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V _ HMS 8| S’UNS' QDDK BINUERY INC. mmnv amuans $Pm: Jnrmcnluj ’ :9 PLACE IN RETURN BOXto romavothb chockoutfrom your «cord. TO AVOID FINES Mum on or baton dd. duo. DATE DUE DATE DUE DATE DUE MSU Is An Afflmativo Actionleal Opportunity Institution W ulna-9.1 '4 ‘7" .- fiffi‘a $12k 5? m . . J. V CHILD FEEDING PRACTICES AMONG LOW INCOME HOUSEHOLDS IN CALI, COLOMBIA by Dorothy Hibbs Riley AN ABSTRACT Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Family Ecology I970 ABSTRACT CHILD FEEDING PRACTICES IN LOW-INCOME HOUSEHOLDS IN CALIF, COLOMBIA By Dorothy Hibbs Riley The purpose of this study was to describe and analyze child-feeding practices among 70 low-income households in Cali, Colombia. The specific objectives were: (I) to determine child feeding practices used by the mothers of children less than five years of age; (2) to determine opinions that mothers hold concerning specific child feeding practices; (3) to estimate the extent to which mothers had adapted new feeding practices and to identify their sources of information regarding child care; (A) to offer suggestions for programs to improve child feeding practices and to identify problems for further study. There were 552 persons in the 70 households with a mean of 7.9 persons per household. Less than one-quamter of these persons were employed. More than one-half of the households - had an average income of 36 U.S. cents per capita per day and one-fourth had an average per capita income of IS U.S. cents per day for all necessities. Dorothy Hibbs Riley Ninety-three percent of the children had been stated on the breast at birth, but weaning begins early with one-half weaned by six months and 80 percent by one year. After weaning the child is usually given the bottle which is combined with the family diet as soon as he is able. This transition takes place over a period of less than a year to three years of age. The typical bottle formula consists of milk, most generally dried, (raw and pasterized milk are also used but to a lesser extent), cereals or flours for thickening, sugar for sweetening and cinnamon for flavoring. Agua Panela (brown sugar water) is commonly used with or without milk. The mother usually buys milk for the youngest child when she can afford to. Among the low income families older children are not generally given milk. The small child often shares food with the family such as soups, cooked dried beans, rice, potatoes and other starchy tubers. Almost all of the mothers knew about one or more of the high-protein supplements (Colombiharina, lncaparina, Duryea), but only one-third said they were using one of the products at the time of survey. The mothers indicated that they were aware that protein foods were best for children after weaning and that they would buy more if they could. The mother's beliefs and Opinions concerning specific feeding practices reflected training from her mother. She Dorothy Hibbs Riley believes there is a trend to wean the child earlier because she does not have enough breast milk or that nursing will damage her body and breasts. The mothers also believed that , theyKhad been better fed by their mothers than they are now feeding their own children because food used to be more I available and less expensive. The mothers strongly indicated that they would use another food that was as nutritious as mllk.if it cost the same or less and that they would be willing to use a new food product on the market would suggest that there is a potential for change in their food patterns. 'Roweved, there are also indications that many mothers do not take advantage of the existing high protein child foods that could fit within their economic means and better nourish their young children. More direct observations of actual child feeding practices_ within family environments would further identify the (/ conditions which contribute to child malnutrition. This a should be accompanied by longitudial studies to improve our knowledge of the relationships between child nutrition, behavior and mental capacity. The methods now being used to tcommunicate better child care practices to mothers should be carefully evaluated as a basis for more effective program development. iv CHILD FEEDING PRACTICES AMONG Low INCOME HOUSEHOLDS IN CALI, COLOMBIA by Dorothy Hibbs Riley A THESIS Submitted to Michigan State University in partial fulfillment of the requirements For the degree of MASTER OF ARTS Department of Family Ecology 1970 TABLE OF CONTENTS Page Acknowledgments . . . . . . . . . . . . . . . . . ii List of Tables. . . . . . . . . . . . . . . . . . v Chapter I Introduction. . . . . . . . . . . . . . l The Problem Objectives Definition of Terms Organization of the Thesis II Review of Literature. . . . . . . . . . 6 Effects of Malnutrition on Child Devel0pment Environmental Factors Affecting Child Nutrition Nutritional Studies in Colombia Ill Research Procedure. . . . . . . . . . . 23 Selection of Samples Development of the Interview Schedule Selecting and Training of the Interviewer Collection of Data Data Analysis Page IV Survey Findings . . . . . . . . . . . . 51 Child Feeding Practices Opinions held on Feeding Practices Adoption of New Practices’ Mother's Sources of Child Care Information V Summary and Conclusions . . . . . . . . 92 Literature Cited . . . . . . . . . . . . . . . . l02 Appendices. . . . . . . . . . . . . . . . . . . . 105 Appendix A Cross-sectional Analysis Tables . . . . 106 B The Interview Schedule . . . . . . . . llZ LIST OF TABLES Socio-Economic Classification of 70 Households Used in Study. Average Daily Food Purchases by Low- Income Families and Estimated Nutritive Content per Capita, Cali, I969. Characteristics of Sample Households. Presence of Father at Meals Socio-Economic Status Characteristics of Sample Households. . . . . . . Characteristics of Mothers in Sample Households. . . . . . . . . . . . Characteristics of Children Less Than 5 Years of Age. Persons Involved in Food Management Decisions in 70 Households. Household Items in 70 Households. Actual Child Feeding Practices by Age of Child at Time of Survey. . . Age of Child When Weaned From Breast. How Child was Weaned From Breast. Mother's Reasons for Weaning From Breast. Age of Child When Taken Off Bottle. How Child Was Taken off Bottle. Foods Used in Bottles (Teteras) and Gruels (Coladas). Number of Mothers Using Different Form of Milk and Reasons for Using the Particular Forms. . . . . . Page 25 35 36 39 Al 42 44 A6 49 53 55 57 57 58 58 60. 64 Table 5.9 5.l2 5.lh 5.15 5.16 5.2l Use of Supplementary Foods by 70 Mothers. . . . Number and Percent of all Children Given Particular Foods and Method of Preparation Foods Given the Child Between Meals Presence of Child at Table With Family at Mealtime . . . . . . . The Rank Order of Serving Meat and Milk Within Surveyed Households Foods Mothers Give to Sick Children Mothers Opinions About the Possible Tendency to Bottle Feed Rather Than Breast-Feed Children. . . . . Foods Thought Best After Weaning. Mothers Opinions About Her Child Feeding Practices as Compared to Those of Her Mother. Foods Thought I'Bad” for Child After Weaning . . . . . . . . . . . . . Foods that Mothers Said They Would Buy More of or Add to the Diet if More Money were Available. . . . Foods that Mothers Thought to be More Nutritious Than Milk. . . . Mothers Opinions Regarding High- protein Supplementary Foods . . . . . Mothers Reactions to the Use of New Food Products Number of Mothers Using Particular Information Sources on Child Care . Sources of Information on Feeding the Sick Child. Page 66 69 7O 72 73 7h 76 78 79 8] 82 8A 86 87 89 9] ACKNOWLEDGMENTS The writer wishes to express sincere gratitude to many persons that have given encouragement, guidance, and assistance throughout the period of time this dissertation was in preparation. Foremost have been the members of my graduate committee; Dr. BeatricePaqucci, Dr. Dena Cederquist, and Dr. Carol Shaffer. A very special note of thanks is extended to Dr. BeatricePaqucci, for guiding this study; to Dr. Frances F. Magrabi and Virginia Beauchamp who gave assistance in analysis of the data; to Dr. Cecelia Florencio for her suggestions in formulating the interview schedule; to the Michigan State University, Institute of International Agriculture for financial assistance to make this research possible; and to Patricia Riley for final typing of the thesis. Appreciation is expressed to those who assisted me in Cali, Colombia and especially to Dr. Alberto Pradilla and Dr. and Mrs. Harrison McKay for their helpful suggestions on organizing the field work; to Emma Baserto, interviewer; Lea Clare, translator; Carmen Gonzalez and Marta De Barona, Dietitian and Social Worker, respectively, (University of Valle Hospital), for their participation in the study. To my husband, Dr. Harold Mr. Riley, deepest appreciation for his assistance and patience without which this thesis would never have been possible. CHAPTER I INTRODUCTION The Problem The seriousness and magnitude of the problems of under- nutrition and malnutrition in the less developed countries demand that attention be directed toward the pre-school age child who is the most vulnerable and whose health may be seriously and irreparably affected (I). Retardation of physical growth and deveIOpment due to nutritional deficiency is widespread and clearly recognized in the less devel0ped countries, as well as within the urban slums and rural I I poverty areas of industralized nations (2). That malnutrition may also influence mental deveIOpment, learning, and behavior lifts this concern to a wholly new level of importance since it is viewed as a major deterrent to future social and economic deveIOpment of the countries affected (3). The results of a I960 nutritional survey (A) conducted in Colombia indicated the prevalence of nutritional problems of major significance. Infant malnutrition, complicated by the presence of infections after weaning, is widespread and the rate of child growth is retarded. A recent Rockefeller Foundation report indicates mal- nutrition among school age children is a major contributing factor to high child mortality rates in most of Latin America (5, p. IO). This report states that about 70 per- cent of the Latin American children under five are mal- nourished to some degree and many are on the threshold of serious deficiencies. About five or six percent of the children manifest the acute deficiency symptoms of retarded growth, swollen belly, severe diarrhea, and abnormal hair color and texture--a condition called kwashiorkor. Sanders (6) writes that the major cause for the high incidence of malnutrition in the pre-school child is an inadequate amount of the right kinds of foods immediately after the weaning period. In general, the most widespread nutritional problem is a multiple nutrient deficiency of proteins, vitamins, minerals and calories. The vast majority of the children in the less developed areas are usually weaned on a diet of gruels made from cereals. While high in calories these gruels are low in protein and other ess- ential nutrients. The mothers lack of knowledge about child care may be a major cause of malnutrition among children. Although poverty may also be an important causative factor in child- hood malnutrition, a considerable portion of this malnutrition might be avoided if local food resources were better utilized. According to Margaret Mead (7), the mothers should be an important target for nutritional education so that children might be better nourished within the constraints of family income and locally available food supplies. She also argues that it is important to know the customs and beliefs with regard to foods,e5pecially those that prevent the use of foods that are, in fact, available. Objectives In order to identify factors that tend to contribute to inadequate diets of young children it is necessary first to determine what child feeding practices exist and what factors in the environment seem to contribute to these practices. The "mother" is a key target for study since she prepares, selects, buys and, in some cases produces the family food. She is the person primarily responsible for the child's care. By studying her opinions about child feeding practices and her knowledge concerning nutrition, observations can be made that could be useful in formulating educational programs for improving child nutrition. New insights into the nature of the problem may also serve as a basis for further studies. I The specific objectives of this study were as follows: I. To determine child feeding practices used by the mothers of children under five years of age in low income households in Cali, Colombia. 2. To determine opinions that mothers hold concerning specific feeding practices. 6 3. To estimate the extent to which mothers had adopted new feeding practices and to identify their sources of information regarding child care. h. To offer suggestions for programs to improve child feeding practices and to identify problems for further study. Definitions of Terms Child feeding practices includes methods of feeding such as; breast, bottle or table, kinds of foods fed, methods of preparation, frequency of feeding and who prepares the food and feeds the child. Opinions are learned preddspositions which influence day to day behavior patterns in carrying out roles such as mother. Opinions may be conditioned by myths, tabods and traditional patterns that are common to a cultural group. Mother is defined in this Study as the person assuming primary responsibility for child rearing. Usually this is the natural mother but in some instances it is another member of the household. Household will be considered to be a group of persons who share a dwelling and who pool their income for, major necessities such as food and housing. Organization of the Thesis Chapter II contains a review of literature concerned with nutritional problems in less developed countries with special emphasis on child nutrition. Theresearch procedure is explained in Chapter III. The geographic setting and description of sample households are described in Chapter IV. Chapter V summarizes the survey information on child feeding practices; opinions that mothers hoki concerning specific practices; the extent to which she has adopted new feeding practices and her sources of information. A general summary and conclusions appear in Chapter VI alOng with implications of the study. Appendix A contains a series of tables presenting the results of a detailed cross-sectional analysis of relation- ships between characteristics of mothers and child feeding practices. Appendix 8 contains the interview schedule, in Spanish, that was used for field data collection. CHAPTER II REVIEW OF LITERATURE The importance of protein malnutrition among pre- school children was established in Chapter I. This problem situation will be further documented in the review of literature which follows in this chapter. Emphasis will be directed to the effects of malnutrition on the physical and mental development of children and the environmental conditions which contribute to child malnutrition. Research literature produced through multi-disciplinary efforts of social scientists and nutritionists will be reviewed. Where possible, studies of the child nutrition problem in Colombia and the Cali area will be brought into this review to further specify the problem in this particular setting. Effects of Malnutrition on Child Development Johnson (3) writes that malnutrition is now believed to be a major cause of growth retardation and impaired capacity to learn. However, progress toward an improved understand- ing of the relationship between maantrition and mental growth and maturation frequently is impeded by inadequacies of methods of measuring the intellectual capacity and adaptive behavior of particular groups of children. Monckeberg (8) working with children in Chile has cited evidence that, compared with other low-income children of comparable age and from the same population,those who suffer marasmus (protein-calorie starvation) do not catch up in IQ by three to six years of age. He states that; “evidence is cumulative and impressive that severe under-nutrition during the first two to three years of life, when brain growth is most active, results in a permanent reduction of brain size and a restricted intellectual deveIOpment.” A forthcoming book described in the Rockefeller Foundation Quarterly (9) reports a recently completed study by Cravioto and Birch of a group of 37 Mexican children who were hospitalized with severe malnutrition between the ages of six to thirty months. Each had reCOvered and at the time of the study was five years old or older. A brother or sister of each child was selected as