Thesis, Master Program in International Health International Maternal and Child Health
Department of Women’s and Children’s Health
Background: Malnutrition is widespread and has been recognized as a public health problem in Bangladesh. People living in absolute poverty are more susceptible to infection, disease and malnutrition. Nearly one-quarter to one-third population of Bangladesh live under extreme poverty – they are called the ultra poor. These ultra poor are often excluded from government and even from the non-governmental poverty reduction programs like microcredit/microfinance. To reach these ultra poor, BRAC has undertaken a comprehensive program in 2001 as ‘Challenging the Frontiers of Poverty Reduction/Targeting the Ultra Poor’ (CFPR/TUP) with the aim of poverty reduction and establish a sustainable livelihood. As poverty and malnutrition are interrelated, information on important dimension of nutrition was required to see the impact of program and modify health intervention.
Objective: The objective was to describe the prevalence of malnutrition and identify the associated factors among the women of ultra poor households targeted by BRAC in Bangladesh.
Design: It was a cross-sectional survey. A total of 978 households were covered in the survey. Adult female aged 15-49 years who were selected for program intervention in households were covered for anthropometric measurements (896), anemia (889) and parasitic infestation (473). Pregnant women were excluded. A sub-sample of 200 women was surveyed for food consumption. Data were collected between July and September 2003.
Nutritional status was assessed by measurement of body mass index (BMI) and hemoglobin concentration. Anthropometric measurements included weight and height. Anemia was assessed by hemoglobin measurements with HemoCue photometer. Stool samples were examined for worm infestation by ‘Direct Microscopic Wet Mounts’ method. A dietary survey was conducted using the 24-h dietary recall method.
Results: Chronic energy deficiency was highly prevalent among women, 56% had BMI <18.5 kg/m2. Mean body weight was 40.3 kg. Even though the mean body height was 148.3 cm, about one third (29%) were less than 145cm. Prevalence of anemia was detected in 48% of the women. The average per capita total energy intake in women was calculated as 1609 kcal/day. Almost 90% calorie came from cereals. Overall parasites infestation prevalence was 66%. The most common parasite was Ascaris with prevalence of 52%, hookworm and Trichuris trichiura were 23% and 14% respectively. Less than 3% had any formal schooling. Only 15% women used sanitary latrine and 19% women took iron tablet during last pregnancy. Significant association was found between BMI and reported illness, perceived health status and signature capability (p<0.05). Anemia prevalence was found to be associated with signature capability, iron tablet intake and total number of pregnancy (p<0.05).
Conclusion: The extent of malnutrition was high among the women in ultra poor households. The nutritional situation showed a disadvantaged position of the women living in ultra poor households compared to the average rural women in Bangladesh