Climate Change and the Rising Risk of Childhood Undernutrition in Low- And Middle-Income Countries

Abstract

Background: Climate change is increasingly affecting child health and nutrition through food insecurity, extreme weather events, displacement, unsafe water, infectious diseases, and disruption of health services.

Objectives: To assess the impact of climate-related household exposures on childhood undernutrition and to identify major environmental, socioeconomic, and health-related factors associated with stunting, wasting, and underweight.

Methods: This analytical cross-sectional study was conducted at District Khairpur Mir’s Sindh, Pakistan from 1^st October 2025 to 30^th April 2026 among 295 children aged 6–59 months. Data regarding sociodemographic characteristics, feeding practices, household food security, water and sanitation, recent illnesses, and exposure to climate-related events during the previous 12 months were collected from caregivers using a structured questionnaire.

Results: There were 119 (40.3%) stunted, 52 (17.6%) wasted and 85 (28.8%) underweight, while 151 (51.2%) had at least one form of undernutrition. Climate-related household shocks were reported by 213 (72.2%) families. Undernutrition was more frequent among children exposed to at least one climate-related shock than among those without such exposure (59.2% vs. 30.5%, p<0.001). Flood exposure, extreme heat, drought or water shortage, food supply disruption, displacement, and household food insecurity were significantly associated with undernutrition. On multivariable analysis, climate-related household exposure remained independently associated with undernutrition (adjusted OR 2.65; 95% CI 1.45–4.85; p=0.002). Household food insecurity (adjusted OR 2.31; 95% CI 1.39–3.84), recent diarrheal illness (adjusted OR 1.89; 95% CI 1.06–3.36), lower maternal education (adjusted OR 1.76; 95% CI 1.05–2.95), and unsafe drinking water (adjusted OR 1.68; 95% CI 1.00–2.82) were also significant predictors.

Conclusion: The childhood under-nutrition was strongly associated with climate-related household shocks, particularly through food insecurity, unsafe water, displacement, and increased infectious disease risk.