Maternal nutrition behaviour, its determinants, and effects of maternal nutrition on child nutrition and health in Bangladesh

In this body of research, I aimed to examine the determinants of maternal nutrition behaviour (chapter 3 and 4) and the association between maternal height and risk of under-five stunting and wasting and neonatal, infant and under-five mortality in Bangladesh (chapter 5 and 6). This research used mixed methods, both quantitative (chapter 3,5,6) and qualitative analysis (chapter 4). Chapter 3 analyzed data from two cross-sectional surveys conducted in rural areas of Bhola, Barguna and Sirajganj districts in Bangladesh. A two-stage random sampling was used to select 496 pregnant women to collect data on socio-demography, household wealth, food frequency and household food consumption (WFP methods). Chapter 4 presented a qualitative study conducted at two rural areas in Jamalpur districts, Bangladesh. Data were collected on perceptions on attributes of foods using IDI (n=36) with the pregnant and lactating women, FGD (n=4) with their husbands and mothers-in-law and KII. The inductive thematic approach was used for data analysis. Chapter 5 and 6 presented the pooled data analysis from Bangladesh demographic and health surveys (BDHS 2004-14) with a nationally representative sample from children aged 0-59 months (anthropometry, (n=28,123) (mortality, n=29,698). Data analysis included stunting (=155 cm). This finding suggests an intergenerational linkage between maternal and child undernuteition and mortality. The insights from this research will help to design nutrition behaviour change communications to improve diet quality in pregnancy and lactation to break the intergenerational cycle of malnutrition for better maternal and child nutrition in Banglades

Can a Combined Agriculture and Nutrition Behaviour Change Intervention Improve Women’s Empowerment? A Mixed Methods Feasibility Study in Rural Bangladesh

Many agricultural and home gardening interventions aim to improve the nutritional status of women and children in low- and middle-income countries by focusing on women as the recipients of the intervention and make assumptions that women will be empowered as a result. This paper examines the potential impact of an intervention study that combined home garden training and support, and nutrition behaviour change communication, with a social safety net payment, on women’s empowerment in rural Bangladesh. We assessed the implementation of this study in terms of feasibility, acceptability, and practical application. Twenty in-depth interviews were conducted with randomly selected women that took part in the study. Qualitative data was coded using thematic analysis (Braun & Clarke 2006) and the results presented using the following five indicators: control over use of income, input into productive decisions, respect among household members, self-efficacy, and input into nutrition and health care decisions. Our study showed that a combined nutrition-specific (nutrition counselling) and nutrition-sensitive (agricultural training and unconditional cash transfer) intervention, delivered on a mobile platform, to women from low-income families in rural Bangladesh was feasible and acceptable. The study further revealed evidence on behaviour change across five key indicators related to women’s empowerment. The study highlights the potential for such an intervention to impact women’s empowerment and provides insight for the aid in the design of larger-scale trials implemented in similar settings

Risk Factors of Mortality in Severely-malnourished Children Hospitalized with Diarrhoea

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severely-malnourished children (weight-for-age <60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p<0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p<0.01). Patients with leukocytosis (>15,000/cm3) had 2.5 times the odds of death (p<0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p<0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p<0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition

Impact of Zinc Deficiency on Vibrio Cholerae Enterotoxin-stimulated Water and Electrolyte Transport in Animal Model

The effect of zinc deficiency on the function of the intestine to absorb water and electrolytes was studied in animal models, stimulated by Vibrio cholerae enterotoxin. Sprague-Dawley rats, used in the study, were divided into four groups: Zinc-deficient, ad libitum zinc-fed control, zinc weight-matched control, and zinc-deficient acutely-repleted. 14C-labelled polyethylene glycol solution was used for measuring the absorption capacity of the small intestine. Significantly lower absorption of water and sodium per cm of the intestine was observed in the zinc-deficient animals compared to the ad libitum zinc-fed control animals (p&lt;0.01). An improved absorption capacity was equally observed in the zinc-deficient acutely-repleted animals and ad libitum zinc-fed control group. The zinc-deficient animals showed four times greater cholera toxin-induced net secretions of water and sodium compared to the ad libitum zinc-fed group (p&lt;0.01), while a 40% reduction was observed in the zinc-deficient acutely-repleted group. The results suggest that zinc deficiency is associated with reduced absorption of water and electrolytes and increased secretion of the same stimulated by cholera toxin

