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. 2025 Mar 18;9(1):e002980. doi: 10.1136/bmjpo-2024-002980

The impact of climate change on child nutrition in Indonesia: a conceptual framework and scoping review of the available evidence

David Colozza 1,✉, Isabella Guo 1,2, Sri Wahyuni Sukotjo 1, Astrid Citra Padmita 1, Rene Gerard Galera 3, Endang Sulastri 4, Inti Wikanestri 4, Mamadou Ndiaye 1
PMCID: PMC11927459  PMID: 40102021

Abstract

Background

Climate change is expected to significantly impact child nutrition, worsening global health inequities. Indonesia, a country highly vulnerable to climate change, also faces substantial child malnutrition challenges. However, comprehensive knowledge on climate change’s impacts on child nutrition in Indonesia is limited. This study addresses this gap through a scoping review of the scientific evidence on the effects of climate change on child nutrition in Indonesia.

Methods

We developed a conceptual framework based on global literature to guide our systematic search, linking climate change to child nutrition and its determinants in Indonesia. Systematic searches were conducted in English and Indonesian on Scopus, Web of Science and PubMed, supplemented by Google Scholar and citation screening. We included peer-reviewed, Scopus-indexed studies focused on Indonesia, examining either direct or indirect impacts of climate change on child nutrition. A narrative synthesis was performed, structured around outcomes identified in our framework: (1) nutrition-associated conditions, (2) diets and disease, (3) social dynamics and (4) food system shocks.

Results

From 3025 records, 134 studies met the inclusion criteria. Studies were either multicountry including Indonesia (23%, n=31), Indonesia-specific across multiple regions (26%, n=35) or region-specific, mainly focused on Java (22%, n=29), Sumatra (11%, n=14), Kalimantan (7%, n=9) and Sulawesi (7%, n=9). Other regions were under-represented (5%, n=7). Most studies used quantitative methods (87%, n=116). Few studies assessed direct links between climate change and nutritional outcomes (n=5), food security or dietary quality (n=7); more focused on indirect pathways such as disease (n=49), social dynamics (n=18) and food system disruptions (n=55).

Conclusions

Evidence suggests significant impacts of climate change on child nutrition in Indonesia, highlighting the need for urgent action. Further localised studies that consider contextual factors, and actions focused on strengthening health and nutrition systems, are critical, especially in regions most vulnerable to both climate change and child malnutrition.

Keywords: Child Health, Low and Middle Income Countries

WHAT IS ALREADY KNOWN ON THIS TOPIC

  • Climate change impacts child nutrition through multiple pathways.

  • Indonesia is highly vulnerable to climate change and child malnutrition.

WHAT THIS STUDY ADDS

  • A synthesis of evidence on climate change’s impacts on child malnutrition in Indonesia.

  • A framework to assess climate change’s impacts on child nutrition in other regions.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • Climate change undermines child nutrition in Indonesia, highlighting the urgent need to climate-proof policies, local food and health systems.

Introduction

Child malnutrition remains a pressing concern in Indonesia. Child stunting and wasting persist at alarming rates1; meanwhile, overweight, obesity and non-communicable diseases (NCDs) are on the rise,2 making Indonesia one of the largest nations grappling with a triple burden of malnutrition.3 Food insecurity also remains concerning, with up to 14.5% of households affected in the most disadvantaged provinces.4 Poor diets are widespread among Indonesian children. Only 60% of children aged 6–23 months achieve minimum dietary diversity,5 and less than 40% consume a minimum acceptable diet,6 while over 95% of school-age children and adolescents do not meet the recommended daily fruit and vegetable intake.2

Climate change is expected to further exacerbate these challenges, putting millions of people at increased risk of malnutrition and food insecurity,7 further amplifying existing global health inequities.8 Estimates for Indonesia indicate uncertain rainfall pattern shifts, owing to the diverse topographies and climates across the country’s 17 500 islands; however, they consistently predict warming temperature trends, under both business-as-usual and mitigation scenarios.9 Moreover, Indonesia ranks high among countries at risk of climate-related disasters, including floods, cyclones, sea-level rise, droughts and heatwaves. A growing number of people, particularly vulnerable populations, including children, are expected to suffer from these hazards and the related rise in malnutrition and food insecurity.9

