Akshaya's journey to recovery from malnutrition

How outreach clinics in rural Sri Lanka are bridging the gap in access to critical healthcare for children

By UNICEF / Pramitha Herath
Akshaya (4) at the clinic with her mother Jayamalini (38) (left) and Dr. S. Roshanth (48)
UNICEF Sri Lanka/InceptChange
27 October 2023

It is 4-year-old Akshaya’s fifth visit to the health and nutrition clinic in Navithanveli, in Sri Lanka’s Eastern Province. She has been receiving treatment here since being identified with Severe Acute Malnutrition (SAM) in January 2023.

Caused by poor intake of nutritious foods, infections, and inappropriate caregiving, or a combination of these factors, children with SAM can easily fall ill from common childhood diseases. They could face lifelong growth and development challenges and in severe cases, death. They risk facing a future marked by illness, poor school results, and poverty – effects that persist across generations.

At the previous assessment, she showed positive signs of growth. Akshaya’s mother, Jayamalini Kristhuthasan (38), is anticipating further good news today and is eager to get to the morning clinic on time.

Ever since Akshaya’s diagnosis, amidst the many hardships the family faces, Jayamalini has focused her attention on getting the correct treatment for her daughter, which includes regular visits to the clinic.

Jayamalini at home with children
UNICEF Sri Lanka/InceptChange
Jayamalini at home with children

“We found out that my daughter was malnourished in January. She weighed only 9.2 kg. Since we started visiting the clinic, there has been considerable progress.  At the last clinic, her weight had increased by 300 grams. Now she is 9.5 kg,” explains Jayamalini. A normal girl child at 4 years of age would weigh between 13 to 19 kg on average.

"Times are hard for us. We work hard to put food on the table. We don’t have a proper place to live in," Jayamalini tears up as she shares the family’s situation. Her husband’s daily wages are often stretched thin, covering not only the family’s sustenance but also ensuring their two older children are able to go to school.

As the outreach clinic is located about 4km away, it’s a day’s investment for Jayamalini. Travelling to the clinic is no small feat either as it requires a significant portion of their earnings given the limited availability of public transport services. Fortunately for Jayamalini, funding is provided to cover the transport and the day’s expenses to those families with children identified with SAM so as not to interrupt the treatment.

The outreach clinic where Akshaya receives treatment is one of many across the country that enhances the existing healthcare network to address the increasing malnutrition among young children in Sri Lanka. With dedicated paediatric care, these clinics provide growth monitoring, therapeutic food and nutrition services to children identified with SAM.

Akshaya being weighted at the clinic
UNICEF Sri Lanka/InceptChange
Akshaya being weighted at the clinic

"Many families in this area are affected by the economic crisis and are struggling to cover even the basic needs”, says Dr. S. Roshanth (48), the Acting Consultant Paediatrician at the Base Hospital, Kalmunai North and the visiting paediatrician for the clinic at Navithanveli. “The importance of this clinic is that it brings health services closer to the community ensuring they receive proper guidance and nutrition.”

"From the commencement of the outreach clinic in January, we have observed that these children are gradually progressing from SAM to Moderate Acute Malnutrition (MAM), which means their weight for their height has improved. They are putting on more weight and becoming healthier,” explains Dr. Roshanth. “Before these clinics were introduced, families with SAM children were asked to visit the nearest hospital. But due to the financial hardships they face, they are unable to,” explains Priyadharshani Dayaharan (39) the midwife who serves the locality.

“But when we introduced the outreach clinics, they were able to regularly access healthcare. As the clinic is dedicated to SAM children, the doctor can spend more time with each family. We provide therapeutic food as well as advice on nutrition at the clinic.” 

“I visit them at their homes as well to make sure the therapeutic food is consumed properly and to guide on proper nutritional intake,” she adds.

"By conducting the clinic at the Office of the Medical Officer of Health (MOH) which is closer to their homes, we have helped people in this area overcome the transport difficulties. However, I feel we need to further expand the outreach as there are still communities living further away that we have not yet reached through this service,” says Dr. Roshanth.

As many families across Sri Lanka struggle to wither the country’s economic slump since early last year, the strain is most visible amongst young children; by October 2022 over 18,000 children below 5 years of age were reported with SAM.

To provide adequate healthcare and ensure a healthy childhood for these children, UNICEF, with funding from the Department of Foreign Affairs and Trade, Australia (DFAT), the United States Agency for International Development (USAID), and the Government of Japan, supported the Government to scale-up nutrition treatment through special health clinics. To expand the reach of these clinics and critical paediatric care to children identified with SAM, with the support of government and civil society partners, UNICEF further provisioned for outreach clinics to be set up across the country. Currently over 10,000 children are receiving healthcare and ready-to-use-therapeutic food (RUTF) through these clinics.