Policy recommendations

· An intervention strategy to improve nutritional status of vitamin A through dietary modification in these communities is feasible and should be implemented. The availability and perceptions of the population towards vitamin A-rich foods provide a potential for increasing dietary intake. An educational campaign can be developed using the information obtained in this study, both in the selection of the foods to be promoted and the formulation of appropriate messages for urban and rural populations of this region.

· Vitamin A status and deficiency symptoms, especially nigh/blindness, require closer examination, particularly in the rural populations, so that the severity of deficiency can be defined adequately.

· Seasonal variation in vitamin A status and food intake needs further exploration. Times when vitamin A-rich sources are available can be exploited. This includes foods such as sweet potato, vitamin A-rich fruits, and green leafy vegetables.

· Increased frequency and amount of carrots used in food preparations can be promoted, particularly in rural populations, as can squash where it is available. These foods consumed regularly in common food preparations can contribute important amounts of vitamin A to the diet during the year.

· Ways to increase the in rake of animal products, such as eggs and fish in Chamis, and eggs, fish, and offal in San Vicente, need to be explored, particularly for small children. If food distribution programs are an alternative micronutrient-rich foods, such as milk, must be included.

· The modification of perceptions towards little-used potential vitamin A sources through a carefully designed communications campaign can be explored. This could be applied to green leafy vegetables or sheep's blood where appropriate.

· The promotion of home gardens with greater availability of seeds is an appropriate intervention for increasing local production of vitamin A-rich foods in rural communities. This can potentially provide more variety as well as increasing intake of vitamin A and other nutrients.

· The promotion of improved infant feeding practices is necessary in both populations, particularly complementary feeding from six months of age. Solid foods need to be introduced at six months and the quantity, quality, and frequency need to be improved for better nutrition, health, and growth. The preparation of appropriate, nutrient-dense foods for this age group, using ingredients from the family pot and including micronutrient-rich foods, needs to be promoted. Children should be given priority for certain nutrient-dense foods, such as eggs. Dietary intake between six and eighteen months is inadequate particularly in rural areas, and ways of stimulating mothers to adopt a more active behavior towards feeding children need to be explored and promoted.

· Exclusive breastfeeding during the first six months and breastfeeding into the second year need to be promoted in urban populations and reinforced in rural areas.

· The development of nutritious preparations acceptable to the different groups of the population, particularly young children, can be conducted through a participatory process of recipe trials with mothers, focusing on selecting vitamin A-rich foods. The feasibility of these dietary modifications can be evaluated through household trials in each of the communities.