Page 12
Sum
his report presents the finding vitamin A deficiency and sever:
sample consisted of 60 cluste selected from 30 Divisional Secretariat assessing vitamin A deficiency status concentration in blood samples of 175 years of age. Prevalence of Bitot's spot corroborative evidence of vitamin A sta was measured using semi-quantitat addition, information is collected on th water and sanitation, breastfeeding.
diarrhoea, and nutritional status.
Vitamin A deficiency status Vitamin A deficiency is a severe pu indicated by 36 percent (against cut serum vitamin A concentration Corroborative evidence for this is seen 0.5 percent. Intake of vitamin A rich i measured by food frequency survey.
There is no statistically significant gen concentration. Vitamin A deficiency i provinces. The deficiency is severe provinces where it is a moderate proble poor environmental sanitation, having
'Divisional Secretariat division is the administrative
Vitamin A Deficiency Status of Children in Sri Lanka
amary
gs from a household sample survey on al World Summit goals for children. The ers of approximately 100 houses each, E (DS) divisions. The principal means of
was by measuring the serum vitamin A 50 children between six months and six ts and night blindness was measured as atus. The adequacy of vitamin A intake sive food frequency methodology. In Le World Summit Goals on access to safe access to iodised salt, prevalence of
ablic health problem in Sri Lanka as off level of 20 percent) of children with below 20 micrograms per decilitre. in prevalence of Bitot's spots exceeding foods is on the margin of inadequacy as
der or age difference in serum vitamin A s a public health problem in each of the - except in the Western and Central em. Children living in poor housing and g no access to safe drinking water are
sub division of the district.
Page 13
Vitamin AI
more likely to be vitamin A deficient than ot variation by mother's education level, which is health and nutrition indicators.
Over 70 percent of mothers are aware of some green leaves are a source of vitamin A was ! mothers. However, less than half the mothe vegetables, and less than one third knew of vitamin A.
Consumption of lodised salt Forty eight percent of households were found kitchens at the time of the survey. This prop compared to less than 10 percent use in early salt samples were observed to be moist or dirty i
Protein energy undernutrition: Among children 6 to 59 months of age, 34 | moderate or severe level. Eighteen percent of percent wasted. There is no significant differe levels of protein energy undernutrition. Undern age in the first months and continues to increa as has been observed in previous national sur province is the worst affected with 54 percent o Central and North Central provinces follow close
Diarrhoea: Prevalence of diarrhoea among children under preceding the survey was 3.8 percent.
eficiency Status of Children in Sri Lanka
hers. There is no significant
a strong differentiator of other
vitamin A rich food. That dark
Cnown to about 70 percent of ers knew of yellow fruits and E animal foods as sources of
to have iodised salt in their portion is a dramatic increase 1995. However, 18 percent of n appearance.
percent are underweight to a 'children are stunted and 14 nce between boys and girls in utrition increases sharply with se although at a slower speed, teys. Geographically, the Uva of children being underweight.
ly.
five years in the two weeks
Page 14
Breastfeeding: Almost all children have been bre Breastfeeding continued until the en children. Just seventeen percent exclusively breastfed for four months.
Access to water and sanitation:
Nearly thirty percent of households ha which is defined as piped water, tube of households have no access to a safe
Fitamin A Deficiency Status of Children in Sri Lanka
astfed for at least a short period. 1 of the second year for 51 percent of of one-year old children have been
Ive no access to a source of safe water, well, or a protected well. Thirty percent latrine.
Page 15
Vitamin AI
Chapter 1
Introduction
Background
Titamin A deficiency (VAD), is the si
childhood blindness in developing contributes significantly to morbidit
childhood diseases. The global conc debilitation including blinding, misery, and deficiency (VAD) gathered considerable mom Heads of State, ministers and other represe pledged to eliminate vitamin A deficiency and blindness by the year 2000 at several intern World Summit for Children (New York, 1990), t Hidden Hunger (Montreal, 1991), and the Nutrition (Rome, 1992).
The Government of Sri Lanka in its National prepared in pursuance of the World Summ achieve virtual elimination of vitamin A de including blindness by the year 2000. There on the status of vitamin A deficiency. The vitamin A deficiency was made in 1974/75 Ministry of Health in collaboration with the C Atlanta (Ministry of Health 1976). This surve months of age in rural areas showed that prevalence of Bitot's spots exceeding the WHO for a significant public health problem. Howev
was confined to a sub-sample of 346 ch inconclusive to determine vitamin A deficiency
Deficiency Status of Children in Sri Lanka
ingle most important cause of
countries. Even mild VAD y and mortality from common cern for eliminating preventable Heath resulting from vitamin A entum since the early 1980s. entatives of countries have all - all its consequences including
ational fora. These include the che Policy Conference on Ending - International Conference on
Plan of Action (NPA), which was uit Goals for children, aims to ficiency and its consequences is no recent national level data only large scale assessment of in a survey conducted by the entre for Disease Control (CDC), ey of 13,450 children of 6 to 71
many of the provinces had a O suggested cut off (0.5 percent) wer, analysis of serum vitamin A nildren and the results were
status.
13
Page 16
The renewed efforts to eliminate v pointed to the need for an assessmer the Medical Research Institute of the a household survey to assess VAD Control Project of the UNICEF assiste of Sri Lanka. At the time the study for an assessment of the situation children. A few of the goals for wl available or needed verification were The goals included access to iod reduction of diarrhoea, improving a basic education.
Objectives of the study: The survey was designed with two ob
i) to assess the prevalence of vitamir. ii) to assess the situation of childre
World Summit Goals.
Organisation of the report The rest of this report is organised i survey methodology. Chapter 3 des deficiency status. Chapter 4 pres assessment of vitamin A rich food survey. Chapter 5 presents the situ Summit Goals.
Vitamin A Deficiency Status of Children in Sri Lanka
itamin A deficiency in the country had at of the situation. Recognising this need,
Ministry of Health undertook to carry out as part of the Micronutritent Deficiency d Nutrition Programme of the Government was being designed, the need also arose
with respect to a few decade goals for hich as at 1995 an assessment was not identified for measurement in this survey. lised salt, reduction of undernutrition, access to safe water and sanitation, and
ejectives.
a A deficiency in Sri Lanka; en with respect to a number of selected
in four chapters. Chapter 2 presents the cribes the methodology and the vitamin A ents the results of a Helen Keller type intake carried out along with the main
lation with respect to a number of World
14
Page 17
Vitamin A
Chapter 2
The Survey Organ The survey was designed and conducted the Medical Research Institute. Prior were sought from Divisional Directo
paediatricians, ophthalmologists, s physicians, and Health Ministry officials. Of : percent responded to the questionnaire and of based on their personal experiences vitamin A certain areas. Almost all wanted to know m status, strategies for reduction of VAD and subsequent consultative meeting, a decision u survey to assess vitamin A deficiency status of
Sample design The sample was designed primarily to obtain : children with serum Vitamin A levels below the information on this proportion, it was assur purpose of computing the sample size. Since v occur in clusters, a fairly high design effect o size required to yield an estimate of populatie error is 1556 children 6 to 71 months of age. equation.
N =
4p(1-p)d
—, where
Z Z
E
|| ||
sample size expected proportion design effect sampling error
If II
Deficiency Status of Children in Sri Lanka
isation a by the Nutrition Department of - to designing the survey, views ers of Health Services (DDHS). staff of universities, family 232 professionals contacted, 48 them 25 percent indicated that
deficiency may be a problem in more about vitamin A deficiency
technical information. At a was taken to carry out a sample children in Sri Lanka.
an estimate of the proportion of e cut off value. Having no prior
med to be 40 percent for the Fitamin A deficiency is known to -f 4 was assumed. The sample on proportion within 5 percent as computed from the following
Page 18
This was increased by 20 percent to 1843 to allow for any refusals to give blood samples, and more likely for loss of blood samples due to spoilage. The required number of households to yield a sample of 1800 children of the age group 6 to 71 months is 5974. The sample size was therefore fixed at 6000 households.
The sample was selected to be representative of the country excluding the northern and eastern provinces, using a stratified t identified as low and high prevalence survey (map 1). The first stage se divisions, which are almost always Health Service divisions (DDHS). Thi stratum, with probability proportiona was GN division, the administrative divisions were selected from each se proportional size. Each selected GNO clusters each containing approxima prepared by the interviewer of the statistician. One segment was sele selected segment were agreed upon marked a starting point and a travel r
Vitamin A Deficiency Status of Children in Sri Lanka
Tap:1 Districts of high and low prevalence
of Bitot's spots, 1975
Hiet
KINI
La
wo stage cluster design. Two strata were e of Bitot's spots as observed in the 1975 lection units were Divisional Secretariat coterminous with Divisional Director of rty DS areas were selected, 15 from each 1 to size. The second stage sampling unit sub-division of the DS division. Two GN lected DS division, again with probability division was demarcated into two or three ately 100 housing units, using a map
respective area in consultation with a cted at random. The boundaries of the ! with the interviewer. The interviewer Foute within each cluster. Thus, a total of
Page 19
Vitamin A
Map 2: DS
loc
60 clusters of approximately 100 housing units were selected from 30 DS divisions. All housing units in each selected cluster, and all children of relevantage groups were included in the sample, for the respective sections of the questionnaire.
5.
The questionnaire consisted of the following sections.
1. Identification
2. Household listing for eligibility screening
3. Background
and consumption of iodised salt
4. Food frequency (Helen Keller)
Breast feeding and complementary feeding 6. Illness and Vitamin A rich food intake
Clinical signs of vitamin A deficiency
Schooling 9.
Mother's information 10. Anthropometry The questionnaire was pre tested in a nondivision, for comprehensibility, appropriatenes of administration. A manual was prepared fo field.
3.
Deficiency Status of Children in Sri Lanka
- Divisions where sample clusters are
ated
survey area, in Kolonnawa DS -s of wording, and any problems or interviewers' reference in the
Page 20
Survey Staff The survey staff consisted of two cen central team consisted of a medical of and two measurers of heights and sample cluster to collect blood samp assess night blindness and Bitot's S peripheral team completed the collec questionnaires. The peripheral team for each DS division) and 60 investig area co-ordinators were the Division respective areas. The household int and public health nursing sisters.
Training Training programmes were conducte household questionnaires, for measu and for the central team on collectin eliciting history of night blindness.
The 60 interviewers were trained at batches. Area co-ordinators also atte three days duration. The training co and its purpose. This was followed by with the questionnaire. The question explained through discussions, mo Following the class room sessions the a few households outside the sample final session of the training the admis questionnaires, instruction manual,
were given to each interviewer.
