Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
International Institute for Population Sciences (IIPS), Mumbai, India.
PLoS One. 2019 Aug 9;14(8):e0220062. doi: 10.1371/journal.pone.0220062. eCollection 2019.
Undernutrition, an important indicator for monitoring progress of development goals, is a matter of concern in many developing countries, including Bangladesh. Despite regional differences in chronic undernutrition in Bangladesh, regional determinants among children under the age of five were not extensively explored.
Using combined repeated cross-sectional nationwide Bangladesh Demographic and Health Surveys (BDHS 2011 and 2014) and employing bivariate and logistic regression analyses, we estimated prevalence, changes and variations in regional determinants of stunting among children aged 6-59 months over two time periods 2011 and 2014.
Our benchmark results suggested that the children from Rajshahi, Khulna, Rangpur, Chittagong and Dhaka tend to be significantly less stunted by 51% (p = 0.000; CI = [0.38, 0.63]), 44% (p = 0.000; CI = [0.44, 0.71]), 26% (p = 0.012; CI = [0.58, 0.93]), 23% (p = 0.012; CI = [0.62, 0.95]) and 22% (p = 0.033; [0.63, 0.97]) respectively, against Sylhet in 2011. With the exception of Dhaka, no region showed significant differences in the odds of stunting over two time periods 2011 and 2014, i.e. only Dhaka revealed significant difference by 30% reductions in the odds of stunting in 2014. Also, rural children were less likely to be stunted (by 19%) of the urban counterparts. Regional covariates of stunting differ. However, children's age, household wealth, mother's height, and parental education were important determinants of stunting in Bangladesh.
Dhaka made an impressive improvement in child nutrition, thus contributed largely to the reduction of stunting levels in Bangladesh for 2014 over 2011. Sylhet and Barisal require strong push to improve nutritional status of children. Further decline is possible through region-specific multipronged interventions that can address area-specific covariates to break the cycle of undernutrition like strengthening economic and educational status, emphasizing the role of father to augment their knowledge in varying aspects like family planning, reduction of fertility and by improving mother's health.
营养不良是监测发展目标进展的一个重要指标，在许多发展中国家，包括孟加拉国，都是一个令人关注的问题。尽管孟加拉国存在区域性的慢性营养不良问题，但针对 5 岁以下儿童的区域性决定因素尚未得到广泛探讨。
本研究使用了孟加拉国全国性的人口与健康调查（BDHS 2011 年和 2014 年）的合并重复横断面数据，并采用双变量和逻辑回归分析，估计了 2011 年至 2014 年期间，6-59 个月儿童的生长迟缓区域性决定因素的流行率、变化和差异。
我们的基准结果表明，来自拉杰沙希、库尔纳、朗布尔、吉大港和达卡的儿童生长迟缓的比例分别显著降低了 51%（p=0.000；CI=[0.38, 0.63]）、44%（p=0.000；CI=[0.44, 0.71]）、26%（p=0.012；CI=[0.58, 0.93]）、23%（p=0.012；CI=[0.62, 0.95]）和 22%（p=0.033；CI=[0.63, 0.97]），而 2011 年时，来自锡尔赫特的儿童生长迟缓比例则显著较高。除了达卡，没有一个地区在 2011 年和 2014 年两个时期的生长迟缓率方面表现出显著差异，也就是说，只有达卡地区在 2014 年时生长迟缓的几率显著降低了 30%。此外，农村儿童生长迟缓的比例（降低 19%）也低于城市儿童。生长迟缓的区域性决定因素有所不同。然而，儿童的年龄、家庭财富、母亲身高和父母教育程度是孟加拉国儿童生长迟缓的重要决定因素。
达卡在儿童营养方面取得了显著改善，这对 2014 年孟加拉国的生长迟缓率下降做出了巨大贡献，与 2011 年相比有所降低。锡尔赫特和巴里萨尔需要大力推动改善儿童的营养状况。通过针对特定地区的多管齐下的干预措施，有可能进一步降低生长迟缓率，这些措施可以解决特定地区的决定因素，例如通过加强经济和教育地位、强调父亲在家庭计划、减少生育和改善母亲健康等方面的作用，来打破营养不良的循环。
