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Socio-demographic risk factors for severe malnutrition in children aged under five among various birth cohorts in Bangladesh

Published online by Cambridge University Press:  13 August 2020

Mohammad Rocky Khan Chowdhury*
Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh College of Nursing, Midwifery and Healthcare, University of West London, UK Department of Population Science and Human Resource Development, University of Rajshahi, Bangladesh
Hafiz T. A. Khan
College of Nursing, Midwifery and Healthcare, University of West London, UK
Md. Nazrul Islam Mondal
Department of Population Science and Human Resource Development, University of Rajshahi, Bangladesh
Russell Kabir
School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK
*Corresponding author. Email:


Tackling malnutrition is a major health priority for a developing country like Bangladesh. This study explored the differences in prevalence of having only one form, and multiple forms, of severe malnutrition (stunting, wasting and underweight) among under-5 children in Bangladesh, and aimed to identify the important factors affecting these. Data were extracted from the Bangladesh Demographic Health Surveys conducted in 2007, 2011 and 2014. The outcome measures were ‘only one form’ and ‘multiple forms’ of severe malnutrition in children aged under 5 years. A Chi-squared test was performed to find the association of outcome variables with selected socio-demographic factors and logistic regression models were applied to identify risk factors. A total of 19,874 children aged under 5 years were included in the analysis. The overall proportion with one form of severe child malnutrition was approximately 12%, and the proportion with multiple forms was 8%. Age, mother’s education, father’s occupation, mother currently working, watching television, source of water, solid waste used in cooking, intimate partner violence (IPV), wealth index, urban/rural place of residence and birth cohort were found to be significant factors for both having only one and having multiple forms of severe child malnutrition. Children with an uneducated mother of poor socioeconomic class had a higher risk of severe malnutrition. Children of fathers with a professional occupation were at lower risk of having multiple forms of severe malnutrition. The proportions of children aged under 5 years with one or multiple forms of severe malnutrition were shown to be high in Bangladesh. The prevention of malnutrition in the country should be seen as a significant public health issue and given top priority.

