bangladesh nutrition situation analysis · there are high rates and large absolute numbers of...

Nutrition Situation AnalysisBangladesh

September 2014

Partnering as UN REACH

UNDERNUTRITION: CURRENT STATUS AND TRENDS

Stunting, wasting, underweight and micronutrient deficiency disorders

2

There are high rates and large absolute numbers of stunted, underweight and

wasted children of under five years of age in Bangladesh.

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Underweight Stunted Wasted

Severe Moderate

Undernutrition in children <5 yearsPopulation in millions, figures in red are current projections

1.6m

3.9m

2.3m

3.9m

1.7m

5.5m(36.4%)

6.2m (7 m)(41.3%)

2.3m(15.6%)

0.6m

Bangladesh Bureau of Statistics (BBS) Population Census 2011Bangladesh Demographic and Health Survey (BDHS) 2011

National demographic profilePopulation in millions, figures in red are current projections

0

20

40

60

80

100

120

140

160

Total 50+ years 15-49 years 5-14 years <5 years

160m144m

74m

35m

15m

20m

3

Graphs – BDHS 2011 (includes indicator data for 2004 and 2007), BDHS 1996/97, BDHS 1999/2000*For 1996/97 and 1999/2000, WHO Algorithm was applied to convert from NCHS to WHO standardsTable – BDHS 2011, Multiple Indicator Cluster Survey (MICS) 2012-13Utilization of Essential Service Delivery (UESD) survey 2013

Levels of child undernutrition have been dropping in Bangladesh since 1996.

However, challenges still remain to keep indicators below WHO public health

‘critical’ thresholds

<5 years children (%) BDHS 2011 MICS 2012-13 UESD 2013

Underweight 36.4 31.9 35.1

Stunting 41.3 42.0 38.7

Wasting 15.6 9.6 18.1

52%

43% 43% 41%36%

0%

20%

40%

60%

1996/97* 1999/2000* 2004 2007 2011

Underweight children <5 years

WHO threshold

30%

MDG Target

33%

60%

51% 51%43% 41%

0%

20%

40%

60%

80%

1996/97* 1999/2000* 2004 2007 2011

Stunted children <5 years

WHO threshold

40%

12%

20%

15%17%

16%

0%

10%

20%

30%

1996/97* 1999/2000* 2004 2007 2011

Wasted children <5 years

WHO threshold

15%

4

Dhaka

Chittagong

Barisal

Khulna

Rajshahi

Rangpur

Sylhet

-1.7%

-4.2%

Wasting Stunting

0.1%

4.6%

Wasting Stunting

0.3%

-1.7%

Wasting Stunting

-4.2%

-0.5%Wasting Stunting

-2.8%

-1.8%

Wasting Stunting

-5.9%

1.1%

Wasting Stunting

-2.7%

-8.1%

Wasting Stunting

Percentage point changesBDHS 2011

Overall, undernutrition rates have reduced between 2007 and 2011. However,

wasting and stunting have worsened in some Divisions, particularly in Sylhet.

6

(*m) – number in millionsBDHS 2011

High levels of undernutrition are found throughout Bangladesh, with Sylhet the

worst affected Division for all three indicators of undernutrition

Underweight (0-59 months)

Dhaka

Chittagong

Barisal

Khulna

Rajshahi

Rangpur

Sylhet

35%(0.6m)

34%(0.6m)

45%(0.6m)

19%(0.4m)

37%(1.8m)

37%(1.2m)

40%(0.3m)

Stunting (0-59 months)

Dhaka

Chittagong

Barisal

Khulna

Rajshahi

Rangpur

Sylhet

43%(0.7m)

34%(0.6m)

49%(0.6m)

34%(0.5m)

43%(2.1m)

41%(1.3m)

45%(0.4m)

Wasting (0-59 months)

Dhaka

Chittagong

Barisal

Khulna

Rajshahi

Rangpur

Sylhet

13%(0.2m)

16%(0.3m)

18%(0.2m)

15%(0.2m)

16%(0.8m)

16%(0.5m)

15%(0.1m)

5

Low to high prevalenceLow to high prevalenceLow to high prevalence

BDHS 2011

Over half of all children under 5 years old in the poorest household wealth quintile

are stunted. The proportions of child stunting drops as household wealth increases.

