With long-term detrimental consequences of irreversible physical and intellectual impairment, stunting remains one of the most prevalent public health problems. This study aimed to identify the factors contributing to stunting among children aged 24 to 59 months in Bangladesh. An analysis of nutrition survey data from the Nutrition, Health and Demographic Survey of Bangladesh analysed the data from a sample of 4,182 children. A predictive model was constructed to identify the association of stunting with family socioeconomics and children’s characteristics. The study found that the development of stunting among 24- to 59-month-old children has been attributed to several factors such as household food security, child feeding practices, parental education and domestic violence. Mothers with secondary education had lower odds of having stunted children. Houses with better flooring quality reduced the probability of stunting by 50%. Children growing up in a moderately food-insecure family had higher odds of becoming stunted. Better child-feeding practices also had lower odds of stunting by 33%. The presence of domestic violence in the household increased the odds of having a stunted child. However, household sanitary conditions, safe water sources and maternal nutritional knowledge and practice were not significantly associated with stunting.
AhmedA., AhmedT., RoyS, AlamN., & HossainM. (2012). Determinants of undernutrition in children under 2 years of age from rural Bangladesh. Indian Pediatrics, 49, 821–824. https://doi:10.1007/s13312-012-0187-2
2.
AkhtaruzzamanM., KhanM. N. I., & IslamS. N. (2013). Nutrition, health and demographic survey of Bangladesh 2011. Institute of Nutrition and Food Science, University of Dhaka.
3.
AkinyemiJ., & MorakinyoO. (2018). Household environment and symptoms of childhood acute respiratory tract infections in Nigeria, 2003–2013: A decade of progress and stagnation. BMC Infectious Diseases, 18(1), 1–12. https://doi:10.1186/s12879-018-3207-5
4.
AliD., SahaK., NguyenP., DiressieM., RuelM., MenonP., & RawatR. (2013). Household food insecurity is associated with higher child undernutrition in Bangladesh, Ethiopia, and Vietnam, but the effect is not mediated by child dietary diversity. The Journal of Nutrition, 143(12), 2015–2021. https://doi:10.3945/jn.113.175182
5.
BhowmikK., & DasS. (2019). On selection of an appropriate logistic model to determine the risk factors of childhood stunting in Bangladesh. Maternal & Child Nutrition, 15(1), e12636. https://doi:10.1111/mcn.12636
6.
BhuttaZ., DasJ., RizviA., GaffeyM., WalkerN., HortonS., WebbP., LarteyA., & BlackR. (2013). Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?. The Lancet, 382(9890), 452–477. https://doi.org/10.1016/S0140-6736(13)60996-4
7.
BlackR., VictoraC., WalkerS., BhuttaZ., ChristianP., De OnisM., EzzatiM., Grantham-McGregorS., KatzJ., MartorellR., & UauyR. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. http://dx.doi.org/10.1016/S0140-6736(13)60937-X
8.
ChaiJ., FinkG., KaayaS., DanaeiG., FawziW., EzzatiM. J.,& FawziM. (2016). Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys. Bulletin of the World Health Organization, 94(5), 331. http://dx.doi.org/10.2471/BLT.15.152462
9.
ChowdhuryM., RahmanM., KhanM., MondalM., RahmanM., & BillahB. (2016). Risk factors for child malnutrition in Bangladesh: A multilevel analysis of a nationwide population-based survey. The Journal of Pediatrics, 172, 194–201. https://doi:10.1016/j.jpeds.2016.01.023
10.
CoatesJ., FrongilloE., RogersB., WebbP., WildeP., & HouserR. (2006). Commonalities in the experience of household food insecurity across cultures: What are measures missing?The Journal of Nutrition, 136(5), 1438S–1448S. https://doi:10.1093/jn/136.5.1438S
11.
DakeS., SolomonF., BobeT., TekleH., & TufaE. (2019). Predictors of stunting among children 6–59 months of age in Sodo Zuria District, South Ethiopia: A community based cross-sectional study. BMC Nutrition, 5(1), 1–7. https://doi:10.1186/s40795-019-0287-6
12.
DanaeiG., AndrewsK., SudfeldC., FinkG., McCoyD., PeetE., SaniaA., Smith FawziM.C., EzzatiM., & FawziW. (2016). Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS Medicine, 13(11), e1002164. https://doi.org/10.1371/journal.pmed.1002164
13.
De OnisM., & BrancaF. (2016). Childhood stunting: A global perspective. Maternal & Child Nutrition, 12, 12–26. https://doi:10.1111/mcn.12231
14.
