Isayas Hafebo Lambebo, Kasahun Eba, Gudina Terefe Tucho
BACKGROUND: Ethiopia struggles with floods, droughts, climate-related health issues, lacking sufficient research on community vulnerability, risk perceptions, and adaptation strategies. METHODS: Employing a mixed-methods approach including household surveys (N = 845), focus group discussions, and key informant interviews the research captures the socio-economic, ecological, and health dimensions of climate vulnerability in Highland, Midland, and Lowland climatic zones. RESULTS: Findings reveal stark regional disparities: Highland communities face heightened exposure to cold waves and water scarcity exacerbated by aging populations and poor housing; Lowland zones are afflicted by heat-related stressors, institutional collapse, and youth-dominated demographics; while Midland areas suffer from hydrological instability fostering disease transmission. Across all regions, systemic health issues such as food- and water-borne diseases (83%) and malnutrition (80%) emerge as pervasive threats. Statistical analysis via logistic regression identifies educational, income, health insurance access, credit availability, and climate information as significant predictors of adaptation. Notably, higher education boosts adaptive capacity by over 13-fold, while females and larger families show reduced engagement in adaptation practices. Local innovations, including Enset and mixed farming, offer culturally rooted strategies for resilience, though feasibility varies regionally. CONCLUSION: The study underscores the need for geographically tailored, integrated climate-health interventions supported by inclusive service delivery, climate-aware education, and gender-responsive programming. It also highlights a critical gap between perceived climate risks and scientifically grounded understanding of causes only 14% attribute climate change to human activities pointing to the importance of culturally attuned climate communication.