Adolescent mental health is an urgent global priority, yet services remain severely inaccessible throughout Southern Africa. Zimbabwean youth are particularly vulnerable to mental health challenges from adverse childhood experiences including food insecurity, sexual and emotional violence, climate change-induced disasters, and national economic difficulties but research is extremely limited. To address this gap, this study examined trauma symptoms and resilience among a large school-based sample of urban and rural Zimbabwean adolescents. A cluster randomized controlled trial was conducted to evaluate the impact of Singing to the Lions, a biopsychosocial workshop for trauma-affected youth in Zimbabwe. Adolescents were randomized by school (n = 13) to an immediate intervention arm or waitlist control arm. Baseline data, including adolescents' demographics, trauma symptoms, and resilience characteristics were analyzed to investigate the prevalence of trauma symptoms and that association with resilience characteristics. The baseline sample (n = 1,342) ranged in age from 12-18 years (x-=14.8); the majority of children were girls (54.6%) and rural (52.4%). Of 18 possible trauma symptoms, youth endorsed an average of 7.6 trauma symptoms (SD = 4.5) with significantly higher rates among girls (t[1325]=3.39, p = .0007). Trauma symptoms were significantly inversely correlated with resilience characteristics including self-esteem (r = -.36, p < .001), hope (r = -.07, p = .01), self-calming (r = -.30, p < .001), and social support (r = -.23, p < .001); however, there was no association between symptoms and self-efficacy. No statistically significant differences in trauma symptom prevalence were found based on children's age, grade, or community (rural versus urban). The high prevalence of trauma symptoms and expressions of trauma found in this study are consistent with the limited previous adolescent mental health research from Sub-Saharan Africa. Results contribute to the sparse knowledge base on trauma-affected youth and adolescent mental health in Zimbabwe more broadly and highlight the need for evidence-based practices that are culturally grounded and contextually specific for the region.
Colleen M. Fisher, Roswitta Gatsi, Natasha Venables et al.
Climate-related disasters are becoming increasingly frequent and severe, posing major threats to child health and nutrition, particularly in low- and middle-income countries (LMICs). These events disrupt food systems, health services, water and sanitation infrastructure, and caregiving practices, increasing the risk of undernutrition among children under five years of age. This narrative review synthesised current evidence on the effects of climate-related disasters on child nutrition and infant and young child feeding (IYCF) practices in LMICs. A narrative review of peer-reviewed literature published up to June 2025 was conducted using PubMed, ScienceDirect, Web of Science, and Google Scholar. Studies were eligible if they examined the association between climate-related disasters including droughts, floods, cyclones, and climate variability and nutritional outcomes or feeding practices among children under five years in LMICs. Findings were synthesised narratively because of substantial heterogeneity in study designs, exposures, and outcome measures. Eleven studies met the inclusion criteria. Most were conducted in Sub-Saharan Africa and South Asia. Droughts and floods were the most frequently investigated climate-related disasters and were consistently associated with increased risks of stunting, wasting, and underweight. Several studies also reported disruptions to breastfeeding and complementary feeding practices, worsening household food insecurity, increased maternal psychological distress, and reduced access to essential health and nutrition services following disasters. Children living in rural and resource-constrained settings were consistently identified as the most vulnerable. Climate-related disasters adversely affect child nutrition through multiple interconnected pathways, including reduced food availability, increased infectious diseases, disruption of feeding practices, and weakened health systems. Strengthening climate-resilient nutrition programmes, protecting infant and young child feeding during emergencies, and integrating nutrition into disaster preparedness and climate adaptation policies are essential to improve child health outcomes in LMICs.
Nomagugu Ndlovu, Makhosi Mahlangu, Nomagugu Minenhle Sibanda et al.