For assessing equity, household wealth indicators are commonly divided into quintiles. Quintile 1 refers to the lowest wealth quintile and quintile 5 refers to the richest.

Undernutrition is not restricted to the poorest families: 1 in every 4 children is stunted in the highest wealth quintile households

This demonstrates that overall economic growth and increasing household wealth are insufficient drivers of improved nutrition. Addressing poverty alone is insufficient for improving child undernutrition.

54%

45%

41%

36%

26%

18%16%

18%

14%12%

0%

10%

20%

30%

40%

50%

60%

Stunting Wasting

Q1 Q2 Q3 Q4 Q5

Undernutrition in children under 5 years oldby household wealth

7

Inadequate height: less than -2 S.D height for age z-score Underweight: less than -2 S.D BMI (Body Mass Index - weight in kg/height m2) for age z-scoreFSNSP 2012 report

Undernutrition is also common among adolescent girls in Bangladesh,

with similar regional variations.

25%

33%31%

24% 23%

29%

40%

30%

12% 11% 11% 12% 13%

8%

12%11%

0%

10%

20%

30%

40%

50% Inadequate height Underweight

Undernutrition in adolescent girls (10-18 years)

Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet National

9

Inadequate height = shorter than 145cmChronically Energy Deficient (CED) = BMI (Body Mass Index - weight in kg/height m2) <18.5Food Security Nutritional Surveillance Project (FSNSP) 2012 report

Undernutrition is common among adult women across Bangladesh,

with marked regional variations.

12%

9%

13%

10% 11%

14%16%

12%

23%

20%17% 17%

20%

24%

35%

20%

0%

10%

20%

30%

40%

50% Inadequate height Chronically Energy Deficient (CED)

Undernutrition in adult women (19-49 years)

8


FSNSP 2012 report

Overweight in adult women is rising, especially in urban areas, but rural areas are

also affected. The increase in percentage of overweight adult women is more than

the decrease in underweight over the last decade.

In BDHS 2011, the proportion of overweight women 15-49 years was 17% using the cut off BMI >25.

11%

22%20%

56%

31%

35%

0%

10%

20%

30%

40%

50%

60%

70% Underweight (<18.5 BMI) Overweight (>23 BMI)

Nutritional status in adult women by locality(19-49 years)

Urban Rural National

Diverging trends in nutritional status of adult women(19-49 years)

33%

29%

23% 20%

18% 22%

30%

35%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2004 2007 2010

Underweight (<18.5 BMI) Overweight (>23 BMI)

10

Women overweight – FSNSP 2012 reportChildren underweight – BDHS 2011, UESD 2013

Bangladesh has an increasing malnutrition double burden: a high proportion of

underweight children under 5 years and a growing proportion of overweight women.

Most recent data reveals a new situation for overall nutrition in the country

The level of overweight among women has nearly doubled since 2004

The level of overweight among women now equals the level of underweight children

43%41%

36% 35%

18%

22%

30%

35%

0%

10%

20%

30%

40%

50%

60%

70% Underweight among children <5 years (WHO standards)

Overweight among ever-married women 15-49 years (BMI >23)

Overweight in women vs. underweight in children

2004 2007 2011 2012-13

11

NPNL women - Non-Pregnant and Non-Lactating womenUNICEF/BBS 2004BDHS 2011National Micronutrient Status Survey (NMSS) 2011-12

Consequences of anaemia:

• Reduced immunity • Increased risk of maternal mortality• Increased risk of perinatal mortality • Intrauterine growth retardation• Premature births• Reduced cognitive development• Reduced psychomotor development• Reduced ability to concentrate • Reduced scholastic performance• Fatigue and reduced productivity• Increased economic burden

Although levels of anaemia dropped by 2013, one third of children aged 6-59

months are anaemic, representing an intergenerational threat to public health.

In NMSS 2011-12, anaemia rates due to Iron deficiency are 7.2% in children 6-59 months of age and 4.8% in NPNL women

49%46%

30%

51%50%

40%

33%

26%

0%

20%

40%

60%

2004 2011 2011-12

Children 6-59 mo. Pregnant women NPNL women

Anaemia

12

WHO threshold

40%

National IDD and USI Survey 2004-05National Micronutrients Status Survey 2011-12

Iodine deficiency remains a serious problem, with only 58% of households

covered with adequately iodized salt despite mandatory Universal Salt Iodization.

