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Opinions and facts in the dilemma of malnutrition

12 Oct 2022

BY Dr. Charuni Kohombange The rapidly unfolding economic crisis has dealt a massive blow to the food security of Sri Lanka. The soaring prices of essential food items have forced Sri Lankans to reduce the quantity and quality of the food they consume, or skip their meals altogether. Parents are struggling to feed their children adequate amounts of nutrients and calories to thrive. Are these evident levels of undernourishment a result of the economic crisis, or has Sri Lanka always been an undernourished nation? Discussions are building up among the medical fraternity on this sphere.  This article compiles opinions and facts on this issue shared by medical experts in several media fora. Consultant Paediatrician Dr. Ajith Amarasinghe   Mainly due to the fall of foreign exchange reserves, food imports are restricted and harvests have considerably declined with the changes that occurred in agricultural practices. In this context, people are unable to afford nutritious food for their families and the food security of the country is at risk.  The United Nations Children’s Fund (UNICEF), the World Food Programme, and other international organisations have reported serious concerns over the situation in Sri Lanka. According to UNICEF, more than 5.7 million people in Sri Lanka, which includes 2.3 million children, are in need of humanitarian assistance, and this accounts for 25% of families. They are also concerned that the increase in the prices of protein-rich food may increase the risk of protein deficiency in the population. Malnutrition can be measured by weight, height, the weight-height ratio, and signs of vitamin and mineral deficiencies. Although these measurements do not change immediately, all possible measures should be taken to face the risk of malnutrition. According to international organisations, if malnutrition reaches a higher level, it can be expected that around 53,000 children are at risk of being hospitalised during the upcoming months. Professor in Paediatrics Harendra de Silva We should admit that there is a problem with food security due to the foreign exchange crisis, which resulted in the lack of imported food items and reduced harvests. The low-income social groups are mostly affected by the crisis, while the economically privileged are still struggling with the problem of obesity. Protein-calorie malnutrition will be the first effect on the weight of a child, and wasting of the child is the first indicator of malnutrition. If the child is exposed to long-term undernutrition, it leads to stunted growth. According to the current data, 15% of Sri Lankan children are already short when considering their age.  If no proper intervention is made, the effects of the current nutritional crisis will be apparent in another four to five years. Monitoring the Child Health and Development Record (CHDR), and monitoring the growth of schoolchildren via school medical inspection visits is vital in assessing any growth-faltering in children. Nutrition of female children is of utmost importance as it affects the growth of their offspring. Under these circumstances, the birth of infants with low birth weight is a high possibility. Chronic malnutrition in children was last seen in Sri Lanka during the 1970s and preventing recurrence of this is vital. Improving food cultivation in the country, parallel to obtaining food grants, is important to overcome this crisis. While, political support is crucial in this aspect.  Consultant Community Physician Dr. Asiri Hewamalage   It is true that the prices of food items are skyrocketing with this present economic crisis, and parents are worried and depressed. However, this is the very moment we need to act creatively and mindfully to overcome these difficult times. According to a recently performed survey, approximately 80% of mothers are educated at least up to GCE Ordinary Level, and about 80% of these mothers are looking after their children at home. In this current context, this is a positive factor to overcome this nutrition crisis. By the time a student reaches the Ordinary Level examinations, they gain a reasonable knowledge about essential nutrients and nutritious foods. With this knowledge, they can creatively think of alternative nutritious foods that they can find in their environment. For example, you can obtain fats not only from expensive butter and cheese, but also through commonly available coconut oil. Similarly, carbohydrates are available not only in rice and bread, but also in sweet potatoes and jackfruit. It is not necessary to eat chicken and sea-fish for protein if you can find freshwater fish in your village. It is important to focus on the preparation of a balanced diet, and be creative in meal preparation to make them more palatable. In this context, Sri Lankans living in rural areas are quite fortunate, as they can find more nutritious food items in their villages.  Consultant Nutrition Physician Dr. Ahamed Rushdi   Cases of protein energy malnutrition like “marasmus” and “kwashiorkor” are still not seen in the country, and it takes a considerable time period for such a situation to occur. However, we should act without delay to prevent such conditions. From 2019 onwards, we are continuously facing crises, and it is affecting the nutrition of our population.  We cannot get a proper understanding of the current situation by the studies conducted at hospital settings, as it captures only the patients, and they might have altered growth measurements due to their disease condition itself. Our focus should be to capture the individuals who are having growth faltering merely due to nutrition deficiencies. In this context, concentrating on home economics is essential. Some individuals still spend a significant amount of their income on liquor and cigarettes, which is totally unnecessary and harmful to their health. It is vital to cut down these unnecessary expenditures and spend that amount on nutritious food for the children at home. Further, cutting down expenses on sweets and other unnecessary items is important in managing home economics to supply a balanced diet to the family.  Government Medical Officers’ Association Secretary Dr. Haritha Aluthge  It is important to carry out a scientific analysis on the current situation to assess the true extent of the problem. Certain communities are still having myths on proper nutrition. It is important to identify the prevailing myths and misbeliefs regarding food products and nutrition. These misbeliefs should be corrected, while public awareness on nutrition and a balanced diet has to be increased. Pointing out the lack of available data to obtain a proper image about current nutrition deficiencies, the Government Medical Officers’ Association has urged the Government to carry out a proper study in this regard. It is commendable to see that the Ministry of Health has initiated a programme to gather data in parallel to the National Nutrition Month. It is vital to analyse these data and make arrangements to collaborate with all stakeholders to plan out functions to rectify this current crisis situation.  Most importantly, these decisions and measures should be conveyed to the grass-root level to implement the actions. High-risk populations and groups should be identified based on these data, and priority should be given focusing on these groups. There is ample evidence from history on the adverse effects that the country had to face due to not using the facts at hand, which results in poor decision-making. Hence, it is vital to take correct decisions and implement them at the correct time to safeguard our future workforce.  Message to the public The Ministry of Health has made all arrangements to measure and record the weight and height-weight ratio of all Sri Lankan children under the age of five. This survey is being carried out within the month of October and is planned to capture the entire population of 1.5 million children under the age of five years. This programme will assess the growth status and whether it is appropriate for the age. The data will be extremely important to activate the emergency nutrition programme as early as possible. Further, this survey is performed in addition to the routine height-weight measurement process that is carried out in the field throughout the year. The Ministry of Health requests all parents with children under five years of age, to meet the area midwife to assess the nutrition level of their children. It is a matter of great importance to your child, as well as for the country at large.  


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