The national child-malnutrition story in Bangladesh, on the broadest indicators, has been one of slow but real progress. Stunting among under-fives has come down from 41 percent in 2014 to 31 percent in 2022. Wasting has fallen too, if more unevenly. But that progress, like maternal mortality before it, is regional — and there is at least one regional story where the trendlines are not moving.
BHRF reporters spent four weeks this monsoon visiting twelve community clinics across the haor basin in Sunamganj district, reviewing growth-monitoring registers and interviewing field-level health workers. What we found was that, across these twelve clinics, the share of under-fives screened as moderately or severely wasted has not moved in three years.
The reasons clinicians cited will be familiar to anyone who has worked in the haor. The annual flooding period reduces the calorie intake of households whose income depends on either agriculture or fishing, and creates a window during which clinics themselves are physically inaccessible. The standard nutrition-screening protocol, which assumes that under-fives are brought in for monthly weight-and-height checks, simply does not survive a four-month water-locked stretch.
There are interventions that have worked elsewhere — community-based management of acute malnutrition, household-level nutrition supplements, and pre-positioning of high-energy ready-to-use therapeutic food before the flood season. None of them are at scale in this part of the country. The line between "national progress" and "regional stagnation" is, at the end of it, an operational one.
BHRF will publish the clinic-by-clinic dataset and a methodological note next week.
