Dr. A M M Anisul Awwal, PhD :
Malnutrition results from the interaction of many factors that involve our daily life and the life style of individual, segment of population or unfortunately, even a big segment of population. The extent and the magnitude of malnutrition can vary across population, geographical area and the continents, but the basic determining factors (causes) are the same in any place of the world. Lack of food (not just foods, but any and every factors that are related to food – food policy, agriculture policy, affordability, availability, food culture, transportation, irrigation, knowledge, taboo etc.), lack of caring practices (not just caring practices but also includes anti-natal, natal and post natal practices, EPI, breastfeeding, eating, feeding, etc) and lack of health services (not just health services, but all the issues related to health – hospital, doctors, nurses, paramedics, medicine, equipments, transportation, behaviour of the service providers, facilities, acceptability etc.) are the basic determining factors of malnutrition. The relationships between and among the factors determine the outcomes of the nutritional status.
If we critically look at the food culture of a pregnant woman of Bangladesh (which may be true for any other developing country), we would find that there are social/familial embargo or restrictions of eating/consuming many types of food during pregnancy. Most unfortunately, when the calorie requirement increases by 300 Kcal/day (from the normal consumption of 2000 – 2200 Kcal/day), due to ignorance of the family member (basically elderly) daily calorie consumption goes down to 300 Kcal from the normal consumption which ultimately results Low Birth Weight babies and sometimes maternal mortality due to acute malnutrition. Over eating is also being manifested in few societies of the country which is also not desirable as that also evokes detrimental results for the baby and the mother.
Women population has two peculiar beliefs with respect to pregnancy. Most of the women who need more food during pregnancy actually reduce intake with the false belief that the child in the uterus would become big, and thus, would make delivery difficult. If it occurs, her life will be threatened. At the same time, they work more to keep themselves active and ‘rest’ becomes a luxury for them. This ‘behavioral practice’ directly affects the intrauterine growth of the child, and makes the mother prone to exhaustion, fat depletion, anaemia, lethargy and last but not the least, death.
In the developing countries, about 55-60% deaths among children under 5 years of age are attributable to malnutrition. About 60-70% pregnant women and children less than 5 years of age have been suffering from nutritional anaemia (iron deficiency anaemia). About 35% populations have iodine deficiency and 20% have goiters of various grades. The incidence and prevalence of night blindness and blindness due to Vitamin-A deficiency are also noticeably high, but within acceptable range amongst the under five populations in Bangladesh.
Low Birth Weight (birth weighing equal or less than 2.5 kg) is the most visible stigma of pregnancy outcomes due to poor maternal nutritional status before and during pregnancy. The more the incidence of LBW, the more the women are deprived of their basic rights – foods, caring practices and health services including safe motherhood, decision making power and gender equity. The weight of a newborn basically reflects the quality of its intrauterine development, respect for women in the society, and the health care including the services the woman received during pregnancy.
The life style of the population of Bangladesh encompasses many undesirable phenomenon like food culture, marriage, eating and feeding practices, low literacy rate, lack of empowerment etc. Adolescent marriage and adolescent pregnancy is universal in this country, which is associated with poverty, lack of social protection, lack of social empowerment, health problems including UTI etc. The other immediate causes of LBW are also an integral part of their life – lack of food, lack of caring practices, lack of health services and lack of environmental sanitation.
In normal physiological state, a healthy mother gives birth to a child weighing usually about 3 to 3.3 Kg. The rate of growth of children since birth should be at least 3.3 Kg at birth, 6.0 kg at three months, 7.8 kg at five months, 9.2 kg at nine months, 10.2 kg at 12 months, 11.5 kg at 18 months and 12.6 kg at 24 months. Birth weight is an important parameter which could be indicative of (1) the immediate viability of the neonate, (2) the state of maternal health and nutrition before and during pregnancy, (3) respect for the women (4) women’s rights and most importantly (5) the future quality of life of the baby.
It is expected that each and every pregnant women would receive the best possible start of their new life. It is also expected that every child since the beginning of the journey of life should have the best possible start, every child should receive a stimulation of connectivity, every child should get good quality of basic education, every child should have the opportunities to develop his or her full potential and contribute to society in meaningful ways. Most of the brain development happens before a child reaches three years of age.
In a short span of 36 months, children develop their abilities to think and speak, learn and reason, and lay the foundation for their values and social behavior as adults.
Choices made and actions taken on behalf of children during this critical period affect not only how a child develops but also how a country progresses.
The most precious organ of the body is the brain which is one of the most sensitive organs as well. When infants are held and touched in soothing ways, they tend to thrive. The brain’s malleability during these early years also means that when children do not get the care they need, or if they experience starvation, malnutrition, abuse or neglect, their brain development may be compromised. Early childhood period starts from fertilization of ovum in the uterus.
The effects of what happens during the prenatal period and during the early months and years of a child’s life can last a lifetime. It affects all the key ingredients of emotional intelligence, confidence, curiosity, intention, self-control, relatedness, capacity to communicate and cooperativeness that determine how a child learns and relates in school and in life. It is, of course, never too late for children to improve their nutrition, health and development, to learn new skills, overcome fears or change their beliefs.
With brain connections proliferating explosively during the first three years of life, children discover new things in virtually every waking moment. At birth, a baby has about 100 billion brain cells. Most of these cells are not connected to each other and cannot function on their own. They must be organized into networks that require trillions of connections or synapses between them. These connections are miracles of the human body, depending partly on genes and partly on the events of early life. Many kinds of experiences affect: how young brains develop, but nothing is more important than early care and nurturing. The uniqueness of the human brain lies not only in its size and complexity but also in the properties that make it extraordinarily interactive with experience. Every touch, movement and motion is translated into electrical and chemical activity that shifts the genetic momentum.
Human interactions are as important to the development of brain connections as having food to eat, sounds to hear and light to see. There are periods in life when the brain is particularity open to new experiences and especially able to take advantage of them. If these sensitive periods pass by without the brain receiving the stimulation for which it is primed, opportunities for various aspects of development may be substantially reduced and ultimately, the child would finally grow up as less intelligent person of the family.
There is no single approach to address malnutrition. The issue itself is a cross-cutting one, and thus, should be tackled from multiple directions. The core importance lies in the efficient management of BCC (behaviour change communication) activities at all levels of intervention with increase in the horizon of services for the recipients, optimum utilization of services, appropriate utilization of the services of the experts, making the services affordable etc.
The role of the journalists and the mass media is magnanimous and unique in creating a positive attitude towards expected behavior change in relation to health, family planning and malnutrition through innovative ideas, constructive criticism, reporting, supporting, writing, forming interest groups, etc.
In this modern era, the ‘key to success’ in the social sector is largely in the hands of the journalists and the mass media along with the sincere devotion of the persons involved in the implementation of nutritional activities.
By recognizing the issue, there should be a group of journalists who should be trained on various dimensions of malnutrition including the health matters so that they can properly assist the government and the people involved with the service delivery and committed to improve the overall socio-economic situation of the country.
(PID-Feature)
(Dr. Awwal is Joint Secretary, Ministry of Labour and Employment, GoB)
