Nourishing the nation

By Dhaneshi Yatawara

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Health is wealth - “Arogya paraman dhanan” - the simple yet deep truth that will never fade away from this earth. Health is precious. It is a phenomenon where you value it when you loose it. With the slightest mistake a person will lose his or her health instantly.

Though we always see this in a very personal angle the issue can create devastations to a country if not properly taken care of. Just seeing the global destructions it becomes quite apparent how adverse the effects could be if health of a nation becomes detrimental.

Being healthy, keeping fit is a result of good, balanced food and proper activities. Consumption of nutritious food plays a major role in ensuring the well-being of the humans. Meals of good quality and quantity ensure these results.

For animals, including man, food is the only main source of energy.

Sri Lanka faces four main issues with regard to the nutrition that have emerged as public health problems - protein energy malnutrition, anaemia, vitamin A deficiency and Iodine deficiency, say medical experts in the Nutrition Coordination Division of the Ministry of Healthcare and Nutrition.

Proudly, Sri Lanka no more cases of iodine deficiency as a public health problem, due to the hard work since 1985. The length of the time period clearly signifies the complexity of rectifying a prolonged deficiency of a community.

With the aim of laying a steady healthy base for the society the Ministry of Healthcare and Nutrition has taken steps to accelerate and boost the actions taken to wipe out or minimize to a greater extent these nutrition deficiencies. One is the ‘National Nutrition Month’. The ministry has implemented massive scale programs in June declaring it as the National Nutrition Month.

According to the Demographic and Health Survey 2000, the Low Birth Weight rate is 16.6%, which indicates the gravity of the maternal malnutrition, said Dr. Shanthi Gunawardana, acting Director of the Nutrition Co-ordination Division.

As she further explained out of the children less than five years of age, 29.4% are underweight while 13.5% are experiencing chronic malnutrition (stunted) 14% are facing acute malnutrition or better known as ‘wasted’.

On the other hand, among the schoolchildren living in the urban areas 10% fall in the overweight category. These figures, with which the health officials are not at all satisfied, are the contributory factors which increase the commonness of non-communicable diseases.

The girl child

For a woman to be in optimal health during her pregnancy the care should start during her adolescence. Dr. Senarath Mahamithawa of the Nutrition Co-ordination division, explaining how this could turn out to be a vicious cycle if not properly taken care of. According to the data in Demographic and Health survey 2000, 30% of the pregnant mothers are suffering from anaemia.

According to a MRI report infants of 10-12 months old are recommended 19mg of dietary allowance of iron while children of 1-2 years of age group is recommended 9mg per day. Girls and boys between 16-18 years of age need to take in 39mg of iron per day. Pregnant and lactating mothers need to take 33mg of iron per day.

The high prevalence of childhood anaemia can be seen as a result of the continuing high prevalence of low birth weight and premature births.

Similar to many developing countries Sri Lanka is also loaded with the problem of anaemia mostly due to nutritional deficiency of iron. The research found out that 57.6% of infants between the ages 6 to 11 months are anaemic.

According to the survey the highest prevalence of anaemia in pregnant and non pregnant women was from the plantation sector.

Cognitive development, concentration, attention span, memory, learning, physical growth, manual dexterity, muscle function, immunity to disease and illnesses demands nutritional iron.

Anaemia is the condition with lowered oxygen carrying capacity in which haemoglobin content of the blood is below the estimated cut off levels set by the World Health Organisation. Although many nutrients are involved in the maintenance of the normal haemoglobin concentration iron deficiency is the most common cause for nutritional anaemia.

Infants, preschool-children, adolescents and women of child bearing age, particularly pregnant women, are at a greater risk of developing iron deficiency anaemia. Loss of iron due to parasitic infestations increases the vulnerability. i.e. worm infections.

The adverse functional effects of anaemia include impaired cognitive development of children from infancy through adolescence, reduced physical work capacity and capability, lowered cellular immunity and child growth, increased morbidity and mortality.

As a survey report done by the Medical Research Institute (MRI) in 2001 mentions the World Health Organisation has revealed that the global prevalence of anaemia in pregnant women was 50% while non pregnant women faced 35%. A higher prevalence has been reported from developing countries.

As it further states with an estimated global prevalence of 50% young children of less than four years of age are also affected.

Anaemia weakens the human functions of all stages of life. Severe anaemia during pregnancy increases the risk of maternal mortality.

In addition iron deficient children are more prone to recurrent infections.

Apart from dietary inadequacies, many other risk factors are seen to contribute to the status seen in Sri Lankans. Poor iron reserves of the mother, prolonged breast feeding without efficient complementary feeding, unfavourable socio-economic conditions, parasitic diseases are among them.

Iron deficiency in schoolchildren increase morbidity from infectious disease and can affect school performance, the report further stated.

Hidden hunger

The other situation prevailing significantly in Sri Lanka is the biochemical vitamin A deficiency among children. According to health officials 35% of children less than five years of age lack the required level of Vitamin A.

According to Dr. Mahamithawa, though the deficiency is not prevailing in clinical level, blood tests done on children of this age group have revealed the deficiency in the blood.

“Presently, we do not see patients with beto’s spots and night blindness as we had 25 years ago. Yet the biochemical vitamin A deficiency rate needs consideration,” he added.

A survey done by MRI during 1995/1996 has shown that children living in poor housing and environment sanitation, having no access to safe drinking water are more likely to be Vitamin A deficiency than others.

According to the survey over 70% of mothers knew Vitamin A rich food. An alarming status compared to other facts and figures found.This deficiency is the single most important cause of childhood blindness in developing countries. Even mild deficiency can significantly contribute to morbidity and mortality from common childhood diseases.

Vitamin A is an essential nutrient for growth and development, vision, immune response and cell differentiation. Even marginal Vitamin A status has been associated with increased morbidity and mortality, decreased growth rate and inefficient iron utilization. The most serious manifestations of Vitamin A deficiency are seen in very young children, six months to six years of age.

‘Dry eye’ or medically known as xerophthalmia is the mostly recognized clinical manifestation of Vitamin A deficiency. This includes all ocular manifestations of Vitamin A deficiency ranging from night blindness to corneal ulceration and resultant blindness.

Dark green leaves, yellow fruits and vegetables, eggs, meat, fish are the main source of Vitamin A.

Mission possible

Achieving the goal of wiping out these deficiencies or at least maintain at a lowest possible level is not impossible for a country like Sri Lanka. With the enormous amount of resources available around us and according our history record we are at a capable level.

“The achievements in the nutrition sector are quite low comparatively to the achievements of other health facilities like maternal mortality, child mortality. Sri Lanka is far ahead than many of the countries,” Dr. Mahamithawa said.

The Ministry of Healthcare and Nutrition have lined up,

Identification of pregnant mothers with Body Mass Index less that 18.5 and implement special intervention and follow up programs.

Special intervention programs for children age six months to two years showing growing faltering.Implement Home gardening program Training staff attached to health education units in hospitals Conducting mobile nutrition clinics Organize nutrition programs with provincial and divisional institutes including agriculture, Livestock, Child development and women empowerment and Samurdhi sectors.Participation of NGOs at provincial and divisional levels under this special project.

Though this is a long term achievement it is encouraging to note that these officials running the month long special project to boost the nutrition of Sri Lankans, are positive that this is a mission possible.

To feed an infant a family has to bear a minimum amount of money. It may be the daily amount of cash the father wasting on liquor, cigarettes or beetle leaves. These nutritious foods do not cost much. Yet if we neglect the price we have to pay will be very high.