Nutritional Status of Children in Bangladesh : Changes and Challenges for Development

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Stunting, underweight and wasting in children under age five years were gradually reduced from 1990s to 2020s and improved children health status over the year. This paper explains the trends of nutritional status of children in Bangladesh over the decades by different age groups of children, causes of changing nutrition status, and future challenges for development in Bangladesh. The national level survey (BDHS), national plan and policy paper, and existing literature are used for the study. Changing nutritional status of children aged under five years from high level stunting, underweight and wasting to gradual improved is remarkable for Bangladesh. Aged between 12-23 months children are more vulnerable for being stunt, waste and underweight than other ages. There have a rural-urban, wealth status and mother’s education affect the nutritional status of children. Income and poverty reduction, improve water and sanitation, maternal and child health, food and dietary practice and many policies and programs are the main causes for changing nutrition level of children in Bangladesh. But there are many challenges for future development for children nutrition status in Bangladesh like child and under five mortality, child malnutrition, double burden of malnutrition, and gaps of policies and programs in Bangladesh to achieve national plan, SDGs target and achieving demographic dividend with healthy population. Internal Medicine Nutrition & Dietetics Nutrition Malnutition Underweight SDGs Policy Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The nutritional status of children is a potential health indicator of development in a country. A person's energy and/or nutrient intake shortages, excesses, or imbalances are referred to as malnutrition. Malnutrition includes all forms of undernutrition (wasting, stunting, and underweight), insufficient vitamin and mineral intake, obesity, and the ensuing noncommunicable diseases linked to diet. The consequences of acute childhood malnutrition include a greater chance of dying from childhood diseases such as diarrhea, pneumonia and malaria and many other psychological problems (WHO, 2024 ). Recent Bangladesh Demographic and Health Survey (BDHS) data on 2022 key indicators revealed that among children, 24% were stunted, 22% were underweight and 11% were wasting (National Institute of Population Research and Training (NIPORT) and ICF, 2023 ). In the 1990s, the trends in nutritional status were quite tenseful and poor. With the emergence of methods for reducing child malnutrition and improving children’s nutritional levels, many interventions and policies have been implemented. According to BDHS 1996-97, 60% of children were stunted, 52% were underweight and 21% were wasting (National Institute of Population Research and Training (NIPORT), 1997 ). Although Bangladesh has made significant progress to reduce malnutrition levels, the prevalence of stunting, underweightness and wasting is still high to achieve the SDGs and 8FYP in Bangladesh. The nutritional status and immunization status of children are significantly influenced by socioeconomic and demographic factors. Rural‒urban residence, education level, household living standards, occupation level, maternal socioeconomic conditions, household size and number of children are also contributing factors to nutritional status differences (Banerjee et al., 2021 ). Moreover, Bangladesh has achieved remarkable success in changing the nutritional status of children. A study revealed that Bangladesh has surprisingly reduced child undernutrition sustainably for at least two decades (Headey et al., 2015 ). The two most common driving factors are parental education and wealth accumulation, which are major factors for reducing children’s nutritional levels (Alom et al., 2012 ; Headey et al., 2015 ). The transition from low nutritional status to improved nutritional status is likely an example of further reducing child malnutrition and improving the health status of children in Bangladesh. However, there is still a lack of policy implementation, and gaps and challenges are visible that are barriers to further development in Bangladesh. Additionally, many national and international plans, such as the 8th Five Year Plan 2020–2025 (8FYP), government policy and SDGs, should be implemented for further future sustained development and demographic dividend achievement by improving health conditions. There are still challenges that can hinder the development of health indicators. If low child nutritional status is still a challenge, Bangladesh cannot focus on further achieving premium development. This paper provides a direction for understanding the nutritional status of children and the causes of remarkable improvement over the past three decades and highlights future challenges associated with developing premium plans, which can further emphasize and improve upon neglected factors for changing nutritional levels in children. Data and Methods In this paper, relevant secondary data from national population surveys, such as the Bangladesh National Census, Bangladesh Demographic and Health Survey (BDHS) data, and government plans and policy papers, were used. Many existing studies have provided a broader view of nutritional status and causes of change. Objectives To describe the trends in the nutritional status of children in Bangladesh. To describe the trends of child nutrition on differentiation among ages. To assess the causes of changing nutritional status in children in Bangladesh. To describe future developmental challenges in Bangladesh. Nutritional Status of Children in Bangladesh Trends in the nutritional status of children According to the BDHS data from 1996-97 to 2022 in Fig. 1 , the nutritional status of children in Bangladesh changes annually. Stunted children (height-for-age) were more vulnerable in the 1990s. Approximately one child out of two was stunted. The number of stunted children in Bangladesh has gradually decreased. Near the two decades since the 1990s, the rate decreased by half compared to that in the 1990s. In 2022, one child out of four was stunted. With a poor health system and gradual progress