01956nas a2200181   4500000000100000008004100001100001500042700001100057700001900068700001400087700001300101700001500114245011100129300001200240490000700252520150100259020001401760       2011                            d1 aLear Scott1 aTeo K.1 aSubramanian S.1 aRahman O.1 aCorsi D.1 aChow Clara00aShared environments: a multilevel analysis of community context and child nutritional status in Bangladesh  a951-9590 v143 a<p>
ObjectiveThe goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 049 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community.ResultsMultilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, 18 (se 0 = 006)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, 13 (se = 0·06)).ConclusionsThe community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.
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