2017年-世界发展银行全球_Multisectoral_Nutrition_Assessment_in_Sri_Lankas_Estate_Sector_75页_9mb

Multisectoral Nutrition Assessment in Sri Lanka's Estate Sector

Core Content

This report presents a comprehensive assessment of maternal and child nutrition in Sri Lanka's estate sector, focusing on the prevalence, determinants, and gaps in nutrition programs. The study was conducted between 2014-2015 and aimed to support multisectoral nutrition programming by identifying key challenges and opportunities for improvement.

Main Objectives

• To assess the status and determinants of undernutrition among the estate sector population.
• To examine access to and utilization of nutrition-related services.
• To identify gaps in current nutrition-specific and nutrition-sensitive programs.

Key Findings

Nutrition Status in the Estate Sector

• Stunting: 36.4% of children under five were stunted, a decline of about 14% from the 42.2% reported in the 2006-07 DHS.
• Wasting: 16% of children under five were wasted, showing an increase compared to the 13.5% in the 2006-07 DHS.
• Underweight: 35.9% of children under five were underweight, an increase of 6 percentage points from the 2006-07 DHS.
• Anemia: 38.4% of children under five were anemic, with 53.1% of children aged 6-23 months and 38.4% of children under five affected.
• Low Birthweight: 27.8% of children were born with low birthweight, which is a key predictor of stunting and is significantly higher than the national rate of 16.6%.

Determinants of Undernutrition

• Low Birthweight: A major determinant of child undernutrition, increasing the risk of stunting, wasting, and underweight by 13 to 26 percentage points.
• Working Mothers: Children of working mothers are more likely to be undernourished (11% more stunted and 4% more underweight) due to reduced child care and early introduction of complementary feeding.
• Maternal BMI and Height: Mothers in the estate sector had lower BMI and shorter heights compared to national averages.
• Education Level: While less educated parents were more likely to have undernourished children, the difference was primarily due to household wealth rather than awareness.
• Livestock and Home Gardens: Ownership of these did not significantly reduce undernutrition due to low consumption rates.

Gaps in Nutrition Programs

Nutrition-Specific Programs

• Thriposha Supplementation: Only 82% of pregnant women received Thriposha regularly, with 18% not receiving it and 10% never receiving it.
• Micronutrient Supplementation: Iron (73.6%), folic acid (74.9%), vitamin C (69.3%), and calcium (64.6%) were not universally provided.
• Compliance: 80% of pregnant women shared their supplements with other household members, indicating poor compliance.

Nutrition-Sensitive Programs

• Service Coverage: Despite most children being born in government healthcare facilities, only 28.4% of mothers with children who had poor weight gain received special advice.
• Micronutrient Supplementation: 54% of children had never received vitamin A supplements.
• Communication Gaps: Materials for illiterate and Tamil-speaking populations were not adequately tailored.
• Monitoring and Coordination: Inadequate monitoring mechanisms and lack of coordination between ministries and programs.

Recommendations

1. Develop an Estate-Specific Behavior Change Communication (BCC) Strategy

• Design a comprehensive, multi-pronged BCC strategy tailored to the estate sector.
• Target mothers, child care providers, the community, and policymakers.
• Focus areas include:
  • Complementary feeding at six months.
  • Appropriate food types for infants.
  • Tamil-based and illiterate-friendly communication materials.
  • Hygiene promotion (e.g., hand-washing, safe water practices).
  • Encouragement of full maternity leave usage.
  • Awareness of the long-term impacts of stunting.

2. Institutionalize Capacity Building for Frontline Nutrition Workers

• Strengthen the capacity of health workers (e.g., Public Health Midwives) to promote nutrition during the pre-pregnancy phase and for children.
• Review the adequacy of frontline worker numbers and develop human resource strategies if needed.
• Enhance the capacity of agricultural extension workers to integrate nutrition promotion with food security initiatives.

3. Utilize Complementary and Innovative Platforms

• Explore new models of nutrition service delivery that can reach working women and adolescent girls, particularly those with teenage pregnancies.
• Address the challenge of late reporting of teenage pregnancies through improved outreach and engagement.

4. Improve the Effectiveness and Efficiency of Existing Programs

• Address supply-side disruptions and improve the regularity and coverage of Thriposha supplementation.
• Enhance the accessibility and utilization of micronutrient supplements.
• Strengthen monitoring and evaluation systems.
• Promote inter-ministerial coordination to ensure alignment and integration of nutrition-sensitive interventions.

Conclusion

The estate sector in Sri Lanka continues to face significant challenges in maternal and child nutrition, despite national progress in health and socioeconomic development. Undernutrition is more prevalent in this sector, particularly stunting, wasting, and anemia, which are influenced by a combination of behavioral, cultural, and economic factors. Addressing these issues requires targeted, multisectoral interventions that focus on improving maternal health and nutrition, enhancing child feeding practices, and strengthening the implementation and coordination of existing nutrition programs.