Nutrition and Food Security Assessment in Sri Lanka - 2009 ... · i Nutrition and Food Security Assessment in Sri Lanka - 2009 AMPARA DISTRICT Dr. Renuka Jayatissa Dr. S.M. Moazzem

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Nutrition and Food Security Assessment in Sri Lanka - 2009

AMPARA DISTRICT

Dr. Renuka Jayatissa

Dr. S.M. Moazzem Hossain

Medical Research Institute Sri Lanka

In collaboration with UNICEF and World Food Programme

September 2010

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LIST OF ABBREVIATIONS

ARI Acute Respiratory Infection BMI Body Mass Index DHS Demographic and Health Survey dl Deciliter ECCD Early Childhood Care and Development ECD Early Childhood Development FGD Focus Group Discussion GN Grama SevaNiladari GRS Growth Reference Standard HAZ Height-for-age Z score Hb Hemoglobin concentration IYCF Infant and Young Child Feeding LBW Low Birth Weight LRI Lower Respiratory Tract Infection MDG Millennium Development Goal MOH Medical Officer of Health MoHN Ministry of HealthCare and Nutrition MRI Medical Research Institute MUAC Mid Upper Arm Circumference NGO Non Government Organization ORS Oral Rehydration Solution PHI Public Health Inspector PHM Public Health Midwife RDHS Regional Director of Health Services SD Standard Deviation SL Sri Lanka UNICEF United Nations Children’s Fund URI Upper Respiratory Tract Infection WAZ Weight-for-age Z score WFP World Food Program WHO World Health Organization WHZ Weight-for-height Z score

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PREFACE

This nutrition and food security survey was carried out by the Department of Nutrition of the Medical Research Institute in collaboration with the UNICEF and the World Food Programme. This survey was focused on the maternal and child under-nutrition which remains a major public health problem in Sri Lanka, despite improvements in many health indicators. This kind of research study is more than timely to assess years of efforts taken by the government and other organizations to prevent and control undernutrition in vulnerable age groups and populations. For a population to be vibrant and work towards its progress, its constituent members have to be of sound health. Nutrition and food security plays a vital role in achieving this end. There is much room for improvements and a tremendous effort has to be made to uplift the prevailing nutritional status in the country. The nutritional status of the majority is below the satisfactory level specially among the poverty stricken people. It is a pity to see that most of them are not aware of how much nutrition contributes to the sound growth of an individual. Relationship of undernutrition to socio-economic and other factors may be used to prioritize communities to which resources should be allocated to improve the situation, and I fervently hope that the findings of this survey will be beneficial to the future policy makers in their effort to oust under nutrition and create a hale and hearty society. I appreciate the efforts taken by the staff of the medical research institute who has successfully conducted this study. I take this opportunity to thank every member of the households in which this assessment was conducted, who gave their unstinted cooperation. I am grateful to UNICEF for being interested in our welfare and investing on a very important venture of this nature. This survey will be very helpful to mitigate this problem and create a Sri Lanka free from undernutrition. Dr. Ravindra Ruberu Secretary Ministry of Health

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MESSAGE FROM UNICEF & WFP REPRESENTATIVES

The Food Security and Nutrition Survey is the first such survey in Sri Lanka to assess the nutrition situation across the country, the underlying causes of malnutrition and the related impact of the increase in global food prices. This detailed analysis of the relationship between food security and nutrition will be used to strengthen and monitor the impact of targeted interventions to mitigate malnutrition in Sri Lanka. The UN World Food Programme (WFP) and the United Nations Children’s Fund (UNICEF) are proud to be partners in this initiative. Effective joint nutrition interventions are required at all levels to achieve the first Millennium Development Goal (MDG) of halving the proportion of people who suffer from hunger and under-nutrition by 2015, and to contribute at the same time to achieving the MDGs related to child mortality, maternal health, primary education, gender equality, and HIV/AIDS. While Sri Lanka is largely on track to attaining most of the MDGs, significant challenges relating to poverty and child malnutrition remain including socio-economic and regional disparities, and the quality of public health care. While overall, with increasing wealth there has been a significant decline in the prevalence of stunting, wasting, underweight and anaemia, this study reveals that there are still significant regional disparities affecting the nutritional status of the people of Sri Lanka. For example the prevalence of stunting and underweight was higher in rural areas such as the estate sector and Hambantota, while wasting was found to be higher in urban areas including Colombo. WFP and UNICEF have a 40 year long history in Sri Lanka in supporting programmes to reduce maternal and child malnutrition and micronutrient deficiencies. WFP and UNICEF will continue to work jointly to support the Government of Sri Lanka and all other relevant stakeholders to take the recommendations of this important study forward. Reza Hossaini Adnan Khan UNICEF Representative WFP Representative

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ACKNOWLEDGEMENTS Many people have contributed to the realisation of the study and it is our desire to express our deep gratitude to all, while it is, unfortunately, impossibly to name them all. We gratefully acknowledge the continued valuable and constructive advise provided by Dr. Athula Kahadaliyanage, Former Secretary, Ministry of Healthcare and Nutrition. We also deeply acknowledge the fruitful and motivating discussions and support from the members of the National Nutrition Steering Committee and many experts, especially during the final stage of the data analysis. Special thanks go to Mr.K.Dharmawardana, Accountant, National Health Fund and his staff for their patient assistance throughout the study. Many thanks go to Dr. Lulu Raschid, Director MRI for the support. Dr. Ayesha Lokubalasuriya, Dr. Neli Rajaratna from Family Health Bureau and Dr. Senaka Thalagala, RDHS Ampara for the support extended to conduct the pilot study. Director General Census and statistics for providing census data for sample selection and providing equipment. Deep gratitude goes to the UNICEF, particularly Mr. Phillipe Duamelle, Country Representative, UNICEF, Mrs. Desiree Jongsman (Deputy country Representatives), Dr. Indra Tudawe (Monitoring and Evaluation Specialist), Mr. Adnan Khan, Country Director, WFP, Mrs. Abbes Aziz (Deputy country representative,WFP), Giancarlor (Programme coordinator,WFP) for the motivation to start and complete the study, the support to conduct the field survey. Special thanks deserve the staff of the RDHS offices, staff of the MOH officers, the District Secretaries’ Offices and Gramaseva Niradari officers. They all worked tremendously hard to complete data collection to ensure accuracy. Even when circumstances were extremely difficult, they were never tired to carry on and their passionate contribution, personal and technical, was crucial to the completion of this survey. We deeply acknowledge the villagers’, the families’, the mothers’ and the children’s willingness and openness to cooperate with us. They, patiently, answered all questions and provided valuable insights. They showed great hospitality, staying with them was always a pleasure as well as a learning experience, and we are full of respect for the way they manage their daily life.

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RESEARCH TEAM

Principal investigator

Dr. Renuka Jayatissa - Consultant Medical Nutritionist, MRI Co-investigators Dr. C.L. Piyasena - Nutritionist Dr. S.M. Moazzem Hossaine - Chief Health and Nutrition, UNICEF

Collaborative Partners Dr. Dula De Silva - Programme officer, WFP Mr. Laksiri Nanayakkara - Programme Assistant, WFP Miss Analeena - Junior Programme officer, WFP International Advisors

Prof. Abbas Bhuiya - Senior Scientist & Head, IC DDR, Bangladesh Prof. Peter Kalestron - Child Health & Nutrition Unit, Belgium

Local Advisors and Report writing Prof. Dulitha Fernando - Prof. of Community Medicine Dr. Upul Senarath - Senior Lecturer, Faculty of Medicine

Survey Manager Mr. J.M. Ranbanda - Nutrition Assistant

Field Coordinators Dr. W.W.S.W.C. Fernando - Medical Officer Dr. A.T.D. Dabare - Medical Officer Mr. Andreas - Research Officer Survey Team Leaders

Mr. A.P. Senevirathne - Public Health Inspector Mr. H.K.T. Wijayasiri - Public Health Inspector Mr. P.V.N. Ravindra - Public Health Inspector Mr. E.G.S. Kulasinghe - Public Health Inspector Mr. W.A.P.I. Pieris - Public Health Inspector Mr. E.C. Paranagama - Public Health Inspector Mr. D.S. Dabare - Public Health Inspector Mr. P.A.K.Y. Wijesundara - Public Health Inspector Mr. R.A.J.C. Jayasinghe - Medical Laboratory Technologist

Field support Mr. S.P. Priyantha - Labourer Administrative support

Mrs. K.H.R. Shyamalee - Development Assistant Mrs. W.R.T.S. Perera - Development Assistant Miss H.I.K.N. Hevawitharana - Development Assistant Mrs. K.M.H.N. Kulathunga - Medical Laboratory Technologist Dr. Chaturangi Liyanarachchi - Pre-intern Medical Officer Dr. Nuwan Jayawardana - Pre-intern Medical Officer Dr. Supun de Silva - Pre-intern Medical Officer

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Mr. Piyadasa Gamage - Laboratory Ordely Mrs. P.P. Wimalamathie - Laboratory Ordely

Data Analysis Mr. Sarath Gamage (Family Health Bureau), Mr. Abdullah-Al-Harun (Save the children, Bangladesh), Mr. Mokalus Rahuman (Bangledesh), Mr. Mohammed Sadeq (Bangladesh), Mr. Mohammed Rashid (Bangladesh) Mr. Indika Siriwardana Dr. Danushka Keerthiratne - Pre-intern Medical Officer

Enumerators B.C. Priyantha, K. Gamini, A.N.U. Kumari, J.A.C.M. Jayakody, H.M.N.P. Jayaweera, N.M.N.U. Nayakarathna, K.G.C.S. Dharmawardana, H.A.D. Rathnayaka, S.R. Asiri Sampath, S. Enoka Nishanthi, J. Gnanarahini, J.A. Virgini, P. Kokilavathani, N. Shanthi, G. Thanujaah, K. Dhamayanthy, N. Tharishini, A. Krishanthy, R. Rathika, S. Janarthani, Priya Ratnarajah, T. Nancy, Jeromy S., A. Kavitha, V. Viwekanathan, T. Jeewanakanth, P. Kantheepan, P. Suhanthan, Thevatharshan, K. Sutharshan, V. Uthaya Chandran, T. Sanlhira Segaram, M. Sanmugapriyan, K. Suresh kumar, K. Rathikumar, N. Sibatharthan, M. Roysal Ranjan, A. David, G. Justin, S. Jeyanupan, Thadschayini, K. Ainkaran, S. Anojithan, T. Theiventhiran, L.S. Pakirathan, R. Jeevananth, S. Nalini, A. Desmon, V. Sivatharshan, M. Mogana, A. Prasanth, B. Ramesh, M. Sadeesh, U. Gayathri, Y. Sivapriya

Data Entry Adeesha Hewawasam, Surangi Pitigala, Samanthi kumara, Harshani Randika, Dinesh Wijayarathna, D.K. Hemali Iresha

District support staff (Gramaniladari, Samurdi Officer, Public Health Inspector, Public Health Midwife) G.G. Dayarathnabanda, D.G.A. Kularathna, S.B.P. Jayasingha, M.G. Sumeda, R.K. Subasingha, Susil Rajapaksa, N.P. Senevirathna, E.P. Kusumalatha, H.N.P. Herath, S. Thennakoon, T.S.D.M. Ilangarathna, P.D.S. Geethani Pallegama, E.J.P. Dharmasena, G. Thilakarathna, S.A. Fajriyo, A.L. Riyaza, K. Ranjanan, J. Feroza, H.K.J.L. Senevirathna, K. Kamalabegai, M.M. Rivaz, A. Amaladasan, I.M. Manzoor, M. Vasanthakumari, S. Subathra, M.A.M. Niyaz, J.M. Nijamudeen, A.L.M. Nazir, S. Kogulan, K. Amudini, M. Ranuja, P. Sudarshan, A.M. Faruk, S. Darmalingam, T. Sivalingam, K.L.S. Faiza

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KEY FINDINGS OF THE SURVEY

Nutrition status of children: Among all children in the age group 0–59 months, 18.5 percent were stunted, 12.0

percent wasted and 22.2 percent were underweight. 33.0 percent of children in the age group 6–59 months were anaemic. The prevalence of LBW was 17.8 percent.

Nutrition status of women: Among non-pregnant women aged between 15 to 49 years, 17.7 percent were

underweight, 19.8 percent were overweight and 10.3 percent were obese. Prevalence of anaemia among pregnant women was 36.7 percent. Among lactating

women, the prevalence was 24.5 and 26.6 percent among non-pregnant women. Childhood illness:

Among the total group, 19.4 percent reported to have had symptoms related to respiratory illness and 10.3 percent had diarrhoea during the specified period in the total sample.

Dietary intake: The percentage of children yet to achieve the target of dietary diversity was 57.1 which

decreased with increasing wealth quintiles up to the middle wealth quintile. Caring:

31.1 percent of children under 24 months had been bottle fed. Of the children aged 36-59 months, 56.3 percent had attended an early childhood

educational programme. Health services and sanitation:

Of all children aged 36 months and over, only 71.6 percent had been given 3 mega doses of Vitamin A.

53.8 percent of the children who had diarrhoea or respiratory symptoms had obtained services from the government sector, 38.8 percent from the private sector and 5.0 percent from other sources.

Of all pregnant mothers, 85.2 percent received iron tablets of whom 91.3 percent took them daily while 82.8 percent received Thriposaha and 28.6 percent women had received “poshana malla”.

Only 41.4 percent of households used both improved water source and sanitary means of excreta disposal.

Food security The percentage of households yet to achieve the target of dietary diversity was 66.6

which declined with increasing income and wealth quintiles. 53.3 percent of the households in the poorest wealth quintile have not received any food

aids. 32.9 percent of households had taken loans within the preceding month and 40.3 percent

out of that used to purchase food. 16.1 percent of households were ‘food insecure’.

