Factors Affecting Malnutrition, Morbidity and Mortality
Factors Affecting Malnutrition, Morbidity and Mortality among Under Five Children of Bangladesh (1998-99)
|Author:||Md. Israt Rayhan|
|Supervisor:||Dr. M. Sekander Hayat Khan|
This study presents factors affecting malnutrition, morbidity and mortality among under five children of Bangladesh. An application is provided on Bangladesh Demographic and Health Survey 1999-2000 (BDHS 1999-2000) data for the analysis of differential impact of some demographic, socio-economic, environmental and health related factors on nutritional condition, prevalence of diseases and survival status of children under age five. Information was available for 6939 children aged under five in the data, of them 6430 children were alive and 84 percent of the alive children (i.e. 5419) were weighted and measured.
Children are classified as malnourished if their Z-scores are below minus two standard deviations from the median of the U.S. National Center for Health Statistics (NCHS) reference population. In this study stunting (a condition reflecting chronic malnutrition), wasting (a condition indicating acute or short-term food deficits) and underweight (which may reflect stunting, wasting or both) are used as malnutrition indicators. The analyses revealed that 45 percent of the children under age five are stunted, 10.5 percent are wasted and 48 percent are underweighted. Based on mothers’ reports, 18.5 percent of the children had acute respiratory infection, 6 percent had experienced diarrhea and 27 percent had a fever at some time in the two weeks preceding the survey. Under-five mortality rate is 79 deaths per 1,000 live births i.e. 1 in every 13 children born during the 5 years before 1999-2000 died within the fifth year of life.
Some bivariate analyses and chi-square test of independence were conducted to determine the interrelationship among variables in the data and the results of bivariate analyses are utilized in selecting variables for the multivariate model. Multivariate logistic regression analyses were employed to identify the determinants of malnutrition, morbidity and mortality among under five children of Bangladesh. Cox’s linear logistic regression model was used for the multivariate analysis considering it’s relative advantages over the other multivariate techniques.
According to our analyses, the main contributing factors for malnutrition are size at birth, previous birth interval, mother’s body mass index and parent’s education. Children with larger size at birth and longer prior birth interval have lower risk of malnutrition. Children of nourished mother have lower risk of being malnourished compared to children of thin mother. The educational level of parent’s is positively related to better nutritional and health status of children. The analysis shows that children whose parents attended secondary or higher level of education are less likely to be suffered from malnutrition than the children of illiterate one.
Type of housing, breastfeeding status, vaccination coverage and mother’s education are depicted to be significant factors affecting morbidity among under five children. Children live in poor quality (raw materials made) houses are more likely to be suffered from acute respiratory infection, diarrhea and fever compared to children who live in better quality (cement made) houses. Prevalence of diarrhea is lower for children who fed breast milk and received all doses of BCG, DPT, POLIO and Measles vaccines. Children of educated mother have lower rate of prevalence of fever than the illiterate one.
Significant association was revealed between under-five mortality and size at birth of the index child. Babies who are very small in size at birth have higher rate of under-five mortality than those with larger size at birth. Previous birth interval also shows strong negative relationship with under-five mortality. As the previous birth interval increases, the under-five mortality rate decreases.
Prevalence of malnutrition, morbidity and mortality among under five children varies by division and age of child. Sylhet division records higher rate of morbidity and mortality among under five children. The analyses also depicted that children of age 6-23 months are more vulnerable for malnutrition and morbidity.
The findings of this study may prove useful for the policy makers in designing and implementing necessary steps to improve nutritional and survival status of children under five years of age in Bangladesh.