Peer-reviewed article
Geography of child stunting and wasting in Bangladesh: a cross-sectional spatial analysis of the 2025 Multiple Indicator Cluster Survey
S.M. Ashraf Ul Hoque, Khairul Islam, Mohammad Khalid Hasan, Md. Mohiuddin Sharif, Tanzin Naher et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study used the 2025 Bangladesh Multiple Indicator Cluster Survey, linked to GPS locations and environmental data, to map where child stunting and wasting occur. In 2025, 24.0% of children under five were stunted and 12.9% were wasted. Stunting was concentrated in the north-east, around Sylhet and Sunamganj, and six environmental and access factors together accounted for much of this clustering. Wasting showed no clear regional pattern, and districts with high stunting did not have more wasted children than their population share would suggest. The authors conclude that surveillance may need to track both measures, with finer-scale data for wasting.
Key points
- 24.0% of children under five were stunted and 12.9% wasted in 2025; the stunting target was met and the 8% wasting target was missed.
- Stunting clustered by region (district Moran's I 0.21, P=0.002), with a north-eastern hotspot centred on Sylhet and Sunamganj.
- Six environmental factors together removed the clustering and explained about 60% of between-district variation (95% CI 28 to 84), more than rainfall alone.
- Wasting showed no clear regional clustering (I 0.05, P=0.17), and district stunting and wasting rates were unrelated (r −0.01).
- Stunting hotspot districts held 5.9% of wasted children, equal to their 5.9% population share; the 902 children with both conditions did not cluster.
Limitations
This is a cross-sectional, area-level analysis, so it shows associations between places and environmental factors rather than causes, and it does not evaluate any intervention. The authors note that the gain over generic regional terms was uncertain and that altitude associations were sensitive to how altitude was modelled.
Abstract
Background. Stunting and wasting drive child mortality and are central to Sustainable Development Goal target 2.2. In 2025, 24.0% of Bangladeshi children under five were stunted and 12.9% wasted, meeting the national stunting target but missing the 8% wasting target. We compared where the two occur and tested whether environmental factors explain the patterns. Methods. We linked the 2025 Bangladesh Multiple Indicator Cluster Survey to cluster GPS locations and environmental data. Moran's I tested clustering and Getis-Ord Gi* found hotspots across 64 districts and 3,144 clusters. We tested whether six environmental and access factors explained the hotspots, estimated what share of affected children each hotspot list reached, and used a joint model to compare factor associations between outcomes. Results. Stunting clustered by region (district Moran's I 0.21, P=0.002), with a north-eastern hotspot centred on Sylhet and Sunamganj. Six environmental factors together removed this clustering (I −0.01, P=0.45) and about 60% of between-district variation (95% CI 28 to 84), more than rainfall alone, with the gain over generic regional terms uncertain. Wasting showed no clear regional clustering (I 0.05, P=0.17), and district stunting and wasting rates were unrelated (r −0.01). Stunting hotspot districts held 5.9% of wasted children, the same as their 5.9% population share. Children with both conditions (902 cases) did not cluster. Altitude and rainfall related differently to stunting than to wasting (all P<0.004), but altitude associations were sensitive to how altitude was modelled. Conclusion. Stunting in Bangladesh is concentrated in the north-east, and six environmental and access factors together account for much of this, though no single factor, including rainfall, does. Wasting shows no clear regional pattern. A stunting hotspot list reached no more wasted children than population share, so surveillance may need both measures, with finer-scale data for wasting.