Photos by Saikat Mojumder

Discovering JiVitAland (continued)

Because the trial is blinded and randomized, Banu doesn’t know if the red tablets she gives Shahinoor contain the 15 nutrients or an iron and folic acid supplement that meets the WHO standard of care.

Today Banu is accompanied by two other women. One is interviewer Lovely Rani Mondol, who will ask Shahinoor about the birth. The other is researcher Parul Christian, who is visiting from Baltimore for two weeks.

Christian has visited the JiVitA Project so many times that she’s lost count, and by now her Bangla is pretty good. She can follow most of what goes on as she crouches in one corner of the atur ghar watching Banu at work.

Banu squats beside the newborn. She uses scissors to snip off the end of the vitamin A capsule, and she deftly squeezes the contents into the baby’s mouth. The baby grimaces, then cries and turns red. With this first taste of something other than milk, the child is benefiting from what researchers discovered in the JiVitA-2 study. In that trial, all JiVitA newborns were given either 50,000 IUs of vitamin A or a placebo.

At any given time, each field distributor is monitoring about 200 women of childbearing age. Each month, the distributors supply vitamins to about 8,000 pregnant women. And on an average day in Jivitaland, those women give birth to 29 babies.

Led by assistant scientist Rolf Klemm, DrPH ’02, MPH ’85, field staff dosed 16,000 newborns. Klemm and colleagues reported the results in the July 2008 Pediatrics: A single two-cent dose of vitamin A cut six-month death rates by 15 percent. Now all JiVitA babies get vitamin A soon after birth.

Standing in the doorway of the house, the baby’s grandmother silently watches the scene. From her point of view, her son and his wife must seem fortunate, for they have never lost a child. Of the grandmother’s eight children, four died in infancy. She lost three boys and a girl.

On a conventional map, JiVitA territory stretches across the sector of northwestern Bangladesh called Gaibandha District and nips into Rangpur District. To the research team, this is “Jivitaland.”

Jivitaland requires its own map. No ordinary map would show Shahinoor’s house in Kamar Pachgachi. The red number 0049 painted on the corrugated iron near the front door signifies her home’s inclusion on an extraordinary digital map, one that records the location of every one of 145,000 households in the JiVitA study area.To create it, 64 survey teams walked the entire project territory—270 square miles. They validated and augmented information on 1930s-era paper maps drafted by the British during the colonial era. They assigned a number to each household, or khana, “those who eat rice from the same cooking pot.” Nine years later, fieldworkers carry bottles of red paint to touch up faded numbers

Funding comes from the Gates Foundation, USAID, the Sight and Life Research Institute in Baltimore and the Micronutrient Initiative of Canada’s international development agency.

It’s a big undertaking: At any given time, each field distributor is monitoring about 200 women of childbearing age. Each month, the distributors supply vitamins to about 8,000 pregnant women. And on an average day in Jivitaland, those women give birth to 29 babies.

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