Maintaining nutrition level key to healthy nation

Lionel Wijesiri

Sri Lanka marked the ‘National Nutrition Month’ a few days ago in the backdrop of an average 34 percent of the newborn babies under the risk of stunting due to malnutrition. Consultant Nutritionist of the Medical Research Institute Dr Renuka Jayatissa told a workshop that apart from the poor nutrition level among babies, 22 percent of the minor population is anaemic and that would seriously affect their mental and physical growth.

Though we should be proud of having excellent indicators in many health sectors in the South Asian region, it is regrettable that malnutrition has, in the recent past, become one of our weaker points.

As Dr Jayatissa says, this is an impediment to maintain a healthy nation and on the health budget in the long run.

So, naturally, we have to do something about it. The Health Ministry has organised an islandwide program to educate the public on the importance to prevent malnutrition under the theme ‘Maintaining nutrition level among the younger generation is the key to a healthy nation.’

Why have some countries been able to improve their childhood nutrition between the 1980s and 2007 while others have not? Research has shown that nutrition is usually influenced by five interrelated factors: political instability; poverty/inequality; ineffective development policy; climate and environmental change; and inadequate and poorly administered food security, health care and nutrition programs.

Many of the countries with stagnant stunting levels are among the most fragile politically, having suffered recent wars. They had limitations in: (1) household access to food, determined by access to land, farm labour and purchasing power, (2) household’s capacity to access and use adequate health care and nutrition and child care for young children, (3) Illness or environmental health conditions (such as mal-absorption of food) that affects the biological utilization of food.

Effective policies

We can assume that many of these factors were instrumental for the malnutrition condition in the North and East Provinces in Sri Lanka.

The percentages of malnutrition were high in Ampara, Batticaloa, Trincomalee, Vavuniya and Jaffna ranging from 43 percent to 53 percent. Aside from the geographic, demographic and political factors, there are significant disparities in stunting between the urban and more-educated mothers and the rural and less-educated mothers. The latter group is often twice as likely to have stunted children under age three. Moreover, the disparities between rural and urban areas and between urban slums and non-slums are growing.

The Way Forward; if we are to formulate and implement more effective policies and programs to reduce high and stagnant child stunting, we need to be able to reliably measure change and to evaluate which policies and programs are effective. This requires advancements in three areas: 1. Policy: Multi-sector policies with well-implemented approaches are more likely to reduce chronic malnutrition in the affected areas. The policies should target poverty reduction, food security, education and gender and disease burden.

2. Programs: Local capacity-building for policy and planning and for assessing, monitoring and evaluating progress in meeting our own goals in reducing hunger and malnutrition, is essential.

Development-oriented and preventive programs in food production, jobs, education, gender, health care and water are more important in the long run than are direct feeding programs.

3. Case study research and evaluation: Case studies of the more successful countries in reducing stunting can provide valuable guidelines for future policy and program work. Support from USAID, UNICEF, FAO, World Bank and other major funders and advisers could allow researchers to evaluate, for example, why Senegal has been so successful in reducing stunting in the past 10 years (by 36 percent), while the levels deteriorated by 31 percent in neighbouring Guinea. We can do so even better from locally owned integrated food and nutrition surveillance systems that have knowledge of the contexts, risks and vulnerabilities, as well as the resilience and capabilities in their areas.

Health experts

Why Nutritional Status? International health experts divide the nutritional status of a country into four components: (1) Safe and clean water source, (2) Availability of affordable food source, (3) Basic health care and (4) Nutritional literacy. Changes in nutritional status have profound effects on all individuals; however, when economic, medical and social support systems fail, the effects of poor nutrition are magnified and a self-repeating chain of effect is observed.

The question remains whether or not nutritional literacy can make an impact in health when dietary choice is limited. The experts believe that it can and does make a positive difference. With proper nutritional counselling, people may be able to better spend the money they are already using to buy food. However, the problem must be dealt on the provider end as well as that of the client to compensate for both the cost and variation required to serve satisfy special dietary needs.

Nutritional training:While it may be financially impossible for the Government and NGO sectors to recruit a load of qualified full-time nutritionists to supervise menu planning and nutritional training, it could be possible with further research to identify more specific areas of improvement.

What does need to change is the approach of case management towards the concept of nutrition. In a research carried out few months ago in an affected area, some parents who were interviewed stated that the advice they had received in the past was too ‘academic’ and they were not made to feel that they could positively affect their outcome. When done properly, nutritional counselling results in both positive psychological and physical effects.

Limitations do exist, of course and some people may not be able to fully adhere to standard dietary recommendations; therefore, it is even more important for the health providers to stress the appropriate use of supplemental income.

In combination with increased voice from the community, the four components of nutritional status evaluation can serve as entry into the system of ongoing care. Through feedback from the population they serve, the health providers can become more effective at meeting needs as well as improving confidence in service provision, which in turn may increase utilization and the outcomes of existing programs.

Literacy skills

Further, by addressing nutritional literacy at the level of the individual, where knowledge varies considerably, one can better develop a plan that takes in to account current alcohol abuse issues and individual needs. This means that multi-cultural, multi-lingual training is a necessity.

Furthermore, while pamphlets alone may not work, documents which address common complaints with nutritional answers (for example: gastrointestinal upset, dehydration, immune function, etc.) as well as basic information targeted to those with low literacy skills should be made available. While it is important to provide basic information to everyone, it is essential to provide more comprehensive information to those who desire it.

When affected people are treated as a herd, no good can come. People are individuals and need to be treated as such. While existing programs are supposed to address these needs through case management, their under-utilization brought about by general distrust, lack of applicable information and lack of voice of those served within the health sector makes positive outcomes a near impossibility.

With improved nutritional inputs that meet the needs and desires of the population and improved nutritional counselling that relies on actual circumstances and availability rather than unreasonable expectations, both the National Health sector with NGOs and those they serve would be aided in their joint goals.