BACKGROUND:
South Africa is experiencing more frequent extreme weather events, including heatwaves and floods, with vulnerable communities experiencing the worst impact. Communities' perceptions of climate change and its health impact can inform policy and guide the development of contextually appropriate interventions. This pilot qualitative study explored perceptions of climate change and health experiences of communities in a peri-urban township in KwaZulu-Natal.

METHODS:
Trained facilitators conducted two focus group discussions with adult community members, using a structured guide to explore perceptions of climate change, extreme heat, and health-related impacts. Discussions were recorded, transcribed and analysed using inductive thematic analysis following Braun and Clarke’s approach.

RESULTS:
Two major themes emerged: (1) perceived climate and environmental change with subthemes of unpredictable weather patterns; environmental degradation, and urbanisation, and (2) health impacts of extreme heat with subthemes of physical and emotional well-being; nutritional and behavioural responses; and livelihood vulnerabilities. Participants described climate change as a lived reality, observed through blurred seasonal boundaries, more intense heat, and localised flooding. They attributed these changes to deforestation, expansion of informal settlements, inadequate drainage, and waste pollution. Reported health effects of heat stress included exhaustion, sleep disruption, cardiovascular and respiratory problems. During periods of heat, water scarcity forced a shift to unhealthy beverages, including alcohol and fizzy drinks, which can negatively impact health. Floods were reported to disrupt employment, agriculture, and household stability, deepening social vulnerability in a constrained community. Children, older adults, and people with chronic illnesses were viewed as especially at risk and climate events threaten food production, increasing hunger and economic strain.

CONCLUSIONS:
Communities demonstrated local knowledge of climate change, linking environmental changes to health and livelihood impacts. This awareness highlights the need to engage them in future research to quantify health impacts of climate change and co-design effective adaptation strategies in South African settings.