Trajectory to a healthy future

When Rajon was born in 2016, his parents -- Mossammat Shajna and Gaus Ali -- were elated. He was after all their first child and the couple had been trying to conceive for a while.

They loved everything Rajon did. The way he smiled, cried and eventually moved around.

But around last year, the couple noticed even though the boy was one year old, he was not growing up like other children. Rajon used to get sick often and was losing weight.

The worried parents, who make and sell bamboo mats for living in Sylhet's Bishwanath upazila, took the child to a local hospital, where doctors told them to provide him with nutritious foods, saying otherwise he might suffer from malnutrition and stunted growth.

During that time, the couple did not even know what stunting was. They were also not aware that the first 1,000 days of a child, from conception until the age of two, is crucial to their overall development.

According to World Health Organization, stunting is the impaired growth and development that children experience from poor nutrition, repeated infections, and inadequate psychosocial stimulation.

Luckily for Shajna and Gaus, with the support of “Suchana” programme, a multi-sectoral nutrition programme of Save the Children in Bangladesh, they were able to learn about the importance of the first 1,000 days for a child's physical and mental development.

Now, Rajon is growing up healthy and strong and keeping his parents on their toes with his shenanigans.

Not just that, the couple had their second child, Raihan, early this year. Thanks to “Suchana”, Shajna and Gaus remained alert since his birth and made sure that he is getting the nutritional support he needed.

“For my second child, who is now 10 months old, I ensured from beginning that he is receiving proper nutrition from food -- especially fruits, vegetables and fish, which we could not provide to our first child in his early days,” Shajna told this correspondent last week.

FIRST 1,000 DAYS

The first 1,000 days of a child is considered the “1,000 golden days” by health experts. It is the most critical period when a child's cognitive ability and immune system take shape, said Dr Shah Nawaz, director general of Bangladesh National Nutrition Council (BNNC).

During the period, ensuring nutrition for a child is an absolute necessity, or else the child might suffer from stunting, which is irreversible and can have adverse functional consequences on the child.

Some of those include poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life, according to WHO.

“Stunting also has long-term effects on individuals and societies, including diminished cognitive and physical development, poor health and a risk of degenerative diseases such as diabetes,” added Dr Shah Nawaz.

Dr Sanjoy Kumer Dey, an associate professor of neonatology at Bangabandhu Sheikh Mujib Medical University, said, “This kind of malnutrition often begins in the womb with a mother who herself is malnourished and is not getting enough nutritious food she needs to support her baby's growth and development during pregnancy.”

“It can continue after birth as a result of poor feeding practices, repeated infections and diets that do not give children the nutrition they need to grow and develop properly,” he said.

Dr Sheikh Shahed Rahman, director of Save the Children's Suchana programme, said, “The Damage, due to chronic malnutrition during that period, is irreversible. There is no way someone can rectify it after growing up.”

“So, ensuring proper nutrition during that time [1,000 days] is a must or else no matter how powerful vitamins or proteins are provided to the child, it will not work for their development as it should be in their first two years,” he said.

PRESENT SCENARIO

According to Bangladesh Demographic and Health Survey (BDHS) 2014, stunting rate among children under 5 years old is 36 percent in the country. It was 41 percent in 2011, 43 percent in 2007 and 51 percent in 2004.

Worldwide, it was 22 percent (151 million children under 5) in 2017, according to WHO.

Although the rate decreased over the years, it is still above WHO's cut-off rate, which is 30 percent, according to WHO.

It said Sylhet division has the highest rate of stunting among all divisions. There are multiple reasons behind it, said Dr Shahed Rahman, adding, “High food insecurity, poor practice in child feeding and care, cultural barriers to follow optimal practices and low literacy are some of those.”

REASONS BEHIND STUNTING

According to experts, poor diet, hygiene and sanitation practices are some of the major reasons behind child stunting. Also, poverty and food insecurity play an important role in this regard.

They said special attention should be given to mothers during pregnancy because a mother's nutrition carries over to her newborn.

PREVENTION

Awareness is a must when it comes to prevent stunting among children. Also, food security, childcare practices, maternal education, financial ability, access to health services and water, hygiene and sanitation conditions are some other vital issues.

Coordinated and concentrated efforts to address issues such as illness and food intake as well as access to quality health care, education and poverty reduction are essential, said health experts.

GOVT MEASURES

The government works on a priority basis and takes an overall approach to ensure nutrition for children, thus leading to reducing stunting, according to Dr Shah Nawaz.

It also follows an “Infant and Young Child Feeding” strategy, where infants, mothers and adolescent girls are given the precedence.

Moreover, there is also a ten-year “National Plan of Action for Nutrition" (2016-25), under which government and non-government bodies are working together, he said. “We have a target to reduce stunting by 1 million within 2025 or within the targeted span of SDG,” he added.

NON-GOVT INTITIATIVES

In addition, non-government organisations are also working in different areas of the country on nutrition.

Save the Children, through “Suchana: Ending the Cycle of Undernutrition in Bangladesh (2015-2022)”, is engaged in 20 upazilas of Sylhet and Moulvibazar with an aim to prevent stunting among children under two.

“Our target is to reduce stunting by additional 6 percent from the national rate in Sylhet division,” said Dr Shahed Rahman. He said their programme supports poor families with women of reproductive age (15-45), who are vulnerable to malnutrition.

“We are working to raise awareness among them and also helping them in income-generating activities so that they don't lag behind in giving nutrition to their child due to poverty,” he added.

Suchana is implemented by eight NGOs, spearheaded by Save the Children. A total of eight ministries are involved with the programme, said Dr Shahed Rahman.