Adult literacy rate associated with geographic variation in childhood stunting prevalence in Bangladesh: a spatial analysis

Childhood stunting prevalence varies across small geographic areas, which may reflect social and built environmental characteristics. Though literacy is a known predictor of stunting, small area research on adult literacy shaping childhood stunting prevalence has not been investigated for Bangladesh. This study examines small area variation in childhood stunting prevalence and estimates the association between small area stunting prevalence and adult literacy rate controlling for other covariates. Data on stunting prevalence, adult literacy rates and other covariates were extracted for 478 subdistricts of Bangladesh. Spatial regression models were used to estimate the relationship between adult literacy rates and childhood stunting prevalence at the subdistrict-level. Stunting prevalence substantially varied across subdistricts in Bangladesh. Subdistrict-level stunting prevalence was inversely associated with the subdistrict-level adult literacy rate. Furthermore, the estimated effect for the female literacy rate was slightly more than the male literacy rate. Among other covariates, higher levels of people without access to a sanitary toilet was linked to greater stunting. The findings of small-area variation in stunting prevalence and its associated area-level compositional and contextual features could be useful for planning and targeting the geographic area-specific interventions to alleviate the extent of childhood stunting in Bangladesh. This study may also help policymakers allocate resources in geographical hotspots of higher stunting prevalence. An integrated approach to improving adult literacy and increasing sanitation coverage through multisectoral collaboration can help reduce the childhood stunting burden in Bangladesh.