Association between socio-economic status and childhood undernutrition in Bangladesh; a comparison of possession score and poverty index

Objective: To determine how much of the variation in nutritional status of Bangladeshi children under 5 years old can be attributed to the socio-economic status of the family. Design: Nutritional status used reference Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ). A 'possession score' was generated based on ownership of a radio, television, bicycle, motorcycle and telephone, and the availability of electricity, with categories of 0 to 41 possessions. A five-point (quintile) 'poverty index' was created using principal component analysis. Setting: The Bangladesh Demographic and Health Survey 2004 was the source of data. Subjects: A sample of 4891 children aged < 5 years was obtained. Results: Some 57.8% of the sample was either stunted, wasted or underweight (7.7% were stunted, wasted and underweight). Of those stunted (48.4%), 25.7% were also underweight. Underweight and wasting prevalences were 40.7% and 14.3%,respectively. Mean WAZ, HAZ and WHZ did not differ by sex. Children of mothers with no education or no possessions were, on average, about 1 SD more underweight and stunted than those with higher educated mothers or with 4+ possessions. The possession score provided much greater discrimination of undernutrition than the poverty index. Nearly 50% of children from households with no possessions were stunted, wasted or underweight (only 27% in the poorest quintile), compared with only 3-6% of children from households with 4+ possessions (over 13% in the richest quintile). Conclusions: Maternal education and possession score were the main predictors of a child's nutritional status. Possession score was a much better indicator of undernutrition than the poverty index.