toward poverty and nutritional improvement, Bangladesh's health benefits have been considered paradoxical (Nisbett et al., 2017 ). Both dietary intake and improved health status are the main determinants of such a reduction in stunting, underweight and wasting. Although wasting rates are decreasing, stunting and underweight still prevail, and these are challenges for Bangladesh. In 1996-97, 52% of the children were underweight. It decreases gradually and gradually at 22% in 2017–2018 and 2022. On the other hand, in 1996-97, 21% of the children were waste and dramatically decreased from 1999-00, reaching 12%, and increased from 2004 to 2007. After 2011 to 2017–2018, potential decreases occurred, but the wasting rate increased again in 2022. Wasting is considered a very stubborn indicator of both increases and decreases (Nisbett et al., 2017 ). Age Differences There was a significant change in stunting from the 1990s to the 2020s. However, there are several differences in the ages of the stunted children. Twelve- to 23-month-old children experienced more stunting than did children of other ages from 1996-97 to 2022 ( Figure 2 ). Intervention should emphasize this age (12-23 months) to reduce stunting in children. The wasting status of children of different ages was greater for children aged 12-23 months and 6-11 months ( Figure 3 ). In 2007, the number of wasting children at 12-23 months was much greater than that at other ages. Additionally, the number of underweight children aged 12-23 months was greater than that of the other age groups (Figure 4 ). Therefore, it is also clear that people of this age are more vulnerable. There are also rural‒urban, wealth status and maternal education factors that affect children’s nutritional levels (Sen et al., 2020 ). Therefore, policy interventions should emphasize reducing stunting, wasting and underweight in this age group. Causes of Changes in the Nutritional Status of Children There are many causes that drive the change in nutritional status of children in Bangladesh. (Headey et al., 2015 ) examines many factors by analyzing the DHS dataset. Some underlying, immediate and basic factors drive changes in the nutritional status of children in Bangladesh (Headey et al., 2015 ). These achievements have been made in Bangladesh over the decades to improve the nutritional status of children and improve child health. Income, poverty and inequality reduction Household wealth improvements and a reduction in poverty are important factors for changing nutritional status in Bangladesh. Real GDP growth and a reduced poverty rate drive the nutritional level of children. Families took more money for medical care and more facilities for their children. Food consumption for women and children was disproportionally distributed. According to HIES 2022, the Gini coefficient of income is 0.499. It was 0.482 in 2016. This indicates that income inequality is increasing. However, the overall monthly household income was 7,203 BDT in 2005, and it is currently increasing by 32,422 BDT (HIES, 2023). Although inequality existed, nutritional status improved. However, after receiving available and more income, it declined. Additional infrastructure developments in Bangladesh, such as a rural electricity supply and improved roads, were also mentioned as fundamental factors linked to better nutritional status. For instance, it was considered that rural electricity made it possible to light outdoor toilets at night and that roads improved access to hospitals and clinics. Along with being a major force behind these developments and more general advancements in income, access to healthcare, and education. Given the increasing health problems and inequality in impoverished, quickly increasing cities, urbanization was also considered a major obstacle to these developments, as was broader advancement in income, access to healthcare, and education. Mothers’ Education Women's education and ability to empower girls' contributions and jobs for young women by delaying marriage and first pregnancies were also perceived as factors in the development of new gender roles in the house and increased female mobility due to employment opportunities. Some stakeholders attributed the initial causes of this increase in women's educational access and attainment to school food programmes starting in the 1970s and girls' education stipends starting in the 1990s (Baulch, 2011 ; Huq & Rahman, 2008 ). Government immunization programmes drive women to work outside of their homes and contribute to their families. According to the Census of Bangladesh in 1974, the female literacy rate was 15%, which increased by 39% in 2001 and 72% in 2022 (Census, 2022). With the rapid increase in women’s literacy and female labor force participation, she gained self-consciousness about her decision making and health care. Water and Sanitation Improving water and sanitation are the main factors for improving children’s nutritional status. The construction of latrines and the eradication of open defecation, the use of soap after toilet, etc.,, improved the sanitation status of the children. A government effort in the early-mid 2000s included giving local councils responsibility for achieving 100% household latrine coverage, utilizing community-led total sanitation and other approaches facilitated by nongovernmental organizations and provision (Hanchett, 2016 ). Reducing open defecation also decreases the incidence of stunting in children (Headey et al., 2015 ). Maternal and Child Health Status Improvements in maternal and reproductive health are considered the key drivers of women’s empowerment and affect both their child and woman status (Nisbett et al., 2017 ). The large scale of the childhood vaccination programme and the successful use of ORSs and zinc in the treatment of diarrhea also improve child health and nutritional levels. To improve antenatal care and postnatal care coverage, skilled birth attendants (National Institute of Population Research and Training (NIPORT), 2018 ) can reduce maternal mortality and increase child health and status. Underfive mortality decreased 134 per 1000 live births in 1993-94 to 88 per 1000 live births in 2004 and 31 in 2022 (National Institute of Population Research and Training (NIPORT) and ICF, 2023 ). Among children aged 