Pa ge 1 Pa ge 1 American Journal of Food Science and Technology (AJFST) Malnutritional Status of 6-59 months Childs of Rural Families in Dinajpur Districts Bangladesh Monika Khatun Sharna1, Masuma Tunazzin Rim2, Anusree Ghosh3*, Anwara Akter Khatun4, Uttam Kumar Majumder5 Volume 3 Issue 2, Year 2024 ISSN: 2834-0086 (Online) DOI: https://doi.org/10.54536/ajfst.v3i2.3023 https://journals.e-palli.com/home/index.php/ajfst Article Information ABSTRACT Received: May 21, 2024 Accepted: June 25, 2024 Published: June 27, 2024 The present status of malnutrition among the children of 6-59 months old was assessed from the rural families in selected areas of Dinajpur district. Anthropometric methods and the data were collected through a face-to-face interview using a semi-structured questionnaire. The prevalence of malnutrition was assessed using three indicators: stunting, under-weight, and wasting following the WHO guidelines and cut-off points. 165 children (6-59 months) and their household of three Upazila (Kaharole, Dinajpur Sadar and Birganj) in Dinajpur district were considered for study subjects. The prevalence of stunting, underweight, and wasting of 6-59 months old children in Dinajpur was 38.8%, 41.3%, and 12.1%, respectively. The mean height of male and female children were 82.99 cm and 84.15 cm. The mean weight of male and female children was 10.97 kg and 10.78 kg. Female children are more susceptible to malnutrition than male children. The main contributing factors for stunting and wasting children were religion, monthly income of the family, parent education, criteria of child’s daily activity, and consumption of egg, cow milk, citrus fruits, leafy vegetables, other vegetables, rice, and pulses. Keywords Bangladesh, Children, Malnutrition, Public Health, Stunting 1 BRAC Health Programme, Manikganj, Bangladesh 2 Department of Food Science and Engineering, Faculty of Engineering Sciences, German University Bangladesh, Dhaka, Bangladesh 3 School of Education, Bangladesh Open University, Gazipur, Bangladesh 4 Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh 5 Statistics discipline, Khulna University, Khulna 9208, Bangladesh * Corresponding author’s e-mail: anusreeghosh62@gmail.com INTRODUCTION In the Asian region, Bangladesh had one of the highest prevalence of malnutrition over the last two decades. Although Neonatal mortality, infant mortality, and under-5 mortalities have decreased, stunting, wasting, and underweight percentages of children are still very high compared globally. Children under the age of 5 years are at risk of malnutrition, especially those under 2 years of age more susceptible to undernutrition. Malnutrition is a condition that occurs when certain vital nutrients are deficient in a person’s diet. The deficiency fails to meet the demands of the body, leading to effects on the growth, physical health, mood, behavior, and other functions of the body. Malnutrition has both short term and long- term consequences. The term malnutrition covers two broad groups of conditions. One is ‘undernutrition’— which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals) such as vitamin A deficiency, anemia and iron deficiency, iodine deficiency disorder (IDD), etc. The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes, and cancer). Children under 5 are also affected by macro and micronutrient deficiencies. Various factors influence malnutrition among children such as socio-demographic, environmental, reproductive, institutional, cultural, political, and regional factors (UNICEF-WHO-The World Bank, 2012). Malnutrition among children also depend on poor nutrition, inadequate food intake, inadequate breastfeeding of child, safe water. The growth of children greatly depend on food. Lack of food results in undernutrition, which can slow the growth of a child. Poor nutrition can also lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity which is irreversible. Good nutrition – an adequate, well-balanced diet combined with regular physical activity – is a cornerstone of good health. Healthy children are better in education, stronger, more productive, and more able to create opportunities to break the cycle of both poverty and hunger in a sustainable way (WHO, 2008). Malnutrition is alarming for developing countries including Bangladesh. It is due to improper knowledge about nutrition of food, ignorance, improper diet, illiteracy, lower family income, poverty, mother occupation, father occupation, densely populated area, sanitation, unhygienic environment, mother education about nutrition, family size, practice of breastfeeding, complete immunization is significant with nutritional status of children. An unhygienic environment and lack of sanitation lead to illness fever, diarrhea which can result in malnutrition. Low birth weight, low height, and weight of mothers who do not breastfeed also manipulate malnutrition. Food insecurity, particularly due to insufficient food access caused by high levels of poverty, as well as food price volatility, natural disasters, and limited land for cultivation. (Bosak et al, 2018). It is necessary to increase the sincerity to find out the determinants of undernutrition and take efficient action to eliminate it in Low- and Middle-Income Countries (LMICs) like Bangladesh. Although various Pa ge 2 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 NGO and government are working for malnutrition, lack of coordination to act on nutrition between and among government ministries, donors, different levels of government, and implementing bodies, such as nongovernmental organizations, at the local level (Chaparro et al., 2014) make it difficult to eradicate malnutrition. This study aimed to explore the stunted, wasted, and underweight status of children (6-59 months old) in the study area in Dinajpur district, Bangladesh. The study’s objective was to know the prevalence of nutrition and health status of children of the rural populations. MATERIALS AND METHOD The community-based cross-sectional study was conducted at different locations in the Dinajpur district of Bangladesh. The study area mainly covered Dinajpur Sadar, Kaharole, and Birganj upazila of Dinajpur district. Dinajpur is one of the extreme northern districts of Bangladesh. In Dinajpur, the poverty level is comparatively high compared with the