4 in 10 school-aged child are iodine

deficient

58% of households use adequately

iodized salt

40%

48%45%

52%

74%77%

71%75%

54% 55%51%

58%

0%

20%

40%

60%

80%

100%

Rural Urban National

1996 1999 2004-05 2012

Coverage of households with adequately iodized salt

27%

34%

41%45%

39%

33%

40%42%

0%

20%

40%

60%

80%

Slum Rural Urban National

School age children NPNL women

Prevalence of Iodine Deficiency

13

CAUSES OF UNDERNUTRITION

14

Underlying causes at household / family level

Undernutrition, death and disability

Inadequate dietary intake

Disease

Insufficient access to FOOD

Immediate causes

Basic causes at societal level

Outcomes

Quantity and quality of actual resources –human, economic and organisational - and the way they are socially and culturally controlled

Inadequate maternal and child

CARE practices

Poor water, sanitation and

inadequate HEALTH services

Potential resources: environment, technology, people

Adapted from UNICEF 1990 model

This nutrition analysis is grounded in the widely-accepted causal Conceptual

Framework pioneered by UNICEF.

15

BASIC CAUSES

Poverty, education and child marriage

16

MICS 2012-13, UESD 2013, BDHS 2011, BDHS 1996/97, BDHS 1999/2000 (Stunting)GDP/Capita : Data from The World Bank (Poverty and GDP per Capita)

60%

51%51%

43% 41%

39%

57%

50% 49%

40%

32%

282

339356

400

467

732

829

0

100

200

300

400

500

600

700

800

900

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

1992 1995 1998 2001 2004 2007 2010 2013

Stunting (<5 children) Poverty GDP per Capita (USD)

The decline in poverty and stunting are not as marked as the rapid increase in

economic growth.

17

42% (MICS)

MICS 2012-13 (stunted children <5)Child Equity Atlas: BBS-BIDS-UNICEF 2013 (Pockets of social deprivation)

Inequity of social deprivation exists. The worst affected areas are north-eastern

haors and south-eastern hills for both social deprivation and stunting.

More stunting

Stunted children <5 by district

Khulna Bhola

Sylhet

Rangamati

Bogra

Tangail

Satkhira Bagerhat

Bandarban

Dinajpur

Comilla

Chittagong

Naogaon

Pabna

Barisal

Noakhali

Mymensingh

Jessore

Sunamganj

Patuakhali

HabiganjSirajganjNatore

Rajshahi

Rangpur

Netrakona

Kurigram

Faridpur

Gazipur

Dhaka

Jamalpur

Maulvibazar

Kishoreganj

Kushtia

Khagrachhari

Feni

Gaibandha

Jhenaidah

Cox's Bazar

Barguna

Chandpur

Narail

Sherpur

Pirojpur

Rajbari

Thakurgaon

Nawabganj

Nilphamari

Gopalganj

Magura

Lakshmipur

Manikganj

BrahamanbariaNarsingdi

Shariatpur

Panchagarh

Madaripur

Lalmonirhat

Chuadanga

Joypurhat

Jhalokati

Munshiganj

MeherpurNarayanganj

Chittagong

Worst social deprivation

Pockets of social deprivation(by composite deprivation index) by district

Khulna Bhola

Sylhet

Rangamati

Bogra

Tangail

Satkhira Bagerhat

Bandarban

Dinajpur

Comilla

Chittagong

Naogaon

Pabna

Barisal

Noakhali

Mymensingh

Jessore

Sunamganj

Patuakhali

HabiganjSirajganjNatore

Rajshahi

Rangpur

Netrakona

Kurigram

Faridpur

Gazipur

Dhaka

Jamalpur

Maulvibazar

Kishoreganj

Kushtia

Khagrachhari

Feni

Gaibandha

Jhenaidah

Cox's Bazar

Barguna

Chandpur

Narail

Sherpur

Pirojpur

Rajbari

Thakurgaon

Nawabganj

Nilphamari

Gopalganj

Magura

Lakshmipur

Manikganj

BrahamanbariaNarsingdi

Shariatpur

Panchagarh

Madaripur

Lalmonirhat

Chuadanga

Joypurhat

Jhalokati

Munshiganj

MeherpurNarayanganj

Chittagong

18

Marriage before the age of 18 is prohibited by law

The national prevalence of low-birth weight infants (<2500 grams) is 26%

Child Equity Atlas: BBS-BIDS-UNICEF 2013BDHS 2011, MICS 2012-13

There has been some reduction in child marriage across the country during the

last two decades but the prevalence is still high

73%69%

65%68% 66% 65%

47% 47%

38% 37%32% 29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

< 18 years <15 years

1993-94 1996-97 1999-2000 2004 2007 2011

Women aged 20-24 years who were first married before age 18, and 15, years old

35%

25%

33%

41%43%

38%

16%

33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Percentage of female teenage (15-19 years) married population by Division (2011)

19

All BDHS reports from 1993-94 to 2011

Women tend to marry later if they continue their education into secondary level.

