25 September, 2020

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20% Of Lankan Population Malnourished

By Charitha Ratwatte –

Charitha Ratwatte

Malnutrition will cost the world US$ 125 billion

The politician responsible for national health care of the people has gone on record saying that over 20% of the population appears to suffer from malnutrition. He was speaking at a Pulasthi Knowledge Foundation event in Polonnaruwa.

Recent research by Save the Children in Ethiopia, India, Peru and Vietnam that infants who do not receive the necessary nutrients in the first 1,000 days of life, from conception to their second birthday, will suffer from developmental brain deficiencies that hold back their learning ability. This will cause a serious obstacle to the progress, both social and economic, of countries and communities suffering from severe malnutrition.

The Save the Children studies monitored 3,000 cases, showed that children who were malnourished scored 7% lower on maths tests and were 19% less likely to read a simple sentence by the time they were eight years old. They were also 12% less likely to be able to write a simple sentence and 13% likely to be in the correct grade in their school.

Save the Children points out that the problems of malnutrition have been ‘under-recognised and underappreciated’ by nations and communities which have traditionally relied on small holder small scale agricultural holdings and lower skilled sectors at the bottom of the economic ladder. This certainly seems to be the problem we are having.

It is not that people who are malnourished and stunted will not be able to get through a basic education; most of them will do so. But as countries need to improve the skills of the workforce into more technical and technological fields, limitations of capacity will emerge. Certainly at hi tech and tertiary levels there would be huge drawbacks. There will be a real constraint to a population’s enhancement of skills and capacity.

Tackling malnutrition: Pitifully slow progress

At a recent Global Nutrition Summit, it was stated that progress in tackling malnutrition has been pitifully slow when compared with the other Millennium Development Goals. Save the Children reported that, for example, overall progress in improving children’s education has been 32%, but nutrition has improved only 13%, since the mid 1990s.

A Consultant Medical Nutritionist at Colombo’s Medical Research Institute disclosed some time ago that 0.38 million Sri Lankan children under five years of age were stunted. She also stated that 0.2 million or one in nine children are wasted, being below normal weight for height, 0.4 million or one in five underweight and 0.24 million are suffering from obesity.

There about one million people who are unable to consume three meals a day; 0.3 million of these are elderly people. Four million people, that is one-fifth of the population, are anaemic. One in five or 0.8 million women are underweight, while one in four, that is nearly 1.3 million women, are obese. The issue is further compounded by the fact that currently Sri Lanka is well below replacement levels for population growth indicators. Our birth rate is 0.7 while the minimum required for a population to replace itself is 2.1 children per woman.

When the number of children a woman can expect to bear in her life time falls from the high levels of three or more to a stable rate of two, a demographic change surges through the country for at least a generation. Children are scarce, the elderly are not too many, longevity has not yet set in the death rate being high and the country has a bulge of working age adults.

Currently all labour intensive industries in Sri Lanka are facing manpower shortages. We have probably passed the demographic dividend time frame. This is compounded by large numbers immigrating for employment to West Asia, Korea and other labour importing countries. Large numbers who were recruited into the armed services, before the war ended, being kept in uniform and deployed on construction, maintaining parks and other projects, and the expansion of Government employment has also taken away potential employment capacity in the labour intensive sectors such as agriculture, fisheries, plantations and industries like the garment sector, which is making a great virtue of being able to successfully retain its machine operators. Already in the construction sector, it is reported, large numbers of work visas have been issued to foreigners from East Asia.

Urgent change needed

So not only do we have diminishing numbers of people of employable age, we also will have more of them stunted and intellectually challenged. The resultant skills ‘mismatch,’ as pointed out by Save the Children, the gap between what the process of education and training provides and what the labour market demands, also makes the problem worse.

To enhance the capacities of the fewer children, the process of education and vocational training needs urgent change. Science, Math and English have to be taught in all school. Participation in extracurricular or co-curricular activities, sports, the creative and performing arts, the crucible of creativity, must be encouraged, students must be encouraged to do independent research and presentations and argue and debate positions, to think out solutions, to surmount challenges. Vocational and technical training must be brought under the discipline of the market.

Urgent steps need to be taken on addressing the nutrition angle, as the reasons for the declining birth rate are not ones that can be easily changed. With more women literate and having the capacity to control their own fertility, with the means for such control being freely available, at one time, by a subsidised healthcare delivery system which reaches out to all parts of the country, with more women in the work force, postponing marriage, having children later in life, there are now reports of this being curtailed.