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TABLE OF CONTENTS LIST OF ABBREVIATIONS .............................................................................................................. III

PREFACE ........................................................................................................................................... IV

MESSAGE FROM UNICEF & WFP REPRESENTATIVES ............................................................. V

ACKNOWLEDGEMENTS................................................................................................................. VI

RESEARCH TEAM ........................................................................................................................... VII

KEY FINDINGS OF THE SURVEY .................................................................................................. IX

TABLE OF CONTENTS ...................................................................................................................... X

LIST OF TABLES ............................................................................................................................. XII

LIST OF FIGURES............................................................................................................................ XV

1. METHODS ......................................................................................................................................... 3

1.1 SELECTION OF HOUSEHOLDS ............................................................................................................................ 3 1.2 COMPOSITION OF THE SURVEY TEAMS................................................................................................................ 3 1.3 THE HOUSEHOLD SURVEY ................................................................................................................................ 3 1.4 SUPERVISION AND QUALITY ASSURANCE ............................................................................................................ 4 1.5 DATA PROCESSING AND ANALYSIS .................................................................................................................... 4

2. RESULTS ........................................................................................................................................... 5

2.1 NUTRITIONAL STATUS ..................................................................................................................................... 5 2.1.1 Nutritional status of children .................................................................................................. 5 2.1.2 Anaemia in children ............................................................................................................... 7 2.1.3 Birth weight ........................................................................................................................... 8

2.2 NUTRITIONAL STATUS OF WOMEN OF 15-49 YEARS.............................................................................................. 9 2.2.1 Non pregnant women (using Body Mass Index) ....................................................................... 9 2.2.2 Anaemia in women ............................................................................................................... 10

2.3 CHILDHOOD ILLNESSES ................................................................................................................................. 11 2.3.1 Respiratory illness ................................................................................................................ 11 2.3.2 Diarrhoea ............................................................................................................................ 11

2.4 DIETARY INTAKE AND FEEDING PRACTICES ....................................................................................................... 11 2.4.1 Breastfeeding practices ........................................................................................................ 11 2.4.2 Complementary feeding and bottle-feeding practices ............................................................ 12 2.4.3 Food Consumption among children in the age group 6 – 59 months ...................................... 12 2.4.4 Dietary diversity................................................................................................................... 12 2.4.5 Individual dietary diversity score for children aged 6-59 months ........................................... 12

2.5 CARE PRACTICES ......................................................................................................................................... 13 2.5.1 Promoting early learning at household level ......................................................................... 13 2.5.2 Childhood education ............................................................................................................ 13

2.6 USE OF HEALTH SERVICES ............................................................................................................................. 13 2.6.1 Attendance at Child Welfare Clinic ....................................................................................... 13 2.6.2 Vitamin A supplementation for children ................................................................................ 13 2.6.3 Source of medical care for common childhood illnesses ........................................................ 13 2.6.4 Use of services at antenatal clinics ....................................................................................... 14 2.6.5 Food and nutrient supplementation for women...................................................................... 14 2.6.6 Samurdhi beneficiaries ......................................................................................................... 14

2.7 WATER AND SANITATION ............................................................................................................................... 14 2.7.1 Use of improved water sources ............................................................................................. 14 2.7.2 Use of sanitary means of excreta disposal ............................................................................. 15 2.7.3 Use of improved water sources and sanitary means of excreta disposal ................................. 15

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2.8 FOOD SECURITY AND COPING STRATEGIES ...................................................................................................... 15 2.8.1 Household food consumption ................................................................................................ 15 2.8.2 Household dietary diversity .................................................................................................. 16 2.8.3 Expenditure on food and other goods and services ................................................................ 16 2.8.4 Coping Strategies ................................................................................................................. 16 2.8.5 Food insecurity .................................................................................................................... 17 2.8.5.1 Household food consumption adequacy score (HFCAS) ..................................................... 17 2.8.5.2 Food insecurity categories ................................................................................................. 17

ANNEX I .............................................................................................................................................. 18

ANNEX II ............................................................................................................................................. 54

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LIST OF TABLES

Table 1: Prevalence of malnutrition: stunting, wasting, overweight and underweight by background characteristics ..................................................................................... 6

Table 2: Prevalence of anaemia among children 6-59 months of age by background characteristics ........................................................................................................ 7

Table 3: Prevalence of low birth weight, and mean birth weight among children born in the 5 years preceding the survey, by background characteristics ............................. 8

Table 4: Distribution of non-pregnant women 15-49 years by BMI levels, by background characteristics ........................................................................................................ 9

Table 5: Prevalence of Anaemia*, among i) pregnant women, ii) lactating women and iii) All non-pregnant women by background characteristics ..................................10

Table A 1: The number of total individuals, women 15-49 years, and children aged less

than 5 years, 2.0-4.9 years and 5.0-14.9 years, by sector and district .....................18 Table A 2: Distribution of households by household headship, size, education level, and

occupation by district ...........................................................................................18 Table A 3: Distribution of households by housing characteristics, by district ..........................19 Table A 4: Percent of households with household possessions and ownership of livestock

and land, by district ..............................................................................................19 Table A 5: Distribution of households according to income and wealth index, by district .......20 Table A 6: Percentage of under-5 children who reported symptoms of respiratory illness

and diarrhoea by background characteristics .........................................................21 Table A 7: Infant and young child feeding practices by background characteristics.................22 Table A 8: Percentage of children aged 6-59 months, who were given different food items

on the day preceding the interview, by background characteristics ........................23 Table A 9: Individual dietary diversity score in children (IDDS) according to background

characteristics for children 6 – 59 months .............................................................24 Table A 10: Minimum meal frequency, minimum dietary diversity, and minimum

acceptable diet in children 6-23 months, by background characteristics.................25 Table A 11: Participation of adult members in activities of children aged 2 to 5 years, and

percentage of under 5 children cared for by a child <10 years, by background characteristics .......................................................................................................26

Table A 12: Use of different types of play items by children under 5 years of age, according to background characteristics ................................................................................27

Table A 13: Percentage of children aged 36-59 months who were attending an early childhood education programme, by background characteristics ...........................28

Table A 14: Percentage of children 5-10 years of age attending Primary School, by background characteristics ....................................................................................29

Table A 15: Percentage of children aged 5-14 years who are involved in child labour activities, and mean hours per week, by background characteristics ......................30

Table A 16: Percentage of children less than 5 years of age who received care at child welfare clinic, by background characteristics ........................................................31

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Table A 17: Percentage distribution of children who received Vitamin A mega dose supplement at 9, 18 and 36 months, by background characteristics ........................32

Table A 18: Source of care provider for children who had diarrhoea or respiratory illness during 2 weeks preceding survey, by background characteristics ..........................33

Table A 19: Percent of pregnant mothers who attended antenatal clinics, and who received “poshana malla”, “thriposha” and Iron tablets, by background characteristics .......34

Table A 20: Percentage of lactating mothers who received “thriposha” and Vitamin A by background characteristics ....................................................................................35

Table A 21: “Samurdhi” beneficiaries” among women 15-49 years by background characteristics .......................................................................................................36

Table A 22: Distribution of households according to main source of drinking water, and households with improved source of water, by background characteristics ............37

Table A 23: Distribution of households according to drinking water treatment methods used, by background characteristics* .............................................................................38

Table A 24: Distribution of households according to duration to and from the source of drinking water, by background characteristics.......................................................39

Table A 25: Distribution of households according to the person collecting water used in the household, by background characteristics .............................................................39

Table A 26: Distribution of household members according to type of toilet used by the household, by background characteristics .............................................................40

Table A 27: Distribution of households using both improved drinking water sources and sanitary means of excreta disposal, by background characteristics .........................40

Table A 28: Percentage of household members (in broad age groups) who consume three or more main meals a day, by background characteristics..........................................41

Table A 29: Proportion of households by type of foods consumed at least once in the day or night preceding the interview, by to background characteristics ............................42

Table A 30: Proportion of households by type of foods consumed in 5 days and more preceding the interview, by background characteristics .........................................43

Table A 31: Household dietary diversity score according to background characteristics............44 Table A 32: Average monthly expenditure for food, services, health, education and

productive assets, by background characteristics (add Total income as total of means) .................................................................................................................45

Table A 33: Proportion of households by type of food groups by the main and secondary sources .................................................................................................................46

Table A 34: Percent of households with coping strategy adopted in the previous 30 days, with its frequency .................................................................................................46

Table A 35: Food-related coping strategies adopted during the 30 days preceding the survey, by background characteristics (Take at least once who adopted out of total) ..........47

Table A 36: Households taken loans and reasons for borrowing money, by background characteristics .......................................................................................................48

Table A 37: Percent of households reported food had run out at some time during the previous 12 months, and months of adequate household food provisioning (MAHFP) by background characteristics ..............................................................49

Table A 38: Current food stock duration, and size compared to last year, by background characteristics (FC8, FC9) ..................................................................................50

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Table A 39: Average number of times a household received food aid in the last 6 months, by background characteristics ....................................................................................51

Table A 40: Household Food Consumption Adequacy Score (HFCAS) and prevalence of household food insecurity status, by background characteristics ............................52

Table A 41: Distribution (No and Percent) of households by food security Levels ....................53 Table A 42: Food Security Levels ............................................................................................53

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LIST OF FIGURES

Figure 1: A map showing Ampara district........................................................................... 01 Figure 2: Assessment of food insecurity levels.................................................................... 54

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DISTRICT PROFILE - AMPARA Ampara district is one of the three districts in the Eastern province of Sri Lanka. The district extends from the lower Eastern border of the country towards the upper part of the central hills, occupying a land area of 4,415 km2. A map showing Ampara district is given in Figure 1. The total population enumerated in the Ampara district was 610,719 according to a special census conducted in 20071. Of them, 19.4 percent resides in the urban sector and 80.6 percent in the rural sector. The ethnic distribution in the district indicates a higher representation of Moors (44.0 percent) than Sinhalese (37.5 percent) and Tamils (18.3 percent). The district includes areas with a wide variation in geographical, climatic and agricultural patterns. Administratively, the district is divided into 20 Divisional Secretary (DS) divisions and 503 Grama Niladhari (GN) divisions. The local government institutions in the province include an Urban Council, a Municipal Council and 16 Pradeshiya Sabahas2.

Figure 1: A map showing Ampara district 1 Department of Census and Statistics. Basic population infor mation on Ampara district – 2007 2 Department of Census and Statistics Dist rict Statistical Handbook 2007.

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Health services are provided by the state sector through a District General Hospital, 06 Base Hospitals and 05 District hospitals. Community health services are provided through 20 Health Unit areas with Medical Officers of Health and field staff under 2 Deputy Provincial Director divisions, Ampara and Kalmunai3. Of the employed population within the district, 32.3 percent are engaged in agriculture, with the percentages employed in the service and industrial sectors being 48.0 and 19.7 respectively. The literacy rate among males was 88.9 percent, with that for females being 82.9 percent according the national census in 2001. The median household income level was Rs.14,556 which is lower than that at national level (Rs.16,735)4.

3 Mini stry of Health , Sri Lanka, Annual Health Bulletin,2007. 4 Department of Census and Statistics , Income and Expenditure survey 2006/07.

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1. METHODS

1.1 Selection of households A sample of 563 households from the district of Ampara was included in the study. The sampling frame used for selection of clusters was the 2001 census from the Sri Lanka Department of Census and Statistics. Clusters were defined at the level of a Grama Niladhari (GN) division. GN divisions were identified using the probability proportional to size technique. Within each cluster, 30 households were identified using a systematic sampling procedure. A Map indicating the selected GN divisions is given in Figure 1. A household was defined as persons routinely sharing food from the same cooking pot and living in the same compound or physical location. Members of a household need not necessarily be relatives by blood or marriage. All selected households were included in the survey, irrespective of whether there was a child under five.

1.2 Composition of the survey teams Each survey team included three interviewers and one team leader. A Co-ordinator was recruited to take the overall responsibility for the conduct of the survey. All team leaders and team coordinators were trained by staff from Medical Research Institute (MRI) with experience from past surveys. The three interviewers from the survey team conducted all interviews. The team leader was responsible for selection of households.

1.3 The Household survey It included several components. Administration of the questionnaire: A pre tested questionnaire was administered to the head of the household. Where possible, mothers were interviewed to obtain information on child care practices and maternal nutrition. The minimum age of respondents was 15 years. Anthropometric assessments: All children aged 0 to 59 months, along with their mothers and any pregnant women in the household, were selected for measurement. All measurements were conducted by team leaders, and standardized procedures for measuring the height/length, weight were used (WHO, 1995). Anthropometric measurements were made using UNISCALES and UNICEF measuring boards. In pregnant women, Mid Upper Arm Circumference (MUAC) was measured in addition to height and weight. Measurement of haemoglobin levels was carried out for all individuals selected for measurements except in children less than six months of age using hemocue method, using capillary blood.

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1.4 Supervision and quality assurance Constant supervision and monitoring of all field activities was attempted. Team leaders monitored the work carried out by the interviewers, while team coordinators monitored team leaders as well as the interviewers. Routine field editing of all questionnaires was conducted by the team leaders.

1.5 Data processing and analysis EPI Info 6.0 software package was used for data management and entry. Data cleaning was carried out in MS Access by sorting records to filter out extreme values and SQL queries to check logical errors. Consistency checks were run to detect and correct data entry errors. Data analysis was conducted in Anthro and SPSS. Anthro was used to calculate nutrition z-scores for women and children based on the anthropometric measurements, using WHO standards as the reference value.

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2. RESULTS A total of 563 households were included in the survey, with 75.5 percent being in the rural sector and 24.5 percent in the urban sector. Of the total 2728 individuals who were usually resident in the selected households, 759 (27.8 percent) were women aged between 15.0 and 49.9 years. There were 360 children aged less than 5 years, amounting to 13.2 percent of the total study population. Percentage of children aged between 2.0 - 4.9 was 7.8 percent and 5.0 to 14.9 years 19.5 percent. The distribution of households by socio-demographic and housing characteristics is described in the Tables A1, A2, A3, A4 and A5.

2.1 Nutritional Status

2.1.1 Nutritional status of children The three indices of physical growth that describe the nutritional status of children according to WHO growth standards (WHO, 2006) are: Height-for-age, Weight-for-height and Weight-for-age. Each of the three nutritional status indicators expressed in terms of standard deviations from the median (Z-scores) of the reference population to assess the prevalence of stunting (height for age <-2SD), wasting (weight for height <-2SD), underweight (weight for age <-2SD) and overweight (weight for height more than +2SD). A total of 360 children under five years were included in the survey, of whom all three anthropometric data were available for 324 in the district. As shown in Table 1, among all children in the age group 0–59 months, 18.5 percent were stunted, 12.0 percent wasted and 22.2 percent were underweight. Severe stunting was seen among 3.4 percent of the total group, with the comparable figures for severe wasting and severe underweight being 1.5 percent and 2.2 percent respectively. There were 1.2 percent children with weight for height values more than +2 SD. Comparisons made between sub-groups are based on relatively low numbers within each such group, hence have to be interpreted with caution. The prevalence of stunting (height for age <-2 SD) was high after the first 6 months of life, with the highest rate of 28.3 percent being found in the fourth year of life. Similar pattern with age was observed in the prevalence of underweight, with the highest rate of 30.0 percent in the 4th year. The highest rates of stunting, wasting, and underweight were found in the lowest income or poorest wealth category. However, there was no clear trend of stunting, wasting and underweight with increasing income level and wealth quintiles. Also no definitive pattern was observed in the prevalence of under nutrition with mother’s level of education.

