STAMINA: Strategies to Mitigate Nutritional Risks among mothers and infants under 2 years in low income urban households in Peru during COVID-19
Lead Research Organisation:
Loughborough University
Department Name: Sch of Sport Exercise & Health Sciences
Abstract
Peru's progress in combatting malnutrition may be reversed with the current COVID-19 pandemic which has caused disruption of maternal and infant nutrition services, closure of health centres and rising unemployment. Peru has experienced one of the highest mortality rates from COVID-19 in South America. Deteriorations in infant nutrition will lead to poorer health outcomes for the next generation. Government and community stakeholders in Peru have highlighted the unknown impacts of the pandemic on the nutrition of mothers and their infants and young children.
This study will examine how the COVID-19 response is impacting on the nutritional risks of mothers and infants (aged 0-23 months) within the household setting in low-income areas of two cities, Huánuco and Lima. This information will be compared with detailed nutritional assessments conducted in the same communities immediately before the national State of Emergency due to COVID-19. To address the emerging nutritional risks, we will work with stakeholders to co-create adapted methods for the delivery of nutritional services including iron supplementation and support for exclusive and continued breastfeeding.
We will identify the nutritional risks resulting from the COVID-19 pandemic by examining short, medium and longer term changes in:
- exclusive breastfeeding rates for infants aged 0-6 months; continued breastfeeding for infants aged 6-23 months, and the extent to which WHO recommended complementary feeding practices are being met.
- the uptake of iron supplementation in infants and young children - a national priority to combat anaemia - in the context of the disrupted health services and new delivery strategies implemented since the pandemic.
- household food security, maternal psychological wellbeing, and changing quality of diet in relation to nutritional risks of undernutrition as well as overweight and obesity at the household level.
- how household dietary practices adapt and respond to the ongoing pandemic.
With these insights, we will co-create support systems for the design or adapted delivery of nutritional counselling, growth monitoring and iron supplementation for infants and young children using information and communication technologies or socially-distanced health services.
We will work with UNICEF Peru as a project partner in order to ensure that efforts to address malnutrition target the most vulnerable groups and are tailored to the challenges experienced by urban communities which make up the majority population of Peru.
This study will examine how the COVID-19 response is impacting on the nutritional risks of mothers and infants (aged 0-23 months) within the household setting in low-income areas of two cities, Huánuco and Lima. This information will be compared with detailed nutritional assessments conducted in the same communities immediately before the national State of Emergency due to COVID-19. To address the emerging nutritional risks, we will work with stakeholders to co-create adapted methods for the delivery of nutritional services including iron supplementation and support for exclusive and continued breastfeeding.
We will identify the nutritional risks resulting from the COVID-19 pandemic by examining short, medium and longer term changes in:
- exclusive breastfeeding rates for infants aged 0-6 months; continued breastfeeding for infants aged 6-23 months, and the extent to which WHO recommended complementary feeding practices are being met.
- the uptake of iron supplementation in infants and young children - a national priority to combat anaemia - in the context of the disrupted health services and new delivery strategies implemented since the pandemic.
- household food security, maternal psychological wellbeing, and changing quality of diet in relation to nutritional risks of undernutrition as well as overweight and obesity at the household level.
- how household dietary practices adapt and respond to the ongoing pandemic.
With these insights, we will co-create support systems for the design or adapted delivery of nutritional counselling, growth monitoring and iron supplementation for infants and young children using information and communication technologies or socially-distanced health services.
We will work with UNICEF Peru as a project partner in order to ensure that efforts to address malnutrition target the most vulnerable groups and are tailored to the challenges experienced by urban communities which make up the majority population of Peru.
Publications
Pradeilles R
(2022)
Diet and food insecurity among mothers, infants, and young children in Peru before and during COVID-19: A panel survey.
