The association of temperature extremes, ecosystem resilience, with child mortality: Novel evidence from India.

The present study investigates how ecosystem resilience affects children's health and acts as a protective shield against high temperature exposure. Ecosystem resilience is the ability of an ecosystem to absorb anthropogenic or climatic shocks and recover from those shocks. The study used various data sources to estimate the impact of temperature extremes on child mortality in India. Data on neonatal mortality (NMR) and infant mortality (IMR) were obtained from the National Family Health Survey (NFHS-5) conducted between 2019-2021. Satellite data were used to assess extreme heat and ecosystem resilience. Univariate and bivariate Local Indicator of Spatial Autocorrelation (LISA) analysis were applied to examine the spatial association of high temperature, ecosystem resilience, and NMR, IMR. Further, a multivariate Cox hazard model, taking into account the censored data, was used to estimate mortality risk in high temperatures and non-resilient ecosystems. The spatial regression model reveals a significant association between higher temperatures and higher NMR (β: 1.78) and IMR (β: 1.79). The cox-proportional hazard models show elevated risks for neonatal and infant deaths due to high temperatures and non-resilient ecosystems. The resilience of the ecosystem plays an important role in exerting a positive effect on children's health, though, at its current state, resilience fails to moderate the high temperature impact on mortality. The present study, the first of its kind in India, highlights the exposure to high temperatures leading to neonatal and infant deaths when reliance imparts limited protective effect to offshoot the impact of high temperature on excess mortality.