Undernutrition Maps Bangladesh 12
Undernutrition Maps Bangladesh 12
Undernutrition Maps Bangladesh 12
Maps of
Bangladesh
2012
Foreword
Over the past two decades, Bangladesh has made impressive economic and social gains. It has significantly
reduced the incidence of poverty, increased education levels, reached self-sufficiency in rice production and
lowered fertility rates and child mortality. However, challenges still remain to keep undernutrition levels below
the World Health Organizations (WHO) public health critical thresholds. Undernutrition costs Bangladesh more
than 7,000 Crore Taka (US$ 1 billion) in lost productivity every year, and even more in health care costs1.
With an increased focus on improving child nutrition, it is critical to understand the geographical variations and
spatial patterns of undernutrition in Bangladesh.
The Bangladesh Bureau of Statistics (BBS) and the World Food Programme (WFP) have a long-standing
partnership and experience in developing poverty maps and undernutrition maps. Responding to the need for
undernutrition maps, BBS, partnering with WFP and with generous financial contribution from the International
Fund for Agricultural Development (IFAD) initiated the undernutrition mapping exercise in May 2013. We are
thankful to Massey University, New Zealand for its technical expertise to conduct and complete this exercise.
The initiative has produced estimates of underweight and stunting, two measures of undernutrition, which
are not subject to major seasonal variation. These estimates for children under five years of age are statistically
valid down to upazila (sub-district) level. These are based on applying the Small Area Estimation technique on
data from the Population and Housing Census 2011, Child and Mother Nutrition Survey 2012 and Health and
Morbidity Status Survey 2012. The resulting estimates have been mapped out to create powerful visual tools,
which are easily understood and objectively verifiable. The mapping exercise was also marked with providing
hands-on training at BBS on poverty and undernutrition mapping, jointly with the World Bank.
The aim of the mapping exercise was to serve policy makers, planners and researchers with a tool to identify the
spatial variation of undernutrition rates in Bangladesh at finer administrative levels. We hope that the district and
upazila level estimates of undernutrition rates, along with the associated maps, will be used in a complementary
manner with key correlates of undernutrition to strengthen decision making and investments on targeted and
integrated nutrition-focused development.
Behind the colours and percentages of the maps are millions of children who require our attention to achieve full
mental and physical potential for a brighter future. We hope that these maps lead to an enhanced engagement of
the Government of Bangladesh and development partners in creating a Bangladesh free of child undernutrition.
Christa Rder
Hubert Boirard
Country Representative
World Food Programme
Director General
Bangladesh Bureau of Statistics
Acknowledgement
The Undernutrition Maps of Bangladesh are the final products
of a collaborative effort between the Bangladesh Bureau
of Statistics (BBS) of the Statistics and Informatics Division
(SID), Ministry of Planning and the World Food Programme
(WFP). The project was funded by the International Fund
for Agricultural Development (IFAD) and WFP. Massey
University, New Zealand provided technical expertise for the
analytical work.
The team acknowledges the leadership and support of Ms.
Suraiya Begum (Secretary, SID), Mr. Md. Nojibur Rahman
(former Secretary, SID) and Mr. Golam Mostafa Kamal (Director
General, BBS). The team would like to thank the members of
the Steering Committee and the Technical Committee, who
reviewed and endorsed both the methodology and results of
the undernutrition mapping exercise.
Professor Stephen Haslett and Associate Professor Geoffrey
Jones of the Institute of Fundamental Sciences, Massey
University spearheaded the analytical work in deriving
upazila level estimates of undernutrition rates. Dr. Marissa
Isidro assisted them in this work.
The BBS team included Mr. Md. Zahidul Hoque Sardar,
Dr. Dipankar Roy, Mr. Anwar Hossain, Mr. Md. Rezaul Karim,
Mr. Md. Jibon Miah and Mr. Dinesh Roy. The WFP team
included Ms. Nusha Choudhury, Ms. Kayenat Kabir and Mr.
Mahabubul Alam of the Vulnerability Analysis and Mapping
(VAM) unit working under the guidance of Ms. Christa Rder
(Country Representative).
Introduction
Undernutrition mapping is a statistical
exercise to estimate the percentage of the
Division
Un
64
District
7 7 59
Up
the
Small
Area
& Tha
na
54 4
Estimation
azila
By Division
micronutrient
deficiencies.
Districts
Two
Barisal
6
40
11
Chittagong
111
(low height-for-
17
Dhaka
163
10
Khulna
The third generation of upazila level poverty maps of
Bangladesh were published in August 2014 by BBS, the
World Bank and WFP.
