Urban-rural differences in the associated factors of severe under-5 child undernutrition based on the composite index of severe anthropometric failure (CISAF) in Bangladesh

Abstract

Introduction Severe undernutrition among under-5 children is usually assessed using single or conventional indicators (i.e., severe stunting, severe wasting, and/or severe underweight). But these conventional indicators partly overlap, thus not providing a comprehensive estimate of the proportion of malnourished children in the population. Incorporating all these conventional nutritional indicators, the Composite Index of Severe Anthropometric Failure (CSIAF) provides six different undernutrition measurements and estimates the overall burden of severe undernutrition with a more comprehensive view. This study applied the CISAF indicators to investigate the prevalence of severe under-5 child undernutrition in Bangladesh and its associated socioeconomic factors in the rural-urban context. Methods This study extracted the children dataset from the 2017–18 Bangladesh Demographic Health Survey (BDHS), and the data of 7661 children aged under-5 were used for further analyses. CISAF was used to define severe undernutrition by aggregating conventional nutritional indicators. Bivariate analysis was applied to examine the proportional differences of variables between non-severe undernutrition and severe undernutrition group. The potential associated socioeconomic factors for severe undernutrition were identified using the adjusted model of logistic regression analysis. Results The overall prevalence of severe undernutrition measured by CISAF among the children under-5 was 11.0% in Bangladesh (rural 11.5% vs urban 9.6%). The significant associated socioeconomic factors of severe undernutrition in rural areas were children born with small birth weight (AOR: 2.84), children from poorest households (AOR: 2.44), and children aged < 36 months, and children of uneducated mothers (AOR: 2.15). Similarly, in urban areas, factors like- children with small birth weight (AOR: 3.99), children of uneducated parents (AOR: 2.34), poorest households (APR: 2.40), underweight mothers (AOR: 1.58), mothers without postnatal care (AOR: 2.13), and children’s birth order ≥4 (AOR: 1.75), showed positive and significant association with severe under-5 undernutrition. Conclusion Severe undernutrition among the under-5 children dominates in Bangladesh, especially in rural areas and the poorest urban families. More research should be conducted using such composite indices (like- CISAF) to depict the comprehensive scenario of severe undernutrition among the under-5 children and to address multi-sectoral intervening programs for eradicating severe child undernutrition.

Determinants of aggregate anthropometric failure among children under-five years in Ethiopia: Application of multilevel mixed-effects negative binomial regression modeling

“…The overall prevalence of severe undernutrition measured by CISAF among children under 5 was 13.9%. This finding aligns with a study from Bangladesh, which reported a prevalence of CISAF among children under five was 11.0% [ 31 ].…”

“…In Asia, CISAF has been successfully used to demonstrate the prevalence of severe undernutrition among the children under-five. For example in Bangladesh CISAF was 11.0% (rural 11.5% vs. urban 9.6%) [ 31 ], indicative of severe undernutrition in this nation, especially in children residing in rural settings.…”

Role of Community Infrastructure in Improving Nutrition in Under-Five Children for Better Implementation of Integrated Child Development Services

“…[24] Similar to our study, geographical variation and urban-rural variation were noticed in earlier studies. [25] Here children of higher birth orders (4 or more) living in rural areas of Central, eastern, and north-eastern regions of the country are benefitting from Anganwadi centres. Anganwadi centres provide mid-day meals to children throughout the country especially in rural areas via the government-run Integrated Child Development Scheme (ICDS).…”

Correlations between Maternal Knowledge, Attitude, and Posyandu Utilization on Nutritional Status in Children Under Five

“…Children with low birth weight are more likely to be severely malnourished regardless of geographical context. In a study by Anik et al, (2021) conducted in Bangladesh, it was shown that children with low birth weight were 3.99 times more likely to experience severe undernutrition. In addition, nutrition that is not fulfilled optimally for the mother and fetus during pregnancy will affect the growth and development of the fetus which manifests in the form of low birth weight or LBW (Wong et al, 2020;Kusparina 2019in Prasojo et al, 2022.…”