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SAFANSI

In Bangladesh, nutrition trainers inspire healthy habits

Snigdha Ali's picture
A group watches videos that raise awareness about nutrition and hygiene in the Rangamati district of the Chittagong Hill Tracts, Bangladesh.
A group watches videos that raise awareness about nutrition and hygiene in the Rangamati district of the Chittagong Hill Tracts, Bangladesh. Photo Credit: ASHIKA Development Associates

It was very early in the morning when the call came.  Minoti Chakma was in labor, and her husband knew something was not right.

She had been in pain for a while. The midwife and the family elderlies were trying to help her deliver the baby, a common practice in that remote indigenous community in the Chittagong Hill Tracts (CHT) of Bangladesh.

But nothing seemed to be working, and Minoti’s husband grew worried.

So, he decided to seek help from a person known locally as the ‘nutrition trainer.

The trainer he met is part of a larger team of twenty-two who raises awareness about nutrition and hygiene among indigenous communities in the Banderban and Rangamati districts.

With support from the South Asia Food and Nutrition Security Initiative (SAFANSI), the nutrition trainers visit families in selected villages, gather women and men into groups, and show them instructional videos.

These low-cost videos introduce communities to best practices in nutrition and health—and challenge long-held social and cultural norms. An open discussion usually follows the projection.

The rising cost of nutritious food in South Asia

Felipe F. Dizon's picture
 World Bank
A malnourished child will face poorer outcomes as an adult. In South Asia, where malnutrition persists in multiple forms, improving nutrition in the early stages of life is critical to a child's future development and health. Credit: World Bank

A malnourished child will face poorer outcomes as an adult.
 
That’s why improving nutrition, especially in the early stages of life, is critical.
 
The path toward better nutrition includes adequate maternal and child care, access to better sanitation facilities, health services, and naturally, nutritious foods.
 
But whether an individual consumes—or not—nutritious food is contingent upon a myriad of factors, ranging from the availability of certain foods, how convenient they can be turned into meals, or simply, if they meet consumers’ tastes.
 
But above all, the high cost of food remains the most critical barrier to proper nutrition and affects the poor more than the rich.
 
And in South Asia, where malnutrition persists in multiple forms, the cost of nutritious food is prohibitive.

South Asia's new superfood or just fishy business?

Pawan Patil's picture
Across South Asia, four known species of indigenous, fully mature, small food-fish – now dubbed ‘NutriFish’ have nutritional and health benefits for pregnant and lactating women and young children when consumed over the first one thousand days. Here, children from Kothi, Odisha in India show their curiosity and share their excitement with a new kind of harvest happening in their village. Credit: Arun Padiyar
Kale, Kefir, and Quinoa have now joined the ranks of better-known foods like Blueberries, Orange Sweet Potato, and Salmon on family dinner tables across the world.

Considered superior for their health and nutrition benefits, these so-called ‘Superfoods’, often considered “new” by the public are now ever-popularized by celebrity chefs and have become all the rage of foodies from San Francisco to Singapore.   

We live in a world of paradox, where old world and almost forgotten food like Quinoa (which dates back as a staple food over three thousand years to Andean civilization but largely disappeared with the arrival of the Spanish) is now back on the menu.  

Salmon, a staple part of Nordic diets from paleolithic times and woven into the culture of native populations across northwestern Canada and many other superfoods share comparable stories.

And, there are many other old world foods, indigenously known, disappearing but not fully forgotten, yet to be re-discovered.

Food is also now advancing to the front-line of the war on poverty

A health and human capital crisis is now sweeping the world, and a lack of diverse, accessible, affordable, and available nourishing foods is increasingly blamed.  

For example, obesity, from poor diet and poor exercise has tripled since 1975 to almost two billion people today.  

Undernutrition contributes to 45 percent of all deaths of children under five years old (3.5 million each year), much of it avoidable, but difficult to detect as it remains “hidden.”  

Policy makers and stewards of national economies are starting to wake up to the fact that poor nutrition has massive economic implications too, reducing GDP by 3-11 percent, depending on the country. 

While economies such as Bangladesh, India, and Pakistan may look strong, just as bellies look full, critical micronutrients and vitamins, essential for healthy physical and cognitive development over the first 1,000 days of life are largely missing from diets of many developing countries and are a proven drag to educational attainment and economic prosperity.  

And parents, from both rich and poor nations alike, seem to know something is not quite right. 

If healthier food choices that are accessible, affordable, and readily available are better known, would parents purchase such food from the market for their families?     

