1. Manchay Momma Aimee, Alexandra, Karlee

2. Introduction  Child (‹5 years) underweight, stunting, wasting, overweight  Stunting levels highest

3. Introduction Chronic malnutrition in children under 5

4. Introduction Malnutrition by region, children under 5

5. Introduction: Justification  Malnutrition and stunting: decreased nutritional status starting at 3 months & continuing to 2 years (37.4% normal at 1-2 years)  Cusco Nutritional Status Study  Giving educational messages followed by exposure gave better message retention in caregivers and adoption of practice  Trujillo successful nutrition education

6. Our Family  Areli  1 year 7 mo  Mayra  25 years old  Live with close family

7. Timeline  Visit 1-  24- hour recall  Observation  Visit 2-  Intervention  Visit 3-  Follow-up

8. Objectives  Increase overall nutritional status  Physical and cognitive growth and development  Affect on future  Pregnancy  Career  Life

9. Diagnosis of Practices, Perceptions, and Knowledge  24-hour recall  Wide variety  Lots of animal products  Eggs, chicken, liver  Solid Foods  Beans, lentils, rice, vegetables, fruits  Milk  Formula- 5 times a day  Frequency of meals and snacks

10. Diagnosis of Practices, Perceptions, and Knowledge  Interview and Observations  Drinking lots of milk  Likes to eat  Independent- Grapes!  Aware of hunger and satiety  Asks for food  Limited hygiene  No hand washing  Patient and Responsive Feeding  Mom was attentive

11. Analysis  Objective  Solid food meal  Consistency  Infants and young children are capable of showing evidence of adequate self regulation  Liquid carbohydrates generally produce less satiety than solid forms  Expectations: Continue normal and healthy growth

12. Intervention  Methods  Materials  Pictures, Table, Soup, Puree  Process  Demonstration  Talking with Mother  Facilitators  Food is already made  Child is hungry  More nutrients  Barriers  Extra work  More food  Motivating Factors  Sleeping through the night  More nutrients, sustained healthy growth

13. Results  Message Received Well  Wanted to Try Recommendation  Understood the Message  Repeated message to us and husband

14. Results of Follow-Up  Recommendation  Mother was able to make evening s-meal  Was not difficult  Understood benefits  Baby slept through the night  Baby wanted food pictured in educational material  Continue  YES!!  Tell the Neighbors  Thicker consistency food makes the baby full and provides more nutrients  Feed with care, no shouting

15. Behavior Change  Reflection  Successfull  Mom was intellegent and willing

16. Recommendations  Improvements  Give card with date and time of next visit  More dynamic/interactive materials  How it could be better  Materials for our now educated mother to give to neighbors  Community education meeting to reach more caregivers

17. Reflections  PATIENCE! It won´t go right all the time  Practicality of recommendations  Understanding cultural aspects  Awareness of body and spoken language  Active listening skills  Sensitive to beliefs  Relating to different populations

18. Bibliography  WHO Graphs: http://apps.who.int/nutrition/landscape/report.aspx?iso=PER&rid=161&templa te=nutrition&goButton=Go http://apps.who.int/nutrition/landscape/report.aspx?iso=PER&rid=161&templa te=nutrition&goButton=Go  INEI Graphs http://www.inei.gob.pe/http://www.inei.gob.pe/  Wolff, M., & Perez, L. (1985). Nutritional status of children in the health district of cusco, peru. American Journal of Clinical Nutrition, 42(3), 531-541. Accessed at: http://ajcn.nutrition.org.proxybz.lib.montana.edu/content/42/3/531.full.pdf html  Robert, R., Gittelsohn, J., Creed-Kanashiro, H., et al (2006). Process evaluation determines the pathway of success for a healt center-delivered, nutrition education intervention for infants in Trujillo, Peru. American Society of Nutrition, vol. 136, no. 3, p. 634-341. Accessed at: http://tinyurl.com/pp3fbbm  An Pan and Frank B. Hu (2011) Effects of carbohydrates on satiety: differences between liquid and solid food. Curr Op Clin Nutr Metabol Care 4: 385–90. Accessed at: http://link.springer.com.proxybz.lib.montana.edu/article/10.1007%2Fs11690- 012-0302-4  Birch, L., Deysher, M. (1986). Caloric compensation and sensory specific satiety: evidence for self regulation of food intake by young children. Appetite, vol. 7, p. 323-331. Accessed at: http://tinyurl.com/p24hnsd

19. ¿Questions?