In this paper we quantify how extreme rainfall events and temperature events have impacted children’s health across 19 countries in Sub-Saharan Africa in the period between 1992 and 2001. We look at the incidence of diarrhea, malnutrition and infant mortality at sub-national regional levels. The use of three indicators is in recognition of the multidimensional nature of health. Additionally the use of multiple health indicators enables us to understand their differential sensitivity to weather shocks within the timeframe we study. We would expect weather shocks to have the most evident impact on the short-term health indicators of diarrhea and weight-for-height malnutrition<sup>3</sup> , rather than on height-for-age malnutrition, which is an indicator of longer term nutritional status and infant mortality, which is rarely the result of one preceding event. We employ measures of malnutrition for the population under age three as it has been demonstrated that, for example, the drought impact on malnutrition manifests most strongly in the age group of 12 to 24 months (Hoddinott and Kinsey, 2001).

The focus on diarrhea is because of its critical importance to child health. The World Health Organization (WHO) estimates that in 2000 recent climate change was responsible for approximately 2.4 percent of global diarrhea. The high prevalence of the disease means that the global impact of this increased incidence is large.

Although we look separately at indicators of children’s malnutrition, disease and mortality, these are closely connected. WHO estimates of under-age-five child mortality rates attribute 22 percent of deaths to diarrhea (Patz et al., 2005). Studies have found that a high cumulative burden of diarrhea, that is accounting for number of episodes and duration, leads to stunting (Checkley et al., 2003; Moore et al., 2001).A vicious cycle between diarrhea and stunting means that children with stunted growth are more likely to contract diarrheal disease (Bern et al., 1992).

In our study, extreme rainfall events are defined as those that cross a defined upper threshold from the seasonally adjusted 20-year monthly rainfall average in the wet season. We also take into account the frequency of monthly rainfall exceeding the threshold in a defined time period. Extreme temperature is gauged by the maximum and minimum monthly average of the highest maximum or lowest minimum temperature of six months of the year.

The links between extreme weather and health have long been recognized but have been hard to quantify accurately. Recent advances in the measurement of weather events and definition of climatic zones permit more detailed study of the effects of weather patterns at sub-national regional levels.

A significant contribution of our study is the compilation of a panel data set across subnational regions in Sub-Saharan Africa that contains indicators of key health outcomes, socioeconomic conditions, access to health and environmental services and critical climate variables including monthly precipitation, maximum and minimum temperature.

> 3 A child is considered to be underweight when his or her weight for age is more than two standard deviations below the NCHS/WHO reference weight. A child is stunted when his or her height for age is more than two standard deviations below the NCHS/WHO reference.

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