1 Malnutrition is an issue of public health concern in Sri Lanka’s estate sector Estate sector has higher levels of undernutrition than other parts of Sri Lanka CHILDREN Stunting - High Wasting - Very high Underweight - Very high Anemia Young children - Severe Older children - Moderate Nutritional improvements Improving in the estate sector nutrition can raise is essential the nutritional indicators in the country for uplifting MOTHERS social welfare of Pre-pregnancy BMI - Low estate Anemia - High communities Low Birth Weight - High Have short stature *according to WHO classification Undernutrition in children under five years and among pregnant women has far-reaching consequences for them and society at large. Low birth weight babies are at higher risk of non-communicable disease such as diabetes Growth Poor Cognitive Poor Academic in their adult life Problems Development Performance Undernourished mothers are more likely to Undernourished children have slow growth and deliver babies with low birth weight development, and slow learning capacities. Decreased ability to work Reduced productivity Malnourished children are very susceptible to infections that trap the child in the vicious cycle of malnutrition 1 Fact Book Multisectoral Nutrition Assessment in Sri Lanka’s Estate Sector Several risk factors prevail in the estate sector that lead children to be malnourished <2500gm Children of Mothers with Poorer Low Birth Weight Working Mothers Short Stature • Ensure good birth weight by proper nutrition of • Strengthen the child care centers pregnant women and antenatal care • Full maternity leave for mothers • Improve adolescent nutrition • Priority attention should be given to ensuring • Strategies for school retention of adolescents proper nutrition during the first 1,000 days of a child’s life Problems have been identified in food utilization and feeding practices CULTURAL AND POOR COMPLEMENTARY BEHAVIOURAL FACTORS FEEDING PRACTICES 78% 61.5% 51.7% 31.8% Exclusive Minimum Minimum Minimum Breastfeeding Rate Meal Frequency Dietary Diversity Acceptable Diet • Design an estate-specific Behavior Change Communication (BCC) strategy and ensure it is an integral part of every nutrition intervention • BCC should be specifically targeted to working mothers, CDCs and care givers such as grandmothers • Educate on good complementary feeding practices • Ministry of Agriculture to take the lead to re-orient their approach to food security beyond the focus on the staple diet (rice and wheat flour) • Promotion of micronutrient rich locally available diet 2 Knowledge is not translated into practice 76% 83% Most can identify energy & protein rich food Inability to • Lack of knowledge about how to afford or introduce complementary foods access • Poor knowledge on the the importance of nutritious foods introducing complementary foods • Traditional beliefs Strengthen monitoring and Design an estate-specific evaluation practices for BCC strategy and ensure it is school based interventions, an integral part of every including relevant classroom nutrition intervention curriculum and school garden programs Gaps in quality of service provision for children were noted 54% 43.7% Never received vitamin A supplements Received deworming never received 50% treatment 6 months prior to the survey deworming treatment The receipt of the Improve the 28% MMN supplement in Nuwara Eliya, Badulla effectiveness and efficiency of the existing programs and Moneragala districts was very 45% poor: only 28% of children surveyed had ever received it; Strengthen leadership, and of them, only coordination, 45% consumed the and performance monitoring for stronger accountability entire sachet 3 Fact Book Multisectoral Nutrition Assessment in Sri Lanka’s Estate Sector Significant space for improving nutrition service delivery for women both before and during pregnancy 30% Pre-pregnancy of Women BMI level 82% received Thriposha while Only half of women received 10% never received below advice on nutrition and it during pregnancy 18.5 family planning before pregnancy A little more than 40% had their weight checked and received vitamin supplements while more than half received deworming 43.6% 41.6% 51.8% treatment before pregnancy • Compliance is an issue with about 80% of pregnant women always sharing the Thriposha with other household members • 26% of women did not receive iron supplementation and 25% of women did not receive Folic acid during pregnancy. • Optimize targeting and reach target population • Establish good monitoring and feedback mechanisms • Establish good coordination among programs • Prioritization of programs • Institutionalize capacity building of frontline nutrition workers • Employ a set of complementary and innovative platforms to target better and reach the underserved • Strengthen leadership, coordination and performance monitoring for stronger accountability • Improve the effectiveness and efficiency of the existing programs • Increase the coverage of Thriposha supplementation to children and pregnant women in the estates by identifying causes of its supply disruption • Changing the packaging of the food supplementation into small single-serving “doses” so that families would treat it more like medicine 4 Poor standards of Child Development Centers Review the existing guidelines for CDCs, and establish, if required, Standard Operating Procedures for optimal child feeding and CHILD DEVELOPMENT CENTERS child care practices 15% Below standards Improved water and sanitation facilities at schools and CDCs 38.9% 7.3% GOVERNMENT ESTATES REGIONAL PLANTATION COMPANY BELOW STANDARDS BELOW STANDARDS More than 15% of the crèches were found to be either ‘not clean’ or ‘extremely not clean’. There were substantial differences by estate types, with the government estates being the most unclean RPC estates (RPC Regional Plantation Companies) being the least unclean Provision of safe water and sanitation facilities prevents malnutrition and diarrhoea • Provision of safe water • Proper use of latrines • Proper hand washing practice 92% of water has high level of E. coli bacteria at source 5