Abstract
SummaryBackgroundChild growth faltering persists in sub-Saharan Africa despite the scale-up of nutrition, water, and sanitation interventions over the past 2 decades. High temperatures have been hypothesised to contribute to child growth faltering via an adaptive response to heat, reduced appetite, and the energetic cost of thermoregulation. We did a cross-sectional study to assess whether child growth faltering is related to environmental temperature in sub-Saharan Africa.MethodsData were extracted from 52 Demographic and Heath Surveys, dating from 2003 to 2016, that recorded anthropometric data in children aged 0–5 years, and were linked with remotely sensed monthly mean daytime land surface temperature for 2000–16. The odds of stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age) relative to monthly mean daytime land surface temperature were determined using multivariable logistic regression.FindingsThe study population comprised 656 107 children resident in 373 012 households. Monthly mean daytime land surface temperature above 35°C was associated with increases in the odds of wasting (odds ratio 1·27, 95% CI 1·16–1·38; p<0·0001), underweight (1·09, 1·02–1·16; p=0·0073), and concurrent stunting with wasting (1·23, 1·07–1·41; p=0·0037), but a reduction in stunting (0·90, 0·85–0·96; p=0·00047) compared with a monthly mean daytime land surface temperature of less than 30°C.InterpretationChildren living in hotter parts of sub-Saharan Africa are more likely to be wasted, underweight, and concurrently stunted and wasted, but less likely to be stunted, than in cooler areas. Studies are needed to further investigate the relationship between temperature and child growth, including whether there is a direct effect not mediated by food security, regional wealth, and other environmental variables. Rising temperature, linked to anthropogenic climate change, might increase child growth faltering in sub-Saharan Africa.FundingUK Medical Research Council and UK Global Challenges Research Fund.
Highlights
Childhood undernutrition, including growth faltering and micronutrient deficiencies, is associated with increased mortality and is estimated to contribute to approximately 45% of deaths of children younger than 5 years globally.[1]
We explore the role of temperature in growth faltering in sub-Saharan Africa
By analysing data for 656 107 children aged 0–5 years in 29 countries across sub-Saharan Africa, a region where growth faltering persists, we show that children living in hotter parts of sub-Saharan Africa are more likely to be wasted, underweight, and concurrently stunted and wasted, but less likely to be stunted, than in cooler areas
Summary
Childhood undernutrition, including growth faltering and micronutrient deficiencies, is associated with increased mortality and is estimated to contribute to approximately 45% of deaths of children younger than 5 years globally.[1] Despite reductions in stunting, wasting, and underweight in most African countries between 2000 and 2015, the prevalence of stunting remains as high as 30% in some parts of sub-Saharan Africa.[2] The WHO Global Nutrition Targets for 2012 to 2025 aim to reduce the prevalence of stunting by 40% and the prevalence of wasting to less than 5%. Evidence from rural parts of The Gambia from the past 3 years suggests that major and sustained improvements in living conditions, disease reduction, diet, and health care might be needed to eliminate undernutrition.[2,6] The causal pathways remain poorly understood, precluding effective intervention
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