Changes in the determinants and spatial distribution of under-five stunting in Bangladesh: Evidence from Bangladesh Demographic Health Surveys (BDHS) 1996-97, 2014 and 2017/18.

BACKGROUND: Bangladesh has experienced tremendous change in child nutrition over the past few decades, but there are large differences between different regions in progress made. The question is whether continuation of current policies will bring the progress needed to reach national and international targets on child nutrition security. DATA AND METHODS: Using national data BDHS 1996/97, 2014, and 2017, this study attempts to map such reductions across Bangladesh and to explore the distribution of covariate effects (joint effects) that are associated with childhood stunting over these two periods, overall and by region. The main contribution of this paper is to link observed stunting scores to a household profile. This implies that different variables are evaluated jointly with stunting to assess the likelihood of being associated with stunting. RESULTS: Overall, the covariates: 'Parental levels of education', 'children older than one year old', 'children live in rural area', 'children born at home' formed the country winning profile in 1996/97, whereas parental levels of education disappear in the winning profile for children stunted in 2014. This implies that over the years, Bangladesh has been successful in addressing parental education for long-term reductions in child undernutrition. In addition, the diversity of profiles of households with stunted children increases over time, pointing at successful targeting of policies to increase food security among children over the period. However, in areas where improvements have been insignificant, also the profiles remain stable, indicating a failure of policies to reach the target populations. The analysis for 2017 confirms this picture: the diversity of profiles remains high, with little change in the dominant profiles. CONCLUSION: Further decline in stunting is possible through region specific multipronged interventions, targeting children older than one year among vulnerable groups, in addition with strengthening family planning programs as larger families also have a higher risk to have stunted children. In general, the profiles in 2014 and 2017/18 are much more diverse than in 1996, which can be explained by the relative success of specific targeted policies in some divisions, while being much less successful in other regions. In sum, our results suggest that the challenge lies in the implementation of policies, rather than in the generic approach and assumed theory of change.

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh.

SUMMARY OBJECTIVE: To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. METHODS: A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). RESULTS: The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). CONCLUSION: A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.

Introduction of routine zinc therapy for children with diarrhoea: evaluation of safety.

On 8 May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommended routine administration of zinc in the management of children, aged less than five years, with acute diarrhoea. In making the recommendation, WHO and UNICEF also suggested careful monitoring for adverse events associated with routine administration of zinc, particularly unusual or excess vomiting. The study assessed, in a phase IV trial, i.e. post-marketing surveillance of zinc, the occurrence of adverse events during the first hour after the administration of the first dose of zinc in children with acute or persistent diarrhoea. The study was conducted at the Dhaka Hospital of ICDDR,B and at an outpatient clinic operated by a local health NGO-Progoti Samaj Kallyan Protisthan (PSKP), Dhaka, Bangladesh. Eligible children, aged 3-59 months, were treated with 20 mg of zinc sulphate provided in a dispersible tablet formulation. The children were observed for 60 minutes following the initial treatment with zinc for adverse events, with particular attention given to vomiting or regurgitation. During the one-year observation period, 42,440 children (male 57% and female 43%) received zinc, and 20,246 (47.8%) of them were observed. Regurgitation and/or vomiting occurred in 4,392 (21.8%) of the children; 90.8% of these children had vomiting only once, 8.7% twice, and 0.5% more than twice. No children revisited the hospital for recurrent vomiting following their discharge. A significant proportion of infants and children may experience vomiting or regurgitation, usually once, following the administration of the first dose of zinc. This is a transient phenomenon that did not impact on continuation of treatment with zinc.