title: Association of Low-Birth Weight with Malnutrition in Children under Five Years in Bangladesh: Do Mother's Education, Socio-Economic Status, and Birth Interval Matter?
abstract: BACKGROUND
  Malnutrition in children under five years remains a significant problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although several studies have been conducted to identify the important risk factors of malnutrition, none of them assess the role of low birth weight (LBW) despite its high prevalence (36%). This study examines the association between LBW and malnutrition using data from the Bangladesh Demographic and Health Survey (BDHS) 2011 and provides practical guidelines for improving nutritional status of children.
  
  
  METHODS
  Malnutrition in children is measured in terms of their height-for-age, weight-for-height, and weight-for-age. Children whose Z-scores for either of these indices are below two standard deviations (-2SD) from median of WHO's reference population are considered as stunted, wasted or underweight, respectively. The association between malnutrition and LBW was investigated by calculating adjusted risk-ratio (RR), which controls for potential confounders such as child's age and sex, mother's education and height, length of preceding-birth-interval, access to food, area of residence, household socio-economic status. Adjusted RR was calculated using both Cochran-Mantel-Haenszel approach and multivariable logistic regression models controlling for confounder.
  
  
  RESULTS
  The prevalence of malnutrition was markedly higher in children with LBW than those with normal birth-weights (stunting: 51% vs 39%; wasting: 25% vs 14% and underweight: 52% vs 33%). While controlling for the known risk factors, children with LBW had significantly increased risk of becoming malnourished compared to their counter part with RR 1.23 (95% CI:1.16-1.30), 1.71 (95% CI:1.53-1.92) and 1.47 (95% CI: 1.38-1.56) for stunting, wasting and underweight, respectively. The observed associations were not modified by factors known to reduce the prevalence of malnutrition, such as higher education of mother, better household socio-economic conditions and longer birth-interval.
  
  
  CONCLUSIONS
  Higher education of mother, better household socio-economic conditions and prolonged birth intervals alone are not sufficient in bringing about substantial reductions in prevalence of child malnutrition in Bangladesh. Targeted interventions should be designed to reduce prevalence of LBW in addition to improving mother's education and other socio-demographic conditions.
authors.affiliation: Institute of Statistical Research and Training, University of Dhaka, Dhaka-1000, Bangladesh.
authors.forename: M Shafiqur
authors.initials: MS
authors.lastname: Rahman
authors.affiliation: Institute of Statistical Research and Training, University of Dhaka, Dhaka-1000, Bangladesh.
authors.forename: Tamanna
authors.initials: T
authors.lastname: Howlader
authors.affiliation: Institute of Statistical Research and Training, University of Dhaka, Dhaka-1000, Bangladesh.
authors.forename: Mohammad Shahed
authors.initials: MS
authors.lastname: Masud
authors.affiliation: Institute of Statistical Research and Training, University of Dhaka, Dhaka-1000, Bangladesh.
authors.forename: Mohammad Lutfor
authors.initials: ML
authors.lastname: Rahman
mesh_terms: D001459:Bangladesh; D001721:Birth Intervals; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications* / Q000453:epidemiology; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D009035:Mothers; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012923:Social Class