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| Sunday, 6 April 2003 |
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| News Business Features Editorial
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Compiled by Carol Aloysius Creating healthy environments for children Tomorrow (April 7) is World Health Day. This year's theme is "Shape the Future of life. Healthy Environments for children." We publish below an extract from a media kit by the WHO dedicated to children.
The risks to children in their everyday environments are numerous. But there are six groups of environmental health hazards that must be tackled as priority issues - household water security, lack of hygiene and poor sanitation, air pollution, vector-borne diseases, chemical hazards, and unintentional injuries (accidents). These risks exacerbate the effects of economic underdevelopment and they cause the bulk of environment related deaths and disease among children. There are many solutions to these environmental health problems. A range of effective interventions exists in the areas of policy, education, awareness raising, technology development, and behaviourial change. Such interventions can be extremely cost-effective and are implemented by policy - and decision-makers, householders, communities, educators, government officials and many other stake holders. Safe household water Contaminated household water can transmit diseases lack of water can prevent minimum hygiene behaviours to protect health. Among water borne diseases diarrhoea is the world's second biggest child killer. Other infectious diseases with similar patterns of transmission include hepatitis A and E, dysentery, cholera and typhoid fever. Lack of household water security is also associated with skin and eye infections including trachoma, and with schistosomiasis, which may be acquired whilst collecting water from infested sources. Many chemicals that have the potential to harm people's health can be found in drinking water. For example, an excess of fluoride is associated with crippling skeletal-fluorosis. Interventions Safe water storage at home - and treatment of water in the home when its quality is in doubt - reduces water contamination and leads to proven health benefits. Reliable safe water supply in schools has a direct impact on health. Hygiene and sanitation
Intervention Ensure that children have access to safe sanitary facilities and that children's faeces are safely disposed of. Proper waste management and relocation of waste dumps away from human settlements. Washing hands with soap before meals and after defecating significantly reduces the risk of diarrhoeal disease. Air pollution Air pollution is a major environment related health threat to children and a risk factor for both chronic and acute respiratory disease as well as other diseases. INDOOR AIR POLLUTION is a major factor associated with acute respiratory infections in both rural and urban areas of developing countries. A pollutant released indoors is often more dangerous to a child's lungs than a pollutant released outdoors. OUTDOOR AIR POLLUTION, mainly from traffic and industrial processes, remains a serious problem in cities throughout the world, particularly in the ever-expanding megacities of developing countries. Interventions Good ventilation, clean fuels and improved cooking stoves decrease indoor air pollution and the exacerbation and development of acute respiratory infections. Protecting children from smoking and from second-hand tobacco smoke reduces the risk of respiratory disorders and other ill-health effects later in life. Diseases All vector-borne diseases are serious threats to children's health. Some however, pose a specific threat to children, because a child's immune system is unable to cope with the assault by the infectious agent, or because the way a child behaves may increase vulnerability to disease. These diseases include: Malaria, which is transmitted by the mosquito, overwhelmingly kills children. Lymphatic Filariasis, an infection of parasitic worms lodging in the lymphatic system, can cause the deformations typical of the disease ("Lymphedema" and "hydrocoele") in children as young as 12. The decrease in healthy life caused by this disease is second only in its magnitude to malaria. Schistosomiasis, a water-based disease caused by blood flukes (worms that live in the blood-stream), affects children and adolescents. Chronic infection leads to debilitation and degenerative disease. Japanese encephalitis Outbreaks particularly affect children under five (about 90 percent of cases); an average of 40,000 clinical cases are estimated to occur each year. Of the survivors, 50 per cent will be affected mentally for life. Interventions General environmental management, including improved water management in irrigated areas, placing cattle strategically between breeding places and homesteads, and drainage or filling of water collections, may help reduce transmission risks in some settings. Cover water storage containers and periodically empty and dry out various containers that retain water including buckets, discarded food containers, drums, flower vases, and car tyres (where water can collect. This will help bring down dengue transmission risks. Chemical pollutants are released into the environment by unregulated industries or are emitted from heavy traffic or toxic waste sites. Pesticides unsafely used, stored and disposed of may harm children and their environment. Household cleaners, kerosene, solvents, pharmaceuticals and other chemical products become dangerous if they are kept in inappropriate containers and in places that are accessible