Syndicate content

Health

আমার সন্তান যেন থাকে মাছে-ভাতে

Susmita Dasgupta's picture
 
A mother feeds her daughter in Bangladesh. Image courtesy: The World Bank


বাঙালির  চিরন্তন প্রার্থনা তার সন্তানের মুখে একটু মাছ তুলে দেয়া।  প্রকৃতির দাক্ষিণ্যে বাংলাদেশে ধান, ফল, আর মাছের অভাব ছিল না।  তাই বাঙালির  সহজাত জ্ঞান ছিল যে মাছ সুপ্রাপ্য, মাছ সুস্বাধু , মাছ পুষ্টি দায়ক আর শিশুর জন্য মাছ পরিপূর্ণ খাবার। মাছ বাংলাদেশের সর্বত্র ছিল সহজলভ্য। নানা ধরণের মাছ, ছোট মাছ  অনেকটা যেন নিজে ধরা দিতো, মাছ আর কেবল শুধুমাত্র ভালো আর পুষ্টিকর খাবার থাকেনি, বাঙালীর ভালোবাসা আর গর্বের বিষয় হয়েছে। বাংলাদেশের সর্বত্র, অধিকাংশ পরিবারে মাছ সামাজিকতার অঙ্গ হয়েছে, আত্মীয়জন মাছ পরিবেশন না করলে মনক্ষুন্ন হয়েছে।  সব বাঙালিই ছোট বয়সে উপদেশ শুনেছে “মাছ খাও না হলে বড় হবে না” “মাছ খাও, মাথায় বুদ্ধি হবে” বা “এই মাছ খাও, পরীক্ষার ফল ভালো হবে” ।

আজকাল কিন্তু আর মাছ নিয়ে অত কথা শুনতে পাওয়া যায় না।  অবশ্যই এ বছর ইলিশ বেশি না কম হলো, এবার রপ্তানি হবে না আমদানি হবে; এরকম খবর দুচারটি খবরের কাগজে ছাপে।  কারণ এগুলো সব দামি মাছ। খবর গুলো হয়তো মাছ নিয়ে নয়, মাছের দাম নিয়ে। ঢাকা অথবা অন্যান্য শহরাঞ্চলে নতুন দারুণ খাবারের দোকান হয়েছে; দেশিবিদেশী নানাবিধ আয়োজনের খাবার পাওয়া যায়।  কিন্তু একটু ভালো মাছ-ভাত কোথায় পাওয়া যাবে, খুঁজতে হলে অনেকদিন অনেক পথে হাটঁতে হবে। যারা শহুরে  মধ্যবিত্ত, অথবা গ্রামাঞ্চলে উচ্চবিত্ত, তাদের অনেকের বাড়িতে বাচ্চারা দামি খাবার খায়, কিন্তু মাছ খাবে না।

অথচ বাংলাদেশের অসংখ্য শিশু অপুষ্টির শিকার। সরকার আর ইউনিসেফের নতুন রিপোর্ট " প্রগতির পথে বিবরণী " জানিয়েছে যে, পরিসংখ্যান মতে ৩০-৪০ শতাংশ শিশু এদেশে অপুষ্টিতে ভুগছে। কেবল গরিবের সন্তান নয়, মধ্যবিত্ত পরিবারের ছেলে মেয়েরাও প্রয়োজনীয় পুষ্টিকর খাবার আর পরিপালনের বাইরে। প্রশ্ন জাগে, চিরন্তন বিশ্বাস যে মাছ শিশুদের পুষ্টি যোগায়, তার থেকে আমরা দূরে সরে যাচ্ছি না তো? শিশু স্বাস্থ্যের সাথে জড়িত মায়েদের স্বাস্থ্য। মায়েরা মাছ খাচ্ছেন তো? এই সব ভাবনা চিন্তা নিয়ে বিশ্বব্যাংকের নতুন একটা গবেষণা প্রকাশিত হলো সম্প্রতি। বাংলাদেশে সামাজিক অর্থনৈতিক প্রসঙ্গে মাছ খাওয়া ও শিশু স্বাস্থ্য (The Socioeconomics of Fish Consumption and Child Health in Bangladesh)।

