New strategies to reduce anaemia and risk of overweight and obesity through complementary feeding of infants and young children in Peru
Lead Research Organisation:
Loughborough University
Department Name: Sch of Sport Exercise & Health Sciences
Abstract
Peru is experiencing rapid change with progressive economic development and increasing migration to cities. Dietary habits and health are also changing. Infants and children are getting taller but also getting heavier. In the last 10 years there have been significant increases in overweight and obesity among children, adolescents and adults. At the same time, however, the diets of infants and young children aged 6-23 months do not contain enough micronutrients (essential vitamins and minerals), particularly iron. Despite good provision of dietary supplements (micronutrient supplements including iron) to women and young children through national health services, there is still a high prevalence of anaemia (a deficiency of red cells or haemoglobin in blood) caused by iron and other micronutrient deficiencies.
New strategies are required to address these two dietary problems of anaemia and overweight/obesity. An underlying driver of these two nutritional challenges is the consumption of foods that are high in energy and low in nutrients.
Infant feeding is a critical time for health because the nutrition and growth of infants has a significant effect on health in childhood, adolescence and adulthood. A lack of research and poor understanding of the multiple factors influencing infant and young child feeding is a barrier to improving nutrition and health. This project will take a holistic approach to identifying the factors that drive food consumption in infants and young children in Peru, particularly the role of caregivers and families, communities and local neighbourhoods (health facilities and daycare facilities). There is a need for stronger evidence that accounts for the environments that people live in to inform strategies to promote healthier feeding of infants and young children.
Our project will use novel methods and adopt a holistic approach to examine infant and young child feeding in two peri-urban centres reflecting different ecologies of coastal Lima and highland Huánuco. As well as understanding infant feeding patterns and practices, we will organise community-based participatory workshops to identify solutions to the identified challenges of healthy complementary feeding. The workshops will lead to prototypes for solutions (interventions) to improve infant and young child nutrition which will be piloted in the local community.
Compliance with Official Development Assistance
This project addresses SDG2: reduce hunger and malnutrition and ensure children have access to sufficient and nutritious food; and SDG3: ensure healthy lives and wellbeing. Optimal infant and child feeding is critical for healthy growth and development and to prevent lifelong disparities in health.
In Peru, peri-urban households with lower socio-economic status are at significant risk of nutrient-poor diets that are also high in energy. This increases the risk of overweight and diet-related non-communicable disease over the lifecourse.
The Peruvian Ministry of Health has invested in national programmes to reduce anaemia and to promote healthy complementary feeding practices, however, this has not yet achieved substantial reductions in anaemia and novel, more holistic, strategies are needed. This study will therefore work with the peri-urban populations in Lima and Huánuco to develop tailored strategies to improve infant and young child feeding. The work will benefit children, families, local communities, health services, regional and national health authorities whilst informing local and national policies.
New strategies are required to address these two dietary problems of anaemia and overweight/obesity. An underlying driver of these two nutritional challenges is the consumption of foods that are high in energy and low in nutrients.
Infant feeding is a critical time for health because the nutrition and growth of infants has a significant effect on health in childhood, adolescence and adulthood. A lack of research and poor understanding of the multiple factors influencing infant and young child feeding is a barrier to improving nutrition and health. This project will take a holistic approach to identifying the factors that drive food consumption in infants and young children in Peru, particularly the role of caregivers and families, communities and local neighbourhoods (health facilities and daycare facilities). There is a need for stronger evidence that accounts for the environments that people live in to inform strategies to promote healthier feeding of infants and young children.
Our project will use novel methods and adopt a holistic approach to examine infant and young child feeding in two peri-urban centres reflecting different ecologies of coastal Lima and highland Huánuco. As well as understanding infant feeding patterns and practices, we will organise community-based participatory workshops to identify solutions to the identified challenges of healthy complementary feeding. The workshops will lead to prototypes for solutions (interventions) to improve infant and young child nutrition which will be piloted in the local community.
Compliance with Official Development Assistance
This project addresses SDG2: reduce hunger and malnutrition and ensure children have access to sufficient and nutritious food; and SDG3: ensure healthy lives and wellbeing. Optimal infant and child feeding is critical for healthy growth and development and to prevent lifelong disparities in health.
In Peru, peri-urban households with lower socio-economic status are at significant risk of nutrient-poor diets that are also high in energy. This increases the risk of overweight and diet-related non-communicable disease over the lifecourse.
