Peer-reviewed article
Lead Exposure and Nutritional Status among Bangladeshi Children: Analysing Based on Bangladesh Multiple Indicator Cluster Survey
Rafid Hassan, Ahadul Hassan Bhuiyan Konok, Tanjina Akter, Masum Ali, Ruhul Amin et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study used data from the 2025 Bangladesh Multiple Indicator Cluster Survey on 10,495 children aged 12–59 months. It examined whether blood lead levels are linked to poor growth (stunting, wasting, underweight). Children with higher blood lead had lower height-for-age, weight-for-age and weight-for-height scores and were more likely to be growth-impaired, even after accounting for arsenic, cadmium and mercury. Elevated blood lead was also linked to lead in household soil, occupational contact with lead-related work and pica behaviour. The authors recommend lead source control and combining growth monitoring with environmental exposure surveillance.
Key points
- Prevalence of stunting, wasting, underweight and CIAF was 25.9%, 14.1%, 26.6% and 38.2%.
- Higher blood lead was associated with lower HAZ (β=-0.075), WAZ (β=-0.062) and WHZ (β=-0.029).
- Higher blood lead was associated with more stunting (APR=1.09), wasting (APR=1.08), underweight (APR=1.08) and CIAF (APR=1.07).
- Elevated blood lead was associated with household soil lead (APR=1.20), occupational contact (APR=1.08) and child pica (APR=1.18).
- Elevated blood lead prevalence varied by district from 4.4% to 93.7%, with higher burden in the central-eastern region.
Limitations
The abstract describes a survey analysis of associations, so it cannot show that lead exposure causes poor growth. The source-related findings are described as exploratory, and the abstract gives no detail on how confounding was handled beyond the stated covariates.
Abstract
Background/Objectives: Bangladesh carries one of the world's highest estimated childhood lead burdens alongside a substantial undernutrition burden, yet no nationally representative study has examined the association of blood lead levels (BLLs) with anthropometric failure. Methods: We analysed data from the 2025 Bangladesh Multiple Indicator Cluster Survey, including 10,495 children aged 12–59 months with BLLs and anthropometric measurements. Venous blood lead, arsenic, cadmium, and mercury were measured alongside anthropometry. Associations of BLLs with height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z-scores were estimated using linear regression; associations with stunting, wasting, underweight, and the Composite Index of Anthropometric Failure (CIAF, comprising six disaggregated failure categories) were estimated using modified Poisson regression yielding adjusted prevalence ratios (APRs). Models considered continuous standardised log-transformed BLLs and elevated BLLs (≥5 µg/dL), with and without adjustment for arsenic, cadmium, mercury, and covariates. Results: The prevalence of stunting, wasting, underweight, and CIAF was 25.9%, 14.1%, 26.6%, and 38.2%, respectively. Elevated blood lead prevalence was 38.6 Higher BLLs were significantly associated with lower HAZ (β=-0.075), WAZ (β=-0.062), and WHZ (β=-0.029), and with higher prevalence of stunting (APR=1.09), wasting (APR=1.08), underweight (APR=1.08), and CIAF (APR=1.07), largely unchanged after adjustment for co-exposure. The association of WHZ was not significant with elevated BLLs. BLLs were associated with several CIAF patterns, most strongly the combined stunting-wasting-underweight category (APR =1.18), with significant associations present across every category involving stunting. In exploratory analyses, elevated BLLs were also significantly associated with household soil lead concentration (APR=1.20), occupational contact with lead-related work (APR=1.08), and child pica behaviour (APR=1.18), and were inversely associated with solid fuel use for cooking (APR=0.78). Elevated BLL prevalence varied substantially by district (range 4.4–93.7%), with higher burden concentrated in the central-eastern region. Conclusions: BLLs are independently associated with impaired growth and specific patterns of CIAF among Bangladeshi children. These findings support prioritising lead-specific source control and integrating growth monitoring with environmental exposure surveillance in national child health programming, and suggest CIAF-based surveillance may capture lead's population-level nutritional burden more fully than single indicators alone. Household soil lead, occupational exposure, and child pica behaviour represent modifiable targets for source-control interventions.