Imperatives for reducing child stunting in Bangladesh†

Although there has been a decline in rates of child stunting in Bangladesh, more than one-third of underfive children still suffer from impaired linear growth. Results of the demographic health surveys since 2004 show that the rate of stunting decreased by only 1.5 percentage points per year (NIPORT, Mitra and Associates & ICF International, 2015). This is not anticipated, given the impressive results the country has demonstrated in reducing infant and maternal mortality over the past two decades (NIPORT, MEASURE Evaluation, and ICDDR,B 2012). Stunting seems to be pervasive throughout the country and is very high in children in slum settlements. Poverty and lack of education are associated with stunting in Bangladesh as elsewhere; however, 21% children from households belonging to the richest wealth quintiles are also stunted. About one-third of children of literate mothers also suffer from stunting. Therefore, the aetiology of stunting is still not clear, although data from Bangladesh suggest that factors associated with the condition include poor maternal nutrition, low birthweight (LBW), severe food insecurity, inappropriate complementary feeding, poverty, illiteracy, poor sanitation, and hygiene practices (Ahmed et al, 2012; Psaki et al., 2014). There is increasing evidence that environmental enteropathy, a condition where the small intestinal mucosa is colonized and damaged by pathogenic bacteria, is one cause of malabsorption of nutrients and stunting. This happens when hygiene and sanitation practices are poor and young children are chronically exposed to bacteria in the environment. The pace at which stunting reduction is taking place in Bangladesh is not enough to achieve the World Health Assembly target of 40% reduction in stunting levels by 2025 (IFPRI, 2014). The current annual average rate of reduction is 2.7%, and this will need to be increased to 3.3% to achieve the target. This is not a phenomenal increase compared with the current rate of reduction, but it will require concerted planning and efforts. From an economic perspective, the cost to Bangladesh of not investing in accelerating this reduction will be huge in terms of lost gross domestic product and income. From a health perspective, it is essential to improve linear growth of children so that the negative effects of excess ponderal growth and resulting overweight and obesity are attenuated. Priority action areas for improving linear growth and increasing the decline in rate of stunting in Bangladesh are summarized in the succeeding text.