The Peruvian Ministry of Health has invested in national programmes to reduce anaemia and to promote healthy complementary feeding practices, however, this has not yet achieved substantial reductions in anaemia and novel, more holistic, strategies are needed. This study will therefore work with the peri-urban populations in Lima and Huánuco to develop tailored strategies to improve infant and young child feeding. The work will benefit children, families, local communities, health services, regional and national health authorities whilst informing local and national policies.
Technical Summary
There are three main components (work packages) to the research.
Work package 1 will conduct formative research on the drivers of infant and young child feeding patterns and practices in relation to caregiver behaviours and household, community and socio-cultural environments. Qualitative and quantitative methods include i) quantitative dietary intakes of infants assessed through 24hr recall ii) 28-day food frequency questionnaires of mothers/caregivers iii) household observations (feeding style, mealtimes, snacking, food environment) and iv) in-depth interviews with maternal and non-maternal caregivers. We will then examine infant and young child feeding (IYCF) practices in the context of health services and daycare facilities to further understand feeding styles and food consumption patterns and practices. A policy mapping component will critically review policy developments and implementation on IYCF in relation to the Double Duty Actions on over- and under-nutrition. Findings from the formative research will be synthesised to identify the key challenges in adopting healthy complementary feeding practices in the two ecological settings (coastal Lima and highland Huanuco).
Work package 2 is a community based participatory design process. Through a series of six sequential workshops with stakeholders and end users (caregivers and families, health professionals, local government) we will formulate the key challenges, then use idea generation and 'futures' workshops to develop prototypes for solutions and interventions to address the dual challenge of micronutrient deficiency and obesity prevention in infants and young children.
Work package 3 will pilot the prototype interventions in households, communities or government health facilities. We will conduct qualitative evaluations of the pilot including acceptability, usability and relevance and bring the body of evidence to a reflective workshop involving the investigators, stakeholders and government.
Work package 1 will conduct formative research on the drivers of infant and young child feeding patterns and practices in relation to caregiver behaviours and household, community and socio-cultural environments. Qualitative and quantitative methods include i) quantitative dietary intakes of infants assessed through 24hr recall ii) 28-day food frequency questionnaires of mothers/caregivers iii) household observations (feeding style, mealtimes, snacking, food environment) and iv) in-depth interviews with maternal and non-maternal caregivers. We will then examine infant and young child feeding (IYCF) practices in the context of health services and daycare facilities to further understand feeding styles and food consumption patterns and practices. A policy mapping component will critically review policy developments and implementation on IYCF in relation to the Double Duty Actions on over- and under-nutrition. Findings from the formative research will be synthesised to identify the key challenges in adopting healthy complementary feeding practices in the two ecological settings (coastal Lima and highland Huanuco).
Work package 2 is a community based participatory design process. Through a series of six sequential workshops with stakeholders and end users (caregivers and families, health professionals, local government) we will formulate the key challenges, then use idea generation and 'futures' workshops to develop prototypes for solutions and interventions to address the dual challenge of micronutrient deficiency and obesity prevention in infants and young children.
Work package 3 will pilot the prototype interventions in households, communities or government health facilities. We will conduct qualitative evaluations of the pilot including acceptability, usability and relevance and bring the body of evidence to a reflective workshop involving the investigators, stakeholders and government.
Planned Impact
The impact of this UK-Peru interdisciplinary collaboration will be to mobilise an interdisciplinary research and policy agenda to promote healthy complementary feeding practices (6-23 months) in rapidly urbanising environments in Peru. We will achieve impact by identifying Double Duty actions to reduce malnutrition in infants and young children that can be translated into the revision of government guidelines on infant feeding currently underway. Our longer term impact goal is to reduce malnutrition (under- and over-nutrition) during early life in Peru. Nutrition in the first two years of life is a critical point in the life-course and healthy complementary feeding is important to reduce the risk of diet-related non-communicable diseases later in life.
The communities involved in the project will benefit directly from the research due to our strategy for engagement and participatory methods. Their experiences and preferences will directly feed into the intervention prototype. Wider beneficiaries of the research include the Ministry of Health and the Department for Development and Social Inclusion and regional organisations of the Fund to Stimulate Development (FED) Committee. FED is a joint initiative of the Ministry of Development and Social Inclusion (MIDIS) and the Ministry of Economics and Finance and will be represented on our stakeholder panel.