Vitamin A Deficiency Status of Children in Sri Lanka
atral teams and a peripheral team. Each ficer, one medical laboratory technologist
weights. The central team visited each ples, measure heights and weights, and Spots. These visits were made after the etion of household data using structured a consisted of 30 area co-ordinators (one ators, (a pair for each DS division). The nal Directors of Health Services of the terviewers were public health inspectors
ed for interviewers on administering the arers on measuring heights and weights, g blood, examining for Bitot's spots, and
the Medical Research Institute in three ended the training. Each training was of -mmenced with an overview of the survey y small group exercises to gain familiarity naire and interview techniques were then =ck interviews, and practice interviews. e trainees interviewed, under supervision, and the problems were discussed. In the nistrative procedures were explained, and check list of duties and other materials
18
Page 21
Vitamin AI
The area co-ordinators were briefed on proc included scrutinising, all questionnaires for a checks and at least one re-interview in each clu
Two members from each of the two central tea heights and weights of children. The measure and accuracy of measurement. For this purpos two measurements of heights and weigh measurements were compared with the meas measurers who failed to reach the accepted le and given opportunity to further practice.
The two medical officers of the central team w examination of Bitot's spots. The team also | night blindness. Words and phrases to use in or caretakers about evidence of child's reduc upon as inability to recognise one's toys and and tendency to knock against household goods
The laboratory staff was trained by a seni technician who has had a training at a spe procedures of separation, fixation, transp technologists were trained to use the High P. (HPLC) to measure serum vitamin A concentratio
Data Collection Data collection was carried out in two stages. respective clusters collected data on the que
mother, or in her absence, the caregiver.
Sixty interviewers were assigned, one for each household questionnaire. Approximately hali
Deficiency Status of Children in Sri Lanka
cedures for supervision, which set of basic requirements, spot ister.
ams were trained in measuring ers were evaluated for precision se each pair of measurers made ats of 10 children.
These surements of the trainer. The
vel of accuracy were re-trained
ere trained to carry out clinical prepared for eliciting history of
asking questions from mothers med vision at dusk were agreed other belongings or individuals,
or trained medical laboratory ecialised centre abroad on the ort and storage. Two lab ressure Liquid Chromatograph on using pooled plasma.
In stage one, interviewers of estionnaire by interviewing the
of the clusters, to canvass the f the interviewers were public
19
Page 22
health nursing sisters and the rest respective DDHS areas. Each intes starting from one end of the cluster.
minimum of three times when it was any other responsible person. Area interviewers. The central team vis progress early in fieldwork. The te schedules, observed at least one investigator and re-interviewed at leas informed of any errors or incorrect pre
Stage two of the data collection interviews in each cluster. The centra spots, elicited history of night blir
weights of children.
Data Processing Data collected from the survey were software package developed by Cen computer processing capacity led to and validation. Analysis was carried
Vitamin A Deficiency Status of Children in Sri Lanka
I were public health inspectors in the Tviewer visited households sequentially
The households were revisited up to a s not possible to interview the mother or Co-ordinators supervised activities of the sited a number of clusters to monitor eam scrutinised a sample of completed
interview being conducted by each st one interviewee. The interviewers were ocedures.
followed the completion of household al teams examined the children for Bitot's adness, and measured the heights and
keyed in to computer files using EPI6, a stre for Disease Control (CDC). Lack of some difficulties and delay in data entry out using SPSS for Windows.
Page 23
Vitamin A D
The Sample Implementation
A total of 6049 households in the 60 clusters w Of these, 5998 were Table 1: Sample In successfully interviewed
Number of househo against the required 6000.
Number of household The urban proportion was
Number of household 15 percent, the same as the
Number of children 6 national urban proportion.
Number of children 6 Table 1 shows the numbers
Number of blood sa of households, and eligible
Number of children u respondents interviewed.
eficiency Status of Children in Sri Lanka
vere visited by the interviewers.
mplementation olds expected Is visited
6000
6049
Is interviewed
5998
1800
to 71 months required
to 71 months in the sample
2869
uples successfully analysed
1750
nder 5 yeaTS
2742
Page 24
Ch Vitamin AD
itamin A deficiency (VAD) preventable childhood blind
an essential nutrient for g response and cell differentiation. E associated with increased morbidity inefficient iron utilisation. The m
Deficiency (VAD) are seen in very yo age. In these children VAD is almost undermutrition, a low intake of fats,
tract infections.
The World Summit for Children t deficiency for all ratifying states to a keeping with global criteria has, in i the goal of virtual elimination of vi including blindness by the year 2000
Measuring Vitamin A deficiency Vitamin A Status is classified ir marginal, satisfactory, excessive and and toxic status are characterised t three stages are not. A deficie xerophthalmia described in a later not associated with overt clinical sig in dim light, reduction in gob abnormalities in many tissues inclu
Vitamin A Deficiency Status of Children in Sri Lanka
apter 3 eficiency Status
is the single most important cause of ness in developing countries. Vitamin A is rowth and development, vision, immune ven marginal Vitamin A Status has been and mortality, decreased growth rate and ost serious manifestations of Vitamin A sung children, SİX months to six years of invariably associated with protein energy gastrointestinal infections and respiratory
herefore, included a goal on vitamin A achieve. The Government of Sri Lanka, in its national plan of Action for Children, set tamin A deficiency and its consequences
ato five sequential categories: deficient, - toxic. The extreme categories of deficient y clinical signs, whereas the intermediate at status is characterised primarily by section. A marginal vitamin A status is ens. It can be detected by impaired vision Let cell frequency, and epithelial cell ding the conjunctiva of the eye, as well as
Page 25
Vitamin AD
by abnormal increases in plasma retinol in resp vitamin A. A satisfactory status means that vitamin A are being adequately met by the exis vitamin. Excessive and toxic statuses result fra of vitamin A. (IVACG, 1993). Although exc particularly by pregnant women have serious c are not investigated in the study.
Traditionally, several types of indicators of VI include clinical and sub-clinical signs, biolog intake of the vitamin, and socio-demographic ir The choice of indicators depends on the purpose the qualities of the indicator. Indicators sh acceptability by the people and data collectors, conditions, and their measurability at reasonab also be sufficiently sensitive and specific to asse the severity of the problem. Thus far, the indica the clinical signs of xerophthalmia, night blin values (WHO, 1993).
Xerophthalmia (dry eye) is the most readily recog vitamin A deficiency. It has been the most wide assessing whether VAD poses a public heal Xerophthalmia includes all ocular manifestat ranging from night blindness to corneal ulcerati
The major eye signs and cut-off points of i suggested by World Health Organization are g criteria are the consensus of expert groups, ind select more stringent criteria.
eficiency Status of Children in Sri Lanka
-onse to a small oral dose of the
all physiological functions of stent total body reserves of the om ingestion of large quantities cessive intakes of vitamin A, consequences, these categories
AD have been in use. These gical indicators, measures of adicators which act as proxies. e for which it is to be used and Lould be feasible in terms of
their obtainability under field le cost. The indicators should ess reliably the magnitude and tors recommended by WHO are adness, and serum vitamin A
gnised clinical Imanifestation of ely used definitive criterion for th problem in a population. ions of vitamin A deficiency on and resultant blindness.
public health significance as iven in Table 2. While these ividual countries may wish to
23
Page 26
Nig
Сог
While xerophthalmia surveys
Tat are considered the primary
Crit reference standard for the assessment and determination of public health problems, the
Bite
low prevalence rate of clinical disease and clustering of cases
Xer
make it necessary to have very
Sou large sample size. This survey
measured the prevalence of
two
indicators
of
xerophthalmia: night blindness and E
Night Blindness and Bitot's spots Night blindness is the inability to s dusk, early dawn or in a dimly lit manifestation of marginal vitamin A widely used definitive criterion for significant public health problem
The WHO recommended interpretatic that vitamin A deficiency is a "seriou percent of children are night blind". is 24 to 71 months of age. For the age this may not be a reliable indica after dark, and therefore their night 1
Testing every child for night blindne adapt to low levels of light is time practical approach is to ask - the caregiver, whether the child is night
Vitamin A Deficiency Status of Children in Sri Lanka
le 2: Clinical criteria for assessing the public
health significance of xerophthalmia erion
Minimum
prevalence it blindness
>10 %
t's spot
>0.5 %
1eal Xeroxes and or ulceration
>0.01%
ophthalmia related corneal scars
>0.05%
Ice:
A Brief Guide to Assessing Current Methods of Assessing. Vitamin A Status. (1993) A Report of the International Vitamin A Consultative Group.
Bitot's spots.
see under low illumination such as late E room. It is often the first functional A deficiency. Its prevalence has been a
assessing whether vitamin A poses a
-n of the prevalence of night blindness is s public health problem when at least one
The age range for computing prevalence very young children under 24 months of tor since they are not particularly mobile -lindness may go unnoticed.
ss by measuring the ability of the eye to
consuming and not practical. A more child's mother, or in her absence the blind. This is particularly easy if a local
24
Page 27
Vitamin A
term for night blindness exists which in recognition of the problem of night blindness. population is considered a basis for using a valid parameter for assessing vitamin A stat Lanka, the term "Thamas Andiriya" meaning bl use, but is not common. In the survey nig eliciting from the mother evidence of difficulty knocking against household items, inability to I
A Bitot's spot is a lesion or a dry, "unwettabl from keratinisation of the surface of the con plaques first form adjacent to the temporal li cheese like material. This cheesy or foamy material is easily wiped
Map 3: off but will re-accumulate rapidly. The presence of the foamy or cheesy material is sufficiently specific for assessment purpose only when present in children under 6 years of age. Temporal Bitot's spots in older children may represent the remains of prior vitamin A deficiency signs and are therefore less useful for population assessment and hence are not commonly covered by population based surveys.
The survey sample had 13 children between 24 to 71 months
Deficiency Status of Children in Sri Lanka
itself is an indication of the
Existence of such a term in a history of night blindness as a us in that population. In Sri urred vision in the evening is in ht blindness was assessed by to see at dusk such as frequent recognise child's belongings.
le" surface in the eye resulting junctiva. Readily recognisable mbus covered with a foamy or
Location of Bitot's spots and night blindness cases
HASH
Nghi dnes.
Page 28
of age with night blindness and 190 with Bitot's spots. The clusters whe and Map 3. As weighted percentage percent night blindness which is slig 0.8 percent prevalence of Bitot's spo percent for public health significance likely to be underestimated, the surv than a precise estimate of the poj prevalence of Bitot's spots and ni deficiency could well be a public heal
Vitamin A Deficiency Status of Children in Sri Lanka
children between 6 and 71 months of age ere they were located are given in Table 3 es, these translate to a prevalence of 0.8 ghtly below the cut off of one percent and ots which is well above the cut off of 0.5 . Considering that night blindness is very ey estimate serves more as a lower bound pulation value. The observed levels of ght blindness suggests that vitamin A th problem in Sri Lanka.
