1. Preventing and Managing Acute Malnutrition: Bangladesh Experience Dr. S.K. Roy Senior Scientist & Chairperson Bangladesh Breastfeeding Foundation (BBF)

2. Introduction 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

3. What is the scale of the problem? Bangladesh context

4. Child Malnutrition in Bangladesh

7. Bangladesh Experiences in Preventing and Managing Acute Malnutrition

8. Components of Intervention Intensive nutrition education (INE) group Supplementar y feeding (SF) group Comparison group Intensive nutrition education Twice a week.Twice a weekfortnightly from the nutrition promoters of BINP Supplementa ry 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

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

10. 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

11. 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

12. 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

13. 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

14. Continued... S.K. Roy et al, Food and Nutrition Bulletin, vol. 28, no. 4 © 2007 Ingredients of khichuri Rice2 fistful (65g) Lentil1 fistful (25g) Oil5 teaspoonfuls (18.8g) Egg/Meat/ Fish1 Piece (55g) Green leafy vegetables 1 fistful Total cooked volume650g Calorie678 kcal Protein10.6g

15. 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

16. Comparison of locally adapted protocol (ICMH) with WHO protocol Outcome parametersWHO Group (n=30) ICMH Group (n=30) P value Outcome, No, (%) Discharge with target weight gain 83.3 % 0.72 Death6.7% 0.6 Time taken, Mean (SD) For edema to subside in days2.7%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 marasmus3.4%3.3%0.28 in kwashiorkor3.7%4.1%0.29 in marasmic kwashiorkor5.8%6.6%0.79 Hossain, et al. 2007

17. Thank You