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BACKGROUND: Little is known about how the COVID-19 pandemic has affected food security and livelihoods in Sri Lanka. OBJECTIVE: This article aims to assess food insecurity, perceived effects of COVID-19, and coping mechanisms among agriculture-based households in rural Sri Lanka. METHODS: We used 2 rounds of panel data from phone surveys (n = 1057 households) conducted in 5 districts. Food insecurity (30-day recall), perceived impacts of COVID-19 (6-month recall), and coping mechanisms (6-month recall) were assessed using a household questionnaire. To assess food insecurity, we used the 8-item Food Insecurity Experience Scale. We tested for differences between T1 (baseline: December 2020-February 2021) and T2 (follow-up: July 2021-September 2021) and explored the association between food insecurity and the perceived effect of COVID-19 on income using a logistic regression model. RESULTS: Food insecurity was highly prevalent (T1: 75%, T2: 80%) but varied across districts. Most respondents were affected by COVID-19 and/or COVID-19-associated mitigation measures (T1: 84%, T2: 89%). Among affected households, commonly reported impacts included those on income (T1: 77%, T2: 76%), food costs (T1: 84%, T2: 83%), and travel (∼90% in both rounds). Agricultural activities were also adversely affected (T1: 64%, T2: 69%). About half of COVID-19-affected households reported selling livestock or assets to meet basic needs. Households whose income was impacted by COVID-19 were more likely to be food insecure (adjusted odds ratio: 2.56, P < .001). CONCLUSIONS: Households in rural Sri Lanka experienced food insecurity and livelihood disturbances during the COVID-19 pandemic. Additional surveys are needed to assess recovery post-COVID-19 and to understand if programs that support livelihoods have been protective.

METHOD: This original article used household level survey data from 2 rounds of phone surveys conducted in 5 districts of Sri Lanka.Using a household-level questionnaire, we recorded experience of food insecurity in the last 30 days, perceived impact of COVID-19, and adopted coping mechanism in the 6 months prior to the survey.We reported statistical means and tested for differences between 2 survey rounds.We also explored association between food insecurity and the perceived effect of COVID-19 on income. RESULTS: Household-level food insecurity was highly prevalent during the pandemic.Households perceived a negative effect of the pandemic on their income and employment sources.Households whose income was impacted by the pandemic were more likely to be food insecure. CONCLUSION: Agriculture-based households in rural Sri Lanka experienced food insecurity and livelihood disturbances during the COVID-19 pandemic.Additional research is needed to assess recovery post COVID-19 and to understand whether livelihood support programs have been protective.

Plain language titleFood Insecurity and Perceived Effects of COVID-19 on Livelihoods in Rural Sri LankaPlain language summaryBackground: Sustained levels of high food insecurity are associated with a range of negative health, nutrition, and well-being effects.The COVID-19 pandemic is expected to aggravate food insecurity and worsen the livelihood situation.Little is known about how the COVID-19 pandemic affected food security and livelihoods of agriculture-based households in rural Sri Lanka.

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Background: There is a co-existence of different forms of malnutrition leading to a Triple Burden of Malnutrition (TBM) in Sri Lanka. Accessing basic needs and services was a challenge during COVID-19 pandemic, which led to issues in food security with an effect on nutrition status of the population. Objectives: To estimate the prevalence of malnutrition and dietary intakes of the population aged 1 to 60 years. Methods: This study was conducted in 2021. A multistage cluster sample was drawn to represent households at national level using 75 clusters, and 24-hour dietary recalls were compared with estimated average requirements of different age groups. Height and weight of all selected participants were measured. Results: A total of 1776 households and 2991 individuals were studied. The prevalence of wasting, stunting and overweight of children aged 1-4 years (n=486) was 14%, 16.3% and 0.8% respectively. Thinness, stunting, overweight and obesity of children aged 5-9 years (n=388) was 21.4%, 8.5%, 5.2%, 5.1%; children aged 10-17 years (n=355) was 21.1%, 14.1%,11%, 8.2%; and adults aged 18-60 years (n=1762) was 9.9%, 5.4%, 32.6% and 11.5% respectively. Dietary intake gaps were minimal with energy and protein while it was wider with majority of vitamins, iron and calcium. Stunting of children aged 1-4 years was significantly associated with the low calcium and iron intakes. Conclusions: The presence of TBM amongst children and adults were observed with a dietary gap of essential micronutrients. This study highlights the need to re-orient the nutritional interventions to control TBM at population level.

