National Estimates and Multilevel Modeling of Child Functional Difficulties in Bangladesh: Evidence from the 2025 MICS

Abstract Background Functional difficulties among children can adversely impact education, development, social participation, and overall well-being. However, recent nationally representative evidence on functional difficulties within children in the 5-17-year age range in Bangladesh is limited. The study estimated the prevalence of functional difficulties and identified related factors using data from the 2025 Bangladesh Multiple Indicator Cluster Survey (MICS). Methods A cross-sectional study examined 36,709 children. The dependent variable was coded as binary, where 0 denoted no functional difficulty and 1 denoted having a functional difficulty. Weighted prevalence estimates were calculated and associated factors were examined. A multilevel mixed-effects logistic regression model was used to adjust for grouping of children within primary sampling units. The analysis yielded adjusted odds ratios (AORs) and corresponding 95% confidence intervals (CIs). Results Weighted prevalence of functional difficulties was 5.67%. Prevalence varied considerably by population characteristics and geographic location. It was highest among children aged 5–9 years (6.96%), those with no education (10.85%), children not attending school (6.38%), and rural residents (6.15%). The highest divisional prevalence was observed in Sylhet (9.54%), followed by Mymensingh (9.07%), whereas Dhaka had the lowest prevalence (2.93%). In adjusted analyses, children aged 15–17 years had higher odds of such difficulties compared with 5–9-year age group (AOR 1.62, 95% CI 1.28–2.06). Primary-level (AOR 0.40, 95% CI 0.33–0.47), secondary-level (AOR 0.18, 95% CI 0.14–0.23), and higher-level education (AOR 0.19, 95% CI 0.11–0.32) showed substantially lower odds. Rural residence showed higher odds (AOR 1.26, 95% CI 1.06–1.50). Higher odds were also observed in Khulna, Mymensingh, and Sylhet, while lower odds were found in Dhaka compared with Barishal. Conclusion Functional difficulties affect a considerable proportion of children in Bangladesh, with pronounced educational, rural–urban, and geographic inequalities. Strengthening early identification, inclusive education, community-based rehabilitation, and accessible support services, especially in underserved areas, should be given priority.