Volume: 25, Issue: 1

Page: 202-209
International Journal of Science and Business
2023
Journal homepage: ijsab.com/ijsb

Child malnutrition in Bangladesh: an

evidence from multiple indicators cluster
survey
Maymuna Jarin, Krishna Roy Chowdhury, & Rajib Dey

Abstract
Bangladesh has made significant progress in reducing child malnutrition over the
years. However, malnutrition remains a considerable challenge in the country,
particularly among children under the age of five years. This study aimed to
determine the risk factors involved with child malnutrition (i.e. underweight,
stunting and wasting) among children under five in Bangladesh. We examined the
potential risk factors of child underweight, stunting and wasting using data based
on multiple indicators cluster survey (MICS) conducted in Bangladesh in 2019.
The data included 18,696 children (under the age of five years) respectively from IJSB
Accepted 17 July 2023
64,400 households. Binary logistic regression models were used to evaluate the Published 19 July 2023
DOI: 10.58970/IJSB.2195
potential risk factors associated with malnutrition in children. About 27% of
children under age five are stunted (short for their age), 10% are wasted (thin for
their height), and 22% are underweight in Bangladesh. The most critical risk
factors of child malnutrition in Bangladesh were the mother’s education, mother’s
age at birth, place of residence and wealth quantile.

ISSN: 2520-4750 (Online) 2521-3040 (Print)

Papers published by IJSAB International are

licensed under a Creative Commons Attribution-
NonCommercial 4.0 International License.

Keywords: Malnutrition, MICS, Binary logistic model, Nutrition status, Stunting, Wasting, Underweight.

About Author (s)

Maymuna Jarin, Department of Statistics, Hajee Mohammad Danesh Science and Technology University,
Dinajpur, Bangladesh.
Krishna Roy Chowdhury, Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh.
202
Rajib Dey (Corresponding author), Department of Statistics, Hajee Mohammad Danesh Science and
Technology University, Dinajpur, Bangladesh.
IJSB Volume: 25, Issue: 1 Year: 2023 Page: 202-209

Introduction
Child malnutrition is a critical issue that directly affects the health and well-being of children.
Malnourished children are more susceptible to illness, have slower cognitive development, and
have a higher mortality risk. Some serious effects of poor nutrition in early childhood are
stunting (too short for age), wasting (too thin for height) and being overweight. WHO (2014)
reported that about 25% children is stunted due to only lack of nutrition, and consequently,
the world has observed more than 2.6 million child deaths every year. In Bangladesh, the
prevalence of stunting among children under five years old has been relatively high. According
to the Bangladesh Demographic and Health Survey (BDHS) 2017-2018, approximately 36% of
children under five were stunted. In Bangladesh, the prevalence of wasting among children
under five is also a concern. The BDHS 2017-2018 reported a wasting prevalence of around
14% among children under five. Underweight is a composite measure of both acute and chronic
malnutrition. In the BDHS 2017-2018, it was found that around 31% of children under the age
of five were underweight. Child malnutrition in Bangladesh is a blend of multiple factors, and
the situation may have evolved since 2017-18. Therefore, for the most up-to-date and accurate
information, we used data from multiple indicators cluster surveys in 2019

Understanding the extent and causes of child malnutrition in Bangladesh helps identify
vulnerable populations and develop effective interventions to save lives and improve
children's overall health. The United Nations has set a series of SDGs to address global
challenges, including the reduction of child malnutrition. By studying child malnutrition in
Bangladesh, policymakers, researchers, and development agencies can monitor progress
toward achieving SDG targets and identify areas where additional efforts are needed. Overall,
studying child malnutrition in Bangladesh is motivated by the desire to improve the health and
well-being of children, achieve sustainable development goals, foster national development,
and promote equity and social justice.

