Results
In this study, the prevalence of underweight among the children under 5 in Bangladesh decreased from the period 40.84% in 2007, 36.00% in 2011, 32.53% in 2014, and 27.56% in 2017 calculated using BDHS data. In 2011, the prevalence of underweight was found to be extreme at 41% (NIPORT, 2007). Other studies have shown the prevalence of underweight and severe underweight in Bangladesh in 2014 was 32.6% and 7.7% respectively (M. R. Islam et al., 2020). And the prevalence of severe underweight at 3.6% and moderate underweight at 16.4% for the BDHS data of 2017-18 (A. Rahman et al., 2021). Bangladesh has been projected to be in the stage of reduction of the prevalence of underweight to 17.4% by 2030 (M. R. Islam et al., 2020). This study also accords with our earlier observations of diminishing trend of prevalence of childhood underweight, which showed that the reduction was from 43% to 33% in the time period of 2004 to 2014 respectively.
Table 1 describes that the majority of the respondents were from the Chittagong division (18.88%) and majority of the respondents were from rural areas (67.30%). Among the respondents, the majority of them were male (51.60%) and they were mostly of the age group of 36-47 months (20.21%). The majority of the mothers belonged to the age group of 15-24 years (48.81%) and the majority of them seemed to have a secondary level of education (42.90%). Most of the women’s (59.14%) BMI were normal. Most of them didn’t get any antenatal care (ANC) (68.28%) and followed the non-cesarean approach (81.04%) during giving birth. The majority of them received home delivery (68.51%) at the time of giving birth. Among the respondents, the majority of the women didn’t have any occupation (74.98%), and their partner’s level of education and occupation were found to be mostly at the primary level (30.67%) and non-agricultural sectors (51.87%) respectively. Most of the children didn’t suffer from diarrhea (94.23%) and also didn’t suffer from recent fever or cough (54.73%). The majority of the children (87.50%) had experienced at least one kind of vaccination. The majority of the respondents belonged to the poorest category (21.67%) of the wealth index; 57.76% of the respondents had improved sanitation facilities and 97.54% had improved quality of water sources.
A geographic study of the prevalence rates of children underweight across divisions of Bangladesh is shown in Figure 2. Maps were used to calculate and display prevalence rates. The findings show significant divisional variation in the prevalance of childhood underweight over time, with Barisal and Rajshahi having the highest rates (35.23% and 34.85%, respectively), closely followed by Chittagong (32.78%) and Sylhet (32.6%). Khulna, however, had a considerably lower prevalance (26.29%). The prevalence rate in Dhaka, the country's capital, was 30.43%. In addition, the newly created division (Rangpur and Mymensingh) over time showed a low prevalence rate of 33.22%.
Table 1. General Characteristics of Study Objects
|
Number
|
Percent
|
2007
|
2011
|
2014
|
2017
|
Division
|
|
|
(19.50%)
|
(27.71%)
|
(25.08%)
|
(27.71%)
|
Barisal
|
3,522
|
11.38
|
779(22.12)
|
955(27.12)
|
897(25.47)
|
891(25.30)
|
Chittagong
|
5,842
|
18.88
|
1,235(21.14)
|
1,710(29,27)
|
1,487(25,45)
|
1,410(24.14)
|
Dhaka
|
5,333
|
17.24
|
1,266(23.74)
|
1,421(26.65)
|
1,363(25.56)
|
1,283(24.06)
|
Khulna
|
3,403
|
11.00
|
701(20.60)
|
963(28.30)
|
853(25.07)
|
886(26.04)
|
Rajshahi
|
3,961
|
12.80
|
958(24.19)
|
1,056(26.66)
|
941(23.76)
|
1,006(25.40)
|
Sylhet
|
4,017
|
12.98
|
1,093(27.21)
|
1,089(27.11)
|
945(23.53)
|
890(22.16)
|
New Division
|
4,862
|
15.71
|
0(0.00)
|
1,379(28.36)
|
1,275(26.22)
|
2,208(45.41)
|
Place of Residence
|
Urban
|
10,116
|
32.70
|
2,054(20.30)
|
2,621(25.91)
|
2,446(24.18)
|
2,995(29.61)
|
Rural
|
20,824
|
67.30
|
