Despite handicaps, Bangladesh set to overshoot the MDG
Wednesday, 11 November 2009
Amanullah Khan
and Abdur Rahman Jahangir
DESPITE handicaps, Bangladesh has been able to cut down the number of under-five child deaths by half since 1990. The donors, non-government organisations (NGOs) and development partners highlight Bangladesh's success story.
According to a Unicef report of 2008, the mortality rate of children under five in Bangladesh has dropped to 69 per thousand in 2006 from 149 in 1990, showing a 4.8 per cent average annual decline. At this rate, by 2015, Bangladesh would be able to over achieve the goal. The Unicef report, titled 'The State of the World's Children 2008', states that the infant mortality rate has fallen from 100 to 52 per thousand live births while the neonatal mortality rate stands at 36 per thousand live births. However, 22 per cent of babies are born underweight while around eight million under-five children (48 per cent) are underweight, the report pointed out.
From what ten mothers of under-5 infants at a slum at Shayamoli, in the capital city, told a team, making a first hand assessment, made it clear that Bangladesh will be able to reduce the under-five child deaths by two-thirds within the deadline set for the millennium development goals (MDGs).
Bakul, 20, mother of two under-five babies and wife of a rickshaw-van puller confirmed that now-a-days hardly any infant dies in their community. She recalled a lone kid died of pneumonia in the slum in one year. Bakul, who works as a domestic help, said she visits doctors whenever her babies suffered any complications. She has immunised her kids on time against measles, polio and tetanus like her neighbours. She tries to provide them nutritious food, though it is tough with her income to afford it everyday. She knows like her neighbours that the children should be immunised at intervals. A vigorous awareness campaigns by the government made it possible.
According to Bakul, successful immunisation coupled with vitamin-A supplementation, resulted in the reduction mortality. Development of the transportation and communication networks made it easier and quicker for the families to reach hospitals to access healthcare. It contributed to the improvement of children's health, she said. However, in remote and far flung areas, with poor infrastructure, health care services are not easily accessible.
The survey observed that the mothers who live in slums are quite conscious about the health of their children. They know how to take care of the infants' health and hygiene. They learnt it from health workers, paramedics and medicos representing NGOs, government health complexes and health messages broadcast by radio and TV networks. Despite economic hardships, mothers regularly bathe and wash their children with soap to prevent bacteria infection. They feed their children soft 'klichuri' made of them vegetable-lintel and rice. Occasional eggs and fruits, they know nourish the babies and strengthen their immune system. All the respondents informed the team that in addition to immunisation, they give their children vitamin capsules, distributed by the government free of cost. They also breast-feed their infants as they are aware that it is an ideal food for the children.
Saleha, 18, mother of a three-year old boy, Munna, said she feeds her son, "khichuri", made of rice, vegetables, eggs and pulses, as the food strengthens his resistance power to ward off diseases. She said she tries to keep her son clean to protect him from infection. She also tries to maintain a close watch so that her son does not take any harmful substances. Her husband Mobarak, a cigarette vendor, also takes care of the boy, she said. But she complained that the hospitals cannot admit when needed, all the sick children, for inadequacy of beds.
All of the respondents said that the incidence of child mortality has dropped significantly in 10 years. When they were young, they said, they used to see more infants dying due to diseases. But those days are over due to the healthcare programmes taken by the government and NGOs.
Child mortality fell, they said, due to improved care at birth, access to better healthcare for the sick children. More doctors, midwives and nurses, attend child birth with the needed medicines. Doctors and health workers are more attentive to towards patients. NGOs' initiatives, together with public-private partnership for healthcare service for children and mothers, have also resulted in lower child mortality, they said. They, however, stressed the need for upgrading, and expansion of, the facilities. A striking feature of the slum community was its awareness about family planning and the benefits it offers. They say they use contraceptives to plan and reduce the size of their families.
