Treatment for malnutrition often comes to an abrupt halt

Pibir Chakma is one and a half years old. She suffers from Severe Acute Malnutrition (SAM). Pibir was admitted to Rangamati General Hospital on August. However, she had to return home after five days without completing her treatment.

Pibir's mother, Sonia Tanchangya, said, “The physician told us to stay for a few more days. But I do not have any money. Staying there involves expenses. We have to buy food. Besides, travelling to and from home costs Tk 1,000.”

She spoke on 29 September. Sonia lives in Ghagra Union under Kaukhali upazila of Rangamati. Her family owns no land. Her husband, Raju Chakma, works in other people's homes, but work is not always available. Sonia lives with her two sons at her brother's house.

Ayesha Begum lives in Tabalchhari, Rangamati. Her four-year-old son, Rakib Hossain, initially went to Rangamati General Hospital with a fever. Physicians there diagnosed him with measles and pneumonia. He was subsequently referred to Chattogram Medical College Hospital. On 23 September, Rakib was admitted to Rangamati General Hospital again. On 27 September, Ayesha was informed that her son was suffering from severe acute malnutrition and would need to stay in hospital for several more days.

Ayesha said, “My husband lives separately with another family. I stay with my mother and son. I borrowed Tk 25,000 to go to Chittagong, and just a few days ago, I borrowed another Tk 4,000. I do not know how many more days we will have to stay in hospital.”

Around one million cases of severe acute malnutrition occur among children in Bangladesh every year. According to the 2019 Multiple Indicator Cluster Survey (MICS), conducted by the Bangladesh Bureau of Statistics (BBS) and UNICEF, the prevalence of severe acute malnutrition among children in the country was 1.6 per cent. By 2025, the figure had risen to 2.5 per cent. According to the World Health Organisation, children suffering from severe acute malnutrition face an 11-fold higher risk of death than healthy children of the same age.

Shirin Akhtar lives in Chowmuhani South Bazar in Begumganj upazila, Noakhali. She has five children, and her youngest, Faiza Islam Jubaida, is two years old. Recently, the child had to be admitted to Begumganj upazila health complex after developing severe acute malnutrition.

However, Shirin returned home with her daughter because of the risk of measles infection. Her husband, Zahirul Islam, sells 'fuchka' at the local market.

Shirin said she has to prepare the ingredients for making 'fuchka' every day and cannot afford to leave her household responsibilities to stay in hospital. She said, “My eldest daughter goes there (to the madrasa). Look, my son has a fever and is unwell. And there is household work to do for my husband as well. I cannot leave all these things unattended.”

From January to August this year, 56 children suffering from severe acute malnutrition received treatment at Begumganj Upazila Health Complex. Physician Md Zahirul Islam of the health facility said most parents or guardians did not want to stay at the health complex.

Children suffering from severe acute malnutrition with complications generally require around two weeks of hospital treatment. However, most parents or guardians are reluctant to stay in hospital because of various financial and family-related constraints.

According to the Directorate General of Health Services' DHIS-2 online database, only 21,036 children suffering from severe acute malnutrition received hospital treatment in Bangladesh last year.

River erosion forces residents in some parts of Noakhali to relocate repeatedly. This disrupts food security among people in the affected areas, said Noakhali Civil Surgeon Anwar Hossain. He said, “There are some migrating families. They face river erosion and storms. They are here today and somewhere else tomorrow.

A large proportion of the population in Hatiya, Subarnachar and Companiganj do not have permanent settlements. As a result, their livelihoods are uncertain, which disrupts food security for their children.”

In its latest report covering January to August 2026, the Integrated Food Security Phase Classification (IPC) identified six districts in the Chattogram, Sylhet and Khulna divisions as facing a critical level of acute malnutrition (Phase 4).

The report noted that nutritional conditions in these districts were deteriorating because of flash floods, measles outbreaks, inappropriate feeding practices for children, and poor water, sanitation and hygiene conditions.

Rangamati Civil Surgeon Nuyen Khisa said, “Malnutrition is far more severe in this area than in any other place. The healthcare system here is not conventional. Policymakers could consider a different approach to healthcare in the hill districts.”

He identified the shortage of healthcare workers in remote areas and dietary habits as key factors contributing to malnutrition in the region.

Hospitals use therapeutic milk formulas F-75 and F-100 to treat children suffering from severe acute malnutrition. Trained healthcare workers prepare these formulas by mixing the prescribed quantities of powdered milk with safe water, following established treatment protocols.

However, many patients leave hospital early, resulting in incomplete treatment. In this situation, relevant stakeholders are calling for greater emphasis on community-based treatment.

According to the National Guidelines for the Facility-Based Management of Children with Severe Acute Malnutrition in Bangladesh, only 10 to 15 per cent of children suffering from severe acute malnutrition require inpatient treatment if healthcare workers identify their condition at an early stage.

Sheikh Fazle Rabbi, Director (Health) of the Chattogram Division said, “For people living below or close to the poverty line, staying in hospital for seven days to receive treatment is difficult. We find that they have to go to work every day. In such circumstances, we need to find a way to ensure that we can provide this treatment at the community level at an earlier stage.”

Many countries around the world use ready-to-use therapeutic food (RUTF) to treat children with uncomplicated severe acute malnutrition at the community level.

RUTF is a nutrient-rich paste made from a mixture of nuts, milk powder, edible oil, sugar, and various vitamins and minerals.

Caregivers can feed it directly to children from the packet. It requires no water, cooking, cups, bottles or other feeding equipment. This makes it easy to administer at home.

RUTF has been used to treat severe acute malnutrition for the past 30 years. Many countries across Africa, Asia and the Middle East currently use it.

In 2017, the government formulated a national guideline on the community-based management of severe acute malnutrition. However, it did not include RUTF. Nevertheless, authorities are using RUTF among Rohingya refugees under special government approval.

In an email response to questions from Prothom Alo, UNICEF Bangladesh Chief of Nutrition Kiross Tefera Abebe said that RUTF was not an alternative to F-75 and F-100, but rather complemented them.

According to the World Health Organisation (WHO) guidelines, healthcare providers should use RUTF to treat children with severe acute malnutrition who have no medical complications at the community level.

Kiross further said, “It can be stored for a long time and transported easily. This makes it suitable for use in remote areas and places with limited infrastructure. Moreover, it does not require water for preparation. As a result, it reduces the risk of bacterial infection associated with food prepared by mixing ingredients with water.”