Urban-rural disparities in age of first marriage continue to exist.

14.8 14.915.4

16.3

19.9

5.0

10.0

15.0

20.0

25.0

No education

Primary incomplete

Primary complete

Secondary incomplete

Secondary or higher

Median age of first marriage of women of age 20-24 based on educational attainment (2011)

15.115.0

15.7 15.7 16.1

17.5

19.0

18.317.1

17.7

5.0

10.0

15.0

20.0

25.0 Rural Urban

1993-94 1996-97 1999-2000 2004 2007

Median age of first marriageof women of age 20-24

20

BDHS 2011

21

The relationship between child marriage and stunting is not clear and warrants

further research. Sylhet and Chittagong have high stunting rates but higher median

age of first marriage.

15.7

16.6

15.8

15.315.2

15.0

17.5

15.8

45%

41%43%

34% 34%

43%

49%

41%

0%

10%

20%

30%

40%

50%

60%

13.5

14.0

14.5

15.0

15.5

16.0

16.5

17.0

17.5

18.0 Median Age of Marriage Stunting

Median age of marriage (women 20-49 years) and stunting (<5 years children)by Division


BDHS 2011Child Equity Atlas: BBS-BIDS-UNICEF 2013

51%49%

45%

37%

23%

18% 17%19%

14%11%

0%

10%

20%

30%

40%

50%

60%Stunting Wasting

No education

Primary incomplete

Primary complete


Secondary or higher

Mother’s education andchild undernutrition, 2011

17%

20%

32% 32%

30% 29%

27%

15%

0%

5%

10%

15%

20%

25%

30%

35%

40% Unmarried Married


Primary completed

Secondary completed or

more

Never to school or primary incomplete

Educational attainment of married and unmarried young women in Bangladesh, 2011

22

Levels of child undernutrition fall with increasing education level of mothers.

Marriage in childhood is strongly related to education attainment in young women.

CARE PRACTICESProper breastfeeding, adequate complementary feeding, personal hygiene

23

Prelacteal - feeds given to neonates before breastfeeding initiationBDHS 2011

Breastfeeding practices are improving overall, particularly reduced pre-lacteal feeds.

However, less than half of newborns are not breastfed within one hour of birth.

41%44%43%

48%43%

47%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Initiation of breastfeeding(within 1 hour of birth)

2007 2011

Urban Rural National Urban Rural National

62%

38%

62%

39%

62%

39%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-lacteal feed(within first 3 days of life)

2007 2011

Urban Rural National Urban Rural National

24

2%

36%

14%

5%

27%

15%

0%

20%

40%

60%

80%

100%

Feeding of children 4-5 months old (2011)

Not breastfeeding

Breastfeeding + plain water

Exclusive breastfeeding

Breastfeeding + non-milk liquids

Breastfeeding + other milk

Breastfeeding +complementary feeding

BDHS 2011

Exclusive breastfeeding rates start high in the first and second months, but drop

significantly by 4-5 months, when other liquids and foods have already been

introduced.

<6 months children (%) BDHS 2011 MICS 2012-13 UESD 2013

Exclusive breastfeeding 63.5 56.4 60.0

46% 45% 46% 42% 43%

64%

0%

20%

40%

60%

80%

100%

Exclusive breastfeeding (for 6 months)

1993-94 1996/97 1999-2000 2004 2007 2011

85%

71%

36%

0%

20%

40%

60%

80%

100%

Exclusive breastfeeding by age in months (2011 only)

months

0-1 2-3 3-4

25

BDHS 2011

Mother’s education is associated with several infant and young child feeding

practices, particularly proper complementary feeding.