12–23 months, 46% had been vaccinated, whereas 86% had been vaccinated in 2017-18; 21% had not been vaccinated in 1993-94, and 0% had been vaccinated in 2017-18 (National Institute of Population Research and Training (NIPORT), 2018 ). The prevalence of exclusive breastfeeding for children aged 0–5 months increased from 45% in 1996-97 to 65% in 2017–2018 (National Institute of Population Research and Training (NIPORT), 2018 ). Food Security and Diet Food intake and improved agricultural production increase food security and dietary diversity in Bangladesh (Nisbett et al., 2017 ). Additionally, the cultivation of new crops and a variety of foods drive the removal of concerns about food insecurity after independence. With respect to education and household income, women with extra household income are able to purchase more variety of food and dietary practices. Nutritional policies and programmes The key policies and programmes from the 1990s marked remarkable success and long-term effects on nutritional changes in children over the decades. There are many policies and programs, such as the following: National Plan of Action on Nutrition (1997) National Food and Nutrition Policy (1997) Bangladesh Pure Food Act (2005) National Food Policy (2006) National Food Policy Plan of Action for 2008–2015 (2006) National Health Policy (2011) National Child Policy (2011) Health Population and Nutrition Sector Development Program (2011) National Food Safety and Quality Policy (2012 draft) National Nutrition Policy (2015) National Strategy on Infant and Young Child Feeding (2007) National Communication Framework and Plan of Action on Infant and Young Child Feeding (2010) Prevention of Iodine Deficiency Diseases Act (1989) National Strategy for Anemia Prevention and Control in Bangladesh (2007) National Guidelines for the Management of Severely Malnourished Children (2008) Additionally, national nutritional programs contribute to improving child nutrition through behavior change communication (BCC) programs and child vaccination. Mainstream health workers continuously work for child health (Headey et al., 2015 ). Future challenges for development in Bangladesh Child and Under5 Mortality rate Bangladesh has made progress in reducing child and under five mortality rates. However, there is still a need to further decrease the mortality rate among children and those under five years old. According to BDHS 2022, the under five mortality rate is 31 per 1000 live births, which is below the target level of the 8FYP of Bangladesh to reduce the under five mortality rates to 27 per 1000 live births by 2025 (Government of the People’s Republic of Bangladesh, 2020 ). The infant and neonatal mortality rates are still high compared to those of the 8FYP target plan by 2025. Therefore, improving the mortality rate of children and children under five years of age is still a challenge for Bangladesh because of the need for better nutrition and child health. Nutritional status should improve for better child health and reduce mortality. Child and Adult Malnutrition Status According to BDHS 2022, 24% of children under five years of age are stunted, 22% are underweight and 11% are wasted (National Institute of Population Research and Training (NIPORT) and ICF, 2023 ). Although Bangladesh has made significant progress toward increasing its child nutritional status over the past several decades, the 8FYP is still expected to reduce stunting by 20%, wasting by 7% and underweight by 15% in Bangladesh by 2025. However, it is still high among children under five years of age. Islam et al., 2022 highlighted in their paper the future challenges of population and development that child nutritional status is still challenging for future development in Bangladesh. Double Burden of Malnutrition A double burden of malnutrition is characterized by the co-occurrence of undernutrition along with overweight and obesity or diet-related noncommunicable diseases within individuals, households and populations (WHO, 2020 ). Underweight decreased and overweight and obesity increased approximately 130% from 2004 to 2014 (Tanwi et al., 2019 ). Therefore, the double burden of malnutrition is also challenging for future development for children in Bangladesh. Gaps to Implement Policies and Programs Currently, there are many plans and policies for Bangladesh, such as the Delta Plan 2100, Perspective Plan 2021–2041, 8th Five Year Plan 2020–2025, National Health Policy 2011 and 4th Health, Population, and Nutrition Sector Program (HPNSP, 2017–2022). However, there is a large gap in terms of management, inadequate resources and proper implementation. The National Population Policy 2012 and National Health Policy 2011 have not yet been updated. The coordination and management problem was mentioned by (Islam et al., 2022 ). Therefore, proper implementation of policies and programs for the future development of children’s nutritional status in Bangladesh is still challenging. Conclusion The nutritional status of children in Bangladesh has changed substantially over the decades. The prevalence of stunting, underweight and wasting gradually decreased from the 1990s to the 2020s. However, it is still challenging for Bangladesh to foster this situation. There are many causes of changing nutritional status in Bangladesh over the course of the year, such as income and poverty reduction, maternal education, water and sanitation improvement and many specific nutritional policies and programs. However, the prevalence of stunting, underweight, overweight and obese, and wasting is still below the national and SDG plan and target levels. Child malnutrition, the double burden of malnutrition and inadequate plans and policy gaps should be improved and implemented immediately. Bangladesh is currently undergoing a major change in its age structure (Islam et al., 2023 ), which has led Bangladesh to achieve economic success by ensuring education, health, the economy and good governance. To ensure health, it is important to improve children’s nutritional status to improve children’s health and achieve the goals of SDG 2 and SDG 3. References Alom, J., Quddus, Md. A., & Islam, M. A. (2012). NUTRITIONAL STATUS OF UNDER-FIVE CHILDREN IN BANGLADESH: A MULTILEVEL ANALYSIS. Journal of Biosocial Science , 44 (5), 525–535. https://doi.org/10.1017/S0021932012000181 Banerjee, S., SubirBiswas, Roy, S., Pal, M., Hossain, Md. G., & Bharati, P. (2021). Nutritional and immunization status of underfive children of India and Bangladesh. BMC Nutrition , 7 (1), 77. https://doi.org/10.1186/s40795-021-00484-6 Baulch, B. (2011). The medium-term impact of the primary education stipend in rural Bangladesh. Journal of Development Effectiveness , 3 (2), 243–262. https://doi.org/10.1080/19439342.2011.570449 Government of the People’s Republic of Bangladesh. (2020). 