Despite the growing evidence of the negative impacts of climate change on child malnutrition,10 11 a comprehensive understanding of the scientific evidence available for Indonesia is lacking. This review seeks to fill this critical knowledge gap, by addressing two questions: (1) what is the current state of the scientific knowledge regarding climate change’s impacts on child nutrition in Indonesia? and (2) what are the main evidence gaps in terms of impact pathways, and of geographical disparities across the country?

Methods

Search strategy and selection criteria

We searched Scopus, Web of Science and PubMed to conduct a scoping review of the literature on climate change impacts on child nutrition in Indonesia. Due to the expected scarcity of country-specific evidence, we also searched Google Scholar and screened citations from the articles included in the review. Searches were conducted on 10 July 2023 and again on 20 December 2023 to capture any relevant studies published in the meantime.

We included studies examining either the direct impact of climate change—such as altered rainfall patterns, rising temperatures and extreme weather events—on nutrition-associated conditions, or its indirect impact through underlying determinants: diets, food security, non-diet-related diseases, socioeconomic shocks and food system disruptions. The theoretical framework underlying the search strategy, analysis and presentation of results (figure 1) was developed based on the global literature on climate change and nutrition,812,16 and on existing food security and nutrition frameworks.17 18

Figure 1. Theoretical framework highlighting the impacts of climate change on food security and nutrition. Climate change impacts nutritional status (the utilisation dimension of food security) directly, via increased risk of nutrition-associated disease, and indirectly, via negative effects on diets and on other communicable and non-diet-related disease (corresponding to the ‘food’ and ‘feeding practices’ underlying determinants in the UNICEF framework). Additionally, climate change affects nutritional status indirectly, via socio-economic shocks and disruptions to food systems (the ‘environment’ underlying determinant in the UNICEF framework), that threaten the accessibility, availability and stability dimensions of food security.

Figure 1

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We included studies focused on Indonesia (or its subregions) and multicountry studies that provided disaggregated findings for Indonesia. Searches were conducted in both English and Indonesian, with no restrictions on year or methodology. For quality assurance, only peer-reviewed studies published in Scopus-indexed journals were included. We excluded articles that did not examine the effect of climate change on relevant nutrition outcomes or underlying determinants (eg, studies on changing rainfall patterns without links to the implications for food production or livelihoods), those focused on climate change adaptation or mitigation, laboratory experiments, policy/legal reviews, conference proceedings and opinion pieces. The full search strategy is detailed in the online supplemental materials. Two reviewers (DC and IG) assessed independently articles retrieved against the set inclusion criteria. Discrepancies were resolved through multiple rounds of discussion between the two coders. Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.

Data analysis

We exported results to JabRef (V.5.8) for initial data cleaning and duplicate removal, then transferred them to a predesigned MS Excel (V.16.7) form, capturing source, title, authors, journal, year, full citation and abstract. After screening records against inclusion criteria, we added further details to the shortlisted articles for coding: geographic scope, exposure (climate change component), outcome (nutrition or underlying determinant), methods and link to the theoretical framework. Given the review’s scoping nature, and the consequent diverse focus and methodology of included studies, a meta-analysis was not feasible. Instead, we provide a narrative synthesis organised across the outcomes outlined in our framework: (1) nutrition-associated conditions, (2) diets and disease, (3) social dynamics and (4) food systems shocks.

Patient and public involvement

No patient involved.

Results

Descriptive characteristics of the studies included

We retrieved 3025 records for screening based on the inclusion criteria. After removing 657 duplicates and 557 records using automated tools (eg, conference papers and abstracts), 1811 records remained for eligibility assessment based on title and abstract, resulting in 136 records for full-text screening. Of these, 18 studies were excluded, 14 were added through citation searching, and 2 more from searches conducted in December 2023, totalling 134 studies included in the review (figure 2).

