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  • This table sorted by Iron Rank, except Sardine Fiesta Zinc and Liver Rankings Match
  • ProPan_Lutter_5.1.12

    1. 1. .• . ProPAN (Process for the Promotion of Child Feeding) Dr. Chessa Lutter for the ProPAN Team CORE Group Meeting May 1, 2012
    2. 2. ProPAN: What and for who?• A step-by-step tool to – identify nutritional, feeding and dietary problems – determine why these problems occur – design and evaluate an intervention based on the problems identified• Aimed at Ministries of Health, NGOs and international organizations interested in improving IYCN
    3. 3. Background• Designing by Dialog excellent for developing interventions using qualitative methods• Gap in the area of quantitative dietary assessment, program design, implementation and evaluation• A tool to assess both quantitative and qualitative aspects of IYCF and design and evaluate an intervention identified as a gap for effective programming
    4. 4. Background• ProPAN includes both BF and CF• Relative emphasis is on CF because information on assessment and programming most lacking• First released in 2003• Currently undergoing major updating
    5. 5. “Ideal BF practices”1. All infants are breastfed within the first hour of birth2. All infants are not fed with prelacteal feeds3. All infants are fed colostrum4. All infants and young children are breastfed on demand, during the day and night5. All infants are exclusively breastfed for the first 6 months6. No children are weaned before 24 months of age
    6. 6. “Ideal CF practices”7. All infants are fed semi-solid CFs beginning at 6 months of age8. All infants and young children meet recommended daily energy requirements9. All infants and young children fed nutrient- and energy-dense foods10. All infants and young children are fed recommended number of meals daily11. All infants and young children fed meat, fish or poultry daily12. All infants and young children are responsively fed
    7. 7. Conceptual framework12 Ideal Practices Practices followed?
    8. 8. Conceptual framework12 IdealPractices Yes Practices Why?followed? No
    9. 9. Conceptual framework12 IdealPractices How motivate Yes to follow? Practices Why?followed? Could they be followed No (modified)?
    10. 10. Conceptual frameworkRecommendations
    11. 11. Conceptual framework Feasible?Recommendations Will have an impact?
    12. 12. Conceptual framework No Necessary Feasible? and possible Yes strategies?Recommendations Yes Will have an impact? No
    13. 13. Conceptual framework No Necessary Feasible? and possible Yes strategies?Recommendations Design of Yes intervention, Will have an monitoring and impact? evaluation plan No
    14. 14. Modules of the ProPAN manual I. Assessment IV. Monitoring and II. Recipe Creation Evaluation and Trials of Recommendations* III. Design of Action Plan* Dickin et al., 1997 (TIPs)
    15. 15. Methods: Module I. Assessment• Quantitative • General survey: BF, SES, communication • 24-hour dietary recall • Market survey• Qualitative methods • Opportunistic observation • Semi-structured interview • Food attributes
    16. 16. Methods: Module I. Assessment • Analysis via – Software program – Matrices • Integration of data, analysis of practices and formulation of recommendationsPhoto credit: Maria Reyna Livia
    17. 17. Results: Module I. Assessment• Problems with diet and feeding practices• Context of practices• Recommendations to address problems Photo credit: Helena Pachón
    18. 18. Methods:Module II. Recipes & Recommendations • Creation of new or modified recipes and/or adoption of new behavior – Groups of caregivers and children, recipe preparation and acceptability – Groups of health care providers • Trials of Recommendations – 1-week home/health center trials and feasibility (Dickin et al., 1997 (TIPs))
    19. 19. Results: Module II. Recipes & Recommendations• Nutritious recipes and/or behavior with a greater chance of being adopted• Feasible and acceptable recommendations Photo credit: Helena Pachón
    20. 20. Methods: Module III. Plan of Action• Review research results• List possible intervention strategies• Choose among intervention strategies• Design plan of action Photo credit: Helena Pachón
    21. 21. Results: Module III. Plan of Action Detailed and Complete Plan of Action  Strategies  Activities  Personnel  Materials  Implementation timelinePhoto credit: Helena Pachón
    22. 22. Methods: Module IV. Monitoring & Evaluation• Specify objectives• Identify inputs, outputs, results, impact and benefits• Design monitoring and evaluation system Photo credit: Helena Pachón
    23. 23. Results: Module IV. Monitoring & Evaluation Comprehensive Monitoring and Evaluation Plan Indicators Sampling TimelinePhoto credit: Helena Pachón
    24. 24. Where ProPAN has been usedBoliviaBrazilEcuadorGuatemalaHondurasJamaicaMexicoPanamaPeru Bangladesh Lao PDRUruguay Cambodia (
    25. 25. Bolivia• Study conducted in El Alto, department of La Paz,• Between June and September, 2001, in a population located in various blocks in the Health District 2-3 of the city.• 205 families were surveyed, covering almost 100% of the homes in the selected blocks• Interviewed or observed 10 informants for the Market Survey, 16 pairs of caregiver-children for the Opportunistic Observation, 9 representatives for the Survey of Personnel in Health Organizations, and 17 mothers for the Recipe Creation Exercise.
