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Milk Production in Canete, Peru

Permanent Link: http://ufdc.ufl.edu/UFE0021044/00001

Material Information

Title: Milk Production in Canete, Peru Research on Child Nutrition and Health
Physical Description: 1 online resource (80 p.)
Language: english
Creator: Medina, Priscilla M
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: animal, canete, child, dairy, malnutrition, milk, peru, santo
Latin American Studies -- Dissertations, Academic -- UF
Genre: Latin American Studies thesis, M.A.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Malnutrition is a world-wide problem affecting children all over the world. It manifests itself in the form of stunted, wasted or underweight children. In Peru, the problem is evident in stunted children. Worldwide research has shown the positive effects animal-based foods have on child growth. Therefore, my study was to analyze the effects on animal-based foods and child growth. Does the consumption of animal products benefit or improve the health of children? I propose that children who consume animal-based foods and those children whose parents are part of the dairy project will benefit more than non-participant children. The dairy project was from 2002-2005 directed by Dr. Gomez of Universidad Nacional Agraria La Molina. Resources and education, when provided to program participants, increases dairy productivity and family wellbeing therefore positively affecting children's health. Data collection was done at participants' homes from May-June 2005. Research was conducted in Santo Domingo, Peru; a small dairy community with limited resources. Twenty-seven families were analyzed about their household with a development indicator survey. Anthropometric data on height, weight and age of 41 children under than six years of age was gathered. The results of my study showed a low incidence of wasted, underweight and stunted children in this community and no major difference was found between participant and non-participant children. The consumption of animal-based foods along with the availability of water, household size, location of residence and amount of dairy milk sold all played factors in the positive health of these children.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Priscilla M Medina.
Thesis: Thesis (M.A.)--University of Florida, 2007.
Local: Adviser: Spring, Anita.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021044:00001

Permanent Link: http://ufdc.ufl.edu/UFE0021044/00001

Material Information

Title: Milk Production in Canete, Peru Research on Child Nutrition and Health
Physical Description: 1 online resource (80 p.)
Language: english
Creator: Medina, Priscilla M
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2007

Subjects

Subjects / Keywords: animal, canete, child, dairy, malnutrition, milk, peru, santo
Latin American Studies -- Dissertations, Academic -- UF
Genre: Latin American Studies thesis, M.A.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Malnutrition is a world-wide problem affecting children all over the world. It manifests itself in the form of stunted, wasted or underweight children. In Peru, the problem is evident in stunted children. Worldwide research has shown the positive effects animal-based foods have on child growth. Therefore, my study was to analyze the effects on animal-based foods and child growth. Does the consumption of animal products benefit or improve the health of children? I propose that children who consume animal-based foods and those children whose parents are part of the dairy project will benefit more than non-participant children. The dairy project was from 2002-2005 directed by Dr. Gomez of Universidad Nacional Agraria La Molina. Resources and education, when provided to program participants, increases dairy productivity and family wellbeing therefore positively affecting children's health. Data collection was done at participants' homes from May-June 2005. Research was conducted in Santo Domingo, Peru; a small dairy community with limited resources. Twenty-seven families were analyzed about their household with a development indicator survey. Anthropometric data on height, weight and age of 41 children under than six years of age was gathered. The results of my study showed a low incidence of wasted, underweight and stunted children in this community and no major difference was found between participant and non-participant children. The consumption of animal-based foods along with the availability of water, household size, location of residence and amount of dairy milk sold all played factors in the positive health of these children.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Priscilla M Medina.
Thesis: Thesis (M.A.)--University of Florida, 2007.
Local: Adviser: Spring, Anita.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2007
System ID: UFE0021044:00001


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MILK PRODUCTION IN CAN~ETE, PERU~: RESEARCH ON CHILD NUTRITION
AND HEALTH





















By

PRISCILLA M. MEDINA


A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ART

UNIVERSITY OF FLORIDA

2007





































O 2007 Priscilla M. Medina


































To my family









ACKNOWLEDGMENTS

I thank everyone who has provided support, guidance and encouragement during my time

at the University of Florida. I gratefully acknowledge the support of Debbie Geiger and the

Southern Scholarship Foundation for their financial support that allowed me to pursue my

education at the University of Florida.

I thank the University of Florida and the Latin American Studies department for allowing

me to complete my bachelor' s degree, master' s degree and this thesis. I am grateful to the

members of my supervisory committee and other professors for their guidance during the time of

this thesis: Dr. Anita Spring, Dr. Richard Beilock, Dr. Michael Moseley, Dr. Jeffrey Burkhardt

and Dr. Jim Stansbury.

I express my immense gratitude to the farmers and children of the Santo Domingo

community for their willingness to participate in this study. A thank you for Teresa Arata,

Chelita Farfan Gaby Cortez and the nurses of Herby Alto and Imperial for their guidance to

conduct this study. A thank you to Dr. Carlos Gomez and all of La Molina Agrarian University

for their support and guidance while doing my research in Peru. Thank you to Sabino Julian,

Victor Cabrera and Elis H. for their support and guidance about the Ca~nete area.

I thank my sister and brother, Susan Medina and Moses Medina, for always making me

laugh and their constant support. I express my eternal gratitude to my parents, Moses Medina

and Susana Medina, for teaching me the value of hard work and for their endless support and

encouragement. An immense thank you to my mother for her assistance while conducting this

study. I thank the rest of my family and all my friends for their endless support. I thank Andres

Vargas for always keeping me smiling, laughing and for his constant encouragement.












TABLE OF CONTENTS


page

ACKNOWLEDGMENTS .............. ...............4.....


LIST OF TABLES ............ ...... .__ ...............8....


LIST OF FIGURES .............. ...............9.....


AB S TRAC T ............._. .......... ..............._ 10...


CHAPTER


1 INTRODUCTION ................. ...............12.......... ......


Introducti on ................. ...............12.................
Statement of Problem ................. ...............12................
Literature Review .............. ...............13....
M alnutrition ................. ...............13........... ....
Measures of Malnutrition ................. ...............13................
Others factors for Malnutrition ................. ...............14................
Child Malnutrition in Latin America............... ...............15
Child Nutrition in Peru ................. ...............15................
Nutritional Value of Cow' s Milk ................ ........... ......... ........ ...........16
Livestock Impacts on Children's Health ................. ...._.._......_. ...........1
Dairy Cows and Child Nutrition in Kenya ....__. ................. ..... .......... .....1
Body Size: Adaptation and Function............... ...............21
Peru and Santo Domingo ................. ...............22................
The Study: Santo Domingo, Peru ................ ...............22...............
Research Problem and Obj ectives ............ ........... ...............23.....
M ethodology ................. ...............24....... ......


2 BACKGROUND: PERU, SANTO DOMINGO AND DAIRY FARMING ........................26


Santo Domingo, Cafiete, Peru: A Milk Producing Region............... ...............26.
Lima' s Milk Situation. ................ ................................ ..................26
Cafiete and Santo Domingo ............_ ..... ..__ ...............26..
Arequipa and Caj amarca ........._.._.. ...._... ...............27...
Health in Santo Domingo, Cailete, Peru ........._._.. ...... .. ...............28
Population and Health Statistics ........._._ ...... .__ ...............29..
Basic Indicators .............. ...............29....

Body Size Indicators............... ...............3
W eight-for-Age .............. ...............34....
Wei ght-for-Hei ght ........._._ ...... .... ............... 5....
Hei ght-for-Age .............. ...............3 5....
Phases of the Proj ect ............... ... .... .... ...... ...._ ............. ..........3
Rapid Participatory Rural Appraisal Phases (October 2002- Septemenb er 2003)...........3 6












Intervention Phase (October 2003-September 2004) .............. ...............38....
Dairy Production System ............ ..... ._ ...............38...
Constraints for Gomez' s Proj ect Success ................. ...............40........... ..
Goals of Gomez Dairy Proj ect .................. ...............40......___. ..
My Research on Santo Domingo Dairy Farmers ................. .....___............. ........4
Conclusion ................. ...............41........ ......


3 M ETHODS .............. ...............43....


Data Collection and Design ...._.. ................. ........_.. ........4
Indicators of Development .............. ...............43....
Limitations of the Research ........._..... ...._... ...............45....
Conclusion ........._.._.. ...._... ...............46....


4 RESEARCH DATA. ............. ...............47.....


Underweight Indicator: Moderate and Severe ................. .........__.......47..... ...
Underweight Indicator: Severe ................. ...............47...... ......
Wasting: Moderate and Severe ................. ...............48...... .....
Stunting: M moderate and Severe ............ ............ ...............48..
Feeding of Animal-based Foods ............ ............ ...............49..
Milk Production and Needs .............. ...............51....
Santo Domingo Households .............. ...............52....
Participant Families ................ ...............52.................
Non-Participant Families ................. .. ......... ... ............ .............5
Participant and Non-Participant Families: Compared Case Studies............... .................5
Height-for-Age and Weight-for-Age............... .............5
Participant Household Case Study "A" ................ ...............53........... ...
Non-Participant Household Case Study "B" ............. ...............54.....
Impact of Dairy Proj ect Participation ................. ...............55...............
Relation Between Milk Sold and Child Health Status............... ...............56.
Gender Division of Labor ................. ........... ...............56. ....
Household and Farm Capital Ownership .............. ...............57....
D iet .............. ...............60....


5 RESULTS, CONCLUSIONS AND RECOMMENDATIONS ................. ......................61

Results and Conclusions ................. ...............61........... ....
Future Research .............. ................... ...............6

Applied Recommendations to Increase Child Nutrition ................. ................ ........ .65

APPENDIX


A ANTHROPOMETRIC DATA SHEET ............ ......__ ...............67..


B DEVELOPMENT INDICATOR SURVEY ................. ...............68................


C ANTHROPOMETRIC DATA .............. ...............72....













D VITAMINS IMPORTANT FOR THE GROWTH OF CHILDREN OBTAINED FROM
ANIMAL PRODUCT S .............. ...............74....


Calcium ................. ...............74.................
Vitam in D .............. ...............74....
Vitam in A .............. ...............74....
Vitamin B 12............... ...............75..


LIST OF REFERENCES ................. ...............76........... ....


BIOGRAPHICAL SKETCH .............. ...............80....











LIST OF TABLES

Table page


2-1 Basic Indicators Latin America Countries (2004) .............. ...............32....

2-2 Body Size Indicators Latin America Countries (2004)............... ...............34.

4-1 Underweight Indicators............... ...............4

4-2 W asting Indicators .............. ...............48....

4-3 Stunting Indicators ................. ...............49...... ......

4-4 Participant Families: Milk Sold, Income Obtained and Number of Producing Cows.......50

4-5 Non-Participant Families: Milk Sold, Income Obtain and Number of Producing
C ow s .............. ...............51....

4-6 Case Studies ........... __..... ._ ...............55....

4-7 Dairy Proj ect Impact ...........__......___ ...............56...

4-8 Gender Division of Labor ...........__......___ ...............57...

4-9 Household and Farm Capital Percentage ....__ ......_____ .......___ ...........5

4-10 Participant Livestock Capital ...........__......___ ...............59...

4-11 Non-Participant Livestock Capital ..........._ .....___ ...............59..

4-12 Sample Diet of Santo Domingo Children ....__ ......_____ .......___ ..........6

C-1 Participant Child Anthropometric Data .............. ...............72....

C-2 Non-Participant Child Anthropometric Data............... ...............73..










LIST OF FIGURES

Figure page

1-1 Cailete, Peru Location. ................. ...............22..__._. ....

2-1 Cajamarca, Arequipa and Cailete Locations Relative to Lima. .............. ....................28

2-2 Santo Domingo, Cailete, Peru ................. ...............29........... ...









Abstract of Thesis Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Master of Art

MILK PRODUCTION INT CAN~ETE, PERU: RESEARCH ON CHILD NUTRITION AND
HEALTH

By

Priscilla M. Medina

August 2007

Chair: Anita Spring
Major: Latin American Studies

Malnutrition is a world wide problem affecting children all over the world. It manifests

itself in the form of stunted, wasted or underweight children. In Peru, the problem is evident in

stunted children. Worldwide research has shown the positive effects animal-based foods have on

child growth. Therefore, my study was to analyze the effects on animal-based foods and child

growth.

Does the consumption of animal products benefit or improve the health of children? I

propose that children who consume animal-based foods and those children whose parents are

part of the dairy proj ect will benefit more than non-participant children. The dairy proj ect was

from 2002-2005 directed by Dr. Gomez of Universidadd~dd acionaldd~~dd~~Agraria La 2olina. Resources

and education, when provided to program participants, increases dairy productivity and family

wellbeing therefore positively affecting children's health.

Data collection was done at participants' homes from May-June 2005. Research was

conducted in Santo Domingo, Peru; a small dairy community with limited resources. Twenty-

seven families were analyzed about their household with a development indicator survey.

Anthropometric data on height, weight and age of 41 children under than six years of age was

gathered.









The results of my study showed a low incidence of wasted, underweight and stunted

children in this community and no maj or difference was found between participant and non-

participant children. The consumption of animal-based foods along with the availability of

water, household size, location of residence and amount of dairy milk sold all played factors in

the positive health of these children.









CHAPTER 1
INTTRODUCTION

Statement of Problem

Malnutrition is a complex, multidimensional and interrelated problem. It affects millions

of children around the world. Malnutrition causes a great deal of human suffering both

physical and emotional. Adults who suffer malnutrition as children are less physically and

intellectually productive and suffer from higher levels of chronic illness and disability. The

personal and social costs of continuing malnutrition on its current scale are enormous (Smith

1999).

