3rd August 1997

Malnutrition: UNICEF reveals shocking facts about the Lankan situation

Something is not working out

By Hiranthi Fernando

One in every four ba bies born in Sri Lanka weighs less than 2.5 kg, the standard for a healthy baby, says a UNICEF report, Progress of Nations 1997, released recently. According to this report, Sri Lanka ranks fourth among the four countries with the highest rates of under weight births, the other three being Bangladesh, India and Pakistan. It is noted that all these four countries are located in South Asia, which is also the region with the highest rates of child malnutrition. Thus it highlights the fact that low birth weight babies are more susceptible to disease and tend to grow up malnourished. Further, the report states that low birth weight which averages at 20% in developing countries, usually results from maternal malnutrition.

‘When a baby is born with low birth weight, he starts life malnourished. From birth, he has a handicap to contend with’, says Dr. Hiranthi Wijemanne of UNICEF. ‘There is a tendency to believe that growth of the baby begins at birth. However, the important growth of an individual takes place during the foetus stage. The stamp of a human being depends largely on what happens in the womb.

"In the womb, the baby is totally dependent on the mother for nutrition and everything he needs. If the mother is under-nourished, the baby will not grow sufficiently. Thus it is necessary to shift the emphasis to pregnant mothers. They should be given the essential food and health care which should be continued during infancy".

Dr. Wijemanne says there are many reasons for the high incidence of low birth weight among Sri Lankan babies. The reasons go back even beyond pregnancy to the adolescence stage of the mother. She says that adolescent girls need to be better nourished and looked after. According to the country wide statistics for 1995, 20% of the children in Sri Lanka are stunted, (low height for their age) 13% wasted,(weight not adequate for their height) and 33% are underweight.

Stunting in children under five years indicates long term malnutrition reflected by inadequate growth of the long bones of the child’s body. It is caused by insufficient or poor quality food, poor feeding patterns, inadequate care of children and women, frequent infection and poverty. Stunting weakens immunity, affects learning capacity and work performance. (Many adolescent girls continue to be stunted. Such a girl starts off with a risk factor for low birth- weight babies. It is important for the parents to give her adequate nourishment and care since her capacity to bear healthy children depends on this.

Anaemia is another major factor which affects adolescent girls and pregnant mothers. During the adolescent years, girls lose a monthly quota of blood, and supplements become very important Dr. Wijemanne explained, If they do not receive the necessary supplements, they enter pregnancy with depleted stores of iron.

"During pregnancy, our mothers do not gain enough weight," Dr. Wijemanne said. According to the cultural practices especially in rural families, the mother eats last. When there is a scarcity of food the pregnant mother does not get sufficient nourishment. Better intra family support is needed for the pregnant mothers. They must be encouraged to eat more during pregnancy.

"They should also avoid becoming anaemic by taking the necessary Iron supplements. Iron and folate supplements are given to pregnant mothers by maternity and child care clinics. Family members should ensure that the pregnant mothers eat properly and take their supplements regularly."

According to Dr. Wijemanne, the intake of iron could be improved by simple dietary habits. For instance, black tea should not be taken with meals since it reduces the absorption of iron. Pregnant mothers should also take sufficient iron containing foods such as pulses. Even if they are not usually meat or fish eaters, they should be encouraged to take even a small piece of dried fish daily during pregnancy.

The intake of vitamin C is also important, though not necessarily in the form of tablets. For example, the popular coconut sambol containing lime juice enhances the absorption of iron. She also stressed the need for pregnant mothers to rest for an hour or two during the day. This period of rest improves the blood supply to the placenta and the foetus and thus helps in improving the weight of the foetus.

Inadequate spacing of children also results in babies with low birthweight Dr. Wijemanne said. "A mother needs some time to regain her resources so spacing of babies is important."

After the birth of the baby, it is necessary to establish proper feeding habits since the process of being malnourished could start at birth. The first five years of a child’s life is a period of rapid growth. The infant’s stomach is however small and cannot take in large quantities of food. Small quantities of good quality food have to be given often.

The World Health Organization and UNICEF recommend exclusive breast feeding for the first four to six months of a child’s life. They stress that particularly for babies in developing nations, breast feeding is imperative. Their very survival depends on the immune-boosting properties of mother’s milk.

‘The lives of almost 1.5 million infants could be saved every year if for the first six months they were exclusively breast fed", states Progress of Nations 1997. "That means nothing but breast milk, no solids, no other liquids, not even water". Dr. Wijemanne explained that the water an infant requires is obtained through the milk. Breast milk digests easily and the risk of diarrhoea is eliminated. Milk is a good culture medium for bacteria and unless it is prepared in hygienic conditions, could cause infection. Further, the UNICEF report states that poor families often dilute costly infant formula with unclean water and mix it in unclean bottles, adding to the risk.

In order to promote healthy nutrition by encouraging and protecting breast feeding, the World Health Assembly in 1981 adopted an International Code of Marketing for Breastmilk Substitutes. It calls on all countries to regulate marketing of breast-milk substitutes to prevent breast feeding from being undermined. Sri Lanka is listed in Category 1 among sixteen countries that have enacted legislation or other enforceable measures that implement this International Code in its entirety.

"It is best to give only breast milk using no bottles and no water for at least four months," Dr. Wijemanne said. "At four months, semi solids such as fruit, cunjee, vegetables, pulses or fish could be introduced along with the breast milk. It is preferable to feed these semi solids using a cup and spoon rather than bottles and teats. As far as possible, locally available food should be given to the baby. It is not necessary to use imported cereals. Rice provides good nourishment. It is also advisable to start the babies on the normal food taken by the family as early as possible."

Another factor that brings on malnutrition in infants is infection. When a child gets an infection, he loses his appetite. A child should therefore continue to be nourished well during sickness. His calorie need is even more to fight the infection.

‘Over the years, Sri Lanka has had so many nutrition programmes", Dr. Wijemanne said. "Despite that, somehow there seems to be a core group of undernourished children in the community. Something is not working out. It could be attitudes, practices or the programme effects not reaching the children who really need it. Perhaps more awareness is needed among family members and in the community to ensure that pregnant mothers and small children are given priority in nourishment.

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