3,978(19.10)
|
5,952(28.58)
|
5,315(25,52)
|
5,579(26.79)
|
Sex of Child
|
Male
|
15,966
|
51.60
|
3,075(19.26)
|
4,409(27.61)
|
4,004(25.08)
|
4,478(28.05)
|
Female
|
14,974
|
48.40
|
2,957(19.75)
|
4,164(27.81)
|
3757(25.09)
|
4,096(27.35)
|
Child`s Age in Months
|
0-<6
|
2,888
|
9.83
|
506(17.52)
|
790(27.35)
|
632(21.88)
|
960(33.24)
|
6-8
|
1,528
|
5.20
|
324(21.20)
|
397(25.98)
|
401(26.24)
|
406(26.57)
|
9-11
|
1,494
|
5.08
|
261(17.47)
|
411(29.52)
|
412(27.58)
|
380(25.44)
|
12-17
|
2,988
|
10.17
|
549(18.37)
|
798(26.71)
|
798(26.71)
|
843(28.21)
|
18-23
|
2,835
|
9.65
|
598(21.09)
|
717(25.29)
|
734(25.89)
|
786(27.72)
|
24-35
|
5,799
|
19.74
|
1,168(20.14)
|
1,526(26.31)
|
1,503(25.92)
|
1,602(27.63)
|
36-47
|
5,938
|
20.21
|
1,135(19.11)
|
1,782(30.01)
|
1,472(24.79)
|
1,549(26.09)
|
48-59
|
5,914
|
20.13
|
1,124(19.01)
|
1,692(28.61)
|
1,463(24.74)
|
1,635(27.65)
|
Mother Age
|
15-24
|
15,101
|
48.81
|
2,963(19.62)
|
4,275(28.31)
|
3,810(25.23)
|
4053(26.84)
|
25-34
|
13,138
|
42.46
|
2,434(18.53)
|
3,555(27.06)
|
3,332(25.36)
|
3,817(29.05)
|
35-49
|
2,701
|
8.73
|
635(23.51)
|
743(27.51)
|
619(22.92)
|
704(26.06)
|
Mother Education
|
No Education
|
5,134
|
16.60
|
1,638(31.90)
|
1,654(32.22)
|
1,215(23.67)
|
627(12.21)
|
Primary
|
9,138
|
29.68
|
1,890(20.58)
|
2,627(28.61)
|
2,171(23.64)
|
2.495(27.17)
|
Secondary
|
13,273
|
42.90
|
2,060(15.52)
|
3,628(27.33)
|
3,559(26.81)
|
4,026(30.33)
|
Higher
|
3,347
|
10.82
|
441(13.18)
|
664(19.84)
|
816(24.38)
|
1,426(42.61)
|
Women Working Status
|
No working
|
23,197
|
74.98
|
4,591(19.79)
|
7,726(33.31)
|
5,808(25.04)
|
5,072(21.86)
|
Working
|
7,741
|
25.02
|
1,441(18.62)
|
847(10.94)
|
1,951(25.20)
|
3,502(45.24)
|
Partner’s Education
|
No education
|
7,750
|
25.17
|
2,063(26.62)
|
2,428(31.33)
|
1,966(25.37)
|
1,293(16.68)
|
Primary
|
9,442
|
30.67
|
1,709(18.10)
|
2,511(26.59)
|
2,350(24.89)
|
2,872(30.42)
|
Secondary
|
9,044
|
29.38
|
1,539(17.02)
|
2,491(27.54)
|
2,326(25.72)
|
2,688(29.72)
|
Higher
|
4,550
|
14.78
|
717(15.76)
|
1,143(25.12)
|
1,117(24.55)
|
1,573(34.57)
|
Partner’s Occupation
|
Agriculture and Farming
|
7,375
|
24.05
|
1,499(20.33)
|
2,338(31.70)
|
1,892(25.65)
|
1,646(22.32)
|
Non Agriculture
|
15,909
|
51.87
|
3,030(19.05)
|
4,113(25.85)
|
3,910(24.58)
|
4,856(30.52)
|
Business
|
6,793
|
22.15
|
1,325(19.51)
|
1,905(28.04)
|
1,739(25.60)
|
1,824(26.85)
|
No works
|
594
|
1.94
|
150(25.25)
|
175(29.46)
|
186(31.31)
|
83(13.97)
|
BMI of Women
|
<18.50 Underweight
|
7,226
|
23.71
|
1,917(26.53)
|
2,316(32.05)
|
1,743(24.12)
|
1,250(17.30)
|
18.51-24.99 Normal
|
18,027
|
59.14
|
3,494(19.38)
|
5,029(27.90)
|
4,501(24.97)
|
5,003(27.75)
|
>25.0 Overweight
|
5,229
|
17.15
|
545(10.42)
|
1,038(19.85)
|
1,454(27.81)
|
2,192(41.92)
|
Birth Order
|
First child
|
11,528
|
37.26
|
2,020(17.52)
|
3,089(26.80)
|
3,069(26.62)
|
3,350(29.06)
|
Second child
|
9,106
|
29.43
|
1,566(17.20)
|
2,485(27.29)
|
2,300(25.26)
|
2,755(30.25)
|
Third child
|
5,094
|
16.46
|
1,006(19.75)
|
1,454(28.54)
|
1,207(23.69)
|
1,427(28.01)
|
Fourth child
|
5,212
|
16.85
|
1,440(27.63)
|
1,545(29.64)
|
1,185(22.74)
|
1,042(19.99)
|
ANC
|
No ANC
|
14,676
|
68.28
|
3,751(25.56)
|
5,322(36.26)
|
3,031(20.65)
|
2,572(17.53)
|
Any ANC
|
6,819
|
31.72
|
1,116(16.37)
|
1,909(28.00)
|
1,421(20.84)
|
2,373(34.80)
|
Cesarean
|
No
|
21,056
|
81.04
|
5,507(26.15)
|
7,270(34.53)
|
4,166(19.79)
|
4,113(19.53)
|
Yes
|
4,926
|
18.96
|
525(10.66)
|
1,303(26.45)
|
1,207(24.50)
|
1,891(38.39)
|
Delivery
|
Home delivery
|
16,746
|
68.51
|
5,021(29.98)
|
6,267(37.42)
|
2,842(16.97)
|
2,616(15.62)
|
Facility delivery
|
7,696
|
31.49
|
1,011(13.14)
|
2,306(29.96)
|
1,814(23.57)
|
2,565(33.33)
|
Recent Diarrhea
|
No
|
2,7838
|
94.23
|
5,134(18.44)
|
7,801(28.02)
|
7,081(25.44)
|
7,822(28.10)
|
Yes
|
1,704
|
5.77
|
551(32.34)
|
380(22.30)
|
367(21.54)
|
406(23.83)