In the past three decades, Latin America has undergone many transformations that have

directly or indirectly influenced the health, nutrition and well-being of children and their families

(Bartell 2001). Around 2000, the proportion of the Latin American population who were

undernourished was 1 1% (nearly 54 million persons). Almost 8% of all children under Hyve

suffered from low weight for age. Almost 22% of the population suffered from undernutrition in

terms of average calorie requirements. Twenty-one percent of the children had moderate to

serious chronic undernutrition (Espindola 2005).

Despite significant progress made in health and nutrition during the last decades, a large

proportion of Peru's population is still at a nutritional disadvantage. An estimated 18,000

children under Hyve die yearly, more than 80% during the first year of life, often from preventable

causes. Twenty fiye per cent of children under five some 750,000 children are stunted. These

figures are significantly higher in the rural regions where poverty and a poor environment are

constant threats (UNICEF Peru 2006).










Ruminant livestock ownership directly and indirectly affects the nutritional status of

children in developing countries. The significant correlation between the quantity of milk

consumed by children and the nutritional anthropometric variables corroborates the importance

of protein food sources from animal origin to child growth. The nutritional status of children

with low consumption of dairy products has been shown to improve with the intake of ruminant

animal products (Tangka 2000).

Literature Review

Malnutrition

Malnutrition should not be confounded with undernutrition. Undernutrition and

overnutrition are two sides of the same coin, called malnutrition. Several definitions of

malnutrition exist. Macronutrient malnutrition results from an imbalanced consumption of

energy providing foods, and includes under and overnutrition. Undernutrition is due to

insufficient calorie (energy) intake. This is prevalent in many countries and is a maj or health

problem. Overnutrition is due to excess calorie intake which can lead to obesity (Kataki 2002).

Measures of Malnutrition

The combination of inadequate dietary intake of protein energy and micronutrients, and

infection, leads to malnourishment. For infants and young children, the extent of

malnourishment is quantified by recording the weight, height and age of this population group

and comparing them to a "reference population" known to have grown well. The measures of

weight, height and age are used to obtain indices on the percent of this population group that are

underweight, wasted or stunted (Kataki 2002).

Nutritional anthropometric (body measure) parameters such as weight-for-age (W/A),

height-for-age (H/A) and weight-for-height (W/H) are commonly used as bases for assessing

malnutrition and evaluating the effects of dietary treatments in children. Weight and height for










age are percentages of adequacy of each of these measurements based on the respective

standards for the child's chronological age. Malnutrition is seen in chronic and acute forms.

Anthropometric indicators for acute and chronic malnutrition are W/H and H/A standardized z-

scores with two or more deviations below reference. Weight-for-age (underweight) is an

intermediate measure of malnutrition that combines wasting and stunting. Acute malnutrition or

wasting can result from short-term factors such as diseases or severe food shortages. It is most

frequent among children below two years of age. Chronic malnutrition or stunting is more

common than acute malnutrition, and reflects past food shortages or low food intake and

recurring bouts of diseases. It is common among children older than one year of age (Tangka

2000).

Malnutrition usually entails a combination of an inadequate intake of total energy and

micronutrients. In children, the most readily measured outcome of malnutrition is poor growth.

Growth failure is also due to intake of low quality protein and vital minerals and vitamins.

Where the quantity of total food intake is deficient, so is the intake of many micronutrients. The

effects of inadequate intake are most pronounced during periods of rapid physiological change

and during stages of accelerated growth such as in infancy and early childhood (Neumann 1999).

Others factors for Malnutrition

Apart from insufficient availability of food, child malnutrition is usually also affected by

others factors associated with extreme poverty, such as lack of access to drinking water and

sanitation. These factors contribute to infectious diseases and diarrhea which result in rapid

weight loss. The most usual expression of hunger and poverty among children in Latin America

is chronic undernutrition (moderate to serious deficits in height for age, or retarded growth).

These deficiencies are serious because they represent the accumulated effect of lack of adequate

food and nutrition during the most critical years of child's development (Espindola 2005).









Child Malnutrition in Latin America

Undernutrition (measured as low weight for age) has declined in Latin America, from 21%

in 1970 to 6.7% in 1997. However, there is great disparity between Latin American countries.

In Chile, Costa Rica and Cuba, less than five percent of the population is undernourished. In

Guatemala, Honduras, Haiti, Ecuador and Bolivia, the range is from 15-33% (similar to several

African countries). Rates of acute protein-energy undernutrition (measured as low weight for

height) are very low in most countries and negligible in some. In a few countries, there is a

relatively high rate of stunting (low heights for age), and in others stunting represents a regional

problem that is more prevalent among rural populations. Stunting is recognized as an expression

of chronic sub-lethal undernutrition (Stuart 1998).

Child Nutrition in Peru

Peru is a geographically diverse country of deserts, mountains, jungle and coast. This

results in regionally diverse inequalities in services and living standards. Many programs in the

country are unevenly distributed across Peru. This includes health programs (Peru Travel

Adventures 2006). Socio-economic disparities and lack of access to health care affect children

and adolescents who are not benefiting from the overall economic growth of the country

(UNICEF Peru 2006).

In Peru, the prevalence of underweight children declined from 10.7% in 1991-92 to 7.8%

in 1996. Wasting does not represent a problem at the national level since it has remained below

two percent. The improvement in the nutritional status of children less than five years between

1991-92 and 1996, at the national level, is a decrease in stunting from 31.8% to 25.8% (FAO

2006).









Nutritional Value of Cow's Milk

Overcoming deficiencies in dietary quantity and quality are maj or nutritional challenges

globally, particularly in developing nations. Dietary quantity is concerned with the availability

and consumption of total food energy (kcal) and dietary quality with the ability of the diet to

supply protein of high biologic value and adequate supplies of micronutrients. The

micronutrients of maj or concern in the growth, development and health of children include

calcium and vitamins A and B l2 (Neumann 1999).

Animal-source foods are a source of digestible and quality protein and provide energy.

They are calorically compact and an efficient source of micronutrients (Neumann 1999). Milk is

a source of many nutrients. It is a source of calcium, phosphorous, vitamin B l2 and vitamin D.

It is also a good source of protein, fat, carbohydrate, vitamin A and niacin (Patton 2004).

However, there are claims that milk is not nutritious and harmful to people's health. It is

argued that milk contains many "ingredients" that the consumer is not aware of. These

"ingredients" include cholesterol, antibiotics and bacteria. For example, recombinant bovine

growth hormone (rBGH) is a non-steroidal hormone inj ected into dairy cattle to increase milk

output. A consequence of this injection is that it increases the growth hormone, IGF-I. IGF-I is

thought to be a key factor in the growth and proliferation of cancer. In addition, it is claimed that

milk contributes to heart disease and increases the risk of breast cancer (Cohen 1997).

Milk is a food that is mostly marketed for its calcium and its contribution to healthy bones.

This is especially true for children because bone mass must be built before adulthood. It is

argued that milk is an excellent source of calcium; however proteins in milk and lack of

magnesium make it an inefficient source for proper calcium absorption (Cohen 1997).

However, it is generally believed that adequate amounts of milk and milk products are

needed throughout the life cycle to promote bone health and contribute to overall health status.









The children in this study were six years or younger. Children in this age range obtain their

calcium requirements by consuming milk and milk products. Calcium is needed throughout

childhood to maintain existing bone and for bone growth. As discussed earlier, milk provides

other important nutrients needed for good health (i.e. protein, phosphorus, potassium, vitamins

A, Bl2, and D, riboflavin and niacin) (Miller 2000).

Vitamin D is an important factor in calcium absorption and metabolism. However, dietary

sources are limited. It is essential for a healthy skeleton throughout life. Vitamin D is

synthesized in the skin when exposed to sunlight and obtained from some foods (Miller 2000).

In the community studied, outdoor exposure is frequent and daily. Activities are performed

outside and the children join their parents in the farming activities. Also, these children walk to

and from school, walk to and from obtaining water, and play outside. Therefore, sunlight

exposure is abundant is this area and could be another explanation for the low incidence of

stunting in this population.

Livestock Impacts on Children's Health

Livestock are a maj or component in agriculture in developing countries and produce much

more than food. Livestock and their products provide direct cash income; they are a living bank

for farmers and are critical to agricultural intensification via provision of power and manure for

fertilizer and fuel. In addition, livestock provide other functions to the livelihood of their

keepers. They are a food supply that can provide milk, butter, cheese, eggs and meat. Animal-

based foods are high in protein and are an important source of energy, minerals and vitamins

(Tangka 2000).

Livestock directly and indirectly affects the nutritional status of children in developing

countries. The nutritional status of children with low consumption of dairy products can be

improved with ruminant animal product intake. The nutritional status of children may easily be









improved from dairy animals if all the milk produced is not sold. There is a misconception that

dietary treatments of growth-retarded children are a waste, since the damage has already been

done and cannot be improved upon. Although height is not as responsive as weight to nutritional

interventions, there is evidence of rapid response of linear growth during a short period of

treatment of malnourished children. Restoration of normal height is possible, up to the age of

about 10. It has been found that the maj ority of the cases that have reported gains in height have

been based on the use of milk or soya-based supplements. For children in boarding schools in

Papua New Guinea, their growth response was proportional to the amount of milk in their dietary

supplement (Tangka 2000).

Ownership of livestock and livestock technologies can give households more opportunities

to improve the nutritional status of their children. There is much literature on the effects of

animal products (especially milk) and the ownership of ruminant livestock on the nutritional

status of children in developing countries. There are examples from Ecuador, Nepal, Uganda and

Rwanda of the correlation between dairy animals and child nutrition. In a study conducted in

rural coastal Ecuador, access to market foods, as measured by per capital food spending and

livestock ownership, mostly cows, showed the strongest correlation with children's nutritional

status (H/A, W/A). Children from farm families owning livestock were less likely to be growth

retarded than children of farmers without livestock. A study from a rural community in Nepal

found that households with a milk-producing buffalo had less chance of having a severely

stunted child than households without lactating buffalo. Ownership of a cow was found to be a

significant predicator of H/A (long-term) nutritional status in children in south-western Uganda.

A study from rural Rwanda found that children between the ages of two and Hyve years old from

households with dairy animals (cattle and goats) were significantly taller than children from









households without these animals. The presence of well-nourished children in households with

ruminant livestock is probably due to the availability and consumption of high quality protein

and calories from dairy products (Tangka 2000).

Further correlation between livestock ownership and its impact on child nutrition has been

found in a study in five Latin American countries. One study showed that milk intake is

associated with better growth in children during the critical developmental stage from 12 to 36

months of age (Staal 2004). A study conducted in Managua, Nicaragua showed that the

proportion of children stunted was lower for those who drank milk on previous day than those

who did not. In Brazil, it was found that the consumption of milk increased height-for-age Z-

score standard deviation units when selected other factors were controlled for (Nicholson 2003).

The role of milk consumption, both goat and cow, was found in Ethiopia to increase child

growth in households raising livestock. Studies in such disparate locations such as China,

Jamaica and Mexico found that children who consumed cow's milk or other dairy products

obtained significantly greater lengths or heights. In school-age-children, where milk and other

dairy product are low, the addition of milk to the diet was found to increase linear growth and

reduce stunting. These results were observed in Malaysia and in Japan using school feeding

programs. In both studies, rapid growth in height was noted (Neumann 1999). In the Dominican

Republic, South Korea, Colombia, Indonesia and Province of Sudan, milk consumption was

found to have a positive association with children's nutritional status (Tangka 2000).

Dairy Cows and Child Nutrition in Kenya

Several studies have been conducted on dairy cow ownership and child nutritional status in

Kenya. In Kenya, nearly one-third of children showed evidence of chronic malnutrition in the

mid 1990s. A maj or cause of malnutrition in Kenya is inadequate dietary intake, both in terms of

quantity and quality. Animal-source foods, including dairy products, are an excellent source of









essential micronutrients and high-quality protein. However, it is unclear whether actual

ownership of dairy cattle brings nutritional benefits to the children within a household. A more

recent study attempted to shed light on this issue (Staal 2004).

The study was carried out in Coast and Central Provinces of Kenya. The proj ect was

carried out by the Smallholder Dairy Proj ect and the Department for International Development

of the United Kingdom. Household surveys were given to cattle-owing households and non-

cattle-owning households to examine the impacts of dairy cow ownership on the nutritional

status of pre-school children. The surveys included anthropometric measurements (including

height and weight) of all household children under the age of five. It was found that children

from cattle-owing households had a higher height-for-age, indicating lower levels of stunting

(Staal 2004).

The benefits brought to the households and children were many. There is an increase in

the amount of milk available for household consumption. The sale of milk can increase

household cash income, which can then be used to purchase further nutrients. Also, the use of

cattle manure may increase food crop yields (Staal 2004).

An additional study in Embu, Kenya by the Global Livestock Collaborative Research

Support Program has shown that supplementation with animal-source foods had positive effects

on Kenyan schoolchildren's growth and cognitive performance. The effect of milk

supplementation was second highest next to meat supplementation (Staal 2004).

One further study conducted in Kenya analyzed dairy cow ownership and child nutrition.

