18

Introduction:
When a person is not getting enough food or not getting the right sort of food,
malnutrition is just knocking the door. Even if people get enough to eat, they will
become malnourished if the food they eat does not provide the proper amounts of
proteins, vitamins, lipids and minerals - to meet daily nutritional reuirements.
!isease and malnutrition are closely linked. "ometimes disease is the result of
malnutrition, sometimes it is a contributing cause. #n fact, $%alnutrition is the largest
single contributor to disease in the world&, according to the '()s "tanding *ommittee
on (utrition +"*(,.
%alnutrition at an early age leads to reduced physical and mental development during
childhood. "tunting, for e-ample, affects more than 1./ million pre-schoolers in
developing countries, according to "*()s World (utrition "ituation 0th report. #odine
deficiency, the same report shows, is the world)s greatest single cause of mental
retardation and brain damage.
'nder nutrition affects school performance and studies have shown it often leads to a
lower income as an adult. #t also causes women to give birth to under-weight babies.
1here are three types of protein-energy malnutrition in children2
Type Appearance Cause
3cute
malnutrition
Wasting or
thinness
3cute inadeuate nutrition leading to rapid weight
loss or failure to gain weight normally
*hronic
malnutrition
"tunting or
shortness
#nadeuate nutrition over long period of time
leading to failure of linear growth
3cute and
chronic
malnutrition
'nderweight 3 combination measure, therefore, it could occur as
a result of wasting, stunting, or both
3ccording to the (ational 4ealth "ervice +(4",, '5, it is estimated that around three
million people are affected by malnutrition +sub nutrition,.
18
3ccording to the 6ood and 3griculture 7rgani8ation +637,, the number of people
globally who were malnourished stood at 9:; million in :<</, an increase of over 8<
million since the 199<-9: base periods.
1he World 4ealth 7rgani8ation +W47, says that malnutrition is by far the largest
contributor to child mortality globally, currently present in .0 percent of all cases.
'nderweight births and inter-uterine growth restrictions are responsible for about :.:
million child deaths annually in the world. !eficiencies in vitamin 3 or 8inc cause 1
million deaths each year.
World 4ealth 7rgani8ation +W47, adds that malnutrition during childhood usually
results in worse health and lower educational achievements during adulthood.
%alnourished children tend to become adults who have smaller babies.
While malnutrition used to be seen as something which complicated such diseases as
measles, pneumonia and diarrhea, it often works the other way round - malnutrition
can cause diseases to occur.
=lobally, as well as in developed, industriali8ed countries, the following groups of
people are at highest risk of malnutrition +sub nutrition,2
Elderly people, especially those who are hospitali8ed or in long-term
institutional care
#ndividuals who are socially isolated
>eople on low incomes +poor people,
>eople with chronic eating disorders, such as bulimia or anore-ia nervosa
>eople convalescing after a serious illness or condition
%alnutrition includes both under nutrition and over nutrition. %alnutrition is a
condition that results from eating a diet in which nutrients are not enough or are too
much such that it causes health problems.
18
7ver nutrition is a form of malnutrition which occurs due to e-cess of nutrients in
body. 7besity, iron poisoning, diarrhea etc. are the main health problems for over
nutrition.
18
Current Situation:
?ates of malnutrition in @angladesh are among the highest in the world. %ore than
0.A of preschool-age children, euivalent to more than 9.0 million children, are
stunted, 0BA are underweight and more than 1/A are wasted. %alnutrition among
women is also e-tremely prevalent in @angladesh. %ore than 0< percent of women
suffer from chronic energy deficiency.
@angladeshi children suffer from micronutrient deficiencies, particularly vitamin 3,
iron, iodine and 8inc deficiency. @angladesh should be commended for making
significant progress in reducing vitamin 3 deficiency +C3!, among preschool
children over the past 10 yearsD however, consumption of vitamin 3 rich foods is still
low, suggesting that the underlying causes of C3! reuire further attention and
support. 3nemia is also highly prevalent among children in @angladesh and few
programs have been initiated to improve their iron status.
18
%alnutrition is such a problem that demands regular assessment. 7ur country is
already one step ahead towards the %illennium !evelopment =oals +%!=s, of '(.
We reduced our child mortality rate 101 to 8/ in per thousand live birth children from
199< to 1999, +see figure 1, that has since slowed considerably, with the figure
standing at 8: in :<<1. #f we have to meet the :<10 %!=s then we have to reduce
child mortality rate into at least /9 per thousand. 3nd no doubt malnutrition is the
main cause of child mortality.
