Annals of Sri Lanka Department of Agriculture. 2007.9:103-111.
IMPORTANCE OF REDUCING MALNUTRITION THROUGH AGRICULTURE IN SRI LANKA M.I.M. RAFEEK, T.H.C.S. PERERA and J.A.T.P. GUNAWARDENE Socio Economic and Planning Centre, Department of Agriculture, Peradeniya
ABSRACT Although adequate food resources are available in Sri Lanka, still a significant level of malnutrition exists. Poverty and inadequate food accessibility are considered major cause of low level of nutrition. The high-input, green revolution agricultural technologies implemented in the past tempted farmers to adopt mono cropping system that displaced the nutrient rich traditional mix cropping pattern consequently, domestic food crop supplies characterized by instability in production. A conceptual model was used to estimate the affected population. Benefit-cost ratio was also estimated with the intervention on nutritional investment. Estimation indicates annually 4.5-5 million people are affected with malnutrition and economic cost is substantial. Further, the finding shows that return to investment in nutrition is 4.8. This implies that improving nutrition is imperative and potential exists in agriculture. Hence vigorous agriculture involvement to micro nutrient-dense staple food approach and diversified food supplies system are required to reduce malnutrition in Sri Lanka. KEYWORDS: Accessibility, Adequate food resources, High-Input Agriculture, Malnutrition, Micro-nutrient dense, Production instability.
INTRODUCTION Malnutrition is at present a problem in Sri Lanka. Malnutrition is an indicator vicious circle that begins even before birth and gets transmitted during reproductive stages of life over to old age. In Sri Lanka, malnutrition can’t usually be seen by the naked eye. It develops slowly and subtly. Young children are the most vulnerable to the effect of malnutrition, so their status is the most sensitive indicator of overall nutrition in the country. Further, malnutrition is also prevalent and common among women. Thus, symptoms of protein energy mal-nutrition (stunting, wasting and low birth-weight), lack of vitamin A, anemia and goiter are common among them (Suzanne and Wisniewski, 2006). Children who do not eat sufficiently to cover their nutritional needs grow slowly, and lag further as time passes. This gradual malnutrition contributes to high death rate and also reduces learning potential, immunity and work productivity. Children with retarded growth become stunted adults who are less productive and are more likely to suffer from chronic diseases. These problems have implications for human achievement and economic development of a country. In addition, malnutrition has long been known to undermine economic growth of a country and perpetuate poverty among people (World Bank, 2006).
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The challenges of development require a strong human resource base; a workforce that is physically strong, mentally alert, and healthy. However, malnutrition robs a country of these resources, preventing entire communities from participating fully in development. Thus addressing malnutrition is not only a good investment, but it is also a social responsibility. Although adequate food resources are available in the country, still a significant level of malnutrition continues to exist in Sri Lanka. Therefore, identification of vulnerable groups and their locations are of paramount importance to tackle malnutrition. Further, it is necessary to give greater attention for the existing food crop-based approach to provide sufficient and diversified food supplies to meet the nutritional requirement and to reduce malnutrition in Sri Lanka. The objectives of this paper were a) to review the status of malnutrition in Sri Lanka b) to identify the causes c) to estimate the cost of malnutrition and d) to identify the agricultural strategies to reduce the malnutrition in Sri Lanka. MATERIALS AND METHODS This study has used primary and secondary data for evaluation. Data were obtained from demographic health survey (Department of Census and Statistic, 2000) and Extension and Research Centre of the Department of Agriculture. Northern and Eastern Provinces were excluded due to non availability of data. Following conceptual equations were used to quantify the affected population. Direct and indirect costs of malnutrition were estimated. Then the benefit cost ratio was derived based on following equation. 1.
