Consideraciones Éticas

The third group of determinants identified were inappropriate food including minor roots related to a dirty kitchen, and poor quality or quantity of food (Figure 5-7).

malnourished

inappropriate food

dirty kitchen

use of clay stove

poor quality and

quantity of food, no complementary food

lack of knowledge

Bangladesh?

5.5.1.3.1 Dirty kitchen

The participants explain that the child is malnourished because, „his mother cook in

a very dirty place…she does not have sufficient knowledge. She is careless (gusae rakhte parena) and doesn‟t arrange well the cooking environment‟. Here the

community health workers stress the lack of knowledge of the mother. According to them, cooking equipment (pots and pans) should be kept neatly in a shelf and drinking water in a kulchi with a cover. They explain that a good community kitchen is a clean kitchen with high gas stoves, because cooking with low gas stoves, is more prone to contamination and is likely to be flooded during the rainy season. Clay stoves or matir chulas are considered to be the worse means of cooking and are associated with malnutrition because they are frequently used in households without access to gas. In the slums, rent for rooms without gas connection is the cheapest. The poorest of the poor cook with a matir chula and it is extremely time consuming, so mothers cook only once a day. It is also costly if combustible material is purchased, although typically mothers will look for wood in the streets. Because of this limitation, participants suggest that mothers will not be able to cook special meals for their children. The community health workers stress that mothers should prepare and feed their IYC special nutritious meals to cover the IYC nutritional needs, but raise the lack of facilities for doing this as a barrier to meeting this goal. During flooding, matir chula are used by more households because gas lines are cut. BRAC community health workers tend to be judgemental about poorer women. Because of the training they received, and their status as community heath workers, they feel they have to endorse the role of advising mothers with regards to other topics in addition to pregnancy and breastfeeding.

5.5.1.3.2 Poor quality and quantity of food

Participants in the mothers group suggest that, „the family eats kola khabar (not

covered) food… that‟s why the child is in bad health‟. Open food is prone to getting

spoiled (nosto) quickly and to being contaminated by flies. Participants in the community health workers group mentioned, „the child doesn‟t get sufficient food

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and cannot prepare nutritious food (birthy kabar) like „khichuri38_{‟. They explained}

„the child is weak because he does not eat vegetable…‟. „Khichuri‟ has been

promoted as the recommended IYC complementary food in Bangladesh by the Ministry of Health and various organisations including BRAC working in the slums.

Khichuri has a high nutritional value, and is easy to prepare at a low cost. However

the community health workers recognise that even they themselves are very rarely able to prepare it for their own children. The use of community kitchens makes it difficult to prepare several meals at a time as users are limited to 2 gas rings for a very short time. They frequently use one gas ring to cook rice and the other one for

dal. Using dirty polluted water (dusoto pani) for food preparation is also associated

with malnutrition because of the risk of disease transmission, „the child is

malnourished…his mother probably washes vegetables with dirty water [flood water]!‟ Mothers in the slums face the difficult choice of using flood water which is

in front of their house but is dirty or having to walk through water to find a water supply on the road.

5.5.1.4 Flooding

During the rainy season, children become ‗bony‘ and lose weight because there is a decrease in food intake and an increase in diarrhoeal episodes (Figure 5-8). At that time, everybody suffer, „Apa39_{, in this unhealthy environment [flooded}

environment], a healthy man becomes unhealthy.

38_{Khichuri is prepared with rice mixed with double proportion of lentils and vegetables.} 39

Apa, meaning sister is commonly used by Bangladeshi women when talking to each other in a

Bangladesh? malnourished

flooding

diarrhoea decrease in food intake

less income

lack of access to food

difficulty in cooking polluted water

difficulty to boil water

less maternal milk Figure 5-8: Conceptual framework for flooding

5.5.1.4.1 Decrease in food intake

Participants explain, „in the month of June, July and August (Assin kartik) it starts

with storm and rain…then we can not work…we have less money to buy food…we eat less and breastfeeding mothers have less milk…life is then so painful (jibon kosto)!‟ Most of the fathers work as rickshaw-puller and cannot work during the

rainy season because the roads are inundated. Women cannot go to work at the garment factories because they fear going through the water and feel ashamed to show parts of their body. The decrease in revenue and availability of foods mean that most participants decrease their food intake by 50%. Mothers tend to skip meals to favour men and children. Consequently some mothers have to stop breastfeeding during the rainy season because of their own poor nutritional health.

5.5.1.4.2 Diarrhoea

Participants explain that children also become malnourished because they suffer from diarrhoea due to the surrounding dirty water, ‘latrines go under water…stools

float on the water…and children have then scabies and diarrhoea‟. Community

health workers mentioned, „they [the slum-dwellers] bathe their children with dirty

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stool in this water and they bathe again‟. Few go to the street and get their drinking

water in a kulchi (water container in clay or metal) from the road tube well because it is too difficult to reach the street.

5.5.2 Comparison of the causal models built by pregnant women,