However, social pressures are difficult to change in the short term. Children will be fewer in number and with child survival rates being high, families end up being nuclear, parents plus two children or less; we have the example of China’s one child policy and the ‘Little Emperors!’

The birth rate will, if at all, go up again, taking trends from the developed world as a model, only where economic conditions allow mothers to stay at home to bring up children, a single parent’s income could support the family, where paid help for child care is available freely, where day care and crèches for children are available suitably supervised, regulated and monitored, where facilities such as paternal leave in addition to maternal leave is available to parents who have a young child. Sri Lanka will not have these facilities for some time.

Therefore the only viable solution is to take some aggressive steps to tackle the problems of malnutrition. Researchers have decisively linked malnutrition and poverty, the one feeds the other and vice versa. At a conservative estimate malnutrition is said to bring about GDP losses of at least 2-3%, leading to a potential reduction in lifetime earnings for each malnourished individual.

Stunting among children is linked to a 4.6 cms loss of height in adolescence, 0.7 grade loss of schooling and a seven-month delay is starting school. Clearly, improved nutrition is a driver of enhanced economic growth. Paradoxically, rapid weight gain after the second year in a child has been linked to impaired glucose tolerance and obesity, in turn linked to lifetime diseases such as diabetes and hypertension.

Sri Lanka is a middle income country. Sri Lanka’s maternal mortality of 46.9 per 100,000 live births, infant and under five mortality rates of 13 and 15 per 1,000 live births and life expectancy at birth, 73 years, are good world class indicators.

Policymakers baffled

Some years ago also, the politician responsible for health had gone on record that ‘policymakers are baffled, as they cannot pinpoint the cause for weak nutritional levels in mothers and children’. Sri Lanka is, paradoxically, faced with double jeopardy of both under nutrition and overweight, which is on the rise, among high income groups and this makes the population susceptible to the high risk of cardiovascular diseases, diabetes and other non communicable diseases. Over 20% of Sri Lankan women are overweight and the trend is increasing.

There is a clear correlation between nutrition and poverty, so with poverty levels supposedly going down, malnutrition should also reduce, in theory. The conundrum is the crisis on the ground does not reflect the theory! It’s the converse of the crack about the Economist, who is puzzled as to why what works in practice does not work in theory! Handing out of free nutrition supplements like Thriposha which are often misused and mis-targeted is not the answer.

Delivery of nutrition services

Fortunately Sri Lanka has a well proven model for the delivery of nutrition services. The Nutrition Fund of the Sri Lanka Poverty Alleviation Project, funded by the World Bank (CREDIT 2231-CE) managed by Jansaviya Trust Fund (1991 to 1998) focused on training mothers to recognise malnutrition in them and their children, sensitised them to long-term debilities which it caused and trained them to prepare more nutritious foods to combat malnutrition.

The Director of Nutrition Fund Dr. Priennie Ranatunga and her team trained mothers to recognise under-nutrition and to appreciate that a malnourished mother will give birth to an underweight girl child, who in turn, due to lack of nourishment, will give birth to malnourished children, in the future and that it was within their power to take action to break this vicious cycle. This is in stark contrast to the present method of distributing food supplement Thriposha, which is issued to pregnant mothers and underweight babies.
In a poor household this is naturally shared among the whole family, if the mother is not sensitised of her and her child’s special needs. Dr. Ranatunga trained mothers to plant, grow, harvest, produce and process their own alternative food supplements in their home gardens.

Thriposha deliveries are never on time, poor pregnant and lactating mothers have to make repeated visits to the clinic to collect their allocation. There is under supply and rationing, timely deliveries are constrained by factors like lorry availability and lack of funds for overtime for drivers and cleaners, it is a bureaucratic nightmare for DMOs.

Some remote areas hardly get deliveries, as was emphasised at the Polonnaruwa function by the politician responsible. Mothers turn up for the clinic and go away frustrated. The system punished success, a successful mother whose baby’s nutrition improves and the positive progress is marked on the age for weight chart at the nutrition clinic is deprived of food supplements!

Four successful strategies

The JTF Nutrition intervention’s success was based on four new and important strategies.