This study was done in the coastal and highland areas of Kenya. For the coastal sample,

ownership of cattle had a statically significant positive effect on the mean height-for-age for the

children of this area. For the highland sample, the cattle ownership has positive effects on









height-for-age as well. Cattle ownership does not have a significant impact on mean weight-for-

height for either region. Therefore, cattle ownership has a large impact on longer-term child

nutritional status (growth) but little or no impact on short-term nutritional status (Nicholson

2003).

Body Size: Adaptation and Function

Economist David Seckler proposed the "small but healthy" hypothesis. A child who is

short but not thin is "small but healthy." Reynaldo Martorell in "Body Size, Adaptation and

Function," argues against this hypothesis. A maj or criterion for judging child' s health is whether

the child is growing as expected. Failure to grow is an indication that something is wrong.

Growth retardation is widely recognized as a response to a limited nutrient supply at the cellular

level. The maintenance of basic metabolic functions takes precedence and resources are diverted

away from growth and physical activity (Martorell 1999).

Poverty affects growth as poverty affects nutrition and infection. The components of

poverty will always lead to low dietary intakes and/or infection which result in decreased

nutrient availability at the cellular level which then gives rise to growth retardation. The diets of

these children are generally lacking in both quantity and quality. Nutrient metabolism is directly

affected by infections which lead to poor nutrient metabolism and nutrient utilization. Therefore,

the basic cause of stunting is poverty and the effects on size are mediated through poor diets and

infection (Martorell 1999).

In the case of Latin America, moderate linear growth retardation is observed, whereas

wasting is rare. At severe levels of deficiency, linear growth ceases altogether and it becomes

necessary for the body to use its tissues reserves. These reserves serve as an energy and nutrient

source to maintain vital functions. However, in less severe stages, normal mass to length









dimensions will be maintained. Dietary deficits are coped with by slowing down in growth and

decreasing physical activity (Martorell 1999).

Peru and Santo Domingo

Peru is located in western South America, bordering the South Pacific Ocean, between

Chile and Ecuador (VirtualPeru.Net 2004). It has a population of about 27,562,000 million

people (UNICEF Peru 2006). The country is divided into 24 "departments," and the

constitutional district of Callao. The capital of the republic is Lima. The official languages are

Spanish and Quechua, but a recognized regional language is Aymara (VirtualPeru.Net 2004).

Research was conducted in Santo Domingo, a providence of Cailete (Figure 1-1).


Lima




de Flores .
San Antor.I.~: L rE-







Imperial
Ica

Figure 1-1: Cailete, Peru Location. (Canete Government 2007)

The Study: Santo Domingo, Peru

Cafiete is a 24,000 ha valley on the west coast of Peru, one of the driest deserts in the

world. The land is highly parceled; there are about 5,000 farms and 80% of them are in hands of

small landholders (10 ha or less). Usually, small farms are family-centered households, where









the main source of labor comes from family members and the farm and the house are highly

interrelated (Cabrera 2002).

The site of this research was in the area of Santo Domingo, Cailete, Peru. Santo Domingo

is located in the lower populated area of Herby Alto, in the district of San Vicente, providence of

Cailete, in the department of Lima-Peru. There are a total of 54 families in this community in a

total population of 152,379 valley residents (Cabrera 2000). Twenty-seven families and their

children under the age of six were studied. Dairy production is the main activity for the

inhabitants in Santo Domingo.

In the community of Santo Domingo, none of the households have water or electricity in

the home. Sanitation conditions are low and diets for the people of this community is limited.

However, out of the children studied in this analysis there was low prevalence of stunting. Of

participant children, 93% of children were in normal range for their height and age. Of non-

participant children, 81% were in normal range for their height and age. This low prevalence of

stunting in this community is being attributed to the presence of animal foods in the diet of the

children. These foods include meats, eggs and milk. In addition, the low prevalence is also

being attributed to other factors such as location of residence, number of times water is obtained,

mother's care and household size.

Research Problem and Objectives

The overall purpose of this study was to conduct a cross-sectional study in Santo Domingo,

Cafiete, Peru. A portion of the inhabitants of Santo Domingo are participants of a dairy program

aimed to assist dairy farmers. This program is sponsored by the Universidad de La Molina. The

research seeks to establish a baseline anthropometric assessment (height, weight, age) for under-

six child growth status of children whose parents are participants of a regional dairy project,

compared to those children whose parents are not participants in the dairy project. In addition,









the study provides a rapid ethnographic assessment of "development indicators" at the household

level that includes household items and number of livestock owned. An obj ective of this study is

to determine the nutritional impact of this dairy proj ect and the impact of animal-based foods on

child health. It is hypothesized that animal products are a daily part of these children's diet and

especially for the children of the participant families, therefore the incidence of underweight and

wasted children will be low but stunted children will be high.

The general objectives of this research are to: (1) enhance the understanding of the benefits

or lack thereof of agricultural change for household nutrition; (2) enhance the knowledge about

family livestock ownership and the effects on child nutrition; and (3) examine the nutritional

effects of milk and sun exposure on children's health.

Methodology

This field study combined anthropometric data along with an assessment of the

development indicators of the household. The study involved 1) measurement of height and

weight of children under six, whose parents are participants of the dairy proj ect, compared to

children whose parents are not participants in the dairy proj ect and 2) conduct a survey of

development indicators at the household level. Nutritional anthropometrics parameters such as

weight-for-age (W/A), height-for-age (H/A) and weight-for-height (W/H) were used as bases for

assessing malnutrition and evaluating the effects of dietary treatment in the children.

Conclusion

Malnutrition in Peru is present in the form of stunting and in some cases underweight and

wasted children. Research has been conducted in several countries around the world that

supports the theory that an animal-based diet improves the health status of children. This theory

was applied to my research conducted in Santo Domingo, Peru; a small dairy community with

limited resources. My study's overall purpose was to conduct a cross-sectional study between









families who are part of a dairy proj ect compared to those who are not. Anthropometric data

along with a development indicator survey was performed at each study household to assess the

health status of the children in Santo Domingo.









CHAPTER 2
BACKGROUND: PERU, SANTO DOMINGO AND DAIRY FARMING

Santo Domingo, Cailete, Peru: A Milk Producing Region

Lima's Milk Situation

Like other developing countries, Peru has experienced strong urban growth during the last

few decades. In 2000, 72% of its 25 million inhabitants lived in cities. Metropolitan Lima alone

makes up 30% of Peru' s total population. Urban consumer preferences are significant in

determining domestic agricultural production, not only in terms of what is produced, but also

how and where it is produced. The proximity between the production region and the market thus

becomes particularly meaningful for milk, a bulky, perishable product with a high market value

(Bernet 2000).

Milk producers on the coast of Lima (such as in Cafiete and Santo Domingo) currently

have favorable market conditions, as milk prices are much higher than in other regions of the

country. Increased competitions among local milk buyers, who are confronted with unused

processing capacities, are unable to meet demand from their "local" market in the city of Lima

(Bernet 2000).

Cailete and Santo Domingo

Santo Domingo is a province of Cailete. Cafiete is a valley in the central coast of Peru

within the department of Lima (Cabrera 1999). It is located 62. 14 miles south of the city of

Lima (Gomez 2002). The valley is irrigated by the Cafiete River water. The weather is desert-

like; there is little rain. The temperature varies from 53.6oF in the winter to 89.6oF in the

summer, with an average of 64.4oF (Cabrera 1999). Average precipitation is 2mm/year (Gomez

2002). There are approximately 150,000 people living in Cafiete; 41,000 of them constitute the

rural population (Cabrera 1999).









Santo Domingo is an annex of Cafiete. Dairy production is the main activity for

inhabitants of Santo Domingo. The community borders past the Cafiete River therefore

vegetation growth stops where the river ends. There are no businesses to purchase household

items, feed for the animals, food or to obtain medical care. It is a community of limited

resources with no running water, electricity or sewage system in any of the homes. This

community differs greatly from the bustle of Cafiete. Cafiete is filled with local businesses such

as a bakery, post office, library, eateries and pharmacies. There is the local open market for the

purchase of clothing, household items and food. There is also the local hospital and private

doctor offices. Cafiete also contains a bus station that operates buses to and from different

locations in Peru, especially to and from Lima. Homes and businesses have indoor plumbing

and electricity. The differences between Cafiete and Santo Domingo are of the basic needs for

survival which Santo Domingo's inhabitants and community does not possess.

Arequipa and Cajamarca

Since the 1940s, Arequipa and Caj amarca have been the largest milk producers in the

country (Bernet 2000). Arequipa is about 700 miles from Cafiete and the second largest city in

Peru (Peru Traveler 2006). Cajamarca is around 433 miles from Cailete (Globe Feed 2006). It is

located in the northern highlands of Peru. Both cities are well-known for their fine cheeses and

dairy products (British Council Peru 2007).

Lima has also remained an important milk-producing region. The reason is its own vast

market and the fact that the other two milk areas have high transportation costs for perishable

and bulky dairy products taken to the Lima market. The fact that Lima City, with its more than

seven million inhabitants, has continued to grow at more than six percent annually in recent

years explains its expanding demand for fresh dairy products. Comprising more than 80% of

national consumption for industrially processed dairy products, Lima is considered "the market"









for the milk processing industry. Consequently, as a production region, Lima has the advantage

in that its market is "next door." It is this geographic advantage that has led to the recent

establishment of additional milk processing plants by different companies in peri-urban Lima

(Bernet 2000) (Figure 2-1).


Figure 2-1: Cajamarca, Arequipa and Cailete Locations Relative to Lima. (Shunya 2007)

Health in Santo Domingo, Cailete, Peru

None of the homes of the families studied have access to electricity. Families do not have

in-home access to adequate water for human or animal consumption. All water is obtained two

to three times a week from the puquio (natural ground water reservoir) using donkeys and at

times horses for the 20-30 minute walk. The water obtained is kept in reservoirs constructed in

each household. The water obtained is for human and animal use (Figure 2-2).










-Y


figure 2-2: Santo D~omingo, Caniete, Peru. (Author 2005)

Medical personal of Santo Domingo includes one doctor, one nurse, two nursing

technicians, and one obstetrician. Demand for medical services in the area does not meet the

supply of medical staff. The main problems that affect the population of Santo Domingo include

respiratory infections and diarrhea infections. Sharp watery diarrhea infections occur mainly

during the summer months. In addition, there is multi-resistant tuberculosis (TB), malnutrition

and parasites (Gomez 2004).

Population and Health Statistics

Basic Indicators

Use of anthropometry requires two essential items: an anthropometric indicator and a cut-

off point. The indicator, often called an anthropometric index, is a measurement or a

combination of measurements made in the field, such as weight and height, or the combination









of measurements with additional data, such as age. Different indices reflect different components

of nutritional status. The index weight-for-height indicates thinness, and because acutely

undernourished persons generally lose body weight but not height, weight-for-height decreases

with acute undemutrition. Young children with chronic undernutrition may not be thinner than

normal children, but may have retarded growth in height. Chronic undemutrition may not be

severe enough to cause weight loss, but does interfere with normal linear growth. As a result,

height-for-age is decreased, and children become stunted. Weight-for-age reflects both acute and

chronic undemutrition because both thin children and stunted children are underweight

(Woodruff 2000).

There are several indicators used to evaluate the condition of children. Basic indicators

and body size indicators are used in this study. Basic indicators used are total population, life

expectancy at birth, under-5 mortality rate, infant mortality rate, annual number of births and

annual number of under-5 deaths (Table 2-1).

Some definitions are necessary for clarity:

Under-five mortality rate (U5MR) probability of dying between birth and exactly five

years of age expressed per 1,000 live births (UNICEF Peru 2006).

Infant mortality rate (IMR) probability of dying between birth and exactly one year of

age expressed per 1,000 live births (UNICEF Peru 2006).

Life expectancy at birth- the number of years newborn children would live if subj ect to the

mortality risks prevailing for the cross-section of population at the time of their birth (UNICEF

Peru 2006).

Statistics from five countries are used to compare to Peru which are Argentina, Bolivia,

Colombia, Costa Rica and Mexico. The following are notable:









Costa Rica has the best basic indicators for its population. Out of the Hyve countries

analyzed, it had the lowest total numbers for under-five mortality rate of 13, infant mortality rate

of 11 and annual number of under-5 deaths at 1,000. Costa Rica has the highest life expectancy

at 78 years in 2004.

Bolivia has the highest basic indicators for its population. It had the highest number for

under-Hyve mortality rate of 69, infant mortality rate of 54 and annual number of under-5 deaths

at 18,000. Bolivian's have the lowest life expectancy at 64 years in 2004.

Infant mortality is used to compare the health and well-being of populations across and

within countries. In the developing world, about half of newborn deaths were from infection,

tetanus and diarrhea (Green 2006). Peru's basic indicator for U5MR is 29. It is a country still

developing and in need of better health care and state involvement. Although not a true indicator

of nutritional status, infant mortality rates do give some insight into the living conditions of

children in a community. There have been substantial improvements in most Latin American

countries, but there still exist disparities among them. Costa Rica, for example, has the infant

mortality rate of a developed country, while Bolivia still has unacceptably high Eigures (Bartell

2001).

The under-Hyve mortality rank is a critical indicator of the well-being of children (UNICEF

Peru 2006). Five diseases pneumonia, diarrhea, malaria, measles and AIDS account for half

of all deaths in children under Hyve. Most of these lives could be saved by expanding low-cost

prevention and treatment measures. These include exclusive breastfeeding of infants, antibiotics

for acute respiratory infections, oral re-hydration for diarrhea, immunization, and the use of

insecticide-treated mosquito nets and appropriate drugs for malaria. Ensuring proper nutrition is

also part of prevention, because malnutrition increases the risk of dying from these diseases










(Child Info 2006). Peru's U5MR is 29. As with infant mortality rate, Peru is nowhere near

Costa Rica in terms of health care and reducing childhood diseases, but Peru' s infant mortality is

not as serious as Bolivia's.

