Seasonality matters: understanding the trends, determinants and coping strategies related to acute child undernutrition in Bangladesh

Abstract

Despite recognition of seasonal variation in child undernutrition, the drivers, lived experiences and coping strategies relating to this variation remain poorly understood, in both urban and rural contexts. This mixed methods PhD thesis investigates the seasonal variations in acute undernutrition among children under five years in Bangladesh. The research incorporates secondary data analysis and primary fieldwork to explore how seasonal determinants and vulnerabilities vary across time, space and socio-economic context.
Successive cross-sectional Demographic and Health Surveys conducted in Bangladesh between 1999 and 2018 are pooled to study seasonal trends. Quantitative methods to study temporal variation in wasting prevalence include descriptive analysis, logistic regression and harmonic Fourier modelling. Temporal trends were studied using different temporal units of analysis, including season, month and dekad (10-day interval). A novel Seasonal Risk Index is introduced, capturing the compounding effect of seasonally varying household and individual-level risk factors of acute undernutrition. Participatory exercises in focus group discussions of parents with children under five and key informant interviews were conducted in urban and rural communities. Seasonal calendar and ranking exercises explored local, knowledge, perceptions and responses to seasonality and child undernutrition.
In Bangladesh, acute undernutrition peaks during the spring-summer transition period and remains elevated through the monsoon before improving in autumn. Nutritional status deteriorates well before the monsoon season begins, contradicting existing literature which assumes that the monsoon season is when food insecurity, disease burden and undernutrition are greatest. Determinants related to disease environments, economic and food-related pathways varied seasonally and coincided shortly before the peak in acute undernutrition. Seasonal patterns in wasting varied by region and population sub-groups, although urban and rural populations shared similar experiences of seasonal infections and undernutrition. Extreme temperatures were perceived to increase infection susceptibility and suppress appetite. Coping strategies included temperature regulation, care and hygiene practices. Financial constraints and seasonal discontinuity in electricity, water and gas supply prevented optimal care, hygiene and food preparation practices.
Targeting preventative interventions in spring and summer may reduce acute undernutrition during the monsoon. Sub-regional seasonal trends can guide more tailored interventions. Seasonality research and policy must consider populations beyond rural agricultural contexts. The Seasonal Risk Index highlights when the compounding risks of acute undernutrition coincide within the year. Integrating local perceptions enhances validity and provides new insights about nutrition seasonality. Greater seasonal awareness is essential in research, monitoring and policy related to health, nutrition and climate change to move beyond reliance on annual averages which are subject to seasonal biases and misinterpretation.

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Identifiers

ORCID for Alice Wolfle: orcid.org/0000-0002-1588-5177

ORCID for Amos Channon: orcid.org/0000-0003-4855-0418

ORCID for Jim Wright: orcid.org/0000-0002-8842-2181

ORCID for Marije Schaafsma: orcid.org/0000-0003-0878-069X

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