Prevalence and risk factors of underweight among under-5 children in Bangladesh: Evidence from a countrywide cross-sectional study

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Abstract

Background

Underweight is one of the important anthropometric components of malnutrition among under-five children and is a major public health concern in Bangladesh because it contributes to mortality as well as morbidity. In designing suitable health programs and policies with the goal of attaining UN SDG Goals, it is necessary to identify the critical risk factors of under-five malnutrition. It is evident that the quantile regression produces robust estimates in the presence of outliers. However, in the context of Bangladesh, no study has been conducted considering the sequential quantile regression on this topic. Therefore, the authors aimed to find the determinants of underweight among under-5 children in Bangladesh considering the latest country representative dataset.

Methods and materials

The paper considers a weighted sample of size 7762 children are used and data were extracted from the latest Bangladesh Demographic and Health Survey (BDHS) 2017–18 data. Multivariable simultaneous quantile regression models were used to fulfill the objectives of this study.

Results

Findings depict that undernutrition affects the majority of children in the population as compared to the reference population. The WAZ-score of the child increases by 0.202 points at the 10th quantile of the conditional distribution, and by 0.565 points at the 90th quantile as we move from children of underweight to overweight women. Moreover, the WAZ scores of children from the richest families in the 10th, 50th, and 75th quantiles, respectively, are increased by 0.171, 0.016, and 0.084 points.

Conclusion

Quantile regression revealed the results of several socioeconomic and demographic factors acting differently across the WAZ distribution. Therefore, policymakers may consider the identified risk factors to lessen malnutrition among under-5 children in Bangladesh.

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Most cited references 62

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Excess deaths associated with underweight, overweight, and obesity.

Katherine Flegal (2005)

As the prevalence of obesity increases in the United States, concern over the association of body weight with excess mortality has also increased. To estimate deaths associated with underweight (body mass index [BMI] or =30) in the United States in 2000. We estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. These relative risks were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate attributable fractions and number of excess deaths, adjusted for confounding factors and for effect modification by age. Number of excess deaths in 2000 associated with given BMI levels. Relative to the normal weight category (BMI 18.5 to or =30) was associated with 111,909 excess deaths (95% confidence interval [CI], 53,754-170,064) and underweight with 33,746 excess deaths (95% CI, 15,726-51,766). Overweight was not associated with excess mortality (-86,094 deaths; 95% CI, -161,223 to -10,966). The relative risks of mortality associated with obesity were lower in NHANES II and NHANES III than in NHANES I. Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category. The impact of obesity on mortality may have decreased over time, perhaps because of improvements in public health and medical care. These findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.

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Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries

Aamer Imdad, Mohammad Yakoob, Zulfiqar Bhutta (2011)

Background Childhood undernutrition is prevalent in low and middle income countries. It is an important indirect cause of child mortality in these countries. According to an estimate, stunting (height for age Z score < -2) and wasting (weight for height Z score < -2) along with intrauterine growth restriction are responsible for about 2.1 million deaths worldwide in children < 5 years of age. This comprises 21 % of all deaths in this age group worldwide. The incidence of stunting is the highest in the first two years of life especially after six months of life when exclusive breastfeeding alone cannot fulfill the energy needs of a rapidly growing child. Complementary feeding for an infant refers to timely introduction of safe and nutritional foods in addition to breast-feeding (BF) i.e. clean and nutritionally rich additional foods introduced at about six months of infant age. Complementary feeding strategies encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this review, we evaluated the effectiveness of two most commonly applied strategies of complementary feeding i.e. timely provision of appropriate complementary foods (± nutritional counseling) and education to mothers about practices of complementary feeding on growth. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG). Methods We conducted a systematic review of published randomized and quasi-randomized trials on PubMed, Cochrane Library and WHO regional databases. The included studies were abstracted and graded according to study design, limitations, intervention details and outcome effects. The primary outcomes were change in weight and height during the study period among children 6-24 months of age. We hypothesized that provision of complementary food and education of mother about complementary food would significantly improve the nutritional status of the children in the intervention group compared to control. Meta-analyses were generated for change in weight and height by two methods. In the first instance, we pooled the results to get weighted mean difference (WMD) which helps to pool studies with different units of measurement and that of different duration. A second meta-analysis was conducted to get a pooled estimate in terms of actual increase in weight (kg) and length (cm) in relation to the intervention, for input into the LiST model. Results After screening 3795 titles, we selected 17 studies for inclusion in the review. The included studies evaluated the impact of provision of complementary foods (±nutritional counseling) and of nutritional counseling alone. Both these interventions were found to result in a significant increase in weight [WMD 0.34 SD, 95% CI 0.11 – 0.56 and 0.30 SD, 95 % CI 0.05-0.54 respectively) and linear growth [WMD 0.26 SD, 95 % CI 0.08-0.43 and 0.21 SD, 95 % CI 0.01-0.41 respectively]. Pooled results for actual increase in weight in kilograms and length in centimeters showed that provision of appropriate complementary foods (±nutritional counseling) resulted in an extra gain of 0.25kg (±0.18) in weight and 0.54 cm (±0.38) in height in children aged 6-24 months. The overall quality grades for these estimates were that of ‘moderate’ level. These estimates have been recommended for inclusion in the Lives Saved Tool (LiST) model. Education of mother about complementary feeding led to an extra weight gain of 0.30 kg (±0.26) and a gain of 0.49 cm (±0.50) in height in the intervention group compared to control. These estimates had been recommended for inclusion in the LiST model with an overall quality grade assessment of ‘moderate’ level. Conclusion Provision of appropriate complementary food, with or without nutritional education, and maternal nutritional counseling alone lead to significant increase in weight and height in children 6-24 months of age. These interventions can significantly reduce the risk of stunting in developing countries and are recommended for inclusion in the LiST tool.

