Association Between Child Stunting and Handwashing facility with Spatial and Stratified Analysis Among Under Five based on Nationally Representative Health and Demographic Survey

Abstract Objective This study examines the association between household handwashing facilities and stunting among children under five, adjusting for relevant sociodemographic and household-level confounders, with disparities between the rural and urban. Design, settings, and participants We contrasted information on 4,420 children under five years old from the Bangladesh Demographic and Health Survey (BDHS) 2022. Descriptive, bivariate, and multivariable logistic regression was used to estimate adjusted odds ratios (AORs) for stunting with 95% confidence intervals (CIs). Outcome measures Children whose height-for-age (HAZ) was up to -2 standard deviations (SD) less than the median were considered stunted. And the study applied stepwise selection based multiple binary logistic regression model. Results Stunting prevalence was 22.96%. 50.20% of households had improved handwashing facilities, 38.44% had basic facilities, and 11.36% had no facilities. Children from households with basic handwashing facilities were at lower risk of stunting (AOR = 0.71, 95% CI: 0.54–0.93, p < 0.05) compared to those without a facility. This effect was even more significant in the rural setting (AOR = 0.69, p < 0.05). Although the sophisticated facilities unveiled a crude increased risk (OR = 1.28, p < 0.05), the adjusted model did not show any association (AOR = 0.86, p > 0.05), suggesting confounding effects. Conclusion The study findings highlight the need for handwashing facilities alongside maternal education and household poverty alleviation strategies to mitigate child stunting.