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Table 1: Prevalence of malnutrition: stunting, wasting, overweight and underweight by background characteristics

Background characteristic Height-for- age

(%) Weight-for-height (%) Weight-for-age (%) Total No of

Children <-2SD <-3SD <-2SD <-3SD >+2SD <-2SD <-3SD

Age of child (months)

<6 3.6 0.0 3.6 0.0 3.6 3.6 0.0 28

6-11 15.6 9.4 12.5 3.1 0.0 18.8 3.1 32

12-23 17.9 2.6 12.8 0.0 1.3 21.8 2.6 78

24-35 19.7 5.3 14.5 1.3 0.0 26.3 0.0 76

36-47 28.3 3.3 5.0 0.0 0.0 30.0 3.3 60

48-59 16.0 0.0 20.0 6.0 4.0 20.0 4.0 50

Sex of child

Male 20.3 4.1 9.9 1.7 1.7 20.9 1.7 172

Female 16.4 2.6 14.5 1.3 0.7 23.7 2.6 152

Sector

Urban 18.4 2.3 6.9 0.0 1.1 18.4 2.3 87

Rural 18.6 3.8 13.9 2.1 1.3 23.6 2.1 237

Mother’s education

No schooling 6.7 0.0 13.3 0.0 0.0 13.3 0.0 15

Primary 19.4 3.2 19.4 0.0 0.0 22.6 3.2 31

Secondary 22.9 3.8 13.3 1.0 1.0 24.8 3.8 105

Passed O’ Level 19.7 4.5 4.5 1.5 1.5 18.2 1.5 66

Higher 20.0 2.9 8.6 0.0 2.9 25.7 2.9 35

Monthly household income

< 9,000 28.3 6.5 16.3 3.3 1.1 29.3 3.3 92

9,000 – 13,999 8.8 0.0 15.8 3.5 0.0 15.8 0.0 57

14,000 – 19,999 17.1 3.9 10.5 0.0 1.3 21.1 3.9 76

20,000 – 31,999 14.5 1.6 4.8 0.0 1.6 19.4 1.6 62

≥ 32,000 14.8 3.7 14.8 0.0 3.7 22.2 0.0 27

Wealth index quintile

Poorest 22.2 3.7 18.5 2.5 0.0 27.2 4.9 81

Second 18.1 1.2 13.3 0.0 1.2 21.7 1.2 83

Middle 17.7 6.5 6.5 0.0 1.6 21.0 0.0 62

Fourth 18.2 4.5 15.9 6.8 2.3 25.0 4.5 44

Richest 14.8 1.9 3.7 0.0 1.9 14.8 0.0 54

Overall 18.5 3.4 12.0 1.5 1.2 22.2 2.2 324

7

2.1.2 Anaemia in children The haemoglobin levels of 301 children in the age group 6–59 months were assessed using the ‘haemocue ‘method (cut off point - Hb <11.0 gms %). As shown in Table 2, the prevalence of anaemia in this group was 33.0 percent, with the highest percentage during the latter half of infancy (40.0 percent), followed by an abrupt decline from the 3rd year to 5th year (from 39.5 to 24.4 percent). Prevalence of anaemia was marginally higher in females than males. There was a steady decline in the prevalence with increasing maternal education. Anaemia prevalence showed higher values in both extremes of income and wealth and some fluctuation in the middle.

Table 2: Prevalence of anaemia among children 6-59 months of age by background characteristics

Background characteristic % of children with Anaemia

(Hb<11.0g/dl)*

Number of Children who were investigated for Hb

Age of child (months) 6-11 40.0 30 12-23 39.2 79 24-35 39.5 77 36-47 25.5 63 48-59 24.4 52 Sex of child Male 31.4 162 Female 35.1 139 Sector Urban 32.3 78

Rural 33.2 223


No schooling 55.6 16

Primary 44.4 27

Secondary 39.0 99

Passed O’ Level 30.9 58

Higher 20.5 34


< 9,000 37.2 90

9,000 – 13,999 28.3 51

14,000 – 19,999 36.8 67

20,000 – 31,999 23.1 59 ≥ 32,000 37.5 25 Wealth index quintile Poorest 46.8 80

Second 24.0 75

Middle 30.6 56

Fourth 14.3 38

Richest 40.0 52 Overall 33.0 301

8

2.1.3 Birth weight The birth weights were obtained from the Child Health Development Records (CHDRs). This study included children born within the 5 years preceding the survey. Considering the newborns with a birth weight of less than 2500 grams as being low birth weight (LBW), the overall prevalence was 17.8 percent. Birth weight distribution by the current age of the child enables comparison of prevalence of LBW among different birth cohorts. There is no definite pattern observed except that the cohort aged between 6-11 months at the time of the study, had the highest prevalence of LBW of 25.0 percent. Table 3: Prevalence of low birth weight, and mean birth weight among children born in the

5 years preceding the survey, by background characteristics

Background characteristic Birth Weight Number of

children < 2500g (%) ≥ 2500g (%) Mean (kg) SD


0-5 16.1 83.9 3.0 0.5 32

6-11 25.0 75.0 2.8 0.5 35

12-23 15.2 84.8 2.9 0.4 81

24-35 17.1 82.9 2.9 0.5 77

36-47 18.0 82.0 2.9 0.4 64

48-59 18.9 81.1 2.9 0.5 60

Sex of child

Male 16.8 83.2 2.9 0.5 187

Female 19.0 81.0 2.9 0.5 162

Residence

Urban 16.5 83.5 3.0 0.5 95

Rural 18.3 81.7 2.9 0.5 254


No schooling 11.8 88.2 3.0 0.4 17

Primary 16.7 83.3 2.9 0.4 31

Secondary 22.4 77.6 2.9 0.5 111

Passed O’ Level 16.9 83.1 2.9 0.5 70

Higher 5.4 94.6 3.1 0.4 37

Monthly household income (n=2592)

< 9,000 22.1 77.9 2.8 0.5 103

9,000 – 13,999 19.4 80.6 3.0 0.5 63

14,000 – 19,999 18.7 81.3 2.9 0.5 77

20,000 – 31,999 7.7 92.3 3.0 0.4 68

≥ 32,000 19.2 80.8 3.0 0.5 28


Poorest 27.4 72.6 2.8 0.4 90

Second 15.4 84.6 2.9 0.4 85

Middle 12.1 87.9 2.9 0.5 69

Fourth 20.4 79.6 3.0 0.6 49

Richest 10.9 89.1 3.0 0.4 56

Overall 17.8 82.2 2.9 0.5 349

9

There is no consistant pattern in the prevalence with increasing levels of income and wealth quintiles. Mean birth weight for the total group in the district was 2.90 ± 0.50 kg.

2.2 Nutritional status of women of 15-49 years

2.2.1 Non pregnant women (using Body Mass Index) A total of 252 non-pregnant women aged between 15 to 49 years, and with a child under 5 years of age were included in the assessment of body mass index. As shown in Table 4, 17.7 percent had BMI less than 18.5 kg/m2 (underweight), 19.8 percent with values between 25 and 29 (overweight ) and 10.3 with BMI values of 30 or above (obese).

Table 4: Distribution of non-pregnant women 15-49 years by BMI levels, by background characteristics

Background Characteristics

BMI category (%) Total

women Underweight (BMI<18.5)

Normal (BMI=18.5-24.9)

Overweight BMI=25.0-29.0)

Obese (BMI>30.0)

Age group (years)

15-19 100.0 0.0 0.0 0.0 6 20-29 20.2 51.9 16.3 11.5 107

30-39 12.3 51.9 25.5 10.4 110

40-49 14.3 64.3 14.3 7.1 29

Sector Urban 14.5 36.4 30.9 18.2 58

Rural 18.6 56.9 16.5 8.0 194

Women’s education level

No schooling 14.3 64.3 0.0 21.4 15 Primary 10.7 57.1 14.3 17.9 29

Secondary 21.8 46.0 19.5 12.6 88

Passed GCE (O/L) 12.5 57.1 28.6 1.8 57

Higher 18.5 44.4 25.9 11.1 30 Monthly household income

< 9,000 22.5 59.2 14.1 4.2 73

9,000 – 13,999 15.0 50.0 22.5 12.5 41 14,000 – 19,999 7.8 64.7 17.6 9.8 53

20,000 – 31,999 21.7 39.1 19.6 19.6 47

≥ 32,000 20.0 26.7 40.0 13.3 15

Wealth index quintiles

Poorest 20.0 69.2 9.2 1.5 65 Second 18.3 46.7 23.3 11.7 62

Middle 17.8 44.4 22.2 15.6 46

Fourth 21.9 50.0 21.9 6.3 36

Richest 9.8 43.9 26.8 19.5 43

Overall 17.7 52.3 19.8 10.3 252

10

There were only 6 women in the 15 -19 age group, and all of them were having a BMI less than 18.5 percent. The prevalence of thinness (BMI less than 18.5) declined from 20.2 percent in the 20-29 years to 12.3 percent in the 30-39 years category.

2.2.2 Anaemia in women Three groups of women were included in this component of the study, (i) pregnant women (30), (ii) lactating women (102), (iii) all non pregnant women including lactating women (244).

Table 5: Prevalence of Anaemia*, among i) pregnant women, ii) lactating women and iii) All non-pregnant women by background characteristics

Background characteristic Pregnant Lactating All Non-pregnant

Percent Total No of Women Percent Total No of

Women Percent Total No of Women

Age group (years)

< 20 0.0 1 0.0 3 16.7 6

20-29 47.6 21 26.5 49 27.2 103

30-39 16.7 6 24.4 41 24.3 107

40-49 0.0 2 22.2 9 35.7 28

Residence

Urban 35.7 14 9.1 22 10.9 55

Rural 37.5 16 28.8 80 31.2 189

Women’s education level

No schooling 50.0 2 42.9 7 42.9 14

Primary 33.3 3 58.3 12 35.7 28

Secondary 42.9 14 12.5 32 24.1 87

Passed GCE (O/L) 16.7 6 15.4 26 19.6 56

Higher 33.3 3 30.8 13 32.1 28


< 9,000 33.3 6 25.9 27 32.4 71

9,000 – 13,999 25.0 8 25.0 20 20.0 40

14,000 – 19,999 50.0 8 29.6 27 23.5 51

20,000 – 31,999 0.0 4 11.8 17 27.7 47

≥ 32,000 66.7 3 66.7 3 33.3 15

Wealth quintile of household

Poorest 37.5 8 17.9 28 28.1 64

Second 28.6 7 32.4 34 28.3 60

Middle 50.0 8 28.6 14 24.4 45

Fourth 33.3 3 28.6 14 18.8 32

Richest 25.0 4 8.3 12 30.2 43 Overall 36.7 30 24.5 102 26.6 244

Pregnant women As shown in Table 5, overall prevalence of anaemia among this group was 36.7 percent. Number of pregnant women in the sub groups is limited, hence no attempt is made to draw any observations on differences between sub groups.

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Lactating women Among lactating women, the overall prevalence was 24.5 percent. All non-pregnant women The overall prevalence among this group was 26.6 percent.

2.3 Childhood Illnesses Diarrhoea and respiratory infections are the two common illnesses that lead to increased morbidity and mortality among children under 5 years. The present study sought information from respondents related to the occurrence of these two illnesses during the two weeks preceding the interview.

2.3.1 Respiratory illness Respondents were asked whether their children less than five years of age had one or more symptoms related to respiratory illness (cough, rapid or difficult breathing) during the period of 2 weeks preceding the survey. A child who was having cough with rapid or difficult breathing, was identified as having had symptoms of respiratory illness. Among the total group, 19.4 percent reported to have symptoms related to respiratory illness during the specified period (Table A 6).

2.3.2 Diarrhoea The respondents were asked whether their children under five years had experienced an episode of diarrhea during the two weeks preceding the survey. (Diarrhoea was defined as three or more loose or watery stools per day or blood in stool). If the child had diarrhoea, information on giving oral dehydration fluid using the packet ‘Jeewani’ during the episode of diarrhoea, was inquired into. Of the total group, 10.3 percent of children reported to have diarrhea during the specified period, of whom 44.4 percent had been given ‘Jeevanie’.

2.4 Dietary intake and feeding practices

2.4.1 Breastfeeding practices Percentages of children less than 24 months of age who were ever breastfed, currently breastfed and started breastfeeding within one hour / one day of birth are given in Table A 7. A great majority (96.9 percent) of children were ‘ever breastfed’. Of them, 81.9 percent were breast fed within the first hour of birth and 88.7 percent were currently breast fed, that is, given breast milk in the previous 24 hours.

12

2.4.2 Complementary feeding and bottle-feeding practices As shown in Table A 7, of the children aged 6-8 months 86.7 percent were given breast milk and solid / semi solid foods. In the total sample, 31.1 percent of infants under 24 months had been bottle fed.

2.4.3 Food Consumption among children in the age group 6 – 59 months Food consumption pattern was based on the information about the food items given to children aged 6 – 59 months on the day preceding the interview. Ten different food items were included in this analysis. Table A 8 shows the percentage of children in this age group who were given the food items within the preceding 24 hours, by background characteristics. For the total sample, 85.5 percent of the children were given grains/roots/tubers, and about 80.4 percent sugary food such as chocolates, sweets, candies, cakes and biscuits. Consumption of Vitamin A rich fruits and vegetables, other fruits and vegetables and meat/poultry/fish ranged from 68.5 to 72.9 percent, and legumes and nuts and eggs were between 51.4 to 56.2 percent. It is important to note that consumption of 2 important categories – diary products and oil and fats were relatively low.

2.4.4 Dietary diversity Dietary diversity is based on the premise that more diverse diets are more likely to provide adequate levels of a range of nutrients.

2.4.5 Individual dietary diversity score for children aged 6-59 months In this study, individual dietary diversity score for children aged 6 – 59 months was assessed. (according to FANTA5). Diversity was calculated by giving 1 point each for 8 broad food groups. As shown in Table A 9, for all children in this age group, the IDDS was 4.9 (SD =2.3). The dietary diversity score of children aged 6-59 in the households belonging to the highest wealth quintile was used as a “target to be achieved” based on the assumption that poorer households will diversify their food consumption practices as incomes rise, and thereby attempting to follow the consumption pattern of wealthier households. Table A 9 shows that IDDS among children in the highest wealth quintile was 5.2. Based on this value, the percentage of children yet to achieve the target was assessed. This percentage was 57.1 for the total sample, and did not show a definitive trend across maternal education, income and wealth categories. Information on Minimum meal frequency, minimum dietary diversity and minimum acceptable diet for children aged 6-23 months are given in Table A 10.

5 FANTA

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2.5 Care Practices Care practices were studied in relation to activities on early childhood development including promoting early learning at household level, practices related to play activities, early childhood education and school enrolment. The age group to be included in the different components in the study of care practices varied, depending on the relevance. 2.5.1 Promoting early learning at household level As shown in Table A 11, the average number of’ activities for which a household adult member involved were 4.7. For the majority children (77.5 percent), an adult was engaged in more than three activities that promoted early learning, during the 3 days preceding the survey. Considering the children under 5 years of age, 13.7 percent were looked after by a child under the age of 10 years, during the week preceding the interview. Information related to play items and child labour is given in Tables A 12 and A 15 respectively.

2.5.2 Childhood education As shown in Table A 13, 56.3 percent of the children aged 36-59 months were attending an early childhood educational programme. All the children who have completed 5th birthday by 31st January 2009 have been enrolled in grade 1, and 98.7 percent of all children 5-10 years of age were attending Primary School (Table A 14).

2.6 Use of health services

2.6.1 Attendance at Child Welfare Clinic As shown in Table A 16, 95.1 percent of the children under 5 years had received care at a Child Welfare Clinic (CWC) and 86.0 percent of the children had their Child Health Development Records (CHDRs) with them at the time of interview. Of the mothers who attended the child welfare clinics, 94.1, 94.8 and 89.5 percent received advice on growth, nutrition and early childhood development respectively. In this district, 17.4 percent of children aged 6-59 months had received at least one packet of thriposha in the previous month. 2.6.2 Vitamin A supplementation for children Of the 268 children who had completed 9 months of age, 82.1 percent of had received a mega dose of vitamin A, with the percentage for children at 18 and 36 months being 81.4 and 71.6 percent respectively. Considering all children aged 36 months and over 71.6 percent had been given 3 mega doses of Vitamin A (Table A 17). 2.6.3 Source of medical care for common childhood illnesses Source of medical care for those children who reported diarrhoea / respiratory symptoms within the 2 weeks preceding the interview was considered according to services provided by the government sector, private sector and other sectors. As shown in Table A 18, 53.8 percent of the total group used services from the government sector, 38.8 percent from the private sector and 5.0 percent from other sectors.

14

2.6.4 Use of services at antenatal clinics Of the 26 pregnant mothers, 84.6 percent had attended antenatal clinics regularly as shown in Table A 19.