26
Page 29
Vitamin AI
Table 3: Location, age and sex of children with Bi
District
DS Division
GN division
Colombo
Colombo Colombo
Colombo
Aluthmawatha
Colombo
Aluthmawatha
Dehiwela/Ratmalana Katukurunduwatte
Katana
Dabaduraya
Gampaha
Katana
Dabaduraya
Katana
Gampaha Gampaha Gampaha Gampaha
Kalutara
Katana
Katana
Matugama
Kalutara
Matugama Naula
Matale
Dabaduraya Dabaduraya Dabaduraya Adawela
Adawela Hapugasdeniya Pahalagoda Kandahena West
Usmalagoda
Usmalagoda Usmalagoda Nedeyawa
Hambantota
Belialla
Kandy
Thumpane
Matara
Kotapola
Matara
Kotapola
Matara
Kotapola Kurunegala
Maho
Puttalam
Karuwalagaswewa Anuradhapura Palagala Ratnapura
Eheliyagoda
Ratnapura
Eheliyagoda
Ratnapura
Nivithigala
Ratnapura
Nivithigala Kegalle
Kegalle
Weerapura
Gamsaba Halmill
Mitipola Mitipola
Delwala
Delwala
Deewala Medagama
Total
Note:
1.Children 24 to 71 months. 2.Children 6 to 71 months.
Zero cases
Deficiency Status of Children in Sri Lanka
itot's spots and night blindness
Age Night Bitot's
(months) Blindness Spots Female
Sex
Female
Male
Male
— — — — — — |
Male
Male
Male
Male
Male
Male
Male
Female
Male
Female
2 3 4 5 6 A + C B & & 3 & 2 3
= L | I - - -
Female
Male
Male
Male
a Female
Male
i = i == ! 1
= = = =
Male
Female
Female
Male
Page 30
Table 4:
Age (months
6-23
24-47
48-71
Total
Mean =
Serum Vitamin A Levels The main focus of the
Survey
was the
measurement of vitamin A concentration in blood which is one of the best indicators of vitamin A status in children. A blood sample was taken by venipuncture from all children in the age group of Six months to six years in the sample households. The serum samples were frozen in the field and transported to the Medical Research Institute in Colombo where it was analysed using a High Pressure
Liquid Chromatograph.
The results are presented below.
Table 5:
Retinol !
< 10 10 - 20 20 - 30 30 - 40 40 - 50 50 - 60 60 - 70 70 - 80 80 + Total
The frequency distribution of serun population provides a useful indicat status. The frequency of values below The cut off values recommended by t Group (IVACG) are 20 mg/dL (0.70 um for deficient. These cut off values are
Vitamin A Deficiency Status of Children in Sri Lanka
Age and sex distribution of children whose serum vitamin A levels are analysed Total
Male
Female No. Percent
No. Percent
No. Percent
391 22
198
21
| 182
22
665 40
357
308
38
704 38
343
42
361
40
888
100
852
100
1750 100
41.2 months
9.6
Percentage distribution of children 6 to 71 months by sex and serum
vitamin A concentration Ig/dl
Male Female
8.3 26.4
26.2 34.1
35.2 20.4
21.2 7.3
7.3 1.0
0.9 0.5
0.1 0.3
0.3 100
100
Total
9.0 26.3 34.6 20.8
7.3
0.4
0.5
0.9 0.4 0.3
0.3 100
n vitamin A obtained from the study or of sub-clinical vitamin A deficiency ra cut off identifies the deficient groups. he International Vitamin A Consultative 10l/L) for low and 10 mg/L (0.35 umol/L) : arbitrary. They have been established
28
Page 31
Vitamin A D
Sex:
from available cross sectional surveys where sampling
Table 6: F
techniques were not necessarily representative. Also requirements of specific age sex groups such as young
Male
Female children and adolescent girls
Age (months are not considered. Some
6 - 23
24 - 47 recent work has shown that
48 -71 serum vitamin A levels have a close to normal distribution
with 95 percent of values greater than or equal old children living in deprived areas who hav vitamin A. Therefore, for diagnostic and E analysis of a baseline distribution against this values greater than or equal to 30 mg /dL), prc the proportion of children below the cut off a insufficiency (IVACG 1993).
Total
The advantage of this method is that a single cro profile of the population's current vitamin A. representative, the results can be extrapolated
measures of central tendency of the distribut deviation, percentiles) of serum vitamin A p population that would benefit from interventions
The 60 clusters had 2869 children 6 to 71 monti collected from 2612 children. It was possible to from 1750 children. The age and sex distributic Table 4.
eficiency Status of Children in Sri Lanka
Percentage of children with serum Fitamin A levels below cut-off values by age and sex.
Cut off value 10 ng/dl 20 mg/dl 30mg /dl
9.6
36.0 34.5
70.2 69.7
8.3
9.0 8.5 9.5
34.8 34.2 36.6
70.5 68.2 712
9.0
35.3
69.9
to 30 pg/dl in two to six year re received a massive dose of program evaluation purposes, s reference (i.e. 95 percent of ovides an objective estimate of and thus at risk of vitamin A
poss-sectional survey provides a status. When the sample is to the larger population, and ion (mean, median, standard -rovide the size of the child s to improve vitamin A status.
hs of age. Blood samples were - successfully analyse samples on of these children is given in
Page 32
Numb
Distribution of serum retinol levels in children The distribution curve of serum vitamin A is shown in Fig.1. The curve is very nearly normal with a median of 24 mg/dl and mean of 24.7 mg/dl. The standard error of the mean is 0.26, implying that the range 23.5 to 24.5 is likely to be the true population mean (at 95% confidence) The standard
deviation of the distribution is 11.2. Table 6 shows the
Table
percentage of children below cut off points discussed Age
earlier.
6 to 23
23 to 4 The percentage of children
48 to 7 with serum
vitamin A
Total concentration below 20 ug/dl is 35.3, very much higher than the WHO recommende vitamin A deficiency is a public hea below 10 pg/dl is considered to be a percent of children in the sample are in populations of children who have 95 percent had serum vitamin A leve of Sri Lankan children only 30 percer
Vitamin A Deficiency Status of Children in Sri Lanka
ig 1: Distribution of serum vitamin A levels
CA00
350 =
300 -
250
200 --
150 ----
100 ----
50
0-5 10 - 15 20 - 25 30 - 35 40-45 50 - 55 60 - 65
ed
7: Mean and median serum vitamin A levels by
age and sex
Male
Female
Total Mean Median Mcan Median Mean Median ng/dl ug/dl Hg/dl Hg/dl ug/dl g/dl
25.223.7 24.224.224.7 24.1 24.9 23.8 25.7 25.0 25.3 24.6 24.5 23.0 23.9 23.224.2 23.0 24.8 23.5 24.7 24.224.7 24.0
ed cut off of 20 percent signifying that lth problem in Sri Lanka. Concentration sign of severe vitamin A deficiency and 9 in this category. Studies have shown that recently received vitamin A supplements, els above 30 mg/dl. In the survey sample at was above this level.
30
Page 33
Vitamin A D
Table 8:
Serum vitamin A concentration by provi percentage below 20 mg/dl
Province
Mean
Western Central Southern North Western North Central
Uva
Sabaragamuwa Total
Total Male Female
28.1 28.5
27.7 23.3 24.2
22.4 29.2 28.7
29.7 21.7 22.3
20.9 17.8 17.3
18.5 23.9 23.3
24.5 20.9 21.0
20.7 24.7 24.8 24.7
Mean
Between boys and girls there is no difference in Nor is there a significant variation with age a indicated by the fitted trend line in Fig. 2, which presents three-month average of the
Fig 2: Age patter
Concentratie mean serum vitamin A concentration.
35 The largest percentages of children with low serum retinol (less than 20mg/dl) are in the North-Central and Sabaragamuwa provinces,
716 25 where half the children have serum vitamin A below the cut off value. The smallest percentages are fr followed by Western province. The mean serum
e u Say
eficiency Status of Children in Sri Lanka
ace: mean, median and
Median
Percentage
below 20mg/dl
Total Male Female 27.6 28.3
27.1 22.7 23.2
210 28.4 27.8
29.0 20.8 21.0
20.7 18.8 18.6
18.8 23.7 22.8
24.9 19.5 19.9
19.2 24.0 23.5
24.2
24.3 22.3 42.5 46.3 57.3
35.0 51.3
36.3
the levels of serum vitamin A. Ithough a marginal decline is
of mean serum vitamin A
DII
MAJAAM
Mean retinol Trend line
34 43 52 61 70 79 88 97 Age group in months
Dund in the Central province vitamin A level is as low as 18
Page 34
pg/dl in the North Central province province.
What is significant is that vitamin A problem in all seven provinces inclu is severe in all provinces except in th is a moderate problem.
How the problem of vitamin A defi groups is shown in Table 9. In ger vitamin A deficient in the lower soci is more prevalent (and the mean vita is poor (perishable materials of Construction,
inadequate ventilation) than when housing is better. It is more when the environment of the houses is not clean than when it is clean. It is more when a community source such as a tube well is the source of drinking water than when living conditions are high enough to have water piped in to the house. It is
more when there is no access to a safe latrine than otherwise.
Vitamin A Deficiency Status of Children in Sri Lanka
and is only 28 ug/dl even in the Western
A deficiency is a significant public health ded in the study. Further, the deficiency he Western and Central provinces where it
iciency varies across the socio-economic neral, a larger percentage of children are 0-economic groups. Vitamin A deficiency min A concentration lower) when housing
Map 4: Prevalence of severe VAD in provinces
0- S. 46
- | vallatale
Northern
ஆகாய் சாப்பா
Titler
FUNCTIE
Crnt
Sainther
Page 35
Vitamin AI
Table 9: Serum vitamin A levels by socio-econ
Mean M
Construction materials Durable material Partly durable All perishable Ventilation of the house Adequate Not adequate Cleanliness of the house Very clean Clean Not clean Access to safe drinking water Piped into the house Common tap Tube well Protected well Unprotected well Other Type of latrine
Water seal (safe) Pit and other type (unsafe) No latrine Mothers education Higher than secondary Secondary Primary
Never Went to school * - Sample size too small
|
25
However, education of the mother does not : This is a remarkable exception to the strong Imother has shown on all other health and I
Deficiency Status of Children in Sri Lanka
nomic indicators
edian
Percentage below 10 ng/dl 20 mg/dl
26
10
40
45
22 11
+ S
34
40
23
33
48
= . = . . . . 5. * E
SE U u u
30 38
39
30
show a significant relationship. positive effect that education of nutrition indicators in previous
Page 36
surveys. While the extent of the proble groups, vitamin A deficiency is a sig groups -- urban or rural, poor or betier
Vitamin A deficiency is a severe publ the proportion of children with low ser across social groups, it is a significant and in all social groups.
