Flood-Exposure is Associated with Higher Prevalence of Child Undernutrition in Rural Eastern India

Recurrent Flooding and Household Food Access in Central Java, Indonesia

It is unknown how recurring flooding impacts household diet in Central Java. We aimed to assess how recurrent flooding influenced household food access over 22 years in Central Java by linking the Global Surface Water dataset (GSW) to the Indonesian Family Life Survey. We examined linear and nonlinear relationships and joint effects with indicators of adaptive capacity. We measured recurrent flooding as the fraction of district raster cells with episodic flooding from 1984-2015 using GSW. Food access outcomes were household food expenditure share (FES) and dietary diversity score (DDS). We fit generalized linear mixed models and random forest regression models. We detected joint effects with flooding and adaptive capacity. Wealth and access to credit were associated with improved FES and DDS. The effect of wealth on FES was stronger in households in more flood-affected districts, while access to credit was associated with reduced odds of DDS in more flood-affected districts. Flooding had more predictive importance for FES than for DDS. Access to credit, a factor that ordinarily improves food access, may not be effective in flood-prone areas. Wealthier households may be better able to adapt in terms of food access. Future research should incorporate land use data to understand how different locales are affected and further understand the complexity of these relationships.

Floods and cause-specific mortality in the UK: a nested case-control study

BACKGROUND

Floods are the most frequent weather-related disaster, causing significant health impacts worldwide. Limited studies have examined the long-term consequences of flooding exposure.

METHODS

Flood data were retrieved from the Dartmouth Flood Observatory and linked with health data from 499,487 UK Biobank participants. To calculate the annual cumulative flooding exposure, we multiplied the duration and severity of each flood event and then summed these values for each year. We conducted a nested case-control analysis to evaluate the long-term effect of flooding exposure on all-cause and cause-specific mortality. Each case was matched with eight controls. Flooding exposure was modelled using a distributed lag non-linear model to capture its nonlinear and lagged effects.

RESULTS

The risk of all-cause mortality increased by 6.7% (odds ratio (OR): 1.067, 95% confidence interval (CI): 1.063-1.071) for every unit increase in flood index after confounders had been controlled for. The mortality risk from neurological and mental diseases was negligible in the current year, but strongest in the lag years 3 and 4. By contrast, the risk of mortality from suicide was the strongest in the current year (OR: 1.018, 95% CI: 1.008-1.028), and attenuated to lag year 5. Participants with higher levels of education and household income had a higher estimated risk of death from most causes whereas the risk of suicide-related mortality was higher among participants who were obese, had lower household income, engaged in less physical activity, were non-moderate alcohol consumers, and those living in more deprived areas.

CONCLUSIONS

Long-term exposure to floods is associated with an increased risk of mortality. The health consequences of flooding exposure would vary across different periods after the event, with different profiles of vulnerable populations identified for different causes of death. These findings contribute to a better understanding of the long-term impacts of flooding exposure.

Nutritional status among earthquake survivors: a systematic review and meta-analysis

OBJECTIVE

Earthquakes, as one of the most devastating natural disasters, have many consequences, including the collapse of buildings where food is produced, stored, and distributed, which can ensue with numerous nutritional problems. This study was to investigate the nutritional status of earthquake survivors.

STUDY DESIGN

This was a systematic review and meta-analysis study.

METHODS

The present review was conducted according to the PRISMA guideline. The data were collected by searching the data resources of PubMed, Scopus, Web of Science, Science Direct, Google Scholar, MagIran, and Scientific Information Database. Meta-analysis was conducted using the random effects model, and the I2 index was used to assess heterogeneity among studies. Publication bias was assessed using Begg's test.

RESULTS

In this study, 342 studies were identified in the primary literature search, and after removing duplicates, 14 of which were finally selected for meta-analysis. Based on the results of the meta-analysis, the overall prevalence was obtained: 4.19% for wasting, 16.78% for stunting, 12.59% for underweight, and 28.06% for anemia after the earthquake.

CONCLUSION

The results indicated that earthquake survivors are exposed to malnutrition. Therefore, it is recommended that adequate food and nutritional supplements are provided to all earthquake survivors.

A synergistic approach towards understanding flood risks over coastal multi-hazard environments: Appraisal of bivariate flood risk mapping through flood hazard, and socio-economic-cum-physical vulnerability dimensions

The dynamics of flood risk over Coastal Multi-hazard Catchments (CMC) exhibit bizarre characteristics. In these regions, flood hazards are governed by a complex interaction of multiple flood-inducing sources; varying in magnitudes, origin, and direction of propagation. Our conventional understanding of vulnerability may be obscure within these catchments. This can be attributable to the heterogeneous nature of various physical and socio-economic entities. The study proposes a comprehensive framework to quantify bivariate flood risks over a severely flood-prone region in India. The study considers flood hazards, along with vulnerabilities transpiring from (a) physical, (b) socio-economic, and (c) composite (combination of both) groups of indicators. To overcome data scarcity prevalent in CMCs, CHIRPS v2.0, a high-resolution Satellite Precipitation Product, along with other ancillary datasets, are forced to 1D2D coupled MIKE+ hydrodynamic model to simulate flood hazards. A set of 24 indicators are considered within the Shannon Entropy-cum-TOPSIS framework to derive three types of vulnerability. The marginal and compound contributions of hazard and each vulnerability type are represented through a novel concept of bivariate flood risk classifier at the village scale. We notice high and very-high flood hazards over the coastline and floodplains. An equitable influence of socio-economic vulnerability and hazards is reflected, as they cover 41 % of villages together under varied degrees of flood risks. The impacts of hazards are underscored in the presence of physical vulnerability, as the latter contributes to risks in about 72 % of villages. Composite vulnerability prevails its impact over 53 % of villages, dominating its influence on flood risks over hazards. The study delivers vital information to the global flood management community on the prudent selection of indicators, as their influence is markedly noticed on the overall flood risks. The diversified characteristics of flood risk inspire a rationalized implementation of structural and non-structural options in resource-constrained conditions.

