Combating child malnutrition

Malnutrition: Recent reports reveal that child malnutrition in Sri Lanka has reached high levels. Research studies have found out that 29 per cent of children below the age of five are suffering from malnutrition. According to the Family Health Bureau, nearly 55,000 babies born each year were underweight (less than 2.5 kgs) due to lack of proper care by expectant mothers.

The danger in this development is that more than 80 per cent of a child's brain growth takes place within the first three years of life. Therefore malnutrition in children below five years would increase the probability of a large number not reaching their fullest potential with regard to brain development.

An international comparison of child malnutrition rates relative to per capita national income, in low- and medium-human development countries, shows that Sri Lanka has a significantly higher child underweight rate than would be expected on the basis of its per capita GDP.

This is in sharp contrast to Sri Lanka's celebrated performance on other human development outcomes such as primary education enrolment, adult literacy, infant mortality and life expectancy, where the country performs well above the levels that would normally be expected at its level of per capita income.

Indeed, Sri Lanka has a child underweight rate that may be three times as high as what would be expected of a country with our level of infant mortality.

There is thus a big gap between Sri Lanka's performance on child health and its performance on child malnutrition.

This inconsistency is difficult to understand as most factors that bring about low rates of infant and child mortality typically also result in lower rates of child malnutrition.

One possible explanation is that infant mortality is largely a function of the utilization of preventive and curative health services, including immunization and maternal and child health services, while child nutrition depends additionally on food and dietary intake during infancy and early childhood.

While Sri Lanka enjoys good medical infrastructure, feeding practices, especially for infants and young children, may be less than ideal.

Although central and local governments and non-governmental development organizations have implemented various direct and indirect programmes to increase the food availability in poor households, they have not had much success.

In Sri Lanka, social development has been given top priority by the successive governments. But due to budgetary constraints, expenditure on the social sector has been drastically reduced since the early 90s resulting in the almost complete withdrawal of food subsidy. The other major constraints in maintaining sustained reduction in malnutrition in Sri Lanka is the continuing ethnic violence in the north-eastern areas which has affected not only the national economy but has also severely limited access to food and health services.

Reducing child malnutrition is a key millennium development goal, as child malnutrition produces a wide and diverse range of adverse economic and social consequences. Malnutrition substantially raises the risk of infant and child deaths, and increases vulnerability to a variety of diseases in later life.

In addition, malnutrition impairs cognitive ability and decreases school performance, and lowers labour productivity and lifetime earnings. Combating child malnutrition is, therefore, of central importance to the future economic and social welfare of our country.

It is now believed that direct measures should be taken to introduce low-cost, affordable to family budget and nutritious food varieties as an alternative policy to ensure household food security. In this scenario local food plants known as tradition food plants, which are cheap compared to socially acceptable varieties can be a one option to assure dietary requirements of rural households. People are used to these plants and know how to cultivate them or harvest from where they grow naturally and to prepare delicious foods agreeable to their palate.

The people have opinions about the nutritive and therapeutic values of these plants. They are grown in a particular ecosystem operating in a particular locality or gathered as wild or semi-wild products.

Consumption of cereals such as finger millet, millet, little millet and foxtail millet, which played a vital role in food system of the people in the past, has fallen dramatically. The roots and tubers are not eaten today as a staple food, but they were prepared into curries to eat with rice. Pulses have been eaten either boiled for breakfast or as a snack. Split pulses, particularly imported lentils made into curries to serve with rice.

A comprehensive plan for a change of food consumption, particularly in under-developed areas, should become operative.

An integrated package of maternal and child health services to address child malnutrition and promote child growth has been designed by the present government.

The package commences at conception and proceeds through foetal life, infancy and childhood. These policies and programmes to reduce child malnutrition are complemented by health and nutrition education.

All well and good. Yet, according to the observers, there is fragmentation of nutrition policies and programmes across different sectors and ministries, without a leadership role played by any institution. Remedial action is needed to rectify these shortcomings.