SAXTONS RIVER — In reading Stephen F. Minkin's Viewpoint [“Helping Bangladesh battle an epidemic of rickets,” March 27], one might be left with the impression that the main cause of rickets in Bangladesh can be attributed to the lack of sufficient small fish (which provide essential calcium), which in turn is due to flood-control projects funded by the Word Bank and other aid agencies and that the problem can, in part, be solved by restoring the flood plains.
This is a rather distorted and oversimplified analysis of the causes of, and cures for, the rickets problem there.
Bangladesh is a country with a population of around 160 million in a country roughly the size of Wisconsin and, as such, is the most densely populated country in the world. Agricultural land is therefore at a premium and must be intensively cultivated to provide sufficient rice, the staple crop, to feed the nation.
Each year, during the spring and summer months, floods caused by the snowmelt run-off from the Himalayas combine with heavy monsoon rains. Frequently, these floods cause devastation both in terms of lives lost and the destruction of dwellings, roads, schools, and livestock.
One of the most devastating floods in living memory occurred in 1998, when two-thirds of the country was flooded, more than 1,000 human lives were lost, 25 million people were left homeless, more than 575,000 hectares of crops were destroyed, and thousands of livestock were lost. The flood caused severe and widespread damage to the infrastructure.
For decades, the Bangladesh government has, with the assistance of the World Bank and other agencies, constructed flood-control systems to mitigate the worst effects of the floods. Without these projects, the devastation to Bangladesh would have been far worse.
Extending the flood plains, a solution Mr. Minkin advocates, would make the population in the affected areas again vulnerable to the disastrous effects of flooding.
A 2008 article in the Journal of Health, Population and Nutrition includes a summary of the findings of the Rickets Convergence Group, comprising international rickets experts. These findings indicate that the cause of rickets in Bangladesh might be due to lack of calcium as a result of increasing rice production to attain food self sufficiency, which has in turn led to less rotation of crops and less dairy production.
The report indicates that a preventive strategy would include improved dietary habits comprising more green leafy vegetables, cowpeas, dairy products and, as Mr. Minkin suggests, greater intake of crushed small bony fish.
However, this last item is not given prominence as a panacea to the problem of rickets in Bangladesh. Furthermore, the article suggests that the necessary increase in calcium intake might also be achieved by the target population using limestone (readily available in Bangladesh) dissolved in water for cooking.
The foregoing is not meant to diminish Mr. Minkin's plea for greater urgency in dealing with the rickets issue in Bangladesh. However, we need to avoid leaving the impression that the problem has a simple cause and an obvious solution.