Nutrition

Globally nutritional status is considered as the best indicator of young childhood wellbeing and for monitoring progress towards the Millennium Development Goals, especially Goal 1. Malnutrition is central to many of the health issues in Bangladesh, as it is in many developing countries, with attendant poor growth, susceptibility to infections, slow cognitive development and low birth weight. Protein energy malnutrition is the most obvious, but other specific deficiencies are also common, including vitamin A, iron, zinc and iodine deficiency. Because so many children are small, Protein energy malnutrition may not be recognized as abnormal. Similarly, health care providers do not always recognize children as malnourished when they come for treatment of common illnesses.

In Bangladesh 45% of newborn infants weigh less than 2500 grams – a proportion higher than any other country. The high incidence of low birth weight is viewed as a major obstacle to improving child health and development. Large-scale nutrition programmes attempt to improve the nutrition of pregnant mothers with the goal of increasing birth weight, but the efficacy of such programmes and the optimal nutritional supplements are not well defined, nor are the roles of other environmental and individual level factors such as infections, stress or workload.

Though breastfeeding is universal in Bangladesh, most mothers still do not exclusively breastfeed for six months, often beginning supplemental feeding at an early age, making infants more susceptible to infections and malnourishment. Effective peer-counselling strategies, developed and evaluated by ICDDR,B in small-scale studies, need to be scaled up.

An equally important problem relates to inadequate and inappropriate complementary feeding from six months of age. Our knowledge about actual feeding practices in older infants and children is limited and much less is known about effective interventions.

As our knowledge about micronutrients has increased, so has the complexity of the related issues. Micronutrients interact in surprising ways and the benefits of supplementation depend on a variety of factors, including nutritional status and other micronutrients.

Malnutrition is a condition that can be treated, but it requires a comprehensive approach. ICDDR,B scientists demonstrated the effectiveness of a protocolized management of severe malnutrition, lowering the fatality rate of this life-threatening condition by 75% at our Dhaka Hospital. As a result, ICDDR,B played a key role in formulating the national treatment guidelines in Bangladesh, in collaboration with the Centre for Medical Education, the Institute of Public Health Nutrition, UNICEF and leading academics from different medical colleges.

Although vitamin A is distributed routinely in Bangladesh, there are opportunities for improving children’s health through identifying foods rich in vitamin A as well as food fortification.

ICDDR,B scientists have documented the effectiveness of zinc therapy when used during the management of diarrhoea episodes in children. Zinc therapy reduces the duration of diarrhoea, lessens the chance it will become chronic, and lowers the overall number of deaths in children by 50%. ICDDR,B is now focusing on validating the effectiveness of zinc in other conditions and scaling up its availability to all children under the age of five in Bangladesh.

At a glance

• Malnutrition is estimated to be an "underlying cause" of about 60% of child deaths in Bangladesh. This attribution as an "underlying cause" hides that observation that if the malnutrition had been corrected, the child would not have died.
• There have been slow improvements in overall nutrition indicators in Bangladesh.
• Exclusive breast feeding is widely recommended, but poorly practiced in Bangladesh. Many small scale interventions have effectively improved rates of exclusive breast feeding, but none have been effectively brought to scale.
• Children in Bangladesh fall off the growth curve when they start to take complementary foods. Improving growth during this time will require efforts to improve complementary feeding behaviours. Families have been receptive to these changes when introduced through small scale educational programmes.