Sri Lanka is facing a growing “triple burden” of child malnutrition that demands urgent, science-driven intervention, a senior health official said at a recent forum organised by the National Science Foundation in Colombo.

Dr. Hiranya S. Jayawickrama, Consultant Community Physician attached to the Family Health Bureau (FHB) of the Ministry of Health, said that the country continued to grapple with undernutrition, micronutrient deficiencies and rising overweight among children, despite decades of maternal and child health interventions.

Addressing the Science Forum on Food Security held at the NSF auditorium recently, Dr. Jayawickrama said malnutrition in Sri Lanka was no longer limited to hunger or food scarcity, but had become a multidimensional public health challenge affecting children across all social strata.

She explained that undernutrition continued to manifest in the form of stunting, wasting and underweight among children. Stunting refers to chronic undernutrition over a long period, usually resulting in low length or height for age. Wasting, by contrast, indicates acute undernutrition and is characterised by low weight for length/height, often caused by sudden food shortages or illness. Underweight is a broader indicator reflecting low weight for age and may result from either chronic or acute  undernutrition.

Dr. Jayawickrama said that micronutrient deficiencies, particularly Iron deficiency, remained widespread among children and mothers, while overweight and obesity were emerging as growing concerns due to changing dietary habits and increased consumption of foods high in sugar/starch, and fat including ultra-processed foods.

She identified several key drivers behind the crisis, with inappropriate infant and young child feeding practices as the leading underlying reason,  with several other contributors such as recurrent infections, low birth weight, poverty, food insecurity and poor sanitation . Persistent myths and misconceptions surrounding child feeding, as well as parenting challenges, had also hampered progress, she said.

“Authentic sources of information is essential  to obtain a clear understanding in addressing this issue,” Dr. Jayawickrama stressed, adding that national nutrition interventions must be guided by routine maternal and child health data collected by the FHB, research conducted by the Medical Research Institute (MRI), and national level surveys conducted   by the Department of Census and Statistics.

Outlining the government’s response, she said the Ministry of Health was implementing an integrated Maternal and Child Health (MCH) package of evidence based interventions aimed at addressing malnutrition at multiple levels.

Dr. Hiranya S. Jayawickrama addressing the forum

Among the interventions highlighted were regular growth monitoring at clinics and field weighing posts, promotion of breastfeeding and appropriate  complementary feeding practices which promote healthy, natural and home based food consumption, and micronutrient supplementation programmes.

Children receive Vitamin A mega-doses through  the MCH programme, while multiple micronutrient powders are also distributed for home fortification of complementary food, she said.

Specialised nutritional support programmes have also been implemented. Thriposha is provided for children suffering from Moderate Acute Malnutrition (MAM), while BP-100 therapeutic food is provided to children diagnosed with Severe Acute Malnutrition (SAM) in hospital settings.

Dr. Jayawickrama said Public Health Midwives (PHMs) continued to play a frontline role through home visits, conducting field weighing posts, nutrition counselling sessions and awareness programmes targeting caregivers.

The interventions are being implemented under the framework of the National Nutrition Policy 2021–2030 and the Maternal and Child Health Policy 2012.

A significant focus of the presentation was the implementation of the Labelling and Advertising Regulations of 2022, which are expected to strengthen legal safeguards for children against misleading food marketing practices.

According to Dr. Jayawickrama, the regulations prohibit the advertising of infant formula intended for children aged below one year and milk-based products marketed for children aged between one and three years.

The regulations also ban the use of images featuring pregnant and lactating mothers, infants and children below the age of 12 years in food advertisements across television, print, digital and social media platforms.

In addition, promoting  any food products to children under the age of 12 years is prohibited unless approval is obtained from the Chief Food Authority.

She warned that aggressive commercial promotion of  ultra-processed foods including milk based commercial products for children undermines breastfeeding practices and healthy dietary behaviours among children.

Dr. Jayawickrama further explained that child nutrition services in Sri Lanka are monitored through a comprehensive  electronic  health management information system operated by the Family Health Bureau. Children are regularly assessed for weight, length/height and growth patterns at maternal and child health clinics and field weighing centres, while standard growth charts are used to identify early signs of growth problems and malnutrition.

The forum also featured presentations by Prof Buddhi Marambe, Emeritus Prof KKDS Ranaweera and Prof Ranuka Silva. NSF Chairman Dr Sudath Samaraweera and Director General Prof Shiromi Perera were also present.