A silent crisis
An integrated approach can tackle malnutrition of children in slums
Rapid urbanisation has been inevitable in Bangladesh and, of course, is a sign of economic development and prosperity. It is believed that if the current rate of urbanisation continues, our urban population will exceed rural population by 2040. Because urban transition occurs in diverse patterns, it has both pros and cons.
Ensuring nutrition for urban citizens, for instance, seems to be one of the most difficult challenges for the coming decades. Special attention should be given to childhood undernutrition which is linked with long-term adverse health effects. In order to build a healthy, meritorious and hard-working generation, we have to concentrate on addressing the existing nutritional challenges with an integrated approach.
A recent report claims that one in every three people lives in slums in Dhaka city. Despite significant reduction of the urban poverty level, the rate is still about 19 percent in Bangladesh. Bangladesh Bureau of Statistics conducted a census on the slum-dwelling and floating population in 2014 and according to the report, Dhaka city alone consists of 3,394 slums. This number has substantially increased over the last four years.
Comparatively, nutritional status of children living in urban slums is worse than in rural areas. A recent study conducted by icddr,b has shown that more than 50 percent of under-five children are stunted. That means they are short for their age and have failed to reach linear growth potential as a result of chronic undernutrition. More alarming is the fact that 15 percent of these children are severely stunted. Inadequate dietary intake and lack of proper nutrition are mainly responsible for such nutritional ailments. However, the scenario is relatively better in other areas within the city corporations, where the rate of stunting is about 25 percent.
In another study, icddr,b investigated the microbial quality of complementary food and water consumed by children. The study was conducted in four different slums in Dhaka city. The study spanned from December 2015 to May 2016 and included 360 children aged below five years. Investigators also recorded household food security information, socio-economic and nutritional status data, hygiene and feeding practices. The findings of the study have recently been published in an international peer-reviewed journal named Acta Paediatrica in February 2018.
The study results indicate that the rate of stunting in slums is much higher than the national rate (58 percent versus 36 percent) and more than 80 percent households are living with food insecurity. The rate is even higher in the slums which are devoid of any assistance from non-governmental organisations. Regardless of the awareness and promotion campaigns pertaining to hand-washing practices, 59 percent of the mothers living in these slums do not wash their hands before handling food. So there remains a high risk of contamination in homemade food. On the other hand, 45 percent of the food served to children is prepared eight hours before consumption, and stored at room temperature, which may lead to further deterioration due to rapid bacterial growth.
Seventy-six percent households do not treat drinking water before consumption. These overcrowded slums have limited space between water sources and poorly maintained toilets. Such proximity is a major threat for contamination of drinking and cooking water by faecal pathogens. The water samples we have collected from different slums were found to be contaminated with multiple organisms such as faecal coliforms, yeasts, moulds (fungi) and staphylococci. Yeasts and moulds were detected in 86 percent of the food samples and coliforms in 73 percent. Contamination in water and food causes diarrhoea, dysentery and other infectious diseases in children under five. Repeated infections impair the gut functions and reduce absorptive capacity of the small intestine, which ultimately leads to impaired growth and poor intellectual performance of children.
Poor environmental conditions, inadequate household hygiene practices and household food insecurity are the main factors affecting the nutrition and growth of children. All of these components indirectly affect the quality of the complementary food they receive. Because these factors are inter-related, it would not be wise to focus on any individual factor. Rather, an integrated approach is required, which includes strengthening public awareness regarding hygiene and clean food preparation, and ensuring food security for all, to save slum-dwelling children from the curse of malnutrition.
Dr Ishita Mostafa is Principal Investigator of the study and Research Investigator, Nutrition and Clinical Services Division at icddr,b. Dr Shah Mohammad Fahim is Research Fellow, Nutrition and Clinical Services Division at icddr,b.