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Family and individual food patterns

Chamis

In Chamis the day starts with the main meal, termed dinner (almuerzo), consumed between 5 a.m. and 8 a.m. depending on the season and type of agricultural work to be done. This meal consists primarily of a cerealbased soup, generally maize or wheat, usually with potato. It is accompanied by dry toasted barley or maize flour, or cooked wheat, maize grain, or boiled tubers, such as potato or oca if in season. An herbal tea is usually consumed with this meal.

The midday meal is light in comparison with the morning meal and usually consists of cereal-based soups. Less frequently rice with a stew of peas, beans, or lentils is prepared; this is considered "dry" food. Again, dry flours or boiled tubers may be served with the soup. The evening snack, generally soup, is consumed around 5 p.m. to 6 p.m. Toasted flours or boiled cereal grains may be served.

At mealtimes the wife serves her husband and other menfolk first. Each person has his or her own plate, the size of which depends on age. The flours are placed in a central bowl from which each person helps himself. This also applies to the green' mixed herbal component of the green soup, so that the amount consumed depends on the taste of each person; small children are served little of this herbal preparation.

Half of the families consumed snacks between meals, children more frequently than adults. Snacks are usually dry, toasted flours with sugar (machica) although they are not given to children under one year for fear that they will choke. Sometimes children eat leftovers and in the summer, fruit or sweet potato.

San Vicente

The majority of the urban population of San Vicente start the day between 6 a.m. and 7 a.m. with breakfast, usually consisting of coffee made from toasted barley grain, tea, herbal infusion, or an oat-based drink eaten with bread. About one-third of families prefer and maintain the rural custom of soup with toasted cereal or cereal flours; this breakfast menu is cheaper than bread.

The main midday meal, (almuerzo), consists of a soup, mostly cereal, but sometimes vegetable-based, and usually a second course. The latter is almost always rice and may or may not be accompanied by a stew of beans, lentils, or fish. Half of the population prepare salad (onion with tomato, hot pepper, or lettuce) instead of beans to accompany the rice when economic resources are limited.

The light evening meal, consumed around 6 P.M., usually consists of soup with an herbal tea or barley coffee; one-third of the population consumes bread or leftovers from the midday meal. Members of the family eat together, with the husband and menfolk served first. Each person is served individually.

Seventy-eight percent of mothers reported offering snacks between meals, mostly for the children. Half the families mentioned fruit; toasted flour with sugar (machica), toasted or boiled maize, and bread are other snacks mentioned.

Feeding patterns by age gender

Chamis

Infant feeding patterns

All mothers breastfeed their infants. Breastfeeding is initiated when the infant begins to cry and wants to suck, and this varies with the child. This can be two hours after birth or up to two to three days if the child sleeps constantly. This illustrates that infant feeding is child-driven in this population; the initiative of giving the breast, or other food later on, is in response to the perceived demands of the child.

Most mothers (92%) reported that breastmilk is the first item given to the infant after birth. In general, colostrum is given by 88. 5% of mothers, although some commented that the first milk is extracted as it is thick and yellow and could sit in the stomach and cause digestive problems (empacho). However, only 11.5% reported not giving colostrum.

The reasons for giving breastmilk are actively positive: so that the child grows and is strong (44% of mothers), or passive: that "this is the custom," "there is nothing else to give," "no money to buy anything else," "so the child doesn't die," or "because the child cries" (44%). In fact, breastmilk is frequently not considered a food; it is natural, an extension of the mother's body, and is given on demand frequently during the day.

Infants are mostly exclusively breastfed up to four to six months of age when herbal infusions are introduced by the majority of mothers (42%). Twenty-seven percent reported giving infusions earlier, between one and three months, and 19% not until after seven months (see Table 7.3). In general, the preferred infusions are those classed as "warm" (caliente) to protect the infant from the cold, stomachache or empacho, usually camomile, salvia (Salvia oppsitiflora R. & P.) and/or boiled water. These are mostly given with a spoon or cup; 30% of mothers reported using a feeding bottle.

The introduction of complementary foods does not usually begin until after the child is six months of age; this is typical of the rural populations of the highlands (see Table 7.3). Mothers start giving foods when they perceive the child has developed hunger, indicated by the child opening his/her mouth, stretching his hand toward the food, or accepting food that is offered. Frequent crying could be an indication that the child is not satisfied by the mother's milk and can be a reason for introducing other foods.

No special foods are prepared for children, they eat from the family pot with the rest of the family. The broth or juice of the soups is selected for children from about six months; 77% of mothers started with soups between six and eight months. The solid ingredients of the soups (rice, maize, maize flour) are considered too strong for infants at those ages. Solid food is usually not introduced until eight months of age, sometimes after one year; the mother considers that the child might choke if it is given earlier, and the timing coincides with development of teeth. The foods given at this age are selected according to what the child likes. The first: solid foods are mashed maize, potato, oca, or ulluco in the soup.

TABLE 7.3
Infant Feeding Patterns in Chamis and San Vicente

Few vitamin A-rich complementary foods are given to the child during the first year. Sweet potato is considered appropriate to give between six and eight months of age by half the population, although in practice it is given infrequently. Half of the mothers give the child small quantities of egg starting at this age, and half believe that egg can prevent the child from talking, and so do not give it until around eighteen months. Onethird of mothers include carrot in the soup at six to eight months, although 46% reported that they did not give this until the child was one year old. Other vitamin A-containing foods are not given until the child is one to two years old. These include green leafy vegetables (which could cause empacho if given earlier), green soup (the herbs are considered "hot" in the humoral system), and fish (because of the bones).

