Nutritional guidance to infant and young child caregivers in the context of public health facilities in Peru

Background and objectives: The PERUSANO project aimed to develop new culturally appropriate interventions and actions to reduce the risk of micronutrient deficiencies and overweight/obesity in infants and young children (IYC) aged 6-23-months. We aimed to identify socio-cultural and environmental influences on IYC feeding practices to inform co-designed interventions. This study aimed to present qualitative findings from health centres (HC) to aid the development of appropriate health provider and policy nutrition intervention strategies. Methods: This qualitative study was conducted in two low-income periurban areas between November 2019 and August 2020. We conducted interviews with 10 healthcare professionals (HP) and observations of 36 well baby consultations and 4 waiting areas of HCs to understand consultation routines relating to IYC feeding practices. The data were transcribed and analyzed using a grounded approach. Results: IYC health services take place in a tense environment with limited space, high demand, crowding, long waiting times and restless children. The HP focus on nutritional assessment with anthropometric measurements, hemoglobin screening and asking about dietary practices and iron supplementation. Messages for anemia control predominate including recommendations for animal source foods and iron supplements and there is little focus on the prevention of overweight and obesity. Individual needs of children and concerns expressed by the caregivers about children's poor appetite are not addressed. Expository, unidirectional counselling predominates, without the use of educational support materials. A lack of cultural sensitivity and a judgmental attitude prevails. Marked competition between attending to the caregiver/child and completing the registration of various forms as required by the health system in the short time available was observed. Conclusions: Nutritional guidance for caregivers occurs within a context that limits optimal counselling at the environmental, structural, attitudinal, and procedural levels. There is a need to promote behavior change for optimum IYC feeding practices and not only to provide information. Education and communication materials need to be adjusted to facilitate counselling in the conditions and limitations within which care is provided and to cover the changing nutritional challenges faced by infants in this context including risk for overweight and obesity.