Devika Saran, MS: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: Childhood stunting remains a pressing challenge across South Asia. We examine how changes in the underlying causes of malnutrition have contributed to improvements in linear growth among children in Bangladesh between 2014 and 2022 and their contributions to the decline in stunting.
Methods: This cross-sectional study used three rounds of the Bangladesh Demographic and Health Survey (BDHS: 2014, 2017–18, 2022). Children aged 0-59 months were linked to mothers and households. Height-for-age z-scores were the primary continuous outcome (stunted HAZ< -2 SD; severely stunted: < -3 SD). Descriptive analysis estimated changes in HAZ, stunting, and severe-stunting covariates across years. Pooled ordinary least squares (OLS) with survey-years and division fixed effects adjusted for household wealth, parental education, sanitation, piped water, birth order, birth interval, maternal height, and child sex. Linear decomposition, Wald tests, LPMs, and Oaxaca-Blinder assessed contributions and robustness.
Results: Among 20,045 children, mean HAZ improved from -1.54 to -1.16 (change = +0.38 SD), stunting fell from 36.5% to 23.5%, and severe stunting from 11.5% to 5.5%. Pooled OLS n = 18,614 identified wealth index β = 0.050 SD; CI: 0.036, 0.064, paternal education β = 0.023; CI: 0.016, 0.029, maternal education β = 0 .019; CI: 0.009, 0.026, maternal height β = 8.05; CI: 7.277, 8.835, significant, and reduced open defecation β = -0.109; 95% CI: 0.199, -0.020 as key HAZ predictors. Piped water and birth interval associations significantly changed over time (Wald <0.05). LPMs confirmed that wealth was protective against stunting, β = -0.020; 2% lower, and severe stunting, β = -0.008; 0.8% lower. Linear decomposition explained 68.4% of the HAZ improvements, with measured characteristics accounting for 39.3% of the improvement from wealth, 26.2% from education, and 30.9% from mother's height.
Conclusions: Bangladesh's decline in child stunting between 2014 and 2022 was driven predominantly by rising wealth and parental education.
