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Objectives To estimate the prevalence of latent iron deficiency (LID) among pregnant women, assess LID in relation to parity, age, education, and household income, and to determine correlations between LID and red cell indices, red cell distribution width (RDW), and red cell morphology. Design Cross-sectional design Setting North Colombo Teaching Hospital, Sri Lanka. Sample Participants comprised 355 pregnant women with normal haemoglobin levels seeking antenatal care within < 20 weeks of gestation. Method Data were obtained from interviews and antenatal records. Participant full blood count (FBC), serum ferritin levels, and blood films were analysed. Main Outcome Measures Prevalence of LID, demographic data (age, parity, period of gestation, gap between pregnancies, income, and education), and blood film morphology. Results LID prevalence was 54%. Statistical significance for the gap between pregnancies being < 2 years was observed but not for participant’s age, parity, income, and education. Blood film morphology depicted statistically significant presence of hypochromic microcytic red cells and pencil cells. RDW was significant in indicating the presence of LID. Among those with LID, 25% had ferritin level in the iron deficiency range. Conclusions LID is highly prevalent in early pregnancy and 25% of participants had ferritin levels in the iron deficiency range. Presence of raised RDW, hypochromic microcytic red cells, pencil cells, and

Top 10 actors for each measure of IYCF network centrality in Sri Lanka. (DOCX 14 kb)

Level of influence of the actors with the highest level of influence. (DOCX 22 kb)

Level of support of the actors. (DOCX 13 kb)

Sri Lanka saw a slow decline in childhood undernutrition during the last decade (Department of Census and Statistics and Ministry of Healthcare and Nutrition, 2009), despite the availability of free health service and education for over eight decades. The nutritional status of children living in the estate sector is poor compared to urban and rural sectors in Sri Lanka. The estate sector, which comprises tea plantations, continues to report high rates of undernutrition (stunting 40.2%, wasting 13.5%, underweight 30.1%), and relatively poorer performance on infant and young child feeding (IYCF) indicators (exclusive breast feeding rate 57.7%, dietary diversity 50.7%, minimum acceptable diet 41.8%), than national averages (Department of Census and Statistics and Ministry of Healthcare and Nutrition, 2009; Senarath, Siriwardena, Godakandage, Jayawickrama, Fernando, & Dibley, 2012; Senarath, Godakandage, Jayawickrama, Siriwardena, & Dibley, 2012). There is an ongoing debate on the effectiveness of traditional methods of nutritional interventions to bring desired outcomes to this population (Weerasinghe & Bandara, 2015). Hence, it is worthy to seek new approaches for improving nutrition and overall health status. Mobile health initiatives have been effectively used in many primary health care settings for different needs such as patient compliance for insulin therapy, HIV treatment and pediatric dental appointment reminders (Franklin, Waller, Pagliari, & Greene, 2006; Nelson, Berg, Bell, Leggott, & Seminario, 2011; Puccio et al., 2006). M-health is the use of portable electronic devices for mobile voice or data communication over a cellular or other wireless network to provide health information (Kahn, Yang, & Kahn, 2010). With the evolution of mobile phone technology and wider usage, many view m-Health as a promising tool to foster behavioral change. Systematic reviews of m-health behavioral change communications found almost no trials conducted in the low and middle income countries except for a single trial in China (Free et al., 2013; Krishna, Boren, & Balas, 2009). According to statistics of the telecommunication regulatory commission in Sri Lanka, the number of mobile phone subscriptions by June 2014 was 21 million. Furthermore, mobile subscriptions per 100 people were 102.5, compared to fixed phone services, which were 13.1 per 100 inhabitants (Telecommunication Regulatory Commission in Sri Lanka, 2014). At individual level, 45%-50% of people in Sri Lanka own a mobile phone, which is higher than the average for the South Asian region. Expansion of mobile networks within the last decade achieved over 90% coverage of 2G and 70% of 3G facilities. In addition, the competition of several providers has reduced the prices of the services (GSMA intelligence, 2013). Current ownership of mobile phones in rural areas is less than of urban setting (53% to 42%). However, annual subscriber growth is estimated to be 7%. While coverage not-spots (signal dead zones) and digital literacy lowers usage, affordability also presents an important factor, especially in rural areas (GSMA intelligence, 2013). Still, m-health nutritional counseling has the potential to be a promising application for health care in Sri Lanka. The aim of this study is to understand the nature of mobile phone use and perceptions of m-health for IYCF counseling among the mothers, their family members, and service providers in the estate sector of Sri Lanka for establishing a mobile platform for counseling. Estate Sector and Health Services In the early 19th century, the predominant subsistence agrarian economy in Sri Lanka, transformed into a commercial type, with the introduction of the plantation (estate) sector to the country by the British Colonial Rule. Among the key cultivation crops in Sri Lanka, tea became the major export crop. In the failure of recruiting sufficient labor from the indigenous Sinhala community, colonial rulers brought thousands of laborers from the South India for employment. …