|
Any Vaccination
|
No
|
1,345
|
12.50
|
173(12.86)
|
445(33.09)
|
385(28.620
|
342(25.43)
|
Yes
|
9,419
|
87.50
|
2,786(29.58)
|
3,012(31.98)
|
2,366(25.12)
|
1,255(13.32)
|
Improve Sanitation
|
Improved sanitation facility
|
16,072
|
57.76
|
2,241(13.94)
|
4,130(25.70)
|
4,832(30.06)
|
4,869(30.29)
|
Unimproved sanitation facility
|
10,787
|
38.77
|
2,824(26.18)
|
3,255(30.18)
|
2,066(19.15)
|
2,642(24.49)
|
Open defecation (no facility/bush/field)
|
967
|
3.48
|
370(38.26)
|
333(34.44)
|
192(19.86)
|
72(7.45)
|
Improve Water
|
Improve source
|
27,151
|
97.54
|
5,224(19.24)
|
7,574(27.90)
|
6,918(25.48)
|
7,435(27.38)
|
Unimproved source
|
685
|
2.46
|
215(31.39)
|
144(21.02)
|
178(25.99)
|
148(21.61)
|
Wealth Index
|
Poorest
|
6,706
|
21.67
|
1,201(17.91)
|
1,908(28.45)
|
1,704(25.41)
|
1,893(28.23)
|
Poorer
|
6,126
|
19.80
|
1,264(20.63)
|
1,666(27.20)
|
1,483(24.21)
|
1,713(27.96)
|
Middle
|
5,788
|
18.71
|
1,128(19.49)
|
1,631(28.18)
|
1,494(25.81)
|
1,535(26.52)
|
Richer
|
6,096
|
19.70
|
1,132(18.57)
|
1,678(27.53)
|
1,586(26.02)
|
1,700(27.89)
|
Richest
|
6,224
|
20.12
|
1,307(21.00)
|
1,690(27.15)
|
1,494(24.00)
|
1,733(27.84)
|
Table 2 describes the prevalence of underweight to the participants’ socio-demographic characteristics. Among all divisions of Bangladesh, Sylhet had the highest percentage of underweighted children (32.98%; CI: 30.92-34.32). Among the male and female children, female children (32.68%; CI: 32.22-33.81) were found more exposed to being underweighted than male children. The major percentage of underweighted children belonged to the age group of 48-59 months (37.00%; CI: 35.76-38.31). Mothers who are underweighted (low BMI) (46.15%; CI: 44.86-47.3) seem mostly to have children who are underweighted; they also have the major percentage (31.77%; CI: 31.1-32.37) of underweighted children when the mothers are not involved in any work. Most of the underweighted children were found (43.15%; CI: 41.56-43.86) in families where the husband had no education. Families, where the husband works in an agricultural or farming sector (39.43%; CI: 38.45-40.72) hold the major percentage of underweighted children. Mothers who didn’t get any antenatal care have had children who are underweighted (35.34%; CI: 34.45-36.05). The major percentage of underweighted children is found (35.50%; CI: 34.89-26.25) in the family where mothers didn’t adopt the cesarean (C-section) delivery procedure. For children who are underweighted, the largest proportion of them appeared to have recent diarrhea (38.12%; CI: 35.35-40.02), and fever (42.90%; CI: 40.38-46.32). Children who got vaccinated hold the major proportion of underweighted children (34.87%; CI: 33.9-35.89). Families who use open defecation as a sanitation procedure have the major proportion of underweighted children (47.70%; CI: 43.7-49.8). Families who don’t have an improved water source hold a major proportion of underweighted children (40.74%; CI: 36.23-44.81). Under the measurement of the wealth index, it gave the impression that the poorest families are holding the largest proportion of underweighted children (43.27%; CI: 41.89-44.34).
Table 2. Prevalence of Underweight in Bangladesh (BDHS 2007, 2011, 2014, 2017-18)
Characteristics
|
Nourish
|
Underweight
|
P value
|
Weighted Prevalence (95% CI)
|
Frequency
|
Percentage
|
Frequency
|
Percentage
|
|
|
Place of residence
|
<0.001
|
|
Urban
|
6,610
|
73.59
|
2,372
|
26.41
|
|
25.37(24.34-26.43)
|
Rural
|
12,182
|
65.66
|
6,371
|
34.34
|
|
33.96(33.32-34.6)
|
Division
|
<0.001
|
|
Barisal
|
2,076
|
66.07
|
1,066
|
32.48
|
|
35.23(32.92-37.61)
|
Chittagong
|
3,470
|
67.52
|
1,669
|
13.74
|
|
32.78(31.6-33.98)
|
Dhaka
|
3,283
|
69.94
|
1,411
|
30.06
|
|
30.43(29.46-31.42)
|
Khulna
|
2,309
|
74.24
|
801
|
25.76
|
|
26.29(24.6-28.05)
|
Rajshahi
|
2,404
|
67.83
|
1,140
|
32.17
|
