Nature vs. nurture: parental care cushions agricultural drought impacts on child health in South Africa.

This study investigates the spatiotemporal trends of drought and its impact on child health in South Africa, focusing on low birth weight (LBW) and severe acute malnutrition in children under five. We collected data on child health indicators (LBW and malnutrition) and social determinants, including orphan status, child food poverty, proximity to clinics, water access, and sanitation access, from the Children's Institute at the University of Cape Town. Environmental data, comprising the Normalised Difference Vegetation Index (NDVI), Standardised Precipitation Evapotranspiration Index (SPEI), and maximum temperatures, were retrieved from MODIS, Global SPEI, and TerraClimate datasets, covering 2002 to 2022. We then fitted a series of linear regressions and combined them into a structural equation model to explore relationships between socio-environmental factors and child health outcomes. Results indicate that the Northern Cape, Western Cape, and Free State are highly vulnerable to agricultural drought, with NDVI showing a strong negative association with LBW and malnutrition. Orphan status emerged as a stronger predictor of malnutrition than drought. The impact of orphan status on malnutrition level is mediated by limited access to basic services such as water and sanitation. Proximity to clinics significantly influenced access to basic services, highlighting a double burden of healthcare and environmental deprivations. These findings expose the need for targeted interventions to enhance food security, water, and sanitation access, particularly for orphaned children, and to integrate drought mitigation into child health policies in South Africa.