A systematic review and meta-analysis assessing the impact of droughts, flooding, and climate variability on malnutrition

Flood exposure and childhood malnutrition in India using composite index of anthropometric failure (CIAF)

The flood exposure in India exacerbates childhood malnutrition, particularly in the vulnerable regions of India. Presently, India is facing a dual burden of natural disasters and malnutrition, especially in the vulnerable regions that are exposed to floods. Many studies have been focused on micro-level or regional-level analyses. The present study is uniquely examining the association between flood exposure and malnutrition at a national scale. The study investigated the impacts of flood exposure on childhood malnutrition, using the Composite Index of Anthropometric Failure (CIAF) to assess stunting, wasting, and underweight among children under five years age group. The present study is based on the analyses of data from the National Family Health Survey (NFHS-5, 2019-2021) and Central Water Commission (CWC) reports. The data were analyzed across flood-affected regions in India and categorized by the frequency of flood events (i.e., non-flooded; 1-2 times flooded; and three times flooded events). The analysis reveals a significant increase in malnutrition rates with higher flood exposure in regions experiencing three flood events, 38 percent of children were stunted, 20 percent were wasted, and 35.7 percent were underweight as compared to non-flooded areas. Factors such as low birth weight, maternal education, sanitation facilities, and household infrastructure intensified malnutrition outcomes. The major findings of the study suggested that repeated flooding events aggravate food insecurity and increase vulnerability to child malnutrition. This study not only highlights the compounded effects of flood exposure and socio-economic disparities on CIAF malnutrition but also offers policy-relevant insights. The results of the study highlight the urgent need for targeted interventions, including developing disaster-resilient infrastructure, educational programs for mothers, and enhanced access to sanitation and healthcare in flood-affected regions in India.

Climate change and child wellbeing: a systematic evidence and gap map on impacts, mitigation, and adaptation

We developed a systematic evidence and gap map (2014-24) to assess how climate change impacts, mitigation, and adaptation affect the wellbeing of children aged 0-18 years globally, and discussed findings with the Children in All Policies 2030 Youth Advisory Board. Health was the most researched child wellbeing domain (84%; 948 of 1127 studies), followed by education (15%; n=171), and food security and nutrition (14%; n=160). Research on children's agency and resilience, displacement, socioeconomic distress, and safety received less attention. Health research gaps included limited studies on vector-borne diseases, children's mental health beyond post-traumatic stress disorder, and health outcomes for children aged 5-18 years. Mitigation and adaptation research focused largely on educational (45%; 114 of 252 studies) and behavioural changes (31%; n=79), with gaps in the evaluation of financing, infrastructure, technology, clean energy, and policy actions. Youth advisory board members emphasised the importance of schools, social media, and intergenerational dialogue in driving climate action while protecting children's wellbeing.

Health-Oriented Strategy for Clean Air and Climate Actions: Differential Health Effects of Atmospheric Components

Health is at the forefront of clean air and climate action. However, most existing studies of health impacts were based on additive single-exposure effects, which often oversimplify the relationships between atmospheric components and health outcomes. This review examines various atmospheric components' common sources and differential health effects, including greenhouse gases and major air pollutants such as fine particulate matter (PM2.5). It emphasizes the need for a comparative assessment of health impacts across various atmospheric components. We further highlight black carbon as an illustrative example, given its higher toxicity compared with other major PM2.5 components. By integrating the best available findings on the differential effects of particulate matter components with multiple gridded estimates of air pollution concentrations and population data, we conducted a risk assessment to quantify the health benefits of particulate matter reductions associated with China's clean air actions (2013-2020) and future climate mitigation scenarios (2020-2060). Our assessments indicate that, in regions or during periods where black carbon accounts for a higher proportion of exposure reduction relative to other PM2.5 components, reducing per-unit concentrations of PM2.5 can prevent more premature deaths. We propose a conceptual framework for a health-oriented strategy to enhance the effectiveness of clean air and climate initiatives.

