Floods and droughts and pediatric malnutrition in low-income countries: a systematic review and meta-analysis.

BACKGROUND: This study systematically reviewed and meta-analyzed the prevalence and risk of child malnutrition following extreme weather events in low- and lower-middle-income countries. METHODS: We searched PubMed, EMBASE, and Cochrane Library for studies assessing child stunting, wasting, underweight, or overweight/obesity after extreme weather events. Random-effects models were used to pool prevalence and association estimates, with subgroup and sensitivity analyses by event type. Risk of bias was assessed using tools appropriate to study design. RESULTS: Twenty-six studies, including over 320,000 children met the inclusion criteria, focusing exclusively on floods and/or droughts; none addressed overweight/obesity. The pooled prevalence of stunting, wasting, and underweight following extreme weather events was 39% (95% CI: 31-48%), 19% (95% CI: 12-28%), and 42% (95% CI: 22-64%), respectively. Wasting prevalence was higher after droughts than floods (22% vs. 13%, p = 0.04), while stunting did not differ by event type (p = 0.68). Meta-analyses revealed no significant long-term association between extreme weather events and stunting, though a transient increase in risk was observed within three months of flood exposure. CONCLUSIONS: Child malnutrition remains highly prevalent in these settings. The complex climate-malnutrition link underscores the need for standardized exposure definitions and robust nutritional surveillance. IMPACT: This meta-analysis provides the first pooled prevalence estimates of wasting, stunting, and underweight after droughts and floods-19%, 39%, and 42%, respectively. Wasting was significantly higher following droughts than floods, suggesting possible climate- and geography-specific nutritional associations. Evidence linking extreme weather events to pediatric malnutrition in low- and lower-middle-income countries remains limited and inconsistent. Findings highlight major research gaps and the need for standardized definitions, baseline data, and climate-resilient nutrition strategies.