Addressing Malnutrition in Bangladesh
Contenu
By Nichola Connell, Nutrition Advisor in Bangladesh
Click on the first picture to start the slide show.
Living conditions are cramped and shelters need to be constantly repaired. There is no room for livestock or gardens, making interventions aimed at improving people's food security extremely challenging.
The monsoon season last from June to September. As the makeshift camp is hilly there is constant flooding. Erosion of slopes during this season, making movement difficult.
Malnourished children and their caretakers queuing at Action Against Hunger’s feeding centre. Over 2,000 children arrive each day when the centre is at its busiest.
The height, weight and mid-upper arm circumference of all new children is recorded on arrival at the centre. This enables the child to be classified according to their level of acute malnutrition. Moderate acute malnutrition is treated in the Supplementary Feeding Programme and severe acute malnutrition is treated in the Outpatient Therapeutic Programme.
Each child is registered into the appropriate feeding programme by taking a form completed with their anthropometric measurements to the registrar. Often the caretaker of the malnourished child is an older sibling as the parents are either working or looking after the other children. The child then visits the nurse for a full medical check-up and routine medication.
A child receiving supplementary porridge, a high-energy therapeutic food for the moderately malnourished. Micronutrient sprinkles are added to ensure the child receives all the essential vitamins and minerals required for optimum growth.
If the child is severely malnourished, he or she is registered into the Outpatient Therapeutic Programme (OTP) where they receive ready to use therapeutic foods each day. The high energy peanut paste contains all the essential micronutrients. The child has to consume one packet in the centre every day, to reduce the risk of selling or sharing the ration.
Children up to 5 years old are accepted into the feeding programmes, although the majority are under two years of age.
Play is an essential part in the recovery from malnutrition. It stimulates the children and also allows them the freedom to try something new where they normally would not have an opportunity to do so. There are no schools in the makeshift refugee camp, so it is also a chance to provide basic education in this particular context.
The centre is run by a dedicated team of Bangladeshi staff and volunteers from the refugee community. Over 40 staff and over 50 volunteers contributed at one point when several different programmes were running.
The Water, Sanitation and Hygiene (WaSH) team have built many drainage areas in the camp to try and control the flow of water, especially in the monsoon season.
11 August 2010 - "Located not far from Cox Bazaar, a seaside resort boasting one of the longest beaches in the world, I found myself in the small village of Kutupalong in the South-East corner of Bangladesh, a stone’s throw from Myanmar across the Naf river. In stark contrast to the beautiful nearby beaches, Kutupalong is an overcrowded and resource-poor area struggling to cope with the added burden of a large refugee population.
Kutupalong hosts one official refugee camp which, together with one other official camp an hour south, is home to 22,000 UN registered refugees who arrived from neighbouring Myanmar in the early nineties. However, another 200,000 to 400,000 unregistered refugees have arrived since then living in two unofficial camps, the largest of which is in Kutupalong, as well as in the surrounding villages. Bangladesh is the second poorest country in the world. With its own population struggling with access to clean water, food, health facilities and education, the country is unable to provide any assistance to the unregistered refugees, leaving them in an extremely vulnerable situation.
As a nutritionist, my job was to take over the running of the nutrition programmes in a newly opened Action Against Hunger Emergency Operation centre in Kutupalong. These are programmes aimed at helping children under five years old suffering from moderate or severe acute malnutrition, as well as pregnant and lactating women. In addition to the nutrition interventions, Action Against Hunger also implements water, sanitation and hygiene programmes and psychological support activities for the population.
I particularly enjoyed my work at the outpatient treatment centre for severely malnourished children under five years of age. Often these children would arrive completely listless and full of infections as well as with a very low weight for height. With a lot of effort from all the staff and volunteers they would grow from strength to strength as they received therapeutic food provided by Action Against Hunger and routine medication from the nurse.
This was certainly the case for Mohammed, a 12 month old boy who arrived severely malnourished. After just 6 weeks he was nearly up to his target weight and his mother Rashida had participated in hygiene promotion sessions aimed at promoting adequate hygiene practices that can help reduce the occurrence of illnesses and relapses into malnutrition. His father came to thank me personally for everything we had provided for his son which enabled him to recover - they had been resigned to the fact he would not live much longer.
One of the severest cases I dealt with involved treating 21 day old twin girls who arrived one day in December. They were brought in by their grandmother as the mother had passed away a few days after giving birth. The twins had not received any breast milk for 15 days. Consequently they were severely malnourished and very hungry. Many people are not aware that it is possible to relactate, enabling grandmothers to breastfeed their grandchildren if needed. Since breastmilk is very important for young infants, we used the Supplementary Suckling Technique which involves stimulating breastmilk production and providing therapeutic milk to the babies at the same time. The grandmother was able to breastfeed the twins on her own after a few days and the condition of the babies stabilised. The twins went on to make a full recovery. Their recovery shows what a huge difference our work can make. By giving just a small amount of advice and guidance, lives can be saved.
The good work of Action Against Hunger continues today in Bangladesh with new nutrition programmes being planned for the Bangladesh people in the surrounding villages, as well as providing continued support to the refugees. Having seen what life-threatening problems people there face every day, it is essential this work continues, to give children such as Mohammed and the twins a better chance in life. We should not forget how lucky we are in the UK to have access to good quality food, water and good advice: such simple things that literally mean the difference between life and death in Bangladesh."
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