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The epidemiology of child malnutrition in Sri Lanka

Structure of the dissertation:

The 1st chapter provides the background, rationale of the study, aims and objectives for this work. Chapter 2 will explain the study methodology; it includes, study design, search strategy, retrieval criteria, ethical issues, timetable and the limitation of the study. In chapter 3, epidemiology of protein-energy malnutrition in Sri Lanka; prevalence and trend in different types; age, gender and district distribution of the disease; possible causes of the issue presented. Chapter 4 contains presentation and an exploratory analysis of the possible causes and determinants of child malnutrition in Sri Lanka .Chapter 5 reviews the characteristics of past and present malnutrition interventions (International, national and local), assess their effectiveness and discuss the mismatch between interventions and causes. Chapter 6 includes recommendations for future policy for reducing malnutrition in Sri Lanka.

Chapter 1: Introduction

Background:

In many countries, life expectancy at birth is less than 50 years and malnutrition is the biggest contributor to child mortality. However, malnourished children usually live in poor environment and this may itself increase their risk of mortality. It has been suggested that malnutrition is directly or indirectly responsible for more than half of the deaths under five years of age and the majority of surviving children will suffer from diseases brought on or aggravated by malnutrition.

Good health is a foundation for the better life and to live a healthy life people must eat and drink enough food containing key nutrients. Without right balance of food people can become weak, vulnerable to diseases and even die. World Health Organisation believes that everyone has the right to adequate nutrition and to be free from hunger (WHO, 1999).But, they mentioned the malnutrition as one of the major health problem in today’s world with 925 million malnourished people(WHO,1999). Globally, ten children die every minute as a result of malnutrition and in some developing countries over half of all under fives are malnourished (UN,2007).The prevalence of malnutrition in Asia is higher than anywhere else on the earth. The countries of the South-East Asia region accounted for over 1.5 million child deaths from the preventable communicable diseases compounded by malnutrition while 1.2 million deaths occur in Sub-Saharan Africa (WHO, 2000). Moreover, malnutrition has been identified as a major health problem in post independent Sri Lanka and it is still continuous to be a serious health concern with nearly one-third of children less than five years are malnourished while 14% of them suffer from acute malnutrition (Ministry of Health Care and Nutrition, 2007) and UNICEF –Sri Lanka was reported that this situation is rather ‘paradoxical’ with the extensive and free health care services ,as well as with a enough food storages in the country (UNICEF-Sri Lanka, 2008).

What is malnutrition? According to the World Health Organisation, malnutrition can be defined as ‘bad nourishment’, it means not enough as well as too much food, the wrong type of food and unable to fully utilise the food we eat due to some illnesses such as diarrhoea. People are malnourished if their diet does not provide adequate calories and protein for growth and maintenance the body (WHO, 2000).There are four types of malnutrition: over nutrition, secondary malnutrition, dietary or micronutrient deficiency and protein-calorie malnutrition. In simple terms, when a person consumes too many calories, the resulting condition is called over nutrition, when a person has a condition or illness that prevents proper digestion or absorption of food, that person suffers from secondary malnutrition, a diet is not include sufficient amount of essential vitamins or minerals, results in dietary deficiency malnutrition and protein-calorie malnutrition is the most lethal form of malnutrition. It is basically a lack of calories and protein. Food is converted into energy by humans, and the energy contained in food is measured by calories.  Protein is necessary for key body functions including provision of essential amino acids and development and maintenance of muscles (Leathers, 2004).

Measuring malnutrition

Nutritional status of a child is usually assessed in three ways; through measurement of growth and body composition (anthropometric indicators); through analysis of the biochemical content of blood and urine (biochemical indicators); and through clinical examination of external physical signs of nutrient deficiencies (clinical indicators). Among the three method of assessment, anthropometric measurement is a common and easy way to assess health and nutrition status. The other two methods are less practical because of the logistical difficulties and because data collection and analysis is expensive and time consuming (Asian Development Bank Institute, 2005) Underweight, stunting, and wasting, are the nutritional status conditions are concerned in anthropometric assessment. Underweight is the most common assessment of child nutrition status. It is routinely collected in growth promotion programs, and is a good indicator for children under 24 months because of the need to do precise measurements of weight for these age groups. Weight for age (WFA) is a simple index, but this index does not take height into account. Children who are taller would be expected to weigh more than other children, just as children who are shorter would be expected to weigh a little less and still be healthy. Stunting is a measure of linear growth. Stunting refers to shortness, and reflects linear growth achieved pre- and postnatal; with its deficits it is generally assumed to indicate long-term, cumulative effects of inadequate nutrition and poor health status. Height for age (HFA) is considered a measure of past nutrition, because a child, who is short today, maybe did not have adequate nutritional intake at some point in the past. Wasting is a measure of acute or short-term exposure to a negative environment. It is sensitive to changes in calorie intake or the effects of disease. Wasting can be calculated without knowing the age of a child. Weight for height (WFH) is a measure of current body mass. It is the best index to use to reflect wasting malnutrition, when it is difficult to determine the exact ages of the children being measured. A child is considered malnutrient if any of these indexes fall below refers two standard deviations (<-2SD) of the median value of the National Center for Health Statistics (WHO, 1995). Severe malnutrition is when the indexes fall below 3 SD of the median value(ibid).

