Peer-reviewed article

Factors associated with severe acute malnutrition among children aged 2 to 23 months presenting with diarrhoea in urban hospitals in Bangladesh.

Islam S, Chowdhury SA, Akash MI, Kabir MF, Ahmed T et al. · 24 Jun 2026

Abstract

Background Severe acute malnutrition (SAM) is a leading cause of morbidity and mortality among children under five years, accounting for over one-third of global child deaths. Aims This study explored clinical and sociodemographic factors asociated with SAM in children aged from 2 to 23 months with diarrhoea. Methods The "Antibiotics for Children with Diarrhoea (ABCD)" study was conducted from July 1, 2017, to July 10, 2019, with Bangladesh as one of the seven-country sites. The data were collected from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). This secondary analysis was conducted among children who were excluded from the 35,504 children initially screened in the ABCD trial. Children were excluded if they had dysentery, suspected cholera, or had SAM, had comorbidities or had been treated with antibiotics for the last 14 days. Age and sex matched controls were randomly selected from excluded children without SAM in a 1:3 ratio of SAM children. SAM cases were compared with non-SAM controls using conditional logistic regression to identify associated factors. Results Of 2,640 children, 660 were cases and 1,980 controls; 57% were male with a mean age of 10 months. Admission characteristics, including dehydration, fever, vomiting and hospital stays, were higher among SAM children (cases). In conditional logistic regression, dehydration was associated with higher odds of SAM (OR: 5.89, 95% CI: 3.48-9.97; p = 0.001). Cough (OR: 2.23 95% CI: 1.36-3.66) and not being breastfed (OR: 1.64 95% CI: 1.12-2.41) were also associated with increased odds (p < 0.05). Recent antibiotic use was shown to be a protective factor (OR: 0.77, 95% CI 0.63-0.95; p < 0.05). In addition, maternal underweight increased the risk, while higher levels of parental education were protective (p < 0.001). Conclusion These findings underscore the importance of early detection of dehydration, breastfeeding and targeted interventions for families with lower educational levels to reduce the risk of SAM.