Gazi Shariful Hasan :
Sumona and her husband work in a Garments factory near Gazipur. They have 3 kids. During working hour Sumona’s old mother take care of their children in house. One day she found that her younger kids couldn’t move properly. Then she went to a doctor with her kid. Doctor said to her that her kid was in lack of nutrition, so it was not possible for the kid to move properly. Sumona was afraid. Doctor advised her to give nutritious food regularly – not one or two day.
Pinky is one and only child of her parents. All the time her mother feed something. For that reason she is now 55 kgs in 13 years age. One day she felt massive pain in her knees. Her parents thought that it is a normal pain. They went to a medicine doctor. But after observation, medicine doctor referred Pinky to an orthopaedic doctor. The parents became afraid. Orthopaedic doctor told them that due to overweight Pinky’s knee become unable to carry her weight. He asked her parents why not they gave her proper diet. Then parents understand their unforgivable fault.
These two cases show us the negative impact of malnutrition and excessive feeding. First we have to know what is proper feeding for children according to their age. Without knowledge of that children may be at risk because of our fault. According to United Nations, Bangladesh is one of the 36 countries with high malnutrition in the world. World Health Organisation (WHO) has stated that Bangladesh is in an alarming situation with 16% of acute malnutrition.
Malnourished babies never become a healthy citizen of the country. They will be the burden of the society. They cannot contribute for building the nation. This is our high time to address this issue properly. If we go for solving this problem, we need multisectoral approach. Because this is quite impossible for Ministry of Health and Family Welfare alone to solve this problem. Evidence has shown that multisectoral approach contributes significantly in reducing malnutrition. Although it is easy to talk about multisectoral approach, it is difficult to implement in reality. Incorporating nutrition sensitive component by each relevant ministry will collaboratively contribute in reducing the prevalence of malnutrition in Bangladesh.
UNICEF has adopted a conceptual framework in 2013. In this framework we find that inadequate dietary intake is interlinked with diseases. When a child suffers from disease it hampers her nutrition absorption. It stunts her childhood development. When she becomes an adolescent the impact lingers on. When she becomes a mother she gives birth to an under-nourished child. This is the vicious cycle of nutrition. To come out of this we need to adopt the multi-sectoral approach. If we look of health sector we will see that Bangladesh has achieved remarkable progress in different health indicators like MMR, IMR, EPI Coverage and so on, except nutrition.
An ICDDR,B study shows that there is a reduction in exclusive breastfeeding after the child reaches three months. Mothers want to exclusively breastfeed their children but after three months the mothers perceive that they do not have enough breast milk to carry on with exclusive breastfeeding. So mothers opt for supplementary foods and that eventually hampers exclusive breastfeeding. Initiation of complementary foods at the beginning of seventh month also does not happen properly. These initial setbacks cause malnutrition and stunting among children. Low birth rate is a major risk factor of child malnutrition. In our country low birth rate is more than 30%. It mostly happens to adolescent mothers. They themselves are malnourished. So we need to start from adolescent girls, then pregnancy, pregnancy nutrition, infant and childhood.
Malnutrition is inter-generational; a malnourished mother gives birth to a baby weighing less than normal. If this baby failed to make up this by gaining adequate weight, it becomes stunted. This is one of the immediate effects. But there are some long term effects too. Stunted children have more chances of suffering from cardiovascular diseases, diabetes, osteoporosis and so on in adult life, which not only reduce individual quality of life but also burden society. An undernourished child lags behind in school attendance and performance because her mental capacity has been negatively affected by malnutrition. Her poor performance in school will impact on her career. These children do not get good jobs and consequently do not live up to their potential. Furthermore, their children suffer from the same vicious cycle.
In Bangladesh, we have a national strategy, a national plan of action for feeding practices, strategic framework for communication, national nutrition policy, BMS Code and maternal leave for six months. Our national document policies like 6th five-year action plan and Vision 2021 has given due importance to nutrition. We have an excellent environment here for doing extensive work on nutrition sector. Besides government, we are also getting effective support from different stakeholders.
In our country, 47 million people live under the poverty line. Among them, 26 million are extreme poor. They do not have access to three meals a day, let alone nutritious food. If we cannot eradicate poverty we would not be able to eradicate malnutrition.
Finally we have to find innovative ways of eradicating malnutrition. Simple is beautiful. Sometimes we create very complex programme for the general people. Programmes should be easily comprehensible. The most important thing is that very few of our programme regarding this issue are sustainable.
Many nutritional interventions are cross-cutting. Nutrition sensitive interventions have been shared by different ministries. They have separate budget for these activities. If we can coordinate these activities then there will be no resource shortage.
Multisectoral activities should be coordinated from the highest level of government. For example, in Brazil, President Lula led the multisectoral programme on nutrition and achieved remarkable success within few years. Bangladesh is now self-sufficient in rice production. With proper incentives we can also become self-sufficient in production of nutrient foods like lentils, wheat, corn etc. This is an example of the multisectoral approach.
Nutrition gets very little attention in our media. Media can play a big role in creating awareness about nutrition. Ministry of information can play a vital role regarding this issue.
Bangladesh has come a long way. Still we have to go longer. In Bangladesh, coordination is not a very easy task. But once it happens properly it would work like a miracle. We need a strong cooperation for accelerating our efforts in nutrition between government agencies and all stakeholders including UN agencies, donor partners, NGO sector, private sector, civil societies and media.
(Gazi Shariful Hasan is a nutrition expert)