18
3mong various growth measurements, the widely used three measurements are2
1. Weight for 3ge. +'nderweight,
:. 4eight for 3ge. +"tunting,
;. Weight for 4eight. +Wasting,
*ategories of
%easurements
(utritional "tatus Male Female
Weight for Age Underweight 3!"# $"!3#
(ormal B/.;A ;:./A
%eight for Age Stunting 3&!'# "(!)#
(ormal B0.0A :9.1A
Weight for %eight Wasting 3!"# '!"#
(ormal B/.;A .0.0A
7besity <A 1.8A
3mong these three measurements any one type of measurement +e.g. weight for age,
is enough to get an overall knowledge about individualEs nutritional status.
#t was found from the analysis of empirical data that on average female children are
more vulnerable and malnourished than the male children of the village. 3lthough in a
few cases obesity is found higher among the female children than of the male. @ut
total scenario represents a risky condition of the female children.
"tudies suggest that there has been little improvement in women)s nutritional status
over the past :< years. *linical C3! is common among women of reproductive age
18
and during pregnancy. "ub-clinical C3! and anemia are also highly prevalent among
pregnant and lactating women. >rograms in @angladesh also need to begin to
incorporate components for adolescents and school-age children who will also benefit
from improvements in nutrition.
#mproving nutrition can have a significant impact on survival as well as physical and
cognitive development and productivity. =ood nutrition, comprising adeuate uality
and uantity of food intake and reduction of illness.
?e-occurring disasters further complicate the stability of food production. ?ecently
the governments of @angladesh and interested organi8ations have started to encourage
non-cereal food production and consumption along with food self-sufficiency. =reater
attention is being given to supportive policies for agriculture input, research on non-
cereal crops, and commercial and homestead promotion of poultry and
fruitsFvegetables are receiving greater attention.
18
Strategies to pre*ent malnutrition:
@angladesh govt. has taken some necessary steps in order to fight against
malnutrition. "ome of them are mentioned below2
+,isting Strategies:
(ational (utrition >roject2
(ational nutrition project is an investment which is going to help @angladeshi govt. to
fight against malnutrition. #t will support the government)s 10 year vision to e-tend
community nutrition services to the entire country, scaling up the successful model
being implemented in the @ank-supported @angladesh #ntegrated (utrition >roject
+@#(>,.
=rameen !anon2
=rameen !anon is a social business enterprise which was founded in :<<B. #i is
designed to provide children with many of the key nutrients that are typically missing
from their diet in rural @angladesh. #t is run on )(o loss, (o dividend) basis.
in :<<0, >rofessor %uhammad Gunus, the founder of =rameen @ank was invited by
6ranck ?iboud, the chief e-ecutive officer of =roupe !anone. 1hen >rofessor
%uhammad Gunus proposed to form a joint venture with =roup !anon in order to
provide nutritious food to the poor children in @angladesh. 1hey decided to fight
against the malnutrition problem in rural area of @angladesh.
=rameen !anon produced a product named $"hokti !oi& which contains protein,
vitamins, iron, calcium, 8inc and other micronutrients. 1his will help to fulfill the
deficit of nutrients. #n rural area, it is sold for B taka and in !hakaD it is sold for 10
taka.
18
-ther strategies:
1here are many effective ways and strategies to prevent malnutrition2
6ood to prevent malnutrition2
We have to focus on storing foods that have carbohydrates, proteins, fats, vitamins
and minerals which help to maintain healthy bodies and decrease the likelihood of
malnutrition.
3 healthy and balanced diet contains foods from all the major food groups.
1he four main food groups are2
1. 6ruit and vegetables H at least 0 times a day.
:. @read, rice, potatoes, pasta, cereals and other starchy foods
;. %ilk and dairy foods H such as cheese, yoghurt, butter, ghee etc.
.. %eat, fish, eggs, beans, nuts, and other non-dairy sources of protein
6oods and drinks high in fat or sugar are not essential for everyone. #t should only be
consumed in small amounts.
#n order to get proper nutrients, some of the nutrient stored foods are mentioned
below2
*arbohydrates2 White rice, pasta, wheat, oats, dehydrated fruits and vegetables,
sugars, honey, fruits, roots and tubers +cook these well, and cereals.
>rotein2 Iegumes, eggs, nuts, peanut butter, canned meats and fish, oatmeal, grains,
wheat, uinoa, %?Es, popcorn.
6ats2 Whole milk, ensure, peanut butter, oil +preferably plant based oils,, nuts and
seeds.
Citamins and %inerals2 %ulti vitamins, Citamin *, Citamin !, vitamin powders,
dehydrated fruits and vegetables.
