title: Shared environments: a multilevel analysis of community context and child nutritional status in Bangladesh.
abstract: OBJECTIVE
  The goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0-59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  The data are from the nationally representative 2004 Bangladesh Demographic and Health Survey.
  
  
  METHODS
  Respondents were ever-married women (aged 15-49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community.
  
  
  RESULTS
  Multilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0.18 (SE 0.07)) and weight-for-age (highest v. lowest tertile, β = 0.21 (SE 0.06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0.13 (SE = 0.06)).
  
  
  CONCLUSIONS
  The community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.
authors.affiliation: Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.forename: M Omar
authors.initials: MO
authors.lastname: Rahman
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D001827:Body Height; D001835:Body Weight; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis / Q000379:methods*; D009752:Nutritional Status; D012044:Regression Analysis; D012111:Residence Characteristics; D012424:Rural Population; D012499:Sanitation; D012931:Social Environment; D058992:Social Participation; D011795:Surveys and Questionnaires; D014881:Water Supply; D055815:Young Adult