Preventing and Managing Acute Malnutrition:

Bangladesh Experience

Dr. S.K. RoySenior Scientist & Chairperson

Bangladesh BreastfeedingFoundation (BBF)

IntroductionIntroduction• Acute malnutrition is a

consequence of energy and protein deprivation resulting in wasting/ bilateral oedema.

• WHO has created cut-off points to indicate the severity of the malnutrition-

Acute Malnutrition

What is the scale of the problem?

Bangladesh context

Child Malnutrition in Bangladesh

Bangladesh Experiences in Preventing and Managing

Acute Malnutrition

Components of Intervention

Intensive nutrition education (INE) group

Supplementary feeding (SF) group

Comparison group

Intensive nutrition education

Twice a week. Twice a week fortnightly from the nutrition promoters of

BINPSupplementary feeding(Khichuri)

No Supplementary Food suggested

Six days in week.

No Supplementary Food suggested

S.K. Roy; J health popul nutr 2005 dec;23(4):320-330

Intensive Nutrition Education with or without Supplementary Feeding Improves the Nutritional Status of

Moderately-Malnourished Children in Bangladesh

S.K. Roy et al , Food and Nutrition Bulletin, vol. 28, no. 4 © 2007

Ingredients of Khichuri

Proportion of study children improved by WAM above 75% of median of the NCHS standard

from baseline up to end of 6-month observation

S.K. Roy; J health popul nutr 2005 dec;23(4):320-330

Growth (weight-for-age z-score) of study children during three-month interventions

and three-month observation

S.K. Roy; J health popul nutr 2005 dec;23(4):320-330

Prevention of Malnutrition using Home based food (Khichuri)

S.K. Roy et al , Food and Nutrition Bulletin, vol. 28, no. 4 © 2007

Components of intervention

Nutritional

education

Breast feeding, complementary food, introducing

“khichuri” as complementary food and

preparation, functions of food

Disease

control

Identification of diseases, home management of

common childhood diseases, proper referral of

the sick children based on IMCI criteria.

Caring

practices

child stimulation, personal hygiene and

sanitation, allocation of extra time, care during

illness and diseases

Component of intervention: Nutrition triangle (UNICEF)

Disease Control Caring Practices

Food Security

Breastfeeding

Complementary Feeding

S.K. Roy et al , Food and Nutrition Bulletin, vol. 28, no. 4 © 2007

Continued...

S.K. Roy et al , Food and Nutrition Bulletin, vol. 28, no. 4 © 2007

Ingredients of khichuriRice 2 fistful (65g) Lentil 1 fistful (25g)

Oil 5 teaspoonfuls (18.8g)

Egg/Meat/ Fish 1 Piece (55g)Green leafy vegetables

1 fistful

Total cooked volume 650gCalorie 678 kcalProtein 10.6g

Figure: Mean weight-for-age median (percentage of NCHS standard) over the

study period.

Intervention

Control

S.K. Roy et al , Food and Nutrition Bulletin, vol. 28, no. 4 © 2007

Comparison of locally adapted protocol (ICMH) with WHO protocol

Outcome parameters WHO Group (n=30)

ICMH Group (n=30)

P value

Outcome, No, (%)

Discharge with target weight gain

83.3 % 83.3 % 0.72

Death 6.7% 6.7% 0.6

Time taken, Mean (SD)

For edema to subside in days 2.7% 1.8% 0.53

For gaining target weight in days

11.5% 6.2% 0.88

Weight gain in g/kg/day, mean (SD)

in marasmus 3.4% 3.3% 0.28

in kwashiorkor 3.7% 4.1% 0.29

in marasmic kwashiorkor 5.8% 6.6% 0.79

Hossain, et al. 2007

Thank You