Feasible Means to Address Moderately Malnourished Children Within BINP Communities
Condition: Mild and Moderate Malnourished Children
MeSH terms: Malnutrition
Study type: Interventional

Summary: 
      The Bangladesh Integrated Nutrition Project (BINP) of the Government of Bangladesh has
      started showing reduction in malnutrition of women and children under two years of age in
      last 3 years of it's activities. That was a demonstration study to test the efficacy of the
      approach on a relatively small number of children with intensive intervention. A study will
      be therefore conducted in 4 division of BINP thanas of Bangladesh over an 18-month period.
      Moderately malnourished children will be in management intervention and mildly malnourished
      and well-nourished infants will be in preventive intervention group. For management
      intervention, a total of 750 moderately malnourished will be randomized to receive either
      intensive nutrition education or less intensive education. For preventive purpose, 380 mildly
      malnourished children of 6 months to 2 years of age and 240 well nourished infants of 6 to 9
      months of age will receive either less intensive education or no education. Infants between 6
      to 9 month ages will be brought under less INE to ensure their complementary feeding
      practice. Care givers of one group of mildly malnourished children and one group of 6-9 month
      old infants will not receive any education to serve as controls. Focus group discussion will
      be held before the educational intervention to identify the perception of the mother, her
      husband and female decision maker of her family on child nutrition, caring practice and
      common practice of health care. BCC materials will be developed after FGD and that will be
      used during nutrition education. Mothers of the first intervention group will receive
      intensive nutrition education for child feeding twice weekly for first three months, which
      will be then reinforced once in a week for the last three months of intervention. The less
      intensive intervention group will receive nutrition education twice a week for the first
      month then once a week for two months and then twice monthly for the last three months of
      intervention. INE will be given for a total of 6 months. An observation will be done to
      identify for sustainability effect for an additional period of 6 months. Their weight and
      length gain will be recorded. It is expected that the results of the study will help define
      the effectiveness of our nutrition education package to prevent and reduce moderate
      malnutrition existing in large proportion of children in setting with different geographical,
      and cultural and feeding practices.
    

Detailed description: 
      Bangladesh has the highest proportion of malnourished children in the world. The infant and
      child mortality are also among the highest in south Asia. In Bangladesh, '. The Government of
      Bangladesh has been trying different ways for reducing childhood malnutrition. Such programs
      include the Vulnerable Group Development (VGD) Project, vitamin A distribution project,
      iodine deficiency disorder control program, iron supplementation program and improving food
      availability for the underprivileged sections of the society. Despite these, not enough
      improvement has been observed in the field of nutrition. In review of the past fifty-year's
      information of dietary intake and growth, it has been observed that food intake has
      substantially decreased and growth faltering in children has worsened (Roy et al 1988).
      Materal malnutrition is evidenced by low weight, short stature and anemia in pregnant and
      lactating women. Micronutrient deficiencies are evidenced by prevalence of xerophthalmia,
      iron deficiency anemia and iodine deficiency disorders. The effects of childhood under
      nutrition, begin with a low birth weight (estimated to occur among 35-50% of births in
      Bangladesh) (Hasan et al 1995) and continue into adulthood.

      The prevalence of PEM among children is very high, and has remained almost the same for the
      last decade. Thirty percent of all children under six years of age are severely stunted and
      another 31.2% are moderately stunted (BBS 1995). As many as 68.3% of the total children are
      under -weight and 16.7% are wasted, the highest rates are in Asia (BBS 1995). Given the
      greatly disadvantaged start by the way of a low birth-weight followed by inadequate
      breast-feeding by their undernourished mothers, average Bangladeshi infants are already below
      the lower end of the range of anthropometric values found among western babies during the
      first three to six months. The late and insufficient introduction of complementary feeding
      further retards the infant's growth; usually the child do not pick up its pace of growth
      before two years of age. By then, it is too late to reverse the early growth lag, which
      persists throughout the life, and similarly some of the damages done to mental development
      are irreparable. The weight for age curve of Bangladeshi children continues to lie below the
      third percentile of the NCHS Standard, though it runs roughly parallel to the standard from
      around the second year of life onward; the older children cope better with the adverse milieu
      of food-insecure and unhealthy household, while being unable to regain lost ground.
    

Intervention name(s): Prospective Longitudinal Interventional Stury
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Mal-nutrition; Morbidity; Nutrition Education; Complementary Feeding; Weight gain; Height