 বাংলাদেশের নিজস্ব জনসংখ্যাতাত্ত্বিক ও স্বাস্থ্য জরিপ (Demographic Health Survey) প্রায় প্রতি চার বছর পর হয়। এরকম ৫ টি জরিপের ( ২০০০, ২০০৪, ২০০৭, ২০১১ এবং ২০১৪ সাল) মোট ৩৬৪৯১ টি বর্ণনার সংখ্যাতাত্ত্বিক প্রতিলিপি (statistical regression) বিশ্লেষণ করা হয়েছে বিশ্বব্যাংকের এই গবেষণায়।  জানা যাচ্ছে যে, দেশের উন্নতির সাথে শিশু মৃত্যুর সংখ্যা কমেছে। পরিবারের আর্থিক উন্নতির সাথে শিশুর খাদ্য তালিকায় সর্ব মোট মাছ , মাংস আর  ডিমের অনুপাত বেড়েছে নজর কাড়ার মতো। কিন্তু আর্থিক উন্নতির সাথে মাছের  অনুপাত শিশুর খাদ্যে প্রত্যাশিত সমানুপাতে বাড়েনি।

গবেষণায় একটি অপ্রত্যাশিত ফল হলো যে পরিবারের প্রধানত: মায়েদের উচ্চশিক্ষার সাথে মাছ খাওয়ানোর প্রবণতা কমেছে। সব মিলিয়ে ডিম ও মাংসের তুলনায় বেশি পুষ্টিকর, উপকারী ও সস্তা হওয়া সত্ত্বেও, পারিবারিক ও আর্থিক সাচ্ছল্যের সাথে শিশুর খাবারে মাছের অনুপাত কমেছে। 

গবেষণাটি দেখিয়েছে যে, শিশু জন্মের আগে ও পরে মায়েরা একটু বেশি মাছ খেলে জন্মের প্রথম বছরে শিশুর মৃত্যুর আশংকা কমে যায়, আর জ্বর, কাশি, পেটের অসুখেও অপেক্ষেকৃত কম ভোগে শিশুরা।  বর্ষাকালে ও বর্ষার ঠিক পরে মাছ যখন সুলভ আর সহজপ্রাপ্য, তখন নিতান্ত নিম্নবিত্ত পরিবারের খাবারের তালিকায় অনুপাতে একটু বেশি হলেও স্থান পায় মাছ। ধারণা করা হচ্ছে এই সময়ে মায়েরাও মাছ খান। ফলত : বর্ষা অথবা তার একটু পরে সদ্যজাত বাচ্চাদের রোগ প্রতিরোধ ক্ষমতা বাড়ে এবং মৃত্যুহার কমে।  আর এর  উল্টো ঘটনা  ঘটে শুকনা মৌসুমে, যখন মাছ অতটা সহজ প্রাপ্য ও সুলভ হয় না। এবং মাছ খাওয়া কমে যায়।  সদ্যজাত শিশুদের রোগ বাড়ে, মৃত্যু হার বাড়ে।

বিশ্বব্যাংকের এই গবেষণার ফলাফল যেন কিছুটা ভুলে যাওয়া ঐতিহ্য মনে করিয়ে দেবার প্রচেষ্টা। শিশু স্বাস্থ্যের খাতিরে মাছের যোগান বাড়াতে হবে। বিশেষত: শিক্ষিত মায়েদের মাতৃ মঙ্গল শিক্ষায় জানাতে হবে মাছ খাওয়া কত প্রয়োজন। কেবল শিশুর খাবার নয়, অন্তঃসত্ত্বা মায়েদের বছর ধরে খেতে হবে আরো একটু বেশী মাছ। গবেষণাটি আশা করে যে শিশুর অপুষ্টির অন্যতম সমাধান হবে বাঙ্গালীর চির পরিচিত মাছে ভাতে। আর ভাবতে ভালো লাগে যে সবার প্রার্থনা যেন হয়, কেবল সন্তান নয়, জননীরাও যেন সবাই থাকেন মাছে - ভাতে। 

 
ডেভিড হুইলার , সুস্মিতা দাশগুপ্ত, তাপস পাল , গোলাম মোস্তফা      

Tackling India’s hidden hunger

Edward W. Bresnyan's picture
India’s National Dairy Development Board (NDDB)
With India’s rapidly growing dairy industry, large-scale milk fortification of Vitamins A and D is a robust vehicle for increasing micronutrients intake across the population. Credit: India’s National Dairy Development Board (NDDB)  
Micronutrient deficiencies, especially Vitamin A and D, are prevalent in India. 
 