Engagement activities
Within three months of inception of the project, we will form stakeholder panels and host a meeting in each region of the study (peri-urban Lima and Huanuco). We will consult the local stakeholder panels at regular intervals throughout the lifetime of the project. The stakeholder panel, along with the research findings and idea generation with the communities, will stimulate debate on the barriers and facilitators for healthy complementary feeding of infants and young children. Participatory design workshops will include mothers, caregivers, community members and government health facilities staff who will continue to be engaged while we pilot the designed intervention prototypes. Engagement of researchers with stakeholders will continue beyond the project through active contribution to advisory groups and committees in nutrition.
Anticipated benefits
The benefit of this project is that the research need has been identified by the Peruvian Ministry of Health in their plans to revise current infant and young child feeding recommendations (0-2 years). It also benefits international agencies who aim to develop an obesity prevention model for children in Peru. Embedding our research within the health services and government facilities of peri-urban areas will bring benefits of tailoring prototypes for intervention to the local socio-cultural contexts and sustainability through existing services. This timely research will offer knowledge translation outside academia and continued engagement with the key stakeholders throughout the project will ensure we continue to align with their requirements.
The communities involved in the project will benefit directly from the research due to our strategy for engagement and participatory methods. Their experiences and preferences will directly feed into the intervention prototype. Wider beneficiaries of the research include the Ministry of Health and the Department for Development and Social Inclusion and regional organisations of the Fund to Stimulate Development (FED) Committee. FED is a joint initiative of the Ministry of Development and Social Inclusion (MIDIS) and the Ministry of Economics and Finance and will be represented on our stakeholder panel.
Engagement activities
Within three months of inception of the project, we will form stakeholder panels and host a meeting in each region of the study (peri-urban Lima and Huanuco). We will consult the local stakeholder panels at regular intervals throughout the lifetime of the project. The stakeholder panel, along with the research findings and idea generation with the communities, will stimulate debate on the barriers and facilitators for healthy complementary feeding of infants and young children. Participatory design workshops will include mothers, caregivers, community members and government health facilities staff who will continue to be engaged while we pilot the designed intervention prototypes. Engagement of researchers with stakeholders will continue beyond the project through active contribution to advisory groups and committees in nutrition.
Anticipated benefits
The benefit of this project is that the research need has been identified by the Peruvian Ministry of Health in their plans to revise current infant and young child feeding recommendations (0-2 years). It also benefits international agencies who aim to develop an obesity prevention model for children in Peru. Embedding our research within the health services and government facilities of peri-urban areas will bring benefits of tailoring prototypes for intervention to the local socio-cultural contexts and sustainability through existing services. This timely research will offer knowledge translation outside academia and continued engagement with the key stakeholders throughout the project will ensure we continue to align with their requirements.
Organisations
Publications
Espinoza-Bernardo S
(2022)
Strategies and behaviors used by mothers in interactions with their young children during a mealtime in peri-urban areas of Huánuco, Peru.
in Dialogues in health
Markey O
(2023)
Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies.
in The Journal of nutrition
Pradeilles R
(2023)
Exploring the magnitude and drivers of the double burden of malnutrition at maternal and dyad levels in peri-urban Peru: A cross-sectional study of low-income mothers, infants and young children.
in Maternal & child nutrition
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
Rousham EK
(2022)
Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis.
in Advances in nutrition (Bethesda, Md.)
