Peer-reviewed article

Extreme weather events and early childhood growth in low- and middle-income regions: A systematic review and meta-analysis.

Xuechun Wang, Lu Lan, Xing Xing, Wenyu Yang, He Zhu et al. · 17 Sept 2025

Abstract

OBJECTIVES: Extreme weather, a significant yet often underrecognized risk factor for early childhood growth, increasingly threatens child nutrition and health, particularly among children under five. This review aims to synthesize current evidence on the associations between extreme weather events and early childhood growth outcomes. METHODS: A comprehensive literature search was performed across PubMed, Embase, Web of Science, and Scopus for studies published between January 1, 1990, and December 31, 2024. The random-effects meta-analysis was conducted to synthesize the regression coefficients (β) and odds ratios (ORs) assessing the associations between extreme weather events and child growth outcomes, with subgroup analyses by the exposure type and the children age. Study quality was assessed using the Newcastle-Ottawa Scale for both cohort and cross-sectional studies. Heterogeneity was assessed using the I2 statistics, and publication bias was examined through funnel plots and Egger's tests. RESULTS: Our search initially identified 2874 records, of which 18 studies met the eligibility criteria and were included in the meta-analysis. Pooled analyses showed significant associations between extreme weather events and reduced height-for-age z-scores (HAZ) (β = -0.08; 95 % CI: 0.12, -0.04), as well as increased odds of stunting (OR = 1.19; 95 % CI: 1.04, 1.36). Subgroup analyses of HAZ indicated strong negative associations for drought (β = -0.11, 95 % CI: 0.16, -0.05), extreme rainfall (β = -0.11, 95 % CI: 0.15, -0.07), and among children under five years (β = -0.08, 95 % CI: 0.13 to -0.03). There was substantial heterogeneity for both HAZ (I2 = 76 %) and stunting (I2 = 97 %). Weight-for-height z-scores (WHZ) also exhibited a negative association (β = -0.05; 95 % CI: 0.08, -0.01), whereas wasting showed no significant association. The risk of bias was generally low. However, publication bias was detected for WHZ and wasting outcomes. CONCLUSIONS: Our findings indicated that extreme weather events were significantly associated with adverse outcomes of early childhood growth, especially concerning linear growth and stunting. Integrating climate resilience into early childhood health planning is crucial to protect and promote child growth and development amid a progressively uncertain climate future.