Health system resilience: quantifying the dynamic impact of environmental shocks on health service utilization using an interrupted time series and time-series forecasting approach in Western Province, Zambia.

Notably, the Interrupted Time Series (ITS) analysis demonstrated that the three major shocks exerted distinct and quantifiable impacts: a drought in 2019 was associated with a substantial immediate reduction in utilization (Level Estimate = −0.105, p < 001) and a subsequent positive recovery trend; the COVID-19 pandemic in 2021 resulted in a significant immediate increase in utilization followed by a negative trend change; and the complex flood event, specifically the double-peak flood in February 2023, although not producing a significant immediate impact, was linked to a significant positive trend change.

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