Precipitation, temperature, and child undernutrition: evidence from the Mali demographic and health surveys 2012-2013 and 2018

BACKGROUND

Undernutrition among children remains a severe burden in Sub-Saharan Africa. Climate change is widely recognized as a major obstacle to improving children's nutritional outcomes. Mali, a landlocked country in West Africa, has one of the highest prevalence of child undernutrition in the region and is also considered one of the most vulnerable nations to climate change globally. This study, therefore, aimed to assess the effects of precipitation and temperature on child undernutrition in Mali, with a focus on climatic differences between the southern and northern regions.

METHODS

We pooled the two most recent cross-sectional datasets from the Mali Demographic and Health Surveys (DHS) 2012-2013 and DHS 2018, integrating them with climatic variables at the DHS cluster level. The study included data from 12,281 children under five years of age. Precipitation and temperature data were extracted from the Advancing Research on Nutrition and Agriculture's DHS-Geographical Information System database, which provides a comprehensive range of climatic and geographic variables at the DHS cluster level. We assessed the effects of precipitation and temperature over periods of three months, six months, one year, and two years before the survey on child undernutrition using multivariable multilevel logistic regression models.

RESULTS

In southern Mali, 25.0% of children under five were stunted (95% CI 23.7-26.3%), 24.9% were underweight (95% CI 23.7-26.1%), and 9.3% were wasted (95% CI 8.5-10.1%). In northern Mali, the prevalence rates were higher: 29.6% for stunting (95% CI 27.0-32.1%), 28.7% for underweight (95% CI 26.0-31.3%), and 10.5% for wasting (95% CI 8.8-12.3%). From the pooled data analysis, we found that higher average monthly rainfall over the last three months (AOR = 0.977, p = 0.012) and six months (AOR = 0.974, p = 0.003) preceding the survey was significantly associated with lower odds of wasting in northern Mali, predominantly comprising desert areas. Moreover, in addition to reducing wasting, rainfall over the one year (AOR = 0.985, p = 0.010) and two years (AOR = 0.984, p = 0.009) prior to the survey showed a significant effect in reducing the odds of underweight among children in the north.

CONCLUSIONS

Increased precipitation had a beneficial effect on children's nutritional status, particularly in the northern part of Mali, where water scarcity is a persistent challenge. Amid growing concerns about declining rainfall due to climate change, the risk of child undernutrition is expected to rise in the northern part. To address this escalating threat, it is crucial to implement effective and timely measures to mitigate the impacts of climate change and improve children's nutrition.

MicroRNAs in Plant Genetic Regulation of Drought Tolerance and Their Function in Enhancing Stress Adaptation

Adverse environmental conditions, including drought stress, pose a significant threat to plant survival and agricultural productivity, necessitating innovative and efficient approaches to enhance their resilience. MicroRNAs (miRNAs) are recognized as key elements in regulating plant adaptation to drought stress, with a notable ability to modulate various physiological and molecular mechanisms. This review provides an in-depth analysis of the role of miRNAs in drought response mechanisms, including abscisic acid (ABA) signaling, reactive oxygen species (ROS) detoxification, and the optimization of root system architecture. Additionally, it examines the effectiveness of bioinformatics tools, such as those employed in in silico analyses, for studying miRNA-mRNA interactions, as well as the potential for their integration with experimental methods. Advanced methods such as microarray analysis, high-throughput sequencing (HTS), and RACE-PCR are discussed for their contributions to miRNA target identification and validation. Moreover, new data and perspectives are presented on the role of miRNAs in plant responses to abiotic stresses, particularly drought adaptation. This review aims to deepen the understanding of genetic regulatory mechanisms in plants and to establish a robust scientific foundation for the development of drought-tolerant crop varieties.

Long-term drought and risk of infant mortality in Africa: A cross-sectional study

BACKGROUND

As extreme events such as drought and flood are projected to increase in frequency and intensity under climate change, there is still large missing evidence on how drought exposure potentially impacts mortality among young children. This study aimed to investigate the association between drought and risk of infant mortality in Africa, a region highly vulnerable to climate change that bears the heaviest share of the global burden.

