Papers by Hiranya Jayawickrama
Level of influence of the actors with the highest level of influence. (DOCX 22 kb)
Level of support of the actors. (DOCX 13 kb)
Top 10 actors for each measure of IYCF network centrality in Sri Lanka. (DOCX 14 kb)
Policy documents relevant to IYCF in Sri Lanka. (DOCX 21 kb)
Current Developments in Nutrition
Objectives To understand the multi-level factors influencing maternal diet in Sri Lanka. Methods ... more Objectives To understand the multi-level factors influencing maternal diet in Sri Lanka. Methods Study design . This ethnographic sub-study was conducted using an iterative four-phase, mixed methods formative research design. Data collection methods and sampling. To understand the multi-level factors influencing maternal diets across the rural, urban and estate sectors of Sri Lanka, community members from each sector were purposefully sampled. Pregnant women (n = 21), community leaders (n = 10) and influencers (n = 37) were interviewed using a semi-structured interview guide. Data analysis. Data were analyzed using Dedoose software and the socio-ecological model to conceptualize influencing factors of maternal diets across sectors. Results In Sri Lanka, a variety of multi-level factors reportedly influence maternal diets. At the community level, high food availability and inter-household food sharing facilitate diverse maternal diets while traditional food rules (e.g., 20 prescripti...
Current Developments in Nutrition
Objectives To describe typical care practices employed by urban, estate, and rural caregivers dur... more Objectives To describe typical care practices employed by urban, estate, and rural caregivers during infant and young child feeding episodes in Sri Lanka. Methods Study design. This ethnographic sub-study was conducted using a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods. Data were collected between Sept. 2020 – Sept. 2021 using direct meal observations (4–8 hours each) and semi-structured interviews. Infants and young children aged 6–23 months (n = 72), as well as community leaders (n = 10), caregivers (n = 58) and influencers (n = 37) were purposively sampled to participate in meal observations and interviews, respectively. Data analysis. Observational data were summarized using simple descriptive statistics while textual data were analyzed thematically using Dedoose. Results During 4–8 hour long observations, most caregivers (80.6%, 58/72) gave infants and young children their full attention duri...
Maternal & Child Nutrition, 2011
Background Stunting is a well-established risk marker of poor child development. Globally in 2017... more Background Stunting is a well-established risk marker of poor child development. Globally in 2017, 155 million children under 5 were estimated to be stunted. While different activities are being done to reduce the burden of stunted growth, the problem is overwhelming in Africa; it was increased by 24%. Therefore, identifying determinants of stunting among children aged 6-59 would help to set priorities for action and to the design of stunting reduction plan at a grassroots level. Methods The unmatched case-control study was conducted in randomly selected 8 rural kebeles of Kindo Didaye woreda, Ethiopia from February to April, 2016 to identify the determinants of stunting among children aged 6-59 months. The sampling frame was identified by enumeration of 6-59 months of age children in the entire households of the study area. From which 155 as cases and 310 as controls were chosen using anthropometric measurement based on the median of WHO 2006 reference population. The anthropometric data were analyzed by WHO Anthro 2010 software to generate Z-score values. Odds Ratio along with 95% confidence interval was estimated to identify determinants of stunting using the multivariable logistic regression. Results Drinking water from unsafe source (AOR = 7.06, 95% CI; 4.40-20.42),occasionally eating animal source food (AOR = 0.51, 95% CI; 0.02-0.68), ARI in the past two weeks (AOR = 3.04, (95% CI; 1.04-13.35), late initiation of breastfeeding after one hours after birth (AOR = 5.16, 95% CI; 2.24-15.90) and lack of vaccination (AOR = 6.38, 95% CI; 2.54-17.10)were significantly associated with stunting.
The Qualitative Report, 2016
Sri Lanka saw a slow decline in childhood undernutrition during the last decade (Department of Ce... more 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 effec...
Current Developments in Nutrition
Objectives To understand how community perspectives toward young child nutritional illness compar... more Objectives To understand how community perspectives toward young child nutritional illness compare to biomedical perspectives in Sri Lanka. Methods This ethnographic sub-study was embedded in a multi-phase, mixed methods formative research design to understand infant and young child feeding practices in urban, rural, and estate sectors of Sri Lanka. Data were collected among caregivers of young children to understand nutritional illness using free lists (n = 150), pile sorts (n = 84), semi-structured interviews with caregivers (n = 21) and community leaders (n = 24). Data were collected in Sinhalese and Tamil languages and translated into English for analysis. Free list and pile sort data were analyzed using cultural domain analysis with Anthropac. Textual data were analyzed thematically using Dedoose. Data sets were combined for methodological triangulation. Results During interviews, caregivers described a combination of biomedical and traditional medicine approaches for treating ...