in Maternal & child nutrition
| Description | We have been tracking the impact of the COVID-19 pandemic on the nutrition and dietary impacts of mothers and infants aged 0-2 years. The third and final of three surveys was completed in March 2023. These surveys assessed dietary intake, household food insecurity, access to health services and sources of social or financial support among peri-urban households in Lima and Huánuco. Qualitative interviews were also conducted with caregivers of infants aged 0-24 months. The findings show that household food insecurity was highest among the lower socio-economic status households. The proportion of households experiencing household food insecurity was highest in the first survey (approx 9 months since the start of the COVID-19 pandemic) and declined in the two subsequent surveys. Households adopted a range of strategies to cope with the financial impact of the pandemic, including reductions in food expenditure, use of savings or assets, use of 'sharing pots' or community kitchens and borrowing money or buying on credit. These coping mechanisms appeared to play an important roles in mitigating the impact of COVID-19 on nutrition of mothers and infants. • ODA relevance of research findings: Minimising household food insecurity has been a major priority in Peru and other DAC list countries that have experienced severe social and economic shocks from the COVID-19 pandemic. We have identified that 46% of households experienced moderate or severe household food insecurity nine months after the beginning of COVID-19. Despite this, important dietary indicators for children aged 6-23 months were not adversely affected by the pandemic. For example, a high proportion of children aged 6-23 months met the recommended minimum dietary diversity and there was an increase in the proportion of infants exclusively breastfeed for the first six months of life. The number of households receiving government food assistance nearly doubled in the survey during COVID-19, compared to levels before COVID-19. This receipt of food assistance may have provided a buffer that prevented worsening of dietary indicators for infants and young children. We are continuing to liaise with stakeholders in central and regional government so that they can follow the impact of the pandemic on the nutrition of mothers and infants in relation to the social and economic conditions in the country. • Non-research findings: no findings to report. |
| Exploitation Route | The study outcomes can be used to understand how households with young infants and children manage under times of crisis caused by high unemployment, disruption to usual health services and closure of schools and other child care facilities. We have shared our findings with health centre staff and regional/municipal government who have found it very valuable to know how mothers with young infants perceived breastfeeding during the COVID-crisis and whether or not mothers had received appropriate support from heatlh services through online and virtual methods. We've been able to show that some of the poorest households did manage to access social and financial support from the government and other providers, which has been an important means of maintaining a nutritious and affordable diet for mothers and young children. |
| Sectors | Agriculture, Food and Drink,Communities and Social Services/Policy,Healthcare |
| Description | • Societal and economic impact: Our research is taking place In Peru which is on the DAC list of middle income countries. The beneficiaries of the research include women and their young children (ages 0- 2 years) in low income peri-urban communities. Our research is tracking the impact of the COVID=19 pandemic on nutrition and dietary intakes of mothers and infants using community-based surveys via telephone interviews. We have shared findings on household food insecurity and nutritional indicators with national, regional and local stakeholders in the two regions of the study. Outputs from the first and second community surveys have been shared with health service providers so that they can modify, change or innovate their practices based on the changing circumstances over different phases of the pandemic. We have led a series of workshops and focus groups with government healthcare providers to identify the current challenges for the provision of nutritional counselling (for exclusive breastfeeding and complementary feeding practices) and iron supplement programmes. In response to reported needs, we have developed a prototype mobile phone app to replace paper-based infant and young child health cards and piloted this with stakeholders (healthcare professionals) with further piloting planned among caregivers. This app could provide increased engagement of caregivers with nutrition and health goals of their infants to reduce the risk of anaemia, stunting and overweight/obesity. • Sustainable Development Goals (SDG) addressed: We are addressing SDG2 'Reduce hunger and malnutrition and ensure children have access to sufficient and nutritious food' and SDG3 'Ensure healthy lives and wellbeing'. We have measured household food insecurity experience in two peri-urban communities during the COVID-19 pandemic and provided this information to national, regional stakeholders to inform them on the extent of moderate and severe food insecurity and identifying the groups that are most affected by this. Large economic disparities exist in the urban population in Peru, and this affects the nutritional health of mothers and their infants and young children. Since COVID-19, vulnerable groups have fallen back into poverty, hence we are working in the communities at risk of coexisting forms of malnutrition including anaemia and stunting as well as overweight/obesity. • Impact related to gender: The majority of caregivers of 0-2 year olds are women (mothers and female caregivers), and through our findings we have provided a platform to feedback the experiences of mothers and female caregivers during the pandemic in relation to their access to health services, the use of telephone appointments and their concerns about nutrition and feeding of their infants and young children. We have engaged with healthcare providers of different genders and used their feedback on the mobile phone app to create multiple interactions and improve the design and functionality. |
| First Year Of Impact | 2021 |
| Sector | Communities and Social Services/Policy,Healthcare |
| Impact Types | Policy & public services |