    26. 26. Bolivia project timelineJune July August September-Logistics -Training -Training -Presentation-Work plan -Data collection -Data collection of resultsdevelopment -Data analysis, -Data analysis,-Hiring of integration and integration andpersonnel interpretation: interpretation:-Training Market Survey Attributes General Survey Recipe Creation 24-Hour Recall -Presentation of Mothers’ results Interview Observations Survey to Personnel of Institutions
    27. 27. Recipes developed and tested by mothers, Brazil, 2003 Recipe name: Rice with chicken liver and squash Energy and nutrient density Ingredients Energy Protein Iron Vit. A Vit. C Ca (kcal/g) (g/100kcal) (mg/100kcal) (( g/100kcal) (mg/100kcal) (mg/100kcal)Chicken liver 1.25 14.40 6.85 4930.66 27.03 8.80 Rice 3.61 1.86 0.17 0 0 2.22 Squash 0.18 6.67 2.21 183.33 100.0 105.56 Onion 0.38 3.05 0.56 0 16.84 52.63 Soy oil 8.84 0 0 0 0 0 Salt 0 0 0 0 0 0 Total 14.26 25.98 9.79 5113.99 143.87 169.21
    28. 28. Frequently Consumed Foods – Kingston Entire sample (n = 75) 6 - 11 months (n = 35) 12 - 23 months (n = 40) Food % Food % Food %Brown Sugar 10.6 Brown Sugar 14.3 Brown Sugar 8.3Cream of wheat w/ 5.3 Cream of wheat w/ 6.7 Cream of wheat w/ 4.5honey honey honeyJuice - Fruit Punch, 4.4 Cornmeal porridge 5.1 Juice - Fruit Punch 4.2naturalGreen banana 3.0 Juice - Fruit Punch, 4.8 Formula: Alacta 1+ 3.4 naturalCornmeal porridge 3.0 Green banana 3.2 Formula: Lactogen 2 3.4Whole milk powder 2.8 Whole milk powder 2.9 Limes, raw 3.0Irish potato 2.6 Irish potato 2.9 Whole milk powder 2.8Chicken, brown stewed 2.5 Cheese, hard 2.2 White rice 2.8Limes, raw 2.4 Chicken, brown stewed 2.2 Green banana 2.8Cheese, hard 2.3 Rice Cereal 1.9 Chicken, brown stewed 2.6
    29. 29. Qualitative Phase Activities • Key Foods List • Food Attributes Testing • Semi-Structured Interviews • Opportunistic Observations • Recipe Creation • Household Testing of Recommendations
    30. 30. Recipe Creation Exercises• 6 sessions• 29 participants – Kingston only• 12 recipes created• All recipes analyzed and ranked• 2 recipes chosen for household testing
    31. 31. Recipe RankingsRecipe Name Iron rank Calcium rank Zinc rankCalypso Liver 1 11 1Sardine Fiesta with Margarine 9 1 9Chicken, Callaloo Irish 2 2 3Liver Dish 3 10 2Veggie-Liver 4 8 4Chicken & Callaloo Surprise w/ Crushed 5 6 5Irish and Mango, Orange, & PawpawDelightChicken and Callaloo Dish with Irish 6 9 6Crushed Carrot and Irish with Liver 7 12 7C.C. Baby Style with Potato Wedges and 8 7 8Tropical ParadisePumpkin Sardine One-Pot 10 5 10Seasoned Rice, Fruit Punch 11 4 11Sardine Seasoned Rice with Mash 12 3 12Pumpkin and Zesti Fruit Punch
    32. 32. Recommendations Tested in Households• Give the child fruit with main meals• Make the child’s porridge thick, like the consistency of mashed potatoes• Feed the child iron-dense foods (example recipe of “Calypso Liver”)• Feed the child calcium-dense foods (example recipe of “Sardine Fiesta with Mangorine”)
    33. 33. Results of Test of Recommendations Compliance Criteria Sardine Calypso Give Fruits Thicker Fiesta with Liver with Meals Porridge MangorineMothers who put it to 78% 63% 89% 100%practice at least onceduring 10-day follow-upperiod*Number of times they put Cooked 1-3 Cooked 1-4 days 1-3 daysrecommendation to times 1-2 timespracticeNumber of times a day 1-3 1-3 1-3 times 1-2 times perthey fed it to the child per day dayChild’s acceptability Most Children Almost all Some babies children who liked it babies love like it and were served and easily the fruit and others don’t, the meal ate it eat it well. about evenly liked it and mixed ate a lotIntention to Continue 67% 63% 78% 44%