|
34.85(33.29-36.45)
|
Sylhet
|
2,384
|
67.02
|
1,173
|
32.98
|
|
32.6(30.92-34.32)
|
New Division
|
2,866
|
65.90
|
1,483
|
34.10
|
|
33.22(31.49-35.00)
|
Sex of Child
|
<0.001
|
|
Male
|
9,781
|
69.13
|
4,368
|
30.87
|
|
30.85(30.1-31.62)
|
Female
|
9,011
|
67.32
|
4,375
|
32.68
|
|
33.01(32.22-33.81)
|
Child's Age in Months
|
<0.001
|
|
0-<6
|
2,157
|
82.08
|
471
|
17.92
|
|
18.46(17.02-19.99)
|
6-8
|
1,192
|
81.64
|
268
|
18.36
|
|
18.83(16.92-20.9)
|
9-11
|
1,085
|
75.93
|
344
|
24.07
|
|
23.1(21.03-25.31)
|
12-17
|
2,055
|
71.80
|
807
|
28.20
|
|
28.32(26.71-30.00)
|
18-23
|
1,814
|
67.43
|
876
|
32.57
|
|
32.59(30.86-34.37)
|
24-35
|
3,507
|
64.66
|
1,917
|
35.34
|
|
35.16(33.9-36.44)
|
36-47
|
3,509
|
63.47
|
2,020
|
36.53
|
|
37.33(36.07-38.61)
|
48-59
|
3,473
|
63.00
|
2,040
|
37.00
|
|
37.03(35.76-38.31)
|
Mother's Age
|
<0.001
|
|
15-24
|
9,151
|
68.93
|
4,125
|
31.07
|
|
31.26(30.49-32.05)
|
25-34
|
8,147
|
68.71
|
3,710
|
31.29
|
|
31.64(30.81-32.48)
|
35-49
|
1,494
|
62.20
|
908
|
37.80
|
|
37.07(35.12-39.07)
|
BMI of Women
|
<0.001
|
|
<18.50 Underweight
|
3,480
|
53.85
|
2,982
|
46.15
|
|
46.08(44.86-47.3)
|
18.51-24.99 Normal
|
11,326
|
69.77
|
4,908
|
30.23
|
|
30.42(29.73-31.12)
|
>25.0 Overweight
|
3,915
|
82.79
|
814
|
17.21
|
|
17.14(16.08-18.27)
|
|
|
|
|
|
|
|
Mother's Education
|
<0.001
|
|
No education
|
2,418
|
54.31
|
2,034
|
45.69
|
|
44.91(43.48-46.35)
|
Primary
|
5,036
|
61.94
|
3,094
|
38.06
|
|
37.75(36.71-38.81)
|
Secondary
|
8,722
|
73.26
|
3,183
|
26.74
|
|
26.87(26.09-27.67)
|
Higher
|
2,616
|
85.88
|
430
|
14.12
|
|
14.63(13.36-16.01)
|
Working Women Status
|
<0.001
|
|
No work
|
14,072
|
68.23
|
6,553
|
31.77
|
|
31.73(31.1-32.37)
|
Working
|
4,719
|
68.30
|
2,190
|
31.70
|
|
32.4(31.33-33.5)
|
Partner's Education
|
<0.001
|
|
No education
|
3,859
|
56.85
|
2,929
|
43.15
|
|
42.71(41.56-43.86)
|
Primary
|
5,431
|
64.69
|
2,964
|
35.31
|
|
34.59(33.59-35.61)
|
Secondary
|
5,985
|
73.73
|
2,133
|
26.27
|
|
26.68(25.73-27.64)
|
Higher
|
3,416
|
83.15
|
692
|
16.85
|
|
17.47(16.3-18.71)
|
Partner's Occupation
|
<0.001
|
|
Agriculture and Farming
|
3,961
|
60.57
|
2,579
|
39.43
|
|
39.58(38.45-40.72)
|
Non-Agriculture
|
9,874
|
69.82
|
4,269
|
30.18
|
|
29.81(29.05-30.57)
|
Business
|
4,436
|
72.57
|
1,677
|
27.43
|
|
27.83(26.7-28.98)
|
No Works
|
351
|
67.63
|
168
|
32.37
|
|
32.77(28.86-36.94)
|
ANC
|
<0.001
|
|
No ANC
|
8,599
|
64.66
|
4,700
|
35.34
|
|
35.25(34.45-36.05)
|
Any ANC
|
4,968
|
78.94
|
1,325
|
21.06
|
|
20.97(19.96-22.02)
|
Cesarean
|
<0.001
|
|
No
|
11,993
|
64.50
|
6,601
|
35.50
|
|
35.57(34.89-26.25)
|
Yes
|
3,628
|
82.25
|
783
|
17.75
|
|
18.19(17.07-19.36)
|
Delivery
|
<0.001
|
|
Home Delivery
|
9,292
|
62.67
|
5,536
|
37.33
|
|
37.19(36.42-37.95)
|
Facility Delivery
|
5,549
|
79.82
|
1,403
|
20.18
|
|
20.37(19.42-21.35)
|
Birth order
|
<0.001
|
|
First child
|
7,204
|
71.38
|
2,889
|
28.62
|
|
28.56(27.90-29.45)
|
Second child
|
5,796
|
70.55
|
2,420
|
29.45
|
|
30.39(29.40-31.39)
|
Third child
|
3,074
|
67.09
|
1,508
|
32.91
|
|
32.10(30.77-33.45)
|
Fourth child
|
2,718
|
58.53
|
1,926
|
41.47
|
|
41.71(40.29-43.13)
|
Diarrhea
|
<0.001
|
|
No
|
17,799
|
68.65
|
8,130
|
31.35
|
|
31.53(30.97-32.1)
|
Yes
|
987
|
61.88
|
608
|
38.12
|
|
37.65(35.35-40.02)
|
Fever
|
<0.001
|
|
No
|
784
|
59.48
|
534
|
40.52
|
|
41.39(38.75-44.07)
|
Yes
|
607
|
57.10
|
456
|
42.90
|
|
43.32(40.38-46.32)
|
Vaccination
|
<0.001
|
|
No
|
790
|
69.18
|
352
|
30.82
|
|
29.92(27.29-32.7)
|
Yes
|
5,551
|
65.13
|
2,972
|
34.87
|
|
34.89(33.9-35.89)
|
Improve Sanitation
|
<0.001
|
|
Improved sanitation
|
10,533
|
72.88
|
3,919
|
27.12
|
|
27.27(26.55-28.01)
|
Unimproved sanitation
|
5,842
|
61.23
|
3,699
|
38.77
|
|
38.32(37.36-39.29)
|
Open defecation
|
444
|
52.30
|
405
|
47.70
|
|
46.74(43.7-49.8)
|
Improve Water
|
<0.001
|
|
Improved water
|
16,472
|
