The challenge of achieving basal energy, iron and zinc provision for home consumption through family farming in the Andes: a comparison of coverage through contemporary production systems and selected agricultural interventions

Background Child undernutrition is persistently high in the central Andes of Peru, and numerous smallholder households fail to meet their basic needs of energy, iron and zinc. Food-based approaches assume household-level nutrition can be improved following agricultural interventions. This study assesses for the first time whether current Andean production systems provide sufficient energy, iron and zinc output to meet household-level requirements and explores the likely effect of commonly promoted food-based approaches. Across four communities, we determined the crop and livestock production output for each household (n = 165) during one growing season. The household-level nutritional demand or input was calculated as a function of household composition and daily requirements of energy, iron and zinc as established by FAO/WHO. We examined five scenarios, current practice or status quo and four food-based interventions: (1) increased potato yield, (2) introduced biofortified potatoes, (3) promotion of guinea pigs and (4) a mixed strategy combining all of the above. Results Under status quo, 86, 62 and 76 % of households obtained sufficient production output to meet energy, iron and zinc requirements, respectively. Considering the three parameters simultaneously, 59 % of households were able to meet their energy, iron and zinc requirements. The total crop production among households provided more than the necessary energy, iron and zinc output to meet the demand of all 165 households. Yet, significant differences between households account for individual deficits or surpluses in household-level output–input balances. Potato (Solanum spp.), barley (Hordeum vulgare) and faba (Vicia faba) production was particularly significant in determining the energy, iron and zinc output. Livestock did not make a substantial contribution. The main difference between households with negative versus positive coverage, in terms of household-level production output from agriculture meeting demand (=input), was available cropping area given household size. None of the explored food-based interventions closed the energy, iron and zinc deficit from production among households with negative coverage. Conclusions The smallholder production systems analyzed are only partially capable of providing sufficient production output to cover household-level energy, iron and zinc demands. Of the four interventions examined, a mixed strategy holds most potential for reducing nutrition gaps. Particularly potato yield increases had a positive effect. The carrying capacity of high-altitude Andean farming systems is strained for households with limited land. Food-based approaches to nutrition under scenarios similar to those reported in this study are advised to balance agricultural interventions with options to enhance off-farm access to food

The Nutritional Contribution of Potato Varietal Diversity in Andean Food Systems: a Case Study

Potato is the backbone of agriculture and diets in high-altitude food systems of Peru, where farmers grow diverse varietal portfolios. Here we report on the role of diverse landraces and modern potato varieties in the Andean diet. The dry matter, energy, protein, iron and zinc content of 12 floury and 9 bitter landraces was determined. The contribution of varietal diversity to the dietary intake of energy, protein, iron and zinc was established during two contrasting periods of overall food availability. Results show that the potato and intraspecific diversity make an important contribution to nutrition. Most floury landraces contain higher concentrations of protein and iron compared to the reference value reported in the 2009 Peruvian food composition table for a boiled and peeled floury landrace. Traditional freeze-drying of bitter landraces doesn’t affect energy or iron concentrations, but reduces protein and zinc content considerably. Protein and iron contents in boiled chuño derived from the bitter landraces are lower compared to the mean value reported in the food composition table. The contribution of varietal diversity ideally needs to be taken into account when conducting nutrition studies in diversity hotspots like the Andes where potato is a main staple. The potato adds positively to the nutritional balance and the recommended requirements for energy, protein, iron and zinc of women and children. Floury landraces and modern varieties complement each other in light of seasonality, providing valuable nutrients during contrasting periods of the year. The potato thus contributes positively to food security. However, the overall diversity of the diet was found to be poor, resulting in micronutrient deficiencies. Options to strengthen food based approaches to attend undernutrition are discussed

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: An overview

Nutritional and developmental insults in the first few years of life have profound public health implications, including substantial contributions to neonatal, infant, and early childhood morbidity and mortality, as well as longer term impacts on cognitive development, school achievement, and worker productivity. Optimal development that can lead to the attainment of the individual's fullest potential therefore requires a combination of genetic capacity, adequate nutrition, psychosocial stimulation, and safe, clean physical environments. Researchers and policymakers have called for integrated child nutrition and development interventions for more than twenty years, yet there are only a handful of efficacy trials and even fewer examples of integrated interventions that have been taken to scale. While a critical component to the design of such interventions is formative research, there is a dearth of information in both the literature and policy arenas to guide this phase of the process. To move the field forward, this paper first provides an overview of formative research methods with a focus on qualitative inquiry, a description of the critical domains to be assessed (infant and young child feeding, responsive feeding, and child development), and currently available resources. Application of these methods is provided through a real-world case study—the design of an integrated nutrition and child development efficacy trial in Andhra Pradesh, India. Recommendations for next steps are discussed, the most important of which is the need for a comprehensive set of formative guidelines for designing locally tailored, culturally appropriate integrated interventions

