Margaret A. Graham

Food allocation in rural Peruvian households: concepts and behavior regarding children.

Intrahousehold food allocation is an important determinant of child health and survival. In this paper I explore the ways in which food is distributed to young children in Ura Ayllu, a farming community located in the southern Peruvian highlands (Province of Sandia, Department of Puno, Peru). Quantitative data on energy intake and growth status are analyzed for two groups of children: toddlers (one through three years) and preschoolers (four through six years). The analyses indicate no gender differences in energy intake or growth among toddlers (one through three years) and preschoolers (four through six years) and that young children do not appear to be deprived of food relative to older household members, especially adults. Relative to standards specific to Andean populations, the mean caloric content of the toddler diet falls slightly below the estimated requirement for the age group while the preschooler diet is found to be calorically adequate. This paper also examines the ideological bases that shape food allocation within households. Regarding the local concepts and cultural rules that guide food allocation to children, Ura Ayllinos view young children as developmentally immature and believe their dietary and health needs are different from those of older children and adults. Infants and young children are considered weak (debil) and vulnerable to illness. Parents state that young children should not feel hunger which is thought to weaken a person and make him more susceptible to the natural and supernatural agents that cause illness. Certain dietary practices, such as on-demand breastfeeding and snacking between meals, suggest that parents try to avoid the experience of hunger and the potential for illness by making food available to their children. This study suggests that young Ura Ayllu children are viewed as having a right to food based on local concepts of child development, personhood, and general health maintenance.

Pilot of a Diabetes Primary Prevention Program in a Hard-to-Reach, Low-Income, Immigrant Hispanic Population

An immigrant Hispanic population in the Texas-Mexico border region urgently requested assistance with diabetes. The project team implemented an exploratory pilot intervention to prevent type 2 diabetes in the general population through enhanced nutrition and physical activity. Social networks in low-income rural areas (colonias) participated in an adaptation of the Diabetes Empowerment Education Program. The program had a pre-post-test design with a comparison group. The intervention had a small but significant effect in lowering body mass index, the biological outcome variable. The process evaluation shows that the participants valued the pilot project and found it culturally and economically appropriate. This program was the first primary prevention program in diabetes to address a general population successfully. The study shows that low-income, rural Mexican American families will take ownership of a program that is participatory and tailored to their culture and economic situation.

Principles that guide weaning in rural Mexico

Women in two Mexican villages use principles conveyed by oral tradition to guide their decisions about weaning. They do not blindly follow unarticulated beliefs, as implied by other studies. The principles that guide weaning inform a mother of the effect of continued lactation, under specific conditions, on the child at certain stages of biological and psychological development. Villagers and physicians have more similar views of weaning than previously understood; both make conscious weaning decisions based on maternal and child health. Villagers’ decisions are situational rather than determined by the childs chronological age. The outcome, according to lactation histories of 285 women, is a heterogeneous pattern of ages at stopping breastfeeding — mean ages ± s.d., 10.04 ± 5.79 months (N = 507 mestizo children) and 20.19 ± 7.75 (N = 282 Indian children).

Seasonal dietary stress in Peruvian children.

This article examines the seasonal variation in energy intake among young children in a fanning community in southern Peru. Caloric intakes among young children fall to their lowest annual level during the post-harvest season even though food and cash resources are at their highest levels. Among toddlers (1-3 years) the decline is statistically significant (p = 0.006). Their energy intake meets only 65.6 per cent of their predicted requirement during the post-harvest season. In contrast to the literature, dietary stress for young children is not greatest in the pre-harvest season. Also, household food availability does not accurately indicate dietary risk among young children in this community.

Diabetes Screening and Prevention in a High-Risk, Medically Isolated Border Community

Introduction A project in a Texas border community setting, Prevention Organized against Diabetes and Dialysis with Education and Resources (POD2ER), offered diabetes prevention information, screening, and medical referrals. The setting was a large, longstanding flea market that functions as a shopping mall for low-income people. The priority population included medically underserved urban and rural Mexican Americans. Components of the program addressed those with diabetes, prediabetes, and accompanying relatives and friends. Background People living in the Lower Rio Grande Valley (LRGV) face challenges of high rates of type 2 diabetes, lack of knowledge about prevention, and inadequate access to medical care. Recent statistics from actual community-wide screenings indicate a high diabetes prevalence, 30.7% among adults in the LRGV compared with 12.3% nationwide. Methods A diverse team composed of public health faculty, students, a physician, a community health worker, and community volunteers conceived and developed the project with a focus on cultural and economic congruence and a user-friendly atmosphere. The program provided screening for prediabetes and diabetes with a hemoglobin A1c test. Screening was offered to those who were at least 25 years of age and not pregnant. When results indicated diabetes, a test for kidney damage was offered (urinary albumin-to-creatinine ratio). A medical appointment at a community clinic within a week was provided to those who tested positive for diabetes and lacked a medical home. Health education modules addressed all family members. Discussion The project was successful in recruiting 2,332 high-risk people in 26 months in a community setting, providing clinic referrals to those without a doctor, introducing them to treatment, and providing diabetes prevention information to all project participants. Implications for research and practice are highlighted. Conclusion This study shows that a regular access point in a place frequented by large numbers of medically marginalized people in a program designed to eliminate cultural and economic barriers can succeed in providing a hard-to-reach community with diabetes prevention services. Aspects of this program can serve as a model for other service provision for similar populations and settings.