With a small grant from the World Bank-administered South Asia Food and Nutrition Initiative (SAFANSI) supported by the EU and the United Kingdom, a partnership with WorldFish was established to test this premise.  

A 60 second TV spot, a collaboration between scientists, economists, a private sector digital media company, broadcasters and the Government of Bangladesh, was created and broadcast across the nation on two occasions and watched by over 25 million people.  

A parallel radio program was also developed and aired reaching millions more, particularly the rural poor and marginalized communities.
 
NutriFish1000 TV

 

Milk fortification in India: The journey so far

Edward W. Bresnyan's picture
 NDDB
In India alone, 185 million people don’t get enough nutrients. This hidden hunger is especially pervasive among children. as more than 70 percent of India’s children under five are deficient in Vitamin D, and 57 percent of all children in the country lack adequate levels of Vitamin A. Credit: NDDB
Globally, more than two billion people are deficient in key micronutrients, which are essential to their good health.
 
In India alone, 185 million people don’t get enough nutrients.
 
This hidden hunger is especially pervasive among children. More than 70 percent of India’s children under five are deficient in Vitamin D, and 57 percent of all children in the country lack adequate levels of Vitamin A. 
 
These deficiencies have contributed to high levels of stunting, wasting and underweight children.
 UNICEF 
Global micronutrient deficiency (as a percentage of the population). Two billion people in the world lack key micronutrients such as Vitamin A or iron. South Asia has the most critical malnutrition levels. Source: UNICEF 


Micronutrient availability can make or break a balanced diet
 
If accessible and affordable, nutritional supplements taken in the form of capsules or tablets can mitigate the symptoms of hidden hunger. But they can become toxic if consumed in large amounts.  
 
Unlike supplements, food fortification is a simple, preventive and low-cost approach to curb micronutrient deficiencies.
 
But except for mandatory iodine fortification of salt, India lags in adopting food fortification as a scalable public health intervention.  
 
This is a missed opportunity as a glass of fortified milk (320g) can provide approximately 34 percent of the recommended daily allowance of Vitamin A and 47 percent of Vitamin D.
 
In 2016, the Food Safety and Standards Authority of India released standards for the fortification of five staple food items: rice, wheat, salt, oil, and milk. Further to that, regulations are now in place to fortify milk variants such as low fat, skimmed, and whole milk with Vitamin A and D.   
 
But despite its significant health benefits, and while established for more than three decades by companies such as Mother Dairy, a subsidiary of the National Dairy Development Board (NDDB), milk fortification is not yet common practice across the Indian milk industry.
 
To fill that gap, NDDB partnered in 2017 with the South Asia Food and Nutrition Security Initiative (SAFANSI), the World Bank, and The India Nutrition Initiative, Tata Trusts to explore the possibilities of large-scale milk fortification in India.
 
Over the last twelve months, this collaboration has enabled ten milk federations, dairy producer companies, and milk unions across the country to pilot milk fortification for their consumers. Fifteen others have initiated the process.

Five takeaways for better nutrition in South Asia—and beyond

Felipe F. Dizon's picture
In many developing countries, governments and health authorities face the dilemma of how to feed their growing population while ensuring their food is nutritious. Credit: World Bank

Together with more than 1,500 academics, scientists, and policymakers, we participated last week in the Rice Olympics.
 
The event—formally known as the International Rice Congress (IRC)—provides a unique window on the latest innovations and policies about the globe’s most important staple crop.
 
For many, rice may not seem worth the cost of a conference trip. Yet, half of the world’s population depend on it as their main supply of nutrients and energy.  
 
Rice isn’t just a crop,” said Rajan Garjaria, Executive Vice President for Business Platforms at Corteva Agriscience. “It’s a way of life. A place can be made or broken, based on their rice crop.
 
The Congress discussed a breadth of topics, but what stood out the most is that rice can be instrumental in making people healthier and in sustaining the planet.
 
The South Asia Food and Nutrition Security Initiative (SAFANSI), a World Bank partnership that aims to improve food and nutrition security across the region, participated in the Symposium on Sustainable Food Systems and Diets and presented its latest research on linkages among food prices, diet quality, and nutrition security.  
 
Overall, the event underscored how governments and health authorities in many developing countries face the dilemma of how to feed their growing population while ensuring their food is nutritious and discussed relevant strategies to transform nutrition security challenges into opportunities.