67.91
|
7,785
|
32.09
|
|
32.25(31.66-32.84)
|
Unimproved water
|
352
|
59.26
|
242
|
40.74
|
|
40.45(36.23-44.81)
|
Wealth Index
|
<0.001
|
|
Poorest
|
3,380
|
56.73
|
2,578
|
43.27
|
|
43.11(41.89-44.34)
|
Poorer
|
3,394
|
62.57
|
2,030
|
37.43
|
|
37.05(35.8-38.33)
|
Middle
|
3,532
|
67.73
|
1,683
|
32.27
|
|
31.16(29.94-32.41)
|
Richer
|
3,975
|
73.31
|
1,447
|
26.69
|
|
27.1(25.93-28.3)
|
Richest
|
4,511
|
81.78
|
1,005
|
18.22
|
|
18.13(17.09-19.22)
|
Year
|
<0.001
|
|
2007
|
3,147
|
60.18
|
2,082
|
39.82
|
|
40.84(39.51-41.19)
|
2011
|
4,838
|
64.34
|
2,681
|
35.66
|
|
36.00(34.93-37.09)
|
2014
|
4,656
|
67.68
|
2,223
|
32.32
|
|
32.53(31.45-33.63)
|
2017
|
6,151
|
77.78
|
1,757
|
22.22
|
|
21.56(20.66-22.48)
|
Table 3 explains the potentiality of the risk factors affecting underweight problem among children in Bangladesh. Through the increment of the age of children in data, from 12-17 months to 36-47 months, the odds of having underweight problem seemed to increase. Mothers with low BMI (<18.50), considered underweighted mothers, were 1.66 times more likely to have underweighted children than those who have normal BMI (18.51-24.99). And the mothers with high BMI rate (>25.0), considered overweight, are found to be less likely to have underweighted children than those with a normal BMI. These results show evidence of educated mothers to have lesser odds of having underweighted children than those who have at least secondary education. Father’s education level was found also to be a potential factor, where, families with a father with no education or lower education level (primary) were tended to have more likeliness to have underweighted children than those who have higher education. Children born through facility delivery were found to be less likely to become underweighted. Children who suffered from diarrhea recently, seemed to have 1.35 time more odds of being underweighted. Households with improved sanitation facility were found to be having less possibility of having any underweighted children than those who use open defection procedure. Finally, as poverty level rises, the likelihood of having any underweighted children increases.
Table 3. Factors associated with Childhood underweight in Bangladesh: (BDHS 2007, 2011, 2014, 2017-18)
Divisions
|
UOR (95% CI)
|
P-Value
|
AOR (95% CI)
|
P-Value
|
|
Barisal
|
0.99(0.90-1.09)
|
0.877
|
0.89(0.69-1.15)
|
0.381
|
|
Chittagong
|
0.93(0.85-1.01)
|
0.095
|
0.96(0.77-1.20)
|
0.744
|
|
Dhaka
|
0.83(0.76-0.91)
|
<0.001
|
0.75(0.59-0.94)
|
0.013
|
|
Khulna
|
0.67(0.61-0.74)
|
<0.001
|
0.78(0.60-1.03)
|
0.081
|
|
Rajshahi
|
0.92(0.83-1.01)
|
0.070
|
0.86(0.67-1.11)
|
0.245
|
|
Sylhet
|
0.95(0.87-1.04)
|
0.293
|
0.78(0.60-1.01)
|
0.057
|
|
New division (RC)
|
|
|
|
|
Place of Residence
|
|
|
|
|
|
Urban (RC)
|
|
|
|
|
|
Rural
|
1.46(1.38-1.54)
|
<0.001
|
0.92(0.79-1.07)
|
0.275
|
Children age in months
|
|
|
|
|
|
0-<6 (RC)
|
|
|
|
|
|
6-8
|
1.03(0.87-1.22)
|
0.730
|
1.05(0.71-1.54)
|
0.807
|
|
9-11
|
1.45(1.24-1.70)
|
<0.001
|
1.06(0.71-1.58)
|
0.767
|
|
12-17
|
1.80(1.58-2.05)
|
<0.001
|
1.76(1.32-2.36)
|
<0.001
|
|
18-23
|
2.21(1.95-2.51)
|
<0.001
|
2.18(1.64-2.90)
|
<0.001
|
|
24-35
|
2.50(2.23-2.81)
|
<0.001
|
2.46(1.91-3.17)
|
<0.001
|
|
36-47
|
2.63(2.35-2.95)
|
<0.001
|
2.63(2.00-3.46)
|
<0.001
|
|
48-59
|
2.69(2.40-3.01)
|
<0.001
|
2.55(1.92-3.39)
|
<0.001
|
BMI of women
|
|
|
|
|
|
<18.50 Underweight
|
1.98(1.86-2.10)
|
<0.001
|
1.76(1.54-2.02)
|
<0.001
|
|
18.51-24.99 Normal (RC)
|
|
|
|
|
|
>25.0 Overweight/obese
|
0.48(0.44-0.52)
|
<0.001
|
0.65(0,52-0.80)
|
<0.001
|
Mother education level
|
|
|
|
|
|
No education
|
2.31(2.15-2.48)
|
<0.001
|
1.14(0.93-1.39)
|
0.214
|
|
Primary
|
1.68(1.58-1.79)
|
<0.001
|
1.00(0.85-1.18)
|
0.958
|
|
Secondary (RC)
|
|
|
|
|
|
Higher
|
0.45(0.40-0.50)
|
<0.001
|
0.64(0.47-0.87)
|
0.005
|
