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REPORT - United States Agency for International  · PDF fileLic. Elisa Gayoso-Velhsquez, Project Anthropologist, ... * This report was prepared by AED consultant

Apr 13, 2018






    February 1995

    Nutrition Communication Project Academy for Educational Development

    1255 23rd Street, N.W. Washington, DC 20037

    This activity was carried out through support from the United States Agency for International Development, Office of Health and Nutrition, under contract DANJ 1 13-2-00-703 1-00 (Project 936-5 1 13). Additional funding for post- project evaluations was provided by USAIDILima and the Bureau for Latin America and the Caribbean through PIO/T NO. 597-0000-3-765304 1 .


    The breastfeeding promotion activities described in this report were conducted by the Nutrition Communication Project (NCP) under the Academy for Educational Development's Contract No. DAN-5 1 13-2-00-703 1-00 with the Office of Health and Nutrition in the Global Technical Bureau of the U.S. Agency for International Development (USAID). Additional funding for post-project evaluations was provided by USAIDtLima and the Bureau for Latin America and the Caribbean through PIO/T No. 597-0000-3-7653041. NCP's work in Peru was carried out as part of a larger two-year intervention research project entitled: "A Controlled Trial to Extend the Duration of Exclusive Breastfeeding Among Low-Income Women in Lima, Peru," (also known, as the Peru Breastfeeding Project) conducted by researchers fiom the Johns Hopkins University and the Universidad Peruana Cayetano 'Heredia in Lima and supported principally by the Population Council, with funding from USAID'S Office of Population. Additional support was provided by the Wellstart, both as a subcontractor to AED and through the Office of Nutrition's Lactation Management Education Program.

    Numerous individuals made contributions to the development, implementation and evaluation of the Peru Breastfeeding Project:

    The Johns Hopkins University

    Dr. Laura C. Altobelli, Principal Investigator and Project Director Johnson & Johnson Postdoctoral Fellow in Infection Prevention (1988-90)

    Dr. Elaine Johnson, Co-Principal Investigator, Johnson & Johnson Postdoctoral Fellowship Program Director, Nutting Chair in Clinical Nursing

    Universidad Peruana Cayetano Heredia

    Dr. Nelly Baiocchi Ureta, Co-Principal Investigator, Department of Pediatrics Dr. Eduardo Salazar Lindo, Department of Pediatrics Lic. Elisa Gayoso-Velhsquez, Project Anthropologist, Department of Pediatrics Dr. Luis Caravedo-Reyes, Research Collaborator, Department of Pediatrics Lic. Margot Zhrate-Lebn, Director, Arzobispo Loayza School of Nursing

    Academy for Educational Development

    Ms. Margaret Parlato, NCP Director Ms. Peggy Koniz-Booher, Breastfeeding Communication Consultant Dr. Claudia Fishman, NCP Deputy Director (Porter/Novelli) Dr. Sandra Huffman, Consultant

  • Post-project evaluations of the communication component:

    Mr. Jose Ignacio Mata, Senior Communication Specialist Dr. Jose A. Romero, Senior Communication Specialist Dr. Sarah M. Vega-Shchez, Consultant Lic. Maria Elena Ugaz, Consultant Dr. Thomas Becker, AED Representative in Peru

    Asociacibn Peru-Mujer

    Dr. Elizabeth Dasso, General Coordinator Ms. h a Bendezli, Social Communicator/Production Coordinator Ms. Luisa Boggio, Artist


    Dr. Audrey Naylor Ms. Ruth Wester

    USAID Office of Nutrition

    Ms. Holly Fluty, Cognizant Technical Officer for NCP (1988-90) Dr. Eunyong Chung, Cognizant Technical Officer for NCP (1990-present)

    USAID Office of Population

    Dr. James Shelton, Director, Office of Research

    Ms. Rita Fairbanks, Health Officer

    The Population Council

    Dr. Beverly Winikoff, Senior Medical Officer Dr. James Foreit, Population Council Representative in Peru

    * This report was prepared by AED consultant Lani Marquez based on NCP trip reports and project documentation and on Peru Breastfeeding Project reports prepared by Laura C . Altobelli. Valuable comments on the draft report were provided by Margaret Parlato, Laura C . Altobelli and Peggy Koniz-Booher.


