For a country that suffers no significant food shortages and provides extensive, free maternal and child health services, it is rather paradoxical that malnutrition affects nearly one-third of children and one quarter of women.
Main factors contributing to malnutrition
The immediate and underlying causes of childhood malnutrition in Sri Lanka range from disease factors and inadequate dietary intake to knowledge and cultural factors that influence the utilization of health services and available food.
Poverty in its many manifestations (among these, low household income, inadequate basic infrastructure, limited access to media), affects nearly 23 percent of households in Sri Lanka and is closely intertwined with household food security. However, while poverty is an important basic determinant of child under nutrition, it does not solely explain the high rates of child malnutrition prevailing in Sri Lanka. Other major determinants of malnutrition in the country include inappropriate feeding practices, micronutrient deficiencies and disease.
Inappropriate infant and young child feeding practices: While exclusive breastfeeding levels have risen significantly, some babies are still being bottle fed during this period. Not only is the food inferior to breastmilk – babies miss out on colostrums, the first milk rich in proteins and antibodies that protect children from several infectious diseases – there are also risks of over-diluting the infant formula and of contaminating it through dirty water. The first priority therefore is to ensure that for the first six months children are exclusively breastfed.
As children move into complementary feeding, the growth of children might be hampered by a shortage of food. But a more common problem is that children are being given the wrong kind of food. Children are often fed little more than a mixture of cereal and water.
Micronutrient deficiencies which affect healthy child growth and development are less obvious forms of under nutrition but constitute major public health problems in Sri Lanka. The most common micronutrient deficiencies in children and women are iodine deficiency disorders, which affect physical and mental development of children; iron – which leads to anaemia and impairs cognitive development in children; and vitamin A which affects eyesight and immunity to diseases. Vitamin A deficiency affects one third of children less than 6 years of age and iron deficiency affects over one half of children 5-10 years old. One out of every five children suffers from iodine deficiency disorders – the single most important preventable causes of physical and mental retardation.
Disease: Although the incidence of diarrhoeal disease is low and static, it continues to contribute to child undernutrition in Sri Lanka. One of the reasons why the incidence of diarrhoeal disease has not changed over time is poor access to safe drinking water and sanitation. Around one third of households have no access to sanitation and about one quarter have no access to safe drinking water. While malaria is under control, acute respiratory infection makes a substantial contribution to infant and under five mortality and morbidity, as well as malnutrition.
Impacts of malnutrition – effects on future development: While the image of the emaciated child is not one associated with Sri Lanka, the impacts of malnutrition are visible in other ways. Approximately 14 percent of children suffer from wasting- recording a lower weight than would be expected for their height and 29 percent of children under are under weight, registering a lower weight than would be expected for their age.
The greatest tragedy of malnutrition is that it prevents children from reaching their full potential for growth and development. Malnutrition during childhood has serious and long lasting consequences
Constraints in dealing with malnutrition
The wide disparities that prevail across the regions and districts of Sri Lanka create major challenges in dealing with malnutrition. As the causes of malnutrition are multifactorial, actions to reduce malnutrition require the concerted efforts of several sectors and the incorporation of nutrition considerations into macro-economic and sectoral policies. The development of a national policy on nutrition will help to define key packages of interventions and efforts needed to be taken by stakeholders.
What is UNICEF doing?
UNICEF is working with a number of government and non-government partners to address problems of malnutrition in Sri Lanka. Initiatives include: