Nutritional and Socioeconomic Determinants of Early Childhood Development in Bangladesh: A Survey-Adjusted Partial Proportional Odds Analysis of the 2019 MICS

Abstract

Early childhood development (ECD) is the foundation for health, cognitive ability, and social and economic productivity throughout life. Nutritional deprivation and socio-economic inequality continue to constrain developmental potential in low- and middle-income countries. This study aimed to assess the nutritional, socio-economic, and caregiving factors associated with early childhood development among children aged 3–4 years in Bangladesh. Data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS), a nationally representative survey, were analyzed. The Early Childhood Development Index (ECDI) was constructed across four domains: literacy-numeracy, physical, social-emotional, and learning. A three-level ordinal outcome (not on track, partially on track, and on track) was derived. Survey-adjusted partial proportional odds models were estimated using Stata 17 to account for the complex sampling design. The proportional odds assumption was evaluated using a design-adjusted Wald test. Among the 8,752 children included in the analysis, 73.3% were developmentally on track, 23.6% were partially on track, and 3.2% were not on track. After adjustment, children without functional disabilities had substantially higher odds of being developmentally on track (AOR = 3.93). Stunted children had 17% lower odds of optimal developmental outcomes (AOR = 0.83). Higher maternal education (AOR = 1.17 per level increase), greater household wealth (AOR = 1.11 per quintile increase), attendance in early childhood education programs (AOR = 1.53), female sex (AOR = 1.40), and increasing age were positively associated with developmental attainment. The interplay of nutritional, socio-economic, and caregiving factors significantly shapes early childhood development in Bangladesh. Developmental outcomes can be improved through interventions addressing child undernutrition, educational inequality, and disability inclusion. A comprehensive and equitable policy framework is necessary to maximize opportunities for children's early development.