BANGLADESHNutritioN

GLANCEat a

Undernutrition is not just a problem of poverty. In the past 2 decades, Bangladesh has made con-siderable progress in development, sustaining high rates of economic growth and reducing poverty rates by 9% between 2000 and 2005 (from 49% to 40%).4 Also, as Figure 2 shows, children are under-nourished in over one-quarter of even the richest households.

Vitamin and Mineral Deficiencies Cause Hidden HungerAlthough they may not be visible to the naked eye, vitamin and mineral deficiencies impact well-being, and are highly prevalent in Bangladesh, as indicated in Figure 3.

• Vitamin A: One-fifth of preschool aged children and one-quarter of pregnant women are deficient in vitamin A.9 Supplementation of young chil-dren and dietary diversification can eliminate this deficiency.

• Iron: Current rates of anemia among preschool aged children and pregnant women are 47%10. Iron-folic acid supplementation of pregnant women and the provision of multiple micronu-trient supplements to infants and young children are effective strategies to improve the iron status of these vulnerable subgroups.

• Iodine: While 84% of households consume io-dized salt, over half a million infants remain un-protected from iodine deficiency disorders.6

Technical Notes Stunting is low height for age.

underweight is low weight for age.

Wasting is low weight for height.

Current stunting, underweight, and wasting estimates are based on comparison of the most recent survey data with the WHO Child Growth Standards, released in 2006. They are not directly comparable to the trend data shown in Figure 1, which are calculated according to the previously-used NCHS/WHO reference population.

Low birth weight is a birth weight less than 2500g.

The methodology for calculating nationwide costs of vitamin and mineral deficiencies, and interventions included in the cost of scaling up, can be found at: www.worldbank.org/nutrition/profiles

Country Context HDi ranking: 146th out of 182 countries1

Life expectancy: 66 years2

Lifetime risk of maternal death: 1 in 512

under-five mortality rate: 54 per 1,000 live births2

Global ranking of stunting prevalence: 23rd highest out of 136 countries2

The Costs of Undernutrition • Children who are undernourished between con-

ception and age two are at high risk for impaired cognitive development, are more likely to die be-fore the age of 5, which can adversely affect the country’s productivity and growth.

• Childhood anemia alone is associated with a 2.5% drop in adult wages.5

• The economic costs of undernutrition include direct costs such as the increased burden on the health care system, and the indirect costs of lost productivity.

Where Does Bangladesh Stand?• 43% of children under the age of five are stunted,

41% are underweight, and 17% are wasted.2

• 1 in 5 infants are born with a low birth weight.2

As shown in Figure 1, although the overall prevalence of stunting and underweight has been decreasing over the past two decades, Bangladesh will not meet MDG 1c (halving 1990 rates of child underweight by 2015) with business as usual.6

Figure 1 Bangladesh’s Progress toward MDG 1 is insufficient

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Stunting Underweight 2015 MDG Underweight Target

1997 2000 2004 20070

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30

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50

60

Source: WHO Global Database on Child Growth and Malnutrition (figures based on NCHS/WHO Standards).

It is encouraging that Bangladesh has lower rates of stunting than several of its neighbors in the South Asia (India, Nepal, Bhutan, Pakistan, Afghanistan) but at 43%, Bangladesh’s stunting rate is still among the highest in the world.

Most of the irreversible damage due to malnutrition in Bangladesh

happens during gestation and in the first 24 months of life.6

Annually, Bangladesh loses over US$700 million in GDP to vitamin and mineral deficiencies.3,4

Scaling up core micronutrient interventions would cost less than US$65 million per year.

(See Technical Notes for more information.)

Key Actions to Address Malnutrition:

Approximate return on investment

(%)12:

Achieve universal salt iodization. 3000

Improve infant and young child feeding through effective education and counseling services.

1400

Ensure an adequate supply of zinc supplements for the treatment of diarrhea.

1370

Photo: Anna Herforth.

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THE WORLD BANKProduced with support from the Japan trust Fund for Scaling up Nutrition

Risk Factors for Undernutrition in Bangladesh

references1. UNDP. 2009. Human Development

Report. 2. UNICEF. 2009. State of the World’s

Children.3. UNICEF and the Micronutrient Initiative.

2004. Vitamin and mineral deficiency: a global progress report.

4. World Bank. 2009. World Development Indicators (Database).

5. Horton S and Ross J. 2003. The Economics of Iron Deficiency. Food Policy 28:517-5.

6. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition.