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BACKGROUND: International labour migration continues to be an integral component in Sri Lanka's economic development. Previous research indicates an adverse perinatal outcome in association with low maternal pre-pregnancy body mass index (PBMI) and gestational weight gain (GWG). However, evidence of this association is limited in migrant families. This study aims to investigate the associations between PBMI, GWG among lactating mothers (LM), and fetal outcomes in migrant households, where the father is the migrant worker. METHODS: A secondary data analysis was done using a nationally representative sample of 7,199 LM. There were 284 LM whose husbands were international migrant workers. Maternal factors were taken as PBMI<18.5 kg/m2 and GWG<7kg. Preterm birth and low birth weight (LBW) were taken as fetal outcomes. Binary logistic regression was performed to assess the associated factors. RESULTS: There was significant difference between LM from migrant and non-migrant households with regards to place of residency, ethnicity, household monthly income, household food security, average household members, husband's education and husband's age. Among migrant, PBMI<18.5 kg/m2 was associated with current BMI and mode of delivery. Migrant LM had significantly higher weight gain (≥12 kg) during pregnancy (p=0.005), were multiparous (p=0.008), delivered in private hospital (p=0.000), lesser percentage of underweight (p=0.002) and higher birthweight (p=0.03) than non-migrant LM. Logistic regression model revealed that for each kilogram increment in birthweight and GWG, preterm delivery decreased by 89%(OR=0.11;95%CI:0.04-0.28) and LBW decreased by 12%(OR=0.89;95%CI:0.81-0.97) respectively. Caesarean deliveries were positively associated with low GWG. CONCLUSION: Our study showed LM in migrant families had invested remittances to utilize private health facilities for deliveries, to improve weight gain during pregnancy and adequate PBMI to deliver higher birth weight babies. In depth study is needed to understand further utilisation of remittances to improve fetal outcomes by increasing birthweight and GWG in migrant families.

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OBJECTIVES: To determine changes and factors associated with child malnutrition, obesity in women and household food insecurity before and after the first wave of COVID-19 pandemic. DESIGN: A prospective follow-up study. SETTING: In 2019, the baseline Urban Health and Nutrition Study 2019 (UHNS-2019) was conducted in 603 households, which were selected randomly from 30 clusters to represent underserved urban settlements in Colombo. In the present study, 35 % of households from the UHNS-2019 cohort were randomly selected for repeat interviews, 1 year after the baseline study and 6 months after COVID-19 pandemic in Sri Lanka. Height/length and weight of children and women were re-measured, household food insecurity was reassessed, and associated factors were gathered through interviewer-administered questionnaires. Differences in measurements at baseline and follow-up studies were compared. PARTICIPANTS: A total of 207 households, comprising 127 women and 109 children were included. RESULTS: The current prevalence of children with wasting and overweight was higher in the follow-up study than at baseline UHNS-2019 (18·3 % v. 13·7 %; P = 0·26 and 8·3 % v. 3·7 %; P = 0·12, respectively). There was a decrease in prevalence of child stunting (14·7 % v. 11·9 %; P = 0·37). A change was not observed in overall obesity in women, which was about 30·7 %. Repeated lockdown was associated with a significant reduction in food security from 57 % in UHNS-2019 to 30 % in the current study (P < 0·001). CONCLUSIONS: There was an increase in wasting and overweight among children while women had a persistent high prevalence of obesity. This population needs suitable interventions to improve nutrition status of children and women to minimise susceptibility to COVID-19.

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AIM: The present study aims to investigate the composition and availability of weight-loss supplements in Sri Lanka and explore the evidence for their effectiveness. METHODS: Data were collected by visiting drug stores, searching the Internet for websites and referring to advertisements in national newspapers and magazines from August to October 2017. RESULTS: A total of 100 weight-loss products were identified of which the majority (n = 57) were available from drug stores. Most commonly, products were available in capsule form (36.0%). The number of active ingredients in products varied from 1 to a maximum of 22 with a total of 155 different active ingredients distinguished. The ingredients mainly originated from plants (77.4%) while green tea (Camellia sinensis), garcinia (Garcinia cambogia) and caffeine anhydrous were the three most common. At least one of the top 10 ingredients was included in 75 of the products sourced. Directions for use were specified in only 72 products, while a further 6 products lacked any information on ingredients. Literature predicted positive weight-loss effects for green tea and ginger while garcinia was reported for both positive and negative effects. CONCLUSIONS: The ingredients are reported to have both beneficial and adverse effects. Many consumers may find it challenging to make informed purchase decisions as a number of products failed to provide adequate nutritional information and safety measures. Government regulatory authorities should pay closer attention to the availability and provision of products sold to the general public.

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Background: Vitamin D deficiency (VDD) and insufficiency (VDI) are public health problems in many countries, and limited data is available on the prevalence of VDD/VDI in Sri Lanka. Objectives: To determine the prevalence and associated factors of VDD in children aged 10- 18 years. Methods: This was a cross-sectional study among school children aged 10-18 years at national level. A representative sample of 2525 children were recruited from July to November 2017. Serum 25(OH)D concentration and the patterns of vitamin D rich foods consumption were assessed. VDD and VDI cut offs were set at serum 25(OH)D concentrations of <12 ng/mL and 12-20 ng/mL, respectively as defined by global consensus in 2016. Results: The mean serum 25(OH)D level was 19.3±7.4 ng/mL. The prevalence of VDD and VDI were 13.2% (95%CI: 11.9%-14.5%) and 45.6% (95%CI: 43.7%-47.5%), respectively. The prevalence of VDD was highest in the central province (32.2%) and highest prevalence of VDI was in the Inabaragamuwa province (58.9%). VDD and VDI were lowest in North Central province (0.7% and 34.7%, respectively). Significantly higher serum 25(OH)D levels were observed with male gender (p=0.000), BMI for age <-2SD (p=0.000), daily milk consumption (p=0.000) and residing in dry zone (p=0.0 Conclusions: Though Sri Lanka is a tropical country, VDD is prevalent among school children aged 10-18 years. It is important to develop a VDD preventive strategy, especially for high risk groups.

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