One in four children under-nourished

 Few die in childbirth, most go to primary school and almost all are vaccinated at the right time, but the sizeable number of Sri Lankan children who are stunted, wasted and underweight for their age is a cause for concern, according to nutritional authorities.

New government statistics show that despite countless initiatives to alleviate malnutrition over the years, the condition is entrenched in the traditionally poor and conflict-hit regions and affects hundreds of thousands of children.

The Demographic and Health Survey 2006/2007 , a draft of which was released by the Health and Nutrition Ministry and the Census and Statistics Department, shows that 22 percent of Sri Lankan children are underweight, 18 percent are stunted and 15 percent show signs of wasting.

"These statistics show that one in four children is under-nourished," said Renuka Jayatissa, medical specialist in charge of nutrition at the UN Children's Fund (UNICEF). "This is despite having all the best nutrition interventions implemented here."

The statistics indicate a slight improvement since the last survey in 2000, which showed that one child in three was under-nourished, but, said Jayatissa, the lack of significant improvement since the 1970s underscored the ineffectiveness of some nutrition programmes.

The latest figures could also be inherently distorted as the survey did not cover five districts in the northern province - Jaffna, Kilinochchi, Mannar, Vavuniya and Mullaitivu - where government forces are fighting rebel Tamil Tiger separatists, and access to accurate data is near impossible.

"The conflict is really affecting the picture. Lots of people who are displaced by the fighting rely on rations and they don't get adequate quantities of good quality food," noted Jayatissa.

MDG goal

UNICEF has already expressed concern that although Sri Lanka's overall health indicators are on track to achieve the Millennium Development Goals (MDGs), the nutritional status of children and mothers is the exception.

The worst-hit districts include Trincomalee and Batticaloa, where the separatist conflict raged until last year, causing large-scale displacement. In the districts of Badulla, Nuwara Eliya, Moneragala and Hambantota, poverty among tea plantation workers and farmers has long been endemic.

At the top of the categories, 41 percent of children in Nuwara Eliya District were stunted, while height-for-weight measurements showed that wasting was highest in Trincomalee at 28 percent, and in Badulla, 32 percent of the children were underweight. The figures reveal regional disparities, with districts in the western and southwestern parts of the island showing less incidence of under-nutrition.

Jayatissa attributes the failure of the programmes to end under-nutrition to a lack of monitoring of targeted populations to assess if they were receiving the correct support and to an insufficient commitment to ensure the goals are achieved. UNICEF, the World Food Programme (WFP) and the government plan to collect baseline data from the poorest districts at regular intervals to monitor health and nutrition indicators.

The problem, according to health experts, is exacerbated because, besides food intake, nutritional status also depends on water and sanitation, birth weight, weaning practices and mothers' education - thus calling for more integrated solutions rather than piecemeal efforts.

Anaemia

Jayatissa also pointed out that 30 percent of Sri Lankan children suffer from anaemia, with up to 58 percent aged 6-12 months showing symptoms.

"The effects of anaemia between birth and the age of two are irreversible, even if it is subsequently treated. The condition affects children's intellectual development, cognitive abilities and critical thinking skills," she said, adding that the poor performance of school students at public examinations and low productivity of the national workforce were signs of the long-term consequences.

Economic threat

"What is very common now is to see people struggling to buy food because of the high prices of staples like rice and bread," said Judy Devadawson, an adviser to a Trincomalee-based NGO, the Women and Child Care Organisation (WACCO). "In some places, we see very thin children with sunken eyes and they seem lethargic."

She saw the effects of the rising cost of living and the shortage of employment opportunities hitting the large proportion of families, especially in conflict zones such as Trincomalee District, where many have only one breadwinner. "It is almost impossible for them to provide enough food for the whole family."

WACCO has provided a group of conflict-affected women in Trincomalee with land to cultivate vegetables using organic farming methods, which they can sell for extra income or consume.