Ahmed 1 the food and nutrition situation in bangladesh

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  • For paper 3, the authors reviewed 45 interventions, including breastfeeding promotion, complementary feeding promotion strategies with or without provision of food supplements, micronutrient interventions, and general supportive strategies for improving family and community nutrition and disease burden reduction. This table summarizes the various interventions with demonstrated impact on maternal and child undernutrition. Importantly, for each of the conditions contributing to nutrition-related disability and death there are already highly effective interventions available.
  • Explain that figure shows the sort of information generated by the model. Go through what it shows – what happens to children between birth and 36 months of age – so by 36 months of age about 9% of children have died and of those who survive over half (58%) are stunted.
  • Explain that figure shows the sort of information generated by the model. Go through what it shows – what happens to children between birth and 36 months of age – so by 36 months of age about 9% of children have died and of those who survive over half (58%) are stunted.
  • Ahmed 1 the food and nutrition situation in bangladesh

    1. 1. Dr Tahmeed Ahmed Director Centre for Nutrition & Food Security ICDDR,B Professor, Public Health Nutrition James P. Grant School of Public Health, BRAC University Food & Nutrition Situation in Bangladesh
    2. 2. Intergenerational Cycle of Malnutrition Llanos, Alvear, Uauy 2004 ADULTS Malnourished Adolescent Stunted Pregnancy Low Weight Gain Child Stunted Baby Low Birth Weight Higher maternal mortality Reduced mental capacity Reduced mental capacity Foetal Malnutrition Higher mortality rate Impaired mental development Untimely / inadequate weaning Frequent infections Inadequate food, health & care
    3. 3. Different Types of Childhood Malnutrition Wasted Low weight for height Stunted Low height for age Underweight Low weight for age Normal Normal height for age Children
    4. 4. Stunting in Early Childhood & Later Development Outcomes Mendez MA, 1999 46 48 50 52 54 56 58 Cognitive score at 8 y Not stunted Mildly stunted Moderately/severely stunted Philippines, n=2489
    5. 5. UNICEF; Black R, 2008
    6. 6. Trends in Prevalence of Underweight in Under-5 Children in Bangladesh 10 20 30 40 50 60 70 80 1989-1990 1996-1997 1999-2000 2004 2007 Percentagebelow-2SD NCHS/WHOReference Ahmed T et al. In press.
    7. 7. Trends in Prevalence of Underweight in Under-5 Children in Bangladesh 10 20 30 40 50 60 70 80 1989-1990 1996-1997 1999-2000 2004 2007 Percentagebelow-2SD NCHS/WHOReference Reasons for the decline: Increased literacy Fertility rate reduced Measles vaccination now at 83% Family size smaller Vitamin A supplementation coverage at 88% Rural electrification Increased food production & energy intake Microcredit? Ahmed T et al. In press.
    8. 8. Trends in Prevalence of Underweight in Under-5 Children in Bangladesh 10 20 30 40 50 60 70 80 1989-1990 1996-1997 1999-2000 2004 2007 Percentagebelow-2SD NCHS/WHOReference Ahmed T et al. In press.
    9. 9. Trends in Prevalence of Underweight in Under-5 Children in Bangladesh 10 20 30 40 50 60 70 80 1989-1990 1996-1997 1999-2000 2004 2007 Percentagebelow-2SD NCHS/WHOReference Assumptions on reasons for the stagnation: •Increase in inequity (increase in Gini coefficient) •Reduction in infant mortality rate resulting in more infants surviving but with malnutrition Ahmed T et al. In press.
    10. 10. Trends in Prevalence of Underweight in Under-5 Children in Bangladesh 10 20 30 40 50 60 70 80 1989-1990 1996-1997 1999-2000 2004 2007 Percentagebelow-2SD NCHS/WHOReference 2015 Required rate of reduction, 1.36 percent points/yr Rate of reduction so far, 1.27 percent points/yr Ahmed T et al. In press.
    11. 11. Malnutrition is more common in Asia than in Sub-Saharan Africa 47.0 47.8 44.9 35.6 38.5 22.6 20.2 0 10 20 30 40 50 60 B angladesh 2007 India 2005-06 N epal2006C am bodia 2005Ethiopia 2005 R w anda 2005 U ganda 2006 Percentagebelow-2SD NCHS/WHOReference
    12. 12. Trends of BMI of Women in Bangladesh 52.0 45.4 34.3 29.7 0 10 20 30 40 50 60 1996-97 1999-2000 2004 2007 PercentofwomenwithBMI<18.5
    13. 13. On the Causes of Malnutrition Population increases in a geometric ratio, while the means of subsistence increases in an arithmetic ratio Thomas Malthus (1766-1834)
    14. 14. 0 200 400 600 800 1000 1200 0 200 400 600 800 1000 1200 1400 Population (millions) PopulationDensity(/sq.km.) Bangladesh Japan Pakistan Nigeria Indonesia Mexico Russia Brazil USA China India Population density in Bangladesh is 3 to 40 times higher than other ‘mega’ countries Limited Land Mass with the Highest Population Density
    15. 15. Korail Slum
    16. 16. Korail Slum •Close to 27% or 40 million live in urban areas •About 40% of Dhaka city population lives in slums •Dhaka is the fastest growing city
