please refer the 1st part of this article first
Micronutrient (vitamin and mineral) Deficiencies
Sri Lanka has three major micronutrient deficiencies that have been identified as public health problems, namely, iron, Vitamin A and iodine. The prevalence of anaemia among children under five years, primary schoolchildren, adolescents, adult females and pregnant women are 29.9%, 20.9%, 22.3%, 31.6% and 30.3% respectively. Iodine deficiency has successfully control with the implementation of universal iodination of salt. It was revealed that 29% of children under five years were suffering from Vitamin A deficiency in 2006.
What causes malnutrition?
The common perception stands that the cause for malnutrition is poverty, but in reality it is multifactorial. The immediate causes of malnutrition are inadequate food intake and illnesses; Underlying causes include inadequacies in access to food, inaccessibility to health services, poor sanitary environment, and inadequate caring practices for children, poor eating behaviors and inadequate personal hygiene etc. Complementary feeding is intricately interwoven with various myths, beliefs and practices; many babies receive diluted, unhygienic foods at the incorrect age and in inadequate quantities; inadequate knowledge of complementary food among parents have become a serious issue.
Why does malnutrition matter?
The risks of malnutrition are extremely high during the stages of fetal development and during the first two years of life, it will affect physical growth and mental development and resulting irreversible damages. Experts have shown that eliminating malnutrition would remove one third of the global burden of disease. World Bank has indicated that a 1% increase in height has been associated with a 4% increase in total wages and eliminating anaemia would contribute to an estimated 5-17% increase in lifetime earning. Same time low birth weight has been shown to reduce intelligent quotation (IQ) scores by 5 points.
What are the loopholes in exiting interventions?
Vitamin and mineral supplementation: Free Supplementations of calcium, iron, folate and vitamin ‘C’ which are provided to all pregnant mothers who attend clinics and Vitamin A supplementation for children at 9 months, 18 months and 3 years by the Ministry of Health. Loopholes are poor compliance with vitamins due to lack of appropriate knowledge.
The Thriposha food supplementation programme has been in operation since 1976 at the cost of around Rs. 600 million annually. A daily ration of 50 gm is distributed to pregnant mothers throughout pregnancy and lactating mothers for a period of 6 months, and under fives who show growth faltering. Production is inadequate to provide all the needy groups. It suffers from distribution problems, especially in remote areas; the food is shared with families; difficult to maintain regular supplies, daily ration is not enough to cover the minimum requirements;
It is mainly implemented at clinics and during home visits by the Public Health personnel. There is hardly any time for nutrition education at many of the largely over-crowded clinics; many mothers travel long distances to the clinic and are impatient to get back to their homes.
Food based dietary guidelines:
Food based dietary guidelines have been developed by the Ministry of Health for Sri Lankans based on customary dietary patterns, taking into account the relevant social, cultural, environmental and agricultural factors affecting food availability, food habits and eating patterns. But the applicability is very low.
Food security interventions:
Since achieving Independence in 1948, Sri Lanka’s Food Security Strategy was determined by three sets of policies
• Achieving self-sufficiency in basic food items such as rice, milk, fish etc.
• A public distribution system through Multi-Purpose Cooperative Societies; and public institutions such as Corporative Wholesale Establishment (CWE), Paddy Marketing Board (PMB) and Food Commissioner’s Dept.
• Welfare Programmes, which included either a food subsidy or food stamps or an income transfer component.
Though the above measures are important to improving food security, the determination of the nutritional status of an individual occurs primarily within a household (family) and is dependent on resource accessibility and availability, intra-household resource distribution and information availability.
Food subsidies and income supplementation programmes: With a view to ensure food security at household level, Sri Lanka has implemented various food subsidy and income supplementation schemes.
• the universal coverage of the food subsidy;
• commodity specific subsidy;
• Food Stamp Scheme;
• the Janasaviya, programme which had micro credit, health and nutrition improvement, infra-structure development, income supplement and entrepreneur development components and lately introduced
• The ongoing Samurdhi programme.
• School breakfast or mid day meal programmes
• Current Mahinda Chinthana programme
Some of these programmes were poor targeting and interrupted flow of distribution, where a substantial proportion of resources were distributed among the non-poor.
Dr.Renuka Jayatissa (MBBS,MSc,MD)
Nutrition Specialist and Head, Department of Nutrition, MRI