Out of poverty

Bangladesh is a country beset by seasonal cycles of poverty and hunger. Almost 20 million people in the country are extremely poor and are vulnerable to natural disasters such as flooding. The UK Department for International Development (DFID) has invested a combined £120 million in two projects aimed at overcoming the poverty cycle by providing people who have almost no assets with the resources to build and secure a sustainable livelihood.

Professor Nick Mascie-Taylor and Dr Rie Goto, together with other members of the Human Epidemiology, Nutrition, Growth and Ecology (HENGE) group in the Department of Biological Anthropology, are supporting the projects by conducting in-depth nutritional and health surveys, as well as looking for ways of improving the nutritional status of the very poor.

Small steps to stability

Under the £65 million DFID-funded ‘shiree’/ Economic Empowerment of the Poorest programme, which runs until 2015, a consortium of NGOs is helping 750,000 of the poorest individuals across Bangladesh to generate assets and improve their income. The idea is that, by stimulating economic improvements, individuals can take iterative steps (shiree is the Bengali word for steps) out of poverty.

The HENGE team will be carrying out annual surveys throughout the project, providing a measure of how nutrition and health changes as a result of the development programmes. The baseline assessment survey has just been completed and the results provide a stark illustration of why the intervention is needed: as many as 80% of individuals are undernourished, compared with 40% across the Bangladesh population. For children, this rises to 85%, and one in seven children is stunted, wasted and underweight.

Cash-for-work

The DFID-funded Chars Livelihoods Programme is focused on an area in north-western Bangladesh where people living on large flat islands (chars) in river channels live with the frequent risk of losing their homes and crops to flooding. The project is providing 55,000 of the poorest households with a raised earthen plinth to lift their homes above the flood plain, plus income-generating assets – livestock or a vegetable garden – to help them not slip back into poverty.

A cash-for-work plinth building programme during the Monga (hungry) season gave local people approximately 2.6 million person-days of paid work. Although cash-for-work schemes are a familiar feature of development programmes, no research has looked at their impact on nutritional status. A concern levelled at such schemes has been that the increased physical work might cause weight loss. Results of the first such investigation have just been published by the HENGE team. Working with chars dwellers engaged in cash-for-work during a particularly severe Monga, they found no evidence to back up the concerns. By contrast, the scheme led to greater food expenditure and consumption, and a significant increase in the nutritional status of families.

Health package

The team is also investigating how they can translate their research into tangible health benefits. They have been looking at the perennial problem among the extreme poor of gut parasites like hookworm (picked up through the soles of bare feet), which damages the lining of the gut, contributing to nutrient loss and anaemia.

Professor Mascie-Taylor has trialled a combination of deworming and dietary supplementation with vitamins, supplied in powdered form so that they can be sprinkled onto food. In only three months, the results were dramatic; the children, in particular, showed a 54% reduction in wasting.

With innovation funding from the shiree project, work has already begun on putting together a combined health package comprising regular deworming, micronutrients in sachets and flip-flops to prevent hookworm infection. ‘Our aim,’ he explains, ‘is to provide a cost-effective means of helping people back to the health needed to sustain graduation out of poverty.’

For more information, please contact Professor Nick Mascie-Taylor (nmt1@cam.ac.uk) at the Department of Biological Anthropology or visit http://henge.bioanth.cam.ac.uk/