Community Based Integrated Intervention, Lesions Learn from Rural Remote Areas of Bangladesh

Full text: Background and Objective: Like other south Asian countries, Bangladesh has frequently taken early steps to tackle malnutrition. The country is thus a signatory to a number of international declarations, which has been demonstrated locally as evidenced by the number of nutrition policies and programs at different times initiated by Government and other partners. Country's public health aspect's still struggling with achieving MDGs, despite remarkable progress has made in some aspects of child and maternal health. Inappropriate IYCF practices are the major concern and contributing malnutrition mostly. Under this context, World Vision Bangladesh has taken a five years project focusing in increasing uptake of health and nutrition services including reduction of moderate and acute malnutrition in the rural community of Bangladesh through integrated approached, livelihood and food security. This current effort assessed the extent of achievement in terms of output, outcome and goal level project and program indicators after implementing five years project successfully. Methodology: The evaluation study followed cross sectional design using both qualitative and quantitative methods. This study used 30 cluster sample design, 30 villages were identified as clusters, 27 households were systematically chosen from the master household listings. With this and the sample size derived from statistical calculations total of 810 households were identified. Purposive sampling method was used to determine the qualitative sample size. 18 Focus Group Discussions (FGD), 32 Key Informants Interview (KII), 6 Case Studies and 30 interviews for "Strength, Weakness, Opportunity and Threat (SWOT)" analysis were used. Results: The proportion of children is low compared to the population aged > 50 years. The mean family size was 4.1, around 10.1% of the total population was married before the age of 18 and agriculture is the primary occupation in that locality. In terms of health and nutrition, special emphasis was given at the WVB project activities. However, projects had great impact on behavior change components and mothers' knowledge on basic concepts of nutrition has increased vastly, doesn't effect on reducing severe and moderate malnutrition. The proportions of mildly under nourished children were underweight (30.2%), stunted (29.3%) and wasted (22.8%). The proportions of children being moderately under nourished were underweight (29.6%), stunted (19.9%) and wasted (24.1%). Indeed progress of achieving severe malnutrition, wasting has decreased drastically to 8% which was 17% in the baseline, however, severe underweight and stunting increased compared to baseline and also slightly higher compare to national data. Access in taking services have increased and among the children suffering from Diarrhea, 92.9% treated by the nearest facilities. Among the children eligible for vaccination, around 63.3% has reported to be fully immunized. Conclusions: While such community based intervention has impact on changing knowledge and uptake of services, limited in reducing acute malnutrition indeed. So, nutrition intervention redesign is necessary and food supplementation as well as treatment of acute malnourished children should be prioritized. (author)