Designing intervention prototypes to improve infant and young child nutrition in Peru: A participatory design study protocol

Introduction: Nutrition during the complementary feeding period (6–23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach. Methods and analysis: The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6–23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6–23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities. Ethics and dissemination: Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications

Design opportunities to facilitate tangible play and promote healthy nutrition in low-resource healthcare settings in Peru

Complementary feeding is crucial to promote healthy nutrition in infant and young children (IYC) and prevent malnutrition. Mothers, families, and healthcare professionals (HCPs) are crucial in helping IYC develop healthy eating habits. However, limited access to adequate nutritional information and health services impacts children's nutrition, especially in low-resource settings. Technology opens up opportunities to address these challenges and potentially improve IYC feeding practices. Taking a co-design approach, we conducted low-fidelity prototyping workshops with caregivers and HCPs to explore the potential of tangible interfaces to facilitate play and promote healthy nutrition for IYC in two low-resource healthcare settings in Peru. Participants envisioned diverse tangible objects and interactions that could augment the waiting spaces of the healthcare centres, encouraging play and enhancing children's and caregivers' experiences, while promoting healthy nutrition and dietary diversity. We outline design opportunities to facilitate tangible play, shared playful experiences, and promote healthy nutrition in low-resource healthcare settings

Physical factors that influence participation: Reflections from co-design workshops with Peruvian low-resource communities

Participatory Design (PD) approaches have been widely applied in different contexts and locations. However, there are still challenges when PD is used in low-resource communities in the Global South. The main objective of this work is to understand how to adapt PD approaches and design materials to enhance participants' engagement during co-design sessions. We conducted four co-design workshops (including two future workshops and two prototyping workshops) with healthcare professionals (HCPs) and caregivers in two low-resource communities in Peru to promote nutrition for children under two years. We identified that physical, social and temporal factors influenced HCPs and caregivers participation. In this position paper, we focus on the physical factors, such as the characteristics of the venue and the design materials to support more active participation in co-design workshops

Farm-Level Agricultural Biodiversity in the Peruvian Andes Is Associated with Greater Odds of Women Achieving a Minimally Diverse and Micronutrient Adequate Diet

Abstract Background The extent to and mechanisms by which agricultural biodiversity may influence diet diversity and quality among women are not well understood. Objectives We aimed to 1) determine the association of farm-level agricultural biodiversity with diet diversity and quality among women of reproductive age in Peru and 2) determine the extent to which farm market orientation mediates or moderates this association. Methods We surveyed 600 households with the use of stratified random sampling across 3 study landscapes in the Peruvian Andes with diverse agroecological and market conditions. Diet diversity and quality among women were assessed by using quantitative 24-h dietary recalls with repeat recalls among 100 randomly selected women. We calculated a 10-food group diet diversity score (DDS), the Minimum Dietary Diversity for Women (MDD-W) indicator, probability of adequacy (PA) of 9 micronutrients by using a measurement-error model approach, and mean PA (MPA; mean of PAs for all nutrients). Agricultural biodiversity was defined as a count of crop species cultivated by the household during the 2016–2017 agricultural season. Results In regression analyses adjusting for sociodemographic and agricultural characteristics, farm-level agricultural biodiversity was associated with a higher DDS (incidence rate ratio from Poisson regression: 1.03; P 60%: OR: 1.21; 95% CI: 1.10, 1.35). Farm market orientation did not consistently moderate these associations, and in path analyses we observed no consistent evidence of mediation of these associations by farm market orientation. Conclusions Farm-level agricultural biodiversity was associated with moderately more diverse and more micronutrient-adequate diets among Peruvian women. This association was consistent across farms with varying levels of market orientation, although agricultural biodiversity likely contributed to diets principally through subsistence consumption

The Biodiversity of Food and Agriculture (Agrobiodiversity) in the Anthropocene: Research Advances and a Conceptual Framework

