Month of June marks the National Month of Nutrition. And with all the social welfare and free health services, reduced infant and maternal mortality rates, it’s often easy to forget those who fall through the cracks. According to the last survey the prevalence of stunting, wasting and underweight among children between six to 59 months of age were 13.1, 19.6 and 23.5 per cent respectively.

The latest survey on nutrition, conducted so far by UNICEF, National Nutrition and Micronutrient Survey 2012, highlighted the prevalence of anaemia among children aged six to 59 months and nutritional status of children in its first installment. It drew attention to the micronutrient deficiencies such as anaemia, iron deficiency, Vitamin A deficiency, calcium, and zinc deficiency.

Dr. Renuka Jayatissa
Dr. Renuka Jayatissa

The survey conducted using a representative sample of 7306 households from the 25 districts of Sri Lanka goes onto say that, “Stunting was low during the latter half of the first year of life and highest during the second year while the prevalence of wasting was consistently increasing up to 36 to 47 months and decreased after that. Stunting and wasting was higher among male children. In general, a high prevalence stunting, wasting and underweight was seen among the children of fathers employed in lower occupational categories.”

It also identified a district wise variation in prevalence of stunting. The survey report recommended addressing the high prevalence of stunting and wasting ‘urgently’, while reiterating the importance of implementing appropriate interventions to minimize disparities at district level.

But four years later nothing much has changed, says Nutrition Specialist and Consultant Community Physician, MRI, Dr. Renuka Jayatissa. “The nutritional needs identified by the report back in 2012 was not duly highlighted,” says Jayatissa, one of the report’s authors. “Stunting is decreasing in Sri Lanka, but the percentage of stunted children is still high. Every one in ten children is stunted.”

What is it?
For those who do not know what ‘stunted’ means, Jayatissa broke it down, the length of a baby should increase by 24 cm in the first year of growth and by 12 cm between one to two years. An average child’s length should be approximately 70 cm by the end of first year and 80 cm by the end of two years. Those who are shorter are identified as stunted. Stunting can lead to lower IQ, attention and memory issues and may lead to low work efficiency and productivity in adulthood.

Although genetics and growth hormone deficiencies can play a minor role in stunting growth in children, Jayatissa, explained that the main reason in the Sri Lanka scenario is improper complementary foods introduced to infants after six months. Complementary foods are foods that are introduced to infants while still being breast fed. “The problem in Sri Lanka is that these foods are inappropriate.”

According to Jayatissa consumption rate of food by children is high in Sri Lanka but the food’s quality is questionable. She explained that introduction of such law quality complementary food lead to weight loss, which predisposes children to illnesses such as diarrhea and respiratory complications, which in turn leads to further loss of weight. “This can lead to chronic malnutrition that leads to stunting.” As you may see it’s a vicious cycle.

Ideal foods
Jayatissa emphasized that it is imperative to provide children with the right amount of nutrients between five to six months during which time their growth rate doubles and after the first year when their growth rate triples. Coupled with breast feeding, the ideal complementary foods should contain enough energy, vitamins, minerals and iron to help the child grow during these quick growing months.

When asked what types of foods would make ideal complementary food, Jayatissa said that the period leading up to six months is a learning curve for parents. “Parents can try out different types of food. After the seventh month infants can be given cereal, vegetables and fish or pulses to fulfill the protein component.”

The iron requirement is high during this accelerated growth period, said Jayatissa. “Plus, being infants, they eat very little, perhaps not even a table spoon of vegetables a day.” She recommended that babies be given iron rich fish or meat during this complementary food months.

A tried and tested recipe is roasted sprats heads with sun dried drumstick leaves, mixed and pounded into powder. Add a tea spoon of the mix into every complementary meal and the baby’s nutritional needs will be met, assures Jayatissa. “Drumstick leaves have 15 vitamins and minerals and sprats contain Omega 3 fatty acids in addition to being iron rich.”

Early detection
Early detection is key to literally stunting stunted growth. “Early detection and providing for the nutritional needs of children is key to curbing stunted growth. This can be done by referring to growth charts,” said Jayatissa. She explained that growth charts are two-fold; weight and height. “A child is healthy as long as he or she is in the green zone of both weight and height charts,” concluded Jayatissa.