Rationale of the study:

Sri Lanka is an island located in the Indian Ocean and its home to around twenty million people with the multi ethnic and religious society. On the one hand, the civil conflict in the North-East region during the last thirty years has resulted in loss of lives; displacement of the population and inadequate services. Such as, health care, food deliveries and other essential services. Therefore, the government of Sri Lanka was faced the enormous task of providing urgently needed services for the affected population and assisting the refugees to resume normal economic activities as well as rehabilitating the different economic sectors in the areas where security permits it (Nutrition country profile, 2006).On the other hand, Sri Lanka was on track to achieve several of the health Millennium Development Goals(MDGs) with the free health care facilities accessible for all citizens across the country: But, the child malnutrition represent the country’s worst public health issue with nearly one-third of malnourished children (UNICEF Sri Lanka,2008).Almost one out of five children are born with low birth weight and around twenty nine percent of under fives are reported to be underweight, rising as high as 37% in some deprived districts. From them, 14% of under fives are suffering from acute malnutrition (wasting) when their weight is compared to the weight of a normal child of the same height(ibid).

Overall, the situation has improved with long term nutritional deficiencies declining to one third of what it was in the early nineteen eighties.However a wasting or acute malnutrition has remained at the same level over the years. These all existing findings imply that children suffer from short-term acute food deficits, reflected in low weight for age, as well as longer-term chronic under-nutrition, manifested in high rates of stunting and wasting. Moreover, according to the country’s health profile, the secondary and the protein calorie malnutrition is seems to be the common types among Sri Lankan children as the third world nations (Ministry of health-Sri Lanka,2003).

Consequences of child malnutrition

Malnutrition is the underlying cause of millions of deaths, but lack public recognition because it does not kill young children directly, as does pneumonia or diarrhoea. The greatest tragedy of malnutrition is that it prevents children from reaching their full potential for growth and development. It can lead to neurological disorders, reduce leaning ability, less physical and intellectual productivity and as well as the most important risk factor for illnesses and even death ( Collier and Longmore,2004).In detailed, vitamin A deficiency can cause night blindness and reduces the body's resistance to disease. In children vitamin A deficiency can also cause growth retardation. Between 100 and 140 million children are vitamin A deficient. An estimated 250,000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight. (WHO,2004). Iron deficiency is a principal cause of anaemia. Two billion people (over 30 percent of the world’s population) are anaemic, mainly due to iron deficiency. For children, health consequences include premature birth, low birth weight, infections, and elevated risk of death. Later, physical and cognitive developments are impaired, resulting in lowered school performance. An iodine deficiency disorder also causes mental impairment that lowers intellectual prowess at home, at school, and at work. It affects over 740 million people, 13 percent of the world’s population. Fifty million people have some degree of mental impairment caused by iodine deficiency disorders(WHO,2004). Therefore, these different types of malnutrition are serious and long lasting issues which should be conscious by the Sri Lankan government.

Considering the above, this research will carry out by taking in to consideration the government efforts to address the child malnutrition in Sri Lanka. Furthermore ,It will be looking at the epidemiology of the disease in the country, major contributing factors, existing policy relation to malnutrition and finally draw a conclusion with recommendations to the government of Sri Lanka concerning this issue ,compliance to international standards.

Aim of the study: To analyse the government efforts to address the child malnutrition in Sri Lanka.

Objectives:

To analyse the epidemiology of child malnutrition in Sri Lanka.

To discuss the major contributing factors for the child malnutrition in Sri Lanka.

To analyse the existing government policies for tackle child malnutrition in Sri Lanka.

To suggest recommendations to overcome the child malnutrition in Sri Lanka, compliance to international standards.

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