Transcript Bangladesh : Dr. Khurshid Talukder, Bangladesh
Severe Acute Malnutrition – what is the best way forward for the region – A panel Discussion
Colombo 19 th November 2009
Extent of the problem in Bangladesh
• • • • • 500,000 cases of SAM (WHZ<-3.00) Total under-5 deaths 216,000 75,600 deaths from malnutrition (35% of all U5 deaths) So how many die from SAM?
Don’t know.
Movie
Why does it happen?
Data from 39 developong countries 1987-1996
Latin America and Caribbean Africa Asia 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh
Kuntal Saha, AJCN 2008
Comparisons between South Asia and Sub-Saharan Africa
80 60 40 20 160 140 120 100 41 24 0 Underweight % South Asia Sub-Saharan Africa 27 15 LBW % 41 41 NMR, 2004 78 148 44 31 75 51 U5MR, 2007 % EBF <6 mo % cont.bf 20-23 mo UNICEF: The State of the World’s Children 2009
Death is also a nutrition parameter
240 U-5 DEATHS EVERY DAY FROM MALNUTRITION
The tragic story of Shathi and Bithi
• • • • Birth weight 800 and 650 g More than doubled to 1.7 kg by 3 months of age on exclusive breastfeeding Then formula fed And died of pneumonia and sepsis soon afterwards 11
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IYCF challenges
• • • • • • efforts to improve breastfeeding practices have not reached the majority of mothers Only 15% of women deliver in a health facility Community-based activities through the National Nutrition Program extend to 20 % of the country only women in government service—a small fraction of the work force—are eligible for maternity leave lack of overall program coordination and oversight weak national commitment and sporadic donor support
IYCF challenges cont.
• • • • • • • lost momentum due to bureaucratic delays high staff turnover inadequately trained communitybased workers missed opportunities within the health system to counsel women on IYCF lack of a standardized monitoring system decline in the quality of baby-friendly hospitals No national IYCF working group
Best way forward
• • • Optimal IYCF monitoring and promotion in the community If not optimal – then weigh/measure MUAC If SAM – refer to hospital – If SAM and sick – admit to hospital – If SAM and not sick - home management
Food-health-care educational intervention to prevent malnutrition. Roy et al: FNB 2007
Reducing moderate malnutrition Roy et al: JHPN 2005
Reducing moderate malnutrition Roy et al: JHPN 2005
Home treatment studies for SAM
• • • • Khanum S, Ashworth A, Huttly SRA. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet 1994;344(8939–8940):1728–32. Ashworth A, Khanum S. Cost-effective treatment for severely malnourished children: what is the best approach? Health Policy Plan 1997;12:115–21.
Khanum S, Ashworth A, Huttly SRA. Growth, morbidity, and
mortality of children in Dhaka after treatment for severe
malnutrition: a prospective study. Am J Clin Nutr 1998;67:940–5.
Ahmed T, Islam MM, Nahar B, Azam MA, Salam MA, Ashworth A, Fuchs GJ. Home-based nutritional rehabilitation of severely-
malnourished children recovering from diarrhea and other acute
illnesses. Paper presented at the 10th Annual Scientific Conference, ICDDRB, Dhaka. 11–13 June 2002.
Home-based foods
Advantages Cost-effective Liked by caregivers; few defaulters Teaches mothers about child-feeding Family foods for rehabilitation also form the basis for good complementary foods Potential to prevent malnutrition in the long term by teaching mothers to prepare good food mixtures, and to feed frequently and responsively Potential ripple effect Disadvantages Families must have food resources Caregiver must be at home full-time Requires formative research to develop advice Requires clinic nearby or community health workers to monitor progress and provide timely treatment for ill children Need to provide micronutrient supplements Requires motivated staff and good communicators Responsive to fluctuating numbers
Costs of domiciliary care 1990-91
How to feed hungry children
Omar ibn Khattab Amir-ul-Muminin 1,400 years ago in Saudi Arabia
Feeding people in emergencies
Cooking food for 2 million people in Tongi
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