Abstract Objectives To examine the association between maternal media exposure and childhood anemia in three sub-Saharan African countries, and to develop a two-stage multiple imputation approach for substantial hemoglobin outcome missingness in Demographic and Health Survey (DHS) data. Design Multi-country cross-sectional analysis of nationally representative DHS data. Setting Community-based household surveys in Ghana (2022), Nigeria (2023–24), and Tanzania (2022). Participants 42,944 children aged 6–59 months across 2,621 clusters. Primary and secondary outcome measures The primary outcome was anemia (altitude-adjusted hemoglobin <11.0 g/dL, WHO criteria); the primary exposure was a composite maternal media score (0–4 channels). Given 61.5% hemoglobin missingness, we imputed altitude-adjusted hemoglobin using multilevel Gaussian models and derived anemia deterministically, then estimated associations using population-averaged generalized estimating equations (pre-specified primary analysis), with six sensitivity analyses and exploratory mediation analysis. Results Media exposure was significantly associated with reduced anemia odds (OR 0.946, 95% CI 0.917 to 0.976, p<0.001; FMI 32.5%), a 5.4% reduction per additional weekly channel. Estimates were consistent across six sensitivity analyses (OR range 0.914–0.961), with no heterogeneity by country (I²=0%, p=0.482). Media exposure predicted antenatal care attendance and iron supplementation (both p<0.001), but neither mediated the anemia association. Conclusions Maternal media exposure was consistently associated with reduced childhood anemia across three sub-Saharan African settings. A two-stage multiple imputation approach addressed substantial (61.5%) outcome missingness while maintaining stable estimates, offering a transferable framework for DHS-based analyses. Prospective and intervention studies are needed before media-based communication can be recommended as a complementary anemia-control strategy. Strengths and Limitations of This Study This is among the first multi-country analyses to directly examine maternal media exposure and childhood anemia using nationally representative biomarker data from three sub-Saharan African countries. A validated two-stage multiple imputation approach addressed substantial (61.5%) hemoglobin missingness, with robustness confirmed across six pre-specified sensitivity analyses. The cross-sectional design precludes establishing temporality and cannot rule out reverse causation or residual confounding from unmeasured household factors. Maternal media exposure was measured as frequency of channel use only, without capturing content, quality, or health-specific programming. Mediation analysis relied on a single imputed dataset with non-clustered models, limiting direct comparability with the primary GEE-based estimate.
The objective of this study was to examine if height at 2 years, 5 years, and 6-8 years of age was related to school-age cognitive development in low resource settings. Some studies report improved scores in those who catch up, while others found no improvement. We hypothesize that persistent stunting will be negatively associated with cognition and that children who experienced catch-up growth would show improved cognition.Follow-up anthropometry and cognitive assessments at 6-8 years were completed in the Brazil, South Africa, and Tanzania MAL-ED cohorts. Semantic and phonemic fluency and reasoning skills were assessed with the Developmental NEuroPSYchological test and Raven Coloured Matrices, respectively. Stunting at 2, 5, and 6-8 years was used to categorize growth into persistently stunted, early catch-up, late catch-up, and never stunted. Multivariable linear regression was used to estimate relationships between linear growth, stunting, and catch-up growth and 6-8-year-old cognition.Stunting prevalence decreased with each follow-up assessment from 40.1% at 2 years to 13.4% at 6-8 years. Height at each age was negatively associated with cognition (Semantic Fluency: 0.2 z-scores, 95% CI: 0.1, 0.3). Persistent stunting was associated with decreased cognitive scores at 6-8 years (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.03). Children with catch-up growth, both early (Semantic Fluency: -0.4 z-scores, 95% CI: -0.6, -0.1) and late (Semantic Fluency: -0.4 z-scores, 95% CI: -0.8, -0.1), did not have improved scores compared to those persistently stuntedLinear growth at 2 years remains an important indicator of cognitive development in late childhood. Efforts to reduce early stunting may continue as catch-up growth is not always associated with improved cognitive functioning.
Amber R. Huggins, Rebecca J. Scharf, Elizabeth T. Rogawski McQuade et al.
In high HIV prevalence settings, pregnancy and early childhood can be stressful periods for mothers with HIV, due to fear of HIV transmission, breastfeeding concerns, poor health and socio-economic challenges. Not much is known about how mothers of young children who are HIV exposed and uninfected (HEU) experience caregiving before and beyond the confirmation of their HIV-negative status. Using the Nurturing Care Framework for early childhood development, this qualitative study explores the caregiving experiences, challenges, and support needs of mothers raising young children who are HEU. Conducted in the Western Cape, South Africa, the study involved in-depth interviews with 20 mothers whose children were exposed to HIV, >1 year old, and tested HIV negative at 12 months. Reflexive thematic analysis guided the data analysis. Mothers' concerns persisted beyond ruling out HIV to encompass the overall health and development of their child during early years of life. Nurturing care practices were hindered by structural challenges - financial constraints, heavy caregiving demands, their own poor health, and limited partner/family support, which were further intensified by mothers' HIV and their child's HIV exposure. Existing efforts to operationalise the Nurturing Care Framework in high-HIV settings need to be strengthened to consider the specific needs and vulnerabilities of mothers of children who are HEU.