| Description | From June 2022 we undertook the participatory co-design component of the project. Participatory co-design is an important way of incorporating the voice of the community in the design and development of health interventions. This entailed conducting workshops with caregivers in the communities in Huanuco and Lima. as well as with healthcare providers in the four health centres in the study areas. We carried out a series of workshops to codesign interventions for healthy complementary feeding in infants aged 6-24 months. The series of workshops covered: idea generation; creating future scenarios; storyboarding, and early implementation and feedback. Based on the design ideas that came from the interactions in the series of workshops, we have developed design interventions selected by participants. We now have two prototype interventions that are being evaluated in the two sites in Peru. Evaluation will continue until the end of March. A final event for the project will also take place in Lima at the end of March. In 2021, we completed the preliminary analysis of our formative research to identify the factors influencing infant and young child feeding (IYCF) and forms of malnutrition in two peri-urban communities in Lima and Huánuco. We are now working on the second phase of the research project which will develop and pilot new actions to address multiple forms of malnutrition among infants and young children through participatory methods and prototyping interventions with families, childcare facilities and health facilities. In 2021 we identified and prioritised the top four challenges for addressing malnutrition and these four challenges will be taken through to the design phase of the project in 2022. • ODA relevance of research findings: In 2021, we completed the mapping of current policy activity against 47 indicators of good practice for the five World Health Organisation Double Duty Actions against malnutrition (undernutrition and overweight/obesity). In-depth mixed-methods interviews with 16 national experts explored their views on the level of and barriers to implementing Double Duty Actions and infrastructure support. The policy experts also prioritised the Double Duty Actions against malnutrition. Through this policy mapping work package, the national experts observed the need to improve implementation of all Double Duty Actions to address multiple forms of malnutrition and identified a range of ways that the enabling policy environment could be strengthened. This policy activity will benefit the economic and societal wellbeing of vulnerable groups, including mothers and young infants in low income peri-urban communities, through increased efforts to implement double duty actions against malnutrition in Peru. • ODA relevance of non-research findings: Not applicable. |
| Exploitation Route | The policy mapping of double duty actions to tackle malnutrition (both anaemia and risk of overweight and obesity) in Peru has been shared with national and regional government representatives and non-government organisations. The prototypes of the design interventions to support healthy complemetnary feeding in infants and young children will be shared with community stakeholders (caregivers, government and local health staff), with the aim of encourage uptake or further development of the designs so that these can be potentially implemented in health services. |
| Sectors | Agriculture Food and Drink Communities and Social Services/Policy Digital/Communication/Information Technologies (including Software) Healthcare |
| Description | Several aspects of the project have led to non-academic impact by being used by relevant government departments and municipal authorities in Peru to inform practice and future policies. Firstly, our policy mapping exercise with 16 national policy experts identified the level of implementation of World Health Organisation Double Duty Actions to prevent malnutrition, specifically anaemia and overweight/obesity which are the most common forms of malnutrition in infants and young children in Peru. Our research enabled national experts to assess the level of implementation of Double Duty Actions to address multiple forms of malnutrition and prioritise actions for strengthening the policy environment. This policy activity was shared with national and local policy makers in March 2023 at a reflective workshop. The main influence we had on policy makers was to highlight the risk of overweight and obesity among children under 2 years of age, and strategies to prevent this. Secondly, the healthiness of diets among infants under 2 years of age has been shared with national and local stakeholders to identify good practices to maintain, and other targets to prove. Exclusive breastfeeding in infants aged 0-6 months was markedly lower among households in our study than reported in national surveys. This discrepancy likely results from different methods of dietary recall. We asked about the introduction of any foods or beverages before the age of six months, whereas national surveys (such as ENDES or DHS surveys) ask about consumption in the 24 hours before the survey, which yields different results. The lower prevalence of exclusive breastfeeding estimated using our methods was shared with stakeholders and practitioners in our reflective workshop and regular meetings with stakeholders. This has prompted further discussions around how to support mothers better to promote and encourage exclusive breastfeeding from 0-6 months of age among policy makers and practitioners. Thirdly, we have assessed complementary feeding practices against WHO and UNICEF recommendations and shown some indicators that perform well, for example, a high proportion of children consuming fruit and vegetables and meeting the recommended dietary diversity, while other indicators, such as high consumption of sweetened foods and beverages, and