(1) Involvement of community organisations, which have delivered development packages to poor communities with no disciplinary blinkers for decades in Sri Lanka. Their incisive understanding of the problems of the poor and their holistic approach to development, (which includes even areas such as culture, values and spiritual development), gives them credibility and asserts their ‘interiority’, thus reducing the social distance between themselves and the people. By the end of 1994, around 40 community organisations had commenced in depth nutrition projects in about 160 divisional secretary areas.

(2) Innovative approach to human development. The highest powers of a human being are those of ingenuity and creativity. Human development therefore requires that brain development proceeds unimpeded. The human foetus and infant (0 -12 months), have the highest state of brain development. 3.5% of the brain being developed, it is estimated at around 3.5 years of life. While brain mass is correlated to nutritional well being, brain stimulation is affected by the child’s environment. The JTF’s Nutrition program used a simple ‘weight/age’ index to measure nutritional status of children, trained mothers to source and feed children with supplements, and supported early childhood education.

(3) Quantification and use of indicators. Voluntary nutrition workers on the program carefully monitored the nutrition of status of children in the village, the access to pure water, the access to latrines, etc., and maintained a scorecard to enable the participants to monitor their own household scores and support was provided to take initiatives which would help to improve the score, for e.g. a community water supply scheme through the JTF’s own participatory Community Projects Fund. A baseline scorecard was prepared and communities shown how they could improve their score and at the same time attain higher mother and child nutrition scores, which were pre-determined through participatory process.

(4) Implementation in a small homogenous geographic area. Community interventions have to be local. Interventions are multi faceted – adult education, preschools, latrine construction and use, water supply schemes, agricultural wells, wells for drinking water, cultivating, processing of supplementary foods, etc. These have to be authentic and sustainable community efforts. A classic case of Schumacher’s ‘Small is Beautiful’. The approach of the JTF’s Nutrition program was participatory with bottom up planning and sequenced, realistic achievable stage by achievable stage.

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Latest comments

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    20% Of Lankan Population Malnourished

    Would the 10 to 20 percent charged on all investments in the past and expected to be levied in the future help stave off Sri Lanka from this vicious circle.

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      The 20% will go up to 24% with the recent increase in electricity rates.

      Just curious, how come None of the Budu Bala Sena Monks are malnourished?

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    Does the govt teaches about nutrition and do they have national programmes which promotes proper nutrition.

    Otherwise, how come diabetes like conditions are prevalent in Sri Lanka ?

    Health minister or ministers are only whining and can not and never show any results.

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    This clearly indicates that 20% of people are below the poverty line. This is confirmed by the World Bank report for 2010 which gives the number of persons earning less than 2 Dollars a day at 23.9%. 2 Dollars is around 260 Rs a day or 7,800 Rs per month and spent on all expenses. So to support a family of four one needs an income of at least 30,000 per month.

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    these are the issues we should be spending time on, not the rubbish that wastes are time in the current socio-political environment we are engulfed in

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    What a foolish country! Sea around the country still suffering lack of protein. Why? Because 65% of the coastline is only used by Tamils. Government should settle Sinhalese fishermen in the north forcefully. Otherwise suffer malnutrition.

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      Another Mahadena Muttha’s crazy comment.

      Eating fish alone does not make one healthy. You should have a balance diet with proper cooking methods with adequate vitamins, minerals, protein,Iron, fiber and daily calories.

      In other countries there are Food Pyramids which they follow.

      http://oldwayspt.org/resources/heritage-pyramids/asian-diet-pyramid
      http://www.macrumors.com/iphone/

      Where as in Sri Lanka they are not been implemented properly.

      Also healthy living, balance diet, outdoor exercise, physical, emotional, spiritual and psychological wellbeing and proper sleeping habits helps wellbeing of the population.

      Excess and cheap adulterated Liquor and smoke ruins a healthy body.

      Quality of Sri Lanka’s Arrack have depleated badly, while there are many other fruits, rice and vegetables available to make healthy Liquor but no effort have been made to do so.

      Also excess chemicals, insecticiseds and fertiliser use kills the nutrients in all agriculture.

      Health is an all round issue wrapped around the society.

      It should be a collective effort to bring up a productive society.

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      Muliyawaikkal, you are another racist. You cannot solve problems without blaming the race. What an idiot!

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      K.A Sumanasekera

      Where are you?

