Factors influencing post-diarrhea growth patterns among children under two years old in rural Bangladesh

Undernutrition in children is a major global health issue. Diarrhea exacerbates undernutrition, creating a vicious cycle of infection and malnutrition. This longitudinal study examined growth patterns and influencing factors among 138 children following diarrhea. Children under two seeking care for watery diarrhea at a rural hospital in Bangladesh were enrolled and followed for three months of home-based visits. Anthropometric measurements--length-for-age z-score (LAZ), weight- for-age z-score (WAZ), weight-for-length z-score (WLZ), and mid-upper arm circumference (MUAC) were taken at enrollment and follow-ups. Linear mixed-effects models assessed associations of clinical, sociodemographic, sanitation, hygiene, and food security factors with growth outcomes. Overall, LAZ declined over three months (-0.260, SD: 0.408), while WAZ, WLZ, and MUAC improved (0.100, SD: 0.484; 0.249, SD: 0.725; 0.672 cm, SD: 0.476). Children with malnutrition at enrollment strongly predicted persistent malnutrition (LAZ < -2, WAZ < -2, WLZ < - 2, MUAC < 12.5 cm) during follow-up compared to new incidence of malnutrition (RR: 3.8, p < 0.001, 95% CI: 1.80, 6.35). Poor growth outcomes were linked to longer diarrhea duration, more vomiting, and hospitalization. Hospitalization was associated with declines in LAZ (-0.095, p = 0.009) and MUAC (-0.098, p = 0.030). Children aged 7-12 months had greater declines in WAZ (- 0.109, p = 0.096) and WLZ (-0.181, p = 0.113). Improved sanitation and hygiene supported growth, while household hunger was linked to declines. This study highlights the multifactorial nature of post-diarrhea growth outcomes and emphasizes the need for integrated interventions addressing clinical care, sanitation, hygiene, and food security. ImportanceChildren under two years of age in low and middle-income countries are highly vulnerable to undernutrition, especially following diarrheal illness. This study shows that growth recovery after diarrhea is not guaranteed and is shaped by multiple factors, including the childs age, the severity of illness, household sanitation and hygiene practices, and food security. Children who were already malnourished at the time of illness were much more likely to remain so months later. Poor hygiene practices and limited access to protein-rich foods further reduced the likelihood of recovery. These findings are critical because they highlight the need for targeted follow-up and integrated interventions to support children after diarrhea. By identifying which children are at highest risk and which environmental and clinical conditions hinder growth, this study provides essential evidence to guide strategies for improving child nutrition and health in similar low-resource settings.