national average. The study period was January 2017 to January 2018. Sampling Design and Sample Size The sample size was determined using the formula: n = z2pq / d2 Where, n = required sample size z = 90% of confident limits (1.645) P= 0.36(The prevalence rate of stunting status of under five children in Bangladesh (BDHS, 2014). d = Precision or error allowed in the study = 6.5% = 0.065 n= Z2 × p(1-p)/m2 = (1.645)2 × 0.36 × 0.64/ (0.065)2 =147 To find the adjusted sample size, allowing nonresponse rate of 20%, the adjusted sample size will be 147+20%=176. But in this study the children of under five families were found for data collection as sample 165. Data Collection Instruments A pre-coded and pre-tested questionnaire was administered to the respondents by asking questions. Both qualitative and quantitative data were collected by interviewing. The questionnaire was designed to collect a bulk of socio-economic, demographic characteristics, health, intake of food related questions. Variables Used for this Study Dependent and independent variables were selected first, before performing any statistical analysis. Independent Variables 1. Age of children 2. Gender of children 3. Child breast feeding status 4. Educational level of mother 5. Educational level of father 6. Religion of family 7. Father occupation 8. Mother occupation 9. Monthly income of family 10. Total number of children of the family 11. Number of children under 5 years of age Dependent Variables 1. Height-for-age Z-scores 2. Weight-for-age Z-scores 3. Weight-for-height Z-scores Assessment of Nutritional Status There are several ways to assess the nutritional status of children. Stunting Stunting referred to low height-for-age. A child who is stunted or chronically malnourished often appears to be normally proportioned but is actually shorter than normal for his/her age. Due to poor diets or recurrent infections Children who suffer from growth retardation tend to be at greater risk for illness and death. The effects of stunting are largely irreversible and generally occurs before age two. Wasting Wasting, or low weight for height, is a sturdy predictor of mortality among children under five. Wasting indicates current or acute malnutrition resulting from failure to gain weight or actual weight loss (Cogill,2003). It is the result of insufficient food intake or a high incidence of infectious diseases, especially diarrhea. It impairs the execution of the immune system and can lead to enlarged harshness and duration of and vulnerability to infectious diseases and an increased risk for death. Underweight Underweight means below a weight considered normal or desirable. A person may become underweight due to metabolism, drug use, lack of food (frequently due to poverty), eating disorder, or illness (both physical and mental), genetics, etc. Anthropometric Indices Anthropometric indices are an essential part of the interpretation of anthropometric measurements (WHO,1986). Indices are formed from two or more raw anthropometric measurements. Various types of anthropometric indices are: Weight for Age Z - Scores (WAZ) According to UNICEF, Moderate and severe - below minus two standard deviations from median weight for age of reference population; severe - below minus three standard deviations from median weight for age of reference population. W/A is commonly used for monitoring growth and to assess changes in the magnitude of malnutrition over time. Weight for age composite measure of height-for-age and weight-for-height, making interpretation difficult. Weight for age reflects body mass relative to age. Pa ge 3 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 The reference standards (NCHS Cut-off point) of height and weight data are given below: Severe (WAZ =< -3.00 SD) Moderate (-2.99 = -2.00 SD) Weight-for-Height Z – Scores (WHZ) According to WHO, is defined as a weight-for-age between -3 and -2 z-scores below the median of the WHO child growth standards. It can be due to a low weight-for-height (wasting) or a low height-for-age (stunting) or to a combination of both. Weight for height is a sensitive index of current nutritional status. The reference standards (NCHS Cut-off point) of height and weight data are given below: Severe (WHZ =< -3.00 SD) Moderate (-2.99 = -2.00 SD) Height-for-Age Z –Scores (HAZ) Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median (WHO, 2018). Low H/A relative to a child of the same sex and age in the reference population are referred to as “shortness”. It cannot measure short term changes in malnutrition. Stunting is a slowing of skeletal growth and of stature, defined by Waterlow, et. al. (1977) as “the end result of a reduced rate of linear growth”. It results from long time inadequate food intake and increased morbidity and is generally found in developing countries where economic conditions are poor. The reference standards (NCHS Cut-off point) of height and weight data are given below: Severe (HAZ =< -3.00 SD) Moderate (-2.99 = -2.00 SD) Formula for Calculating Z-Scores Weight for age z= Observed weight at age X – Standard weight at age X/Standard deviation of weight at age X Height for age= Observed height at height X – Standard height at age X/Standard deviation of height at age X Weight for height =Observed weight at height X- Standard height at height X/Standard deviation of weight at height X Software Used and Statistical Analysis for the Study For socio-economic, demographic, health and food preferences data analysis, general statistical software SPSS22.0 was used. For identifying risk factors associated with child health and nutrition ANTHRO software was used to calculate Z-scores. For the chi-square test we used a custom table. The overall software used for data entry, data analysis, graphical representation and writing reports were SPSS 22.0, ANTHRO, MS WORD, MS-EXCEL etc. Descriptive measures, like, means, variances, proportions, standard error of mean were calculated. To test the significance of the association between two categorical variables Chi-square (X2)-test was used. Logistic (binary) Regression Binary logistic regression estimates the probability that a characteristic is present (e.g., estimate probability of ‘success”) given the values of explanatory variables, in this case a single categorical variable; π =Pr (Y=1/X=x). Single Level Binary Logistic Regression Let Y be a dichotomous dependent variable, say nutritional status taking values 0 and 1 and suppose that Y=I if a child is malnourished and Y=0 otherwise. Also let X be an independent variable. Then the form of the logistic regression model is Then a transformation of P known as the logic transformation and is defined as The importance of this transformation is that g(x) has many of the desirable properties of a linear regression model. The logic, g(x) is linear in its parameters, may be continuous, and may range from -∞ to + ∞ depending on the range of x. For more than one independent variable the model can be generalized as Model Fit To determine the factors associated with the response variables (e.g., stunning, wasting, and underweight) the cox’s logistic regression model (single level) was fitted and the odds ratio of occurring an event was calculated for different independent variables using SPSS 22.0. All the independent variables found significant at the bi- variate analysis were considered but only the significant variables in regression analysis were retained in the final regression model. The possibility of multicollinearity and confounding was also explored. Interaction effects were tested and reported in the result section where found. RESULTS AND DISCUSSION Findings The findings from the study are described below. The status of malnutrition noted in the table and graph are of the time period 2017 to 2018: Food Intake Table 1 determined the distribution of food intake frequencies of children (6-59 months) in a week of selected households on a categorical scale. This table indicated that 57.6% of children were breastfeeding and Pa ge 4 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 42.4% children were not breastfed. 61.8% of children consumed meat sometimes or never, 33.9% consumed meat 2-4 days, 4.2% consumed 5-7 times per week. Regarding fish, 29.7% consumed sometimes or never, 47.3% consumed 2-4 times per week, 23% consumed 5-7 times per week. 35.8% of children sometimes or never, 32.7% children 2-4 times per week, 31.5% children 5-7 times per week consumed egg. Cow milk was consumed 2-4 times per week by 6.7 % children, 5-7 times per week by 23% children and 70.3% children consumed sometimes or never. In the case of citrus fruits, 47.9% children sometimes or never, 40% children 2-4 times per week, 12.1% children 5-7 times per week were consumed. 49.7% children sometimes or never, 33.9% children 2-4 times per week, 16.4% children 5-7 times per week consumed color fruits. Results implied that 56.4% children 2-4 times per week, 21.2% children 5-7 times per week and 22.4% children sometimes or never consumed leafy vegetables. Besides, color vegetables were consumed by 35.2% children sometimes or never, 2-4 times per week by 42.4% children, 5-7 times per week by 22.4% children.14.5% children sometimes or never, 67.9% children 2-4 times per week, 17.6% children 5-7 times per week consumed other vegetables. Most of the children, 94.5% were consumed rice bread and 5.5% children were not consumed. In case of pulses, 47.3% children sometimes or never, 33.9% children 2-4 times per week, 18.8% children 5-7 times per week consumed pulses. 23.1% children sometimes or never 47.3% children 2-4 times per week, 29.1% children 5-7 times per week consumed cake, biscuits etc. Table 1: Percentage distribution of food intake frequencies of children per week of selected rural families having children (aged 6-59 months old) in Dinajpur district Variables Categories No % Current breastfeeding of child Yes 95 57.6 No 70 42.4 Subtotal 165 100.0 Meat consumption Sometimes/never 102 61.8 2-4 times/week 56 33.9 5-7 times/week 7 4.2 Subtotal 165 100.0 Fish consumption Sometimes/never 49 29.7 2-4 times/week 78 47.3 5-7 times/week 38 23.0 Subtotal 165 100.0 Egg consumption Sometimes/never 59 35.8 2-4 times/week 54 32.7 5-7 times/week 52 31.5 Subtotal 165 100.0 Cowmilk consumption Sometimes/never 116 70.3 2-4 times/week 11 6.7 5-7 times/week 38 23.0 Subtotal 165 100.0 Citrus fruit consumption Sometimes/never 79 47.9 2-4 times/week 66 40.0 5-7 times/week 20 12.1 Subtotal 165 100.0 Color fruit consumption Sometimes/never 82 49.7 2-4 times/week 56 33.9 5-7 times/week 27 16.4 Subtotal 165 100.0 Leafy vegetables consumption Sometimes/never 37 22.4 2-4 times/week 93 56.4 5-7 times/week 35 21.2 Subtotal 165 100.0 Pa ge 5 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Color vegetables consumption Sometimes/never 58 35.2 2-4 times/week 70 42.4 5-7 times/week 37 22.4 Subtotal 165 100.0 Other vegetables consumption Sometimes/never 24 14.5 2-4 times/week 112 67.9 5-7 times/week 29 17.6 Subtotal 165 100.0 Rice, bread consumption Yes 156 94.5 No 9 5.5 Subtotal 165 100 Pulse consumption Sometimes/never 78 47.3 2-4 times/week 56 33.9 5-7 times/week 31 18.8 Subtotal 165 100.0 Cake, biscuits consumption Sometimes/never 39 23.6 2-4 times/week 78 47.3 5-7 times/week 48 29.1 Subtotal 165 100 Nutritional Status of Children Under –Five of Selected Rural Families and Identification of Causal Factors Table 2 showed that the average height of boys and girls were 82.99 cm and 84.16 cm. The average weight of boys and girls were 10.97 kg and 10.78 kg weight were significant. It indicated the average height of female children were higher than male children. But the average weight of male and female children was almost the same. The average weight for age for boy and girl were -1.53 SD and -1.66 SD. It showed that the value was greater than -2 SD which indicated normal underweight. The average height for age for boy and girl was -1.64 SD and -1.71 SD which were greater than -2 SD and also showed normal stunting status. The average weight for height of boy and girl was height -.67 SD and -.75 SD that were also greater than – 2 SD which showed normal wasting. Results of average z-scores also indicated that the prevalence of stunting, wasting and underweight children for female was higher than male children. Table 2: Mean, Standard deviation and Standard error of mean of anthropometric indicators of 6-59 months old children of selected rural families by gender, 2017-18. Gender N Mean Std. Deviation Std. Error Mean Height(cm) Boy 82 82.9906 13.25411 1.46367 Girl 83 84.1566 11.74473 1.28915 P value (t-test) .114 Weight(kg) Boy 82 10.9721 