Country: Bangladesh
Closing date: 07 May 2019
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Background:
Maternal and child undernutrition cause 45% of all deaths in children aged 0-59 months in low and middle-income countries (LMICs). Among surviving children, these forms of undernutrition impair children’s physical growth and brain development, school readiness and educational achievement, and earning potential and productivity in later life (2). Globally, about 151 million children under 5 remain stunted and their physical growth and brain development compromised. Evidence indicates that a substantial proportion of childhood undernutrition has its origins in the fetal period. Maternal undernutrition in the form of short stature and low body mass index is related to small for gestational age births and other adverse pregnancy outcomes. In all, it is estimated that small for gestational age births may account for ~20% of the stunting burden observed in low- and middle-income settings as well as~20% of neonatal mortality. One particularly widespread problem of maternal undernutrition in low- and middle-income countries are deficiencies in micronutrients.
In Bangladesh context, one third of Bangladeshi pregnant women are underweight and 42% of ever married women of reproductive age (15-49 years) are anaemic. A body mass index (BMI) of less than 18.5 is observed among 24% of ever married women of reproductive age. Around 13% of women in reproductive age are severely stunted (less than 145 cm) leading to prolonged/obstructed labour, the proportion of which out of the causes of maternal death has remained unchanged for a decade in Bangladesh. Fifty percent of women suffer from iron deficiency anaemia and 2.8% from night blindness. Though women’s nutritional status has improved slightly over the years, maternal malnutrition still contributes to a high rate of maternal mortality and under weight babies and further contributes to high stunting rates in children under 5 specially in first 2 years of their lives. At the same time, overweight and obesity are increasing, thus contributing to Non-Communicable Diseases (NCDs) and pregnancy-associated metabolic risks.
The Government of Bangladesh (GoB) has few policies in place supporting maternal nutrition interventions such as provision of dietary counselling and iron and folic acid supplementation (IFAS) and has attempted to strengthen institutional delivery and improve quality of antenatal care (ANC) services at health facilities, the overall emphasis on maternal nutrition is limited. To illustrate, only little attention is given to maternal nutrition in the Comprehensive Competency-based Training on Nutrition (CCTN) designed by the Government of Bangladesh for service providers. Similarly, the quality of ANC services in Bangladesh remains low, as only 31% women receive four or more antenatal care visits. No recent data is available on consumption of IFA supplementation during pregnancy, but coverage is likely to be low.
Furthermore, a 2016 national expert consultation recommended that IFA programs should be strengthened through actions on both the demand and supply sides as well as improved monitoring to inform program implementation. Given the minor role of iron deficiency as a contributor to anemia, possibly related to high iron concentrations in groundwater in many parts of the country, the consultation recommended to lower the recommended iron dose offered to pregnant women as part of the standard of care from 60mg to 30mg. To address the high prevalence of other micronutrient deficiencies that contribute to anemia in the country, the consultation recommended that the Government of Bangladesh consider replacing iron/folic acid supplementation with prenatal multiple micronutrient supplements (MMS) among pregnant women.
Purpose of Assignment
To this end, the Government of Bangladesh has requested UNICEF to assist in conducting the situation analysis on the maternal nutrition service and current initiatives to improve the coverage and quality of maternal nutrition services through ANC platform, including the use of MMS; adapting WHO ANC 2016 Guidelines; improving maternal nutrition training guidelines and materials of the CCTN. An International expert will be hired to provide technical assistant for the mentioned activities. Because the work will involve numerous consultations with government and development partners, as well as comprehensive process toward endorsement of maternal nutrition programme guidelines, training guidelines and materials, a national consultant will be hired though this TOR to work with the appointed International Consultant.
Key tasks for the National Consultant are:
Deliverables Description:
Deliverables/Outputs:
Timeframe
(Payment Schedule - %)
1
Inception report with detailed workplan of consultancy as complementary to the international consultant
10 days - within one month after contract signed - (6%)
2
Hard copy and links of online materials collected for review
30 days - within 2 months - (17.6%)
3
Reports on consultation meetings conducted with government partners and development partners
30 days - within 5 months - (17.6)
4
Compilation of feedback from partners from the shared draft materials
30 days - within 7 months - (17.6%)
5
Report on pretesting of Maternal Nutrition Training Guidelines and Materials and recommendations
10 days - within 8 months - (6%)
6
Final draft of Bangla version of developed documents
40 days - within 10 months - (23.5%)
7
Next steps toward endorsement of documents by the government
20 days - within 11 months - (11.7%)
Total Estimated Consultancy Costs (All inclusive)
170 days (Contract duration of 11 months)
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Remarks:
How to apply:
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