As a first step the affected population was quantified. 4
Affected Population (A) = P
∑
CiKi
where C - affected population
i= 1
K - constant Total direct cost of malnutrition for a particular year was estimated. Total direct cost = M * A. where, M - per capita expenditure on health A - affected population 3. Indirect Cost; the costs representing the lost productivity caused by malnutrition. This was assumed to be 10% of life span earning. 4. The cost of intervention that could be taken to prevent the malnutrition. 5. Benefit-cost ratio was estimated based on the following equation. 2.
t= n
∑
t=1
t= n
Bt /(1 + i )t / ∑ Ct /(1 + i )t Where, B - Benefit t=1
C - Cost t - Years i - interest rate
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This approach was used to show what happened overtime in the country and to compare the net benefits of the situation in the country. RESULTS AND DISCUSSION Nutritional status in Sri Lanka Nutritional status in Sri Lanka is usually described from Demographic of health survey and other special studies conducted by Medical Research Institute (MRI). Three anthropometric indices are used to measure protein energy under nutrition namely height for age, weight for height and weight for age. Children who are too short for age are considered stunted. Their linear growth has been retarded over a long period of time and they are chronically undernourished. Children whose weight is inadequate for their height are categorized as wasted. This is an acute under nutritional situation. Children whose weight is too low for age are designated as underweight. Over the years, the level of malnutrition indicated by stunting, wasting and underweight have declined in children under age 5 in Sri Lanka, but they still remain a significant problem. The average incidence of stunting, wasting and underweight of children from 3 to 59 months is shown in Table 1. Table 1. Average incidence of Stunting, Wasting and Underweight by year (Percent). Year Stunted Wasting Underweight 1993 23.8 15.5 1996 16.1 12.8 2000 13.5 14.0 Source: Demographic Health Survey 2000.
37.7 30.7 29.4
Table 2. Incidence of malnutrition by provinces and sectors (Percent). Stunting Wasting Underweight Sector Urban 11 8 Rural 19 15 Province Western 12 10 Central 20 11 Southern 16 16 North Western 21 17 North Central 20 14 Uva 29 17 Sabragamuwa 22 23 Source: Demographic Health Survey 2000.
20 36 24 35 36 37 41 54 39
Undernutrition is considerably higher in rural areas than urban. A child in a rural area is 1.8 times more likely to be underweight than a child
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in an urban area. The lowest levels are found in the western province. The highest levels are in the Uva province where underweight is as high as 54%, stunting 29% and wasting 17% (Table 2). Prevalence of vitamin A, anemia and goiter The higher percentages of anemia are in the North Central and North Western provinces. The Central and Uva province showed about 36%. In the case of Vitamin A deficiency, the high percentages of children are in the North Central and Sabragamuwa provinces (Medical Research Institute, 1998). The lower percentages are found in the Central province followed by Western province (Table 3). Goiter prevalence also vary geographically; higher percentages are reported in Uva and North Central provinces. A lower percentage was reported in the Western province. Table 3. Micronutrient deficiencies in provinces. Provinces Anemia among child Vitamin A under 6 years (%) deficiency (%)
Goiter in child of 8-10 years (%)
Western 47 24.3 16.3 Central 36 22.3 24.3 Southern 48 42.5 17.1 North Western 57 46.3 17.2 North Central 55 57.3 26.2 Uva 36 35.6 26.0 Sabragamuwa 43 51.3 19.4 Sri Lanka 45 36.3 20.9 Source: Vitamin A Survey, Medical Research Institute (1995/96).
