Urban-rural Differences in the Risk Factors of Severe Under-5 Child Malnutrition in Bangladesh

Abstract

IntroductionSevere under-5 child malnutrition (i.e., severe stunting, severe wasting and severe underweight) is high in Bangladesh. The interplay between risk factors needs to be understood to address this complex public health issues. We aim to explore the prevalence and risk factors for severe under-5 child malnutrition in Bangladesh's rural and urban areas using the Composite Index of Severe Anthropometric Failure (CISAF).MethodsWe analysed data from Bangladesh Demographic Health Surveys (BDHSs), 2017-18. Severe malnutrition was defined using the CISAF, and conventional nutritional indicators were aggregated to estimate malnutrition's overall burden. The proportional differences of variables between non-severe malnutrition and severe malnutrition group were assessed using Chi-square test. Risk factors for malnutrition were analysed using regression models to assess the odds ratio (OR) and 95% confidence interval (CI).ResultsThe overall prevalence of severe under-5 child malnutrition was 11% with 12% in rural areas and 10% in urban areas. The key risk factors in rural areas were children born with small birth weight (OR: 2.4, 95% CI: 1.5–3.8), socio-economically poorest households (OR: 2.3, 95% CI: 1.4–3.7) and children aged 36-47 months (OR: 2.1, 95% CI: 1.6–2.8). The key risk factors in urban areas were children born with small birth weight (OR: 5.0, 95% CI: 2.9–8.6), children of mothers with no formal education (OR: 2.0, 95% CI: 1.2–3.6) and children's birth order ≥4 (OR: 1.8, 95% CI: 1.2–2.8). 52% lower risk difference of parents with formal education vs no formal education, and 71% higher risk difference of most affluent vs poorest household for being severely malnourished were estimated in rural areas than in urban areas.ConclusionOne in ten children living in both rural and urban areas experience severe malnutrition. Children of parents with no formal education, children of underweight mothers, those living in socio-economically poorest households and children of small birth weight experienced severe malnutrition regardless of setting. Educational attainments and access to health and nutritional care may not be enough to reduce the burden of severe malnutrition in rural settings. Our study provides helpful guidelines for context-specific interventions to reduce under-5 severe malnutrition.