ښه تغذي د افغانستان یو له لومړیتوبونو څخه

Michelle Mehta's picture
Also available in: English | دری
Community based, preventative approaches to health care will improve stunting and wasting outcomes for Afghan children
د روغتیا پالنې په برخه کې د خلکو د اړتیاوو پر بنسټ د مخنیونکو تدابیرو نیول کولاۍ شي د ماشومانو د پڅې ودې او د هغوی د روغتیايي نیمګړتیاوو له امله ناوړه اغېزو کې ښه والۍ راولي. انځور: د رومي مشورتي شرکت/ نړیوال بانک

افغانستان شپېتم هېواد وو چې تېر کال د خوارځواکۍ د له منځه وړلو د نړیوال خوزښټ سره مل شو. د خلکو لپاره د یوې سوکاله او غوره راتلونکې د برابرولو لپاره دغه هېواد د دغه تصمیم په نیولو سره خپل پیاوړۍ هوډ کې څرګند کړ او دا پانګونه ېې خورا اړینه وبلله.
 
په دغه نړیوال خوخوزښټ کې د افغانستان ګډون په خورا حساس وخت کې ترسره شوی ده، ځکه له څلوېښت سلنې زیات افغان ماشومان اړینه وده نلري او په مزمنه خوارځواکۍ اخته دي او یا ټیټ قدونه لري.
 
په لږ عمر کې له ودې څخه پاتې کېدل د ماشومانو د ناکافي تکامل او ودې بېلګه بلل کېږي، چې د هېواد د اقتصادي ودې او پرمختګ لپاره د هغوی د مشارکت ځواک راکموي.
 
له بلې خوا، هغه ماشوم، چې ښه تغذیه شوی وي، تحصیل او زده کړو ته زیاته لېوالتیا لري، او خپل درس ښه زده کوي، چې دا په خپل وار سره د ځوانۍ په مهال د هغه لپاره د زیات عاید د ترلاسه کولو زمینه برابروي. له همدې کبله دا احتمال، چې دغه شان ماشومان د ودې د پړاونو په بشپړولو او د تغذېې لپاره د وړ شرایطو پوره کولو سره له بېوزلي څخه وژغورل شي، زیاتېدونکی ده.[1]

Afghanistan makes better nutrition a priority

Michelle Mehta's picture
Also available in: دری | پښتو
Community based, preventative approaches to health care will improve stunting and wasting outcomes for Afghan children
Community based, preventative approaches to health care will improve stunting and wasting outcomes for Afghan children.  Photo Credit: Rumi Consultancy/ World Bank

Last year, Afghanistan became the 60th country to join Scaling Up Nutrition (SUN), a global movement to end malnutrition, and thus signaled its strong commitment to invest in a better future for its citizens.

This engagement comes at a critical time as more than 40 percent of Afghan children are currently stunted—or of low height for their age.

Stunting in early life is a marker of poor child growth and development and will reduce their potential to contribute toward their country’s growth and prosperity.

On the other hand, a well-nourished child tends to complete more years of schooling, learns better, and earns higher wages in adulthood, thereby increasing the odds that he or she will escape a life of poverty.[1] 

As such, Afghanistan stands to gain enormous benefits by reducing stunting, which in turn can help boost its economic growth, productivity, and human capital development.

To help the Afghan government invest in better nutrition, the South Asia Food and Nutrition Security Initiative (SAFANSI), the Ministry of Public Health (MoPH), World Bank and UNICEF have partnered to determine what it would take to reach more children, women, and their families and provide them with essential nutrition services that would ultimately reduce stunting and anemia.

It’s time to end malnutrition in South Asia

Idah Z. Pswarayi-Riddihough's picture
Chronic malnutrition remains prevalent across the region as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices.
Chronic malnutrition remains prevalent across South Asia as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices.

In Sri Lanka, as in the rest of South Asia, improving agricultural production has long been a priority to achieve food security. 

But growing more crops has hardly lessened the plight of malnutrition. 

Chronic malnutrition remains prevalent across the region as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices. 
And children and the poorest are particularly at risk.

South Asia is home to about 62 million of the world’s 155 million children considered as stunted-- or too short for their age. 

And more than half of the world’s 52 million children identified as wasted—or too thin for their height—live in South Asia. 

Moderate-to-severe stunting rates ranged from 17 percent in Sri Lanka in 2016 to a high 45 percent in Pakistan in 2012–13, with rates above 30 percent for most countries in the region.

Moderate-to-severe wasting rates ranged from 2 percent in Bhutan in 2015 to 21 percent in India in 2015–16, with rates above 10 percent for most countries in the region. 

The social and economic cost of malnutrition is substantial, linked to impaired cognitive development, chronic disease, and lower future earnings.

And sadly, much remains to be done to ensure children across South Asia can access the nutritious foods they need to live healthy lives. 