2.6.5 Food and nutrient supplementation for women The two main nutrition supplementation programmes aimed at pregnant women are the provision of a food basket (“poshana malla”) through the Samurdhi programme implemented by the: Ministry of Samurdhi and Poverty Alleviation and the Thriposha programme implemented by the Ministry of Healthcare and Nutrition. Of the pregnant women attending antenatal clinics, 82.8 percent received Thriposha and 28.6 percent received “poshana malla” (Table A 19). Recipients of iron tablets totaled to 85.2 percent and 91.3 percent of such recipients were using them regularly. Of the lactating mothers with an infant under 6 months of age, 80.0 percent had received “thriposha” (Table A 20) while vitamin A mega dose had been given to 91.1 percent, after childbirth.

2.6.6 Samurdhi beneficiaries In the households included in the study, there were 149 non pregnant, non lactating women in the age group 15 – 49 years. Of this group, 32.2 percent received Samurdhi benefits being members of Samurdhi beneficiaries families (Table A 21). Percentage beneficiaries among the pregnant women and lactating women were 12.5 percent and 26.2 percent respectively.

2.7 Water and Sanitation

2.7.1 Use of improved water sources About 66 percent of households had access to improved sources of water (Table 22). The households with improved water increased with increasing wealth quintiles, from 49 percent in the poorest quintile to 86.4 percent in the richest quintile. However, there was no variation by income categories. Of the households, 56.8 percent used any one of the appropriate water treatment methods to treat their drinking water, with ‘boiling’ being the most frequently used method practiced by 31.6 percent of the households included in the study (Table A 23). Information on the time consumed to collect water and the person collecting water are given in Tables A 24 and A 25 respectively.

15

2.7.2 Use of sanitary means of excreta disposal Use of flush toilets connected to sewage systems, or septic tanks was considered as sanitary means of excreta disposal. As shown in Table A 26, the percentage of households using sanitary means of excreta disposal was relatively low (61.8 percent).

2.7.3 Use of improved water sources and sanitary means of excreta disposal Table A 27 shows the distribution of households that use both improved sources of drinking water and sanitary means of excreta disposal. For the district sample, 41.4 percent of households reported using both improved water source and sanitary means of excreta disposal. The percentage of households that had both facilities increased with increasing levels of income and wealth quintiles.

2.8 Food Security and Coping Strategies

2.8.1 Household food consumption Table A 28 provides information on the household members who consume three or more main meals a day. The food items consumed by the households were grouped into 11 categories based on the FAO classification of food groups with some modifications to include coconut and sugar separately. These food groups were used in assessing the food consumption pattern as shown in Tables A 29 and A 30. Table A 29 provides information on food items consumed within 24 hours preceding the survey. Consumption of rice and rice products was close to 100 percent while coconut and sugar were 97.8 and 97.3 percent respectively. The consumption pattern of these 3 items was consistent across all sub groups studied. The consumption rates of vegetables and meat/poultry/fish were between 85.1-87.7 percent, and fruits and diary products between 63.1-69.2 percent. Egg consumption was as low as 48.3 percent. Information on the consumption of different foods for at least 5 days during the week preceding the survey is shown in Table A 30. This information indicates the consistency of consumption of the foods and shows the important differences from the Table A 29, which is focused on the consumption pattern during the 24 hours preceding the survey. Similar to the 24-hour consumption pattern, rice, coconut and sugar were consumed by a great majority indicating regular consumption. However, there was a marked reduction in certain food groups, such as nuts/pulses (12.1 percent), bread/wheat products (10.5 percent), fruits (29.4 percent) and meat/poultry/fish (43.4 percent) indicating that majority of households cannot consume these items on a daily basis.

16

2.8.2 Household dietary diversity Household dietary diversity score (HDDS) is a proxy measure of households consuming a variety of food indicating a nutritionally ‘satisfactory’ diet and is calculated by giving 1 score for each of the 11 broad food groups6. The table (A 31) indicates that the mean HDDS for the total group was 7.6 (SD 1.8). The value shows an increasing trend with increasing income and wealth quintile. The HDDS obtained by the households in the highest wealth quintile category (8.3) was taken as the ‘target ‘to be achieved and the percentage of households yet to achieve the target was calculated. For the total sample, the percentage of households yet to achieve the target was 66.6.The percentage showed a consistent decline with increasing income and wealth quintiles.

2.8.3 Expenditure on food and other goods and services Study of household expenditure for a one-month period showed that 43.0 percent of the total household monthly income was spent on food, and 38.4 percent on productive assets (Table A 32). Type of food groups by source, food availability at household, food stocks and food aid are given in tables A 33, A 37, 38 and 39 respectively.

2.8.4 Coping Strategies During the periods when there are limitations in food availability, different coping strategies are adopted by households (Table A 34). Use of such strategies during the month preceding the survey was studied paying attention to the frequency of practice. Of the total households 43.4 percent had adopted 1 or more food-related coping strategies. Of the total households, nearly equal percentages relied on less preferred food (30.7 percent), purchased food on credit (30.7 percent), and borrowed food (29.9 percent). Similar percentages, 17.8 and 17.3 reduced meal size or reduced number of meals per day, respectively. The main non-food strategies adopted were: pawning jewellary (17.2 percent) and selling agricultural tools/seeds (16.4 percent), and selling livestock (15.9 percent). The distribution of the households that adopted a specific food-related coping strategy by background characteristics is shown in Table A 35. There were steady declines with increasing income and wealth quintiles. Taking loans is a commonly adopted strategy to cope with difficult situations, whether it be food related or not. As shown in Table A 36, 32.9 percent of households had taken loans within the preceding month which were used for: purchasing food (40.3 percent) and income generation activities (15.1 percent).

6 Anne Swindale & Paula Bilinsky. Household Dietary Diversity Score (HDDS) for Measurement of Househol d Food Access:

Indicator Guide VERSION 2 September 2006) Washington, D.C.: Food and Nutri tion Technical Assistance Project, Academy for Educational Development, 2006.

17

2.8.5 Food insecurity A state of food insecurity exists when nutritionally adequate and safe foods are not readily available or there is inability to acquire acceptable foods. In this study, food insecurity levels were determined according to the method described by the World Food Programme (WFP), given in annex 2.

2.8.5.1 Household food consumption adequacy score (HFCAS) As shown in Table A 40, the mean HFCAS for all households was 64.7 (SD=15.2). The score was higher in the richest households. Study of HFCAS categories indicate that 0.5 percent of the households had poor food consumption, 1.8 percent were borderline and 97.7 percent, had adequate food consumption.

2.8.5.2 Food insecurity categories Food insecurity levels obtained by cross-tabulating food access categories (as indicated by percentage expenditure on food) and food consumption categories for households with a child aged less than 5 years (n= 291) are presented in Table 42. Of these households, only 1.0 percent was found to be ‘severely food insecure’, with comparable percent for ‘moderately insecure’ 15.1 percent. Almost 83.8 percent were food secure households. In interpreting food insecurity, the two categories, moderately and severely food insecure categories were considered together. Considering the key socio-economic indicators included in this study, the marked influences such indicators have on food insecurity is clearly shown. There was a consistent downward trend in food insecurity, with increasing income levels and wealth quintiles.

18

ANNEX I

Table A 1: The number of total individuals, women 15-49 years, and children aged less

than 5 years, 2.0-4.9 years and 5.0-14.9 years, by sector and district

Sector Total

Number of individuals

Women 15.0-49.9 years Children < 5 years Children 2.0-4.9

years Children 5.0-14.9

years

No % No % No % No %

Urban 709 189 26.7 99 14.0 50 7.1 142 20.0

Rural 2019 570 28.2 261 12.9 163 8.1 391 19.4

Total 2728 759 27.8 360 13.2 213 7.8 533 19.5

Table A 2: Distribution of households by household headship, size, education level, and occupation by district

Characteristic Districts

No %

Household headship

Male 521 92.5

Female 42 7.5

No. of members resident

1-3 135 24.0

4-6 349 62.0

≥7 79 14.0

Mean (Median) 4.8 0.0

Years of schooling (head of household)

No Schooling 52 10.2

1-5 111 21.9

6-10 204 40.2

11-13 132 26.0

Higher 9 1.8

Median (years) 8

Years of schooling (spouse)

No Schooling 50 10.5

1-5 93 19.6

6-10 186 39.2

11-13 142 29.9

Higher 4 0.8

Median (years) 8

19

Table A 3: Distribution of households by housing characteristics, by district

Characteristic No. %

Flooring Material Cement 449 80.0

Tile or Terrazzo 13 2.3 Mud/ cow dung 82 14.6

Other 17 3.0

Roofing material

Tiles 381 67.7 Asbestos 69 12.3

Concrete 6 1.1

Corrugated sheet 81 14.4

Cadjan 23 4.1

Other 3 0.5 Type of wall

Brick/ cabok 368 65.5

cement block 97 17.3

Clay 82 14.6 Wood 7 1.2

Cadjan 5 0.9

Other 3 0.5

Availability of Electricity Yes 390 69.3

No 173 30.7

Table A 4: Percent of households with household possessions and ownership of livestock

and land, by district

Possession / ownership No %

Household items Radio 366 65.0

Television 381 67.7

Mobile telephone 315 56.0

Telephone (non mobile) 238 42.3

Refrigerator 133 23.6

Transport facilities

Bicycle 367 65.2

Motorcycle/Scoter 177 31.4

Trishaw 27 4.8

Car/Van/Bus/Truck 20 3.6

Boat 9 1.6

Tractor/Land Master 39 6.9

Livestock

Yes 117 20.8

No 446 79.2

Lands

Mean extent of lands (Acres) 0.6

20

Table A 5: Distribution of households according to income and wealth index, by district

Characteristic No. %

Monthly household income (LKR)

< 9,000 163 38.3

9,000 – 13,999 114 26.8

14,000 – 19,999 78 18.3

20,000 – 31,999 52 12.2

≥ 32,000 19 4.5

Pattern of income

Daily paid irregular 124 28.2

Daily paid regular 111 25.3

Weekly 87 19.8

Monthly 74 16.9

Seasonal 43 9.8

Wealth Index Quintile

Lowest 83 19.4

Second 130 30.4

Middle 16 3.7

Fourth 171 40.0

Highest 28 6.5

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Table A 6: Percentage of under-5 children who reported symptoms of respiratory illness and diarrhoea by background characteristics

Background characteristic Total number of children

% reported symptoms of Total No. of children reported

Diarrhoea

% Given Jeewanee * Respiratory

illness Diarrhoea


<6 30 16.7 16.7 5 25.0

6-11 29 31.0 24.1 7 40.0

12-23 79 17.7 13.9 11 55.6

24-35 71 15.5 4.2 3 66.7

36-47 63 19.0 6.3 4 33.3

48-59 58 22.4 6.9 4 33.3

Sex of child

Male 177 20.3 11.3 20 47.1

Female 153 18.3 9.2 14 40.0

Sector

Urban 86 14.0 9.3 8 57.1

Rural 244 21.3 10.7 26 40.0


No schooling 17 29.4 29.4 5 33.3

Primary 30 26.7 6.7 2 100.0

Secondary 108 23.1 13.9 15 46.2

Passed O’ Level 67 20.9 3.0 2 0.0

Higher 36 16.7 11.1 4 50.0


< 9,000 95 21.1 10.5 10 42.9

9,000 – 13,999 59 18.6 8.5 5 100.0

14,000 – 19,999 73 19.2 5.5 4 50.0

20,000 – 31,999 66 19.7 12.1 8 37.5

≥ 32,000 28 17.9 21.4 6 40.0

Wealth quintile

Poorest 86 25.6 9.3 8 50.0

Second 79 22.8 12.7 10 44.4

Middle 62 16.1 12.9 8 57.1

Fourth 48 16.7 8.3 4 50.0

Richest 55 10.9 7.3 4 0.0

Overall 330 19.4 10.3 34 44.4

22

Table A 7: Infant and young child feeding practices by background characteristics

Background characteristic

Percent

No. of children under 2

year Ever

breastfed Currently breastfed

Initiated breastfeedi

ng within one

hour of birth*

Initiated breastfee

ding within

one day of birth

Introduced complementary food

among infants 6-8

months

Bottle-fed

Age of child in months

<6 100.0 100.0 80.6 96.8 0.0 14.8 32

6-11 94.4 94.4 76.5 100.0 0.0 45.2 35

12-23 95.8 79.2 84.8 97.8 0.0 31.1 81

Sex of child Male 96.4 91.1 79.6 98.1 87.5 30.7 81

Female 97.6 85.4 85.0 97.5 85.7 31.6 67

Residence Urban 96.6 89.7 75.0 92.9 80.0 31.7 49

Rural 97.1 88.2 84.8 100.0 90.0 30.8 99

Maternal education No schooling 100.0 100.0 100.0 100.0 100.0 37.5 9

Primary 83.3 66.7 60.0 100.0 100.0 22.2 10

Secondary 100.0 87.5 81.3 100.0 33.3 33.3 47

Passed GCE (O/L) 100.0 100.0 74.1 92.6 100.0 23.5 36

Higher 85.7 85.7 83.3 100.0 100.0 42.9 14


< 9,000 100.0 96.4 89.3 100.0 100.0 26.5 39

9,000 – 13,999 94.4 88.9 70.6 94.1 71.4 34.6 27

14,000 – 19,999 100.0 92.9 78.6 96.4 100.0 26.5 39

20,000 – 31,999 100.0 73.3 80.0 100.0 100.0 33.3 27

≥ 32,000 66.7 66.7 100.0 100.0 100.0 41.7 12


Poorest 100.0 86.4 95.5 100.0 100.0 25.0 29

Second 100.0 92.6 81.5 96.3 60.0 22.2 46

Middle 90.0 80.0 77.8 100.0 100.0 43.5 28

Fourth 100.0 100.0 76.9 92.3 100.0 33.3 21

Richest 93.3 86.7 71.4 100.0 100.0 37.5 24

Overall 96.9 88.7 81.9 97.9 86.7 31.1 148

23

Table A 8: Percentage of children aged 6-59 months, who were given different food items on the day preceding the interview, by background characteristics