Figure 2. PRISMA flowchart of records retrieval and selection based on inclusion criteria. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

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Selected articles span the period 1999–2023 and show a growing trend over time, with about half (49%, n=66) published between 2020 and 2023, and about one-third (32%, n=43) between 2015 and 2019. Half of the studies are multicountry studies also including Indonesia (23%, n=31) or Indonesia-specific studies covering multiple regions (26%, n=35). The remaining studies are region-specific, and mostly focus on Java (22%, n=29), followed by Sumatra (11%, n=14), Kalimantan (7%, n=9) and Sulawesi (7%, n=9), with fewer on East/West Nusa Tenggara, Bali (2 each) and Papua (1). Most studies use quantitative methods (87%, n=116).

Regarding exposure, most studies (72%, n=96) examine climate variables, with 62% (n=83) assessing multiple variables, and others focusing on temperature (7%, n=9) and rainfall (3%, n=4). Extreme events like droughts, floods, tsunamis, landslides and fires are the second most studied (14%, n=18), while two studies each cover sea-level rise and coral bleaching. The remaining studies (13%, n=17) assess combined climate, environmental and socioeconomic factors.

Analysis of findings

Direct impacts on nutrition-related diseases

Evidence directly linking climate change with nutrition-associated conditions in Indonesia is limited, with only five of the 134 studies focusing on this connection. Two studies suggest a significant negative impact of delayed monsoon onset and lack of rainfall on child height,19 stunting and wasting.20 This is explained as primarily the effect of decreased agricultural yields, which reduce availability and access to diverse, nutritious foods during drier seasons, impacting child nutrition. Another study examined the effects of a 1998 climate-induced coral bleaching event, finding that children exposed to the event were more likely (29.6%) to be severely stunted than their peers 2 years later, and to fail a grade in school by 2007.21 This was attributed, among others, to income shocks and reduced food availability from marine ecosystem degradation, leading to decreased dietary protein intake.

The remaining two studies projected future impacts of climate change on all forms of malnutrition16 and diet-related NCDs.22 By 2050, Indonesia could face a substantial increase in climate-induced deaths due to underweight (+14.7%), despite a parallel decrease in overweight-related deaths. Additionally, climate-related deaths per capita could rise to an estimated 35 per million (95% CI 6.6, 64.1), primarily due to reduced fruit and vegetable consumption.16 Future projections also suggest that increased days with temperatures above 30°C could significantly impact diet-related NCDs,22 with increases in primary healthcare visits for diabetes (25%), cardiovascular disease (14%) and all causes (8%) from 2060 to 2080, along with an estimated additional annual financial burden of US$ 25 million (IDR 336 billion) from primary healthcare costs under a high-emission scenario.22

Indirect impacts through diets and disease

Several studies (n=56) examined climate change’s impacts on nutrition via two closely related pathways, food security and dietary quality and via non-diet-related diseases.

Diets

Studies on the link between climate change, food security and dietary quality (n=7) overall highlight negative impacts. A study using longitudinal data from 13 provinces suggests that climate shocks such as delays in monsoon onset and higher temperatures led households to skip meals, substitute nutritious foods for less nutritious alternatives or allocate higher household budget shares to food expenditures.23 Similarly, studies conducted in Central Sulawesi province show that drought events led 85% of the farm households surveyed to reduce food expenditures by up to −64%. This resulted in significant declines in both the quality and quantity of foods consumed, with 30% of the households forced to eat less than three meals per day, and all of them reducing consumption of protein-rich foods such as fish and meat.24

Evidence from the provinces of East Nusa Tenggara,25 Central and East Java and Yogyakarta26 also suggests severe impacts from climate change and climate-induced extreme events such as drought and floods across multiple food security dimensions. These include impacts on availability, with reduced crop yields and livestock production, accessibility, with negative effects on farmers’ income, and utilisation, with increased occurrence of infectious disease. A study on the effects of coral bleaching on fisheries-reliant communities across 13 provinces also found a decline in dietary quality, resulting from lower household consumption of protein-rich foods due to reduced incomes.27