The effects of climate change-induced flooding on harvest failure in Burkina Faso: case study

Background

Climate change leads to more frequent and severe extreme weather events including floods, heatwaves, heavy rainfalls, and droughts. In contrast to the majority of research on weather extremes in sub-Saharan Africa, which focus primarily on how a lack of rainfall causes droughts, this paper aims to elucidate the effect of flooding on harvest failure in rural Burkina Faso.

Methods

We conducted a case study in north-western Nouna, Burkina Faso, between August and December 2021 covering a study population of n = 180 participants. The study comprised four components: (i) interviews with farmers (n = 180) on whether any of their fields had been inundated and if so, on harvest loss on these fields; (ii) determining the feasibility of using Sentinel-2 satellite images to validate study participants reports of floods; (iii) characterizing short-term weather including frequency and duration, of extreme rainfall events within the study area, as well as comparing cumulative rainfall (long-term) over the past 50 years; and (v), estimating both the food energy and economic loss of harvest failure due to flooding.

Results

49% of interviewed farmers (n = 88) reported that floods had damaged at least one of their fields. Some fields (n = 13, 7%) had no harvest due to flooding, while some farmers (n = 14, 8%) had lost part of their harvest. Images from the Sentinel-2-Satellite indicated that reported and remotely observed flooding were consistent. According to time series of data from the local weather station, there has been an increase irregular rainfall distribution and at the same time of cumulative annual rainfall in Nouna. Furthermore, a first illustrative calculation allowed us to estimate the amount of energy lost when one hectare of a common crop is flooded.

Conclusion

This case study demonstrated that flood-related harvest failures leading to crop losses in sub-Saharan Africa, exemplified by Burkina Faso, are likely to be substantial. This study serves as a proof-of-principle for flooding effects on food security. This could provide more detail for agricultural adaptation and mitigation strategies. Inundation-vulnerable fields need alternative and novel management practices, which may only be effectively implemented if agricultural institutions and national policy-making bodies receive evidence of flooding e.g., from remote sensing.

Mechanisms underlying food insecurity in the aftermath of climate-related shocks: a systematic review

Food insecurity is prevalent, affecting 1·2 billion people globally in 2021. However, the effects of food insecurity are unequally distributed across populations and climate-related shocks threaten to exacerbate food insecurity and associated health consequences. The mechanisms underlying this exacerbation at the household level are largely unknown. We aimed to synthesise the available evidence on the mechanisms connecting extreme climate events to household-level food insecurity and highlight the research gaps that must be addressed to inform better food security and health policy. For this systematic review, a comprehensive literature search was done by a medical librarian in February, 2021 for articles about food security and climate-related shocks. Relevant publications were identified by searching the following databases with a combination of standardised index terms and keywords: MEDLINE, Embase, CINAHL, GreenFILE, Environment Complete, Web of Science Core Collection, and Global Health. Searches were limited to human studies published in English. Included studies measured food security outcomes using indicators developed by the UN Food and Agricultural Organization (ie, consumption patterns, livelihood change, malnutrition, and mortality) and explained the mechanism behind the household-level or population-level food insecurity. Purely theoretical, modelling, and review studies were excluded. Quality assessment was conducted using the appropriate Joanna Briggs Institute Critical Appraisal Tool. Data were analysed using thematic analysis of the categories of mechanism (interpreted using internationally accepted frameworks), risk and resilience factors, and author policy recommendations. We found a paucity of data with only 18 studies meeting criteria for inclusion out of 337 studies identified for full-text review. All the studies that were included in our analysis showed worse food security outcomes after climate-related shocks. Food availability was the most common mechanism cited (17 studies), although most studies addressed at least one additional mechanism (15 studies). Studies were of mixed methodologies with nuanced discussions of risk and resilience factors, and of policy recommendations. This systematic review shows that there is an incomplete assessment of food security at the household and community level after climate-related shocks in the literature and finds that food availability is the primary mechanism studied. The low number of studies on this topic limits subgroup analysis and generalisability; however, the good quality of the studies allows for important policy recommendations around improving resilience to climate shocks and suggestions for future research including the need for a more granular understanding of mechanisms and feasible adaptation solutions.

Climate change vulnerability, and health of women and children: Evidence from India using district level data

OBJECTIVE

To understand how climate change vulnerability is associated with women and children's health (WCH) at the district level in India.

METHODS

The district-specific climate change vulnerability index was mapped to the district level NFHS-5 data (N = 674). Fractional regression and spatial analyses were performed to examine the strength of association and the presence of geographic clustering.