Yet, these deficiencies -- often referred to as ‘hidden hunger’ -- go largely unnoticed and affect large populations.
 
Night blindness, a condition afflicting millions of pregnant women and children, stems from low intake of foods rich in essential nutrients like Vitamin A.
 
Budget constraints limit access to nutrient-rich foods for many families, who are unaware or unable to afford a nutritious diet.
 
National programs help supplement diets with Iron and Vitamin, but their scope is too narrow to adequately address these deficiencies.
 
 India’s National Dairy Development Board (NDDB)  
Food fortification is a relatively simple, powerful and cost-effective approach to curb micronutrient deficiencies. It is in general socially accepted and requires minimal change in existing food habits. Credit: Credit: India’s National Dairy Development Board (NDDB)


Fortified Milk Helps Increase Vitamins Intake
 
When fortified with vitamin A and D, milk, which remains a staple for many Indians, can help alleviate dietary deficiencies when supplementation is not available.

Food fortification is a relatively simple, powerful and cost-effective approach to curb micronutrient deficiencies. It is in general socially accepted and requires minimal change in existing food habits.

The process is inexpensive and costs about 2 paisa per liter or about one-tenth of a cent.  And because it only adds a fraction of daily recommended nutrients, the process is considered safe.

For these reasons, food fortification has been successfully scaled up in some emerging economies.

However, except for salt fortification with iodine, India has not yet achieved large-scale food fortification. 

With India’s rapidly growing dairy industry, large-scale milk fortification of Vitamins A and D is a robust vehicle for increasing micronutrients intake across the population.

Towards a clean India

Guangzhe CHEN's picture

When Prime Minister Narendra Modi launched the Swachh Bharat Mission in 2014, it marked the beginning of the world’s largest ever sanitation drive. Now, a 2017 survey by the Quality Council of India finds that access to toilets by rural households has increased to 62.45 per cent, and that 91 per cent of those who have a toilet, use it. Given India’s size and diversity, it is no surprise that implementation varies widely across states. Even so, the fact that almost every Indian now has sanitation on the mind is a victory by itself.

 Guy Stubbs

Achieving a task of this magnitude will not be easy. Bangladesh took 15 years to become open defecation free (ODF), while Thailand took 40 years to do so. Meeting sanitation targets is not a one-off event. Changing centuries-old habits of open defecation is a complex and long-term undertaking.

Securing a prosperous future for Afghanistan amidst challenges

Christina Wieser's picture
Also available in: دری | پښتو
 Rumi Consultancy/ World Bank
According to a recent report, just over half of Afghan children attend primary school and most of them were boys. Photo Credit: Rumi Consultancy/ World Bank


Fueled by unprecedented levels of aid, literacy, school enrollment, and access to basic services, Afghanistan made tremendous progress between 2007–08 and 2011–12. However, declining aid and increasing conflict during the period between 2011–12 and 2013–14 slowed progress, especially on education and maternal health outcomes, as documented by our recent World Bank report, the “Afghanistan Poverty Status Update: Progress at Risk.”

In this blog, we look at how Afghanistan has performed across several important development indicators in the last few years.

