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Sociodemographic and geographical inequalities in under- and overnutrition among children and mothers in Bangladesh: a spatial modelling approach to a nationally representative survey

  • Mohammad Nahid Mia (a1), M Shafiqur Rahman (a2) and Paritosh K Roy (a2)
Abstract
Objective

To investigate the sociodemographic and geographical variation in under- and overnutrition prevalence among children and mothers.

Design

Data from the 2014 Bangladesh Demographic and Health Survey were analysed. Stunting and wasting for children and BMI<18·5 kg/m2 for mothers were considered as undernutrition; overweight was considered as overnutrition for both children and mothers. We estimated the prevalence and performed simple logistic regression analyses to assess the associations between outcome variables and predictors. Bayesian spatial models were applied to estimate region-level prevalence to identify the regions (districts) prone to under- and overnutrition.

Settings/Subjects

Children aged<5 years and their mothers aged 15–49 years in Bangladesh.

Results

A significant difference (P<0·001) was observed in both under- and overnutrition prevalence between poor and rich. A notable regional variation was also observed in under- and overnutrition prevalence. Stunting prevalence ranged from 20·3 % in Jessore to 56·2 % in Sunamgonj, wasting from 10·6 % in Dhaka to 19·2 % in Bhola, and overweight from 0·8 % in Shariatpur to 2·6 % in Dhaka. Of the sixty-four districts, twelve had prevalence of stunting and thirty-two districts had prevalence of wasting higher than the WHO critical threshold levels. Similarly, fifty-three districts had prevalence of maternal underweight higher than the national level. In contrast, the prevalence of overweight was comparatively high in the industrially equipped metropolitan districts.

Conclusions

Observed sociodemographic and geographical inequalities imply slow progress in the overall improvement of both under- and overnutrition. Therefore, effective intervention programmes and policies need to be designed urgently targeting the grass-roots level of such regions.

