Correlates of stunting among under-five children in Bangladesh: a multilevel approach

Papia Sultana,Md Mahfuzur Rahman,Jahanara Akter

doi:10.1186/s40795-019-0304-9

Papia Sultana, Md Mahfuzur Rahman + Show 1 more

Open Access

https://doi.org/10.1186/s40795-019-0304-9

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Abstract

BackgroundChild malnutrition still remains a major cause of childhood morbidity and mortality in Bangladesh. This study aims to determine the prevalence and identify the associated risk factors of child malnutrition in Bangladesh using multilevel logistic regression model on data from the Bangladesh Demographic and Health Survey (BDHS), 2014.MethodsA total sample of 6965 children aged 0–59 months was extracted from BDHS 2014. We performed descriptive analysis and multilevel generalized linear regression analysis with clustered data structure.ResultsOur findings show that among children the prevalence of moderate and severe values was respectively: 25 and 12% for stunting; 11 and 3.1% for wasting; 25 and 7.9% for underweight. The probability of stunting increased with age, with highest rate among children aged 36–47 months, which was significantly higher than children aged less than 6 months (OR = 6.71, 95% CI = 4.46, 10.10). Female children are found to be 11% less likely to be stunted than male children (OR = 0.89, 95% CI = 0.78, 1.02). Children with birth interval less than 24 months were significantly more likely to be stunted than children of first birth by 36% (OR = 1.36, 95% CI = 1.11, 1.67). Mothers with a normal BMI were 16% less likely to have children with stunting compared to mothers who are underweight (OR = 0.84, 95% CI = 0.76, 0.93). Other factors which were associated with a higher risk of stunting included parents with lower educational levels, children from the poorest wealth index, and mothers aged less than 20 years as first birth.ConclusionGovernment and non-government organization should generate effective program to aware women of reproductive age about adverse effect of short birth interval, and to aware parents about standard height and weight according to age and gender of children. Overall, necessary steps may be taken to make people educated and to reduce household wealth inequality to improve nutritional status of children.

Highlights

Child malnutrition still remains a major cause of childhood morbidity and mortality in Bangladesh
Among the respondents 68.6% were from rural area and 21.7% were of poorest wealth index
RC stands for ‘reference category’ aModel 1: two level generalized linear regression considering division as second level hierarchical factor bModel 2: two level generalized linear regression considering residential status as second level hierarchical factor cModel 3: three level generalized linear regression considering residential status as third level and division as second level hierarchical factors less likely to be stunted than male children (OR = 0.89, 95% confidence interval (CI) = 0.78, 1.02)

Summary

Introduction

Child malnutrition still remains a major cause of childhood morbidity and mortality in Bangladesh. The nutritional status of under-five children is the most sensitive indicator of a society, country as well as world public health status. Rates of child malnutrition in Bangladesh are among the highest in the world, with rates of stunting affecting more than 54% of preschool-age children, underweight in 56% and wasting in 17% [5]. The average annual rate of reduction (AARR) of stunting in Bangladesh is 2.7 which is much less than the required 3.9 AARR [9] to reach the global World Health Assembly (WHA) target to have 40% reduction in child malnutrition by 2025 [10]. Bangladesh is not likely to achieve the WHA target for reducing childhood malnutrition

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