Floods and droughts and pediatric malnutrition in low-income countries: a systematic review and meta-analysis.

BACKGROUND

This study systematically reviewed and meta-analyzed the prevalence and risk of child malnutrition following extreme weather events in low- and lower-middle-income countries.

METHODS

We searched PubMed, EMBASE, and Cochrane Library for studies assessing child stunting, wasting, underweight, or overweight/obesity after extreme weather events. Random-effects models were used to pool prevalence and association estimates, with subgroup and sensitivity analyses by event type. Risk of bias was assessed using tools appropriate to study design.

RESULTS

Twenty-six studies, including over 320,000 children met the inclusion criteria, focusing exclusively on floods and/or droughts; none addressed overweight/obesity. The pooled prevalence of stunting, wasting, and underweight following extreme weather events was 39% (95% CI: 31-48%), 19% (95% CI: 12-28%), and 42% (95% CI: 22-64%), respectively. Wasting prevalence was higher after droughts than floods (22% vs. 13%, p = 0.04), while stunting did not differ by event type (p = 0.68). Meta-analyses revealed no significant long-term association between extreme weather events and stunting, though a transient increase in risk was observed within three months of flood exposure.

CONCLUSIONS

Child malnutrition remains highly prevalent in these settings. The complex climate-malnutrition link underscores the need for standardized exposure definitions and robust nutritional surveillance.

IMPACT: This meta-analysis provides the first pooled prevalence estimates of wasting, stunting, and underweight after droughts and floods-19%, 39%, and 42%, respectively. Wasting was significantly higher following droughts than floods, suggesting possible climate- and geography-specific nutritional associations. Evidence linking extreme weather events to pediatric malnutrition in low- and lower-middle-income countries remains limited and inconsistent. Findings highlight major research gaps and the need for standardized definitions, baseline data, and climate-resilient nutrition strategies.