Rainfall and long-term water availability in a region before a woman becomes pregnant and during pregnancy predicted future growth outcomes of children in Uganda, according to new research led by a team from the Penn State Health Milton S. Hershey Medical Center and the Penn State College of Medicine.
Women living in an area that did not receive adequate rainfall or experienced drought were more likely to give birth to children who don’t grow at the expected rate for their age between birth and age 5. Children who are undernourished and behind in their growth are more susceptible to infections and may experience cognitive, physical, and metabolic developmental impairments.
These environmental factors, like rainfall, influence the availability of food, the researchers said, which, in turn, can affect a woman’s nutritional status before and during pregnancy. If a mother doesn’t eat enough or is undernourished, the effect can be passed on to her childâthe child may be born at a low birth weight or experience growth faltering.
The findings, published in the journal JAMA Network Open, could help inform the design of precision public health programs to improve women’s nutrition and children’s nutritional outcomes at birth and later in life.
“This is the first paper to tease out longer-term weather dynamics and how they may affect child nutrition status,” said Paddy Ssentongo, infectious disease fellow at Penn State Health Milton S. Hershey Medical Center and lead author of the study. “If a child is born within a specific time period, in a specific environment and under specific conditions, we are able to predict whether or not they would be malnourished.”
Children who falter in their growthâthose who experience stunting, where their height is significantly below the average for their age, or wasting, where they are too thin for their heightâoften show signs at or shortly after birth. Stunting is a long-term response to poor dietary intake or repeated illness, while wasting can be an acute response to undernutrition.
Previous research on risk factors for malnutrition has focused on economic status and food availability. However, few studies have looked at why people in countries like Uganda, which have environments conducive to agriculture, experience undernutrition. Did environmental factors such as rainfall, drought, temperature, and the land’s topography influence the risk of malnutrition in children?
The team set out to understand the prevalence of malnutrition among children in Uganda and how environmental factors affected the risk of malnutrition. Ssentongo explained that Uganda served as a good representative for Sub-Saharan Africa as well as for low- and middle-income countries. It also served as an example of areas within high-income countries where food isn’t easily accessible.
Using the 2016 Ugandan Demographic and Health Survey, they analyzed data on weight and length or height for more than 5,200 children between birth and just under 5 years old. The researchers assessed each child according to growth curves from the World Health Organization to determine how each child compared to the average for their age.
They found that more than 30% of children had stunting, which translates to an estimated 2.2 million of the 7.2 million children under the age of 5. Over 12% of children were underweight, and nearly 4% had wasting, indicating a failure to gain weight or severe weight loss. The incidence of stunting was particularly high in the northeastern and western regions of the country, where 40% of children under 5 years old were short for their age.
The team then examined the relationship between meteorological and environmental factors and childhood malnutrition outcomes. Using data from the National Oceanic and Atmospheric Administration and NASA, they looked at factors such as rainfall, temperature, and drought at a village level, from 12 months before the child’s birth to when they were born.
“With this data, we were able to look at the long-term effect of weather and capture periods of drought, not just whether it rained today,” Ssentongo said.
The team mapped the children to their geographical location, down to a 1 kilometer by 1 kilometer scale. They found that if a mother lived in a location with higher rainfall 11 months before birthâor up to two months before conceptionâher child had a lower risk of being malnourished. Conversely, if a mother lived in a location that experienced drought three months before birth, her child had a higher risk of malnutrition.
The researchers also noted that they expected to find that areas of higher poverty were associated with poor growth outcomes, but they didn’t find such a link.
“It’s often assumed that socioeconomic status is a primary driver of malnutrition due to limited access to nutritious food, but our analysis suggests that there are other actionable factors at play,” Ssentongo said.
Understanding how these environmental factors influence nutrition and growth outcomes in children and the spatial distribution of these outcomes can help inform the design of more cost-effective and precise public health programs, the researchers explained. In addition to sending food aid to regions of a country that have the highest burden of malnutrition, public health officials could also identify areas that are struggling with water availability.
“We can prevent kids from being malnourished from day one or even before they are born,” Ssentongo said. “We can make water available through irrigation or provide ‘smart seeds,’ which can still grow in harsh and water-poor environments. By doing this even before the babies are born, we are setting up mothers for success, pregnancies for success, and these babies will be born healthy.”
More information:
Paddy Ssentongo et al, Preconception and Prenatal Environment and Growth Faltering Among Children in Uganda, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2025.1122. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831699
Provided by Pennsylvania State University. (http://www.psu.edu/)
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