Overview of the Bangladesh Demographic and Health Survey 2011

Introduction and Survey Objectives

The primary objective of the BDHS 2011 was to provide up-to-date estimates of basic demographic and health indicators. In 2011, Bangladesh was undergoing significant transitions in its health landscape, with declining fertility rates and improvements in child survival. However, malnutrition remained a persistent public health challenge. The survey aimed to furnish policymakers and program managers with the data necessary to evaluate existing programs and design new strategies to address the health needs of the population, with a specific focus on women of reproductive age (15-49 years) and children under five years of age.

The nutritional component of the 2011 survey was particularly vital. It assessed the prevalence of malnutrition among children and mothers, micronutrient deficiencies, and feeding practices. This data serves as a baseline to measure progress toward the Millennium Development Goals (MDGs), specifically those related to eradicating extreme poverty and hunger, reducing child mortality, and improving maternal health.

Methodology

The BDHS 2011 employed a nationally representative sample. The survey utilized a two-stage stratified sample design based on the 2001 Population Census. In the first stage, 600 enumeration areas (EAs) were selected, with 207 EAs from urban areas and 393 from rural areas. In the second stage, a systematic sample of households was selected from each EA. A total of 17,511 households were successfully interviewed, yielding a high response rate of 98 percent.

Within these households, 18,222 ever-married women aged 15-49 were identified for individual interviews. The interviews covered a wide array of topics, including fertility history, knowledge and use of family planning, breastfeeding practices, vaccinations, and nutritional status. Furthermore, anthropometric measurements (height and weight) were collected from 8,753 children under age five and 17,742 women to assess nutritional status. Blood tests were also conducted to screen for anemia among women and children.

Nutritional Status of Children

One of the most critical findings of the 2011 survey concerned the nutritional status of children. The data revealed that while there had been gradual improvements over the years, malnutrition rates remained alarmingly high. Malnutrition is often categorized into three primary indices: stunting (height-for-age), wasting (weight-for-height), and underweight (weight-for-age).

Stunting (Chronic Malnutrition)

Stunting serves as an indicator of chronic malnutrition, reflecting the cumulative effects of undernutrition and poor health environments over time. In 2011, 41 percent of children under five were stunted. This figure showed a slight decrease from previous surveys but indicated that a significant portion of the child population was failing to reach their physical growth potential due to long-term nutritional deficiencies. The prevalence of stunting was found to increase with the child's age, peaking between the ages of 24 and 35 months, suggesting that the weaning period is a critical window where dietary intake often fails to meet the needs of growing children.

Wasting (Acute Malnutrition)

Wasting measures acute malnutrition, typically resulting from a recent period of starvation or severe disease. The survey found that 16 percent of children were wasted. Wasting is a critical factor in child mortality, as a wasted child has a significantly higher risk of dying from common infections. The rate of severe wasting was 4 percent. The prevalence of wasting was generally higher in younger infants (under 6 months) and toddlers, highlighting the vulnerability of these age groups to sudden food insecurity or illness.

Underweight

The composite indicator of underweight combines information on acute and chronic malnutrition. In 2011, 36 percent of children under five were underweight. This statistic underscored the fact that more than one-third of the nation's children were malnourished. Disparities were evident across different demographic divides; children from mothers with no education were significantly more likely to be underweight compared to children whose mothers had completed secondary or higher education. Furthermore, children from the poorest households had significantly higher rates of under-nutrition than those from the wealthiest households, highlighting the strong link between socioeconomic status and health outcomes.

Infant and Young Child Feeding Practices

Nutrition outcomes are intrinsically linked to feeding practices. The BDHS 2011 collected extensive data on breastfeeding and complementary feeding. The survey found that 98 percent of children were breastfed at some point, indicating a strong cultural acceptance of breastfeeding in Bangladesh.

However, the initiation of breastfeeding within the first hour of birth (a practice recommended by the WHO to reduce neonatal mortality) was practiced by only 45 percent of mothers. Exclusive breastfeedinggiving only breast milk for the first six months of lifewas reported for 64 percent of infants under six months. While this was an improvement compared to prior years, it fell short of the global target. Complementary feeding practices also required improvement; the introduction of solid, semi-solid, or soft foods often occurred too early (before six months) or too late, diminishing the nutritional benefits of breast milk necessary for optimal development.

