20th October 1996

They are dying for a meal

By Hiranthi Fernando

"Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow. His name is today." - Gabriela Mistral.

These words by Nobel Prize winning Chilean poet stress the urgent need to provide children with their basic necessities for a healthy life. For a child to grow well he or she needs not only food but also a healthy environment, basic health services and good quality child care. Recognising these needs, Article 24 of the UN Convention on the Rights of the Child calls on "States, Parties to take appropriate measures to combat disease and malnutrition ..............through..............the provision of adequate nutritious food and clean drinking water, taking into consideration the dangers and risks of environmental pollution.

"In the developing world today, 165 million children under five years of age are estimated to be malnourished. Further, it has been found that approximately half this number live in South Asia. Thus Protein Energy Malnutrition (PEM) has become a priority concern for the SAARC countries since its average prevalence in the region is as high as 50%.

In Sri Lanka too, the extent of undernutrition in children is found to be quite high. Surveys have revealed that 7% of children under three years of age are severely malnourished, 31% moderately and 25% mildly malnourished. In other words, two out of three children suffer from some degree of malnutrition.

UNICEF in cooperation with the Government of Sri Lanka is involved in a multipronged programme to alleviate the problem of malnutrition in the country. Brita Ostberg the UNICEF representative in Sri Lanka explained that there are three classifications of Protein Energy Malnutrition. Children who have not grown sufficiently tall for their age are said to be stunted. Those whose weight is not adequate for their height are classed as wasted. The most severely malnourished group is both stunted and wasted. They have not only grown inadequately in height but they also do not have a weight adequate even for their stunted frames.

Protein Energy Malnutrition is the outcome of a combination of factors. Household food insecurity, inadequate caring and access to health services and an unhealthy environment cause inadequate dietary intake and disease, the end result of which is malnutrition.

Thus good nutrition depends not on food alone but on good health and good child care as well.

Speaking of reasons for malnutrition in children, Mrs. Ostberg said that low birth weight is one of the commonest indicators of malnourishment. A child should weigh a minimum of 2500 grams at birth. In Sri Lanka, a quarter of the children weigh less than this. The reasons for low birth weight go back prior to birth. It indicates that the baby was malnourished in the womb or the mother was malnourished during pregnancy or even earlier in her life.

Short stature of the mother and inadequate weight gain during pregnancy results in low birth weight of the baby. In Sri Lanka, 25% of the mothers are shorter than 148cm. Also, average weight increase among pregnant mothers in Sri Lanka is 7 kilograms as compared to 12.5 kilograms in the west. Mrs. Ostberg has found that many women here in Sri Lanka do not eat enough during pregnancy with the misconception that the child would grow too big to bear.

"Exclusive breast feeding up to four to six months is the best nourishment a child can have", stressed Mrs. Ostberg. "Breast milk has everything a child needs at that age. It is the cleanest form of food. Breast feeding should start ideally between 15 - 30 minutes after the birth of the child. Although the local tradition is to discard the very first discharge of colostrum from the breast, it is in fact good for the child. The colostrum contains many nutrients and also immunological factors which protect the child from disease."

Mrs. Ostberg says that it is preferable that bottles and teats are not used at all while the child isbeing breast-fed. The baby may prefer the bottle since the artificial teat is easier to suck from. Also inadequately sterilised bottles could cause infection. It is recommended to supplement breast milk with other foods using a cup and spoon right from the start.

The process of being malnourished starts from birth and continues upto to 18 - 24 months. After three months the child is usually left at home while the mother goes back to a job or to work in the fields.

The child is then dependent on what is available at home. During this period of dependence the child is most susceptible to malnutrition.

"It is not poverty that causes malnutrition", said Mrs. Ostberg. "Children need so little food at that age. Just a little mashed rice with oil, mashed vegetables and fruit is sufficient nourishment if cleanly prepared and given 6-7 times a day. They could use what is growing round them. However, the tendency to give tea to small babies is not a good practice since Tannin prevents absorption of vitamins.

"The deficiency of certain vital micronutrients is also another factor that contributes to malnutrition in children. The most damaging are deficiencies of Iron, Iodine and Vitamin A. According to statistics, 65% of pregnant mothers in Sri Lanka suffer from anaemia due to Iron deficiency. This leads to lack of resistance in the foetus and low birth weight. "Hygiene is very important", says Mrs. Ostberg. "The same enzymes that are used to grow are used to fight infection". So when children have to fight infection, their growth is naturally less.

Deficiency of Iodine causes inadequate thyroid hormone production which in turn causes not only goitre but can also lead to irreversible mental retardation. Even a small amount of Iodine deficiency can cause 10% reduction of IQ levels. In Sri Lanka, there is a belt from the Kalutara area on the west coast across the country to the east coast, where a high incidence of goitre is seen. Upto 30% of the people in this belt show signs of goitre due to Iodine deficiency. To counteract this, UNICEF has supplied machinery and chemicals to the Salt Corporation as well as private producers in order to ensure the marketing of iodised salt. It has been found that 50% of the population now use iodised salt. The problem is that salt crystals which are cheaper and used by a greater number of people cannot be iodised. "Such practices need to be changed by making the people aware of the dangers of Iodine deficiency", commented Mrs. Ostberg.

Deficiency in Vitamin A causes night blindness, lowered resistance to infection and anaemia in children between 5 - 10 years of age. Vitamin A deficiency is found to be over 70% in the North Western Province.

"Basically, knowledge, attitudes and practices in the care of children have to be changed in order to make a success of a nutrition programme", said Mrs. Ostberg. The people themselves have to do it. They must become aware of the nutrition problem. It is not really a food scarcity problem but a care problem.

"The Nutrition Programme started by UNICEF the government, involves all the relevant ministries under the leadership of the Plan Implementation Ministry. The comprehensive programme includes support to national policies for raising awareness, growth monitoring and promotion programmes, control of micronutrient deficiencies, nutrition education aimed to bring about behavioural change and a Participatory Nutrition Improvement Programme in the AGA Divisions.

The aim of the Participatory Nutrition Improvement Programme (PNI) is to establish community based empowerment mobilisation systems. Awareness programmes are being conducted at divisional level. Four thousand external facilitators, drawn from the Divisional Secretariats are being trained to initiate and conduct community based programmes. Ten thousand community facilitators drawn from the various communities are in turn being trained by the external facilitators. Training manuals are being prepared and will be distributed to NGOs.

Mrs. Ostberg spoke enthusiastically about the success of the programme which was started at 'Mahiyangana which is a disadvantaged area. "The external facilitators are very active", she said. "They go out to the communities and gather the people together. They select community facilitators. They go to any meeting or gathering and spread the message. Role plays are enacted to emphasise their point. Fathers groups are formed to meet and discuss the needs of mothers during pregnancy. It is also important to emphasise that teenage girls should also get sufficient nourishment to help them in their later life as pregnant mothers. It is planned to conduct these programmes in 100 more divisions. The communities must be made aware of the importance of breast feeding, hygiene, sanitation and clean drinking water to ensure the wellbeing of their children."

Continue to Plus page 2 - 'God will bring them home'

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