Child undernutrition and its association with household environmental conditions in Bangladesh.

OBJECTIVE: Undernutrition among children under the age of five years is a prevalent global issue, especially in Bangladesh. This study aimed to explore the relationships of household environmental conditions (HECs) with child undernutrition in Bangladesh, with a specific focus on rural-urban variations. DESIGN: We analysed children's data from the 2017/18 Bangladesh Demographic Health Survey. The outcome variable considered were measures of child undernutrition, including stunting, wasting and underweight. The primary exposure variables considered were indicators of HEC. We used a hierarchical multilevel mixed-effect generalized linear models (GLM) modified with a Poisson regression to explore the association between outcomes and exposures, adjusting for potential confounders. SETTING: Nationally representative cross-sectional survey. PARTICIPANTS: 8,057 under-5 children. RESULTS: The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8%, and 22%, respectively, with notable urban-rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1·17), exposed to household air pollution (aPR: 1·37), had unimproved drinking water sources (aPR: 1·28) or had poor handwashing facilities (aPR: 1·24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, with variations in the effect size across urban-rural areas. CONCLUSION: The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs, therefore, integrated approaches should be adopted to address these environmental factors collectively. Policies and programmes should prioritse enhancing housing quality to achieve sustainable improvements in child nutritional outcomes.