Vitamin A Deficiency Status of Children in Sri Lanka
em is larger in the lower socio-economic gnificant public health problem in all -off, educated or not.
ic health problem in Sri Lanka. While um vitamin A varies geographically and - public health problem in all provinces,
Page 37
Vitamin AI
Chapter 4 Adequacy of Vitamin A ric
Mothers' Awareness and children's consump
he Survey
investigated
Table
mothers' awareness of vitamin A rich foods by asking two questions.
Has he
Has he
The first question was the following.
DE
EE
"Have you heard that certain foods help good vision and prevent blindness?" Please name all such foods you have heard of.
Dark green leaves Yellow fruits Yellow vegetables Eggs/meat/fish Other
Over 70 percent of mothers has heard that certain foods help Table 11: Perc
rich good vision. That dark green leaves help good vision was
Food known to about 75 percent of mothers. However, less than
Dark green leaves
Yellow fruits or half the mothers knew about
vegetables yellow fruits and vegetables,
Eggs/mea/fish and less than one third knew
Deficiency Status of Children in Sri Lanka
h food Intake
otion of vitamin A rich foods
10: Mother's awareness of foods
that help good vision
Percentage ard of any food helping
74 good vision eard of ark green leaves ellow fruits and vegetables Sgs/meat, fish cher
|- 88 %
entage of children given vitamin A foods in the week prior to the survey
Sex
Age (months)
- Total Male Female 6-23 24-47 48-71
83 86 74 89 89 85 85 87 84 86 88 86 78 80 68 85 82 79
Page 38
about animal foods as belonging to this category.
The second question was whether the child was given vitamin A rich foods in the week prior to the survey. The responses given in Table 11, shows that high percentage close to or over 80 percent reported having given these foods. There is no gender differ an age bias except that leaves and an ages under two years. This is proba later than six months for some childre
Mothers who were aware that these for them more than others, as seen in T whether the child was given vitamin which supplements were given was available, the investigator was asked t
Although high proportions of mothe rich food and supplements, vitamin implies one or more of several possib the feeding of these foods, the quanti as food preparation, eating habits and inhibiting the bioavaiability of the vita
Vitamin A Deficiency Status of Children in Sri Lanka
Table 12: Percentage of children given vita
min A rich foods according to mother's awareness
AwΙΓΟΠess
Not Type of food
Aware
Total
aart: Dark green leaves
85 Yellow fruits and
90 80 vegetable
Meat, fish, egg, etc.
84 75 79
87
72
86
ence in giving these foods. Nor is there nimal products are given slightly less at ably because such foods are introduced
en.
ods help good vision have reported giving Cable 12. The mothers were also asked
A supplements. If so the duration for e asked and if the supplements were
o see if they were vitamin A capsules.
rs are reported to have given vitamin A
A deficiency is widely prevalent. This milities. Mothers may have over reported ity may be inadequate, and factors such general health status of children may be min, especially dietary carotenoid.
36
Page 39
Vitamin A D
Helen Keller Food Freque
Felen Keller Food Frequency method is not a nutritional deficiency is a population. It is a semi-quantitative
nutrient intake through measuring f quantity consumed.
Methodology
The method essentially asks one question: "Hov days did (child's name) eat (specific food item)" asked by the interviewer for 28 food items (see s The 28 food items already selected and tested following categories of food in the same order.
A staple food, which most children consume on a daily This item is included first to elicit a positive "sever respondent at ease A food that is almost never consumed such as chillies This item is asked second to make the respondent com rarely provides certain foods to the child.
Major sources of vitamin A These foods contain at least 100 retinol equivalents per likely that a normal serving provides a significant quan
Major sources of fat, oil and protein Adequate consumption of these foods is necessary 1 vitamin A.
The order of questioning introduces a com respondent by first asking about the consumptio or bread, which elicits an 'every day' response. : eaten by children or rarely eaten such as ch
eficiency Status of Children in Sri Lanka
ncy Survey
- designed to assess whether or public health problem in a e dietary method of estimating requency of consumption, not
v many days in the past seven ? This question is repeatedly section 4 of the questionnaire). 1 are available and consist of
basis. n days a week" response to put the
fortable with saying that she never or
- 100 grams of food and are therefore, tity of dietary vitamin A.
for the absorption and utilisation of
afortable progression for the on of a staple food such as rice This is followed with a food not hillies, which elicits a 'never
Page 40
response. The ordering of the ques as well as increases the likelihood o
Of the 28 food items some can be s habits. Certain others cannot be rep available. These food items are mar listed below.
Main staple, spicy food, dark green dark yellow or orange pumpkin, no other legume), chicken (or other for Sweet Potato leaves (or other DGLV). (or other plant source rich in vita weaning food fortified with vitamin margarine fortified with vitamin A (o
The foods included in the survey inclusion of locally available vitamir
replacements necessary, for the mo basic survey instrument. The ques replacement foods, but alterations
based on regional availability.
Whether a surveyed community determined by either of the following
Mean number of days of consumption of anii Or Mean number of days of total consumption by type of source) less than or equal to six. . The entire surveyed area is deterT problem if 70 percent or 11 of the 1 deficiency problem
Vitamin A Deficiency Status of Children in Sri Lanka
tions lightens the mood of the respondent Funinhibited responses from the mother.
ubstituted if necessary to suit local eating placed even if they are not locally eaten or ked with a • in the questionnaire and are
leafy vegetables, milk, carrots, ripe mango, podles (or other staple food), peanuts (or
wl or legume), Amaranth (or other DGLV), | lentils (or other legume or meat) Apricots amin A), coconut oil (or other fat or oil)
A (or other food fortified with vitamin A) r other food fortified with vitamin A).
are consumed by all, but provides for 1 A rich food sources. Often there are no ist common foods are all included on the tionnaire used for this study included no for the DGLVs, which were determined
has a vitamin A deficiency problem is
cut off values.
mal sources of vitamin A less than or equal to four.
of animal and plant sources of vitamin A (weighted
nined as having a vitamin A deficiency 5 surveyed communities have a vitamin A
38
Page 41
Vitamin A De
Weighted total number of days = number of day 1/6 x (number of days plant sources consumed)
The weighting of plant sources is to adjust for vitamin A in plant sources as beta carotene and i sources provide vitamin A in the form of retin body, whereas plant sources provide beta carote conversion into retinol before utilisation. There plant sources is weighted by a fraction of one : days of consumption.
The Sample Along with the main survey, the HKI question households where there was a child between 1 each household, information on food frequency with respect to one child 12 to 71 months of a than one child, one child was selected randomly meeting the requirements of the HKI methodology
The HKI method requires that in each area, for w 15 communities are included in the survey and children 12 through 71 months of age success were identified for estimation according to the from serum vitamin A concentration. These a consisting of the Western and Central province consisting of the other provinces, namely No Southern, Sabaragamuwa and Uva provinces, communities were formed by regrouping the 60 The clusters where the number of mothers of chi were less tharı 50 were amalgamated within the s were amalgamated to yield 20 communities w
ficiency Status of Children in Sri Lanka
s animal sources consumed +
the lowered bio-availability of not retinol. In general, animal Dl, absorbed directly into the ene, which must undergo biofore, the total consumption of sixth in calculating the mean
nnaire was canvassed at all -2 and 71 months of age. In vas obtained from the mother ge. If a household had more 1. A sample of these mothers I was selected as follows.
Ef
thich an estimate is required, 50 mothers or care takers of fully interviewed. Two areas
magnitude of VAD estimated re low VAD prevalence area, !s, and high prevalence area rth Western, North Central, as shown in Table 8. The clusters of the main survey. ldren 12 to 71 months of age ame DS division. 40 clusters ith more than 50 children.
9
Page 42
Twelve sample clusters with a sar community clusters, which gave : From each sample cluster, 50 ch selected for the survey. However, from each of the strata classified as serum vitamin A concentration. Or prevalent stratum. Fifteen of the re the more prevalent area.
Results
In the stratum where VAD prevalen percent had a mean number of days values. According to the HKI crite public health problem in these fiv.
western and central -- only two numbers below the cut off. These vitamin A deficiency as a public hea public health problem as measure serum vitamin A concentration belo
HKI methodology results show thate North Central, Southern, Uva, and Saba is likely to be a public health problem.
However, in the Western and Central pr to the others, the methodology does not
Vitamin A Deficiency Status of Children in Sri Lanka
nple of over 50 were not combined into 32 clusters with more than 50 children. uildren 12 to 71 months were randomly it was not possible to obtain 15 clusters s less and more prevalent according to the aly 14 clusters could be formed in the less emaining sixteen clusters were taken from
ce is high, 11 of the 15 communities or 70 as of vitamin A food intake below the cut-off ria vitamin A deficiency is likely to be a e provinces In the other two provinces -- of the 14 clusters has a weighted mean areas are therefore not identified as having alth problem even though, VAD is indeed a ed by over 20 percent of children having
w 20 mg/dl.
in five of the provinces, namely North Western, ragamuwa, taken as a whole, vitamin A deficiency
Fovinces, where prevalence of VAD is less relative identify vitamin A deficiency status correctly.
40
Page 43
Vitamin AI
Table 13: Mean frequency of consumption of vitamin Ari
District
DS Division From plant From a
Sources
SC
11.8 10.4
14.5
8.3 10.5
8.1 9.4 6.5
9.8
11.3 6.8
7.2 12.2
9.0
Less prevalent Colombo
Colombo Dehiwela/Ratmalana Moratuwa
Kesbewa Gampaha
Biyagama Katana
Meerigama
Wattala Kalutara
Beruwela
Matugama Kandy
Kandy
Thumpane Matale
Naula Nuwara Eliya Kotmale Total
More prevalent Galle
Ambalangoda
Karandeniya Matara
Kotapola Hambantota
Beliatta Kurunegala
Galgamuwa
Maho Puttalam
Karuwalagaswewa Anuradhapura Kuruluwewa
Palagala Polonnaruwa
Hinguragoda Badulla
Kandaketiya Ratnapura
Eheliyagoda
Nivithigala Kegalle
Kegalle Monaragala Madagama Total
9.0
8.0 4.9 6.7 6.2 7.0 13.1
1.4
11.7 6.5 9.0 7.9 7.6 6.3 11.0
Deficiency Status of Children in Sri Lanka
ich foods
inimal Durces
Weighted VAD a frequency problem
No
14.4 11.4
9.5
16.4 13.0 12.0
No
No
6.0
6.5
12.8
11.0
5.6 11.1
No No No
6.9
No
12.8
6.5
5.4
No No
9.6
7.9 14.8
No
3.3
16.1
4.4 5.0
9.1 10.9
Yes Yes
3.9
7.1
No
9.4
No •
No
4.7
6.2
No Yes
5,1
3.8 3.0
3.8
Yes
7.2
No
8.3 3.0
2.0
Yes
4.1
5.3
Yes
13.8
No
4.7
12.6
3.5 3.4 4.5
5.4
Yes Yes Yes
5.6
3.3
4.8
4.2
5.5
3.9
5.1
Yes Yes Yes
No Yes
8.1
7.1 4.5
6.0
Yes
41
Page 44
Cha Selected Worl.