Table 2-1 Basic Indicators Latin America Countries (2004)
Annual no. Life
Total Under-5 Infant Annual no. of under-5 expectancy
Population mortality mortality of births deaths at birth
(thousands) rate rate (thousands) (thousands) (years)


Argentina 38372 18 16 685 12 75


Bolivia 9009 69 54 265 18 64


Colombia 44915 21 18 970 20 73

Costa
Rica 4253 13 11 79 1 78


Mexico 105699 28 23 2201 62 75


Peru 27562 29 24 627 18 70
Source: UNICEF State of the World's Children 2006

Body Size Indicators

Another indicator used is body size. Body size indicators used are underweight: moderate

and severe; underweight: severe; wasting: moderate and severe; and stunting: moderate and

severe (Table 2-2). Body size is generally the best indicator of physical well-being in children,

because inadequate food intake, poor nutritional quality of the diet, and various infections affect

growth. The most common measure of undernutrition in children are weight and height either

individually or combined (Martorell 1995).

Definitions are necessary for clarity:









Underweight: moderate and severe- below minus two standard deviations from median

weight for age of reference population (UNICEF Peru 2006).

Underweight: severe- below minus three standard deviations from median weight for age

of reference population (UNICEF Peru 2006).

Wasting: moderate and severe- below minus two standard deviations from median height

for age of reference population (UNICEF Peru 2006).

Stunting: moderate and severe below minus two standard deviations from median height

for age of reference population (UNICEF Peru 2006).

The same five countries statistics are used to compare to Peru's. The results are:

Argentine and Costa Rica have the lowest occurrence of underweight: moderate and severe

for children under five at five percent. Bolivia has the highest at eight percent.

Costa Rica has the lowest occurrence of underweight: severe at zero percent, while all the

other countries had an indicator of one percent.

Bolivia, Colombia and Peru all had the lowest indicator for wasting: moderate and severe

at one percent. The highest was at three percent for Argentina.

Costa Rica had the lowest indicator for stunting: moderate and severe at six percent.

Bolivia had the highest occurrence at 27%.










Table 2-2 Body Size Indicators Latin America Countries (2004)

Percent of under-fives (1996-2004) suffering from:

Underweight Wasting Stunting

Moderate
and Moderate and
severe Severe severe Moderate and severe


Argentina 5 1 3 12


Bolivia 8 1 1 27


Colombia 7 1 1 14

Costa
Pica 5 0 2 6


Mexico 8 1 2 18


Peru 7 1 1 25
Source: UNICEF State of the World's Children 2006

Weight-for-Age

Weight-for-age reflects body mass relative to chronological age. Weight-for-age is also a

good indicator of the nutritional state of a child. Weight increases or decreases more rapidly

than height. The metrics used for this index are overweight, normal, and undernourished. A

child is classified as overweight if s/he is in the range of +2 or greater standard deviations (SD).

Normal range is from -2 to +2 SD and undernourished is under -2 SD (Reyes, 2005). Low

weight-for-age is described as "lightness" or "underweight." While high weight-for-age is

described as "heaviness" (WHO 1995).









The underweight indicator for Peru was on average the same as other Latin American

countries. Low weight-for-age is not as severe a problem in Peru as it is in other regions of the

world, e.g. Sub-Saran Africa. The prevalence in 1990 for underweight children was eight

percent in South America (Martorell 1995). The share of underweight children actually

increased from 28.8 to 3 1. 1% between 1990 to 1995 in this region of Africa (Smith 1999).

Weight-for-Height

Low weight-for-height and high weight-for-height are two growth indicators for children.

Wasting or thinness usually indicates a recent and severe process of weight loss. This is usually

associated with acute starvation and/or severe disease. It is also possible that wasting is the

result of a chronic unfavorable condition. The prevalence of wasting is usually below five

percent even in poor countries. Low weight-for-height shows a peak in the second year of life

(WHO 1997). Any child with low weight for their height is undernourished (Reyes 2005).

At the opposite end of the spectrum is high weight-for-height. "Overweight" is the

preferred term to describe high weight-for-height. There is a strong correlation between high

weight-for-height and obesity. However, greater lean body mass can also contribute to high

weight-for-height. On a population wide basis, high weight-for-height can be considered as an

adequate indicator of obesity (WHO 1997).

The weight-for-height indicator for Peru (1) was on average the same compared to other

Latin American countries. Wasting is not a severe problem found in Latin American countries as

compared to countries in Asia. High levels of wasting are found in Asia, probably due to lower

energy intakes than in Latin America (Martorell 1995).

Height-for-Age

Children with very low height for their age are termed as stunted. Low height-for -age is

the result of reduced skeletal growth (Keller 1991). High levels of stunting are aociated with









poor socioeconomic conditions and increased risk of frequent and early exposure to adverse

conditions such as illness and/or inappropriate feeding practices. Prevalence starts to rise at the

age of about three months; the process of stunting slows down at around three years of age

(WHO 1997).

Latin American children are often faced with chronic but moderate deficiencies of

nutrients. They may respond by growing less in height without altering weight-for-height rations

(Martorell 1995). In Latin America, there is high prevalence of chronic malnutrition expressed

as starting. Stunting is always more prevalent in rural populations than in urban ones (Bartell

2001). Peru's stunting indicator at 25% is the second highest behind Bolivia's at 27%.

Stunting is a health problem concern for Peru.

This research is based on a dairy proj ect in the area of Santo Domingo, Peru directed by

Dr. Carlos Gomez Bravo, an animal nutritionist professor at the Universidaddddddddddddddd Nacional Agraria

La M~olina in Lima. Fifty-four families in this area are involved in dairy farming as their

principal source of income. A sample of 18 small dairy farmers were selected for the proj ect

based on the number of dairy cattle owned; however 17 resulted in participating in the proj ect.

These farmers had Holstein genotype dairy cows and have been established in the area for the

last 10 years (Gomez 2005).

Phases of the Proj ect

Rapid Participatory Rural Appraisal Phases (October 2002-Septemenber 2003)

Phase I of this dairy proj ect consisted of a survey of total producers in the area (three field

visits) followed by selection of producers (two field visits) invited to a participatory workshop

and follow up proj ect activities (Gomez 2005).









Phase II encompassed a meeting with the farmers on their site with the purpose to have a

participatory workshop where they expressed the situation of their production systems (Gomez

2005).

The workshop was carried out in the Universidadddddddd~ddddddd Nacional Agraria La M~olina 's nearby

research facility in October 2002. The university in 1999 established a nearby research site in

Santo Domingo nearby to the farmers of this area. This research site consists of a dairy unit of

about 100 cows for the purposes of teaching, research and extension purposes. The Kellogg

Foundation funded an extension proj ect which has supported initial activities with dairy farmers

of Santo Domingo. In addition, students are involved in various development activities (Gomez

2002).

In this workshop, 20 small farmers participated. The workshop went as follows:

Presentation was made to the participants.
Participants were divided into four groups.
Each group was given paper, pencils and any other needed materials to draw and
present their dairy production system.
Each group presented and explained their production system.

After the presentation of each group, it was established that the negative factor affecting

these farmer' s production systems were forage availability, livestock management technical

deficiencies, lack of water supply and health and reproductive problems.

Eighteen farmers of the 20 were in agreement with the work plan presented. The field

activities were finalized and included training in organization and basic record keeping.

Two graduate students also visited the research site twice a month, for 12 months. Data

were collected on milk production, herd dynamics, the feed system, reproduction, health and

social economic aspects.









Phase III consisted of a meeting held in January 2003 as a follow up participatory

workshop. Any project advances were evaluated and any adjustments that were needed were

noted (Gomez 2005).

Intervention Phase (October 2003-September 2004)

During October and December of 2003, Hield visits were conducted to prepare for the

intervention phase of this proj ect. Four farmers began using concentrated feed that was prepared

at a nearby commercial feed mill. These four farmers were indicated on the appropriate quantity

and handling of the concentrated feed during the months of January-March 2004. By July 2004,

a total of nine farmers were purchasing the concentrated feed and by the end of the month, 1 1

families were utilizing the feed. Bulletins were also prepared and distributed among the

participants of the proj ect (Gomez 2005).

During this phase, the number of lactating and dry cows in each herd was compared to the

previous year and the numbers stayed about the same. Artificial insemination use remained the

same, although no specific activity was conducted in order to change this issue. Farmers did

however express a high interest in its implementation. In addition, there was no significance

difference in the price of milk received from the buyer for milk sold by the farmers. Milk

production also remained fairly the same and the costs of inputs (Gomez 2005).

Dairy Production System

The production systems of the participants of this proj ect were established at low potential

levels. The participants of this proj ect were established to have a large number of bulls and

growing males which limits total milk production and consumption of resources (Gomez 2005).

Weight on the dairy cattle was 20-40% below expected body condition and was at an inadequate

level for all. Farmers did not maintain records on lactation length, calving intervals or lactating









and dry cattle. In addition, no records on calf mortality, parasites and any other health problems

affecting the herds were kept (Gomez 2002).

Families whose property is located closer to the water channel own more cattle than those

whose property is located farther away from the channel. Hand milking was observed in all of

the units. There is no use of artificial insemination (AI) and each family owns their own bull for

reproduction purposes or shares one with the neighbor (Gomez 2002). General difficulty was

observed in the availability of appropriate bulls for service. Success of pregnancy is a problem

for the herds of Santo Domingo. During an evaluation conducted in May of 2003, the number of

cows in the sample was 1 12 and during the period of evaluation (245 days) 21 calvings occurred.

The result is a 19% natality rate. Rectal palpation was conducted and only eight percent of the

cows were pregnant. The main problem is lack of ovarian activity due to low body condition in

the dairy cattle (Gomez 2005).

In addition, the feed provided to theses herds were of poor quality and limited quantity.

Poor quality forage was being fed such as sweet potato foliage and corn stover. Some

households were feeding supplementary concentrates to their cattle but it was of very limited

amount. Also, there is limited availability of a constant water supply available to these cattle

(Gomez 2002).

Most of the income supporting the families in Santo Domino comes from the selling of

milk. There is no data to show where money earned from income received goes however the

percentages of the expenses related to dairy farming was obtained. Expenses related to

maintaining dairy herds are broken down as such: 48% for forage expenses, 28% manual labor,

22% concentrate purchases and one percent each for facilities and other expenses.









Constraints for Gomez's Project Success

Dairy producers of Santo Domingo were restricted to receive financial support and the

herd size was a constraint for improvements. With possible intervention of this project,

improvements were possible. Possible interventions were the introduction of quality feed and an

adequate supply to the cows. This would assist in the undernutrition of the cows in this

community. Also, reproductive management needs to be revised in order to tackle the problem

of the large number of non-lactating dry cows. Therefore, this proj ect planned to impact these

farmers and their herds by an increase in total milk production due to greater milk production per

cow and more cows per herd (Gomez 2002).

Goals of Gomez Dairy Project

The main goal of the project was to improve dairying in the Cafiete region. The proj ect

began in 2002 and operated until the end of 2005. The obj ectives of the proj ect were to: (1)

identify the priorities, constraints and opportunities of selected dairy farmers in the Cafiete

region; (2) determine the important limiting factors; (3) develop intervention strategies and

assess the economic impact of the proj ect; and (4) develop methodologies for recording and

demonstrating the economic impact of the proj ect (Gomez 2002).

The obj ectives of Gomez' s proj ect inter-related to my obj ectives for my research. Both

proj ects aimed to assess the economic impact of the dairy proj ect to this community. As Gomez

looked to identify issues that face the dairy farmers, I searched to identify the nutritional issues

of this community that could be affected by the limited resources and production of the dairy

farmers .

My Research on Santo Domingo Dairy Farmers

The dairy farmers who are part of the Gomez dairy proj ect are labeled as "participant"

families for this study. These farmers were selected for this program based on the number of










dairy cattle they owned. The dairy farmers who did not have the number of dairy cattle to meet

the requirements of the program are labeled as "non-participant" families for this study. All of

participant families rely on dairy farming as their main source of income. Eighty-two percent of

non-participant families rely on dairy farming as their main source of income. The 18% of those

families who do not rely on dairy farming rely on other sources of income such as working on

others farm land.

The price of milk during my study was twenty-five cents (0.83 centimos litro) per liter of

milk. An average of 20 liters of milk per day is sold per family. Therefore, families are living

off an average of $5.15 per day.

The population studied lives in the rural area of Santo Domingo. Of seventeen families

involved in a dairy project monitored by Gomez eleven had children six or under. One family

refused to participate in the study. Thus only 10 families were studied. All children (15 in total)

under age six in these 10 families were subjects. They were measured for weight and height, and

surveys were administered to each mother of the household. The date of birth and sex were also

recorded of each measured child.

An additional 17 non-participant families with similar income, education levels and those

who had children under the age of six years old were selected randomly. All non-participants

owned dairy cattle and dairy farming was the main source of income for the maj ority. All 26

children under age six in these families were measured for their weight and height. Date of birth

and sex were also recorded. The maj ority of those living in Santo Domingo live in adobe made

homes.