3.10307 .34268 Girl 83 10.7867 2.40962 .26449 P value (t-test) .006 Weight for age Boy 82 -1.5356 1.10017 .12149 Girl 83 -1.6698 1.12128 .12308 P value (t-test) .646 Height for age Boy 82 -1.6483 1.29220 .14270 Girl 83 -1.7187 1.44628 .15875 P value (t-test) .470 Weight for height Boy 82 -.6723 1.20067 .13259 Girl 83 -.7504 1.19436 .13110 P value (t-test) .921 Pa ge 6 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Table 3 demonstrated the mean and standard error of mean of the anthropometric indices according to age category of selected surveyed children of 6-59 months old. For children aged 6-12 months old, the mean of height of boy and girl were 67.25 cm and 63.71 cm. For children aged 13-24 months old, the mean of height of boy and girl were 76.87 cm and 74.19 cm. For children aged 25 and above months old, the mean of height of boy and girl were 92.17 cm and 90.56 cm. It clearly indicated that for each group of age the average height of male is higher than female. The average weight of male and female children were 7.47 kg and 7.81 kg for aged 6-12 months old, 9.52 kg and 8.78 for aged 13-24 months old, 13.04 kg and 11.93 kg for aged 25 and above months old children. Results indicated that weight of boy and girl was almost same at the age of 6-12 months old, but weight of male was higher than female for remaining two group. The mean z-scores value of weight for age for boy (-1.25 SD) and girl (-.39 SD) for aged 6-12 months old, boy (-1.89 SD) and girl ( -1.71 SD) for 13-24 months old, boy (-1.55 SD) and girl (-1.82 SD) which were greater than -2SD that indicates normal underweight of children for each group. The mean z-scores value of height for age for boy (-1.35 SD) and girl (-2.04 SD) for aged 6-12 months old, boy (-1.93 SD) and girl ( -1.98 SD) for 13- 24 months old, boy (-1.69 SD) and girl (-1.58 SD) which were greater than -2SD that indicates normal underweight of children for each group. At age 6-12 months female were moderately stunted where male was normal. The remaining two group of age were normal. The mean z-scores value of weight for height for boy (-.51 SD) and girl (1.68 SD) for aged 6-12 months old, boy (-.83 SD) and girl (-.68 SD) for 13-24 months old, boy (-.69 SD) and girl (-1.09 SD) which were greater than -2SD that indicates normal wasting status of children for each group. Among the 6-59 months old children of selected rural families. Among the children, 61.2% were not stunted, 22.4% were moderately stunted and 16.4% were severely stunted. Whereas 58.8% were not underweight, 35.2% were moderately uunderweight and 6.1% were severely underweight. Findings also shows that among them 87.9% of children were not wasted. 9.1% were moderately wasted, and 3% were severely wasted. Table 3: Mean, Standard deviation and Standard error of mean of anthropometric indicators according to age category of 6-59 months old children of selected rural families by gender, 2017-18. Age in months 6-12 13-24 25 and above Gender Boy Girl Boy Girl Boy Girl Mean SE Mean SE Mean SE Mean SE Mean SE Mean SE Height(cm) 67.25 1.13 63.71 1.02 76.87 1.55 74.19 1.12 92.17 1.31 90.56 1.08 Weight(kg) 7.47 0.30 7.81 0.42 9.52 0.51 8.78 0.26 13.04 0.31 11.93 0.27 Weight for age -1.25 0.29 -0.39 0.52 -1.89 0.36 -1.71 0.23 -1.55 0.12 -1.82 0.14 Height for age -1.35 0.29 -2.04 0.63 -1.93 0.35 -1.98 0.37 -1.69 0.19 -1.58 0.18 Weight for height -0.51 0.37 1.68 0.39 -.83 0.41 -0.68 0.18 -0.69 0.11 -1.09 0.13 Table 4: Stunting status of children according to socio-demographic, economic and household charateristics of selected rural families having children (aged 6-59 months old) in Dinajpur district, 2017-2018. Variables Categories Stunting status Not Stunting Stunting No % No % Age of children in months 6-12 17 16.8 11 17.2 13-24 18 17.8 18 28.1 25 and above 66 65.3 35 54.7 Subtotal 101 100.0 64 100.0 Chi-square 2.636NS Gender Male 51 50.5 31 48.4 Female 50 49.5 33 51.6 Subtotal 101 100.0 64 100.0 Chi-square .066 NS Pa ge 7 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Religion Muslim 79 78.2 58 90.6 Hindu and others 22 21.8 6 9.4 Subtotal 101 100.0 64 100.0 Chi-square 4.280* Type of family Nuclear 79 78.2 43 67.2 Joint 22 21.8 21 32.8 Subtotal 101 100.0 64 100.0 Chi-square 2.474 NS Father occupation Farmer 35 34.7 22 34.4 Day labour 38 37.6 26 40.6 Service holder and other 28 27.7 16 25.0 Subtotal 101 100.0 64 100.0 Chi-square .201 NS Mother occupation Housewife 81 80.2 53 82.8 Day labour 11 10.9 6 9.4 Service holder and other 9 8.9 5 7.8 Subtotal 101 100.0 64 100.0 Chi-square .176 NS Monthly income of family (Tk) =<10000 58 57.4 27 42.2 >10000 43 42.6 37 57.8 Subtotal 101 100.0 64 100.0 Chi-square 3.642*** Mother education No formal education 29 28.7 9 14.1 Primary 48 47.5 44 68.8 Secondary and above 24 23.8 11 17.2 subtotal 101 100.0 64 100.0 Chi-square 7.615* Father education No formal education 32 31.7 20 31.2 Primary 39 38.6 35 54.7 Secondary and above 30 29.7 9 14.1 Subtotal 101 100.0 64 100.0 Chi-square 6.314* Total number of children of family 1 41 40.6 27 42.2 2-3 and above 60 59.4 37 57.8 Subtotal 101 100.0 64 100.0 Chi-square .041 NS Number of children under 5 year 1 81 80.2 49 76.6 2 20 19.8 15 23.4 Subtotal 101 100.0 64 100.0 Chi-square .310 NS Criteria of child's daily activity Very active 92 91.1 61 95.3 Active several hours 9 8.9 3 4.7 Subtotal 101 100.0 64 100.0 Chi-square 1.036 NS Note: Level of significance*p<0.05, **P<0.01, **P<0.10, NS = Not Significant Table 4 clearly shows the association with stunting status of children according to socio-demographic, economic and household characteristics of selected families. Results revealed that religion, monthly income of family mother education, father education had significant association with stunting status of children. Pa ge 8 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Table 5: Underweighting status of children according to socio-demographic, economic and household charateristics of selected rural families having children (aged 6-59 months old) in Dinajpur district, 2017-2018 Variables Categories Underweighting status Not underweighted Underweighted No % No % Age of children in months 6-12 20 20.6 8 11.8 13-24 18 18.6 18 26.5 25 and above 59 60.8 42 61.8 subtotal 97 100.0 68 100.0 Chi-square 3.000 NS Gender Male 53 54.6 29 42.6 Female 44 45.4 39 57.4 Subtotal 97 100.0 68 