.re*ention and Treatment:
%alnutrition is often associated with people living under e-treme conditions, usually
due to natural disasters or from living in underdeveloped parts of the world. @ut even
in developed countries, under-nutrition occurs in people who are poor or homeless
18
and who are ill or have psychiatric disorders. %alnutrition occurs when you do not get
enough calories or nutrients. We can prevent malnutrition by learning its causes and
symptoms, and treating the problem.
>revention "teps
"tep 1
6irst of all learn the causes of malnutrition. Iack of nutrients, even just one vitamin or
mineral, can lead to malnutrition. #nsufficient nutrition can be caused by an
unbalanced diet, eating too little, e-creting too much of a nutrient, some medications,
malabsorption of nutrients and a variety of medical conditions.
"tep :
Watch for high risk factors. "ome life stages, such as infancy, childhood, adolescence,
pregnancy and old age, demand more nutrition than others, and people in these groups
might be at a higher risk. "urgery, trauma, infections, burns and chronic diseases also
can affect nutritional needs and increase the chance of malnutrition.
"tep ;
#dentify the symptoms, which might be slow to appear, but the most obvious one is
weight loss. 7ther symptoms include fatigue, di88iness, brittle nails, chronic diarrhea,
slow wound healing, bone or joint pain and confusion. *hildren might become
e-tremely thin, have stunted growth or have a swollen gut.
1reatment "teps
"tep 1
?eplace missing nutrients. 3 well-balanced diet must be consumed. Gou might need to
gradually increase the number of calories through several small meals at regular
intervals during the day. (utritional supplements, or liuid nutrition, might be needed,
depending on the severity of the malnutrition. #n severe cases, hospitali8ation might
be necessary.
18
"tep :
1reat underlying medical conditions. #f an underlying medical condition or
medication caused the malnutrition, then it must be treated to prevent ongoing loss of
nutrients. *hronic lack of nutrients might also cause a medical condition that needs
treatment.
"tep ;
%onitor eating habits and conditions. #f malnutrition occurs due to environmental,
financial or psychological reasons, ongoing supervision might be necessary to ensure
that adeuate nutrition is consumed. 1each about nutrition and how to maintain a
balanced diet, especially if medical problems demand a special diet.
Treating o*er nutrition:
!iet intervention2
@y creating a perfect balanced diet, we can prevent over nutrition. We should also
avoid non-nutritious foods and over eating to prevent further health problems.
E-ercise2
!oing daily e-ercise is also good to deal with over nutrition. 1his will help burn up
unnecessary nutrients such as fats, carbohydrates etc.
18
/ecommendations
We made some recommendations to the government of @angladesh, (=7s and
international organi8ations who are working to prevent malnutrition
'niversities and institutions should be involved in innovative research and
work to prevent malnutrition programs. >ublish of authentic information
collected through systematic scientific studies should be encouraged.
6or health, housing and social care professionals, the strategy should ensure
that nutrition-related training is included in both undergraduate and
postgraduate courses, and that appropriate nutritional care forms a core part
both of continuing professional development reuirements, and of the fitness
to practice procedures operated by the professional regulatory bodies.
1he micronutrient composition of local foods, both raw and cooked, should be
determined, with special emphasis on identifying micronutrient-rich traditional
foods.
1he e-tent, type, prevalence and distribution of malnutrition in @angladesh
should be documented with periodic updates to determine trends and should
be kept under continuous surveillance.
#nstitutions that could provide training on various aspects of the problem of
malnutrition should be identified, and collaboration among institutions within
developed countries should be organi8ed for e-change of staff for training in
speciali8ed fields.
4ome gardening should be promoted more e-tensively. Efforts should be
made to select fruits and vegetables rich in micronutrients. 1arget populations
should have access to high-yielding seeds and other inputs. =overnments
should support the development of local infrastructure in order to promote
home gardening.
>rocessing of fruits and vegetables should be encouraged to add value to these
products. "imple processing technologies should be adapted to enable women
to earn e-tra income, thus improving their ability to purchase other
micronutrient-rich foods. >rocessing would make it possible to use some of
the surplus during the lean season.
18
"trong initiatives should be taken to implement the food-based nutrition
interventions identified in the (ational >lans of 3ction for (utrition of
@angladesh to improve the nutritional status of the population and nutrition
deficiencies.
=overnments should promote pre- and post-harvest technologies and methods
to prevent wastage of fruits and vegetables and should provide adeuate
transportation and marketing outlets for the sale of produce.
(utrition education should be an integral part of all nutrition improvement
programs. 3n integrated and coordinated approach should be employed in the
development of nutrition education messages for the public to avoid creating
confusion. 3ll available media and methods should be used and messages
should be addressed to all target groups - primary, secondary and tertiary - to
create a nutrition movement in @angladesh.
