Determinants and Projections of Minimum Acceptable Diet among Children Aged 6-23 Months: A National and Subnational Inequality Assessment in Bangladesh.

Subnational evidence on the level of inequality in receiving complementary feeding practice among Bangladeshi children is lacking. This study estimated inequality in the minimum acceptable diet (MAD) among Bangladeshi children aged 6-23 months, and identified risk factors for and developed projections of the MAD up to 2030. Data from the Bangladesh Demographic and Health Survey 2017-2018 were used in this cross-sectional study. Regression-based slope (SII) and relative index of inequality (RII) were used to quantify the level of absolute and relative inequality, respectively. A Bayesian logistic regression model was used to identify the potential determinants of a MAD and project prevalence up to 2030. About 38% of children aged 6-23 months received a MAD. The national prevalence of a MAD was 26.0 percentage points higher among children from the richest compared to the poorest households, and 32.1 percentage points higher among children of higher-educated over illiterate mothers. Socioeconomic inequality was found to be the highest in the Chattogram division (SII: 43.9), while education-based inequality was highest in the Sylhet division (SII: 47.7). Maternal employment and the number of ANC visits were also identified as significant determinants of a MAD, and the prevalence of a MAD was projected to increase from 42.5% in 2020 to 67.9% in 2030. Approximately two out of five children received a MAD in Bangladesh and significant socioeconomic and education-based inequalities in the MAD were observed. Subnational variation in socioeconomic and education-based inequalities in the MAD requires further public health attention, and poverty reduction programs need to be strengthened.