It is indeed poor feeding practices, not a lack of food, that are frustrating the fight against malnutrition in Bangladesh, a study shows.
According to the Bangladesh Demographic and Health Survey 2011 findings, over one in four under-5 children of the most affluent people have stunted growth due to malnutrition. It is even 36 per cent among the children just below the highest wealth group.
‘Wealth alone will not correct malnutrition. They have to be aware of what to feed their children,’ Tahmeed Ahmed, director of ICDDR,B nutrition programme, said.
A child is recommended to be exclusively breastfed up to six months and given homemade food containing animal protein and vegetables after six months while continuing with breastfeeding.
Experts say it is critical to act during the first two years of a child’s life — which is a window of opportunity. ‘If it closes, it is too late to reverse the damage,’ said Rukshana Haider, chairperson of Training and Assistance for Health and Nutrition.
‘This is when under-nutrition peaks and when interventions during pregnancy and after birth can lessen damaging effects on children’s physical growth and capacity to learn.’
The BDHS showed only 21 per cent families strictly follow the under-2 feeding practices in Bangladesh where 41 per cent children are too short for their age while 36 per cent are underweight.
Only 30 per cent children under-2 from the wealthiest group are fed appropriately, as per the study.
‘The rich and the poor have equal knowledge about nutrition unless someone teaches them,’ said SM Mustafizur Rahman, programme manager, National Nutrition Services.
‘We eat considering the taste of food, not nutritional values,’ he said, adding the government will start a campaign and school nutrition education programme to change the common belief and knowledge.
‘We have to invest in nutritional interventions as in the long run well-nourished children will grow up to become productive members of the workforce and help power the economic development of the nation.’
Khurshid Talukder, senior consultant paediatrician at the Centre for Woman and Child Health, said, ‘If proper feeding practices were followed, children under-2 were unlikely to fall sick with common illnesses.’
He said families were unaware of how to breastfeed their children and what types of food they should offer after six months.
‘Primarily, they give rice-based food. Far fewer children receive animal protein like eggs, meat, poultry and fish which provide vitamin, calcium, iron, energy and high quality protein essential for normal growth and development.’
‘There are prevailing misconceptions on children’s diet. Many parents ask us if they should give their one-year baby fish and meat,’ Dr Talukder said.
‘When they ask this question, it is already late for the baby.’
‘Parents believe young children cannot eat or digest fish and meat.’
Citing studies, he said only 10 per cent children received animal protein at the age of seven months. But it was 75 percent at the age of 2 or 3 years in the same socio-economic group.
‘So economic condition does not always play a role,’ he said, adding, ‘We can check it by increasing the knowledge of the healthiest feeding practices.’
‘Caregivers need to know how long to breastfeed children, when to introduce complementary foods, how to assess and increase breast milk supply, how to motivate children to eat, what types of food to offer, how much and how often, and how to prepare these food hygienically.
‘Messages should be directed not only at mothers, but also at other family members and the broader community,’ he said.
According to British medical journal, The Lancet, steps that promote exclusive breastfeeding up to six months and the timely introduction of appropriate complementary foods — combined with micronutrient and disease control interventions — can reduce stunting by about a third and mortality by a quarter at the age of 36 months.
Bangladesh has been able to cut under-5 mortality but still remains home to one of the largest number of malnourished children in the world.