As part of its AdSEARCH dissemination series, icddr,b held a scientific seminar on Monday at the Sasakawa Auditorium in Mohakhali, where it shared results from the Nutri-CAP study.
According to the press release of ICDDRB, it’s conducted in the Bauniabadh slum of Dhaka, the study offers compelling evidence that a locally led and integrated nutrition and hygiene programme can significantly improve the health and well-being of pregnant women, adolescent girls, and young children living in Bangladesh’s informal urban settlements.
Bangladesh has made remarkable progress in health over the past two decades. Yet rapid urbanisation—rising from 8 percent in 1973 to 40 percent in 2022—has introduced new challenges.
With 62 million people now living in urban areas, and projections indicating this number could double by 2035, pressure is mounting on already strained urban health systems.
While average health outcomes tend to be better in cities than in rural areas, stark disparities persist within urban populations. In slum communities, food insecurity affects more than half of all households, and up to 50 percent of children are stunted. Only 40 percent of women in slums receive the recommended four or more antenatal check-ups with trained providers, compared to over 53 percent in non-slum areas.
Slums are also disproportionately young—more than 30 percent of residents are under 15 years of age—underscoring the need for focused investments in maternal, adolescent, and child health.
Bauniabadh reflects many of the challenges faced by Bangladesh’s urban poor. Among more than 15,000 married women living in the area, 721 were identified as pregnant during the study period. Alongside them, the programme engaged over 4,200 adolescent girls and nearly 2,500 children under the age of two. The study reached 16,532 households in total, with a focused analysis conducted on 2,826 households between November 2021 and February 2022.
Despite some indicators of relative stability, hardship remained widespread. The median household income was 21,000 BDT, but nearly one in four families reported distress financing for food, and among food-insecure households, over 91 percent had taken loans. While 47 percent of households were categorised as upper-income within the slum context, 13.5 percent fell into the lower-income group. Overcrowding was common, with 39 percent of households having more than three people per sleeping room. Women contributed to household incomes in 42 percent of families, and just over a third of household heads had completed primary education.
The Nutri-CAP intervention focused on three vulnerable groups—pregnant women, adolescent girls, and children under two—and introduced a package of integrated services. Pregnant women received monthly home-based counselling, nutritional supplements including iron, folic acid, calcium, and vitamin D, and regular monitoring of weight, blood pressure, haemoglobin, and blood sugar. They were also encouraged to attend antenatal care visits and rest adequately.
These efforts led to measurable improvements. Women in the intervention group gained an average of 8.9 kilogrammes during pregnancy, compared to 7.5 in the comparison group, and were significantly more likely to reach optimal weight gain. Facility-based deliveries and good pregnancy outcomes were more common in the intervention group, while adverse outcomes such as abortion, stillbirth, and neonatal death were lower. The risk of babies being born small-for-gestational-age was reduced by 16 percent.
Adolescent girls in the intervention group saw a substantial increase in haemoglobin levels, rising from 12.0 to 12.8 g/dL, compared to a smaller gain in the comparison group. While dietary diversity remained unchanged—possibly due to rising food prices—the girls reported better awareness of health and nutrition issues. Prevalence of thinness among this group was 14.9 percent, with overweight at 12.6 percent, figures that align with national urban trends.
For young children, the study recorded significant improvements in growth. Adjusted analysis found a meaningful reduction in growth faltering in terms of height-for age and weight-for-age in the intervention group. Improvements in gut health were also observed. Biological markers indicated lower intestinal inflammation and more responsive immune activity among adolescents in the intervention arm.
The programme also brought economic benefits. Out-of-pocket health expenditure was consistently lower among intervention households, especially for pregnant women and children. While indirect costs such as time spent accessing services were slightly higher, total healthcare spending was lower compared to the control group. Medicines and diagnostic costs were reduced, and although human resources remained the largest component of provider costs, the study found that these could be optimised over time as the model is integrated into existing systems.
Speaking at the seminar, Dr Mustafa Mahfuz, principal investigator of the study, explained that the programme’s success stemmed from its locally rooted approach. “This model worked because it listened to the community, trained local women, and addressed multiple barriers at once,” he said. “The results are a testament to what is possible when evidence meets empathy.”
Dr Tahmeed Ahmed, executive director at icddr,b said in his remark that, “Slum dwellers are underserved when it comes to primary healthcare. With its adaptable and locally driven design, the Nutri-CAP model is not only effective but ready to scale in other informal settlements in Bangladesh and similar settings elsewhere.”
The dissemination seminar opened with a welcome address by Dr Thaddaeus David May, senior director of the Nutrition Research Division at icddr,b. A representative from Global Affairs Canada shared reflections on Canada’s commitment to supporting community-based nutrition programmes. Dr Shams El Arifeen, Project Director of AdSEARCH and Senior Scientist at icddr,b, closed the event by highlighting opportunities for scale-up and partnerships.
Mr Edward Cabrera, first secretary – Development (Health), Canada’s International Development – Global Affairs Canada, said, "By better understanding the crucial nutrition challenges impacting adolescent children and pregnant women among persons living in underprivileged neighborhoods in urban areas, this project will be able to provide concrete evidence on effective interventions that can lead to better decision-making at the policy level."
The seminar was attended by a wide range of stakeholders including government officials, development partners, NGOs, and researchers.