Related work section

Child malnutrition is a significant issue in Bangladesh, a developing country in Asia. Extensive
literature exists on the determinants of child nutrition status in developing countries, including
Bangladesh. The studies based on Chen et al. (1980) and Roy et al. (1983) have highlighted
various factors associated with infant and child malnutrition in the country. These factors
include low dietary intake, low birth weight, family size, lack of parental education,
breastfeeding practices, the incidence of diarrhea, previous birth interval, maternal body mass
index (BMI), household economic status, and delayed weaning. Moreover, Bairagi and
Chowdhury (1994) have indicated that the sex and birth order of the index child are significant
determinants of malnutrition. Socioeconomic factors and diseases have also been found to play
a substantial role in child nutrition. Siddique et al. (2011) have demonstrated that malnutrition
in Bangladesh is a significant risk factor for childhood mortality. Muaz et al. (2010) has shown
higher malnutrition rates in rural and hilly areas compared to urban and metropolitan areas.
Gender inequality, stemming from socioeconomic structure, has been identified as a significant
differentiating factor in the nutritional status of children. Additionally, Cochrane (1982) has
suggested maternal antenatal care-seeking behaviour, and healthcare knowledge are essential
determinants of child nutrition status, particularly for infants. The literature reveals that
socioeconomic conditions, parental education, healthcare-seeking behaviour, and dietary
practices influence child malnutrition in Bangladesh. Understanding these determinants is
crucial for developing effective interventions and policies to address child malnutrition and
improve the nutritional status of children in Bangladesh.

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Methods
Data & Variables
The data for this study were obtained from the Multiple Indicators Cluster Survey (MICS)
conducted in 2018-19. The survey was carried out by the Bangladesh Bureau of Statistics (BBS)
in collaboration with the United Nations International Children's Emergency Fund (UNICEF).
It was conducted between January 19 and June 1, 2019, with the aim of collecting national-level
data on key indicators across the eight divisions of the country. A two-stage stratified cluster
sampling approach was employed to select the survey sample, utilizing the 2011 census frame
for cluster selection. Standardized questionnaires were administered to collect data, ensuring
consistency in data collection procedures. The dataset includes comprehensive information
from 64,400 households, with questionnaires completed by parents of 23,099 children aged
five years and below. To minimize recall bias and avoid duplicating households in the analysis,
only the youngest child under the age of five from households with multiple children in that
age group was included in the study. Thus, the final sample consisted of 18,696 children under
five years of age, whose data from the MICS 2019 were utilized for calculations and analysis.

Response Variable
The indicators stunting, wasting and underweight are used to measure nutritional insufficiency.
Stunting measures chronic malnutrition, indicating low height-for-age among children.
Wasting is a measure of acute malnutrition, meaning low weight-for-height among children.
Underweight is a composite measure of both acute and chronic malnutrition, indicating low
weight-for-age among children. Underweight is defined as weight-for-age <-2 standard
deviations (SD) of the WHO Child growth standards median. Stunting – height-for-age <-2 SD of
the WHO Child growth standards median; Wasting – weight-for-height <-2 SD of the WHO Child
growth standards median.

Explanatory variables
To examined the influence of socioeconomic related variables of child malnutrition the
following variable are considered- Sex of child, Area, Division, Age in Months, Mother’s age at
birth, Wealth index quintile, Mother’s Education, Ethnicity of household head.
Results
This study was based on the data of 18,696 children under age five who were eligible for
height and weight measurements. Complete case analysis for the response variable:

Table 1 Complete case analysis

Height for age Weight for age Weight for height
Complete case 84.77% 84.47% 84.93%
Missing 15.23% 15.53% 15.07%

Complete height-for-age measurements were obtained for 85.77% of eligible children. Similarly,
complete weight-for-height measurements were obtained for 84.93% of eligible children and
valid weight- for-age measurements were obtained for 84.47% of eligible children. We
performed complete case analysis to omit missing values. Finally, 18,696 participants were
recruited for the study. Table 2 presents the nutritional status of children aged five years or
younger in Bangladesh based on three anthropometric measures. The findings indicate that
approximately 27% of children were reported to have stunted growth, indicating a chronic
form of malnutrition characterized by low height-for-age. Around 22.1% of children were
underweight. Additionally, 10.10% of children were classified as having a "wasting" status,
indicating acute malnutrition characterized by low weight-for-height.

