Infant and young children's nutritional health and feeding practices in relation to flooding in Bangladesh

Bangladesh is one of the poorest developing countries in the world where infant and young children (IYC) suffer from extremely high levels of malnutrition resulting in high morbidity and mortality rates. IYC are defined here as birth to 3 years old. Due to the double burden of climate variability and urbanisation, longer and more severe floods affect people living in urban slums, with IYC being highly vulnerable. Insufficient research exists into understanding the mechanisms leading to poor nutritional child health related to flooding in urban slums. Maternal nutritional status associated with infant and child health has been established previously, but rarely in the aftermath of a flood. This study explores, 1) whether maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) the impact of flooding on IYC feeding practices during flooding compared to non-flooding and the coping strategies developed by caretakers in urban slums, 3) the perceptions of root causes of malnutrition including flooding for IYC living in urban slums and 4) develops a pilot study for an intervention to tackle malnutrition in IYC living in urban slums. The research uses 1) quantitative data (n=143, secondary analysis of data collected after the 1998 flood in Bangladesh) to answer the first research question, and 2) a mixed method approach of qualitative data (participant observation n=24, semi-structured interviews n=23 (18 mothers, 5 community health workers), and focus group discussions n=10) and quantitative data (household questionnaire n=23 and anthropometric measurements n=55 for IYC and n=23 for mothers and community health workers) collected in slums in Dhaka to answer the second and third research questions. A new technique is used to answer question three. This technique is based on existing methods for the building of a causal model combined with a pile sorting of photographs to understand the root causes and processes leading to malnutrition. The participants of the mixed method were mothers, pregnant women and Bangladesh Rural Advancement Committee (BRAC) community health workers living and working in the slums. The key findings are: 1) maternal nutritional status measured soon after a flood can predict the current nutritional status and the risk for future deterioration of nutritional status of their children, 2) feeding practices for IYC deteriorate during flooding in Dhaka slums, 3) the coping strategies of IYC caretakers are limited and their resilience capacity to floods is low, 4) there is a good perception of the root causes of malnutrition by participants living in Dhaka slums but feeding practices are not meeting the WHO guidelines due to barriers, limitations and poor knowledge, and 5) there is a need for a pilot project to test the feasibility of an intervention aiming at improving IYC nutritional health and feeding practices. This research deepens the understanding of coping strategies for feeding practices and perceived roots of malnutrition for IYC living in urban slums exposed to flooding. It brings evidence of the interactions between coping strategies and nutritional health in relation to flooding. It also casts new anthropological light onto the series of existing studies and previous research essentially focused on the flood event itself. As a result, the research leads to recommendations for risk reduction strategies and nutrition promotion for flood exposed populations with infants and young children.