a control group. It was found that the once-malnourished children scored lower on standard I.Q. tests than did their siblings who had not suffered the severe malnutrition. In Jelliffe's study (IO) of children in the tropics he found that rapid growth is a fundamental characteristic of a healthy, well-fed young child and the growth curves for young children are revealing, as they indicate the type of circumstances which lead to the deveIOpment of malnutrition. He states that weight gain in the first four to six months is usually very good as the child is receiving an adequate supply of protein and calories from his mother's milk and has his own stores acquired during pregnancy to rely upon. During the second six months breast feeding is usually continued, but the quantity of milk is no longer sufficient for the growing infant. During this period the growth slows down as compared to the earlier months. Jelliffe indicates that the second year isla potentially dangerous period. At this stage breast feeding may or may not be continued and the supplemental diet is frequently including rather ill-cooked, indigestible, high-carbohydrate vegetables. The protein content of the diet iSLsually low, while at the same time the child is likely to be involved in a continuous succession of bacterial, viral, and para- sitic infections. It is during this transitional period that the growth curve of the malnourished child becomes seriously abnormal. Weight may continue to increase very slowly, or the curve may remain almost flat during some or all of this period. In some children, the weight may actually decrease and may decline into severe forms of marasmus or kwashiorkor. This is usually most common during the third growth period from one to three years. After three years of age, the child has frequently acquired a certain degree of resistance to various infections and is able to obtain and digest a wider range of the family diet, although he may remain below standard weight and height for years. Jelliffe concludes that there is little doubt that the short stature and under weight of the population of less devel0ped communities is the result of childhood malnutrition together with Continued inade- quate nutrition thereafter. Jelliffe's diagnostic observations tend to be confirmed by a number of other researchers, Behar (ll), Thomson (l2) and Whiting (l3). Environmental Factors Affecting Child NUtrition During an interprofessional conference on malnutritiOn and food habits in I962 (lh - Introduction), Fremont-Smith stated the purpose of the conference that brings out a continuing area of concern: 5 ”There is already enough scientific knowledge to bring about considerable improvement in the nutritional health of children in many parts of the world, if it could be widely applied. This knowledgecannot, however, be used Where it is needed unless the people themselves want to use it, know how to do so, and are prepared to accept the changes necessary for its effective use. Unfortunately, there appear to be psycho- logical, sociological, and cultural factors which create barriers against rapid changes in food ' habits, and which are less well_understood than the impersonal aspects of nutrition and mal- -nutrition.” Burgess (lh, Part I) observed that the family acts as a cushion between the individual child and his environment. In order to meet their basic needs families must devise ways of dealing with their environment so as to realize certain satisfactions that are necessities as well as those lO that are desirable. Therefore, many areas must be taken into account that influences the family when one attempts to understand patterned ways of behavior such as food habits. Richardson (l5,pp. 3&6-60) states that: "The identification of conditions under which nutritional factors influence mental ability will be a major scientific advance. In order to prevent conditions of malnutrition which affect mental development, it will be necessary to study the social factors that influence the amounts and kinds of food given to infants and children.” Richardson also observes that in all communities some children are better fed than others, and variations in customs and practices between families who feed their children well and those who feed them poorly may provide some suggested solutions to the malnutrition problem. In an F.A.0. Document (l6) it is suggeSted that what pe0ple eat sometimes depends on factors other than those of food availability. Rigid customs and taboos, growing out of the experiences of innumerable generations, may prescribe not only how crops will be planted and harvested or which game killed and eaten, but also how and by who the food is consumed. Changes in food habits tend to accompany social, economic and cultural changes. That foods people are willing to eat is determined by a complex system of attitudes, ideas and assumptions that form the local ll cultural patterns. These include religious restrictions, taboos, ideas pertaining to the merits or demerits of a food and other attitudes which are as yet little understood. Simoons (I7) has done extensive work in food avoidances around the world. In an historical study concerned with present day food restrictions and usages he found that many eating habits of mankind are chosen in accordance with cultural attitudes and patterns of behavior in what he describes as ”group foodways”. These patterns tend to be followed generation after generation with attached set beliefs and taboos and without understanding why these patterns are so imposed. He believes that children can play a major role in changing food habits in families by introducing new attitudes learned at school. It is less generally recognized that children tend to be permitted greater deviation from the "group foodwayS” and are therefore in an ideal position to act as innovators. He also found that mothers and other women seemed to resist changing their ”foodways”. The holders of power and authority in the household (e.g., the grandmother or father) or community 'trend- setters' may also be of importance. How the mother was reared and taught concerning family food practices as well as who she may tell her troubles to (friends, relatives, l2 village doctor, priest) all strongly influence the mother's choice of food for the child (l6). Nutrition Studies in Colombia A National Dietary Survey (4) was conducted on the Armed Forces of Colombia and the general civilian population in May through August, I960, by a joint COIombian-United States team of medical doctors, nutritionists, agricul- turists and educators. Military units in IA different areas in Colombia were surveyed. A total of 3,700 members of the Armed Forces were examined through detailed dietary studies and clinical and biochemical examinations. Evaluations of the dietary studies in the armed forces indicated that intakes of calories and protein were adequate and the nutritional status of the soldiers was good. However, there was evidence of caloric deficiency among the civilian population. This was borne out by the observation of a rapid decrease in the number of men in the low body weight group with increasing time in the armed forces (A, p. l9). This national dietary survey also included a total of h,8l8 civilians that were examined by a clinical team and an additional 1,263 subjects were examined by a pediatric team. The caloric intake of these subjects was, in general, I3 lower than requirements established by the National Research Council and Food and Agriculture Organization and adjusted for mean annual temperature, body build and activity. Daily protein intakes per capita varied from 25 grams in Cali to 42 grams in Cartagena; nearly two- thirds of the protein was of a vegetable origin. These observations were reflected in the below average height- weight age relationships in both children and adults (h,pp. 20-23). ' . It was also found that the heights and weights of Colombian children during the first six months of age were approximately the same as the heights andeeights of children in the United States of the same age (4, pp. l85- l92). However, at approximately six monthsof age, when mother's milk alone becomes insufficient to maintain normal growth, the growth curve of Colombian children began to fall below similar height-weight curves for U.S. children. Although genetic and other factors may play a role in the difference between Colombian and United States children, it appears from a comparison of Colombian children in a private school in Neiva with children in an orphanage in Bogota that these differences are at least in part the result of nutritional factors (4, pp. l9l-2). In I964 Mitchell (l8) conducted a study of food purchase patterns among 48 low-income families in barrio l4 Siloe located on the outskirts of Cali. He found that the average family size was 7.3 persons with slightly more than 50 percent of the family members being under 2l years of age. Eighty-five percent of the families had bought platanos (cooking bananas), rice, Sugar, panela (crude brown sugar), manteca (lard or vegetable shortening) bread and meat during the week of the study. Twenty-five percent of the families were not buying milk in any form including families with children less than five years of age. Nearly all the families bought food on a day to day basis at the plaza markets or at neighborhood stores. Mitchell reports that lncaparina, then a new high protein food supplement for children, was being used by one-third of the families. Information about Incaparina was being communicated by radio, health centers and by the medical personnel. Most of the families had radios, but there were no T.V.'s in the homes visited and few newspapers. In I969, a Michigan State University group directed a comprehensive study of market coordination in the Cauca Valley of Colombia with a central focus on the food system serving the city of Cali (I9). The purpose of this study was to diagnose marketing problems and formulate recommend- ations to reduce food costs and improve marketing services. The project (Proyecto Integrado de Mercadeo Urbano-Rural, PIMUR) was carried out by a joint Colombian-Michigan State l5 University task force. They found that the urban food distribution system in Cali was becoming increasingly un- satisfactdry for a city of nearly one million people. Consumers frequently had to travel long distances to buy food especially meat, fruit and vegetables.. Sanitary conditions were also serious threats to health of those purchasing milk and meat. Low-income families in the new areas of the city had the poorest access to retail markets and paid relatively higher prices for their food than families in higher income areas. Recommendations were made for action programs to improve the food system and some of those are now being implemented. In l963-64 a study was carried out by the University of Valle in the town of Candelaria, an. agricultural sugar cane community,located approximately l0 miles from Cali (20). Dr. Joe E. Wray, serving as a pediatric consultant from the United States, and Dr. Alfredo Aguirre, a Colombian pediatrican, assessed the nutritional status of l,094 pre-school children under six years of age. They obtained information about the children's families (506) and other socio-economic factors contributing to their nutritional status. From the data obtained two things were evident. ”Since more than forty perCent of children were classified as malnourished, Proteinecalorie mal- nutrition was obviously a problem demanding attention in l6 Candelaria; secondly, children between the ages of I2 and 36 months clearly constituted the most vulnerable age group" (20, p. 8l). The epidemiologic data show that commonly considered causal factors, poverty and ignorance, are at work; they also show that other factors, social and demo- graphic, interact with these in a complex web of causation. The data also points out that it is the mother who 'transmits' these factors, thus determining the nutritional status of the child. She in turn is affected by some of these factors. It was suggested that if.mothers in Candelaria were able to limit their family size the nutritional situation of preschool children would improve (20, p. 96). Florencio (2i) investigated the efficiency of food expenditure among certain working-class families in Colombia. Linear programming was used to solve the problem of finding least-cost diets that would meet the following levels of nutritional allowances: The estimated actual level of nutritional intake, the minimum dietary standard, the most generous Colombian dietary standard and the additional nutrients necessary to raise the nutritional content of the actual diet to the level specified in each of the two dietary standards (2],Abstract).. 'Data for estimating the actual nutritional intake of the 40 families studied were taken from the original food consumption records obtained by the Interdepartmental Committee on Nutrition and National Defense (ICNND) in its l7 nutritional survey of Colombia from May to August of I960 (2L p. 6). Florencio found that: Not one of the forty families met l00 percent of the minimum allowance for all nutrients. And yet, given the actual amounts spent for food, if the families had selected the least- cost diets, 32 of them could have obtained adequate nutrition not only at the minimum but also at the higher Colombian level (2l, . l27) The primary difference between the actual diets and the least-cost diets that would have provided the same level of nutritional intake was the change in the percentage cost contribution of milk and meat (Abstract). Florencio observed that some families were undernourished and/or malnourished not because of limitations in availa- bility of foods nor because their purchasing power was small, but because they do not buy their nutrition efficiently. The problem was not having too little to spend but spending unwisely what one can afford to spend (2|, p. 44). The Institute of Nutrition for Central America and Panama (INCAP) headquartered in Guatemala City has conducted research for more than ten years on increasing protein intake in p0pulations where animal protein is scarce and expensive. This research has resulted in.a number of vegetable mixtures called "lncaparina" which are comparable in protein value to animal protein (l, p.632). In c00peration with the Quaker Oats Company, Incaparina was I8 market-tested in Colombia in I960 where a product of this type had considerable commercial potential. The utiliza- tion of locally available ingredients has been one of the primary principles on which lncaparina is based. The protein concentrate portion has usually been derived from corn, soya and cotton seed flours. Other ingredients include calcium carbonate and a vitamin mixture (22). Considerable effort has been put into the marketing of this product by various health and nutrition agencies in Colombia. The Quaker Oats Company in Cali, Colombia has recently prepared a new formula, lncaparina Blanca, that is designed to improve the color and taste appeal of the product. Information on the composition is not available to the researcher at this time. 5 Recently, a new high protein strain of corn (opaque-2) was introduced into Colombia and adapted to the environ- mental conditions of the Cauca Valley by Dr. Dale Harpstead, then a corn geneticist with the Rockefeller Foundation Agricultural research group. i i The protein of opaque-2 corn contains the two amino acids, lysine and tryptophane, which make this particular variety of corn a complete protein plant food (6, p. l3). As the locally adapted varieties of opaque-2 corn became available Dr. Harpstead established a working relationship l9 with Dr. Alberto Pradilla, a pediatrician with the University of Valle Medical Center in order to conduct feeding tests with severely malnourished children. Dr. Pradilla first tested the corn on two children that were in a severe state of kwashorkor. The home diets of the children were duplicated except that the starches were replaced with Opaque-2 corn. Both children recovered in weight and bone growth (6, pp. 4-l8). Since that time, Dr. Pradilla has conducted several feeding tests with opaque-2 corn and has achieved remarkable results. Pradilla observes that: ”The capacity of a diet to cure malnutrition is the most severe tests that can be applied to it. By using Opaque-2 corn at suboptimal levels, we have proven the feasibility of using mixtures that include other plant protein which is both low in cost and effective in dietary improvement. While a diet that relies on protein from opaque-2 corn cannot be considered ideal, it is far_superior to anything yet available from cereal grains" (6, p. l8). Following the development and child feeding tests with opaque-2 corn CPC International, a food processing corporation, that was producing the product Maizena (a corn starch commonly used by Colombians), became interested in the possibility of introducing a high-protein supplementary food for pre-school children. A product, Duryea, was developed, using the opaque-2 corn as a basic ingredient and was test marketed in Cali beginning in August, I969. 