RESULTS

Bivariate analysis revealed that the levels of WCH indicators were lower in districts with a high vulnerability index than in those with a low vulnerability index. Multivariable analyses suggested that with a 1% increase in the vulnerability index, the proportion of modern contraceptive use was reduced by 0.22, four or more prenatal care visits by 0.14, postnatal care by 0.11, and full immunization by 0.12; whereas wasting and underweight proportions increased by 0.07 and 0.10, respectively. The spatial analysis found that in about 70-118 districts, mostly in eastern India, where climate vulnerability was high the WCH outcomes were also poor.

CONCLUSION

There is a macro-level association between climate change vulnerability and WCH, as districts that had high levels of climate change vulnerability also performed poorly in WCH. There is a need for an integrated approach that considers geography-specific climate change threats to develop health programs.

Impact of floods on undernutrition among children under five years of age in low- and middle-income countries: a systematic review

BACKGROUND

Weather and climate-related disasters, including floods, impact undernutrition through multiple pathways, including food security, inadequate child care practices, and water and sanitation. This review aimed to provide systematic evidence of the impact of floods on undernutrition in children under five years of age in Low and Middle-income countries (LMICs).

METHODS

We searched PubMed, Web of Science, Embase, MEDLINE, CINAHL and Scopus for peer-reviewed articles. Popline, WHO Library database (WHOLIS), the International Disaster database (EM-DAT), Food and Agriculture Organisation (FAO), UNICEF and Eldis were searched for grey literature articles. Database searches were first conducted in 2016 and updated in 2020. We included English language articles that reported the effect of floods on undernutrition outcomes in children under 5 years of age in LMICs, without limitation to study design and year of publication. The quality of selected studies was assessed using the National Institutes of Health (NIH) tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

Of the 5701 articles identified, 14 met our inclusion criteria. The review noted stunting as the most frequently reported significant form of undernutrition in flood-affected areas. Severe and recurrent floods showed the greatest impact on undernutrition. Due to weak and limited evidence, the study is inconclusive on the most significant forms within the short-term and intermediate periods following floods. On the other hand, stunting was noted as the most frequently reported significant form of undernutrition in the long-term period following floods. There was generally little evidence of the effect of floods on micronutrient deficiencies. Factors associated with child undernutrition in the flood-affected areas included age, gender, diarrhoea, maternal and paternal education, maternal age, household size, land ownership and socioeconomic status. Overall, the quality of the evidence was fairly weak, with the main challenge lying in the inability of the studies to establish causal pathways for the observed effects.

CONCLUSIONS

The review suggests clear plans and strategies for preventing and reducing the long-term impact of floods on undernutrition in children under five years. Future research utilising long-term prospective data is indispensable to provide more robust evidence to guide better prevention measures, response decisions and interventions.

Climate change impacts on the health of South Asian children and women subpopulations - A scoping review

Background and objectives

Climate change impacts are felt unequally worldwide; populations that experience geographical vulnerability, those living in small island states and densely populated coastal areas, and children and women are affected disproportionately. This scoping review aims to synthesize evidence from relevant studies centred on South Asia, identify research gaps specifically focused on children and women's health, and contribute to knowledge about South Asia's existing mitigation and adaptation strategies.

Methods

A research librarian executed the search on six databases using controlled vocabulary (e.g., MeSH, Emtree, etc.) and keywords representing the concepts “vulnerable populations” and “climate change” and “health impacts” and “South Asia.” Databases were searched from January 2010 to May 2020. Papers were screened independently by two researchers.

Results

Forty-two studies were included, of which 23 were based in India, 14 in Bangladesh, and five in other South Asian countries. Nineteen studies focused on meteorological factors as the primary exposure. In contrast, thirteen focused on extreme weather events, nine on air pollution, and one on salinity in coastal areas. Thirty-four studies focused on the health impacts on children related to extreme weather events, meteorological factors, and air pollution, while only eight studies looked at health impacts on women. Undernutrition, ARI (acute respiratory infection), diarrheal diseases, low birth weight, and premature mortality were the major health impacts attributed to extreme weather events, meteorological factors, and air pollution exposure in children and women in the region.

Conclusion

Extreme weather events, meteorological factors and air pollution have affected the health of children and women in South Asia. However, the gap in the literature across the South Asian countries concerning relationships between exposure to extreme weather events, meteorological factors, air pollution and health effects, including mental health problems in children and women, are opportunities for future work.

The impact of climate change on the risk factors for tuberculosis: A systematic review

BACKGROUND

Tuberculosis (TB) continues to pose a major public health risk in many countries. The current incidence of disease exceeds guidelines proposed by the World Health Organisation and United Nations. Whilst the relationship between climate change and TB has surfaced in recent literature, it remains neglected in global agendas. There is a need to acknowledge TB as a climate-sensitive disease to facilitate its eradication.

OBJECTIVE

To review epidemiological and prediction model studies that explore how climate change may affect the risk factors for TB, as outlined in the Global Tuberculosis Report 2021: HIV infection, diabetes mellitus, undernutrition, overcrowding, poverty, and indoor air pollution.

METHODS

We conducted a systematic literature search of PubMed, Embase, and Scopus databases to identify studies examining the association between climate variables and the risk factors for TB. Each study that satisfied the inclusion criteria was assessed for quality and ethics. Studies then underwent vote-counting and were categorised based on whether an association was found.

RESULTS

53 studies met inclusion criteria and were included in our review. Vote-counting revealed that two out of two studies found a positive association between the examined climate change proxy and HIV, nine out of twelve studies for diabetes, eight out of seventeen studies for undernutrition, four out of five studies for overcrowding, twelve out of fifteen studies for poverty and one out of three studies for indoor air pollution.