100.0 Chi-square 2.300 NS Religion Muslim 76 78.4 61 89.7 Hindu and others 21 21.6 7 10.3 subtotal 97 100.0 68 100.0 Chi-square 3.658*** Type of family Nuclear 71 73.2 51 75.0 Joint 26 26.8 17 25.0 Subtotal 97 100.0 68 100.0 Chi-square .068 NS Father occupation Farmer 34 35.1 23 33.8 Day labour 34 35.1 30 44.1 Service holder and other 29 29.9 15 22.1 subtotal 97 100.0 68 100.0 Chi-square 1.786 NS Mother occupation Housewife 76 78.4 58 85.3 Day labour 13 13.4 4 5.9 Service holder and other 8 8.2 6 8.8 Subtotal 97 100.0 68 100.0 Chi-square 2.447 NS Monthly income of family (Tk) =<10000 52 53.6 33 48.5 >10000 45 46.4 35 51.5 subtotal 97 100.0 68 100.0 Chi-square .413 NS Mother education No formal education 21 21.6 17 25.0 Primary 53 54.6 39 57.4 Secondary and above 23 23.7 12 17.6 Subtotal 97 100.0 68 100.0 Chi-square .941 NS Father education No formal education 33 34.0 19 27.9 Primary 39 40.2 35 51.5 Secondary and above 25 25.8 14 20.6 Subtotal 97 100.0 68 100.0 Chi-square 2.055 NS Pa ge 9 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Total number of children of family 1 39 40.2 29 42.6 2-3 and above 58 59.8 39 57.4 Subtotal 97 100.0 68 100.0 Chi-square .098 NS Number of children under 5 year 1 75 77.3 55 80.9 2 22 22.7 13 19.1 Subtotal 97 100.0 68 100.0 Chi-square .304 NS Criteria of child's daily activity Very active 91 93.8 62 91.2 Active several hours 6 6.2 6 8.8 Subtotal 97 100.0 68 100.0 Chi-square .413 NS Note: Level of significance*p<0.05, **P<0.01, **P<0.10, NS = Not Significant Table 6: Wasting status of children according to socio-demographic, economic and household charateristics of selected rural families having children (aged 6-59 months old) in Dinajpur district, 2017-2018. Variables Categories Wasting status Not wasting Wasting No % No % Age of children in months 6-12 23 15.9 5 25.0 13-24 32 22.1 4 20.0 25 and above 90 62.1 11 55.0 Subtotal 145 100.0 20 100.0 Chi-square 1.043 NS Gender Male 73 50.3 9 45.0 Female 72 49.7 11 55.0 Subtotal 145 100.0 20 100.0 Chi-square .201 NS Religion Muslim 120 82.8 17 85.0 Hindu and others 25 17.2 3 15.0 Subtotal 145 100.0 20 100.0 Chi-square .063 NS Type of family Nuclear 108 74.5 14 70.0 Joint 37 25.5 6 30.0 Subtotal 145 100.0 20 100.0 Chi-square .183 NS Father occupation Farmer 50 34.5 7 35.0 Day labour 56 38.6 8 40.0 Service holder and other 39 26.9 5 25.0 Subtotal 145 100.0 20 100.0 Chi-square .034 NS Mother occupation Housewife 119 82.1 15 75.0 Day labour 14 9.7 3 15.0 Service holder and other 12 8.3 2 10.0 Subtotal 145 100.0 20 100.0 Chi-square .657 NS Pa ge 10 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Monthly income of family (Tk) =<10000 74 51.0 11 55.0 >10000 71 49.0 9 45.0 Subtotal 145 100.0 20 100.0 Chi-square .111 NS Mother education No formal education 33 22.8 5 25.0 Primary 80 55.2 12 60.0 Secondary and above 32 22.1 3 15.0 Subtotal 145 100.0 20 100.0 Chi-square .526 NS Father education No formal education 45 31.0 7 35.0 Primary 65 44.8 9 45.0 Secondary and above 35 24.1 4 20.0 Subtotal 145 100.0 20 100.0 Chi-square .215 NS Total number of children of family 1 59 40.7 9 45.0 2-3 and above 86 59.3 11 55.0 subtotal 145 100.0 20 100.0 Chi-square .135 NS Number of children under 5 year 1 115 79.3 15 75.0 2 30 20.7 5 25.0 Subtotal 145 100.0 20 100.0 Chi-square .195 NS Criteria of child's daily activity Very active 137 94.5 16 80.0 Active several hours 8 5.5 4 20.0 Subtotal 145 100.0 20 100.0 Chi-square 5.467* Note: Level of significance*p<0.05**P<0.01, **P<0.10,, NS = Not Significant Table 6 clearly showed the association with stunting status of children according to socio –demographic, economic and household characteristics of selected rural families. Results revealed that criteria of child’s daily activity had significant association with stunting status of children. Table 7: Stunting status of children according to food intake frequencies of children per week of selected rural families having children (aged 6-59 months old) in Dinajpur district, 2017-2018. Variables Categories Stunting status Not Stunting Stunting No % No % Do you breastfeed your child Yes 54 53.5 41 64.1 No 47 46.5 23 35.9 Subtotal 101 100.0 64 100.0 Chi-square 1.801 NS Meat consumption Sometimes/never 61 60.4 41 64.1 2-4 times/week 36 35.6 20 31.2 5-7 times/week 4 4.0 3 4.7 Subtotal 101 100.0 64 100.0 Chi-square .357 NS Pa ge 11 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Fish consumption Sometimes/never 33 32.7 16 25.0 2-4 times/week 48 47.5 30 46.9 5-7 times/week 20 19.8 18 28.1 Subtotal 101 100.0 64 100.0 Chi-square 1.959 NS Egg consumption Sometimes/never 28 27.7 31 48.4 2-4 times/week 38 37.6 16 25.0 5-7 times/week 35 34.7 17 26.6 Subtotal 101 100.0 64 100.0 Chi-square 7.423* Cow milk consumption Sometimes/never 65 64.4 51 79.7 2-4 times/week 10 9.9 1 1.6 5-7 times/week 26 25.7 12 18.8 Subtotal 101 100.0 64 100.0 Chi-square 6.227* Citrus fruit consumption Sometimes/never 41 40.6 38 59.4 2-4 times/week 44 43.6 22 34.4 5-7 times/week 16 15.8 4 6.2 Subtotal 101 100.0 64 100.0 Chi-square 6.687* Color fruit consumption Sometimes/never 49 48.5 33 51.6 2-4 times/week 33 32.7 23 35.9 5-7 times/week 19 18.8 8 12.5 Subtotal 101 100.0 64 100.0 Chi-square 1.150 NS Leafy vegetables consumption Sometimes/never 22 21.8 15 23.4 2-4 times/week 58 57.4 35 54.7 5-7 times/week 21 20.8 14 21.9 Subtotal 101 100.0 64 100.0 Chi-square .122 NS Color vegetables consumption Sometimes/never 38 37.6 20 31.2 2-4 times/week 39 38.6 31 48.4 5-7 times/week 24 23.8 13 20.3 Subtotal 101 100.0 64 100.0 Chi-square 1.552 NS Other vegetables consumption Sometimes/never 17 16.8 7 10.9 2-4 times/week 65 64.4 47 73.4 5-7 times/week 19 18.8 10 15.6 Subtotal 101 100.0 64 100.0 Chi-square 1.638 NS Rice, bread consumption Yes 97 93.1 62 96.9 No 7 6.9 2 3.1 Subtotal 101 100 64 100 Chi-square 1.100 NS Pulse consumption Sometimes/never 49 48.5 29 45.3 2-4 times/week 34 33.7 22 34.4 5-7 times/week 18 17.8 13 20.3 Subtotal 101 100.0 64 100.0 Pa ge 12 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Chi-square .220 NS Cake, biscuits consumption Sometimes/never 26 25.7 13 20.3 2-4 times/ week 46 45.5 32 50 5-7 times/week 29 28.7 19 29.7 Subtotal 101 100 64 100 Chi-square .666 NS Note: Level of significance*p<0.05, **P<0.01, **P<0.10, NS = Not Significant Table 7 clearly revealed the association with stunting status of children