Nutrition situation is deteriorating in the country with the outbreak of diarrhoea when 12 to 15 percent of children are already suffering from malnutrition due to poverty, food insecurity, low birth weight, lack of awareness and hygiene practice. Diarrhoea is a major cause of malnutrition and morbidity of children aged under five years across the globe, and 17 percent of children below five years die every year globally due to diarrhoea, of which 95 percent children are in developing countries, says World Health Organisation. There is a vicious cycle of child malnutrition and diarrhoea. If a child is infected with diarrhoea, it becomes malnourished and if a child is malnourished it gets diarrhoea easily, experts said, adding that after suffering from diarrhoea for more than 15 days, a child certainly develops malnutrition, and eliminating malnutrition could avert half of all childhood mortality. Though different programmes have been taken to address child nutrition, the nutrition situation is still grave in the country and if diarrhoea is not addressed in an integrated way, the nutrition situation would not improve soon, experts cautioned. " The death rate due to diarrhoeal diseases has decreased much in the country, but the incident of diarrhoea is not reduced at all,' said Dr Shahadat Hossain, scientist and head of Longer Stay Unit of ICDDR,B. If safe drinking water could be ensured, prevalence of diarrhoea would decrease 35 percent and it would improve further 35 percent through improved sanitation, he said, adding that still very few people in the country have access to safe drinking water. Even in the capital the quality of drinking water is very low. Every year around 11 million children under five years die globally. About half of these deaths are associated with under nutrition and about 2 million with diarrhoea, said the experts. "As soon as a child is affected with diarrhoea, lots of important ingredients like water, sodium, zinc, copper and magnesium come out from the body that leads to death,' said senior scientist of International Centre for Diarrhoeal Diseases and Research, Bangladesh (ICDDR, B) Dr S K Roy, adding that whenever the children suffer from diarrhoea, their food intake reduces from 30 to 40 percent that further leads to weight loss as the body burns muscle to produce energy. He said diarrhoea also hampers the growth of the children for next one year. It has been seen that a child suffering from malnutrition needs more time to recover from diarrhoea than a healthy baby, he added. "Severe malnutrition contributes to more than 15 percent of all deaths among children under five years in the developing world. If severe malnutrition in childhood cannot be managed properly, the risks of death are as high as 40 percent. To reduce child mortality by two thirds by 2015, the problem of severe malnutrition should be addressed properly,' opined the experts. Hospitals experience huge number of diarrhoea patients twice a year. Once it persists from May to June and then from August to mid October. The ICDDR,B authorities told The Daily Star that it itself experienced 600 to 650 patients on an average every day during this summer. "It is important to provide safe drinking water, sanitation facilities, food hygiene and nutrition education to mothers to reduce the frequency of diarrhoea,' suggested Dr Roy. According to Bangladesh Demographic and Health Survey 2004, the prevalence of child underweight during a period between 1990 and 2004, fell from 67 percent to 48 percent, and child stunting from 66 percent to 43 percent. Yet the current prevalence is still unacceptably high. According to experts, nutrition programmes often cease to function properly as soon as the government or donor support is withdrawn. Lack of communication and collaboration among the different sectors to address the problems in a unified manner has also contributed to poor nutritional situation. Dr SM Mostafizur Rahman, assistant director of National Nutrition Programme (NNP), said, lots of problems like lack of household food security, care for mother and children, health environment and services, adequate knowledge about nutrition, safe drinking water and sanitation are acting as impediments to improve the nutrition status in the country. "The NNP is covering only 105 upazilas of 34 districts, and the programme needs permanent central, district and upazila level offices with required number of skilled manpower for its better performance,' he added.