Healthy, happy and wise: nutrition for under five

On a gloomy morning, Rabiya (4) sat with her legs crossed on the front yard of her parents’ mud hut. A pot of steaming white broth made of rice water laid innocently beside her lap, and she was carefully blowing on it to cool it down.

The rice water, with its dull flavour and gluey consistency, would have been too plain for most of our tastes. Besides, who would fancy such a bland liquid meal that is nearly devoid of all nutrients? But for Rabiya, this happened to be the scrumptious version of an ultimate breakfast. Moreover, she was too hungry to complain and it was not like she had any option for our regular eggs and bacon/ roti-chapati.

At noon it gets better, she thought. Her mother would cook rice and boil edible leaves that she always collected from the riverside, and she would then garnish them with green chilies and onions. Rabiya liked chilies, unlike most of the children of her age, because they were hot and made it easier to overlook the tastelessness of the plain meals she ate.

She loved eggs, and despite the abundance of chickens at their house she was hardly ever allowed to have one, as her mother sold eggs for money to pay her debts to the local landlord. But Rabiya barely complained. She was too young to understand any of this, and may be because of that, she hadn’t had the faintest idea why she was so short of her age, or why despite being underfed she had a bloated belly. She could not even understand why she had problems seeing in faint light, or why she fell sick so often.

Rabiya didn’t have any idea of the fact that she was unjustly malnourished, and neither did her parents.

This scenario could be seen in almost every corner of the rural geo-space in Bangladesh. A study conducted in 2007 found that one in 15 children born in Bangladesh dies before reaching their 5th birthday. According to a World Bank study in 2004, malnutrition rates in Bangladesh were among the highest in the world. Approximately 50 percent of children under the age of five had been stunted and underweight.

During infancy, the risk of dying in the first month of life (37 per 1,000) is nearly 2.5 times greater than in the subsequent 11 months (15 per 1,000). Death in the neonatal period accounted for 57 percent of all under-five deaths. It all became too obvious, and it was about time someone stepped in and make some essential changes in this extremely important socio-cultural phenomena. That is the when BRAC health programme started the Alive and Thrive project.

The first phase of Alive and Thrive was initiated in three sub districts and one slum in order to test and refine the model. The results were promising, so we extended the to many other districts and sub districts in 2010, following the advice of the Gates Foundation and the AED/FHI 360.

Currently, the project is active in 16 districts across the country, and is providing nutritional care to 1.9 million children under two years of age. The front line workers of Alive and Thrive the infant and young child feeding promoters (pushti kormis in Bengali), the community health workers (shasthiya kormis in Bengali), and the health volunteers (shasthiya shebikas in Bengali). At present, a total of 1,082 promoters, 633 community health workers and 7,154 health volunteers are providing infant and young child feeding services in their communities.  The front line health workers are recruited carefully and are expected to develop and improve the community-based Alive and Thrive initiative.

The health workers are trained by BRAC in order to counsel, coach and show the mothers how to breastfeed their children as well as on how to give them cost-effective proper meals with complete nutrients. Mothers of children less than 12 months of age are prioritised because infancy is a vulnerable period for all children.

The health promoters also demonstrate how to make age appropriate meals for children, for example, mashing the food, or removing a portion from the family’s food for the children before adding spice, etc. The parents and caregivers are not only enlightened about the different consistencies of food needed for children at various ages, but also about the importance of personal hygiene and hand washing before and after meals and after using the toilet.

Different social groups, such as religious spokespersons, village doctors and the government health workers are also involved with this nutrition project, providing with their unconditional support to communities.

Sabina Yasmin is a infant and young child feeding promoter in the village of Zinari, who was recruited by BRAC after completing her high school-level education. Initially, it was a challenge for her to convince parents and caregivers on how to provide proper nutrition to their little ones, because no one paid attention to a young girl teaching them about proper and improper means of feeding, and it takes time for people to learn and adopt new behaviours.

However, things eventually started changing, especially when a mother complained that her two-month-old son Yasin was sick and fatigued due to an intake of powdered milk that she gave him as she was not providing him enough breast milk. When Sabina showed her how to breastfeed properly, correcting her positioning and the way of holding the baby, the mother found out that she was in fact producing enough breast milk. Thanks to Sabina’s advice, Yasin is alive and thriving now.

A thousands health promoters and health workers are working relentlessly countrywide just to ensure that the infants and children are receiving proper nutrition and growing up healthy, and the BRAC family is proud of them.

By Miftahul Jannat Chowdhury
Intern
BRAC Communications

Click here to learn how you can support mothers and their children in Bangladesh.