Assessment of Nutritional Status and Associated Factors in Northern Province
The end of three decades of violent conflict between the Sri Lankan Armed Forces and the Liberation Tigers of Tamil Eelam (LTTE) which ended in May 2009 lead to the displacement of a substantial proportion of the population in the Northern Province. Resettlement of the displaced population commenced towards the end of 2009. By October 2011, the resettlement process is nearing completion.
In implementing the resettlement programme, emphasis was placed on ensuring the safety of the resettled population, availability of infrastructure facilities such as road network, facilities to ensure environmental sanitation, educational facilities, provision of livelihood support and legal issues related to identifying ‘places’ (land/ housing etc.) of resettlement. Availability of health service was also considered as an area of priority.
During the period of displacement of the population, community-based Nutrition Rehabilitation Programmes (NRP) were implemented by the Ministry of Health in collaboration with UNICEF and WFP with the aim of having a positive impact on the health and nutritional status of the displaced community. These programmes were continued after resettlement.
With the resettlement process nearing completion, it was considered relevant to make an assessment of the status of nutrition and associated factors among the resettled population in particular and the host population in general and make comparisons with the data obtained during the previous year, to fulfill the information needs required to plan health, nutrition and food aid programs for the Northern Province in the long term. It will also give useful information about the coverage of the current interventions.
A descriptive cross sectional study was carried out in a random sample of households in the five districts of the Northern Province, Vavuniya, Jaffna, Mannar, Killinochchi and Mullativu. A sample of 1192 households was included from the five districts with the percentage being highest from the Jaffna district. Data collection was carried out using an interviewer administered questionnaire. Anthropometric measurements, weight and height of the children were taken to assess the nutritional status.
During the analysis, emphasis was placed on comparing the status between the resettled households and the resident households. However, caution in interpreting these results is suggested as the sample was not stratified by resident and resettled populations.
Of all children, 16.5 percent were ‘low birth weight’ (LBW), with this percentage being comparatively higher in the two cohorts aged between 24 – 47.9 months, among female children and among those in the resident households. Maternal educational status did not show a consistent pattern in relation to the prevalence of low birth weight, except for the high percentage of LBW children among babies of mothers with no education. Mean birth weight for the total sample was 2.9 kg with a SD of 0.48
Of the total group 22.8 percent were stunted, 18.3 percent wasted and 29.5 percent underweight with the percentages of severe stunting, wasting and underweight being 4.7 percent, 1.3 percent and 7.0 percent respectively. Prevalence of stunting was lowest in the under 6 months age group and showed an increase up to the age of 36–47 months and then a decline. Data on wasting shows that the prevalence was low in age groups under 6 months and 6-11 months, with high prevalence values in the age groups 24-35 months and 48-59 months, thus not showing a consistent pattern. The prevalence of under weight also does not show a consistent pattern with increasing age.
There were no consistent differences between boys and girls in the prevalence of stunting but a higher prevalence of wasting and underweight was seen among boys. There was an indication that the prevalence of all three indicators declined with increasing levels of education of the mother.
Health services availability and use was relatively satisfactory except for the Vitamin A supplementation programme and to a lesser extent, the services for ‘deworming’, and the pattern of use of services not showing differences between the two groups of households. Availability of sanitation facilities and practices related to proper hygiene were better among the resident households.
Of all children 80 percent were enrolled in a feeding programme, this proportion being comparable between the children from resident and resettled households. The commonest food supplement provided was Thriposha with micronutrients being provided to 15 percent of participants and plumpy nut and BP 100 being given to 2 and 4 percent respectively.
Daily labour was the main source of income in these households with this percentage being higher among the resettled families. Less than half of the households had undertaken paddy cultivation during the most recent harvesting season with a small percentage of households having home gardens.
Nearly a third of the sample, had received humanitarian assistance within the preceding three months, with this percentage being higher among the resettled households, the main types of assistance being food assistance and Samurdhi vouchers.