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    Community-based management of acute malnutrition in Bangladesh: feasibility and constraints
    (© 2014 United Nations University Press, 2014) Choudhury, Nuzhat; Ahmed, Tahmeed; Hossain, Md Iqbal; Mandal, Barendra Nath; Mothabbir, Golam; Rahman, Mustafizur; Islam, M Munirul; Husain, Mohammad Mushtuq; Nargis, Makhduma; Rahman, Ekhlasur; BRAC James P Grant School of Public Health
    Background. To achieve the United Nations Millennium Development Goals, particularly reduction in child mortality (Millennium Development Goal 4), effective interventions to address severe and moderate acute malnutrition (SAM and MAM) among children under 5 years of age must be implemented and brought to scale alongside preventive measures. Bangladesh has an estimated 600,000 children with SAM, for a prevalence of 4%, while 1.8 million children suffer from MAM. Objective. To assess the feasibility and constraints of community-based management of acute malnutrition (CMAM), a relatively new approach, in managing SAM and MAM among children in Bangladesh. Methods. The methodology involved desk reviews of documents by searching through PubMed and other databases for published literature on CMAM in Bangladesh. We also did a hand search of policy and program documents, including the draft National Nutrition Policy 2013; the Health, Nutrition, Population Sector Development Program document of the Ministry of Health and Family Welfare, Government of Bangladesh; the Sixth Five Year Plan; and the Operational Plans of the National Nutrition Services of Bangladesh. Results. The conventional approach in Bangladesh has been to treat children suffering from SAM and associated complications in hospital settings. There is no program to take care of children with MAM. There is a dearth of local evidence to operationalize and implement CMAM in the context of Bangladesh. This paper summarizes the scientific literature and rationale for the implementation of CMAM in Bangladesh. It also provides recommendations to improve health strategies related to CMAM, discusses diets being developed that may result in better implementation of CMAM, and offers recommendations for areas of additional necessary research. Conclusions. A recommended approach for Bangladesh on the management of acute malnutrition would be to integrate CMAM into the rollout of the National Nutrition Services so that screening, identification, referral, and treatment of acutely malnourished children could be effectively managed within the community-based health service delivery system. Given that the vast majority of children are suffering from MAM and could be treated with locally developed food supplements, a significant emphasis of the CMAM approach in Bangladesh should be to screen and treat MAM. Over time, this would also result in fewer SAM cases. However, even with this approach, there would still be a small number of children who have SAM and who ideally should be treated with specialized therapeutic foods. While the Government of Bangladesh is awaiting full-scale production of a local ready-to-use therapeutic food (RUTF), an interim strategy is needed to effectively treat these severely wasted children on an outpatient basis.
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    Adherence to multiple micronutrient powder among young children in rural Bangladesh: a cross-sectional study Global health
    (© 2015 BioMed Central Ltd., 2015) Raj Angdembe, Mirak; Choudhury, Nuzhat; Raisul Haque, Mohammad; Ahmed, Tahmeed; BRAC James P Grant School of Public Health
    Background: Multiple micronutrient powder (MMNP) can be sprinkled onto any semisolid food and can be given to young children to address iron deficiency anemia. The female community health volunteers of BRAC (an NGO) known as Shasthya Shebikas (SS) sell MMNP sachets during their regular household visits. Currently there are no data on adherence or real uptake of MMNP by children. The objective of the study was to assess adherence to MMNP and associated factors among children aged 6-59 months in rural Bangladesh. Methods: A cross sectional study was conducted in Saturia Sub-district among 78 children aged 6-59 months who were fed MMNP supplied by BRAC SS in the past 60 days. A one stage cluster sampling technique was used to select mothers with eligible children. Semi-structured questionnaire was used for interviews. A logistic regression model was developed to obtain adjusted odds ratios (AOR) with 95% CI. Results: Sample mean adherence was calculated to be 70%. In multivariate analysis, age of mother in years (AOR∈=∈0.74, 95% CI: 0.61-0.88), households belonging to poorer (AOR∈=∈0.01, 95% CI: 0.00-0.68), middle (AOR∈=∈0.04, 95% CI: 0.00-0.35) and richer (AOR∈=∈0.11, 95% CI: 0.01-0.84) wealth quintiles and mothers who prefer to feed flexibly (AOR∈=∈0.03, 95% CI: 0.00-0.26) were significantly associated with high adherence. Further, for every one unit increase in visit by BRAC SS in the past 60 days, the odds of having high adherence significantly increased by 55% (AOR∈=∈1.55, 95% CI: 1.09-2.20). Conclusions: SS are the key to improving adherence through regular visits to households of MMNP users. However, expanding coverage beyond the vicinity of the SS's household is a challenge. Perception of families whose children have low adherence should be studied.