But many mothers in the slum community said out of ignorance and blind faith, some of families still seek medical advice from untrained pharmacists, herbal medical practitioners, quacks faith healers and the like when their children fall sick, which often result in disastrous consequences. Malnutrition of children of parents unable to buy nutritious food, often trouble some of the slum families. Many mothers give birth to underweight and weak children as they cannot afford healthy food during their pregnancies. Malnutrition remains the underlying cause of deaths of many children in the country each year. According to the Communication and Media Research Initiative (Camri), around 900 children die of malnutrition in Bangladesh everyday mainly due to a poor dietary intake in the first months of their life.
But the slum community did not know about the MDGs though they are familiar with different health related programmes of the government and the NGOs. In spite of a sharp decline in child mortality rate, there still persists a number of formidable challenges in the way of achieving the MDGs. The slum people identified a lack of specialised doctors, inadequate beds and medicines in government healthcare centers, shortage of trained midwives, scarcity of ambulances or other vehicles to carry emergency patients and the doctors' preference for private practice over low paid government service, as factors that could impede the achievement of the goals. High incidences of upper respiratory infections, diarrhoea, lack of safe water and sanitation and social taboos are among the other barriers to be overcome.
The slum community suggested for a further improvement in the situation that would keep Bangladesh on the track for attaining the goals in time. They called for strengthening the community healthcare services, establishing more medical colleges and hospitals, increasing beds in healthcare centers, accelerating nutritional support programmes, creating employment opportunities for women, ensuring supply of safe water and better sanitation facilities, further improvement of roads and transport system and increased support from the government, NGOs, and donors.
It is encouraging that the government is considering to set up 18,000 community health clinics across the country to make healthcare facilities, with special care of mothers and children, available to the rural population. Other improvements that are considered vital, as described above, should also be introduced earlier than later.
The government and the donor agencies should allocate more resources to help strengthen efforts to achieve the MDGs. It is important to ensure healthy births and post-natal services to keep the new born safe from diseases. More emphasis should be laid on the crucial need for the mothers to give birth to healthy babies with appropriate weight.
Awareness campaigns by media can help better policy decisions and take corrective steps, whenever they go wrong, to reduce child mortality and ensure better health.
The article is based on a community
centered survey on selected MDG issues under a UNESCO/AMIC project
and Abdur Rahman Jahangir
DESPITE handicaps, Bangladesh has been able to cut down the number of under-five child deaths by half since 1990. The donors, non-government organisations (NGOs) and development partners highlight Bangladesh's success story.
According to a Unicef report of 2008, the mortality rate of children under five in Bangladesh has dropped to 69 per thousand in 2006 from 149 in 1990, showing a 4.8 per cent average annual decline. At this rate, by 2015, Bangladesh would be able to over achieve the goal. The Unicef report, titled 'The State of the World's Children 2008', states that the infant mortality rate has fallen from 100 to 52 per thousand live births while the neonatal mortality rate stands at 36 per thousand live births. However, 22 per cent of babies are born underweight while around eight million under-five children (48 per cent) are underweight, the report pointed out.
From what ten mothers of under-5 infants at a slum at Shayamoli, in the capital city, told a team, making a first hand assessment, made it clear that Bangladesh will be able to reduce the under-five child deaths by two-thirds within the deadline set for the millennium development goals (MDGs).
Bakul, 20, mother of two under-five babies and wife of a rickshaw-van puller confirmed that now-a-days hardly any infant dies in their community. She recalled a lone kid died of pneumonia in the slum in one year. Bakul, who works as a domestic help, said she visits doctors whenever her babies suffered any complications. She has immunised her kids on time against measles, polio and tetanus like her neighbours. She tries to provide them nutritious food, though it is tough with her income to afford it everyday. She knows like her neighbours that the children should be immunised at intervals. A vigorous awareness campaigns by the government made it possible.
According to Bakul, successful immunisation coupled with vitamin-A supplementation, resulted in the reduction mortality. Development of the transportation and communication networks made it easier and quicker for the families to reach hospitals to access healthcare. It contributed to the improvement of children's health, she said. However, in remote and far flung areas, with poor infrastructure, health care services are not easily accessible.
