Peer-reviewed article
Preconception and Prenatal Environment and Growth Faltering Among Children in Uganda.
Paddy Ssentongo, Claudio Fronterre, Jessica E Ericson, Ming Wang, Laila Al-Shaar et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how weather and environmental conditions before and during pregnancy affect childhood growth in Uganda. Using data from 5,219 children under five years old, researchers found that higher rainfall and water availability in the months before conception and during pregnancy were associated with better child nutrition outcomes. Growth faltering was most common in northeastern and southwestern Uganda, with stunting affecting 30% of children nationally.
Key points
- 30.22% of children aged 0-59 months in Uganda had stunting, 12.23% were underweight, and 3.63% had wasting
- Large geographical disparities exist within Uganda, with northeastern and southwestern villages showing the highest prevalence of all forms of growth faltering (>40% stunting, >16% underweight, >6% wasting)
- Higher rainfall and water availability 3-11 months before birth were positively associated with improved height-for-age, weight-for-age, and weight-for-height outcomes
- Drought conditions (low SPEI and high Aridity Index) in the preconception and prenatal period were associated with poorer childhood growth outcomes
- Findings suggest meteorological factors during critical periconception and prenatal windows influence spatial distribution of childhood malnutrition
Limitations
This cross-sectional study cannot establish causality or determine the mechanisms through which environmental factors affect fetal growth. The study relies on correlation between historical meteorological data and current child anthropometry, so individual-level exposure during actual pregnancy periods is not directly measured.
Abstract
IMPORTANCE: Children with growth faltering are more susceptible to infections and may experience cognitive, physical, and metabolic developmental impairments. OBJECTIVE: To assess whether prenatal and preconception meteorological and environmental factors are associated with village-level rates of childhood growth outcomes in Uganda. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data collected between June 20, 2015, and December 16, 2016, from the 2016 Ugandan Demographic and Health Survey for individuals aged 0 to 59 months with available anthropometric measures (weight and length or height). Data analysis was conducted from October 2020 to April 2024. EXPOSURES: Factors assessed included meteorological information, such as drought index (Standardized Precipitation-Evapotranspiration Index [SPEI]), Aridity Index, rainfall, temperature, and vegetation indices; demographic and economic development factors (nighttime light emissions, driving time to the nearest city); and land topography (slope angle, elevation above sea level). MAIN OUTCOMES AND MEASURES: The main outcomes were height-for-age z score (HAZ), weight-for-age z score (WAZ), and weight-for-height z score (WHZ). Spatial resolution estimates, at 1 km × 1 km of childhood growth faltering indicators, were created. RESULTS: Of the 5219 individuals aged 0 to 59 months included in the analysis, 2633 (50%) were female; mean (SD) age was 29 (17) months. Of these individuals, 30.22% (95% CI, 29.36%-30.98%) had stunting, 12.23% (95% CI, 11.55%-12.91%) had underweight, and 3.63% (95% CI, 3.46%-3.80%) had wasting. Large disparities in the burden of childhood growth faltering existed within Uganda at smaller and larger spatial scales; villages in the northeastern and southwestern areas of the country had the highest prevalence of all forms of growth faltering (stunting, >40%; underweight, >16%; and wasting, >6%). Higher SPEI at 3 months before birth was positively associated with all childhood growth outcomes: HAZ (β, 0.06; 95% CI, 0.02-0.10), WAZ (β, 0.04; 95% CI, 0.01-0.07), and WHZ (β, 0.03; 95% CI, 0.001-0.06). Higher location mean rainfall 11 months before birth was also positively associated with HAZ (β, 0.06; 95% CI, 0.01-0.10). Aridity Index associations with WAZ (β, 0.09; 95% CI, 0.04-0.13) and WHZ (β, 0.09; 95% CI, 0.02-0.16) were consistent with findings for SPEI. CONCLUSIONS AND RELEVANCE: In this study of 5219 individuals 0 to 59 months of age in Uganda, rainfall and long-term availability of water at preconception and during gestation were positively associated with nutritional child growth outcomes. Understanding the relative contributions of meteorological environment factors on the spatial distribution of undernutrition at various spatial scales within Uganda (from the village to the district level) may help in the design of more cost-effective delivery of precision public health programs.