د شته ستونزو سربېره؛ آیا په افغانستان کې د سوکاله راتلونکي رامنځته کېدل امکان لري؟

Christina Wieser's picture
Also available in: English | دری
 Rumi Consultancy/ World Bank
د وروستۍ رپوټ پر بنسټ، یوازې څه باندې نیمایي په شرایطو برابر ماشومان لومړني ښوونځي ته ځي، چې البته ډیرۍ شمیر یی هلکان دي.  انځور: د رومي مشورتي شرکت/ نړیوال بانک

په بې ساري ډول افغانستان سره د نړیوالو مرستو کولو ته په کتو، د ۲۰۰۷ – ۲۰۰۸ کلونو او بیا په ۲۰۱۱- ۲۰۱۲ زیږدیز کلونو پر مهال د سواد کچه، په ښوونځیو کې د زدکوونکو شمولیت یا نوم لیکنه او بنسټیزو خدمتونو ته لاسرسی په هر اړخیز او پراخ ډول بدلون موندلی. خو د پرمختګونو سره سره، د نړیوال بانک وروستی راپور، چې  د "په افغانستان کې د فقر او بیوزلۍ د حالت تحلیلي رپوټ: له خطر سره مخامخ پرمختګ"، تر سرلیک لاندې بشپړ شو؛ د دې ښکارندوي کوي، چې په ۲۰۱۱ – ۲۰۱۲ او ۲۰۱۳-۲۰۱۴ کلونو ترمنځ د مرستو کمښت او د نا امنیو زیاتېدل، په افغانستان کې د پرمختګ او ودې مسیر یې پڅ کړی دی، څرنګه، چې د پوهنې او د مور او ماشوم د مړینې کچې په اړه، د اندیښنې وړ راپور وړاندې شوی دی.

په دې ځای کې هڅه کیږي، څو په افغانستان کې په څو وروستیو کلونو کې د یو شمېر ځانګړتیاوو ته په کتو د پرمختګ څرنګوالی وڅیړو.
 

علی الرغم چالشهای موجود، ایا تحکیم اینده مرفع در افغانستان ممکن است؟

Christina Wieser's picture
Also available in: English | پښتو
 Rumi Consultancy/ World Bank
براساس اخرین گزارش، فقط بیشتراز نصف اطفال واجد شرایط به مکتب ابتدایه میروند که البته اکثر انها را بچه ها تشکیل میدهد. عکس: شرکت مشورتی رومی/بانک جهانی


با توجه به سرازیر شدن میزان بی سابقه کمک های مالی بین المللی، میزان سطح سواد، شمولیت در مکاتب و دسترسی به خدمات اساسی در افغانستان در جریان سالهای ۲۰۰۷ - ۲۰۰۸ و سپس ۲۰۱۱ - ۲۰۱۲  به طور همه جانبه و گسترده متحول گردیده است. اما وجود پیشرفتها، یافته های آخرین گزارش بانک جهانی، "وضعیت فقر در افغانستان، پیشرفت در معرض تهدید"، حاکی از آنست که کاهش کمک ها و افزایش میزان نا امنی ها در سالهای ۲۰۱۱ - ۲۰۱۲ و ۲۰۱۳ – ۲۰۱۴ میلادی، سیر رشد و پیشرفت در افغانستان را به شدت بطی ساخته، طوریکه در بخش های معارف و همچنان میزان مرگ و میر مادران وضعیت خیلی ها ناگوار گزارش داده شده است.

در این جا سعی مینمایم، تا چگونگی پیشرفت ها در افغانستان را پیرامون چندین شاخص های عمده انکشافی در جریان چند سال اخیر مورد مطالعه قرار دهم.
 

Towards a cleaner Bangladesh: Safe water, sanitation, and hygiene for all

Qimiao Fan's picture
 
 The World Bank
Bangladesh has made progress in recent years in the field known as WASH -water, sanitation access, and hygiene. Image courtesy: The World Bank

Community-Led Total Sanitation might be the greatest Bangladeshi export you’ve never heard of.  In countries across Asia, Africa and Latin America, a consensus has emerged that the best approach is Community-Led Total Sanitation, which is widely credited with changing people’s behavior around the world to no longer defecate in the open, which has greatly improved global health.

Bangladeshis can take plenty of pride in these far-away accomplishments. That’s because it is Northern Bangladesh - more specifically the Mosmoil village in Rajshahi district - that pioneered this approach seventeen years ago. Its success at home led to its widespread adoption abroad.