Working women status
|
|
|
|
|
|
No work
|
1.00(0.95-1.06)
|
0.909
|
0.98(0.85-1.13)
|
0.799
|
|
Working (RC)
|
|
|
|
|
Partner’s education status
|
|
|
|
|
|
No education
|
3.75(3.41-4.12)
|
<0.001
|
1.35(1.01-1.81)
|
0.040
|
|
Primary
|
2.69(2.45-2.96)
|
<0.001
|
1.41(1.08-1.86)
|
0.013
|
|
Secondary
|
1.76(1.60-1.94)
|
<0.001
|
1.14(0.88-1.48)
|
0.309
|
|
Higher (RC)
|
|
|
|
|
Mother age
|
|
|
|
|
|
15-24(RC)
|
|
|
|
|
|
25-34
|
1.01(0.96-1.07)
|
0.709
|
0.88(0.74-1.04)
|
0.121
|
|
35-49
|
1.35(1.23-1.48)
|
<0.001
|
0.86(0.66-1.12)
|
0.262
|
ANC
|
|
|
|
|
|
No ANC
|
2.05(1.91-2.20)
|
<0.001
|
1.09(0.92-1.29)
|
0.336
|
|
Any ANC (RC)
|
|
|
|
|
Cesarean
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
0.39(0.36-0.43)
|
<0.001
|
0.99(0.76-1.30)
|
0.951
|
Delivery
|
|
|
|
|
|
Home delivery (RC)
|
|
|
|
|
|
Facility delivery
|
0.42(0.40-0.45)
|
<0.001
|
0.79(0.63_0.98)
|
0.032
|
Birth order
|
|
|
|
|
|
First child
|
0.57(0.53-0.61)
|
<0.001
|
0.92(0.72-1.17)
|
0.481
|
|
Second child
|
0.59(0.55-0.64)
|
<0.001
|
0.81(0.66-0.99)
|
0.042
|
|
Third child
|
0.69(0.64-0.75)
|
<0.001
|
0.82(0.68-1.00)
|
0.052
|
|
Fourth child (RC)
|
|
|
|
|
Diarrhea
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
1.35(1.21-1.50)
|
<0.001
|
1.31(1.04-1.65)
|
0.022
|
Vaccine
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
0.75(0.64-0.89)
|
0.007
|
0.88(0.70-1.10)
|
0.264
|
Improve sanitation
|
|
|
|
|
|
Improved sanitation facility
|
0.41(0.35-0.47)
|
<0.001
|
0.66(0.49-0.89)
|
0.007
|
|
Unimproved sanitation facility
|
0.69(0.60-0.80)
|
<0.001
|
0.70(0.53-0.93)
|
0.014
|
|
Open defection (RC)
|
|
|
|
|
|
|
|
|
|
|
Improve water
|
|
|
|
|
|
Improved source (RC)
|
|
|
|
|
|
Unimproved source
|
1.45(1.23-1.71)
|
<0.001
|
1.00(0.70-1.42)
|
1.000
|
|
|
|
|
|
|
Wealth index
|
|
|
|
|
|
Poorest
|
3.42(3.14-3.73)
|
<0.001
|
1.56(1.19-2.03)
|
0.001
|
|
Poorer
|
2.68(2,46-2.93)
|
<0.001
|
1.41(1.09-1.82)
|
0.008
|
|
Middle
|
2.14(1.96-2.34)
|
<0.001
|
1.27(1.00-1.62)
|
0.054
|
|
Richer
|
1.63(1.49-1.79)
|
<0.001
|
1.10(0.88-1.37)
|
0.420
|
|
Richest (RC)
|
|
|
|
|
Year
|
|
|
|
|
|
2007
|
2.32(2.15-2.50)
|
<0.001
|
1.71(1.36-2.15)
|
<0.001
|
|
2011
|
1.94(1.81-2.08)
|
<0.001
|
1.60(1.29-1.99)
|
<0.001
|
|
2014
|
1.67(1.55-1.80)
|
<0.001
|
1.38(1.09-1.75)
|
0.007
|
|
2017 (RC)
|
|
|
|
|
|
RC= Reference Category
|
|
|
|
|
The Table 4 presents the decomposition of the CIX in response to wealth status. The decomposition of this CIX is calculated to observe the impact of different independent variables on inequality. Among the people of Bangladesh, we can see that, with a lower socioeconomic status, the value of CIX for childhood underweight was (CIX: -.15009722, p<0.001), showing socioeconomic discrepancy in childhood underweight. This table also demonstrates the level of disparity, which has the value range between -1 to +1. The value of 0 indicates the perfect equality, meaning that the independent variable is evenly distributed across the population. The column containing the percentage contributions of the independent variables explains their relative contribution to inequality. The contribution of each variable is expressed as a percentage, where the negative value of the percentage defines the contribution of the variable in lowering concentration and the positive value represents the contribution in increasing inequality. In the observed inequality due to wealth status, which is -0.150, 5.2% is contributed by place of residence, 3.82% by divisions, 1.96% by vaccination status, and 1.32% by sanitation. The values in column “Elasticity” explains the magnitude, where the positive values indicate that with the increase in independent variable, there’s increase in childhood underweight, and the negative values indicating that decrease in childhood underweight will occur with the increase in independent variable.
