Environmental temperature and growth faltering in African children: a cross-sectional study

Lucy S Tusting, John Bradley, Samir Bhatt, Harry S Gibson, Daniel J Weiss, Fiona C Shenton and Steve W Lindsay


Background Child  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.

Methods Data  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.

Findings The  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.

Interpretation 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.  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.