The pattern of moderate acute malnutrition in a rural area of Sri Lanka: Integrated approach is needed to address the problem

Full text: Introduction: Sri Lanka has a well-established preventive health care system. Irrespective of well-established preventive health care system, malnutrition of children is yet a public health challenge in Sri Lanka. Aims: To assess the current nutritional status and associated factors with the malnutrition in Nawagaththegama area, Sri Lanka. Methods: A descriptive cross-sectional study was conducted among a representative sample of children under 5 years (total population = 1434). Twenty five clusters were selected by probability proportionate to the size of the under five children in 19 Gramasewa Niladari Divisions (the smallest administrative division in the area). Height and weight of children under 5 years were measured according to the WHO protocol, and an interviewer administered questionnaires was used to ascertain socio demographic characteristics, feeding practices, common morbidities of children and health service utilization pattern. WHO Standards were used to assess the nutritional status. Hemoglobin levels were assessed in a subsample. Results: The questionnaire was completed by 493 children. Weight, height, hemoglobin was measured among 442, 419, 120 children respectively. Out of weight measured children, 24.7% (confidence interval (CI) = 19.4 – 30.8) had weight for age <-2SD and 4.8% (CI = 2.5 - 8.8) had weight for age < -3SD. Out of height measured children, 16.5% (CI = 13.1 – 20.5) had height for age < -2SD and 4.1% (CI = 2.2 - 7.4) had height for age < -3SD. Global acute malnutrition (GAM) was 18.5% (CI= 2.3% -26.9%) and Moderate Acute malnutrition is 15.6% where as Severe Acute Malnutrition is (SAM) was 2.9% (CI = 1.3% - 5.9%) . Lowest percentage having the weight for age <-2SD and weight for height/length was reported from the age group of 1 – 6 months (11.8 % (CI = 4.6 -27.1))and 12.9% (CI = (3.4% - 38.1%)). Over 99% of children were continue to have the breast milk at the completed 6 months while 4.2 % gives the formula milk and 8.8% have initiated the solid/semi-solid food during the first 6 months. Highest weight for age percentage of <-2SD reported from the children age 49 - 60 months (33.3% (CI = 21- 48.5)). Highest percentage of MAM was reported in the age group of 49-60 months. About 10% of children had presumed pneumonia with in the 2 weeks prior to the survey. A wide disparity was noticed in underweight proportions over the geographical localities. Majority of the children had haemoglobin levels less than 11.0 g/dl (n = 78, 65.0%). Conclusions and recommendations: Weight for age percentage of <-2SD is higher than the national average while weight for height percentage of -2SD is lesser than the National average. Multiple factors such as high levels of respiratory tract infections, poverty, lack awareness etc. may contribute to the low nutritional status of children. Integrated approach is needed to address the malnutrition in this area. A short term targeted interventions should be designed for the MAM child. (author)