Current Developments in Nutrition
Objectives 1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To expl... more Objectives 1) To understand how Sri Lankan caregivers conceptualize young child foods; 2) To explore local food classification systems; 3) To explain why some foods are culturally prescribed (remedies) or proscribed (taboos) for young children Methods Design: This ethnographic sub-study was conducted within a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods and sampling. Data were collected between Oct. 2020 – Feb. 2021 using free lists, pile sorts, and semi-structured interviews in urban (Batticaloa and Colombo), rural (Kilinochchi, Ratnapura, and Matara), and estate (Nuwara Eliya) sectors of Sri Lanka. Free lists (n = 150) and pile sorts (n = 84) were conducted among caregivers of young children. Both community leaders (n = 24) and caregivers (n = 21) were purposively sampled for interviews. Data analysis. Cultural domain analysis was conducted using Anthropac. Textual analysis of interview data follo...
Journal of the College of Community Physicians of Sri Lanka
Journal of the College of Community Physicians of Sri Lanka
Journal of the College of Community Physicians of Sri Lanka
BMC Public Health
Background: Infant and young child feeding practices (IYCF) play a critical role in growth and de... more Background: Infant and young child feeding practices (IYCF) play a critical role in growth and development of children. A favourable environment supported by appropriate policies and positive contributions from all stakeholders are prerequisites for achieving optimal IYCF practices. This study aimed to assess the IYCF-related policy environment and role of stakeholders in policy making in Sri Lanka, in order to identify opportunities to strengthen the policy environment to better support appropriate IYCF and reduce childhood malnutrition. Methods: We mapped national level policy-related documents on IYCF, and conducted a stakeholder analysis of IYCF policy making. A matrix was designed to capture data from IYCF policy-related documents using a thematic approach. A narrative synthesis of data from different documents was conducted to achieve the first objective. We then conducted an analysis of technical and funding links of stakeholders who shape IYCF policies and programmes in Sri Lanka using the Net-Map technique, to achieve the second objective. A total of 35 respondents were purposively selected based on their knowledge on the topic, and individual interviews were conducted. Results: Twenty four policies were identified that contained provisions in line with global recommendations for best-practice IYCF, marketing of breast milk substitutes, strengthening health and non-health systems, maternity benefits, inter-sectoral collaboration, capacity building, health education and supplementation. However, there is no separate, written policy on IYCF in Sri Lanka. Participants identified 56 actors involved in shaping IYCF policies and programmes through technical support, and 36 through funding support. The Government Health Sector was the most connected as well as influential, followed by development partners. Almost all actors in the networks were supportive for IYCF policies and programmes. Conclusions and recommendations: All evidence-based recommendations are covered in related policies. However, advocacy should be targeted towards strategic support for IYCF in high-level policy documents. The stakeholder analysis confirmed a network led by the government health sector. Enhancing the multi-sectoral commitments stressed in policy documents is an opportunity to strengthen IYCF policy process in Sri Lanka.
Identification of factors that predict a woman's infant feeding choice is important for breastfee... more Identification of factors that predict a woman's infant feeding choice is important for breastfeeding promotion programmes. We analysed a subsample of children under 2 years of age from the most recent Sri Lanka Demographic and Health Survey (SLDHS) to assess breastfeeding practices and factors associated with suboptimal practices. SLDHS 2006-2007 used a stratified two-stage cluster sample of ever-married women aged 15-49 years. Breastfeeding indicators were estimated for the last-born children (n = 2735). Selected indicators were examined against independent variables through cross-tabulations and multivariate analyses. Of the sample, 83.3% initiated breastfeeding within 1 h of birth. Continuation rates declined from 92.6% in first year to 83.5% in second year. Exclusive breastfeeding (EBF) rate under 6 months of age was 75.8%, with median duration being 4.8 months. Delayed initiation of breastfeeding was associated with low birthweight [odds ratio (OR) = 2.24] and caesarean delivery (OR = 3.30), but less likely among female infants (OR = 0.75), mothers from 'estate' sector (OR = 0.61) or richer wealth quintile (OR = 0.60). Non-EBF was associated with children from urban areas (OR = 1.72) and estate sector (OR = 4.48) and absence of post-natal visits by a public health midwife (OR = 1.89). A child was at risk for not currently breastfeeding if born in a private hospital (OR = 3.73), delivered by caesarean section (OR = 1.46) or lived in urban areas (OR = 2.80) or estate sector (OR = 3.23). Those living in estates (OR = 11.4) and not receiving post-natal home visits (OR = 2.62) were more likely to discontinue breastfeeding by 1 year. Breastfeeding indicators in Sri Lanka were higher compared with many countries and determined by socio-economic and health care system factors.
Food and nutrition bulletin, 2010
In Bangladesh, poor infant and young child feeding practices are contributing to the burden of in... more In Bangladesh, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition. Objective. To estimate the determinants of selected feeding practices and key indicators of breastfeeding and complementary feeding in Bangladesh. The sample included 2482 children aged 0 to 23 months from the Bangladesh Demographic and Health Survey of 2004. The World Health Organization (WHO)-recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Only 27.5% of mothers initiated breastfeeding within the first hour after birth, 99.9% had ever breastfed their infants, 97.3% were currently breastfeeding, and 22.4% were currently bottle-feeding. Among infants under 6 months of age, 42.5% were exclusively breastfed, and among those aged 6 to 9 months, 62.3% received complementary fo...
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Papers by Hiranya Jayawickrama