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

Incremental financial costs of strengthening large-scale child nutrition programs in Bangladesh, Ethiopia, and Vietnam: retrospective expenditure analysis

BACKGROUND

Inattention to young child growth and development in a transitioning global environment can undermine the foundation of human capital and future progress. Diets that provide adequate energy and nutrients are critical for children's physical and cognitive development from 6 to 23.9 months of age and beyond. Still, over 70% of young children do not receive foods with sufficient nutrition particularly in low-and-middle income countries. Program evaluations have documented the effectiveness of large-scale behavior change interventions to improve children's diets, but the budgetary implications of programs are not known. This paper provides the incremental financial costs of strengthening three large-scale programs based on expenditure records from Bangladesh, Ethiopia, and Vietnam.

RESULTS

The programs reached between one and 2.5 million mothers and children annually per country at unit costs of between $0.9 to $1.6 per mother and child reached. An additional 0.7 to 1.6 million people who were influential in supporting mothers and achieving scale were also engaged. The largest cost component was counselling of mothers. Rigorous external impact evaluations showed that over 434,500 children benefited annually from consuming a minimum acceptable diet in all countries combined, at an annual cost per country of $6.3 to $34.7 per child benefited.

CONCLUSIONS

Large scale programs to improve young children's nutrition can be affordable for low- and middle-income countries. The study provides the incremental costs of selectively strengthening key program components in diverse settings with lessons for future budgeting. The costs of treating a malnourished child are several-fold higher than prevention through improved improving young children's dietary practices. Differences across countries in program models, coverage, costs, and outcomes suggest that countries need a minimum investment of resources for strengthening high-reach service delivery and communication channels and engaging relevant behavioral levers and community support for mothers to achieve impact at scale.

Unveiling predictive factors for household-level stunting in India: A machine learning approach using NFHS-5 and satellite-driven data

OBJECTIVES

Childhood stunting remains a significant public health issue in India, affecting approximately 35% of children under 5. Despite extensive research, existing prediction models often fail to incorporate diverse data sources and address the complex interplay of socioeconomic, demographic, and environmental factors. This study bridges this gap by employing machine learning methods to predict stunting at the household level, using data from the National Family Health Survey combined with satellite-driven datasets.

METHODS

We used four machine learning models-random forest regression, support vector machine regression, K-nearest neighbors regression, and regularized linear regression-to examine the impact of various factors on stunting. The random forest regression model demonstrated the highest predictive accuracy and robustness.

RESULTS

The proportion of households below the poverty line and the dependency ratio consistently predicted stunting across all models, underscoring the importance of economic status and household structure. Moreover, the educational level of the household head and environmental variables such as average temperature and leaf area index were significant contributors. Spatial analysis revealed significant geographic clustering of high-stunting districts, notably in central and eastern India, further emphasizing the role of regional socioeconomic and environmental factors. Notably, environmental variables like average temperature and leaf area index emerged as strong predictors of stunting, highlighting how regional climate and vegetation conditions shape nutritional outcomes.

CONCLUSIONS

These findings underline the importance of comprehensive interventions that not only address socioeconomic inequities but also consider environmental factors, such as climate and vegetation, to effectively combat childhood stunting in India.

Factors influencing the acceptance of alternative protein sources

INTRODUCTION

The adequate consumption of protein-rich foods is essential for optimal human growth, development and health. However, climate change threatens global food security by disrupting agriculture and food supply chains. One possible strategy to avoid this is a sustainable diet and the consumption of plant-based protein substitutes, insect-derived proteins and cultured meat.

METHODS

The factors that could explain the (non-)acceptance of such foods in the population were investigated. The study included 458 adults who responded to our online questionnaire.