20 Prior to introducing the product, Duryea, the CPC International conducted studies to determine the market potential for such a product. Weiss (23) writes in the introduction of his report: It was agreed that our product would be directed to families of the lower socio-economic classes, who are within the monetary economy and its function would be to better nourish their children between the weaning age and the teen-a e, at a price they could afford. This product wou d havebo fit into their current eating habits (23, 9.1). Weiss also obtained considerable survey information on the use of weaning foods by a sample of l,006 children in four major cities (Cali being one of them). Some of the data will be presented later in Chapter V asta comparison with the results obtained from mothers interviewed in this thesis project. A locally produced high-protein supplementary food, Colombiharina (24) has a limited market in Cali. The protein composition of this product is rice flour (70%) and soybean flour (30%) with the addition of vitamins and minerals. It is used in much the same way as lncaparina and Duryea. . .The National Institute of Nutrition (25) in Colombia, working with funds provided from the United Nations, had deveIOped a program of applied nutrition (PINA) in which 2l health and child-care information is provided to mothers by way of classes in local health centers. These programs are being further developed in order to make this type of information available to larger numbers of families with the hope of raising the nutritional level of the national p0pulation. Programs for sanitation, health and nutrition education for school age children as well as a supple- mental feeding program is being introduced in the school system in Colombia through these same United Nations funds. Currently there is a long term child development research program underway in Cali under the direction of Dr. Harrison McKay and his wife, both social physiologists from Northwestern University and Dr. Leonardo Sinisterra, Pediatrician from the University of Valle Medical Center (26). This program has been initiated with various studies of the neighborhoods and families in economically deprived areas of Cali with the behavioral and biomedical devel0p- ment of the young human in the early years of life as the primary focus. The information from the adult members of the community or family is being utilized to better under- stand and predict this development, and intervention pro- grams with the adult population are being assessed through their effect upon the young children (26,pp. l5-l6). 22 The program operates through a research facility in a low-income barrio where base line data has been collected; Various child feeding experiments are being tried and the effects on child devel0pment and behavior is observed over time within the context of the family environment. Other testing is being done with mothers of the children to determine better methods of teaching child-care and nutrition. CHAPTER III RESEARCH PROCEDURE The discussion of procedure is divided into five parts: selection of sample; development of the interview schedule; selection and training of interviewer; data collection and data analysis. Selection of Sample A sample of 70 households was selected from a larger group of households that had been included in a comprehen- sive study of household food purchasing patterns. This larger study had been conducted as part of the PIMUR project (Proyecto Integrado de Mercadeo urbano Rural) which was directed by the Michigan State University Latin America Market Planning Center under contracts with the U.S. Agency for International Development and the Colombian Government (l9). _‘ " tThe PIMUR household sample was chosen to be represen- tative of the urban area of Cali was drawn from I60 Barrios within the city limits by the use of listings of users of electric power within the city. In one large barrio on the outskirts of the city an area sampling was used to obtain a representative sample since it lacked public 23 24 facilities. An initial questionnaire on food buying patterns and family characteristics was taken with a 629 household sample. In subsequent visits detailed food purchase data was carried out with 239 families of which l82 records were sufficiently completed for detailed analysis (l9, p..30). From the sub-sample of 182 households.that participa- ted in the Market-Basket Survey, lIO households contained children under five years of age. The houSeholds used in this study were selected from the two lowest-income socio-economic classifications in a six level classification scheme devised by the city planning office for Cali. There were 86 households that met the criteriaset up by the researcher. The criteria used: (I) the hausehold must contain one or more children under five years of age and, (2) the household must be located in alow-income barrio within the two low income socio-economic categories. Out of the 86 potential households 70 were recruited for this study (Table 3.1). . ' ACCording to the PIMUR study 60 percent of the Cali households and 70 percent of the population were located in the two lower socio-economic groupings. The average monthlyincome per household was estimated to be about $90 (U.S. Dollars) in the low-income Category and about $60 in the low-low-income category. Average size of family was about 6.3 persons. 25 Table 3.l. Socio- -economic classification of 70 households used in study Socio-economic Number of classé/ households Low-income 50“ Low-low-income 20 Total 70“ alBased upon a six category classification scheme used by the Municipal Planning Office for the city of Cali. . During the month of September, prior to the data collection in October and November, a social worker from the University de Valle Hospital visited the selected families in order to solicit their participation in this study and a possible follow-up study by the University of Valle nutrition group. Development of the Interview Schedule A three part questionnaire was developed (See Appendix B). Part I consisted of basic household information, part of which was transferred from the PIMUR study. Questions centered around; number and ages of children under five- 26 years of age; composition of the household and the rela- tionships of older family members to the yOunger children; the identification of the family member responsible food management decisions within the household.' Part II consisted of a series of questions about the care and feeding of each child under five years of age including current food intake and methods used for weaning children. Part III was devised to determine the mother's Opinions and beliefs she holds about specific foods and child feeding practices and her sources of information.'1 The preliminary interview schedule was developed on the Michigan State University campus before taking it to the field in Cali, Colombia in August, I969. In Cali, the schedule was translated into Spanish and six pretests were conducted. Three of the schedules were pretested by social workers in a low-income barrio and three were pretested by an interviewer hired and trained by the researcher. Comments and suggestions were sought by the researcher for improvement of the interview schedule. Items such as the time required for the.iDterview, under- standability of the questions, easy flow Of the question sequences and acceptability of certain questions by the respondents were examined. A revision Of the schedule was made and three more pretests were cdnducted in the field 27 before the researcher returned to Michigan State University in late August, I969. The schedule was revised again back at the Michigan State University campus. When the researcher returned to Cali in October, I969 the revised schedule was translated into Spanish and tested again in low-income households whose characteristics were similar to the criteria used for the households in the study. After minor adjustments, the Interview Schedule was finalized and reproduced for use in the field. It Was necessary to engage the services of a trans- lator to assist in the translation of the English version of the schedule into the colloquial Spanish of the area. After the data were collected the information given on the Open-ended questions regarding Opinions given by mothers was translated from Spanish to English. The translator hired was the Colombian wife of a member_Of the PIMUR Staff. She was bicultural, having lived both in Colombia . and the United States. She held a 8.8. degree at California Polytechnic College at San Luis Obispo. She was a skilled translator employed by the University del Valle as a simultaneous translator for cross-cultural conferences and seminars. 28 'Selection and Training of the Interviewer The interviewer selected was a Colombian homemaker, approximately 26 years of age, married, with a two year old daughter. She had a high school education with specialized training in social work at the University of Valle. _She had previous field survey experience in inter- viewing before being hired by PIMUR to Collect data for two sets of questionnaires (l) the general household food consumption survey and (2) the more detailed market-basket study. She was recommended by the researcher by the director of the PIMUR consumer study as one of their best interviewers. I A The researcher contracted the interVIewer in August, I969, to collect data for the pretests which gave her an opportunity to become acquainted with the contents and general plan of the study to be conducted during October and November, I969. A i The interviewer had lived in Cali all_her life and was knowledgable in locating addresses within the city, as well as understanding the transportatiOnsystem and how it could best be utilized for the collectiOn Of data. Collection of Data Six weeks were allocated for the cOlIection of the data, with the final two weeks to include visits by the 29 researcher, accompanied by the Interviewer, to selected families in the study for observations and photographs. The Interviewer was able to average three to four families per day. Close supervision was given by the researcher and periodic checks on the completness of the interviews were made throughout the survey. The Interviewer used an introduction that identified her with the University of Valle nutrition-group and the PIMUR project. Positive identification-of households were made by making checks against the PIMUR market-basket data on the same households. The interviewing required 45 minutes to one and one-half hours per hOusehold depending upon the number of children in the household under five years ofage. 4‘ The Interviewer carried with her samples of three high protein supplementary foods (Colombiharina, Incap- arina Blanca, and Duryea) which were given to the mother after the interview. ,Observations by the researcher were made during the last two weeks of data collection. She accompanied the Interviewer to the homes, but did not make the visits until the Interview had been taken. ,The Researcher made notes as to the type and size of the dwelling, the surrounding environment, observed the physical appearance of the 30 children that were present and talked with the mother as she prepared the children for photographs. In this way the Researcher could acquaint herself with the living conditions and standards of living in the households. The Researcher used a Polaroid camera for instant photos in black and white and a 35 mm camera for color slides. The family was given a Polaroid photograph of the family before the Researcher departed. Data Analysis The data from the interview schedules were hand tab- ulated and subsequently transferred to IBM cards for frequency counts on the 3600 CISSR computer at the Michigan State University Computer Center. Cross sectional analyses were later made to examine differences in child feeding practices among mothers classified by levels of age, education and income. Information abOut the family and their home environment were summarized and related to child feeding practices. CHAPTER IV GEOGRAPHIC SETTING AND DESCRIPTION OF HOUSEHOLDS Geographic Setting Colombia lies in the northwestern corner of South America and is the only nation in S.A. bordering on the two major bodies of water, the Caribbean Seas and the Pacific Ocean. About 40 percent of the Colombians are mestizos, or persons of mixed white and Indian descent. About 30 percent are white, mostly Spanish; about l5%, mulattoes; 7% Indian, and 5%, Negro. Most Colombians are members of the Roman Catholic Church (27). ' Estimates of the current annual rate of pOpulation growth in Colombia range from 3.2 to 3.5 percent. At this rate Colombia will double its population in 20 to 22 years. Even if family planning efforts, now gaining momentum, are reasonably successful, pOpulation growth rates cannot decline rapidly because 46.7 percent of the Colombian pOpulation is under I5 years of age. These young peOple will soon contribute significantly to pOpulation growth even if they adOpt family planning practices (28). Nearly one-half of Colombia's l9.8 million peOple are engaged in agriculture. As in many Latin American 3l 32 countries, rural-to-urban migration continues at a rel- atively rapid pace, challenging present food systems, income earning capacity of migrants, and, in turn, the effective consumer demand for food (I9, pp. l2-I5). This study was carried out in the city of Cali, which is the capital of the state of Valle and is a dominant commercial center in the southwestern area of Colombia. A highway network links Cali with other major Colombian cities. The Cauca Valley area, in which Cali is located, supplies most of the major food products for the city. The valley has an average elevation of 3500 feet and is bound on both sides by mountains. The climate is warm with a mean annual temperature of 25° C. There are two rainy seasons making it possible to produce two grain crops per year. Sugar cane, corn, soybeans, cotton and beans are the principal cultivatedcrOps inthe Valley. In the mountain highlands surrounding the Cauca Valley coffee is the principal cash crop although fruits, vegetables, corn and beans are also produced in small quantities (19. p. 9). Demographic Characteristics of Call The population of Cali in I969 was estimated at 895,000 with a growth rate of approximately seven percent 33 annually reflecting both a high rate of natural increase plus a heavy inflow of immigrants from rural areas (19, p. 13). If past trends continue the pOpulation of Cali is estimated to reach 1,624,000 by year 1979 and 2,699,000 by 1989 (19. p. 15). ' ' It was estimated that 23 percent of the total population was employed outside the household at the time of the PIMUR survey in early 1969. Indications were that the unemployment rate among the adult labor force might be as high as 20 percent. Theincome distribution was quite dis- proportionate with 67 percent of the families earning 2100 pesos ($1l6 U.S.) or less per month while the mean family income was 2500 pesos monthly (19, p. 13). About 42 percent of total household expenditures are for foOd. However, due to the unequal distribution of incomes, the poorest one- fourth of the families are spending more than 80 percent of their total income for food (19, p. 31). l I The nutritive content of the food purchased by low-income families was estimated using data from the PIMUR (Table 4.I) market-basket study and the nutritive compOsition reported in an earlier Colombian nutrition study by Arnold Schaffer (4, pp. 256-260). The daily caloric intake for the same one- fourth of families with the lowest per capita income group was estimated to be around 1400 per capita and the protein intake was about 27 grams per day. These overall averages 34 are approximately the same as those reported for low income families in Cali in the 1960 study by Schaffer. In both instances the observed nutrition levels reveal deficiencies in terms of both calories and proteins when compared with recommended intakes. Nutritional needs vary substantially by age, sex and physical size of individuals. Hence, protein requirements may vary frOm about 40 to 90 grams per person per day. .The caloric requirements per capita in a warm climate such as that of Cali ranges from around 1000 to 1200 calories for children Under five years of age to around 2500 to 2700 calories for male adults, with an Overall family average of roughly ISOO calories per person (l9, p. 36). Description of Seventy Households in Study Information concerning socio-economic status and house- hold characteristics were taken from the PIMUR market? basket questionnaire, while other detailed information was collected on the interview schedule for this study. These characteristics are summarized in Table 4.2. Household Characteristics of Sample _Half (35) of the seventy househOlds interviewed were nuclear families, that is, man, woman and children with or without a hired maid. The other half (35) were extended households which Included a specified number of persons, most of them related, that shared the same dwelling and income. Table 4.1. 