    34. 34. Mexico: Foods with the highest energy and nutrient values (peso) Vitamin C Vitamin A (µg RE/1 CHO (g/1 Calcium Protein Energy (kcal/1Order (mg/1 (mg/1 (mg/1 (mg/1 peso) peso) peso) peso) peso) peso) peso) peso) peso) (g/1 Zinc (g/1 Iron Fat1 Sunflower Sunflower Chickpeas Rice Sesame Sesame Chicken Guava Sesame Oil Oil (19.8) (115.2) seed seed liver (205.8) seed (959.6) (108.6) (12.9) (6.9) (6164.7) (860.4)2° Safflower Safflower Beans Tortilla Chicken Chickpeas Beef liver Orange Tortilla Oil Oil (18.3) (white liver (3.5) (3296.7) (113.9) (white (871.6) (98.6) maize) (8.6) maize) (77.7) (291.7)3° Corn Oil Corn Oil Chicken Chickpeas Chickpeas Chicken Carrot Broccoli Milk (Fluid, (605.6) (68.5) liver (62.1) (6.4) liver (2269.9) (82.2) filled) (18.0) (3.7) (166.0)4° Rice Sesame Sesame Noodles Beans Beans Sweet Black Dry Whole (523.2) seed seed (enriched (6.4) (2.2) potato Zapote Milk (43.9) (15.6) with iron (2112.6) (62.0) (136.6) (56.2)5° Sesame Sweet Broad Corn Noodles Broads Spinach Papayas Añejo seed Cookie Beans dough (enriched Beans (1537.8) (42.5) Mexican (505.7) (14.7) (13.3) treated with with egg) (1.8) Cheese lime (3.6) (128.8) (53.0)
    35. 35. Examples of how ProPAN has been Used • Lao PDR 2001 • Used to train in, collect, and analyze formative- research data • An infant-feeding intervention was developed (Source : Hilary Creed-Kanashiro)
    36. 36. Examples of how ProPAN has been Used • Ecuador 2002-2003 • The ProPAN software was used to evaluate the diet of children participating in an evaluation of a national nutrition program • 2008: To enter and analyze 24-h recall data from a survey of pregnant women (Source : Chessa Lutter, Alicia Rodríguez)
    37. 37. Examples of how ProPAN has been Used • Mexico 2004 • Used in a summer course offered at the INSP: Design, Implementation and Evaluation of Communication Interventions in Nutrition (Source : Hilary Creed-Kanashiro)
    38. 38. Examples of how ProPAN has been Used • Cambodia 2006 • A food composition table was developed based on ProPAN’s table • 24-hour dietary recall data were analyzed as part of a formative study on infant- feeding practices (Source : Tita Picado)
    39. 39. Examples of how ProPAN has been Used • Guatemala 2006 • 28 persons were trained in ProPAN with an emphasis on formative research and to develop education and communication strategies to improve infant-feeding practices (Source : Hilary Creed-Kanashiro)
    40. 40. Examples of how ProPAN has been Used • Peru 2006 • Was used in the Iowa-IIN Course in International Nutrition in the Nutrition Education and Communication Module (Source : Hilary Creed-Kanashiro)
    41. 41. Examples of how ProPAN has been Used • Uruguay 2007 • Used the software to calculate intakes and nutrient adequacy in breastfed and non breastfed children • Basis for proposal to World Bank (Source : Chessa Lutter)
    42. 42. Examples of how ProPAN has been Used • Honduras 2008 • Used the manual to assess breast and complementary feeding practices in Honduras (Source : Evelia Kory)
    43. 43. Advantages• Leads to the identification of specific nutritional and dietary problems and an understanding of the context in which these problems occur• Presents a method for identifying, ranking and selecting practices that are practical, feasible, and acceptable by the community• Provides electronic forms for data collection forms and software for standardized output of nutrition, feeding and diet information
    44. 44. Advantages• Jointly considers breastfeeding and complementary feeding practices• Integrates quantitative and qualitative methods• Explains how to analyze information• Offers guidelines on how to convert data into an implementable program• Modules can be used separately “cafeteria style”• Incorporates a globally relevant Food Composition Table• Can be useful to training in nutrition research methods
    45. 45. Updates (ProPAN 2.0)• Uses the WHO Child Growth Standards• Incorporates the WHO/UNICEF Infant and Young Child Feeding Indicators• Measures responsive feeding• Includes questions on HIV and infant feeding• Produces output to use with WHO’s OPTIFOOD’s program• Is available in French, English and Spanish
    46. 46. ProPAN Team• Chessa Lutter, PAHO/WHO• Helena Pachón, Emory Rollins School of Public Health• Kevin Sullivan, Emory Rollins School of Public Health• Roger Mir, CDC• Edith Chung, UNICEF• Christine Rudart, UNICEF• Hilary Creed de Kanashiro, Institute for Investigation in Nutrition, Peru