to children. Chronic exposure to various pollutants in the environment is linked to damage to the nervous and immune systems, and to effect on reproductive function and on development. For example, children are very vulnerable to the neurotoxic effects of lead in paint and air, which may reduce their IQ and cause learning disabilities. They are also vulnerable to the developmental effects of mercury released into the environment or present as a food contaminant. Most exposures to toxic chemicals and pollution are preventable. Unintentional injuries (accidents) Unintentional injuries include road traffic injuries, poisonings, falls, burns and drowning. World-wide the leading causes of death from unintentional injury among children are road traffic injuries (21 percent of such for this age group) and drowning 19). Improve enforcement of existing laws. Institute systematic surveillance for unintentional injuries. Educate community members in first aid. Coordinate emergency services. (Courtesy WHO) *********** The health profile of the Lankan child . 22 per cent of children under 5 years are stunted i.e. significantly shorter for their normal age. Stunting delays growth and delays onset of menarche in girls. . 15 per cent of children are wasted i.e. significantly lighter for their normal age . Approx. 18 per cent of the entire population including children are deficient in iodine. . Over 30 per cent of all pregnant women and half of all pre-schoolers are anaemic due to low iron stores. . One third of all children under 6 years are deficient in Vitamin A which affects their eye sight. . Around 17 per cent of children born in the past 5 years had lower than the specified 2.5 kgs weight. . One of the chief causes for stunting wasting and low birth weight is malnutrition. According to a Demographic Health survey of 2000 more girls suffered from acute malnutrition than boys. . Most children in Sri Lanka have had at least one diarrhoeal attack a year. By the age of 5 years most children have suffered from at least 3-4 attacks of diarrhoea. *********** Healthy environments - a guide to parents, community . Make public places smoke free. . Wash your child's and your own hands with water and soap before
preparing food and eating, and after defecating. *********** Overcoming malnutrition on the home front by Dr. Priennie Ranatunge Malnutrition the tip of the iceberg of social imbalance, now has two peaks in Sri Lanka. One is the malnutrition precipitated by lifestyles of overindulgence by the rich.
Malnutrition in children under five is still around 30 per cent in Sri Lanka. The unacceptable malnutrition rate of 30 per cent indicates that there is a "rising pool of substandard survivors with impaired stamina, poor productivity and increased susceptibility to infections" presenting a challenge to nutrition policy planners. We are now in a transition phase. This requires new modes of thinking and action. Clinic based programs must give way to community based services. For example, a mother should be able to take her child any day, any time, to a well-trained village health volunteer to check the temperature of her child, to weigh her baby, dress a simple cut/wound or get some advice on simple health/nutrition problems. Thus more promotional programs need to be developed for mothers in rural, estate and other less served ares. Mothers still do not know enough about child health, baby care and feeding practices. A low nutrition status paves the way for regular fevers and diarrhoeas compounded by inadequate household water use, lack of sanitary latrines and poor household finance management. How come, that Home Economics is not given its due place in Sri Lanka? An attempt at reducing malnutrition by the National Development Trust Fund (NDTF: 1991-96) showed trends towards improving birthweights in project areas. This was brought about by a vibrant mother-education program via NGO volunteers. Wrong eating practices are now producing another malnutrition among the rich. Consumption of fast foods, fatty foods, processed meats influenced by the media especially TV, and inadequate intake of fresh fruit and vegetables are contributory causes. Sedentary lifestyles (eg. travel by car always, working at the computer and munching fried food) and stressful living aggravate the condition. Medical personnel say that stress, sedentary lifestyle and media-influenced eating practices and lifestyles give rise to cancer, heart diseases, diabetes, gastric ulcers and obesity. Thus we have two malnutrition peaks; one due to affluence and wrong values, and the other to poverty. Reversing the trend In Sri Lanka our existing good literacy rate is a strong resource base. However, literacy alone is not the same as "education required for development". Many women ('O' and 'A' levels) cannot state the normal temperature of a human person and have not had adequate education in health, nutrition, baby care, food preservation and home gardening, etc, so necessary to bring about better nutrition status. Such education is the need of the hour. It helps to bridge the literacy gap in basic sciences and promotes good nutritional outcome. This should be followed by organising women to establish service centres in their own communities. Health education and promotion, education on low cost nutrition with local foods, baby care, promotion of home gardening and backyard animal husbandry, time management, external beauty care with good nutrients and hygiene, inner beauty of wholesome values, etc, could minimise the destructive effects globalisation has on the poor. People should be trained and encouraged to grow food even in small home garden plots