snacks high in salt or fat, being out of line with recommended complementary feeding guidelines. These dietary indicators show the mixed pattern of diets which is commonly associated with the nutrition transition, changing from wholegrain, home-prepared and healthy diets to relatively more processed and ultra processed foods that are low in nutrients but high in energy. We have discussed with stakeholders how nutritional counselling for caregivers with infants aged 6-24 months in health centres needs to be adapted in light of these changing diets to prevent risk of overweight and obesity in young children. Finally, the participatory co-design process has had impact within the two study areas in Lima and Huánuco influencing the practices within the health centres among health care providers and caregivers. The participatory co-design workshops developed design prototypes to support healthy complementary feeding among caregivers and health care professionals. These impacts link to Sustainable Development Goals (SDG): SDG2 'Reduce hunger and malnutrition and ensure children have access to sufficient and nutritious food' and SDG3 'Ensure healthy lives and wellbeing'. |
| First Year Of Impact | 2023 |
| Sector | Agriculture, Food and Drink,Communities and Social Services/Policy,Healthcare |
| Impact Types | Policy & public services |
| Description | Effect of unhealthy food and beverage consumption in children |
| Amount | £43,000 (GBP) |
| Organisation | World Health Organization (WHO) |
| Sector | Public |
| Country | Global |
| Start | 11/2020 |
| End | 12/2021 |
| Description | STAMINA: Strategies to Mitigate Nutritional Risks among mothers and infants under 2 years in low income urban households in Peru during COVID-19 |
| Amount | £216,186 (GBP) |
| Funding ID | EP/V034057/1 |
| Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 08/2020 |
| End | 03/2022 |
| Title | Maternal and child nutrition and health survey questionnaire: the PERUSANO study |
| Description | Survey questionnaire for the PERUSANO study (available in both English and Spanish languages). Data collected include household socio-demographic characteristics, maternal and infant 24 hour dietary recalls, maternal food frequency questionnaire, maternal and child anthropometry (height, weight), morbidity and maternal and infant haemoglobin concentration. Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (reference 388-2019/CIEI-IIN) and Loughborough University (C19-87). |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| Impact | Publications |
| URL | https://repository.lboro.ac.uk/articles/dataset/Maternal_and_child_nutrition_and_health_survey_quest... |
| Title | PERUSANO study data on household socio-demographic variables, maternal and infant diet, hemoglobin concentration, and infant anthropometry |
| Description | The dataset includes data from a cross-sectional survey of mothers and infants (aged 6-23 months) collected from Huanuco city in Huanuco district, and Pachacamac district in Lima city in Peru from December 2019 to March. 2020. Data collected include household socio-demograhic |
| Type Of Material | Database/Collection of data |
| Year Produced | 2021 |
| Provided To Others? | Yes |
| Impact | This dataset was used to report on the nutritional of children and mothers in Peru before COVID-19 in comparison to health and nutirtion in the same communities during the pandemic. |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_PERUSANO_study_quantitative_dataset/16691455 |
| Title | Supplementary information files for Designing intervention prototypes to improve infant and young child nutrition in Peru: A participatory design study protocol |
| Description | (c) the authors, CC-BY 4.0 Supplementary files for article Designing intervention prototypes to improve infant and young child nutrition in Peru: A participatory design study protocolIntroduction: 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- 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 1), 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 1. 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/CIEIIIN), 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. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2024 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/Supplementary_information_files_for_Designing_interv... |
| 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 | The STAMINA study: questionnaire for survey 1 |
| Description | The STAMINA unbalanced panel study was designed to examine the nutritional risks of low-income peri-urban mothers, infants and young children (IYC), and households in Peru during the COVID-19 pandemic. The study was designed to capture information through repeated cross-sectional surveys (n=3) at approximately 6 month intervals over an 18 month period, starting in December 2020. The surveys were carried out by telephone in November-December 2020, July-August 2021 and in February-April 2022. The third survey took place over a longer period to allow for a household visit after the telephone interview. The targeted areas were Manchay (Lima) and Huánuco district in the Andean highlands (~ 1900m above sea level). In each study area, we purposively selected the principal health centre and one subsidiary health centre. Peri-urban communities under the jurisdiction of these health centres were then selected to participate. The sampling strategy (i.e. systematic random quota sampling according to IYC age (6-11, 12-17 and 18-23 months) targeting n=250 mother infant dyads) for the different surveys of the STAMINA study was set to match the sampling of a pre-COVID-19 survey conducted from December to early March 2020 (PERUSANO study). Sampling for both the STAMINA and PERUSANO studies has been described in detail elsewhere (Pradeilles et al. 2022). Additional information on the PERUSANO quantitative survey can be found here 10.17028/rd.lboro.c.6329105. Data