Change in nutritional status of urban slum children before and after the first COVID-19 wave in Bangladesh: A repeated cross-sectional assessment.

The onset of COVID-19 severely disrupted economies and increased acute household food insecurity in developing countries. Consequently, a global rise in childhood undernutrition was predicted, especially among vulnerable populations, but primary evidence on actual changes in nutritional status remained scarce. In this paper, we assessed shifts in nutritional status of urban slum children in Bangladesh pre- and post- the country's first wave of COVID-19 and nationwide lockdown. We used two rounds of cross-sectional data collected before and after the pandemic's first year in two large slum settlements (Korail and Tongi) of Dhaka and Gazipur, Bangladesh (n = 1119). Regression models estimated pre-post changes in: 1) predictors of childhood undernutrition (household income, jobs, food security, dietary diversity, healthcare utilization, and hand hygiene); and 2) under-five children's nutritional status (average height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), stunting, and wasting). Subgroup analysis was done by household migration status and slum area. Over the sample period, average monthly household income dropped 23% from BDT 20,740 to BDT 15,960 (β = -4.77; 95% CI:-6.40, -3.15), and currently employed fathers slightly declined from 99% to 95% (β = -0.04; 95% CI:-0.05, -0.02). Average HAZ among the slum children improved 0.13 SD (95% CI: 0.003, 0.26). Among non-migrant children in Tongi, the odds of stunting increased (OR = 2.01, 95% CI: 1.16, 3.48) and average WHZ reduced -0.40 SD (95% CI: -0.74, -0.06). Despite great economic hardship, and differential patterns of representativeness by household geography and migration status, slum children in Bangladesh generally demonstrated resilience to nutritional decline over the first year of the pandemic. While underlying threats to nutritional deterioration persisted, considerable job and income recovery in the post-lockdown period appeared to have cushioned the overall decline. However, as the pandemic continues, monitoring and appropriate actions are needed to avert lasting setbacks to Bangladesh nutritional progress.