35 Average daily food purchases by low income families and estimated nutritive content per capita, Call, 1969 Average Product quantity Calori Grams g_ per capita8 Intake of Protein Beef .079 lb. 59.42 4.79 Milk 45.5 gms. 22.75 1.55 Eggs .077 eggs 6.02 .47 Rice .137 lb. 245.56 5.34 Beans .027 1b. 40.77 2.75 Corn - .043 lb. 70.52 1.63 Potatoes .217 lb. 72.91 1.65 Platano .194 lb. 69.84 0.88 Tomatoes .032 lb. 2.18 .11 Cooking fat .025 lb. 111.50 - Sugar . .076 lb. 145.92, - Pan Sugar .119 lb. 185.64_ .30 Bread .112 loaves 56.62 1.51 Pastas ' 3.31 gms. 11.55, .35 Coffee .013 lb. 6.24 .23 Chocolate .006 1b. 13.23' .11 TOTAL 1120.67 21.66 Adjusted Totalc 1392.14‘ 26.91 Ag aAverage quantity purchased per capita b y PIMUR market basket families in lower quartile when grouped by per capita income. bBased upon nutrient composition values which appear in , Appendix Table VI, Colombian Nutrition Survey, May-August 1960, A Report by the Interdepartmental Committee on National Defense, Washington, D. C. 1961. cThe items listed above in this table represented about 80.5 percent of the total market basket purchased by these families. The total nutritive intake has been adju$ted to include these other food items. Harold Riley, Kelly Harrison et al., Market . Coordination in the Development'af the Cauca Vall_1 Region - COlombia, esearCh Report no. ~5: Eatin AmerIcan Studies Center, Michigan State University, East Lansing, Michigan, 1970, p. 37. Source: 36 Table 4.2. Characteristics of sample households Number of* . Percent Characteristics households .r-of total #4 or individuals " sample Family structure 70 households Nuclear 35 50 Extended 35 50 Z0 100 Family size 70 households I ‘3-5 members 12 1 17 6-8 members 34 48 9-11 members 18 I 26 12317 members 6 I _5_ 9 TOTAL , 2° ' 100 Ages of Household 552 individuals .Members 5 Under 5 yrs. 120 '6 I 22 5-15 yrs. 190 , 34 16-35 yrs. 139 , 25 36-55 yrs. 80 i 15 56-§§ yrs. 2; * . 4 37 Table 4.2, cont'd. Characteristics households , of total or individuals ' sample Relationship of house- 442 individuals. hold Members to 120 Children Less than 5 yrs. of age in 70 Households Fathers 61 15 Mothers 65 , 15 Siblings 196 'g 45 Grand Parents 36 8 Cousins 5 3 Aunts/Uncles 52 t) 12 Servants and Others 7 A I. 2 TOTAL 432 ‘ 100 Death of Children 40 individuals I 5 yrs. in 70 Households Age in Months Birth - 3 mo. 12 - w 30 4 - 12 mo. 14 . 35 I3 - 24 mo. 10 * 25 25 --36 mo. 2 .I 5 37 - 48 mo. 2 I 74‘ 5 _49-60mo. O 0 TOTAL A no ‘ - “_100 38 The mean household size was 7.9 persons with a range of three to seventeen persons. About one-half of the households contained six to eight persons. Twelve house- holds had five persons or less with six cOntaining twelve persons or more. There were 265 males and 285 females in the sample households. Thirty-four percent of the individuals in the sample households were in the five to fifteen years age range with 25 percent in the 16 to 35 age range. The mean age of 'all individuals in the sample was 19 years with ages ranging from less than a month to 85 years. When the household members were classified as to relationship to the young children it was found that there were 61 fathers and 65 natural mOthers which together composed 30 percent of the total sample of 432 persons. The number of siblings totaled 196 or 45 percent of that total. There were 36 grandparents living in the households, 15 cousins and 52 aunts and uncles. Seven servants or unrelated persons were also living in these households. Fourty-six percent of household members were reported as helping care for the children under five years of age. .It was found that 40 children under five years of age that had been born alive, had died before reaching four years of age due to illness and other causes identified by - the mother. Sixty-five percent of the child deaths were in 39 the "soon after birth” to the one year range. About 90 percent of the child deaths occurred befOretwo years of age. . Forty-five of the 61 fathers in the sample households were at home every day for dinner while 16 were present only on holidays and Sunday (Table 4.3).) Table 4.3. Presence of Father at meals) P MealsTTaken wT 5 Family Presence of Father Breakfast Lunch* TDInner Non —%I No. ‘%' No. %— Every day 30 ' 49.2 25 41.0 45 73.8 Only onholidays .‘ ' i . and Sunday - 31 50.8 36 g_§2}0 16 26.2 TOTAL 61 100 61 .100 j 61 100 Socio-Economic Status Characteristics ‘ ‘ Forty-three percent of the heads of_households of which nearly all were reported to be male has lived in their present location less than five years would Indicate a rather-high degree of mobility. or the 57-percent that had lived in the same locale more than five years, one-half were reported to have lived there all their lives. Fifteen percent of the 552 persons in the sample households were employed full-time and eight percent were 4O employed part-time. Twenty-nine percent Of the individuals were students and the remaining 48 percent were home full- time. The households were divided in three income groups (Table 4.4). The mean income per househOld was 1544 Pesos or $87 U.S. dollars. Among all households the mean income per month per person was 216 pesos. This means that all necessities had to be purchased with an average of seven pesos per day per person or 39 U.S. Cents.‘ Characteristics Of Mothers The “mother“ in the household was-the major care-taker of the child and she was the one that has interviewed for her child feeding practices and opinions concerning specific practices and foods. Mothers ages ranged from 18 to 65 years with a mean of 32.5 years (Table.4.5). Forty-one percent were less than 30 years of age.'; Formal education of the mothers ranged between 0 to nineyears with a mean of 4.2 years. Only four percent reported no formal education. Nine mothers reported some special vocational educational training in addition to their formal education. I 1 Eleven percent of the mothers Interviewed were employed full-time outside the home. In addition, four had a small business in the home sewing, making paper bags, minding a 41 4.4. Soclo-economic status characteristics of sample households W A Percent OI Characteristics Number . total sample Length of time head of N- 70 households. household has lived in ' barrio Less than 5 yrs. 30 43 More than_5 yns. ,, 4O 57 TOTAL :0 '- 100 Occupation of household Na 552 persons 4 members . ' Employed Full-time 84 15 Employed Part-time 43 8 Students 160 .1. 29 At home_§glI-time 265 . ;_ 48 TOTAL '2 , . 100 Inc/household/month N- 70 househOlds’ pesosa . $420-$999 22 ” 31 31000-31999 28 .‘ 4O - 2000- 3999 20 29 TOTAL , _70 g 100 Inc/capita/month N- 70 households) pesos . . 50-$199 38 f- 54 200- 399 . 23 33 _g 400- 699 _9 ‘ .ll______ TOTAL 70 ":. ' 100 e'i 3The exchange rate at the time of the Study was 18 pesos equal One U.S. Dollar. , - 42 4.5. Characteristics of Mother in sample households Percent of Characteristics Number Total sample + Age of Mother (in years) 18-25 15 21 26-30 14 20 31-35 15 21 36-40 18 26 41-65 8 12 TOTAL 70 I I 100 Education (Formal) ‘ (in yrs.) 0 3 4 1-2 8 11 3-4 27 39 5-6 22 31 557-9 10 15 TOTAL 20 “.= 100 Occupation I At home Full-time 55 ' p 79 Employed Full-time 8 . ll Employed Part-time 5 ~r‘ 7 Student 2 __3_____ TOTALA 3. L 70 ' h' 100 43 small store and a beauty shop. The mothers that were employed full-time worked at jobs, such as;_janitoress in schools and hospitals, maids in other homes or as factory workers. Only one of the mothers had a partetime job and two were taking special training as beauticians and were - absent from home two afternoons a week. Four of the mothers assisted their husbands in their spare time, but 55 of the 70 mothers were at home the major part of the time and were the principal care-takers of the small children in the household. Sixty-four of the 'mothers' interviewed were the natural mothers of the small children in the households while six were the grandmothers or other individuals. When asked who takes the major role as care-taker of the children 55 of the natural mothers said they fulfilled that role. In the remaining 15 households there were ten grandmothers; two sisters, one aunt and two servants were carried out the major child care role. ghggggteristics of Children Less than Five Years The sex ratio among the 120 children less than five years of age in sample households favored the males (Table 4.6). It is interesting to_note the unequal dis- tribution of children by age groupings (Table 4.6). 44 Table 4.6. Characteristics of children less than 5 years of age *Akg Percent Of7h Characteristics Number total sample Sex ' . Male . 66 - 55 Female .54 _ 45 TOTAL 120 w 100 Age (in months) 0-12 mo. 16 13 13-24 mo. 21 I 18 25-36 mo.' 28 23 37-48 mo. 26 I. , 22 49:60 mo. 29 24 _z, Number of children less than 5 rs. In 70 househo ds 1 ‘ 35 50 2 23 _ 33 3_ 9 '5' 13 4 3 a 4, TOTAL A 10 .'1‘ 100 45 There were relatively fewer children in the less than 12 months and 13 to 24 months age ranges as compared to the older groupings. This might suggest a decline in birth rates although the sample size is too small to provide conclusive evidence on this point. There was an average of 1.7 children under five years of age in the sample households with 50 percent of the households having only one child in the age range and only seven percent with three or more under five years (Table 4.6). Household Food Management Food management within the household appears to be centered around the mother. She is the person who usually decides, buys, prepares and serves the fOod with some assistance from other members of the household. Table 4.7 gives some indication how food management is shared within the family structure. Observations made by the researcher revealed that the food is usually prepared in the kitchen On portable two- burner kerosene or electric stoves or Over small charcoal burners. Kerosene was the most common fuel since it is relatively inexpensive as compared to electricity. Table 4.7. Persons involved in food management decisions in 70 sample households Person Who decides Who buys Who prepares Who serves *No. No. 77 ‘No. (No. __— Mother 42 38 4O 45 Father 9 7 - -1 Mother-Father 3 6 - - Grandmother IO 7 6 8 Mother-Grandmother 2 4 13 3 Sister-Grandmother l 2 - - Aunt l 2 3 3 Servant. 1 4 4 ,Others 2 2 2 2 TOTAL 70 70 7O 10 In 60 of the 70 households the foodwas served on individual plates directly from the kitchen. Food was served "family style", that is placing the food on the table in bowls for each individual to serve himself, in only five households. 47 Dwellings and Household Possessions The researcher had the opportunity to visit 14 of the 70 dwellings in the study. An attempt was made to visit different types of households so as to get arepresentative set of observations. The size of dwellings were not closely related to the number of persons living therein and the houses were often small and over-crowded. Houses were typically built close together so that outer walls were used in. common by houses next to each other. Many of the houses had walls made Oflé single layer of brick which was often exposed and floors were often dirt, covered with pieces of cardboard;or tile. Enclosed patios were part of the dwelling and walls were made of a layer of brick or split bamboo poles apprOximately four to six feet high. In some of the newer barrios many of the patios contained an outhouse in the COrner as well as a laundry area which generally consisted of a tub or sink, usually homemade, that was mounted on a wooden stand. Here the clothes were washed, people bathed, and kitchen utensils and dishes washed. The water was obtained by either dipping from a barrel or (if a water main was near) from a rubber hose attached to a water outlet at the front of the house near the road. Very few hOuses were observed to have'plumbing. 48 In one barrio the drinking water was brought in by barrel on horse-drawn carts in which households would have to purchase their water for cooking and drinking. Some- times a well was dug in the front yard near the laundry area and water from the well was used for laundry and other household chores. At this location waste water could easily be drained into open sewers that ran on both sides of a narrow dirt street. Many of the dwellings appeared to be shared with domestic animals such asdogs, cats, pigs, chickens and ducks. Rodent and insect infestation appeared to be very common. Most of the observed houses had a minimum of furnishings. Most frequently there was a wooden table, several chairs and benches, beds, clothescloset, (either Open or in'a portable close closet). In the kitchens cooking facilities and utensils were limited and there were storage shelves on the walls on which.to place articles. There were no ovens observed and little evidence of storage areas for food but nearly 30 percent of the household's had refrigerators. Thus, the other 70 percent of the households had to purchase perishebles on a day to day basis. , Additional data from the PIMUR study were used from. the 70 households in this study to determine household 49 items they now possessed and items they hoped to possess within a six month period. A stove of some type, electric or karosene appears to be in most of the hOmes, as well as irons and radios. Twenty households have arefrigerator with five mothers indicating they hope to have one in six months.’ A sewing machine appears to be the most highly desired item to add to their household possessions. In some instances the mother may anticipate an Opportunity to add to the family income by doing custom dressmaking in the home. Table 4.8. Household items in 70 households Number that Number that Item already .hope to possess y pOssess in ' 6 months Stove, electric 27 ‘2 Stove, kerosene 44 . Refrigerator 20 .-5 Washing machine 3 6 Ironv 63 - 1 Sewing machine 26 17 Radio, electric 50 f 3 Radio,-battery 23 - Record player 14 . 4 T.V. set ' 12 5 Source: Data from PIMUR household survey, 1969. Other unpublished data from the PIMUR study available on 52 of the 70 households gave some indication of what 50 the mothers considered to be their most urgent needs and what they would buy first if they had an increase in salary of 200 pesos per month. Generally, they said they would Spend the money, first to buy food, second for education '(tuition, books), and third to buy articles for the house. The need for money for education is due tO the fact that public schOols are not available to all children of school age. Hence, many families find it necessary to pay tuition to send their children to private schools. CHAPTER V SURVEY FINDINGS This study was directed toward four qUestions regarding child nutrition problems in Cali, Colombiai' 1.. What are the feeding practices USed by mothers in low-income households with children less Ithan five years of age? 2. What are the Opinions held by these mothers .concerning specific feeding practices? 3. To what extent have mothers adopted new child feeding practices and from where do they receive information regarding child care?d 4. What suggestions can be offered fOr programs to improve child feeding practices and to identify problems for further study? The survey findings for the first three objectives are contained in this Chapter. The fourthObjective will be presented in Chapter VI, Summary and Conc1usions. Child Feeding Practices The child feeding practices summarized in this chapter 51 52 were based upon survey infOrmation from 70 mothers' caring for a total of 120 children less than five years of age. In most tables concerning feeding practices the basic unit of observation is the child. In later sections on Opinions and information sources the basic unit of observation is the mother. - Feeding Practices at Time of Survey At the time of the survey all of the children under 12 months of age were being fed on the breast or bottle Or some combination of these methods of feeding. Only three children out of 120 were being exclusively breast fed while another six were receiving a bOttle to supplement the breast (Table 5.1). Seven of the nine children receiving the breast were less than 12 mOnths of age. Two-thirds of the children were receiving at least part of their food from the bottle while 31 percent were receiving nearly all of their food "at the table". Most of the table-fed children were over three years of age althOUQh the transition to table feedingwas beginning as early as 13 months of age. Nevertheless, 45 percent of the children in the three to five year age range were still receiving a bottle. . IThe person interviewed was the One having primary responsibility for child rearing. UsUally this was the natural mother but in some instances it was another member of the household. See Chapter 1, page 4. e.an .AM In: _m a. MN. k.s .o ..e.