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28th December 1997

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It's a deadly silence!

By Tharuka Dissanaike

The danger in malnutrition is that a child suffering from deficiencies would not show overt signs of it, except in cases where the children are big bellied and painfully thin. Therefore the problem is easy to ignore.

The UNICEF report calls it a 'silent emergency'. Silent because of its unobtrusive presence and emergency because of its consequences. Malnutrition is a problem in many developing countries world-wide. Not just the lack of nutrition but also the need for proper nutrition which is strongly felt in many countries including Sri Lanka, where so many children suffer the results of inadequate food supply.

In the UNICEF report 'State of the World's Children 1997,' the issue discussed is the prevalence of malnutrition world-wide. The report launched last week, gives staggering statistics where more than half the 12 million under five, child deaths in developing countries each year are attributed to malnutrition.

Despite this, the report says, it is a problem that has stirred little public alarm. The danger in malnutrition is that a child suffering from deficiencies would not show overt signs of it, except in cases where the children are big bellied and painfully thin. Therefore the problem is easy to ignore.

One would be inclined to think that in a country like ours where food supply is not really difficult and literacy is comparatively high, there would be no need for a problem like malnutrition to occur. But facts persist. What's more, the problem in Sri Lanka has not shown signs of improvement for at least fifteen years, according to UNICEF officials.

"Probably the situation would have deteriorated further had there not been immunisation campaigns conducted quite successfully islandwide," Dr. Hiranthi Wijemanne said.

According to Dr. Wijemanne the problem should be addressed at its very root. Maternal health is vital in ensuring correct-weight babies and better nutrition for a growing child. To be healthy at pregnancy and after, a woman has to be taken care of while she is a girl. "The girl child has to be properly nurtured," Dr. Wijemanne said.

In a male dominated society where the woman of the household eats last and the best food and meat or fish is usually devoured by the males, it is essential for girl children to have access to a fair share of nutrition.

Anaemia caused by the lack of iron is a big problem among our women. Iron lost through menstruation is not supplemented back to the body. This is attributed to low protein intake among females who are used to a largely vegetarian based diet.

In Sri Lanka, according to UNICEF, malnutrition manifests in four areas, low birth weight babies, stunted children, anaemic mothers (Iron deficiency) and iodine deficiency.

"There is an iodine belt in Sri Lanka; certain areas due to their geographical location do not have iodine in the soil and people of these areas suffer from thyroid and goitre problems."

Iodine deficient children turn out to be slow learners whose mental development has been retarded.

The problem has also been greatly aggravated by the war situation in the North and East.

Because of refugee camps in conflict areas where food scarcity is felt, malnutrition and ill health occurs in a vicious cycle.

The government rations are inadequate to fulfil their daily nutritional needs and diseases like diarrhoea and dysentery abound. Ill health then results in lack of nutrition and stunted growth.

For most part, the Wanni which was earlier a food surplus area now suffers under the constant threat of war and the resulting displacement. Little or no cultivation takes place in areas that are still not under govt. control.

The problem of malnutrition is also severe in slum areas in the cities. This is because they live in abject poverty and insanitary conditions. Being mostly day-wage earners who cannot cope with the ever rising cost of living, parents rarely send children to school or practise pre-natal care.

The environs of the slums being what they are, the children are susceptible to disease. Hence these two groups of children namely, refugees and slum children represent the worst case scenario as far as Sri Lanka is concerned.

Dr.Wijemanne feels there is a lack of co-ordination between the various agencies , departments and campaigns that are all aimed at health and nutrition causes.

"Confusing messages are sent out to the public and this has been counter productive and has undermined the very function they were established for."

Dr. Wijemanne emphasises that good nutrition does not have to consist of fancy imported foods. Dhal, pulses, green leafy vegetables and yellow vegetables, rice and fresh fruit can provide people with the essential nutrients.

"There are several important phases in the development of a child," Dr. Wijemanne said. "The first begins when he is in the mother's womb. The second is upto four months after birth when the baby's birth weight should have doubled, and then by three years it should have tripled."

Dr. Wijemanne said that earlier they emphasised on nutrition upto the age of five, when the child develops fastest and the mental faculties are developed. "But now we say, at least upto the age of three good balanced nutrition is essential."

It is not, she emphasises, whether the child had a full meal. A child can eat to fulfil immediate hunger but yet be malnourished for the lack of a balanced diet.

"Immunisation campaigns are easy, you give the shots and do not worry about it thereafter. But nutrition is continuous and programmes have to be sustained for a long duration." A child could be rescued from malnourishment if treated early and put on a proper diet. But stunting and slow development of the brain could have longer effects on a child. "A low birth weight child can recover from the initial setback by good nutrition. But here too the mother has to maintain her health so that she can breast feed the baby well and concentrate on the baby's nutrition and well being."


Continue to Plus page 4  *  These kids become slaves in rich houses  *  The story of Ms. K  *  Why do they go?

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