Malnutrition condition resulting from faulty, inadequate or unbalanced nourishment. Malnutrition may also be considered as under- and over supply of nutrients than the amount needed to maintain a normal growth, development and maintenance of health. Malnutrition caused by over supply of nutrients is not a problem in Bangladesh. Rather, malnutrition caused by the under-supply of nutrients is a major public health problem in the country. A downward trend in the intake of cereals, pulses, vegetables, fruits, fish, meat, milk and oil has been recorded over last few decades. Intake of cereals has decreased from 546g in 1962-64 to 427g in 1991-92, intake of pulses decreased from 40g in 1937 to 7g in 1991-92. Similarly, vegetables intake decreased from 284g in 1937 to 176g in 1991-92. Intake of fruits, total animal foods, fish, meat, milk and oils has also decreased resulting in the decrease of intake of total amount of food.
As a result of low intake of nutrients, lack of nutrition education, food taboos, traditional food habits, excessive and unscientific methods of processing and cooking, faulty intra-household food distribution among the members of the family, large-scale adulteration of foods, infection and frequent attack of diarrhoeal diseases, measles, partussis, faulty weaning practices, and for some other related causes, the nutritional status of the people is very poor.
Most affected group of population is the children and the pregnant and lactating mothers. Only 6.2% of the children aged 0-72 months are normal. The remaining 93.8% children suffer from various degrees of malnutrition.
Gender differential analysis shows that girls are more severely malnourished than the boys of same age groups. Again higher proportions of rural children are malnourished than their urban counterpart. Infant mortality decreased from 250 per 100,000 in 1962 to 94 in 1990, and 77 in 1994. Child mortality rate was 151 in 1990, which dropped to 134 in 1994. Of all the under 5 deaths, 50-60% were directly or indirectly related to malnutrition. More than 50% of all deaths in parental and neonatal period are related to low birth weight and premature delivery.
One third of all deaths among children in Bangladesh is associated with severe malnutrition. The risk of dying from severe malnutrition is high among girls compared to boys. Colostrum rejection is common (60-90%) in the country. Exclusive breast-feeding is only 4%. Bottle feeding is practiced by 90% mothers in urban areas. Prelacteal food is given to 100% of the infants. Mean weight and height of non-pregnant women are 39 kg (32-48 kg) and 148 cm (135-157 cm) respectively. Loss in mother's body weight per child is estimated to be 1 kg. About 74% of adult women and 80% of the pregnant and lactating mothers suffer from anaemia (Hb 11g/dl blood).
Maternal mortality is as high as 450 per 100,000. Mean birth weight of babies is 2.7 kg, 37-41% babies born in rural areas are of low birth weight (2500g) as against 23-27% babies in urban areas. About 1.7% of the children aged between 6 and 71 months in 1989 suffered from night blindness compared to 3.6% in 1982-83, and about 30,000 children are becoming blind every year due to vitamin A deficiency. The people of Bangladesh are at a risk of iodine deficiency. In 2000, about 69% of the population were iodine deficient, 47% had goitre and 9% had visible goitre, about 5,00,000 persons were mentally retarded due to iodine deficiency. [M Kabirullah]
Child malnutrition Although the country has recently achieved nearly self-sufficiency in food production that is, mainly rice and to a lesser extent wheat, the poor children have little access to the food because of lack of buying capacity on the part of their parents. Also, rice alone cannot provide the necessary nutrients for balanced growth, there is a need for certain amount of protein intake such as meat and fish, and of food items with high vitamin and mineral content such as fruits and vegetables. The typical manifestation of child malnutrition is a deficiency what is described as protein-energy malnutrition - that is, deficiency of both protein-containing food and energy-providing cereal. Prolonged protein-energy malnutrition in children results in growth stunting and wasting; weight gained at a certain age (weight for age) is much less than what is accepted as normal in such children.
In the mid-1990s, it was estimated by the FAO that about 56% of Bangladesh's children were underweight for their age suggesting chronic malnutrition. The situation has not improved. Around two-thirds of children under the age of five years suffer from some degree of malnutrition in Bangladesh. Malnourished children are more vulnerable to infectious diseases, have stunted growth and suffer from slower mental development. Data show that with per capita annual income of less than Tk 2,000, nearly 85% of the children in that income-group are malnourished. With per capita annual income in the range Tk 2,000 to 10,000 about 60% children are malnourished, and with over Tk 12,000 the percentage of malnourished children is still quite high, about 30%. The last finding suggests that only income is not sufficient for achieving proper nutritional status, there are other factors such as food habit, disease susceptibility etc that are also to be taken into account.
An NGO called Hunger Project recently (end of year 2000) estimated that in Bangladesh as many as 700 deaths occur in a day, of which 655 are children, due to causes related to 'persistent hunger'. This is an astounding figure, but given the level of acute poverty and its painful manifestations that are too seen in various settings, the figures may not be too far removed from the truth. This nutritional deprivation occurred despite many of the nutritional intervention programmes that were instituted by the government under the aegis of the World Bank to cushion the adverse effects of free market transition on health of the poor. Among these, a major project was the National Integrated Nutrition Project, funded by the World Bank, and Vulnerable Group Feeding programme. These were targeted at the poor below poverty line, since it is well established that this group suffers most for a few years during the transition from a regulated economy to free market economy; these people become poorer during this time with grave consequences on their nutritional status.
Child malnutrition due to vitamin A deficiency that causes night-blindness in children is high in Bangladesh. Most rural children run a high risk of vitamin A deficiency because of inadequate dietary intake of the vitamin, due largely to poverty, and partly due to poor eating habits resulting from ignorance. Surveys that have been carried out in recent years suggest a prevalence of vitamin A-associated night blindness in children of 1-6 years of age, of about 2%. Each day, nearly 82 children become blind in Bangladesh due to vitamin A deficiency, again an unbelievable number, but it tells the painful truth. For infants, it has been found that the Bangladeshi lactating mother can provide nearly 70% of the infant's vitamin A requirement. Vegetables and fruits are very rich in vitamin A. Homesteads in rural areas can serve well in producing green vegetables for the family with little cost and effort in our country since the weather is congenial for cultivation of some vegetables and fruits throughout the year. In recent years the government has instituted the extended programme oN immunization (EPI) programme where children under the age of 5 years are given high potency vitamin A capsule. However, the coverage achieved so far varies considerably from region to region, the range is 16% to 85%.
Another nutritional deficiency in children of Bangladesh is iodine deficiency disorder (IDD). But the problem is more pronounced among the adults. To ameliorate this, the government has promoted production and marketing of iodized salt which, it is hoped, will largely eliminate this deficiency from' the population. [Zia Uddin Ahmed]