Safe drinking water is a right and proper sanitation is dignity of the citizens. Proper management of freshwater ecosystems and access to safe water and sanitation are essential to human health, environmental sustainability and economic prosperity. Water and sanitation are at the core of sustainable development critical to the survival of people and the planet. Goal 6 of Agenda 2030 not only addresses the issues relating to drinking water, sanitation and hygiene, but also the quality and sustainability of water resources worldwide.

The ‘Global Water Supply and Sanitation Assessment’ by World Health Organization (WHO), United Nations Children Fund (UNICEF), Water Supply and Sanitation Collaborative Council (WSSCC) reported that in 2012 about 40% (2.6 billion) of the world’s population was without access to safe water. Approximately 4 billion cases of diarrhea each year causes 2.2 million deaths, and majority of them are children under the age of five. This situation in Bangladesh is also challenging. A study by Water and Sanitation Program (WSP) wing of the World Bank reveals that Bangladesh incurred a loss of Tk295.48 billion in 2010 due to inadequate sanitation, which is 6.3% of the GDP.
 
Indeed, there is much to emulate in Bangladesh’s remarkable progress in recent years in the field known as WASH -water, sanitation access, and hygiene. Today, 98 percent of the population gets drinking water from a technologically improved source – water which comes from a manmade structure– up from 79 percent in 1990.  Bangladesh also largely succeeded in providing access to basic sanitation. It is estimated that only three percent of the population practice open defecation, down from 34 percent in 1990, thanks to behavior change campaigns and the building of many new toilets. 

But, much has yet to be done. Bangladesh has still a long way to go to meet the Sustainable Development Goal (SDG) of providing universal access to clean water and sustainable sanitation by 2030. The World Bank recently completed a study, the WASH Poverty Diagnostic, which examines the remaining challenges in ensuring access to safe water, sanitation, and hygiene. The findings are startling.

Engaging communities in the Golden 1,000 Days in Nepal

Kaori Oshima's picture
Field survey team in Nepal
A field survey team for the qualitative study holding a focus group discussion with women in one of the SHD project communities. Photo credit: World Bank

In Nepali, “Sunaula Hazar Din” means, “Golden 1000 Days” – which is a critical window of opportunity between conception and the age of two years that, with good health and nutrition, can mitigate the risks of malnutrition that hamper a child’s long-term physical and cognitive development.

Sunaula Hazar Din (SHD) is also the local nickname of the Government of Nepal’s recently completed “Community Action for Nutrition Project”, implemented by the Ministry of Federal Affairs and Local Development and  financially supported by the World Bank from 2012 to 2017. The project aimed to improve practices that contribute to reduced under-nutrition of women of reproductive age and children under the age of two and to provide emergency nutrition and sanitation response to vulnerable populations in earthquake affected areas.

The project used a “Rapid Results Approach (RRA)”, where target communities formed groups of nine members that would collectively select and work on an activity to address malnutrition for 100 days. RRA focused especially on the “1000 days” households– namely, households with children under 2 years and pregnant and/or lactating women and also had community -wide interventions targeted to address malnutrition.  

To better understand the local dynamics around the SHD design and activities, a qualitative study was conducted, with support from the South Asia Food and Nutrition Security Initiative (SAFANSI).

The study team gathered the voices of various stakeholders, including the community members, facilitators, and the village and district-level authorities. Listening to the voices of these stakeholders makes development practitioners and project teams recognize how participatory designs may work as expected – or not – in a specific context.

Karnataka Becomes India’s First State to Safely Dispose Biomedical Waste at all Public Health Facilities

Suresh Mohammed's picture

What happens when infected needles, syringes, plasters, surgical gloves and intravenous sets are disposed of carelessly? Well, for a start, they spread hepatitis and HIV, not only among the poor rag-pickers who unsuspectingly handle them, but also infect all the waste around, multiplying the hazard manifold.  Then, when the waste is not properly incinerated, it causes further damage, polluting the very air we breathe. Liquids wastes are particularly harmful; they can leach into the soil and contaminate the water supply, with often devastating consequences.

Yet it is heartening to see how a few dedicated individuals can make a difference.
 