METHODS AND FINDINGS

In this cross-sectional study, we obtained data on infant mortality in 34 African countries during 1992-2019 from the Demographic and Health Surveys program. We measured drought by the standardized precipitation evapotranspiration index at a timescale of 24 months and a spatial resolution of 10 × 10 km, which was further dichotomized into mild and severe drought. The association between drought exposure and infant mortality risk was estimated using Cox regression models allowing time-dependent covariates. We further examined whether the association varied for neonatal and post-neonatal mortality and whether there was a delayed association with drought exposure during pregnancy or infancy. The mean (standard deviation) number of months in which children experienced any drought during pregnancy and survival period (from birth through death before 1 year of age) was 4.6 (5.2) and 7.3 (7.4) among cases and non-cases, respectively. Compared to children who did not experience drought, we did not find evidence that any drought exposure was associated with an increased risk of infant mortality (hazard ratio [HR]: 1.02, 95% confidence interval [CI] [1.00, 1.04], p = 0.072). When stratified by drought severity, we found a statistically significant association with severe drought (HR: 1.04; 95% CI [1.01, 1.07], p = 0.015), but no significant association with mild drought (HR: 1.01; 95% CI [0.99, 1.03], p = 0.353), compared to non-exposure to any drought. However, when excluding drought exposure during pregnancy, the association with severe drought was found to be non-significant. In addition, an increased risk of neonatal mortality was associated with severe drought (HR: 1.05; 95% CI [1.01, 1.10], p = 0.019), but not with mild drought (HR: 0.99; 95% CI [0.96, 1.02], p = 0.657).

CONCLUSIONS

Exposure to long-term severe drought was associated with increased infant mortality risk in Africa. Our findings urge more effective adaptation measures and alleviation strategies against the adverse impact of drought on child health.

Exploring the effects of climate change on child malnutrition: protocol for a scoping review

INTRODUCTION

Rapid climate changes in the early 21st century have triggered a global syndemic intertwining obesity, undernutrition and climate change, profoundly affecting health, especially children. Despite increasing research, a significant gap persists in understanding the mechanisms linking climate change to child malnutrition, particularly in children under 5 years old. This protocol proposes a scoping review to address this gap, with the aim of mapping the available evidence on the relationship between climate change and malnutrition among children under 5 years old.

METHODS AND ANALYSIS

This scoping review will be conducted according to the Joanna Briggs Manual for Evidence Synthesis, and the results will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to ensure a replicable process. The search will be conducted using MEDLINE (PubMed), Web of Science, Scopus and Embase databases. The studies to be included will be selected according to the inclusion and exclusion criteria defined based on the Population, Concept and Context technique. The study population will consist of children under 5 years old, with a focus on examining the impact of climate change on health outcomes related to nutrition, obesity and undernutrition. Original articles in English, Spanish and Portuguese will be selected without any restrictions on the publication year. Two researchers will independently select the articles and extract the data. The results will be presented through narrative synthesis.

ETHICS AND DISSEMINATION

This study relies on analysing existing scientific literature and does not require ethical approval. The outcomes of this scoping review will be submitted for publication in a peer-reviewed journal, with a preference for open access.

STUDY REGISTRATION

OSF (osf.io/swt4b).

Intergenerational impact of drought and famine on health systems in developing countries - symposium proceedings

The 2024 edition of the One Health symposium explored the intergenerational health impacts of drought and famine in developing countries, with a focus on innovative strategies for resilience-building in healthcare infrastructures. Organized by students of the CIHLMU Center for International Health at Ludwig-Maximilians-Universität Munich, Germany, the event convened experts and participants from diverse backgrounds to address the urgent challenges posed by climate change-induced crises. Through presentations, panel discussions, and collaborative exchanges, the symposium underscored the profound health and socioeconomic implications of climate-related disasters, emphasizing the need for cross-sectoral cooperation and transformative action. Key recommendations emerged, including integrating climate change considerations into health systems, fostering multidisciplinary collaboration, and empowering communities to withstand future challenges. Despite the severity of the current situation, the symposium instilled optimism and determination among participants, inspiring a collective commitment to building a brighter and more resilient future for generations to come.