Access to lodised Salt
odine deficiency is the single mo
retardation, brain damage, and in Lworldwide. Deficiency of iodine o
most visible manifestation is go Goitre, however, is only the tip of ta manifested as goitre, many damagin women causes miscarriage, stillbirth, and infant and retarded psychomoto exposed to moderate iodine deficiency stunted, apathetic and compromi performance. However, a simple doat iodisation.
The Goal
Universal Iodisation of salt for human
Current Status In the survey, a sample of salt from e household was tested for the presen iodine. The method of testing was to a drop of the testing reagent, which stabilised starch solution, to about h tea spoon of salt. The colour of reagent turning blue on contact with indicates the presence of iodine in This is only an indicative test, which
Vitamin A Deficiency Status of Children in Sri Lanka
pter 5 d Summit Goals
est common cause of preventable mental tellectual under development of children causes many disorders in the body. The pitre, which is a swelling in the neck. he iceberg. Before iodine deficiency is ng processes occur. IDD in pregnant
irreversible brain damage in the foetus or development in the child. Children
as in the case of Sri Lanka can grow up sed in intellectual and educational ble and cost effective solution exists: salt
i consumption.
26
each
Table 14: Results of testing for
iodine in salt found in ce of
households add
Percentage Total changed colour
47 is a
Turned dark blue alf a
Turned light blue
the
No colour change =
49 Not tested, no salt etc. Total
100 salt.
Unweighted n= 6012 shows the presence or absence of iodine
salt
42
Page 45
Vitamin A I
Fig. 3: Results of testing for iodine in salt.
Fig.4;
- Not
tested 4%
Dark blue
26%
Uncl but
30
No colour change 49%
Light blue
21%
in salt. It does not provide a measure of the the colour is lighter than the dark blue color container of the reagent, the iodinė concentrat specified concentration of about 25-30 parts pe
The results of the test are Table 15: Percentag given in Table 14. Of the
status anc samples tested from 6012 households, 47 percent changed colour, indicating
Dry
Moist that the salt is iodised. This shows a rapid change
Clean
in the access to iodised
Packaged and labelled salt from a level below 10
iodised percent in early 1995.
Packaged but not
labelled as iodised This sharp increase was
Not packaged most likely due to
Dirty
Deficiency Status of Children in Sri Lanka
- Irripurities and moisture in salt
Unclean and moist
109%
läİN
dry
Clean &
dry 40%
Clean but moist 20%
quantity of iodine. However, if ur, which is indicated on the ion is likely to be less than the
million
ge of salt samples by iodisation
other characteristies.
Iodised Dark Light Total
iodised blue bluc
Not
Total
95 89 93 83 86 5 11 8 17 14
92 76 85 4966 8 24 1551 34
64 38 387 29
1219 19 15: 15
24 43 4378 56
43
Page 46
awareness of iodised salt created in from a campaign launched on both el
What is remarkable is that the use lack of local production of iodised sal salt was less than 10 percent of requi
While there has been a rapid char concern remain. First, the supply o than from local production where pre This is because of various difficu production of iodised salt. Second, a seen in Table 14, half of iodised sa had less than the require concentration of iodine. Salt tha contains less than the require concentration may not be effective i preventing IDD. and this is a undesirable state. Third, not a iodised salt was clean in appearance Nearly 15 percent of iodised sa appeared to be dirty, and eigh percent damp. (see Table 15) Als over 40 percent of iodised salt was no packaged and a further 20 percen packaged but not labelled. It is likel that crude salt has been iodise
without purifying and sold as rock sa
Thus the quality of iodised salt in te and packaging need much improvem
Vitamin A Deficiency Status of Children in Sri Lanka
the interim period, which resulted largely lectronic and print media.
of iodised salt has increased despite the It. In 1996 the local production of iodised irement.
age over to iodised salt, many issues of of salt had to come from imports rather
viously all salt has been produced locally. Ities encountered in commencing local
Map 5: Use of iodized salt in provinces
S0 - 60
0 - 50 CO
Hot Ivailable
Northe
Hartli Ordrul
Hari Meilen
le
Isle
alt in large blocks.
rms of adequacy of iodine content, purity ent. It is therefore, necessary to improve
44
Page 47
Vitamin AI
the quality of salt, to ensure adequate iodine co
production of good quality iodised salt.
Use of iodised salt is somewhat more common the rural sector (46 percent). Use was fairly across most provinces except in the southern where it was much less, 35 and 25 percent res 16). The use of iodised salt is also more wides groups (Table 16) as reflected in the type of hou to mother's level of education. The proportion percent to over 60 percent from household schooling to those where the mother has higher
Table 16: Percentage of households using iodised salt
Colour change Dark blue
I Sector
Urban
39 Rural
24 Province
Western
37 Central Southern North Western North Central Uva Sabaragamuwa Material of House
Thatched roof and mud floor Either thatched roof or mud floor Floor and roof durable Mother's Education
No schooling
17 Primary
20 Secondary OLVAL
32 Higher All
Deficiency Status of Children in Sri Lanka
ontent, and to step up the local
in the urban (54 percent) than uniform -- about 50 percent -- n and north central provinces spectively (see map 5 and Table pread in higher socio-economic asing. It is very strongly related using iodised salt rises from 44 as where the mother has no - education.
by socio-economic groups
Total Unweighted Light blue
iodised
A
54
46
892 5013
19
**
1918 801 813 790
53
18
605
18
376 612
22
41
875
40
1085 3938
51
a aaa a A
44 40 46
446 1269 1771 1918
86 5905
Page 48
Protein Energy Undernutrition Undernutrition predisposes children but, 'even mild and moderate levels risk of death from disease.
The Goal The global goal is reduction of undernutrition in children under five implies reducing stunting to 12 underweight to 19 percent.
Methodology The methodology is the same as th Surveys of 1987 and 1993. The age months. Weight was measured to balance. Height and length was measuring board. Children under 24 those 24 to 59 months standing up.
Three anthropometric indices are undernutrition: height for age, weight who are too short for age are stunted over a long period of time, and shor They are chronically undernourished. their height are wasted. This is acute is to too low for age are underweight. or both, or even be neither stunted na
Vitamin A Deficiency Status of Children in Sri Lanka
to death. Not only severe undernutrition of undernutrition increase many fold the
1990 levels of severe and moderate years by half or more. In Sri Lanka, this percent, wasting to 8 percent, and
nat adopted in Demographic and Health F group of children included was 6 to 59 the nearest 100g using a Salter spring
measured using the Shorr's portable E months were measured lying down, and
e used to measure protein energy E for height, and weight for age. Children 1. Their linear growth has been retarded rtness of stature is a cumulative result.
Children whose weight is inadequate for e undernutrition. Children whose weight
Such children may be stunted, wasted,
or wasted.
46
Page 49
Vitamin AE
The proportion of children with z
Table 17. I score , more than 2 standard deviation below the international reference
population
Stunting (NCHS/CDC/WHO) of whichever the
Wasting indicator, is taken as the level of
Underweigh moderate
and
severe undernutrition with respect to Table 18: P that indicator.
Age (in month
Only stunted The z-scores for height for age.
Only Wasted weight for height and weight for
Only underwe
Only stunted age, were computed using EPINFO
wasted developed by the Centre for
Only stunted
underweight Disease Control in Atlanta.
Only Wasted a underweight
Stunted waste Current Status and trends
underweight
Total Undernutrition among children has remained high in 1995. As shown in Table 17 of children 6 to
Fig 5: T 59 months, 34 percent were underweight to - a moderate or severe level. Eighteen percent were stunted or had inadequate height for age. Fourteen percent were wasted or had inadequate weight for height. Table 18 presents the percentage of children
by combinations of three indicators. The Table shows that children who
Се
o un 3 8 *
Source:
ମା
Deficiency Status of Children in Sri Lanka
Moderate and severe undernutrition in children 6-59 months by sex, 1995/96
Total
18
14
Male Female
17
19
15
34
33
| 35
mercentage of children 3 to 59 months by type of undernutrition
Total Male Female
33
as)
11 10
right and
and
109
und
U 006
9 un o . .
A 0 E
d and
5 5
38. 37
rend in stunting and wasting in children to 36 months
JSunting Dwasting
1987
1993
1995/96
37 and 1993 data are from Department of Rus and Statistics. Demographic and Health
vey 1993.
Page 50
Was
Table 19: Stunting, wasting and under Age
Stunting (in months)
1987 1993 1996 1 3-5
7.8 4.9 3.7 6-11
15.2 11.8
8.5 12-23
3LI
25.7
19.2 24-35
34.0
23.7
14.7 36-47
27.5
15.3 48-59
28.7
22.0 Total 3-35
27.5
20.8 14.5 Total 3-59
23.8 16.1
are either stunted or wasted are als children are neither stunted nor was five percent of children in very sever underweight.
These results indicate a declining tre which gives the indicators from the 1987 and 1993 Demographic and Health surveys. For the age group 3 to 35 months, moderate and severe stunting has declined from 27.5 percent in 1987 to 14.5 in 1995/96. The annual pace of decline has increased from just over one percent in the 1987-93 period to more than two percent in the 1993-96 period.