    17. 17. On the Causes of Malnutrition Famine and malnutrition are a result of a collapse of entitlements for a certain segment of society and the failure of the state to protect those entitlements. Amartya Sen
    18. 18. BBS, World Bank, WFP 2005 •Poverty •Food insecurity •Poor maternal nutrition •Low birth weight •Low rates of EBF •Lack of proper CF •Frequent illnesses
    19. 19. Food Security in Urban Slums Household consumption Dhaka Chittagong Khulna Rajshahi All <2,122 kcal/person/d 42.4 56.0 52.0 61.3 47.8 <1,805 kcal/person/d 24.2 35.8 38.5 36.0 29.0 Urban food security Atlas, 2008
    20. 20. Howarth Bouis, 2006 Share of Energy Intake in Bangladesh Staples Non-staple plants Fish and animal
    21. 21. - Carbohydrates in diet - ‘Fast food’ culture - Lack of exercise Slum Non-slum Underweight (BMI <18.5) 26.7 12.9 Over weight (BMI ≥25) 14.8 34.2 Diabetes mellitus 5.5 17.0 Hypertension 12.1 21.4
    22. 22. Severe Acute Malnutrition 2.9% in Bangladesh ~500,000 children At risk of death from • Hypoglycemia • Hypothermia • Infections
    23. 23. A 2 yr old girl with dysentery, pneumonia Weighed only 3.8 kg Treated with • therapeutic diets • antibiotics • micronutrients Diagnosed TB and treated appropriately Admission 2 weeks 4 weeks 5 weeks
    24. 24. Timeliness: Early Versus Late Presentation
    25. 25. There has been some improvement but much more is required
    26. 26. The Lancet Series on Maternal and Child Undernutrition
    27. 27. Evidence-Based Interventions Bhutta ZA, Ahmed T et al. Lancet 2008
    28. 28. Interventions with Sufficient Evidence to Implement in All Countries Maternal and Birth Outcomes • Iron folate supplementation • Maternal supplements of multiple micronutrients • Maternal iodine through iodization of salt • Maternal calcium supplementation • Interventions to reduce tobacco consumption or indoor air pollution Newborn Babies • Promotion of breastfeeding (individual and group counseling) Infants and Children • Promotion of breastfeeding (individual and group counseling) • Behavior change communication for improved complementary feeding • Zinc supplementation • Zinc in management of diarrhea • Vitamin A fortification or supplementation • Universal salt iodization • Handwashing or hygiene interventions •Treatment of SAM Bhutta ZA, Ahmed T et al. Lancet 2008
    29. 29. Interventions with Sufficient Evidence to Implement in All Countries Maternal and Birth Outcomes • Iron folate supplementation • Maternal supplements of multiple micronutrients • Maternal iodine through iodization of salt • Maternal calcium supplementation • Interventions to reduce tobacco consumption or indoor air pollution Newborn Babies • Promotion of breastfeeding (individual and group counseling) Infants and Children • Promotion of breastfeeding (individual and group counseling) • Behavior change communication for improved complementary feeding • Zinc supplementation • Zinc in management of diarrhea • Vitamin A fortification or supplementation • Universal salt iodization • Handwashing or hygiene interventions •Treatment of SAM Hygiene interventions: Reduce incidence of diarrhea by 30%, reduce odds of stunting Bhutta ZA, Ahmed T et al. Lancet 2008
    30. 30. Evidence-Based Interventions Bhutta ZA, Ahmed T et al. Lancet 2008
    31. 31. Coverage is most important ! Reduction in deaths Reduction in stunting % of DALYs averted 99% coverage 25% 35% 25% 90 % coverage 22% 32% 23% 70 % coverage 17% 27% 17% Bhutta ZA, Ahmed T et al. Lancet 2008
    32. 32. To eliminate stunting in the longer term, these Interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women’s empowerment.
    33. 33. Recommendations • Business as usual will not work • Need to think out of the box now • There is no one size that fits all, several strategies need to be tried
    34. 34. Recommendations • Immediate need is to improve existing services and scale them up – Primary health care focusing on child & maternal health and nutrition should be priority – Increase number of centers, staff – Improve quality of counseling – Rigorous monitoring of quality of services to reduce dissatisfaction with existing services
    35. 35. Recommendations • Primary health care intervention package should be expanded and improved – IFA tablets for adolescent girls, PLW – Breastfeeding & complementary feeding – Micronutrient powder for infants & young children – Management of moderate & severe acute malnutrition
    36. 36. Undernutrition hotspots need special attention – Monga-prone areas in the north – The coastal belt and char areas – Areas in Chittagong & Sylhet divisions with higher prevalence of child malnutrition – Rat-infested areas in the Hill Tracts
    37. 37. Recommendations • But the ultimate goal is to prevent/control rapid unplanned urbanization – Create livelihoods in rural Bangladesh – Control population growth drastically – Improve livelihood & living conditions of people who are already living in urban areas

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