Recurrent Flooding and Household Food Access in Central Java, Indonesia

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

The Effect of Rainfall and Temperature Patterns on Childhood Linear Growth in the Tropics: Systematic Review and Meta-Analysis

Despite existing research on child undernutrition in the tropics, a comprehensive understanding of how weather patterns impact childhood growth remains limited. This study summarizes and estimates the effect of rainfall and temperature patterns on childhood linear growth among under-fives in the tropics. A total of 41 out of 829 studies were considered based on preset inclusion criteria. Standardized regression coefficients (β) were used to estimate effect sizes, which were subsequently pooled, and forest plots were generated to visually represent the effect size estimates along with their 95% confidence intervals. Of the total reports, 28 and 13 research articles were included in the narrative synthesis and meta-analysis, respectively. The studies establish that patterns in rainfall and temperature either increase or decrease childhood linear growth and the risk of stunting. An increase in every one standard deviation of rainfall results in a 0.049 standard deviation increase in linear growth (β = 0.049, 95% CI: 0.024 to 0.073). This positive association is likely mediated by various factors. In countries where agriculture is heavily dependent on rainfall, increased precipitation can lead to higher crop yields which could in turn result in improved food security. The improved food security positively impacts childhood nutrition and growth. However, the extent to which these benefits are realized can vary depending on moderating factors such as location and socio-economic status. Temperature pattern showed a negative correlation with linear growth, where each standard deviation increase resulted in a decrease in linear growth by 0.039 standard deviations, with specific impacts varying by regional climates (β = -0.039, 95% CI: -0.065 to -0.013). Additionally, our meta-analysis shows a small but positive relationship of childhood stunting with temperature pattern in western Africa (β = 0.064, 95% CI: 0.035, 0.093). This association is likely due to temperature patterns' indirect effects on food security and increased disease burden. Thus, the intricate interaction between weather patterns and childhood linear growth requires further research to distinguish the relationship considering other factors in the global tropics. While our findings provide valuable insights, they are primarily based on observational studies from sub-Saharan Africa and may not be generalizable to other tropical regions.

Spatial Machine Learning for Exploring the Variability in Low Height-For-Age From Socioeconomic, Agroecological, and Climate Features in the Northern Province of Rwanda

Childhood stunting is a serious public health concern in Rwanda. Although stunting causes have been documented, we still lack a more in-depth understanding of their local factors at a more detailed geographic level. We cross-sectionally examined 615 height-for-age prevalence observations in the Northern Province of Rwanda, linked with their related covariates, to explore the spatial heterogeneity in the low height-for-age prevalence by fitting linear and non-linear spatial regression models and explainable machine learning. Specifically, complemented with generalized additive models, we fitted the ordinary least squares (OLS), a standard geographically weighted regression (GWR), and multiscale geographically weighted regression (MGWR) models to characterize the imbalanced distribution of stunting risk factors and uncover the nonlinear effect of significant predictors, explaining the height-for-age variations. The results reveal that 27% of the children measured were stunted, and that likelihood was found to be higher in the districts of Musanze, Gakenke, and Gicumbi. The local MGWR model outperformed the ordinary GWR and OLS, with coefficients of determination of 0.89, 0.84, and 0.25, respectively. At specific ranges, the study shows that height-for-age decreases with an increase in the number of days a child was left alone, elevation, and rainfall. In contrast, land surface temperature is positively associated with height-for-age. However, variables like the normalized difference vegetation index, slope, soil fertility, and urbanicity exhibited bell-shaped and U-shaped non-linear associations with the height-for-age prevalence. Identifying areas with the highest rates of stunting will help determine the most effective measures for reducing the burden of undernutrition.

Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review

BACKGROUND

The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people's way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing.

OBJECTIVE

This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative.

METHODS

A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement.

RESULTS

From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50%) assessed climate change-related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36%), knowledge databases (n=5, 36%), data collection and analysis (n=3, 21%), gamification (n=1, 7%), and educational resources (n=2, 14%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7%), collaborative (n=1, 7%), and cocreative (n=1, 7%) approaches, to ensure the relevance and use of digital apps.

CONCLUSIONS

Most digital apps identified provided a service to citizens to either prevent adverse climate change-related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions.