Copyright
Corresponding author
* Corresponding author: Email nahid15sust@gmail.com
References
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1. Black, RE, Victora, CG, Walker, SP et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
2. Grantham-McGregor, S, Cheung, YB, Cueto, S et al. (2007) Developmental potential in the first 5 years for children in developing countries. Lancet 369, 6070.
3. Victora, CG, Adair, L, Fall, C et al. (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340357.
4. Pelletier, DL, Frongillo, EA Jr & Habicht, J-P (1993) Epidemiologic evidence for a potentiating effect of malnutrition on child mortality. Am J Public Health 83, 11301133.
5. Pelletier, DL & Frongillo, EA (2003) Changes in child survival are strongly associated with changes in malnutrition in developing countries. J Nutr 133, 107119.
6. United Nations System Standing Committee on Nutrition (2004) 5th report on the world nutrition situation: Nutrition for improved development outcomes. https://www.unscn.org/web/archives_resources/files/rwns5.pdf (accessed July 2017).
7. Bhutta, ZA, Das, JK, Rizvi, A et al. (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382, 452477.
8. Bredenkamp, C, Buisman, LR & Van de Poel, E (2014) Persistent inequalities in child undernutrition: evidence from 80 countries, from 1990 to today. Int J Epidemiol 43, 13281335.
9. de Onis, M, Frongillo, EA & Blössner, M (2000) Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980. Bull World Health Organ 78, 12221233.
10. Tzioumis, E, Kay, MC, Bentley, ME et al. (2016) Prevalence and trends in the childhood dual burden of malnutrition in low- and middle-income countries, 1990–2012. Public Health Nutr 19, 13751388.
11. Ebbeling, CB, Pawlak, DB & Ludwig, DS (2002) Childhood obesity: public-health crisis, common sense cure. Lancet 360, 473482.
12. World Bank (2017) Global Database on Child Growth and Malnutrition. http://www.data.worldbank.org/indicator/SH.STA.STNT.ZS?locations=BD (accessed May 2017).
13. Victora, CG, Requejo, JH, Barros, AJ et al. (2016) Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet 387, 20492059.
14. National Institute of Population Research and Training, Mitra and Associates, & IFC International (2016) Bangladesh Demographic and Health Survey 2014. Dhaka: NIPORT, Mitra and Associates, and IFC International.
15. Sack, DA (2008) Achieving the Millennium Development Goals for health and nutrition in Bangladesh: key issues and interventions – an introduction. J Health Popul Nutr 26, 253260.
16. International Institute for Population Sciences (1998–1999) National Family Health Survey (NFHS-2). https://www.dhsprogram.com/pubs/pdf/FRIND2/FRIND2.pdf (accessed July 2017).
17. International Institute for Population Sciences (2015–2016) National Family Health Survey (NFHS-4). https://dhsprogram.com/pubs/pdf/FR338/FR338.BR.pdf (accessed July 2017).
18. Ministry of Health Nepal, New ERA & ICF (2017) Nepal 2016 Demographic and Health Survey: Key Findings. Kathmandu: Ministry of Health Nepal.
19. Meshram, I, Balakrishna, N, Sreeramakrishna, K et al. (2016) Trends in nutritional status and nutrient intakes and correlates of overweight/obesity among rural adult women (≥18–60 years) in India: National Nutrition Monitoring Bureau (NNMB) national surveys. Public Health Nutr 19, 767776.
20. Bleich, SN, Vercammen, KA, Zatz, LY et al. (2018) Interventions to prevent global childhood overweight and obesity: a systematic review. Lancet Diabet Endocrinol 6, 332346.
21. Islam, MA, Rahman, MM & Mahalanabis, D (1994) Maternal and socioeconomic factors and the risk of severe malnutrition in a child: a case–control study. Eur J Clin Nutr 48, 416424.
22. Dewey, KG & Cohen, RJ (2007) Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr 3, 151173.
23. Campbell, CC (1991) Food insecurity: a nutritional outcome or a predictor variable? J Nutr 121, 408415.
24. Ramakrishnan, U (2004) Nutrition and low birth weight: from research to practice. Am J Clin Nutr 79, 1721.
25. Rahman, MS, Howlader, T, Masud, MS et al. (2016) Association of low-birth weight with malnutrition in children under five years in Bangladesh: do mother’s education, socio-economic status, and birth interval matter? PLoS One 11, e0157814.
26. Mohsena, M, Goto, R & Nicholas Mascie-Taylor, CG (2015) Regional variation in maternal and childhood undernutrition in Bangladesh: evidence from demographic and health surveys. WHO South East Asia J Public Health 4, 139149.
27. Bangladesh Bureau of Statistics (2016) Statistical Pocket Book of Bangladesh 2015, p. 8. Dhaka: BBS.
28. Wyatt, SB, Winters, KP & Dubbert, PM (2006) Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci 331, 166174.
29. Deurenberg, P, Yap, M & Van Staveren, WA (1998) Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 22, 11641171.
30. United Nations (2017) World Population Prospects: The 2017 Revision. New York: UN.
31. Finance Division, Ministry of Finance (2016) Bangladesh Economic Review 2015. Dhaka: Finance Division, Ministry of Finance.
32. Bangladesh Bureau of Statistics (2010) Report on Monitoring of Employment Survey 2009. Dhaka: BBS.
33. Bangladesh Bureau of Statistics (2012) Report of the Household Income and Expenditure Survey 2010. Dhaka: BBS.
