Climate Change and Health Vulnerability of Coastal Communities in Timor-Leste: A Small Island Comparative Study

Abstract

Climate change threatens public health in small island developing states, including Timor-Leste, where adaptive capacity remains limited. This study analysed climate-related health impacts and measured the composite health vulnerability index of coastal communities in Municipios Manatuto and Baucau. A concurrent embedded mixed-methods design with a matched case-control component was used. Quantitative data came from 400 household heads: 200 cases with a facility-recorded episode of dengue, acute diarrhoea, or acute respiratory infection in the preceding 12 months, and 200 controls without such an episode, matched on sex, age group (±5 years), and suco. Qualitative data came from in-depth interviews with 24 purposively selected informants, continued until thematic saturation. Analyses used chi-square tests, Pearson correlation, and binary logistic regression, preceded by tests of normality, multicollinearity, and goodness of fit; qualitative data were examined through six-phase thematic analysis. Dengue prevalence was higher in Manatuto (7.2%) than Baucau (5.8%) and correlated positively with mean temperature (r = 0.72; p < 0.001). Under-five stunting reached 48.5% and 45.2% respectively. The composite index was 3.8 (high) in Manatuto and 3.5 (moderate-to-high) in Baucau, with the gap driven by exposure (3.8 versus 3.5) and sensitivity (4.1 versus 3.7) rather than socio-economic conditions (2.0 versus 2.3). Significant risk factors were limited clean-water access (OR = 3.45), inadequate sanitation (OR = 2.87), and subsistence farming (OR = 2.14). Because Manatuto scored 3.8 against Baucau's 3.5, adaptation should prioritise water, sanitation, and health-facility resilience in Manatuto while consolidating Baucau's adaptive-capacity advantage