May 21, 2013 | 10:28 PM (BD Time)
21 May, 2013 Tuesday
An overview of under-nutrition in Bangladesh
Under-nutrition has been and continues to be a serious public health problem in Bangladesh. Although there has been a reduction in child under-nutrition in Bangladesh, the prevalence of under weight children <5 is 41%. At the low annual rate of reduction in child under-nutrition of 1.27 percentage points it is unlikely that Bangladesh will be able to achieve the Millennium Development Goal targeting under-nutrition. For sustainable improvement, direct nutrition and health interventions, such as promotion and support for exclusive breast feeding and appropriate complementary feeding, micronutrient supplementation, de-worming, and improved hygiene should be implemented at scale covering at least 70% of the population. In addition to these direct interventions, accelerated actions on the determinants of under-nutrition such as income, agricultural production, girls' education, and gender equality are urgent to improve the overall health and nutrition status.
Malnutrition includes both under-nutrition and over-nutrition. Undernutrition includes both protein-energy malnutrition and deficiencies of micronutrients, such as essential vitamins and minerals (1). This article provides an overview of the current status of under-nutrition in Bangladesh.
(1) (Figure 1). Under-nutrition is the underlying cause of 3.5 million deaths worldwide, and accounts for 35% of the disease burden in children under five (2). Child and maternal under-nutrition seriously challenge progress towards national and international economic, health and development goals, including the Millennium Development Goals (3). The consequences of under-nutrition are serious, long-term, intergenerational and mostly irrevocable, resulting in increased morbidity and mortality, increased disease burden, and decreased IQ, physical capacity, and productivity. All of these have negative effects on income and economic growth of the country (3). Of the total global disability-adjusted life years (DALYs), 11% are lost due to child malnutrition (2).
Measures of under-nutrition
There are three commonly used indicators to assess growth faltering in children. These include height-for-age, weight-for-height and weight-forage. Deficits in these three indicators reflect a distinct process or outcome of growth impairment. Low height-for-age, commonly known as stunting, or chronic malnutrition, reflects a process of failure to reach linear growth potentials as a result of sub-optimal health or nutritional conditions. In younger children, aged 2 to 3 years, it reflects an ongoing process of 'failing to grow', whereas in older children it reflects the state of 'having failed to grow' or being 'stunted'. Low weight-for-height, commonly known as wasting or acute malnutrition, measures thinness and indicates a recent event of weight loss that is often associated with acute disease conditions or starvation.
Provided that there is no food shortage, the prevalence of wasting is usually below 5% even in low income countries. A prevalence between 10%-14% is regarded as serious and above 15% it is critical, warranting public health interventions (4). Low weight-for-age, or underweight, measures body mass relative to chronological age. It is influenced by both the child's height (height-for-age) and weight (weight-for-height). Thus weight-for-age fails to identify whether a child who is underweight is stunted, wasted or both. In children >3, low weight-for-age is primarily caused by stunting in most lowincome countries, although in famine situations low weight-for-age usually represents wasting (5).
Under-nutrition has been and continues to be a serious public health problem in Bangladesh (6). The prevalence of underweight children, defined as weight-for-age <-2 Z-score among children <5, was more than 65% in 1989-1990 (7) (Figure 2). Although it decreased to 47% in 2000, there has been little change since then. The most recent national nutrition survey shows that the prevalence of underweight children <5 is 41% (6).
Percentage of children with weighfor- About 43% of children <5 are stunted (height-for-age <-2 Z-score). Wasting
is present in 17% of children <5, with 3.4% of children <5 being severely wasted (6,8). This accounts for more than 0.5 million children with severe acute malnutrition in the country. Furthermore, rates of low birth weight among Bangladeshi infants, although reduced from 40%, are still among the highest in the world, ranging from 20-22% (9-11). These children are at risk of death or severe impairment of growth and development. Unlike children, the nutritional status of women in Bangladesh shows a better trend. In 1997, 52% of women had chronic energy deficiency, defined as body mass index <18.5 kg/m2. Ten years later, there has been a sustained reduction in prevalence of chronic energy deficiency (30% in 2007) (6).
Micronutrient malnutrition is often termed as 'hidden hunger' as the consequences are not always visible. There are four micronutrients that are of particular relevance to public health: vitamin A, iron, iodine and zinc. Vitamin A deficiency disorders include the specific ocular manifestations of xerophthalmia and its blinding sequelae (which encompass - night blindness, bitot's spot, corneal xerosis and xerophthalmia) as well as nonspecific consequences such as anaemia, immune dysfunction, and increased susceptibility to infection, poor growth, and mortality (5). In Bangladesh, there has been a dramatic reduction in prevalence of night blindness among preschool children from the 1980s to 2004, which is attributed to the successful vitamin A supplementation programme launched in 1973 (12-15) with an impressive coverage of 88% (6). Post-partum vitamin A supplementation coverage for mothers, however, is very low at only 20% (6). Iron deficiency is one of
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