Despite progress in health status and achievements in Millennium Development Indicators, Bangladesh presents a gloomy scenario for nutrition. In 2009, BRAC (formerly known as Bangladesh Rural Advancement Committee) has begun to implement a community-based approach of Alive & Thrive with Family Health International 360, aiming to reduce undernutrition among children under two by promoting exclusive breastfeeding and appropriate complementary feeding practices. To address anemia and other micronutrient deficiencies, home-fortification with micronutrient powders (MNP) has been promoted among under-fives across Bangladesh along with the Global Alliance for Improved Nutrition (GAIN). BRAC's frontline community health workers play a critical role in promoting micronutrient powders with better feeding practices. Over the years, improvements have been observed in the intervention areas: exclusive breastfeeding rose from 49% to 83% of children (0-6 months), 86% of children received complementary feeding at 6-8 months with about two/thirds being fed the recommended number of times; and 70% of children (6-59 months) adhered to MNP use, ie consumption of 1 sachet per day in the past 60 days. However, many challenges are still observed in traditional feeding practices, along with limited skills of community health workers and households' poor access to quality food, necessitating constant interactions between caregivers, mothers-in-law and fathers with the frontline workers. Maintaining the supply chain of micronutrient powders and a visible and convincing change in nutritional status of children are key success factors. The partnerships between BRAC, GAIN and Renata, the producer of MNP in Bangladesh, have given birth to a home-fortification model that can deliver impact at scale.
儘管健康狀況的進步及千禧年發展指標的成就，孟加拉對於營養仍呈現悲觀的 情境。從2009 年，孟加拉農村發展委員會（BRAC）開始執行一個社區型的 Alive & Thrive with Family Health International 360 計畫，旨在藉由推廣全母乳 哺育及餵食適當的副食品，進而降低兩歲以下兒童的營養不良。為了解決貧血 及其他微量營養素缺乏，針對有五歲以下兒童的家庭，整個孟加拉與全球營養 改善聯盟（GAIN）採用家庭強化微量營養素粉（MNP）。在推動微量營養素 粉以達更佳的餵食方法，BRAC 的第一線社區健康工作人員扮演重要的角色。 多年來，在介入地區已可看到改善：兒童（0-6 個月）的全母乳哺育由49%上 升至83%；86%的兒童在6-8 個月時開始吃副食品，其中約有2/3 餵食達建議 次數；70%的兒童（6-59 個月）遵守MNP 的使用，意即在過去60 天，每天攝 取一包。然而，由於社區健康工作人員的技巧有限，加上家戶難以獲得有品質 的食物，傳統餵食方法仍然面臨許多挑戰。因此照護者、婆婆/岳母和公公/岳 父和第一線工作者間需要持續的互動。維持微量營養素粉的供應鏈，以及兒童 營養狀況有看得見且具說服力的改變，將會是成功的關鍵。BRAC、GAIN 及 孟加拉微量營養素粉的生產者Renata 間的伙伴關係，讓家庭強化模式得以產 生並發揮巨大的影響力。