Conclusion

Even though Peru over the past several decades has had an improvement in child health,

there is still a high incidence of starting. Peru's wasting and underweight indicators are low










even when compared to other Latin American countries. However, Peru's stunting indicator is

high therefore my study assumed a high incidence in the children of Santo Domingo.

Santo Domingo has a population that has limited access to basic necessities such as

electricity and water. It is a population where the maj ority of the families depend on dairy

farming as their main source of income. The Gomez proj ect implemented a dairy proj ect to

involve eligible dairy farmers to participate in this project and provide services. My study was

conducted based on the Gomez proj ect and involved a small sample of the children and families

of this area.









CHAPTER 3
IVETHOD S

Data Collection and Design

The study involved: (1) measuring the height and weight of children under six, whose

parents are participants of a dairy proj ect compared to parents who are not participants in the

dairy proj ect and (2) conducting a survey of development and wealth indicators at the household

(HH) level.

Anthropometric and vaccine data for the children in Santo Domingo was collected from

the la postal (basic clinic facility administered by the Ministry of Health which is located in

Herby Alto). All communication was conducted in Spanish.

I introduced myself as a graduate student from the University of Florida and explained

what I was researching and read them their rights if they chose to participate in my study

(through the informed consent form). I then obtained a signature from the parent who was

present. Formal compensation was not specified in the informed consent process or proposal,

but customary gifts included photos, candy and clothes for the children, fruit, bread and clothing

detergent.

Indicators of Development

The survey administered for this study was for wealth indicators (Indicator 2006). The

survey asked about household capital, including the availability of water, electricity and sewage

in the home. The health impacts of having these utilities in the home were hypothesized to be

very important. Water and sanitation improve child's health and nutrition by decreasing

exposure to pathogens, thereby reducing diarrhea and improvements in anthropometric indices in

children and reductions in total mortality (Pinstrup-Andersen 1995). Key criteria included in the

survey included:










Household capital ownership

*TV
Iron
Number of beds
Stove
Vehicle (car/truck)
Refrigerator
Sewing machine
Radio
Bicycle
Tractor

Amenity Ownership

Electricity
Water in house
Outhouse

Income

Income from farm
Income off farm from source other than farm

The other method used was a survey on the indicators of development. This allows

collecting both social and agro-economic data. This survey asked about key indicators of

development which are used as a way to measure the effects of proj ect intervention, such as the

dairy project (Spring 1995).

Mother and father' s age, education and occupation were obtained. Mother's age and

education are important to know. Women are the main providers of nutrients and informal

health care to their children and other members of their household (Pinstrup-Andersen 1995).

Mother' s education has a substantial effect on the child's health and mortality rate even

after controlling for major lifetime events and economic status. Previous studies have shown the

effect mother's education has on child health. A study done in Uganda on 720 children showed a

higher prevalence of stunting among children of non-educated mothers. When all socio-









economic indicators were simultaneously adjusted for in conditional regression analysis, it left

mothers' education the only independent predictor of stunting. Children of non-educated

mothers are significantly more likely to be stunted compared to those of mothers educated above

primary school (Wamani 2004).

A study done in Peru equated improving women's education to improving a community's

healthcare facility, water supply and sewage system. The study found that over 25 % of

children were stunted and chronically malnourished. These children were from rural community

homes where the average schooling for mothers is four years compared to urban mothers with

nine years of schooling. This implies that a mother' s educational level directly affects a child' s

nutritional status. In areas with many educated mothers, the entire community's health improves

because the mothers share health advice and information (Escobal 2005).

In the present works, the diet of the children was also investigated to see if animal-source

foods are consumed in the home. Nutritional status of children may be easily improved from

dairy animals if all the milk produced is not sold. Although height is not as responsive as weight

to nutritional interventions, there is evidence of rapid response of linear growth during a short

period of treatment of malnourished children. Restoration of normal height is possible, up to the

age of about 10. It was found that the maj ority of the cases that have reported gains in height

have been based on the use of milk or soya-based supplements. For example, children in

boarding schools in Papua New Guinea, their growth response was proportional to the amount of

milk in their supplement (Tangka 2000).

Limitations of the Research

It is important to mention the possible caveats of this research proj ect. No geographic

region is identical throughout. However, in this community, the households were almost

identical. Higher nutritional status or food consumption may be a reflection of preexisting social









economic status (SES) or independent (or actual proceeding) participation. Conversely a

decrease in nutritional status and food consumption can reflect the result of the proj ect. The

research was conducted during the cold climate time for the coast. Anthropometric data could be

somehow affected but it should not be a significant factor.

In addition, there was only one proj ect in progress in this community at the time of this

study. Santo Domingo is a small community and in a remote location that there has been little

study done on this community. The sample taken for this research was a small sample and a

limited amount of data was collected.

The variables analyzed were household nutrition (foods such as milk, animal-sources,

vegetables, etc.) and growth indices of children. Independent variables were project

participation or not, parent' s education and income. Child health under five is a sensitive marker

of household and community health, a goal of the proj ect; however due to the limited number of

children under five years of age children under six years of age were also included.

Conclusion

Anthropometric data and household indicator data was obtained from 27 families and 41

children in Santo Domingo. Anthropometric data was conducted on children less than six years

of age. Development and wealth indicators were used to analyze the households of the children

studied. Indicators collected included household and farm wealth capital. Based on the small

sample obtained there are limitations to my study. All data contained was utilized to analyze the

health situation of the children of Santo Domingo.









CHAPTER 4
RESEARCH DATA

Underweight Indicator: Moderate and Severe

Table 4-1 provides a comparison between Peru, Latin America (LA), Santo Domingo

Participants, and Santo Domingo Non-Participants for the underweight indicator: moderate and

severe. As mentioned in Chapter 2, a child is considered a moderate and severe case when

below -2 standard deviations from median weight for age of the reference population. As the

table displays, the Santo Domingo study groups had zero percent of under-fives suffering from

moderate and severe underweight compared to the rest of Latin America and Peru who each are

at seven percent for this category (UNICEF Peru 2006).

Underweight Indicator: Severe

A child suffering under the underweight category is below -3 standard deviations for their

median weight for age of reference population (UNICEF Peru 2006) (Table 4-1).

Table 4-1 Underweight Indicators
Percentage of under-fives suffering from:
Underweight



Moderate and severe Severe

*Peru
(1996-2004) 7% 1%
*LA and
Caribbean
(1996-2004) 7% 1%
**Santo Doming
Participants
(2007) 0% 0%
**Santo Domingo
Non-Participants
(2007) 0% 4%
Source: *UNICEF State of the World's Children 2006
**Author 2005











Wasting: Moderate and Severe

The prevalence of wasting is much lower than that of stunting or underweight. The

expected prevalence in developing countries is two-three percent. The highest prevalence in the

world is South Central Asia (15.4%) and West Africa (15.6%). A child is considered a

moderate and severe case when they are below -2 standard deviations for median height for age

of reference population (UNICEF Peru 2006). Peru as a whole was at one percent and Latin

America at two percent compared to Santo Domingo Participants and Santo Domingo Non-

Participants who were both at zero percent (Table 4-2).

Table 4-2 Wasting Indicators
Percentage of under-Hyves suffering from:
Wasting



Moderate and severe

*Peru
(1996-2004) 1%

*LA and Caribbean
(1996-2004) 2%

**Santo Domingo
Participants (2007) 0%


**Santo Domingo Non
Participants (2007) 0%
Source: *UNICEF State of the World's Children 2006
**Author 2005

Stunting: Moderate and Severe

Stunting that is classified as moderate and severe is below -2 standard deviations from

median height for age of reference population. For children less than five years old, a low

prevalence of stunting is <20% and 20-29% is a medium prevalence. Latin America is









considered as low prevalence but Peru is considered as medium prevalence region. Peru is still

not as high as East Africa which is at 48% for stunting of children under five years old and the

highest incidence of stunting worldwide.

As for Santo Domingo, participants and non-participants are considered as low prevalence;

however it is substantially lower for the children of those families who participated in the dairy

project. (Table 4-3).

Table 4-3 Stunting Indicators
Percentage of under-fives suffering from:
Stunting



Moderate and Severe


*Peru (1996-2004) 25%


*LA and Caribbean (1996-2004) 16%


**Santo Domingo Participants (2007) 7%


**Santo Domingo Non-Participants
(2007) 19%
Source: *UNICEF State of the World's Children 2006
**Author 2005

Feeding of Animal-based Foods

Eighty-five percent of Santo Domingo families feed their children animal products based

on the sample diet provided by all those questioned. These animal products include milk, eggs,

goat, turkey, chicken, lamb and beef. For families that retain milk produced for family

consumption, there is no refrigeration therefore what is retained is consumed daily. Of non-










participating families, 70% give their children milk on a daily basis. Of participating families,

90% give their children milk on a daily basis and 60% give eggs as part of their diet.

All families (participants and non-participants) boiled the water they obtain from the puqio

when used for drinking and when given to the children. In addition, despite the limited income

obtained by these families, 81% take their children to the postal (clinic in Herby Alto), doctor or

hospital when their children are sick. Children are fed on average three full meals per day. All

of the children are taken care of by their mother and in some occasions by their mother and

mother's sister.

Some households retain more milk for household use and others sell more. This conduct

has an effect on the income from milk sold (Table 4-4) (Table 4-5).

Table 4-4 Participant Families: Milk Sold, Income Obtained and Number of Producing Cows
Participants
Range: $1.02-$15.32
Average: $5.07

HH # Liters/day of milk sold Amount sold
100 14 3.58
101 10 2.55
102 20 5.11
103 8 2.04
104 30 7.66
105 25 6.38
106 5 1.28
107 18 5.79
108 60 15.32
109 4 1.02
Source: Author 2005










Table 4-5 Non-Participant Families: Milk Sold, Income Obtain and Number of Producing Cows
Non-Participants
Range: $2.55-$15.32
Average: $5.62

HH # Liters/day of milk sold Amount sold

500 none-cheese only n/a
501 10 2.55
502 n/a n/a
503 32 8.17
504 11 2.81
505 18 4.60
506 25 4.85
507 20 5.11
508 50 12.77
509 60 15.32
510 28 7.15
511 7 1.79
512 n/a n/a
513 20 5.11
514 50 12.77
515 34 8..68
516 15 3.83
Source: Author 2005

Milk Production and Needs

Dairy cattle require several components in order for them to produce milk. One dairy

cattle can produce 6-7 gallons (23-27 liters) per day of milk. Dairy cattle consume about 100

pounds of feed per day and 25-50 gallons of water per day. They require a balanced diet that

consists of hay, grains, protein sources and other vitamins and minerals. In addition, shade and

protection from the elements with bedding that is made of wood chips and sand also are required

for the caring of and optimum production of milk. In areas where it is hot, sprays misters are

used to fan water out to keep the cattle cool (Dairy Farming Today 2007).

The requirements for optimum dairy cattle production are limited to the farmers of Santo

Domingo and their dairy cattle. Therefore, the amount of milk produced by the dairy cattle in

Santo Domingo is lower due to several reasons. The maj ority of dairy cattle here are not










provided shade or given protection from the elements. In addition, they are not provided with

the usual 25-50 gallons of water needed per cow per day for optimum milk production. Homes

in Santo Domingo do not have water and must obtain it from an outside source twice per week.

The amount of water obtained and reserved is not sufficient for each cow. The feed given to the

cattle is not a mix of a balanced diet but mostly cane shavings, sweet potatoes foliage and corn

cobs. This feed is obtained in exchange for labor in agricultural fields. In addition, the cattle are

not provided with proper bedding other than sand or cane shavings. Therefore, these dairy

producing households could produce more milk if provided with the means to obtain the above

necessary tools to achieve optimum milk production. Education and payment alone will not

result in optimum milk production.

Santo Domingo Households

Participant Families

The composition of each household was not obtained. However, data collected does show

that for participant households, there is a range of 4-10 members in each, with an average of six

family members per household. The mothers of the children studied range in age from 18-41

years of age and father' s age between 27-46 years of age. All of mothers label their occupation

as housewife and farmer. Eighty percent of fathers label themselves as farmers. The range of

number of rooms is one to four rooms, with an average of two rooms per household.

Non-Participant Families

The composition of each non-participant household was also not obtained. However, data

collected does show that for non-participant households, there is a range of 2-14 members in

each, with an average of six family members per household. The mothers of the children studied

range in age from 19-37 years of age and father' s age between 24-40 years of age. All of mothers

label their occupation as housewife and farmer. Eighty-eight percent of fathers label themselves










as farmers. The range of number of rooms is one to four rooms, with an average of two rooms

per household. Comparing participant and non-participant households, they very similar in all

comparisons.

Participant and Non-Participant Families: Compared Case Studies

Height-for-Age and Weight-for-Age

In each group of participant and non-participant households, there were children who

surpassed the healthy range in height for age and weight for age. As previously discussed, the

ranges for height-for-age is +2 or greater SD which is classified as tall, normal range is from -2

to +2 SD and stunted is under -2 SD. The ranges for weight-for-age is +2 or greater SD is

classified as overweight, normal range is from -2 to +2 SD and undernourished is under -2 SD

(Reyes 2005).

The maj ority of the children in this community are within normal ranges of health for

height-for-age and weight-for-age. However, there were children who resulted in Eigures greater

than -2SD or +2 SD. Two families, one from participant and one from non-participant families,

had children at extreme levels of health and were thus chosen as case studies. Table 4.6 displays

the similarities and differences between these families.