DISCUSSION

We found evidence supporting a positive association between climate change and each of the discussed risk factors for TB, excluding indoor air pollution. Our findings suggest that climate change is likely to affect the susceptibility of individuals to TB by increasing the prevalence of its underlying risk factors, particularly in developing countries. This is an evolving field of research that requires further attention in the scientific community.

Residential district multi-hazard risk is associated with childhood undernutrition: evidence from Bangladesh

Child undernutrition and natural disasters are major public health concerns in Bangladesh, but research into their relationship is lacking. This study assessed the association between residential district multi-hazard-risk and undernutrition among children aged less than 5 years (under-5) in Bangladesh. Data for 22,055 under-5 children were extracted from the 2019 Multiple Indicator Cluster Survey of Bangladesh. Multi-hazard risk was categorized as low (score<10), moderate (score 10-20), and high (score>20) using a combined score of four major hazards: tornado, cyclone, earthquake, and flood. We found that children from high multi-hazard risk districts were 19% more likely to be stunted and 23% more likely to be underweight compared to low-risk districts. However, wasting was not associated with multi-hazard risk. Strategies such as agricultural adaptation and coping mechanisms, long-term post-disaster nutritional response, extended periods of relief supports, and enhanced quality maternal and child care services may help to reduce undernutrition burdens in Bangladesh.

Current dichotomous metrics obscure trends in severe and extreme child growth failure

Historically, the prevalence of child growth failure (CGF) has been tracked dichotomously as the proportion of children more than 2 SDs below the median of the World Health Organization growth standards. However, this conventional "thresholding" approach fails to recognize child growth as a spectrum and obscures trends in populations with the highest rates of CGF. Our analysis presents the first ever estimates of entire distributions of HAZ, WHZ, and WAZ for each of 204 countries and territories from 1990 to 2020 for children less than 5 years old by age group and sex. This approach reflects the continuous nature of CGF, allows us to more comprehensively assess shrinking or widening disparities over time, and reveals otherwise hidden trends that disproportionately affect the most vulnerable populations.

Malnutrition and Associated Risk Factors among Children 6-59 Months Old in the Landslide-Prone Bududa District, Eastern Uganda: A Cohort Study

BACKGROUND

The United Nations Sustainable Development Goal 2.2 calls for an end to all forms of malnutrition. This might be derailed due to persistent landslide disasters in low-income countries like Uganda.

OBJECTIVES

The prevalence of malnutrition and the impact of seasonal variations and associated factors were assessed among children aged 6-59 mo in the landslide-affected households in Bududa District, eastern Uganda.

METHODS

A prospective cohort study using a 2-stage simple random technique was applied to select 422 households including 392 children during May-August (food-plenty season) 2019. After 6 mo, in January-March (food-poor season) 2020, 388 households and 366 children were assessed. Socioeconomic and demographic data were collected using structured questionnaires. Child malnutrition outcomes were defined according to WHO criteria. Factors associated with malnutrition outcomes were identified by bivariate and multivariate logistic regression.

RESULTS

Stunting, underweight, wasting, and overweight prevalences were 37.7%, 13.3%, 3.6%, and 4.3%, respectively, in the food-plenty season and 42.6%, 14.2%, 2.1%, and 2.7%, respectively, in the food-poor season. Residing in the landslide-affected sub-county increased the odds for stunting [adjusted OR (aOR): 1.68; 95% CI: 1.08, 2.59; P = 0.025] and underweight (aOR = 4.25; 95% CI: 1.10, 15.36; P = 0.032) for children in the food-plenty season. Child age, sex, breastfeeding status, a nonimproved drinking water source, migration of any household member, and parents' education were significant risk factors in the food-plenty season. In the food-poor season, parents' education status, loss of any household member, child sex, and child age were significant risk factors.

CONCLUSIONS

Stunting and underweight were more prevalent in the food-poor season while wasting and overweight were more prevalent in the food-plenty season. With the exception of child age, child sex, and parents' education, child malnutrition risk factors differed between food-plenty and food-poor seasons. There is a need to address seasonality factors in program interventions targeting children <5 y in landslide-prone areas.

Preparedness to Combat Determinants of Underweight-Based Child Malnutrition in Flood-Affected Areas of Pakistan

Aims. Floods badly impact the food and nutrition security in developing countries. The role of the government and the impact of floods on the underweight status of children in the affected areas is not clear. We aimed to find the determinants of underweight in flood-affected areas of Khyber Pakhtunkhwa, Pakistan. Methods. We used a multistage sampling technique and selected 656 households during in the flood-affected areas of Pakistan. Data were collected in the three most affected districts. A validated questionnaire was used to find socioeconomic and demographic information, hygiene, and sanitation information. We used logistic regression to find the determinants of underweight, controlling for confounders. Results. The prevalence of global malnutrition based on underweight was 25.2%. The prevalence of underweight was higher in young age mothers (40.6%), younger age children (71.4%), large family size (28.4%), joint family (27%), and no toilet facility (28.9%). District Nowshera was at high risk of underweight based undernutrition, followed by district Charsadda compared to children belonging to Dera Ismail Khan. The significant risk factor that causes underweight was child lower age ( $p<0.01$ ), young age of mothers ( $p<0.01$ ), children access to unimproved water sources ( $p<0.01$ ), and location (districts) due to environmental and constant flood consequences ( $p<0.01$ ). Conclusion. In conclusion, risk factors of underweight should be appropriately targeted in the flood-hit areas of Pakistan. Governments should preallocate budgetary resources and enhance the emergency preparedness levels to facilitate the communities with flooding incidents and their aftermath in the shape of child underweight-based malnutrition.

