Effects of El Niño and the Positive Indian Ocean Dipole (+IOD) on Health, Food Security, Economics, and Conflict in Low- and Middle-Income Countries in the Indo-Pacific: A Systematic Review.

Climate drivers such as the El Niño Southern Oscillation (ENSO) and the Indian Ocean Dipole (IOD) can impact multiple sectors globally. We are currently witnessing the effects of these teleconnections against the backdrop of a changing climate. This systematic review takes stock of the available evidence on compounding and cascading effects of El Niño and the Positive IOD on health, economic, migration, conflicts, and nutrition outcomes in low- and middle-income countries from the Indo-Pacific region. The review sheds light on how effects vary between and within the considered countries and explores potential sources of heterogeneity. The search of studies was carried out in January 2024 in 12 major databases/search engines and 14 institutional websites, using English keywords, and paired by forward and backward citation tracking of the included studies. The review's inclusion criteria encompassed quantitative studies as long as they provide an estimate of relationship between the climate driver and outcome, and qualitative studies that aim to infer causation such as realist evaluation or process tracing. The analysis used a combination of meta-analysis with random-effects models, median effects from correlational and regression studies, and narrative synthesis. We found that El Niño is likely to decrease agricultural production and productivity at the Indo-Pacific level, although the analysed studies are highly diverse. The absence of evidence on the effects of the considered climate drivers on migration, conflict, food security and nutrition is an important evidence gap. We found limited evidence on the differential effects by El Niño's and +IOD's magnitude and no studies examining their combined impact or qualitative effectiveness studies. The high risk of bias detected across studies calls for more thorough attention to study design, conduct, and reporting in answering questions about effects. Despite remaining evidence gaps, this review highlights potential effects of El Niño and +IOD in the Indo-Pacific and underscores the need for context-specific policy responses to mitigate risks at local and regional levels. Caution is warranted in interpreting the overall findings given the generally high risk of bias of evidence.