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This report provides a systematic review of the evidence to date, both published and grey literature, on the relationship between water and sanitation and nutrition. We also survey the potential impact of improved water, sanitation, and hygiene (WASH) on undernutrition. This is the first report that undertakes a thorough review and discussion of WASH and nutrition in Bangladesh. The report is meant to serve two purposes. First, it synthesizes the results/evidence evolving on the pathway of WASH and undernutrition for use by practitioners working in the nutrition and water and sanitation sectors to stimulate technical discussions and effective collaboration among stakeholders. Second, this report serves as an advocacy tool, primarily for policy makers, to assist them in formulating a multisectoral approach to tackling the undernutrition problem.

Undernutrition among children under the age of five years is a prevalent global issue, especially in Bangladesh. This study aimed to explore the relationships of household environmental conditions (HECs) with child undernutrition in Bangladesh, with a specific focus on rural-urban variations. We analysed children's data from the 2017/18 Bangladesh Demographic Health Survey. The outcome variable considered were measures of child undernutrition, including stunting, wasting and underweight. The primary exposure variables considered were indicators of HEC. We used a hierarchical multilevel mixed-effect generalized linear models (GLM) modified with a Poisson regression to explore the association between outcomes and exposures, adjusting for potential confounders. Nationally representative cross-sectional survey. 8,057 under-5 children. The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8%, and 22%, respectively, with notable urban-rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1·17), exposed to household air pollution (aPR: 1·37), had unimproved drinking water sources (aPR: 1·28) or had poor handwashing facilities (aPR: 1·24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, with variations in the effect size across urban-rural areas. The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs, therefore, integrated approaches should be adopted to address these environmental factors collectively. Policies and programmes should prioritse enhancing housing quality to achieve sustainable improvements in child nutritional outcomes.

•Child malnutrition is a major public health problem.•Globally in 2020, 149 million children <5 y of age were estimated to be stunted (too short for age) and 45 million were wasted (too thin for height).•The most consistent factors associated with child malnutrition are maternal education, household income, and maternal nutritional status. Child undernutrition is a major public health problem. Globally in 2020, 149 million children <5 y of age were estimated to be stunted (too short for age), 45 million to be wasted (too thin for height), and 38.9 million were overweight. The aim of this review was to examine previous studies to determine the factors associated with malnutrition and contribute to the existing body of evidence needed for the formulation of effective interventions. This systematic review was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The Google Scholar database was used to search the studies conducted between 2012 and 2021. The included studies were searched by using some combinations of keywords and saved in Mendeley Desktop for review and referencing. Of 2150 articles retrieved from the Google Scholar databases, 37 met our inclusion criteria. Of the 37 studies reviewed; 13 were conducted in India, 5 in Ethiopia, 3 in Bangladesh, 2 in Ghana, 2 in Nepal, 2 in developing countries, and 1 each in Bolira, Benin, Netherland, Columbia, Pakistan, Malaysia, Africa, Egypt, Ecuadorian, and Indonesia. The most consistent factors associated with child malnutrition were maternal education, household income, maternal nutritional status, age of the child, availability of sanitation facility at home, size of family, birth order in the family, and child's birth weight. Breastfeeding and caring practices, cooking area and the fuel used, sex, and socioeconomic status of the children also contribute toward child malnutrition.

South Asia continues to be the global hub for child undernutrition with 35% of children still stunted in 2017. This paper aimed to identify factors associated with stunting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent Demographic and Health Surveys (2014–2018) was combined of five countries in South Asia. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. The common factors associated with stunting in three age groups were mothers with no schooling ([adjusted odds ratio (AOR) for 0–23 months = 1.65; 95% CI: (1.29, 2.13)]; [AOR for 24–59 months = AOR = 1.46; 95% CI: (1.27, 1. 69)] and [AOR for 0–59 months = AOR = 1.59; 95% CI: (1.34, 1. 88)]) and maternal short stature (height < 150 cm) ([AOR for 0–23 months = 2.00; 95% CI: (1.51, 2.65)]; [AOR for 24–59 months = 3.63; 95% CI: (2.87, 4.60)] and [AOR for 0–59 months = 2.87; 95% CI: (2.37, 3.48)]). Study findings suggest the need for a balanced and integrated nutrition strategy that incorporates nutrition-specific and nutrition-sensitive interventions with an increased focus on interventions for children aged 24–59 months.