~ m. co. ea. Jake» m— m— w 0— I I I I I I 4N mu 00 I m: m —— m— m— I I I I I I NN mN w: I hm m o m. m. m o - - - - ma AN om - mN n.o — m —_ N m N.O — 5.0 — m— ~N 3N I M— - - - - e m e m m._ N m. e_ N. - a ems “as? fish sweet whamamm ates a smut was“; amoeba”? Banshmemaa mc_ooom mo oosuoz _ma_ocmcm >o>czm mo oE_u um_Oe_:o mo.omo >3 woo_uudca mc_ooou o_mcu _mauu< ...m o_nmh 54 Of the 120 children in this study eight had been exclusively breast-fed following birth and 19 had been bottle-fed indicating that 93 children received combined feedings from breast and bottle until weaned from the breast. Weaning From Breast It was found that 40 percent of the children that had been completely or partially breast-fed were weaned from the breast by three months of age (Table 5.2). .By age six months 52 percent had been weaned and by one year of age 80 percent had been weaned. It is apparent that many children were breast-fed for relatively short periods of time and then shifted to other methods of feeding. This pattern of child feeding is similar to that reported in another study based upon a city-wide survey of mothers in Cali. In this earlier study Weiss (23) found that 45 percent of the children were being weaned before three months of age and 59 percent before six months of age. The reader should note that Weiss' sample included families at all levels of income whereas this thesis study was limited to low-income families. . I I I MOthers with more educatiOn and incOme tend to wean their babies earlier than mothers with less education and income. Thirty-three percent of the mothers with four years or less of education weaned their Children by age 55 Table 5.2. Age of child when weaned from breast age of - - child . No. of ‘ Percent months ‘ Childrena 1 15 . I f 16.1 2 9 9.7 3 13 . 14.0 4 I " 1.1 5 4 . 4.3 6 7 7.5 7-12 26 _ . 27.9 13-18 12 *‘ _ 12.9 19-24" 5 ‘* -‘ 5.4 25-36 1 'g. 1.1 ITOTAL , ' 93 ‘ x 100.0 aBased upon 93 children that had been breast fed and weaned prior to survey. 56 three months while 45 percent of the mothers having 5 or more years of education said they had weaned their children by age 3 months. Similarly, 56 percent Of the mothers In families with more incomes of more than 200 pesos per capita per month weaned by age 3 months while only26 percent of the mothers in lower income families had weaned by age 3 months. There was no difference in weaning age when related to the ages of mothers (See Appendix A, Table l). Fifty-four percent of the children were gradually~ weaned from the breast, while 38 percent were weaned all at once (Table 5.3). The major reasons given for weaning was that the mother did not have enough milk for the child (20%) or that the child rejected the breast (17%) (Table 5.4). Nine mothers said they weaned their children by no longer sleeping with the child and three used a bitter herb on their nipples to discourage nursing. Bottle Feeding _ While 112 of the 120 children had been bottle-fed or partly bottle-fed, only 35 percent were taken off the bottle by the mother (Table 5.5). There seems to be little attempt to take the child from the bottle until he rejected it himself as occurred in 64 percent Of the children that had been taking the bottle (Table 5.6).- 57 Table 5.3. How child was weaned from breast W How Child was Weaned Number , of Childrena ' Percent All at once . 35 I I 37.6 Little by little ' 50 I . 53.8 Did not wean 8 ' 8.6 TOTAL 93 . ‘ 100.0 aBased upon 93 children who had been breast fed. Table 5.4. Mother's reasons for weaning from breast Reasons I - Number _, .5 Percent of childrena Child rejected breast l6 1' A 17.2 Not enough milk 19 ... _ 20.4 Child was ill 4 :" 4.3 Mother works 2 w A I 2.1 Mother - pregnant 8 ' ' 8.6 No response 44 ._ 47.4 TOTAL' ' 93 - . ’ 100.0 3Based on 93 children weaned from the breast 58 Table 5.5. Age of child when taken off bottle Agemgntfis"d ghiigfeng ggPercent l - 12 5 14.3 13 - 24 12 . 34.4 25 - 36 8 22.8 37 - 48 8 22.8 49 - 60 H;__ 5.1 TOTAL 35 : 100.0 6Based on 35 children that had been taken off bottle Table 5.6. How child was taken off bottle. Method of Number of Weaning. Childrena . Percent All at once 10 10.0 Litt e‘by little 25 22.0 Child did/will reject 71 63.0 No respOnse 6 5.0 TOTAL 112 100.0 aBaSed on 112 children that had taken_the bottle 59 The bottle is often given as a supplement along with table feeding to 43 percent of the children receiving their food from both sources with age ranges of 145 years (Table 5.1). , Most mothers (63%) feed their children at regular hours, while 37 percent say they feed thetchild when he is hungry. The number of feedings per day per child range from three to nine with almost 50 percent feeding six times per day. The mOther usually prepares the bottle but in some households there is help from other household members. The mother generally feeds the small child if he needs assistance. I An attempt was made to determine the ingredients that went into the bottle for the 80 children that were receiving the bottle at the time of the survey. ,The foods used in the preparation of bottles (teteros) and gruels (coladas) are shown in Table 5.7. Teteros, which are basically milk, or milk and water, may be reinforced with a cereal product and sweetened. Coladas are basically the same as teteros but thickened with a cereal eiflour or corn starch product (Maizena). _ I 4 Seventy-four of the 80 children were receiving milk in some combination of ingredients fOr their principal food intake. Dried milk appears to be the most common fonn 60 Table 5.7. Foods used in bottles (Teteros) and gruels (Coladas) - Number ofChiIaren5 Food BOttles ' rue o a as (Tetero) .. used in bottles (Tetero) Dried milk preparations Klim-(whole) 21 ' 14 526 (dietetic) 3 SMA 2 Liquid milk Raw 9 " lO Pastuerized ll 4 Supplementary foods lncaparina 5 Colombiharina 4 Duryea 5 Cereal preparatiOn Superbaby 2 Maizena‘ 13 Oat-meal 12 Flours Barley ' 1 A > 1 Plantain ' 5 Milo 2 ' Wheat _ l_ Flavoring . White sugar 6 14 Panela 5 Cinnamon . l . l7 Agua-panela 21 8Based on 80 children that were taking. the bottle at time of survey 61 of milk used in the preparation of bottles (Table 5.7). One-half of the 80 children were receiving reconstituted dried milk with 5 of that number getting a dietetic dry milk. Thirty-four children were gettingliquid milk with raw milk being consumed by 19 children and pasteurized milk by 15. ' Proteinbenriched foods' (lncaparina, COlombiharina and Duryea) was less frequently used than is other cereal preparations (oatmeal, corn starch and flour). A typical formula would be a combination of dried milk, water, thickened with maiziena, sweetened with white sugar and flavored with cinnamon. The use of aguapanela, which is a crude brown sugar dissolved in water, is given the child with or without milk. Nearly all mothers had a high regard for milk as a food for children after weaning from the breast. Only one "mother", a grandmother to the child, did not feel that milk was important after weaning. I Fifty of the mothers reported that they were buying milk regularly, but 12 of this number were buying only for the youngest child in theh'household. Eighteen mothers indicated that they bought milk when they could afford it and two never bought milk in any form. 'lnformation on high-protein supplementary foods is found in Chapter 11, pages 17 to 20. 62 When asked about the form of milk thatthey bought, eighteen of the mothers mentioned that they purchased milk in two forms, most generally a combination of dried and liquid milk, with the dried milk being used in tetegg for the youngest child. I Dried milk costs almost twice as much as liquid milk and for the city as a whole powdered milk consumption is less than 10 percent of total milk intake and is used primarily for infant feeding (19, p. 158).. This form Of milk is usually available on the shelves.of most neighbor- hood stores and local markets. I Fluid milk is most generally sold in two forms; raw and pasteurized. More than one-half (56%) of the Cali . fluid milk supply is distributed as raw milk, with the other 44 percent being pasteurized. Raw milk sells for about 15 percent less than pasteurized milk and is extremely variable in quality (19, p. 158). -.~ Raw milk is often sold in "expendiosV (specialized milk stores) usually located in a house or garage in the low-income barrios where it is brought in by truckers. Only 47 percent of the expendios use refrigeration and the milk is dipped or poured from large containers into small buckets or kitchen utensils to be carried home for family use.‘ This differs somewhat from the middle and upper income 63 barrios where the raw milk is often delivered to the households by truckers. In the expendios as well as house to house delivery a dipper is used to measure the amount sold to each customer. This is an unsanitary practice and also facilitates cheating on the part of the dispenser. Adulteration of raw milk is estimated toaverage more than l0% before reaching the consumer (l9, p. l65). Pasteurized milk can be bought at most neighborhood stores by carton or bottle or a part thereof. PIMUR found that one-half of the pasteurized milk is distributed through personal service stores with another 3| percent home delivered (19, p. I63). x Some of the reasons cited by surveyed mothers as to why certain forms of milk are bought wereé~ raw milk is cheaper; pasteurized milk is best for the child and most easily obtained; and powdered milk is best as well as cleaner (Table 5.8). J Education seemed to influence the form in which milk was purchased. The mothers with more than four years of education indicated they used pasteurized milk because it was cleaner, best for the child and the most easily obtained. The mothers with less than four years of education tended to use more raw milk because it was cheaper and they liked the flavor. The use of powdered milk was about equal with both groups considering cleanllness and best for the child as its main qualifications. (Appendix A, Table 2) 64 mo show 020 cos» ocoe pom: mcozuoe cuou:m_wo .lmrlllhmz. ucoeeou oz ban um: _. _ __ m m m __ m .lLNlllhmzllLNI,.oz vo:_muno >_mmmm commune umoz .x__E o~ J. __ m _: mu vocuozom _N m. n m .m mm qu_c:oummm om _N 30a Mr. .ozILNII.oz LNI .oz o__;u . muc_m: ecu umom cocmo_o measuoz usm30m x__: . mo consaz no Econ .mc_m: LOm chmmmm Ecow cm_:u_ucoo ozu momma ecu chmmoc new x__E mo mELOm ucocomm_o mc_m: mcozuoe mo guessz .m.m o_nmh 65 High_Protein Preparations High protein supplementary foods were being used by almost 30 percent of the mothers interviewed. Nearly 90 percent knew about such foods and said they had used one or more of the different products of this type (Table 5.9). There were three main types of highsprotein, supple- mentary foods on the market in Call at the time of the survey, Colombiharina, lncaparina, and Duryea (See Chapter II, pp. l7-20). Questions were directed to the 70 mothers as to whether they knew about these products and towhat extent they used them. ' Colombiharina, the locally manufactured product was known by almost 75 percent of the mothers with slightly more than 50 percent having used it. Only seven percent were using it at the time of thesurvey and thought it was the best high protein food supplement. ‘Colombiharina has, a limited market and is not always available in the stores. lncaparina, a product made by the Quaker Oats Company, has been marketed in Colombia slncel960.' Ninety percent of the mothers questioned knew about the product and over 75 percent had used it at some time, but only eleven percent were using it at the time of the survey._ Nevertheless, 4l percent thought that lncaparina was.the best product. A new product, lncaparina Blanca, was being placed on the market with changes in ingredients to improve color and taste appeal. Results of the market teSt is not known by the researcher. 66 Table 5.9. Use of supplementary foods by 70 mothers _L Level of ‘Product. Knowledge ' and Use tolombTharina lncaparina ‘TUuryea No. % No. No. Don't Know -. ' About it l6 22.9 2 2.9 27 38.6 Know about it But Have Not Used l6 22.9 8 ll.4. l2 l7.l' Know about it and - Have Used 36 5|.4 55 78.6 25 35.7 Using NOW 5 7.l 8 ll.4 . 8 ll.4 Best Product 5 7.l 29 4|.4 l5 2l.4 67 Duryea, a new product, was being test-marketed in Cali, at the time of survey. It was produced and sOld by Maizena a Colombian firm owned and operated by CPC international. The principal ingredient in Duryea is opaque-2 corn with dried milk added. Slightly over 50 percent of the mothers knew about Duryea and 36 percent said they had used it with ll percent using it at the time of the interview. Twenty-one percent considered it the best product. Duryea does not require additional milk to be used in the preparation of a colada whereas, Colombiharina and lncaparina give better nutritional value when prepared with milk. 'All three products are prepared.as coladas in bottles by boiling with milk, milk and water or water for 20 minutes with addition of sugar for sweetening. Colombiharina and lncaparina are sold in bulk form in retail stores at two pesos (approximately l2t U.S.) for 500 grams while lncaparina Blanca sells at two pesos, 20 centavos for the same amount. Duryea is_a prepackaged product selling at a higher price, two pesos, 80 centavos for 250 grams, however, the Duryea contains dried milk, while the other two products do not. Other Foods Fed to Children ‘ Much of the food given children under five years of age was part of the family diet. 'Some foods are specially 68 prepared such as eggs that are boiled fOr 75 percent of the children and fruit juices. Meats, beans, legumes and tubers are often cooked in soups and the softer portions are fed to the young children. Eighteen percent of the mothers said that they ground meat for the children. Coladas are often prepared with potatoes, rice and other soft starchy foods (Table 5.lO). . According to the mothers 75 percent of the children received both meat and eggs. However, the PIMUR data suggest that low-income families are unable to provide meat and eggs regularly for the family members. it appears that foods such as meat, rice, tubers and legumes are consumed as family food while eggs, fruits, vegetables and high- protein supplementary foods are prepared for children apart from the family food preparation. .6 ' I ‘ Weiss (23) indicated,in a table of foods frequently eaten by children the day before his survey,that rice and meat were the most commonly consumed foods and the children start at weaning time on this type of.food. Eighty-three of the lZO children were receiving some- thing to eat or drink between meals (Table 5.ll). It appears that the bottle, often panela water,is the most commOn offering with fruit juices andcoffee mentioned as second choices. Mostly liquids rather than solids appear to be given children between meals..‘ 69 .coco_w:u cu. __m con: cameo mommucuocomo I I . a m I I I I :_ , o. _ m. . «u «3 0m neonahIm053moa I I _I _ I I I I I I o_. N. .o... N. ..mneosa_ I «_mutuu. I I _ _ _ _ I I m. m. m m o o_wo_eoeumu> :o_.u> one coucu I I I I I I mm mm m 4 I I awacm I I I I I I I I I r a. u. I I mecca >cmucoEo_ooam _ mu cm I I I I I I _ . I I mmmu m a w m m. NN m a N: om you: N, .02, NI .0: N, .ozI Ni .02 INI wmz, N, .02, .o vo_cu __0m ocaoto moo_ow outs; mono—00 o30m mooom mco_umtmaoco. mo tongue ocm moOOm Lm_:o_utma co>_m coco—_go __m mo ucoucoa one consaz .o_.m o_n0h 70' Table 5.ll. Foods given the child between meals Foods Given Number of Childrena lst Choice _ 72nd Choice Bottle ', 35 ...”b l Milk in'Glass 7 I .67 a Coladas , 4 l 2 Cereals and .. ' Breads ~ 2 ‘ » . l2' Fruits I ~ ‘ I. Fruit Juices 5 '-,' 26 Chocolate 3 .4 6 Panela Water 24 '.'l. 5 Coffee ‘ 2 5.”. l5 Whatever - .6 . Available ' l T ” 5 No Other Food 37 . f 3Based on information on l20 children in survey. 7l Feeding the Child at the Table Eighty-eight out of the l20 children took part of their food at the family table (Table 5.l).