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Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia

Mandefro Asfaw, Mekitie Wondaferash, Mohammed Taha … (2015)

Background More than one-third of deaths during the first five years of life are attributed to undernutrition, which are mostly preventable through economic development and public health measures. To alleviate this problem, it is necessary to determine the nature, magnitude and determinants of undernutrition. However, there is lack of evidence in agro-pastoralist communities like Bule Hora district. Therefore, this study assessed magnitude and factors associated with undernutrition in children who are 6–59 months of age in agro-pastoral community of Bule Hora District, South Ethiopia. Methods A community based cross-sectional study design was used to assess the magnitude and factors associated with undernutrition in children between 6–59 months. A structured questionnaire was used to collect data from 796 children paired with their mothers. Anthropometric measurements and determinant factors were collected. SPSS version 16.0 statistical software was used for analysis. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to nutritional status of the children Statistical association was declared significant if p-value was less than 0.05. Results Among study participants, 47.6%, 29.2% and 13.4% of them were stunted, underweight, and wasted respectively. Presence of diarrhea in the past two weeks, male sex, uneducated fathers and > 4 children ever born to a mother were significantly associated with being underweight. Presence of diarrhea in the past two weeks, male sex and pre–lacteal feeding were significantly associated with stunting. Similarly, presence of diarrhea in the past two weeks, age at complementary feed was started and not using family planning methods were associated to wasting. Conclusion Undernutrition is very common in under-five children of Bule Hora district. Factors associated to nutritional status of children in agro-pastoralist are similar to the agrarian community. Diarrheal morbidity was associated with all forms of Protein energy malnutrition. Family planning utilization decreases the risk of stunting and underweight. Feeding practices (pre-lacteal feeding and complementary feeding practice) were also related to undernutrition. Thus, nutritional intervention program in Bule Hora district in Ethiopia should focus on these factors.

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Author and article information

Contributors

Md. Moyazzem Hossain:

ORCID: https://orcid.org/0000-0003-3593-6936

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Faruq Abdulla: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Azizur Rahman:

ORCID: https://orcid.org/0000-0002-7670-5192

Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing

Jayanta Kumar Bora: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLOS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 24 April 2023

Publication date Collection: 2023

Volume: 18

Issue: 4

Electronic Location Identifier: e0284797

Affiliations

[1 ] Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh

[2 ] School of Mathematics, Statistics and Physics, Newcastle University, Newcastle upon Tyne, United Kingdom

[3 ] Department of Applied Health and Nutrition, RTM Al-Kabir Technical University, Sylhet, Bangladesh

[4 ] School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia

VART Consulting PVT LTD, INDIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: hossainmm@ 123456juniv.edu (MMH); faruqiustat09mnil@ 123456gmail.com (FA)

Author information

Md. Moyazzem Hossain https://orcid.org/0000-0003-3593-6936

Azizur Rahman https://orcid.org/0000-0002-7670-5192

Article

Publisher ID: PONE-D-23-00547

DOI: 10.1371/journal.pone.0284797

PMC ID: 10124832

PubMed ID: 37093817

SO-VID: 864244a7-1f53-496f-83ae-2b7ae5a53e7b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 7 January 2023

Date accepted : 7 April 2023

Page count

Figures: 1, Tables: 2, Pages: 15

Funding

The author(s) received no specific funding for this work.

Custom metadata

Data Availability This study is based on the secondary dataset. One can access the data set via the following link http://dhsprogram.com/data/available-datasets.cfm.

Prevalence and risk factors of underweight among under-5 children in Bangladesh: Evidence from a countrywide cross-sectional study

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Most cited references 62

Excess deaths associated with underweight, overweight, and obesity.

Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries

Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Bule Hora district, South Ethiopia

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