RESULTS

The results of our survey showed that 66.2 % of the respondents were open to including plant-based sources in their diet. 23.1 % were willing to eat meals derived from insects and 21 % were willing to eat cultured meat. Acceptance of these alternative protein sources was found to be influenced by a number of factors, including demographics, familiarity, frequency of meat consumption and the intention to reduce meat consumption in the future. Men and people who had tried insect-based foods in the past were more favourable towards the consumption of insect-based foods and cultured meat. The regression analysis showed that the higher the level of neophobia towards food technologies and aversion to eating insects, the lower the interest in trying cultured meat. Women have a lower interest in trying cultured meat.

CONCLUSIONS

The consumer acceptance of new protein sources in the diet can be measured by assessing their attitudes towards such sources. This understanding can in turn facilitate the formulation of future public health strategies to create more sustainable dietary standards in the face of climate change.

The impact of climate change on child nutrition in Indonesia: a conceptual framework and scoping review of the available evidence

BACKGROUND

Climate change is expected to significantly impact child nutrition, worsening global health inequities. Indonesia, a country highly vulnerable to climate change, also faces substantial child malnutrition challenges. However, comprehensive knowledge on climate change's impacts on child nutrition in Indonesia is limited. This study addresses this gap through a scoping review of the scientific evidence on the effects of climate change on child nutrition in Indonesia.

METHODS

We developed a conceptual framework based on global literature to guide our systematic search, linking climate change to child nutrition and its determinants in Indonesia. Systematic searches were conducted in English and Indonesian on Scopus, Web of Science and PubMed, supplemented by Google Scholar and citation screening. We included peer-reviewed, Scopus-indexed studies focused on Indonesia, examining either direct or indirect impacts of climate change on child nutrition. A narrative synthesis was performed, structured around outcomes identified in our framework: (1) nutrition-associated conditions, (2) diets and disease, (3) social dynamics and (4) food system shocks.

RESULTS

From 3025 records, 134 studies met the inclusion criteria. Studies were either multicountry including Indonesia (23%, n=31), Indonesia-specific across multiple regions (26%, n=35) or region-specific, mainly focused on Java (22%, n=29), Sumatra (11%, n=14), Kalimantan (7%, n=9) and Sulawesi (7%, n=9). Other regions were under-represented (5%, n=7). Most studies used quantitative methods (87%, n=116). Few studies assessed direct links between climate change and nutritional outcomes (n=5), food security or dietary quality (n=7); more focused on indirect pathways such as disease (n=49), social dynamics (n=18) and food system disruptions (n=55).

CONCLUSIONS

Evidence suggests significant impacts of climate change on child nutrition in Indonesia, highlighting the need for urgent action. Further localised studies that consider contextual factors, and actions focused on strengthening health and nutrition systems, are critical, especially in regions most vulnerable to both climate change and child malnutrition.

Climate change and tuberculosis: an analytical framework

Climate change is likely to exacerbate a range of determinants which drive tuberculosis, the world's leading infectious disease killer. However, tuberculosis is often neglected in wider climate health discussions. Commissioned by the World Health Organization, we developed an analytical framework outlining potential causal relationships between climate change and tuberculosis. We drew on existing knowledge of tuberculosis determinants, identified which are likely to be sensitive to the effects of climate change, and conceptualised the mechanistic pathways through which this might occur. We collated evidence for these pathways through literature reviews. Our reviews found no studies directly linking climate change and tuberculosis, warranting research to build evidence for action. The available evidence supports the existence of plausible links between climate change and tuberculosis, and highlights the need to include tuberculosis in climate risk adaptation and mitigation programmes, and climate-resilient funding and response mechanisms. Further evidence is urgently needed to quantify the effects of climate change on tuberculosis.

Using Machine Learning to Fight Child Acute Malnutrition and Predict Weight Gain During Outpatient Treatment with a Simplified Combined Protocol

BACKGROUND/OBJECTIVES

Child acute malnutrition is a global public health problem, affecting 45 million children under 5 years of age. The World Health Organization recommends monitoring weight gain weekly as an indicator of the correct treatment. However, simplified protocols that do not record the weight and base diagnosis and follow-up in arm circumference at discharge are being tested in emergency settings. The present study aims to use machine learning techniques to predict weight gain based on the socio-economic characteristics at admission for the children treated under a simplified protocol in the Diffa region of Niger.

