Bangladesh has a population of about 140 million with an average of more than 2,639 people per sq. mile. About 22 million households are in rural areas with a per capita annual income of 375 US$. It has one of the highest rates of malnutrition, with 46% stunting, 40% underweight and 15% wasting among children. Annually > 500,000 cases of severe malnutrition occur in Bangladesh which can be reduced by achieving optimal early birthing and breastfeeding practices. Most of these children look nothing like the skin and bones media images accompanying reports on malnutrition, yet many of them die, especially in their first 28 days of life.
Inappropriate infant and young child-feeding practices have been identified as a major cause of malnutrition. Initiation of breastfeeding within one hour in South Asian countries varies from 16% to 75%, with Bangladesh at 42%. Exclusive breastfeeding rates in Bangladesh lies around 46% during this period and this rate becomes stagnant from last decade. Most newborns in low-income countries die, not of anemia, not of severe acute malnutrition, but of sepsis. This sepsis in newborns (37% of whom are low birth weight in Bangladesh) is in part a nutrition issue – brought on by delaying anti-infective breastmilk and often expressing and throwing away colostrum. Four parameters of Infant and Young Child Feeding (IYCF) have been identified as important in tracking under 5 child survival to achieve Millennium Development Goal 4. These are breastfeeding initiation within 1 hour of birth, exclusive breastfeeding rate <6 months, complementary feeding at 6-9 months and continued breastfeeding at 20-23 months.
In Bangladesh, the good news is that at 20-23 months, 92% are still breastfeeding– unheard of in most countries of the world. Exclusive breastfeeding throughout the first 6 months is rare. In the 2007 DHS survey, >60% of infants < 2 mo of age were exclusively breastfeeding but the median duration was 2.5 mo with medical delivery, 2.0 mo with delivery by traditional birth attendant (TBA) and 1.4 mo with other types of delivery. This clearly shows that exclusive breastfeeding is not a traditional practice and requires active promotion and support by the modern sector.
Giving colostrum has increased, but too little attention has been given to early initiation of breastfeeding, avoidance of prelacteal feeds, and six months of exclusive breastfeeding, all of which are rarely optimal. About 85% of deliveries in Bangladesh still occur at home and mostly by TBAs .
Under the above context Eminence is currently implementing an operational research “Assessing the cost effectiveness of training and supervision of frontline workers on early breastfeeding practices” with financial assistance from Alive and Thrive Small Grants program and managed by University of California Davis. This one year operational research has started in May, 2010 in Panchagarh district, the most northern part of Bangladesh, including a total of nine unions from three selected upazilas with the aim to improve breastfeeding practices by strengthening capacity of front line workers. It is Randomized Control Trial (RCT) in design where unions were selected randomly for intervention and control group. This RCT was designed by training front line health workers on breastfeeding practices in six unions and the remaining three unions were considered as control areas where health workers were not trained. The activities of front line workers under three unions where training was given were monitored by supervisor.
The activities of this research began by screening mothers with children under 6 months of age and pregnant women passing their 2nd or 3rd trimester for baseline and intervention. During intervention period, the trained front line workers visited mothers and discussed about different breastfeeding issues by using flip chart. Moreover, front line workers ensured initiation of breastfeeding by presenting in delivery point and also maintained timing of cord clamping. The baseline survey was conducted to understand their present early child feeding practices. Then interventions were placed for six months and after completing intervention an end line survey had been carried out. The result of the surveys will be analyzed shortly. There are some expected outcomes of this project. They are as follows –
- Increase the rate of initiation of breastfeeding within an hour of a child’s birth.
- Increase the rate of early months breastfeeding
- Decrease the rate of prelatic feeding
- Increase in the rate of delayed cord clamping.
- Increase the overall knowledge of mothers and health workers regarding feeding practices of infant and young children.
Moreover, to prioritize breastfeeding and appropriate complementary feeding practices Eminence carried out different policy level advocacy in different times. National Round Table Discussion on Invest More on Breastfeeding and Home Cooked Complementary Feeding National Seminar on Health Policy: Nutrition & Infant and Young Child Feeding (IYCF), National Media Consultation Workshop on Secure Nutritious Diet, Save Children’s Life for Save the Children UK are few policy level advocacy which Eminence did in last few years.
As part of this, different research and evaluation activities have been conducted for different international organization with prioritize IYCF and child nutrition. Recently we are assessing KAP on IYCF in northern part of Bangladesh for ACF. Moreover, another study relating to under nutrition, food security and climate change related hazards also being conducted for ACF. Other than these, Rapid Nutritional Assessment of Rat Infested Chittagong Hill Tracks Areas , Post Disaster Food Security and Nutritional Status of Children Age Under Five Children funded, Determinant of Exclusive Breast Feeding in Bangladesh, Baseline and midterm evaluation of Integrated Nutrition Project (INP), End line Evaluation on Knowledge Practice and Coverage of Urban Nutrition and Household Food Security Program for Save the Children UK, Plan Bangladesh , BBF, NNP, Concern Worldwide etc.