The objective of this study was to explore the relationship between various forms of child nutritional disorders and early childhood development in Bangladesh. We analysed data from the nationally representative cross-sectional 2019 Multiple Indicator Cluster Survey. Early childhood development was evaluated using the Early Childhood Development Index (ECDI), which comprised 10 yes-or-no questions across four domains: literacy-numeracy, physical well-being, socio-emotional development, and learning abilities. Nutritional disorders (e.g. stunting, wasting, and underweight) were measured based on the World Health Organization's height and weight guidelines. To investigate the relationships between child development and nutritional disorders, we used multilevel logistic regression models. Bangladesh. Data of 9,455 children aged 3 and 4 years. Approximately 38 % of the children analysed experienced a nutritional disorder, with stunting being the most prevalent at 28·15 %. Overall, 25·27 % did not meet expected developmental progress measured by the ECDI. Stunted children were more likely to be off track developmentally, while those without any nutritional disorder were more likely to be on track. Socio-demographic factors, including age, sex, attendance in early childhood education programme, maternal education, maternal functional difficulties, region, and income, were identified as determinants of ECDI. Childhood nutrition and socio-demographic factors significantly affect multiple developmental domains and overall ECDI among children aged 3-4 years. Prioritising policies and programmes that improve nutrition and address these determinants are crucial for fostering optimal development in children.

•It examines undernourishment in India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste.•Stunting, wasting, and underweight among children aged 0 to 59 months in rural areas is high.•Considerable variation between countries and between primary sampling units is observed.•Maternal illiteracy, unsafe drinking water, and dirty fuel are positively associated with undernourishment.•Children from impoverished households in India, Pakistan, and Cambodia were disproportionately malnourished.•Temperature and rainfall also emerged as influential determinants of undernourishment in India, Bangladesh, and Timor-Leste. Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.

Rates of migration have increased substantially in recent years and so has the number of left-behind children (LBC). We investigated the impact of parental migration on nutritional disorders of LBC in Bangladesh. We analysed data from the nationally representative cross-sectional Multiple Indicator Cluster Survey 2012-2013. Child stunting, wasting and underweight were used as measures of nutritional disorders. Descriptive statistics were used to describe characteristics of the respondents and to compare nutritional outcomes based on status of parental migration. Multivariate logistic regression models were used to examine the associations between parental migration and child nutritional disorders. Bangladesh.ParticipantsData of 23 402 children (aged <5 years), their parents and households. In the unadjusted models, parental migration was found significantly protective for stunting, wasting and underweight - both separately and jointly. After potential confounders were controlled for, no difference was found between LBC and non-LBC in any of these three nutritional outcome measures. Household wealth status and maternal educational status were found to significantly influence the nutritional development of the children. At the population level there is no negative impact of parental migration on stunting, wasting and underweight of LBC in Bangladesh. Remittance from parental migration might enhance affordability of better foods, health care and supplies for a cleaner environment. This affordability is crucial for the poorest section of the society.

We assessed associations of maternal common mental disorders (CMD) with undernutrition and two common illnesses in children aged 0-5 years. Cross-sectional survey. Maternal CMD was measured using the WHO Self-Reporting Questionnaire-20. Child undernutrition was defined as stunting, underweight or wasting. Child illnesses included diarrhoea and acute respiratory infections (ARI). Multivariate logistic regression was used to test these associations adjusting for confounders at child, maternal and household levels. Bangladesh, Vietnam and Ethiopia. Mothers with children aged 0-5 years from 4400 households in Bangladesh, 4029 households in Vietnam and 3000 households in Ethiopia. The prevalence of maternal CMD was high, ranging from 31 % in Vietnam to 49 % in Bangladesh. Child undernutrition was more prevalent in Bangladesh and Ethiopia than in Vietnam. Symptoms of ARI and diarrhoea were also prevalent. In multivariate analysis, maternal CMD was associated with child stunting in Bangladesh (OR = 1·21; 95 % CI 1·03, 1·41) and with child underweight in Vietnam (OR = 1·27; 95 % CI 1·01, 1·61); no association was found with wasting. Maternal CMD was strongly associated with diarrhoea and ARI in all three countries. Maternal CMD, which affected nearly half of women in Bangladesh and one-third in Vietnam, was an important determinant of child stunting and underweight, respectively. No such association was found in Ethiopia, although CMD affected 39 % of women. Maternal CMD was strongly associated with childhood illnesses in all three countries. Interventions to support maternal mental health are important for women's own well-being and could make important contributions to improving child health and nutrition.

•Children who had experienced flooding had a higher chance of having chronic undernutrition than children who had not experienced flooding.•A significant direct effect was observed in the model of exposure to flood and the likelihood of child chronic undernutrition.•Inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen significantly mediate the relationship between exposure to flood and the likelihood of child chronic undernutrition. Although there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association. This cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y. In our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53–2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure–child undernutrition association. Flood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.