Participant Household Case Study "A"

Participant "A" is a household typical of Santo Domingo. The residents obtain their water

from the water reserve as the rest of the community. They obtain water once a week and boil the

water before it is given to the children of the household. Income of this household is obtained

from the sale of milk and there is no off-farm income. There are no maj or or minor crops grown.

Child care and food preparation is performed by the mother.

Household "A" has limited resources. They do not own a battery operated TV or radio.

There are two beds in the home and two rooms. This home is made of straw panels and does not










have a roof. There is no water, electricity or outhouse access. In addition to owing dairy cattle,

other livestock owned are six meat cattle, two goats, and four calves. This household's normal

residence is in the upper region of Santo Domingo. The environment is harsher in the upper

region therefore current residence was with the wife' s father at the time of this study. The

youngest child had a respiratory infection due to the colder climate compared to their usual

residence.

Non-Participant Household Case Study "B"

Non-participant "B" is also typical of families in Santo Domingo. Water is obtained from

the water reserve as the rest of the community. The residents obtain water twice a week and boil

the water before it is given to the children of the household. Income of this household is

obtained from the sale of milk and there is no off-farm income. There are no maj or or minor

crops grown. The mother of this household is responsible for food preparation and child care.

Household "B" owns a battery-operated TV and radio. There are four beds and two rooms.

This home is made of straw and cane panels. There is no water, electricity or outhouse access.

In addition to owing dairy cattle, other livestock owned are two donkeys, 10 chickens, and four

ducks (Table 4-6).












Under
5
childr
H/A W/A W/H en


Lactatin
g cows


Table 4-6 Case Studies


Milk
sold
(liters


Times
child


# in Material
HH of home

Straw, No
4 Roof


/ Surplus fed/ Child's
day) milk day diet

Eggs,
8 Family 3 Milk

Oatmeal
Milk,
Bread,


Participan
A


2.23 2.26 2


Non Cane, Rice,
Participan Wheat Soup,
B 8 Panels 5 20 Family 3 Eggs -2.54 -1.62 -0.02 1
Source: Author 2005


Impact of Dairy Project Participation

So what impact did the Dr. Gomez proj ect provide from the participants perspective? The

dairy proj ect provided animal care education, concentrated feed at a lower price, and faster

payment of milk sold (Table 4-7). Eight of the 10 participants perceived some type of change

from participating in this project. The majority of participants' perceived changes associated

with knowledge and education on how to better care for their livestock. Not one of the

participants commented that the education received or purchase of feed increased their milk

production.

In addition, some participants commented that they receive faster payment of the milk they

sell. Previously, payment did not come or took up to four months; however at the time of this

study, payment was coming in every week. Information was obtained from an employee of

Fongal which was the previous dairy COLLECTIVO that was collecting and distributing the milk

obtained from the Santo Domingo dairy farmers. Fongal was closed at the time when it visited.

However, the informant did comment that the administrator of Fongal was stealing money from

the company therefore utilities were not being paid and were shut off. Therefore, Santo

Domingo dairy farmers were not getting paid for months.


4










Table 4-7 Dairy Proj ect Impact
Participant's Comments on Dairy Proj ect Impact

HH # What Does the Proj ect Provide? Perceived Changes from the Proj ect
Concentrated feed at a lower cost
100 than local sellers Little change
Faster payment, dairy cattle Faster payment, dairy cattle management and
101 management and education education
102 Animal care education Animal care education
103 Animal care education Animal care education
Guidance, education and
104 concentrated feed Better cared of animals
Orientation on the care of
105 animals Orientation on the care of animals
Orientation on the care of
106 animals Better care of animals
107 Animal care education None
Concentrated feed, animal care
108 education Concentrated feed, animal care education

109 Animal care education Better understanding of how to raise cattle
Source: Author 2005

In addition, participants of the dairy proj ect were asked what items they possessed before

and after the proj ect. All of the participant households had the same items before and after the

project. The items that were questioned were the ownership of the following: battery operated

TV, iron, number of beds, stove, vehicle, refrigerator, sewing machine, battery operated radio,

bicycle and tractor. The proj ect had no effect on the purchasing of household capital.

Relation Between Milk Sold and Child Health Status

Gender Division of Labor

No formal data were obtained on the gender division of labor in Santo Domingo.

However, when conducting the questionnaire and obtaining the anthropometric data on the

children, activities were observed. In addition, those being questioned would provide

information on the gender division of labor (Table 4-8).










Elder males or females were not observed often in this community. When elders were

present, the assistance each provided was observed through childcare, obtaining water or

obtaining forage for the cattle. Children, male or female, were only observed accompanying

their parents to obtain water from the PUQIO or if they were very young, they would accompany

their mothers to obtain forage and water. Other than obtaining water, children were solely

observed attending school and playing with other children. Adult females were those observed

the most during the time of this study.

Off-farm work performed was also discussed. This category does not include labor such as

weeding, the preparation of farm land, planting or harvesting because none of the families in

Santo Domingo are able to produce any crops. The environment is too dry to support any crop

life.

Table 4-8 Gender Division of Labor

Male Female Male
adult adult child Female child Male elder Female elder
Ag riculItu ral
Labor d d
Milking d
Cleaning d
Cooking d
Child Care d d
Obtaining
Forage for
Cattle d d d d
Feed Cattle d d
Obtaining
Water from
Outside
Source d d d d d d
Source: Author 2005

Household and Farm Capital Ownership

When comparing participant and non-participant families to household capital ownership,

similarities and some differences are found (Table 4.9).









Table 4-9 Household and Farm Capital Percentage
Percentage of Households with Capital Ownership
TV Sewing Stereo

(battery) Iron Stove Vehicle Fridge Machine (battery) Bicycle Tractor
Participant 60 0 20 0 0 0 70 0 0
Non

Participant 52 5 5 0 0 5 65 11 0
Source: Author 2005

The table displays household capital and the percentage of ownership. No one owns a

refrigerator or vehicle. There is low ownership of irons, sewing machines and bicycles. Over

than half of households, have battery operated TV and radios. One main difference is stove

ownership. There are a greater number of participant families who own charcoal or wood stoves.

As for farm capital, the table shows that no one owns tractors and other farm equipment.

The only farm capital documented and visually evident was that of livestock and other small

animals for Santo Domingo participants and non-participants (Table 4-10) (Table 4-11).

Horses and burros are used for transportation of people, water, food shavings and other

goods. Non-participant households have a greater variety of livestock, as well as higher numbers

of ownership.











Table 4-10 Participant Livestock Capital
Cows Meat
Lactating Cows Pregnant Cattle
100 2 3 0
101 4 0 0
102 4 0 6
103 6 0 6
104 6 1 0
105 3 3 0
106 2 0 0
107 6 0 0
108 3 3 0
109 1 2 0
Source: Author 2005


Table 4-11 Non-Participant Livestock Capital
Cows Cows Meat
ul Lactating Pregnant Cattle Lamb
S500 3 0 6 6


Lamb
3
5
0
0
0
7
2
7
0
0


Horses
0
1
0
0
0
2
0
0
0
0


Burros
2
3
2
0
4
2
2
0
0
0


Chickens Turkeys
0 0
7 0
0 2
0 0
6 0
10 0
0 0
0 0
0 0
0 0


Goats
0
0
0
2
0
0
0
0
0
0


Calves
0
0
0
4
0
9
2
3
8
6


Doves
0
0
0
0
20
0
0
0
0
0


Burros Chickens Ducks Goats Calves Doves Pigs
2 12 0 45 0 0 0


Parakeets Geese
0 0


Source: Author 2005









Diet


This research study did not investigate in depth the daily diet of this community.

However, selected items were mentioned during the part of the questionnaire when asked what

the children were fed during the day. Some households mentioned what they fed their children

by the meal of the day (Table 4-12).

Table 4-12 Sample Diet of Santo Domingo Children
Average #
Times
Breakfast Lunch Dinner Fed/Day
Breast milk, Breast milk,
beans, rice, eggs, rice,
Breast milk, oatmeal, salad, eggs, soup, lentils,
Participants milk, eggs, potato bread meat 3
Non Rice, fried
Oatmeal, milk, eggs, Beans, meat, rice, foods, potato,
Participants bread soup, potato milk, soup, 3
Source: Author 2005

Conclusion

The data obtained from my study was compared to different factors that could affect the

health of children. Data was analyzed for gender division of labor, income received per family,

the impact of the Gomez project, farm capital ownership and the diet of the children. All of

these factors were analyzed and presented in detail.









CHAPTER 5
RESULTS, CONCLUSIONS AND RECOMMENDATIONS

Results and Conclusions

Although child nutrition and its effects have been thoroughly studied, the inter-relating

factors of why some children grow healthier than others are still studied throughout the world. A

principal obj ective of this study was to find a link between feeding animal products and the

growth of children whose parents were part of the Gomez Dairy Proj ect in Santo Domingo, Peru.

It was assumed that participants of the dairy proj ect would be nutritionally healthier than non-

participants. However, the findings did not support the original hypothesis of this study and the

reasons why will be discussed in this chapter.

When this study began, it was hypothesized that because animal products were a daily part

of the children' s diet (especially for the children of the participant families) and that the children

appeared physical healthy, the incidence of underweight and wasted children would be low but

stunted children would be high. The hypothesis that the number of stunted children would be

high is because of the high incidence of stunted children in Peru. It was also assumed that there

would be a difference between participant and non-participant children because participant

children were part of the dairy project and receiving monetary and educational benefits. As

discussed in Chapter 1, the literature supports the notion that there is a positive effect from milk

and other animal products on the health of children worldwide. However, no differences were

found between participant and non-participant families in terms of child nutrition. Family and

physical environment was similar throughout the whole community including the ownership of

livestock and especially dairy cattle. The only difference initially found for the participants of

the proj ect was weekly payment of milk sold (faster payment of what was previously received).

However, faster payments were due to the Gomez researched proj ect and this affected all of









Santo Domingo dairy farmers, and therefore, all farmers received timely weekly payment for

milk sold.

It was believed that there would be a high number of stunted children because as discussed

in Chapter 2 there is a high prevalence of stunting, especially in the rural areas of Peru. Peru is

affected by poor socioeconomic conditions and exposure to adverse conditions such as illness

and/or inappropriate feeding practices. Peruvian children are often faced with chronic but

moderate deficiencies of nutrients therefore they tend to be "short for their age." It was assumed

that the children of Santo Domingo were part of this country-wide health problem. This study

shows a low prevalence of stunted children for participant anzd non-participant children. Even

with the limited sample of this study and small variation throughout the community, the children

of this community were found not to be malnourished. Anthropometric findings show that none

of the children, participant or non-participant, were found to be underweight moderate and

severe or under the wasting category. Ninety-six percent of the non-participant children were

found to be healthy under the category of severe underweight, and the entire group of participant

children was found healthy under this same category. Of the participant children, 97% were

non-stunted and 81% of non-participant children were non-stunted.

What was different for the children who were not healthy? As discussed in Chapter 4,

several case studies were presented of the children in the undernourished category. These cases

showed several factors coming into play. These children were found in households with low and

with no daily milk production. There is little income to purchase items for the household. In

addition, these households are larger in size and often have more than one child under the age of

five. Two families have limited amounts of milk so little is retained for family consumption; one









family produced no milk at all. Also, one family only obtained water once a week compared to

twice a week compared to the other households that obtained water.

Therefore, it is conj ectured that low milk or animal food consumption may be a factor in

the undernourishment of these children; however, it is not the sole cause of why they are

unhealthy. It is evident that there are other factors to consider in addition to the intake of animal

products. These factors are clean water availability, the number of people in a household, the

amount of milk reserved for the household, and for specific family members the amount of other

animal and vegetable protein products consumed on a daily basis, the location of residence, the

number of young children in a household, and proper mothering skills. Families with healthy

children most likely had a combination of the se factors.

The many factors have an effect on child health and development. Water availability can

affect the amount of daily clean and fresh water a child is receiving and can prevent dehydration.

The environment of Santo Domingo is dry and there is unlimited sun exposure. The children of

this community perform the maj ority of their daily activities outside (e.g., as walking to and from

school, assisting in household or farm duties, and playing). The number of residents in a

household reduces the amount of food available for each individual of the household especially

vital foods such as oatmeal, eggs, milk, legumes, and rice. Any food products, including animal

products that contain proteins, carbohydrates, vitamins, etc, affect the growth of children. The

closer the residence is to the Canete River, the closer it is to the water supply which affects

feeding livestock. The further away a residence is from the river the drier and colder is the

environment and limits the number of times water is obtained, as well as other activities such as

washing clothes. Proper mothering skills are one more factor affecting child growth. One of the









households discussed in Chapter 4 where the mother did not properly care for her children well

in terms of appearance and hygiene compared with the other mothers interviewed.

What are some reasons why the maj ority of the children studied are healthier than children

in the rest of Peru? Several factors could be involved. Santo Domingo households own a variety

of livestock such as cattle and chickens. This allows for a variety in the children's diet that can

include eggs, meat and milk. The water given to the children is boiled before consumption to

kill bacteria and pathogens. Children are also exposed to sun exposure and therefore get Vitamin

D. The diet fed to the children, even though limited, includes foods that provide carbohydrates,

fat, and protein.

Future Research

Feeding practices during the first years of life have an important influence on the

nutritional status, growth and function in young children (Allen 2001). Hence future studies of

Santo Domingo should have additional types of data collected and use some additional

methodology compared to this study.