according to food intake frequencies of children per week of selected rural families. Results indicated that consumption of egg, cow milk, citrus fruit per week had significant association with stunting status of children. Table 8: Underweight status of children according to food intake of children per week of selected rural families having children (aged 6-59 months old) in Dinajpur district, 2017-2018. Variables Categories Underweighting status Not Underweighted Underweighted No % No % Do you breastfeed your child Yes 57 58.8 38 55.9 No 40 41.2 30 44.1 Subtotal 97 100.0 68 100.0 Chi-square .136 NS Meat consumption Sometimes/never 64 66.0 38 55.9 2-4 times/week 31 32.0 25 36.8 5-7 times/week 2 2.1 5 7.4 Subtotal 97 100.0 68 100.0 Chi-square 3.569 NS Fish consumption Sometimes/never 29 29.9 20 29.4 2-4 times/week 45 46.4 33 48.5 5-7 times/week 23 23.7 15 22.1 Subtotal 97 100.0 68 100.0 Chi-square .089 NS Egg consumption Sometimes/never 33 34.0 26 38.2 2-4 times/week 34 35.1 20 29.4 5-7 times/week 30 30.9 22 32.4 Subtotal 97 100.0 68 100.0 Chi-square .613 NS Cow milk consumption Sometimes/never 69 71.1 47 69.1 2-4 times/week 7 7.2 4 5.9 5-7 times/week 21 21.6 17 25.0 Subtotal 97 100.0 68 100.0 Chi-square .325 NS Citrus fruit consumption Sometimes/never 46 47.4 33 48.5 2-4 times/week 39 40.2 27 39.7 5-7 times/week 12 12.4 8 11.8 Subtotal 97 100.0 68 100.0 Chi-square .025 NS Pa ge 13 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Color fruit consumption Sometimes/never 48 49.5 34 50.0 2-4 times/week 33 34.0 23 33.8 5-7 times/week 16 16.5 11 16.2 Subtotal 97 100.0 68 100.0 Chi-square .005 NS Leafy vegetables consumption Sometimes/never 24 24.7 13 19.1 2-4 times/week 52 53.6 41 60.3 5-7 times/week 21 21.6 14 20.6 Subtotal 97 100.0 68 100.0 Chi-square .902 NS Color vegetables consumption Sometimes/never 34 35.1 24 35.3 2-4 times/week 42 43.3 28 41.2 5-7 times/week 21 21.6 16 23.5 Subtotal 97 100.0 68 100.0 Chi-square .106 NS Other vegetables consumption Sometimes/never 14 14.4 10 14.7 2-4 times/week 65 67.0 47 69.1 5-7 times/week 18 18.6 11 16.2 Subtotal 97 100.0 68 100.0 Chi-square .157 NS Rice, bread consumption Yes 90 92.8 66 97.1 No 7 7.2 2 2.9 Subtotal 97 100 68 100 Chi-square 1.417 NS Pulse consumption Sometimes/never 46 47.4 32 47.1 2-4 times/week 35 36.1 21 30.9 5-7 times/week 16 16.5 15 22.1 Subtotal 97 100.0 68 100.0 Chi-square .978 NS Cake, biscuits consumption Sometimes/never 26 26.8 13 19.1 2-4 times/week 41 42.3 37 54.4 30 30.9 18 26.5 Subtotal 97 100 68 100 Chi-square 2.519 NS Note: Level of significance*p<0.05, **P<0.01, **P<0.10, NS = Not Significant Table 9: Wasting status of children according to food intake of children per week of selected rural families having children (aged 6-59 months old) in Dinajpur district, 2017-2018. Variables Categories Wasting status Not wasting wasting No % No % Do you breastfeed your child Yes 84 57.9 11 55.0 No 61 42.1 9 45.0 Subtotal 145 100.0 20 100.0 Chi-square .062 NS Meat consumption Sometimes/never 91 62.8 11 55.0 2-4 times/week 49 33.8 7 35.0 5-7 times/week 5 3.4 2 10.0 Pa ge 14 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Subtotal 145 100.0 20 100.0 Chi-square 1.957 NS Fish consumption Sometimes/never 42 29.0 7 35.0 2-4 times/week 69 47.6 9 45.0 5-7 times/week 34 23.4 4 20.0 Subtotal 145 100.0 20 100.0 Chi-square .331 NS Egg consumption Sometimes/never 54 37.2 5 25.0 2-4 times/week 45 31.0 9 45.0 5-7 times/week 46 31.7 6 30.0 Subtotal 145 100.0 20 100.0 Chi-square 1.801 Cow milk consumption Sometimes/never 103 71.0 13 65.0 2-4 times/week 8 5.5 3 15.0 5-7 times/week 34 23.4 4 20.0 Subtotal 145 100.0 20 100.0 Chi-square 2.552 NS Citrus fruit consumption Sometimes/never 69 47.6 10 50.0 2-4 times/week 58 40.0 8 40.0 5-7 times/week 18 12.4 2 10.0 Subtotal 145 100.0 20 100.0 Chi-square .106 NS Color fruit consumption Sometimes/never 70 48.3 12 60.0 2-4 times/week 49 33.8 7 35.0 5-7 times/week 26 17.9 1 5.0 Subtotal 145 100.0 20 100.0 Chi-square 2.290 NS Leafy vegetables consumption Sometimes/never 32 22.1 5 25.0 2-4 times/week 78 53.8 15 75.0 5-7 times/week 35 24.1 0 .0 Subtotal 145 100.0 20 100.0 Chi-square 6.297* Color vegetables consumption Sometimes/never 48 33.1 10 50.0 2-4 times/week 62 42.8 8 40.0 5-7 times/week 35 24.1 2 10.0 Subtotal 145 100.0 20 100.0 Chi-square 3.026NS Other vegetables consumption Sometimes/never 19 13.1 5 25.0 2-4 times/week 97 66.9 15 75.0 5-7 times/week 29 20.0 0 .0 Subtotal 145 100.0 20 100.0 Chi-square 5.880*** Rice, bread Yes 139 95.9 17 85 No 6 4.1 3 15 Subtotal 145 100 20 100 Chi-square 4.021*** Pa ge 15 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 Pulse consumption Sometimes/never 66 45.5 12 60.0 2-4 times/week 54 37.2 2 10.0 5-7 times/week 25 17.2 6 30.0 Subtotal 145 100.0 20 100.0 Chi-square 6.146* Cake, biscuits consumption Sometimes/never 32 22.1 7 35.0 2-4 times/week 69 47.6 9 45.0 5-7 times/week 44 30.3 4 20 Subtotal 145 100 20 100 Chi-square 1.915 NS Note: Level of significance*p<0.05, **P<0.01, **P<0.10, NS = Not Significant Table 9 showed the association with children’s wasting status according to children’s food intake frequencies per week of selected families. Results revealed that consumption of leafy vegetables, other vegetables, rice, bread, pulses per week had significant association with wasting status of children. Binary logistic regression analysis was performed to identify the factors affecting the stunting status of the rural children in the study area in Dinajpur. For this analysis, we merged two categories of stunting i.e., severe and moderate as stunted (code1) and other category remained as not stunted (code 0). Various socio-demographic and economic variables such as gender, religion, type of family, father occupation, mother occupation, monthly income of family, mother education, father education, age of children was inserted in the binary logistic regression model as independent categories. Table 10: Results of binary logistic regression analysis of significant studied variables for stunting of children aged 6-59 months old of selected rural families according to socio-demographic, economic and household characteristics in selected areas Dinajpur district, 2017-18. Variables Level B S.E DF P value Odds ratio (OR) 95% C.I. for OR Lower Upper Type of family Nuclear -.776 .401 1 .053 .460 .210 1.011 Joint (RC) - - - - 1.00 - - Monthly income of family =<10000 0.224 .180 1 .003 1.251 0.879 1.780 >10000 (RC) - - - - 1.00 - - Father education No formal education 1.739 .514 1 .001 5.691 2.080 15.572 Primary 1.700 .573 1 .003 5.472 1.782 16.807 Secondary and above (RC) - - - - 1.00 - - Note: RC-Reference category; Level of significance*p<0.05, **P<0.01 Table 10 showed the significant studied variables for stunting status of selected rural families children aged 6-59 months old at study area in Dinajpur district. The variables like type of family, monthly income of family and father education were statistically significant variables with stunting status of children. Result shows that children of nuclear families were .460 times lower risk of being stunting then joint families. It means the risk of stunting number decreases among children with the increase the family members. The families having monthly income <= 10,000 (TK) had 1.250 times higher risk of being stunted than monthly income of family more than 10,000 (TK). It implied risk of stunting status reduced among children with the increase of their monthly income. Children stunting status increased in 5.69 and 5.47 times for the No formal and Primary educated fathers respectively compared to the children of Secondary and above level educated fathers. It indicated that risk of stunted children reduced with the increase of their father’s education. Table 11: Results of binary logistic regression analysis of significant studied variables for stunting of children aged 6-59 months old of selected rural families according to food consumption frequencies of children in selected areas of Dinajpur district, 2017-18. Variables Level B S.E DF P value Odds ratio (OR) 95% C.I. for OR Lower Upper Fish consumption Sometimes/ never 1.058 .536 1 .020 2.880 1.007 8.236 Pa ge 16 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 2-4 times/week .437 .375 1 .358 1.548 .742 2.228 5-7times/week (RC) - - - - 1.00 - - Egg consumption Sometimes/ never 1.019 .475 1 .032 2.772 1.092 7.036 2-4 times/week .062 .484 1 .497 1.064 .412 2.747 5-7times/week (RC) 1.00 Cow milk consumption Sometimes/ never .397 1 .247 1.487 .651 3.396 2-4 times/week .818 .615 1 .048 2.265 .678 2.023 5-7times/week (RC) - - - - 1.00 - - Note: RC-Reference category; Level of significance*p<0.05, **P<0.01 In table 11 we used different food consumption habits such as meat, fish, egg, cow milk, citrus fruits, color fruits and other, leafy vegetables, color vegetables, other vegetables, rice, pulses consumption per week to find out the stunting status of children using binary logistic regression model. For this analysis, we merged two categories of stunting i.e., severe and moderate as stunted (code1) and other category remained as not stunted (code 0). Table 11 showed the result of binary logistic regression analysis of significant studied variables for stunting of selected rural families children aged 6-59 months old at study area in Dinajpur district. The variables like fish consumption, egg consumption and cow milk consumption were found statistically significant with stunting status of children. Children who consumed fish sometimes/never were 2.280 times higher risk of being stunted than who consumed 5-7 times/week. It implied the risk of stunting reduced among children with the increase of fish consumption. Children who consumed egg sometimes/never per week were 2.722 times higher risk of being stunted than who consumed 5-7 times/week. It implied the risk of stunting reduced among children with the increase of egg consumption also. Children who consumed cow milk 2-4 times/week were 2.265 times higher risk of being stunted than who consumed 5-7 times/week. That means the risk of stunting number reduced among children with the increase of cow milk consumption the child age under five. DISCUSSION Majumdar et. al. (2011) has conducted a similar study Socioeconomic and Demographic Determinants: Malnutrition of 6-59 Months Old Rural Santal Children and Food Security Status of Their Families in Dinajpur during 2011-12. That study found that factor showing significant role of hunger families are age of HH head, occupation of housewife, earning family members, monthly family income and child breastfeeding status. The currents study supports the statements. Islam and Biswas (2015) stated the same. ng children under the age of five. In rural areas, stunting prevalence rate was found to be more than six times higher than in urban areas. Income inequality was also a significant predictor of stunting. Similarly, the level of mother’s education is strongly related to stunting: the higher the level of mothers’ education, the lower the prevalence rate of stunting among children under five. Since wealth or income is a strong predictor of place of residence (urban/rural) as well as mothers’ level of education. Hoque et al. (2016) conducted a survey on nutritional Status among under-5 Children of a selected slum in Dhaka city. Regarding Anthropometric assessment according to weight for height Z-score, 39% were wasted moderately and 13% were severely wasted and height for age Z-score, showed 47% of children were stunted moderately and 14% children were severely stunted. According to weight for age Z- score, 46% of children were moderately underweight and 16% children were severely underweight. Mustafa et al. (2017) surveyed of nutritional Status of Children of Under-5, attending a District Hospital – A Secondary Level Care Hospital at Gazipur District Hospital. Their findings reflects that the rural children are more unfortunate. A study conducted by Roy Roy et al. (2015) found that breastfeeding practice and monthly family income were significantly associated with wasting, stunting and underweight. Children who were not exclusively breast fed had higher rate of moderate wasting (59.5%), stunting (70.5%) and underweight (74.6%). Children with illiterate father were found to have more odd value of having wasting, stunting and underweight compared to literate father. Furthermore, early age (6-24 month) of children is more susceptible for malnutrition as compared to the age (25- 59 months) of children. Bosak et al. (2018) reviewed the contribution of the non-government organizations in Bangladesh studying the malnutrition status in Dinajpur. Analyses determined that only 