Malnutrition is one of the major issues for child mortality in low and middle income nations (Kouam, 2014). Around 2 billion inhabitants globally suffering from a different point of malnutrition (Kamruzzaman, 2017). Malnutrition is a vital cause of death of almost yearly 45% children has died globally (WHO, 2018). It mostly occurs in the first five years of life (Aheto, 2015). Malnutrition in children is harmful. According to WHO (2018), malnutrition is defined as excesses of food, deficiency, imbalances in the intake of nutrients and energy. Moreover, deficiency in nutrients not only have bad impact on the health of children but also alleviate ability to work which leads to the worst outcome in adults life such as weaken the immune system, digestive problem, reducing the learning ability and in its worst it ends with even blindness (Kouam, 2014). Other social factors also affect such as abuse, poverty, gender bias, the pressure of population, and misleading family planning (Kamruzzaman, 2017). This report will discuss the major malnutrition issue in Bangladesh. Besides, how stockholders play their role by implanting policy like CMAM to overcome this health issue. Moreover, it will also elaborate on the six blocks of system thinking approach given by WHO, and describe the challenges and management to improve the health situation in Bangladesh.
Malnutrition is the cause of around 3.1 billion deaths yearly in middle income and lower-income nations (Kouam, 2014). Malnutrition in children measured by anthropometric to describe the nutritional value: weight-for-height, height-for-age, weight-for-age. For any above indices, malnutrition explains as an a-z score below 2-0 (Kouam, 2014). Malnutrition can be classified as acute and severe malnutrition.it again divides into severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). However, the prevalence of global acute malnutrition is 13.5% which means 2.2 billion children, 10.1% MAM and 3.4% of SAM suffer someone time (Kouam, 2014).
Malnutrition in Bangladesh and the role of policyholders
In Bangladesh, about 34.7%of under-five children are under weigh and 48.6% inhibited (Kouam, 2014). Also in Dhaka has a high prevalence rate of malnutrition in Bangladesh (Kamruzzaman, 2017). Despite a significant number of nutrition interventions accomplished by non-government organizations (NGOs) in current years to address malnutrition in the nation (Kouam, 2014). Malnutrition is a pivotal issue, many projects closed due to intervention in malnutrition tackle by NGOs. To overcome this global issue policy, planning and decision were formulated by the ministry of health and welfare (MOHFW). The policy is implemented with the help of the four authorities: the director of general health services, director of family planning, nursing services, director of drug administration. In the public health sector, there are private and public health sectors in urban and rural areas, each particular level of the health system is mostly managed by the NGOs (Kouam, 2014).
WHO building blocks implementation
Importantly, WHO blocks of the health system are usually adapted to public health nutrition to evaluate the system of health to integrate community-based management of acute malnutrition (CMAM) (Delisle, 2014). Moreover, six themes classified into 16 criteria. Which leads to a stable result of different contexts.
Nutrition is a priority for the government of Bangladesh. The ministry of health and welfare (MOHFW) originate policy concerning this issue. The Bangladesh integrated nutrition program was the first universal nourishment project apply in the country, a goal to overcome the incident of the underweight birth and malnutrition in children. Moreover, the policy has been defiantly improved the status of nutrition in children (Kouam, 2014).
The major fund was provided by the World Bank, the United Kingdom department of international development, a united state agency, and UNICEF. 7% of the government budget was given to nutrition. Besides, Bangladesh health policy comes up with the free of charge primary health care for children, yearly supported by the MOHFW (kouam, 2014).
In research, the site had a total of 39 health centers, among them 4 delivered inpatient activity and outpatient activity. Nutritional data were taken monthly using weight-for-age to identify the malnutrition cases (Kouam, 2014). During services, the main issue has occurred which had been drastically incremented of diarrhea during the year. Moreover, screening and managing malnutrition were not part of the community health services.
As a human resource team, they were not being able to manage malnutrition cases because of the absence of the training (Kouam, 2014). NGOs had not seems any lack of staff members. Even though, there was almost half the vacancy of the post in sub-district and family welfare clinics. At, nationally, policymakers and NGOs very well aware of the vacancy of the staff in the rural area and they agreed to employ more health care workers and volunteers to fulfill the shortage of the staff (Kouam, 2014).
At the health care center has hospitalization, consultation and storage room facility, each complex has water, electricity and other services (Delisle, 2014). However, the kitchen area also provided by the government but unfortunately, it was not good and well equipped as per standard. Medically examine tools were available and have better working conditions but weighing machine and board for measurement was out of order. In, addition to that not even one center provide a basic meal as per national guideline for inpatient of SAM (Delisle, 2014).
The health care worker supervised the sites on monthly and look out the delivery of services, health facility and supervisor had conversation with a health worker about their routine management quarries and gave them practical instruction to overcome it (Kouam, 2014).
A health system report demonstrated that the strategy for the short term would be more based on strengthening the leadership of the government in nutrition implementation. Moreover, they have to recognize the source of funding, improved the services and supply activity through the health centers. Moreover, the major challenge was tanning for health care workers would be improvised with the help of volunteers to manage the SAM and MAM. It needs to be also more focused on encouraging the health worker to provide medical services in rural areas. A long-term goal would be a commitment of funding which requires for productive integration of CAMA in the health system. Thus, stakeholders always play a key role to overcome the issue by applying the policy. Moreover, policy for nutrition analysis always tends to reduce the challenges in the impact of malnutrition in Bangladesh (Mohseni, 2019).
- Aheto, J., Keegan, T., Taylor, B., & Diggle, P. (2015). Childhood Malnutrition and Its Determinants among Under-Five Children in Ghana. Pediatric & Perinatal Epidemiology, 29(6), 552–561. https://doi.org/10.1111/ppe.12222
- Kamruzzaman, Md & Hakim, Md. (2017). Food and Nutrition Counseling in Bangladesh: A NC4HD Approach in Health Statistics. 5. 1-5.
- Kouam, C., Delisle, H., Ebbing, H., Israël, A., Salpéteur, C., Aïssa, M., & Ridde, V. (2014). Perspectives for integration into the local health system of community-based management of acute malnutrition in children under 5 years: a qualitative study in Bangladesh. Nutrition Journal, 13(1), 22. https://doi.org/10.1186/1475-2891-13-22
- Mohseni, M., Aryankhesal, A., Kalantari, N., & Vellakkal, S. (2019). Prevention of malnutrition among children under 5 years old in Iran: A policy analysis. PLoS ONE, 14(3), e0213136. https://doi.org/10.1371/journal.pone.0213136