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Ironing out anaemia in the CHT

© UNICEF Bangladesh/2009/Naser Siddique
Women attend their community centre where they receive health and nutrition advice in Manikchori sub-district, Chittagong Hill Tracts, Bangladesh.
By Naimul Haq

Bandarban, Bangladesh: For almost eighteen months, school girls Ummey Aiman, 15, and Shefali, 16, were haunted by regular episodes of severe dizziness and weakness. These symptoms are common among adolescent girls in the Chittagong Hill Tracts (CHT), a remote hilly area mostly inhabited by tribal people, in eastern Bangladesh.

Aiman and Shefali were so fatigued they often skipped school and stayed home.

“I regularly experienced extreme tiredness, fatigue and severe headaches,” said Aiman, a student of class nine. She comes from a very poor family in Masjidghona village in the Bandarban district, some 500km southeast of the capital, Dhaka.

Aiman and Shefali were among thousands of young girls who had iron-deficiency anaemia. Low iron intake causes the blood’s haemoglobin levels to drop, preventing the blood from carrying sufficient oxygen to body cells, which results in the symptoms experienced by Aiman and Shefali.

Anaemia lowers immunity, inhibits growth, decreases learning ability and work capacity and contributes to low birth weight, say health experts.

A survey conducted by UNICEF in the three CHT districts in 2004 revealed that about 46 per cent of adolescents aged 13 to 19 suffered from iron-deficiency anaemia, compared with only 30 per cent of adolescents in the rest of the country.

The same study found that about 80 per cent of children aged 6-23 months suffered anaemia compared with 61 per cent elsewhere.

To help address the problem, a comprehensive anaemia prevention package was introduced in 2007 under the Integrated Community Development Project (ICDP), an initiative of UNICEF and the CHT Development Board. The programme provides iron supplementation and education on anaemia to high-risk groups - pregnant women, adolescent girls and young children.

Community promoters, who are already trained on awareness raising and behavioural change for other programmes, received additional training to deliver this package to households.

Adolescent girls were also selected as leaders to educate their peers about anaemia and provide iron supplements and follow–up support, under the mentorship of the community promoters.

The promoters and young leaders not only work on advocacy and distribution, but also supervise the actual intake of the iron tablets.

© UNICEF Bangladesh/2009/Naser Siddique
Misaching Marma, Community Nurse, checks the blood pressure of women in the community health clinic, Bandarban, Chittagong Hill Tracts, Bangladesh.
Each adolescent leader has a group of about 20–30 adolescent girls who assemble every week to discuss nutrition and take their iron tablets. Deworming tablets are also supplied every six months.

Aiman and Shefali are participating in such a group. Their symptoms of anaemia disappeared once they began treatment and they are now able to regularly attend school.

Sajeda Aktar, 13, an adolescent leader in Ghilatoli village, confirms this in her own words: “Many of my friends were very sick at the start of the programme. Some had sunken eyes while others had very skinny bodies. But as we progressed those who had been treated with iron tablets started to show improvement in their physique.”

Remote communities

Asma Akter, 32, is one community promoter working to reduce the burden of anaemia in her neighbourhood in Naikkhangcharri sub-district.

Early in the morning on a rainy day Asma walks along slippery paths up and down small hills to reach a housewife in Masjidghona. Her mission is to ensure that every woman in her designated area at risk of anaemia understands the importance of taking the iron pills regularly.

“Initially we faced resistance. People did not accept the pills easily. But continuous advocacy eventually broke the ice,” said Asma.

Zaheda Begum, 40, is working as a community promoter in the same sub-district. She shares her experience: “One of the challenges we face in the hill districts is the very high rate of illiteracy among the tribal people. It is hard to develop a sense of understanding among them.”

“In such an inaccessible forest region with almost no roads and public transport, people don’t pay many social visits. But when we started paying home visits for advocacy the beneficiaries warmly appreciated it.”

Every month community workers like Asma and Zaheda hold courtyard meetings with housewives and visit 30-50 homes to distribute iron tablets.

Improving nutrition

Parents are also advised on improving their children’s eating habits, with an emphasis on breastfeeding and timely introduction of solid and semi-solid foods.

The project also focuses on children aged 6-35 months, who are given a powder sachet containing five micronutrients – A, C, folic acid, iron and zinc. Mothers are advised to mix the powder with their babies’ food on alternate days.

“For many malnourished children the powder works like magic. Their weight increases in a couple of months while some babies become very active,” said  Zaheda.

“My eight-month old son was very frail and hardly had any interest in eating. But since I started to use the powder about a year ago I noticed a gradual improvement in him. He started to play, shows eagerness to eat and most importantly he no longer cries all day long,” said Rahima Aktar, mother of three from Adarshagram village in Naikkhangcharri.



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