Academic journal article Journal of Health Population and Nutrition

Nutrition: Basis for Healthy Children and Mothers in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Nutrition: Basis for Healthy Children and Mothers in Bangladesh

Article excerpt


Protein-energy malnutrition is a syndrome resulting from interaction between poor diets and diseases, leading to anthropometric deficits and generally with deficits in micronutrients. Protein-energy malnutrition in children can be of three types by clinical classification: marasmus (wasting from malnutrition), kwashiorkor, and marasmic kwashiorkor; the latter two are oedematous malnutrition. Three anthropometric indices are commonly-used indicators of malnutrition: weight-for-age (underweight), height-for-age (stunting), and weight-forheight (wasting) (length is used if the age is less than two years or the length is less than 85 cm). A deficit (z-score below -2) in any one of these indices reflects malnutrition, and a z-score below -3 reflects a severe form of that condition.

In developing countries, an estimated 50.6 million children aged less than five years (under-five children) are malnourished, and those who are severely malnourished with a severe illness leading to hospitalization face a case-fatality rate exceeding 20% (1). In the early 1990s, using data from eight community-based, prospective studies conducted in Asia and Africa, Pelletier et al. estimated the relative risk for mortality associated with different degrees of childhood malnutrition as 2.5, 4.6, and 8.4 for mild, moderate, and severe malnutrition respectively (2). Recent data from the World Health Organization showed that 60% of all deaths, occurring among under-five children in developing countries, could be attributable to malnutrition, and the Global Burden of Disease Study estimated that childhood malnutrition alone accounted for approximately half (15.9%) of the global loss of disability-adjusted life years (DALYs) (3) (DALYs represent the sum of years of life lost from premature mortality and years lived with disability adjusted for severity). Thus, poor nutrition severely hinders personal, social and national development. Bangladesh has the highest prevalence of childhood underweight among all countries in the world, except North Korea, and only seven countries have a higher prevalence of child stunting (4).

Protein-energy malnutrition impairs the immune system, leaving malnourished children less able to combat common diseases, prolongs or exacerbates the course of an illness, heightens the adverse impacts of toxic substances, causes short stature and reduced physical work capacity, and increases the future risk of heart diseases. In addition to increasing the risk of death (2), severely-malnourished children are likely to have a lower intelligence level, behaviour problems, and poor school achievement. Impaired mental development is perhaps the most serious long-term handicap associated with early childhood malnutrition (5).

At the ICDDR,B hospital, severe malnutrition was observed as an associated underlying disorder contributing to the death of 74% of children admitted to the Special Care Unit of the hospital (6). Even after discharge from the hospital, the severely-malnourished children were found to have significantly higher death rates; the first three months after discharge being the most critical. About 70% of deaths occurred in that period and severely-malnourished children had a risk of death 14 times that of their well-nourished counterparts (7). Certain factors increase the risk of marasmus, including other siblings aged less than five years in the family, being female, and history of using milk substitutes (8,9). Higher maternal education reduced the risk. Bhuiya et al. found that severely-malnourished children in Bangladesh had a risk of death nine times that of their counterparts with better nutritional status (10).

In addition to being a direct health concern, nutrition is central to overall health, and, in fact, the nutritional status of children and women is likely the best indicator of overall well-being. In this paper, we discuss the nutritional trends in the country and highlight some key issues for deficient nutritional status. …

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