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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
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet National
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%
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet National
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
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet National
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 incomplete
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
Secondary incomplete
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 incomplete
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 incomplete
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
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet National
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%
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet National
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
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet
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
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet
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
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