and to eat fresh food. National policies for establishing Regional Training Centres for poorer women and girls on health, nutrition and home management need to be established. A nutrition authority Nutrition is too important a subject to be just a part of any one Ministry. It is time to consider a separate authority, because the "science of nutrition" and the "practice of nutrition" are two different entities. The latter requires a cross fertilisation of all the nutrition-related sciences with sociology and its management in the communities. The nutrition-related sciences range from food and milk production to health, sanitation and child care. A Nutrition Authority could co-opt the NGO sector, because NGOs themselves focus on multidisciplinary activities (from credit, leadership development to community infrastructure and baby care) in small geographic areas. Such an authority could link up NGOs and Community Based Organisations (BCOs) with the separate Ministry officers at the level of the Divisional Secretariat. Corrective programs can then be well-targeted on the most needy. The final thrust for nutritional improvement thus lies in the empowerment of women (rich and poor), with high quality training. *********** Growth faltering in school children - Dr. T. W. Wickramanayake The main nutritional problems facing school age children include stunting, underweight, anaemia, iodine deficiency and Vitamin A deficiency. In countries experiencing the nutrition transition from traditional life-styles to that of the West, overweight and obesity are increasing problems of school-age, especially among urban children and affluent rural household.
The prevalence of stunting, wasting and underweight among pre-school children varies by region and sub region throughout the low-income countries. Stunting is widely believed to occur in pre-school children, mostly by 3 years of age, through a cumulative process. The degree of stunting present in the pre-school period tends to increase throughout the school-age years. However, children can exhibit catch-up growth if the environment improves, indicating that interventions can reduce levels of stunting and its effects on health and education. A recent study of anthropometric status of rural school children in five low-income countries found an overall prevalence of stunting and underweight to be high in all five countries, ranging from 48 to 50 per cent for stunting and 34 to 62 per cent for underweight. The data indicated that, in all five countries, as the children get older they become progressively shorter relative to the FAO/WHO/UNO reference population. Boys tended to be more stunted than girls in most countries. In all countries boys were more underweight than girls. Sanitation and housing conditions have been identified as risk factors for growth-faltering in school-age children. Short stature is associated with poverty. Reducing poverty and its consequences is critical. Height differences have little to do with ethnicity. Out-of-school children: There are considerable differences between enrolled children and non-enroled children. The non-enrolled of both genders have significantly short stature, about 50% of the non-controlled at age 6 to 7-year being stunted when compared with the enrolled. Most of the chronic health problems encountered in the 6 to 7-year children are the products of disease and poor sanitation before they enrolled in school. Inspect on Education: Studies indicate that chronic under-nutrition is associated with lower achievement levels in school children. Stunting in the first 2 years of life is strongly associated with lower test scores, at ages 8 to 11 years. These adverse effects may decline over time, lower test scores are related to late enrollment, increased absenteeism and repetition of school years, among stunted children. Therefore, both the stunted and non-stunted can benefit similarly from education. A study in Vietnam showed that chronic malnutrition was not associated with language and mathematics test scores. Studies should be initiated to identify (1) whether the height deficits accrued during the primary school years are made up through the larger pre-pubertal growth in height, and at what age children stop growth in height. (2) the functional implications of linear growth retardation in school-age children. (3) the age at which school based interruptions could prevent stunting. (Condenced from a publication of the UN system) |
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| Editorial | Security Produced by Lake House |
The children of today are adults of tomorrow ....
The safe disposal of human faeces - including those of children - is a
prerequisite to protecting health. In the absence of basic sanitation, a
number of major diseases are transmitted through faecal pollution of the
household and community environment. These include diarrhoea,
schistosomiasis, hepatitis A and E, dysentery, cholera and typhoid fever.
Lack of sanitation is also associated with infection with helminth and
with trachoma. Trachoma causes irreversible blindness and today about 6
million people are visually impaired by this disease.
The other, a result of "poverty" of the poor. The common
denominator is the globalisation of the economy which polarises society,
both within nations and between nations.
The main health problems they face are helminth infestations,
respiratory infections, diarrhoeal disease and malaria. Direct and
indirect effects of HIV/AIDS are likely to become important in the future.
Much of this disease burden derives from poor environmental conditions,
including biological, chemical and physical health hazards.