Prevalence and determinants of stunting among preschool and school-going children in the flood-affected areas of Pakistan

Stunting is a significant public health problem in low- and middle-income countries. This study assessed the prevalence of stunting and associated risk factors of stunting among preschool and school-going children in flood-affected areas of Pakistan. A cross-sectional study was conducted by visiting 656 households through multi-stage sampling. Respondent's anthropometric measurements, socio-demographic information and sanitation facilities were explored. A logistic regression model was used to determine determinants of stunting, controlling for all possible confounders. The overall prevalence of stunting in children was 40.5%, among children 36.1% boys and 46.3% of girls were stunted. The prevalence of stunting in under-five children was 50.7%. Female children (OR=1.35, 95% CI:0.94-2.0), children aged 13-24 months (OR=6.5, 95% CI: 3.0-13.9), mothers aged 15-24 years (OR=4.4, 95% CI: 2.6-7.2), joint family (OR=2.1, 95% CI: 1.4-3.0) did not have access to improved drinking water (OR=3.3, 95% CI: 1.9-5.9), and the toilet facility (OR=2.8, 95% CI, 1.9-4.3), while the children from district Nowshera (OR=1.7, 95% CI: 0.9-3.2) were significantly (P<0.05) associated in univariate analysis. The regression model revealed that child age, maternal age, family type, quality of water, and toilet facility, were the significant (P<0.05) factors contributing to child stunting in the flood-hit areas. Identification of key factors might be helpful for policymakers in designing comprehensive community-based programs for the reduction of stunting in flood-affected areas. In disasters such as flood, the detrimental consequences of the stunting problem could be even more on children. Evidence-based education and care must be provided to the families in the flood-affected regions to reduce the stunting problem. The determinants of stunting should be targeted by making comprehensive policies regarding proper nutrition, livelihood, clean water, and sanitation facilities in flood-hit regions.

Climate change and child health: a scoping review and an expanded conceptual framework

Climate change can have detrimental effects on child health and wellbeing. Despite the imperative for a fuller understanding of how climate change affects child health and wellbeing, a systematic approach and focus solely on children (aged <18 years) has been lacking. In this Scoping Review, we did a literature search on the impacts of climate change on child health from January, 2000, to June, 2019. The included studies explicitly linked an alteration of an exposure to a risk factor for child health to climate change or climate variability. In total, 2970 original articles, reviews, and other documents were identified, of which 371 were analysed. Employing an expanded framework, our analysis showed that the effects of climate change on child health act through direct and indirect pathways, with implications for determinants of child health as well as morbidity and mortality from a range of diseases. This understanding can be further enhanced by using a broader range of research methods, studying overlooked populations and geographical regions, investigating the costs and benefits of mitigation and adaptation for child health, and considering the position of climate change and child health within the UN Sustainable Development Goals. Present and future generations of children bear and will continue to bear an unacceptably high disease burden from climate change.

Risk Factors of Mid-upper Arm Circumference (MUAC) Based Child Malnutrition in the Flood-affected Areas of Pakistan: A Cross-sectional Study

Low- and middle-income countries are usually at high risk of malnutrition. Not only that but the prevalence of malnutrition is much higher. It is important to evaluate the determinants of malnutrition in flood-affected areas of Pakistan. The present study examined the prevalence and risk factors of MUAC-based child malnutrition in flood-hit regions of Khyber Pakhtunkhwa, Pakistan. Multi-stage sampling was employed to select 656 households. Finally, 298 children of 6-59 months were selected. MUAC, an independent anthropometric parameter, was used to investigate the nutritional status of children. An automated logistic regression model was used to identify the risk factors of MUAC-based malnutrition. The prevalence of MUAC-based malnutrition was found 46%, including 40.5% females and 52.1% males. More than 90% of people had improved water quality and soap hand washing facility. Almost 17% of respondents had no toilet facility. Through automated logistic model, child age, maternal age, family size, income level, mother education, water quality, toilet facility were the significant determinants (P < .05) of MUAC-based undernutrition in flood affecting the area. The findings suggest that MUAC-based malnutrition can be minimized in flood-hit areas by targeting the listed risk factors. Community-based awareness programs regarding guidance on nutrition might be a key to reducing malnutrition in the target areas.

Impact of improved small-scale livestock farming on human nutrition

Micronutrient deficiencies and stunting rates are high in many low-income countries. Increasing and diversifying food intake are often challenging for small-scale farmers in lowland areas as flooding often results in crop losses and drowning of livestock. A cluster-randomised controlled trial was conducted over 12-months in Bangladesh, involving 150 small-scale duck rearing households, including 50 control, and 50 households each in two intervention arms. Interventions focussing on improving duck health and duck nutrition were applied on a village level. Data analysis focussed on assessing the impact of interventions on duck mortality, sales and consumption, and on dietary diversity of household members. Improved duck rearing increased the consumption and the sales of ducks. Household selling more ducks were more likely to purchase and consume milk products, contributing to an improved households’ dietary diversity. Our results suggest that improving duck rearing can provide a suitable and sustainable alternative to maintain and improve dietary diversity of households in flood-prone areas.