Further investigation would be to obtain a larger sample of Santo Domingo children and

household members. A more detailed account of the food bought and food fed to the children

would be recorded. Food fed to children should be broken down into categories such as

carbohydrates, fats and proteins. In addition, the amount of water or other liquids given to

children on a daily basis should be measured or counted. Medical techniques could be

incorporated to analyze if any of the children are dehydrated. A food intake survey could be

given to each household member.

Other areas of Peru without livestock could be analyzed and compared to Santo Domingo

to see if the difference in health is the presence of animal products in the diet. The La Molina

dairy unit discussed in Chapter 2 would be a good comparison area to live at because it is located









in Santo Domingo and allow for direct observation of the households. A further study could

include interviewing the elders of the community and questioning changes they have observed

over time in the community. In addition, research should include fertility and natality histories

of women.

This study could have also analyzed different hypotheses. Other hypothesis that could

have been researched is, does a greater number of livestock household make a household better

off! Are children in larger household sizes worse off nutritionally? Did participants of the dairy

proj ect negatively affected by the proj ect?

Applied Recommendations to Increase Child Nutrition

Given the poor economic situation of the Santo Domingo families and their children, is it

reasonable to recommend that their children continue to consume animal products? The answer

is that this will continue for these families because dairying is their source of income and food.

Strategies to improve and continue the consumption of animal products in Santo Domingo

include :

* Educating the mother to target small amounts of animal products (such as liver and meat)
to her young children
* Encouraging consumption of cheaper animal products (e.g., eggs, fish, dried milk)
* Supporting home production of small animals such as fish and birds
* Giving fermented rather than fresh milk because refrigeration is not needed (Allen 2001)

It is further recommended that a community-wide dairy program/project be implemented

to provide animal care education. Provide nutrition workshops to the families on the importance

of feeding animal products, legumes and oatmeal. Provide hygiene workshops to teach the need

of a daily and clean water supply.

The children and the families of Santo Domingo even with their limited amount of

resources have been able to provide a basic nutritional environment for their children. The










recommendation of a community well or water supply in close proximity and a safe source of

water for cooking and drinking purposes should be implemented. There should be some type of

sewage system for the proper management of human waste. There would even be a

recommendation for the neutering/spaying of the dog population presently in Santo Domingo to

reduce the risk to livestock and spread of dog waste and diseases.

Conclusion

The findings of my study did not support the original hypothesis proposed. There was

low incidence of stunted children and the children were found not to be malnourished. Animal-

based foods was not the only factor affecting the health of the children of Santo Domingo; other

factors were found to have an effect such as household size, mother' s care, location of residence

and water availability. Therefore my study gives indication that further research is needed in the

community of Santo Domingo and that not only diet but environment affects the health of

children. The proper interventions and programs can support the health of all children around

the world including those of Santo Domingo.









APPENDIX A
ANTHROPOMETRIC DATA SHEET

Anthropometry
Study of Nutrition and Health -- 2005
Cailete, Peru
University of Florida English Translation Code:

Date:

Hour:

Measurement by:

Name of the obj ective child:

Name of the mother:

Name of the father:



Sex: 1. Male 2. Female

Date of Birth: / / Age: in months


Height and Weight of the Child:

Size (cm):

Weight (kg):

Recumbent measurement
(Check if YES)










APPENDIX B
DEVELOPMENT INDICATOR SURVEY

Study of Nutrition and Health 2005
Cailete, Peru
Date:
Code :
University of Florida
Survey of Development Indicators (English Translation):

A. HH SIZE AND COMPOSITION

-# in HH:

-Relationship Age Gender Yrs Schooling Occupation
*1.








2. Io
3. Bds
4. tv
5. a
6. rc
7. Rfieao
8. Swn ahn

B. HH CPITA



30. Bed (s)
41. Stove




9. terea om md u f





-Do you have in your home...?

Electricity
Water (If answer is NO then ask next question)










Toilet (sewage system)


-If NO WA TER is in the home...

From where is it obtained?
How often is it obtained?

Do you boil the water to drink? Yes No
Is it boiled for when given to the children? _Yes _No


C. INCOME

Sources of income:

- On farm income:




- Off farm income:




Amount of milk sold

Current price of milk sold per

Surplus of milk what is done with it?



D. PROJECT SERVICES

What does the proj ect provide to you?





Perceived changes as a result of the proj ect?





























F. FARM CAPITAL

- Types of animals owned


"V"--~U -Y-rVU'


E. LAND AND CROP INFORMATION

- Land size:

- Ownership of Land Status:

-Maj or Crops Grown:




-Minor Crops Grown:


# Owned


Purpose


1. DE FCIDE

2.scde fcid(e)frbrafslnhaddne?()

3.D

4.scde o hl rn)we ik


- How often child (ren) are fed?




- What is done with child (ren) is sick?









-Who is main caregiver to the child (ren)?


-Who prepares their food?














Table C-1. Participant Child Anthopmet ic Data
ID # Gender HT/AGE WT/AGE WT/HT
100 F 0.29 0.70 0.78
101 M 0.49 1.81 1.93
102 F -0.53 0.47 0.93
103 M 0.04 1.48 1.79
104 M -0.20 0.24 0.46
105 F -1.27 -0.88 -0.28
106 M -2.46 -1.07 0.61
107 F -0.58 -0.58 -0.10
108 M -0.76 -0.32 0.26
109 F -0.45 -1.92 -1.99
110 M 0.14 1.28 1.60
111 M 0.37 2.23 2.26
112 M 0.70 1.02 0.71
113 M -1.69 -1.27 -0.01
114 F 0.29 -0.42 -0.51


APPENDIX C
ANTHROPOMETRIC DATA










Table C-2. Non-Participant Cl-ild Anthropametric Data
ID # Gender HT/AGE WT/AGE WT/HT
500 M 1.63 2.21 1.20
501 M -1.00 0.26 1.07
502 M -1.49 -1.76 -0.90
503 F -2.17 -0.81 0.67
504 M -1.84 -0.70 0.64
505 F -1.03 -0.50 0.15
506 F -0.32 -1.17 -1.22
507 F -2.48 -1.10 0.52
508 F 0.27 1.05 1.23
509 M -1.43 -0.60 0.36
510 F -1.63 -0.31 0.78
511 M 1.55 1.59 1.09
512 F -2.30 -3.29 -2.89
513 F -1.90 0.35 1.97
514 F -0.66 0.21 0.70
515 F -0.46 0.29 0.71
516 M -1.90 -0.08 1.10
517 F 0.70 2.98 3.19
518 M -1.85 -0.23 1.35
519 M -2.04 -0.31 1.04
520 F -2.54 -1.62 -0.02
521 F -1.61 -0.71 0.29
522 F -1.76 -0.67 1.05
523 M -1.59 0.06 1.51
524 M -1.38 -0.53 0.53
525 F -1.69 -1.20 -0.20









APPENDIX D
VITAMINS IMPORTANT FOR THE GROWTH OF CHILDREN OBTAINED FROM
ANIMAL PRODUCTS

Calcium

In the case for children, calcium is an important nutrient for growth. It is difficult for a

child to even approach the average calcium requirements (around 345 mg/d) on a cereal-based

diet (Neumann 1999). Milk is the major dietary source of calcium for bone growth. Calcium not

only builds bones and teeth, it is utilized in essential functions all over the body. Infants undergo

growth and development for many years. Disposition of calcium into bones continues until the

third year of life (Patton 2004).

Vitamin D

Vitamin D is also an important nutrient for children. It is a requirement for the digestive

absorption of calcium. Proper development and mineralization of the human skeleton requires

this vitamin. The human body requires exposure to sunlight to generate vitamin D from 7-

dehydrocholetrol, a precursor in the skin. It is the ultraviolet component of sunlight that

accomplishes this reaction. Vitamin D produced by this means is effective in meeting the body's

needs for the vitamin. (Patton 2004).

Vitamin A

Vitamin A deficiency leads to high cases of blindness and high infant and child mortality.

Around 40 million children suffer from vitamin A deficiency and about 35,000 infants and

young children are blinded annually. It is important for maintaining the structure and function of

the cornea and lens and produces necessary components for night vision. Vitamin A also plays a

role in resistance to infection through multiple functions; mechanical barriers against invasion of

pathogens and maintain a role in immunity. Animal-source foods, especially milk, are an

excellent source of pre-formed vitamin A (retinol) (Neumann 1999).









Vitamin B12

Animal-source foods are nearly the sole source of vitamin B l2 for humans. In developing

countries, mal-absorption of this vitamin is present because due to a wide variety of infections

and intestinal parasites in all ages. Vitamin Bl2 deficiency affects the hemalogic system, the

nervous system and immune function. Vitamin Bl2 is found in eggs and dairy products among

other animal food sources. The prevalence of Bl2 deficiencies in developing countries is not

well documented, but is probably widespread where consumption of animal products is low or

absent. There is a need for the study of the prevalence of vitamin Bl12 deficiency in developing

nations because of the serious health and neurological consequences for women, infants and

young children (Neumann 1999).









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Gomez C, Salazar I, Alvarado E. 2002. Preliminary information on peri-urban dairy
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Miller GD, Jarvis JK, McBean LD. 2000. Handbook of Dairy Foods and Nutrition. Boca
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BIOGRAPHICAL SKETCH

Priscilla M. Medina was born in Columbus, Indiana on March 22. She grew up in the

small and beautiful beach town of Mexico Beach, Florida. She received her bachelor' s degree in

animal science from the University of Florida, Gainesville, Florida, in 2002. She will graduate

with her master' s degree in Latin American Studies with a specialization in anthropology from

the University of Florida, Gainesville, Florida, in 2007.

Priscilla M. Medina plans after graduation to work helping families and children from

Latin America. She currently resides in Gainesville, Florida with her boyfriend Andres Vargas

and German Shepard mix rescue Lima.





PAGE 1

1 MILK PRODUCTION IN CAETE, PER : RESEARCH ON CHILD NUTRITION AND HEALTH By PRISCILLA M. MEDINA A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ART UNIVERSITY OF FLORIDA 2007

PAGE 2

2 2007 Priscilla M. Medina

PAGE 3

3 To my family

PAGE 4

4 ACKNOWLEDGMENTS I thank everyone who has provided support, guidance and encouragement during my time at the University of Florida. I gratefully acknowledge the support of Debbie Geiger and the Southern Scholarship Foundation for their fina ncial support that allowed me to pursue my education at the University of Florida. I thank the University of Florida and the La tin American Studies department for allowing me to complete my bachelors degree, masters degree and this thesis. I am grateful to the members of my supervisory committee and other pr ofessors for their guidance during the time of this thesis: Dr. Anita Spring, Dr. Richard Beilo ck, Dr. Michael Moseley, Dr. Jeffrey Burkhardt and Dr. Jim Stansbury. I express my immense gratitude to the farmers and children of the Santo Domingo community for their willingness to participate in this study. A thank you for Teresa Arata, Chelita Farfan Gaby Cortez and the nurses of He rby Alto and Imperial for their guidance to conduct this study. A thank you to Dr. Carlos Gom ez and all of La Molina Agrarian University for their support and guidance while doing my re search in Peru. Thank you to Sabino Julia n, Victor Cabrera and Elis H. for their support and guidance about the Can ete area. I thank my sister and brother, Susan Medi na and Moses Medina, for always making me laugh and their constant support. I express my eternal gratitude to my parents, Moses Medina and Susana Medina, for teaching me the value of hard work and for their endless support and encouragement. An immense thank you to my mo ther for her assistance while conducting this study. I thank the rest of my fam ily and all my friends for their endless support. I thank Andres Vargas for always keeping me smiling, laughing and for his constant encouragement.

