Changing childhood malnutrition in Bangladesh: Trends over the last two decades in urban-rural differentials (1993-2012)

Objective: The present study determined trends in malnutrition among under-5 children in urban and rural areas of Bangladesh. Design: Surveillance. Setting: The study was conducted in the urban Dhaka and the rural Matlab hospitals of the International Centre for Diarrhoeal Disease Research, Bangladesh, where every fiftieth patient and all patients coming from the Health and Demographic Surveillance System were enrolled. Subjects: A total of 28 816 under-5 children were enrolled at Dhaka from 1993 to 2012 and 11 533 at Matlab between 2000 and 2012. Results: In Dhaka, 46 % of the children were underweight, 39 % were stunted and 28 % were wasted. In Matlab, the corresponding figures were 39 %, 31 % and 26 %, respectively. At Dhaka, 0·5 % of the children were overweight and obese when assessed by weight-for-age Z-score >+2·00, 1·4 % by BMI-for-age Z-score >+2·00 and 1·4 % by weight-for-height Z-score >+2·00; in Matlab the corresponding figures were 0·5 %, 1·4 % and 1·4 %, respectively. In Dhaka, the proportion of underweight, stunting and wasting decreased from 59 % to 28 % (a 53 % reduction), from 54 % to 22 % (59 % reduction) and from 33 % to 21 % (36 % reduction), respectively, between 1993 and 2012. In Matlab, these indicators decreased from 51 % to 27 % (a 47 % reduction), from 36 % to 25 % (31 % reduction) and from 34 % to 14 % (59 % reduction), respectively, from 2000 to 2012. On the other hand, the proportion of overweight (as assessed by BMI-for-age Z-score) increased significantly over the study period in both Dhaka (from 0·6 % to 2·6 %) and Matlab (from 0·8 % to 2·2 %). Conclusions: The proportion of malnourished under-5 children has decreased gradually in both urban and rural Bangladesh; however, the reduction rates are not in line with meeting Millennium Development Goal 1. Trends for increasing childhood obesity have been noted during the study period as well