34. Spray, AL, Eddy, B, Hipp, JA et al. (2013) Spatial analysis of undernutrition of children in Leogane Commune, Haiti. Food Nutr Bull 34, 444461.
35. World Health Organization (2006) WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: WHO.
36. World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series no. 854. Geneva: WHO.
37. Filmer, D & Pritchett, LH (2001) Estimating wealth effects without expenditure data – or tears: an application to educational enrollments in states of India. Demography 38, 115132.
38. Rutstein, SO & Johnson, K (2004) DHS Comparative Report 6: The DHS Wealth Index. Calverton, MD: ORC Macro.
39. Vyas, S & Kumaranayake, L (2006) Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21, 459468.
40. Howe, LD, Hargreaves, JR & Huttly, SR (2008) Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol 5, 3.
41. Besag, J (1974) Spatial interaction and the statistical analysis of lattice systems. J R Stat Soc Series B Methodol 36, 192236.
42. Banerjee, S, Carlin, BP & Gelfand, AE (2014) Hierarchical Modeling and Analysis for Spatial Data. Boca Raton, FL: CRC Press/Chapman & Hall.
43. Kandala, N-B, Madungu, TP, Emina, JB et al. (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.
44. Semba, RD, de Pee, S, Sun, K et al. (2008) Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet 371, 322328.
45. Mengistu, K, Alemu, K & Destaw, B (2013) Prevalence of malnutrition and associated factors among children aged 6–59 months at Hidabu Abote District, North Shewa, Oromia Regional State. J Nutr Dis Ther T1, 001.
46. Wang, CC & Pies, CA (2004) Family, maternal, and child health through photovoice. Matern Child Health J 8, 95102.
47. Di Cesare, M, Bhatti, Z, Soofi, SB et al. (2015) Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey. Lancet Glob Health 3, e229e239.
48. Jesmin, A, Yamamoto, SS, Malik, AA et al. (2011) Prevalence and determinants of chronic malnutrition among preschool children: a cross-sectional study in Dhaka City, Bangladesh. J Health Popul Nutr 29, 494499.
49. Mishra, VK & Retherford, RD (2000) Women’s education can improve child nutrition in India. Natl Fam Health Surv Bull issue 15, 14.
50. Kanjilal, B, Mazumdar, PG, Mukherjee, M et al. (2010) Nutritional status of children in India: household socio-economic condition as the contextual determinant. Int J Equity Health 9, 19.
51. Bhutta, ZA, Gazdar, H & Haddad, L (2013) Seeing the unseen: breaking the logjam of undernutrition in Pakistan. IDS Bull 44, 19.
52. Desai, S & Alva, S (1998) Maternal education and child health: is there a strong causal relationship? Demography 35, 7181.
53. Das, SK, Chisti, MJ, Malek, MA et al. (2015) Changing childhood malnutrition in Bangladesh: trends over the last two decades in urban–rural differentials (1993–2012). Public Health Nutr 18, 17181727.
54. Stevens, GA, Finucane, MM, Paciorek, CJ et al. (2012) Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet 380, 824834.
55. Nair, K (2007) Malnourishment among children in India: a regional analysis. Econ Polit Wkly 15 Sept issue, 3797–3803.
56. Slifkin, R, Goldsmith, L & Ricketts, T (2000) Race and Place: Urban–Rural Difference in Health for Racial and Ethnic Minorities. Working Paper no. 66. Chapel Hill, NC: NC Rural Health Research and Policy Analysis Program.
57. Kandala, NB, Fahrmeir, L, Klasen, S et al. (2009) Geo‐additive models of childhood undernutrition in three sub‐Saharan African countries. Popul Space Place 15, 461473.
58. Uddin, MJ, Larson, CP, Oliveras, E et al. (2009) Child immunization coverage in rural hard-to-reach Haor areas of Bangladesh: possible alternative strategies. Asia Pac J Public Health 21, 818.
59. Rahman, M & Obaida-Nasrin, S (2010) Factors affecting acceptance of complete immunization coverage of children under five years in rural Bangladesh. Salud Publica Mex 52, 134140.
60. Rasheed, S, Siddique, A, Sharmin, T et al. (2016) Salt intake and health risk in climate change vulnerable coastal Bangladesh: what role do beliefs and practices play? PLoS One 11, e0152783.
61. World Bank (2005) Maintaining Momentum to 2015? An Impact Evaluation of Interventions to Improve Maternal and Child Health and Nutrition in Bangladesh. Washington, DC: World Bank.
62. Nahar, S, Mascie-Taylor, CG & Begum, HA (2009) Impact of targeted food supplementation on pregnancy weight gain and birth weight in rural Bangladesh: an assessment of the Bangladesh Integrated Nutrition Program (BINP). Public Health Nutr 12, 12051212.
63. Hossain, SM, Duffield, A & Taylor, A (2005) An evaluation of the impact of a US $60 million nutrition programme in Bangladesh. Health Policy Plan 20, 3540.
64. Chowdhury, AMR, Bhuiya, A, Chowdhury, ME et al. (2013) The Bangladesh paradox: exceptional health achievement despite economic poverty. Lancet 382, 17341745.
65. El Arifeen, S, Christou, A, Reichenbach, L et al. (2013) Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh. Lancet 382, 20122026.
66. Katz, J, Lee, AC, Kozuki, N et al. (2013) Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet 382, 417425.
67. Bickel, G, Nord, M, Price, C et al. (2000) Guide to Measuring Household Food Security (Revised 2000). Alexandria, VA: US Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition, and Evaluation.
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