ASSOCIATION BETWEEN NUTRIENT ADEQUACY AND MALNUTRITION OF CHILDREN IN URBAN SLUM

Abstract

Background: Bangladesh is maintaining more or less a constant GDP growth since last decade, however, child anthropometric failure especially in slum areas is still commonly visible. Relationship between household income and child dietary diversity (CDD) is not clear due to lack of quality data. Lower dietary diversity score (DDS) among slum children is considered an indicator of slum malnutrition situation. In this context few immersing questions needed to be resolved and they are: (1) Did household income of slum dwellers increase as a consequence of increased GDP per capita? (2) Did purchasing power act as a proxy of income which has influential capacity to increase the intake frequency of diversified foods? and (3) Did CDD improvement of the children of the slums has any positive correlation with their nutritional status? Therefore, the present study was conducted to reveal plausible answers of these questions.

Methodology This study was cross-sectional and conducted among 275 children between 6-12 years of age in five selected slums of Dhaka city. A stunting prevalence of 22% among urban children of 6-59 months of age according to BDHS 2014 data was considered as prevalence of dependent variable for sample size calculation. The study samples were collected randomly from selected slums. To collect the socioeconomic and demographic information a semi-structured pre-tested questionnaire was utilized. Person to person interview of the mothers/or caretakers of the children were conducted and anthropometric data were also collected. To determine dietary diversity scores (DDSs) of the studied children a 24-hour dietary recall method along with a structured food frequency questionnaire was used. Between the years of October 2015 to April 2017 all interviews and measurements were conducted.

Findings Among the slum children level of stunting (18%), wasting (19.4%), and underweight (22%) were observed that showed similarity with current national data. A sizable number of the households (HH) showed increased DDS (>5), thereby indicating an increased HH purchasing power (PP). Bivariate regression analysis disclosed that children from lower household income group (≤6000 BDT) were 3 times more likely to be stunted as compared to children with higher family income group [Unadjusted Odds Ratio/AOR=3.097; p<0.001]. Multiple logistic regression revealed that children who had <5 DDS were 2 times more likely to be stunted than children who had ≥5 DDS [Adjusted OR=2.127, p=0.036]. Therefore, an inverse association was seen between CDD and anthropometric failure.

Conclusions The income-child health gradient is seen as a causal phenomenon of child malnutrition. Arguably a significant portion of income's role on child health operates through various other determinants. Thus, the present study essentially established that CDD, a proxy indicator of micronutrients adequacy, could be an operational linkage in income-child health gradient.