2.9 2.9

3.6 3.7

4.4

0.0

1.0

2.0

3.0

4.0

5.0

No education

Primary incomplete

Primary complete


Secondary or higher

Median duration of exclusive breastfeeding (months)and mother’s education (2011)

10%

17%18%

23%

36%

0%

5%

10%

15%

20%

25%

30%

35%

40%

No education

Primary incomplete

Primary complete


Secondary or higher

Proper complementary feeding for children6-23 months and mother’s education (2011)

26

1% 2%

15%

63%

90% 91%96%

0%

20%

40%

60%

80%

100%

Complementary feeding practices (children 6-23 months old)

0-1 2-3 4-5 6-8 9-11 12-17 18-23

BDHS 2011

18% of children receive complementary foods too early.

Nearly 40% start too late.

Inappropriate complementary feeding is a cause of stunted growth and development, which leads to –

Concurrent problems and short-term consequences• Increased morbidities and mortality • Decreased cognitive, motor, and language

development• Increased health expenditure and opportunity

costs for care of sick child

Long-term consequences• Stunted adult stature, reproductive health

problems, obesity and associated co-morbidities• Decreased school performance, learning capacity• Decreased work capacity and productivity

27

BDHS 2011

Less than a quarter of children under 2 years old receive a minimum acceptable

diet with a serious situation evident for rural areas.

Minimum diet diversity – Proportion of children 6–23 months of age who receive foods from 4 or more food groups.Minimum meal frequency – Proportion of breastfed and non-breastfed children 6–23 months of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children) the minimum number of times or more.Minimum acceptable diet – Proportion of children 6–23 months of age who receive a minimum acceptable diet (apart from breast milk).

24%

64%

21%

41%

69%

15%

25%

65%

21%

0%

20%

40%

60%

80%

Breastfed children Non-breastfed children All children

Minimum diet diversity

Minimum meal frequency

Minimum acceptable diet

Complementary feeding practices(children 6-23 months old, 2011)

35%

68%

28%22%

64%

19%

0%

20%

40%

60%

80%

Urban Rural

Minimum diet diversity

Minimum meal frequency

Minimum acceptable diet

Complementary feeding practices by locality(all children 6-23 months old, 2011)

28

BDHS 2011

Levels of child undernutrition are strongly related to Infant and Young Child

Feeding (IYCF) practices, with a strong geographical association

11%

17% 18%

21%23%

25%

28%

49%

41%

45%43% 43%

34% 34%

0%

10%

20%

30%

40%

50%

60%

Minimum Acceptable Diet Stunting

Sylhet Chittagong Barisal Rangpur Dhaka Rajshahi Khulna

IYCF practice and stunting

11%

17%18%

21%

23%25%

28%

18%

16%15%

13%

16%16%

15%

0%

5%

10%

15%

20%

25%

30%

Minimum Acceptable Diet Wasting

IYCF practice and wasting

Sylhet Chittagong Barisal Rangpur Dhaka Rajshahi Khulna

29

BDHS 2011

Three quarters of the population do not practice recommended hygiene

behaviours, with little variation by Division but a marked urban-rural difference.

14%

24%28%

20%24%

27% 25% 25%

0%

20%

40%

60%

80%

100%

Observed use of soap and waterfor hand washing by Division


46%

17%

25%

0%

20%

40%

60%

80%

100%

Urban Rural National

Observed use of soap and waterfor hand washing by locality

30

BDHS 2011

Hand washing behaviour improves significantly with household wealth

and is related to level of stunting.

According to FSNSP 2012, although half of caregivers reported washing hands with soap after using the toilet, only 3% overall reported this behaviour before feeding a child.

4%9%

13%

28%

67%

54%

45%41%

36%

26%

0%

20%

40%

60%

80%

100%Hand washing with soap and water Stunting

Q1 Q2 Q3 Q4 Q5

Hand washing behavior indifferent wealth quintiles and stunting

31

HEALTH: SERVICES AND ENVIRONMENT

Health care services, micronutrient supplementation, water and sanitation

32

BDHS 2011

While the level of the recommended uptake (repeat visits) of antenatal care

services is still very low, it has been rising in the last decade.

