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Exploring the intergenerational effects of undernutrition: association of maternal height with neonatal, infant and under-five mortality in Bangladesh
  1. Wajiha Khatun1,
  2. Ashraful Alam1,
  3. Sabrina Rasheed2,
  4. Tanvir M Huda1,
  5. Michael J Dibley1
  1. 1 Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
  1. Correspondence to Wajiha Khatun; wajiha.khatun{at}


Background Global or regional evidence showed maternal height as a strong predictor of child survival. However, there is limited information that confirms the intergenerational effect of short maternal height on the risk of offspring mortality in Bangladesh. Therefore, this study aimed to examine the association of maternal height with neonatal, infant and under-five mortality in Bangladesh.

Methods It was a pooled analysis of data from four rounds of Bangladesh Demographic and Health Surveys 2004, 2007, 2011 and 2014. We included singleton children aged 0–59 months born to mothers aged 15–49 years (n = 29 698). Mothers were interviewed to collect data on maternal and child characteristics, and socio-demographic information. Maternal height was measured using an adjustable measuring board calibrated in millimetres. We used STATA V.14.2 and adjusted for the cluster sampling design. Multivariate ‘Modified Poisson Regression’ was performed using stepwise backward elimination procedures to examine the association between maternal height and child death.

Results In the adjusted model, every 1 cm increase maternal height was associated with a reduced risk of neonatal mortality (relative risk (RR) = 0.973, 95% CI 0.960 to 0.986), infant mortality (RR = 0.980, 95% CI 0.969 to 0.991) and under-five mortality (RR = 0.982, 95% CI 0.972 to 0.992). Children of the shortest mothers (height<145 cm) had 1.73 times greater risk of neonatal mortality, about 1.60 times greater risk of infant mortality and 1.48 times greater risk of under-five mortality compared with those of tall mothers (height≥155 cm). Among the children of the shortest mothers (height<145 cm), the absolute probabilities for neonatal, infant and under-five mortality were 4.4%, 6.0% and 6.5%, respectively, while for the children of the tall mothers (height≥ 155 cm), the absolute probabilities for neonatal, infant and under-five mortality were 2.6%, 3.7 %, and 4.4%, respectively.

Conclusion These findings suggest a robust intergenerational linkage between short maternal height and the risk of neonatal, infant and under-five mortally in Bangladesh.

  • cross-sectional survey
  • child health
  • maternal health
  • epidemiology
  • nutrition

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  • Handling editor Sanni Yaya

  • Contributors WK had substantial contributions to conceptions, data collection, data analysis, interpretation of data and drafting the manuscript. TH had a contribution to data analysis. MJD, SR and AA contributed in revising it critically for valuable intellectual content. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The institutional review board of ICF Macro in Calverton, MD, USA, approved ethics of the BDHS surveys.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data statement Bangladesh Demographic and Health Survey data are available at the public domain in

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