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Table 2 Distribution of under five children in different categories of malnutrition

Height for age Weight for age Weight for height
Normal Stunting Normal Underweight Normal Wasting Total
Total 73% 27% 77.9% 22.1% 89.9% 10.1% 18,696
Sex of child
Male 72.4% 27.6% 78.1% 21.9% 89.2% 10.8% 9790
(51.61%)
Female 73.6% 26.4% 77.6% 22.4% 90.6% 9.4% 8906
(48.39%)
Area
Urban 75.8% 24.2% 82.0% 18.0% 90.8% 9.2% 3489
(18.39%)
Rural 72.3% 27.7% 76.9% 23.1% 89.7% 10.3% 15,207
(80.17%)
Division
Barisal 72.3% 27.7% 77.0% 23.0% 88.9% 11.1% 1732
(9.131%)
Chattogram 73.0% 27.0% 78.2% 21.8% 89.4% 10.6% 3685
(19.43%)
Dhaka 73.3% 26.7% 80.8% 19.2% 91.5% 8.5% 3692
(19.46%)
Khulna 79.2% 20.8% 80.8% 19.2% 90.5% 9.5% 2735
(14.42%)
Mymenshing 67.5% 32.5% 74.5% 25.5% 89.2% 10.8% 1106
(5.831%)
Rajshahi 74.2% 25.8% 77.5% 22.5% 90.3% 9.7% 2075
(10.94%)
Rangpur 72.3% 27.7% 76.9% 23.1% 88.9% 11.1% 2292
(12.08%)
Sylhet 64.1% 35.9% 69.3% 30.7% 88.4% 11.6% 1379
(7.27%)
Children’s age (in months)
0-11 82.4% 17.6% 84.1% 15.9% 90.3% 9.7% 4086
(21.54%)
12-23 70.4% 29.6% 78.1% 21.9% 88.8% 11.2% 4090
(21.56%)
24-35 66.0% 34.0% 74.7% 25.3% 90.5% 9.5% 3771
(19.88%)
36-47 69.9% 30.1% 75.9% 24.1% 90.7% 9.3% 3632
(19.15%)
48-59 76.2% 23.8% 75.4% 24.6% 89.0% 11.0% 3117
(16.43%)
Mother’s age at birth (in years)
<20 71.9% 28.1% 77.1% 22.9% 89.7% 10.3% 11017
(58.08%)
20-34 74.6% 25.4% 79.0% 21.0% 90.2% 9.8% 7641
(40.28%)
35+ 65.8% 34.2% 76.3% 23.7% 92.1% 7.9% 38
(0.2%)
Wealth index quintile
Poorest 63.9% 36.1% 71.3% 28.7% 87.6% 12.4% 4554
(24.01%)
Poorer 70.4% 29.6% 74.7% 25.3% 88.8% 11.2% 4003
(21.1%)
Middle 75.4% 24.6% 78.4% 21.6% 90.2% 9.8% 3613
(19.05%)
Richer 77.8% 22.2% 81.1% 18.9% 91.5% 8.5% 3529
(18.6%)
Richest 81.6% 18.4% 87.6% 12.4% 92.5% 7.5% 2997
(15.8%)
Mother’s Education
Pre-primary 61.3% 38.7% 68.3% 31.7% 86.3% 13.7% 1941
or none (10.23%)
Primary 67.7% 32.3% 73.5% 26.5% 88.5% 11.5% 4496
(23.7%)

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Primary 75.4% 24.6% 79.3% 20.7% 90.3% 9.7% 9351

Secondary (49.3%)
Higher 81.2% 18.8% 86.4% 13.6% 93.0% 7.0% 2908
secondary (15.33%)
Ethnicity
Bengali 73.1% 26.9% 77.8% 22.2% 89.9% 10.1% 18283
(96.38%)
Others 70.0% 30.0% 79.9% 20.1% 90.1% 9.9% 413
(2.177%)