Himani Bhardwaj Pandya, Xanthe Hunt, Peter Suwirakwenda Nyasulu et al.
Childhood stunting is the most prevalent form of chronic malnutrition, affecting 149 million children under the age of five worldwide. As the determinants of stunting are complex and multicausal, it is important to look at area specific determinants and determine whether these are similar to the general determinants. This study investigated the prevalence and determinants of stunting in children under the age of five, visiting Bisho Hospital clinic in the Eastern Cape, South Africa. A cross-sectional, qualitative design was used. All children under the age of five, visiting Bisho Hospital’s clinic during the data collection period, and whose mothers provided consent, were included in the sample of 219 participants. An interview-administered questionnaire was used to determine possible factors that may play a role in stunting. Anthropometrical measurements (height, weight and mid-upper arm circumference) were used to calculate z-scores for the children. IBM SPSS Statistics 26 (version 24.0) was used for statistical analysis. Dietary diversity was calculated with a seven food group classification. The prevalence of stunting was 47.5 %, of which 57.7 % were classified as moderately stunted, and 42.3 % severely stunted. There was a significant correlation between the participants’ main form of sanitation and stunting in all age groups (p = 0.007; Cramer’s V = 0.413 and p = 0.04; Cramer’s V = 0.326, respectively). A statistical significance was found between the child support grant and stunting (p = 0.032) in children younger than six months, but not in the older group. No statistical significance was found between other determinants of stunting that were analysed. As stunting is multi-causal, it requires a combination of nutrition-specific and nutrition-sensitive interventions, together with strong political and financial commitment from stakeholders to eradicate stunting in children. Keywords: Stunting, Children, Sanitation, Infections, Breastfeeding
Renal biomarkers change rapidly in early childhood, but pediatric reference intervals used in African laboratories are often extrapolated from non-African populations and discrete age partitions. This study derived continuous age-dependent centile curves and preliminary reference intervals for body mass index (BMI), serum creatinine, urea, and electrolytes in healthy Kenyan children aged 0 to 60 months. In this cross-sectional study, 176 children (90 males, 86 females) were systematically recruited at Kitui County Referral Hospital between June 2024 and February 2025. Children underwent clinical screening, World Health Organization-standard anthropometry, and morning fasting venous blood sampling. Creatinine and urea were measured using isotope-dilution mass spectrometry-traceable enzymatic assays, and electrolytes by direct ion-selective electrode. Centiles (2.5th, 50th, 97.5th) were estimated non-parametrically with 90% bootstrap confidence intervals, and continuous age trends modeled using generalized additive models for location, scale, and shape or quantile regression. BMI showed modest age-related variation, with median values rising from 15.8 kg/m2 (2.5th-97.5th: 11.4-20.2) at 0 to 11 months to 16.5 kg/m2 (10.1-23.0) at 48 to 60 months, with dispersion narrowing after age 2. Median creatinine rose steeply in infancy and more gradually thereafter, from 17.4 to 31.2 µmol/L. Urea increased gradually from a median of 2.59 to 3.63 mmol/L, with overlapping centile limits across adjacent strata. Electrolytes were tightly regulated and largely age-invariant: sodium ranged from 135 to 147 mmol/L (median ~141), potassium 3.6 to 5.7 mmol/L (median declining from 4.9 to 4.5), and chloride 100 to 111 mmol/L (median ~105-106). Sex-specific partitions were supported only in early life (BMI in infancy, creatinine in toddlers); correlations between anthropometric z-scores and biomarkers were weak (|ρ| < 0.15; P > .10). These continuous centile curves provide the first preliminary age-dependent reference estimates for renal biomarkers in Kenyan children under 5, showing rapid early renal maturation alongside stable electrolyte homeostasis. As this cross-sectional design cannot capture within-subject variation, larger multicenter and longitudinal studies are needed to confirm these trajectories, refine intervals, and develop age-dependent z-score calculators for clinical use.