The Impact of Malnutrition on the Developing Lung and Long-Term Lung Health: A Narrative Review of Global Literature

Worldwide, over 2 billion children under the age of 5 experience stunting, wasting, or are underweight. Malnutrition contributes to 45% of all deaths in this age group (approximately 3.1 million deaths) [1]. Poverty, food insecurity, suboptimal feeding practices, climate change, and conflict are all contributing factors. Malnutrition causes significant respiratory problems, including increased risk of respiratory infections, impaired lung function, and increased risk of subsequent adult respiratory disease, including asthma, COPD, and lung cancer. Childhood malnutrition not only has serious consequences for children's health but it also has numerous consequences on wellbeing and educational attainment. Childhood malnutrition is a complex and multifaceted problem. However, by understanding and addressing the underlying causes, and investing in prevention and treatment programs, it is possible to maximize children's health and wellbeing on a global scale. This narrative review will focus on the impact of childhood malnutrition on lung development, the consequent respiratory disease, and what actions can be taken to reduce the burden of malnutrition on lung health.

Climate change impacts on child and adolescent health and well-being: A narrative review

Background

Worldwide, the climate is changing and affecting the health and well-being of children in many ways. In this review, we provided an overview of how climate change-related events may affect child and adolescent health and well-being, including children's mental and physical health, nutrition, safety and security, learning opportunities, and family caregiving and connectedness.

Methods

In this narrative review, we highlighted and discussed peer-reviewed evidence from 2012-23, primarily from meta-analyses and systematic reviews. The search strategy used a large and varied number of search terms across three academic databases to identify relevant literature.

Results

There was consistent evidence across systematic reviews of impact on four themes. Climate-related events are associated with a) increases in posttraumatic stress and other mental health disorders in children and adolescents, b) increases in asthma, respiratory illnesses, diarrheal diseases and vector-borne diseases, c) increases in malnutrition and reduced growth and d) disruptions to responsive caregiving and family functioning, which can be linked to poor caregiver mental health, stress and loss of resources. Evidence of violence against children in climate-related disaster contexts is inconclusive. There is a lack of systematic review evidence on the associations between climate change and children's learning outcomes.

Conclusions

Systematic review evidence consistently points to negative associations between climate change and children's physical and mental health, well-being, and family functioning. Yet, much remains unknown about the causal pathways linking climate-change-related events and mental and physical health, responsive relationships and connectedness, nutrition, and learning in children and adolescents. This evidence is urgently needed so that adverse health and other impacts from climate change can be prevented or minimised through well-timed and appropriate action.

Climate change and healthy ageing: An assessment of the impact of climate hazards on older people

Background

Climate change not only directly impacts older people's longevity but also healthy ageing, which is the process of maintaining physical and mental capacities while optimising functional abilities. The urgency to address both population ageing and climate change necessitates a rethink and assessment of the impact of climate change on older people. This includes identifying what can be done to anticipate, mitigate and adapt to climate change and engage older persons.

Methods

A review of climate change and healthy ageing forms the basis of evidence in this report. We developed a comprehensive search to assess current literature, combining terms related to ageing and climate change across four major data sets and assessing articles published up to the end of 2021.

Results

We summarised the current and future impact of climate change on older people and developed a framework identifying climate change impacts on older persons, recognising social and environmental determinants of healthy ageing. Major hazards and some key exposure pathways include extreme temperatures, wildfire, drought, flooding, storm and sea level rise, air quality, climate-sensitive infectious diseases, food and water insecurities, health and social care system displacement, migration, and relocation. Strategies to address climate change require interventions to improve systems and infrastructure to reduce vulnerability and increase resilience. As a heterogeneous group, older people's perceptions of climate change should be integrated into climate activism. Increasing climate change literacy among older people and enabling them to promote intergenerational dialogue will drive the development and implementation of equitable solutions. Pathways may operate via direct or indirect exposures, requiring longitudinal studies that enable assessment of exposures and outcomes at multiple time points, and analyses of cumulative impacts of hazards across the life course.

Conclusions

The lack of systematic reviews and primary research on the impact of most climate hazards, except for heat, on older people is apparent. Future research should include outcomes beyond mortality and morbidity and assess how older people interact with their environment by focusing on their capacities and optimising abilities for being and doing what they value.

