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Social inequalities mediate temperature–child maltreatment associations in Africa

Nature Climate Change (2026) Cite this article

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Abstract

Emerging evidence demonstrates a positive relationship between heat exposure and child maltreatment. However, mechanisms remain unclear and evidence from Africa is limited, where children face high risks from both ambient temperature and trauma. Using data from 114,051 children and adolescents across 8 sub-Saharan African countries, we identified a nonlinear, J-shaped relationship between ambient temperature and child maltreatment, with minimum risk at the 27th temperature percentile. At the 95th temperature percentile, the odds ratio for any abuse was 1.50 (95% confidence interval 1.35–1.67), with stronger effects for psychological than for physical abuse. Effect modification was significant for low maternal education, maternal acceptance of physical punishment, female-headed households, rural residence, lack of air conditioning and absence of social support. Mediation analysis suggested that occupational heat exposure among working adolescents was associated with 18.8% of the estimated indirect pathway, and household water shortage with 7.1%. These findings underscore the need to integrate child protection into climate adaptation planning.

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Fig. 1: Exposure–response relationship between 30-day temperature percentiles and maltreatment.
The alternative text for this image may have been generated using AI.
Fig. 2: ORs for specific types of child maltreatment at the 95th temperature percentile.
The alternative text for this image may have been generated using AI.
Fig. 3: ORs for child maltreatment at the 95th temperature percentile, stratified by socio-demographic and household characteristics.
The alternative text for this image may have been generated using AI.
Fig. 4: Mediation analysis examining statistical pathways between extreme heat exposure (95th temperature percentile) and child maltreatment.
The alternative text for this image may have been generated using AI.

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Data availability

The underlying data used in this study are from MICS conducted by UNICEF. These data are publicly available upon request through the official MICS website (https://mics.unicef.org/), subject to UNICEF’s data access procedures and terms of use. The authors are not permitted to redistribute the raw survey data.

Code availability

The main analysis code supporting this study is publicly available via GitHub at https://github.com/chenghe1130/temperature-child-maltreatment-associations-in-Africa.

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Acknowledgements

We thank UNICEF for making the MICS6 data publicly available, and we acknowledge the children, caregivers, field teams and national statistical offices in the participating countries whose contributions made this study possible.

Author information

Authors and Affiliations

  1. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Cheng He & Wafaie W. Fawzi

  2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Wafaie W. Fawzi

  3. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Wafaie W. Fawzi

Authors
  1. Cheng He
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  2. Wafaie W. Fawzi
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Contributions

C.H. and W.W.F. conceived the study. C.H. curated the data, developed the analytic strategy, conducted the statistical analyses, generated the figures and wrote the first draft of the paper. W.W.F. supervised the study, contributed to the interpretation of the findings and critically revised the paper. Both authors reviewed and approved the final version of the paper.

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Correspondence to Cheng He.

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Nature Climate Change thanks Jorge Cuartas, Olalekan Lalude and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Extended data

Extended Data Fig. 1

Spatial distribution of survey clusters and sample sizes across study countries in sub-Saharan Africa (MICS6, 2017-2022). Basemap data from Natural Earth (https://www.naturalearthdata.com).

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Supplementary Methods, Figs. 1 and 2 and Tables 1–7.

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He, C., Fawzi, W.W. Social inequalities mediate temperature–child maltreatment associations in Africa. Nat. Clim. Chang. (2026). https://doi.org/10.1038/s41558-026-02650-9

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