Causes of malnutrition Root causes of malnutrition are diverse and there is a broad agreement that food intake, poverty, domestic agriculture production and price behavior are expected to cause malnutrition (World Bank Report, 2006). Food intake Nutritional status is associated with food intake which in turn is taken to be dependent on income. Poverty and inadequate food availability are the major causes of low level of nutrition (Osmani, 1997). The national average total diet energy per person for Sri Lanka is 2260 calories (DCS, 2004). Those persons whose daily calorie intake falls below the required minimum were reckoned to be nutritionally deficient. But this calorie intake varies with income level. Table 4 shows the proportion of persons with daily energy consumption below 2260 calories. Accordingly, first two deciles do not receive the minimum required amount of energy. In all sectors, the low
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income earners still fail to meet the minimum requirement. The proportion drops down with level of income. Table 4. Proportion of persons with daily energy consumption below 2260 calories. Income Deciles of Urban Rural Estate All Sector spending units 1 2 3 4 5 6 7 8 9 10
77.4 77.9 73.0 70.6 73.2 49.0 62.2 48.9 47.8 34.0
70.9 71.1 64.2 62.9 56.8 49.4 45.0 42.8 35.9 30.0
45.9 43.9 36.0 39.5 38.6 40.8 19.6 29.1 29.4 24.4
70.2 70.1 64.0 62.7 58.0 48.9 45.7 42.9 37.2 30.1
Poverty Poverty is one of the important causes of malnutrition. Poverty is predominantly a rural phenomenon with about 85% poor households. Poverty is lowest in the Western province, which has a larger concentration of industrial and service sector activities (Table 5). Poverty is highest in Uva followed by Sabragamuwa, the Central and Southern provinces (DCS, 2004). It is observed that generally, low income groups are vulnerable to malnutrition and their food intake is also low. Table 5. Percentage of poor based on the official poverty line by sector and province. Sector and Survey period province 2002 1995-96 1990/91 Sri Lanka 19.2 24.3 Sector Urban 6.2 11.0 Rural 20.8 25.9 Estate 24.3 32.2 Province Western 9.2 13.0 Central 20.8 31.3 Southern 23.6 27.0 North Western 22.3 23.6 North Central 18.1 20.4 Uva 31.8 40.2 Sabaragamuwa 28.9 36.1 Source: Department of Census and Statistics, 2004.
21.8 12.9 24.7 16.7 15.6 25.8 24.7 21.6 20.4 27.0 26.8
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Domestic agriculture production and price behavior Presently domestic agricultural production is associated with high-input green revolution agricultural technologies to increase the production. As a result, farmers in the best agricultural environments rapidly adopted mono cropping system displaced more diverse mix cropping pattern despite their lower calorie protein output, provided foods with higher contents of essential micro nutrients. For instance, pulses are particularly significant because of their richness in protein. Yet, the production in recent years has declined (Fig. 1). 35000
Gre en Gram -Production
30000 Production (t)
25000 20000 15000 10000 5000 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year Maha
9000
Yala
Annual
Black Gram - Production
8000 Production (t)
7000 6000 5000 4000 3000 2000 1000 0
Production (t)
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year Maha Yala Annual 18000 16000 14000 12000 10000 8000 6000 4000 2000 0
Cow pea- Production
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year Maha
Yala
Annual
Source: Department of Census and Statistics. Figure 1. Production trend in green gram, black gram and cowpea.
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The situation has remained generally static for other crops too. Nutritionally, pulses are a rich sources of dietary protein and are therefore important additions to a cereal-based diet for improving essential amino acid profile. The production of fruits and vegetables has also not kept pace with population growth. The result is lower availability and higher price for micro nutrient-rich foods; factors that limit their accessibility, particularly to low income families. Hence, it is important to ensure adequate access to food for these low income families. Generally, adequate access to food is a function of people’s income and purchasing power in relation to the price of food in the market. In recent years the prices are on the increase (Fig. 2) and this situation may aggravate malnutrition among low income families.
Rupees
Average retail price of s electe d pulse s 90 80 70 60 50 40 30 20 10 0 2000
2001
Black grame
2002 2003 Ye ar Green grame
2004 Cow pea
Source: Department of Census and Statistics Figure 2. Average retail price of pulses.