8th Five Year Plan July 2020-June 2025 . https://plancomm.gov.bd/sites/default/files/files/plancomm.portal.gov.bd/files/68e32f08_13b8_4192_ab9b_abd5a0a62a33/2021-02-03-17-04-ec95e78e452a813808a483b3b22e14a1.pdf Hanchett, S. (2016). Sanitation in Bangladesh: Revolution, Evolution, and New Challenges—Sanitation Learning Hub . https://sanitationlearninghub.org/resource/sanitation-in-bangladesh-revolution-evolution-and-new-challenges-2/ Headey, D., Hoddinott, J., Ali, D., Tesfaye, R., & Dereje, M. (2015). The Other Asian Enigma: Explaining the Rapid Reduction of Undernutrition in Bangladesh. World Development , 66 , 749–761. https://doi.org/10.1016/j.worlddev.2014.09.022 HIES. (2023). Income, Expenditure-&-Poverty—বাংলাদেশ পরিসংখ্যান ব্যুরো-গণপ্রজাতন্ত্রী বাংলাদেশ সরকার. https://bbs.portal.gov.bd/sites/default/files/files/bbs.portal.gov.bd/page/b343a8b4_956b_45ca_872f_4cf9b2f1a6e0/2023-12-28-14-40-ac2b3d298f569f155a80871a49b7dd9e.pdf Huq, M., & Rahman, P. M. M. (2008). Gender Disparities in Secondary Education in Bangladesh. International Education Studies , 1 (2), 115–128. Islam, M. M., Abdullah, S. M., & Hossain, M. (2023). Age Structure Transition and Demographic Dividend in Bangladesh (pp. 109–139). Islam, M. M., Hossain, Md. A., & Sanjowal, R. K. (2022). Bangladesh at Fifty: Changes and Challenges in Population and Development. Journal of Governance, Security & Development , 3 (1), 1–38. https://doi.org/10.52823/PNIF4859 National Institute of Population Research and Training (NIPORT). (1997). Bangladesh Demographic and Health Survey 1996-97 . National Institute of Population Research and Training (NIPORT). (2018). Bangladesh Demographic and Health Survey 2017-18 . National Institute of Population Research and Training (NIPORT) and ICF. (2023). Bangladesh Demographic and Health Survey 2022: Key Indicators Report . Nisbett, N., Davis, P., Yosef, S., & Akhtar, N. (2017). Bangladesh’s story of change in nutrition: Strong improvements in basic and underlying determinants with an unfinished agenda for direct community level support. Global Food Security , 13 , 21–29. https://doi.org/10.1016/j.gfs.2017.01.005 Population and Housing Consensus—2022 বাংলাদেশ পরিসংখ্যান ব্যুৰো-গণপ্রজাতন্ত্রী বাংলাদই শ সরকার. (n.d.). Retrieved March 14, 2023, from http://www.bbs.gov.bd/site/page/47856ad0-7e1c-4aab-bd78-892733bc06eb/Population-and-Housing-Census Sen, L. C., Ahmed, M. S., Touhiduzzaman, A. S. M., Mandal, S., Ahmed, A. T., Das, S. K., & Saha, R. (2020). Nutritional status of underfive children in rural Bangladesh. International Journal of Public Health Science (IJPHS) , 9 (3), Article 3. https://doi.org/10.11591/ijphs.v9i3.20425 Tanwi, T. S., Chakrabarty, S., & Hasanuzzaman, S. (2019). Double burden of malnutrition among ever-married women in Bangladesh: A pooled analysis. BMC Women’s Health , 19 (1), 24. https://doi.org/10.1186/s12905-019-0725-2 WHO. (2020). WHO Double burden of nutrition | Nutrition site . World Health Organization - Regional Office for the Eastern Mediterranean. http://www.emro.who.int/nutrition/double-burden-of-nutrition/index.html WHO. (2024). Fact sheets—Malnutrition . https://www.who.int/news-room/fact sheets/detail/malnutrition Additional Declarations The authors declare no competing interests. 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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-4345998","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":297000773,"identity":"694d22f4-96bc-462d-aa83-ae608dc1829f","order_by":0,"name":"Md Idris Ali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYBACNoYEhgMMDMxAZgLjAyDJw0eKFmYDkBY2wvYkgAiwFjYJiCEEAB977sODPxis8+Tbc8wqv+bYybAxMD98dAOfw3ieGxzmYUgvNjjzxuy27LZkoMPYjI1z8GmRSGM4zMBwOHGDRI7ZbcltzEAtPGzShLQAHXY4cf6MHLNiyW31xGk5wAPU0nAjx4zx47bDRGjhecZwmMcA5JdnxdKM247zsDET8It8exrzxx8VoBBL3vjx57Zqe3725oeP8WmBAANo7PCASYLKIQCshfEHkapHwSgYBaNgZAEAnvtB/ngz1vUAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0003-9283-0406","institution":"University of Dhaka","correspondingAuthor":true,"prefix":"","firstName":"Md","middleName":"Idris","lastName":"Ali","suffix":""}],"badges":[],"createdAt":"2024-04-30 03:35:02","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4345998/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4345998/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.26596/wn.202415380-88","type":"published","date":"2024-09-30T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55768545,"identity":"e2b9a7d2-a4d5-41ec-8ef9-4fde73a9104c","added_by":"auto","created_at":"2024-05-02 20:32:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153655,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4345998/v1/22351c9c4d37c3ea00945c56.jpg"},{"id":55768076,"identity":"9a2326ed-5ed9-4ac0-b5fb-37a3a2bd15ba","added_by":"auto","created_at":"2024-05-02 20:24:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":225008,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4345998/v1/150b84501617bfaf7a300c74.jpg"},{"id":55768544,"identity":"bc7f7dc0-0ac9-4088-ac22-acb9428aed65","added_by":"auto","created_at":"2024-05-02 20:32:25","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":217692,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4345998/v1/60955ba3605e096f59c8fddf.jpg"},{"id":55768546,"identity":"d49f1ea8-7069-4e24-9192-a8a15e103ffe","added_by":"auto","created_at":"2024-05-02 20:32:25","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":223136,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4345998/v1/3db0eb6541ba56875e5715ad.jpg"},{"id":71904844,"identity":"3ec0f47c-9750-4418-8362-7bf5ea8b3b02","added_by":"auto","created_at":"2024-12-19 15:02:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1194071,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4345998/v1/b5aefc36-0598-4403-bc69-5ecd0515e740.