The Association Between Heat Stress and Child Stunting, Wasting, and Underweight Under Varying Vegetation Covers in Ethiopia.

Climate change has significantly contributed to rising malnutrition rates, particularly in low- and middle-income countries. However, evidence linking heat stress to child nutritional status remains limited. This study estimated the association between heat stress exposure and severe stunting, wasting and underweight among rural children across areas with varying vegetation density. We used data from Ethiopia's Food and Nutrition Strategy Baseline Survey, a population-based cross-sectional study conducted between 2021 and 2023. Our study population included a total of 7166 children aged 0-59 months. We estimated environmental exposures to heat stress and green areas using satellite-based data on Universal Thermal Climate Index (UTCI) and the Normalized Difference Vegetation Index (NDVI). We used multilevel logistic regression models to assess associations between heat stress and severe stunting, wasting and underweight, adjusting for child age, maternal education, family size, and household wealth. About 23% of children (n = 1541) were severely stunted, 5.4% (n = 443) were identified with severe wasting and 8.4% (n = 761) with severe underweight. Among children living in low-vegetation areas (NDVI < 0.44), exposure to heat stress was associated with higher odds of severe wasting (AOR = 1.63, 95% CI = 1.06-2.51) and severe underweight (AOR = 1.63, 95% CI = 1.20-2.22) compared with children not exposed to thermal heat stress conditions. Conversely, in areas of moderate-to-high vegetation covers (NDVI ≥ 0.44), heat stress was associated with a 28% decrease in odds of severe stunting (AOR = 0.72, 95% CI = 0.52-0.99). Our findings call on policymakers to implement climate-resilient agriculture, and enhance social protection to safeguard livelihoods and food systems in vulnerable, low-resource settings.