Research Article
© The Author(s), 2020. Published by Cambridge University Press

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Ackerson, LK and Subramanian, SV (2008) Domestic violence and chronic malnutrition among women and children in India. American Journal of Epidemiology 167(10), 11881196.CrossRefGoogle ScholarPubMed
Aguayo, VM, Badgaiyan, N and Paintal, K (2015) Determinants of child stunting in the Royal Kingdom of Bhutan: an in-depth analysis of nationally representative data. Maternal and Child Nutrition 11(3), 333345.CrossRefGoogle ScholarPubMed
Akombi, BJ, Agho, KE, Hall, JJ, Merom, D, Astell-Burt, T and Renzaho, AM (2017) Stunting and severe stunting among children under-5 years in Nigeria: a multilevel analysis. BMC Pediatrics 17(1), 15.CrossRefGoogle ScholarPubMed
Bhutta, ZA (2017) Global child nutrition and the Sustainable Development Goals. Lancet Child and Adolescent Health 1(4), 256257.CrossRefGoogle ScholarPubMed
Black, RE, Victora, CG, Walker, SP, Bhutta, ZA, Christian, P, de Onis, M et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382(9890), 427451.CrossRefGoogle ScholarPubMed
Chan, Y (2004) Biostatistics 202: logistic regression analysis. Singapore Medical Journal 45(4), 149153.Google ScholarPubMed
Chowdhury, MR, Rahman, MS and Khan, MM (2016a) Levels and determinants of complementary feeding based on meal frequency among children of 6 to 23 months in Bangladesh. BMC Public Health 16, 944.CrossRefGoogle ScholarPubMed
Chowdhury, MR, Rahman, MS, Khan, MM, Mondal, MN, Rahman, MM and Billah, B (2016b) Risk factors for child malnutrition in Bangladesh: a multilevel analysis of a nationwide population-based survey. Journal of Pediatrics 172, 194–201.e191.CrossRefGoogle ScholarPubMed
Das, S and Gulshan, J (2017) Different forms of malnutrition among under five children in Bangladesh: a cross sectional study on prevalence and determinants. BMC Nutrition 3(1), 1.CrossRefGoogle Scholar
Development Initiatives (2018) 2018 Global Nutrition Report: Shining a Light to Spur Action On Nutrition. URL: (accessed 11th December 2019).Google Scholar
FAO (2015) National Nutrition Policy 2015. Nutrition Is the Foundation for Development. Food and Agriculture Organization. URL: (accessed 24th December 2019).Google Scholar
Hasselmann, MH and Reichenheim, ME (2006) Parental violence and the occurrence of severe and acute malnutrition in childhood. Paediatric and Perinatal Epidemiology 20(4), 299311.CrossRefGoogle ScholarPubMed
Hong, R, Banta, JE, and Betancourt, JA (2006) Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh. International Journal of Equity Health 5, 15.CrossRefGoogle ScholarPubMed
Hossain, MB and Khan, MHR (2018) Role of parental education in reduction of prevalence of childhood undernutrition in Bangladesh. Public Health Nutrition 21(10), 18451854.CrossRefGoogle ScholarPubMed
Islam, A and Biswas, T (2015) Chronic stunting among under-5 children in Bangladesh: a situation analysis. Advances in Pediatric Research 2, 18.Google Scholar
Islam, MM, Alam, M, Tariquzaman, M, Kabir, MA, Pervin, R, Begum, M and Khan, MM (2013) Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized poisson regression model. BMC Public Health 13, 11.CrossRefGoogle ScholarPubMed
Islam, MR, Rahman, MS, Rahman, MM, Nomura, S, de Silva, A, Lanerolle, P et al. (2019) Reducing childhood malnutrition in Bangladesh: the importance of addressing socioeconomic inequalities. Public Health Nutrition 23(1), 7282.CrossRefGoogle Scholar
Jesmin, A, Yamamoto, SS, Malik, AA and Haque, MA (2011) Prevalence and determinants of chronic malnutrition among preschool children: a cross-sectional study in Dhaka City, Bangladesh. Journal of Health Population and Nutrition 29(5), 494499.CrossRefGoogle ScholarPubMed
Kandala, NB, Madungu, TP, Emina, JB, Nzita, KP and Cappuccio, FP (2011) Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter? BMC Public Health 11, 261.CrossRefGoogle ScholarPubMed
Khan, S, Zaheer, S and Safdar, NF (2019) Determinants of stunting, underweight and wasting among children< 5 years of age: evidence from 2012–2013 Pakistan Demographic and Health Survey. BMC Public Health 19(1), 358.CrossRefGoogle ScholarPubMed
Khattak, UK, Iqbal, SP and Ghazanfar, H (2017) The role of parents’ literacy in malnutrition of children under the age of 5 years in a semi-urban community of Pakistan: a case-control study. Cureus 9(6), 1316.Google Scholar
Kyu, HH, Georgiades, K and Boyle, MH (2009) Maternal smoking, biofuel smoke exposure and child height-for-age in seven developing countries. International Journal of Epidemiology 38(5), 13421350.CrossRefGoogle ScholarPubMed
McDonald, CM, Olofin, I, Flaxman, S, Fawzi, WW, Spiegelman, D, Caulfield, LE et al. (2013) The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. American Journal of Clinical Nutrition 97(4), 896901.CrossRefGoogle ScholarPubMed
Madhusudhan, K, Shireesha, ARPK and Ushashree, GV (2017) Study of risk factors of severe acute malnutrition (SAM) in children 6 months to 5 years of age and evaluation of effect of micronutrient supplementation (WHO protocol) on serum zinc and magnesium levels: a case control study. International Journal of Contemporary Pediatrics 4(4), 8.CrossRefGoogle Scholar