Towards food supply chain resilience to environmental shocks

Environmental variability and shock events can be propagated or attenuated along food supply chains by various economic, political and infrastructural factors. Understanding these processes is central to reducing risks associated with periodic food shortages, price spikes and reductions in food quality. Here we perform a scoping review of the literature to examine entry points for environmental variability along the food supply chain, the evidence of propagation or attenuation of this variability, and the food items and types of shock that have been studied. We find that research on food supply shocks has primarily focused on maize, rice and wheat, on agricultural production and on extreme rainfall and temperatures-indicating the need to expand research into the full food basket, diverse sources of environmental variability and the links connecting food production to consumption and nutrition. Insights from this new knowledge can inform key responses-at the level of an individual (for example, substituting foods), a company (for example, switching sources) or a government (for example, strategic reserves)-for coping with disruptions.

Monsoon weather and early childhood health in India

BACKGROUND

India is expected to experience an increase in the frequency and intensity of extreme weather events in the coming decades, which poses serious risks to human health and wellbeing in the country.

OBJECTIVE

This paper aims to shed light on the possible detrimental effects of monsoon weather shocks on childhood undernutrition in India using the Demographic and Health Survey 2015-16, in combination with geo-referenced climate data.

METHODS

Undernutrition is captured through measures of height-for-age, weight-for-height, stunting and wasting among children aged 0-59 months. The standardised precipitation and evapotranspiration index (SPEI) is used to measure climatic conditions during critical periods of child development.

RESULTS

The results of a multivariate logistic regression model show that climate anomalies experienced in utero and during infancy are associated with an increased risk of child undernutrition; exposure to excessive monsoon precipitation during these early periods of life elevates the risk of stunting, particularly for children in the tropical wet and humid sub-tropical regions. In contrast, the risk of stunting is reduced for children residing in the mountainous areas who have experienced excessive monsoon precipitation during infancy. The evidence on the short-term effects of climate shocks on wasting is inconclusive. We additionally show that excessive precipitation, particularly during the monsoon season, is associated with an increased risk of contracting diarrhoea among children under five. Diseases transmitted through water, such as diarrhoea, could be one important channel through which excessive rainfall increases the risk of stunting.

CONCLUSIONS

We find a positive association between childhood undernutrition and exposure to excessive monsoon precipitation in India. Pronounced differences across climate zones are found. The findings of the present analysis warn of the urgent need to provide health assistance to children in flood-prone areas.

A new bivariate risk classifier for flood management considering hazard and socio-economic dimensions

Identification of flood-risk dynamics is pivotal for refurbishing the existing and future flood-management options. The present study quantifies the marginal and compound contributions of hazard and vulnerability to flood-risk through an innovative concept of Risk-classifier, designed in the form of a 5 × 5 choropleth. The proposed framework is demonstrated at the finest administrative scale of village-level over Jagatsinghpur district in Mahanadi River basin, Odisha (India) for two-time frames: Scenario-I (1970-2011) and Scenario-II (1970-2001). An increase in high and very high hazard and vulnerable villages is noticed in Scenario-I, the majority of them lying in the coastal stretches (S-E region) and adjoining flood plains of Mahanadi River (N-W region). Scenario-I is characterized by the majority of hazard-driven and compound (both hazard and vulnerability) risk villages, while Scenario II is characterized by a majority of vulnerability driven-risk villages. For the vulnerability-driven risk villages, rigorous enforcement of policies and mitigation schemes are recommended, while for hazard-driven risk villages, enhancement of structural measures and flood-plain zoning should be exercised. Such exhaustive flood-risk information may serve as a valuable cartographic product for the civic authorities and stakeholders and help in prioritizing flood mitigation actions for improved environmental planning and management.

Do Deviations From Historical Precipitation Trends Influence Child Nutrition? An Analysis From Uganda

Changes in precipitation patterns might have deleterious effects on population health. We used data from the Uganda National Panel Survey from 2009 to 2012 (n = 3,223 children contributing 5,013 assessments) to evaluate the link between rainfall and undernutrition in children under age 5 years. We considered 3 outcomes (underweight, wasting, and stunting) and measured precipitation using household-reported drought and deviations from long-term precipitation trends measured by satellite. We specified multilevel logistic regression models with random effects for the community, village, and individual. Underweight (13%), wasting (4%), and stunting (33%) were common. Reported drought was associated with underweight (marginal risk ratio (RR) = 1.18, 95% confidence interval (CI): 1.04, 1.35) in adjusted analyses. Positive annual deviations (greater rainfall) from long-term precipitation trends were protective against underweight (marginal RR per 50-mm increase = 0.94, 95% CI: 0.92, 0.97) and wasting (marginal RR per 50-mm increase = 0.93, 95% CI: 0.87, 0.98) but not stunting (marginal RR per 50-mm increase = 1.00, 95% CI: 0.98, 1.01). Precipitation was associated with measures of acute but not chronic malnutrition using both objective and subjective measures of exposure. Sudden reductions in rainfall are likely to have acute adverse effects on child nutritional status.

