In spite of the outstanding achievements of Bangladesh in consistently reducing the malnutrition rates among children through the last few decades through various intervention programs taken by the Government and the development partners, the findings of this study (with 36% stunted, 15% wasted and around 33% underweight children under age five in the year 2014) state the scope of further improvement of the child nutritional status is Bangladesh.
In this study, age of children, place of residence, division, religion, education of parents, occupation of parents, BMI of mothers, wealth index and toilet facilities used by the household have significant association with child nutritional status.
Malnutrition for stunting and underweight are relatively lower in younger children (less than 18 months). The fraction of stunted or underweight children increases abruptly with the child’s age after 18 months and then falls again after 47 months (see Table 1). For both the measures, malnutrition hits the highest point at age 18 to 35 months. In general, wasting decreases as child grows older. Unfortunately, even during the first six months of life, when the majority of the children are breastfed, 14–22% children remain malnourished as indicated by the three indices. Furthermore, after the first six months, while children are generally given additional foods along with breast milk, the percentage of stunted or underweight children increase gradually with highest amount of children stunted (48%) and underweight (37%) at the age of 18 to 23 months, indicating need of attention of the policy makers to the matter. This finding was in agreement with other studies [25–28]. The odds ratios of .245, .302, .465 .757, 1.58, 1.14 and 1.41 respectively for the age groups (<6 months, 6 to 8 months, 9 to 11 months, 12 to 17 months, 18 to 23 months, 24 to 35 months, 36 to 47 months) in the logistic regression model also supports the fact (reference group children aged 48 to 59 months).
Being male gender was identified as a risk factor of malnutrition in several studies [27–31] and our study also found that prevalence of malnutrition in male children is slightly higher as compared to the same in females. However, stunting and underweight were not significantly associated with sex.
In developing countries, the rural-urban disparities in child nutrition outcomes remained persistent since long [32–34] presumably due to the difference in economic levels and poor accessibility to health facilities, education and other factors. Although many of the previous studies identified that rural children are more vulnerable to be malnourished [32–34], this study found that children living in urban area are more vulnerable to be stunted in Bangladesh. The urban population in last few decades has changed a lot due to migration of rural people to urban area for work and other opportunities. Many of these migrated people are poor and cannot afford to nutritional food and health care facilities which might be the underlying reason behind this increased proportion of malnourished children in urban areas and requires attention of the health policy makers into this matter.
The logistic regression analysis identified significant association between division and malnutrition. Sylhet division is running far behind the other divisions in controlling malnutrition among children in Bangladesh.
The study also indicated that both the parents’ education are significantly associated with nutritional status of their children. Children from illiterate father (as well as mother) or father (or mother) with primary education were twenty to thirty percent more likely to remain stunted or underweight in comparison with their counterparts. This finding was coherent with previous studies held in Bangladesh and other countries [35–40]. This is understandable because educated mothers have greater knowledge regardingthe health and nutrition of their children, improved child care, usage of health services, hygiene and sanitation, etc. On the other hand, father’s education is also important for the health and nutritional status of his child because of his contribution in household income and his role in decision making forselecting food for the family.
In addition, this study indicated that proportion of malnourished children is higher among children whose mothers are occupied in physical labor related works or others (mainly housewives) compared to the children of mothers in service or business. This may be rationalized as in Bangladesh; people who are occupied in service or business are usually wealthier and are often more educated as well which consequently allows them to know about nutritional foods as well as importance of such food for children.
A mother with good nutritional status is likely to have healthier babies , and in our study also, Mother’s BMI is found to have negative association with child malnutrition; this reminds us to not to forget the importance of mother’s nutritional status while making policies for lowering or reducing child malnutrition. Because good nutritional status is essential for a mother not only for breastfeeding but also for recovery from physical and possibly emotional stress during pregnancy and after labor in order to cope with raising and caring children.
Wealth index is, as expected [36, 38–42]; negatively associated with malnutrition and odd of being malnourished is substantially high among the poorer groups. This undoubtedly points at the unmet need of policies for poorer groups of people in Bangladesh.
Last but not the least, presence of hygienic toilet facilities was found as an important factor that was found associated with child nutritional status. Children from households with hygienic latrine facilities were less likely to be stunted as compared to their counterparts. This finding was also consistent with other studies [9, 13, 35]. This is very rational in the sense that unhygienic toilets are often causes of diarrheal and other diseases, which, as a consequence, may turn children malnourished.
The study has certain limitations. First of all, since this study was based on a cross-sectional data. and as a result, exploring the association between selected factors and prevalence of malnutrition cannot establish causal association between the two. Secondly, due to unavailability of the data on potential confounders including diet, physical exercise, and smoking behavior of the parents, these were not included in analysis. Third, the definition of urban and rural areas in Bangladesh has been changed over time with the most rapid growth in urbanization. As a result, some areas, earlier classified as rural in the previous BDHSs were considered urban in the more recent BDHSs, which may bring in some error in urban-rural calculations. Fourth, Mymensingh is a new division created from the Dhaka division and this information is not available in the 2014 BDHS.