The incorporation of the child into the typical family diet is delayed; 11% percent reported that children eat the same as the rest of the family starting between one-and-a-half to two years, 54% from two to two-and a-half years. It is recognized by some, however, that children between one and two years need to eat more frequently than other members of the family and if not, they have not learned to eat enough and are in danger of becoming malnourished.

Continued breastfeeding is the norm in this population: more than half of the mothers reported breastfeeding into the third year of a child's life (see Table 7.3). There is a belief that if the child is weaned before two years of age he or she will become malnourished and be unprotected against illness. If breastfeeding goes on too long, however, the child will become perverse as he or she is sucking blood, not milk. Mothers stop breastfeeding when they become bothered by the continual feeding or pregnant again. Those who continued to breastfeed into the third year commented that the child does not want to be weaned.

Children between two and six years old eat with the rest of the family, although they are given smaller portions depending on age. Older children may be served two or three plates of food at a meal. However, certain preferences are given to children in this age group: mango, oranges, and sweet potato are often bought with children in mind because they are sweet and they like them.

A young child is not encouraged to eat, the initiative must come from the child. If the child does not accept offered food it is perceived that he or she does not need it. Those who cry or demand more eat more. There are no apparent gender differences in feeding children in these age groups.

Some mothers (38%) reported their children do not eat when ill, due to a lack of appetite; others give soups or the liquid parts of the food preparations (27%). However, certain foods are considered good during illness, including potato (15%), mutton (15%), legumes (12%), and rice (12%). Foods considered "hot" or "fresh" in the humoral system may not be given depending on the illness.

Pregnant and lactating women

In general there is little recognition that nutritional needs are greater during pregnancy, although certain foods are considered good for the optimum growth of the baby. In practice women generally do not modify their diet except for those foods they associate with not feeling well or nausea.

Mothers reported that lactating women modify their diet, particularly during the first days postpartum. Certain foods that could adversely affect the infant through the milk may be avoided, but in general the mothers eat "what there is," similar to the rest of the family. The consumption of vitamin A-rich foods is the same as other members of the family.

San Vicente

Infant feeding patterns

All the mother-respondents in the urban barrio of San Vicente breastfeed their children (Table 7.3). Breastmilk is considered good and nutritious and is given on demand. The majority of mothers reported giving colostrum to their infants (84%); it is generally considered good for the child, and two mothers commented that it helps to eliminate the meconium. Nevertheless 16% said they do not give colostrum as it can cause empacho. However, 50% reported giving an herbal infusion to their infants as the first item after birth, to avoid flatulence and colic or to clean the stomach.

Exclusive breastfeeding during the first months is rare in this population. Infusions are introduced at an early age as shown in Table 7.3. Eighty-two percent of mothers give infusions within the first three months, mainly aniseed water, primarily to cure and prevent colic (52%), or clean the stomach or prevent constipation (44%).

In addition to infusions, half of the population gives nonhuman milk to children during the first few months, 50% of these from the first month, as the mothers consider their milk insufficient and that fresh cow's milk (the most commonly given) satisfies their child's hunger. In San Vicente 72% of the mothers use a feeding bottle to give milk and infusions.

Complementary foods other than milk are introduced mostly between four and six months (63%), although 14% reported giving foods at three months and 22% maintained the rural practice of not introducing food until seven months or later (see Table 7.3). The main reasons for introducing foods were that the infant asks to eat, is hungry, and does not fill up with breastmilk. Purees were reported as the complementary foods given to children, although 30% also mentioned soups.

Vitamin A-rich foods are introduced progressively during the first year. Squash is given from an early age, and carrot at six months by one-third of the population, at eight months by another one-third, and at one year of age by the rest, coinciding with the development of teeth. Each of these foods are given in small quantities, mashed in soup. Eggs are given at six months by 50%, and at one year by 25%. Chicken liver is considered an appropriate food at six months of age by 60% of the mothers. Fruits, such as mango, are not introduced until one year, as is the green herbal soup since it is considered too strong for the child's stomach.

Mothers had different perceptions as to the age their children can eat the family diet: one-third mentioned one year, eighteen months, and two years, respectively.

Breastfeeding into the second year of life is less frequent than in Chamis. Half of the mothers discontinue breastfeeding by one year, the other half between eighteen and twenty-four months (see Table 7.3). Reasons mentioned for weaning are primarily related to the child eating other foods: either that the child is eating foods and breastmilk is no longer necessary or he or she will not eat other foods and weaning is necessary to encourage the child to eat. Twenty-six percent continue breastfeeding because the child does not want to wean.

Children from two to six years eat the same food as the rest of the family, but in smaller quantities. However, they eat more snacks than other family members. This community has access to the municipal milk program for children six months to thirteen years of age, thus these children receive one cup of fresh cow's milk a day. Some families give preference to the child when eggs or fruit are available.

Children are not encouraged to eat more; their appetites determine how much they eat. There appears to be no gender difference in serving food at this age.

Twenty-seven percent of mothers reported giving normal food to their children when they are ill, although a similar number give liquids or soft foods. Foods mentioned that are not given during illness include milk (19%) and beans (15%)

Pregnant and Lactating Women

Although women recognize that certain nutritionally good foods are necessary for a healthy baby, in practice, pregnant women usually eat everything that is normally prepared, except for foods that may make them feel ill. Women reported that they should only eat what is necessary during pregnancy to avoid a difficult birth.

All respondents agreed that there are special foods that the mother should consume during the postpartum period. However, in practice, lactating mothers eat the same as the rest of the family, perhaps drinking more liquids that are perceived as producing more milk.

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

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.

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