Under-five mortality in Sri Lanka

use the school meal program for this purpose. Moreover, countries such as Japan have used the meal program to go beyond just providing a nutritional meal to teaching students other practical life skills such as cooperation and teamwork (in preparing and serving the meal). Sri Lanka may wish to consider exploring such models to maximize the various impacts of SHPP.

UNDER-FIVE MORTALITY IN SRI LANKA

The under-five mortality rate is one of the most widely used health-related indicators. Poor health in childhood diminishes the formation of human capital. Evidence supports the notion that much of a person’s physiological and cognitive development happens in childhood, and economic theories call for human capital investments to be made early in life. under-five mortality refers to deaths among children from birth to age five. Deaths that occur during the first five years of life are categorized according to the time of death: (1) early neonatal deaths (deaths in first seven days of life), (2) neonatal deaths (deaths in first 28 days of life), (3) postneonatal deaths (deaths between 29 and 364 days), and (4) infant deaths (deaths in the first year of life).

Current status of under-five mortality

The latest Demographic and Health Survey (2016) reports that the under-five mortality rate in Sri Lanka is 11 per 1,000 live births (Sri Lanka, DCS 2017). According to the Family Health Bureau’s 2016 annual report, however, the under-five mortality rate in the country is 9.3 per 1,000 live births (Sri Lanka, MoH 2018a). Most under-five mortalities in the country occur within the first year of life, particularly during the neonatal period. The infant mortality rate is 10 per 1,000 live births, of which seven per 1,000 live births correspond to neonatal mortality (Sri Lanka, MoH 2018b). Some 68 percent of infant mortalities occur during the neonatal period. A relatively lower percentage of deaths occur between the ages of one and five, reflecting improvements in external factors such as infections and nutrition that determine child survival. The immediate causes of under-five mortality are categorized according to the infant period and the period between one and four years. In both periods, the primary cause of death is congenital abnormalities (54.5 percent and 35 percent, respectively). Although Sri Lanka has the potential to control many of the external determinants of childhood survival, the high percentage of neonatal deaths highlights the need for further improvements in obstetric care and proper management of perinatal and early neonatal complications. under-five mortality is not equally distributed among geographic areas. Map 3.1 reveals that there is substantial geographic variation in the under-five mortality rate, with the highest rate reported in kilinochchi District, 44 per 1,000 live births, and the lowest in Polonnaruwa District, three per 1,000 live births (Sri Lanka, DCS 2017). DHS 2016 also found high rates in Trincomalee District (26 per 1,000 live births) and Mullaitivu District (22 per 1,000 live births). Similar to stunting, a significant variation in the under-five mortality rate was observed according to the place of residence. Estate dwellers had the highest rates (15 per 1,000 live births), whereas urban populations had lower rates (11 per 1,000 live births). under-five mortality is not equally distributed among segments of the population. Of the social determinants of child survival, maternal education and