Too many stunted girls in Bangladesh

With 44 percent of the girls aged between 15 and 19 too short for their age, Bangladesh is home to the world’s largest number of stunted adolescent girls after Guatemala, medical journal The Lancet says.

Short height exposes them to the risk of complicated pregnancy and childbirth and poor fetal growth.

The findings were made public during the Dhaka launch of ‘The Lancet’ series on maternal and child nutrition released last month in London, nearly five years after a similar series in 2008.

It says adolescence is a period of rapid growth and maturation from childhood to adulthood. But in low and middle-income countries like Bangladesh they are three times more likely to bear a child that researchers found ‘further slow and stunt their growth’.

The Lancet series called for concerted actions including engaging the ‘private sector’ to combat the menace malnutrition which it said held back economic growth of a nation.

The new set has been released at a time when the world is preparing for the next development agenda after 2015, the deadline for the current UN-prescribed MDGs.

It called for countries to make political commitments to address malnutrition as researchers found it evident that “good nutrition is a fundamental driver of a wide range of developmental goals”.

It said the post-2015 development agenda “must put addressing all forms of malnutrition at the top of its goals”.

The series have found that under-nutrition has dropped worldwide but not at a pace to catch the World Health Assembly’s target to cut 40 percent deaths by 2025.

Still malnutrition —stunting, wasting, and micronutrient deficiencies—accounts for more than 3 million deaths each year and an estimated 165 million children under five are stunted because of poor nutrition.

Researchers also found that maternal and child malnutrition leads to a whole host of health and economic problems, including preterm and low birth weight babies, cognitive deficits, stunted growth and death.

But the prevalence of malnutrition is more in poor and middle-income countries than others.

It is noted that progress has been made following steps after The Lancet 2008 series generated evidence calling for effective interventions and delivery strategies.

The 2013 issue makes ten specific recommendations the 90 percent coverage of which in 34 most malnourished countries, it says, could save nearly a million of lives a year at a cost of $9.6 billion.

These include: universal salt iodization, the promotion of early and exclusive breastfeeding, micronutrient supplementation for all pregnant women, calcium supplements for pregnant women who need them; food supplements for pregnant women who need them; vitamin A supplements for children between six months and five years; zinc supplements for children between one and five years; education about appropriate complementary feeding, backed by supplements where needed; proper management of moderately acute malnutrition; and proper management of severe acute malnutrition.

It suggested continued investments in nutrition-specific measures to avert maternal and child under-nutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population “can make a great difference”.

If this improved access is linked to nutrition-sensitive approaches like women’s empowerment, agriculture, food systems, education, employment, social protection, and safety nets, The Lancet says, they can greatly accelerate progress in countries with the highest burden of maternal and child under-nutrition and mortality.

However, these interventions drew flak in India, where the Indian Academy of Paediatrics expressed misgivings as most of the recommendations were found to be product-based approaches and there was a call to engage private sector.

The issue is contentious given the past history with marketing of breast-milk substitutes by the private companies.

In a statement they said the new set of papers on malnutrition “should not be allowed to become an opportunity for commercial exploitation of malnutrition”.

They also pointed out that two of The Lancet authors work with the Micronutrient Initiatives (MI) that work on micronutrients.

A director of ICDDR, B Dr Tahmeed Ahmed, an author of The Lancet, replying a question said he personally did not “think it (engaging private sector) should be a problem”.

He was presenting his part at ICDDR, on Tuesday at the launching.

“Government alone cannot do everything. We need to engage the private sector, NGOs and everyone,” he said. Dr Ahmed said he knew one of the authors sat in the MI’s governing board. “But MI works with governments in different countries”.

However, The Lancet’s lead author Robert Black while presenting the series said there were ‘risks and potentials’ to engage private sector to deal with nutritional issues.

But he suggested regulations and monitoring.

The British medical journal influences policy decisions.

In the 2008 series, it identified the need to focus on the first 1000 days, from conception to age 2, in which nutrition interventions have the greatest impact.

Later this “window of opportunity” became critical for both programming and advocacy efforts.

This series also include the growing problem of maternal and child overweight and obesity, which can cause complications during pregnancy and childbirth.

The health minister AFM Ruhal Haque, who was present during the presentation, asked the researchers to find out something “which is locally available for ensuring sustainable nutritional growth”.

Save the Children’s country director Michael McGrath said this Lancet would contribute significantly in combating malnutrition.

He said with a large young and growing population, Bangladesh had to make sure that they were ‘equipped to contribute effectively’ to make the country a middle-income one.

“This is not just about dealing with the issue of hunger…this is about contributing to make Bangladesh lead in the world,” he said as The Lancet found under-nutrition’s link in 10 percent economic growth reduction.

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