Determinants of Malnutrition among Under-Five Children in Bangladesh: A Cross-Sectional Analytical Study Comparing Multinomial Logistic and Proportional Odds Regression Models Using MICS 2019 Data

Determinants of Malnutrition among Under-Five Children in Bangladesh: A Cross-Sectional Analytical Study Comparing Multinomial Logistic and Proportional Odds Regression Models Using MICS 2019 Data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Malnutrition among Under-Five Children in Bangladesh: A Cross-Sectional Analytical Study Comparing Multinomial Logistic and Proportional Odds Regression Models Using MICS 2019 Data Mahmila Sanjana Mim, Anamul Haque Sajib, Jannatul Ferdous Nipa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7797725/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jan, 2026 Read the published version in Journal of Health, Population and Nutrition → Version 1 posted 12 You are reading this latest preprint version Abstract Background Malnutrition among children under five remains a pressing public health issue in Bangladesh. Identifying its determinants is critical for designing effective interventions. This study aims to evaluate the suitability of statistical models that account for the ordinal nature of malnutrition categories, comparing Multinomial Logistic Regression (MLR) and the Proportional Odds Regression Model (POM) using data from the sixth round of UNICEF’s Multiple Indicator Cluster Survey (MICS). Methods Child nutritional status was assessed using weight-for-age Z-scores (WAZ), categorized into severely undernourished, moderately undernourished, and nourished. MLR and POM were applied to model the relationship between malnutrition and various socio-demographic and health-related factors. Model performance was compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Results POM demonstrated superior model fit (AIC: 8788.996, BIC: 9099.4353) compared to MLR (AIC: 8844.849, BIC: 9451.617). Significant predictors of malnutrition identified through POM included geographical division, child’s sex, mother’s BMI, maternal education, prenatal care, birth size, and household wealth index. Conclusions The Proportional Odds Regression Model outperformed Multinomial Logistic Regression by effectively capturing the ordinal structure of malnutrition categories. These findings underscore key determinants of child malnutrition and offer valuable guidance for targeted nutritional policies and development programs in Bangladesh. Child malnutrition Bangladesh weight-for-age Z-score Proportional Odds Model Multinomial Logistic Regression UNICEF MICS Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Jan, 2026 Read the published version in Journal of Health, Population and Nutrition → Version 1 posted Editorial decision: Revision requested 15 Nov, 2025 Reviews received at journal 14 Nov, 2025 Reviews received at journal 14 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviewers agreed at journal 21 Oct, 2025 Reviewers invited by journal 10 Oct, 2025 Editor assigned by journal 08 Oct, 2025 Submission checks completed at journal 08 Oct, 2025 First submitted to journal 07 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7797725","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":533385302,"identity":"07eff270-e8d9-4f98-8e40-d433583455ce","order_by":0,"name":"Mahmila Sanjana Mim","email":"","orcid":"","institution":"University of Dhaka","correspondingAuthor":false,"prefix":"","firstName":"Mahmila","middleName":"Sanjana","lastName":"Mim","suffix":""},{"id":533385304,"identity":"7583d535-3d22-4315-ae02-4fa03a3b9792","order_by":1,"name":"Anamul Haque 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Nutrition","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Child malnutrition, Bangladesh, weight-for-age Z-score, Proportional Odds Model, Multinomial Logistic Regression, UNICEF MICS","lastPublishedDoi":"10.21203/rs.3.rs-7797725/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7797725/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eMalnutrition among children under five remains a pressing public health issue in Bangladesh. Identifying its determinants is critical for designing effective interventions. This study aims to evaluate the suitability of statistical models that account for the ordinal nature of malnutrition categories, comparing Multinomial Logistic Regression (MLR) and the Proportional Odds Regression Model (POM) using data from the sixth round of UNICEF\u0026rsquo;s Multiple Indicator Cluster Survey (MICS).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eChild nutritional status was assessed using weight-for-age Z-scores (WAZ), categorized into severely undernourished, moderately undernourished, and nourished. MLR and POM were applied to model the relationship between malnutrition and various socio-demographic and health-related factors. Model performance was compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePOM demonstrated superior model fit (AIC: 8788.996, BIC: 9099.4353) compared to MLR (AIC: 8844.849, BIC: 9451.617). Significant predictors of malnutrition identified through POM included geographical division, child\u0026rsquo;s sex, mother\u0026rsquo;s BMI, maternal education, prenatal care, birth size, and household wealth index.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe Proportional Odds Regression Model outperformed Multinomial Logistic Regression by effectively capturing the ordinal structure of malnutrition categories. These findings underscore key determinants of child malnutrition and offer valuable guidance for targeted nutritional policies and development programs in Bangladesh.\u003c/p\u003e","manuscriptTitle":"Determinants of Malnutrition among Under-Five Children in Bangladesh: A Cross-Sectional Analytical Study Comparing Multinomial Logistic and Proportional Odds Regression Models Using MICS 2019 Data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 23:10:37","doi":"10.21203/rs.3.rs-7797725/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-15T12:22:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-14T14:33:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-14T09:26:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162412821166625041296046216973052396937","date":"2025-11-14T02:12:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253141337727156722283886472497866595365","date":"2025-11-13T16:57:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186623539274262246266810979815226332645","date":"2025-11-13T14:23:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10745928215633132489901084356313734234","date":"2025-10-26T06:41:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62964356801206713682205433669279281727","date":"2025-10-21T06:51:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-10T08:35:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T06:30:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-08T06:29:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Health, Population and Nutrition","date":"2025-10-07T08:57:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-health-population-and-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"johp","sideBox":"Learn more about [Journal of Health, Population and Nutrition](http://jhpn.biomedcentral.com/)","snPcode":"41043","submissionUrl":"https://submission.nature.com/new-submission/41043/3","title":"Journal of Health, Population and Nutrition","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1dea97cd-1345-43f2-80d7-2d05b28df693","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:15:13+00:00","versionOfRecord":{"articleIdentity":"rs-7797725","link":"https://doi.org/10.1186/s41043-025-01201-w","journal":{"identity":"journal-of-health-population-and-nutrition","isVorOnly":false,"title":"Journal of Health, Population and Nutrition"},"publishedOn":"2026-01-10 15:58:03","publishedOnDateReadable":"January 10th, 2026"},"versionCreatedAt":"2025-10-23 23:10:37","video":"","vorDoi":"10.1186/s41043-025-01201-w","vorDoiUrl":"https://doi.org/10.1186/s41043-025-01201-w","workflowStages":[]},"version":"v1","identity":"rs-7797725","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7797725","identity":"rs-7797725","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}