Data and methods
The Bangladesh Children Record-2007 of the Demographic and Health Surveys
(DHS) was utilized for this study. In this survey “all children under five years of age
were weighed and measured to determine their nutritional status” (NIPORT 2009, p.
146). The DHS programme helps developing countries conduct national surveys on
population characteristics, and maternal and child health. The DHS are nationally
representative surveys with large sample sizes, supported by the United States Agencyfor International Development (USAID). The surveys are based on household inter-
views of women of childbearing age, and they record standardized anthropometric
measurements and some biochemical measurements (DHS 2011).
For children, there are three indicators of under-nutrition: Stunting-(low height-for-age),
Wasting-(low weight-for-height), Underweight–(low weight-for-age) (WFP 2005).
Nutritional status, especially in children, has been widely and successfully assessed by
anthropometric measures in both developing and developed countries (WHO 1995). The
Z-score system expresses anthropometric values as several standard deviations (SDs)
below or above the reference mean or median value (Meia et al. 2007). Z-scores were
calculated using the new child growth standards of World Health Organization (WHO)
(de Onis M et al. 2006). The computation of Z-scores involves comparison with an
international reference population as recommended by the World Health Organization
(Dibley et al. 1987a and Dibley et al. 1987b). To measure under-weight and wasting,
weight-for-age and weight-for-height Z-scores are used as indicators respectively
(Nyovani 1999). A wasted child is one who is underweight (with a weight less than 2
standard deviations from the median of the reference population) for his or her height.
To assess the regional differences of under-nutrition in Bangladesh only the Z-score
of wasting (Weight-for-Height) of six divisions is considered as dependent variable.
Wasting is a measure of acute or short-term exposure to a negative environment. Height-
and weight-based anthropometric measurement is an excellent tool to gauge general
nutritional status in a population (WHO 1995). It is sensitive to changes in calorie intake
or the effects of disease. Wasting can be calculated without knowing the age of a child.
Weight-for-height (WFH) is a measure of current body mass. It is the best index to use
to reflect wasting under-nutrition, when it is difficult to determine the exact ages of
the children being measured (Setboonsarng 2005). McMurray in 1996 argued that for
cross-sectional data, weight-for-height is the best indicator of current under-nutrition.
Whereas measures of stunting indicate long-term nutritional deficiencies whereas
wasting scores represent a more acute form of under-nutrition (Nyovani, 1999).