摘要：Objectives. To examine an association between climate variability and birth weight in Mali and Kenya in relation to the local agricultural specialization. Methods. We combined health and sociodemographic data from the Demographic Health Surveys for Kenya (2008 and 2014) and Mali (2006 and 2012) with detailed data on precipitation, temperature, and vegetation. We analyzed the association between climate variability and birth weight by using multilevel regression models for the most common agricultural specializations: food cropping, cash cropping, and pastoralism. Results. There are differences in sensitivity to climate among different agricultural communities. An additional 100 millimeters of rainfall during the 12-month period before birth was associated with a 47-gram ( P = .001) and 89-gram ( P = .10) increase in birth weight for food croppers in Kenya and Mali, respectively. Every additional hot month in food-cropping communities in Kenya was associated with a 71-gram decrease in birth weight ( P = .030), likely because of food croppers’ limited use of modern agricultural techniques. Overall, cash croppers are least sensitive to climate variability in both countries. Conclusions. Effective climate change adaptation strategies are essential for protecting and improving health outcomes and should be tailored to local households’ livelihood strategies. Climate change manifests itself differently depending on the location: for example, North Africa is predicted to experience a decrease in rainfall by the end of the 21st century, whereas increased rainfall is predicted for the mountainous areas of East Africa. 1 As a consequence, the effects of climate change are not uniform and depend on the local geographic and socioeconomic context. 2 Although most of the studies of the climate change–health nexus are conducted at specific sites or at the level of entire countries, it is important to use a spatially detailed approach and consider how the observed effects vary depending on the local economic and demographic backgrounds. 3,4 Sub-Saharan Africa (SSA) is particularly vulnerable to the adverse effects of climate change because of its low adaptive capacity and geographic characteristics. The combined burden of climate change and poor health outcomes potentially hinder the ability of African nations to foster human and economic development. Undernutrition and poor child growth account for 11% of annual gross domestic product losses in Africa. 5 In 2016, one third of children younger than 5 years in Africa experienced stunted growth. 5 Within SSA, Kenya and Mali have demonstrated stalled progress in improving child health as the percentage of children with low birth weight (LBW; < 2.5 kg World Health Organization standard) 6 has risen in recent years. 7,8 Poverty and rapid population growth 9,10 coupled with climate variability suggest that a large number of children are and will continue to be born into households with undermined food and economic security, having an impact on both immediate and later-life health and well-being. This study builds on previous research of climate, food insecurity, and infant health and adds a unique perspective by investigating the responses to variable rainfall and temperature—short-term consequences of climate change—among communities specializing in distinct types of agricultural production in Kenya and Mali. We combined cross-sectional health surveys and environmental and agricultural specialization data, and employed a multilevel analytic framework to investigate associations among climate change, agricultural specialization, and birth weight in these 2 climatically vulnerable countries.
