|Culture, Environment, and Food to Prevent Vitamin A Deficiency (International Nutrition Foundation for Developing Countries - INFDC, 1997, 208 pages)|
|Part III. Assessing natural food sources of Vitamin A in the community|
|7. Peru: The rural community of Chamis and the urban suburb of San Vicente in Cajamarca|
Geographic and demographic Characteristics
The climate of Cajamarca is dry, of low humidity and semi-arid. The annual rainfall is around 780 mm, falling mainly between October and April. July is the driest month and March the wettest. Due to this semiarid climate cultivation depends on irrigation; Cajamarca lacks water (Manco Pisconti, 1985; Manco Pisconti and Cáceres, 1986). The average annual maximum temperature is 21°C with little variation. The average minimum temperature is 4.6°C in the cold, dry season (May-August) and 8.7°C in the warmer season.
The population of the department of Cajamarca is 1,273,696 inhabitants, representing about 5.8% of the total population of the country, 22,128,408, 29% of whom reside in the capital city, Lima (Censo Nacionales, 1994). Of the total population, 15% are under five years of age and 22% are women of fertile age. The city of Cajamarca is situated on the western range of the Northern Andes at an altitude of 2,750 meters above sea level. The estimated total population of the city is 104,810. The rural area of the province of Cajamarca is divided into 496 settlements (caserios).
The principal activity of the area is agriculture. It is a major milk producing area, primarily by large transnational companies who also buy the local peasants' production. Recently mining (mainly gold) has become an important activity and is affecting the economic profile of Cajamarca.
The population of the region of Cajamarca was originally nomadic, gradually changing to a sedentary agricultural way of life. Between the years of 1000 and 500 BC, the inhabitants came under the influence of the pre-Colombian Chavin culture of northern Peru, known for their work in stone and ceramics. This culture continued for many centuries until it was dominated by the rule of Cuismanca around 1250 AD. The Cuismanca rule lasted for about 200 years when it was conquered by the Incas who came from the south (Cusco) in 1470 AD. The population accepted the language, religion, and subservience to the Incan empire until the arrival of the Spaniards in 1532 (Medcalf, 1990).
The Spanish conquest of South America began in Cajamarca. Today all Cajamarquinos have a mixture of Spanish and indigenous blood. Perhaps for this reason most but not all of this rural population speak Spanish, in contrast to other rural, sierran peoples of Peru, the majority of whom speak the local indigenous languages, Quechua or Aymará.
During the colonial period the Cajamarcan peasant was further exploited, the land was divided into estates (haciendas) owned by the Spaniards and the indigenous Indians were treated as slaves, in many cases within the feudal system. More Spaniards came to settle as animal production, clothmaking, and the mines were productive. The Indians began to learn Spanish, and in 1802 it was documented that Quechua was being spoken only outside of the city.
The Republican period, after Independence in 1820, was characterized in this part of the country by constant wars and disputes between different families who were descendant of the Spaniards. In 1854, Cajamarca was created as a department and organized by municipalities. The twentieth century has seen the development of communication systems, primarily along the coast. Toward the end of the 1950s, the division of lands began which became effective with the Agrarian reform of 1969 and the return of land to the peasants (Censor Nacionales, 1993; Medcalf, 1990).
In spite of this history, the peasants of Cajamarca are recognized for the organizational ability they demonstrated with the formation of peasant patrols (rondas campesinos) in 1976. This organization developed from the traditional need to defend property and protect lands and communities from theft and abuses. The patrols were formed on the initiative of the peasants and supported by the local authorities (Rojas, 1989). In recent years these rondas campesinos have been a source of protection from terrorist movements; although Cajamarca is one of the poorest and most rural departments, few areas have been infiltrated by terrorist groups.
Health and Nutrition Status
A recent national nutrition and health survey indicated that the infant mortality rate during the decade 1981 to 1991 was sixty-four per 1000 live births, and the childhood mortality rate, ninety-two per 100 (ENDES, 1992). This was greater in rural areas (ninety and 131, respectively) than urban (forty-eight and sixty-seven). In Lima the infant mortality rate was thirty and the childhood rate forty per 1000 live births. For the Nor Oriental region these rates were sixty-one and eighty-nine, respectively.