    List of Boxes, Tables and Figures Acronyms



    Rationale for the Peru Breastfeeding Project Scope of NCP Activities in Peru


    Objectives and Design of Peru Breastfeeding Project Rationale for the Hospital Intervention Institutional Actors and Roles Synopsis of Project Phases


    Review of Formative Research Behavioral Objectives and Communication Strategy Selection of the Peruvian Production Group Selection of Materials Process of Message Development Design and Implementation of the Training for Hospital Personnel Production of the Materials Lessons Learned


    Description of the Breastfeeding Promotion Intervention Use of the Materials in Training of Health Workers and Education of Mothers Lessons Learned

    vi vii

    ... Vl l l

  • TABLE OF CONTENTS, Continued

    * V. EVALUATION AND PROJECT IMPACT 26 Evaluation Strategy 26 KAP Changes in Health Personnel 27 Results of the Prospective Study of Mothers 28 Findings of the One-year Follow-up in the Two Intervention Hospitals 29 Conclusions on Project Accomplishments 3 1


    Effective Use of the Social Marketing Process for Message and Materials Development 32 Effective Use of Training for Health Personnel 32 Effective Counseling of Mothers 3 2 Sustainability of the Intervention 3 2 Replicability of the Intervention 3 3 Recommendations for Future Training Activities for Health Personnel 34 Recommendations for Future Breastfeeding Communication Activities for Mothers 3 4


    APPENDIX: Peru Breastfeeding Project Selected Evaluation Results 3 8



    Box 1 Peru Fact Sheet, 1990 Box 2 Peru Breastfeeding Project Fact Sheet for the IEC Component Box 3 Key Findings from the In-depth Interviews in Four Districts of Lima Box 4 Communication Strategy Synopsis Box 5 Tasks Performed by Asociacion Ped-Mujer Box 6 Key Questions Explored in the Focus Groups Box 7 An Example of Strategic Decisions in Message Development


    Table 1 Tirneline of Key Activities (1988-90)

    9 Table 2 Refinement of the Key Breastfeeding Messages


    Figure 1 Breastfeeding Reference Guide for Health Personnel Figure 2 Flip Chart for Use by Health Personnel Figure 3 Poster/Calendar for Mothers Figure 4 Calendar Allows Health Worker to Fill in Date Complementary Feeding

    Should Start a








    Academy for Educational Development

    Information, education and communication

    Knowledge, attitudes and practices

    Nutrition Communication project

    Training of Health Personnel in Clinical Management of Children with Diarrhea or Acute Respiratory Infection and Management of Breastfeeding and Weaning Project

    U.S. Agency for Internationid Development



    The Peru Breastfeeding Project was a two-year quasi-experimental study to develop and evaluate the effectiveness of a hospital-based intervention in increasing the proportion of mothers who exclusively breast-fed their infants up to six months of age. The breastfeeding promotion intervention was carried out between 1988 and 1990 in two large hospitals serving low-income groups in Lima, using a third public hospital as a control. The project was canied out by researchers fiom the Johns Hopkins University and the Universidad Peruana Cayetano Heredia with primary funding fiom the Population Council, under agreements financed by the U.S. Agency for International Development, Office of Population. To aid in the design of the project's information, education and communication (IEC) component, the researchers requested the technical assistance of the Academy for Educational Development's Nutrition Communication Project (NCP).

    The project had four stages. The fust sought to identify the behavioral and institutional constraints to exclusive breastfeeding through interviews with mothers in four districts of Lima and hospital interviews with postpartum women in the study hospitals, a survey of knowledge, attitudes and practices (UP) of hospital personnel, and a review of hospital procedures in the three sites. The second stage applied the fmdings of the first stage to the training of hospital personnel and the development of educational materials. In stage three, mothers in the intervention hospitals were then exposed to breastfeeding promotion messages through interpersonal communication with health personnel and the educational materials developed by . the project. In the fourth and fmal stage, the effects of the intervention were evaluated through a repeat KAP survey of hospital personnel and a prospective follow-up of 360 mother-infant pairs who had delivered at the three hospitals.

    NCP's role in the project was concentrated in the second stage, using the findings fiom the ethnographic and baseline research to understand hospital personnel's and mothers' existing knowledge, attitudes, practices and perceived constraints to exclusive breastfeeding. NCP then worked with a local Peruvian production group (Asociacion Peni-Mujer) to develop specific communication messages and educational materials aimed at mothers and health workers, focusing on the early introduction of water and traditional teas - practices that had been identified as the biggest barriers to exclusive breastfeeding in the urban population.

    The educational materials developed with NCP

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