The survey observed that the mothers who live in slums are quite conscious about the health of their children. They know how to take care of the infants' health and hygiene. They learnt it from health workers, paramedics and medicos representing NGOs, government health complexes and health messages broadcast by radio and TV networks. Despite economic hardships, mothers regularly bathe and wash their children with soap to prevent bacteria infection. They feed their children soft 'klichuri' made of them vegetable-lintel and rice. Occasional eggs and fruits, they know nourish the babies and strengthen their immune system. All the respondents informed the team that in addition to immunisation, they give their children vitamin capsules, distributed by the government free of cost. They also breast-feed their infants as they are aware that it is an ideal food for the children.
Saleha, 18, mother of a three-year old boy, Munna, said she feeds her son, "khichuri", made of rice, vegetables, eggs and pulses, as the food strengthens his resistance power to ward off diseases. She said she tries to keep her son clean to protect him from infection. She also tries to maintain a close watch so that her son does not take any harmful substances. Her husband Mobarak, a cigarette vendor, also takes care of the boy, she said. But she complained that the hospitals cannot admit when needed, all the sick children, for inadequacy of beds.
All of the respondents said that the incidence of child mortality has dropped significantly in 10 years. When they were young, they said, they used to see more infants dying due to diseases. But those days are over due to the healthcare programmes taken by the government and NGOs.
Child mortality fell, they said, due to improved care at birth, access to better healthcare for the sick children. More doctors, midwives and nurses, attend child birth with the needed medicines. Doctors and health workers are more attentive to towards patients. NGOs' initiatives, together with public-private partnership for healthcare service for children and mothers, have also resulted in lower child mortality, they said. They, however, stressed the need for upgrading, and expansion of, the facilities. A striking feature of the slum community was its awareness about family planning and the benefits it offers. They say they use contraceptives to plan and reduce the size of their families.
But many mothers in the slum community said out of ignorance and blind faith, some of families still seek medical advice from untrained pharmacists, herbal medical practitioners, quacks faith healers and the like when their children fall sick, which often result in disastrous consequences. Malnutrition of children of parents unable to buy nutritious food, often trouble some of the slum families. Many mothers give birth to underweight and weak children as they cannot afford healthy food during their pregnancies. Malnutrition remains the underlying cause of deaths of many children in the country each year. According to the Communication and Media Research Initiative (Camri), around 900 children die of malnutrition in Bangladesh everyday mainly due to a poor dietary intake in the first months of their life.
But the slum community did not know about the MDGs though they are familiar with different health related programmes of the government and the NGOs. In spite of a sharp decline in child mortality rate, there still persists a number of formidable challenges in the way of achieving the MDGs. The slum people identified a lack of specialised doctors, inadequate beds and medicines in government healthcare centers, shortage of trained midwives, scarcity of ambulances or other vehicles to carry emergency patients and the doctors' preference for private practice over low paid government service, as factors that could impede the achievement of the goals. High incidences of upper respiratory infections, diarrhoea, lack of safe water and sanitation and social taboos are among the other barriers to be overcome.
The slum community suggested for a further improvement in the situation that would keep Bangladesh on the track for attaining the goals in time. They called for strengthening the community healthcare services, establishing more medical colleges and hospitals, increasing beds in healthcare centers, accelerating nutritional support programmes, creating employment opportunities for women, ensuring supply of safe water and better sanitation facilities, further improvement of roads and transport system and increased support from the government, NGOs, and donors.
It is encouraging that the government is considering to set up 18,000 community health clinics across the country to make healthcare facilities, with special care of mothers and children, available to the rural population. Other improvements that are considered vital, as described above, should also be introduced earlier than later.
The government and the donor agencies should allocate more resources to help strengthen efforts to achieve the MDGs. It is important to ensure healthy births and post-natal services to keep the new born safe from diseases. More emphasis should be laid on the crucial need for the mothers to give birth to healthy babies with appropriate weight.
Awareness campaigns by media can help better policy decisions and take corrective steps, whenever they go wrong, to reduce child mortality and ensure better health.
The article is based on a community
centered survey on selected MDG issues under a UNESCO/AMIC project