Other studies offer qualitative evidence on the impacts of climate change on food security. Research among children aged 10–17 shows that those residing in rural areas reported several perceived threats to their food security and nutritional status, including increased crop failure risk due to drought and water scarcity, migration of their parents and flooding events affecting their houses.28 Meanwhile, a study in Central Sulawesi found significant food security impacts among local coastal communities, with increased coastal erosion and adverse weather conditions reducing availability and access to local indigenous food resources due to limited physical access to fishing and hunting grounds or increased time needed to collect food.29

Disease

A large number of studies (n=49) examined the impact of climate change on communicable and non-diet-related diseases that affect nutrition and food security. These conditions can increase child malnutrition risk through direct effects (eg, diarrhoea limiting nutrient absorption) and indirect effects (eg, reduced appetite and socioeconomic shocks like income loss due to illness). Studies focused on the relationship between climate variables (rainfall, temperature, humidity) or extreme events (floods, droughts, fires) and health conditions suggest significant potential negative impacts.30

Several studies explored vector-borne diseases such as dengue/dengue haemorrhagic fever (DHF), malaria and chikungunya. Research consistently shows positive correlations between higher temperatures, rainfall and humidity with increased DHF risk.31,54 However, studies reveal a high degree of heterogeneity, suggesting a nuanced role of local climate conditions.33,3551 55 56 For example, a lack of precipitation in typically high-rainfall areas may heighten DHF risk by creating mosquito breeding grounds, while extreme rainfall might reduce incidence by washing out these grounds. Conversely, in drier areas, high rainfall can increase breeding grounds, while a lack of precipitation might eliminate them. Only one study suggested that lower night temperatures might increase DHF risk, potentially due to increased outdoor activity during cooler nights.52 Future projections of climate change suggest varying impacts on dengue mosquito suitability across Indonesia, with potential increases in Java, Bali, East and West Nusa Tenggara, Sulawesi and inland Papua and declines in parts of Sumatra, Kalimantan and Papua from 2030.38 55

Evidence on malaria also suggests an overall positive association with higher temperatures and increased disease risk,56,60 but more mixed patterns of association with precipitation.58 59 Studies estimating future projections suggest possible suitability increase for malaria across most of the country, based on expected climatic changes between 2050 and 210060; however, the lack of localised climate data limits the possibility to provide accurate estimates, considering the importance of local factors in explaining the association.57 The only study focused on chikungunya found instead weak and mixed patterns of association, attributed to a strong effect of unobserved local climate variables in explaining the association.61

Other studies focused on diarrhoea, showing mixed patterns of association between climate variables and increased disease risk.62,65 However, some offer evidence of increased future risk due to the broader impacts of climate change on extreme weather events, such as flooding, which can increase transmission risk63 and water and sanitation systems.65 A study looking at multiple waterborne diseases came to similar conclusions, suggesting increased future risk due to higher likelihood of floods under Representative Concentration Pathway 4.5 precipitation scenario, estimating a twofold increase in infected people in the study locations (Medan and Surabaya).66 Two studies focused on the association between climate variables and COVID-19, finding weak and mixed links, likely due to strong confounding from other socioeconomic and environmental variables.67 68

Studies looking at heat-related stress also found significant negative impact from climate change on workers’ health—particularly those working outdoors, who are exposed to dangerous temperatures for longer.69 Projections of future heat stress risk also suggest a possible substantial increase in mortality among older people, with an estimated 12–15 times increase in the 2050s compared with the 2010s,70 and a possible increase in all-cause mortality in deforested areas due to increased temperatures.71 Other studies focused on climate change impact on respiratory diseases. One study found that changes in rainfall patterns and land cover, leading to increased occurrence of fires and air pollution, resulted over the past 20 years in a substantial increase in respiratory illnesses (+8.5% during dry years).72 Similarly, others found a strong link between drought-induced fire and air pollution with increased respiratory illness risk, premature death and livelihood impacts via workdays lost.55 73 74