De OnisM., DeweyK., BorghiE., OnyangoA., BlössnerM., DaelmansB., PiwozE., & BrancaF. (2013). The World Health Organization’s global target for reducing childhood stunting by 2025: Rationale and proposed actions. Maternal & Child Nutrition, 9, 6–26. https://doi:10.1111/mcn.12075
15.
DeweyK. (2016). Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: Evidence, challenges and opportunities. Maternal & Child Nutrition, 12, 27–38. https://doi:10.1111/mcn.12282
16.
FenskeN., BurnsJ., HothornT., & RehfuessE. (2013). Understanding child stunting in India: A comprehensive analysis of socio-economic, nutritional and environmental determinants using additive quantile regression. PloS One, 8(11), e78692. https://doi:10.1371/journal.pone.0078692
17.
FrostM., ForsteR., & HaasD. (2005). Maternal education and child nutritional status in Bolivia: Finding the links. Social Science & Medicine, 60(2), 395–407. https://doi:10.1016/j.socscimed.2004.05.010
18.
HackettM., Melgar-QuiñonezH., & ÁlvarezM. (2009). Household food insecurity associated with stunting and underweight among preschool children in Antioquia, Colombia. Revista Panamericana de Salud Pública, 25(6), 506–510. https://doi:10.1590/s1020-49892009000600006
19.
HoddinottJ., AhmedI., AhmedA., & RoyS. (2017). Behavior change communication activities improve infant and young child nutrition knowledge and practice of neighboring non-participants in a cluster-randomized trial in rural Bangladesh. PloS One, 12(6), e0179866. https://doi:10.1371/journal.pone.0179866
20.
HudaT., UnicombL., JohnstonR., HalderA., SharkerM., & LubyS. (2012). Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Social Science & Medicine, 75(4), 604–611. https://doi:10.1016/j.socscimed.2011.10.042
21.
IslamM., AlamM., TariquzamanM., KabirM., PervinR., BegumM., & KhanM. (2013). Predictors of the number of under-five malnourished children in Bangladesh: Application of the generalized Poisson regression model. BMC Public Health, 13(1), 1–8. https://doi:10.1186/1471-2458-13-11
22.
JesminA., YamamotoS., MalikA., & HaqueM. A. (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), 494. https://doi:10.3329/jhpn.v29i5.8903
23.
KhanS., ZaheerS., & SafdarN. (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), 1–15. https://doi:10.1186/s12889-019-6688-2
24.
KhanalV., SauerK., & ZhaoY. (2013). Determinants of complementary feeding practices among Nepalese children aged 6–23 months: Findings from demographic and health survey 2011. BMC Pediatrics, 13, 1–13. https://doi:10.1186/1471-2431-13-131
25.
LakeC. (2010). The violence of technique and the technique of violence. In Hewitt & Donahoo, (Eds.), Flannery O’Connor in the age of terrorism: Essays on violence and grace(pp. 25–39). The University of Tennessee Press.
26.
MarkovitzA., GoldstickJ., LevyK., CevallosW., MukherjeeB., TrostleJ., & EisenbergJ. (2012). Where science meets policy: Comparing longitudinal and cross-sectional designs to address diarrhoeal disease burden in the developing world. International Journal of Epidemiology, 41(2), 504–513. https://doi:10.1093/ije/dyr194
27.
MiaM., RahmanM., & RoyP. (2018). Sociodemographic and geographical inequalities in under- and overnutrition among children and mothers in Bangladesh: A spatial modelling approach to a nationally representative survey. Public Health Nutrition, 21(13), 2471–2481. https://doi:10.1017/s1368980018000988
28.
MostafaK. (2011). Socio-economic determinants of severe and moderate stunting among under-five children of rural Bangladesh. Malaysian Journal of Nutrition, 17(1), 105–118.
29.
MyattM., KharaT., SchoenbuchnerS., PietzschS., DolanC., LelijveldN., & BriendA. (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(1), 1–11. https://doi:10.1186/s13690-018-0277-1
30.
NaserI., JalilR., MudaW., NikW., ShariffZ., & AbdullahM. (2014). Association between household food insecurity and nutritional outcomes among children in Northeastern of Peninsular Malaysia. Nutrition Research and Practice, 8(3), 304–311. https://doi:10.4162/nrp.2014.8.3.304
31.
National Institute of Population Research Training (NIPORT); Mitra and Associates; ICF International. (2018). Bangladesh Demographic and Health Survey 2017; NIPORT, Mitra and Associates, and ICF International: Dhaka, Bangladesh and Calverton, Maryland.
32.