#nstitutions working in nutrition in @angladesh should be prepared, and
national capacity building - particularly for universities and national
institutions of research and information, education and communication
activities - should be enhanced.
(utrition education should be introduced in school curricula as an integral part
of instruction.
1he current program of iron and folate tablet distribution should include
deworming and should encourage the regular consumption of citrus fruits to
help absorb iron.
6ood-based dietary guidelines should be prepared and should encourage the
consumption of micronutrient-rich foods, particularly fruits and vegetables.
(utrition improvement programs should be developed as an integral part of
national development plans, and an integrated, comprehensive and holistic
approach should be used. 6ood, care and health should be the integrated
components of the program. 1hese programs should be implemented with the
active participation of the people and should be addressed to specific target
groups, reviewed periodically and modified to meet the needs of the
community.
18
3ll ongoing food-based programs in @angladesh should be continuously
monitored and kept under surveillance. "uccess stories should be disseminated
for adoption in other countries.
6ortification of food commonly consumed by the people should be
encouraged. "teps should be taken to keep the price of the fortified food
within the purchasing capacity of the target groups.
3 regulatory body to enforce uality control of fortified food should be
established to prevent fraudulent practices and to protect consumers.
3 sub regional network on food-based actions for prevention and control of
micronutrient malnutrition should be established to e-change information and
technology with other countries.
Workshops should be held every one or two years to assess progress in food-
based actions in @angladesh.
3 consultation on e-isting, promising or adaptable technologies in the field of
food processing and food fortification should be organi8ed in the near future.
>ublic health department of @angladesh should initiate a program of
awareness-raising on malnutrition for the general population.
18
Conclusion
%alnutrition is an impediment to development, and its presence indicates that basic
physiological needs have not been met. What is observed as malnutrition is not only
the result of insufficient or inappropriate food, but also a conseuence of other
conditions, such as poor water supply and sanitation and a high prevalence of disease.
1hus reversing the procedure is comple-, because many issues need to be addressed
more or less simultaneously. 3nd every situation is different, so that there is no single
solution for all.
1here can only be general guidance on directions to pursue. E-perience from lessons
learnt shows that considerable time is needed to redress a situation +ten years and
more,, and that a strong supportive political and policy environment remains crucial
throughout the period. 1here is no $uick-fi-& to this problem. 7nce achieved,
however, the effect is likely to become permanent, offering a substantial return on
investment.
/eferences:
18
+:<1.,. ?etrieved 1< 3ugust :<1., from
http2FFweb.worldbank.orgFe-ternalFdefaultFmainJ
page>5K;.;/<Lpi>5K;..:.Lthe"ite>5K.B</Lmenu>5K;..B;Lcontent%!
5K:<<1:0;.v
!istrict, (. +:<1.,. 1hird Eye2 (utritional "tatus of %ale and 6emale *hildren in
?ural @angladesh2 3 *omparative "tudy on 1entultala Cillage of 5hulna
!istrict. Sajalkroy.blogspot.com. ?etrieved 1< 3ugust :<1., from
http2FFsajalkroy.blogspot.comF:<11F<1Fnutritional-status-of-male-and-
female.html
I#CE"1?7(=.*7%,. +:<1;,. 4ow to >revent and 1reat %alnutrition M
I#CE"1?7(=.*7%. ?etrieved 1< 3ugust :<1., from
http2FFwww.livestrong.comFarticleF01<<;0-how-to-prevent-and-treat-
malnutritionF
%edical (ews 1oday,. +:<1.,. What is malnutritionJ What causes malnutritionJ.
?etrieved 1< 3ugust :<1., from
http2FFwww.medicalnewstoday.comFarticlesF1/9;1B.php
?eadynutrition.com,. +:<1.,. 1he . 1hings Gou %ust Eat 1o 3void %alnutrition M
?eady (utrition. ?etrieved 1< 3ugust :<1., from
http2FFreadynutrition.comFresourcesFthe-.-things-you-must-eat-to-avoid-
malnutritionN:<1<:<11F
18
Wfp.org,. +:<1.,. What is malnutritionJ M W6> M 'nited (ations World 6ood
>rogramme - 6ighting 4unger Worldwide. ?etrieved 1< 3ugust :<1., from
http2FFwww.wfp.orgFhungerFmalnutrition
Wikipedia,. +:<1.,. =rameen !anone. ?etrieved 1< 3ugust :<1., from
http2FFen.wikipedia.orgFwikiF=rameenN!anone
Wikipedia,. +:<1.,. %alnutrition. ?etrieved 1< 3ugust :<1., from
http2FFen.wikipedia.orgFwikiF%alnutrition
18