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Child malnutrition: A case for concern

© UNICEF/BANA2014-01438/Haque
A mother and child participate in a UNICEF supported nutrition survey by the Rapid Nutrition Assessment Team, RNAT, at Netrakona.
By Kamrul Hasan Khan

Netrakona, Bangladesh, 6 July, 2014: An extremely bony appearance, low weight, infections and distaste for food – all indicate severe malnutrition in 14-month-old baby girl Omi, but her mother Lucky Akter thought she was fine, a dangerous ignorance.

 “Her poor health, continuous whimper, nagging cold and fever, irregular sleeping habit worry me a lot, but neighbour’s told me that these were not big problems. They told me these bothering signs will go away when she would grow up,” Lucky, 22 says.

 A poor housewife and mother of two from SingherGaon village in the northern district of Netrakona, Lucky tried hard to buy better food as much as her construction labourer husband can afford, but the health condition of Omi did not change.

 “I spend very busy days doing household and all other family chores as my husband migrated to Dhaka for work. On top of that, it seems too much for me to take care of such a child,” she says.

 The Rapid Nutrition Assessment Team (RNAT)

 After the death of two of her infant children who died within 30 minutes of birth, Lucky was extra careful and regularly consulted doctors when she got pregnant with her current three-year-old daughter. Consulting the doctors cost her husband 25,000 taka ($320) that pushed them deeper into poverty.

 “Sometimes, I thought about taking Omi to doctors, but nobody around me could guide me,” the mother says.

 So, there was nobody to advise her about the malnutrition and her daughter's alarming health condition until a survey group supported by UNICEF visited her house to assess the nutritional situation in the district.

 The survey group leader, M. Akhtaruzzaman, a professor at the Institute of Nutrition and Food Science (INFS), University of Dhaka, who was leading a group of enumerators, found severe malnutrition in Omi and warned Lucky.

 “The child's clinical signs indicate severe malnutrition. So, we asked the parents to take her to a doctor immediately and assured them that proper treatment can help her grow like other children,” professor M. Akhtaruzzamanexplains.

In impoverished Bangladesh, the prevalence of malnutrition is very high and is one of the leading causes of morbidity and mortality in children. According to the Bangladesh Demographic and Health Survey (BDHS) 2011 around 600,000 or 4 percent of under-five children in Bangladesh are severely wasted at any one point in time.

 According to the BDHS 2011, some 41 percent of under-five children are short for their age, 16 percent are wasted, and 36 percent are underweight.

© UNICEF/BANA2014-01453/Haque
The Rapid Nutrition Assessment Team, RNAT, measures the weight of a child during a household survey on nutrition status at Netrakona.
The coming of the RNAT

Akhtaruzzaman is a member of the Rapid Nutrition Assessment Team (RNAT), an intervention under the UNICEF-supported programme 'Strengthening National and Local Capacities in Nutrition Assessments and Preparedness in Ten Disaster-prone Districts'. The project funded by ECHO aims to build national and local systems and capacities to assess and prepare for nutrition in emergencies.

Other than Netrakona the programmealso covers the following districts:Faridpur, Sunamganj, Habiganj, Rajshahi, Tangail, Cox’s Bazar, Khulna, Jamalpur and Satkhira. These are among the 20 districts highly vulnerable to cyclones, floods, flash floods and water logging.

The project is being implemented in partnership with the Government of Bangladesh and the Dhaka University's INFS.

Bangladesh is among the world’s most climate-vulnerable countries, with more than 80 percent of its population potentially exposed to floods, earthquakes and droughts and more than 70 percent people to cyclones, according to the World Bank (2012). The country faces one of the highest rates of mortality risk from natural disasters.

Inadequate infant and young child feeding practices and poor hygiene leading to infections are the main causes of child malnutrition. Disruption of livelihoods in an emergency can increase the likelihood, causing rapid deterioration of nutrition situation, especially among the most vulnerable and the poor.

‘’The combination of pre-crisis vulnerability in relation to the nutrition and the impact of disasters on livelihood and child feeding practices means the nutrition situation should be assessed and monitored’’, says Andrew Musyoki, Nutrition Cluster Coordinator, UNICEF Bangladesh.

Work in the field, not a walk in the park

For the purpose of conducting the surveys, this RNAT team -- four members of which are from the INFS and two from development organisations/partners -- has been trained on Standardised Monitoring and Assessment of Relief and Transition (SMART), a survey method recognised the world over.

“The main purpose of establishing and training the RNAT is to ensure that they can gain skills on how to undertake good quality nutrition surveys using SMART methodology,” Andrew explains, adding that surveys are essential for assessing and monitoring the nutrition situation for they help in defining the most appropriate assistance to address the identified needs.

“In case the nutrition cluster or any partner needs to undertake a nutrition survey, they can hire the RNAT to do it. In the event of a disaster, these people will be deployed in the field to undertake a nutrition survey,” he adds.

“Training of the RNAT team was a blend of academic knowledge and working experience,” says SMART trainer, Blessing Mureverwi, explaining that the team members were already experts in nutrition and disaster.

“The RNAT members have been trained on ways to guide the enumerators, who are essential for conducting a survey, and to take measurements of children as well as interview parents to ensure quality’’, adds the SMART trainer, Blessing.

The SMART methodology is being used to harmonise the country's nutrition surveys so that tracking the trends in nutrition situation evolution over time and comparability of results can be ensured.

The Netrokona survey is among the two surveys planned under the current project.Other key interventions include preparation of harmonized national nutrition survey guidelines and tools and training of 300 disaster management committee memberson nutrition in emergency.

As a result of the intervention, over 700 people are expected to benefit directly.





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