Grains/Roots/Tub

ers

Legume/Nuts

Vit A rich

fruits and

vegetables

Other fruits and

vegetables

Dairy product/Milk / yogurt/ cheese*

Eggs

Meat/fish/Pou

ltry/ organ meats

Food cooked

with oil or Fat

Fortified

Food

Sugary Food


6-11 62.9 40.0 45.7 40.0 17.1 45.7 42.9 28.6 37.1 54.3

12-23 81.5 50.6 67.9 63.0 45.7 51.9 71.6 39.5 45.7 80.2

24-35 87.0 57.1 72.7 77.9 46.8 51.9 77.9 44.2 62.3 79.2

36-47 92.2 59.4 76.6 71.9 34.4 48.4 78.1 50.0 45.3 89.1

48-59 95.0 68.3 85.0 76.7 45.0 56.7 80.0 58.3 51.7 88.3

Sex of child

Male 84.3 58.1 72.7 68.6 41.3 50.6 72.1 48.3 50.0 80.8

Female 86.9 53.8 70.3 68.3 39.3 52.4 73.8 41.4 49.7 80.0

Residence

Urban 80.0 40.0 65.9 65.9 41.2 56.5 72.9 43.5 36.5 78.8

Rural 87.5 62.1 73.7 69.4 40.1 49.6 72.8 45.7 54.7 81.0

Maternal education

No schooling 88.2 58.8 76.5 70.6 64.7 70.6 94.1 70.6 52.9 88.2

Primary 88.9 51.9 70.4 51.9 37.0 51.9 70.4 44.4 37.0 63.0

Secondary 84.3 52.9 63.7 72.5 40.2 54.9 68.6 35.3 51.0 83.3

Passed GCE (O/L) 93.4 59.0 75.4 68.9 34.4 27.9 70.5 39.3 50.8 80.3

Higher 91.7 58.3 77.8 69.4 38.9 52.8 72.2 41.7 41.7 80.6


< 9,000 86.0 64.5 74.2 75.3 45.2 60.2 68.8 45.2 63.4 83.9

9,000 – 13,999 85.7 66.1 69.6 67.9 32.1 55.4 80.4 53.6 50.0 76.8

14,000 – 19,999 82.6 44.9 68.1 62.3 36.2 36.2 69.6 39.1 39.1 78.3

20,000 – 31,999 89.1 46.9 75.0 62.5 46.9 54.7 81.3 46.9 39.1 78.1

≥ 32,000 88.5 69.2 73.1 84.6 50.0 50.0 73.1 46.2 61.5 88.5


Poorest 90.4 60.2 67.5 68.7 27.7 41.0 61.4 37.3 51.8 80.7

Second 77.9 50.6 76.6 58.4 44.2 53.2 74.0 41.6 44.2 77.9

Middle 80.6 61.3 72.6 61.3 51.6 71.0 74.2 50.0 54.8 80.6

Fourth 90.0 55.0 65.0 82.5 37.5 42.5 82.5 52.5 60.0 82.5

Richest 90.9 52.7 74.5 80.0 43.6 49.1 80.0 50.9 41.8 81.8

Overall 85.5 56.2 71.6 68.5 40.4 51.4 72.9 45.1 49.8 80.4

(*Breast milk was not included)

24

Table A 9: Individual dietary diversity score in children (IDDS) according to background characteristics for children 6 – 59 months

Background characteristic IDDS (range 0-8)

% of individuals yet to achieve the target Total number of children

Mean SD


6-11 3.2 2.6 77.1 35

12-23 4.7 2.2 56.8 81

24-35 5.2 2.2 57.1 77

36-47 5.1 2.2 57.8 64

48-59 5.7 1.9 45.0 60

Sex of child

Male 5.0 2.4 56.4 172

Female 4.9 2.1 57.9 145

Residence

Urban 4.7 2.3 61.2 85

Rural 5.0 2.2 55.6 232

Maternal education

no schooling 5.9 1.6 29.4 17

Primary 4.7 2.5 63.0 27

Secondary 4.7 2.3 61.8 102

Passed GCE (O/L) 4.7 2.1 62.3 61

Higher 5.0 2.3 58.3 36


< 9,000 5.2 2.1 51.6 93

9,000 – 13,999 5.1 2.7 50.0 56

14,000 – 19,999 4.4 2.2 69.6 69

20,000 – 31,999 5.0 2.2 53.1 64

≥ 32,000 5.3 1.8 53.8 26


Poorest 4.5 2.1 66.3 83

Second 4.8 2.5 55.8 77

Middle 5.2 2.5 46.8 62

Fourth 5.1 2.1 57.5 40

Richest 5.2 2.0 56.4 55

Overall 4.9 2.3 57.1 317

25

Table A 10: Minimum meal frequency, minimum dietary diversity, and minimum acceptable diet in children 6-23 months, by background characteristics


Minimum meal frequency Minimum Dietary

diversity score, Mean (range 0-7)

% with minimal dietary

diversity (≥4 groups)

Percentage of minimum acceptable

diet

Total no. of

children Breastfed Non- Breastfed

Age group in months

6-8 60.0 0.0 2.3 33.3 13.3 15.0

9-11 57.1 0.0 3.5 45.0 15.0 20.0

12-14 11.1 10.0 4.7 73.7 10.5 19.0

15-17 57.1 26.7 3.9 58.6 27.6 29.0

18-20 22.2 0.0 4.2 60.0 13.3 15.0

21-23 50.0 0.0 4.7 77.8 16.7 18.0

Sex of child

Male 44.4 13.3 3.7 54.5 18.2 66.0

Female 42.1 3.2 4.1 64.0 16.0 50.0

Residence

Urban 25.0 13.0 3.4 48.7 10.3 39.0

Rural 51.3 5.3 4.1 63.6 20.8 77.0

Maternal education

No schooling 25.0 20.0 4.7 88.9 22.2 9.0

Primary 100.0 0.0 3.8 50.0 16.7 6.0

Secondary 36.8 5.3 3.8 50.0 10.5 38.0

Passed GCE (O/L) 72.2 22.2 4.1 70.4 37.0 27.0

Higher 20.0 0.0 4.2 61.5 7.7 13.0


< 9,000 44.4 9.1 4.8 75.9 27.6 29.0

9,000 – 13,999 33.3 9.1 3.4 45.0 5.0 20.0

14,000 – 19,999 50.0 7.7 3.8 54.8 19.4 31.0

20,000 – 31,999 28.6 12.5 3.4 47.8 13.0 23.0

≥ 32,000 100.0 0.0 4.5 90.0 20.0 10.0


Poorest 41.7 10.0 4.0 63.6 18.2 22.0

Second 44.4 10.0 3.7 52.6 18.4 38.0

Middle 22.2 16.7 3.8 61.9 14.3 21.0

Fourth 25.0 0.0 4.2 58.3 8.3 12.0

Richest 66.7 0.0 4.1 60.9 21.7 23.0

Overall 43.6 8.2 3.9 58.6 17.2 116.0

26

Table A 11: Participation of adult members in activities of children aged 2 to 5 years, and percentage of under 5 children cared for by a child <10 years, by background

characteristics


Household adult member involved Father’s involvement

Tot

al c

hild

ren

2- u

p to

5

year

s

% of children

left under the care of <10

year old child in the past

week Tota

l Chi

ldre

n un

der

5 ye

ars

Mean No. of

activities

% of children with four or more activities

Mean No. of

activities

% of children with at

least one activity

Age in months

24-35 4.6 75.0 1.8 51.6 36 12.5 64

36-47 4.9 84.5 1.8 48.3 52 15.5 58

48-59 4.5 72.5 1.4 41.2 44 19.6 51

Sex of child

Male 4.9 83.1 2.0 49.4 76 16.4 116

Female 4.5 71.4 1.3 45.2 56 11.2 107

Residence

Urban 4.5 74.4 1.6 39.5 17 10.4 77

Rural 4.7 78.5 1.7 50.0 115 14.8 229

Maternal education

No schooling 6.0 100.0 4.0 71.4 6 10.0 10

Primary 4.6 73.7 1.4 52.6 12 13.6 22

Secondary 4.5 71.9 1.4 47.4 36 11.5 78

Passed GCE (O/L) 4.8 76.7 1.2 33.3 42 16.3 43

Higher 5.0 84.2 2.2 57.9 24 9.5 21


< 9,000 4.0 60.7 1.3 41.1 50 16.4 67

9,000 – 13,999 4.5 87.1 2.0 61.3 35 14.0 43

14,000 – 19,999 5.1 82.9 2.0 48.6 22 14.3 49

20,000 – 31,999 5.0 82.9 2.0 45.7 18 4.7 43

≥ 32,000 5.6 100.0 0.9 36.4 5 28.6 14 Wealth quintile of household

Poorest 4.9 81.6 1.8 53.1 46 6.7 89

Second 4.4 70.3 1.4 43.2 30 15.2 66

Middle 4.1 66.7 1.5 41.7 24 20.0 55

Fourth 4.8 78.3 2.0 43.5 22 12.2 41

Richest 5.2 92.9 1.9 53.6 10 18.2 55

Overall 4.7 77.5 1.7 47.4 132 13.7 306

27

Table A 12: Use of different types of play items by children under 5 years of age, according to background characteristics


Percentage of children who play with: Total number of children <5

year Household

objects Outdoor material

Homemade toys

Ready-made toys

3 or more types of play

items Age group in months

24-35 81.3 82.8 81.3 70.3 71.9 64

36-47 77.2 77.2 82.5 61.4 63.8 58

48-59 76.5 66.7 72.5 47.1 56.9 51

Sex of child

Male 77.5 77.5 80.9 57.3 64.0 89

Female 79.5 74.7 77.1 63.9 65.5 84

Residence

Urban 81.4 55.8 74.4 58.1 51.2 43

Rural 77.5 82.9 80.6 61.2 69.2 130

Maternal education

No schooling 85.7 85.7 71.4 85.7 85.7 7

Primary 84.2 84.2 89.5 63.2 73.7 19

Secondary 78.9 80.7 75.4 59.6 68.4 57

Passed GCE (O/L) 86.2 82.8 89.7 69.0 73.3 30

Higher 78.9 73.7 89.5 78.9 78.9 19


< 9,000 76.4 76.4 69.1 54.5 57.1 56

9,000 – 13,999 71.0 67.7 80.6 54.8 54.8 31

14,000 – 19,999 88.6 77.1 91.4 68.6 77.1 35

20,000 – 31,999 80.0 82.9 80.0 62.9 71.4 35

≥ 32,000 81.8 81.8 72.7 81.8 72.7 11


Poorest 89.6 91.7 79.2 68.8 77.6 49

Second 73.0 78.4 75.7 62.2 67.6 37

Middle 63.9 58.3 77.8 36.1 41.7 36

Fourth 73.9 73.9 82.6 69.6 69.6 23

Richest 89.3 71.4 82.1 67.9 64.3 28

Overall 78.5 76.2 79.1 60.5 64.7 173

28

Table A 13: Percentage of children aged 36-59 months who were attending an early childhood education programme, by background characteristics


Percent attending

Preschool or Daycare

Mean SD Total number of children

Age group in months

36-47 50.0 4.7 0.6 58

48-59 63.6 4.6 1.0 51

Sex of child

Male 58.5 4.7 1.0 53

Female 53.5 4.6 0.6 56

Residence

Urban 38.5 4.4 1.3 25

Rural 59.0 4.7 0.7 84

Maternal education

No schooling 40.0 4.0 0.0 5

Primary 87.5 5.0 0.7 13

Secondary 46.2 4.7 0.6 38

Passed GCE (O/L) 65.7 4.6 0.9 16

Higher 46.7 4.9 0.4 11


< 9,000 60.0 4.3 1.1 36

9,000 – 13,999 51.7 5.0 0.7 18

14,000 – 19,999 55.6 4.8 0.7 18

20,000 – 31,999 50.0 4.8 0.4 23

≥ 32,000 100.0 5.0 0.0 10


Poorest 53.1 4.5 0.9 29

Second 52.4 4.8 0.4 24

Middle 55.0 4.7 0.9 23

Fourth 64.7 4.6 1.3 16

Richest 66.7 4.7 0.5 17

Overall 56.3 4.6 0.8 109

29

Table A 14: Percentage of children 5-10 years of age attending Primary School, by background characteristics


Percentage of children of primary

school age currently attending

Primary School

No. of children of primary school age (5-10 years)

% entered Grade 1

No. of Children Completed 5 yrs

By 31st of Jan 2009

Sex of child

Male 98.2 166 100.0 18

Female 99.3 146 100.0 12

Residence

Urban 98.6 73 100.0 5

Rural 98.7 239 100.0 25


< 9,000 98.8 82 100.0 7

9,000 – 13,999 95.8 48 100.0 2

14,000 – 19,999 100.0 45 100.0 4

20,000 – 31,999 100.0 51 100.0 3

≥ 32,000 100.0 17 100.0 1


Poorest 97.6 84 100.0 7

Second 97.3 73 100.0 5

Middle 100.0 50 100.0 9

Fourth 100.0 45 100.0 4

Richest 100.0 60 100.0 5

Overall 98.7 312 100.0 30

30

Table A 15: Percentage of children aged 5-14 years who are involved in child labour activities, and mean hours per week, by background characteristics


Working outside household in the previous week

Working outside household in the last year Total number of

children aged 5-14 year Paid

work Unpaid work

Mean hours per

week Paid work Unpaid

work

Age group in years

9-11 0.0 3.0 5.0 0.0 5.0 143

12-14 0.0 5.1 4.5 0.0 5.7 155

Sex of child

Male 1.1 7.4 4.3 1.2 9.5 285

Female 0.0 2.2 5.0 0.0 2.6 248

Residence

Urban 0.0 5.3 2.5 0.0 9.1 142

Rural 0.7 4.8 4.9 0.7 5.7 391


< 9,000 1.6 6.5 4.6 1.9 7.4 115

9,000 – 13,999 0.0 3.7 3.0 0.0 4.5 66

14,000 – 19,999 0.0 3.0 5.0 0.0 3.2 57

20,000 – 31,999 0.0 4.5 2.0 0.0 5.3 59

≥ 32,000


Poorest 1.4 1.4 4.0 1.6 1.6 155

Second 0.0 11.4 5.3 0.0 20.8 136

Middle 0.0 7.7 5.0 0.0 8.3 86

Fourth 0.0 7.7 2.5 0.0 8.3 70

Richest 0.0 0.0 0.0 0.0 0.0 86

Overall 0.5 4.9 4.4 0.6 6.2 533

31

Table A 16: Percentage of children less than 5 years of age who received care at child welfare clinic, by background characteristics


Availability of CHDR

Children Attended

CWC

% of children whose mothers received advice on %

Received Thriposha*

Total No. of

Children % % Growth Nutritional status ECCD

Age group in months

<6 75.0 92.9 88.9 88.9 84.6 17.1 35

6-11 85.7 96.7 93.1 96.6 85.7 12.3 81

12-23 91.4 97.3 91.3 90.9 85.7 22.1 77

24-35 87.0 98.5 100.0 98.5 92.3 17.2 64

36-47 95.3 88.1 92.3 94.1 92.2 18.3 60

48-59 73.3 96.0 95.6 97.9 93.2 17.1 35

Sex of child

Male 86.1 94.1 96.2 96.1 91.4 15.7 172

Female 85.8 96.4 91.5 93.1 87.3 19.3 145

Residence

Urban 88.4 94.0 94.6 95.8 94.5 18.8 85

Rural 85.0 95.6 93.9 94.4 87.7 16.8 232

Maternal education**

No schooling 82.4 100.0 100.0 93.8 100.0 11.8 17

Primary 80.6 96.7 92.9 96.3 76.9 22.2 27

Secondary 90.1 94.8 93.2 95.6 90.6 17.6 102

Passed GCE (O/L) 92.9 95.4 91.7 91.5 84.5 23.0 61

Higher 94.6 94.3 96.9 96.9 96.9 19.4 36 Monthly household income***

Up to 9000 83.5 96.6 93.9 92.9 85.5 18.3 93

9000-13999 84.1 89.7 98.0 98.0 93.9 21.4 56

14000-19999 84.4 94.1 95.2 96.7 85.5 20.3 69

20000-31999 92.6 96.7 88.1 91.5 91.4 9.4 64

32000 + 85.7 100.0 95.7 95.5 95.5 19.2 26 Wealth quintile of household

Poorest 90.0 98.8 97.4 96.2 89.5 20.5 83

Second 83.5 96.1 94.2 97.1 90.8 18.2 77

Middle 75.4 93.1 88.9 89.1 84.9 19.4 62

Fourth 91.8 91.3 92.3 94.7 91.9 12.5 40

Richest 91.1 93.8 95.7 95.6 91.3 12.7 55

Overall 86.0 95.1 94.1 94.8 89.5 17.4 317

32

Table A 17: Percentage distribution of children who received Vitamin A mega dose supplement at 9, 18 and 36 months, by background characteristics


Children 9-59 months

Children 18-59 months Children 36-59months Of the

children 36-59,

percentage never

received Vit A.