Nutritional Status of Women

Maternal nutrition is a direct determinant of child health outcomes, particularly influencing birth weight and infant mortality. The 2011 survey assessed the Body Mass Index (BMI) of women to determine adult nutritional status. The results showed that 18 percent of women were thin or undernourished (BMI < 18.5 kg/m), while 18 percent were overweight or obese (BMI 25.0 kg/m).

This dual burden of malnutritioncoexisting undernutrition and overnutritionis a characteristic feature of the nutrition transition in developing countries. The prevalence of undernutrition was highest among young women (aged 15-19) and women in rural areas. Conversely, overweight and obesity were more prevalent in urban areas and among older women, suggesting that lifestyle changes and dietary patterns in urban centers were contributing to rising non-communicable diseases.

Anemia was another significant concern. The survey estimated that 26 percent of women aged 15-49 were anemic. Anemia during pregnancy is associated with higher risks of maternal mortality, low birth weight, and preterm birth. While the prevalence of anemia had decreased slightly since previous surveys, it remained a moderate public health problem requiring continued iron and folic acid supplementation programs.

Demographic and Health Indicators

While nutrition was a primary focus, the BDHS 2011 also illuminated broader demographic trends that intersect with health status.

Fertility and Family Planning

Total Fertility Rate (TFR) had declined to 2.3 children per woman, a significant drop from the high rates observed in the 1970s and 1980s. This decline was attributed to the increased use of family planning methods. Contraceptive prevalence among currently married women was 61 percent. The pill remained the most popular method (27 percent), followed by injectables (12 percent) and female sterilization (5 percent). Despite these gains, unmet need for family planningwomen who want to stop or delay childbearing but are not using contraceptionstood at 12 percent, indicating room for improvement in family planning services.

Maternal and Child Health Care

Access to quality healthcare services is paramount for improving nutrition and survival rates. Antenatal care (ANC) coverage improved but was still far from universal. Only 26 percent of mothers received four or more ANC visits from a skilled provider, such as a doctor, nurse, or midwife. More concerning, only 27 percent of births were delivered in a health facility; the majority of births (73 percent) still occurred at home, often assisted by traditional birth attendants or relatives without formal medical training.

In terms of child health, vaccination coverage was one of the success stories. 84 percent of children aged 12-23 months had received all basic vaccinations (BCG, measles, DPT, polio). However, coverage for Vitamin A supplementation, a crucial intervention to prevent blindness and boost immunity, was reported as having fluctuated compared to previous years, emphasizing the need for robust delivery systems for such nutrition-specific programs.

Child Mortality

The survey provided vital statistics on child mortality. The under-five mortality rate (U5MR) was estimated at 53 deaths per 1,000 live births, while the infant mortality rate (IMR) was 43 per 1,000 live births. While these numbers reflected a downward trend from previous decades, they were still high. Malnutrition is a contributing factor in a substantial percentage of these deaths, often as an underlying cause that weakens the child's immune system, making them susceptible to diarrheal diseases, pneumonia, and other infections.

Conclusion

The Bangladesh Demographic and Health Survey 2011 painted a picture of a country in transitionone that has made remarkable strides in fertility reduction, immunization, and basic health access, yet continues to grapple with the pervasive challenge of malnutrition. The data revealed that malnutrition remains entrenched, particularly affecting the poorest households and the rural population.

The survey highlighted the "dual burden" of nutrition, with a sizeable portion of the population suffering from under-nutrition while a growing segment faces the health risks associated with over-nutrition. The findings underscored the necessity for a multi-sectoral approach. Addressing stunting and underweight status requires not just health interventions like supplementation and breastfeeding promotion, but broader investments in poverty alleviation, female education, sanitation, and food security.

Ultimately, the BDHS 2011 served as a crucial diagnostic tool. The detailed health and nutrition statistics provided by the survey allow the government of Bangladesh and its development partners to target resources more effectively, identifying the most vulnerable populations and designing interventions that can break the cycle of poverty and malnutrition. The reduction of child stunting from 51 percent in 2004 to 41 percent in 2011 proves that progress is possible, though the 2011 data made it clear that accelerated efforts were required to meet the ambitious health targets set for the coming decade.