The State of the World's Children 1998: Focus on Nutrition

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Panel 14

Tackling malnutrition in Bangladesh

Photo: Better caring practices, including improved personal hygiene, are essential to reducing malnutrition. In Bangladesh, a nutrition promoter helps women who are about to feed their children to wash their hands.

A new project in Bangladesh is helping to reduce malnu trition among children and mothers by improving caring practices, supporting breastfeeding and empowering women and their communities.

Some 56 per cent of Bangladeshi children under five suffer from moderate and severe malnutrition, 21 per cent of whom are severely underweight, and studies show that more than 70 per cent of pregnant and breastfeeding women are also malnourished. Protein-energy malnutrition is the main problem but, as often happens, it occurs together with such conditions as iron deficiency anaemia and vitamin A deficiency. In Bangla desh, lack of food is not the main cause of malnutrition; the lack of proper caring practices for children and pregnant women is an important contributing factor.

Recognizing that malnutrition is hindering national development, the Government has formulated a Na tional Nutrition Policy and launched a nationwide nutrition intervention programme, the Bangladesh Inte grated Nutrition Project. The initiative aims to address malnutrition directly and help promote faster socio-economic development.

Community nutrition promoters are the backbone of the project. Earning about $12 a month, they are trained for two months, including one month on the job. They learn how to understand the causes and signs of malnutrition and techniques for its treatment and prevention. They canvass their communities, persuading mothers to bring their children to the Community Nutrition Centres for monthly weighing and growth monitoring, and explaining the importance of child care, including children's needs for exclusive breastfeeding in the first six months; the need for smaller, more frequent and nutritious meals up to age three; and for extra feeding during and after illnesses to prevent malnutrition.

Marium Begum, one of the nutrition promoters, has already started to achieve results in her village. During growth monitoring sessions at her Community Nutrition Centre, situated in one of the homes in her village, Ms. Begum could see that Shewli, a one-year-old girl, was suffering from severe malnutrition. Ms. Begum explained to Shewli's mother, Shamsun, how to give her daughter a special locally made diet supplement. She also helped Shamsun to understand that she had been unable to breastfeed because she had not been eating enough herself. Fol lowing local tradition, Shamsun was accustomed to eating last, after serving food to her family, and there was often little food left. Ms. Begum explained how to re-lactate - that is, to resume lactation after it has stopped for some time - and ar ranged for intensive counselling at the Community Nutrition Centre.

Improving the nutrition of adolescent girls and pregnant and lactating women is another priority of the pro j ect. The nutrition promoters urge women to use iodized salt in their households to prevent iodine deficiency disorders, and to use oral rehydration therapy when a child has diarrhoea to prevent dehydration. They discuss the use of vitamin A and iron supplementation.

Special diet supplements are provided to malnourished women and children. Village Women's Groups, comprising up to 11 volunteers in each community, buy ingredients for the supplement - a carefully weighed mixture of rice, lentils, molasses and oil - at local markets to prepare and package them. Each member of the group earns about $10 per month through the sale of packets to the nutrition centres.

The Ministry of Health and Family Welfare, with the assistance of the Bangladesh Rural Advancement Committee (BRAC), has established nearly 1,000 Com munity Nutrition Centres in people's homes, each operating six days a week. The centres cover 65,000 children and 16,000 pregnant and lactating women. By the year 2001, the goal is to have 8,000 community nutrition promoters reaching 100,000 pregnant or lactating women and 500,000 children under the age of two.

In the case of Shamsun, her diet has improved with the guidance and encouragement of Marium Begum. She was able to breastfeed her daughter, complementing the breastmilk with normal family food and the special dietary supplement. And instead of selling the eggs her six hens lay, she feeds them to her family. Shewli, although still small and thin, has resumed healthy growth.

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