Number of

children

% received Vit A at

9 months

Number of

children

% received Vit A at

18 months

Number of

children

% received Vit A at

36 month

% received 3 doses of Vit A

Sex of child

Male 145 84.1 105 84.8 52 73.1 73.1 5.6

Female 123 79.7 99 77.8 50 70.0 70.0 21.2

Residence

Urban 72 83.3 55 76.4 22 63.6 63.6 19.0

Rural 196 81.6 149 83.2 80 73.8 73.8 11.8 Maternal education

No schooling 13 69.2 7 85.7 3 66.7 66.7 25.0

Primary 23 91.3 18 83.3 11 81.8 81.8 8.3

Secondary 92 81.5 67 76.1 36 66.7 66.7 13.5 Passed GCE (O/L) 51 88.2 39 87.2 15 86.7 86.7 0.0

Higher 32 81.3 24 91.7 12 75.0 75.0 8.3 Monthly household income

Up to 9000 79 77.2 58 74.1 29 69.0 69.0 12.5

9000-13999 47 78.7 41 73.2 19 68.4 68.4 26.3

14000-19999 56 91.1 39 94.9 17 76.5 76.5 5.6

20000-31999 56 78.6 43 83.7 23 65.2 65.2 16.7

32000 + 22 95.5 16 93.8 10 90.0 90.0 0.0 Wealth quintile of household

Poorest 76 85.5 61 83.6 31 83.9 83.9 5.9

Second 61 83.6 44 77.3 20 55.0 55.0 22.7

Middle 46 71.7 32 75.0 18 61.1 61.1 6.3

Fourth 37 75.7 32 78.1 16 68.8 68.8 25.0

Richest 48 89.6 35 91.4 17 82.4 82.4 11.1

Overall 268 82.1 204 81.4 102 71.6 71.6 13.2

33

Table A 18: Source of care provider for children who had diarrhoea or respiratory illness during 2 weeks preceding survey, by background characteristics

Background characteristic Source of provider (%) Number of children

who had diarrhoea or respiratory illness in

previous 2 weeks Gov.

sector Private sector Other


<6 85.7 14.3 0.0 12

6-11 57.1 14.3 14.3 15

12-23 53.3 40.0 6.7 36

24-35 53.8 38.5 7.7 27

36-47 56.5 39.1 4.3 28

48-59 33.3 60.0 0.0 22

Sex of child

Male 54.5 38.6 2.3 76

Female 52.8 38.9 8.3 64

Residence

Urban 30.8 69.2 0.0 33

Rural 58.2 32.8 6.0 107 Mother’s education

No schooling 100.0 0.0 0.0 10

Primary 42.9 42.9 0.0 13

Secondary 72.0 24.0 4.0 53

Passed O’ Level 40.9 45.5 9.1 31

Higher 41.7 58.3 0.0 9


Up to 9000 76.9 15.4 3.8 50

9000-13999 53.8 34.6 7.7 23

14000-19999 50.0 50.0 0.0 27

20000-31999 14.3 85.7 0.0 23

32000 + 0.0 83.3 16.7 13


Poorest 61.3 29.0 3.2 39

Second 82.4 11.8 5.9 33

Middle 42.9 57.1 0.0 27

Fourth 28.6 57.1 14.3 21

Richest 0.0 100.0 0.0 20

Overall 53.8 38.8 5.0 140

34

Table A 19: Percent of pregnant mothers who attended antenatal clinics, and who received “poshana malla”, “thriposha” and Iron tablets, by background characteristics


Regular ANC Visits*

“poshana malla”, “thriposha” Iron tablets Total

No. of Pregna

nt women

Percent

Total No of

Mothers

Percent

Total No of

Mothers

Percent

Total No of

Mothers

Percent received tablets

Of the received, percent

took daily

Total No of

Mothers

Residence

Urban 83.3 12 33.3 12 84.6 13 84.6 81.8 13 15

Rural 85.7 14 25.0 16 81.3 16 85.7 100.0 14 17 Maternal education

No schooling 0.0 2 0.0 2 0.0 2 0.0 0.0 2 2

Primary 66.7 3 33.3 3 66.7 3 66.7 50.0 3 3

Secondary 90.0 10 41.7 12 92.3 13 100.0 90.9 11 15 Passed GCE (O/L) 100.0 7 14.3 7 100.0 7 85.7 100.0 7 7

Higher 100.0 3 33.3 3 100.0 3 100.0 100.0 3 3 Monthly household income

Up to 9000 80.0 5 16.7 6 83.3 6 60.0 100.0 5 6

9000-13999 85.7 7 50.0 8 87.5 8 100.0 87.5 8 9

14000-19999 85.7 7 16.7 6 71.4 7 85.7 83.3 7 8

20000-31999 75.0 4 50.0 4 75.0 4 75.0 100.0 4 4

32000 + 100.0 3 0.0 3 100.0 3 100.0 100.0 3 3 Wealth quintile of household

Poorest 66.7 6 0.0 7 62.5 8 83.3 80.0 6 8

Second 66.7 6 33.3 6 66.7 6 50.0 66.7 6 7

Middle 100.0 7 22.2 9 100.0 9 100.0 100.0 8 10

Fourth 100.0 3 66.7 3 100.0 3 100.0 100.0 3 3

Richest 100.0 4 66.7 3 100.0 3 100.0 100.0 4 4

Overall 84.6 26 28.6 28 82.8 29 85.2 91.3 27 32

*(First visits were excluded)

35

Table A 20: Percentage of lactating mothers who received “thriposha” and Vitamin A by background characteristics


“thriposha” (child <6 months)

Vitamin A mega dose (child <24 months)

Percent Total No of Women

Percent

Total No of Women

Sector

Urban 66.7 3 93.8 16

Rural 83.3 12 90.0 40 Maternal education

No schooling 0.0 0 100.0 5

Primary 75.0 4 57.1 7

Secondary 80.0 5 100.0 17

Passed GCE (O/L) 100.0 4 100.0 14

Higher 0.0 1 83.3 6 Monthly household income

Up to 9000 83.3 6 82.4 17

9000-13999 80.0 5 100.0 15

14000-19999 100.0 3 92.3 13

20000-31999 0.0 1 90.0 10

32000 + 0.0 0 0.0 0 Wealth quintile of household

Poorest 100.0 5 92.3 13

Second 50.0 4 91.3 23

Middle 100.0 2 85.7 7

Fourth 75.0 4 85.7 7

Richest 0.0 0 100.0 6

Overall 80.0 15 91.1 56

36

Table A 21: “Samurdhi” beneficiaries” among women 15-49 years by background characteristics


Pregnant Lactating Non-pregnant & non- lactating

Percent Total No

of Women

Percent Total No

of Women

Percent Total No

of Women

Residence

Urban 6.7 15 21.7 23 25.7 35

Rural 17.6 17 27.5 80 34.2 114

Maternal education

No schooling 50.0 2 57.1 7 37.5 8

Primary 33.3 3 58.3 12 70.6 17

Secondary 6.7 15 25.0 32 37.5 56

Passed GCE (O/L) 14.3 7 15.4 26 22.6 31

Higher 0.0 3 0.0 13 0.0 17


up to 9000 33.3 6 37.0 27 50.0 46

9000-13999 11.1 9 33.3 21 45.0 20

14000-19999 0.0 8 22.2 27 15.4 26

20000-31999 25.0 4 23.5 17 26.7 30

32000 + 0.0 3 0.0 3 16.7 12


Poorest 25.0 8 28.6 28 54.1 37

Second 28.6 7 32.4 34 42.9 28

Middle 0.0 10 21.4 14 21.9 32

Fourth 0.0 3 21.4 14 27.3 22

Richest 0.0 4 15.4 13 10.0 30

Overall 12.5 32 26.2 103 32.2 149

37

Table A 22: Distribution of households according to main source of drinking water, and households with improved source of water, by background characteristics


Main source of drinking water

Improved source of drinking water*

Improved sources

Uni

mpr

oved

so

urce

s

Pipe

d in

to

dwel

ling

Pipe

d in

to

yard

or

plot

Publ

ic ta

p /s

tand

pipe

Tube

wel

l/ bo

reho

le

Prot

ecte

d w

ell

Prot

ecte

d sp

ring

Rai

nwat

er

colle

ctio

n

Bot

tled

wat

er

Sector

Urban 31.9 5.1 23.2 0.7 25.4 0.0 0.0 0.0 13.8 86.2

Rural 12.9 0.5 7.1 1.9 36.5 0.5 0.0 0.0 40.7 59.3

Income group

< 9,000 17.6 1.0 10.4 0.5 33.2 0.0 0.0 0.0 37.3 62.7

9,000 -13,999 16.8 2.8 13.1 1.9 32.7 0.0 0.0 0.0 32.7 67.3

14,000 – 19,999 12.4 1.9 6.7 4.8 41.9 0.0 0.0 0.0 32.4 67.6

20,000 – 31,999 25.0 1.0 10.0 1.0 30.0 1.0 0.0 0.0 32.0 68.0

≥ 32,000 18.6 2.3 14.0 0.0 25.6 2.3 0.0 0.0 37.2 62.8 Wealth index quintiles

Poorest 3.9 0.0 4.6 2.0 38.6 0.0 0.0 0.0 51.0 49.0

Second 12.0 0.7 19.0 1.4 33.1 0.0 0.0 0.0 33.8 66.2

Middle 17.6 2.9 15.7 2.0 30.4 0.0 0.0 0.0 31.4 68.6

Fourth 29.5 5.1 11.5 1.3 24.4 0.0 0.0 0.0 28.2 71.8

Richest 39.8 1.1 3.4 1.1 38.6 2.3 0.0 0.0 13.6 86.4

Overall 17.6 1.6 11.0 1.6 33.7 0.4 0.0 0.0 34.1 65.9

38

Table A 23: Distribution of households according to drinking water treatment methods used, by background characteristics*


Water treatment method used in the household

Appropriate water

treatment method *

Total No of

household Non

e

Boil

Add

bl

each

/chl

orin

e

Stra

in th

roug

h a

clot

h

Use

wat

er fi

lter

Sola

r di

sinf

ectio

n

Let i

t sta

nd a

nd

sett

le

Oth

er

Sector

Urban 21.7 35.5 29.0 19.6 14.5 0.0 25.4 2.9 61.6 138

Rural 30.9 30.4 21.2 22.4 17.4 2.8 10.8 2.8 55.3 425


Poorest 34.0 33.3 15.7 30.7 15.7 0.7 9.2 2.6 51.0 153

Second 26.8 36.6 28.9 15.5 10.6 2.1 16.2 2.1 62.7 142

Middle 26.0 26.5 26.5 27.5 17.6 3.9 21.6 2.9 52.9 102

Fourth 29.5 26.9 26.9 14.1 19.2 5.1 14.1 6.4 56.4 78

Richest 24.1 30.7 19.3 15.9 25.0 0.0 12.5 1.1 62.5 88

Income group

< 9,000 31.6 34.7 22.8 22.8 18.1 3.6 11.4 4.7 58.0 193

9,000 – 13,999 31.1 27.1 25.2 17.8 12.1 0.9 21.5 0.9 51.4 107

14,000 – 19,999 23.8 38.1 23.8 21.9 14.3 1.9 12.4 1.9 61.0 105

20,000 – 31,999 21.0 27.0 27.0 24.0 19.0 2.0 18.0 3.0 61.0 100

≥ 32,000 33.3 27.9 14.0 23.3 25.6 0.0 9.3 2.3 53.5 43

Overall 28.6 31.6 23.1 21.7 16.7 2.1 14.4 2.8 56.8 563

39

Table A 24: Distribution of households according to duration to and from the source of drinking water, by background characteristics


Time to source of drinking water Mean time to source of

drinking water (excluding those

on premises)

Number of households Water on

premises Less than

15 minutes

15 minutes to less than 30 minutes

More than 30 minutes

Sector Urban 37.0 50.0 5.8 2.2 7.2 138 Rural 13.4 58.4 12.5 10.6 10.1 425

Wealth index quintiles Poorest 3.9 62.1 18.3 15.7 12.9 153 Second 12.7 63.4 8.5 5.6 7.6 142 Middle 20.6 57.8 8.8 6.9 8.4 102 Fourth 34.6 46.2 11.5 3.8 8.3 78 Richest 40.9 42.0 3.4 6.8 8.1 88 Income group

< 9,000 18.7 58.5 12.4 6.2 8.9 193

9,000 – 13,999 19.6 57.9 7.5 12.1 10.3 107

14,000 – 19,999 14.3 57.1 15.2 7.6 9.7 105

20,000 – 31,999 26.0 55.0 6.0 7.0 7.9 100

≥ 32,000 20.9 44.2 11.6 14.0 13.1 43 Overall 19.2 56.3 10.8 8.5 9.5 563

Table A 25: Distribution of households according to the person collecting water used in the household, by background characteristics


Person collecting drinking water Number of households Adult

man Adult

woman Male child (under 15)

Female child

(under 15) Other

Sector Urban 36.6 53.5 2.0 0.0 7.9 138 Rural 17.6 77.4 0.0 1.3 3.8 425


Poorest 19.0 78.4 0.0 1.3 1.3 153 Second 23.4 70.3 0.8 0.8 4.7 142 Middle 22.0 68.1 1.1 1.1 7.7 102

Fourth 21.2 68.2 0.0 0.0 10.6 78

Richest 23.0 73.8 0.0 1.6 1.6 88 Income group

< 9,000 20.8 74.9 0.0 1.1 3.3 193

9,000 – 13,999 22.7 72.2 1.0 2.1 2.1 107

14,000 – 19,999 20.7 73.9 0.0 1.1 4.3 105

20,000 – 31,999 21.7 72.3 1.2 0.0 4.8 100

≥ 32,000 28.1 62.5 0.0 0.0 9.4 43 Overall 21.4 72.5 0.4 1.0 4.6 563

40

Table A 26: Distribution of household members according to type of toilet used by the household, by background characteristics

Table A 27: Distribution of households using both improved drinking water sources and sanitary means of excreta disposal, by background characteristics


Percentage of household population

using improved sources of drinking

water *

Percentage of household

population using sanitary means of

excreta disposal **

Percentage of household population using improved sources of drinking water and using sanitary means

of excreta disposal

Number of household

Sector Urban 86.2 68.1 60.1 138 Rural 59.3 59.8 35.3 425 Wealth index quintiles Poorest 49.0 38.6 17.0 153 Second 66.2 48.6 31.0 142 Middle 68.6 65.7 42.2 102 Fourth 71.8 85.9 57.7 78 Richest 86.4 97.7 85.2 88 Income group

< 9,000 62.7 56.0 32.6 193

9,000 – 13,999 67.3 53.3 37.4 107

14,000 – 19,999 67.6 61.9 43.8 105

20,000 – 31,999 68.0 73.0 51.0 100

≥ 32,000 62.8 83.7 55.8 43 Overall 65.9 61.8 41.4 563


Type of toilet facility used by household Percentage of population using sanitary means of excreta disposal *

Number of households

Flush Pit Temporary No toilet Missing

Sector Urban 68.1 29.7 0.7 0.7 0.7 68.1 138

Rural 59.8 29.4 3.8 5.4 1.6 59.8 425 Wealth index quintiles Poorest 38.6 36.6 10.5 13.7 0.7 38.6 153 Second 48.6 46.5 0.7 2.1 2.1 48.6 142 Middle 65.7 32.4 0.0 0.0 2.0 65.7 102

