Malnutrition hangs on hill districts despite health sector development

DHAKA, Dec 29, 2016 (BSS) - Sajek tourist spot is one of the attractions of Chittagong Hill Tracts (CHT). The picturesque natural beauty of Sajek Valley draws tourists. But the people of this area still remain neglected.

Most of them are suffering from malnutrition. Many of these malnourished people were seen during a visit to Sajek tourist spot.

On way back to Khagrachhari from Sajek tourist resort in Baghaichhari upazila of Rangamati district by a pickup van, a hill couple was seen along with their three kids. The children are aged four years, two years and one year. They have swollen bellies and anemic faces. It was apparent that the children are suffering from malnutrition. Their father Raju Tripura is also lean and thin. Their mother, who was sitting beside, with her youngest kid in her lap, has a pale face. She is anemic too. This means that they all are suffering from malnutrition.

Such mothers and children are very often seen in the CHT region. They are suffering from different diseases because of malnutrition. According to a statistics, 48 percent mothers and children in three CHT districts are suffering from malnutrition.

Nutritionist M.A. Rifat gave an overall account of nutrition situation in Khagrachhari district. He said the rate of chronically malnourished or stunted children among 0-5 age group is 35 percent. The rate of low-weight children (compared to their height) is 9.7 percent. The rate of low birth weight babies is 28.9 percent. The rate of anemia among children aged 5 to 59 months is 51.6 percent while the rate is 38.4 percent among married women aged from 15 to 49 years. The rate of feeding newborns colostrums within one hour of birth is 71.1 percent while the rate of exclusive breastfeeding for six months is 88.9 percent. The rate of low-weight adolescent girls is 11 percent. The nutrition situation in Khagrachhari could be termed as frustrating. The situation in two other CHT districts - Rangamati and Bandarban - is almost the same. Notable that Bangladesh achieved remarkable success in reducing child mortality rate and improving birth control and maternal health, but it could not make expected progress in nutrition.

According to different studies, 65,000 children die every year in the country because of severe malnutrition. Five lakh children aged 5 years are suffering from malnutrition related diseases. Their lives are at risk. A UNICEF report says that there is hardly any arrangement of medical treatment for these children.

Let along the CHT districts, there is no facility of improved treatment for such children anywhere in the country apart from several hospitals in Dhaka. Healthcare services improved tremendously across the country, but the common people in the hill districts are not getting expected services because of different types of mismanagement. Lack of doctors in hospitals is one of the problems there. There is hardly any specialist doctor in hospitals as posts remain unmanned. Therefore, medical treatments for complicated and malnutrition related diseases are unavailable in hospitals, resulting in death of affected children.

Yet, Khagrachhari district Civil Surgeon Dr. Nishit Nandi Majumder voiced a note of hope, saying that the nutrition situation is improving in the district. The situation was horrific in the past, but now it has improved a lot, particularly in the area of maternal and child health, he said. The situation is no more frustrating now, he claimed and highlighted some steps taken for its improvement.

The civil surgeon said names of pregnant women are being registered to ensure necessary health services for them. Names of 19,820 expectant mothers were listed from January to October in 2016. In the same period, 12,748 children were registered. All the mothers and children were brought under healthcare services. Of the children, only 1,345 were breastfed, 303 were skeletal, 494 stunted and 599 low-weight. The data was collected from community clinics in the district, said the civil surgeon.

He said 67 community clinics are working for nutrition of mothers and children in the district. Their current nutrition activities include

identifying malnourished children by determining weight, height and age of children of 0-5 years. Severely malnourished children are referred to SAM (severe acute malnutrition) corner at the district hospital for improved treatment. Pregnant and lactating mothers and adolescent girls are provided with micronutrients, including iron-folic acid tablets to prevent anemia.

Pregnant and lactating mothers are given calcium tablets. They and adolescent girls are given teachings on nutrition. They are advised about breastfeeding, giving other foods to children, food and rest during pregnancy, main problems related to malnutrition and the ways to prevent those.

Along with community clinics, there are joint projects of the government and UNICEF to reach nutrition services to remote areas. Distribution of micronutrients, observance of different national campaigns, teachings on nutrition and other activities are taking place under the projects. There are apprehensions about the success of the projects in remote hill areas having very rough communication system. Health workers cannot reach nutrition services to those remote areas. The activities may be seen on papers, but those are not implemented much.

BRAC official Rupam Chakma said the people of remote areas eat

vegetables without adding oil during cooking and as a result, they are deprived of vitamins and suffer from malnutrition.

Not only the hill people lack in knowledge of nutrition, most people on the plain land also do not know the nutritional value of kachu shak (taro leaves) growing on roadsides. Even many people do not know that sojina shak (drumstick leaves) can meet nutritional deficit in children and mothers. Meat and fish are not the only sources of nutrition. Beans, nuts, pulses and green vegetables contain huge iron. Iron deficiency in mothers and children is responsible for many diseases.

According to experts, malnutrition causes diseases like swelling, gaunt, night blindness, anemia, ulcer on lips and tongue and iodine deficiency problem. These diseases are seen among most mothers and children in remote hill areas. But they cannot take services in hospitals coming to district towns from isolated hill areas. Even they are not aware of the modern medical treatments.

Former chairman of Thanchi upazia in Bandarban district, Khaichat Murung said the hill people do not tend to go to doctors. They see ojha-boidda (faith healers) to cure diseases. Herbal treatment and worshiping gods are also common among them to heal diseases. Hence, they do not avail of the government's health services. Malnutrition among the people of Bangladesh is known worldwide. The World Bank has pledged US$ 100 crore to overcome child nutrition in Bangladesh for next three years.

Not only in Bangladesh, one-third population of the developing countries are suffering from malnutrition. Currently, a total of 120 crore people are suffering from malnutrition in the world. Ten children die of malnutrition every minute in the world.

According to a report published in 2012, 25 percent people in Bangladesh suffer from malnutrition. Poverty has reduced in the country in last four years along with the improvement in living standard. Therefore, the nutrition situation is improving and it is expected to improve further dispelling all frustrations. However, the government needs to take more initiatives to improve nutritional status of CHT districts, lagging behind in this particular sector.

Source: Bangladesh Sangbad Sangstha (BSS)