The prevalence of infectious diseases in the country is high. The above-mentioned survey indicated that the prevalence of respiratory infection in children under five years of age was 23.4% during the two weeks prior to the survey, and that in the Nor Oriental region, 26.1% (ENDES, 1992). Similarly the prevalence of diarrhea! disease was 18.4%; that of the Nor Oriental region, 16.5%. Diarrhea is generally more prevalent in urban than in rural areas.
The major nutritional problem in the country is growth retardation or stunting, occurring primarily during the first two years of life. Table 7.1 shows anthropometric indicators and that the nutritional status of the population of the Nor Oriental region is inferior to the national average.
Prevalence of Malnutrition by Anthropometric Indicators
Percentage of Children Under 5 Years of Age More than 2SD Below
NCHS Median, (ENDES 1992)
Nor Oriental Region
Vitamin A Situation
In Peru the situation with respect to vitamin A deficiency is not clear, but specific, localized studies indicate a public health problem in certain areas. Serum levels of retinol were measured in Piura (northern coast) where 37.8% of children under six years had levels below 20 mg/dL (Del Aguila et al., 1991). In a study of the urban population in the southern highlands, 24% of children under four years old had serum retinol levels below 20 mg/dL and 1.4% below 10 mg/dL (Anon. 1993). Similar results were found in Lima shanty towns and other coastal towns. Clinical manifestations (Bitot's spots, corneal scarring) have been reported infrequently: in Piura the prevalence of corneal scarring was 0.4% (Del Aguila et al., 1991). Other clinical manifestations including nutritional blindness have not been described.
Dietary surveys revealed vitamin A intakes well below recommended levels in several areas of the country. Household surveys conducted between 1963 and 1971 documented intakes between 20% and 86% of recommended values in different populations of the highlands and northern coast (Collazos Chiriboga et al., 1985), whereas in Lima shanty towns mean intakes covered recommended values, although some age groups consumed inadequate amounts. A study of children two to eighteen years old in Lima shanty towns, conducted between 1972 and 1974, reported a mean intake of 76% of requirements (Creed and Graham, 1980). The consumption of b-carotene was related to the achieved height of the children (Graham et al., 1981).
A two-day individually weighed dietary intake study, conducted in 1991 in a representative sample of Cajamarca cities including San Vicente, showed that mean intakes were 40% to 50% of recommended values (Lopez de Romaña et al., 1991). In comparison a study in Lima showed mean intakes of 95% of recommended levels. The principal sources of vitamin A in urban Cajamarca were carrots (25% of vitamin A) and green vegetables and herbs (21%), followed by milk (13%). Other food groups that contributed to vitamin A intakes were legumes (10%), fruit (7%), and eggs (7%). For children zero to six months of age an estimated 65% of the vitamin A consumed was provided by breastmilk thus permitting higher intakes; in the age group six to thirty-six months breastmilk contributed approximately 20%. The effects of seasonality were not evaluated in any of these studies.
In each community natural food sources of vitamin A were assessed using the guidelines for ethnographic studies. Interviews were conducted with eight key-informants, selected in each community during the first visits to the village, and were recommended by community authorities, community leaders, health workers, and market vendors.
Structured interviews and the application of the modules were undertaken with a randomly selected sample of mother-respondents during several visits. To select the sample in Chamis the area was divided into three clusters. Houses that were more than a forty-five minute walk from the center of Chamis were excluded (about 20%). In each cluster an initial house was selected randomly and if the family met the required criteria and was willing to participate, an interview was conducted. As the houses were considerably dispersed in Chamis, each successive one toward the right was visited and included in the sample if the criteria were met and the mother was at home. The criteria for Chamis were at least one child between six months and six years of age, no close family link with another respondent (e.g., sister), and willing to participate. Twenty-six mothers were interviewed and completed most of the modules.
San Vicente was divided into three clusters of six blocks each. In each cluster an initial house was selected randomly and if the family met the criteria and was willing to participate, an interview was conducted. Subsequently each fourth house was approached for inclusion in the sample. If the criteria were not met, the next house was approached. The criteria for San Vicente were at least one child between six months and six years of age, come from an area ecologically similar to Chamis, (i.e., not from a fertile, fruit-producing valley), live in San Vicente (not a visitor), and willing to participate. The sample included women who participated in community kitchen programs as well as those who did not, and women of different religious beliefs. Twenty-seven mothers were interviewed in San Vicente.
In both Chamis and San Vicente the information obtained from the interviews was complemented with continual observations during the two-month study period. The evaluation took place during the months of October and November, 1993.