- Not all of these children ate all three meals at the table. However, it does appear that over 70 percent eat all three meals at the table with other household members (Table 5.l2). Fiftyrthree of the 70 mothers said-that the younger children were served meat before other family members were served while 30 said that the father was served first or at the same time. According to the mothers the children under fiVe are the major consumers of milk while children over five are less likely to receive milk. This is also true for other family members (Table 5.13). Feeding the Sick Child The mother was asked what fOods or remedies she would give a child sick with fever, stomach pain, and diarrhea. Several mothers mentioned two remedies(Table 5.l4). The use of toasted cereal water for fever was the most common remedy. The grain (rice, barley or milo) is toasted, then boiled in water making a broth, this is given to the child to drink. This cereal water is also given as first choice for the child with diarrhea. Herb tea and lemon water are often given for stomach pain and diarrhea. M32. @2129. .(a home serum that is boiled water with sugar and salt added) is given as second choice for diarrhea. This remedy 72 Table 5.l2. Presence of children at table with family at mealtimea M Meal Children at Table Children Not at Table .No. ‘TPercent *No. '. If TPETEEFT_ Breakfast 69 78.4 l9 . 2l.6 Lunch 63 71.6 25 - .4 28.4 Dinner 72 8l.8 l6 ".. l8.2 aBased upon information about 88 children receiving at least one meal a day at the table. 73 $305030... on .05 E ..wcosuofi so...» .Hmomcoamec. .eaas.a..IaI b.0eehsez c. mcocuo memo» m I coco—“cu + mcoo> m auto—_co cacao: cocoon mm o . m .m an _ a m. N. m o o o :m o o a m. mm m: o _ N m. ~_ 0 m ow mu mm o a m m m m m. mN m— Nm o N o_ o o. m A 0N 0m .02! .oz nmz, .02, .02, .0 .oz .02, . = ,.oz uncommom cu: can ocu um. omco mum sun can vcu um— oz 0: s__z.eo mcz>tam umoz mo mcm>com own—ocomao; uo>o>cam c_;um3 x__E use yous mcm>c0m mo cuoco xcmc ugh .m_.m e_bae 74 .mcozuoe as Eccmmomcoamoc vacuum use umc_m con: bummed as ONI dN, as as as 4o_cmn qu_cv Loam: _oocuu ooummOh mou_:m umacu move—cu ma30m .oz Immmi .02 one .02 .oz mmm umb .02 iv...“ aesttmto ;b_s b__;u came semeobm aa_s b._;e tb>ae.;a.s b__;u .02 um_ boom mo oa>h mambo—_gu xo_m cu o>mm mcozuos muoou .:_.m o_nm» 75 .is often recommended by health workers and doctors to prevent the deletion of fluids from the body during a bout with diarrhea. , Opinions Held On Child FeedingiPractices The 70 mothers interviewed were asked to express their views and Opinions concerning specific child feeding practices and certain foods. These responses to open ended questions were written down by the interviewer in order to gain some insights as to why certain methods of feeding were being used. ‘ Seventy-seven percent of those interviewed thought .that there was a tendency for mothers to shift toward bottle feeding rather than breast feeding.- Over 50 percent thought this was because mothers did not have enough milk to feed the child while another l7 percent said that it was probably due to the "bad diet" Of the mother. Twenty-three percent felt that breast feeding the child damages the mother's body and breasts, and l4 percent said that mothers sometimes work and cannot'breast feed. Only seven percent thought that mothers breast fed as much as ever beCause it was best for the child. Sixteen percent did not express an opinion, because they did not know or had not thought about it (Table 5.l5). 76 uaonm co_c_ao cao> m_ yon: :~>ucoocou m_£u :wfiflum umMOLD CMSU LflzumL vOOm M qufl. cu mcocuoe to» omccmo cao> cw >ucoocou o m_ «Lesa xcmzu :o oo:IIco_umo:oo ill‘ oo.omd om 4o coca egos 4..“ m 02 new» umooco mcosuoz m~.:, ..m ; >~o_,otm.meuauoz , :_.u m camcocum one ;u_oo: Lou boo mc_mc:z m~.:— 0. too» ammocn uoc ooIIxcoz mcosuoz om.- m. mummoca one m_.~n :m mo> mo_oon mc_:c mc_mc:z :_.m. N. muo_o soon: cu use main .3 V: _s 335 6: mtozuoz mo mcosuoz mo ucoutom. consaz mco_c_ao m.to;uoz .ucoocom consaz momcoamom s coco—.50 boom ammocn coca Locum; o_uuon ou >ucoocou o_n_mmoo ozu uaonm mcomc_oo nausea: .m_.m 0.3m» 77 Meat, eggs and dairy foods were thought to be the 'best"foods to feed the child after weaning. Fruits and juices as well as soups were also considered important (Table 5.l6). ‘ When making a comparison of age and education of mothers as to foods they thought lbest" for the weaned child, there does not appear to be an appreciable amount of difference except for the use of green vegetables. Younger mothers with more than four years of education thought it was more important to use green vegetables than older mothers with four years or less of education (Appendix A, Table 3). l. Fortyéseven percent of the mothers believed that they had been better fed by their mothers than they were feeding their own.children (Table 5.l7). They feltthat the reasons for this was that food used to be cheaper and more plentiful .than at the present time. Thirty-two perCent responded that they fed their children better than their mothers fed them because they prepared and cooked the food better ' while 20 percent felt that their feeding practices were about the same as their mothers. _ Almost 63 percent of the mothers did not think there were any foods that were considered ”bad" for the child. 78 Table 5.l6. Foods thought"best"after weaninga W Foods Number ' .Percent of Mothers ' Coladas. 2l "-"30.oo Soups 4 37 I ' 53 Meat-fish ' 59 .' . 8h Dairy products ' 49 4 70 Eggs ' 63 ' , I 90 Fruits a Juices 49 ' _ 70.00 Green vegetables 3 33 V“ '47 Cereals 8 Legumes 33 a 47_ Sweets 5 Oils ‘3 ' h aBasediupon open ended question, "What foods do you think are "best" for the child after weaning?" 79 app—_gu n.0c03 :o>_co;3.cuzuos Lao>>o.oucea0ca.mo00m ecu coca neocomw_v ouo cocv__su cao> tam.ocoa0ce 30>.mv00m oz» xc_cu :o& oo: voxmm couumeao echo. I _ — zocx u.coa I oN :— _asuu 9:034 a a _ e m _ am 2 .533 mooom 05m couuon tom 2 m. m _ o 3 . mm .6505 to... ucmocan< zocx co_c_ao o>_mcoQXm co_umLoouum >ocoz o_om_mm>< x measuoz mo co_c_ao uhcmDI 02i mmog boon cuuuomI ocoz, ouoe boom . consaz .mtocuoz mco_c_ao m.co;uoz mcosuoe to; mo omosu o» oocooEou mo moumuumca mcmoouu o__:u to; uaonm mco_c_ao mcocuoz .n_.m o_ooh 80 Six percent felt that if the food was properly prepared and was well cooked it could never be "bad".. However, 22 of the mothers thought there were some "bad“ foods for children suCh as dried beans or lentils and thick soups because they were thought to be too heavy for the child's stomach. Agua panela seem to be considered "bad" by ll mothers for several reasons such as irritation to the stomach, gives diarrhea, gives diabetes, too heavy to be digested, and has no vitamins (Table 5.l8).” Adoption of New Practices Changes in patterned ways of behavior are difficult to measure particularly the extent to which new practices are adopted. An attempt was made to determine if the 70 mothers in this study would accept changes and to what. extent they have made these changes. t1 . Mothers were asked if they would buy more of the same food they are now buying to feed theirfamilies or additional foods if they had more money with which to purchase. "Most mothers said they would buy more beef, milk and eggs and add chicken, fish, butter and cheese to the family diet. Very few said they would purchase more legumes, tubers and cereals. Several said they would add sweets and.other miscellaneous items to the family diet. ‘.Thus, it appears that animal protein foods are highly preferred by most of the mothers interviewed (Table 5. l9). 8l .mcosuo: -,wo momcoamou ecu co oumomo ._ _ , I N ouweou 4, _ z.._ .... A ._ .._ caboose : w .. . . _._ use memento _ s ~ . I .. Velez, emu. co>_4 .oq_cbj _ . _ moon—cu Lao—m m m_ouc_4 oco mcmom . N N N _ : m_ocmo mam< N N mum—ouocu m esom xumea mc_EMu_> oz ooumomwo uoz mouunm_o mosctm_o cumEOum mm: >>muzlomh . mo>wui mo>ku .moumwhcu_ mco_c_oo.oo_u_omom mc_o_oxmmcocuoz mo LonE:z, . ._ , ._ mooom mc_cauz teeth e__;u toe same: uzmsoeu auooe .m_.m u_aae 82 Table 5.l9. Foods that mothels said they would buy more of or add to the diet i f more money were availablea ‘ w Buy more '} Add this Food of _ food No. Percent No. Percent Beef 4l 58.57 .4 T 5.7l Chicken 3 4.57 47 67.l4 Fish 2 2.86 43 6l.43 LiVer 3 4.29 l4 20.00 Milk 37 52.86 ‘lO - l4.29 Eggs 25 35.7l ' l6 22.86 Butter i6 22.86 ' us'” 64.29 cheese iS 2i.43 an ‘ 62.86 Fruits and '4 I Green Vegetables l6 22.86 l7‘ 24.29 Legumes and h -' Cereals 3 4.29 J 3 .4.29 Cookies- " Crackers O O eiO l4.29 Gelatin- sweets and ‘; canned goods 0 O .217. l0.00 8Questions asked were"lf more money was available for food what food would you buy more of? What foods would you add?" 83 Although most of the mothers considered it very import- ant to give the child milk after weaning Sl percent agreed * that there might be foods more nutritious than milk. Thirty-six mothers named one or more foods that they thought more nutritious than milk; the most often mentioned being high protein supplementary foods and special dried milk mixtures (27%), meat and fish (l3%), and eggs (9%) (Table 5.20.) w ' . Mothers were asked if they would use another food as nutritious as milk if it cost the same as milk. Eighty- three percent said they would and 87 percent said they would if the food was as nutritious as milk but cost less. The high percentage that would buy highly nutritious foOds other than milk suggests that there is a market potential for high protein foods for children. s The Opinions expressed by the 70 mothers about the three high-protein supplementary foods, Colombiharina, lncaparina, and Duryea were responses to questions directed to them by the interviewer in order to get some insights about how they perceive and use these products for their children. lncaparina is the most widely known and had been used at some time by nearly all the mothers. Twenty- seven mothers thought it was good for the child but l7 said their major objection to this product is that they did not like the flavor. Colombiharina, a local'product with a Table 5.20. Foods that mothers thought to be more nutritious than milka Foods Number of mothers8 Percent Fruits 5 juices 2 2.9 Vegetables - Legumes - Soybeans 6 8.6 Special dr. milk formulas Supplementary foods 20 27.l Dairy products 4 5.7 Eggs 6 8.6 Meat-fiSh 9 l2.9 Solid salty foods l l.4 Coffee l l.4 3Some of the respondents listed more than one food that they considered more nutritious than milk. 8S limited market, has been used by one-half of the mothers. Twenty-two thought it was good and eight did not like the flavor. Duryea had just been introduced on the market on a test basis at the time of data collection._ Nevertheless. over one-third of the mothers had used it and 2l considered it a good product. Comments such as; "no milk needs to be added" or "heard about it and plan to use it" were noted (Table 5.2l). A cross-sectional analyses indicated that older mothers with less income and education were the most frequent purchasers of the more established high protein foods, lncaparina and Colombiharina. 0n the other hand the younger, better educated and higher income mothers were more likely to be buying the new product, Duryea (Appendix A, Table 5). An attempt was made to gain some indication of the willingness of mothers to try new food products. When asked if they would try a new product, 50 percent said they would try it right away, 24 percent said they would wait until they heard good comments about the product and 2i percent said they didn't have much interest in new products (Table 5.22). Younger mothers with more than four years of education and low incomes indicated that they were more inclined to try new products although there appears to be an economic restraint on their ability to buy (Appendix A, Table 6). 86 _N .ooxLao mm m N _ _ m m m I I m N. __ N NN newcoeouc_ _m I I N m m N NN oc_cmz_nEo_0u co_c_oo o>_mcooxo OmaIcm_o oooooc OOOm ox__ auto—_zu to» Lo>m_m ox__ oooo uuaooLm 02 00h voomIOLOOI, x—~E oz,m00m yo: yo: Obi mzowuhuusz coworvzp mcohcpoo mao.Lo> mcwoho;,mcocu05imo LooEJZI, mooOm >LmucoEo_aa3m c_0uoLo 5mm: mcwotomot mco_c_ao .mcocuoz ..N.m 0.96» Table 5.22. Mothers reaction to the use 0 87 new products Comments Number .' of Mothers Percent Try right away 35 50.00 Use after hearing good comments l7 24.28 Don't have much interest in new products l5 2l.43 Don't know 2 2,86 No response l _ l.43 70 lO0.00 TOTAL 88 Mother's Sources of Child Care lnfOrmation In order to determine the child care information sources available to the mother, questiohs were asked about how often she used the local health center; where she took her children for medical care; who she asked for more information; did she listen to a radio, and did she have access to a newspaper. I Health.centers did exist in most lowincome barrios. These centers were staffed by social workers with medical doctors from the local area donating part of their time to attending patients. Classes in child care,nutrition and' sanitation are offered in some of the health centers. About 50 percent of the mothers say they had taken their children to the health center in their barrio, and 33 percent had attended classes on child care at either the health center or at the hospital in the preventive medicine. clinic. Seventy- eight percent of the mothers had radios that were Operating in their homes while 27 percent said they read a newspaper daily. Eighty-ninerercent of the mothers indicated they could read, but no measure was taken on their ability (Table 5. 23). " In order to gather further information on sources thrOugh which the mother learns to care for the child, 89 Table 5.23.” Number of mothers using particular information sources on child care I . Information Source 3' Number a of Mothers Health center in barrior ' 85.7 Take children there - ' 5l.4 Attend classes in child care I Health Center in barrio I =2l.4 Social Security Health Center 8.6 Preventive medicine Clinic at Hospital _ 2.9 m Received help from social worker _ l4.3 Radios that work in home ‘ 78.5 Take newspaper Daily * ‘ 27.l Occasionally ; 52.8 3Based on responses from 70 Mothers. 90 she was asked where she received her knowledge on how to feed a sick child as well as whom she cOnsulted if she needed more information. It appears that her information source.is most often her mother and the home environment. She is most likely to take her seriously Sick child to the hospital or clinic (47%) and to the doctor (I9%) if she needs more help (Table 5.24). i All but one of the mothers indicated that they would like to have more information on child care and feeding practices. 9i oo.oo_ oN oo.oo_ oN oo.oos oNw oo.oo_ oN u_aa_e¢ ma._ m m~.am :N om.~m Nm mm.Nm Nm >__smu oco OEOI a_.N o m~.a_ o. Nm.m a m:... m u_e__u .euz um mummm_u N .62 N .62, N .62 N ,wmz cowumEL0mc_ wave—zocx oc mostcm_o c_om .cu>om mo mOOLJOm. L: xmm Cu 053 . LUMEOUM .. o__;u xu_m osu mc_o00e co co_umEt0mc_ mo moot:Om .a~.m e_bme CHAPTER VI SUMMARY AND CONCLUSIONS Nutritional studies have indicated that inadequate nutrition, especially protein deficiency, inhibits the potential physical and mental development of young children. It is important that factors contributing to inadequate child nutrition be identified within households where children are nurtured in order to suggest changes in child feeding practices. V The major purpose of this study was to.describe and analyze child feeding practices among low-income families in Cali, Colombia. Information for thisstudy was based upon interviews taken from 70 mothers caring for a total of 120 children less than five years of age. The objectives of the study were: (I) to determine child feeding practices used by the mothers of children‘I under five years of age; (2) to determine opinions that mothers hold concerning specific feeding practices; (3) to estimate the extent to which mothers had adopted new feeding practices and to identify their sources of informa- tion regarding child care, and (4) to Offer suggestions for programs to improve child feeding practices and to identify problems for further study. ' 92 93 There were 552 persons in the 70 households studied, with a mean of 7.9 persons per household. The-number of persons per household ranged from three to I] members. Thirty-five households were considered nuclear families (man, woman and children) while 35 househo lds were extended families where most of the members were related and were sharing the same dwelling and pooling their income. More than one-half of the heads of the 70 households had lived in their present locals for more than five years. Less than one-quarter of the total persons in these households were employed full or part-time. Seventy-one percent of households had total incomes of less than 2000 pesos per month ($llO U.S. dollars).. Fifty-four percent of the households were receiving less than 200 pesos ($ll U.S. dollars) per capita per month or 36 U.S. cents per day per capita for all necessities.and one-fourth of the households have an average per capita income of l8 U.S. cents per day. . g In the 70 households, 40 children had died before reaching five years of age. Ninety percent Of these children had died before two years of age. 