{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T11:16:22Z","timestamp":1791717382380,"version":"4.3.4"},"reference-count":51,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["FOOD\/2017\/392-492"],"award-info":[{"award-number":["FOOD\/2017\/392-492"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the association between household access to water, sanitation and handwashing (WaSH) facilities and child undernutrition in Bangladesh.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>Cross-sectional study of children less than 5\u2009years using data collected from the 2019 Multiple Indicator Cluster Survey (MICS) and the 2017\u20132018 Bangladesh Demographic and Health Survey (BDHS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>Stunting, wasting and underweight, defined as a Z-score &lt;\u22122 SD for height-for-age, weight-for-height and weight-for-age, respectively. We applied hierarchical multiple binary logistic regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 30\u2009514 children 0\u201359 months, there was a high prevalence of child undernutrition (MICS: 28.0% stunted, 9.8% wasted, 22.6% underweight; BDHS: 30.8% stunted, 8.4% wasted, 21.7% underweight). Most children came from households lacking basic sanitation (MICS: 39.1%, BDHS: 55.3%) or handwashing facilities (MICS: 43.8%, BDHS: 62.6%). Children from households without access to WaSH facilities experienced the highest rates of undernutrition. Exposure-specific adjusted logistic regression models showed that a lack of access to improved water sources was associated with greater odds of wasting (MICS: adjusted OR (AOR) 1.36, 95% CI 1.00 to 1.85, p&lt;0.05); basic sanitation facility with higher rates of stunting (MICS: 1.13, 1.04 to 1.23, p&lt;0.01) and underweight (BDHS: 1.18, 1.02 to 1.37, p&lt;0.05); and a lack of handwashing facilities with stunting (BDHS: 1.27, 1.10 to 1.48, p&lt;0.01) and underweight (MICS: 1.10, 1.01 to 1.19, p&lt;0.05). In fully adjusted models, no basic sanitation facility was associated with higher odds of stunting (MICS: AOR 1.12, 1.03 to 1.22, p&lt;0.01) and a lack of handwashing facilities with higher odds of underweight (BDHS: AOR 1.30, 1.10 to 1.54, p&lt;0.01;MICS: AOR 1.09, 1.01 to 1.19, p&lt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings demonstrate a significant association between poor household WaSH facilities and high prevalence of child undernutrition. Improving WaSH may help reduce child undernutrition in Bangladesh.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-065330","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T14:35:32Z","timestamp":1685630132000},"page":"e065330","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Association of access to water, sanitation and handwashing facilities with undernutrition of children below 5 years of age in Bangladesh: evidence from two population-based, nationally representative surveys"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-0506","authenticated-orcid":false,"given":"Md Mehedi","family":"Hasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9631-081X","authenticated-orcid":false,"given":"Chowdhury Abdullah Al","family":"Asif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Barua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archis","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-8519","authenticated-orcid":false,"given":"Md Abul","family":"Kalam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Kader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasnuva","family":"Wahed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Wali","family":"Noman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aminuzzaman","family":"Talukder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,1]]},"reference":[{"key":"2023073121201161000_13.6.e065330.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-81132-8"},{"key":"2023073121201161000_13.6.e065330.2"},{"key":"2023073121201161000_13.6.e065330.3","unstructured":"United Nations Children\u2019s Fund (UNICEF), World Health Organization, International Bank for Reconstruction and Development . 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