Abstract
BackgroundDespite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor. We use population representative data to identify key predictors of child stunting in Bangladesh and assess their contributions to linear growth differences observed between urban poor and non-poor children.MethodsWe combined six rounds of Demographic and Health Survey data spanning 2000-2018 and used official poverty rates to classify the urban population into poor and non-poor households. We identified key stunting determinants using stepwise selection method. Regression-decomposition was used to quantify contributions of these key determinants to poverty-based intra-urban differences in child linear growth status.ResultsKey stunting determinants identified in our study predicted 84% of the linear growth difference between urban poor and non-poor children. Child’s place of birth (27%), household wealth (22%), maternal education (18%), and maternal body mass index (11%) were the largest contributors to the intra-urban child linear growth gap. Difference in average height-for-age z score between urban poor and non-poor children declined by 0.31 standard deviations between 2000 and 2018. About one quarter of this observed decrease was explained by reduced differentials between urban poor and non-poor in levels of maternal education and maternal underweight status.ConclusionsAlthough the intra-urban disparity in child linear growth status declined over the 2000-2018 period, socioeconomic gaps remain significant. Increased nutrition-sensitive programs and investments targeting the urban poor to improve girls’ education, household food security, and maternal and child health services could aid in further narrowing the remaining linear growth gap.
Highlights
Despite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor
Across the full sample period, the proportion of urban poor children stunted was 48.3%, compared to 29.5% of urban non-poor children and 43.2% of rural children
During early infancy (0-5 months), stunting among urban poor children (16.9%, 95% confidence interval (CI): 12.8-22.0%) was roughly comparable with that of urban non-poor children (16.0%, 95% CI: 13.2-19.2%), and lower than that of rural children (20.9%, 95% CI: 19.2-22.8%)
Summary
Despite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor. We use population representative data to identify key predictors of child stunting in Bangladesh and assess their contributions to linear growth differences observed between urban poor and non-poor children. A key indicator of childhood undernutrition and early life growth faltering is stunting. Children are considered stunted if their height-for-age z score (HAZ) is more than two standard deviations (SD) below the World Health Organization (WHO) child growth standards median [6]. The global distribution of childhood stunting is concentrated in low-income countries, where large numbers of children generally experience linear growth faltering compared to the international reference median [12]. A number of studies examined intra-urban heterogeneities and revealed urban poor and slum residents in some countries to be disadvantaged within urban areas, and when compared with rural populations [17,18,19]
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