Climatic conditions and child height: Sex-specific vulnerability and the protective effects of sanitation and food markets in Nepal.

Environmental conditions in early life are known to have impacts on later health outcomes, but causal mechanisms and potential remedies have been difficult to discern. This paper uses the Nepal Demographic and Health Surveys of 2006 and 2011, combined with earlier NASA satellite observations of variation in the Normalized Difference Vegetation Index (NDVI) at each child's location and time of birth to identify the trimesters of gestation and periods of infancy when climate variation is linked to attained height later in life. We find significant differences by sex: males are most affected by conditions in their second trimester of gestation, and females in the first three months after birth. Each 100-point difference in NDVI at those times is associated with a difference in height-for-age z-score (HAZ) measured at age 12-59 months of 0.088 for boys and 0.054 for girls, an effect size similar to that of moving within the distribution of household wealth by close to one quintile for boys and one decile for girls. The entire seasonal change in NDVI from peak to trough is approximately 200-300 points during the 2000-2011 study period, implying a seasonal effect on HAZ similar to one to three quintiles of household wealth. This effect is observed only in households without toilets; in households with toilets, there is no seasonal fluctuation, implying protection against climatic conditions that facilitate disease transmission. We also use data from the Nepal Living Standards Surveys on district-level agricultural production and marketing, and find a climate effect on child growth only in districts where households' food consumption derives primarily from their own production. Robustness tests find no evidence of selection effects, and placebo regression results reveal no significant artefactual correlations. The timing and sex-specificity of climatic effects are consistent with previous studies, while the protective effects of household sanitation and food markets are novel indications of mechanisms by which households can gain resilience against adverse climatic conditions.