Empirical studies of factors associated with child malnutrition: highlighting the evidence about climate and conflict shocks

Molly E Brown,Trey Billing,Peter White,Shannon Doocy,Paul Huth,David Backer,Kathryn Grace

doi:10.1007/s12571-020-01041-y

Abstract

Children who experience poor nutrition during the first 1000 days of life are more vulnerable to illness and death in the near term, as well as to lower work capacity and productivity as adults. These problems motivate research to identify basic and underlying factors that influence risks of child malnutrition. Based on a structured search of existing literature, we identified 90 studies that used statistical analyses to assess relationships between potential factors and major indicators of child malnutrition: stunting, wasting, and underweight. Our review determined that wasting, a measure of acute malnutrition, is substantially understudied compared to the other indicators. We summarize the evidence about relationships between child malnutrition and numerous factors at the individual, household, region/community, and country levels. Our results identify only select relationships that are statistically significant, with consistent signs, across multiple studies. Among the consistent predictors of child malnutrition are shocks due to variations in climate conditions (as measured with indicators of temperature, rainfall, and vegetation) and violent conflict. Limited research has been conducted on the relationship between violent conflict and wasting. Improved understanding of the variables associated with child malnutrition will aid advances in predictive modeling of the risks and severity of malnutrition crises and enhance the effectiveness of responses by the development and humanitarian communities.

Highlights

Malnutrition is preventable, yet remains a major public health challenge
Assessments of food security conducted by organizations such as the Famine Early Warning Systems Network (FEWS NET) and the Integrated Food Security Phase Classification (IPC) initiative have sought to project the future status of at-risk countries and issue alerts about impending and ongoing crises months in advance, aiming to ensure enough lead time for the coordination and implementation of appropriate responses (Brown et al 2007; Funk et al 2019; IPC 2012)
Just over 34% of the reviewed studies modelled wasting. More studies operationalized this outcome with a binary variable than with a z-score

Summary

Introduction

Malnutrition is preventable, yet remains a major public health challenge. This condition affects one in five children and contributes to nearly half of all deaths during childhood globally (Black et al 2013). Various development and humanitarian interventions focus on fostering healthy communities where children are better protected and able to recover from nutrient deficits (Collins et al 2006) To facilitate those interventions, assessments of food security conducted by organizations such as the Famine Early Warning Systems Network (FEWS NET) and the Integrated Food Security Phase Classification (IPC) initiative have sought to project the future status of at-risk countries and issue alerts about impending and ongoing crises months in advance, aiming to ensure enough lead time for the coordination and implementation of appropriate responses (Brown et al 2007; Funk et al 2019; IPC 2012). Assessments that focus on early warning have advantages relative to relying on measuring the prevalence of malnutrition in a community, which can detect a crisis only after it emerges (Maxwell et al 2020) Assessments such as FEWS NET and IPC, do not gauge, much less substantiate, associations between malnutrition at an individual level and relevant factors. Modelling these empirical relationships is integral to detecting vulnerabilities, diagnosing their sources, and directing assistance

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Results

Conclusion