'Thus, the most vulnerable age range, as indicated by this_data, is from birth to age two years. 94 The "mother" interviewed was the person within the household that was the major care-taker of the young children. Her mean age was 32 years and the mean number of years of formal education was four. .oth ll percent of the mothers were employed outside their homes. She is the one that makes the major decisions concerning the foods used by the household. She usually purchases, pre- pares, and serves the foods used by all members of the family. ~ Sixty-six boys and 54 girls made up the total of 120 children less than five years of age in the households. The mean age was 2.6 years and the mean number of children per household was l.7. Child Feeding Practiceg‘ .. It.was found that breast feeding was Of short duration even though 84 percent of the l20 children in the studywere started on the breast at birth. Forty percent were weaned by 3 months and over one-half were weaned before they were six months old. By one year of age 80_percent of the children that breast-fed were weaned.‘ Weaning from the breast is most generally a gradual proceSs with the main reason given by the mother is that she does not have enough breast milk. This would suggest that the mothers diets may 95 be insufficient for her body to supply the demands made upon her by the nursing child and the data wOuld indicate that this may be true. Almost eighty percent of the mothers thought that there was a tendency toward bottle feeding rather than breast feeding. They believed that early weaning was becoming more of a practice and the main reason given was that mothers did not have enough breast milk or that it would damage the body particularly the breasts. It is necessary therefore, to give the child a bottle supplement and/or food from the family table. At the time of the survey only three children were receiving all their food as breast-milk with six receiving the breast and bottle combined. _ There appeared to be no differerce in age of the child at weaning when related to the mothers age. There was a difference which indicated that mothers with more education and income weaned their children earlier.- This may suggest that mothers with less income per capita would continue to nurse their children as long as physically possible because of the cost of supplying supplemental food for the child after he is weaned. Breast feeding might be encouraged if information supporting this could be made a part of child care information. 96 At the time of data collection 80 children were receiving the bottle as their total or partial food intake. For 23 of these children it was their total.food source while six were receiving the bottle combined with breast milk and SI combined the bottle with food-from the table. Milk is highly regarded by the mothers asta fOod to use in the bottle for the child. Whole dried milkaapeared to be the form of milk most often used. 'Raw andpasteurized milk were also used but to a lesser extent. The use of- dried milk is probably partly due to its cOnvenience, keeping quality and cleanliness, but at the present time in Cali, dried milk costs almost twice as much as an equi- valent amount of fluid milk. Ingredients other than milk that are generally used in bottles are cereals and flours for thickening, sugar for sweetening and cinnamon for flavouring. Agua-Panela (brown sugar water) is commonly used with or without milk as a bottle food. [angle is always available, inexpensive and considered a traditional dinner drink for the whole family. 1' Children are generally permitted to take the bottle as long as they want it. The mother usually prepares the bottle and feeds the younger child that needs assistance. Other household members are often inVOlved in this activity but to a lesser degree. The practice of permitting the child to take the bottle as long as he wants it gives him 97 supplemental food apart from family diet, but the quality of food supplied in bottles is often deficient. VThe food from the table is often combined with the bottle for the daily food intake of the child that has been weaned from the breast. Nearly every mother either buys milk for the younger child or does so when she can affOrd to. There are a few foods that the mother said she prepared specially for small children such as boiled eggs and fruit juices. The soft starchy portions of the family soup are frequently fed to children as well as liquids from coOked, dried beans. Rice, beans and potatoes are used as coladas (gruels) for the child because of their consistancy. This is the typical diet that_is high in carbohydrates and low in protein that is so essential for the Continued normal development of the child in his most formative years. Ninety percent of the mothers knew abOut one or more of thelflgh protein supplements (ColOmbriharina, lncaparina, and Duryea), but only 30 percent were using one of these products at the time of data collection.. Over the past lO years a great deal of information regarding lncaparina has been made available to the low-income families, using many methods of communication. I . ’Incaparina was found to be the beSt.known of the high- protein supplementary foods. It had been used at some time by as many as 80 percent of the mothers questioned, but 98' only ll percent were using it at the time of survey. There appeared to be little or no difference as to age, education or income of the mothers that had used lncaparina. The mothers that were using it at the time of survey were the older, better educated, but with less income. Colombriharina was known by 50 percent of the mothers while seven percent were using it at the time of the survey. However, it was the younger mother with more education and less income that was using it when interviewed. Duryea, a new product, was known by almost 40 percent of the mothers with ll percentactually using it. The users were young mothers with more education and income which was the target group for the initial introduction of the product. The more costly foods such as meat,.butter, eggs and cheese were highly desired by the mothers as foods best for children after weaning. There did nOt appear to be much difference in the educational levels Of the mothers as to which foods were considered best. HoweVer, yOunger V mothers seemed to have higher regard fOr the use of green vegetables as compared with older mothers.~ If mothers had more money for food they said they would‘buy more meat, milk and eggs and they would add chicken, fish, butter and cheese to the diet. There is little difference in the foods that would be increased or added by mothers with different ages or levels of education. 'The desire for more 99 expensive, high protein foods is evidenced, while foods such as cereals and legumes would be less affected by additional income. There is no doubt that the mothers strongly desire the animal protein foods which are the most expensive. They evidenced some knowledge of foods known to be high in protein, but the major barrier here is probably an economic one. Does the mother prefer these foods because they have certain prestigiOus value to her since she sees the upper classes buying them and she cannot? Does she really know that protein is important for the normal growth of her child? If so, then their use of plant proteins should be greater since the costs of these foods are within the posSibility of their incomes. Weiss (23) wrote that mOthers in his study did not consider proteins as the most important nutrient, while over 50 percent of the respon- . dents attached a high level of importance to vitamins. Eighty percent of the mothers indicated they would use another food if it was as nutritious as milk and cost _‘ was the same or less. The fact that almoSt 80 percent of Ithe mothers said they would use another.product as nutritious as milk with comparable prices would suggest that there is probably a good market potential for high-proetin supple- mentary foods. '6 One-half of the mothers said they wOUId use a new food product, right away. One-fourth would wait until they had l00 ”good comments about it” and the rest were not interested in trying new products. The higher educated, younger mother with less income would appear to be the one most likely to try a new product subject to her income constraint. Mothers may not place a high value On feeding their children a nutritious diet. Traditional practices, ignorance and economic restraints continue to be major barriers to changing food patterns. What the mother learns from her home environment she transmits to her children. Thus, it would seem logical that changes could be brought about with the young school-age child who is the most teachable and . innovative. This training should start early in the’ school and continue through higher grades in order to bring about better practices in areas such as; sanitation, health,child care and nutrition in their future households. Studies need to be continued on child behavior, phy- sical and mental deveIOpment as related to environmental factors within the households and communities. Close observation of interrelationships of households members ' could reveal information that is impossible to collect on the interview Schedule. In what way dOes the structure of . the household contribute to child feeding practices? How is the available food proportioned and distributed among individual family members and does the small child get his IOI ”fair share?" How can the mothers be helped to buy the most nutrition possible for the money they have to spend on food and would they accept the suggestion that Florencio (2i) brought forth in her Thesis concerning a reportioning the food that is commonly bought in order to increase the protein in the diet? Since most of the low-income barrios have Health Centers in which one-half of the mOthers interviewed said they took their children for medical care, it would appear that this is an area that could be greatly enlarged for a wider range of programs for child-care information. Thirtyathree percent of the mothers said that they had attended some type of class in child-care and feeding at Health Centers where sanitation, home impfovements or nutrition was taught by social workers. PINA (a National Nutrition Agency) with FAO (Food and Agricdlture Organization) funding is enlarging this program througthlasses for mothers with food supplements as an incentive for attendance. This could present an opportunity for related studies with mothers involved in these programs to evaluate adOption‘ of new practices and improved child care methods. Three-quarters of the households hate radios that were usable while one-quarter had access to a Baily newspaper. It is possible that programs on home improvements. sanitation, and child-care could be thansmitted over radio. Current prices of available foods in the market and sugges- tions for their preparation could also be helpful to mothers. I0. LITERATURE CITED President's Science Advisory Committee, The World Food Problem, Volume II. The White House, . . Government Printing Office, I967. p. IO. Schaefer, Arnold E., "Nutritional AspeCts of the World's Food Needs", The Land-Grant Universit and World Food Needs. University of Illinois, Special Pfiblication I3, I967. p. I6. . Johnson, Howard, ”Society, Nutrition, and Research", Malnutrition, Learnin and Behavior, Editors: Melvin Schrimshaw and JOhn Gordon, l968. Part.l. Colombia, Nutritional Survey, A Report by the Inter- departmental Committee on‘Nutrltion for National Defense. December, I96I. ’ Byrnes, Francis C. "A Matter of Life and Death," The Rockefeller Foundation anrterly,l, I969, pp. 5-55. Sanders, Irwin T., ”Institutional and Cultural Obstacles to Expandin Food Production and Meetin Nutritional Needs', in he Land-Grant Universit an World Food Needs. Special Publicatlon l3, University of llllnois, Mead, Margaret, Food Habits Research: Problems of the l260's. National Academy of Sciences, National Research ounCIl, Publication I225, I964. Monckeberg, M.D., "Effect of Early Marasmlc Malnutrition on Subsequent Physical and Psycho ogital Development". Malnutrition Learnin and Behavior, Ed. By Nevin r Sogglmsfiaw and John Gordon, The M.l.l. Press, Part 5, 9 o I '. War on Hun er, "Malnutrition and Intelligence," Volume IV, No. 4, April, I970, p. l6. Jelliffe, D.F., Child Nutrition in Develo in Countries. A Handbook for Fleldfiorkers, U.S. Department of Health, Education, and Welfare, Public Health Service, v// _ Washington, D.C., Chapter 5. PP. 7l-95. I02 ll. I2. l3. l4. I5. l6. I7. I8. 19. 20. 2]. I03 Behar, Moses, "Prevalence of Malnutrition Among Preschool Children of Developing Countries", Malnutrition, Learnin and Behavior, Ed. by Nevin Schrimshaw and* // John_Gor80n. lhe M.l.T. Press, I968, Part 2. Thomson, Angus M. "Historical PrespéctiVes of Nutrition, Reproduction, and Growth", Malnutrition, Learnin and Behavior. Ed. by Nevin SchrimShaw and John Gordon, lhe . . ress, I9 8. Part 2, pp. l7-27. Whitin , Beatrice, "The Mixtecans of Juxtlanuaca, Mexico” Six Cu tures: Studies of Child Rearin-, John Wiley 8 Sons. I933. PP. 555-690. ' Burgess, Anne and R.F.A. Dean, Malnutrition and Food Habits, Report of an International and lnterprofesslonal on erence. The MacMilIan CO., New York, I962. Richardson, Stephen A., "The Influence of Social- Environmental and Nutritional Factors on Mental Ability", Malnutrition Learnin and Behavior, Ed. by Nevin Schrimshaw and John Gordon, The h.l.T. Press, I968, 7‘ Part 6. 5 . F.A.O. Document, Education and Trainln In Nutrition. Freedom from Hunger Campaign, Basic Study No. 6, l962. Chapter 2, pp. 9-22. Simoons, Frederick, "Food Avoidances In the Old World", Eat_Not This Flesh, The University of Wisconsin Press, Igs—I . I h ‘ ‘ Mitchell, Glen H. "Aspectors Seleccionados de Ias Formas de Consumo Y Commercialization de Alimentos en Siloe, Area de Bajos Ingresos en Cali, Colombia," Monografia No. 20, Octubre, I964. '” Riley, Harold; Harrison, Kelly et. al., Market _ Coordination in the Develo ment of the Cauca alle Re ion--Colombia,‘Researéh Reportho.‘5, Eatin American Studies Center, Michigan State University, East Lansing, Michigan, I970. ”'8' Wray, Joe D. and Aguirre, Alfredo. “Protein-Calorie Malnutrition in Candelaria, Colombia", Re rlnted from The Journal of Tropical Pediatrics, oI. I5, No. 3. pp. 7W9. _ . 'Florencio, Cecilia A. "The Efficiency of Food Expenditure Among Certain Working-Class Families in Colombia." Unpublished Ph.D. Thesis, Department of Foods and Nutrition, Michigan State University, l967. 22. 23. 24. 25. 26. 27. 28. IO4 Inca arina. "The Low Cost Protein-RichFood Product." Special Bu Iletin, Guatemala, C. A., I968. Weiss, Andre. Director of Market Research, CPC International, Unpublished Data from Study of Weaning Foods in Colombia, I969. . Sinisterra, Leonardo, Colombiharina, Departamento de Nutricion, Universidad e a e. "El Programa Integrado De Nutricion Aplicada (PINA) g2 Colombia,”‘lnstituto Nacional De Nutricion, PINA- -l5, T I 5 McKay, Harrison E., Report of Activities 6/68-7/69. Human Ecolor Research Station, Cali, Colombia. Intersocietal Studies, Northweatern University, Evanston, Ill. ' . The world Book Enc clo edia, I962 Ed., Volume 3. Field Enter rises Educational Corporation, Chicago, Illinois, p. Andrew, Christopher 0. "Improving Performance of the Production- Distribution System for Potatoes in Colombia." Unpublished Thesis for the Degree of Ph. 0., Michigan State University, I969. pp. 4-5. APPENDICES III I ‘l l l\ I l l l 'I l l l [ [ III lull I 'III l l ll l l‘ I III. III Ill-TI Ill ill l I lili. I IO6 I.>com0umu umumNLOuuoLosu Luzuoe come c_ auto—.30 mo consac con: pumps oLo mOUOucoucoo echo Item enacts coon on; umzu auto—_cu mm.mc_cLoocou cowuoEcOucw com: oomomo Amzucoev memo acetamm_o um oocmoz oucoucoe mo .02 .. Ao.oo_, o.~ . o.~. .~.o_ ” o.o_ . N.o_ a.om mm +oo~ .o.oo_ I a.N_ N.a_; ~.mm ; NJo_ ono~_ . am; , mm_-om . . a «onuxuee. o.oo_ I Aa.~ IN.a_ a._~ N.o_ «In: N: -mIWII o.oo_ o.~ m.N m... «.mm m... m.mm _m an .mu> cm co_umu:ou o.oo_ I mIa a... m._m o.m_ Neww a: +Nw o.oo_ o.~ ..a «.4. m.o~ m.o_ m.mm ma NmIm_ mcmo> c_ om< seeoe oMImN o~-m_ m_Im_ ~_IN oIa MI. coto__tu tosses to mu_um_L0uumcmsu ocunuoe mo n: um; ...odumcmcu o_EOcouoIo_00m Ou ovum—0t umooLo EOLm oocmoz o_mno mo om< ._I< o_ooe Table A-2. I07 Opinions given by mothers why forms. of milk (raw- -pasteurized- -powdered) are used as related to educationa Years of Education Opinion 0- 4 years 5- 9 years (N=38) ' (N-32) Forms of milk Forms of milk Raw *Past. Powd. aw ast- ow .. Cleaner - 2.6 l0.5 2 I2.5 9.4 Best for - ' Child - IS.8 I8.4 - 28.l 2l.9 Cheaper l3.2 - 9.4‘ - - Most easily ' obtained 7.9 l0.5 2.6a 6.2, . l2.5 .