Maternal nutrition behaviour, its determinants, and effects of maternal nutrition on child nutrition and health in Bangladesh

Abstract

In this body of research, I aimed to examine the determinants of maternal nutrition behaviour (chapter 3 and 4) and the association between maternal height and risk of under-five stunting and wasting and neonatal, infant and under-five mortality in Bangladesh (chapter 5 and 6). This research used mixed methods, both quantitative (chapter 3,5,6) and qualitative analysis (chapter 4). Chapter 3 analyzed data from two cross-sectional surveys conducted in rural areas of Bhola, Barguna and Sirajganj districts in Bangladesh. A two-stage random sampling was used to select 496 pregnant women to collect data on socio-demography, household wealth, food frequency and household food consumption (WFP methods). Chapter 4 presented a qualitative study conducted at two rural areas in Jamalpur districts, Bangladesh. Data were collected on perceptions on attributes of foods using IDI (n=36) with the pregnant and lactating women, FGD (n=4) with their husbands and mothers-in-law and KII. The inductive thematic approach was used for data analysis. Chapter 5 and 6 presented the pooled data analysis from Bangladesh demographic and health surveys (BDHS 2004-14) with a nationally representative sample from children aged 0-59 months (anthropometry, (n=28,123) (mortality, n=29,698). Data analysis included stunting (<-2HAZ), wasting (<-2WHZ), deaths at neonatal (0-1 months), infancy (0-11 months) and under-five ( 0-59 months) as primary outcomes, maternal height as main exposure and other maternal, child, household level covariates. For statistical analyses, multivariable modelling with linear regression (Chapter 3) and ‘modified Poisson regression’ (Chapter 5 and 6) were performed using STATA Version 14.2. Chapter 3 showed that, household food insecurity and poor household wealth were the significant predictors of woman’s lower dietary diversity. Women with lower dietary diversity score (DDS) mostly had lack of animal source foods, fruits and legumes. High cost, household’s lack of purchasig power and lack of women's access to market were the barriers to access these foods at home (Chapter 4). When foods was available in the household, personal preference, husband’s choice and cultural taboos were important drivers of women’s food choice. Chapter 5 and 6 showed a robust inverse association between maternal height and under-five stunting and wasting and neonatal, infant and under-five mortality. Children of the shortest mothers (<145 cm) had greater risk of stunting, wasting, neonatal, infant and under-five mortality compared to children of tall mothers (>=155 cm). This finding suggests an intergenerational linkage between maternal and child undernuteition and mortality. The insights from this research will help to design nutrition behaviour change communications to improve diet quality in pregnancy and lactation to break the intergenerational cycle of malnutrition for better maternal and child nutrition in Bangladesh