BACKGROUND

Rickets has emerged as a major source of disability in the Chakaria area of SE Bangladesh. Based on preliminary studies by us and our colleagues, the disease does not appear to involve vitamin D deficiency. Available evidence suggests that low Ca intake is likely to be a major cause of the disease in Chakaria; however, its recent emergence (within the last 15-20 yrs.) suggests that other food/soil/water-borne factors may also be important in its etiology.

GOAL

The goal of this work is to increase the intakes and utilization of Ca by infants and children in Chakaria, Bangladesh, in sustainable ways that also improve their status with respect to other limiting micronutrients. The project seeks to develop multiple opportunities in the Chakaria food system, emphasizing those that increase the supplies of multiple nutrients.

OBJECTIVES

A. Model the Chakarian Food System

We are conducting a detailed survey of 480 households in 6 villages to characterize the Chakaria food system with the aim of identifying opportunities to improve yields of, access to, and bioavailability of calcium and other limiting nutrients for children and their mothers.

B. Evaluate and Develop Home Gardens

We are collaborating with a local NGO, SARPV(1), the Asian Vegetable Research and Development Center, and USAID, Bangladesh mission, to develop model small-scale/homestead gardening practices in Chakaria, emphasizing vegetables that are known to be sources of calcium and other limiting nutrients.

C. Elucidate the Prevalence and Etiology of Rickets

We are collaborating with the Bangladesh Institute of Mother and Child Health and the Bangladesh Rural Advancement Committee to estimate the prevalence of rickets in Chakaria Thana and Cox's Bazaar District, as well as to develop methods for surveying the entire country. In addition, we are collaborating with Smith-Kline, Beacham, Ltd. to plan a household-based, clinical intervention trial to determine whether increasing the calcium intakes of children (1-3 yrs.) can reduce their risks to pre-clinical indicators of rickets and whether supplementation of other limiting nutrients is necessary to realize benefits from calcium supplementation.

PROGRAM DEVELOPMENT

These efforts have been launched over the last two years with support from the United States Agency for International Development as a strategic planning effort for a longer-term program aimed at developing options with local Bangladeshi food systems to improve child and maternal health in sustainable ways.

1. Social Assistance and Rehabilitation for the Physically Vulnerable