Can Peru’s new government continue to make progress on child nutrition?

The Guardian

It’s thriving economically and benefits from a state nourishment scheme, but Peru has yet to overcome chronic infant malnutrition.  For Dr Carlos Acosta, who has overseen important work on child nutrition in Peru over the past five years, the new government’s motto of “social inclusion” can only be a good thing. Acosta, the director general for people’s health at Peru’s health ministry (Minsa), is convinced the administration that took office in July will “continue the work we’ve been doing and not go backwards”.Tackling malnutrition in the midst of an economic boom has been a frustrating experience, says Acosta. Peru has grown at more than 7% annually for the past five years, and former president Alan García suggested earlier this year that the nation is on target to meet the UN’s millennium development goals. Yet chronic infant malnutrition has been difficult to stamp out, particularly in rural areas.

“Peruvians have a huge variety of nutritious food available to them, but a great misunderstanding of the importance of nutrition,” says Acosta.  “In areas where livestock are plentiful, there are the highest levels of malnutrition in the country. They would rather sell their milk and cheese to buy potatoes than consume it.”

Habit rather than hunger is typically the cause of chronic malnutrition among under-fives, which in rural areas is three or four times that of urban areas.  Nationally, chronic malnutrition in under-fives has been reduced from 22.9% in 2005 to 16.5% in 2011. But the figures in rural Andean regions show that it is still widely prevalent. Huancavelica, Peru’s poorest province, had the highest rate, with a figure of 44.7% in 2010.

In Cusco, the centre of Peru’s multi-million dollar tourism industry, official figures for 2010 put chronic malnutrition in under-fives at 36%. The rate for anaemia was 50%. Erika Challco, the children’s health co-ordinator at the health ministry’s regional office, said the principal problem was geography. It’s a mountainous region, where the higher you go, the poorer people get.  “There’s a big cultural gap between our personnel, many of whom don’t speak fluent Quechua, and the mothers in these remote communities who don’t speak Spanish,” said Challco.

But, she added, programmes such as Juntos, in which mothers can receive regular monthly payments of 100 Peruvian soles (£23.18) in return for making regular health clinic visits with their children and ensuring they attend school, are making a difference. Additionally, a state nutrition programme (Programa Integral de Nutrición) ensures nutritional intake is monitored up to the age of 12 years. The health ministry distributes “chispitas”, multi-coloured sachets with multi-nutrients and vitamins that can be mixed into food, while public health messages are broadcast in Quechua on Radio Tawantinsuyo and other local broadcasters. Radio is the only medium that reaches highland communities.  “The idea is that the children are well nourished so they can face the cold weather,” says Challco. Respiratory infections such as pneumonia are the biggest killers of the very young and old during the cold months from May to September.

For several decades, the harsh conditions in parts of Peru’s Andes have driven migrants to seek a better life in the capital, Lima. But what families gain in economic opportunities they often lose in terms of nutrition. Lima is surrounded, on every side but one – Peru’s Pacific coast, to the west – by enormous shanty towns in varying stages of development. The newer they are, the scarcer the basic services and infrastructure. Older settlements like Villa El Salvador, to the south, now have paved roads, electricity and running water. But more than a fifth of Lima residents still lack access to piped drinking water or a connection to a sewage system.

The change in environment and habits has also meant dietary deficiencies, says Shirley Loncharich, a Plan International co-ordinator in the sprawling Ventanilla district, about 35km north of the capital. Shrouded in seasonal sea fog, wooden shacks mingle with brick structures in the area’s arid coastal desert. More than 60% of the inhabitants of the port city of Callao live there – 300,000 or more people.  In Ventanilla, four in nine women who fall pregnant are teenagers, the highest rate in Peru, and health workers try to meet the needs of the children of young mothers in the impoverished neighbourhood.

Plan supports a project pioneered by the NGO Kusi Warma (which means “happy home” in Quechua) to set up centros de vigilancia (vigilance centres) in Ventanilla and other neighbourhoods, helped by local volunteers. Colourfully painted in the drab slum surroundings, the centres look like nursery schools. The big difference is that for a child to attend, they need to be accompanied by their mother or another female relative.

Mery Salvador, 26, says both she and her one-year-old son, Abel, have benefited. “Here we’ve learned so much, for example how to combat anaemia with foods which contain iron,” she said.  “The truth is the situation is very difficult. This centre allows us to protect our children. He’s more active, more stimulated than his older brother, who I didn’t bring here.”

Sangrecita, or chicken’s blood, is the cheapest and most readily available source of iron and protein. Mothers at the centres are encouraged to compete with each other to see who can prepare the best dish with sangrecita, be it a Chinese stir-fry or even mousse and other desserts, says Loncharich.  Other products the mothers are encouraged to make more palatable for their children include eggs, fish, liver and giant squid.

As well as nutrition, the centres offer early stimulation for children using toys made from recycled material. They also encourage young mothers to talk to their unborn babies during pregnancy.  The multi-sectoral approach has worked, claims Acosta, especially in educating people about what to eat. The model has been exported around the world and the view of the new government, which has yet to spend 100 days in power, is expected to be: if it ain’t broke, don’t fix it.