      We like to listen to your “Good News Sri Lanka”.

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      Muliyawaikkal

      “Why? Because 65% of the coastline is only used by Tamils.”

      Good point, send them to Tamilnadu Coastal area (length 910 km India 7,000km).

      Send the Sinhalese to Bihar coastal area, on second thought send them to Tamilnadu if they really want to be fisher folks.

      We will have enough coastline to ourselves.

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    Seems like 20% of the Lankan population has been malnourished for 20 + 20 + 20 + 20 years… in fact, I can predict next years report: 20% of the population will be malnourished. I can even predict the report 10 yrs from now, yes, 20% of the population… Do they even bother with actual data collection, or just wake up and decide 20% of the population is malnourished? See this report by a Colombo U group, http://www.ncbi.nlm.nih.gov/pubmed/17315588, that says childhood obesity is increasing. Now, this is an interesting thing, if both obesity and malnourishment are occuring at the same time, except that that is impossible!

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      The article say in the beginning that……”The politician responsible for national health care of the people has gone on record saying that over 20% of the population appears to suffer from malnutrition.”

      May be they took the wrong segment of the Population for the research to come with the 20% figure.

      I have a strong feeling that they tested the Parliament ministers and the clergy and not the ordinary people.

      Yes now 20% is standard in Sri Lanka with 20% interest, 20% commission, 20% “santhosam” Tip or gratuity and 20% minority population.

      Of couse eating Rice and starch for all three meals makes one Obese. That’s why there should be a balance, mixed and a variable diet.
      It’s the quality and not the quantity that matters.

      To Muliyawakkal, I could only say is that now GOSL has given deep water fishing to a China Company to fish in our waters. So don’t blame Tamils for occupying 65% coastline.

      It is not the coastline, but shortage of deep sea fishing trawlers and latest Technology to track where fish are that matters.

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        If 20% of the population (4 million people) were malnourished, there should be outbreaks of disease. There have been none, except for dengue and some illnesses due to agrochemicals. There are many ways to see that this claim of 20% is rubbish.

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          Can you survive on 300 Rs a day?

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          There’s a big difference between Malnourished / undernourished and Outbreaks of disease. Two different scenarious.

          Go to NIH or following web.and type to find the difference. http://www.nih.gov/

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            Malnourished and undernourished are the same thing.

            Malnutrition occurs in people who are either undernourished or overnourished.

            http://www.hopkinschildrens.org/Malnutrition.aspx

            The poverty level in Sri Lanka has been decreasing over the past 10, while real GDP growth has been increasing. How can the country be more and more productive each year if 20% of the population is malnourished?

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              *over the past 10 years

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              I said the difference between Malnourished and Outbreak of diseases.

              Two different scenarious and are not linked to each other.

              Also if you could show people how to survive on a 90 rupee day income….(2,500 per month as per Bandula Gunawardena) and still being healthy.

              Political Jokers know how to dupe uneducated village muts and get their vote.

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              Two different scenarious and are not linked to each other.

              Wrong, as usual. Everything you write here is rubbish.

              “Health experts are blaming high malnutrition levels for an outbreak of hand, foot and mouth disease (HFMD) that has killed more than 54 children in impoverished Cambodia since April.”

              http://www.ipsnews.net/2012/07/malnutrition-implicated-in-child-killer-epidemic/

              Use some common sense (assuming you have an education). Malnutrition over a long period of time lowers the level of immunity, making individuals more suspectible to disease. Also, if Sri Lankans are so malnourished, the infant mortality rate should be much higher than it is. This is clearly not the case; Sri Lanka has the best indicators in the region, even when compared to India.

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      ” Now, this is an interesting thing, if both obesity and malnourishment are occuring at the same time, except that that is impossible!”

      THIS COULD COME FROM ONLY AN IDIOT LIKE LESTER.

      MALNOURISHMENT IS WHEN ONE DOES NOT HAVE THE BASIC REQUIREMENTS OF FOOD
      GENERALLY PREVALENT AMONG THE POOR.

      OBESITY IS BEING FAT AND OVERWEIGHT,WHICH COMES FROM OVEREATING AND WRONG FOODS AND OF COURSE LACK OF EXERCISE.

      JUST STAND OUTSIDE FAST FOOD OUTLETS AND YOU CAN SEE THE OBESE EATING AWAY,WHILE THE MALNOURISHED ARE WAITING OUTSIDE TO FIND SOMETHING IN THE GARBAGE BIN.