METHODS

The sample consists of 535 children aged 6-59 months receiving outpatient treatment for acute malnutrition, for whom information on 51 socio-economic variables was collected. First, the Variable Selection Using Random Forest (VSURF) algorithm was used to select the variables associated with weight gain. Subsequently, the dataset was partitioned into training/testing, and an ensemble model was adjusted using five algorithms for prediction, which were combined using a Random Forest meta-algorithm. Afterward, Receiver Operating Characteristic (ROC) curves were used to identify the optimal cut-off point for predicting the group of individuals most vulnerable to developing low weight gain.

RESULTS

The critical variables that influence weight gain are water, hygiene and sanitation, the caregiver's employment-socio-economic level and access to treatment. The final ensemble prediction model achieved a better fit (R2 = 0.55) with respect to the individual algorithms (R2 = 0.14-0.27). An optimal cut-off point was identified to establish low weight gain, with an Area Under the Curve (AUC) of 0.777 at a value of <6.5 g/kg/day. The ensemble model achieved a success rate of 84% (78/93) at the identification of individuals below <6.5 g/kg/day in the test set.

CONCLUSIONS

The results highlight the importance of adapting the cut-off points for weight gain to each context, as well as the practical usefulness that these techniques can have in optimizing and adapting to the treatment in humanitarian settings.

Climate and conflict-induced child nutrition crisis in Sub-Saharan Africa

This commentary explores the intersection between climate, conflict, and child nutrition, highlighting the severe child nutrition crisis in Sub-Saharan Africa exacerbated by climate change and ongoing conflicts. Shifting climate patterns disrupt agricultural productivity and food security, while persistent conflicts displace populations and destroy infrastructure, significantly increasing food insecurity and malnutrition among children. Recent UNICEF data indicates that 1 in 4 children globally live in severe food poverty, with those affected up to 50% more likely to suffer from life-threatening malnutrition. Over half a billion children reside in areas prone to climate-related extreme weather events, challenging food production, distribution, and access. Extreme weather events have led to crop failures, food shortages, and price spikes, disproportionately affecting vulnerable populations. Changes in temperature and precipitation patterns also alter the nutritional content of crops, worsening nutritional challenges. Conflicts in SSA have led to a food crisis of unprecedented scale, with over 80% of the 137 million Africans facing acute food insecurity located in conflict-affected countries. The conflict between Russia and Ukraine has further disrupted global food and fertilizer supply chains, exacerbating food shortages and inflation in many African countries. Addressing this crisis requires a multifaceted approach integrating evidence-based, cost-effective strategies. This commentary advocates for the adoption of the 3 C approach-climate-smart school feeding programs, cultivation of edible insects, and community-based food hubs-as solutions to enhance child nutrition and build climate resilience.

Projected impact of climate change on human health in low- and middle-income countries: a systematic review

Low- and middle-income countries (LMICs) contribute relatively little to global carbon emissions but are recognised to be among the most vulnerable parts of the world to health-related consequences of climate change. To help inform resilient health systems and health policy strategies, we sought to systematically analyse published projections of the impact of rising global temperatures and other weather-related events on human health in LMICs. A systematic search involving multiple databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies with modelled projections of the future impact of climate change on human health. Qualitative studies, reviews and meta-analyses were excluded. The search yielded more than 2500 articles, of which 70 studies involving 37 countries met criteria for inclusion. China, Brazil and India were the most studied countries while the sub-Saharan African region was represented in only 9% of studies. Forty specific health outcomes were grouped into eight categories. Non-disease-specific temperature-related mortality was the most studied health outcome, followed by neglected tropical infections (predominantly dengue), malaria and cardiovascular diseases. Nearly all health outcomes studied were projected to increase in burden and/or experience a geographic shift in prevalence over the next century due to climate change. Progressively severe climate change scenarios were associated with worse health outcomes. Knowledge gaps identified in this analysis included insufficient studies of various high burden diseases, asymmetric distribution of studies across LMICs and limited use of some climate parameters as independent variables. Findings from this review could be the basis for future research to help inform climate mitigation and adaptation programmes aimed at safeguarding population health in LMICs.