Promoting better nutrition in Bhutan

Izabela Leao's picture
 Izabela Leao / World Bank
School children singing and dancing in Samtse Dzongkhag. Photo Credit: Izabela Leao / World Bank

Bhutan is no ordinary place.

A landlocked Himalayan kingdom tucked in a mostly rugged mountainous terrain between India and China, it measures prosperity by assessing its citizens’ level of happiness by way of a Gross National Happiness index.

Equally striking, Bhutan’s constitution mandates that 60 percent of its national land be preserved under forest cover, making Bhutan the world’s only carbon-negative country.

Bhutan’s geography – with land rises ranging from 200 meters in the southern foothills to 7,000 meters in the high northern mountains – consists of three major agro-ecological zones that allow for a rich biodiversity and seasonal foods.

This natural wealth, however, comes with its caveats as Bhutanese living in isolated rural areas can’t access a reliable diverse diet throughout the year.

"Many families in rural Bhutan practice two meals rather than three meals a day," reports Ms. Kinley Bidha, Tarayana Foundation Field Officer in Samtse Dzongkhag. "Some for cultural reasons, others due to a shortage of food, others due to a shortage of land too farm," she adds.

Overall socio-economic development in the last three decades has led to a rapid improvement in health and nutrition outcomes in Bhutan – the country’s infant mortality rate declined to 30 per 1,000 live births in 2012 down from 90 per 1,000 in 1990; while the rate of stunting in children under 5 years declined 24 percent from 1986 levels.

Nonetheless, the lack of variety of foods in diet remains a key concern, especially for pregnant and nursing women as well as young children. And while most families feed their children complementary food, fewer than a quarter of parents provide them nutritious meals essential to their health.

In addition, 67 percent of Bhutanese adults consume less than the recommended five servings (or 400 grams) of fruits and/or vegetables per person a day [National Nutrition Survey (NNS) 2015].

When consumed, vegetables consist for the most part of two national staples, potatoes and chilies, which hardly provide essential vitamins and minerals.

Keeping regional variations in mind, between 16 and 34 percent of children under 5 are stunted—or too short for their age—seven percent of children are underweight, 35 percent of children of age 6-59 months and 44 percent of women of reproductive age are either anemic or iron deficient. Exclusive breastfeeding rates for six-month-old children remain at a low 50 percent (NNS, 2015).  

Damages caused by malnutrition during pregnancy and the first years of a child’s life are irreversible and contribute to stunting and lower immunological and cognitive development, and predispose to adult-onset diseases (including metabolic syndrome).

Thankfully, the negative impact of malnutrition on Bhutan’s economy is now better understood and has become a priority to promote its national development.

Can cash transfers solve Bangladesh’s malnutrition?

Rubaba Anwar's picture
Silvi and her mother arrive with Silvi’s birth certificate to enroll into Jawtno. a cash transfer program aimed to help 600,000 poor families in Bangladesh access prenatal and child care.
Silvi and her mother arrive with Silvi’s birth certificate to enroll into Jawtno. a cash transfer program that aims to help 600,000 poor families in Bangladesh access prenatal and child care. Credit: World Bank


Silvi is eight months old. She lives in a remote village in one of the poorest regions of Bangladesh.
 
Her mother Maya often reflects on her pregnancy and worries about her daughter’s wellbeing as she recalls her morning sickness, the uncertain and painful birth, and the long nights at Silvi’s side as the baby lay wide awake wailing, fighting one illness after the other.
 
She remembers, too, the thrills of hearing Silvi giggle at the sound of her rattle, and when she began to crawl.
 
Despite the little joys that her baby brings to Maya, Silvi’s early childhood was marked with apprehension: Shouldn’t she be a little heavier? When will she learn to walk? Will she be healthy and intelligent enough to earn a decent living when she grows up? Or would she be handed down her parents’ poverty and get married like Maya had to, at only sixteen?
 
But with the right kind of support, Silvi can have a chance at a better life and bring her family out of poverty.
 
Growing evidence has shown that adequate nutrition before birth and the two years after – or in the first 1,000-days – has lasting effects on a child’s intelligence and brain development.
 
When they’re properly fed and exposed to learning, children can reach their full potential and break the poverty trap.
 
Thus, investing in early childhood nutrition and cognitive development (CNCD) is critical to curbing poverty in a country like Bangladesh, where 36 percent of children below the age of 5 are stunted —or too short for their age--, low birth weight is prevalent, and maternal nutrition remains poor.
 
Sadly, poor families like Maya’s are not utilizing services available to them.  

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