Table 4: Decomposition of Inequality Measurement of Childhood Underweight
Variables
|
Elasticity
|
CIX
|
Contribution to overall CIX
CIX= (-.15009722, p<0.001)
|
Absolute contribution
|
Percentage contribution
|
|
Place of Residence
|
|
|
|
|
|
Urban
|
|
|
|
|
|
Rural (RC)
|
-.12743873
|
.06120729
|
-.00780018
|
5.1967513
|
|
Divisions
|
|
|
|
|
|
Barisal
|
.01147432
|
-.7443346
|
-.00854074
|
5.6901358
|
|
Chittagong
|
-.00199608
|
.00075165
|
-.00874571
|
.00099959
|
|
Dhaka
|
.00891633
|
.5500946
|
.00490483
|
-3.2677666
|
|
Khulna
|
-.00729682
|
-.40710373
|
.00297056
|
-1.9790918
|
|
Rajshahi
|
.05650987
|
-.08977345
|
-.00507309
|
3.379867
|
|
Sylhet
|
3.379867
|
0
|
-.30246786
|
0
|
|
New Division (RC)
|
|
|
|
|
|
Sub Total
|
|
|
-0.316952
|
3.824144
|
|
Age of the Children
|
|
|
|
|
|
0-<6 (RC)
|
|
|
|
|
|
6-8
|
-.01020652
|
.00181604
|
-.00001854
|
.01234899
|
|
9-11
|
.04806251
|
.03154169
|
.00151597
|
-1.009994
|
|
12-17
|
.00742978
|
.00336305
|
.00002499
|
-.01664699
|
|
18-23
|
.07656854
|
.00769127
|
.00058891
|
-.39235197
|
|
24-35
|
.16173566
|
.00057747
|
.0000934
|
-.06222506
|
|
36-47
|
.17789376
|
-.00094677
|
-.00016842
|
.11221025
|
|
48-59
|
.20690991
|
-.0086106
|
-.00178162
|
1.1869763
|
|
Sub Total
|
|
|
0.00025469
|
-0.1696825
|
|
Diarrhea
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
.00502209
|
.03174832
|
.00015944
|
-.10622654
|
|
Fever
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
.02765323
|
.00589676
|
.00016306
|
-.10863923
|
|
Vaccine
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
-.33673918
|
.00874904
|
-.00294615
|
1.962825
|
|
Mother’s Age
|
|
|
|
|
|
15-24 (RC)
|
|
|
|
|
|
25-34
|
-.20274575
|
.00143263
|
-.00029046
|
.19351439
|
|
35-49
|
-.04325436
|
-.02905627
|
.00125681
|
-.83733094
|
|
Sub Total
|
|
|
0.00096635
|
-0.6438166
|
|
Ceaseran
|
|
|
|
|
|
No (RC)
|
|
|
|
|
|
Yes
|
.00524391
|
-.00145119
|
-.00494311
|
.00506997
|
|
Partner’s Education
|
|
|
|
|
|
No Education (RC)
|
|
|
|
|
|
Primary
|
-.00192693
|
-.00225521
|
-.00324219
|
-.0028952
|
|
Secondary
|
.00873335
|
-.0028652
|
-.00002502
|
.01667107
|
|
Higher
|
-.04770708
|
-.05030113
|
.00239972
|
-1.5987772
|
|
Sub Total
|
|
|
-0.0008675
|
-1.5850013
|
|
Women Working
|
|
|
|
|
|
No Work (RC)
|
|
|
|
|
|
Working
|
-.01425381
|
-.001692
|
.00002412
|
-.01606792
|
|
Birth Order
|
|
|
|
|
|
First Child
|
-.13747552
|
-.00043531
|
.00005984
|
-.03987071
|
|
Second Child
|
-.06768814
|
-.00766926
|
.00051912
|
-.34585429
|
|
Third Child
|
-.00466547
|
.00805586
|
-.00003758
|
.02504001
|
|
Fourth Child (RC)
|
|
|
|
|
|
Sub Total
|
|
|
0.00054138
|
-0.360685
|
|
Delivery
|
|
|
|
|
|
Home Delivery (RC)
|
|
|
|
|
|
Facility Birth
|
-.12180615
|
-.03866242
|
.00470932
|
-3.1375138
|
|
Sanitation
|
|
|
|
|
|
Improved Sanitation (RC)
|
|
|
|
|
|
Unimproved Sanitation
|
-.01533928
|
.01297393
|
-.00019901
|
.13258796
|
|
Open Defecation
|
-.01235466
|
.14444306
|
-.00178454
|
1.1889258
|
|
Sub Total
|
|
|
-0.0019836
|
1.3215138
|
|
Water Source
|
|
|
|
|
|
Improved Source (RC)
|
|
|
|
|
|
Unimproved Source
|
.00624193
|
-.22046804
|
-.00137615
|
.91683619
|
|
Partner’s Occupation
|
|
|
|
|
|
Agriculture and Farming
|
.09413506
|
.02890798
|
.00272125
|
-1.8129946
|
|
Non-agricultural Sector
|
.14210421
|
-.0106138
|
-.00150827
|
1.0048589
|
|
Business
|
.05441735
|
-.01113302
|
-.00060583
|
.4036247
|
|
No Work (RC)
|
|
|
|
|
|
Sub Total
|
|
|
0.00060715
|
-0.404511
|
|
Mother’s Education
|
|
|
|
|
|
No Education
|
.10983006
|
.04801237
|
.0052732
|
-3.5131909
|
|
Primary
|
.19162088
|
.00640063
|
.00122649
|
-.81713296
|
|
Secondary
|
.23170868
|
-.00474531
|
-.00109953
|
.73254563
|
|
Higher (RC)
|
|
|
|
|
|
Sub Total
|
|
|
0.00540016
|
-3.5977782
|
|
Year
|
|
|
|
|
|
2007
|
0
|
.01435238
|
0
|
0
|
|
2011
|
0
|
-.00522363
|
0
|
0
|
|
2014
|
0
|
.04137754
|
0
|
0
|
|
2017 (RC)
|
|
|
|
|
|
Sub Total
|
|
|
0
|
0
|
|
Mother’s BMI
|
|
|
|
|
|
Underweighted (<18.50)
|
.07312176
|
-.01277876
|
-.00093441
|
.62253336
|
|
Normal (18.51-24.99) (RC)
|
|
|
|
|
|
Overweighted/Obese (>25.0)
|
-.16394303
|
-.02583713
|
.00423582
|
-2.8220488
|
|
Sub Total
|
|
|
0.00330141
|
-2.1995154
|
|
Wealth Index
|
|
|
|
|
|
Poorest
|
.03419028
|
.00957152
|
.00032725
|
-.21802725
|
|
Poorer
|
.01023295
|
-.00449623
|
-.00004601
|
.03065324
|
|
Middle
|
-.03398318
|
.01828099
|
-.00062125
|
.41389583
|
|
Richer
|
.010582
|
.01373893
|
.00014539
|
-.09686085
|
|
Richest (RC)
|
|
|
|
|
|
Sub Total
|
|
|
-0.000195
|
0.129661
|
Using the Lorenz curve tactic, Figure 3 shows the differences in childhood underweight status between the 4 separate years. The figure shows that all four lines are curved below the equality line. This suggests that childhood underweight tends to be more common in poorer families. However, it also appears that the difference between the equality line and the concentration curve is greatest in 2014.