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eNutritional Status of Children in Bangladesh : Changes and Challenges for Development\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe nutritional status of children is a potential health indicator of development in a country. A person's energy and/or nutrient intake shortages, excesses, or imbalances are referred to as malnutrition. Malnutrition includes all forms of undernutrition (wasting, stunting, and underweight), insufficient vitamin and mineral intake, obesity, and the ensuing noncommunicable diseases linked to diet. The consequences of acute childhood malnutrition include a greater chance of dying from childhood diseases such as diarrhea, pneumonia and malaria and many other psychological problems (WHO, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent Bangladesh Demographic and Health Survey (BDHS) data on 2022 key indicators revealed that among children, 24% were stunted, 22% were underweight and 11% were wasting (National Institute of Population Research and Training (NIPORT) and ICF, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In the 1990s, the trends in nutritional status were quite tenseful and poor. With the emergence of methods for reducing child malnutrition and improving children\u0026rsquo;s nutritional levels, many interventions and policies have been implemented. According to BDHS 1996-97, 60% of children were stunted, 52% were underweight and 21% were wasting (National Institute of Population Research and Training (NIPORT), \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). Although Bangladesh has made significant progress to reduce malnutrition levels, the prevalence of stunting, underweightness and wasting is still high to achieve the SDGs and 8FYP in Bangladesh. The nutritional status and immunization status of children are significantly influenced by socioeconomic and demographic factors. Rural‒urban residence, education level, household living standards, occupation level, maternal socioeconomic conditions, household size and number of children are also contributing factors to nutritional status differences (Banerjee et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, Bangladesh has achieved remarkable success in changing the nutritional status of children. A study revealed that Bangladesh has surprisingly reduced child undernutrition sustainably for at least two decades (Headey et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The two most common driving factors are parental education and wealth accumulation, which are major factors for reducing children\u0026rsquo;s nutritional levels (Alom et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Headey et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The transition from low nutritional status to improved nutritional status is likely an example of further reducing child malnutrition and improving the health status of children in Bangladesh. However, there is still a lack of policy implementation, and gaps and challenges are visible that are barriers to further development in Bangladesh. Additionally, many national and international plans, such as the 8th Five Year Plan 2020\u0026ndash;2025 (8FYP), government policy and SDGs, should be implemented for further future sustained development and demographic dividend achievement by improving health conditions. There are still challenges that can hinder the development of health indicators. If low child nutritional status is still a challenge, Bangladesh cannot focus on further achieving premium development. This paper provides a direction for understanding the nutritional status of children and the causes of remarkable improvement over the past three decades and highlights future challenges associated with developing premium plans, which can further emphasize and improve upon neglected factors for changing nutritional levels in children.\u003c/p\u003e"},{"header":"Data and Methods","content":"\u003cp\u003eIn this paper, relevant secondary data from national population surveys, such as the Bangladesh National Census, Bangladesh Demographic and Health Survey (BDHS) data, and government plans and policy papers, were used. Many existing studies have provided a broader view of nutritional status and causes of change.\u003c/p\u003e"},{"header":"Objectives","content":"\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eTo describe the trends in the nutritional status of children in Bangladesh.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTo describe the trends of child nutrition on differentiation among ages.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTo assess the causes of changing nutritional status in children in Bangladesh.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eTo describe future developmental challenges in Bangladesh.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Nutritional Status of Children in Bangladesh","content":"\u003cdiv id=\"Sec5\" class=\"Section4\"\u003e\n\u003ch2\u003eTrends in the nutritional status of children\u003c/h2\u003e\n\u003cp\u003eAccording to the BDHS data from 1996-97 to 2022 in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, the nutritional status of children in Bangladesh changes annually. Stunted children (height-for-age) were more vulnerable in the 1990s. Approximately one child out of two was stunted. The number of stunted children in Bangladesh has gradually decreased. Near the two decades since the 1990s, the rate decreased by half compared to that in the 1990s. In 2022, one child out of four was stunted.\u003c/p\u003e\n\u003cp\u003eWith a poor health system and gradual progress toward poverty and nutritional improvement, Bangladesh's health benefits have been considered paradoxical (Nisbett et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Both dietary intake and improved health status are the main determinants of such a reduction in stunting, underweight and wasting. Although wasting rates are decreasing, stunting and underweight still prevail, and these are challenges for Bangladesh. In 1996-97, 52% of the children were underweight. It decreases gradually and gradually at 22% in 2017\u0026ndash;2018 and 2022. On the other hand, in 1996-97, 21% of the children were waste and dramatically decreased from 1999-00, reaching 12%, and increased from 2004 to 2007. After 2011 to 2017\u0026ndash;2018, potential decreases occurred, but the wasting rate increased again in 2022. Wasting is considered a very stubborn indicator of both increases and decreases (Nisbett et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eAge Differences\u003c/h2\u003e\n\u003cp\u003eThere was a significant change in stunting from the 1990s to the 2020s. However, there are several differences in the ages of the stunted children. Twelve- to 23-month-old children experienced more stunting than did children of other ages from 1996-97 to 2022 (\u003cstrong\u003eFigure 2\u003c/strong\u003e). Intervention should emphasize this age (12-23 months) to reduce stunting in children.