characteristics and the prevalence of child malnutrition. Approximately half of the children
(48.39%) were female, and a majority (80.17%) resided in rural areas. About a quarter of the
children came from poor families, and 15.33% had mothers with higher education. More than
half of the children (56.7%) belonged to households with more than five members, and the
majority (96.38%) were from Bengali families. Additionally, 58.08% of the children had
mothers aged over 20. The table also presents the prevalence of malnutrition based on child
age, maternal education, household wealth status, type of residence, and division. For instance,
approximately 34.0% of children in 24-35 months age group were stunted, while 11.2% of
children aged 12-23 months were wasted, and 25.3% of children aged 24-35 months were
underweight. Among children of uneducated mothers, prevalently stunted, underweight, and
wasted rates were 38.7%, 31.7%, and 13.7%, respectively. Children from poorer households
had higher rates of stunting (36.1%), wasting (12.4%), and underweight (28.7%). Regarding
residence, rural children had rates of 27.7% for stunting, 10.3% for wasting, and 23.1% for
underweight. Children from the Sylhet division had rates of 35.9% for stunting, 10.3% for
wasting, and 30.7% for underweight. The binary logistic regression model was used to examine
the potential candidates of malnutrition under-five children. Female children were six percent
less likely to experience stunting, fifteen percent less likely to be wasted, and three percent
more likely to be underweight than male children. Children aged 12-23 months, 24-35 months,
36-47 months, and 48-59 months were more likely to be stunted compared to children aged 0-
11 months. Similarly, children aged 12-23 months, 24-35 months, 36-47 months, and 48-59
months were likelier to be underweight. Children aged 24-35 months and 12-23 months were
less likely to be wasted, while children aged 12-23 months and 48-59 months were more likely
to be wasted than children aged 0-5 months.

Children of mothers wirh primary, secondary, or higher levels of education were less likely to
be classified as normal children compared to those whose mothers had no education. Similar
patterns were observed for wasted and underweight children. Children from households with
poorer, middle, richer, and richest economic statuses were less likely to be classified as normal
children than those with the poorest economic status. For underweight children, the prevalence
was lower among the poorest economic households compared to all other economic statuses.
In the case of wasting, children from the poorest economic households had a lower prevalence
than those with other economic statuses. Children born to mothers aged 20-35 years were less
likely to experience stunting and underweight than those born to mothers younger than 20.
Children born to mothers aged 35 years or older were more likely to be underweight and
stunted but less likely to be wasted compared to those born to mothers younger than 20 years.
Rural children were less likely to be classified as normal than urban children. Similar results
were observed for wasted and underweight children. Children from the Chittagong division had
higher odds of stunting and underweight compared to those from the Barisal division. Similarly,
children from the Sylhet division had a significantly higher risk of stunting and underweight
than their counterparts in the Barisal division.

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Table 3 Odds ratio (95% CI.) and S. E of different covariates of malnutrition