Multiple knowledge systems are crucial to understand human-environment interactions of the biodiversity of agriculture and food systems (agrobiodiversity). This article synthesizes these knowledge systems to formulate the novel Agrobiodiversity Knowledge Framework comprised of four themes: (1) ecology and evolution; (2) governance; (3) food, nutrition, and health; and (4) global environmental and socioeconomic changes. Resulting characterization of these knowledge themes, joined with cross-theme integration, demonstrate advances of agrobiodiversity research, management, and policy amid the accelerated global environmental and socioeconomic transformations of the Anthropocene. Framework results guide the presentation of new data from the Agrobiodiversity, Food, and Nutrition project (AFN) in Peru. These results integrate an emphasis on factors of global change, including climate change. The combination of the new knowledge framework and project results is utilized to point toward future directions for research, policy, and management. The Agrobiodiversity Knowledge Framework is essential to address the transformative planetary challenges of the Anthropocene that include sustainable development with nutritional security, biodiversity conservation, social justice, climate change, and nutrient pollution. Strengthening the focus on and analysis of the complex human-environment interactions of biodiversity in agriculture and food is vital as a nexus of science, scholarship, management, and policy in the era of Earth systems dominated by human activity

How participatory is parental consent in low literacy rural settings in low income countries? Lessons learned from a community based study of infants in South India

<p>Abstract</p> <p>Background</p> <p>A requisite for ethical human subjects research is that participation should be informed and voluntary. Participation during the informed consent process by way of asking questions is an indicator of the extent to which consent is informed.</p> <p>Aims</p> <p>The aims of this study were to assess the extent to which parents providing consent for children's participation in an observational tuberculosis (TB) research study in India actively participated during the informed consent discussion, and to identify correlates of that participation.</p> <p>Methods</p> <p>In an observational cohort study of tuberculosis in infants in South India, field supervisors who were responsible for obtaining informed consent noted down questions asked during the informed consent discussions for 4,382 infants who were enrolled in the study. These questions were post-coded by topic. Bivariate and multivariate analysis was conducted to examine factors associated with asking at least one question during the informed consent process.</p> <p>Results</p> <p>In total, 590 out of 4,382 (13.4%) parents/guardians asked any question during the informed consent process. We found that the likelihood of parents asking questions during the informed consent process was significantly associated with education level of either parent both parents being present, and location.</p> <p>Conclusions</p> <p>The findings have implications for planning the informed consent process in a largely rural setting with low levels of literacy. Greater effort needs to be directed towards developing simple participatory communication materials for the informed consent process. Furthermore, including both parents in a discussion about a child's participation in a research study may increase the extent to which consent is truly informed. Finally, continuing efforts need to be made to improve the communication skills of research workers with regard to explaining research processes and putting potential research participants at ease.</p

An increase of cereal intake as an approach to weight reduction in children is effective only when accompanied by nutrition education: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The main emphasis of dietary advice for control of obesity has been on reducing dietary fat. Increasing ready to eat cereal (RTEC) consumption could be a strategy to reduce fat intake and increase carbohydrate intake resulting in a diet with lower energy density.</p> <p>Objectives</p> <p>1. To determine if an increase in RTEC intake is an effective strategy to reduce excess body weight and blood lipids in overweight or at risk of overweight children. 2. To determine if a nutrition education program would make a difference on the response to an increase in cereal intake. 3) To determine if increase in RTEC intake alone or with a nutrition education program has an effect on plasma lipid profile.</p> <p>Experimental design</p> <p>One hundred and forty seven overweight or at risk of overweight children (6–12 y of age) were assigned to one of four different treatments: a. One serving of 33 ± 7 g of RTEC for breakfast; b. one serving of 33 ± 7 g of RTEC for breakfast and another one for dinner; c. one serving of 33 ± 7 g of RTEC for breakfast and a nutrition education program. d. Non intervention, control group. Anthropometry, body composition, physical activity and blood lipids were measured at baseline, before treatments, and 12 weeks after treatments.</p> <p>Results</p> <p>After 12 weeks of intervention only the children that received 33 ± 7 g of RTEC and nutrition education had significantly lower body weight [-1.01 (-1.69, -0.34) ], p < 0.01], lower BMI [-0.95 (-1.71, -0.20), p < 0.01] and lower total body fat [-0.71 (-1.71, 0.28), p < 0.05] compared with the control group [1.19 (0.39, 1.98), 0.01 (-0.38, 0.41), 0.44 (-0.46, 1.35) respectively]. Plasma triglycerides and VLDL were significantly reduced [-20.74 (-36.44, -5.05), -3.78 (-6.91, -0.64) respectively, p < 0.05] and HDL increased significantly [6.61 (2.15, 11.08), p < 0.01] only in this treatment group. The groups that received 1 or 2 doses of RTEC alone were not significantly different to the control group.</p> <p>Conclusion</p> <p>A strategy to increase RTEC consumption, as a source of carbohydrate, to reduce obesity is effective only when accompanied by nutrition education. The need for education could be extrapolated to other strategies intended for treatment of obesity.</p> <p>Trial Registration</p> <p>Australian New Zealand Clincial Trial Registry. Request no: ACTRN12608000025336</p