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Health

Nutritional Blindness

Healthy Child Healthy Eyes

Every minute a child goes blind. The World Health Organization (WHO) estimates that 37 million people are blind worldwide, and another 124 million have poor vision and are in danger of becoming blind. Unfortunately 75% of these cases of blindness could have been prevented. The majority of the blind live in the poorest areas of the developing world, such as Bangladesh, and they have no access to preventable measures. Or do they?

HKI/ Bangladesh celebrates 30 years of innovation this month.

Malnutrition, a severe problem in Bangladesh, leads to a number of serious public health concerns. One of the main concerns is vitamin A deficiency, which is responsible for thousands of pre-school age children needlessly becoming blind every year. Child health in Bangladesh is at a great risk due to a limited access of vitamin-A rich foods, inadequate feeding, high prevalence of infectious diseases, frequent disasters and poverty. In some parts of Bangladesh, such as the Chittagong Hill Tracts (CHT), the prevalence of vitamin A deficiency, as a result of malnutrition, is particularly prominent. Fortunately, a nutritional surveillance study conducted by the Helen Keller International (HKI) and the Institute of Public Health Nutrition (IPHN) in 2003 has brought attention to this problem. At the time, night blindness, the first clinical sign of vitamin A deficiency was proven to be four times higher among children between 18 and 59 months in the CHT, than children in other parts of Bangladesh.

The Government of Bangladesh has a well-established policy to distribute vitamin A capsules (VAC) supplements to children 9-59 months, ensuring successful vitamin A distribution at a minimum of 80% coverage for Bangladesh -- indeed a global success story. These supplements are distributed through the National Vitamin A Capsule Campaign (NVAC) and through National Immunisation Days (NID), which take place twice a year throughout Bangladesh. The programme has proven an essential strategy in reducing the child mortality rate and combating vitamin A deficiency for child survival. However, due to the difficult geographical locations and hard-to-reach settlements of the CHT, about 30% of the children between 6 to 24 months do not receive their intended VAC. These children are most at risk of increased ill health, vitamin A deficiency, and death.

Helen Keller International (HKI) has been a long-time supporter of the Government's VAC campaign since the 1990s. As the leading NGO in the field of eye health and nutrition, HKI is devoted to help meet the Millennium Development Goals (MDGs) as well as Vision 2020, the global initiative to eliminate avoidable blindness. Addressing the issue above, HKI/Bangladesh is currently supporting the Government in community mobilisation and strengthening health systems in order to target the hard-to-reach areas of the CHT. This initiative aims to enhance awareness in order to reach 35,000 additional children with vitamin A.

The project is implemented in collaboration with the Government of Bangladesh, Micronutrient Initiatives (MI), UNICEF and BRAC, and the Integrated Development Foundation (IDF) is acting as the implementing partner of HKI in the CHT.

When HKI conducted a survey on VAC distribution coverage in the Chittagong Hill Tracts (CHT) in 2007, Kaingpre was four years old. He and his family were living in Ramnipara village in the Bandarban District, one of the hard-to-reach areas in Bangladesh, where there is a high prevalence of vitamin A deficiency. Kaingpre's mother became aware of the importance of vitamin A after seeing posters and hearing announcements in their village. On National Immunisation Day (NID), held on the 10th of May this year, she decided to take her young children to the nearest health vaccination centre where she learned that vitamin A is essential in keeping her children healthy and preventing them from nutritional blindness. Now she is certain she will continue to bring Kaingpre and her siblings to NID twice a year until they are five-years old.

As a part of creating awareness and promoting the National Immunization Day, HKI developed and distributed posters, calendars, key rings, leaflets, hygiene packs for school children, umbrellas, and T-shirts. In addition to this, HKI has trained and developed local volunteers to motivate the community through Inter Personal Communication skills. Through community announcements about the NID-NVAC through miking and by local community gate-keepers such as the mosques, temples and teachers to let people know about the date and venue for VAC. This has ensured that many more children received vitamin A. It was this effort that caught the attention of Kaingpre's mother, ensuring that she and her siblings were brought to the local health center to receive vitamin A. The reward for bringing them there is obvious healthy, smiling children, fit to meet the challenges of each day. Not only Kaingpre's family, but many mothers, fathers, and members of hard-to-reach communities in the CHT are now aware of the National Vitamin A campaign through HKI's mobilisation campaign.

It is still important to remember that even though vitamin A capsule distribution is a life saving strategy in Bangladesh, other approaches must also be considered in the overall attempt to address vitamin A deficiency and nutritional blindness. The best prevention and the main goal for Bangladesh in this regard should be to improve children's nutritional state through a better diet with a larger variety of nutritious foods, the improvment of personal hygiene practices and the safe usage of water. This is especially important now when the monsoon months are upon us, making diarrhea and measles epidemics prevalent. Knowing that 80 percent of the blind children in Bangladesh come from landless households without access to sufficient food, it is important to influence agricultural policy and directly address food security and malnutrition through homestead food production. Homestead food production and the consumption of a variety of vitamin A-rich foods is proven to improve people's nutritional status and consequently prevent vitamin A deficiency and nutritional blindness.

Another key to preventing nutritional blindness among children is to improve infant feeding habits. Exclusive breastfeeding for children under 6 months and the use of more nutritious complementary food, while still breastfeeding the child upto age two years must be strongly promoted and supported. Basic eye care must also be recognised as essential for child health. Not only all health workers, but also the general population, should be aware of the causes of nutritional blindness and its potential for prevention and immediate treatment. Nutritional education among mothers and other household members must be enhanced and brought into the mainstream in order to raise knowledge and awareness about these matters. In order to ensure that women are given equal power in decision making, this will, in turn, benefit all members of the household and increase the nutritional status of family members. Through numerous surveys, HKI has proven that the empowerment of womenthrough homestead food production programmes leads to increased food production, improved food distribution and more income spent on food and health.

The media can and should play a central role in preventing blindness and improving child nutrition, both by promoting consumption of vitamin A rich foods, addressing the issue of nutritional blindness and promoting the National Immunisation Days. Always reminding the public that healthy children with healthy eyes is essential for Bangladesh's future development. Helen Keller, one of the founding members of HKI stated: “Instead of being satisfied to alleviate suffering, we shall labor hard and continually try to prevent it”. And that is what we need to do -- prevent suffering.

Compiled by Parvez Babul, Information and Advocacy Officer of Helen Keller International, Bangladesh.