collected included: household socio-demographic characteristics; infant and young child feeding practices (IYCF), child and maternal qualitative 24-hour dietary recalls/7 day food frequency questionnaires, household food insecurity experience measured using the validated Food Insecurity Experience Scale (FIES) survey module (Cafiero, Viviani, & Nord, 2018), and maternal mental health. In addition, questions that assessed the impact of COVID-19 on households including changes in employment status, adaptations to finance, sources of financial support, household food insecurity experience as well as access to, and uptake of, well-child clinics and vaccination health services were included. This folder includes the questionnaire for survey 1 in both English and Spanish languages. The corresponding dataset and data dictionary for survey 1 are available at 10.17028/rd.lboro.18785666. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_STAMINA_study_questionnaire_for_survey_1/1682550... |
| Title | The STAMINA study: questionnaire for survey 1 |
| Description | The STAMINA unbalanced panel study was designed to examine the nutritional risks of low-income peri-urban mothers, infants and young children (IYC), and households in Peru during the COVID-19 pandemic. The study was designed to capture information through repeated cross-sectional surveys (n=3) at approximately 6 month intervals over an 18 month period, starting in December 2020. The surveys were carried out by telephone in November-December 2020, July-August 2021 and in February-April 2022. The third survey took place over a longer period to allow for a household visit after the telephone interview. The targeted areas were Manchay (Lima) and Huánuco district in the Andean highlands (~ 1900m above sea level). In each study area, we purposively selected the principal health centre and one subsidiary health centre. Peri-urban communities under the jurisdiction of these health centres were then selected to participate. The sampling strategy (i.e. systematic random quota sampling according to IYC age (6-11, 12-17 and 18-23 months) targeting n=250 mother infant dyads) for the different surveys of the STAMINA study was set to match the sampling of a pre-COVID-19 survey conducted from December to early March 2020 (PERUSANO study). Sampling for both the STAMINA and PERUSANO studies has been described in detail elsewhere (Pradeilles et al. 2022). Additional information on the PERUSANO quantitative survey can be found here 10.17028/rd.lboro.c.6329105. Data collected included: household socio-demographic characteristics; infant and young child feeding practices (IYCF), child and maternal qualitative 24-hour dietary recalls/7 day food frequency questionnaires, household food insecurity experience measured using the validated Food Insecurity Experience Scale (FIES) survey module (Cafiero, Viviani, & Nord, 2018), and maternal mental health. In addition, questions that assessed the impact of COVID-19 on households including changes in employment status, adaptations to finance, sources of financial support, household food insecurity experience as well as access to, and uptake of, well-child clinics and vaccination health services were included. This folder includes the questionnaire for survey 1 in both English and Spanish languages. The corresponding dataset and data dictionary for survey 1 are available at 10.17028/rd.lboro.18785666. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_STAMINA_study_questionnaire_for_survey_1/1682550... |
| Title | The STAMINA study: questionnaire for survey 2 |
| Description | The STAMINA unbalanced panel study was designed to examine the nutritional risks of low-income peri-urban mothers, infants and young children (IYC), and households in Peru during the COVID-19 pandemic. The study was designed to capture information through repeated cross-sectional surveys (n=3) at approximately 6 month intervals over an 18 month period, starting in December 2020. The surveys were carried out by telephone in November-December 2020, July-August 2021 and in February-April 2022. The third survey took place over a longer period to allow for a household visit after the telephone interview. The targeted areas were Manchay (Lima) and Huánuco district in the Andean highlands (~ 1900m above sea level). In each study area, we purposively selected the principal health centre and one subsidiary health centre. Peri-urban communities under the jurisdiction of these health centres were then selected to participate. The sampling strategy (i.e. systematic random quota sampling according to IYC age (6-11, 12-17 and 18-23 months) targeting n=250 mother infant dyads) for the different surveys of the STAMINA study was set to match the sampling of a pre-COVID-19 survey conducted from December to early March 2020 (PERUSANO study). Sampling for both the STAMINA and PERUSANO studies has been described in detail elsewhere (Pradeilles et al. 2022). Additional information on the PERUSANO quantitative survey can be found here 10.17028/rd.lboro.c.6329105. Data collected included: household socio-demographic characteristics; infant and young child feeding practices (IYCF), child and maternal qualitative 24-hour dietary recalls/7 day food frequency questionnaires, household food insecurity experience measured using the validated Food Insecurity Experience Scale (FIES) survey module (Cafiero, Viviani, & Nord, 2018) and maternal mental health. In addition, questions that assessed the impact of COVID-19 on households including changes in employment status, adaptations to finance, sources of financial support, household food insecurity experience as well as access to, and uptake of, well-child clinics and vaccination health services were included. This folder includes the questionnaire for survey 2 in both English and Spanish languages. The corresponding dataset and data dictionary for survey 2 are available at 10.17028/rd.lboro.21740699 . |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_STAMINA_study_questionnaire_for_survey_2/2174060... |
