In Sri Lanka, the nutritional status of children under five years of age is poor. At national level, according to the 1995 nutritional status survey, the prevalence of stunting in children under five years of age was 20%, that of wasting 13% and of underweight 33%. The nutritional status of pre-school children showed significant inter-provincial differences. In the Western Province the children under five years of age have a better nutritional status and the prevalences of stunting, wasting and underweight are the lowest compared to the other provinces. Although this province has the highest population density and is the most urbanised, it also has the best health facilities both in quality and quantity. This permits greater access to better health services. The Central province had the highest prevalence of stunting 33% but the highest prevalence of underweight (39%) and wasting (21%) were observed in the Sabaragamuwa province.
The adult population group is also affected by undernutrition as indicated by the prevalence of chronic energy deficiency which is more than 33% in women and nearly 37% in men. The high prevalence of undernutrition in the adult population limits their work output, productivity and income-generating ability. There exist provincial differences in the nutritional status of adults and the lowest mean BMI was observed for both sexes in the Central province.
Desegregated data show that 9% of the female population suffer from severe chronic energy deficiency (CED) with a BMI value <16.0 kg/m2, while one quarter of the women have a BMI between 16.0 and 18.5 kg/m2 and suffer therefore from mild and moderate CED (Ramanujan and Nestel, 1997). Although the prevalence of severe CED is slightly lower in men (5%), overall 37% of men suffer from CED (BMI<.18.5 kg/m2). The high percentage of CED in the population is likely to be reflected in lower labour productivity.
Regarding micronutrient deficiencies, nearly 19% of the population was diagnosed as iodine deficient. About 45% of pre-school children, 58% of children 5 to 11 years old, 36% of adolescents and 45% of non-pregnant women suffer from anaemia. Women 18-45 years old seem to be the most affected and significant inter-provincial variations in the prevalence of anaemia were observed in this group. More than 30% of pre-school children have marginal serum values of vitamin A.
The provision of health infrastructures have improved over time but remain inadequate particularly in rural areas. However, the country's social welfare indices are impressive. The infant mortality rate which is an important index of health and nutritional status of a community has decreased from 48 to 17 per thousand live births between 1970 and 1997, life expectancy has increased up to 73 years and literacy rate in the country exceeds 90% for both sexes. A large number of infectious diseases such as respiratory and intestinal infections remain responsible for up to 50% of deaths of children under five, with malnutrition being an aggravating factor especially in the most populated areas.