Evidence for Policies and Practices to Address Global Food Insecurity

Food insecurity affects an estimated 691-783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and climate change, among other demographic and globalization forces. This review summarizes evidence for policies and practices across five elements of the agrifood system framework and identifies gaps that inform an agenda for future research. Under availability, imbalanced agriculture policies protect primarily staple food producers, and there is limited evidence on food security impacts for smallholder and women food producers. Evidence supports the use of cash transfers and food aid for affordability and school feeding for multiple benefits. Food-based dietary guidelines can improve the nutritional quality of dietary patterns, yet they may not reflect the latest evidence or food supplies. Evidence from the newer food environment elements, promotion and sustainability, while relatively minimal, provides insight into achieving long-term impacts. To eliminate hunger, our global community should embrace integrated approaches and bring evidence-based policies and practices to scale.

Climate crisis risks to elderly health: strategies for effective promotion and response

The climate crisis significantly impacts the health and well-being of older adults, both directly and indirectly. This issue is of growing concern in Canada due to the country's rapidly accelerating warming trend and expanding elderly population. This article serves a threefold purpose: (i) outlining the impacts of the climate crisis on older adults, (ii) providing a descriptive review of existing policies with a specific focus on the Canadian context, and (iii) promoting actionable recommendations. Our review reveals the application of current strategies, including early warning systems, enhanced infrastructure, sustainable urban planning, healthcare access, social support systems, and community engagement, in enhancing resilience and reducing health consequences among older adults. Within the Canadian context, we then emphasize the importance of establishing robust risk metrics and evaluation methods to prepare for and manage the impacts of the climate crisis efficiently. We underscore the value of vulnerability mapping, utilizing geographic information to identify regions where older adults are most at risk. This allows for targeted interventions and resource allocation. We recommend employing a root cause analysis approach to tailor risk response strategies, along with a focus on promoting awareness, readiness, physician training, and fostering collaboration and benchmarking. These suggestions aim to enhance disaster risk management for the well-being and resilience of older adults in the face of the climate crisis.

Causes and consequences of child growth faltering in low-resource settings

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

Health and wellbeing implications of adaptation to flood risk

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning.

The role of explainable Artificial Intelligence in high-stakes decision-making systems: a systematic review

A high-stakes event is an extreme risk with a low probability of occurring, but severe consequences (e.g., life-threatening conditions or economic collapse). The accompanying lack of information is a source of high-stress pressure and anxiety for emergency medical services authorities. Deciding on the best proactive plan and action in this environment is a complicated process, which calls for intelligent agents to automatically produce knowledge in the manner of human-like intelligence. Research in high-stakes decision-making systems has increasingly focused on eXplainable Artificial Intelligence (XAI), but recent developments in prediction systems give little prominence to explanations based on human-like intelligence. This work investigates XAI based on cause-and-effect interpretations for supporting high-stakes decisions. We review recent applications in the first aid and medical emergency fields based on three perspectives: available data, desirable knowledge, and the use of intelligence. We identify the limitations of recent AI, and discuss the potential of XAI for dealing with such limitations. We propose an architecture for high-stakes decision-making driven by XAI, and highlight likely future trends and directions.

Mini Review: The Impact of Climate Change on Gastrointestinal Health

Global warming and climate change are important worldwide issues which are a major human health threat. Climate change can affect the gastrointestinal (GI) system in many ways. Increased rainfall events and flooding may be associated with increased GI infections and hepatitis. Climate change could cause changes in gut microbiota, which may impact the pattern of GI diseases. The stress of access to essential needs such as clean water and food, the effects of forced migration, and natural disasters could increase brain-gut axis disorders. The association between air pollution and GI disorders is another challenging issue. There is a lot to do personally and professionally as gastroenterologists regarding climate change.

Heat Stroke in the Work Environment: Case Report of an Underestimated Phenomenon

Average global temperatures continue to trend upward, and this phenomenon is part of the more complex climate change taking place on our planet over the past century. Human health is directly affected by environmental conditions, not only because of communicable diseases that are clearly affected by climate, but also because of the relationship between rising temperatures and increased morbidity for psychiatric diseases. As global temperatures and the number of extreme days increase, so does the risk associated with all those acute illnesses related to these factors. For example, there is a correlation between out-of-hospital cardiac arrest and heat. Then, there are pathologies that recognize excessive heat as the main etiological agent. This is the case with so-called "heat stroke", a form of hyperthermia accompanied by a systemic inflammatory response, which causes multi-organ dysfunction and sometimes death. Starting with a case that came to their attention of a young man in good general health who died while working unloading fruit crates from a truck, the authors wanted to express some thoughts on the need to adapt the world of work, including work-specific hazards, in order to protect the worker exposed to this "new risk" and develop multidisciplinary adaptation strategies that incorporate climatology, indoor/building environments, energy use, regulatory perfection of work and human thermal comfort.