      THERE IS ENOUGH FOOD IN THE WORLD FOR EVERYONE. ITS JUST THAT SOME
      OF US ARE NOT BOTHERED ABOUT THE LESS FORTUNATE.

      IN THE WORLD IF ONLY WE WILL “CARE AND SHARE” WE CAN CHANGE THIS SITUATION.

      LET US BRING ABOUT THIS CHANGE

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    Top 20% of the population enjoy 44% of the income while the bottom 20% only 7%. Bottom 10% only 4%. That is the reason for the difference in waistlines. Read the WB report. CB report is BBS BS.

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      Where did you get your statistics from, Quran?

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        This is from the World Bank report on poverty 2010. You seem to be surprised?

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          Whether your statistics are right or wrong, you cannot assume there is a significant correlation between income and malnutrition.

          Moreover, the fact that there is a less than perfect correlation between nutritional status and either national income levels or national income distribution is often used to distinguish those countries that are atypical or to motivate research to account for this. In places such as Sri Lanka or the Indian state of Kerala where higher levels of health status have been achieved than might have been expected given their aggregate level of income or rates of poverty, this has often happened as a result of the provision of public services (Anand and Ravallion, 1993). Similarly, but less optimistically, in countries where the data show that nutritional status has not improved as rapidly as might have been expected given their income growth, this may indicate that there is a need to make specific investments in human resources(Alderman and Garcia, 1994).

          http://www.nottingham.ac.uk/credit/documents/papers/01-05.pdf

          The government can subsidize food, electricity, etc. That is why 1 in 7 Americans use a government subsidy to buy food, yet the USA has the highest rate of obesity.

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            How can you be healthy when you have no money to eat or buy medicines? The govt has been reducing all subsidies instead of increasing. Also the currency is getting devalued and purchsing power reduced.

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              Go and check your WB data again. Real GDP is increasing and the poverty level is decreasing annually. Less than 10% of the population is at or below the poverty line. Your argument about purchasing power decreasing is nonsense. The Government is not cutting subsidies; example, with the new formula for electricity rates, the poorest segment gets a big break.

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              long before, I felt that Lester is a mad person – and anti muslim by birth is not second to the buddhist monk who dared to insist via hate speeches that muslims in SL serve food to Sinhalese fellow citizens unhygenic food (tea, meals etc). This aggresive monk stammered all these stories to create anti muslims fracitons among us buddhists.

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            How can you quote an article published in 1993 in response to data given in 2010 ? Ignorance or stupidity?

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              The article was published in 2001, not 1993. Another idiot who doesn’t know how to read scientific papers. The paper is about a general trend, e.g. relation between income growth and malnutrition levels, not specific data. You cannot use data for one year to make any sensible argument; only the trend matters.

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            As per report from UNICEF

            http://www.unicef.org/srilanka/activities_1667.htm

            The situation

            For a country that suffers no significant food shortages and provides extensive, free maternal and child health services, it is rather paradoxical that malnutrition affects nearly one-third of children and one quarter of women.

            Almost one out of five children are born with low birth weight – Around 29 per cent of under fives are reported to be underweight, rising as high as 37.4 per cent, in some deprived districts.
            14 per cent of under fives suffer from acute malnutrition (wasting) when their weight is compared to the weight of a normal child of the same height.
            Nearly 58 per cent of infants between 6 and 11 months and 38 per cent children between 12 – and 23 months are anaemic.

            Main factors contributing to malnutrition

            The immediate and underlying causes of childhood malnutrition in Sri Lanka range from disease factors and inadequate dietary intake to knowledge and cultural factors that influence the utilization of health services and available food.

            Poverty in its many manifestations (among these, low household income, inadequate basic infrastructure, limited access to media), affects nearly 23 percent of households in Sri Lanka and is closely intertwined with household food security. However, while poverty is an important basic determinant of child under nutrition, it does not solely explain the high rates of child malnutrition prevailing in Sri Lanka. Other major determinants of malnutrition in the country include inappropriate feeding practices, micronutrient deficiencies and disease.

            http://www.unicef.org/srilanka/activities_1667.htm

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              The article lists other possible causes of malnutrition: lack of clean water, babies not being breastfed, children being given the wrong kind of food (as opposed to food per se), insufficient Vitamin A intake, etc. This just confirms what I said earlier: raising everyones income level will not make malnutrition disappear overnight.