What should I eat today? Evidence, guidelines, dietary patterns and consumer's behavior

Over the past century, dietary recommendations emphasizing food patterns as means to deliver essential nutrients have garnered widespread acceptance. The necessity for foods supplying vital nutrients and energy throughout various life stages requires the involvement of local resources and cultural practices to prevent nutrient deficiency diseases. Since the 1980s, dietary guidelines aimed at adverting chronic diseases have relied on epidemiological research to predict which dietary patterns correlate with reduced risk of chronic disease or links to health outcomes. Dietary guidelines have been broad, typically recommending avoiding excess or deficiency of single nutrients. Efforts to fine-tune these recommendations face challenges due to a scarcity of robust scientific data supporting more specific guidance across the life cycle. Consumers have become skeptical of dietary guidelines, because media coverage of new studies is often in conflict with accepted nutrition dogma. Indications to align individual and planet's health have been issued supporting the concept of sustainable dietary patterns. Whether we really have a science-based databank to support dietary guidelines is still a matter of ongoing debate, as presented in this paper.

Assessment of Human Health Risk Indices Due to Metal Contamination in the Surface Water of the Negro River Sub-Basin, Áncash

The accelerated loss of glacial cover in the Cordillera Blanca in Áncash, Peru, exposes the underlying rocks with high concentrations of sulfides from the Chicama Formation to oxidation and leaching processes, generating acid rock drainage (ARD) in glacial and periglacial areas. These are transported by surface runoff, contaminating the surface water with high concentrations of metals and sulfates, as well as increasing the acidity, which poses a risk to human health and the ecosystem. Therefore, the risk indices for human health due to metal contamination were evaluated at 19 surface water sampling points distributed in the Río Negro sub-basin. Hydrochemical analyses revealed average metal concentrations in the following order: Fe (28.597 mg/L), Al (3.832 mg/L), Mn (1.085 mg/L), Zn (0.234 mg/L), Ni (0.085 mg/L), Co (0.053 mg/L), Li (0.036 mg/L), Cu (0.005 mg/L), and Pb (0.002 mg/L). The risk was determined by calculating the Heavy Metal Pollution Index (HPI) and the Hazard Index (HI). The average HPI value was 360.959, indicating a high level of contamination (HPI ≥ 150). The human health risk assessment indicated that adverse effects caused by iron, lithium, and cobalt in children and adults should be considered. Through the use of Pearson correlation analysis, principal component analysis, and cluster analysis, it was identified that SO42-, Fe, S, Al, Co, Mn, Ni, Zn, and Li originate from natural sources, associated with the generation of ARD in glacial and periglacial areas.

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.

The Climate Crisis and Breastfeeding: Opportunities for Resilience

The climate crisis is an emerging global challenge that poses potential risks to breastfeeding practices and outcomes. There are multifaceted effects of climate change affecting the breastfeeding dyad across environmental, societal, and human health dimensions. Breastfeeding support in the face of climate change will require solutions at the structural level-healthcare, community, and workplace settings-and at the mother-infant dyad level. Breastfeeding can additionally be an adaptive response to crisis situations and can mitigate some of the environmental challenges associated with climate change. Despite the undeniable significance of climate change on breastfeeding (and vice versa), our perspective as experts in the field is that this topic has not been systematically addressed. Although we highlight some of the challenges, potential solutions, and co-benefits of breastfeeding in the context of climate change, there are numerous issues that could be further explored and necessitate additional preparedness planning.

