School-aged children and adolescents face significant nutritional challenges in sub-Saharan Africa yet remain understudied compared to under-five populations. Climate variability increasingly threatens food security in rural communities, but evidence on climate-nutrition relationships beyond early childhood is limited. We investigated associations between hydro-climatic anomalies, livelihood strategies, demographic characteristics, and thinness among school-aged children and adolescents on the slopes and surrounding plains of Mount Meru, northern Tanzania. We analysed five waves of anthropometric data from 26,009 records of children and adolescents aged 6–18 years attending 18 public primary schools in the Mount Meru ecosystem between 2010 and 2015. Thinness was defined as BMI-for-age Z-score < -2 using the World Health Organisation (WHO) 2007 growth references. Bayesian logistic mixed-effects models were used with school-level and temporal random effects to examine associations of thinness with sex, age, dominant livelihood (farming, agropastoralism, pastoralism), and standardized anomalies in precipitation, evapotranspiration, and land-surface temperature. Overall thinness prevalence ranged from 61.2% in 2010 to 72.7% in 2015. Girls had lower odds of undernutrition than boys (odds ratio OR: 0.58, 95% credible interval CrI: 0.54–0.61), but age-sex interactions revealed complex developmental patterns. Girls showed peak vulnerability at age 12 years followed by sharp decline, while boys demonstrated more sustained risk through mid-adolescence. Children and adolescents from pastoralist communities had substantially higher undernutrition odds compared to farming communities (OR: 2.21, 95%CrI: 1.31–3.50). Above-normal precipitation was protective (OR: 0.34, 95% CrI: 0.20–0.54), while elevated evapotranspiration increased the odds of thinness (OR: 2.18, 95%CrI: 1.41–3.24). The odds of thinness among school-age children and adolescents vary substantially by livelihood strategy and respond dynamically to hydro-climatic anomalies. Age- and sex-specific vulnerability patterns reveal critical windows requiring targeted interventions. Evapotranspiration emerged as a particularly informative climate indicator for nutritional surveillance. These findings support integrating climate monitoring into school-based nutrition programs and developing livelihood-specific adaptation strategies for climate-vulnerable communities.
Ceppi et al. (Mon,) studied this question.
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