| Title | Supplementary information files for Diet and food insecurity among mothers, infants and young children in Peru before and during COVID-19: a panel survey |
| Description | Supplementary information files for article Diet and food insecurity among mothers, infants and young children in Peru before and during COVID-19: a panel survey The COVID-19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low-income urban areas of Peru. We conducted a panel study, with one survey prepandemic (n = 244) and one survey 9 months after the onset of COVID-19 (n = 254). We assessed breastfeeding and complementary feeding indicators and maternal dietary diversity in both surveys. During COVID-19, we assessed household food insecurity experience and economic impacts of the pandemic on livelihoods; receipt of financial or food assistance, and uptake of health services. Almost all respondents (98.0%) reported adverse economic impacts due to the pandemic and 46.9% of households were at risk of moderate or severe household food insecurity. The proportion of households receiving government food assistance nearly doubled between the two surveys (36.5%-59.5%). Dietary indicators, however, did not worsen in mothers or IYC. Positive changes included an increase in exclusive breastfeeding <6 months (24.2%-39.0%, p < 0.008) and a decrease in sweet food consumption by IYC (33.1%-18.1%, p = 0.001) and mothers (34.0%-14.6%, p < 0.001). The prevalence of sugar-sweetened beverage consumption remained high in both mothers (97%) and IYC (78%). In sum, we found dietary indicators had not significantly worsened 9 months into the COVID-19 pandemic. However, several indicators remain suboptimal and should be targeted in future interventions. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | Publication. |
| URL | https://repository.lboro.ac.uk/articles/dataset/Supplementary_information_files_for_Diet_and_food_in... |
| Title | Supplementary information files for Diet and food insecurity among mothers, infants and young children in Peru before and during COVID-19: a panel survey |
| Description | Supplementary information files for article Diet and food insecurity among mothers, infants and young children in Peru before and during COVID-19: a panel survey The COVID-19 pandemic may impact diet and nutrition through increased household food insecurity, lack of access to health services, and poorer quality diets. The primary aim of this study is to assess the impact of the pandemic on dietary outcomes of mothers and their infants and young children (IYC) in low-income urban areas of Peru. We conducted a panel study, with one survey prepandemic (n = 244) and one survey 9 months after the onset of COVID-19 (n = 254). We assessed breastfeeding and complementary feeding indicators and maternal dietary diversity in both surveys. During COVID-19, we assessed household food insecurity experience and economic impacts of the pandemic on livelihoods; receipt of financial or food assistance, and uptake of health services. Almost all respondents (98.0%) reported adverse economic impacts due to the pandemic and 46.9% of households were at risk of moderate or severe household food insecurity. The proportion of households receiving government food assistance nearly doubled between the two surveys (36.5%-59.5%). Dietary indicators, however, did not worsen in mothers or IYC. Positive changes included an increase in exclusive breastfeeding <6 months (24.2%-39.0%, p < 0.008) and a decrease in sweet food consumption by IYC (33.1%-18.1%, p = 0.001) and mothers (34.0%-14.6%, p < 0.001). The prevalence of sugar-sweetened beverage consumption remained high in both mothers (97%) and IYC (78%). In sum, we found dietary indicators had not significantly worsened 9 months into the COVID-19 pandemic. However, several indicators remain suboptimal and should be targeted in future interventions. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | Publication |
| URL | https://repository.lboro.ac.uk/articles/dataset/Supplementary_information_files_for_Diet_and_food_in... |
| Description | Food Security Congress, Peru |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Hilary Creed-Kanashiro was invited to present the work of the STAMINA and PERUSANO projects to the Food Security Congress held in Lima on October 5th 2021. Our data on nutrition pre-COVID-19 and during COVID-19 in the same peri-urban communities was important for highlighting the impact of the pandemic on nutrition and dietary indicators of mothers and infants. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://infoalimentario.com/2021/09/10/peru-evento-congreso-internacional-de-seguridad-alimentaria-y... |
| Description | Invited presenter and participant at the British Council/ UK ENIC event with MesaINTEDU Peru |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | I was an invited participant and keynote presenter at an transnational event organised by the British Council in Lima and Peruvian government representatives of Ministry of Education, Ministry of Foreign affairs, National Superintendance for Higher Education d to Peruvian to discuss international collaboration and transnational education. I was invited to present on experiences of remote/virtual international collaboration and partnership building through the STAMINA research project and to identify benefits and challenges of these experiences during COVID-19 and future opportunities. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Stakeholder workshops with healthcare professionals in Peru |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | During 2021 we held a series of focus groups with the key personnel (nurses, nutritionists, other healthcare professionals) in the healthcare centres in the peri-urban areas where the STAMINA project is located. The workshops were conducted in order to improve upon the current paper-based health cards provided to caregivers for tracking the progress of their infant or young child's growth and development, immunisation and nutritional guidance. Initial stakeholder workshops were used to assess the current utility of the health cards and identify limitations. Then the stakeholders took part in the iterative design and early evaluation of a mobile app designed to replace the health card and support caregivers' engagement with healthcare of infants from 6-23 months. The series of focus groups held virtually enabled us to analyse qualitative feedback on the protoype app and conduct early testing of the functionality and design. |
| Year(s) Of Engagement Activity | 2021 |