Impact of Climate Change, Food Insecurity, and COVID-19 on the Health of Neonates and Children: A Narrative Review

Climate change, food insecurity, and epidemics affect all population sub-groups. This article reviews the current evidence on the relationships between climate change, food insecurity, and the COVID-19 pandemic in the context of newborn and child health. The authors searched Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases using a structured approach. Food insecurity, particularly from the lack of food access and affordability, increased amidst the COVID-19 pandemic. Factors such as nationwide lockdowns, increased unemployment and financial instability, and school closures precipitated food insecurity. Children born to immigrant parents, belonging to racial and ethnic minority groupsor low-income families, and those who were Autistic were highly vulnerable. Climate change also contributes to food insecurity, with increased susceptibility among neonates and children compared to adults. There is a need for further research on the relationships between climate-linked exposures and COVID-19 transmission. Multisectoral collaborations and multilevel interventions are necessary to mobilize local and national resources for mitigating and preventing the synergistic effects of the three concurrent crises. The evidence-informed discourse on this topic can help in improved preparedness and response for future outbreaks and epidemics. The policy interventions for newborn and child survival need to factor in climate change, food insecurity, and emerging diseases.

Artificial Intelligence Applications to Public Health Nutrition

Public health nutrition occupies a paramount position in the overarching domains of health promotion and disease prevention, setting itself apart from nutritional investigations concentrated at the individual level [...].

Adherence to WHO guidelines on severe pneumonia management in children and its impact on outcome: an observational study at Jinka General Hospital in Ethiopia

Introduction

Poor adherence to guidelines during empirical antibiotic prescription in low-income countries could increase antimicrobial resistance without improving outcomes. Revised World Health Organization (WHO) guidelines published in 2014 on childhood (2-59 months) pneumonia re-defined the classification of severe pneumonia and changed the first-line treatment. The adherence to WHO guidelines in southern Ethiopia at the hospital level is unknown. We sought to determine the adherence to WHO guidelines on severe pneumonia first-line treatment in children in an Ethiopian referral hospital and assess the impact of non-adherence on patient outcomes.

Methods

An observational study was conducted on all children (2-59 months) clinically diagnosed with severe pneumonia and admitted to the Pediatric Ward of Jinka Hospital from 1 June 2021 to 31 May 2022. Exclusion criteria included a known HIV infection, ongoing antibiotic treatment before the event not related to acute pneumonia, or any other severe bacterial infection, confirmed or suspected. Adherence to guidelines was defined as first-line treatment with ampicillin or benzylpenicillin and gentamicin at the recommended dose. We compared the patients treated adherently vs. non-adherently. For categorical variables, the chi-square or Fisher's exact test was used, while for continuous variables, the Mann-Whitney U-test was used. Multivariate logistic regression was used to evaluate the association between adherence and demographic and clinical characteristics.

Results

During the observational period, 266 patients were registered as having severe pneumonia with an age between 2 and 59 months. After excluding 114 patients due to missing charts or other exclusion criteria, a total of 152 patients were included in the analysis. Of these, 78 (51%) were girls with a median age of 10 months (IQR 7-14). Overall, 75 (49%) patients received therapy according to the WHO guidelines. Compared to patients treated adherently to the guidelines, patients not treated adherently had similar outcomes [median length of stay of 3 (IQR 3-5) and 4 (IQR 3-6) days], median duration of oxygen therapy of 2 (IQR 1-3) for both the groups, and self-discharge rates of 5% and 6.5%, respectively).

Conclusion

Adherence to the revised WHO guideline was limited and not associated with outcomes. Efforts should focus on reducing the gap between theory and practice.

Infant and Young Child Feeding Practices and Health

Early childhood feeding practices are fundamental for a child's healthy growth, development and potential [...].