Features
Childhood malnutrition: the double-edged sword
BY Dr B. J. C. Perera
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
In an article published in the prestigious British Medical Journal as far back as 2004, titled “Is there hope for South Asia? Yes, if we can replicate the models of Kerala and Sri Lanka”, two erudite medical scholars Zulfiqar Bhutta and Samiran Nundy, held up our Motherland and its health system as a prototype for other countries in the region to follow. The authors noted that after gaining independence from the British, Sri Lanka invested heavily in education and health as a cornerstone of socioeconomic development. They also went to the extent of complimenting our country on achieving superlative results in achieving the very best health indices despite an ongoing civil war. The publication clearly documented that these results were due to committed political will, grassroots support, and an important policy plank based on primary healthcare, especially in maternal and child health, through a multi-layered health system with adequate provision of basic services at the community level. Indeed, we were top-of-the-pops in our Asian region.
Fast-forward 18 years. The very same British Medical Journal in an article published in November 2022, titled “Sri Lanka’s health crisis: Urgent action is needed to maintain vital services”, written by two Sri Lankan authors Shashika Bandara and Inosha Alwis, has taken an about turn of a complete 180 degrees. They state categorically that Sri Lanka is facing a severe political and economic crisis, and the health system is at risk of collapse. The authors say, “Interconnected challenges, including a severe shortage of essential medicines, a worsening socioeconomic landscape, and human rights violations, remain substantial threats to health in Sri Lanka”. Then the authors go on to describe two vitally important pieces of information that should make us sit up bolt-upright and take intense notice. They document that nearly six million Sri Lankans; three in every 10 households, are food insecure and face an 80% inflation rate for food. Then they go on to state that UNICEF estimates that over two million children in Sri Lanka require humanitarian assistance. The authors conclude that as far as policy imperatives go, Sri Lanka’s leaders need to improve their policy on health system strengthening in both the short term and the longer term.
All this brings us pointedly to the current situation regarding the fiasco in providing optimal nutrition for the children of our land. They are the jewels that would shape the future of our beautiful country. This author in an article titled: The “Feed a Child” initiative: A laudable effort of love from the Sri Lanka College of Paediatricians, published in The Island newspaper, as far back as 17th October 2022, in a telling lamentation stated “Childhood Malnutrition is the miserable topic of our times in the current fiasco of the crisis in our country. Many international organisations, as well as local authorities, have placed our land at the rock bottom of the abyss of childhood malnutrition”.
Then later on in that article, I went on to say “However, make no mistake, the current state of inadequate childhood nutrition is the harbinger of the resurgence of such dangerous forms of clinical states in the not-too-distant future. If steps are not taken to arrest the current trend, these would be the likely consequences that would threaten the lives of children”.
It is noteworthy that a so-called top legislator, not too long ago, in the citadel of the legislature, totally denied that there is childhood malnutrition in our country. That took place even despite compelling evidence to the contrary from several sources. The opposition, which usually breathes fire and shouts till they are hoarse, was silent. Their lot included several medical personnel too. Their silence too was deafening.
Then, hey presto., just a week after that incident, the same legislator had to eat humble pie and admit in the well of the citadel itself that childhood malnutrition was rampant. The opposition was still silent, perhaps in the belief that silence is golden, even when a person had lied through that person’s back teeth. As the former Prime Minister of Russia, Nikita Khrushchev once said about politicians “they are all the same”. Shame on all of them.
Here is something that is not all that well known. There is a gradual and most surreptitious increase in the number of low-birth-weight babies over the last couple of years. That is, at least in part, due to maternal malnutrition. The foetus needs all nutrients to grow within the womb and if the pregnant mother does not get sufficient essential nutrients in her diet, it will be the baby inside her who will suffer. That baby will be born malnourished.
The sword of childhood malnutrition is double-edged. It will lead to a stunted, frail, physically disadvantaged cluster of young people and adults. I do not have to spell out the obvious problems that may arise as a result of that. The other cutting edge of the sword is that we will have an intellectually disadvantaged and cognitively impoverished population as the growth of the young brain and the development of intellectual abilities depend on optimal nutrition. We have some of the best brains in our country at present. If we allow malnutrition to take root in our population, in 10 to 20 years, it may not be the case at all.
Now to a suggestion for a remedy in the short-term, perhaps to be undertaken even in the longer term.
The government should make sure that ALL students in ALL the schools, right around the country, will be provided breakfast in the school. It need not be exotic food., even manioc, sweet potatoes, yams, rice, sambol, gravy and an egg would do. A glass of fresh liquid milk will be a real bonus if the authorities can manage it. All these will give the students sufficient calories and proteins to work on during the day. None of them will faint due to hunger and low blood sugar levels.
Then they will go to their classes and will be taught, and taught well. That is entirely up to the teachers.
During the lunch interval, ALL students in ALL the schools, right around the country, should be provided lunch in the school. A simple meal of rice and curry with all locally available ingredients. The authorities can alternate different carbohydrates such as rice, manioc, sweet potatoes, yams, etc., with some locally available lentils, vegetables, fish/meat/eggs or textured vegetable proteins (TVP).
Of course, all of this will need money., loads of it. The government will have to somehow provide it. Just tax the high flyers. An extra two to five per cent tax for all those who are earning more than five million a year will easily cover the cost. Of course, the authorities will have to round up those liable to it, irrespective of caste, creed, political affiliations, etc. The henchmen and henchwomen of politicians, as well as the latter breed themselves, should not be allowed to escape at all costs. In addition, I am quite sure that there will be many local philanthropists who would like to join in this initiative. Their voluntary contributions should be tax-free donations. Parents and well-wishers could be roped in to attend to the logistics of the entire initiative as well.
Now, here is the crunch. For a start, all children will attend school, even simply for food. If the children get some evening meal or dinner at home, it will be nice. But…, and this is a BIG BUT; in the case of severely impoverished families, even if the children do not get anything substantial to eat after they come home from school, it would not matter that much as their daily nutrition would already have been looked after by the government…, at least to a reasonable degree.
It is most definitely a tall order. Are the legislators up to this? It will need real patriotism to somehow achieve this plan. It should be reiterated that with great power comes even greater responsibility. With the all-encompassing power they wield, they should shoulder this responsibility. They owe it to the people of our island nation.
As to whether they are up to it, your guess is as good as mine. My considered opinion is that none of the current lots would fit the bill. We will need a benevolent and far-sighted statesman or stateswoman to get this job done. Once accomplished, the rewards would be very many.