Infant feeding practices in the Peruvian Amazon: implications for programs to improve feeding / Prácticas de alimentación de lactantes en la Amazonia Peruana: implicaciones para los programas de mejora de la alimentación

OBJECTIVE: To characterize feeding practices in a community in the Peruvian Amazon and to consider how this information could be used to strengthen programs and policies designed to improve nutrition and reduce child malnutrition in vulnerable communities METHODS: Data from three structured questionnaires were combined to produce a comprehensive depiction of feeding in a sample of 246 infants from birth through 8 months of life in the community of Santa Clara de Nanay near Iquitos, Peru. Breastfeeding initiation practices, exclusive breastfeeding in the first 180 days of life, the introduction of solids, and complementary feeding practices from 6-8 months, were described and related to maternal, infant, and household characteristics, including food insecurity RESULTS: The median duration of exclusive breastfeeding was 19 days. However, over the first 180 days of life, children were exclusively breastfed on 46.1% of days. Overall, 68.3% of infants received some semi-solid or solid food between 0-6 months and all had received semi-solids by the end of 8 months of age. The proportion of infants consuming a minimally acceptable (frequent and diverse) complementary diet was 2.9%, 7.9%, and 16.1% at 6, 7, and 8 months respectively CONCLUSIONS: Although breastfeeding is nearly universal, promotion programs are needed in Santa Clara to 1) delay the introduction of plain water, other non-breast milk liquids, and semi-solid foods; 2) extend the period of exclusive breastfeeding; and 3) increase food diversity and the frequency of feeding during the period of complementary feeding. These results can be used to guide programs and policies to improve nutrition and reduce child malnutrition.

OBJETIVOS: Determinar las prácticas de alimentación en una comunidad de la Amazonia peruana y analizar cómo esta información podría usarse para fortalecer los programas y las políticas diseñadas para mejorar la nutrición y reducir la desnutrición infantil en las comunidades vulnerables MÉTODOS: Se combinaron datos de tres cuestionarios estructurados para obtener una descripción integral de la alimentación en una muestra de 246 lactantes, desde el nacimiento y hasta los 8 meses de vida, en la comunidad de Santa Clara de Nanay cerca de Iquitos, Perú. Se describieron las prácticas de iniciación de la lactancia materna, lactancia materna exclusiva en los 180 primeros días de vida e introducción de alimentos sólidos y las prácticas de alimentación complementaria desde los 6 hasta los 8 meses, y se las relacionó con las características maternas, de los lactantes y los hogares, lo que incluyó la inseguridad alimentaria RESULTADOS: La mediana de duración de la lactancia materna exclusiva fue 19 días. Sin embargo, en los 180 primeros días de vida los niños habían sido amamantados exclusivamente 46,1% de los días. En términos generales, 68,3% de los lactantes recibieron algún alimento semisólido o sólido entre los 0 y los 6 meses de vida, y hacia el final del octavo mes de vida todos habían recibido alimentos semisólidos. La proporción de lactantes cuyo régimen alimentario complementario había sido mínimamente aceptable (frecuente y diverso) fue 2,9% a los 6 meses, 7,9% a los 7 meses y 16,1% a los 8 meses CONCLUSIONES: A pesar de que la lactancia materna es prácticamente universal, en Santa Clara son necesarios programas de promoción para 1) retrasar la introducción de agua corriente, otros líquidos fuera de la leche materna y alimentos semisólidos; 2) extender el período de lactancia materna exclusiva, y 3) aumentar la diversidad de los alimentos y la frecuencia de la alimentación durante el período de alimentación complementaria. Estos resultados pueden ser útiles para guiar los programas y las políticas de mejora de la nutrición y reducir la desnutrición infantil.

Directing Diarrhoeal Disease Research towards Disease-burden Reduction.

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions; the efficacy and effectiveness of the intervention resulting from the research; the maximal potential for disease-burden reduction of the interventions derived from the research; the affordability, deliverability, and sustainability of the intervention supported by the research; and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015.