Community-based treatments may hold the key to whittling down high rates of severe acute malnutrition among children under five in Bangladesh. A pilot scheme on this is being run by the NGO Médecins Sans Frontières (MSF), which hopes to evaluate it by May 2011.
Half a million children suffer from severe “wasting” – or acute malnutrition – in Bangladesh. Due to starvation or disease they are far under the weight of healthy children their height, according to a 2009 survey conducted by the UN and the government.
The public health system has failed these children, according to a 2008 government report on the treatment of severely malnourished children.
“Active case finding [of severely malnourished children] in the community is rare or absent; many families cannot afford the economic and opportunity costs associated with facility-based inpatient care and health facilities cannot reasonably handle such a high case load,» the report said.
The Ministry of Health and Welfare in the report promoted community treatment as a solution for children who do not have medical complications.
Since May 2010, health promoters and MSF have been visiting homes to identify severely malnourished children and to offer almost 700 cooking demonstrations to mothers.
The classes emphasize food hygiene and offer new ways of preparing local dishes so nutrients are not lost.
Roxana Begum, whose son is recovering from severe malnutrition, told IRIN: “After a month, my son was sick of eating Plumpy’nut paste [protein-rich food]. So now I can also cook `khichuri’ [local lentil dish] in a clean and healthy way.”
The project operates in conjunction with MSF’s therapeutic feeding centre in Kamrangir Char, a slum on the outskirts of Dhaka with 400,000 people squeezed into 3sqkm.
A 23-year-old mother of two, Nusrat Jahan, whose son was diagnosed with severe wasting in June, has visited the clinic four times. “I was so worried about my son and… I had no idea where to find help.”
An MSF doctor, Shanmim Shafid, told IRIN he hopes the project will help change poor food habits. “Most mothers are working and don’t have time to cook, so children are left on the streets with enough money to buy cheap, sweet biscuits.”
The still-rising cost of food is one of several factors contributing to persistently high rates of wasting. Food prices in June 2010 increased by almost 11 percent over the previous year, according to the government.
Jahan told IRIN: “Our food intake consists of potatoes, ´dal ´ [lentils] and rice. We never eat meat, because one kilogram of chicken would cost us more than our total daily food budget.”
Another factor is the lack of treatment facilities and specialists to treat severe malnutrition at most primary healthcare centres, said Diane Lindsey, the country director of NGO Helen Keller International – and more often than not there is no nearby health centre, noted the US-based Feinstein International Centre.
If judged to be successful financially and nutritionally, MSF will expand the scheme to other urban as well as rural communities, Niklas Bergstrand, MSF’s communications officer, said.