Trends of childhood Composite Index of Anthropometric Failure prevalence, determinants and inequity in Bangladesh: insights from Bangladesh Demographic and Health Surveys

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OBJECTIVE: The childhood Composite Index of Anthropometric Failure (CIAF) effectively identifies multiple anthropometric deficits among under-five children. This study aimed to analyse undernutrition among under-five children, as measured by childhood CIAF, to evaluate trends, determinants and disparities in Bangladesh between 2007 and 2022. DESIGN: The study utilised data from five rounds of the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, 2017-2018 and 2022. The CIAF was estimated using six mutually exclusive anthropometric failure categories in accordance with the WHO child growth standards. Multivariable logistic regression was performed to explore determinants of CIAF. The concentration index and concentration curve were used to assess the changes in inequity. SETTING: Bangladesh. PARTICIPANTS: 32 096 under-five children. RESULTS: The prevalence of childhood CIAF declined significantly from 56 % (95 % CI: 55, 58) in 2007 to 35 % (95 % CI: 33, 36) in 2022. The significant reduction in 'stunting and underweight' from 23 % (95 % CI: 22, 24) in 2007 to 11 % (95 % CI: 10, 12) in 2022 was a major contributor to the decrease in childhood CIAF. Child age, household socio-economic status (SES) and mother's education were significant determinants of childhood CIAF across all study periods. Negative concentration indices for SES, residence and mother's and father's education indicate pro-poor inequality in childhood CIAF, which declined from 2007 to 2022. CONCLUSIONS: Despite significant progress, disparities in childhood CIAF across SES, residence and parental education persist in Bangladesh. Targeted policy interventions are crucial to mitigating childhood undernutrition and achieving Sustainable Development Goal 2.2.

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