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close this bookCulture, Environment, and Food to Prevent Vitamin A Deficiency (International Nutrition Foundation for Developing Countries - INFDC, 1997, 208 pages)
close this folderPart III. Assessing natural food sources of Vitamin A in the community
close this folder7. Peru: The rural community of Chamis and the urban suburb of San Vicente in Cajamarca
View the document(introductory text...)
View the documentIntroduction
View the documentOverview of the location
View the documentFood sources of Vitamin A
View the documentPrincipal differences between Chamis and San Vicente
View the documentFamily and individual food patterns
View the documentFeeding patterns by age gender
View the documentVitamin A-rich food patterns
View the documentCultural beliefs
View the documentVitamin A and health
View the documentSummary and conclusions
View the documentPolicy recommendations
View the documentRecommendations for research

Vitamin A-rich food patterns

Chamis

The population of Chamis consumes a limited variety of foods. An evaluation of food frequency for one week indicated a mean of eleven of the thirty-one key foods were consumed as shown in Table 7.4. The frequency of consumption of foods varies little within families and between age groups, with the exception of children under one year, who consume a mean of eight of the key foods during the week, including breastmilk. Older children and women have a slightly greater variety. Mothers commented that the distribution of food within the family is fairly equal, "we eat what there is," although the amount varies according to age and the perceived needs of each member. However, the range in the variety of foods between families is great: in two families children as well as adults eat as few as four foods during the study week, and two as many as twenty-four. This limited variety was confirmed with a 24-hour recall in a subgroup of twelve families. Due to the seasonality of food availability, more foods will be consumed at other times of the year.

TABLE 7.4
Mean Number of Key Foods Consumed per Week by Age Group


6-11 Months

1-3 Years

4-6 Years

Women

Total Men

%

Chamis

8

10

12

11

11

35.5

San Vicente

11

12

14

13

13

44.8

The amount of vitamin A-containing foods consumed also varied more between families than between age groups within a family, although the younger children have greater vitamin A intakes than other age groups due to breastmilk. Other vitamin A sources are eaten in similar amounts by each family member, at least at that time of year. The vitamin A intake (excluding breastmilk) was very low for each group when estimated through food frequency and 24-hour recall, with mean values of 10% to 24% of recommended intakes. An evaluation during the season of greater availability of vitamin A-rich foods is needed to determine the levels of intake reached.

Breastmilk provides most of the vitamin A for children under three years of age. The foods providing most of the vitamin A for the other family members were principally carrots, consumed in small quantities in the soup, followed by eggs, green herbs, peas, and sweet potatoes. Families with higher intakes consume more carrots, sweet potatoes, herbs, and green leaves.

San Vicente

The number of foods consumed by the population of San Vicente is slightly higher than in Chamis, with a mean of thirteen of the twenty-nine key foods during the week of evaluation as shown in Table 7.4. Similarly the intrafamily distribution is equitable. Children six to eleven months old have a slightly wider variety of foods than those in Chamis with a mean of eleven including breastmilk. The number of foods consumed by the different families range from nine to twenty during the week. These results were similar to those of the 24-hour recall conducted in a subgroup of twelve families. As in Chamis, the variation is greater between than within families.

The total vitamin A intake is higher than in Chamis. The major sources for the small children were breastmilk followed by cow's milk; the milk distribution program made a significant contribution. Other important sources are carrot and squash, both consumed in small quantities in soups, with egg, sweet potato, green herbs, Swiss chard, and fish contributing smaller but significant quantities. Children and adult women consume a mean of 70% of the daily requirement for vitamin A (excluding breastmilk), as estimated through a 24-hour recall.

Comparisons in Feeding Patterns Between Chamis and San Vicente

The population of San Vicente incorporates urban feeding practices while maintaining some of the practices common in rural communities such as Chamis. With respect to breastfeeding practices, the tendency is to adopt less beneficial practices as shown in Table 7.3; moving away from exclusive breastfeeding during the first months with consequent negative effects on health and nutrition. Complementary foods are introduced prematurely in the urban population and late in the rural. The ideal age is five to six months; yet a wider variety of foods is given in San Vicente and vitamin A-rich foods are introduced earlier. Both populations need to improve the energy and nutrient densities of the complementary foods offered to children over six months of age, as well as to increase the frequency of feeding.

The higher vitamin A intake observed in San Vicente, compared with Chamis, is due principally to the consumption of more carrots and milk. Carrots are eaten mostly in soups. It appears that the regular use of carrots contributes more to the total vitamin A intake than the less frequent consumption of larger portions of other sources, such as sweet potato.

Milk is an important source of vitamin A in San Vicente. Eighty percent of respondents consume milk, 67% daily, compared with 30% in Chamis, where it is consumed irregularly. Milk is purchased by half of the mothers in San Vicente, and half obtain it from the municipal milk distribution program, whereas milk does not reach the rural community, probably due to the difficulties of distribution.

Clinical Deficiency of Vitamin A

No clinical deficiencies of vitamin A were observed in either area, even with the low intakes observed in Chamis at this time of the year. Nevertheless when asked if they knew anyone with nightblindness, 46% of respondents in Chamis and 16% in San Vicente answered positively. In Chamis one woman related nightblindness to pregnancy and mental illness, another to childbirth, and others to the sun, eye pain, and headaches. Two children in one family were described as "not seeing in the dark." Four people referred to older gentlemen in the community. In San Vicente one mother referred specifically to nightblindness. On further exploration there was no clear or general recognition of this condition in either population and no specific name given to describe it. However, this suggestion of nightblindness, particularly in Chamis, needs to be explored.