Nurses using needle cutter to destroy used syringes

په ډایکندي ولایت کې د صحت برنامې مثبتې اغېزې

Fahimuddin Fahim's picture
Also available in: English | دری



که څه هم زه په ډایکندي ولایت کې د پروژو د مدیریت په برخه کې پراخه تجربه لرم، خو د عامې روغتیا وزارت له خوا په دې ولایت کې د صحت برنامې د تطبیق اغیز او پراخوالی په رښتیا هم ډېر الهام بښونکی دی – د بېلګې په توګه کولای شم په دغه ولایت کې د هغو ۳۹ روغتیايي مرکزونو یادونه وکړم کوم چې هلته لومړني روغتیايي خدمات وړاندې کوي، چې دا ټول په میاشتنۍ توګه د څه باندې ۷۷۰۰۰ ناروغانو درملنه او پالنه ېې ترسره کوله. د ۲۰۱۶ کال د اکټوبر په میاشت کې، دغو مرکزونو وکولای شول، تر څو د خپلو ناروغانو د زېږون ۶۱۵ پیښو ته رسیدنه وکړي، چې له دې ټولټال نویو زیږول شویو ماشومانو څخه څه باندې ۶۹ یې یوازې د تیمران په روغتیايي مرکز کې نړۍ ته سترګې راغړولې دي.
 
په حقیقت کې، کله چې د بحث محور د ښځو پر روغتیا باندې ولاړ وي، نو د صحت د زده کړې برنامه پر دې توانیدلی، تر څو په هر یوه دغه روغتیايي مرکز کې لږ تر لږه د یوې ښځینه روغتیايي کارکوونکې د شتون زمینه برابره کړي. دا کار تر یوه ځایه پورې د کلیو په کچه د ماشوم د زېږون د ماهرانو او روغتیايي نرس قابله ګانو د روزنیز پروګرام د بریالي پای ته رسیدو له کبله ممکن شوی ده، چې کولای شو له دغو روزنیزو او ښوونیزو پروګرامونو څخه په دې ولایت کې د کلیو په کچه د قابله ګانو  او د ټولنې په کچه د نرسانو د روغتیايي زده کړې په توګه یادونه وکړو. همداشان، دغه پروګرام د صحت د برنامې تر پوښښ لاندې ټولو سیمو کې، د کلیو په کچه یو لړ روغتیايي مرکزونه هم د سیمه ییزو شوراګانو په مرسته جوړ او پیاوړي کړل او د روغتیايي کارکوونکو د دندو پر صلاحیت او اعتبارلیکونو باندې یې څارنیز تدابیر او جدي څېړنه عملي کړه.
 
د صحت برنامه د عامې روغتیا وزارت یو له مهمو پروګرامونو څخه شمېرل کېږي، چې د هغې تمویل د بې وځله هېوادونو لپاره د نړیوال بانک د نړیوالې پرمختیايي ادارې له بودیجې او د افغانستان د بیارغونې صندوق لخوا د څو نورو نړیوالو تمویلوونکو ادارو په ګډ مشارکت تر سره کېږي. د افغانستان د اسلامي جمهوري دولت د عامې روغتیا وزارت له ۲۰۱۳ کال څخه د ۲۰۱۷ کال د جون تر میاشتې پورې د PU-AMI په نوم له یوې غیر دولتي ادارې سره تړون لاسلیک کړی وو، تر څو د ډایکندي په ولایت کې د وزارت له لوري د څرګندو شویو روغتیايي ملي موخو سره سم بنسټیز روغتیايي خدمات وړاندې کړي. په دغو موخو کې د مور او ماشوم د مړینې د پیښو راکمول او د ماشوم د روغتیا ښه والی او د معیاري تغذي په خاطر د تدابیرو نیول شامل وو. له همدې کبله، دغه برنامه روغتیايي خدماتو ته د لاسرسي د زیاتوالي، ظرفیت جوړونې، د همکارۍ او همغږۍ د پیاوړتیا، د څارنې او ارزونې د اطلاعاتو د کارونې دودوالي او د درملو د لېږد او ورته د لاسرسي په برخه کې د اسانتیاوو په رامنځته کولو باندې متمرکزه ده.

Pages