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            This report has onlt a passing reference to the paper by Anand and Ravallion, 1993 and only refers to Sri Lanka in that context. Other than that there is no reference to Sri Lanka in any of the data tables except in table 7 in one place where it gives some data of 1977. Data for 1993 papar is pre 1993. It is useless talking about outdated data when things have changed drastically as reported by UNICEF.

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              Again you are missing the point. The paper is talking about a GENERAL TREND. To understand a GENERAL TREND, you need to look at data for 10, 20, 30 years. The general trend the paper is talking about is that there is weak correlation between malnutrition and income level. This trend has been established by looking at data over decades. Only fools like you think 1 year is meaningful.

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            How can you establish a general trend without fresh data. Data pre 1993 cannot correlate to the situation today, twenty years later, unless you consider recent data. What happens between 1993 and 2013?

            Fresh Data collected on an yearly basis gives the realistic yearly position. Trends are useful in predicting but have to be based on real data taken at regular intervals. Trends lines rarely fit the real situation and cannot supercede real data.

            You are the fool who is displaying your ignorance. Public in Sri Lanka is well educated and cannot be fooled by such glib talk of ‘General Trends’.

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              Hey Idiot,

              It is STILL the trend that malnutrition does not correlate well with income level. This was trend was established LONG BEFORE 1993. I am not going to tell you to go and examine the literature, because you obviously have no clue how to read professional papers.

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            I think you are the idiot. Havent you read the last paragraph of the report quoted by you

            ‘However, we also stress that income growth is also part of this balanced strategy. Sustained per capita income growth will go a long way towards the goal of halving child malnutrition rates by 2020. Indeed, despite the potential of direct nutrition interventions ranging from community-based behavior change activities (such as infant growth promotion) to national campaigns for immunization, micronutrient supplementation and food fortification the impact of such interventions is likely to be hampered in the absence of the income growth.’

            Can you tell me any positive actions by the govt like the Malla for pregnant women that was promised but never happened.

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              You must have missed the words “balanced strategy.” Or do you not know what a balanced strategy is. Your initial assumption was that only income level matters for malnutrition. That is obviously a foolish assumption.

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            The relationship between malnutrition and income levels has been the subject of much discussion

            http://www.humaninfo.org/aviva/ch31.htm – 1998

            “This article takes issue with mainstream evidence in the literature purporting to show that increasing household income alone is not enough to do something significant towards combating malnutrition in the world. It argues that poverty lines used as a threshold to surpass (in order to show measurable improvements in the nutritional status of vulnerable women and children in the short term) are too low. It further points out that the primary determinant of nutritional status of young children may actually not be total household income, but rather that portion of it earned and controlled by the mother.

            Modernization and market expansion have created consumption preferences that compete with food as a need thus leading to decreasing percentages of household income being spent on food. With competing expenditure options, the relative poverty line for a given location (based on current local food prices plus the prices of other needs) is clearly at a higher household income cut-off point than the absolute poverty line that researchers reviewed are using as a threshold. Households that raise their income barely beyond the poverty-line-set-too-low still do not show the expected improvements in the nutritional status of vulnerable household members. The point is made that poverty alleviation of an order of magnitude significantly beyond absolute poverty is needed for lasting nutritional improvement to occur; providing for an adequate minimum nutrition of all household members year-round is simply taking more, because the percentage of total income being spent on food is lower due to competing needs.”

            “But somehow, current interpretation of available data is leading to a double message: income generation has a role to play in reverting malnutrition in-the-long-run, and non-income related interventions in-the-short-run. As a result, policies derived from this message notoriously first and foremost target the short term interventions -considered to be more ‘doable’- and leave the long term ones for ‘others’ to do something about.