7. WHO. 2009. Global Database on Child Malnutrition (Database)

8. FAO. 2009. The state of food insecurity in the world: Economic crises – impacts and lessons learned.

9. WHO. 2009. Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO Global Database on Vitamin A Deficiency.

10. WHO. 2008. Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia.

11. Horton S. et al. 2009 Scaling Up Nutrition: What will it cost?

12. Micronutrient Initiative. 2009. Investing in the future: a united call to action on vitamin and mineral deficiencies. Ottawa.

BANGLADESH

• Low Birthweight: Low birthweight is a major fac-tor in child malnutrition and mortality rates in Ban-gladesh. Approximately 40% of babies are born with a low birthweight and are more likely to continue to be malnourished during childhood.2

• Sub-optimal infant and Young Child Feed-ing Practices: Fewer than half (43%) of all newborns receive breast milk within one hour of birth,2 and less than half (43%) of infants under six months are exclusively breastfed.2 Moreover, during the important transition period to a mix of breast milk and solid foods between six and nine months of age, one-quarter of infants are not fed appropriately with both breast milk and other foods.2

• High Disease Burden: Close to 1 in 5 child deaths are due to diarrhea.6 Undernutrition increases the risk of falling sick. Moreover, undernourished chil-

dren who fall sick are much more likely to die from illness than well-nourished children.

• Poor Water and Sanitation: Frequency of disease is dependent on many factors, but especially on safe water and sanitation. In Bangladesh, poor water and sanitation affects personal hygiene, latrine use, insufficient hand-washing, the inability to keep food clean, and unsafe refuse disposal. These all increase the burden of illness.

• Low Status of Women: A central factor in mal-nutrition in Bangladesh is the status of women. Despite the rapid increase in educational attainment and entry into the workforce by women in the past twenty years, women in the country generally have less freedom to make decisions about what, how and when to feed their children—decisions that are dominated by mothers-in-law and husbands. Social mores about independent behaviors and social

interactions also compromise the quality of child care.

• Vulnerability to Natural Disasters: Bangladesh is extremely vulnerable to climatic and physical environ-mental changes such as cyclones, floods, droughts, and river-bank erosions. Repeated frequency of these natural disasters in short intervals has direct implications on water-borne disease outbreaks and household food security of the general population.

• Dietary Quality: Caloric availability does not guarantee food security. Between 2000 and 2007, Bangladesh was largely self-sufficient in terms of production of rice. However, improvements in caloric availability have not translated into positive effects on maternal health and child nutrition. Low dietary diversity and lack of equitable distribution of food manifest as vitamin and mineral deficiencies, and maternal and child undernutrition.

World Bank Nutrition-Related Activities in BangladeshProjects: The Bank has been actively supporting GOB’s area-based community nutrition (ABCN) ac-tivities since 1995. The Bangladesh Integrated Nutri-tion Project (BINP, 1995–2002) was followed by the National Nutrition Project (2000–2006). Since 2007, the nutrition activities have been integrated and implemented through the GOB-led ongoing sector-wide program, Health, Nutrition and Population Sector Program (HNPSP, 2005–2011), co-financed by seven other Development Partners under the HNPSP pool funds. For nutrition, HNPSP supports the GOB to facilitate and supervise the implementa-tion of ABCN interventions, as well as other verti-cal interventions such as vitamin A supplementation and deworming. Under the FY10–14 Country As-

sistance Strategy, the Bank will continue to integrate nutrition interventions in basic health services, while also seeking appropriate instruments to support a multisectoral approach to combating malnutrition.

Analytic Work: Several policy notes have been pro-duced in past years examining Bangladesh’s prog-ress towards meeting the health MDGs (and indica-tors related to nutrition); and evaluating the effec-tiveness of a multi-sectoral approach to nutrition.

Addressing undernutrition is cost effective: Costs of core micronutrient

interventions are as low as US$0.05–3.60 per person annually.

Returns on investment are as high as 8–30 times the costs.11

Figure 2 undernutrition Affects All Wealth Quintiles –Poor infant Feeding Practices and Disease are Major Causes

Prevalence of Stunting Among Children Under 5 (%)0 10 20 30 40 50 60

Poorest

Second

Middle

Fourth

Richest 26

39

42

51

54

Source: DHS 2007 (figures based on the 2006 WHO Child Growth Standards).

Figure 3 High rates of Vitamin A and iron Deficiency Contribute to Lost Lives and Diminished Productivity

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)

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101520253035404550

AnemiaVitamin A Deficiency

Pregnant WomenPreschool Children

Source: 1998 vitamin A and 2001 anemia data from the WHO Global Data-base on Child Growth and Malnutrition.