Wawa Illari

The aim of the Wawa Illari two year project in Pachacamac (near Lima), Peru, was to create better developmental conditions for children through a multi-disciplinary approach.

The approach included several components:

- A community health programme to detect and refer cases of malnutrition and infection and provide micronutrient supplements for children 6-36 months.
- A programme that offered support in breastfeeding, hygiene and nutrition;
- The ICDP psychosocial intervention to enhance the emotional bond and interaction between caregivers and their children
- Community and home gardens were introduced to grow food for better nutrition and as a space for interaction, in which parents could practice new skills.

The project was researched by Doris González-Fernández from the McGill University in Montreal, Canada, with the involvement of a number of other colleagues. The text below was taken from their report:

The project recruited 157 children in the control group and 158 in the intervention group. Children were aged 0-3 and living in the proximity of 3 health centres in Pachacamac. The baseline analysis confirmed that despite the project’s efforts to find a comparable control community, the intervention community was quantifiably more vulnerable than those in the surrounding area in terms of food security, nutrition and the presence of health problems that can lead to development delays in young aged 0-3.

Through Community Health Promoters (CHP), the caregivers of the children in the intervention group received the following:
1) Home garden materials, training and follow-up
2) Conscious nutrition workshops, recipes, main ingredients and cooking demonstrations using accessible/nutritious foods
3) ICDP methodology for improving caregiver-child interactions

Data collection and evaluations were done at 3 points in time: at baseline, at 8 and at 12 months. The Ministry of Health nurses evaluated main outcomes:

1) Physical growth using WHO Z-scores for weight/age, height/age and weight/height;
2) Child development, using PAHO milestones for age;
3) Child health using: history of diarrhoea/respiratory infection/visit to the doctor in the last month, haemoglobin and intestinal parasitism;
4) Nutrition and diet, using food security and food-frequency questionnaires, intake of home produced foods and application of nutrition workshops;
5) Caregiver-child interactions using ICDP guidelines.
A stress score was also applied. Children with at least 2 evaluations (127 CG and 113 IG) were included for final analyses. Comparison of frequencies and means, T-test, one-way ANOVA and Kruskall-Wallis tests evaluated improvement of health outcomes by group of intervention.

Results: The project attended the most vulnerable, and despite their disadvantages, the intervention group showed lower rates of diarrhoea and respiratory infections, stable anthropometry, improvement in food security, stable motor, social and cognitive development and importantly, they better achieved language milestones for age than the control group. Further statistical analyses will allow differentiating which components of our combined methodology contributed most to this achievement.

Indirect impacts of the project include:

 1) In Manchay, the Colegio Niña Maria now has an extensive sustainable garden for food production. This continues to be a learning space for staff, families and children, in addition to providing for future cohorts of children.

2) The ICDP training received by community nurses changed their attitudes to families under their care and led to improved communication and trust between them and caregivers. This change is likely to benefit all community members, and increase the likelihood of families utilising the health centres.
 
3) Training provided by the project led to improved skills of community nurses in assessment of developmental milestones. Nurses are now better able to detect developmental delays and these skills can be applied to children under their care.

4) The ICDP training received by community nurses, health promoters and caregivers highlighted the importance of providing children with caring and safe environment. This led some mothers to reflect on the presence of domestic and gender-based violence in their lives and the negative effects for their children.
Some women were able to take the decision to separate from abusive partners to ensure the security of their children and themselves.

5) The planting of over 100 fruit trees in the area is expected to have long term indirect impacts by providing a free food supply, stabilising soil at risk of erosion, and its capacity to retain water in this desert environment.

__________________  

Photo above: Community health promoters receiving training on conscious nutrition workshops

Photo below: Community health promoters receiving certificate as ICDP facilitators