The vicious cycle of malnutrition among under five children in Bangladesh: Using local food models as a gateway to health and nutrition

Summary:

According to a recent series in the Lancet, undernutrition is the cause of 3.1 million child deaths annually in low- and middle-income countries, which contributes to 45% of all child deaths. In Bangladesh, malnutrition of the mother is a major cause of infant mortality. Using qualitative research techniques as part of the Ujjiban formative study, we investigated the causes of severe malnutrition in children under five years and solutions derived from local communities. The study is guided by the socio-ecological model, Connell's theory of gender and power, and Kincaid's bounded social normative influence. The theoretical framework allows for an exploration of gender dynamics, nutritional food models, and the intersections between gender, food scarcity, and food diversity for children under five years. A vicious cycle was observed from the nutrition-focused interviews. Excessive crying and small size of newborns led family members to start providing food other than breast milk. Children that could not get enough breast milk fell sick frequently. Reduced consumption of breast milk and complementary food during illness resulted in irritable mood and loss of appetite among children. Under nutrition was perpetuated by a local belief emphasizing the need to reduce food for children recovering from illnesses, especially diarrhea. Food diversity can be promoted through school health programs and mobile games to promote healthy nutrition-related behaviors. Ujjiban is implementing a Nutri-Champs intervention with urban and rural adolescents where they can promote local food models with young mothers as a gateway to change.

Background/Objectives:

According to a recent series in the Lancet, undernutrition is the cause of 3.1 million child deaths annually in low- and middle-income countries, which contributes to 45% of all child deaths. In Bangladesh, malnutrition of the mother is a major cause of infant mortality. Using qualitative research techniques as part of the Ujjiban formative study, we investigated the causes of severe malnutrition in children under five years and solutions derived from local communities.

Description of Intervention and/or Methods/Design:

This qualitative study is guided by the socio-ecological model, Connell's theory of gender and power, and Kincaid's bounded social normative influence. The theoretical framework allows for an exploration of gender dynamics, nutritional food models, and the intersections between gender, food scarcity, and food diversity for children under five years. The Ujjiban research team conducted 40 semi-structured interviews, 18 case studies, and 18 FGDs with mothers and fathers of under five children and adolescent girls and boys. Six case studies focused primarily on child nutrition. Data were transcribed from Bangla audiotapes and translated into English. Qualitative data were coded with an online based software named Dedoose based on different thematic areas. During analysis we explored food consumption, children's feeding patterns, frequency, and amount of feeding. Mothers' health condition during pregnancy and delivery, complications and care seeking both for mother and children were also explored.

Results/Lessons Learned:

A vicious cycle was observed from the nutrition focused interviews. Most currently malnourished children were found to have low birth weight and a history of low flow of breast milk. Excessive crying and small size of newborns led family members to start providing food other than breast milk. Children that could not get enough breast milk fell sick frequently. Reduced consumption of breast milk and complementary food during illness resulted in irritable mood and loss of appetite among children. Undernutrition was perpetuated by a local belief emphasizing the need to reduce food for children recovering from illnesses, especially diarrhea and other bowel problems. Malnourished children consumed less protein and dairy and ate less frequently compare to healthy children. Both healthy and malnourished children had low food diversity. Children liked doi (yogurt), dal (lentils), and dimer pitha (local cakes with egg), which could supplement milk or fulfill protein needs.

Discussion/Implications for the Field:

Interviews illuminated challenges to nutritional status and food diversity of children, with a vicious cycle of malnourishment and illness episodes experienced by children. Building on these findings, food diversity can be promoted through school-based social and behavior change communication (SBCC) programs and mobile games to promote healthy nutrition-related behaviors. Ujjiban is implementing a Nutri-champs intervention with urban and rural adolescents where they can promote local food models with young mothers as a gateway to change. Successful SBCC programs working to address nutrition in Bangladesh and elsewhere should build on local food models to inform future programmatic approaches.

Abstract submitted by:

Sabina Shahnaz - JHU CCP Bangladesh
Nandita Kapadia Kundu - Johns Hopkins Bloomberg School of Public Health
Syed Jafar Raza  Rizvi - JHU CCP Bangladesh
Zoe Hendrickson - Johns Hopkins Bloomberg School of Public Health
Yasmin Siddiqua - JHU CCP Bangladesh
Patrick Coleman - Johns Hopkins Bloomberg School of Public Health