Nutrition The public health nutrition program under the Ministry of Health and Family Welf are of Bangladesh

is operated through Institute of Public Health Nutrition (IPHN) and t wo major programs under the Health, Nutrition and Population Sector Program (HNPSP). Thes e two programs are Micronutrient Supplementation (MS) and National Nutrition Program ( NNP). The IPHN and MS work under the Directorate General of Health Services (DGHS) and the NNP works directly under the ministry. Conventionally the director of IPHN works as the line director of MS, and nutrit ion programs of both IPHN and MS are carried out under one platform. The programs include: (a) C ontrol of micro-nutrient deficiencies focusing nutritional blindness of vitamin A; (b) Con trol of Protein Energy Malnutrition (PEM); (c) Control and prevention of iron deficiency and oth er nutritional anemia; (d) Control of iodine deficiency disorders and other micronutrient probl ems; (e) School health nutrition education program targeting school children; and (f) Revitaliza tion of existing baby friendly hospitals. The programs of IPHN and MS cover the entire country. The coverage of NNP, on the other hand, is in 172 upazilas, which will be scaled to 232 upazilas by 2011 and to all 483 upazilas by 2021. In NNP program area, satellite communit y nutrition center is operated 6 days a week, one per 1,200 people. One lady community nutri tion worker runs the nutrition center. There are 36,764 community nutrition workers for the 172 upazilas and 3,732 community nutrition organizers, 960 field supervisors and 172 upazila managers. The target populations of NNP s nutrition programs are: (a) under-2 children; (b) preg nant and lactating mothers; (c) newly married couples; (d) adolescents boys and girls; an d (e) in-laws and (f) husbands of pregnant women. The latter two target groups are for advocacy. T he services include nutrition supplementation of malnourished children and all pregnant and lactating women; monitoring weight of under-2 children and pregnancy weight gain; training ; behavior change communication; and food security interventions through vulnerable group f eeding as well as through encouraging people for homestead gardening and poultry farming. The IPHN and MS sources say that following contributions have been made by the i nstitution and program: Vitamin A program

Every year two rounds of vitamin A capsules supplementation to children aged 12 to 59 months are done. Around 20 million of children are covered. The current coverage rate i s about 98% to 99%. Along with the vitamin A supplementation, anti-helminthes tablet, albandazo le (400 mg) are also administered to children aged 24 to 59 months. About 86% of the childre n who receive vitamin A fall into this age group, who received albendazole in the past rounds. The coverage 1 | Nutrition Situation in Bangladesh

was 98% to 99%. Coverage of vitamin A to under-1 year children has been continui ng to improve. The last available data shows a coverage rate of 94% in 2008 from a fig ure of 85% in 2007. It is stated that coverage of postpartum mothers with vitamin A was 35% in 2007. Protein Energy Malnutrition (PEM) IPHN undertook efforts for creating awareness for the improvement of protein ene rgy malnutrition situation in the country through using the data and resources, such as, Child Nutrition Surveys (CNU) 1995 and 2000, Child and Mother Nutrition Survey (CMNS) 2005, UNICEF 2008 (State of the World Children 2008) and WHO. The organization also cl aimed to work with the National Nutrition Program (NNP) to improve nutritional status of pregnant and lactating women, malnourished children and adolescent girls to improve PEM situa tion. Figure1 shows the rate (%) of underweight under-5 children of Bangladesh from 1980 to 20 08. Table-1 shows the trend of prevalence of underweight, stunting and wasting among the under5 children over the years. Data from the Bangladesh s own sources also show urban an d rural trend in the prevalence. Table-1. Prevalence of malnutrition among the under <5 children (Year 2000 to Ye ar 2008) Source and Year Location Underweight% Stunted% Wasted% Child Nutrition Survey 2000 Urban 41.8 37.5 10.9 Rural 52.6 50.2 12.2 National 51.0 48.3 12.0 Child & Maternal Nutrition Survey 2005 Urban 38.5 32.5 10.8 Rural 50.0 44.9 13.1 National 47.8 42.4 12.7 UNICEF 2000-2006 National 48.0 43.0 13.0 Bangladesh Demographic & Health Survey 2007 Urban 33.4 14.4 36.4 Rural 43.0 18.2 45.0 National 41.0 43.0 17.0 WHO 2008 National 41.0 43.0 17.0 2 | Nutrition Situation in Bangladesh