Finally, two studies looked at the impacts of extreme events (specifically landslides) on mental health.75 76 Findings show both short and long-term impacts in affected populations, due to damage to infrastructure and farmland, as well as loss of social and family networks and connections, with severe effects particularly among those who were displaced after the event and those who were living in more precarious housing. Two studies provided qualitative evidence on the perceived effects of climate change across multiple health conditions among 200 respondents in Semarang, Central Java77 and of perceived impacts related specifically to dengue among 400 respondents located in Jakarta.78 Findings highlight how most respondents were aware and had experienced climate change (including changing weather patterns, increased temperatures and higher frequency of extreme events) and perceived potential health impacts in terms of increased disease risk.

Indirect impacts through social dynamics

Other studies (n=18) examined climate-induced socioeconomic shocks that negatively impact child nutrition by reducing the quantity, quality and affordability of food, threatening child care and feeding practices and disrupting access to essential nutrition services. Most studies used multi-indicator indexes to assess various socioeconomic and well-being dimensions, consistently finding adverse effects of climate change on livelihoods in Indonesia through multiple pathways. Communities reliant on agriculture and fisheries are particularly vulnerable, with climate change and extreme events damaging agricultural productivity79,85 and negatively impacting fish stocks and fishing practices, for example, due to increased weather unpredictability,86 87 reduced food availability and employment opportunities,80 88 increased conflict over water resources,79 decreased wages and higher household expenditures, including for food.83 89 Macrolevel studies also highlighted negative impacts on fisheries,90 91 tourism and leisure services91 and increased rice prices,92 alongside increased violence resulting from declining food availability, increased prices,93 water insecurity94 and increased poverty.95 Marginalised communities are disproportionately affected,96 with one study showing that individuals most vulnerable to floods were less likely to relocate to safer areas postevent.97

Indirect impacts through food systems shocks

Another subset of studies (n=55) examined the impact of climate change on child nutrition through disruptions in food systems, focusing on crop production, fisheries or both. Most studies on crop production assessed how climate variables and extreme events affect crop yields, finding significant potential for negative impacts due to increased climate variability and anomalies that directly damage crops and indirectly threaten production.

Many studies focused on rice, suggesting potential negative effects from higher temperatures, delayed monsoon onset, reduced precipitation,98,113 extreme rainfall events,114 drought115,120 and floods,116 121 leading to direct crop damage, reduced suitable growing areas and suboptimal crop growth conditions. While some studies suggest possible yield benefits from higher CO2 levels122 123 and expanded suitable growing areas,101 these may be outweighed by the negative impacts described earlier.101 Additionally, one study noted indirect impacts on rice production due to increased heat stress risk for workers.124

Changing temperatures and rainfall patterns are expected to reduce suitable growing areas for crops like coffee125,128 and oil palm, with projections indicating up to a 47% decline nationwide by 2050,129 and significant reductions in key regions, for example, Kalimantan130 and Sumatra.131 While expansion to new regions could partially offset these suitability declines, it could also lead to increased deforestation.128 129 Similar trends are observed for eucalyptus,132 cashew133 and avocado,133 with reduced suitability due to higher temperatures or wetter conditions.

Several studies highlighted increased crop damage risk from higher climatic suitability for pests and diseases, leading to more frequent outbreaks. Affected crops include rice,134 oil palm,135,137 eucalyptus,132 cocoa,138 mango139 and rubber tree, with mixed associations between temperature and disease type.140 141 Potato blight risk was instead negatively associated with increased temperatures, although with minimal effect size.142 One study noted potential negative impacts on crop wild relatives—an essential resource to ensure future resilience of essential crops and protect communities against food insecurity and malnutrition—predicting significant decreases in their distribution range by 2080, although none is expected to go extinct.143