Rajshahi
Rangpur
64
8
70
8
58
Sylhet
Upazilas
4
38
Unlike
not
be
evident
as
the
Sustainable Development
Undernutrition Mapping
Methodology
Small-area estimates (SAE) of stunting and underweight in children under
five years of age in Bangladesh are produced at upazila (sub-district) level
by combining survey data from CMNS 2012 and Health and Morbidity
Status Survey (HMSS) 2012 with auxiliary data derived from Census 2011.
SAE is a mathematical technique to extract more detailed information from
existing data sources by statistical modelling. The SAE method used for
the undernutrition mapping exercise is an extended and modified version
of the ELL method (developed by Elberts et al, 2003) which has also been
used for developing the Bangladesh Poverty Maps.
The CMNS, which is conducted by BBS every 4-5 years, is one of the
indicator.
towards
the
Development
the survey and the census. The data sources have a common set of
indicator.
been fitted to the CMNS data. These models provide predictions of the
two measures for every child under five years in the census. In turn, the
predictions have then been used for estimating stunting and underweight
and their accuracy for children under five, by converting height-for-age to
stunting and weight-for-age to underweight, followed by aggregation to
district and upazila levels.
In August 2014, the preliminary undernutrition maps and technical report
were reviewed by the Technical Committee members. The final versions
of the maps were endorsed in the meeting of the Steering Committee on
3 November 2014.
For visual display of the spatial variation in stunting and underweight at
district level and upazila level the estimates have been presented in the
four maps on the next pages.
The other two are Bangladesh Demographic and Health Survey (BDHS) conducted under the
authority of the National Institute of Population Research and Training (NIPORT) of the Ministry of
Health and Family Welfare and the Multiple Indicator Cluster Survey (MICS) conducted by BBS. The
MICS 2009 did not survey for anthropometric measurements and the MICS 2012-13 dataset which
does have them was not available yet during the study period.
Stunting Map
District Level
Underweight Map
District Level
Stunting Map
Upazila Level
Underweight Map
Upazila Level
Results at a Glance
Division Level Undernutrition Estimates
The small area estimates for the child undernutrition measures, stunting and underweight, were accumulated to
high levels of aggregation for comparison with the direct estimates available from the CMNS 2012. The tables
below show a comparison of the estimates from CMNS 2012, the mapping exercise, the Bangladesh Demographic
and Health Survey (BDHS) 2011 and the Multiple Indicator Cluster Survey (MICS) 2012-2013. The division level
estimates from the mapping exercise have better agreement with both CMNS 2012 and BDHS 2011, than they
have among themselves.
CMNS
SAE
BDHS
MICS
Barisal
31.0
39.7
45.1
41.4
5.5
Chittagong
45.9
42.1
41.3
43.1
22.1
Dhaka
42.6
40.4
43.3
42.1
31.3
Khulna
34.9
39.5
34.1
34.4
8.9
Rajshahi
39.3
41.0
33.7
39.4
11.7
Rangpur
36.2
42.1
42.9
43.7
11.4
Sylhet
51.3
44.6
49.3
50.6
9.1
CMNS
SAE
BDHS
MICS
Barisal
26.7
33.4
40.0
35.2
Chittagong
39.4
36.8
37.4
32.2
Dhaka
33.5
32.3
36.6
30.8
Khulna
26.2
32.0
29.1
28.5
Rajshahi
37.3
34.0
34.2
29.9
Rangpur
32.7
35.7
34.5
32.6
Sylhet
39.5
38.5
44.9
39.7
Results from CMNS 2012 and the undernutrition mapping exercise show that both stunting and underweight
rates at division level are highest in Sylhet, followed by Chittagong. Stunting and underweight rates according
to BDHS 2011 and MICS 2012-13 are also highest in Sylhet. Sylhet and Chittagong also have the highest share
of the countrys total stunted children.
Barisal and Khulna have the lowest stunting and underweight rates as well as the lowest share of the countrys
total stunted children.
