Impressive progress has been made in health, education, and sanitation over the past decade in Bangladesh. Most children are immunised against preventable diseases, majority of households have basic drinking water services, literacy rate is at 93 percent among the youth and 75 percent of children complete primary school. These factors have contributed positively to improving children’s development, but a lot more work remains to be done, especially in the areas of nutrition and early stimulation for young children.

Undernutrition is a major public health problem in Bangladesh that results in poor long-term development, school achievement, and low IQ outcomes. According to a UNICEF report (2019), 28 percent of children are born weighing less than 2.5 kg and more than one-third of children under five years of age suffer from stunting (low height for age). On the other hand, over 250 million children under five years in low- and middle-income countries do not reach their full potential due to poverty, poor nutrition and inadequate cognitive stimulation.

In Bangladesh only 13 percent of 3-5 year old children attend a preschool programme, 64 percent are not developmentally on track, and only nine percent of under-five children have access to children’s books.

One study showed that in rural Bangladesh, children from poorer families had significantly lower development scores compared to children from richer families as early as at seven months of age. By the time they were five years old, the difference between them increased to 15 IQ points.

This has severe implications for a country that is growing very fast. Consequences of lower IQ are reduced school attendance and school grades and more school drop-outs, subsequently leading to lower income, thus continuing the poverty cycle.

How do we address these problems?

Nutrition

Adequate diet during pregnancy is the first step towards reducing the low birth weight in children. The next step is exclusive breast-feeding for six months that helps good nutrition, less illnesses, better attachment between mother and child among several other benefits. From six months onwards, family diet, fresh fruits and vegetables, dietary varieties, all from seasonal and low-cost food items available in the country, are required for children. Avoidance of fast food and junk food for children’s wellbeing is of vital importance. Children who consume these foods are at risk of developing obesity which has consequent illnesses in older age.

Development

It is important to understand that all children have talents and capacities. They are like a mine that is rich in hidden gems, but to bring out those gems, they need early education and stimulation. Once their capacities and talents are nourished, it can help them as well as the society.

Parents must try to look for their children’s talents and help them grow that talent. Some children are good at music, some are good at mathematics, while others may be talented in writing, singing, drawing, etc. If parents identify the child’s talent at an early stage, they can help them hone that talent and excel in it.

To address developmental deficits in undernourished children or to help non-malnourished children grow and develop adequately, play and psychosocial stimulation is also required. Several studies globally and in Bangladesh have shown that development of stunted and severely malnourished children is benefited by early childhood parenting programmes with play and stimulation.

The child development unit of icddr,b has developed a curriculum of play and stimulation that was tested in several studies in Bangladesh, where weekly or fortnightly sessions of play and stimulation activities for young children resulted in improvement in their cognition, language and motor development and behaviour.

In one study, the increment was as high as 13 IQ points for undernourished children (Hamadani et al. 2019). Stimulation activities such as playing with toys with children, chatting with them, telling them stories, singing for/with them, reading/showing them books, taking them outside the home and labelling things in the surrounding environment for them from birth improve their development.

Praising children for the good things they have done or can do helps their self-esteem and confidence. Ignoring negative behavior and avoidance of physical or mental punishment helps them understand that their negative behavior does not attract attention from adults, while doing good things is rewarded with praise.

The world of humanity is like a bird, and men and women are like the wings of the bird; to fly high, both the wings have to be strong. Therefore, treating boys and girls equally and providing them with similar opportunities in terms of nutrition, play, education and all aspects of life is also very important and helps build a strong community.

Parents must refrain from having arguments or talking abusively with each other in front of their children. Children who are exposed to violence in the family suffer from long-term emotional and physical problems.

Safety and security of children are also very important. Parents must be watchful of the environments to which their children are exposed and keep an eye out for possible child abuse of their children by strangers or even other family members or relatives.

Moral values

From an early age, children must be educated in the highest moral values, e.g. truthfulness, trustworthiness, generosity, kindness, forgiveness, respect and politeness, etc. Of course, unless parents have these values, it is impossible to teach that to children and, therefore, we must all try to acquire these virtues to be able to build a moral society.

Together, we can work to ensure that all children in Bangladesh grow up in families and communities that are safe, secure, healthy, nurturing, and stimulating for their optimal development and growth.

Dr Jena Hamadani is Emeritus Scientist, Maternal and Child Health Division, icddr,b. For more information, please contact jena@icddrb.org.

References:

1. UNICEF – THE STATE OF THE WORLD’S CHILDREN 2019

2. Hamadani JD, Mehrin SF, Tofail F, Hasan MI, Huda SN, Baker-Henningham H, Ridout DA, Grantham-McGregor SM. Integrating an early childhood development programme into the Bangladeshi Primary Health Care Services: A cluster randomised trial. February 2019. Lancet Glob Health 2019; 7: e366–75. DOI: 10.1016/S2214-109X(18)30535-7.