Fourth 85.9 12.8 0.0 0.0 1.3 85.9 78

Richest 97.7 1.1 0.0 0.0 1.1 97.7 88 Income group

< 9,000 56.0 33.2 6.2 3.1 1.6 56.0 193

9,000 – 13,999 53.3 35.5 3.7 5.6 1.9 53.3 107

14,000 – 19,999 61.9 31.4 0.0 6.7 0.0 61.9 105

20,000 – 31,999 73.0 24.0 0.0 3.0 0.0 73.0 100

≥ 32,000 83.7 9.3 0.0 2.3 4.7 83.7 43

Overall 61.8 29.5 3.0 4.3 1.4 61.8 563

41

Table A 28: Percentage of household members (in broad age groups) who consume three or more main meals a day, by background characteristics

Background Characteristic 5-17 years 18-59 years 60 years or above

Male Female Male Female Male Female

No. of members in family

1-3 89.5 90.5 93.1 92.9 81.3 82.4

4-6 90.8 94.5 92.1 92.6 95.0 90.9

≥ 7 93.3 95.2 95.5 94.0 100.0 100.0

Sector

Urban 89.3 93.2 95.0 94.1 100.0 100.0

Rural 91.9 94.6 92.2 92.6 87.5 87.8 Monthly household income (LKR)

< 9,000 85.5 88.3 87.5 88.2 80.0 84.0

9,000 – 13,999 90.0 91.3 89.5 89.4 83.3 80.0

14,000 – 19,999 91.9 100.0 96.6 95.6 100.0 100.0

20,000 – 31,999 97.9 100.0 96.6 97.8 100.0 94.4

≥ 32,000 94.4 100.0 100.0 100.0 100.0 100.0

Wealth quintile

Poorest 91.5 93.8 89.4 90.2 92.9 88.2

Second 88.0 88.9 90.2 91.6 75.0 83.3

Middle 92.7 95.3 93.1 93.3 100.0 87.5

Fourth 90.6 96.9 97.1 95.8 100.0 100.0

Richest 94.3 97.6 97.4 96.2 92.3 95.0

Overall 91.2 94.3 92.8 92.9 92.2 90.6

42

Table A 29: Proportion of households by type of foods consumed at least once in the day or night preceding the interview, by to background characteristics

Background Characteristic

Food Groups

Rice Wheat Nuts/ pulses

Vegetables Fruits

Meat/poultry/

fish Eggs

Milk/diary products

Oils/ fats

Coconut

Sugar


1-3 100.0 48.2 60.2 85.6 67.8 83.5 50.0 60.2 78.0 96.3 98.5

4-6 99.1 56.2 58.5 88.3 68.2 84.3 47.3 62.5 79.0 98.0 96.5

≥ 7 100.0 63.0 56.8 88.3 76.0 92.0 50.0 70.6 87.0 100.0 98.7

Sector

Urban 100.0 55.2 50.0 89.0 73.7 88.2 51.2 47.8 67.2 94.9 97.8

Rural 99.3 55.5 61.3 87.2 67.7 84.1 47.1 69.9 84.4 98.8 97.1 Religion of the HH Head

Budddhist 99.2 30.2 61.6 93.0 55.8 80.1 24.8 86.0 91.9 98.4 97.1

Hindu 98.9 68.9 67.9 92.0 73.8 81.4 69.1 44.1 60.8 98.8 98.8

Islam 100.0 66.1 52.5 79.7 81.0 91.1 56.3 50.3 70.8 96.7 96.7

Catholic 100.0 66.7 33.3 100.0 66.7 100.0 66.7 100.0 50.0 100.0 100.0 Monthly household income

< 9,000 100.0 49.6 60.3 85.6 66.7 80.1 48.9 58.0 81.8 97.4 98.4

9,000 – 13,999 100.0 61.6 58.9 86.7 66.3 88.6 47.2 56.5 80.2 97.1 96.2

14,000 – 19,999 98.1 59.7 51.5 85.7 73.0 86.4 49.4 65.0 82.5 99.0 97.1

20,000 – 31,999 99.0 54.9 63.6 94.8 74.0 90.0 50.0 70.0 73.6 98.0 96.0

≥ 32,000 100.0 36.0 58.5 88.1 67.5 88.1 42.4 78.8 88.1 97.7 97.7

Wealth quintile

Poorest 100.0 46.4 56.0 91.3 55.6 74.8 46.6 65.3 86.8 96.7 98.0

Second 98.6 60.7 53.5 81.2 67.6 84.2 48.0 52.7 69.3 96.4 96.4

Middle 100.0 64.9 65.2 84.8 76.3 84.8 49.4 56.9 81.3 99.0 96.0

Fourth 100.0 49.1 66.7 90.8 75.0 94.8 49.3 72.9 89.0 98.7 96.2

Richest 98.9 52.4 56.6 92.0 80.7 95.4 48.7 71.4 74.4 100.0 100.0

Overall 99.5 55.4 58.7 87.7 69.2 85.1 48.3 63.1 79.9 97.8 97.3

Total No. 559 388 508 551 523 545 439 371 493 558 556

43

Table A 30: Proportion of households by type of foods consumed in 5 days and more preceding the interview, by background characteristics


Food Groups

Rice Wheat Nuts/ pulses

Vegetables Fruits

Meat/poultry/

fish Eggs

Milk/ diary products

Oils/ fats

Coconut Sugar


1-3 97.8 7.4 13.3 68.1 23.0 40.7 13.3 27.4 43.7 91.0 88.1

4-6 97.1 11.2 11.2 69.6 29.2 43.8 11.7 28.7 48.7 94.5 91.6

≥ 7 96.1 13.0 14.1 74.4 41.0 46.2 6.4 37.7 59.0 94.8 93.5

Sector

Urban 94.9 13.8 7.2 66.7 40.6 37.7 15.2 29.7 45.7 90.6 92.0

Rural 97.9 9.5 13.7 71.0 25.7 45.3 10.1 29.6 50.0 94.8 90.7 Religion of the HH Head

Budddhist 98.8 3.7 18.0 88.2 21.6 53.1 10.0 60.0 85.0 98.3 98.3

Hindu 95.5 12.5 14.8 68.2 33.0 40.9 24.4 21.1 49.1 91.4 92.8

Islam 95.7 16.9 5.1 51.9 36.0 34.6 13.0 20.4 53.7 96.3 98.1

Catholic 100.0 0.0 0.0 66.7 0.0 33.3 19.4 26.7 66.7 93.1 86.2 Monthly household income

< 9,000 93.2 26.3 17.9 55.6 21.7 30.2 22.2 20.5 47.8 90.6 93.1

9,000 – 13,999 93.9 25.4 12.3 73.7 31.6 28.1 20.2 26.3 58.8 93.8 94.7

14,000 – 19,999 96.2 20.5 11.5 74.4 33.3 37.2 15.4 34.6 62.8 96.2 94.9

20,000 – 31,999 98.1 28.8 19.2 73.1 34.6 44.2 25.0 34.6 67.3 98.1 94.2

≥ 32,000 94.7 15.8 26.3 68.4 57.9 42.1 15.8 26.3 78.9 89.5 94.7

Wealth quintile

Poorest 91.1 24.4 18.5 63.7 21.8 27.4 17.7 22.0 50.4 90.2 92.7

Second 91.7 23.9 9.1 68.2 22.0 34.5 19.1 26.4 61.8 91.7 91.7

Middle 98.9 31.0 13.8 72.4 36.8 35.6 27.6 26.4 57.5 97.7 97.7

Fourth 95.9 23.0 18.9 63.5 33.8 33.8 21.6 29.7 54.1 93.2 91.9

Richest 100.0 20.9 18.6 67.4 51.2 37.2 11.6 34.9 62.8 97.7 100.0

Overall 97.1 10.5 12.1 69.9 29.4 43.4 11.4 29.6 48.9 93.7 91.0

Total No. 558 560 562 562 562 562 562 561 562 558 558

44

Table A 31: Household dietary diversity score according to background characteristics


Household diversity score % of households yet to

achieve the target No of households

Mean SD

No. of members in Household

1-3 7.4 1.8 73.3 135

4-6 7.7 1.8 66.5 349

≥ 7 8.0 2.0 55.7 79

Sector

Urban 7.8 1.7 66.7 138

Rural 7.6 1.8 66.6 425

Religion of the HH Head

Budddhist 7.4 1.5 74.7 245

Hindu 8.0 2.0 60.2 88

Islam 7.8 2.0 59.8 214

Catholic 6.3 4.6 75.0 4


< 9,000 7.3 1.8 74.6 193

9,000 – 13,999 7.7 2.0 61.7 107

14,000 – 19,999 7.9 1.6 65.7 105

20,000 – 31,999 8.0 1.7 58.0 100

≥ 32,000 7.9 1.5 58.1 43

Wealth quintile

Poorest 7.1 1.7 81.7 153

Second 7.4 2.0 70.4 142

Middle 7.8 1.8 63.7 102

Fourth 8.3 1.6 50.0 78

Richest 8.3 1.4 52.3 88

Overall 7.6 1.8 66.6 563

45

Table A 32: Average monthly expenditure for food, services, health, education and productive assets, by background characteristics (add Total income as total of means)


Average monthly expenditure in LKR Number of

Households

Food Liquor/ tobacco

Utility services

Health

Education

Productive

assets Total


1-3 55.7 8.2 11.1 6.5 1.5 17.0 18276 50

4-6 48.1 3.3 9.4 5.3 2.6 31.2 30312 201

≥ 7 29.3 1.5 5.9 2.2 1.4 59.7 60392 41

Residence

Urban 28.8 1.6 7.3 3.2 2.4 56.6 58066 79

Rural 51.8 4.3 8.9 5.3 2.2 27.6 25749 213

Religion of household Head

Buddhist 45.2 3.5 6.8 3.0 2.7 38.8 23160 103

Hindu 67.5 5.2 10.7 6.8 1.5 8.4 19903 52

Islam 36.9 2.6 8.4 4.5 2.2 45.4 47126 126

Catholic and other Christian 72.6 0.0 15.1 7.4 4.9 0.0 21149 3

Education of household Head

No schooling 72.9 6.6 11.0 6.2 3.3 0.0 22354 21

Primary 60.4 1.5 6.5 4.2 2.8 24.6 22018 34

Secondary 45.4 3.1 8.4 5.0 2.0 36.0 29506 106

Passed O’ Level 57.5 5.9 13.5 4.8 4.3 14.0 23446 56

Higher 22.4 0.5 5.6 2.6 1.2 67.7 68565 36


< 9,000 62.9 3.2 8.5 6.0 3.2 16.2 19208 89

9,000 – 13,999 59.7 5.6 11.1 5.5 3.4 14.7 24668 56

14,000 – 19,999 65.8 5.1 11.1 8.2 2.9 6.9 21756 67

20,000 – 31,999 40.2 2.9 10.1 4.2 2.5 40.1 40474 55

≥ 32,000 30.1 1.6 10.9 3.3 1.3 52.8 60227 18

Wealth quintile

Poorest 65.8 6.3 5.9 5.7 2.1 14.2 17220 75

Second 63.7 5.1 11.0 6.4 4.2 9.5 21109 76

Middle 60.4 4.1 11.9 7.3 2.7 13.7 25427 54

Fourth 38.1 1.4 10.5 3.6 3.3 43.1 42973 39

Richest 30.4 2.4 8.1 3.8 1.5 53.8 56522 48

Overall 43.0 3.2 8.5 4.5 2.3 38.4 33126 292

46

Table A 33: Proportion of households by type of food groups by the main and secondary sources


Food Groups

Rice Wheat

Nuts/ pulses

Vegetables

Fruits

Meat/poultry

Fish Eggs

Milk/diary products

Oils/fats

Coconut Sugar

Main source

Own production 24.1 1.5 7.5 17.2 19.7 0.8 2.0 4.8 1.4 7.1 19.4 0.5

Purchase 69.5 91.0 85.6 76.0 73.4 90.0 92.5 87.4 90.5 85.6 74.2 90.5 Purchase on credit 2.1 1.5 1.4 1.1 0.8 1.1 1.1 0.9 0.5 1.2 1.3 2.7

Traded goods or services 0.2 0.0 0.0 0.0 0.2 0.3 0.2 0.0 0.3 0.0 0.0 0.0

Borrowed 0.4 0.3 0.6 0.5 0.4 0.3 0.2 0.7 0.5 0.4 0.5 0.7 Gift from family or relatives

1.1 0.3 0.4 0.7 1.0 1.4 0.6 0.7 1.6 0.6 0.7 0.9

Food aid 0.0 0.5 0.0 0.2 0.0 0.0 0.0 0.0 0.3 0.0 0.2 0.0

Cash assistance 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2

Other 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0

Table A 34: Percent of households with coping strategy adopted in the previous 30 days,

with its frequency

Coping Strategy

% of households adopted strategy

Total households Never

Ever Once in a

while (1-2 per week)

Pretty often (3-6 per week)

Daily (>24 days)

Food-related coping strategy a. Relied on less preferred food 69.3 15.9 13.8 1.1 560 b. Borrowed food 70.1 17.2 12.0 0.7 559 c. Purchased food on credit 69.3 16.4 13.0 1.3 560 d. Consumed seeds held for next season 92.6 4.5 2.2 0.7 555 e. Reduced meal size 82.2 8.6 8.8 0.4 555 f. Reduced number of meals per day 82.7 9.5 6.8 0.9 556 g. Restricted consumption for adults 86.0 9.2 4.5 0.4 557 h. Sent children to live with relatives 95.0 2.5 2.0 0.5 556 i. Reduced expenditure on health and

education 90.1 7.0 2.7 0.2 556

% of Households Total Households Non-food coping strategies No Yes

j. Sold livestock 69.3 15.9 549

k. Pawned jewellary 70.1 17.2 551 l. Sold agricultural tools, seeds 69.3 16.4 552 m. Sold other assets 92.6 4.5 552

n. Used savings 82.2 8.6 551 o. Borrowed money from

relatives/neighbours 82.7 9.5 554

p. Took children out of school to earn income 86.0 9.2 553

47

Table A 35: Food-related coping strategies adopted during the 30 days preceding the survey, by background characteristics (Take at least once who adopted out of total)


Percent of households adopted strategy at least once during the preceding 30 days