            I repeat, large absolute increases in poor households’ incomes are necessary along with synergistic public expenditures in health, water, sanitation, nutrition and women’s and children’s care in order to root out poverty-linked malnutrition in the world.”

            http://www.adbi.org/files/2005.01.14.dp21.malnutrition.poverty.indonesia.pdf

            “XII. Conclusion and Recommendation
            Although income or expenditure level as a poverty indicator appears relevant conceptually,the practical use is limited by its reliability, cost effectiveness, timeliness, and comparability
            across countries. The use of income or expenditure as poverty indicator has numerous problems particularly in using it in monitoring poverty impacts of agriculture and rural
            development projects. Prompted by the need for an alternative indicator for ADB rural development project, the paper evaluates the possibility of introducing child malnutrition as an alternative poverty indicator to the commonly used income indicator. The evaluation shows that child malnutrition as poverty indicator to assess the fulfillment of socio-economic
            development goals and targets is conceptually sound and is more practical. Empirical studies show that child malnutrition is closely linked to income level, the widely used poverty
            indicator. A study also shows that child malnutrition is reflective and indicative of other desirable development outcomes i.e. gender equality, intra-household distribution, and health
            environment quality. That the relationship between child malnutrition and poverty is most sensitive at the lower end of the income range makes child malnutrition a good indicator for
            development intervention projects and programs, which generally target this section of the population.”

            Thus the relationship between poverty and malnotrition at the lower end of the income range is well established. State intervention through subsidies and health care is decreasing due to economic reasons and people have to fend for themselves.

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              “This article takes issue with mainstream evidence in the literature purporting to show that increasing household income alone is not enough to do something significant towards combating malnutrition in the world.”

              Do you know what mainstream means? It means the standard view. Again, you are refuting your initial argument by posting from articles which you obviously do not have the intellectual capacity to decipher. In this case, the mainstream view is that household income and malnutrtion are only marginally related, which has been my point all along.

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        LESTER- DO NOT TRY TO MAKE FUN OF THE QURAN.
        YOU ARE EXCEEDING THE LIMIT. I WOULD NEVER BELITTLE THE BUDDHA OR
        DHAMMAPADHA.

        YOU ARE ACTING LIKE THE “SON OF A FEMALE DOG”

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    Ah! Now the real statistics are out. The official statistics for the past few years state that Sri Lanka is becoming a rich country. Up until last year people were struggling to have two meals a day and now with the hikes in cost of living due to electricity tariffs and very soon bus fares, people have to fight very hard to have one meal a day. when walking down the public roads, you could see from the faces of the school children, workers and the elderly, how hungry and unhappy they are. Getting slimmer may be a fad for the rich but here the majority of the people are think and small made because of the lack of food. I pray and hope that the government would take remedial action by tackling waste and corruption.

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    Lester seems to attack muslims for any issue ? He should have been born with anti muslim gene :(

    I think these levels of malnutrition we have been having for the last few decades and it is common with many other poorest countries such as ours.

    But the problems lies somewhere else, that the rulers have not system to eradicate the corrupted events and divert those funds for the benefit of the poorest of the the poor in the country.

    Instead of brainwashing by state media bla bla – implementation of the genuine efforts in terms of solving malnutrition issues is imperative to date.

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    I presume that proper nourishment and it’s influence on brain development applies only to infants and young children. My thoughts went to our parliamentarians who appear to be well nourished, but without the attendant brain development. Could they have been undernourished when they were children? The ‘stunting’ and ‘skills mismatch’ that is observed is also present in parliament. An interesting subject for research don’t you think?

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    20% Of Lankan Population Malnourished

    including mahinda.Poor man,can see the bones in his cheeks.Wife on strike and not feeding him.No money to buy food too, because he has been lavishly giving food to the poor and has now run out of money for himself.Mahinda,before you open your doors wide and let every tom,dick and harry come in and eat from your kitchen,please ask yourself this question,who is going to feed you one day.See,you are starving now.

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    Come to think of it,charitha ratwatta also looks malnourished.

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      yes, in that case, that cant be named as mal nourished but rather as anorexia.

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    kirby Lannerolle is the answer to this problem.Over to you president,hand the job to kirby to make them breatharians.

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      Appoint Rev.Gnanasara as the Nutrition and health minister and BBS as advisers. Seems like they have all the symptoms to have and keep a healthy body.

      Remember body size matters and says a lot.

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      WE DONT HAVE TO GO TO KIRBY!!!

      SOON WE WILL ONLY HAVE THE AIR WE BREATHE FREE,THAT TOO POLLUTED.
      MAHINDA CHINTHANAYA BROUGHT ABOUT THIS SITU’.

      LOOKING AT MAHINDA,SIRIPALA AND GALABODAWATTE,ARE BURSTING AT THEIR “SEAMS”

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