All plants mentioned or observed during the study were identified with the aid of local documentation and specialists of the Botany department of the National University of Cajamarca (Sanchez Vega and Bríones Rojas, 1992; Sanchez Vega and Tapio Nuñez, 1992).
The comunidad campesina of Chamis is situated on the sides of the valley of the river Manzanas, on the western slopes of the eroded hillsides that surround the city of Cajamarca. The area is situated between 2,850 and 3,750 meters above sea level (mas). Within this zone there are three agroecological levels: the zone of maize or Ladera baja (2,850-3,150 mas), the zone of tubers and cereals or Ladera alta (3,150-3,600 mas), and that of natural pastures of the Jalca (3,600-3,750 mas) (Kholer and Tillmann, 1988). Each of these ecological levels have distinct climatic characteristics. In the Ladera alta and Ladera baja, the climate is temperate with temperatures higher than 8°C whereas the Jalca is colder, experiencing temperatures below 8°C.
The soil is exposed to consent water erosion, provoked by strong, irregular rains, and exacerbated by the reduction in the natural vegetation. Previous landowners showed little interest in protecting the land from erosion and as a consequence it is not very fertile.
The area consists of eighteen settlements and three comunidades campesinos of which Chamis is the largest. The center of Chamis is nine kilometers from the city; it covers each of these ecological areas although the major part of the population lives in the two lower zones. There is only one dirt road passable to motor vehicles leading to the communal center of Chamis, from here access to the widely dispersed houses is by foot. There is no public transport to Chamis; it takes one hour on foot to reach Cajamarca.
The total population of the comunidad campesina of Chamis is 612 (48.5% male, 51.5% female) distributed among 131 families living in 112 houses, an average of 5.46 people per household (Anon. 1993).
The principal activity is farming. Eighty percent of the husbands of the mothers interviewed were agricultural workers. The size of the lands owned by the families varies between 0.1 and 6 hectares. In addition the population of Chamis has collectively-owned land in the Jalca and Ladera alta.
Most of the produce is grown for the family's own consumption; a certain amount is stored for seed. Produce is also used for the payment of services, such as to the owner of land that is worked by tenant farmers and for the work by neighbors who help with sowing and harvesting (mingas). Some produce is interchanged and some is sold in the market, the latter estimated to be 4% of the production (Sanchez Vega and Tapio Nuñez, 1992).
The amount of money available for expenditure on goods ranged on average between $2 and $ 14 US per week. This varied between families and time of year.
A relatively high proportion of the population has had no formal schooling and does not read or write. Fifty-five percent of females and 26% of males over five years of age, have had no formal education (Anon; 1993). These levels are higher than those for the total rural population of the department of Cajamarca, 37% and 17%, respectively.
At the time of the study there was a primary school in Chamis with a capacity for sixty pupils and two teachers. In Peru the official age for starting school is six years, however, a number of children do not attend or attend irregularly depending on the need for work in the house or fields. Those who attend secondary school walk the nine kilometers to Cajamarca and back each day.
Typically parents, children, and grandchildren live together in a group of two to three rooms, including a separate kitchen, built around a central patio. Each house has a corral nearby for the animals and small constructions for storing grains and tubers.
Water is a scarce commodity. At the time of the study, a dam was being built that should improve the water supply considerably. Water for domestic use comes from springs that are channeled to family's taps, or from the irrigation channels, in which case it may be stored in wells constructed for this purpose.
There is one health post in Chamis, situated in the community center that has functioned since 1988 and is under the jurisdiction of the health post Atahualpa in the city of Cajamarca. A voluntary health auxiliary from Cajamarca attends once a week. She coordinates with the local health promoter of Chamis. The service offered is principally preventive rather than curative, and includes care of the newborn, growth monitoring, immunizations, family planning, pre- and post-natal controls, and treatment or referral of clinical cases.
There are two types of local healers in Chamis. One is an empirical healer who exclusively fixes bone fractures or dislocations (huesero), generally using animal fats in the treatment. However, the health resource most used is the traditional healer (medico de campo), who is generally recognized by the community as having the capacity to eradicate illness, thanks to a special quality given by God. His main function is to determine the cause of the problem and recommend the appropriate treatment, whether it be cleaning with herbs or compresses of traditional medicine, or the use of pharmacological products. If the illness is due to something he recognizes he is unable to cure, he recommends the health promoter, medical post, or hospital, accordingly.