42%

37%

32%

17%

22%

26%

0%

10%

20%

30%

40%

50%

60%No ANC Four or more ANC visits

2004 2007 2011

Trends in ANC coverage

17%

12% 13%14%

45%

37%

16%15%

12%

20%

32%

15% 14%13%

26%

0%

10%

20%

30%

40%

50%

60%Urban Rural National

No visit 1 visit 2 visits 3 visits 4+ visits

Number of ANC visits (2011)

33

FSNSP 2012

Undernutrition is more prevalent among pregnant women in rural areas, with

Rangpur and Sylhet the worst affected Divisions.

4% 5% 4%

23%

17%

25%

0%

5%

10%

15%

20%

25%

30%

35% Severe (MUAC <207mm) At risk (MUAC <230mm)

National Urban Rural

Undernutrition among pregnant womenby locality

5% 4% 5%2% 2%

5%8%

19%24% 23%

17%20%

28%

29%

0%

5%

10%

15%

20%

25%

30%

35%

40% Severe (MUAC <207mm) At risk (MUAC <230mm)

Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet

Undernutrition among pregnant womenby Division

34

Universal access to an improved source of drinking water (99%)

Most common sources of drinking water are tube well or borehole

For 71% of households, drinking water is available within the premises

BDHS 2011, MICS 2012-13

Overall access to improved water source and sanitation is gradually improving,

particularly in rural areas. Safe disposal of child faeces remains a challenge.

40% 43%

25%34%

0%

25%

50%

75%

100%

Urban Rural

2007 2011

Population with access to improved,not shared, sanitation facilities (2011)

35

39%38%

46%44%

35%

21%

36%

39%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%


Percentage of children (0-2 years) whose last stools were disposed of safely (2012-13)

FOOD SECURITYFood availability, access and consumption

36

HFIAS: Household Food Insecurity Access ScaleFSNSP 2012

Nearly 60% of rural households are food insecure (household availability and

access). Food insecurity is related to child stunting.

56%

41%

59%

37%

28%

38%

11%

7%

12%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0%

10%

20%

30%

40%

50%

60%

70%

HFIAS Stunting Severe Stunting

National Urban Rural

HFIAS and stunting

59%61%

49%

59%

53%

65% 64%

36%

40%

33% 34% 35%

41%

50%

11%13%

10%

7%9%

11%

21%

0%

10%

20%

30%

40%

50%

60%

0%

10%

20%

30%

40%

50%

60%

70%

HFIAS Stunting Severe Stunting


HFIAS and stunting

37

FSNSP 2012

Poor and borderline household Food Consumption Score levels are widespread

across the country but the relationship with undernutrition is weak by Division.

38

23%

13%

8%

18%

22%

29%

15%

36%

40%

33% 34% 35%

41%

50%

10% 12%9%

11%

15%

11% 12%

0%

10%

20%

30%

40%

50%

60%Poor or borderline food consumption score Stunting Wasting

Poor and borderline household Food Consumption Score vs. undernutrition by Division


Household food insecurity drops with income.

The poorest remain at very high levels of food insecurity and undernutrition.

HFIAS: Household Food Insecurity Access ScaleFSNSP 2012

FSNSP 2012 report says that the overall levels of food insecurity have fallen in the last few years.

However, even the wealthiest quintile still has significant food insecurity and undernutrition

84%

72%

60%

40%

18%

48%

42%39%

29%

19%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Food Insecurity Stunting

Q1 Q2 Q3 Q4 Q5

Household food insecurity (HFIAS) and stunting according to household wealth

39

Levels of food insecurity are related to undernutrition in adult women but the

relationship is not as marked for adolescent girls.

HFIAS: Household Food Insecurity Access ScaleFDS: Food Deficit ScaleFCS: Food Consumption ScoreDD: Diet DiversityFSNSP 2012 report

10%13%

11%

16%

11%

16%

11%13%14%

25%

19%

28%

19%

28%

16%

23%

0%

25%

50%Inadequate height (<145cm) Chronically Energy Deficient (< BMI 18.5)

Undernutrition in adult women by food consumption and diet diversity

Secure Insecure No deficit Deficit Acceptable Borderln./poor 5+ groups Inadequate

HFIAS FDS FCS DD

26%

33%30%

32%30%

32% 32%

26%

10%12% 11%

13%11% 11%

13%10%

0%

25%

50% Inadequate height (< -2 S.D height for age z-score ) Underweight (<-2 S.D BMI for age z-score)

Undernutrition in adolescent girls by food consumption and dietary diversity

Secure Insecure No deficit Deficit Acceptable Borderln./poor 5+ groups Inadequate

