Supporting children’s nutrition during the COVID-19 pandemic

Dr Thakshila Yapa (48) conducts the maternal and child welfare clinic at the Office of the Medical Officer of Health (MOH), Panadura, a coastal town located in the Kalutara District, 28km south of Sri Lanka's capital city, Colombo. For her the work here is more than just dispensing medical advice.

A regular clinic day here starts early. It involves two main sessions: maternity care for more than 20 pregnant women, care for about 20 mothers with new-borns after childbirth and support for over 30 infants and young children with their mothers. It’s a busy time for Thakshila and her team.  

The clinic is managed expertly. With over 19 years of experience in public health, including four years in the current position as Additional Medical Officer of Health (AMOH) at the MOH, she exudes confidence and care. Here she has found her dream.

“To provide free medical assistance for the most vulnerable has been my dream since childhood. The opportunity to work in the public health sector in Sri Lanka is an honour for me. To this date all my time and effort is put into public service,” says Thakshila as she and her team takes on the day with diligent screening, medical care and case-by-case support ensuring the optimal health of the mothers and the young ones.

Overcoming urban undernutrition

The health clinic is one of many operating around the country providing local families with maternity care, including regular screening, health and nutrition advice, providing essential vitamins and micronutrients, and nutrition supplements when required, referral of high risk mothers for specialist care, and care of both the mother and the baby after the delivery specifically, post-delivery check-ups, breastfeeding support, new-born examination, introducing age-appropriate complementary foods and monitoring the growth of children under 5 years.   

In the clinic’s urban setting it services a community of urban low-income settlements with higher prevalence of undernutrition amongst children.

“Nutrition among children has become a grave problem in this community. Therefore, we use specific screening techniques for early identification of nutrition needs in ensuring a baby grows to be a healthy child. However, this requires constant engagement with the community and gaining their trust and creating a positive environment for them at the clinic,” Thakshila emphasizes.

Maternal and child nutrition in Sri Lanka is a grave public health concern. Pre-pandemic studies revealed up to 15% wasting among children under 5 years of age. Disruption of routine healthcare and clinical services due to Covid-19 further compromised the situation. A study in 2020 conducted in urban underserved areas in the Colombo District revealed that 38.9% of under 5 children were either mild or moderately underweight.

Prioritizing nutrition through the pandemic

“Disrupted food systems and income loss would prevent mothers and children from accessing nutritious diets and essential health services.  Continuing monitoring for growth was critical given the circumstances - early detection and treatment of child wasting has never been so vital to continue to maintain standards of maternal and child health in our community,” explains Thakshila.

As scheduled services of clinics were disrupted due to Covid-19, Thakshila and her team set up a patient management system ensuring continued care for the community and to address any critical undernutrition cases. Timely identification of Failure to Thrive (FTT) - an infant or child who does not gain weight at the expected rate, is critical for prompt interventions such as correcting breastfeeding techniques and introducing nutrient supplements.

“We continued household level nutrition and growth assessments. Local screening posts were held for weight and height. Cases were managed through division of localities; mothers were given telephone numbers to contact the clinic or individuals directly. Special clinics were held for critical cases. And as with all interventions, we took all Covid-19 precautionary measures.” 

To scale up prevention and response to wasting of children under five years of age during the pandemic, in 2020 UNICEF, at the request of the Family Health Bureau of the Ministry of Health (MoH), procured Multiple Micronutrients (MMN) to be given routinely to all children at 6, 12 and 18 months, Therapeutic Food BP 100 for the management of children with severe acute malnutrition, and growth monitoring equipment for the use in Child Welfare Clinics.

“Having access to nutrition supplements such as MMN, and growth monitoring equipment was a huge asset and helped sustain community work even through the pandemic, explains Thakshila. 

“To this date I remember receiving a call to inform of a feeding problem including food refusal. It was during a lockdown. But we took all measures to intervene on time and provide the mother with nutrition supplements and advice on how to administer it to the child. A special clinic remedied the situation further and we managed to maintain the growth of the child.”    

Continuing commitment to the community

Harshini Piyankar (37) is a mother of two. Her 9-month-old daughter, the youngest, is currently under the clinic’s care.  

“Today I brought Chenuli for growth monitoring, Harshini explains. “She has been on nutrition supplements (Thriposha) provided by the clinic since she was 6 months. My husband and I are so happy that she maintains the proper weight and height for her age. Being part of the clinic has helped us achieve this. Though both my children were delivered at private hospitals, I rely on this government clinic to provide me with all the support and advice before and after delivery. Even during the lockdown we had facility to call the clinic or the midwife for assistance and advice.” 

Like Harshini, many mothers are returning to the clinic for their second, and even third, pregnancies. The positive experience at the clinic has gained their trust in Thakshila and her team to provide them with the best healthcare. Good clinical participation means the clinic can provide the best care for the families and identify and intervene in any health and nutrition related problems. 

As a healthcare worker, Thakshila dispenses more than just clinical advice. For her the health of the mother and the child is important. Connecting with the mother, identifying special cases, respecting and responding to the client’s needs, she reminds us that compassion and empathy are two of the most important characteristics that underpins the healthcare network that’s supports the well-being of mothers and children.