during drought and flood periods [50]. Our findings show the disproportionate intergenerational nutritional deficits due to this lack of dietary diversity. Maternal undernutrition aggravated by inadequate food access during pregnancy contributes to low birth weights and elevated neonatal mortality [51,52]. Infants born small are more susceptible to neonatal mortality, infectious diseases, and impaired neurodevelopment [53]. Women who endured childhood malnutrition often enter adolescence and adulthood with compromised nutritional reserves, increasing their own pregnancy risks and completing the cycle [54]. This impact is less pronounced in regions with more varied traditional food systems.

These climate-driven disruptions are further exacerbated by structural inadequacies in Kilifi County. Participants highlighted chronic underinvestment in rural infrastructure (e.g., unpaved roads and inadequate water storage), which magnifies flood and drought impacts. County-level climate adaptation plans, while typically aligned with Kenya’s National Climate Change Action Plan [55], often lack localized implementation or community input, leaving heavily agrarian locations disproportionately vulnerable.

This disparity underscores the critical role of place-based studies like ours in exposing how extreme weather impacts manifest unevenly across regions. Kilifi’s agrarian economy, coupled with its marginalized infrastructure and resource allocation, makes it an example of climate injustice where national policies fail to translate into local reality. By centering community experiences, our study reveals the local realities urging policymakers to tailor interventions to the specific vulnerabilities of high-risk counties.

Despite the depth of insight offered by our qualitative, community-based participatory approach, several limitations warrant consideration. First, the study’s geographic scope was confined to two sub-counties (Ganze and Magarini) within Kilifi County. While these areas exemplify agrarian, rain-fed economies vulnerable to extreme weather, findings may not capture heterogeneity across other Kenyan regions or agrarian settings with different ecological or infrastructural profiles. Second, although focus group discussions were stratified by age and gender to gain diverse perspectives, group dynamics and settings may have influenced participants’ willingness to disclose sensitive experiences (e.g., transactional sex and domestic violence). Future work might incorporate individual interviews to complement focus group discussions and mitigate these effects. Further, future research could integrate mixed methods to quantify the prevalence of health impacts identified in this study.

By acknowledging these limitations and focusing on transferability, we aim to inform targeted, context-sensitive interventions in other East African agrarian communities confronting similar climate-driven health challenges. Targeted, actionable interventions are necessary to disrupt the climate change vulnerability cycle, as indicated by the Kilifi findings. Policymakers and NGOs should consider economic supports like cash transfers that can protect against income disruptions, while investments in drought-resistant crops and microfinancing for small non-agricultural businesses can bolster long-term stability. Infrastructure improvements such as elevated roads, decentralized water points, and engineered flood defenses can enhance physical resilience, especially when co-designed with communities. Simultaneously, health-system adaptations must be mobile, decentralized, and climate-proof, ensuring care continuity during crises. Training community health workers, equipping mobile clinics, and subsidizing access for vulnerable populations are critical steps. Together, these measures would promote long-term resilience while simultaneously mitigating immediate disruptions.

11. Conclusions

This study demonstrates that climate change is impacting social determinants of health by deepening inequities across economic stability, the physical environment, healthcare access, education, nutrition, and community cohesion in rural Kenya. In Kilifi County, droughts and floods trigger loss of livelihood, food insecurity, educational disruptions, disease outbreaks, and mental-health crises that disproportionately burden women and girls. Severe weather events set off a chain reaction across multiple domains of the social determinants of health. A single weather event can simultaneously decimate crops, deplete water supplies, and reduce school attendance as families prioritize basic survival. These disruptions lead to ripple effects: malnutrition weakens immunity, increasing susceptibility to disease, and income loss drives harmful survival strategies like transactional sex, intensifying gendered risks and mental health burdens. When viewed through a holistic lens, these challenges are not isolated. They interact in complex, reinforcing ways that deepen vulnerability and erode community resilience. Addressing one sector without considering others misses the synergistic nature of these stressors and their compounding effects. Recognizing these intersections is crucial for developing multisectoral interventions that address not only climate adaptation but the structural inequities driving its health impacts.