Wealth-Based Inequalities in Child Undernutrition and the Double Burden of Malnutrition Among Child-Mother Dyads at the Same Household in Bangladesh: A Decomposition Approach Using Cross-Sectional Data.

Backgrounds and Aims: Child undernutrition and the double burden of malnutrition (DBM) at the household level are pressing public health issues. Still, an understanding of the wealth-based inequalities in child undernutrition and DBM among child-mother dyads has received little attention, particularly in Bangladesh. This study examines wealth-based inequality, the associated factors of child malnutrition, and DBM. Methods: This study analysed data from the most recent Bangladesh Demographic and Health Survey (BDHS) conducted in 2017-18. The DBM refers to the coexistence of an undernourished child and an overweight/obese mother (body mass index ≥ 25 kg/m²) within the same household. This study employed a binary logistic regression model to identify the characteristics associated with undernutrition in children and DBM. Additionally, concentration curve and index were utilized to assess wealth-based inequalities, and regression-based decomposition was applied to explore their underlying causes in child undernutrition and DBM. Results: This study found that 38.54% of children experienced undernutrition, and DBM impacted 7.50% of child-mother pairs. The concentration index for child undernutrition and the DBM were -0.191 (pro-poor inequality) and 0.163 (pro-rich inequality), respectively. The decomposition analysis indicated that household wealth status, maternal education, and paternal education accounted for 41.34%, 15.54%, and 14.33%, respectively, of socio-economic inequality in child undernutrition. Conversely, their contributions to socio-economic inequality in DBM were 93.49%, -32.05%, and 15.20%. Conclusion: Health policymakers and authorities must prioritise factors such as wealth, education, and living conditions to reduce child undernutrition and DBM in Bangladesh. Prompt and decisive action is necessary to identify and address these issues effectively.