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006-2007 used a stratified two-stage cluster sample of ever-married women 15-49 years, and included details about foods given to children aged 6-23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) - (introduction of solid/semi-solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6-23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty-four per cent of infants aged 6-8 months were introduced to complementary food. The proportion of infants aged 6-8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6-23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6-11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs.

Improving infant and young child feeding practices will help South Asian countries achieve the Millennium Development Goal of reducing child mortality. This paper aims to compare key indicators of complementary feeding and their determinants in children aged 6-23 months across five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka. The latest Demographic and Health Survey and National Family Health Survey India data were used. The analyses were confined to last-born children aged 6-23 months - 1728 in Bangladesh, 15,028 in India, 1428 in Nepal, 2106 in Sri Lanka and 443 infants aged 6-8 months in Pakistan. Introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency and minimum acceptable diet, and their significant determinants were compared across the countries. Minimum dietary diversity among children aged 6-23 months ranged from 15% in India to 71% in Sri Lanka, with Nepal (34%) and Bangladesh (42%) in between. Minimum acceptable diet among breastfed children was 9% in India, 32% in Nepal, 40% in Bangladesh and 68% in Sri Lanka. The most consistent determinants of inappropriate complementary feeding practices across all countries were the lack of maternal education and lower household wealth. Limited exposure to media, inadequate antenatal care and lack of post-natal contacts by health workers were among predictors of inappropriate feeding. Overall, complementary feeding practices among children aged 6-23 months need improvement in all South Asian countries. More intensive interventions are necessary targeting the groups with sup-optimal practices, while programmes that cover entire populations are being continued.

Inappropriate complementary feeding increases risk of undernutrition, illness and mortality in infants and children. This paper aimed to determine the factors associated with inappropriate complementary feeding practices in Sri Lanka. The Sri Lanka Demographic and Health Survey 2006–2007 used a stratified two‐stage cluster sample of ever‐married women 15–49 years, and included details about foods given to children aged 6–23 months during the last 24 h. The new World Health Organization indicators for infant and young child feeding (IYCF) – (introduction of solid/semi‐solid or soft foods; minimum dietary diversity; minimum meal frequency; and minimum acceptable diet) were calculated for 2106 children aged 6–23 months. These indicators were examined against explanatory variables with multivariate analyses to identify factors associated with inappropriate practices. Eighty‐four per cent of infants aged 6–8 months were introduced to complementary food. The proportion of infants aged 6–8 months who consumed eggs (7.5%), fruits and vegetables other than those rich in vitamin A (29.6%) and flesh foods (35.2%) was low. Of children aged 6–23 months, minimum dietary diversity was 71%, minimum meal frequency 88% and minimum acceptable diet 68%. Children who lived in tea estate sector had a lower dietary diversity and minimum acceptable diet than children in urban and rural areas. Other determinants of not receiving a diverse or acceptable diet were lower maternal education, shorter maternal height, lower wealth index, lack of postnatal visits, unsatisfactory exposure to media and acute respiratory infections. In conclusion, complementary feeding indicators were adequate except in the 6–11 months age group. Subgroups with inappropriate feeding practices should be the focus of IYCF promotion programs.