Discussion
The current study was completed with a view to identify the factors associated with the prevalence of underweight among children under five years of age in Bangladesh. In this study, socio-economic status defined through wealth index was found to be associated, where poorest and poorer families have greater odds of having underweighted children than the richest families. This outcome was found to be consistent with certain earlier investigations (A. Rahman et al., 2021; Islam et al., 2020; A. Rahman, 2015; T. R. Chowdhury et al., 2018; Das & Gulshan, 2017; Alom et al., 2012; M. A. Islam et al., 1994; Nahar et al., 2010; Srinivasan et al., 2013; Doak et al., 2002; Hong et al., 2006; Janevic et al., 2010; Khor & Sharif, 2003; Larrea & Freire, 2002; Wang et al., 2002 Sarker et al., 2020).
In this study, children with educated mothers were estimated to be less likely to be underweight than those whose mothers had secondary education. The results are aligned similar to those reported by (M. R. K. Chowdhury, Rahman, Khan, Mondal, et al., 2016; A. Rahman et al., 2021; M. R. Islam et al., 2020). Mother’s education was found to be highly impactful, as the odds of having an underweight child seem more acute in lower educational status in this study. This result remained identical to the results found in a study in which children of mothers with incomplete secondary education had a lower risk of being underweight than those whose mothers had no formal education, and children of mothers with completed secondary education had a lower risk of being underweight (T. R. Chowdhury et al., 2018). The result of this study is similar to that of comparable studies (Alom et al., 2012; M. A. Islam et al., 1994; Nahar et al., 2010; Srinivasan et al., 2013; Alasfoor et al., 2007; Mohsena et al., 2010; Mukabutera et al., 2016). Earlier research conducted in Bangladesh revealed similar results, demonstrating that children of uneducated mothers were substantially more likely to be severely underweight than children whose mothers had a relatively better degree of education (Chisti et al., 2007; Henry et al., 1992, 1993b, 1993a; Iqbal Hossain et al., 1999; A. Rahman & Chowdhury, 2007; Sarker et al., 2020).
In this study, fathers with no education and primary education tended to have more odds of having underweighted children than fathers with higher education. This outcome aligns with the result in a study where children of illiterate fathers had a 30% higher probability of being underweight than children of fathers who had completed primary education, according to (Das & Gulshan, 2017).
The results of this study did not find significance in antenatal care (ANC) as a factor associated with the odds of having an underweighted child. Areas regarding the association of ANC where significant differences and contradictions of the results of this study have been found in (Das & Rahman, 2011; A. Rahman et al., 2021).
In this study, it was found that as children’s ages increased, there was an increased risk of being underweight among children under the age of five, which aligns with the findings of (Ahsan et al., 2017; Das & Gulshan, 2017). This study found that children who suffered from recent diarrhea had a greater odd of being underweight than those who did not. This result is consistent with the results of a previous study (Das & Gulshan, 2017).
Interestingly, this study found that mothers with a greater BMI or who are overweight/obese (>25.0) had lesser odds of having an underweighted child than mothers with a normal BMI (18.51-24.99). However, mothers with a small BMI rate or who are underweight (<18.50) have a greater odd of having underweighted children. This result is consistent with some previous studies (M. R. K. Chowdhury, Rahman, Khan, Mondal, et al., 2016; M. R. Islam et al., 2020; A. Rahman et al., 2021).
n this study, improved sanitation resulted in relatively lower odds of underweight children. Families having improved and unimproved sanitation facilities tend to have a lesser likelihood of having underweighted children than those who have open defection as a sanitation procedure , which is consistent with the studies cited in (T. R. Chowdhury et al., 2018).
In this study, water source was found to show an insignificant association with odds regarding underweighted children, which is also similar to the results of study (A. Rahman et al., 2021).
This research, using national demographic health survey data, also explored socioeconomic inequalities linked with childhood underweight in Bangladesh. Inequalities in childhood underweight status have many causes. Families with higher income and higher socioeconomic status are less concentrated in issuing underweight children, as found in several studies (Mohsena et al., 2010b; A. Rahman et al., 2009). Mothers with relatively lower ages in the lower socioeconomic group had more likeliness to give birth to underweight children. Mothers with no working status in the lower socioeconomic group were found to have a higher likelihood of having underweight children.
Strength and Weaknesses
This study includes both strengths and limitations. One of the major strengths of this study is – this study incudes the nationally-representative data of Bangladesh. So, the findings can be generalized on the overall situation of Bangladesh’s entire population. Most of the factors were found out by through extensive literature review, in order to find out the impacts of the factors on childhood underweight. So, the factors’ contributions can also be assessed comparing to other countries.
There are certain restrictions in this study as well. This study is cross-sectional in nature. Therefore, the link between the parameters chosen for this investigation and childhood underweight could not support a known cause. Additionally, some potential factors, such as food security and safety, maternal exercise, breastfeeding practices, parental smoking habits, and other organic factors like a lack of any organic elements in the body, could not be evaluated in this study due to a lack of data on those factors. These aspects might have a different impact on the study's conclusions if they could be evaluated.