Control and prevention of iron deficiency and other nutritional anemia Control and prevention of iron deficiency and other nutritional anemia is broadl y operated through country s entire health service delivery network and National Nutrition Pr ogram with key components of distribution of iron-folate supplementation to the target, vul nerable and anemic groups. Intestinal parasite control through distribution of albendazole t ablets is done along with vitamin A capsules distribution programs. IPHN continued advocacy for food fortification. The National Nutrition Program undertook dietary improvement and production of micronutrient-rich foods. Control of iodine deficiency disorders and other micronutrient problems IPHN provided training to 2,197 doctors, health staffs on control of iodine defi ciency disorders. In the laboratory of IPHN, 165 salt samples were analyzed to check iodine conten t. To further contribute to the quality control of iodization salt, training was given to mana gers, chemists and others of salt factories of three zones (Chittagong, Potia, Cox s bazar) in collab oration with Bangladesh Small and Cottage Industries Corporation (BSCIC). IPHN also developed and distributed different IEC materials on control of iodine deficiency disorders. C urrent data on iodine nutritional status are not available. However, Table-2 summarizes the iod ine nutritional situation based on the available data. Table-2. Iodine nutritional status based on available national data Indicator Reference Point Measurement Point Year Rate Year Rate Rate of household salt consumption 1995 44% 2006 84% Biochemical iodine deficiency among children (<100 g/L) 2004-05 33.8% 1993 71% Biochemical iodine deficiency among general population (<100 g/L) 2005 38.6% 1993 70.2% Prevalence of goiter among children (6-12 years) 1993 49.8% 2004-05 6.2% Prevalence of goiter among women (15-44 years) 1993 55.6% 2004-05 11.7% Child nutrition program IPHN has a school health nutrition education program targeting school children. It also has an Infant and Young Child Feeding (IYCF) program. For the latter program, the institu te developed a strategy paper and trained 2,197 doctors, senior staff nurses, sanit ary inspectors, health inspectors and other officers on Breast Milk Substitutes Codes (BMS codes ) for Baby Food (Sweet Baby II). The institute also performs the regulatory function on BMS codes, under

which, registration was denied to several breast milk marketing companies due to lack of necessary papers. Legal cases were also filed against 11 companies for having me lamine contents in their baby food products. The institute has also undertaken a revita lization of existing baby friendly hospital program. Under this program, the child nutrition units (CNUs), one at IPHN and 19 in upazila health hospitals of 19 districts are being continu ed. More functional supports are being provided to these units as part of revitalization program. Data show that the child nutrition units provided services to 2,020 malnourished moth ers and children in the first six months of 2008-2009. Among the treated children, 900 w ere moderately malnourished and 12 were severely malnourished. 3 | Nutrition Situation in Bangladesh

Figures-2 to 5 show the coverage of services by the National Nutrition Program ( NNP) in the 109 upazilas from the year 2004 to 2009. Figure-13.2 summarizes the coverage for pregnancy care services. It is revealed that pregnancy weight gain was measured for 98% of the pregnant women. Antenatal care to pregnant women steadily increased to 97% in 2009 from a baseline figure of 52.8% in 2004. Whereas 43.4% of the pregnant women received iron table ts in 2004, the figures rose to 98% in 2009. Pregnant women requiring supplementary feeding decreased from 21% in 2004 to 9.1% in 2009. Figure-3 quantifies the services given to lactating mothers in the 109 NNP upazi las. In 2004, only 8.1% of the lactating mothers received vitamin A capsules. In 2009, 99% of them were receiving the vitamin A capsules, although the coverage was 100% in 2007. In 200 4, 45% of the lactating mothers were recorded to receive iron tablets. This figure rose to 100 % in 2006 and maintained also in 2007. In 2008, it was 98%, which was seen to rise to 99% in 2 009. 4 | Nutrition Situation in Bangladesh

Figure-4 shows the coverage of newborns and young children service provided by N NP in 109 upazilas. As of 2009, 96.3% of the newborns were taken birth weight. In 2009, 8% of the newborns in the program area were found to be low brith weight, which is drop by 12.7% from a figure of 20.7% in 2004. In 2009, all newborns were reported to feed colostrum which was 93.3% in 2004. Exclusive breastfeeding rate was markedly increased from 9.9% in 2004 to 95% in 2009. Figure-5 shows the trend in household iodized salt use in the 109 program upazil as of NNP. As of 2009, 92% of the households are consuming iodized salt which was 61% in 2004. A sharp increase in household iodized salt consumption was noticed in later part of 2004 to 82% and thereafter a steady increasing rate was maintained. 5 | Nutrition Situation in Bangladesh