2025
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Publication Open Access Identifying the causes of adolescent malnutrition in Nuwara-Eliya District, Sri Lanka(Nature Research, 2025-05-06) Nandajeewa, S; Aluthwatta, S; Weerarathna, R; Rathnayake, N; Rajapakse, V; Wijesinghe, N; Liyanaarachchi, TMalnutrition, a persistent illness, significantly reduces fat, muscle and bone levels, harming internal organs. The economic crisis in Sri Lanka has led to widespread malnutrition among children, including adolescents experiencing growth spurts. This study identifies factors influencing malnutrition in grade 10 pupils in the Nuwara-Eliya District, with the highest rates of malnutrition and also a multicultural area with many estate sector residents. Using a cross-sectional, quantitative approach, the data was collected from 379 respondents via a Likert scale questionnaire. Structural Equation Model (SEM) analysis was conducted using Smart PLS 4.0. Key findings indicate that environmental factors, such as access to clean water and sanitation, significantly influence adolescent malnutrition. A comprehensive strategy incorporating education, healthcare, and environmental improvements is essential for this. Ongoing observation, community engagement, and cooperative tactics are crucial for sustainable solutions. Addressing environmental issues and promoting a holistic approach to health education and infrastructure improvements are vital to combat adolescent malnutrition in vulnerable populations.Publication Open Access Economic and healthcare determinants of under-five mortality in low-income countries(Springer Nature Link, 2025-06-06) Rajapakse, V; Fernando, A; Sudangama, N; Adikari, D; Sundaram, A; Jayathilaka, RBackground Under-five mortality (U5MR) remains a critical development challenge, particularly in low-income countries (LICs), where children face the highest risk of preventable deaths. This study explores the influence of three key variables, per capita Gross Domestic Product (PGDP), DTP1 immunisation coverage, and Government Healthcare Expenditure (GHE), on U5MR across 19 LICs from 2000 to 2020, providing a clearer understanding of their individual and combined effects. Methods A balanced panel dataset was analysed using both fixed-effects and random-effects panel regression models. Additionally, country-level insights were derived through multiple linear regression (MLR) to capture variations across different LIC contexts. Results The analysis revealed a strong inverse relationship between PGDP and U5MR, highlighting the role of economic growth in improving child survival. DTP1 immunisation coverage showed mixed effects, positively linked to reduced mortality in most LICs, but unexpectedly associated with higher U5MR in specific contexts like Malawi and the Central African Republic, suggesting challenges in access or implementation. Similarly, GHE showed varied impacts, with some countries benefiting significantly, while others demonstrated weaker or adverse effects, likely due to inefficiencies in spending. Conclusions The findings highlight that reducing U5MR in LICs requires more than isolated actions. It calls for combined strategies that connect economic improvements with fair healthcare investments and better immunisation delivery. Policymakers must design context-specific solutions to ensure lasting and meaningful progress in child health outcomes.Publication Open Access Surviving the first five years: the economic and healthcare determinants of child mortality in Sri Lanka(Springer Nature Link, 2025-06-21) Rajapakse, V; Jayathilaka, RBackground This study investigates the role of economic growth, healthcare investment, immunization coverage, and malnutrition in reducing under-five mortality rates (U5MR) in Sri Lanka. Understanding how these factors interact within socio-economic ecosystems is essential to formulating sustainable strategies to improve child survival outcomes. Methods This study employs multiple linear regression to analyze the statistical associations between economic growth, healthcare investment, immunization, malnutrition, and under-five mortality in Sri Lanka. Using secondary data from the World Bank and UNICEF (2000–2021), U5MR was modeled against economic growth (per capita GDP), government healthcare expenditure (GHE), immunization coverage (DTP1), and malnutrition (MLN), with significance assessed through p-values and model fit via R². Results The multiple linear regression model demonstrated strong explanatory power, accounting for 85% of the variation in under-five mortality (R² = 0.85). Economic growth and immunization coverage were negatively associated with U5MR and found to be statistically significant (p < 0.05 and p < 0.10 respectively), indicating their potential role in reducing child mortality. Malnutrition showed a strong positive association (p < 0.01), emphasizing its continued threat to child health. Although government healthcare expenditure had a negative association, it was not statistically significant, suggesting possible inefficiencies in resource utilization. Conclusion The study highlights the significant role of economic growth, healthcare expenditure, immunization coverage, and nutrition in shaping U5MR trends in Sri Lanka. The findings emphasize the need for targeted policy interventions to enhance child health outcomes and ensure sustainable progress in reducing child mortality.
