Nutritional vulnerabilities and double burden of food insecurity (FI) and inadequate WASH in coastal Bangladesh

Abstract Eliminating malnutrition remains an elusive goal for developing countries like Bangladesh. This study aimed to comprehensively assess child and maternal nutritional vulnerabilities, risk factors and the dual burden of FI and inadequate WASH access in the climate-sensitive coastal regions. A cross-sectional survey was conducted between February and July 2023 in three coastal districts where mothers with children aged 6–59 months were recruited from randomly selected 469 households. Multivariable logistic regression and Structural Equation Modelling (SEM) were performed to identify determinants and dual impacts of FI and WASH on malnutrition. High rates of child stunting (54.4%), underweight (25.2%) and wasting (9.4%) were observed, with 61.6% exhibiting at least one anthropometric failure. One-third of mothers were obese, and 43.5% were anaemic. Older children aged 24–35 and 48–59 months had significantly lower odds of malnutrition, [adjusted odds ratio (AOR) = 0.46, 95% confidence interval (CI): 0.22–0.98)] and (AOR = 0.40, 95% CI: 0.18–0.88), respectively than those aged 6–11 months. Children from poor households had over twice the odds of malnutrition (AOR = 2.15, 95% CI: 1.07–4.30) compared to the richest households. Malnutrition risk increased with the severity of household FI, (mild: AOR = 2.13, 95% CI: 1.01–4.49; severe: AOR = 3.66, 95% CI: 1.45–9.23) and lack of basic drinking water (AOR = 2.66, 95% CI: 1.66–4.25) and sanitation access (AOR = 1.93, 95% CI: 1.22–3.05). Children of underweight mothers and those experiencing diarrhoea were at higher risk of malnutrition. SEM showed that combined effect of food security and WASH access had statistically significant positive effects on child’s and maternal nutritional outcomes with a standardised coefficient value 0.50 and 0.68, respectively, indicating large effect size. Findings underscore the prime need for integrated nutrition and WASH interventions, coupled with targeted social protection and food security programs, to reduce child and maternal malnutrition in coastal Bangladesh.