An empiric midwife attends complicated births. The people commented that she does not have much work as most of the births are normal and are attended by the female relatives of the woman giving birth, usually her own mother. She sometimes "positions the baby correctly" toward the end of pregnancy.
The most common health problems mentioned by the mothers were respiratory infections, colds, coughs, and fever (76%), digestive disorders, such as stomachache and diarrhea, or empacho (16%), and the effects of heat from the sun (16%). Measles occur, although there are immunization programs organized through the health center in Cajamarca; intestinal parasites and skin afflictions were also mentioned.
The community authorities are the Mayor, Lieutenant Governor (Teniente Gobernador), and President of the Peasant Patrols responsible for the physical protection of the community.
There are two community kitchens supported by different nongovernmental (NGO) or governmental organizations and used by different groups of people. In addition, there is a municipal milk distribution program for children and pregnant and lactating women, a school breakfast program, a mother's club, and a literacy program of the Ministry of Education; all of these distribute donated food. A United Nations NGO has been working with the community in recent years in agricultural development.
Although the majority of the population of Peru is Catholic, there has been a strong influence of the Evangelical denominations in Cajamarca. In Chamis, the women reported that half the population belong to Evangelical denominations, and 35% of the mothers interviewed were practicing members. This may influence feeding patterns with respect to some vitamin A-rich foods as they do not eat animal blood, readily available in the market, nor guinea pig meat, commonly consumed in the highlands.
San Vicente, a periurban suburb or barrio, is situated on one of the steep slopes surrounding the center of Cajamarca. It was created in 1976 when it was legally designated as belonging to a group of peasants. Originally it consisted of 153 hectares, principally for agriculture. The land was divided into plots for each of the peasant families during the Agrarian reform of 1970. With these divisions people began to move into the lower parts to build houses, but the peasants maintained that San Vicente was essentially agricultural land. In 1973 the University evaluated the land for its agricultural potential, finding it to be extremely poor. Consequently, it was designated for urban development. San Vicente is currently estimated to cover an area of thirty-three hectares.
There is a frequent small bus service between the lower part of San Vicente and the central market of the city. Otherwise, it takes twenty minutes by foot.
The population of San Vicente
The present inhabitants of San Vicente were either born in Cajamarca or migrated from other parts of the department, including the higher pasture areas and the warmer v alleys, as well as from the coast. Of those who migrated, the majority (or their parents) came to find work in the city. Half of the population has lived in San Vicente for more than ten years. At the present time the population of San Vicente is estimated to be 4,000 inhabitants.
Although a precise description of the inhabitants of San Vicente is not available, interviews with the sample of twenty-seven mothers indicated that the most men (80% of those interviewed) are construction laborers. The majority of women interviewed were housewives, although some also sold food in the market or as street vendors, and others did laundry.
The average amount of money available for purchasing goods ranged between $20 and $35 per week; 60% is spent on food (Lopez de Romaña et al., 1991).
The level of education is higher in the urban population. There is no specific data for San Vicente, however, illiteracy rates of the urban population of the department of Cajamarca are 5.9% for men and 36.8% for women (Censos Nacionales, 1993).
There is no school in San Vicente; children attend schools in adjacent suburbs of Cajamarca. Attendance at school for children over six years of age is almost universal.
The houses are constructed of adobe and situated on the steep hillside. Many have small home gardens and areas for small animals. The water supply and sewage has recently been installed, although connections to each house are still incomplete.
Healthcare is under the jurisdiction of a health post in the adjacent shanty town. Many go directly to the city hospital where they report the attention is better. There is no community health promoter in San Vicente. The people also seek the services of the local traditional healer and empiric midwives.
All mothers reported that children suffer from respiratory disease and half noted diarrhea! and intestinal diseases - higher levels than in Chamis. These are the illnesses that were reported most frequently and are of major concern to the mother.
The authorities in San Vicente are the Mayor, the Lieutenant Governor (Teniente Gobernador), and the President of the Committee of Self-defense and Development, equivalent to the President of the Peasant Patrols in a rural community.
There is a communal center, supported by the local parish, where a mothers' club functions. There are two community kitchens, as well as municipal milk distribution programs for children, and pregnant and lactating women.
In San Vicente, 15% of the mothers interviewed belonged to Evangelical denominations.