Qualitative evidence suggested heightened perceptions of climate change’s widespread impacts on Indonesia’s agricultural systems. Rice farmers in Sumatra cited climate change, particularly floods, as a major factor in rice crop failures.144 In Kalimantan, many local rubber farmers reported medium (48%) or high (27.5%) impacts on yields from climate change, including increased rainfall and altered timing. Factors such as increased rainfall quantity, altered timing and extended duration negatively affect their farming activities.145 Similar concerns were raised by vegetable farmers in Java, who noted more frequent pest and disease outbreaks and reduced crop yields.146 Beekeepers across multiple provinces also identified climate-related factors as a significant cause of bee mortality in their operations.147

A small subset of studies focused on climate change impacts on fisheries, forecasting significant disruptions. Indonesia was identified as one of the countries with the largest projected decline in fisheries productivity, up to −20% in maximum catch potential.148 Other studies raised urgent concerns about climate-related damage to local fisheries, with one study ranking Indonesia as the most vulnerable among 27 countries to coral reef fisheries damage,149 and another estimating declines in catch potential of −15.9% on average, and up to −32% in specific sites.150 These findings highlight significant food security concerns. Given that many Indonesian communities depend on fisheries rather than agriculture, potential gains from climate-induced agricultural improvements (eg, increased CO2 fertilisation) may not compensate for losses in the fisheries sector.150 Subregional studies also identified climate-induced changes in season timing as a threat to local ecosystems. For example, projected temperature increases in Sulawesi were found to threaten coral reefs and alter species distributions, impacting local aquaculture productivity,151 while climate-induced changes in Java marine ecosystems were projected to reduce tuna fisheries productivity.152 153

Discussion

We conducted a scoping review of the available scientific evidence on climate change’s impact on child nutrition in Indonesia, identifying 134 relevant articles. Although direct estimates of impacts on nutritional outcomes are limited (n=5), the data show significant negative associations between climate variables, undernutrition, food security and dietary quality. Delayed monsoon onset and rising temperatures were linked to reduced crop yields and decreased access to nutritious diets,19 20 while climate-induced coral bleaching affected the availability and affordability of foods from marine ecosystems.21 27 Future projections also indicate potential mortality increases due to climate-induced underweight, NCDs and reduced fruit and vegetable consumption.16 22 These findings align with global evidence showing negative links between climate change, child undernutrition and food security.10 154 However, no study addressed climate change’s impact on obesity risk, such as through the substitution of healthy foods with unhealthy ultraprocessed foods. While establishing a direct causal link remains challenging, the evidence suggests potentially significant negative impacts on nutrition in Indonesia, especially given the country’s high rates of child undernutrition, food insecurity and the rising burden of obesity and NCDs.3

A larger number of studies highlight the ongoing and projected impacts of climate change on the underlying determinants of child nutrition, via non-diet-related disease, socioeconomic shocks and food system disruptions. In line with global evidence, changing climatic variables are expected to impact future climatic suitability and transmission risk for diseases like dengue,31,54 malaria56,60 and diarrhoea,62,65 although estimates carry substantial uncertainties.155,157 Higher temperatures, wildfires, air pollution and climate-induced extreme events can also increase risk of heat-related stress,69,71 respiratory diseases72,74 and mental disorders.75 76 These issues not only harm individual health directly but can also lead to income loss and worsened living conditions, thereby affecting child nutrition indirectly. Indonesia’s high vulnerability to fires,158 pollution and environmental challenges,159 and lack of mental healthcare services160 will likely aggravate these effects.

