Bangladesh made substantial progress in reducing malnutrition between 1990 and 2000, with the proportion of underweight children falling from 66.6 per cent to 51.1 per cent, and the level of child stunting falling from 65.5 per cent to 48.8 per cent. If this current rate of improvement continues, the percentage of underweight and stunted children will be halved by 2015. Nevertheless, the prevalence of child stunting and underweight in 2000 are still 'very high' according World Health Organization (WHO) criteria. Chronic energy deficiency in non-pregnant women declined from 52 per cent in 1996-97 to 45 per cent in 1999-2000, but is still very high. Low birth weight is estimated to affect 30-50 per cent of infants.
Since 1997, the prevalence of night blindness, an early indicator of vitamin A deficiency, has been maintained below the 1 per cent threshold that indicates a public health problem. This success has largely been due to the vitamin A supplementation programme, which increased in coverage from 41 per cent in 1993 to over 85 per cent in the second half of the decade by linking the distribution of vitamin A capsules with the NIDs. Coverage of iodized salt increased from 19 per cent in 1993 to 70 per cent in 1999, and correspondingly, the prevalence of iodine deficiency fell from 69 per cent to 43 per cent.
While these findings are encouraging, they mask the fact that infants and children continue to consume diets that are grossly inadequate in vitamin A, iron and other micronutrients. This is indicated by surveys in early 2003 , which found that anaemia, which is largely due to iron deficiency, affects about 50 per cent of children under five, a level that denotes a severe public health problem. Breastfeeding is rarely exclusive for the first six months of life, and complementary foods are often introduced too early or too late and are of poor quality.
The nutritional status of adolescent girls and women is a key factor in the persistence of malnutrition in Bangladesh. Children are much more likely to be of low birth weight and to remain malnourished throughout their lives if their mothers were malnourished during adolescence and prior to and during pregnancy. Malnourished children are physically weak, they lack resistance to disease, they do less well at school, they are less productive as adults and they remain vulnerable for the rest of their lives.
In Bangladesh, malnutrition is caused by multiple factors. The immediate causes are diseases and inadequate intake of food. The underlying causes of malnutrition include the inability of households to grow and/or purchase sufficient food for their needs; poor maternal and child-care practices, including inadequate breastfeeding and complementary feeding for infants and young children and inadequate provision of food for adolescent girls and pregnant and lactating women.
These are compounded by delays in recognizing the signs of malnutrition or disease and in seeking care for children and women, inadequate access to quality health services, including family planning, immunization and medical services and poor access to sanitary facilities and potable water.