| Title | The STAMINA study: questionnaire for survey 2 |
| Description | The STAMINA unbalanced panel study was designed to examine the nutritional risks of low-income peri-urban mothers, infants and young children (IYC), and households in Peru during the COVID-19 pandemic. The study was designed to capture information through repeated cross-sectional surveys (n=3) at approximately 6 month intervals over an 18 month period, starting in December 2020. The surveys were carried out by telephone in November-December 2020, July-August 2021 and in February-April 2022. The third survey took place over a longer period to allow for a household visit after the telephone interview. The targeted areas were Manchay (Lima) and Huánuco district in the Andean highlands (~ 1900m above sea level). In each study area, we purposively selected the principal health centre and one subsidiary health centre. Peri-urban communities under the jurisdiction of these health centres were then selected to participate. The sampling strategy (i.e. systematic random quota sampling according to IYC age (6-11, 12-17 and 18-23 months) targeting n=250 mother infant dyads) for the different surveys of the STAMINA study was set to match the sampling of a pre-COVID-19 survey conducted from December to early March 2020 (PERUSANO study). Sampling for both the STAMINA and PERUSANO studies has been described in detail elsewhere (Pradeilles et al. 2022). Additional information on the PERUSANO quantitative survey can be found here 10.17028/rd.lboro.c.6329105. Data collected included: household socio-demographic characteristics; infant and young child feeding practices (IYCF), child and maternal qualitative 24-hour dietary recalls/7 day food frequency questionnaires, household food insecurity experience measured using the validated Food Insecurity Experience Scale (FIES) survey module (Cafiero, Viviani, & Nord, 2018) and maternal mental health. In addition, questions that assessed the impact of COVID-19 on households including changes in employment status, adaptations to finance, sources of financial support, household food insecurity experience as well as access to, and uptake of, well-child clinics and vaccination health services were included. This folder includes the questionnaire for survey 2 in both English and Spanish languages. The corresponding dataset and data dictionary for survey 2 are available at 10.17028/rd.lboro.21740699 . |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_STAMINA_study_questionnaire_for_survey_2/2174060... |
| Title | The STAMINA study: questionnaire for survey 3 |
| Description | The STAMINA unbalanced panel study was designed to examine the nutritional risks of low-income peri-urban mothers, infants and young children (IYC), and households in Peru during the COVID-19 pandemic. The study was designed to capture information through repeated cross-sectional surveys (n=3) at approximately 6 month intervals over an 18 month period, starting in December 2020. The surveys were carried out by telephone in November-December 2020, July-August 2021 and in February-April 2022. The third survey took place over a longer period to allow for a household visit after the telephone interview. The targeted areas were Manchay (Lima) and Huánuco district in the Andean highlands (~ 1900m above sea level). In each study area, we purposively selected the principal health centre and one subsidiary health centre. Peri-urban communities under the jurisdiction of these health centres were then selected to participate. The sampling strategy (i.e. systematic random quota sampling according to IYC age (6-11, 12-17 and 18-23 months) targeting n=250 mother infant dyads) for the different surveys of the STAMINA study was set to match the sampling of a pre-COVID-19 survey conducted from December to early March 2020 (PERUSANO study). Sampling for both the STAMINA and PERUSANO studies has been described in detail elsewhere (Pradeilles et al. 2022). Additional information on the PERUSANO quantitative survey can be found here 10.17028/rd.lboro.c.6329105. Data collected included: household socio-demographic characteristics; infant and young child feeding practices (IYCF), child and maternal qualitative 24-hour dietary recalls/7 day food frequency questionnaires, household food insecurity experience measured using the validated Food Insecurity Experience Scale (FIES) survey module (Cafiero, Viviani, & Nord, 2018), maternal mental health, and anthropometric measurements and haemoglobin concentration for mothers and IYC. In addition, questions that assessed the impact of COVID-19 on households including changes in employment status, adaptations to finance, sources of financial support, household food insecurity experience as well as access to, and uptake of, well-child clinics and vaccination health services were included. This folder includes the questionnaire for survey 3 in both English and Spanish languages. The corresponding dataset and data dictionary for survey 3 are available at 10.17028/rd.lboro.21741014. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_STAMINA_study_questionnaire_for_survey_3/2174092... |
| Title | The STAMINA study: questionnaire for survey 3 |