Composite Index of Anthropometric Failure (CIAF) among Sonowal Kachari tribal preschool children of flood effected region of Assam, India

Undernutrition is considered to be a serious public health problem in most of the developing countries. Globally, the anthropometric measures are widely used to estimate the magnitude of undernutrition in children. The Composite Index of Anthropometric Failure (CIAF) provides the overall magnitude of undernutrition as an aggregate single measure over the conventional anthropometric indices and helps in identification of single or double or multiple anthropometric failures in preschool children. The present investigation assesses the age-sex specific prevalence of undernutrition using both conventional anthropometric measures and CIAF among Sonowal Kachari tribal preschool children of Assam, India. This cross-sectional investigation was carried out among 362 (162 boys and 190 girls) Sonowal Kachari tribal children younger than 5 years of flood affected regions of Lakhimpur district of Assam, India. Anthropometric measurements of height and weight were measured using standard procedures. Age-sex specific Z-score value of weight-for-age, height-for-age and weight-for-height were calculated by using WHO-Anthro, v. 3.2.2. A child Z-score <−2.00 of any anthropometric indices was considered to be undernourished and the standard CIAF classification was used to calculate the prevalence of undernutrition. The overall prevalence of wasting, underweight, stunting and CIAF was observed to be 11.6%, 22.9%, 36.2%, and 48.6%, respectively. The sex-specific prevalence of wasting (15.8% vs. 6.9%), underweight (30.5% vs. 14.5%) and stunting (42.1% vs. 29.6%) observed to be significantly higher among girls than boys (p<0.05). The girls (61.05%) were found to be more affected than boys (34.9%) by CIAF (p<0.01). The present investigation reported higher magnitude of undernutrition using CIAF over conventional anthropometric measures, hence the CIAF is relatively better indicator that reflects higher magnitude of undernourishment as compared to any conventional anthropometric indices in children. This research investigation has also reinforced the importance of appropriate intervention programme and strategies needed to reduce the prevalence of undernutrition in childhood and in population as a whole.

Scientific evidence on natural disasters and health emergency and disaster risk management in Asian rural-based area

INTRODUCTION

Disaster epidemiological studies indicate that Asia has the highest frequency of natural disasters. Rural communities are heavily impacted by natural disasters and have different healthcare needs to urban ones. Referencing Asian countries, this paper's objective is to provide an overview of health impacts and the current evidence for designing programmes and policies related to rural health emergency and disaster risk management (health-EDRM).

SOURCES OF DATA

This paper uses published English-only reports and papers retrieved from PubMed, Google Scholar, Embase, Medline and PsycINFO on rural disaster and emergency responses and relief, health impact and disease patterns in Asia (January 2000-January 2018).

AREAS OF AGREEMENT

Earthquakes are the most studied natural disasters in rural communities. The medical burden and health needs of rural communities were most commonly reported among populations of extreme age. Most of the existing research evidence for rural interventions was reported in China. There lacks published peer-reviewed reports of programme impacts on personal and community preparedness.

AREAS OF CONTROVERSY

There is a lack of evidence-based health-EDRM interventions to evaluate implementation effectiveness in rural areas despite vast volumes of health-related disaster literature.

GROWING POINTS

Climate change-related disasters are increasing in frequency and severity. Evidence is needed for disaster risk reduction interventions to address the health risks specific to rural populations.

AREAS TIMELY FOR DEVELOPING RESEARCH

To support global policy development, urgent evidence is needed on the intervention effectiveness, long-term health outcomes, local and cultural relevance as well as sustainability of health relief produced by Health-EDRM programmes in rural areas.

The long-term physical and psychological health impacts of flooding: A systematic mapping

BACKGROUND

Flooding has caused significant and wide ranging long-term health impacts for affected populations. However, until now, the long-term health outcomes, epidemiological trends and specific impact factors of flooding had not been identified. In this study, the relevant literature was systematically mapped to create the first synthesis of the evidence of the long-term health impacts of flooding.

METHODS

The systematic mapping method was used to collect and categorize all the relevant literature. A study was included if it had a description or measurement of health impacts over six months after flooding. The search was limited to peer reviewed articles and grey literature written in English, published from 1996 to 2016.

RESULTS

A total of 56 critical articles were extracted for the final map, including 5 qualitative and 51 quantitative studies. Most long-term studies investigated the psychological impacts of flooding, including PTSD, depression, anxiety, psychiatric disorders, sleep disorder and suicide. Others investigated the physiological impacts, including health-related quality of life, acute myocardial infarction, chronic diseases, and malnutrition. Social support was proved to be protective factors that can improve health outcomes in the long-term after flooding. To date, there have been relatively few reviews had focused on the long-term health impacts of flooding. This study coded and catalogued the existing evidence across a wide range of variables and described the long-term health consequences within a conceptual map.

DISCUSSION AND CONCLUSIONS

Although there was no boundary between the short-term and the long-term impacts of flooding, the identified health outcomes in this systematic mapping could be used to define long-term health impacts. The studies showed that the prevalence of psychological diseases had a reversed increasing trend occurred even in the long-term in relatively poor post-flooding environments. Further cohort or longitudinal research focused on disability, chronic diseases, relocation population, and social interventions after flooding, are urgently required.

Climate Change-Related Water Disasters' Impact on Population Health

PURPOSE

Rising global temperatures have resulted in an increased frequency and severity of cyclones, hurricanes, and flooding in many parts of the world. These climate change-related water disasters (CCRWDs) have a devastating impact on communities and the health of residents. Clinicians and policymakers require a substantive body of evidence on which to base planning, prevention, and disaster response to these events. The purpose of this study was to conduct a systematic review of the literature concerning the impact of CCRWDs on public health in order to identify factors in these events that are amenable to preparedness and mitigation. Ultimately, this evidence could be used by nurses to advocate for greater preparedness initiatives and inform national and international disaster policy.