Further, with continued population growth, increasing agricultural production and focusing on staple food crop production is likely to increase micro nutrient malnutrition (Christopher et al., 1999). Micro nutrient deficiency can be overcome by including pulses in diets along with vegetables and fruits. Cost of malnutrition and benefit cost ratio The cost of malnutrition to society comes as direct and indirect costs. Direct costs mainly include the medicinal costs for treating underweight children and mothers who fall ill frequently. An estimation revealed that about 4.5–5 million people were malnourished in 2005. The direct costs add up to around Rs. 900-1000 million annually. Indirect costs refer to loss of productivity and income caused by premature death, disability and lower educational and occupational opportunities. A rough estimate suggests that these indirect costs range into 3 times direct costs. Both direct and indirect costs show that these are unacceptably high and also markets are failing to address the malnutrition problem. Therefore government should intervene to reduce malnutrition problem. Hence, third type of costs namely the costs of
110 RAFEEK et al.
interventions that could be taken to prevent and eliminate malnutrition should also be taken into account. These may include Research and Development as well as home garden programs. It is estimated that about Rs. 500 million is needed annually to minimize malnutrition. The estimates suggest that every rupee invested in well targeted interventions to reduce malnutrition and micronutrient deficiencies can yield five fold benefits. Agricultural strategies Designing the agriculture programs to improve malnutrition is imperative. It is observed that prevalence of malnutrition is in the rural areas where the potential for increasing crop production is also high. Therefore, better approaches are needed to meet the increasing nutritional demand of rural population. The approach should encompass increasing micronutrient production, reducing micronutrient losses and increasing their utilization. A breeding strategy that produces plants to fortify and develop micronutrientdense staple food crops such as rice, maize and pulses could provide a lowcost sustainable way to reduce micronutrient malnutrition. Approaches necessarily will vary according to local circumstances (Combs et al., 1996). In recent years, domestic crop production has changed to simple cropping pattern from multiple cropping. Hence, re-diversifying cropping pattern through introduction of micro nutrient-rich crops into crop rotation is essential. Inclusion of early maturing legumes in rotations of rice can increase the availability of pulses while returning some nutrients to soil to overcome stagnating cereal productivity. Home gardening efforts emphasizing vegetables and fruits will continue to be important. Therefore, it will be necessary to exploit the potentials of improved food production and utilization system. This will require changes in thinking about agriculture and national development. CONCLUSIONS The consequences of malnutrition lead to sickly, inefficient and poorly educated workforce resulting in lost income thus perpetuating poverty. The economic effects of malnutrition extend far beyond households and affects the entire economy. Adequate nutrition is therefore crucial to any sustainable economic development strategy. The cost of treating and caring sick children is borne by families and government. It is estimated that malnutrition costs at least Rs. 900-1000 million per year. Addressing malnutrition cost-effectively would cost less than Rs. 500 million per year. Nutrition interventions are necessary for the development and future economy of the country.
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REFERENCES Christopher, L., J.M. Staat and J.F. Teft. 1999. Agriculture Development and Child Nutrition: What do we know? MSU Agricultural Economics, Policy Synthesis No 52. Combs, Jr. G.F.R., M. Welch and J.M. Duxbury, 1996. Food-Based Approaches to preventing Micronutrient Malnutrition: An International Research Agenda. Cornell University, Ithaca, New York. Department of Census and Statistic. 2000. Demographic health survey, Colombo, Sri Lanka. Department of Census and Statistic. 2004. Official Poverty Line, Colombo, Sri Lanka. Medical Research Institute, A Survey Report. 1998, Vitamin A Deficiency Status of Children, Sri Lanka. Osmani, S.R. 1997. Poverty and Nutrition in South Asia. Lecture delivered at the Symposium on Nutrtion and Poverty held at UN ACC /SCN 24th Session, Kathmandu. Suzanne and L.W. Wisniewski., 2006. Linking Childhood Nutrition and Health Problems to Scgool Achievement, Department of Applied Economics, University of Minnesota. World Bank Report. 2006. Repositioning Nutrition as Central to Development: a Strategy for Large-Scale action, IBRD, Washington.