Exploring under-five child malnutrition in Bangladesh: analysis using the Extended Composite Index of Anthropometric Failure (ECIAF)

Abstract

Objective: The current study is an attempt to explore under-five child malnutrition in a low-income population setting using the Extended Composite Index of Anthropometric Failure (ECIAF).

Design: Data from the Bangladesh Demographic and Health Survey 2017-2018 were analysed. Malnutrition using ECIAF was estimated using stunting, wasting underweight and overweight. Multilevel logistic regression models identified factors associated with malnutrition. Geospatial analysis was conducted using R programming.

Setting: Bangladesh.

Participants: Children under 5 years of age.

Results: In Bangladesh, as indicated by the ECIAF, approximately 40·8 % (95 % CI: 39·7, 41·9) of children under five experience malnutrition, whereas about 3·3 % (95 % CI: 2·9, 3·7) were overweight. Children of parents with no formal education (56·3 %, 95 % CI: 50·8, 61·8), underweight mothers (53·4 %, 95 % CI: 50·4, 56·3), belonging to the lowest socio-economic strata (50·6 %, 95 % CI: 48·3, 53·0), residing in rural areas (43·3 %, 95 % CI: 41·9, 44·6) and aged below 3 years (47·7 %, 95 % CI: 45·2, 50·2) demonstrated a greater age- and sex-adjusted prevalence of malnutrition. The Sylhet division (Eastern region) exhibited a higher prevalence of malnutrition (> 55·0 %). Mothers with no formal education (adjusted OR (AOR): 1·51, 95 % CI: 1·08, 2·10), underweight mother (AOR: 1·54, 95 % CI: 1·03, 1·83), poorest socio-economic status (AOR: 2·14, 95 % CI: 1·64, 2·81), children aged 24-35 months (AOR: 2·37, 95 % CI: 1·97, 2·85) and fourth and above birth order children (AOR: 1·41, 95 % CI: 1·16, 1·72) were identified key factors associated with childhood malnutrition while adjusting community- and household-level variations.

Conclusions: In Bangladesh, two out of five children were malnourished, and one in thirty-five children was overweight. Continuous monitoring of the ECIAF over time would facilitate tracking changes in the prevalence of different forms of malnutrition, helping to plan interventions and assess the effectiveness of interventions aimed at addressing both undernutrition and overweight.

Keywords: Bangladesh; Children; Composite index; Malnutrition; Overweight; Undernutrition.

Figure 1.

Prevalence of various indicators of anthropometric failures (malnutrition indicators). ECIAF, Extended Composite Index of Anthropometric Failure; CIAF, Composite Index of Anthropometric Failure.

Figure 2.

Geospatial distribution of prevalence of malnutrition, undernutrition and overweight. BDHS, Bangladesh Demographic and Health Survey; CIAF, Composite Index of Anthropometric Failure; ECIAF, Extended Composite Index of Anthropometric Failure.