Findings also suggest that climate change can significantly impact child nutrition indirectly, through socioeconomic shocks that undermine availability and access to adequate food and care practices. Within communities, data suggest widespread harm to livelihoods, through damage to agricultural production and fisheries,79,88 increased conflict risk,79 93 declining incomes83 89 and increased labour needs, with potentially significant impacts on children’s nutritional health, childcare and feeding practices, and essential nutrition services. Nationally, evidence suggests substantial economic losses in the agriculture, fishery and tourism sectors90,92 and impacts on food prices,92 93 poverty95 and other socioeconomic indicators. Evidence also suggests that these impacts will disproportionately affect communities that are already marginalised,96 97 for example, due to socioeconomic status or geography, highlighting how, in Indonesia, climate change will likely widen further existing health inequities.8

A last set of studies focused on the impacts of climate change on food systems. Research on food system disruptions focuses primarily on production—most frequently of rice,98100,124 but also other crops like coffee125,128 and oil palm129,131135—suggesting substantial direct and indirect damage (eg, from increased pest and disease outbreak frequency) and consequent heightened malnutrition risk. Studies on fisheries similarly predict productivity declines,148,153 with significant nutrition implications given the reliance of many Indonesian communities on the sector. Overall, our findings align with global evidence showing that climate change is having severe impacts on food systems, and in turn on child health and nutrition.11 30

While our study was guided by a robust theoretical framework and systematic literature search, it has some limitations. First, as a scoping review, coverage may not be exhaustive. Although our search strategy retrieved all studies linking climate change directly with nutritional outcomes, it may not have fully captured evidence on underlying determinants. Additional reviews focused on specific determinants (eg, agricultural production, livelihood shocks, health services, childcare practices) could provide a more comprehensive understanding. Second, our tailored theoretical framework helped us synthesise results across categories relevant to policymakers and practitioners. However, given the interconnected nature of child nutrition determinants (eg, crop production impacts can affect simultaneously food availability, income and other socioeconomic variables), categorising climate impacts by primary outcome may have overshadowed other relevant findings. We believe this does not affect the validity of the results, as our goal was to provide an overview of available evidence rather than exhaustively cover each pathway. Finally, the heterogeneity among studies precluded a uniform synthesis, necessitating a narrative presentation.

Despite these limitations, this study provides valuable evidence to guide future interventions addressing climate change and child malnutrition in Indonesia. Although direct evidence linking climate change to nutritional outcomes is limited, data indicate significant negative effects. We identify several knowledge gaps that, if addressed, could inform the design of evidence-based policies and programmes. First, there is a critical gap in understanding the direct link between climate change and nutritional outcomes in Indonesia. Few studies analyse these factors as primary outcomes, limiting our ability to effectively address these challenges. Additionally, robust longitudinal evidence is scarce—most studies rely on cross-sectional data, which fails to capture the gradual nature of both climate change and certain nutrition-related conditions (eg, NCDs). Furthermore, while there is more evidence on the impact of climate change on food production, other aspects of the food system, such as supply chains, distribution, storage, and waste, remain understudied.

Finally, while data highlight the key role of localised climatic variables in mediating climate change’s impacts on child nutrition, subnational evidence remains scarce. Half of the reviewed studies focus on large geographical scales, either as part of multicountry or multiregion studies on Indonesia. Localised evidence is particularly scarce outside Java, Sumatra and Sulawesi, which account for only 5% of the studies reviewed. This lack of localised data limits significantly the generation of robust estimates and projections needed for evidence-based interventions. This is especially concerning for regions like Papua and East Nusa Tenggara, which are particularly vulnerable to compounded risks from malnutrition, climate change and socioeconomic challenges.

supplementary material

online supplemental file 1
bmjpo-9-1-s001.docx (21KB, docx)
DOI: 10.1136/bmjpo-2024-002980

Acknowledgements

The authors wish to thank Roland Kupka (UNICEF) for his review and comments on a previous version of this article.

Footnotes

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Provenance and peer review: Part of a Topic Collection; Not commissioned; externally peer-reviewed.

Patient consent for publication: Not applicable.

Ethics approval: Not applicable.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Author note: DC, SWS, ACP, RGG and MN are UNICEF staff members. The opinions and statements in this article are those of the authors and may not reflect official UNICEF policies.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Supplementary Materials

    online supplemental file 1
    bmjpo-9-1-s001.docx (21KB, docx)
    DOI: 10.1136/bmjpo-2024-002980

    Data Availability Statement

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