Community-based management of severe and moderate acute malnutrition during emergencies in Sri Lanka: Challenges of implementation

Background. With the documentation of high rates of acute malnutrition in children under 5 years of age, the Ministry of Health of Sri Lanka established a Nutrition Rehabilitation Program in Jaffna District of the Northern Province. Objective. To assess the impact of community-based management of acute malnutrition among children under 5 years of age and its operational challenges. Methods. The Nutrition Rehabilitation Program was introduced and implemented in phases covering the entire district and was integrated into the routine healthcare system from the beginning. Children were categorized into severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) groups according to World Health Organization weight-for-height growth standards. Children with SAM were given ready-to-use-therapeutic food (RUTF), and children with MAM were given 100 g (450 kcal) of high-energy biscuits (HEBs) provided by UNICEF. All children received daily supplementary food consisting of locally produced Thriposha or 50 g of corn soya blend provided by the World Food Programme that provides approximately 200 kcal in addition to the general food ration. The children were followed up according to the guidelines stipulated in the Nutrition Rehabilitation Program manual. Results. An endline representative survey conducted 2 years after implementation of the Nutrition Rehabilitation Program revealed that the prevalence of global acute malnutrition (GAM) among children under five dropped from 18% to 9.6%, a reduction of 47%, while the prevalence of SAM dropped from 3.5% to 0.7%, a reduction of 80%. However, the prevalence of anemia remained at 34%, which is higher than the national prevalence of 25%, in spite of supplementation with 200% of the Recommended Nutrient Intake of iron and vitamin A. Conclusions. Proper targeting of feeding programs with good coverage can reduce the rates of acute malnutrition in emergencies. It is important also to consider the control of anemia in emergencies.