Integrating nutrition into primary care: A way forward to prevent disease and help people thrive

Bangladesh has made notable progress in improving many health outcomes. Yet, primary healthcare services remain insufficient in both rural and urban areas. The Health Sector Reform Commission submitted its report last year, recommending a constitutional amendment to recognise primary healthcare as a basic human right. Such a move would create a legal obligation to ensure access to and efficient delivery of primary care for all citizens. However, the report does not explicitly address the integration of nutrition into primary healthcare.

Poor nutrition is a major contributor to preventable diseases and is responsible for nearly half of all deaths among children under five years of age. Yet, nutrition is often inadequately addressed in healthcare settings, leading to slow progress towards achieving universal health coverage. Integrating nutrition into primary care offers the opportunity to improve diagnosis, promote health for all, and transform preventive care at the population level. It can also yield benefits by raising awareness, enabling early diagnosis, and initiating preventive measures earlier, leading to broader improvements in the health and well-being of the nation. 

Malnutrition increases the risk of infectious diseases and worsens clinical outcomes. In Bangladesh, the scale of the problem is alarming. Nearly one in four children under five is stunted, one in eight is wasted, and more than one in five is underweight. These numbers represent children who are more likely to be hospitalised and more at risk of death from preventable diseases. Height, weight, mid-upper arm, waist, and hip circumferences are among the most reliable predictors of health outcomes in children with malnutrition, including nutritional recovery and mortality risk. Therefore, timely and accurate assessments are essential for identifying at-risk children and guiding appropriate, individualised care. 

Despite their importance, these measurements are not taken or are frequently delayed in primary care facilities due to a lack of tools, poor functionality of existing equipment, and the shortage of trained healthcare personnel. These assessments are fast, painless, and inexpensive, but save lives by enabling earlier detection and personalised care of the nutritional impairments.

Primary care settings should also be equipped with facilities to screen for anaemia and common micronutrient deficiencies, which affect millions of children and women in Bangladesh. Point-of-care devices can be used to detect anaemia and micronutrient deficiencies with a small drop of blood, without the need for advanced laboratories or highly skilled staff. Early detection allows early treatment, especially in resource-limited settings where people may not otherwise seek care. 

Bangladesh also faces a growing burden of chronic diseases such as diabetes, high blood pressure, heart disease, and non-alcoholic fatty liver disease (NAFLD). Nearly 23 percent women and almost 17 percent men in the country live with high blood pressure. Diabetes is also widespread, affecting 17 percent of women and 15 percent of men aged 18 years and above. Alarmingly, nearly one-third of the population suffers from NAFLD. Together, these diseases, increasingly linked to poor diets and nutrition, and their complications, account for almost half of all adult deaths in the country. Primary care facilities should be equipped to screen for these illnesses using simple, cost-effective and validated diagnostic tools and medical devices. 

One of the major challenges in primary care, especially in rural areas, is the shortage of doctors and nurses. Without trained clinicians, physical exams and proper diagnosis become difficult. The government must find ways to attract and retain physicians in hard-to-reach areas. Offering incentives, better job security, and contractual recruitment for hard-to-reach areas, along with safety measures to prevent workplace violence, could help in addressing the workforce shortages in primary care settings.

Nutrition is also about what people eat. Primary care facilities should routinely assess dietary intake. Digital tools that reflect local foods, recipes, and portion sizes could make this process faster and more accurate. Screening for food insecurity should also be part of this effort, since lack of access to food is also linked with increased risk of malnutrition, illness, and premature death.

Primary care can also strengthen existing programmes. Vitamin A supplementation, deworming, and other nutrition interventions can reach more children if they are delivered through primary care facilities. The country made notable progress in some of these areas, but primary care offers a way to address the remaining gaps.

Nutrition counselling and health education must become a core component of primary healthcare. Healthcare providers should be able to guide families on healthy diets, physical activity, and lifestyle choices, including the harms of consuming tobacco and alcohol. None of this will succeed without adequate training. Healthcare providers need skills not only in measurement and diagnosis, but also in counselling, behaviour change communication, and respectful care. With proper training, healthcare providers in primary care settings can act as a powerful frontline against malnutrition and its lifelong consequences.

Malnutrition and its adverse consequences are not inevitable. Integrating nutrition into primary care, with basic screening tools, point-of-care diagnostics, essential medicines and supplements, a trained workforce, and strong political commitment, can help ensure optimal growth in children, reduce the burden of anaemia, micronutrient deficiencies, and chronic diseases, prevent disability and premature deaths from nutrition‑related non-communicable diseases, and ease the financial strain on families and health systems.

Dr Shah Mohammad Fahim is a physician and associate scientist at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). He can be reached at sf543@cornell.edu.

Views expressed in this article are the author's own. 

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