\u003c/p\u003e\n\u003cp\u003eThe wasting status of children of different ages was greater for children aged 12-23 months and 6-11 months (\u003cstrong\u003eFigure 3\u003c/strong\u003e). In 2007, the number of wasting children at 12-23 months was much greater than that at other ages. Additionally, the number of underweight children aged 12-23 months \u003cstrong\u003ewas greater than that of the other age groups (Figure\u003c/strong\u003e\u003cstrong\u003e 4\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eTherefore, it is also clear that people of this age are more vulnerable. There are also rural‒urban, wealth status and maternal education factors that affect children\u0026rsquo;s nutritional levels (Sen et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, policy interventions should emphasize reducing stunting, wasting and underweight in this age group.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Causes of Changes in the Nutritional Status of Children","content":"\u003cp\u003eThere are many causes that drive the change in nutritional status of children in Bangladesh. (Headey et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e) examines many factors by analyzing the DHS dataset. Some underlying, immediate and basic factors drive changes in the nutritional status of children in Bangladesh (Headey et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThese achievements have been made in Bangladesh over the decades to improve the nutritional status of children and improve child health.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003eIncome, poverty and inequality reduction\u003c/h2\u003e\n \u003cp\u003eHousehold wealth improvements and a reduction in poverty are important factors for changing nutritional status in Bangladesh. Real GDP growth and a reduced poverty rate drive the nutritional level of children. Families took more money for medical care and more facilities for their children. Food consumption for women and children was disproportionally distributed. According to HIES 2022, the Gini coefficient of income is 0.499. It was 0.482 in 2016. This indicates that income inequality is increasing. However, the overall monthly household income was 7,203 BDT in 2005, and it is currently increasing by 32,422 BDT (HIES, 2023). Although inequality existed, nutritional status improved.\u003c/p\u003e\n \u003cp\u003eHowever, after receiving available and more income, it declined. Additional infrastructure developments in Bangladesh, such as a rural electricity supply and improved roads, were also mentioned as fundamental factors linked to better nutritional status. For instance, it was considered that rural electricity made it possible to light outdoor toilets at night and that roads improved access to hospitals and clinics.\u003c/p\u003e\n \u003cp\u003eAlong with being a major force behind these developments and more general advancements in income, access to healthcare, and education. Given the increasing health problems and inequality in impoverished, quickly increasing cities, urbanization was also considered a major obstacle to these developments, as was broader advancement in income, access to healthcare, and education.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003eMothers\u0026rsquo; Education\u003c/h2\u003e\n \u003cp\u003eWomen\u0026apos;s education and ability to empower girls\u0026apos; contributions and jobs for young women by delaying marriage and first pregnancies were also perceived as factors in the development of new gender roles in the house and increased female mobility due to employment opportunities. Some stakeholders attributed the initial causes of this increase in women\u0026apos;s educational access and attainment to school food programmes starting in the 1970s and girls\u0026apos; education stipends starting in the 1990s (Baulch, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e; Huq \u0026amp; Rahman, \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e). Government immunization programmes drive women to work outside of their homes and contribute to their families. According to the Census of Bangladesh in 1974, the female literacy rate was 15%, which increased by 39% in 2001 and 72% in 2022 (Census, 2022). With the rapid increase in women\u0026rsquo;s literacy and female labor force participation, she gained self-consciousness about her decision making and health care.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eWater and Sanitation\u003c/h2\u003e\n \u003cp\u003eImproving water and sanitation are the main factors for improving children\u0026rsquo;s nutritional status. The construction of latrines and the eradication of open defecation, the use of soap after toilet, etc.,, improved the sanitation status of the children. A government effort in the early-mid 2000s included giving local councils responsibility for achieving 100% household latrine coverage, utilizing community-led total sanitation and other approaches facilitated by nongovernmental organizations and provision (Hanchett, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). Reducing open defecation also decreases the incidence of stunting in children (Headey et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eMaternal and Child Health Status\u003c/h2\u003e\n \u003cp\u003eImprovements in maternal and reproductive health are considered the key drivers of women\u0026rsquo;s empowerment and affect both their child and woman status (Nisbett et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). The large scale of the childhood vaccination programme and the successful use of ORSs and zinc in the