Vitamin A Deficiency Status of Children in Sri Lanka
rweight: 1987, 1993 and 1995/96 sting
Underweight 987 1993 1996 1987 1993 1.9 3.1 0.6 3.7 5.8 3.9 6.8 3.3 - 23.4 17.9
18.2 17.3 42.5 36.3 13.3 15.4 12.9 47.9 42.1
18.2
11.5
46.7 17.6 16.9
43.0 12.9
13.9 11.9 38.1
32.6 15.5 12.8
37.7
19.3
1996
0.6 16.9 33.4 36.4 30.6 35.4
29.1
30.7
S0 underweight. However, 11 percent of ted but, they are underweight. There are e condition of being stunted, wasted and
nd in undernutrition as seen in Table 19,
Fig.6: Age pattern of stunting, 1995/96
Z Score
! . :
-15
Relac
48
Page 51
Vitamin A D
Table 20: Stunti
age al
Stunting Total Male Female
Wasting Total Male Female Underweight Total Male Female Unweighted n 2:
For the age group 3 to 59
months, between 1993 and 1995/96 stunting declined from 23.8 percent to 16.1 percent; wasting from 15.5 to 12.8 percent and underweight from 37.7 percent to 30.7 percent. This is a substantial decrease, particularly in stunting and underweight, of over 2 percentage points a year. There is no significant difference between boys and girls in any of the three indicators of stunting, wasting or under weight. The level of undernutrition increases very sharply in the first year after birth as seen in Table 19. This rapid retardation is seen clearly in Figure 6, which shows the fall
with age of the mean z-score of height for age from the mean of the reference population. A similar and a much sharper drop has been seen in the Demographic and Health Surveys of 1987 and 1993.
Марб
eficiency Status of Children in Sri Lanka
ing, wasting, and underweight by nd sex
Age (months) otal 6-11 12-23 24-35 36-47 48-59
18 9 20 16 16 23 17 1218 16 13 23 19 722 17 19 22
以8%nn8
14 4 18 14 13 17 15 420 14 13 17 13 - 3 16 13 12 18
13
34 1835 39 33 36 33 19 34 39 30 34 35 17 3540 37 38 304 255 532 518
504
i: Prevalence of underweight in
provinces 1995/96
40 - 58 15.40 < 25 na isailkails
Northern
Martin Central
WestEFT
ExterTA
tril
Southern
49
Page 52
Table 21: Indicators of moderate and
characteristics
Sector
Urban Rural Province Western Central Southern North Western North Central
Uva
Sabaragamuwa Material of House
Thatched roof and mud floor Either thatched roof or mud floor Floor and roof durable Mother's education
No schooling
Primary
Secondary OVAL
Higher All
Prevalence of undernutrition varies population (see Table 21). Undernut than urban. A child in a rural area than a child in an urban area.
undernutrition – whether stunting, Western province. The highest underweight is as high as 54 pero percent. As expected, children livir to be undernourished than other rapidly with mother's level of educ education to 54 percent in the no so
Vitamin A Deficiency Status of Children in Sri Lanka
severe malnutrition by background
Percentage Wasting Underweight Unweighted in
Stunting
20
350
11 - 19
1954
12
10
24
11
727 316 372
16
36
17 14
317
218 157 197
16
537
638
14
12
1928
29
22
18
20
162 16
43
647 14
35
1028 13
13
28
1152 13
614 18
14
34
2304 s considerably between subgroups of the rition is considerably higher in rural areas is 1.8 times more likely to be underweight Between provinces, the lowest levels of wasting or underweight – is found in the levels are in the Uva province where ent, stunting 29 percent and wasting 17 ng in substandard housing are more likely B. Children's undernutrition level rises sation --- from 20 percent in the highest
hooling category.
Page 53
Vitamin A D
Diarrhoea Prevale
Diarrhoea kills children from dehydration. I prevented with a simple remedy -- Oral Rehydra treating diarrhoea depends on continuously E after diarrhoea begins, as well as feeding the ch offset the nutritional damage that diarrhoea ca such fluids and continued feeding is called Oral
The Goal Achieve 80 percent usage of ORT as part of the programme to control diarrhoeal diseases.
Table 22: Prev
cha
Current Status
In the two weeks prior to the survey 2.8 percent of children under five years had an episode of diarrhoea which lasted three or more days. The prevalence of diarrhoea ranges from a low of 1.7 percent in Sabaragamuwa province to 3.7 percent in the Uva Province. Prevalence exceeds three percent in three other provinces - North Central, North Western and Central. Prevalence is higher among children in poorer housing.
Sector
Urban
Rural Province
Western Central Southern North Western North Central Uva Sabaragamuw Material of Hon Thatched roof
mud floor Either thatche Imud floor
Floor and root Mother's educa
No schooling Primary Secondary OLJAL Higher
eficiency Status of Children in Sri Lanka
ence
Most of these deaths can be tion Therapy (ORT). Success in giving appropriate fluids soon nild to provide energy and help n cause. The administration of Rehydration Therapy.
alence of diarrhoea by selected Tacteristics
Prevalence Unweighted n of Diarrhoea
2.2 2.8
403 2256
2.5
3.1
2.1
3.1
829 366 434 358 246 188 238
3.5 3.7
1.7
use Fand
3.3
465
d roof or
3.1
544
2.5
1632
F durable ation
5.2 2.7
131 549 876
2.9
996
2.5 2.9
35
Page 54
The group which has the highest p children whose mothers had no scho
Estimating the use of oral rehydra because the number of children who small, only 74. Approximately 40 diarrhoea stated that the children continued to feed. Those who were to feed was 11 percent. In other rehydration therapy during the diarrt survey.
The definition of ORT is "offering more fluids and continuous feeding". This survey asked the following two questions to measure these. A key measurement here is "was the child offered more fluids". A single question "was the child given more fluids?" as was asked in this survey probably did not elicit a reliable response. Offering would be in response to the child's demand for something to drink. Whether the child was offered when she did not ask for it must be questions. Also a comparison with w the mother and the response may no was continued feeding is equally diffi
Vitamin A Deficiency Status of Children in Sri Lanka
prevalence, exceeding five percent, is the oling.
ation therapy is difficult in this survey, o had diarrhoea in the reference period is percent of mothers of children who had
were given more fluids and 28 percent given both increased fluids and continued
words, only 11 percent practiced oral neoa episode in the two weeks prior to the
25
Table 23: Feeding patterns during diarrhoea in
children under five years of age
Percentage
given 'oods given during diarrhoea
Breastmilk
90 Cunjee
49 ORS
37 Other suitable foods
35 Milk luids Less Same as before
40 More than before
40 Don't know 'eeding
Less than before Same as before
More than before ncreased fluids and continued feeding
Yes
RAN
: elicited through a series of appropriate That was given before may be difficult for ot be accurate. Measuring whether there icult based on the above single question.
52
Page 55
Vitamin A D
Children suffering from diarrhoea usually have Mothers' usual comment is that they don't eat determined again through a series of questions this survey may not have elicited an accurate r that the particular questions and the manne capable of determining whether the child was
was continued during illness.
Breastfeeding and Complem Breastfeeding is the best possible start a child o and good nutrition in infancy and childhood. T set out a goal for all ratifying nations to achieve.
The Goal Empowerment of all women to
Table 24: I breastfeed their children exclusively for four to six months
Age (months)
Less than 4 and to continue breastfeeding,
4 –5 with complementary food, well
6–7
8 – 11 into the second year.
12 - 23 24 = 35
Total 0-35 Current status of all children under 5 years, 98 percent 1 duration. This proportion remains unchanged social groups including mothers' education.
eficiency Status of Children in Sri Lanka
no appetite and refuse to eat. . Was the child fed has to be s. The two questions used in response. The survey staff feel er they were asked were not offered more fluids or feeding
entary Feeding -ould have towards good health The World Summit for Children
99
Percentage of children ever breastfed
y sex
Male
Fermale
Total 100
10C 100
100 98
100 98
99 98
98 98
98 98
98
10C
99
*
has been breastfed for some d across provinces, and other
Page 56
Fig 7: Age pattern of breastfeeding
| 10 100 90
*R$$$$
0-2 24 5 6 & 10 10-12 13-14 TE16
Percentage of children breastfed up to 23 to 24 months is another indicator proper
breastfeeding practices. Of 564 children who were two years old ( between 12 to 23 months) (51 percent) were breastfed two years. There is no difference in continued breastfeeding between girls boys,
respective percentages being 52 and 50 M percent.
AI
Vitamin A Deficiency Status of Children in Sri Lanka
-Male -Finale
- Total
16-18 18-N 0-2 2-N-* * 3 PM MY
Table 25. Percentage of children ever breastfed by background characteristics.
Ever breastfed
of
97.7 98.9
half
for
ector
Urban Rural rovince
Western Central Southern
North Western North Central Uva Sabaragamuwa onstruction Material of House Thatched roof and mud floor Either thatched roof or mud floor
Floor and roof durable Tother's Education
No schooling Primary Secondary OLVAL Higher
98.3 98.8 99.3 99.3 99.2 98.7 97.5
and
99.6 97.5 98.8
100.0 97.4 99.8 98.4 100.0 98.7
Page 57
Vitamin A I
Children must be exclusively breastfed at leas 421 one-year old children 17 percent has bee
months. Nearly two thirds of children under tr the end of the fourth month. Other foods cor fourth month are fruit juice (44 percent), rice ca percent). Less than 10 percent of children a vegetables, rice, biscuits, fish in the first
Table 26: Age at introduction of fluids and mushy foc
Food
mo
Less than 4
months
65.2 43.7 29.5 22.8
| 8
9.2
Water Fruit juice Cunjee
Milk Biscuit Vegetable Rice/Potatoes Egg Fruit Fish
Meat Thriposha/cereal Soup
4 to 6 months
25.6 39.8 49.5 16.8 41.2 33.8 24.3 16.1 14.3 10.1
2.8 29.1 33.7
6.1
5.8
6.9
6.8 15.6 13.2 14.3
Deficiency Status of Children in Sri Lanka
st in the first four months. Of n exclusively breastfed for four wo years are given water before mmonly given before the end of unjee (30 percent), and milk (23 are given other foods such as four months. (See table 26)
ods
sto 88 months Tiths and over
1.9 6.9
4.3
1.8
| 9
16
6.8 39.2
30.3
28.6 31.8 27.8 25.5 21.6
6.7 31.1
15.3 23.4 32.8 44.8 47.7 56.1 67.9
21
21
24.8
Page 58
Access to Wat It is a basic right of all human bei sanitation. Access to safe water and s and health. Convenient access to safe particularly for women.
Goal
The decade goals for access to water a
Increase water supply to narrow the gap
one-fourth.
Increase sanitation to narrow the gap bety
tenth.
Foi
Methodology Measuring access to water has a number of difficulties. The key issues are the operational definitions of safe water, safe sanitation, and access. What the national data collection systems have collected in the population and housing censuses and large scale surveys are the source of water and type of latrine. Their classifications vary widely. Source of water is commonly classified as tap, protected well, unprotected well, river, stream
Vitamin A Deficiency Status of Children in Sri Lanka
er and Sanitation ngs to have access to clean water and sanitation has a large impact on nutrition e water also has socio-economic benefits,
nd sanitation are as follows.
between the 1990 levels and universal access by
veen the 1990 levels and universal access by One
Table 27: Source of Drinking water and type of
Latrines
Percentage 1993 1995/96
34
43
17'
13
Source of drinking Water
Protected well Tap inside premises Common Tap Tube well Unprotected well Other (including not stated) Total safe
19
e une
602
Type of latrine
Water seal
Pit
Other unsafe None
Note: 1/ All pipe bome water systems including common tap.
