Nutrition, parental love and care in MENU FOR NATIONAL PROGRESS

Excerpts from the interview.

Q: Though Sri Lanka ranks first in the Human Development Index (HDI) in South Asia, much ahead of many other countries in the region in health indicators, malnutrition has become a worrisome health issue. How and Why?

The HDI is a composite index combining indicators of life expectancy, educational attainment and income. Sri Lanka has done extremely well in these areas especially in literacy and high life expectancy mainly due to free education and health services provided by successive governments. Globally we are ranked 92nd and among the best in countries in South Asia. Malnutrition means that the nutrition needs of a person have not been met. It could be under-nutrition (underweight, stunting or wasting) or over-nutrition (overweight and obesity). I must tell you that Sri Lanka has the best indicators relevant to under nutrition compared to other South Asian countries. However we are not very happy with other achievements. As a country we have done well in improving most health indicators such as reducing infant mortality, maternal mortality, combating communicable diseases, achieving high coverage in immunisation, improving life expectancy etc., but the progress made in the field of nutrition has been rather slow.

Q: Studies show that 32% of newborn male babies and 25% of the female new- born babies are at risk of being stunted due to malnutrition. How do you propose to tackle this serious health and social problem?

I don’t agree with the statistics you quote. According to the National Nutrition and Micronutrient Survey done by the MRI in 2012, 17.9% of newborn babies are born with a birth weight less than 2500 grams which is defined as ‘Low Birth Weight’. 15.3% of male babies and 20.6% female babies are born with Low Birth Weights. Of this, 2/3rds are at a higher risk of becoming undernourished (stunted and underweight) later in life. As a country we have to be concerned about this because the LBW incidence has remained almost static for more than ten years. When the LBW incidence in a country is more than 15% it is identified as a major public health problem.

Q: Apart from the poor nutritional level among babies, 22% of the minor population is anaemic a condition which will affect their mental and physical growth. How would this phenomenon affect the overall progress of the country?

Iron is an essential micronutrient for brain development especially for cognitive development. Brain development is most rapid during the first three years in a child’s life and iron is a vital micronutrient for this. Iron deficiency will have long-term irreversible impairment in brain development especially in cognitive development. Studies have shown that even though it is corrected later, the negative impact on brain development will be irreversible. Therefore such children will not be able to make optimal use of the opportunities provided to optimise brain development during the first three years of life and thereafter through education. Their problem-solving skills will be impaired. Such children may not do well in mathematics which needs cognitive skills and as a result will not reach their optimal productivity. In short iron deficiency experienced early in life affects the quality of human resource in a negative manner.

The Ministry of Health through its Maternal and Child Health programme is supplementing all infants at the ages of 6, 12 and 18 months with Multiple Microinuttients to prevent iron deficiency anemia during early childhood. The regime is one sachet daily for 2 months with a gap of 4 months. (This means a child gets MMN 60 sachets thrice). Also through the school health programme, all children from grade 1-12 are given weekly iron, Vitamin C & folic acid for 24 weeks.

Q: Maintaining sufficient nutritional inputs among the population is vital for the existence of a healthy nation and to prevent vulnerability to diseases especially among the young generation. How

can we address this issue?

It is important to take three main meals per day. It is also important to have a mixed diet. Dietary diversity is very important. The diet should comprise sources of energy, protein and micronutrients. For example, lunch can comprise rice, a green leafy vegetable, another vegetable and a piece of fish, meat, dried fish or an egg. A vegetarian may have to take foods such as dhal, cowpea or soya for his/her protein requirement. The dietary guidelines prepared by the Ministry of Health can be helpful in planning the diet. Although under-nutrition is a problem among very young children, obesity too has been identified as a problem among the population. Therefore restrictions on the intake of sources of energy such as sugar and oil should be implemented among the overweight to maintain optimal body weight.

Energy intake should be based on the physical activity of an individual. We should teach our children to eat less starchy foods but more vegetables, fish, meat, eggs and fruits.

Further excess salt, sugar and fats should be avoided to keep healthy. Regular exercise is a must to maintain optimal body weight in relation to height.

Q: What is the progress that has been made after declaring a National Nutrition Policy by the Health Ministry in mid June of 2010?

Tackling under-nutrition is a major problem and the responsibility does not lie only with the Ministry of Health. There are many risk factors contributing to this issue of which poverty is a main cause. Talking of poverty, it is not only due to unemployment and lack of income but it is very often due to incorrect management of incomes. Often earnings are for substance abuse, gambling etc. in vulnerable populations. Therefore it has to be tackled in a holistic manner with a multi-cultural approach addressing social issues.

A National Nutrition Council headed by President Mahinda Rajapaksa was established. A national committee chaired by Dr Lalith Chandradasa has prepared a working plan targeting vulnerable age groups and populations to address the risk factors in under-nutrition. A holistic and multi-sectoral programme supported by the UNICEF was implemented jointly by the Ministry of Health and the district secretaries in the Nuwara-eliya and Monaragela Districts as a pilot project. This programme was closely monitored by the district secretaries periodically. Based on these findings the National Nutrition Council is planning to adopt a multi-sectoral approach throughout the country in a phased out manner.

Ministry of Health is testing the feasibility of supplementing either salt or wheat flour with iron in order to prevent iron deficiency in the population at large as it is directly related to productivity and the quality of the human capital.

Q: What are the social and economic consequences bearing a large population subject to malnutrition in a country?

A large population with malnutrition affects the quality of the human capital and thereby the productivity of a country. Further, the government has to spend a lot of money on the sick population during their productive years to maintain their health. Therefore it is a double burden on the government. On the one hand the human capital during their peak productivity years cannot contribute optimally and on the other hand the country has to spend huge amounts on individuals to treat them for long periods thus burdening the free health system of our country.

Q: Malnutrition or anaemia among expectant mothers causes still births and underweight babies. This is an impediment to maintain a healthy nation and a heavy burden on the health budget. How can Sri Lanka prevent this?

Sri Lanka has already taken cost-effective measures to reduce anaemia among pregnant mothers. All expectant mothers get de-worming tablets and supplementary iron tablets to be taken with a tablet of Vitamin C from the third month of pregnancy onwards until six months after delivery in order to prevent anaemia both during pregnancy and during the period of lactation. Also the mothers’ haemoglobin levels are checked and those with iron deficiency anaemia treated accordingly.

Q: Sri Lanka has almost eradicated malaria, leprosy, polio and smallpox. What must the government and the public do to eradicate malnutrition?

There are many causes for malnutrition. Although poverty is a main cause as shown by evidence it is also connected to the behaviour of caregivers. It is difficult to eradicate malnutrition totally as data show that even children in families with high incomes are stunted and underweight.

In addition to food, children need love, care and interaction with the primary caregivers. Nowadays some parents do not have time to interact with their children as their priorities have changed and thus such children do not grow well even though they get adequate meals. Frequent illness in children and inadequate feeding during bouts of illness also contributes to poor nutrition. Therefore it must be remembered that under-nutrition in Sri Lanka is more concerned with the behaviour of individuals and caregivers.

Q: Do you think food preferences of Sri Lankans have a bearing on malnutrition among children and expectant mothers particularly in the estate sector?

Yes. The quality of the diet is a major concern. Most do not take a diversified diet. When it comes to children, all infants should be given breast milk until they complete six months. Thereafter breast milk should be continued while introducing other foods gradually. Although during the first year in a child’s life, breast milk should be the main food with other complementary foods from six months onwards, after the completion of one year the child should receive three main meals with breast milk in between.

Pic by Samantha Perera