Overall, the nutritional status of children under 5 years in Sri Lanka has not improved in the past ten years. In 2009, 19.2 percent of children were stunted, 21.6 percent underweight and 11.7 percent were wasted nationwide, compared with 18.4 percent stunting, 22.8 percent underweight and 15.5 percent wasting in year 2000.
Malnutrition remains a serious problem for Sri Lankan children and Sri Lanka generally. The 2009 NFSS(National Food Security Survey) indicates that only 36.4 percent of households in the poorest quintile reported having had adequate food supply for every day in the past 12 months compared to 91.4 percent of the richest quintile.
In Sri Lanka, even the children of the relatively rich suffer from high rates of malnutrition which goes up to 11.9%. This supports the perception that while inadequate food access (and by extension low incomes and low and variable productivity of food crops for household consumption) is critical, poor infant and child feeding practices (e.g. too early or too late introduction of complementary feeding and inappropriate complementary food) and poor public health also play a significant role.
Vitamin A deficiency is linked to access to vitamin-rich food for children, poor breastfeeding practices, and high prevalence of childhood diseases such as acute respiratory infections, diarrhea and measles. According to the 2006 national survey, 29 percent of children under 5 were Vitamin A deficient and 74.6 percent were given vitamin A megadose. Children of mothers with at least primary schooling are at least 16 percent more likely to receive vitamin A than those without schooling.
Sri Lanka has also reported high levels of anaemia – 25.2 percent among children, 22.2 percent among women, 16.7 percent among pregnant women, (NFSS 2009).
As with other health indicators, child malnutrition sharply declines with increases in the level of the mother’s education, in particular between primary and secondary level schooling. Thus it is clear that educating women is a critical factor in reducing malnutrition over time. Education is important and links need to be sought with the education sector for school-based interventions (e.g. school feeding programs or micro-nutrient initiatives). Effective nutrition programs are likely to have a significant impact in estate areas given the higher prevalence of malnutrition amongst the poorer quintiles.
Weight-for-age (underweight) is a composite index of height-for-age (stunted) and weight- for-height (wasted). It takes into account both acute and chronic malnutrition. Children whose weight-for-age is below minus two standard deviations (-2 SD) from the mean of the reference population are classified as underweight.
According to the 2006 DHS(Demographic and Health Survey) report, the highest prevalence of underweight in children under five is observed in Badulla district, where it is more than 30 percent. The prevalence of underweight in Kandy, NuwaraEliya, Batticaloe, Trincomalee, Polonnaruwa and Monaragala districts is between 25 and 30 percent.. The lowest prevalence of underweight is observed in Colombo, Gampaha and Kalutara districts.
Wasting PrevalenceThe weight-for-height index (wasted) measures body mass in relation to body length and describes current nutritional status. Children whose Z-scores are below minus two standard deviations (-2 SD) from the mean of the reference population are considered thin (wasted) for their height and are acutely malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or a recent episode of illness causing loss of weight and the onset of malnutrition.
According to the 2006 DHS report, the highest prevalence of wasting among children under 5 is observed in Trincomalee district, where it is more than 28 percent. The prevalence of wasting in Kandy, Matara, Batticaloe, Ampara, Polonnaruwa, Badulla, Monaragala and Kegalle districts is between 15 percent and 20 percent.
Stunting PrevalenceThe height-for-age index is an indicator of linear growth retardation and cumulative growth deficits. Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the mean of the reference population are considered short for their age (stunted) and are chronically malnourished. Stunting reflects the failure to receive adequate nutrition over a long period of time and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents the long-term effects of malnutrition in a population and does not vary according to recent dietary intake.
According to the 2006 DHS report, the highest prevalence of stunting among children under five is observed in NuwaraEliya, Trincomalee and Badulla districts, where it is greater than 30 percent.
Prevalence of Anemia in Children
Common causes of anemia include inadequate intake of iron, folate, vitamin B12 or other nutrients. Anemia can also result from thalassemia, sickle cell disease, malaria, and intestinal worm infestation. Anemia may be the underlying cause of maternal mortality, spontaneous abortion, premature birth, and low birth weight.
According to the NFSS 2009 data more than one fourth (25 percent) of Sri Lankan children between the age 6-59 months are anemic. Anemia is highest among children age 6-11 months, and children who live in Jaffna district.
Some of the important measures to reduce anemia includes iron and folic acid supplementation, antimalarial prophylaxis for pregnant women, promotion of the use of insecticide-treated bed-nets and deworming for children.
Over-Nutrition implies overweight and obesity, known as the “Nutrition Transition”. They are measures of excess weight relative to height for children and adults (measured by body mass index (BMI), or weight/height2). This is primarily due to increased intake of fats and processed carbohydrates and reduced physical activity. Overweight and obese individuals have greater risk of developing Non Communicable Disease (NCD): diabetes, high blood pressure, stroke, cardiovascular disease, and some forms of cancer. NCDs, often precipitated by poor nutrition, presently account for 60% of global deaths and 46% of the global burden of diseases (the overall impact of disease and injuries at the individual and societal level). By 2020, NCDs and obesity are predicted to cause 73% of all deaths and 60% of all disease. Today, about 1.2 million Sri Lankan adults are overweight and among schoolchildren 0.4 million are overweight in Sri Lanka.
Currently 0.1 million pregnant women are underweight in Sri Lanka. Malnourished mothers leads to higher rates of complications and deaths and end up with poor pregnancy outcomes, such as low birth weight, birth defects, bleeding, high-risk deliveries, all of which influence survival and child development. Though the energy and nutrient needs are more during the pregnancy, mothers actually consume less food during pregnancy often out of fear of labour complications resulting from a larger fetus. Low birth weight babies face a higher risk of obesity and or NCDs in adulthood. Today, one fifth of babies are born as low birth weight babies, lead by NuwaraEliya district which indicates that one third of babies born in this district are low birth weight.
Finally, however vast the problem is the conclusion is simple.
We must UNITE for malnutrition through inter-sectoral collaboration under one umbrella developing common action plan for all sectors with TARGETED interventions in order for us to thrive for better nutrition within Sri Lanka.
Dr.Renuka Jayatissa (MBBS,MSc,MD)
Nutrition Specialist and Head, Department of Nutrition, MRI