Computed as sum of percentages of tube well and estimated proportions of protected well and pipe borne water.
2/
Page 59
Vitamin AE
etc. A common classification of type of latrir, bucket. A measure of access is not availabl sanitation. Often information on whether the sharing is available. Sometimes the distance to is available, but data on distance seem question
The National Water Supply and Drainage Boarc has set up a water and sanitation related info1 access to safe drinking water is defined as havin is treated piped water, protected well or tube
which has a wall at least 2 ft high, with a covere and a separate rope and bucket. Unprotected streams, rivers streams etc. are unsafe sources defined as having a safe latrine for either shared or exclusive use of the household. A safe latrine is one that is water sealed. Pit and bucket latrines are considered unsafe.
Fig
The National Water Supply and Drainage Board (NWSDB)- through the network of Public Health Inspectors collected information
Note: Proj about the source of water and
is estimate
51 and 49 sanitation for all households, schools and institutions and published the information for 1992. The infor and is published. The data from this system safe drinking water as 61 percent and to safe sa
eficiency Status of Children in Sri Lanka
e is as water sealed, pit, and e for either drinking water or latrine is for exclusive use or the latrine or the water source able.
1 in collaboration with UNICEF
mation system in 1992. Here ug a source of safe water, which
well. A protected well is one, ed net, a proper drainage basin
well, untreated pipe systems, 3. Access to safe sanitation is
8: Source of drinking water
Unprotected
well 31
Protected
well
Tute well
79%
Other 64 Tp within рнетінея 13E
Сотитын бир
13E
Iortion of protected and unprotected wells d by prorating the total wells in the ratio of
mation was updated for 1993 provide estimates of access to ritation as 60 percent in 1993.
Page 60
National Statistical system has not a Household surveys carried out even between protected and unprotected v Practical difficulties of applying the d ascertaining whether piped water consensus are the reasons for this.
The present survey collected data o latrine, distance to the latrine, and
use. However a protected well wa irrespective of its height, or the prese practice in national surveys by the D borne water was not classified as trea
Estimate of access to safe drinking those of NWSDB. The main differer taking water from a protected well. protected well and consequently of : very much lower. The difference i protected in the survey are unprot NWSDB.
Vitamin A Deficiency Status of Children in Sri Lanka
dopted the definitions of the NWSDB yet. in recent years have not distinguished vells using the definitions of the NWSDB. lefinition of heights of parapet walls etc., is treated, and absence of a national
on the type of source of water, type of
whether it is for exclusive use or shared as taken as one with a wall around it ence or absence of an apron, which is the epartment of Census and Statistics. Pipe ted or untreated.
water therefore, is not consistent with ace lies in the proportion of households
Due to the narrower definition of the safe water, NWSDB estimate of access is is that a fraction of wells classified as tected by the definition adopted by the
Page 61
Vitamin A
Table 28: Source of Water and type of latrine by sele
Source of drinking water
Piped to Common Tube Protected
the
tap well
well house
Sector
Urban
28 0.2 108
8
49
8 " && * ° - +
16 3 24 16 9 3 1 13 7 20 9 .6 17.5
Rural Province
Western Central Southern
North Western North Central Uva Sabaragamuwa Material of House
Thatched roof and
mud floor Either thatched roof or mud floor Floor and roof durable Mother's education
No schooling Primary Secondary OLIVAL Higher
9 14
47
اليا اليا
36
18 145
44
5.3
11
11 7 14 8 14 16 8
9 6
9.9
Y E O 00 00 N
All
137
Deficiency Status of Children in Sri Lanka
ected background characteristics
Un- Other protected
well
Unweighted n latrine
0.7
922
0.3 22 6
93 65
5074
8 2 89 15 4 27 9 71 22 1 17.2 37 19
1956 814 815
808 613 378 612
886
Un o A
* B u 4
1098
5 85
4002
448
1284
1797
269 24 7 19 4 14 4 6 3 195
83
1943
69
87 5996
Page 62
Therefore, to estimate the protected wells, the total wells is prorated by the proportion of In protected wells reported in the 1993 data by the NWSDB, which is 51 percent. Similarly the proportion of households obtaining water from a tap is adjusted by a factor of 0.98 percent which is the proportion of t estimates. The adjusted estimate of a is therefore 65 percent.
E PER 2 A < |
Overall, access to a safe latrine is 67 province where only about one third North Central, and North Western households with access to a safe latrii and within 50 m. for 78 percent. Ne have access to a latrine have it for excl
Vitamin A Deficiency Status of Children in Sri Lanka
able 29: Type of availability and distance to
safe latrine istance
Percentage the house
16 Pithin 50m Tore than 50m
on't know
18
Page 63
Vitamin A DI
NATIONAL SURVEY ON VITAMIN A DEFICIENCY
SRI LANKA
1. District
J
5. Segment No
2. Divisional Secretariat
J
6. Housing Uni
3. Grama Niladari Divison
7. Household N
O
4. Sector
Urban 1 Rural 2 Estate 3
INTERVIEWER VISITS
Date
Interviewer's
Name & Code
Results (*)
Next visit
Date Time
Result code 1 Completed 2 No competent respondent at home 3 Postponed 4 Refused 5 Other
eficiency Status of Children in Sri Lanka
& CHILD DEVELOPMENT
J
it No.
TO
J
FINAL VISIT
Month Date
J
O
Total No of visits
Page 64
MODULE 2 - HOUS
Enter names of all persons who live here (de facto)
Identification
O[
Line No
Relationship HНН
NAME HHH's name first, then spouse's name followed by names of children from youngest to eldest. Then the names of others
01
02
03
1 2 3 4 :
1 2 3 4 :
1 2 3 4
| 1 2 3 4
1-23-4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
Answer column 03 above with a circle
1. Chief Occupant 2. Wife/Husband 3. Mother/Father 4. Others
Total No of Inmates
Total women (Married)
within 15-49 years
Vitamin A Deficiency Status of Children in Sri Lanka
EHOLD INFORMATION
JO O O IDD
to
Sex
|Year & month
of birth
M 1 F 2
Eligibility 1.0-71 months 2.5-14 years 3. Married women
15-49 yrs 4. Not eligible
06 1 2 3 4
04 51 2
2
2
1 2 3 4
5
1 2 3 4
1 2 3 4
, 1 2 4 5 i 2 III1 2 3 4
1 2 3 4 1 2 I 1 2 3 4 5 2 I 1 2 3 4
III | 2. IO 1 2 3 4 |1 2 TIUJ 1 2 3 4
LIII 5 1 2 1 2 3 4 3 1 2 2 3 4 3 1 2 || 1 2 3 4 |
1 2 3 4
2
1 2 3 4
2
1 2 3 4
2
1 2 3 4
No of Infants within 0-71 months (Infants born in or after August 1989) Total children within 5-14 years (Children born between 1981 Aug.
& 1990 Aug)
O
62
Page 65
Vitamin A Defi
MODULE - 3 BACKGROU
JO DO
Identification
Respondent's Name...
Respond
| No
Re
301
Question Type of housing (Observe and record)
302
Ventilation
303
Cleanliness in and around the dwelling
304
What is the source of drinking water for members of your household
Thatched Tile/Asb. Thatched Tile/Asb. Adequate Not adequ Very cleal Clean Not clean Piped - in Public tap Tube well Protected Unprotect Others (SP Water sea Pit latrine Bucket lat None Exclusive Common In dwellin Less than Imore than Do not kn No school Primary 0 Secondary GCE OLI
Higher
305
What kind of toilet facility does your household use?
306
Is this facility for exclusive use
of your family or common How far is the toilet from your dwelling?
307
308
Highest grade the mother has passed?
309
Main occupation of the husband
iciency Status of Children in Sri Lanka
ND
J O DO
ID
Line No.
dent: -
Mother 1 If not Mother 2
esponse roof and mud floor roof and mud floor Toof & cement floor roof & cement floor
late
dwelling/premises
dug well ed dug well Decify)
TI E II I III I II IETE
led
un A W N-W N = N = W N = m w N = N = N = N
trine
50m 50m [Ꮃ.
ling
year 1-5)
(year 6 - 10) AL
Page 66
SALT 101
No 310
Question Result of the test
311
Is this salt dry
312
Is this salt clean
313
Record type of salt
Pitamin A Deficiency Status of Children in Sri Lanka
PISATION
Line No.
Response Dark blue Light blue
No colour change No salt in the household Not tested Yes
– N 9 n|- N - N
No
Yes No (If discoloured or visibly Contaminated., circle 2) In a bag labelled as iodised In a bag not labelled as iodised Rock salt Others (specify). Not known
– N m o
64
Page 67
Vitamin A DE
MODULE 4 - DIETARYS
Identification
DO O
Fill in for one child between 12 - 71 months selected from How many days, in the past seven days did..
E = E
01
02
03 04
| 05
06 | 07
08
09
| 10
| 11
12 13
| 14 | 15
Staple food (rice, bread) select only one Hot spices (eg. Chillies)
Dark green leaves | Milk (excluding breast milk)
CarTots Ripe mango Dark yellow or orange pumpkin
· Spinach Ripe Papaya + Noodles |Eggs with yolk
Small fish (liver intact)
· Peanuts (or other legumes) Yellow Sweet potatoes
Chicken or other fowl (or other meat or legume)
• Gotukola (or other GLV) Any kind of liver * Kathurnumurunga leaves Beef, Pork, Mutton or other meat Butter
Dhal (other legume or meat) Red palm oil Cod liver oil Fried food
• Passion fruit
Coconut (other oils) Complementary food - vitamin A added
(or other vitamin added food) -
• Margarine - vitamin A added
| 16 | 17
| 18
| 19
| 20
21 | 22 | 23 24 25 26
27
28
eficiency Status of Children in Sri Lanka
URVEY
O DO O
the household. name) eat following?
Line No. of selected child
No, of days eaten per week
== wwwww =WN IN
C
Page 68
MODULE:
Identification
JI
Questions
| Sr No. O
Sr No. Youngest child's name
Line No 501 Date of birth Day Month Year
Male 1 Female 2
502 503
Sex Birth Wİ
gain
99
504
Don't know Did you breast feed? (Name)
Yes 1 No 2
= N
505
U
Currently breast fed - 88
506
day
night
J
How Imany
mths was ...(name) breast fed How Imany times.... (Narne)
breast fed last 24 hrs
Did... - (name) get any other food or drink during this time ?
