Association between Frequent Diarrhea and Malnutrition among Children under Five Years of Age

Abstract

Diarrhea and malnutrition remain major contributors to childhood morbidity and mortality in low-resource settings, with a bidirectional relationship that exacerbates health outcomes. In Bangladesh, frequent diarrheal episodes are common among children under five, yet prospective data quantifying this association in urban hospital settings are limited. The objective of this study was to determine the association between frequent diarrhea and malnutrition among children under five years of age. Methods: A prospective cohort study was conducted from January 2025 to December 2025 at Bangladesh Shishu Hospital and Institute. A total of 147 children under five years were enrolled using purposive sampling. Malnutrition was defined as moderate or severe underweight, stunting, or wasting according to the WHO growth standards. Data were analyzed using SPSS version 23.0, employing chi-square tests and logistic regression to assess associations. Among 147 children, 68 (46.3%) experienced frequent diarrheas. Malnutrition prevalence was 60.5% overall. Children with frequent diarrhea had significantly higher odds of malnutrition compared to those without (adjusted odds ratio 3.42; 95% CI: 1.78–6.58; p < 0.001). The strongest association was observed for wasting (AOR 4.12; p < 0.001), followed by underweight (AOR 3.87; p < 0.001) and stunting (AOR 2.56; p = 0.008). Urban slum residence was also significantly associated with malnutrition (p = 0.006). Frequent diarrhea is significantly associated with malnutrition in under-five children attending Bangladesh Shishu Hospital and Institute. Early identification and integrated management of recurrent diarrhea and nutritional deficits are essential. Future larger multi-center studies are recommended.  

CBMJ 2026 July: Vol. 15 No. 02 P:246-252