Shiree partners primarily operated asset transfer programmes, which only indirectly impact on nutrition, the logic being that an improved income stream will lead to greater expenditure on the quantity and quality of food consumed by household members. However, monitoring to 2013 showed no significant improvement in childhood stunting, wasting, weight and other key indicators of nutritional status.
The Nutrition Innovation Fund was a small fund to pioneer innovative methods to increasing protein intake among pregnant women and children aged between 6 and 23 months who are living in extreme poverty. Four projects were funded under this fund, and insights into this can be found in the Nutrition Lesson Learning Report.
1) WorldFish developed two unique fish-based products, using dried small fish species (a very concentrated source of animal protein, essential micronutrients and fats): for women; dried fish with oil and spices, served as an accompanying dish to daily meals; for children; a pre-prepared instant product of powdered fish, rice, orange-fleshed sweet potato and oil, to be served as a porridge. To fulfill stringent food safety standards, the children’s product was produced by a private sector partner. The women’s product was produced locally, generating income, especially for women, thus broadening the potential benefits to the community, as well as ensuring long-term sustainability.
2) TOYMU supported households in Bandarban with training and inputs for pigeon keeping. The project worked with extreme poor households having a pregnant woman or a children of 6-23 months of age, and aimed to provide them with adequate animal protein from squab (young pigeon) as well as additional income to meet other protein and nutritional needs.
3) SCI Khulna: aimed to increase protein intake among pregnant women and Children under 2 years, through a combination of providing nutritious foods such as ducks (for eggs), bean seeds for cultivation, and behaviour change communication ( BCC) improving hygienic practices with 400 households. The project trained women union members as nutrition champions, who provided information to other community members, and raised awareness of the need to increase protein intake.
4) Terre des Homes: aimed to develop the capacity of children to act as agents of change for increasing the protein intake of pregnant and lactating women (PLW), as well as of infants aged from 6 to 23 months. The project trained children on tilapia cultivation, and keyhole garden vegetable production, and provided training on nutrition education and hygiene at school. The children replicated the garden at home, and raised awareness of protein intake and healthy nutrition and hygiene behaviours with their families.
Bangladesh has made impressive progress towards attainment of the Millennium Development Goals, particularly in reducing child mortality, but improvement in overall nutritional status has been relatively slow.
- The Bangladesh Demographic and Health Survey found that 41 % of children under five are stunted (low length or height-for- age indicating that they are not achieving their linear growth potential) and 36% were underweight (low weight-for-age)
- The percentage of underweight children in Bangladesh is 16 % higher than in sixteen other Asian countries at similar levels of per capita GDP; about 400,000 children under 5 years of age suffer from severe acute under-nutrition.
- In Bangladesh, women are often undernourished and suffer from multiple nutrition-induced problems. A high proportion of women (15 %) are below the critical height of 145 centimetres.
- The BDHS 2007 survey data indicated that, 30% of women have a Body Mass Index (BMI) <18.5 (the cut-off for chronic energy deficiency)
- Roughly 10% of women suffer from more serious under-nutrition (BMI <17)
Protein Intake of the Poorest
Data from Shiree’s M&E system, the Change Monitoring System or CMS, illustrates the lack of access and insufficient level of protein intake (particularly animal protein) among extreme poor households. At baseline, almost all households reported consuming no milk, chicken and meat in the last 7 days (92%, 96% and 91%, respectively) while 71% did not eat eggs and 37% had no fish in their diets. Households had poor food security; two thirds of families ate less than 3 meals a day and 50.5% of all household heads had severe chronic energy deficiency defined as a BMI < 18.5
Protein is one of the three macronutrients, along with carbohydrates and fats. Protein is the major functional and structural component of all body cells and tissues. It is also the principle material in blood, enzymes, antibodies and many hormones. Lack of adequate protein in the diet is associated with impaired immunity and increased risk of infection and disease. Evidence from different studies indicates that Intra-uterine growth is most affected by maternal dietary nutrient deficiencies (particularly deficiencies of protein and micronutrients) during pregnancy.
Protein has not often been considered or used in supplementation programmes, despite the fact that it is clearly a major nutrient which would inevitably result in poor growth if dietary intake was inadequate. The main reason for this is that estimates of required protein intake have remained unchallenged. However, in the context of developing countries, there is reason to believe that current figures for recommended protein intake may be a significant underestimate. Children in developing countries need more protein because:
- They suffer frequent and persistent illnesses leading to a near constant activation of their inflammatory and immune systems – functions which utilise dietary protein
- Illness invariably results in poorer nutritional status. Following episodes of disease, children will need to undergo catch-up growth if they are to meet their original growth trajectory; this requires the increased intake of protein
- The majority of infants in developing countries develop a persistent inflammatory enteropathy of the small intestine during the first year of life which reduces nutrient digestion and absorption. Not only is protein assimilated from the diet less readily, but more is required to regenerate the damaged tissue.