Abstract / Summary
Background. Stunting and wasting drive child mortality and are central to Sustainable Development Goal target 2.2. In 2025, 24.0% of Bangladeshi children under five were stunted and 12.9% wasted, meeting the national stunting target but missing the 8% wasting target. We compared where the two occur and tested whether environmental factors explain the patterns. Methods. We linked the 2025 Bangladesh Multiple Indicator Cluster Survey to cluster GPS locations and environmental data. Moran's I tested clustering and Getis-Ord Gi* found hotspots across 64 districts and 3,144 clusters. We tested whether six environmental and access factors explained the hotspots, estimated what share of affected children each hotspot list reached, and used a joint model to compare factor associations between outcomes. Results. Stunting clustered by region (district Moran's I 0.21, P=0.002), with a north-eastern hotspot centred on Sylhet and Sunamganj. Six environmental factors together removed this clustering (I -0.01, P=0.45) and about 60% of between-district variation (95% CI 28 to 84), more than rainfall alone, with the gain over generic regional terms uncertain. Wasting showed no clear regional clustering (I 0.05, P=0.17), and district stunting and wasting rates were unrelated (r -0.01). Stunting hotspot districts held 5.9% of wasted children, the same as their 5.9% population share. Children with both conditions (902 cases) did not cluster. Altitude and rainfall related differently to stunting than to wasting (all P<0.004), but altitude associations were sensitive to how altitude was modelled. Conclusion. Stunting in Bangladesh is concentrated in the north-east, and six environmental and access factors together account for much of this, though no single factor, including rainfall, does. Wasting shows no clear regional pattern. A stunting hotspot list reached no more wasted children than population share, so surveillance may need both measures, with finer-scale data for wasting.