No

of h

ouse

hold

s ad

opte

d co

ping

st

rate

gies

Pe

rcen

tage

of

hous

ehol

ds a

dopt

ed

copi

ng s

trat

egie

s

Rel

ied

on le

ss p

refe

rred

fo

od

Bor

row

ed fo

od

Purc

hase

d fo

od o

n cr

edit

Con

sum

ed se

eds h

eld

for

next

sea

son

Red

uced

mea

l siz

e

Red

uced

num

ber

of

mea

ls p

er d

ay

Res

tric

ted

cons

umpt

ion

for

adul

ts

Sent

chi

ldre

n to

live

w

ith r

elat

ives

Red

uced

exp

endi

ture

on

hea

lth a

nd

educ

atio

n


1-3 60 44.4 70.0 68.3 66.7 18.3 40.0 40.0 20.0 5.0 16.7

4-6 149 42.7 71.1 68.5 69.1 17.4 38.3 38.9 33.6 12.8 21.5

≥ 7 35 44.9 68.6 68.6 82.9 11.4 51.4 40.0 45.7 17.1 37.1

Sector

Urban 44 31.9 61.4 77.3 68.2 18.2 25.0 20.5 22.7 11.4 22.7

Rural 200 47.2 72.5 66.5 71.0 16.5 44.0 43.5 34.0 11.5 22.5

Religion of the HH Head

Budddhist 68 27.8 91.2 66.2 79.4 22.1 50.0 42.6 44.1 5.9 17.6

Hindu 51 58.0 70.6 70.6 68.6 9.8 45.1 51.0 23.5 13.7 27.5

Islam 117 54.9 59.8 68.4 65.8 17.9 35.0 33.3 28.2 13.7 23.1

Catholic 2 50.0 0.0 50.0 50.0 0.0 0.0 0.0 50.0 0.0 0.0


< 9,000 121 62.7 77.7 75.2 78.5 18.2 51.2 50.4 33.1 14.0 29.8

9,000 – 13,999 51 47.7 72.5 70.6 60.8 15.7 33.3 39.2 29.4 13.7 15.7

14,000 – 19,999 41 39.0 56.1 58.5 56.1 14.6 26.8 19.5 36.6 7.3 22.0

20,000 – 31,999 21 21.0 52.4 42.9 66.7 19.0 28.6 23.8 28.6 4.8 4.8

≥ 32,000 3 7.0 100.0 66.7 66.7 33.3 33.3 0.0 0.0 0.0 0.0

Wealth quintile

Poorest 86 56.2 86.0 74.4 73.3 17.4 53.5 51.2 41.9 14.0 24.4

Second 78 55.3 65.4 74.4 75.6 14.1 47.4 46.2 32.1 12.8 28.2

Middle 41 40.2 58.5 56.1 61.0 12.2 26.8 19.5 26.8 7.3 24.4

Fourth 23 29.5 65.2 52.2 69.6 26.1 13.0 17.4 21.7 4.3 4.3

Richest 16 18.2 50.0 62.5 56.3 25.0 12.5 25.0 6.3 12.5 6.3

Overall 244 43.4 70.5 68.4 70.5 16.8 40.6 39.3 32.0 11.5 22.5

48

Table A 36: Households taken loans and reasons for borrowing money, by background characteristics


Received loan Main reason for loan (% of the total received loan)

No %

Purc

hase

food

Med

ical

cos

t

Rep

air

of d

amag

ed

hous

e

Tra

nspo

rt

Rep

ay lo

an

supp

ort a

dditi

onal

m

embe

rs

Mar

riag

e

Inco

me

gene

ratio

n

othe

r


1-3 38 28.1 46.2 7.7 7.7 0.0 10.3 2.6 0.0 17.9 7.7

4-6 119 34.3 35.8 10.0 8.3 1.7 9.2 0.8 1.7 15.0 17.5

≥ 7 27 34.6 51.9 18.5 7.4 0.0 0.0 0.0 3.7 11.1 7.4

Sector

Urban 46 33.8 50.0 13.0 4.3 2.2 15.2 2.2 0.0 6.5 6.5

Rural 138 32.5 37.1 10.0 9.3 0.7 5.7 0.7 2.1 17.9 16.4


< 9,000 83 43.0 44.6 10.8 9.6 1.2 7.2 0.0 0.0 14.5 12.0

9,000 – 13,999 40 37.4 48.8 7.3 0.0 2.4 12.2 0.0 2.4 14.6 12.2

14,000 – 19,999 30 29.1 32.3 16.1 3.2 0.0 9.7 3.2 3.2 16.1 16.1

20,000 – 31,999 20 20.0 10.0 15.0 25.0 0.0 5.0 0.0 5.0 15.0 25.0

≥ 32,000 5 11.6 20.0 0.0 20.0 0.0 0.0 0.0 0.0 40.0 20.0

Wealth quintile

Poorest 56 36.6 42.1 12.3 7.0 1.8 3.5 0.0 0.0 12.3 21.1

Second 63 45.0 48.4 7.8 6.3 1.6 10.9 1.6 1.6 14.1 7.8

Middle 36 35.6 27.8 16.7 5.6 0.0 13.9 2.8 2.8 22.2 8.3

Fourth 12 15.4 41.7 8.3 8.3 0.0 0.0 0.0 8.3 16.7 16.7

Richest 17 19.3 29.4 5.9 23.5 0.0 5.9 0.0 0.0 11.8 23.5

Overall 560 32.9 40.3 10.8 8.1 1.1 8.1 1.1 1.6 15.1 14.0

49

Table A 37: Percent of households reported food had run out at some time during the previous 12 months, and months of adequate household food provisioning (MAHFP) by

background characteristics

Background characteristic % household food had run out during past 12

months Average MAHFP % yet to acheive

the target No. of

Households


1-3 34.1 11.1 7.5 135

4-6 32.1 11.1 7.7 349

≥ 7 38.5 11.1 7.9 79

Residence

Urban 21.7 11.4 4.6 138

Rural 37.3 11.0 8.7 425


No schooling 48.1 10.2 14.9 52

Primary 43.2 10.9 9.0 111

Secondary 34.0 11.1 7.4 204

Passed O’ Level 25.3 11.4 4.7 87

Higher 14.8 11.5 3.9 54


< 9,000 56.0 10.5 12.7 193

9,000 – 13,999 37.4 11.2 6.5 107

14,000 – 19,999 20.0 11.3 5.5 105

20,000 – 31,999 12.0 11.4 4.8 100

≥ 32,000 4.7 11.9 1.0 43

Wealth quintile

Poorest 50.3 10.2 14.8 153

Second 46.1 11.0 7.9 142

Middle 25.5 11.4 4.7 102

Fourth 15.4 11.6 3.6 78

Richest 9.1 11.8 2.0 88

Overall 33.5 11.1 7.7 563

50

Table A 38: Current food stock duration, and size compared to last year, by background characteristics (FC8, FC9)


Size of food stock compared to last year Mean No. of days

current food stock last

No. of households More (%) Same (%) Less (%) Much less

(%)


1-3 13.6 42.4 32.0 12.0 6.24 125

4-6 17.0 40.2 34.3 8.5 7.12 306

≥ 7 28.8 37.0 21.9 12.3 6.34 73

Sector

Urban 12.8 52.0 27.2 8.0 7.37 125

Rural 19.5 36.4 33.5 10.6 6.59 379


No schooling 10.9 50.0 26.1 13.0 3.00 46

Primary 17.2 40.4 31.3 11.1 6.43 99

Secondary 17.2 38.3 35.6 8.9 7.03 180

Passed O’ Level 23.8 37.5 28.8 10.0 7.67 80

Higher 23.1 36.5 32.7 7.7 9.71 52


< 9,000 12.4 33.1 39.6 14.8 4.94 169

9,000 – 13,999 14.3 38.5 34.1 13.2 6.69 91

14,000 – 19,999 22.1 47.4 26.3 4.2 8.05 95

20,000 – 31,999 24.2 44.2 26.3 5.3 7.99 95

≥ 32,000 20.0 50.0 30.0 0.0 9.67 40

Wealth quintile

Poorest 17.9 35.0 35.0 12.1 5.14 140

Second 11.8 40.0 36.4 11.8 6.76 110

Middle 13.7 46.3 28.4 11.6 6.42 95

Fourth 25.7 39.2 25.7 9.5 7.18 74

Richest 23.5 43.5 30.6 2.4 9.47 85

Overall 17.9 40.3 31.9 9.9 6.78 504

51

Table A 39: Average number of times a household received food aid in the last 6 months, by background characteristics

Characteristic Not

received food aids

Type of food aid (mean no. of times per 6 month)

No. of households

WFP

/GA

Sam

urdh

i

Food

Bas

ket

Scho

ol

feed

ing

CSB

Thri

posh

a

Food

for

wor

k

Oth

er


1-3 72.6 30.0 5.3 2.5 6.0 4.3 9.7 0.0 0.0 135

4-6 65.8 4.0 4.3 4.9 38.5 4.0 3.3 2.0 4.0 349

≥ 7 67.5 0.0 3.8 2.5 0.0 4.0 2.1 0.0 0.0 79

Sector

Urban 73.0 0.0 3.2 3.7 58.0 2.6 3.2 0.0 0.0 138

Rural 66.0 15.2 4.7 4.7 14.7 4.5 4.5 2.0 4.0 425


< 9,000 57.5 14.0 4.4 4.4 4.0 3.9 3.0 2.0 4.0 193

9,000 – 13,999 67.0 0.0 3.9 2.0 73.0 0.0 4.6 0.0 0.0 107

14,000 – 19,999 72.1 0.0 4.9 6.0 6.0 4.2 6.7 0.0 0.0 105

20,000 – 31,999 78.0 6.0 4.8 4.5 0.0 3.7 2.5 0.0 0.0 100

≥ 32,000 76.7 0.0 5.0 4.4 0.0 4.7 1.3 0.0 0.0 43


Poorest 53.3 17.0 5.0 5.0 110.0 4.4 3.7 0.0 0.0 153

Second 65.7 2.0 3.9 3.6 12.5 3.7 6.9 2.0 4.0 142

Middle 67.6 6.0 3.8 0.0 0.0 4.0 2.8 0.0 0.0 102

Fourth 79.5 0.0 5.2 6.0 0.0 4.5 1.7 0.0 0.0 78

Richest 85.2 0.0 3.3 0.0 0.0 3.0 3.0 0.0 0.0 88

Overall 67.7 12.7 4.5 4.3 32.0 4.0 4.1 2.0 4.0 563

52

Table A 40: Household Food Consumption Adequacy Score (HFCAS) and prevalence of household food insecurity status, by background characteristics


Mean (SD) HFCAS Score*

HFCAS Score Category (%) No. of households

Poor Borderline Adequate


1-3 63.4 (14.8) 0.7 3.0 96.3 135

4-6 65.1 (15.0) 0.6 1.7 97.7 348

≥ 7 65.0 (16.9) 0.0 0.0 100.0 77

Residence

Urban 67.6 (15.3) 0.7 0.7 98.6 138

Rural 63.7 (15.1) 0.5 2.1 97.4 422

Religion of household Head

Buddhist 60.7 (13.0) 0.4 3.3 96.3 245

Hindu 66.7 (16.1) 1.1 0.0 98.9 87

Islam 68.1 (15.3) 0.5 0.9 98.6 213

Catholic and other Christian

62.4 (42.6) 0.0 0.0 100.0 3


No schooling 65.2 (15.9) 1.9 0.0 98.1 52

Primary 61.9 (13.8) 0.0 3.6 96.4 111

Secondary 63.7 (15.3) 0.5 3.0 96.6 203

Passed O’ Level 67.5 (13.0) 0.0 0.0 100.0 87

Higher 71.3 (13.8) 0.0 0.0 100.0 54


< 9,000 60.0 (14.8) 1.0 2.6 96.4 192

9,000 – 13,999 65.7 (15.2) 0.0 0.9 99.1 106

14,000 – 19,999 66.3 (12.8) 0.0 1.9 98.1 105

20,000 – 31,999 69.5 (13.7) 0.0 2.0 98.0 100

≥ 32,000 68.8 (17.5) 2.3 0.0 97.7 43

Wealth quintile

Poorest 58.3 (14.7) 1.3 3.9 94.8 153

Second 64.8 (14.4) 0.0 0.0 100.0 140

Middle 66.3 (16.5) 0.0 2.0 98.0 101

Fourth 67.6 (14.5) 1.3 2.6 96.2 78

Richest 70.9 (12.7) 0.0 0.0 100.0 88

Overall 64.7 (15.2) 0.5 1.8 97.7 560

53

Table A 41: Distribution (No and Percent) of households by food security Levels

Food Consumption Food Access (Percent expenditure on food)

Poor (0-21) Borderline (21.01 – 35) Adequate (> 35.01)

Poor ( > 90 %) 0 (0.0) 3 (1.0) 44 (15.1)

Average (75-90 %) 0 (0.0) 0 (0.0) 118 (40.5)

Good (<75 %) 0 (0.0) 1 (0.3) 125 (43.0)

Table A 42: Food Security Levels

Background characteristic Food Security Level

No. of households Food Secure (%) Moderately Food

Secure (%) Food Insecure

(%)


1-3 84.0 14.0 2.0 50

4-6 84.1 14.9 1.0 201

≥ 7 82.5 17.5 0.0 40

Sector

Urban 92.4 7.6 0.0 79

Rural 80.7 17.9 1.4 212


No schooling 71.4 28.6 0.0 21

Primary 67.6 32.4 0.0 34

Secondary 81.1 16.0 2.8 106

Passed O’ Level 92.9 7.1 0.0 56

Higher 94.4 5.6 0.0 36


< 9,000 72.7 25.0 2.3 88

9,000 – 13,999 87.5 12.5 0.0 56

14,000 – 19,999 83.6 14.9 1.5 67

20,000 – 31,999 90.9 9.1 0.0 55

≥ 32,000 100.0 0.0 0.0 18

Wealth quintile

Poorest 62.7 33.3 4.0 75

Second 82.9 17.1 0.0 76

Middle 92.5 7.5 0.0 53

Fourth 100.0 0.0 0.0 39

Richest 95.8 4.2 0.0 48

Overall 83.8 15.1 1.0 291

54

ANNEX II The steps followed in estimating levels of food insecurity were as follows:

Step1: Calculate a household food consumption adequacy score (HFCAS) based on food groups consumed during 1 week prior to survey, grouped into 3 categories as described in footnote7. Step 2: Estimating the expenditure on food as a percentage of the total household expenditure, and categorizing the households into 3 groups indicating different levels of food access (<75 percent - good; 75t o 90 percent - average and >90 percent - poor food access). Step 3: Cross-tabulation between food consumption categories and food access categories.

Food insecurity levels were assessed in accordance with the classification given in Figure 2.

Figure 2: Assessment of food insecurity levels

Food consumption Poor Borderline Adequate

Food access

Poor Severely food insecure Severely food insecure Moderately food insecure

Average Severely food insecure Moderately food insecure Food Secure

Good Moderately food insecure Food Secure Food Secure

7 Eight food groups were used to calculate the Food consumption adequacy score.

Food group Food times 1. Staple foods (starches) Rice, bread / chapti /roti 2. Pulses/legumes Pulses 3. Vegetables vegetables (including leaves) 4. Fruits fruits 5. Animal protein Fish, meat (beef, pork, chicken), eggs 6. Sugar sugar/ jaggary 7. Dairy products Curd, milk (liquid or powder) 8. Oil/fats palm oil, vegetable oil, fats, coconut products (dried copra)

The number of days the food items were consumed during the previous week was summed for the food items in each of the 8 food groups. If the total sum of the number of days of the separate items in a food group was higher than 7 days, the sum is converted to 7. Thus, the maximum score for each food group is 7 days. The food score of each household is calculated as follows: Simple food score = 2 * staple + 3 * pulses + 1 * vegetables + 1* fruit + 4 * animal protein + 0.5 * sugar + 3 * dairy + 0.5 * oil The households were grouped according to their scores by applying the standard cut-offs as follows:

Poor food consumption: simple food score is 0 – 21 Borderline food consumption: simple food score is 21.01 – 35 Adequate food consumption: simple food score is 35.01 and higher

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Nutrition and Food Security Assessment in Sri Lanka - 2009 ... · i Nutrition and Food Security Assessment in Sri Lanka - 2009 AMPARA DISTRICT Dr. Renuka Jayatissa Dr. S.M. Moazzem