treatment of diarrhea also improve child health and nutritional levels. To improve antenatal care and postnatal care coverage, skilled birth attendants (National Institute of Population Research and Training (NIPORT), \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e) can reduce maternal mortality and increase child health and status. Underfive mortality decreased 134 per 1000 live births in 1993-94 to 88 per 1000 live births in 2004 and 31 in 2022 (National Institute of Population Research and Training (NIPORT) and ICF, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). Among children aged 12\u0026ndash;23 months, 46% had been vaccinated, whereas 86% had been vaccinated in 2017-18; 21% had not been vaccinated in 1993-94, and 0% had been vaccinated in 2017-18 (National Institute of Population Research and Training (NIPORT), \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). The prevalence of exclusive breastfeeding for children aged 0\u0026ndash;5 months increased from 45% in 1996-97 to 65% in 2017\u0026ndash;2018 (National Institute of Population Research and Training (NIPORT), \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eFood Security and Diet\u003c/h2\u003e\n \u003cp\u003eFood intake and improved agricultural production increase food security and dietary diversity in Bangladesh (Nisbett et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additionally, the cultivation of new crops and a variety of foods drive the removal of concerns about food insecurity after independence. With respect to education and household income, women with extra household income are able to purchase more variety of food and dietary practices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eNutritional policies and programmes\u003c/h2\u003e\n \u003cp\u003eThe key policies and programmes from the 1990s marked remarkable success and long-term effects on nutritional changes in children over the decades. There are many policies and programs, such as the following:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eNational Plan of Action on Nutrition (1997)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Food and Nutrition Policy (1997)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eBangladesh Pure Food Act (2005)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Food Policy (2006)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Food Policy Plan of Action for 2008\u0026ndash;2015 (2006)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Health Policy (2011)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Child Policy (2011)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eHealth Population and Nutrition Sector Development Program (2011)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Food Safety and Quality Policy (2012 draft)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Nutrition Policy (2015)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Strategy on Infant and Young Child Feeding (2007)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Communication Framework and Plan of Action on Infant and Young Child Feeding (2010)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePrevention of Iodine Deficiency Diseases Act (1989)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Strategy for Anemia Prevention and Control in Bangladesh (2007)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNational Guidelines for the Management of Severely Malnourished Children (2008)\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eAdditionally, national nutritional programs contribute to improving child nutrition through behavior change communication (BCC) programs and child vaccination. Mainstream health workers continuously work for child health (Headey et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Future challenges for development in Bangladesh","content":"\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\n\u003ch2\u003eChild and Under5 Mortality rate\u003c/h2\u003e\n\u003cp\u003eBangladesh has made progress in reducing child and under five mortality rates. However, there is still a need to further decrease the mortality rate among children and those under five years old. According to BDHS 2022, the under five mortality rate is 31 per 1000 live births, which is below the target level of the 8FYP of Bangladesh to reduce the under five mortality rates to 27 per 1000 live births by 2025 (Government of the People\u0026rsquo;s Republic of Bangladesh, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). The infant and neonatal mortality rates are still high compared to those of the 8FYP target plan by 2025. Therefore, improving the mortality rate of children and children under five years of age is still a challenge for Bangladesh because of the need for better nutrition and child health. Nutritional status should improve for better child health and reduce mortality.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eChild and Adult Malnutrition Status\u003c/h2\u003e\n\u003cp\u003eAccording to BDHS 2022, 24% of children under five years of age are stunted, 22% are underweight and 11% are wasted (National Institute of Population Research and Training (NIPORT) and ICF, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). Although Bangladesh has made significant progress toward increasing its child nutritional status over the past several decades, the 8FYP is still expected to reduce stunting by 20%, wasting by 7% and underweight by 15% in Bangladesh by 2025. However, it is still high among children under five years of age. Islam et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e highlighted in their paper the future challenges of population and development that child nutritional status is still challenging for future development in Bangladesh.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eDouble Burden of Malnutrition\u003c/h2\u003e\n\u003cp\u003eA double burden of malnutrition is characterized by the co-occurrence of undernutrition along with overweight and obesity or diet-related noncommunicable diseases within individuals, households and populations (WHO, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Underweight decreased and overweight and obesity increased approximately 130% from 2004 to 2014 (Tanwi et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Therefore, the double burden of malnutrition is also challenging for future development for children in Bangladesh.