# Prevalence and Determinants of Undernutrition Among Children Under Five in Coastal Bangladesh: A Community‐Based Study

## TL;DR

This study finds high rates of undernutrition in young children in coastal Bangladesh and identifies factors like poverty, education, and climate risks that contribute to poor nutrition.

## Contribution

The study uses the Social Ecological Model to identify multi-level determinants of undernutrition in children under five in a disaster-prone region.

## Key findings

- Over half of children under five in coastal Bangladesh suffer from severe stunting.
- Undernutrition is linked to factors like low birth weight, poor feeding practices, and household vulnerability.
- Integrated local and global policies are needed to address child undernutrition in climate-affected regions.

## Abstract

This study investigates the prevalence and determinants of undernutrition among children under five in coastal Bangladesh employing the Social Ecological Model (SEM). A cross‐sectional survey was conducted among 348 randomly selected caregivers from six villages in Dacope upazila of Khulna district, between July and October 2024. Undernutrition in children was assessed using World Health Organization (WHO) standards for stunting, wasting, and underweight. Findings revealed high levels of undernutrition prevalence among children under five, with 56.3% severe stunting and 33.3% moderate stunting, 16.4% severe wasting and 40.5% moderate wasting, and 28.7% severe underweight and 59.2% moderate underweight, respectively. Multivariate analyses demonstrated that stunting was significantly associated with child age, birth weight, caregivers' occupation and mass media exposure, education of the household head, household food insecurity, vulnerability, and membership of non‐governmental organization (NGO). Wasting prevalence was influenced by child age and sex, exclusive breastfeeding, feeding practices, caregivers' education, occupation, income, religion, and mass media exposure, household vulnerability, NGO membership, and place of residence. Underweight prevalence was primarily associated with child age, sex, birth weight, caregivers' income, and exposure to natural disasters. This study emphasizes the need for integrated, multi‐level strategies to address child undernutrition. Local actions should prioritize young and low‐birth‐weight children through improved feeding practices, maternal education, and livelihood support in disaster‐prone areas, while national policies must embed nutrition within health, poverty alleviation, and social protection programs. Globally, climate‐resilient and context‐specific nutrition policies, supported by WHO, United Nations Children's Fund (UNICEF), and World Food Programme (WFP), are vital to ensuring sustainable and equitable child health outcomes.

This study examined undernutrition among children under five in coastal Bangladesh employing the Social Ecological Model. A cross‐sectional survey of 348 caregivers from six villages in Dacope upazila (July–October 2024) revealed high levels of stunting, wasting, and underweight prevalence. Multi‐level determinants of childhood undernutrition were identified across personal, interpersonal, community, and policy levels. The study recommends integrated strategies spanning local, national, and global policies, along with cross‐country collaborations, to promote equitable and sustainable improvements in child nutrition and health outcomes.