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Low birth weight: Girl child suffers most

Dr. A.M.M. Anisul Awal, PhD :

Malnutrition is a global problem with definite trend of inclination towards developing countries. The extent and magnitude of the problems of malnutrition varies significantly across countries and regions. Analysis of data reveals that malnutrition is more predominant in Asia, particularly in the South-Asia than in any other region of the world. UNICEF reports that 70% of the world's malnutrition is in the South-East Asia; and India and Bangladesh constitutes 70 percent of malnutrition prevailing in this region.
Malnutrition and poverty are closely related. Poverty causes lack of enough food, lack of appropriate caring practices and lack of proper health system including safe environmental sanitation, which in combination leads to malnutrition. The relationship also works in other direction - malnutrition decreases earning capacity resulting from low IQ, poor physical capability, poor knowledge base and increase disease burden. Thus, malnutrition and poverty are in a vicious cycle, making each other worse.
Women and the girl children are the worst sufferers. More than 50 percent children under the age of five years have been suffering from moderate and sever grades of malnutrition. Although, latest data depicts that the extent and the magnitude of malnutrition has reduced significantly from that of the previous surveys, nevertheless, the percentage of malnutrition level is still unacceptably high.
In the developing countries, about 55-60% deaths among children under 5 years of age are attributable to malnutrition. About 60-70% pregnant women and children less than 5 years of age have been suffering from nutritional anaemia (iron deficiency anaemia). About 40% population have iodine deficiency and 20% have goiters of various grades. The incidence and prevalence of night blindness and blindness due to Vitamin-A deficiency are also noticeably high, but within acceptable range amongst the under five populations.
Among all the manifestations of malnutrition, LBW (birth weighing equal or less than 2.5 kg) is the most visible stigma of poor maternal health and nutritional status before and during pregnancy. The more the incidence of LBW, the more the women are deprived of their rights - safe motherhood, decision making power and gender inequity. The weight of a newborn basically reflects the quality of its intrauterine development, and the health care including the services the woman received during pregnancy. Birth weight is an important parameter which could be indicative of (1) the immediate viability of the neonate, and (2) the state of maternal health & nutrition before and during pregnancy.
In normal physiological state, a healthy mother gives birth to a child weighing usually about 3-3.3 Kg. The rate of growth of children since birth should be 3.3 Kg at birth, 6.0 kg at three months, 7.8 kg at five months, 9.2 kg at nine months, 10.2 kg at 12 months, 11.5 kg at 18 months and 12.6 kg at 24 months.
Data provided by the World Health Organization (WHO) show significant differences in mean birth weights of babies in different parts of the world.  The mean birth weight is 3.5 to 3.6 in North America and Australia, 3.1 to 3.3 in Eastern Europe, 2.9 to 3.1 in Africa and East Asia, 2.7 in South Asia, 2.63 in India, 2.85 in Myanmar, 2.8 in Nepal, 2.84 in Sri Lanka, 3.0 in Thailand and 2.6 in Bangladesh.
The people of Bangladesh have some certain peculiarities of their own. Adolescent marriage and adolescent pregnancy is universal in this country associated with poverty, lack of social empowerment, different type of health problems including UTI etc. The other immediate causes of LBW are also an integral part of their life - lack of food, lack of caring practices, lack of health services and lack of environmental sanitation.
Women population has two peculiar beliefs with respect to pregnancy. Most of the women who need more food during pregnancy actually reduce intake with the false belief that the child in the uterus would become big, and thus, would make delivery difficult.
 If it occurs, her life will be threatened. At the same time, they work more to keep themselves active and 'rest' becomes a luxury for them. This 'behavioral practice' directly affects the intrauterine growth of the child, and makes the mother prone to exhaustion, fat depletion, anaemia, lethargy and last but not the least, death.
There is no single approach to address malnutrition. The issue itself is a cross-cutting one, and thus, should be tackled from multiple directions. The core importance lies in the efficient management of BCC (behavioural change communication) activities at all levels of intervention with optimum services utilizing the experts of the country. The role of the journalists and the mass media is magnanimous and unique in creating a positive attitude towards expected behavior change in relation to health, family planning and malnutrition through innovative ideas, constructive criticism, reporting, supporting, writing, forming interest groups, etc. It would indeed not suffice to say that in this modern era, the 'key to success' in the social sector is largely in the hands of the journalists and the mass media.

(PID- UNICEF Feature)