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This study aimed to investigate the association between drought and risk of infant mortality in Africa, a region highly vulnerable to climate change that bears the heaviest share of the global burden.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec010\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>In this cross-sectional study, we obtained data on infant mortality in 34 African countries during 1992\u20132019 from the Demographic and Health Surveys program. We measured drought by the standardized precipitation evapotranspiration index at a timescale of 24 months and a spatial resolution of 10 \u00d7 10 km, which was further dichotomized into mild and severe drought. The association between drought exposure and infant mortality risk was estimated using Cox regression models allowing time-dependent covariates. We further examined whether the association varied for neonatal and post-neonatal mortality and whether there was a delayed association with drought exposure during pregnancy or infancy.<\/jats:p>\n<jats:p>The mean (standard deviation) number of months in which children experienced any drought during pregnancy and survival period (from birth through death before 1 year of age) was 4.6 (5.2) and 7.3 (7.4) among cases and non-cases, respectively. Compared to children who did not experience drought, we did not find evidence that any drought exposure was associated with an increased risk of infant mortality (hazard ratio [HR]: 1.02, 95% confidence interval [CI] [1.00, 1.04], <jats:italic>p<\/jats:italic> = 0.072). When stratified by drought severity, we found a statistically significant association with severe drought (HR: 1.04; 95% CI [1.01, 1.07], <jats:italic>p<\/jats:italic> = 0.015), but no significant association with mild drought (HR: 1.01; 95% CI [0.99, 1.03], <jats:italic>p<\/jats:italic> = 0.353), compared to non-exposure to any drought. However, when excluding drought exposure during pregnancy, the association with severe drought was found to be non-significant. In addition, an increased risk of neonatal mortality was associated with severe drought (HR: 1.05; 95% CI [1.01, 1.10], <jats:italic>p<\/jats:italic> = 0.019), but not with mild drought (HR: 0.99; 95% CI [0.96, 1.02], <jats:italic>p<\/jats:italic> = 0.657).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec011\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Exposure to long-term severe drought was associated with increased infant mortality risk in Africa. Our findings urge more effective adaptation measures and alleviation strategies against the adverse impact of drought on child health.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1004516","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T18:46:28Z","timestamp":1738349188000},"page":"e1004516","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long-term drought and risk of infant mortality in Africa: A cross-sectional study"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8031-8494","authenticated-orcid":true,"given":"Pin","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9581-7384","authenticated-orcid":true,"given":"Tormod","family":"Rogne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6274-6970","authenticated-orcid":true,"given":"Joshua L.","family":"Warren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4078-8755","authenticated-orcid":true,"given":"Ernest O.","family":"Asare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4303-019X","authenticated-orcid":true,"given":"Robert A.","family":"Akum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3139-6581","authenticated-orcid":true,"given":"N\u2019datchoh E.","family":"Toure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9218-3320","authenticated-orcid":true,"given":"Joseph S.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0164-1112","authenticated-orcid":true,"given":"Kai","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"pmed.1004516.ref001","unstructured":"World Health Organization. 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