How Sri Lanka could prevent more of her children from becoming malnourished

The prediction is that out of the 22 million population in the country around 5.7 million would be affected by this food scarcity 

Malnutrition can be measured in many ways. This includes weight, height and body mass index apart from nutrient and vitamin deficiencies.  But none of these measures indicates the incidence of malnutrition in society at the onset of a food shortage

Children in higher income segments could be obese, but that doesn’t mean that there’s no malnutrition in the country

Nutrition plays a big role in the development of a child and children are an important human resource in the country. Malnutrition affects a child’s brain development as well 

Sri Lanka had been known for its positive health development factors including low infant mortality, low maternal mortality and good nutritional status in children. But today, a sizeable percentage of the population is ‘nutritionally at risk’ following the prevailing economic crisis that resulted in the scarcity of food. Therefore, international organisations such as UNICEF states that this crisis is likely to have affected around 2.3 million children in the country and that immediate interventions are required to prevent these populations from becoming malnourished. During a recently held discussion, Medical Professionals for System Change invited three eminent speakers to shed light on the vulnerabilities of children in low-income segments, how the lack of nutrition could lead to stunting and wasting, and the sociological challenges and solutions. 

Possible nutrient deficiencies 
The inability to import food items due to import restrictions and the shortage of forex and the crop failure experienced during the Yala and Maha seasons have been identified as the two main reasons for the prevailing crisis. In the case of nutrition, people need adequate amounts of carbohydrates, proteins, fats, vitamins and nutrients. However, the prices of all food items have soared, particularly of food that comprise proteins. The prices of chicken and eggs are expensive. “As a result, people are likely to experience a protein deficiency; then there’s an issue with carbohydrates due to the surge in the price of rice, bread and other items,” opined Consultant Paediatrician Dr.Ajith Amarasinghe. “Therefore many international organisations have concluded that 25% of family units in the country are likely to experience a famine-like situation. The prediction is that out of the 22 million population in the country, around 5.7 million would be affected by this food scarcity. There are 2.3 million children within this population and international organisations claim that these children would require humanitarian assistance at this point,” underscored
Dr. Amarasinghe. 

If a child’s weight is less compared to his height, we say that he is showing signs of stunting. But if we compare the height against age, the child may be shorter (or in other words, this is known as wasting)

Another issue is malnutrition. However, it takes some time for food scarcity to lead to malnutrition. “Malnutrition can be measured in many ways. This includes weight, height and body mass index apart from nutrient and vitamin deficiencies.  But none of these measures indicates the incidence of malnutrition in society at the onset of a food shortage. However, the prevailing food scarcity could certainly lead to malnutrition in future. Therefore we have to prevent the possibility of developing malnutrition. UNICEF for instance has said in a statement that seven out of 10 families taken for their survey have reduced the consumption of food. International organisations have estimated that as many as 53,000 children will be admitted to government hospitals due to acute malnutrition. Sometimes it could be due to lower birth weight as well,” Amarasinghe added.  

Malnutrition, stunting and wasting 
As an initial step, it is important to identify those who are directly affected by the crisis and the long-term and short-term impacts. Children can be affected and it depends on the level of income as well. “Every child has a right to food,” said Founder Chairman of the National Child Protection Authority and Paediatrician, Prof. Harendra De Silva. “Children in higher income segments could be obese, but that doesn’t mean that there’s no malnutrition in the country. The scarcity of food would lead to a protein-calorie imbalance and this imbalance will lead to wasting in children. Previously too, around 15% of Sri Lanka’s children experienced wasting. This percentage would increase in another five years due to the prevailing conditions. As a result, children can also experience stunting.

As a short-term plan, we should see if a child would experience stunting as a result of the scarcity of food. If a child’s weight is less compared to his height, we say that he is showing signs of stunting. But if we compare the height against age, the child may be shorter (or in other words, this is known as wasting). In most instances, healthcare workers don’t indicate these figures in record books.  We therefore need statistics depending on the level of income and area. The child born to a pregnant woman who is either stunted or wasted will be of low birth weight. Around 16% of children have low birth weight. There’s a tendency for a child born with low birth weight to experience stunting during his lifetime. If there’s less food at home and there’s a pregnant woman she is likely to feed her other children from her plate. Therefore she will be deprived of food herself. If the pregnant mother remains hungry, it will deprive the unborn child of food and he will be born with a low birth weight. Food scarcity in this situation will lead to immediate and long-term issues. The deficiency of protein and calories would lead to conditions such as marasmus. In 1975, when I was working as a doctor, I saw skeleton-like children due to deficiencies in proteins and calories leading to marasmus and it could be fatal. Kwashiorkor on the other hand is where the body swells as it is unable to produce its own proteins. This was prevalent during 1975,” said Prof. De Silva.

Consumers now have access to various types of ‘unnecessary’ food due to commercialisation. “But those expenses could be allocated to purchase rice, dhal, vegetables and other food items, so we need to manage finances accordingly. 

The amount of income is relative and if people are unable to utilise their finances accordingly, we have a responsibility to educate the masses. We also need to keep in mind that there are commercial entities that take advantage from soaring prices of food items. We need to raise awareness about managing the consumption of food when there’s low income in the household. There has to be knowledge about maximising food production and we need equipment and these components should be included in the aid we receive,” he further said.

Sociological challenges and solutions  
Nutrition plays a big role in the development of a child and children are an important human resource in the country. Malnutrition affects a child’s brain development as well. From a sociological point of view, the lack of mental and physical development affects education. This is an issue that impacts society as a whole. “Every child has a right to access basic necessities like every other citizen,” said Emeritus Professor of Sociology
Siri Hettige. 

“It’s a social responsibility. We have been talking about literacy on the lines of the ability to read and write. But we also need to talk about scientific literacy which is the ability to look at a problem in a scientific manner. In order to choose food we need to have literacy, but if there’s no scientific literacy this is difficult. Another important aspect is environmental literacy and this is important for families in rural areas because they live in sync with the environment. Digital literacy is another aspect which helps in communication. But this hasn’t been involved in the education system,”
said Prof. Hettige. 

Prof. Hettige then suggested how the target populations are affected due to the scarcity of food that could be identified by using the resources that are already in place. “The state administration ministry for example has links to Grama Niladhari offices from Colombo to rural areas and it’s linked to the Divisional Secretariats. The Provincial Councils comprise its officers and the relevant information could be obtained by using a simple form. With the use of smartphones and other tools, this information can then be sent to the Divisional Secretariats. 

If this can be implemented across the island, we can find out the actual number of vulnerable families and locate them using Google maps. Thereafter we need to update this database and categorise these children into red, yellow and green zones. Green indicates that there is no issue, red indicates children at high risk and yellow indicates children who are vulnerable,” he suggested while adding that the level of malnutrition could then be estimated to formulate the
needs assessment.