HFIAS FDS FCS DD 40

INDICATOR DASHBOARD

For use as a monitoring and advocacy tool

41

Indicator Status Source Year Severity Trend

Nu

trit

ion

al im

pac

t Stunting Prevalence of stunting among children 0-59 months old1 41.3% BDHS 2011 improving

WastingGAM prevalence among children 0-59 months old1 15.6% BDHS 2011 improving

SAM prevalence among children 0-59 months old1 4.0% BDHS 2011 worsening

Vitamin A deficiency Children <5 with Vitamin A deficiency 20.5% BNMS 2012 improving

Iron deficiencyChildren 6-59 mo. with anaemia 51.3% BDHS 2011 worsening

Women 15-49 yrs. with anaemia 42.4% BDHS 2011 worsening

Iodine deficiency disorder School-aged children w/ iodine deficiency disorders 40.0% BNMS 2012 worsening

Un

der

lyin

g ca

use

s

Food security

Households with poor or borderline food consumption 16.0% FSNSP 2012 improving

Proportion of population undernourished 16.8% SOFI 2012 improving

Global Hunger Index rating 58/78 GHI 2013 improving

Health and Sanitation

Under 5 mortality rate (deaths per 1,000 live births) 53 BDHS 2011 TBD improving

Women 15-49 yrs. w/ problem(s) accessing health care n.a. not available

Household access to improved water source 98.5% BDHS 2011 improving

Household access to improved sanitation facilities 36.6% BDHS 2011 TBD improving

Care

Timely initiation of breastfeeding 47.1% BDHS 2011 improving

Infants 0–5 mo. exclusively breastfed 63.5% BDHS 2011 improving

Children 6-23 mo. old with min acceptable diet 20.9% BDHS 2011 not available

Caregivers washing hands after using toilet n.a. TBD not available

Time to fetch water (households that take ≥30 min) 3.7% BDHS 2011 TBD not available

Bas

ic c

ause

s

EducationFemales that completed primary school or higher 11.6% BDHS 2011 TBD improving

Literate females ages 15-49 yrs. old 72.3% BDHS 2011 TBD improving

Population Total fertility rate 2.3 BDHS 2011 TBD improving

Gender

Women ages 20-49 yrs. with first birth at 15 yrs. old 10.9% BDHS 2011 TBD no change

Women’s intra-household decision-making power 41.5% BDHS 2011 TBD improving

Global Gender Gap ranking 86 GGGR 2012 worsening

Poverty Population living under national poverty line (upper) 31.5% HIES 2010 TBD improving

Requiring action

Serious problem requiring urgent action

Not currently a serious problem

Not applicable

1 Adjusted from 6-59 to 0-59 months to incorporate BDHS data. 2Comparing anaemia level for NPNL women, baseline 33.8% and current 40.0% (baseline for all women 15-49 n.a.). 3 Change in definition/methodology.BDHS – Bangladesh Demographic and Household Survey, BNMS – Bangladesh National Micronutrient Survey, FSNSP – Food Security and Nutrition Surveillance ProjectSOFI – The State of Food Insecurity in the World, GHI – Global Hunger Index, GGGR – The Global Gender Gap report, HIES – Household Income and Expenditure Survey

Indicator Dashboard

42

TBD To Be Determined

Acknowledgements

Mostafa Al Banna Ministry of Food, Government of Bangladesh

Lalita Bhattacharjee Food and Agriculture Organization of the United Nations, FAO

Farzana Bilkes World Health Organization, WHO

Rachel Fuli World Food Programme, WFP

Dr. Nasreen Khan National Nutrition Services, Government of Bangladesh

Mary Manandhar UN REACH Bangladesh

Navaratnasamy Paranietharan World Health Organization, WHO

Noreen Prendiville United Nations Children’s Fund, UNICEF

Christa Räder World Food Programme, WFP

Dr. Iftekhar Rashid USAID (formerly with UN REACH Bangladesh)

Mike Robson Food and Agriculture Organization of the United Nations, FAO

Edwyn Shiell UN REACH Bangladesh

Holly Sedutto UN REACH Global Secretariat

Gillian Waid Helen Keller International

Pascal Villeneuve United Nations Children’s Fund, UNICEF

45

bangladesh nutrition situation analysis · there are high rates and large absolute numbers of...

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