Yes 1 Ւս շ
507
Yes 1
No 2
Vitamin A Deficiency Status of Children in Sri Lanka
5 - FEEDING
Sr No.
Next child's name
O Sr No. I
Sr No. Next child's name
GOOD IDD SEAN anders as dienas. O PE MonthYPE Muth. YEL TITUT
Line No.
Day Month Year
Line No Day Month Year
| Male 1 Female 2 Male 1 Female
99
1
= N
2
Yes 1
| Yes
N.
No 2
No 2
66
Page 69
Vitamin A
Questions
Serial No
Youngest child *s Name..
508
How many months old was (name).. when you introduced the following foods
Line No Complete 508 for all childi introduced during 1st mont never introduced don't know
months
No of times Yesterday
Water infusions (tea, corriander water) rice conjee powdered or fresh milk bread / biscuits vegetables rice / potatoes eggs Dark green leafy vegetables fish / dry fish / sprats Imeat thriposha / cerelac Soup others (specify)
Deficiency Status of Children in Sri Lanka
Serial No
Next child's Name.
Line No ren under 24 months
00
96
99
months
No of times Yesterday
Page 70
MODULE 6
Identification
O [
Questions
Sr No Youngest child's name..
Line No
601
Has...... (name) had diarrhoea in the last 2 weeks Yes 1(if yes how
many days) No 2 DK 9
602
= N O
602
Yes No DK 1 2 9 1 2 9
Has............(name) had diarrhoea in the last 2 weeks
Yes 1 (if yes how many days) No 2 DK 9 During the episode of diarrhoea did name. A Breast milk B Rice conjec C Locally defined home fluids ............(specify)
D ORS E Powdered/fresh
milk F Water with meals G Water only H None During this episode of diarrhoea did she/he drink -
Much less or none About the same
More DK
1 2 9 1 2 9 1 2 9
= = = = =
o ON
1 2 9 1 2 9 1 2
29
603
o w N –
Vitamin A Deficiency Status of Children in Sri Lanka
- MORBIDITY
JOOD IDD
Sr No Next child's name.
Sr No Next child's name.
Line No
Line No
– N O
O N –
Yes No DK 1 2 9 1 2 9
Yes No DK 1 2 9 1 2 9
O
1 2 9 1 2 9 1 2 9
ORO
1 2 9 1 2 9 1 2 9
1 2 9
NN
1 2 9 1 29 1 2 9
= N en o
O W N –
68
Page 71
Vitamin A De
Identification
DO O C
Questions
Sr No Youngest child's name.
Sr No
Next cl name..
Line No
Line N
604
o un b w N –
During bout of diarrhoea did..... (name) take less, about the same or more food
None Much less Some what less About the same More than usual DK Did.........(name) have cough or colds in the last 4 weeks
Cold Cough Cold & cough How many days? Did..........(name) have measles
605
w N
W N –
606
Yes
607
No |When did...(name)
have measles
Within last month 1
1 - 3 **
3 - 6 ** More than 6 months 4
w N –
608
Is this child given
Vitamin A capsules Yes (seen) Yes (not seen) No INTERVIEWER: see the capsules
w N =
iciency Status of Children in Sri Lanka
OD TO O
ild's
Sr No
Next child's name.
==
Phine I
Line No
سے نا بنا تنل الما یا
o un w N –
w N –
w N –
– N
WN
W N =
W N =
Page 72
Identification
O I
Questions
Sr No Youngest child's name.
Line No
609
long
How has.. (name) been given Vitamin A - Weeks
weeks (less than I month) Months
month | 610 | Have you heard any messages which pr
help prevent blindness? Yes 1
No 2 If res
Don't know 9 611
Can you tell me all such foods? (circle A Dark green leaves
1 Yes B Yellow fruits C Dark yellow vegetables DEgg/Meat/ Fish E Others..
........Specify 612
| During last week, did
1 yes .(name)
2 No Take DG leaves
9 DK 613
During last week, did
1 yes .........(name) take
2 No yellow fruits or
9 DK vegetables 614
During last week did
1 yes ..(name) take eggs
2 No or meat
9 DK
Vitamin A Deficiency Status of Children in Sri Lanka
JO O O DO
Sr No Next child's name.
Sr No Next child's Narme....
Line No
**** Line
No
O weeks
weeks
months
months omote certain foods that are important for sight and
iponse is 2 or 9 go to module 7
code if mentioned. Do not prompt).
2 No
2
1 yes 2 No 9 DK 1 yes 2 No 9 DK
1 yes 2 No 9 DK 1 yes 2 No 9 DK
1 yes 2 No 9 DK
1 yes 2 No 9 DK
Page 73
Vitamin A
MODULE 7 - CLINICAL OBS
Identification
DO O O
Questions
Sr No Youngest child's
Sr No Next name
name.
Line No
Line
701
2
702
Night Blindness Yes
| 1 No Bitot's spots Yes No 2 Blood sample taken Yes 1 No 2 If not reason
703
704
Retinol ug/dl
I O
Deficiency Status of Children in Sri Lanka
ERVATIONS
口口||口口
child's
Sr No
Next child's name。
PIHH HILLIII|11||
A
Line
| || ||
|- -
1
11
一
|-
口口回口|
Page 74
MODULE 8 - SCHOOLING (
Identification
O C
Questions
Sr No Youngest child's name.
TTTTTTTTTTTTT
Line No
801
Has.......(name) ever
Attended school
year
802
...(name) Schooling now?
1 yes 2 no 3 DK
803
(Name)........is in veår. . . . Did.........(name)
804
year. 1 yes 2 no 3 DK
go
to school last year
805
In what year did (name).......study last year
year....
Vitamin A Deficiency Status of Children in Sri Lanka
for children between 5 - 14 years)
JO O O OITO O
Sr No Next child's name..
Sr No
Next child's name..
I I II I II E
ET EFT
Line No
Line No
1 yes 2 no 3 DK
1 yes 2 no 3 DK
1 yes 2 no 3 DK
1 yes 2 no 3 DK
year.. 1 yes 2 no 3 DK
year.
1 yes 2 no 3 DK
year...
year..
Page 75
Vitamin AI
MODULE 9 - PARTICULARS
Identification
O O O
Mother's Name.
901
Mother's date of birth. (If not known enter the estimated year in the year cage
& 99 in the day cage.
902
Last date of menstruation of mother. (If not Known enter 99 in day cage. If she is in Immediate post partum enter 98).
Are you expecting a baby
903
904
Are you nursing (with breast milk)
905
Do you have a card or other document with your own immunisation listed
906
907 908
When you were pregnant with your last child did you receive any injection to prevent tetanus If yes, how many times
Did you receive any TT injections at any time Before your last pregnancy either during a Pregnancy or in between - If yes, No of times
When was the last dose received
909
If month or year not known , how long ago you last received a dose.
Bet
910
| Total No of doses (907+908)
911
| Mother's Height
Deficiency Status of Children in Sri Lanka
OF MOTHER
O O ID O
.... Line No. O
Line No.
JU U
Day
Month
Year
O D O
1 yes 2 no 3 DK 1 yeas 2 no 1 yes (seen) 2 yes (not seen) 3 no 9 DK 1 yeas 2 no
3 DK T| times
times
1 yes
2 no
3 DK
Month
Year
years
fore
TIL | cm
CIT)
Page 76
| 912
Mother's Weight
913
| Mother's MUAC
914 915
Sample of the breast milk taken Vitamin A level in breast milk
If not taken enter 99.9 Mother's Hb % g/dl
If not taken enter 99.9
916
Vitamin A Deficiency Status of Children in Sri Lanka
- kg
L- cm
Cm
1 Yes
2 No
TITI
Page 77
Vitamin A De
MODULE 10 - ANTHRO
Identification
O O O C
Questions
Sr No Youngest child's name. Line No
Sr No
Next child's Tname Line
No
1001
Date of Birth
M
1002
No Te | ir
ITALI Length (om ions | Mac Dolní | consolationer's G
Li MMR
Weight (kg)
Height/ length (cm)
1003
1004
MUAC (cm)
1005
Measurer's Code
1006
Date of Measurement:
ficiency Status of Children in Sri Lanka
OPOMETRY
口口 ||口口
Sr No Aext child's
THIE,
Line
No
1品的
]]||DD|
口 |可口口 | || ||
Y
Page 78
Refe
Department of Census and Statistics. (1975)
Ministry of Health (1976) Sri Lanka Nuti Colombo
Helen Keller International Vitamin A Techn HKI Food Frequency Method to Assess Comi
IVACG (1993) A Brief Guide to Current M. the International Vitamin A Consultative Gro
WHO (1992) Control of Vitamin A Deficienc Geneva.
WHO and UNICEF (1994), Indicators for as in monitoring and evaluating intervention consultation, Geneva, Switzerland 9-11 Nove
National water supply and Drainage Bo information 1993
Vitamin A Deficiency Status of Children in Sri Lanka
erences
Demographic and Health Survey 1993. ritional Status Survey Sept. 1975 - March 1976.
ical Assistance Programme (1993) How to use the
munity Risk of Vitamin A Deficiency.
ethods of Assessing Vitamin A Starus. A report of sup, USA
Ey and Xeropthalmia, Technical Reports series 672,
sessing Vitamin A Deficiency and their application
programmes. Report of a joint WHO/UNICEF ember, 1992
ard (1996) Water supply & sanitation related
Page 79
Vitamin AD
Survey Team
Team leader
- Dr. Chandrani Piyasena Assistant team leader - Dr. A MASB Mahamithawa
Central Team
Dr. Chandrani Piyasena (Medica Dr. A MASB Mahamithawa (1 Dr. Kamal Gunatunge (Medical
Mr. TNR Peiris (PHI) Mr.S Navaratnasinghe (PHI) Mr. KD Chandrathilake (PHI) Mr. J M Ran Banda (Nutrition A Mr. UH Bandula (MLT) Mrs. KN Jayaratne (MLT) Mrs. BY Gamage (MLT) Mrs. Kaushalya Gamage (MLT) Mr. Seebert Perera (Orderly)
Mr. PA Kulathilake (Orderly) Peripheral Team
30 DDHSs, 60 PHNSs and PHIS Data Entry
Mr. JS Deen Miss. Rupika Fernando Mrs. Champa Ariyaratne
Deficiency Status of Children in Sri Lanka
al Officer)
Medical Officer) Officer)
Assistant)
of the respective clusters
77
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PAINTED BY A PAINTS, 14. STATION ROAD. DEHIWELA