21.2% households were food secured, while 78.8% households were insecure. Among the insecure families about 19.4% households were insecure in food without hunger, 20.6% households were food insecure with moderate hunger and 38.8% families were insecure in food with severe hunger. Overall, 59.4% farmers’ families were hunger and rest of them was not hunger (40.6%). But food insecurity level as well as hunger families were more prevalent among the families of landless farmers compared to marginal and small groups. Only 3.6% families give rich foods to the female child. Binary logistic regression analysis found that total land of the family, total family members and monthly family income were the significant contributing factors for determining hunger and not-hunger families. According to Rahman et al. (2017) family income, maintain proper diet during pregnancy period, proper Pa ge 17 https://journals.e-palli.com/home/index.php/ajfst Am. J. Food. Sci. Technol. 3(2) 1-17, 2024 diet maintains for children have negative significant effect on child malnutrition. Debnath et al. (2017) accompanied a survey on malnutrition and morbidity profile of under Five in a rural area of Bangladesh. They found that about one-third (33.5%) of the children were stunted in Height for Age Z score. While 23.3% were moderately wasted and 6.5% were severely wasted in Weight for Height Z score. Severely underweight was 8.6%, 20.6% were moderately underweight and 70.8% of the children’s weight was within the normal limit for their age. In MUAC measurement, about one-fourth (21.8%) were moderate acute malnutrition (MAM) and 1.1% were severe acute malnutrition (SAM). Most prevalent disease (45.0%) was the diarrhoeal disease with respiratory tract infection was 32.0% and pneumonia was 18.0%. CONCLUSION Although the stunting, underweight, and wasting status of children have decreased in the past few years, the percentage rate is still high in Bangladesh and is a serious problem for our country. In the study area, the prevalence of underweight children (41.3%) was comparatively higher than stunted children (38.8%) and wasted children (12.1%). Results showed that the prevalence of stunting and underweight status were higher than the national level of Bangladesh, which is very concerning. The female children were more stunted, underweighted and wasted than male children. Religion, the family’s monthly income, the mother’s education, and the father’s education were considerably dependent on the stunting status of the children. But wasting status of children was associated with criteria of child daily activity. Egg, cow milk, and citrus fruit consumption was also dependent on the stunting status of children. But leafy vegetables, other vegetables, rice bread, and pulse consumption depended on children’s wasting status. The type of family, Monthly income of the family, and the father’s education were major determinants of the stunting status of children. Consumption of fish, cow milk, and egg were also the most important determinants of the stunting status of children. It is necessary to increase awareness about child nutrition and the quantity of food consumed. Educating presents by training about the nutrition of child, nutrition of food and diet chart of children. Persuading father and mother to regularly measure the height and weight of children will improve the situation. Government and NGOs should pay concentration to the nutrition status of rural children in relation to underweight and stunting. Acknowledgments The authors are grateful to Samia Arfin and Junaida Binta Rahman for their kind help in data collection in the rural area. Tabassum Rahman supports in data accumulation, sincere thanks to her. REFERENCES Bosak, L., Majumder, U. K. & Sarker, B. C. (2018). Food Security level and Hunger Status of a NGO Supported Farmers’ Families in Dinajpur, Bangladesh. IOSR Journal of Humanities and Social Science (IOSR-JHSS) 23(2), 39-47. Chaparro, C., Oot, L. & Sethuraman, K. 2014. Bangladesh Nutrition Profile. Washington, DC: FHI 360/FANTA. Cogill, B. (2003). Anthropometric Indicators Measurement Guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development, Washington, D. C. Debnath, S. C., B. K., Islam, M. Z. & Samin, S. (2017). Malnutrition and Morbidity Profile of Under Five Children: A Cross-Sectional Scenario in a Rural Area of Bangladesh. MOJ Public Health, 5(6), 1-5. Hoque, M. A., Sayeed, M. A., Ahsan, M. R., Mamun, M.A.A. & Salim, F. (2016). Nutritional Status among under-5 Children of a selected slum in Dhaka city. Northern International Medical College Journal, 7(02), 143- 145. Islam, A., & Biswas, T. (2015). Chronic stunting among under-5 children in Bangladesh: A situation analysis. Advances in Pediatric Research, 2(18). https://doi. org/10.12715/apr.2015.2.18 Majumder, U. K., Roy, L. N., Dey, R., Rahman, M. M., & Hassan, M. Z. (2011). Socioeconomic and demographic determinants: Malnutrition of 6-59 months old rural Santal children and food security status of their families in Dinajpur. South Asian Journal of Population and Health, 4, ISSN 1560-4373. Mustafa, M., Mustafa, M., Islam, T. & Khan, I.S. (2017). Nutritional Status of Children of Under-5, Attending a District Hospital – A Secondary Level Care Hospital. Dinajpur Medical College Journal, 10(1). Rahman, M. S., Ali, M., & Ahmed, N. A. M. F. (2017). Contributing factors to under-five child malnutrition in rural Bangladesh. Juniper Online Journal of Case Studies, 4(2). Roy, R. K., Matubbar, M. S., Kamruzzaman, M., & Ud-Daula, A. (2015). Determination of nutritional status of under-five year children employing multiple interrelated contributing factors in southern part of Bangladesh. International Journal of Nutrition and Food Sciences, 4(3), 264-272. UNICEF, WHO, & The World Bank. (2012). Joint child malnutrition estimates: Level and trends in child malnutrition. Waterlow, J., Buzina, R., Keller, W., Lane, J., Nichaman, M., & Tanner, J. (1977). The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin of the World Health Organization, 55(4), 489. World Health Organization. (1986). Use and interpretation of anthropometric indicators on nutritional status. Bulletin of the World Health Organization, 64(6), 929-941. World Health Organization. (2018). World health statistics 2018: Monitoring health for the SDGs.