Height for age Weight for age Weight for height
Normal Stunting Normal Underweight Normal Wasting Total
Total 73% 27% 77.9% 22.1% 89.9% 10.1% 18,696
Sex of child
Male 72.4% 27.6% 78.1% 21.9% 89.2% 10.8% 9790
(51.61%)
Female 73.6% 26.4% 77.6% 22.4% 90.6% 9.4% 8906
(48.39%)
Area
Urban 75.8% 24.2% 82.0% 18.0% 90.8% 9.2% 3489
(18.39%)
Rural 72.3% 27.7% 76.9% 23.1% 89.7% 10.3% 15,207
(80.17%)
Division
Barisal 72.3% 27.7% 77.0% 23.0% 88.9% 11.1% 1732
(9.131%)
Chattogram 73.0% 27.0% 78.2% 21.8% 89.4% 10.6% 3685
(19.43%)
Dhaka 73.3% 26.7% 80.8% 19.2% 91.5% 8.5% 3692
(19.46%)
Khulna 79.2% 20.8% 80.8% 19.2% 90.5% 9.5% 2735
(14.42%)
Mymenshing 67.5% 32.5% 74.5% 25.5% 89.2% 10.8% 1106
(5.831%)
Rajshahi 74.2% 25.8% 77.5% 22.5% 90.3% 9.7% 2075
(10.94%)
Rangpur 72.3% 27.7% 76.9% 23.1% 88.9% 11.1% 2292
(12.08%)
Sylhet 64.1% 35.9% 69.3% 30.7% 88.4% 11.6% 1379
(7.27%)
Children’s age (in months)
0-11 82.4% 17.6% 84.1% 15.9% 90.3% 9.7% 4086
(21.54%)
12-23 70.4% 29.6% 78.1% 21.9% 88.8% 11.2% 4090
(21.56%)
24-35 66.0% 34.0% 74.7% 25.3% 90.5% 9.5% 3771
(19.88%)
36-47 69.9% 30.1% 75.9% 24.1% 90.7% 9.3% 3632
(19.15%)
48-59 76.2% 23.8% 75.4% 24.6% 89.0% 11.0% 3117
(16.43%)
Mother’s age at birth (in years)
<20 71.9% 28.1% 77.1% 22.9% 89.7% 10.3% 11017
(58.08%)
20-34 74.6% 25.4% 79.0% 21.0% 90.2% 9.8% 7641
(40.28%)
35+ 65.8% 34.2% 76.3% 23.7% 92.1% 7.9% 38 (0.2%)
Wealth index quintile
Poorest 63.9% 36.1% 71.3% 28.7% 87.6% 12.4% 4554
(24.01%)
Poorer 70.4% 29.6% 74.7% 25.3% 88.8% 11.2% 4003
(21.1%)
Middle 75.4% 24.6% 78.4% 21.6% 90.2% 9.8% 3613
(19.05%)
Richer 77.8% 22.2% 81.1% 18.9% 91.5% 8.5% 3529
(18.6%)
Richest 81.6% 18.4% 87.6% 12.4% 92.5% 7.5% 2997
(15.8%)
Mother’s Education
Pre-primary 61.3% 38.7% 68.3% 31.7% 86.3% 13.7% 1941
or none (10.23%)
Primary 67.7% 32.3% 73.5% 26.5% 88.5% 11.5% 4496
(23.7%)
Primary 75.4% 24.6% 79.3% 20.7% 90.3% 9.7% 9351
Secondary (49.3%)

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Higher 81.2% 18.8% 86.4% 13.6% 93.0% 7.0% 2908

secondary (15.33%)
Ethnicity
Bengali 73.1% 26.9% 77.8% 22.2% 89.9% 10.1% 18283
(96.38%)
Others 70.0% 30.0% 79.9% 20.1% 90.1% 9.9% 413
(2.177%)

Discussion & Conclusion

The study identified urban residence as a significant factor influencing child malnutrition. It
found that women in urban areas were more likely to have formal education compared to
those in rural areas. Additionally, urban areas generally have better access to water and
sanitation facilities, higher socioeconomic status, and improved child healthcare services,
leading to a lower risk of child malnutrition compared to rural areas. Furthermore, the study
highlighted the influence of household economic status on child malnutrition. Children from
very poor and poor households were at a higher risk of malnutrition than those from
households with medium or higher economic status. Economic resources are crucial in
reducing food insecurity and enabling adequate care for children, and urban households often
have better access to these resources. The education level of the mother was also identified as
an essential determinant of child malnutrition. Children of higher-educated mothers had a
lower likelihood of malnutrition compared to those of lower-educated mothers. The study also
revealed that previous birth intervals and the age of the child (mainly those aged 24-35
months) were significant risk factors for malnutrition. The birth order of children was also
found to influence the child's nutritional status.

The study's findings have implications for policy formulation in addressing child malnutrition
in Bangladesh. It suggests the need for policies that focus on improving girls' education,
particularly beyond the primary level, to enhance mothers' understanding of child nutrition.
Additionally, policies targeting rural households, such as social protection programs to increase
household resources, could help address the higher risk of malnutrition in rural areas. In
summary, the study underscores the impact of urban residence on child malnutrition, with
higher levels of malnutrition observed among children living in urban areas compared to rural
areas. Factors such as maternal education, household economic status, birth intervals, and child
age were significant determinants of child malnutrition. The findings emphasize the
importance of targeted policies to improve education, household resources, and social
protection to combat child malnutrition in Bangladesh.

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Cite this article:

Maymuna Jarin, Krishna Roy Chowdhury, & Rajib Dey (2023). Child malnutrition in
Bangladesh: an evidence from multiple indicators cluster survey. International Journal of
Science and Business, 25(1), 202-209. doi: https://doi.org/10.58970/IJSB.2195

Retrieved from http://ijsab.com/wp-content/uploads/2195.pdf

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