- Like flavor IO.S 2.6 - 3.l’ 3.1 - Use, No .I Comment 5.3 I0.5 l0.5 ,‘3.I, 622 6.2w aQuestion asked was "why do you use this particular form of milk?” lO8 Table A-3. Foods thought best for child after weaning related to age and education of mother' Age of Mother Education of Mother l8-32 zrs 33+ yrs 0*N4 5-9 yrs. (N=3) (N-3u) (N629) iu-zzl Soups 50.0 53.0 52.6 53.I Colladas 25.0 32.3 ‘ 36.8 21.9 Meat . _ Fish 88.9 76.5 89.5 . 78.! Dairy L A . ‘ Products' 66.7 73.5 71.0 68.7 Eggs . 83.3 94.I 92.I‘ 87.5 Fruit 'V 72.2 67.6 63.1 78.l. Gr. Vegs.l 55.5 38.2 34.2 ' 62.5 Cereals ‘ Legumes 47.2 44.I 44.7 50.0 Sweets . ’ Oils 505 209 -- ' 90h aQuestion--”What foods do you believe are best for the child after weaning?” I09 . :Noom 30> p.303 mpOOm umcz ocm mo OLOE >3o 30> o_:o3 mUOOm umzz OOON LON o_nm__m>m >oc0E OcOE mm: Ococu m_:IIm:o_umo:om m.m_ I m.m I m.m. I m.m I m.m, I m.m_ I .060 .oc_um_um .muoozm.0m_z m.N_ I w.m_ I m.N_ I m.m_ I m.__ I m.m_ I mtoxomuu mo_xooU I ..m m.N m.m ..m N.m m.m o.N m.m m.m I m.N m_motuo _ . mossmog N.m_ ~._m _o.m~ m.m_ N.m_ 4.:m. m.m~ ..m_. m.o~ m.m~ N.- ~.~N no_onwmw> o.om N._m N.mN ..m. o.om N._m N.mN ..m_ m.ON m.m m.Nm m.mm omouzo o.N: 4.:m m.mN ..m_ 0.0m :.:m N.mN ..m_ m.MN m... w.Nm m.mm emuuzm m.m o._: N.:m o._m m.m m.o: N.:m m.mN :.mN N._: m.m_ m.om mmmm ..m ..mm N.MN N.Nm N.m ..mm o._N N.Nm N.:_ o.om .... m.mm x__z m.N_ m.m m.mN I o.mN ..m m.m_ m.m m.oN m.N :.m_ m.m uo>_u ..mm I :.mm m.m N.mm N.o m.mo I m.Nm I :.mo m.m nm_e m.Nm N.o o._N w.N m.mo NIm mImm o.N o.Nm m.m N.ww m.N cuxu_cu ..m, QIom .m.N_. m.mm, N.o ..mm m.m ..mm m.m o.om m.N m.mm comm oo<+ ,. ut_ Io: .ua. ..oo<_ anus. oo<. .oe. _ ooa ,_Iua_. oo< ..ut_ AmOmoe c_. mu_ooo\uc. cacao: mo.co_uooaom Lozuoz. mo om< mmLGLUOE m0 m0.um.I—0HUM._M£U O...— UGHN—OL mm 000% to» u-no_.o>m no; >ocoE OLOE m. ouooo to oummucoc_ on o_:oz umcu mooom .:I< o-nmh ll0 Table A-5. Opinion and uSe of three supplementary foods -- Colombiharina, lncaparina, Dureya as related to characteristics of mothers COLOMBIHARINA Characteristics Have “Knowledge ‘Using' No Thinks of mothers Used Buthot Now Knowledge Best se - 12— T T , ‘ r—T A e I _gT8-32 yrs. ' (N=36) 38.9 22.2 5.5 '* .33.3 5.5 33 yrs. + f ' (N=3u) 61.8 23.5 - i 11.8 8.8 Education' . VUFh rs. . . (N=38). 55.3 28.9 - '. l5.8 . 7.9 5-9 yrs. . _ ("=32l- “6.9, 15.6 6.2 '- 31.2 6.2 Inc/cap., . 5—Less than . 200 esos " (N-BS) 50.0 23.7 5.2 .. 2l.0' 7.9 More than 200 pesos ‘ (N=32) 53.l 2l.9 - 5 . 25.0 6.2 INCAPARINA A e W 8-32 yrs. ' ' ‘ . (N=36) 80.5 ll.l 2.8 5.5 30.5 33 yrs. + " (N=3“) 73.5 ll.8 ll.8» - 50.0 lll Table A-5, cont'd. COLOMBIHARINA Characteristics Have Knowledge Using No. Thinks of mothers used Buthot Now Knowledge Best Use % % r IT- T Education . (N= W38 78.9 13.1 5.3, 1 2.6 39.5 5-9 yrs. ' ‘ (N=32) 78.1 25.0 15.6’ 6.2 u3.7 Inc/cap. T‘Less than 200 gesos ."r (N=3) 78.9 7.9 10.5 ' 2.6 52.6 More than . 200 pesos ' (N= 32) 78.1 15.6 . 3.l ; 3.l _28.l DURYEA A e V _STB- 32 yrs “' . (N =36) 38.9 19.0 11.1; _ 30.5 .27.8 33 yrs. +‘ .g ' : (N= '3“) 32.3 lh.7 5I9-'_ hh.l ‘ 'lh.7 Education . .5 (N= “35% 26.3 l8.h 5.317; 50.0 l3.l 5- 9 yrs. 'j ’ . (N=32) 06.9 15.6 12.5 _. 25.0 31.2 Inc/cap. - ' ‘ *_Less than 200 esos . ~ , (N=3§)31.6 l5.8 7.9: hh.7 l3.l More than ‘ 200 pesos (N=32) no.6 18.7 g9;u- 31.2 31.2 llZ Table A-6. Use of new food products on the market by 70 mothersa ‘ j Characteristics Try right Use after No Don't of mother away Good Comment “Interest Know 2 2 .72 75—. A e 8-32 yrs. ~ . 1 ' (N=36) 55.5 22.2 22.2 - 32 yrs. + - "3 (N=3h) . hl.2 26.5 . 20.6 _S.9 Education (N-38V ° 07.4 21.0 ' 26.3 5.3 591'. . (N =3 fl) S3.l 28.l 15.6 - Inc/capita (Tn pesos) 50-200 1 . ' (N=38) 57.9 21.0 _, 1518 5.3 200 + * (N=32) h0.6 28.l ,- 28.l - aQuestion asked was "When a new food product comes on the' market do you use it right away?" . cuesronAnxo Eatudio do Fractious as Alimentacian eggs Nifios Manors. For :Dopartananto de Pediatria, Universidad del Valle . Wm da Ciencias Faniliaras, Michigan Stab University A. IDENTIFICACIUN FAMILIAR (Informacién del EstudioPIflUH) lelllro a la Entravista PIWR Barrio 013133160 Nival do Ingram Manson]. Familiar ___ manifioamenoraadastafioa WanifioaentreIOSSy‘ISafioe 'A ‘_______, Mini-m da persona: myorea de 15 afioa :~ Jafc a la familia --- Hanbra watt Edadcblamadecasa Moudaodmacifinwalmdecua) B . IM'MW FAMILIAR 1. can as llaman y cudles son lea adades d3 qua hijos viva. m do 5 afloa? Mantra EFT;W_ m'NaciIulnfo fi— ‘ Mesa: (1') (2) (3) (4) (5) - 2 - 2. Murié alguno de sus nifios como bebés o menoraa d3 5 afios? No Si Cuéntos y a cuéles edades? 3. Quién mas vive en su case ademés de lo: nifioa ya mancionadoa? a. Me podria decir cuél es su relacién con los'nifios menoraa? (padre, madre, harmano, tie, etc.) b. Dual es la edad aproximada y el sexo de cada one? o. Ayuda él o ella a cuidar a 105 nifios? d. Cuél es la actividod de cada persona —- (1) permanece en case, (2) eStudia, (3) tiene un empleo regular, (4) tiena amplao irregular?* a. Relacién ; b. - b. c. Ayuda can 103} d. 1 I Edud! Sexo nifios manure: .Actividad 1 = 81 Ea (1) g (2) f (3) i- (a) i , ‘__ 'T ._ 5 L) ”__ - _ - - (6) ‘ ... , W W... W -...-.,-.....WL_. --..-- (7) . . 1..-“--- ..--..-...- —.—__ L ——A -- o...- u‘mew-..-.-§{stm‘m ELMWW -L __ -____ L, -_ ..- -.—;_‘A m..rm a. Helacién b. ; b. ?E:lkyud§ can 108 , d ._ 3 cdad Sexo 1 nifios manoraa_g Actividad -> ”as... odb-o-. a . .“Fw. Ar. Lwtfi—mfi-o‘no i_‘ h- :--.~.-1 : ‘ F 9) ' V”. 0...... bWb-mn-O o J «to “o-Ch‘vo-jr-Mn- ...... Lo—h M“ “...-A»... --.-Q tout-“M (10) I ' ...-0'“ ..~0 ‘ C - O >0 "mint 0 t C 5‘ O v.4)- . -- -o-cna who-0.... - ._.. ".tha- .-. .... QuJL a.-- .-...t-.—. D ...‘C-‘ (11) i vP-no-uo-c-Q~o ...-..-“...sA—{b- u aso-an‘fik“ a no.--*{L‘.§*Op--L.-‘ .c ...-aualLuo-“Qs- M-~A¢.g-.c..u -Oa-1 (12) P.-- vaocxgmu- . no- o-u.‘.-qun ...‘ . . b.g\1Lum-m ..a“ - r..- n. . -.‘n—w em; a t Lariat-... -o-c.~...o~o . o O 0.01 (13) .w scan-0.041. tIAC'. a... --O—s+>~ a . . a o u o A.-_'b.t~c-++da.t-O-“fi‘fiu.L o -oa...&.o.rnooOsa-It-s-n-samo o..- suc1 (14) | I h..- ...n.c..‘.m-l..u a ... .- o o o g... two“...a 4.4.-UL"- u'uo s -0 coo-‘a .-. ‘I ...—W"... .-.-.0 O... “oh-02.1 (31 1a madre - o ama de casa—- tiane trabaJo fuera'de la casa .proauntl - ) a. Qué dies y a qué horas del dia estd usted fUBrg do 1: case an an trabajo? ...-db f Dias (Circulaj ‘““_“§5}§éfafiioximdhamentijr_- §w_~_ _ “w“- _h_.__ ...... #»-~mu Im-wuun—.”nwm t~C ...-s a... A.‘ “0“”--u-‘a.“oo-uo¢n- a‘-‘§ M -L'Oul I Q ‘ | ‘- .“OU‘A-Onfi‘- In-“-‘y.-_--..\‘ $.““.‘I—~“.-‘ ‘ -.‘A “ ~--. .‘-.‘-.’-“‘--I‘y ' M b-4-us—1..-H. h-‘ ...-4.-.... ‘ a. h... ...-.v J L— A-O-I 1 -.-.-‘o. 0-0 .... c -. ...-......“ a-T ~0-b‘x‘a." ‘.-‘ ".l- ...-s .-s O-rb-O Av Ivy “...: .....-.--4-.b1| . V . .40 ...-...;- s a ‘ .wuulv‘u-‘cfldafi—O-u. 0 Or-.. .4. “~~-- Tr H‘N-O-s no: s.--u~-‘.—-~.~o I-ht*-‘r~‘-u-1.“-.-‘o-~-~-.OU-. 5.0.-. C-va-O-u ~04. U004} I , l h-‘A‘..h ... o A. ...—.-- now. --a.- . 0. .......¢ ...—a up‘ 0 u...- ‘ 5.0..-Ww.‘a—4 . 0 CD. I.Qrmo—usin-On.’ . . D . I . ~m“~‘*u‘~-‘m.—U“ ——-—-— “—-— Mun-QM“: c. P959395 DE_A.}£E1\JTACIW meg (En Ias raspuestas indique relacionea de acuordo con 61 Cuadro 8.2!) 1. Ganeralmente quién decide en la Familia and-alimentoo so conpran? _-—A‘_ - A! ...-.- A ...-...- _.. “ m - _ 2. Generalmente quién compra las comidaa para 31 hogar? “-..-C“ - ‘..M;A“*A - ‘ —— —AAM- -—-— _— 3. Generalmente quién prepare Ias comidas para la familia? m”--~~§-. - --‘aOM-.w-‘ u-- A— - AMAAAM_—._- — -.- M- _ A A— —-~—.-- - “.... - 4 _ 4. (51 hey padre) Generalmente, qué comida tome ei padre con 91 reato de la familia? Desayuno I“ W... Almuerzo Comida ...—“w.- No aplica 5a. Cuales de los hijos menores de 5 afios comen en'ld menu con la finilia y qué comidas? -. .. _--..__A--‘ I 0.~“ Nombra o Namero del Jami—La- -...‘2..- --u.p.-._r£.— - - - -*-c— - — mnm°.....-...1 O ......A:A - ...-.-...nfilfin.‘ 0'. .{pcamu‘M‘-s'u hb"u-fi»‘m~M~-mswo.l0 . O... ...—o M~Q¢n o-Q-u-..-h.- . u. .y..‘..-Jbo—o on.-. “‘4‘. I. M‘&*~+“-bO--C C mnw-MI'U b... O '- .... I< .Lflo—n‘u‘éh‘ .. .-;.o a . -k-a.&a.lL . a -.s ;‘ fi§h‘.--“.g..dL .“u-.“ 5 ...—v ...-lo‘OJ-OIO-QI. 0.-.! J]- o a ..-..‘4. n a..- a... o o . l 4.. ..-.. n“- -u an a... h-..-¢.¢.c-. --hi—Q-Q--L‘u.l>.--J‘ ~D-fi‘¢.a .- 5.. .l.-.-.¢--. Comentario : ‘ .- “Q ..‘o U'“I.O-~ u‘ b- A. ... 0.‘--...~ o. t 54 o.!~-.‘--‘o. . I.Q.“...DOO .. b. « “O suuw... ‘QI‘0‘ ~----¢'-1-- .u‘I “ AHO-C-O- c -I CIA-Ub‘l ‘ O fi-Ow‘J ‘fi-.~ I-v ‘-. I-‘E'b UP. ‘0“- 5‘ -. . -‘fitfi-O—u- D's-“.... ..M.”‘ .u. u.r - n. 4 -..—..--.. §-a- ou.u.‘- U C- “...-....O—‘a JM-‘lh-MC-M- I M... -l 5b. Es comfin que los nifios menores coman en otra~caaa7 No _ 51 Explique dénde y go;- we?“ ‘ h‘._ _-A-__.—._— -LA--— -m‘w ”Mme-..” M “~w O- -..—.0 6. De qué manera sirve Ias comidas en la mesa - Pasamos la comida alradedor de la mesa "Alguna persona sirve laa comidas. Quién sirva? Q... --_~ ...-I m-m-Mum--mm ‘um-.u“w C-O— Q .~-- I O ...-Q».- w-“ufi... Wv&w‘WM.HM-‘O _ 5 - En qué orden sirve uated la comida a 103 difarantaa mienbroa do la familia? A quién sirve de 19 ..29- 39 etc.? __—A. _“ I Persona ......J 4 ...—... Padre J Rm ““ 15....“ .‘m-. ...-‘5‘- ..--‘- ...-‘4 Nifios ~ tpw -..-vr.-o.” h..~o-.~.—..bo~. . Mayores de 5 afios Dunn----- “an“... a- o a. .a Menoraa de 5 afios ”~a-a-n. ...»§ . I. arm- o .o a Otroa (Quién?) M1“. a on“... ... ..--'o—a-osu ‘1 ”l O O—Sfioi" w ....u or--. an-.. a a-‘ . 4‘4 7. ~“.m-sm..1 L. .-‘~. ..-“-.. “-- "“.~|~fi P. b46-‘~‘~-‘-‘ u 0 -..”-.. --~. . ‘5‘- bt-d ...-...oa -s‘s .- «.-.. ¢m a... M-U-;A-“‘- --. .- 0 ‘v. -.-. ‘n‘ l.‘ P I. L ~‘~- . ' OJ. »5 .---‘. “fifi-‘OoI- Orden :_ .‘e. '0rdan“"" ‘ Lacha “raw-.4L' *w“ ttttt .....- .J ”an.-. ....v-t .4 ya out .-MO-I.d 5...“... a..-“ on... o a-un.a—o.-mL-‘-A.ooc—. —A-A “‘4 ; pa- l- .-.. § A: .‘~ nL On. I.“ .. ~\bu‘ L . o...rr..u....-~. s a an. a“-. an... -—--“-Gor-- a a s . tbs. “Ha-...... v L”-I.- --...-4 a... a" 4 .b-‘uu- a... ..a. ...“-.. a. ...-n; hJL.““-uouu-A Varid Bate orden para la lache? No use leche No Si Cuél es el orden para la leche? (Contestar an al Cuadro anterior para cuaatién 7.) - 5 - o. mmmxm 05 L08 NIQos memes 01-: Mme Puede decirme algunos asuntos eobre sue practices do alimentacidn para 108 nifios que tienen menos de 5 afioe. Wm, para el niflo --- - ) ma: pequefio —— se llama (________.,-.,._.._.;‘....... 3e refiere a1 Cuadro 8.1 1. Actualmente le asté dando pecho, tetero o amboa camp alimentacidn principal? Pecbo _~_____ 81 ...... No Tetero ...... Si ______ No Ambos Si No (51 31 nifio recibe su alimentacién principal del pecho o tutu-o haga lea preguntae 0—2 - 11.) (61 e1 nifio recibe el tetero coma alimentacién adicional. pas. a la pregunta D-12.) 2. (81 da e1 tetero pregunte -— ) Duel es el contenido y cualee eon lae proporcionea qua uated use en el tetero? WQMW&JM.WL‘ non—gu-h- ‘ =u‘»-;---4-m _--m“&me“MA-M~-L——A—“---4-‘—---“ =mm.m._a.~ 3. Le da 91 tetero (o pecho) en horario regular 0 cuando el nifio tinn- hambre? * Horario regular Cuando tiene hambre __ _ A _.._ m -_._- .. _ _- . ...-am.“ A - 4. Generalmente cudntas vecea a1 dia coma e1 nine? __ Vecae (fl '9 10. Quién prepara el tetero para el nifio ? (Relacién baaada en el Cuadro B 2) u A“ - _‘AA‘A‘AL-A-‘A -_~‘ _.m“-~- t ...-..- W-w~w¢w‘o—w- Quien da e1 tetero a1 nifio? (Relacién basada en el Cuadru 8.2) ‘—--‘— - A -.. - -— --‘- ————_- ““4.- ”WA-...”... ...-...“-..uw“. Desde su nacimiento, cuantos meses Is he dado pecho a1 nifio? No se aplica Meses Cudntos meses 16 ha dado tetero a1 nifio? wNo se aplica asses ‘AA A and edad (en meses) espera dated quitarle e1 pecho y/o al tat-re a1 nifio? _~_ No se aplica E1 pecho (meses) “- ”-..-0-..... w E1 tetero (meses) Cémo le dejaré de dar el pecho 0 el tetero a1 nifio? (Chequoar todaa las que responda) - De una aola vez Paco a poco ‘ User una sustancia amarga Mandarlo a un familiar __ Otro método (expnque) “ ‘ _-_“n———__‘h ‘ No sabe 11. Haste ahora, qua otros alimentos Is he dado e1 nifio adamas de pecho o tetero? En qua Forma le da las come sopaa, coladas u otroa? Alimentos 59 Forms W . ~Wu. M. m..- “*me ... PIMUR Ndmero “ “- - -"mm‘-*‘ Nombre del Nifio (Si 81 nifio no recibe el_pequwgvg} tete§9_como‘a11mentac16n principal huge las siguientes preguntas.) 12. Le da ustad a1 nifio la misma comida qua prepare para el resto do la familia? Si Comentarios: _ _AAu —‘--——‘-—-~ _-‘-A_ No .4; ~u-m&o-u u. M-usac~.-.«“..a --"‘I -.. wad-O M 13. Le da a1 nifio un tetero alguna vez durante el die? 51 Que contiene el tetero? -‘u.H—.‘u—A An‘ - M cm.ossm “M. “...‘_“m.'--.- ... m ‘4‘ ‘__._A m A— _ A _.__4—.._ -_._- A ~- 14. Que alimentos come e1 nifio entre comidas? Alimentos Comentarios (IL! '1']. l I I'll (ll I .‘Il 1' I'll ll. (III (II .ll‘ ‘ 1" Illll [..[t I. III .lvl (1.} V I!!! l {l l I r ....ln ... 15. Durante la semane pasada recibid e1 nifio leche - huevos - o earns? '51 No Leche HUBVO8 Carne 16. Cuales comidas prepare de menera especial para al nifio? Dual es el metodo de preparaoion Ninguno ‘A w u “- - —‘-- *wm-MMM-m ALM‘ ..-—... Método de Prepaggpiéfi__ __ —:] En pure Masticado Picado Otro l' __ __. ......-.___.____,. _Hm-.___.+L.-mu-____‘ u -f_1.“ ““ --—-—--.c.a‘-a.-Ma- “-jpuuujba-omgo'qw‘ “‘ ~A¢“‘“‘MA-“‘-‘~*“ ~-- -‘ “ ‘-- ‘Iv'hWO‘M-‘ “‘ “ A“ .ho-J.-W-‘ - ...... .41... 4.0.. 5 “.O'.. ’O-Aa‘l" en‘- ‘- -~--“‘-—-“---'--“- - ~ww+ofiwfi vm-~-- c.--a- .. c. -....‘w. ......u‘...... a".-- s 5.11%...“ - ., ‘ ~a»- Fw~flrauauwaa 1L...“ ...—cw... . ..‘.sw. ..‘a ..- a a a. ...-n. o... g a a' :. a-..“ ...-....d . a"; -..a—umaJha—s 0- ...» s 4.4 n..- “O-OO‘QJ 17. Cuando este nifio estaba recien nacido le did uataa nacho, tetaro o embos? El Pecho Cementerios: ___ E1 tetero Amboa .... “...-...“.-mswa-bru-uu-M“ ~_- ‘ :‘vzofia 18. Durante cudntos mesas 1e did el pecho? No se splice Moses 19. Durante cuantos mases 13 did tetero? ___~__No se aplica ‘ Mesea {111. It Ill. I(I‘. II I [ [.4 l l- ( l [I ll'll.. l ‘1'. I [I r. I. fill ll {11 1.1. .llll 4' 1‘ I 1" {I -10.. 20. Did e1 tetero 0 e1 pecho an un horario regular 0 cuendo e1 nifio tenia hambre? Horario regular Cuando tenia hembre Otro : -* ...-Jawnrfimuaa‘ .mau“m.fi 0. “--.- “m an... ‘a—uaga “sue ‘ ;‘I“.h“m.—§.MQ¢.—O “C. I—§~O'~ 21. Cudles otros alimentos did al nifio adamas del pecho a el tetero? £151,192 Omega: - "a“. w... -.Mmuo-m... . ...... ”A...“ —- --—- ..--“_‘-A— A...‘ W“‘oo:“d~ra a... 0...... “a - “a... ...—-..Muw M 22. Cdmo 1e dejd de dar el pecho 0 al tetero al nifio? (Chequaar todaa las qua responda.) De una sole vez Poco a poco ______Usd una sustancia emerge Lo mandd a casa de un familiar ______ Dtro método (explique) ___ __ m l... m .. -‘-m ......"a ‘itlt‘llf'l‘ll1ll‘|.lvl n I‘ll‘tll Ill] .ilg‘lltvll . .l I .... E. _ 11 - EEEEEEE£§.I;£§I$IEQE§. 1. 2. 3. 40 Cree usted qua los alimentos qua prepare para sus,nifios son difarentas a los qua su madre prepard para usted cuando era una nine? ~___“‘No ‘ Si Explique cualas son las difarencias principales? ‘ ‘0 .- ..- 0 -»w ..‘o... O..- h“ ornaawwuu15.1»..‘4-MMH-o-c. u.“ ...-s.“ ... .“u‘.m‘w-cw-a ‘..l 5.--... ”A. ...—A. ...-4.... ...-Ab. Cree usted qua an ésta barrio hay una mayor tancbncia da 163 madraa a dar tetero qua pacho asus babes? No sé No ...—...:- Si Qua piansa usted see la razdn para asta tandencia? w ...—...”-mm- ...-ah“... ‘ ‘ “ ‘ fl“u "‘-‘ ‘ “W“. subaao I. a .0 a “a... t..-b.5-a. ...-... b-.-- 5.. A arm.» a I .-u. bat... az-‘Ah. ...... “I ...; I. a~u I I. '4‘ ...;- I- a-l A—O Cu. IND—-lJ-ta... ..‘.&-h‘. “-O-l .l-oU...-I<'.-.'.o¢'t.- Daspuas da quitar al pacho 0 al tetero a1 nifio cree usted qua es muy importanta darle lecha? ‘_ No ad I!“ No W 81 9...... Compra lacha para sus Nifios? No M Si Que forma de leche compra usted? ‘___ Lecha cruda I. ______Lache pastaurizada Lacha an polva'. ...... Lache condensada Por qua compra la lecha an asta forms? 5. Babe usted da algdn alimento qua see tan.nutritivo como la leche? No Si Cuél as? - “__A A__— ‘ A 4.00....“ “----"‘4‘... 6. a. Si usted sup.ara da un alimento tan nutritive como la leche, lo usaria an lugar da 1a leche, s1 costara la misma? No sé No Si b. Si asta alimento costara manos qua la leche. la usaria usted? No 36 .0 Si 7. a. Conoce usted los siguientas productos? (a) Si Producto (b) Ha usado (c) Cual as (d) Bu opinidn . major- Colombiarina lncaparina If.“ ”...“. Duryea ...-_— M- 6“-“ Maizena Superbaby ‘ __A_ b. Cudlas he usado de allos? c Duel producto as major ? (Si alle ha usado due a mes.) d. iDua opinidn tiane del producto usado? B. a. En su opinidn cudlaa alimentos son los majores para nifioa paquafloa cuendo se las quite a1 pacho 0 e1 tetero? w wh__-_ -.4._ _ -.....A -_A.._-_..__ “-..-_- M._-—- A “A -Au“ -w-‘ Ankh-fin --M-—A‘- "‘“‘ _ - —- - a “...now.*o.o-avu.uu. ‘ “ ...... a. Cudlea alimentos craa usted que son males para nifios pequefioa cuendo sa las quite a1 pacho 0 al tetero»? For qua? Alimentos A ~-~.‘— Mun-AA m-~