Esther Casanueva

Implementation, Monitoring, and Evaluation of the Nutrition Component of the Mexican Social Programme (PROGRESA)

Mexico has implemented a number of food and nutrition programmes and policies since 1950. However, these initiatives have been largely ineffective. A new social programme targeted to poor families has been implemented. It now covers almost 2 million families and is expected eventually to cover 4.2 million families. The programme facilitates access of beneficiaries to health and education services, and includes monetary transfers and a nutrition component targeted to the critical development period between gestation and the age of two years. Pregnant and lactating women and children under two years of age receive food supplements fortified with key micronutrients. After decades of food and nutrition interventions that were not carefully evaluated, the programme performance and its nutritional impact will be evaluated. A baseline survey was conducted in 1998 on a random sample of communities selected as beneficiaries of the programme and on a sample of similar communities that will participate in the programme after the end of the evaluation. Additional surveys will be conducted in 1999 and 2000. Each survey will include a cross-sectional evaluation of children and women and a cohort of children zero to 12 months of age at baseline who will be followed. Preliminary results from the baseline survey of beneficiaries are presented and discussed.

Desarrollo y evaluación de suplementos alimenticios para el Programa de Educación, Salud y Alimentación

OBJECTIVE: To develop and evaluate nutritional supplements destined to a program of social assistance. MATERIAL AND METHODS: In the design of the nutritional supplements a series of criteria were considered including nutrient composition, physicochemical properties and feasibility of production and utilization. Final products were initially evaluated to determine the level of acceptance in 40 children, 52 pregnant women and 62 lactating women in Mexico City. A community trial was also carried out to determine acceptance and consumption in 108 children and 128 women from a rural community in the state of Morelos. RESULTS: The specific formulation and technical processes of production of the nutritional supplements are presented. Products proved to be widely accepted, with average scores of 4.11-4.29 for the childrens beverage, and 3.98-4.15 for a more viscous pap (range of scores was 1 to 5). Products for women received average scores from 4.75 to 5.70 in pregnant and from 4.8 to 5.4 in lactating women (range of scores from 1 to 7). In the community trial, supplements were very well accepted. Average consumption was > 75% among children and > 98% among women. Mean energy intake from supplements was 244 Kcal/day for women, and for children, 168 Kcal/day with the pap and 147 Kcal/day with the beverage. Consumption was consistent in all cases along the study. CONCLUSIONS: Nine nutritional supplements were developed and evaluated which comply with the necessary nutritional, physicochemical and hygienic characteristics for the target population, besides being relatively simple to prepare, and widely well accepted and consumed.

Placentas of small-for-dates infants: A small controlled series from Mexico City, Mexico

Thirty-five placentas of small-for-dates infants were compared with control placentas of normally grown infants. They were small by weight, area, and volume and tended to have a marginal cord insertion; marginal cord insertion was associated with a thick cord, and central insertion, with a thin cord. When the two groups were compared, the first showed increased fibrinoid deposits and atherosis, more severe fetal abnormalities, and abnormal nutrition in the mother, together with a high incidence of preeclampsia. In the mothers of both groups, peak diastolic blood pressure was lower than that in the control group; additional factors leading to a probable reduction in placental blood flow were different in the two groups.