| Description | The STAMINA unbalanced panel study was designed to examine the nutritional risks of low-income peri-urban mothers, infants and young children (IYC), and households in Peru during the COVID-19 pandemic. The study was designed to capture information through repeated cross-sectional surveys (n=3) at approximately 6 month intervals over an 18 month period, starting in December 2020. The surveys were carried out by telephone in November-December 2020, July-August 2021 and in February-April 2022. The third survey took place over a longer period to allow for a household visit after the telephone interview. The targeted areas were Manchay (Lima) and Huánuco district in the Andean highlands (~ 1900m above sea level). In each study area, we purposively selected the principal health centre and one subsidiary health centre. Peri-urban communities under the jurisdiction of these health centres were then selected to participate. The sampling strategy (i.e. systematic random quota sampling according to IYC age (6-11, 12-17 and 18-23 months) targeting n=250 mother infant dyads) for the different surveys of the STAMINA study was set to match the sampling of a pre-COVID-19 survey conducted from December to early March 2020 (PERUSANO study). Sampling for both the STAMINA and PERUSANO studies has been described in detail elsewhere (Pradeilles et al. 2022). Additional information on the PERUSANO quantitative survey can be found here 10.17028/rd.lboro.c.6329105. Data collected included: household socio-demographic characteristics; infant and young child feeding practices (IYCF), child and maternal qualitative 24-hour dietary recalls/7 day food frequency questionnaires, household food insecurity experience measured using the validated Food Insecurity Experience Scale (FIES) survey module (Cafiero, Viviani, & Nord, 2018), maternal mental health, and anthropometric measurements and haemoglobin concentration for mothers and IYC. In addition, questions that assessed the impact of COVID-19 on households including changes in employment status, adaptations to finance, sources of financial support, household food insecurity experience as well as access to, and uptake of, well-child clinics and vaccination health services were included. This folder includes the questionnaire for survey 3 in both English and Spanish languages. The corresponding dataset and data dictionary for survey 3 are available at 10.17028/rd.lboro.21741014. |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | Yes |
| URL | https://repository.lboro.ac.uk/articles/dataset/The_STAMINA_study_questionnaire_for_survey_3/2174092... |
| Description | Engagement with British Ambassador, Lima, sharing of Newton Fund project work |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | In September 2022 the project team, both UK and Peruvian investigators, were invited to share the project work and discuss implications of the work with the British Ambassador in Lima, along with senior Embassy staff. In the two-way dialogue and discussion we considered benefits of the research to Peru and the policy implications for nutrition, food security and prevention of nutrition-related non-communicable diseases, as well as how to ensure further engagement with relevant Ministries in Peru. |
| Year(s) Of Engagement Activity | 2022 |
| 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 | PERU SANO Project Launch, Huanuco, 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 | We launched the PERU SANO meeting with key stakeholders in Huanuco city, Peru. The purpose of the launch was to outline the project aims, whilst providing opportunities for stakeholders to provide their input on health prioritisies for infants and young children in the region, and programme developments for the delivery of health and social services. The participating stakeholders came from the regional and municipal authorities who have responsibility for health services and social development in the communities participating in the project. Stakeholders expressed their interest and desire to continue participating in the three year project with regular meetings between the project team and key policymakers and practitioners in the region. |
| Year(s) Of Engagement Activity | 2019 |
| Description | Policy mapping of WHO Double Duty Actions on malnutrition |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | We conducted in-depth interviews with 16 national experts in nutrition policy and implementation in Peru, the policies were prioritised and barriers to implementation identified. A summary paper on the policy mapping findings has been shared with the 16 national experts and other government departments in Peru. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Reflective workshop with national and regional stakeholders |
| 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 | A reflective workshop was held in March 2023 to engage with key national and regional stakeholders in Peru. The event was held in Lima and we supported stakeholders and participants from the two study sites (peri-urban district of Lima, and Huanuco city) to travel to the event and share their experiences of being involved the study. We shared the emerging findings from the Perusano study (policy mapping, quantitative survey data on diet and nutrition, qualitative interviews and participatory co-design) with input and discussion from delegates attending. The workshop participants reflected on how this aligned or differed from previous knowledge in this area and what was novel and important from our study. Representatives from the Ministry of Health and Ministry of Social Inclusion and Development spoke to give their insights and reflections on how this might impact on policy and future practices for improving nutrition and complementary feeding practices, and tackling the double burden of malnutrition in Peru. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Stakeholder engagement consultation |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Based on phase 1 of the PERUSANO project, we prioritised four nutritional challenges for infants aged 0-2 years. In a workshop with policymakers, we shared the four challenges along with the formative research findings to explain how these have arisen. We aimed to validate these challenges through feedback from the policymakers on how they perceived the challenges and whether these challenges were appropriate for future co-design activities. |
| Year(s) Of Engagement Activity | 2021 |