Stunting Rate
(at District Level)
Underweight Rate
(at District Level)
Minimum
Maximum
Minimum
Maximum
Barisal
37.0
(Jhalokati)
42.9
(Bhola)
28.8
(Jhalokati)
38.1
(Bhola)
Chittagong
40.1
(Chandpur)
47.7
(Bandarban)
32.8
(Rangamati)
39.7
(Lakshmipur)
Dhaka
34.2
(Dhaka)
44.3
(Kishoreganj)
22.8
(Dhaka)
39.1
(Netrakona)
Khulna
36.7
(Narail)
41.7
(Kushtia)
29.1
(Khulna)
34.2
(Chuadanga)
Rajshahi
36.9
(Joypurhat)
45.1
(Sirajganj)
30.1
(Joypurhat)
36.7
(Sirajganj)
Rangpur
40.6
(Panchagarh)
43.4
(Nilphamari)
33.0
(Dinajpur)
38.7
(Kurigram)
Sylhet
43.8
(Maulvibazar)
46.1
(Sunamganj)
36.7
(Maulvibazar)
40.9
(Sunamganj)
Stunting rates are highest in Bandarban district of Chittagong division, which is a hilly area; followed by Coxs
Bazar district in the coastal belt of Chittagong division and Sunamganj district of Sylhet division which largely
consists of haor (wetland) areas. Both stunting and underweight rates are lowest in Dhaka district where the
national capital is situated.
39 out of 64 districts in Bangladesh have stunting rates above the WHO critical threshold level for stunting (40
percent). And 55 districts are above WHO critical threshold level for underweight (30 percent).
At upazila level 300 out of a total of 544 upazilas (55 percent) in Bangladesh have a stunting rate above 40
percent and 440 upazilas (81 percent) have an underweight rate above 30 percent.
The stunting rate varies from as low as 28 percent in Dakhshinkhan thana, Dhaka district to as high as 51
percent in Ukhiya upazila, Coxs Bazar district.
The upazilas surrounding the divisional cities of Dhaka, Chittagong, Khulna and Rajshahi have the lowest rates
of stunting in the respective divisions.
Upazilas within a district have considerable spatial variation in undernutrition rates. The difference in stunting
rate between the highest and lowest ranked upazila within the respective districts range from 5 to 13 percent.
Within Dhaka district, which has the lowest stunting rate in Bangladesh, the stunting rates varies from as low
as 28 percent in Dakhshinkhan thana to as high as 41 percent in Keraniganj thana.
Causes of Undernutrition
Undernutrition is the outcome of insufficient intake of
energy, protein and/or micronutrients; poor absorption
or rapid loss of nutrients due to illness or increased
energy expenditure. The causes of undernutrition
are multi-level and multi-sectoral. The underlying
causes at household level are insufficient access to
food, inadequate maternal and child care practices
WFP/Kauser Haider
Outcome
Undernutrition, death
and disability
Immediate causes
Inadequate dietary
intake
Underlying causes
at household/family
level
Basic causes at
societal level
Insufficient
access to FOOD
Disease
Inadequate
maternal and child
CARE practices
10
Stunting Map
11
the highest poverty rates, it has one of the lowest stunting rates. The BDHS 2011 reports one in four children
(26 percent) under five years old stunted and one in five children (21 percent) underweight, even in the highest
household wealth quintile. Clearly factors contributing to undernutrition lie beyond household income levels.
12
Stunting Map
13
child gets older, while maintaining frequent breastfeeding. A comparison of the maps below show that Khulna
division which has a low stunting rate compared to other divisions also has better IYCF practices; while Sylhet and
Chittagong divisions, which have high stunting rates, do not fare well on this indicator.
14
Stunting Map
15
in Sylhet division and in the drought zone in the westernmost part of Rajshahi division are among the regions
performing worst on access to drinking water and sanitary toilet.
16
Stunting Map
IFPRI (2013). Agriculture, Income, and Nutrition Linkages in India. Available from: http://www.ifpri.org/sites/default/files/publications/ifpridp01195.pdf
17
are more than two times more likely to have stunted children than educated mothers8. While higher education
levels of mothers may also be indicative of the income status of the household, poverty is definitely not the only
determining factor of undernutrition
BDHS 2011 results show that 51% of children of mothers with no schooling were stunted compared to 23% for children of mothers with secondary or
higher education.
18
Concluding Remarks
Maps are easily understood and objectively verifiable, but they do not tell us directly
about the underlying causes of a situation, in this case of undernutrition in a particular
area. These maps should thus be used with caution and in a complementary manner
with other maps and information on possible underlying causes and up-to-date local
information. The comparison of the undernutrition maps with key causal maps indicate
that the commonly identified causes do not have the same level of effect in all areas, but
there is an interplay of different factors. As the causes of undernutrition are manifoldso are the solutions, there is no one solution, but the solutions are multi-sectoral.
The regional concentration of undernutrition suggests that geographic targeting of
nutrition interventions can have a high pay off in achieving significant reductions in the
Kayenat Kabir
Parishankhyan Bhaban
E-27/A, Agargaon
Sher-e-Bangla Nagar
Dhaka-1207, Bangladesh
Tel: 880 2 9112589
Fax: 880 2 9111064
www.bbs.gov.bd