DESIGN AND METHODS

A systematic literature review of publications identified through a comprehensive search of five relevant databases (PubMed, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, Scopus, and Web of Science) was conducted using a modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach in January 2017 to describe major themes and associated factors of the impact of CCRWDs on population health.

FINDINGS

Three major themes emerged: environmental disruption resulting in exposure to toxins, population susceptibility, and health systems infrastructure (failure to plan-prepare-mitigate, inadequate response, and lack of infrastructure). Direct health impact was characterized by four major categories: weather-related morbidity and mortality, waterborne diseases/water-related illness, vector-borne and zoonotic diseases, and psychiatric/mental health effects. Scope and duration of the event are factors that exacerbate the impact of CCRWDs. Discussion of specific factors amenable to mitigation was limited. Flooding as an event was overrepresented in this analysis (60%), and the majority of the research reviewed was conducted in high-income or upper middle-/high-income countries (62%), despite the fact that low-income countries bear a disproportionate share of the burden on morbidity and mortality from CCRWDs.

CONCLUSIONS

Empirical evidence related to CCRWDs is predominately descriptive in nature, characterizing the cascade of climatic shifts leading to major environmental disruption and exposure to toxins, and their resultant morbidity and mortality. There is inadequate representation of research exploring potentially modifiable factors associated with CCRWDs and their impact on population health. This review lays the foundation for a wide array of further areas of analysis to explore the negative health impacts of CCRWDs and for nurses to take a leadership role in identifying and advocating for evidence-based policies to plan, prevent, or mitigate these effects.

CLINICAL RELEVANCE

Nurses comprise the largest global healthcare workforce and are in a position to advocate for disaster preparedness for CCRWDs, develop more robust environmental health policies, and work towards mitigating exposure to environmental toxins that may threaten human health.

Nutrition interventions for children aged less than 5 years following natural disasters: a systematic review

OBJECTIVES

The objective of this paper was to review various nutritional interventions targeted at under-five children in countries that had suffered from natural disasters and to analyse their effect on nutrition-related outcomes.

DESIGN

Systematic review.

SETTING

Countries that had suffered from natural disasters.

PARTICIPANTS

Children aged <5 years who were given any nutritional intervention to improve overall nutritional status after a natural disaster.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary nutrition-related outcomes were stunting, wasting and underweight. The secondary nutrition-related outcome was anaemia.

RESULTS

Of the 1218 studies that the reviewers agreed on, five matched the inclusion criteria and were included in this narrative synthesis. Four studies were longitudinal and one was cross-sectional in design. Food supplementation was an integral part of nutritional interventions in all the included studies. The most consistent nutritional outcome in all five included studies was reduced prevalence of wasting, followed by reduced prevalence of underweight in four, stunting in three and anaemia in one of the five included studies. The largest reduction in the prevalence of wasting and underweight was reported by the study in Sri Lanka. Overall, the quality of evidence ranged from moderate to weak.

CONCLUSIONS

Integrated nutrition interventions using locally available health resources yielded the best results. However, sound evidence on the most effective interventions is still lacking. Intervention studies with comparison groups are necessary to obtain more robust evidence on the effectiveness of nutrition interventions.

Looking upstream: enhancers of child nutritional status in post-flood rural settings

Background. Child undernutrition and flooding are highly prevalent public health issues in many developing countries, yet we have little understanding of preventive strategies for effective coping in these circumstances. Education has been recently highlighted as key to reduce the societal impacts of extreme weather events under climate change, but there is a lack of studies assessing to what extent parental education may prevent post-flood child undernutrition. Methods and Materials. One year after large floods in 2008, we conducted a two-stage cluster population-based survey of 6-59 months children inhabiting flooded and non-flooded communities of Jagatsinghpur district, Odisha (India), and collected anthropometric measurements on children along with child, parental and household level variables through face-to-face interviews. Using multivariate logistic regression models, we examined separately the effect of maternal and paternal education and other risk factors (mainly income, socio-demographic, and child and mother variables) on stunting and wasting in children from households inhabiting recurrently flooded communities (2006 and 2008; n = 299). As a comparison, separate analyses on children in non-flooded communities were carried out (n = 385). All analyses were adjusted by income as additional robustness check. Results. Overall, fathers with at least completed middle education (up to 14 years of age and compulsory in India) had an advantage in protecting their children from child wasting and stunting. For child stunting, the clearest result was a 100-200% lower prevalence associated with at least paternal secondary schooling (compared to no schooling) in flooded-areas. Again, only in flooded communities, an increase in per capita annual household income of 1,000 rupees was associated to a 4.7-4.9% lower prevalence of child stunting. For child wasting in flooded areas, delayed motherhood was associated to better nutritional outcomes (3.4% lower prevalence per year). In flooded communities, households dedicated to activities other than agriculture, a 50-51% lower prevalence of child wasting was estimated, suggesting farmers and fishermen as the most vulnerable livelihoods under flooding. In flooded areas, lower rank castes were at higher odds of both child wasting and stunting. Conclusions. In the short-term, protracted nutritional response in the aftermath of floods should be urgently implemented and target agricultural livelihoods and low-rank castes. Education promotion and schooling up to 14 years should have positive impacts on improving children nutritional health in the long run, especially under flooding. Policies effectively helping sustainable livelihood economic development and delayed motherhood are also recommended.