Child undernutrition and its association with household environmental conditions in Bangladesh

Abstract

Abstract Background Child undernutrition, a persistent global concern, is particularly prevalent in Bangladesh. Little is known about the relationship between household environmental conditions (HEC) and child nutrition. This study aimed to explore how HEC is associated with undernutrition among under-5 children in Bangladesh, with a specific focus on rural-urban differences. Methods We analysed 8,653 under-5 children’s data from the 2017/18 Bangladesh Demographic Health Survey. The outcome variables were various forms of undernutrition, namely stunting, wasting and underweight, as well as their combinations. The exposure variables were HEC indicators, including housing materials, household air pollution (HAP) from the use of solid fuel, water sources, drinking water treatment to ensure safe water, sanitation facilities, and combinations of these exposures. We used a hierarchical Poisson regression model to explore the association between outcomes and exposures adjusted for potential confounders. Results The prevalence of stunting, wasting and underweight among under-5 children in Bangladesh was 31%, 8% and 22%, respectively, with notable variations across geographical divisions and urban-rural areas. Under-5 children who lived in houses constructed with unimproved materials (natural or rudimentary) (aRR: 1.17), had high exposure to HAP (aRR: 1.37), used unimproved drinking water sources (aRR: 1.28), or had poor handwashing facilities (aRR: 1.24) had a greater likelihood of stunting compared to their counterparts living in households with better conditions. Similar associations were observed for underweight as well. The lower the cumulative score of HEC (indicating poor conditions), the higher the likelihood of children with stunting and underweight. A significant urban-rural difference in the magnitude of the association was also observed. Conclusion The prevalence of stunting and underweight was relatively high among under-5 children in Bangladesh, with notable urban-rural differences. Significant negative associations were observed between HEC indicators and these nutritional measures. Public health interventions are needed to reduce children’s exposure to polluted indoor air, ensure access to clean water and promote proper handwashing facilities, particularly in rural settings.