Reducing childhood malnutrition in Bangladesh: the importance of addressing socio-economic inequalities

Abstract

Objective:To obtain projections of the prevalence of childhood malnutrition indicators up to 2030 and to analyse the changes of wealth-based inequality in malnutrition indicators and the degree of contribution of socio-economic determinants to the inequities in malnutrition indicators in Bangladesh. Additionally, to identify the risk factors of childhood malnutrition.Design:Cross-sectional study. A Bayesian linear regression model was used to estimate trends and projections of malnutrition. For equity analysis, slope index, relative index and decomposition in concentration index were used. Multilevel logistic models were used to identify risk factors of malnutrition.Setting:Household surveys in Bangladesh from 1996 to 2014.Participants:Children under the age of 5 years.Results:A decreasing trend was observed for all malnutrition indices. In 1990, predicted prevalence of stunting, wasting and underweight was 55·0, 15·9 and 61·8 %, respectively. By 2030, prevalence is projected to reduce to 28·8 % for stunting, 12·3 % for wasting and 17·4 % for underweight. Prevalence of stunting, wasting and underweight were 34·3, 6·9 and 32·8 percentage points lower in the richest households than the poorest households. Contribution of the wealth index to child malnutrition increased over time and the largest contribution of pro-poor inequity was explained by wealth index. Being an underweight mother, parents with a lower level of education and poorer households were the key risk factors for stunting and underweight.Conclusions:Our findings show an evidence-based need for targeted interventions to improve education and household income-generating activities among poor households to reduce inequalities and reduce the burden of child malnutrition in Bangladesh.

The prevalence and socio-demographic risk factors of coexistence of stunting, wasting and underweight among children under five years in Bangladesh

“…Surprisingly, watching television less than once a week increased the risk of coexistence of stunting, wasting and underweight by 54% among children than households not exposed to this media. This nding was not consistent with a study conducted in Bangladesh [8,33]. Inconsistent contents of food advertisements regarding dietary recommendations and poorer understanding of nutrition from food advertisements in television might cause adverse nutritional outcomes, indicating need of attention of the policy makers to the matter [34,35].…”

“…In recent survey, we found the risk of coexistence of stunting, wasting and underweight increased by 402% in children of uneducated mothers which was insigni cant in 2014 survey. Lack of maternal education was not assessed most in uential risk factors of child malnutrition in previous studies in Bangladesh and other developing countries [8,23,24,25]. Current evidence also showed that three out of fty children of uneducated mothers were suffering from coexistence of stunting, wasting and underweight as children of underweighted mothers did.…”

“…Further, improving women's education can contribute towards increasing family income, access to a better quality of diet consequently improving children's health [32]. Increasing education opportunities for females, especially in rural areas is recommended [8]. Surprisingly, watching television less than once a week increased the risk of coexistence of stunting, wasting and underweight by 54% among children than households not exposed to this media.…”

“…Although malnutrition rates in Bangladesh declined since the 1990s, progress to tackle all forms of malnutrition remains unacceptably slow [8]. Risk factors for single malnutrition indicators (i.e.…”

Determinants of stunting among children under 2 years in urban informal settlements in Mumbai, India: evidence from a household census

“…Maternal exposure to physical violence substantially increased a child's risk of stunting in our study. At the household level, evidence suggests that children in households in the poorest socio-economic groups have higher prevalence of malnutrition [71][72][73]. This emphasizes the impact of the differential availability of resources to families that act as a major determinant of malnutrition.…”