Mengistu, K, Alemu, K and Destaw, B (2013) Prevalence of malnutrition and associated factors among children aged 6–59 months at Hidabu Abote District, North Shewa, Oromia Regional State. Journal of Nutritional Disorders and Therapy 1, 115.CrossRefGoogle Scholar
Mishra, V and Retherford, RD (2006) Does biofuel smoke contribute to anaemia and stunting in early childhood? International Journal of Epidemiology 36(1), 117129.CrossRefGoogle ScholarPubMed
Myatt, M, Khara, T, Schoenbuchner, S, Pietzsch, S, Dolan, C, Lelijveld, N and Briend, A (2018) Children who are both wasted and stunted are also underweight and have a high risk of death: a descriptive epidemiology of multiple anthropometric deficits using data from 51 countries. Archives of Public Health 76, 28.CrossRefGoogle ScholarPubMed
Ngari, MM, Iversen, PO, Thitiri, J, Mwalekwa, L, Timbwa, M, Fegan, GW and Berkley, JA (2019) Linear growth following complicated severe malnutrition: 1-year follow-up cohort of Kenyan children. Archives of Diseases in Childhood 104(3), 229235.CrossRefGoogle ScholarPubMed
NIPORT (2009) Bangladesh Demographic and Health Survey 2007. National Institute of Population Research and Training, Mitra and Associates and Macro International, Dhaka, Bangladesh. URL:[April-10-2009].pdf (accessed 25th December 2019).Google Scholar
NIPORT (2013) Bangladesh Demographic and Health Survey 2011. National Institute of Population Research and Training, Mitra and Associates and Macro International (accessed 25th December 2019).Google Scholar
NIPORT (2016) Bangladesh Demographic and Health Survey 2014. National Institute of Population Research and Training, Mitra and Associates and Macro International, Dhaka, Bangladesh. URL: (accessed 25th December 2019).Google Scholar
Nkurunziza, S, Meessen, B, Van Geertruyden, JP and Korachais, C (2017) Determinants of stunting and severe stunting among Burundian children aged 6–23 months: evidence from a national cross-sectional household survey, 2014. BMC Pediatrics 17(1), 176.CrossRefGoogle ScholarPubMed
Olack, B, Burke, H, Cosmas, L, Bamrah, S, Dooling, K, Feikin, DR et al. (2011) Nutritional status of under-five children living in an informal urban settlement in Nairobi, Kenya. Journal of Health Population and Nutrition 29(4), 357363.CrossRefGoogle Scholar
Pongou, R, Ezzati, M and Salomon, JA (2006) Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health 6, 98.CrossRefGoogle ScholarPubMed
Pravana, NK, Piryani, S, Chaurasiya, SP, Kawan, R, Thapa, RK and Shrestha, S (2017) Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case-control study. BMJ Open 7(8), e017084.CrossRefGoogle ScholarPubMed
Rahman, M, Poudel, KC, Yasuoka, J, Otsuka, K, Yoshikawa, K and Jimba, M (2012) Maternal exposure to intimate partner violence and the risk of undernutrition among children younger than 5 years in Bangladesh. American Journal of Public Health 102(7), 13361345.CrossRefGoogle ScholarPubMed
Reyes, H, Perez-Cuevas, R, Sandoval, A, Castillo, R, Santos, JI, Doubova, SV and Gutierrez, G (2004) The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study. BMC Public Health 4, 57.CrossRefGoogle ScholarPubMed
Senarath, U and Gunawardena, NS (2009) Women’s autonomy in decision making for health care in South Asia. Asia Pacific Journal of Public Health 21(2), 137143.CrossRefGoogle ScholarPubMed
Smith, LC, Ruel, MT and Ndiaye, A (2005) Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Development 33(8), 12851305.CrossRefGoogle Scholar
Sultana, P, Rahman, MM and Akter, J (2019) Correlates of stunting among under-five children in Bangladesh: a multilevel approach. BMC Nutrition 5(1), 41.CrossRefGoogle ScholarPubMed
Talukder, A (2017) Factors associated with malnutrition among under-five children: illustration using Bangladesh demographic and health survey, 2014 data. Children 4(10), 88.CrossRefGoogle ScholarPubMed
Tebeje, N, Bikes, G, Abebe, S and Yesuf, M (2017) Prevalence and major contributors of child malnutrition in developing countries: systematic review and meta-analysis. Journal of Childhod Obesity 2(1), 16.Google Scholar
Tiwari, R, Ausman, LM and Agho, KE (2014) Determinants of stunting and severe stunting among under-fives: evidence from the 2011 Nepal Demographic and Health Survey. BMC Pediatrics 14, 239.CrossRefGoogle ScholarPubMed
UNICEF (2015) Undernutrition Contributes to Nearly Half of all Deaths in Children Under 5 and is Widespread in Asia and Africa. URL: (accessed 5th December 2019)Google Scholar
Vilcins, D, Sly, PD and Jagals, P (2018) Environmental risk factors associated with child stunting: a systematic review of the literature. Annals Global Health 84(4), 551562.CrossRefGoogle ScholarPubMed
Walson, JL and Berkley, JA (2018) The impact of malnutrition on childhood infections. Current Opinion in Infectious Diseases 31(3), 231.CrossRefGoogle ScholarPubMed
WASH (2007) Interactions of: Malnutrition, Water Sanitation and Hygiene, Infections. Diarrhoea and malnutrition. Water Sanitation and Hygiene (WASH). URL: (accessed 20th December 2019).Google Scholar
WHO (2018) Household Air Pollution and Health. World Health Organization, Geneva. URL: (accessed 29th December 2019).Google Scholar