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003eGaps to Implement Policies and Programs\u003c/h2\u003e\n\u003cp\u003eCurrently, there are many plans and policies for Bangladesh, such as the Delta Plan 2100, Perspective Plan 2021\u0026ndash;2041, 8th Five Year Plan 2020\u0026ndash;2025, National Health Policy 2011 and 4th Health, Population, and Nutrition Sector Program (HPNSP, 2017\u0026ndash;2022). However, there is a large gap in terms of management, inadequate resources and proper implementation. The National Population Policy 2012 and National Health Policy 2011 have not yet been updated. The coordination and management problem was mentioned by (Islam et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, proper implementation of policies and programs for the future development of children\u0026rsquo;s nutritional status in Bangladesh is still challenging.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe nutritional status of children in Bangladesh has changed substantially over the decades. The prevalence of stunting, underweight and wasting gradually decreased from the 1990s to the 2020s. However, it is still challenging for Bangladesh to foster this situation. There are many causes of changing nutritional status in Bangladesh over the course of the year, such as income and poverty reduction, maternal education, water and sanitation improvement and many specific nutritional policies and programs. However, the prevalence of stunting, underweight, overweight and obese, and wasting is still below the national and SDG plan and target levels. Child malnutrition, the double burden of malnutrition and inadequate plans and policy gaps should be improved and implemented immediately. Bangladesh is currently undergoing a major change in its age structure (Islam et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which has led Bangladesh to achieve economic success by ensuring education, health, the economy and good governance. To ensure health, it is important to improve children\u0026rsquo;s nutritional status to improve children\u0026rsquo;s health and achieve the goals of SDG 2 and SDG 3.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlom, J., Quddus, Md. A., \u0026amp; Islam, M. A. (2012). 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Nutritional status of underfive children in rural Bangladesh. \u003cem\u003eInternational Journal of Public Health Science (IJPHS)\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(3), Article 3. https://doi.org/10.11591/ijphs.v9i3.20425\u003c/li\u003e\n\u003cli\u003eTanwi, T. S., Chakrabarty, S., \u0026amp; Hasanuzzaman, S. (2019). Double burden of malnutrition among ever-married women in Bangladesh: A pooled analysis. \u003cem\u003eBMC Women\u0026rsquo;s Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 24. https://doi.org/10.1186/s12905-019-0725-2\u003c/li\u003e\n\u003cli\u003eWHO. (2020). \u003cem\u003eWHO Double burden of nutrition | Nutrition site\u003c/em\u003e. World Health Organization - Regional Office for the Eastern Mediterranean. http://www.emro.who.int/nutrition/double-burden-of-nutrition/index.html\u003c/li\u003e\n\u003cli\u003eWHO. (2024). \u003cem\u003eFact sheets\u0026mdash;Malnutrition\u003c/em\u003e. https://www.who.int/news-room/fact sheets/detail/malnutrition\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nutrition, Malnutition, Underweight, SDGs, Policy","lastPublishedDoi":"10.21203/rs.3.rs-4345998/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4345998/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBangladesh have made a remarkable change of nutritional status of children over the decade despite of poverty. Stunting, underweight and wasting in children under age five years were gradually reduced from 1990s to 2020s and improved children health status over the year. This paper explains the trends of nutritional status of children in Bangladesh over the decades by different age groups of children, causes of changing nutrition status, and future challenges for development in Bangladesh. The national level survey (BDHS), national plan and policy paper, and existing literature are used for the study. Changing nutritional status of children aged under five years from high level stunting, underweight and wasting to gradual improved is remarkable for Bangladesh. Aged between 12-23 months children are more vulnerable for being stunt, waste and underweight than other ages. There have a rural-urban, wealth status and mother’s education affect the nutritional status of children. Income and poverty reduction, improve water and sanitation, maternal and child health, food and dietary practice and many policies and programs are the main causes for changing nutrition level of children in Bangladesh. But there are many challenges for future development for children nutrition status in Bangladesh like child and under five mortality, child malnutrition, double burden of malnutrition, and gaps of policies and programs in Bangladesh to achieve national plan, SDGs target and achieving demographic dividend with healthy population.\u003c/p\u003e","manuscriptTitle":"Nutritional Status of Children in Bangladesh : Changes and Challenges for Development","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 20:24:21","doi":"10.21203/rs.3.rs-4345998/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ab95ce3-0c1c-4b88-8d4f-f6bf44fb530c","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":31327323,"name":"Internal Medicine"},{"id":31327324,"name":"Nutrition \u0026 Dietetics"}],"tags":[],"updatedAt":"2024-12-19T15:02:16+00:00","versionOfRecord":{"articleIdentity":"rs-4345998","link":"https://doi.org/10.26596/wn.202415380-88","journal":{"identity":"world-nutrition","isVorOnly":true,"title":"World Nutrition"},"publishedOn":"2024-09-30 00:00:00","publishedOnDateReadable":"September 30th, 2024"},"versionCreatedAt":"2024-05-02 20:24:21","video":"","vorDoi":"10.26596/wn.202415380-88","vorDoiUrl":"https://doi.org/10.26596/wn.202415380-88","workflowStages":[]},"version":"v1","identity":"rs-4345998","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4345998","identity":"rs-4345998","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}