Interlinkages between Climate Change and Food Systems: The Impact on Child Malnutrition-Narrative Review

The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.

Economic impacts and nutritional outcomes of the 2017 floods in Bangladeshi Shodagor fishing families

OBJECTIVES

As climate change continues to increase the frequency and severity of flooding in Bangladesh and globally, it becomes increasingly critical to understand the pathways through which flooding influences health outcomes, particularly in lower-income and subsistence-based communities. We aim to assess economic pathways that link flooding to nutritional outcomes among Shodagor fishing families in Bangladesh.

METHODS

We examine longitudinal economic data on kilograms of fish caught, the income earned from those fish, and household food expenditures (as a proxy for dietary intake) from before, during, and after severe flooding in August-September of 2017 to enumerate the impacts of flooding on Shodagor economics and nutrition. We also analyze seasonally collected anthropometric data to model the effects of flooding and household food expenditures on child growth rates and changes to adult body size.

RESULTS

While Shodagor fishing income declined during the 2017 flooding, food expenditures simultaneously spiked with market inflation, and rice became the predominant expenditure only during and immediately following the flood. Our nutritional models show that children and adults lost more body mass in households that spent more money on rice during the flood. Shodagor children lost an average of 0.36 BMI-for-age z-scores and adults lost an average of 0.32 BMI units during the flooded 2017 rainy season, and these metrics continued to decline across subsequent seasons and did not recover by the end of the study period in 2019.

CONCLUSIONS

These results show major flood-induced economic impacts that contributed to loss of child and adult body mass among Shodagor fishing families in Bangladesh. More frequent and severe flooding will exacerbate these nutritional insults, and more work is needed to effectively stabilize household nutrition throughout natural disasters and economic hardship.

Impact of floods on undernutrition among children under five years of age in low- and middle-income countries: a systematic review

BACKGROUND

Weather and climate-related disasters, including floods, impact undernutrition through multiple pathways, including food security, inadequate child care practices, and water and sanitation. This review aimed to provide systematic evidence of the impact of floods on undernutrition in children under five years of age in Low and Middle-income countries (LMICs).

METHODS

We searched PubMed, Web of Science, Embase, MEDLINE, CINAHL and Scopus for peer-reviewed articles. Popline, WHO Library database (WHOLIS), the International Disaster database (EM-DAT), Food and Agriculture Organisation (FAO), UNICEF and Eldis were searched for grey literature articles. Database searches were first conducted in 2016 and updated in 2020. We included English language articles that reported the effect of floods on undernutrition outcomes in children under 5 years of age in LMICs, without limitation to study design and year of publication. The quality of selected studies was assessed using the National Institutes of Health (NIH) tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

Of the 5701 articles identified, 14 met our inclusion criteria. The review noted stunting as the most frequently reported significant form of undernutrition in flood-affected areas. Severe and recurrent floods showed the greatest impact on undernutrition. Due to weak and limited evidence, the study is inconclusive on the most significant forms within the short-term and intermediate periods following floods. On the other hand, stunting was noted as the most frequently reported significant form of undernutrition in the long-term period following floods. There was generally little evidence of the effect of floods on micronutrient deficiencies. Factors associated with child undernutrition in the flood-affected areas included age, gender, diarrhoea, maternal and paternal education, maternal age, household size, land ownership and socioeconomic status. Overall, the quality of the evidence was fairly weak, with the main challenge lying in the inability of the studies to establish causal pathways for the observed effects.

CONCLUSIONS

The review suggests clear plans and strategies for preventing and reducing the long-term impact of floods on undernutrition in children under five years. Future research utilising long-term prospective data is indispensable to provide more robust evidence to guide better prevention measures, response decisions and interventions.

Climate Change and Child Health Inequality: A Review of Reviews

There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low-middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.