Background: Both the civil war in 1998 and the tsunami in 2004 in Sri Lanka resulted in a large number of orphans. Objective: To examine the effect of nutritional intervention on one-year period of stunting and/or emaciated status. Methods: Study setting: Twenty-eight girls aged 5 - 19 years old were in the care of Grace Girls’Home, an orphanage for girls located in the port town of Trincomalee, Sri Lanka, at the time of the survey. Nineteen of them had two available anthropometric measurements recorded over one year of follow-up. Anthropometric measurements were obtained prior to the intervention of nutritional mentoring to the local caregivers, and one year after intervention. Height-for-age, weight-for-age, and BMI-for-age z-scores were calculated using SMART methodology. Nutritional consultancy recommended an additional 15 - 20 grams of high quality protein per day, which was given to the girls. The kitchen team was encouraged to regularly prepare a variety of pulse-based dishes, using local foods and recipes. The local palm oil, rich in saturated fatty acids, was replaced with sunflower oil, rich in polyunsaturated fatty acids. Results: Stunting was decreased from Height to age Z-score (−1.19 ± 0.94) to (−0.90 ± 1.06) (P = 0.016), and BMI Z-score from (−0.80 ± 0.79) to (−0.50 ± 0.74) (P = 0.004). Conclusions: A single nutritional education intervention, culturally adapted and implemented by the local caregivers, can decrease stunting in orphans within one year.
References
[1]
Arasaratnam, S. and Peiris, G.H. (2020) Sri Lanka. Encyclopedia Britannica.
https://www.britannica.com/place/Sri-Lanka
[2]
Department of Census and Statistics (2017) Demographic and Health Survey 2006-2007.
https://catalog.ihsn.org/index.php/catalog/2551 http://www.statistics.gov.lk/social/DHS%20200607%20FinalReport.pdf
[3]
World Health Organization (WHO) (2018) Health SDG Profile: Sri Lanka.
https://apps.who.int/iris/bitstream/handle/10665/276842/sdg-profile-SriLanka-eng.pdf?sequence=5&isAllowed=y&ua=1#:~:text=Life%20expectancy%20at%20birth%E2%81% B4%20provides,health%20for%20the%20country’s%20population
[4]
Victora, C.G., Adair, L., Fall, C., Hallal, P.C., Martorell, R., Richter, L. and Sachdev, H.S. (2008) Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital. The Lancet, 371, 340-357.
https://doi.org/10.1016/S0140-6736(07)61692-4
[5]
Reid, B.M., Harbin, M.M., Arend, J.L., Kelly, A.S., Dengel, D.R. and Gunnar, M.R. (2018) Early Life Adversity with Height Stunting Is Associated with Cardiometabolic Risk in Adolescents Independent of Body Mass Index. The Journal of Pediatrics, 202, 143-149. https://doi.org/10.1016/j.jpeds.2018.06.047
[6]
Predrendergast, A.J. and Humphrey, J.H. (2014) The Stunting Syndrome in Developing Countries. Paediatrics and International Child Health, 34, 250-265.
https://doi.org/10.1179/2046905514Y.0000000158
[7]
Martorell, R. and Zongrone, A. (2012) Intergenerational Influences on Child Growth and Undernutrition. Paediatric and Perinatal Epidemiology, 26, 302-314.
https://doi.org/10.1111/j.1365-3016.2012.01298.x
[8]
Hossain, M., Choudhury, N., Adib Binte Abdullah, K., Mondal, P., Jackson, A.A., Walson, J. and Ahmed, T. (2017) Evidence-Based Approaches to Childhood Stunting in Low and Middle Income Countries: A Systematic Review. Archives of Disease in Childhood, 102, 903-909. https://doi.org/10.1136/archdischild-2016-311050
[9]
Dror, D.K. and Allen, L.H. (2011) The Importance of Milk and Other Animal-Source Foods for Children in Low-Income Countries. Food Nutrition Bulletin, 32, 227-243. https://doi.org/10.1177/156482651103200307
[10]
Sadik, A. (2010) Orphanage Children in Ghana: Are Their Dietary Needs Met? Pakistan Journal of Nutrition, 9, 844-852. https://doi.org/10.3923/pjn.2010.844.852
[11]
Silva, V., Jayasinghe, M.A., Senadheera, S.A. and Ranaweera, K.K.D.S. (2020) Determination of Macronutrient Compositions in Selected, Frequently Consumed Cereals, Cereal Based Foods, Legumes and Pulses Prepared According to Common Culinary Methods in Sri Lanka. Journal of Food Science and Technology, 57, 816-820.
https://doi.org/10.1007/s13197-019-04085-x
[12]
SMART (2006) Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations: SMART Methodology.
http://www.nutrisurvey.de/ena_beta/SMART_Methodology_08-07-2006.pdf
[13]
Kalyankar, S.D., Deshmukhs, A.M., Chopde, S., Khedkar, C.D. and Lules, S. (2016) Milk Powder. In: Caballero, B., Finglas, P.M. and Toldrá, F., Eds., Encyclopedia of Food and Health, Elsevier, Amsterdam, 724-728.
https://doi.org/10.1016/B978-0-12-384947-2.00465-7
[14]
Schwingshackl, L., Bogensberger, B., Bencic, A., Knüppel, S., Boeing, H. and Hoffmann, G. (2018) Effects of Oils and Solid Fats on Blood Lipids: A Systematic Review and Network Meta-Analysis. Journal of Lipid Research, 59, 1771-1182.
https://doi.org/10.1194/jlr.P085522
[15]
WHO (2020) Growth Reference 5-19 Years. https://www.who.int/growthref/en
[16]
Grantham-McGregor, S., Cheung, Y.B., Cueto, S., Glewwe, P., Richter, L., Strupp, B. and International Child Development Steering Group (2007) Developmental Potential in the First 5 Years for Children in Developing Countries. The Lancet, 369, 60-70. https://doi.org/10.1016/S0140-6736(07)60032-4
[17]
de Onis, M., Garza, C., Victora, C.G., Onyango, A.W., Frongillo, E.A. and Martines, J. (2004) The WHO Multicentre Growth Reference Study Planning, Study Design, and Methodology. Food and Nutrition Bulletin, 2, S15-S26.
https://doi.org/10.1177/15648265040251S103
[18]
Le Mare, L. and Audet, K. (2006) A Longitudinal Study of the Physical Growth and Health of Postinstitutional Romanian Adoptees. Paediatric Child Health Journal, 11, 85-91.
[19]
Rutter, M. (1998) Developmental Catch-Up, and Deficit, Following Adoption after Severe Global Early Privation. English and Romanian Adoptees (ERA) Study Team. Journal of Child Psychology and Psychiatry, 39, 465-476.
https://doi.org/10.1111/1469-7610.00343
[20]
He, Z. and Ji, C. (2007) Nutritional Status, Psychological Well-Being and the Quality of Life of AIDS Orphans in Rural Henan Province, China. Tropical Medicine & International Health, 12, 1180-1190.
https://doi.org/10.1111/j.1365-3156.2007.01900.x
[21]
Hailegiorgis, M.T., Berheto, T.M., Sibamo, E.L., Asseffa, N.A., Tesfa, G. and Birhanu, F. (2018) Psychological Wellbeing of Children at Public Primary Schools in Jimma Town: An Orphan and Non-Orphan Comparative Study. PLoS ONE, 13, e0195377.
https://doi.org/10.1371/journal.pone.0195377
