Asia-Pacific, Development & Aid, Headlines, Health

HEALTH-BANGLADESH: Valuable Lessons in Tackling Malnutrition

Tabibul Islam

BOGRA, Bangladesh, Jan 9 1998 (IPS) - Perseverance has paid off in the villages of Gabtoli sub-district, some 230 kms northwest of the Bangladesh capital, where severe malnutrition among children under two has been wiped out.

Though only half the population of this very poor country lives in absolute poverty, a staggering 93 percent of children under five are malnourished, suffering from dietary deficiencies like goitre and anaemia. Most babies are born underweight, since their mothers are chronically malnourished.

Not anymore in Gabtoli ‘thana’ though. An ambitious World Bank financed government programme to overcome malnutrition has been providing children under two with supplementary food and teaching their mothers what kind of foods are best for them since November 1996.

At ‘community nutrition centres’ set up under the project, children were fed ‘pusti’ — a mixture of 20 gms of powdered rice, 10 gm of powdered lentil, 5 gm of molasses and 3 ml of soybean, which is easy to make at home.

The ‘pusti’ was distributed free at the nutrition centres by BRAC, a leading Bangladesh NGO which is assisting the government in implementing the Bangladesh Integrated Nutrition Project (BINP), a brain child of the U.N. children’s agency, UNICEF.

“The ‘children feeding programme’ ended after the last child checked out on Aug. 31 last year. Now there is no under-2 child suffering from severe malnourishment in Gabtoli thana,” a representative of BRAC claims.

Introduced in 1996 in six ‘thanas’ (sub-districts), the BINP will run for five years. By the turn of the century, the government hopes to cover 40 of the 460 thanas in the country.

Women and children are the primary beneficiaries. Apart from raising awareness on health issues, the programme also seeks to tackle poverty alleviation by advising women on income generating activities like kitchen gardens, poultry farming and cattle raising, money for which is given as loans from a credit scheme.

“BINP is creating mass awareness about ways of improving the health of children without much effort and much cost,” observed Rahim Mollah, a teacher in a local primary school.

In the project area, pregnant women and mothers queue up six days a week to meet the community nutrition promoter (CNP), a local woman — who has to have studied up to class eight — trained by BINP to motivate rural women to attend the counselling sessions on health, family planning, immunisation, sanitation and environment.

“Though BINP is yet to be fully evaluated, initial results in all the six ‘thanas’ are promising,” said a senior official of the Health Ministry.

The project is based on the experiences of successful nutrition schemes in India, Indonesia and Tanzania. It is being implemented at a cost of 67.3 million dollars, the bulk of the money (59.8 million dollars is a loan from the International Development Agency (IDA), the concessional lending affiliate of the World Bank, the rest is from the government.

Very broadly, the programme aims to reduce malnutrition among women and children through household food security, behavioural changes related to food intake, infant feeding practices, growth monitoring and caring practices.

For the first time in Bangladesh, poverty is not being seen as the only reason for malnutrition. The focus is on caring practices about food and feeding, about health and hygiene and about psycho-social development that account for malnutrition which is immediately removable without having to wait for more economic development or increased food production.

BRAC which is implementing the project by itself in three thanas, and in cooperation with the government in the rest, has set up 972 ‘nutrition centres’, where the growth of baby’s who visit regularly is monitored, and their mother’s are advised to continue breastfeeding.

Every month, infants are weighed and their progress charted on cards that their mothers are taught to fill. Pregnant and lactating women are also covered by the supplementary feeding programme.

Project planners envisage the nutrition centre will eventually become a community centre, where women can meet regularly to discuss not just nutrition but a broad range of welfare issues.

Optimistic officials say BINP will increase the child survival rate in Bangladesh, which in turn will lead to lower birth rates and improvements in women’s health.

Half a million children die every year due to complications resulting from malnutrition, annually 30,000 children go blind due to Vitamin A deficiency and 56 million people have visible and palpable goitre due to iodine deficiency.

UNICEF, which has planned the programme, is giving technical assistance and expertise.

According to a report presented by UNICEF country representative Rolf C. Carriere to Prime Minister Sheikh Hasina Wajed that evaluates the economic cost of malnutrition, primarily in agriculture, Bangladesh stands to lose some 22 billion dollars over a 10 year period up to 2003.

However, the report is optimistic that every dollar spent on the nutrition programme will reap 7 dollars for the country, one of the poorest in the world.

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