That children from the slums of Dhaka have an unequal start in life is not a revelation. Sanitation systems are poor or non-existent, poverty affects nutrition levels, and access to advanced health care is limited.
But here is an appalling fact: by the time they are two years of age, the children of Mirpur Bauniabandh slum take 10 courses of antibiotics. In the first two years, these children have approximately 10 episodes of illnesses that warrant antibiotic intervention.
This was found in a World Health Organisation study that compared the conditions of 265 children in Bauniabandh with those living in similar conditions in Pakistan, Tanzania, Brazil, Peru, South Africa, India and Nepal.
So how did Bangladesh compare? The average number of antibiotic courses taken by children across the countries was 4.9, less than half of what the children of Bauniabandh were taking. In fact, Bangladesh comes out second-highest—the children of Naushahro Feroze in Pakistan topped the list by taking 12 courses of antibiotics in their first two years.
“Of course, pharmacists and doctors in Bangladesh prescribe antibiotics indiscriminately, but children in these slums are actually catching more infections,” confirms Dr Tahmeed Ahmed, one of the main authors of this exploratory study and Senior Director of Nutrition and Clinical Services Division at International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
Three-year-old Sumaiya lives in a one-room corrugated-tin house teetering on the edge of the Beribandh canal. The child drinks water straight out of the tap but not due to habit—rather, it is because her family does not have a working gas connection and cannot afford firewood.
“Firewood costs BDT 12 per kilogram, and I end up spending BDT 150 or 200 just to cook food. I don't have the money to boil water,” says Sumaiya's mother Asha. “Is that what you spend weekly?” I ask. “Weekly?” she laughs, “I spend that daily!” Most people with gas connections have to pay only around BDT 800 per month, which is the amount Asha spends in half a week. The mother works as a domestic worker in people's homes.
None of the mother-daughter duo's neighbours in the slum boil water for the simple reason that they do not have access to a working gas connection. Rowshanara Begum's four-year-old suffers from chronic diarrhoea. “I need to buy medicine several times a year for the child, simple oral saline solutions are not enough,” says Rowshanara.
Their living conditions are similar to those in all slums—each of the families is squeezed into tiny windowless rooms of corrugated tin sheets. The bathrooms are open pits leading to the canal. All the households dump trash in the canal because the monthly garbage collection bill is an added burden nobody wants. That the contamination levels of this large water body has an effect on children's health came to light in a study last year that tested 200 water samples across four slums in the city and found distressing levels of fecal matter. The highest levels of contamination—about 600 fecal coliform bacterial colonies in every 100 ml of water—were found in the water from underground reserve tanks. Water samples collected from household containers like jugs were also highly contaminated. In comparison, the water supplied by the municipality was tested at source and it had no fecal matter. What that means is that the bacteria enter the water when being transported through underground pipes—pipes that come in close contact with soil that is already contaminated by the canal water, for example. The study was done by BRAC University, Dhaka University, Dushtha Shasthya Kendra and WaterAid Bangladesh among others.
Shabana Begum, a 24-year-old mother in the same slum, managed a gas connection to boil water but her four children have another reason for falling sick—they have not completed their necessary vaccinations for illnesses like cholera.
“I moved into a room inside a brick building two years ago, so that I could get access to gas for cooking. The bathroom is also better,” says Shabana. The building also houses a tiny one-room school run by an NGO, where her children spend their days. The room costs more than the makeshift structures on the side of the canal. If the mother is so committed to giving her children a better environment to grow up in, why has she not vaccinated them?
“The older women in the slum said my children will fall sick if they get vaccinated. The health workers will leave after vaccinating him but perhaps I will be left to deal with a sick child,” says Shabana. The mother was married off at the age of 14 after she completed sixth grade and could not study further. She even had cholera vaccination registration cards given to her by icddr,b for her children, but quietly slipped away when the health workers came to her block because of her misconception about vaccination.
An additional fact to be concerned about is that the children studied in the research were being given stronger antibiotics from the get-go. Experts agree that this contributes to antibiotic resistance in the future. “The infants of Dhaka were more likely to be given highly potent antibiotics like macrolides (generic name being Azithromycin) for diarrhoea, as opposed to anti-protozoal drugs like Flagyl,” says Dr Tahmeed Ahmed.
Children from the slums invariably get less of a shot at life than the rest of the kids in the city—they go to worse schools, end up in lower-paying jobs. Must their bodies fail them too because of man-made factors?