Risk Factors of Mortality in Severely-malnourished Children Hospitalized with Diarrhoea

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severelymalnourished children (weight-for-age &lt;60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p&lt;0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p&lt;0.01). Patients with leukocytosis (&gt;15,000/cm3) had 2.5 times the odds of death (p&lt;0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p&lt;0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p&lt;0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition

Key stakeholders and platforms/networks in food systems transformation in Bangladesh in 2022

The stakeholder identification is initiated under the CGIAR Research Initative on Sustainable Healthy Diets through Food Systems Transformation (SHiFT) to identify with whom the project needs to engage with to achieve food system transformations. It brings together all the stakeholders working on food systems issues in a so-called ‘living’ database that can quickly identify potential stakeholders in each of the SHIFT target countries. Understanding, engaging and capacitating the different food system stakeholders will provide diverse perspectives to foster collaborations to leverage transformative actions across the system to improve outcomes. This stakeholder identification is a first step to building an understanding of who (people and institutions) is engaged with food system issues at different governance levels, including public and private actors, and those working in formal and informal sectors at national, regional, and local government levels. In addition, the SHiFT country engagement approach is looking to connect with and strengthen existing stakeholder (coordination) mechanisms or platforms in food system transformation rather than establish new collaborative structures. Applying a stakeholder platform mapping tool to detect (coordination) structures engaged around food system issues, existing platforms, and networks are identified.Non-PRIFPRI1; 2 Promoting Healthy Diets and Nutrition for al

Key stakeholders and platforms/networks in food systems transformation in Bangladesh in 2022

The stakeholder identification is initiated under the CGIAR Research Initative on Sustainable Healthy Diets through Food Systems Transformation (SHiFT) to identify with whom the project needs to engage with to achieve food system transformations. It brings together all the stakeholders working on food systems issues in a so-called ‘living’ database that can quickly identify potential stakeholders in each of the SHIFT target countries. Understanding, engaging and capacitating the different food system stakeholders will provide diverse perspectives to foster collaborations to leverage transformative actions across the system to improve outcomes. This stakeholder identification is a first step to building an understanding of who (people and institutions) is engaged with food system issues at different governance levels, including public and private actors, and those working in formal and informal sectors at national, regional, and local government levels. In addition, the SHiFT country engagement approach is looking to connect with and strengthen existing stakeholder (coordination) mechanisms or platforms in food system transformation rather than establish new collaborative structures. Applying a stakeholder platform mapping tool to detect (coordination) structures engaged around food system issues, existing platforms, and networks are identified

Assessing the Intergenerational Linkage between Short Maternal Stature and Under-Five Stunting and Wasting in Bangladesh

Short maternal stature is identified as a strong predictor of offspring undernutrition in low and middle-income countries. However, there is limited information to confirm an intergenerational link between maternal and under-five undernutrition in Bangladesh. Therefore, this study aimed to assess the association between short maternal stature and offspring stunting and wasting in Bangladesh. For analysis, this study pooled the data from four rounds of Bangladesh Demographic and Health Surveys (BDHS) 2004, 2007, 2011, and 2014 that included about 28,123 singleton children aged 0&ndash;59 months born to mothers aged 15&ndash;49 years. Data on sociodemographic factors, birth history, and anthropometry were analyzed using STATA 14.2 to perform a multivariable model using &lsquo;Modified Poisson Regression&rsquo; with step-wise backward elimination procedures. In an adjusted model, every 1 cm increase in maternal height significantly reduced the risk of stunting (relative risks (RR) = 0.960; 95% confidence interval (CI): 0.957, 0.962) and wasting (RR = 0.986; 95% CI: 0.980, 0.992). The children of the short statured mothers (&lt;145 cm) had about two times greater risk of stunting and three times the risk of severe stunting, 1.28 times the risk of wasting, and 1.43 times the risk of severe wasting (RR = 1.43; 95% CI: 1.11, 1.83) than the tall mothers (&ge;155 cm). These findings confirmed a robust intergenerational linkage between short maternal stature and offspring stunting and wasting in Bangladesh