Coordinated efforts key to preventing malnutrition in CHT: Stakeholders

Bangladesh is self-sufficient in food, but people are still suffering from malnutrition, especially in the Chattogram hill tracts region, due to a lack of access to balanced nutritional foods and poor awareness, say stakeholders.

The coordination gaps among the different government agencies and non-government organisations is also a big factor in addressing malnutrition, notably in Khagrachari district, they said at a roundtable meeting on Tuesday at the Khagrachari Hill District Office.

Malnutrition causes people to suffer from becoming underweight, stunting and wasting away of the body, the speakers pointed out at the event. titled "Advancing Nutrition Commitments for Chattogram Hill Tracts".

"Nutrition is the foundation of development. Many children, pregnant women and elderly person are suffering from malnutrition across the country and we could not address it, in particular in the CHT area," Dr Akhter Imam, deputy director, Bangladesh National Nutrition Council, said at the meeting organised by the District Nutrition Coordination Committee (DNCC), Khagrachari.

"Those of us who are working in the area of nutrition, we need to ask ourselves how much we know about the extent of our job responsibilities. Otherwise, it will not be possible to play a proper role in addressing the nutritional deficiency of the people," he added.

"Creating awareness is important, of course. But if people in remote areas in the mountains do not have access to nutritious food, what good is creating awareness," asked Deputy Commissioner Protap Chandra Biswas, who chaired the event, which was supported by the Leadership to Ensure Adequate Nutrition (LEAN) project.  

"So we need to ensure how we can provide access to nutrition in the hill tracts," said Biswas, who is also president of DNCC.

The speakers also said that main challenges for improving nutrition in CHT are nutrition demand creation and service availability as well as addressing the lack of skilled manpower (doctor, nurses) and ensuring logistic support, regular monitoring, and training.

There is scope to develop inter-department coordination in DNCC that will help reduce the resource gaps of nutrition products and ensure an availability of supply, they said.

In Bangladesh, more than 54% of preschool-aged children, equivalent to more than 9.5 million children, are stunted, 56% are underweight and more than 17% suffer from wasting away of the body, according to an FAO report in 2019.

According to profile.org, the prevalence of stunting is 27% in Khagrachari and 27% in Chattogram division while nationally it is 28%.

On the other hand, the prevalence of the underweight factor is 16% in Khagrachari, 23% in Chattogram division and 23% nationally, which also showed progress toward the national prevalence rate of underweight (23%).

Wasting is 10% in Chattogram division and 10% at national level, which shows a good prevalence rate in terms of nutrition indicators.

But it is not up to the mark as per global standard for malnutrition prevalence rate (wasting <5%, stunting <20%, underweight <10%.) 

Titan Khisa, executive officer, Khagrachari Hill District Council, said, "Even 25-30 years ago, there were more fountains, watercourses and forests in Khagrachari. They were a source of many natural fruits, fish and meat. Today, the opportunity to meet the nutritional needs of people in remote areas has decreased."

He said, "Hill people sell nutritious foods like chicken and bananas to meet their other needs. So, their own nutritional needs are hardly met."

Dr Md Shafiuddin, deputy director, Agriculture Extension Department, Khagrachari, said along with nutrition safe foods must also be ensured.

Sumaya Naznin, district food controller, (DC Food), said more research is needed to determine if children are stunted genetically or due to lack of nutrition.

"Since rice is the staple food, we are distributing nutritional rice in which 6 micronutrients have been added," she added.

Dr Anutosh Chakma, Upazila Health Officer, Panchari, said, "The challenge here is that many places are remote and hard to reach. As a result, we are not able to reach out to families and create awareness among mothers and children at the field level."

Some 7.5 lakh people live in Khagrachari district and of them some 4.5 lakh live in rural areas, according to available data.

In Khagrachari, use of improved drinking water is 78%, improved sanitation 55%, water and soap availability 60%, whereas in Chattogram division it is 97%, 84% and 69% and nationally 99%, 64% and 75%, in that order.

The speakers also stressed raising awareness at the primary and secondary educational institutions.

Jannat Noor, project director of LEAN and the keynote presenter at the event, mentioned that the CHT administrative structure is not included in the national nutrition governance policy, an issue that needs to be addressed.

Dr Mohammad Saber, civil surgeon of the district, moderated the event, which was funded by the European Union and media-partnered by The Business Standard.

The next roundtable is slated for Thursday at the Parjatan Motel Rangamati and will focus on the hill district.

Under the leadership of DNCC, LEAN along with all consortium partners has been facilitating a nutrition governance process, particularly to improve maternal and child nutrition in the CHT since 2018 with funding support from the European Union.

The project, funded by the EU, covers 78 unions in 18 upazilas of three hill districts (Khagrachari, Rangamati & Bandarban) in Chattogram Hill Tracts. The timeline is 1 September 2018 to 31 August 2023.

The Bangladesh National Nutrition Council (BNNC) has been working as an apex body in rolling out the plan and reports directly to the Prime Minister's Office.