# Geospatial variation and risk factors for malnutrition among postpartum women in rural Bangladesh

## TL;DR

This study examines the double burden of malnutrition in rural Bangladesh, finding that postpartum women's nutritional status varies geographically and is influenced by socioeconomic factors.

## Contribution

The study provides new evidence on the spatial variation and risk factors for both underweight and overweight/obesity among postpartum women in rural Bangladesh.

## Key findings

- Underweight and overweight/obesity prevalence among postpartum women was 15.2% and 17.3%, respectively.
- Higher socioeconomic status was protective against underweight but increased the risk of overweight/obesity.
- Nutritional status varied spatially at the community level, indicating the need for targeted interventions.

## Abstract

Rising prevalences of overweight and obesity and the continued elevated prevalence of underweight in South Asia have contributed to the double burden of malnutrition. This study evaluates geospatial variation in nutritional status and assesses risk factors for poor nutritional status among postpartum women in rural northwestern Bangladesh. This analysis included postpartum women enrolled in the Protein Plus trial, a cluster-randomized controlled infant feeding trial, from 2018 to 2020. We assessed geospatial variation in nutritional status at the individual level using point pattern analysis and at the spatial area level using global Moran’s I. In addition, we ran multivariable multinomial logistic regression models to identify risk factors for being classified as underweight and overweight/obesity in this population. A total of 3,801 women were included in this analysis. The prevalence of underweight and overweight/obesity in this study population was 15.2% and 17.3%, respectively. While no spatial dependence was found at the household level, clustering of underweight and overweight was observed at the community level. In an adjusted analysis, women living in households in the highest socioeconomic (SES) quintile were 51% (Relative risk ratio (RRR): 0.49; 95% CI: 0.34-0.69) less likely to be classified as underweight (p < 0.001) while 2.4 (RRR: 2.37; 95% CI:1.69, 3.32) times more likely to be classified as overweight/obese compared to those in lowest SES quintile (p < 0.001). Higher levels of maternal education and greater food variety were also associated with an increased risk of being classified as overweight/obese. In this area of Bangladesh, we found evidence of the double burden of malnutrition among women 6 months postpartum, with over 30% of postpartum women classified as either overweight or underweight, and nutritional status varied spatially at the community level.

Many countries in South Asia are experiencing the double burden of malnutrition with rising prevalences of overweight and obesity and a continued high prevalence of underweight, particularly among women. In this cross-sectional study, we evaluated geospatial variation in nutritional status and assessed risk factors for malnutrition among postpartum women living in a rural region of Bangladesh. Women included in this analysis were enrolled in a cluster-randomized infant feeding trial with anthropometry measured at 6 months postpartum. We found that the prevalence of underweight and overweight/obesity was 15.2% and 17.3%, respectively. Within this rural area, the prevalence of under- and overnutrition varied spatially. In the risk factor analysis, socioeconomic status was found to be protective against the classification of underweight, but women of higher socioeconomic status were at a greater risk of being classified as overweight/obese based on body mass index (BMI). Our findings provide further evidence of the double burden of malnutrition and highlight that even in rural areas, there can be spatial variation in nutritional status. This may be important for nutritional policies and programs to consider to reduce the prevalence of undernutrition while also halting the rise in the prevalence of overweight and obesity.