National Institute of Population Research and Training (NIPORT) & ICF International. (2016). Bangladesh demographic and health survey 2014: Policy briefs. NIPORT and ICF International.
33.
NeiraM., & Prüss-UstünA. (2016). Preventing disease through healthy environments: A global assessment of the environmental burden of disease. Toxicology Letters, 259(S), S1.
34.
NIPORT Mitra and Associates ICF International. (2018). Bangladesh demographic and health survey 2017. NIPORT, Mitra and Associates, and ICF International.
35.
PearceN. (2011). Epidemiology in a changing world: Variation, causation and ubiquitous risk factors. International Journal of Epidemiology, 40(2), 503–512. https://doi:10.1093/ije/dyq257
36.
PerumalN., BassaniD., & RothD. (2018). Use and misuse of stunting as a measure of child health. The Journal of Nutrition, 148(3), 311–315.
37.
PryerJ., & RogersS. (2006). Epidemiology of undernutrition in adults in Dhaka slum households, Bangladesh. European Journal of Clinical Nutrition, 60(7), 815–822. https://doi:10.1038/sj.ejcn.1602385
38.
RahmanA., & ChowdhuryS. (2007). Determinants of chronic malnutrition among preschool children in Bangladesh. Journal of Biosocial Science, 39(2), 161–173. https://doi:10.1017/S0021932006001295
39.
RahmanM., HowladerT., MasudM., & RahmanM. (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(6), e0157814. https://doi:10.1371/journal.pone.0157814
40.
RahmanM., SaimaU., & GoniM. (2015). Impact of maternal household decision-making autonomy on child nutritional status in Bangladesh. Asia Pacific Journal of Public Health, 27(5), 509–520. https://doi.org/10.1177/1010539514568710
41.
RuelM., & MenonP. (2002). Child feeding practices are associated with child nutritional status in Latin America: Innovative uses of the demographic and health surveys. The Journal of Nutrition, 132(6), 1180–1187. https://doi:10.1093/jn/132.6.1180
42.
SarmaH., KhanJ., AsaduzzamanM., UddinF., TarannumS., HasanM., RahmanA., & AhmedT. (2017). Factors influencing the prevalence of stunting among children aged below five years in Bangladesh. Food and Nutrition Bulletin, 38(3), 291–301. https://doi.org/10.1177/0379572117710103
43.
SembaR., de PeeS., SunK., SariM., AkhterN., & BloemM. (2008). Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: A cross-sectional study. The Lancet, 371(9609), 322–328. https://doi:10.1016/s0140-6736(08)60169-5
44.
SmithT., & ShivelyG. (2019). Multilevel analysis of individual, household, and community factors influencing child growth in Nepal. BMC Pediatrics, 19(1), 1–14. https://doi:10.1186/s12887-019-1469-8
45.
StewartC., IannottiL., DeweyK., MichaelsenK., & OnyangoA. (2013). Contextualising complementary feeding in a broader framework for stunting prevention. Maternal & Child Nutrition, 9, 27–45. https://doi:10.1111/mcn.12088
46.
SultanaP., RahmanM., & AkterJ. (2019). Correlates of stunting among under-five children in Bangladesh: A multilevel approach. BMC Nutrition, 5(1), 1–12. https://doi:10.1186/s40795-019-0304-9
47.
UNICEF WHO/World Bank Group (2018). Levels and trends in child malnutrition. Joint child malnutrition estimates. Key findings of the 2017 edition.
48.
United Nations International Children’s Emergency Fund. (1990). Strategy for improved nutrition of children and women in developing countries: A UNICEF policy review. ERIC Clearinghouse.
49.
UrkeH., BullT., & MittelmarkM. (2011). Socioeconomic status and chronic child malnutrition: Wealth and maternal education matter more in the Peruvian Andes than nationally. Nutrition Research, 31(10), 741–747. https://doi:10.1016/j.nutres.2011.09.007
50.
UthmanO. (2009). A multilevel analysis of individual and community effect on chronic childhood malnutrition in rural Nigeria. Journal of Tropical Pediatrics, 55(2), 109–115. https://doi:10.1093/tropej/fmn093
51.
VilcinsD., SlyP., & JagalsP. (2018). Environmental risk factors associated with child stunting: A systematic review of the literature. Annals of Global Health, 84(4), 551. https://doi:10.29024/aogh.236110.9204/aogh.2361
52.
World Food Programme. (2012). WFP Bangladesh nutrition strategy 2012–2016.
53.
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.
54.
World Health Organization. (2014). Global nutrition targets 2025: Policy brief series.
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