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BACKGROUND:
In 2023, a thorough SMART survey was undertaken in the flood-ravaged districts of Sylhet Division, Bangladesh, to address a pressing gap in current, district-specific nutrition data. The Bangladesh Health Demography Survey (BDHS) 2022 and Multiple Indicator Cluster Survey (MICS) 2019 primarily offer insights at a divisional level, which obscures vital information regarding disparities at the district level. Sylhet Division continues to battle significant malnutrition challenges, particularly when compared to national figures. The prevalence of wasting in Sylhet Division showed a decline from 12.1% in 2014 to 10.4% during the 2017-18 period; however, it alarmingly surged to 12.2% in 2022, highlighting ongoing acute malnutrition problems. The underweight prevalence in Sylhet experienced a reduction from 39.8% in 2014 to 31.7% in 2022, indicating improvement but still remaining above the WHO’s critical threshold of 30%. Stunting rates in Sylhet witnessed significant progress, dropping from 49.6% in 2014 to 31.2% in 2022, yet it is still classified as “very high” according to WHO standards. Moreover, Sylhet Division suffers the repercussions of recurring floods, mainly from May through July. The catastrophic floods of June 2022 had a devastating impact, affecting approximately 7.2 million individuals in Sylhet Division, resulting in extensive damage to infrastructure, homes, and livelihoods. Tragically, 269,550 individuals in the region are currently classified at IPC phase 4, indicating an emergency level of acute food insecurity. The ongoing challenges, compounded by the lack of district-level nutrition data, underscore the urgent necessity for evidence to inform appropriate, context-specific nutrition programming. This survey, a recommendation put forth by the National Nutrition Service (NNS) and nutrition cluster partners, is designed to assess the nutritional status of children aged 6–59 months and pregnant lactating women, while identifying the malnutrition situation and exposing district-level disparities. This data-driven approach equips organizations to make informed decisions regarding the timely and effective implementation of life-saving interventions and steers post-recovery efforts. Consequently, the World Food Programme (WFP), with the expert support of Action Against Hunger (ACF), has resolved to conduct this survey to establish evidence-based programming and advocacy, aiming to tackle Sylhet’s nutritional crises while promoting long-term improvements.
**Interview with Dr. Amina Rahman, Nutrition Expert and Researcher**
**Interviewer:** Thank you for joining us today, Dr. Rahman. Can you give us a brief overview of the recent SMART survey conducted in Sylhet Division?
**Dr. Rahman:** Thank you for having me. The SMART survey was conducted in 2023 primarily to address the significant gaps in nutrition data at the district level. Previous surveys like the BDHS 2022 and MICS 2019 provided insights but did not capture the disparities within districts. Sylhet Division has been facing severe malnutrition challenges, and this survey aimed to uncover more localized data to better understand and tackle these issues.
**Interviewer:** What were some of the key findings regarding malnutrition in the Sylhet Division?
**Dr. Rahman:** One of the most concerning findings was the rise in the prevalence of wasting. While it declined from 12.1% in 2014 to 10.4% in 2017-18, it unfortunately increased to 12.2% in 2022. This resurgence indicates that we still face significant acute malnutrition challenges in the region. Moreover, the prevalence of underweight and stunting remains high, exacerbating the health crisis.
**Interviewer:** Why is it essential to have district-specific data when addressing nutrition issues?
**Dr. Rahman:** District-specific data is crucial because malnutrition can vary significantly within different areas. Understanding these disparities helps policymakers and health organizations tailor their responses more effectively. It enables us to pinpoint which districts need immediate intervention and allows for targeted programs that address the specific needs of those communities.
**Interviewer:** What measures do you believe should be prioritized in response to the findings from the SMART survey?
**Dr. Rahman:** It is imperative to implement comprehensive nutrition programs that focus on education, access to nutrient-rich foods, and healthcare services in affected areas. Community involvement is also vital; we need to empower local organizations and leaders to take part in these initiatives. Furthermore, ongoing monitoring and future surveys are necessary to ensure we are making progress and adapting to any new challenges that arise.
**Interviewer:** Thank you, Dr. Rahman, for sharing these insights. It’s clear that the situation in Sylhet Division requires urgent attention and action.
**Dr. Rahman:** Absolutely, and thank you for helping to raise awareness about this critical issue.