Background: Stunting remains a major public health challenge in Nigeria, affecting 40% of children according to the Nigeria Demographic and Health Survey (NDHS, 2024) amid persistent insecurity orchestrated by Boko Haram/ISWAP insurgency, farmer-herder conflicts, and banditry. However, much of the existing studies treat conflict exposure as a binary condition, overlooking important differences in event frequency and fatality intensity and their potentially distinct implications for child growth and development. Aims: We aimed to assess whether cumulative conflict exposure, captured by event frequency and fatality intensity, better explains childhood stunting in Nigeria than measures of conflict presence alone. Methods: This cross-sectional analysis used the 2024 NDHS dataset (children under 59 months = 9,410), ACLED events (2009-2025 = 73,147), and UCDP GED (1990-2025 = 8,255) as data sources. Conflict events were geocoded to NDHS clusters using 5 km, 10 km, and 50 km buffers. The frequency and intensity of conflict exposure were estimated separately and jointly using weighted cluster-robust logistic regression. Model performance for cumulative exposure versus binary presence/absence exposure was assessed using AIC, BIC, and McFadden's pseudo-R². Results: Weighted prevalence of stunting was 39.1%, with the highest rate observed in the North-West at 52.4% and the lowest in the South-South at 17.9% (p < .001). Conflict experience also differed significantly across geopolitical zones based on both ACLED and UCDP GED indicators (p < .001). The adjusted result showed a significant negative correlation between higher frequency of ACLED events and stunting (AOR = 0.85, 95% CI: 0.76–0.97, p = .012). Overall, the findings indicate that the relationship between armed insecurity and stunting varies by the frequency, intensity, and cumulative nature of conflict exposure. Conclusions: Insecurity involving conflict was correlated with childhood stunting, although this was context-specific, depending on how conflict was captured and what data were utilised. Frequency was a better indicator than fatality, and cumulative metrics were not superior to non-cumulative indicators of conflict. Based on this study’s results, we recommend that nutrition interventions focus on regions experiencing the highest levels of insecurity and childhood stunting.
BACKGROUND: Globally, 15 million children were born HIV-exposed uninfected (CHEU) from mothers living with HIV. CHEU have increased mortality, morbidity and stunting compared to children HIV-unexposed (CHU). Our objective was to compare body composition between CHEU and CHU, which may underlie this vulnerability. METHODS: In a substudy among 223 children (36 CHEU and 187 CHU) enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe, we measured height, knee-heel length, weight, calf circumference, skinfold thicknesses (triceps, subscapular and calf), and bio-electrical impedance at 2 years of age. Generalised estimating equations were used to compare body composition between CHEU and CHU, and interactions with linear growth and birthweight. RESULTS: CHEU had significantly lower length-for-age, knee-heel length, weight-for-age, mid-upper arm circumference and calf circumference compared to CHU. CHEU had a lower impedance index (adjusted mean difference -0.49, 95% CI -0.87, -0.11), reflecting less lean mass, and lower skinfold thicknesses (subscapular Z-score adjusted mean difference -0.49 (95% CI -0.97, -0.02); triceps Z-score -0.48 (95% CI -0.83, -0.13)), indicating reduced subcutaneous fat. In early-life, CHEU had lower birthweight. However, no significant interaction between stunting or birthweight and HIV exposure was observed for body composition outcomes. CONCLUSION: CHEU have a distinct pattern of body composition by 2 years of age, characterised by reduced lean and fat mass compared to CHU which was not explained by reduced linear growth or lower birthweight. This pattern of early-life growth may contribute to the increased vulnerability of CHEU to mortality, morbidity and reduced neurodevelopment.
Joseph D. Piper, Robert Ntozini, Idah Mapurisa et al.
Climatic variability affects many underlying determinants of child malnutrition, including food availability, access, and utilization. Evidence of the effects of changing temperatures and precipitation on children’s nutritional status nonetheless remains limited. Research addressing this knowledge gap is merited given the short- and long-run consequences of malnutrition. We address this issue by estimating the effects of temperature and precipitation anomalies on the weight and wasting status of children ages 0-59 months across 16 countries in sub-Saharan Africa. Linear regression models show that high temperatures and low precipitation are associated with reductions in child weight, and that high temperatures also lead to increased risk of wasting. We find little evidence of substantively meaningful differences in these effects across sub-populations of interest. Our results underscore the vulnerability of young children to climatic variability and its second-order economic and epidemiological effects. The study also highlights the corresponding need to design and assess interventions to effectively mitigate these impacts.