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5 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........8 LIST OF FIGURES................................................................................................................ .........9 ABSTRACT....................................................................................................................... ............10 CHAPTER 1 INTRODUCTION..................................................................................................................12 Introduction................................................................................................................... ..........12 Statement of Problem........................................................................................................... ..12 Literature Review.............................................................................................................. .....13 Malnutrition................................................................................................................... ..13 Measures of Malnutrition................................................................................................13 Others factors for Malnutrition........................................................................................14 Child Malnutrition in Latin America...............................................................................15 Child Nutrition in Peru....................................................................................................15 Nutritional Value of Cows Milk....................................................................................16 Livestock Impacts on Childrens Health.........................................................................17 Dairy Cows and Child Nutrition in Kenya......................................................................19 Body Size: Adaptation and Function..............................................................................21 Peru and Santo Domingo........................................................................................................22 The Study: Santo Domingo, Peru...........................................................................................22 Research Problem and Objectives..........................................................................................23 Methodology.................................................................................................................... .......24 2 BACKGROUND: PERU, SANTO DOMINGO AND DAIRY FARMING........................26 Santo Domingo, Caete, Peru: A Milk Producing Region.....................................................26 Limas Milk Situation......................................................................................................26 Caete and Santo Domingo.............................................................................................26 Arequipa and Cajamarca.................................................................................................27 Health in Santo Domingo, Can ete, Peru.................................................................................28 Population and Hea lth Statistics.............................................................................................29 Basic Indicators...............................................................................................................29 Body Size Indicators........................................................................................................32 Weight-for-Age...............................................................................................................34 Weight-for-Height...........................................................................................................35 Height-for-Age................................................................................................................35 Phases of the Project.......................................................................................................... .....36 Rapid Participatory Rural Appraisal Phases (October 2002-Septemenber 2003)...........36

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6 Intervention Phase (October 2003-September 2004)......................................................38 Dairy Production System........................................................................................................38 Constraints for Gomez s Project Success...............................................................................40 Goals of Gomez Dairy Project................................................................................................40 My Research on Santo Domingo Dairy Farmers....................................................................40 Conclusion..................................................................................................................... .........41 3 METHODS........................................................................................................................ .....43 Data Collection and Design....................................................................................................43 Indicators of Development.....................................................................................................43 Limitations of the Research....................................................................................................45 Conclusion..................................................................................................................... .........46 4 RESEARCH DATA...............................................................................................................47 Underweight Indicator: Moderate and Severe........................................................................47 Underweight Indicator: Severe...............................................................................................47 Wasting: Moderate and Severe...............................................................................................48 Stunting: Moderate and Severe...............................................................................................48 Feeding of Animal-based Foods.............................................................................................49 Milk Production and Needs....................................................................................................51 Santo Domingo Households...................................................................................................52 Participant Families.........................................................................................................52 Non-Participant Families.................................................................................................52 Participant and Non-Participant Families: Compared Case Studies.......................................53 Height-for-Age and Weight-for-Age...............................................................................53 Participant Household Case Study A...........................................................................53 Non-Participant Househ old Case Study B...................................................................54 Impact of Dairy Project Participation..............................................................................55 Relation Between Milk Sold and Child Health Status............................................................56 Gender Division of Labor................................................................................................56 Household and Farm Capital Ownership........................................................................57 Diet........................................................................................................................... .......60 5 RESULTS, CONCLUSIONS AND RECOMMENDATIONS..............................................61 Results and Conclusions........................................................................................................ .61 Future Research................................................................................................................ ......64 Applied Recommendations to Increase Child Nutrition.........................................................65 APPENDIX A ANTHROPOMETRIC DATA SHEET..................................................................................67 B DEVELOPMENT INDICATOR SURVEY...........................................................................68 C ANTHROPOMETRIC DATA...............................................................................................72

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7 D VITAMINS IMPORTANT FOR THE GROWTH OF CHILDREN OBTAINED FROM ANIMAL PRODUCTS..........................................................................................................74 Calcium........................................................................................................................ ...........74 Vitamin D...................................................................................................................... .........74 Vitamin A...................................................................................................................... .........74 Vitamin B12.................................................................................................................... ........75 LIST OF REFERENCES............................................................................................................. ..76 BIOGRAPHICAL SKETCH.........................................................................................................80

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8 LIST OF TABLES Table page 2-1 Basic Indicators Latin America Countries (2004).............................................................32 2-2 Body Size Indicators Latin America Countries (2004)......................................................34 4-1 Underweight Indicators..................................................................................................... .47 4-2 Wasting Indicators......................................................................................................... ....48 4-3 Stunting Indicators........................................................................................................ .....49 4-4 Participant Families: Milk Sold, Income Obtained and Number of Producing Cows.......50 4-5 Non-Participant Families: Milk Sold, Income Obtain and Number of Producing Cows........................................................................................................................... .......51 4-6 Case Studies............................................................................................................... ........55 4-7 Dairy Project Impact....................................................................................................... ...56 4-8 Gender Division of Labor..................................................................................................57 4-9 Household and Farm Capital Percentage...........................................................................58 4-10 Participant Livestock Capital.............................................................................................59 4-11 Non-Participant Livestock Capital.....................................................................................59 4-12 Sample Diet of Santo Domingo Children..........................................................................60 C-1 Participant Child Anthropometric Data.............................................................................72 C-2 Non-Participant Child Anthropometric Data.....................................................................73

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9 LIST OF FIGURES Figure page 1-1 Can ete, Peru Location........................................................................................................22 2-1 Cajamarca, Arequipa and Can ete Locations Relative to Lima..........................................28 2-2 Santo Domingo, Can ete, Peru............................................................................................29

PAGE 10

10 Abstract of Thesis Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Art MILK PRODUCTION IN CAETE, PERU : RESEARCH ON CHILD NUTRITION AND HEALTH By Priscilla M. Medina August 2007 Chair: Anita Spring Major: Latin American Studies Malnutrition is a world wide problem affecti ng children all over the world. It manifests itself in the form of stunted, wasted or underweigh t children. In Peru, the problem is evident in stunted children. Worldwide research has shown the positive effects animal-based foods have on child growth. Therefore, my study was to anal yze the effects on animal-based foods and child growth. Does the consumption of animal products bene fit or improve the health of children? I propose that children who consume animal-based foods and those children whose parents are part of the dairy project will benefit more than non-participant children. The dairy project was from 2002-2005 directed by Dr. Gomez of Universidad Nacional Agraria La Molina. Resources and education, when provided to program particip ants, increases dairy pr oductivity and family wellbeing therefore positively affecting childrens health. Data collection was done at participants homes from May-June 2005. Research was conducted in Santo Domingo, Peru; a small dairy co mmunity with limited resources. Twentyseven families were analyzed about their househ old with a development indicator survey. Anthropometric data on height, weight and age of 41 children under than six years of age was gathered.

PAGE 11

11 The results of my study s howed a low incidence of wa sted, underweight and stunted children in this community and no major di fference was found between participant and nonparticipant children. The consumption of animal -based foods along with the availability of water, household size, location of residence and amount of dairy milk sold all played factors in the positive health of these children.

PAGE 12

12 CHAPTER 1 INTRODUCTION Statement of Problem Malnutrition is a complex, multidimensional and interrelated problem. It affects millions of children around the world. Malnutrition causes a great deal of human suffering both physical and emotional. Adults who suffer mal nutrition as children are less physically and intellectually productive and suffer from higher leve ls of chronic illness and disability. The personal and social costs of continuing malnutrition on its curr ent scale are enormous (Smith 1999). In the past three decades, Latin America has undergone many transformations that have directly or indirectly influenced the health, nutr ition and well-being of children and their families (Bartell 2001). Around 2000, the proportion of the Latin American population who were undernourished was 11% (nearly 54 million persons). Almost 8% of all children under five suffered from low weight for age. Almost 22% of the population suffered from undernutrition in terms of average calorie requirements. Twenty -one percent of the ch ildren had moderate to serious chronic undernut rition (Espindola 2005). Despite significant progress made in health and nutrition during the last decades, a large proportion of Perus population is still at a nutritional disadvantage. An estimated 18,000 children under five die yearly, more than 80% duri ng the first year of life, often from preventable causes. Twenty five per cent of children under five some 750,000 children are stunted. These figures are significantly higher in the rural regions where poverty and a poor environment are constant threats (UNICEF Peru 2006).

PAGE 13

13 Ruminant livestock ownership directly and indirectly affects the nutritional status of children in developing countries The significant correlation between the quantity of milk consumed by children and the nut ritional anthropometric variable s corroborates the importance of protein food sources from animal origin to child growth. The nutritio nal status of children with low consumption of dairy products has been shown to improve with the intake of ruminant animal products (Tangka 2000). Literature Review Malnutrition Malnutrition should not be confounded w ith undernutrition. Undernutrition and overnutrition are two sides of the same coi n, called malnutrition. Se veral definitions of malnutrition exist. Macronutrient malnutrition results from an imbalanced consumption of energy providing foods, and includes under and overnutrition. Undernutrition is due to insufficient calorie (energy) intake This is prevalent in many countries and is a major health problem. Overnutrition is due to excess calorie intake which can l ead to obesity (Kataki 2002). Measures of Malnutrition The combination of inadequate dietary inta ke of protein energy and micronutrients, and infection, leads to malnourishment. Fo r infants and young children, the extent of malnourishment is quantified by recording the we ight, height and age of this population group and comparing them to a reference population known to have grown well. The measures of weight, height and age are used to obtain indice s on the percent of this population group that are underweight, wasted or stunted (Kataki 2002). Nutritional anthropometric (body measure) para meters such as weight-for-age (W/A), height-for-age (H/A) and weight -for-height (W/H) are commonly used as bases for assessing malnutrition and evaluating the effects of dietary treatments in children. Weight and height for

PAGE 14

14 age are percentages of adequacy of each of these measurements based on the respective standards for the childs chronolog ical age. Malnutrition is seen in chronic and acute forms. Anthropometric indicators for acute and chronic malnutrition are W/H and H/A standardized zscores with two or more deviations below refe rence. Weight-for-age (underweight) is an intermediate measure of malnutrition that combines wasting and stunting. Acute malnutrition or wasting can result from short-term factors such as diseases or severe food s hortages. It is most frequent among children below two years of age. Chronic malnutrition or stunting is more common than acute malnutrition, and reflects pa st food shortages or low food intake and recurring bouts of diseases. It is common am ong children older than on e year of age (Tangka 2000). Malnutrition usually entails a combination of an inadequate intake of total energy and micronutrients. In children, the most readily meas ured outcome of malnut rition is poor growth. Growth failure is also due to intake of low quality protein and vital mi nerals and vitamins. Where the quantity of total food intake is deficien t, so is the intake of many micronutrients. The effects of inadequate intake are most pronounced during periods of rapid physiological change and during stages of accelerated growth such as in infancy and early childhood (Neumann 1999). Others factors for Malnutrition Apart from insufficient availability of food, ch ild malnutrition is usually also affected by others factors associated with extreme poverty, such as lack of access to drinking water and sanitation. These factors contri bute to infectious diseases an d diarrhea which result in rapid weight loss. The most usual expression of hunger and poverty among children in Latin America is chronic undernutrition (moderate to serious defi cits in height for age, or retarded growth). These deficiencies are serious because they repres ent the accumulated effect of lack of adequate food and nutrition during the most critical ye ars of childs development (Espindola 2005).

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15 Child Malnutrition in Latin America Undernutrition (measured as low weight for age) has declined in Latin America, from 21% in 1970 to 6.7% in 1997. However, there is grea t disparity between Latin American countries. In Chile, Costa Rica and Cuba, less than five percent of the populati on is undernourished. In Guatemala, Honduras, Haiti, Ecuador and Bolivia, the range is from 15-33% (similar to several African countries). Rates of acute protein-en ergy undernutrition (measured as low weight for height) are very low in most countries and neglig ible in some. In a few countries, there is a relatively high rate of stunting (low heights for ag e), and in others stuntin g represents a regional problem that is more prevalent among rural popula tions. Stunting is reco gnized as an expression of chronic sub-lethal un dernutrition (Stuart 1998). Child Nutrition in Peru Peru is a geographically diverse country of deserts, mountains, jungle and coast. This results in regionally diverse ine qualities in services and living standards. Many programs in the country are unevenly distributed across Peru. This includes health programs (Peru Travel Adventures 2006). Socio-economic disparities and lack of access to health care affect children and adolescents who are not benefiting from the overall economic growth of the country (UNICEF Peru 2006). In Peru, the prevalence of underweight childr en declined from 10.7% in 1991-92 to 7.8% in 1996. Wasting does not represent a problem at th e national level since it has remained below two percent. The improvement in the nutritional st atus of children less than five years between 1991-92 and 1996, at the national level, is a decr ease in stunting from 31.8% to 25.8% (FAO 2006).

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16 Nutritional Value of Cows Milk Overcoming deficiencies in dietary quantity and quality are major nutritional challenges globally, particularly in developing nations. Diet ary quantity is concerned with the availability and consumption of total food ener gy (kcal) and dietary quality with the ability of the diet to supply protein of high biologic value and ad equate supplies of micronutrients. The micronutrients of major concern in the growt h, development and health of children include calcium and vitamins A and B12 (Neumann 1999). Animal-source foods are a source of digestible and quality pr otein and provide energy. They are calorically compact and an efficient so urce of micronutrients (N eumann 1999). Milk is a source of many nutrients. It is a source of calcium, phosphorous, vitamin B12 and vitamin D. It is also a good source of protein, fat, carbohydrate, vitami n A and niacin (Patton 2004). However, there are claims that milk is not nut ritious and harmful to pe oples health. It is argued that milk contains many ingredients that the consumer is not aware of. These ingredients include cholestero l, antibiotics and bacteria. Fo r example, recombinant bovine growth hormone (rBGH) is a non-st eroidal hormone injected into dairy cattle to increase milk output. A consequence of this inj ection is that it increases the gr owth hormone, IGF-I. IGF-I is thought to be a key factor in the growth and prolif eration of cancer. In a ddition, it is claimed that milk contributes to heart disease and incr eases the risk of br east cancer (Cohen 1997). Milk is a food that is mostly marketed for its calcium and its contribution to healthy bones. This is especially true for children because bone mass must be built befo re adulthood. It is argued that milk is an excellent source of cal cium; however proteins in milk and lack of magnesium make it an inefficient source fo r proper calcium absorption (Cohen 1997). However, it is generally believed that ade quate amounts of milk and milk products are needed throughout the life cycle to promote bone health and contribu te to overall health status.

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17 The children in this study were six years or younger. Children in this age range obtain their calcium requirements by consuming milk and m ilk products. Calcium is needed throughout childhood to maintain exis ting bone and for bone growth. As discussed earlier, milk provides other important nutrients needed for good health (i.e. protein, phosphorus, potassium, vitamins A, B12, and D, riboflavin a nd niacin) (Miller 2000). Vitamin D is an important factor in calcium absorption and metabolism. However, dietary sources are limited. It is essential for a h ealthy skeleton throughout life. Vitamin D is synthesized in the skin when expos ed to sunlight and obtained from some foods (Miller 2000). In the community studied, outdoor exposure is fre quent and daily. Activities are performed outside and the children join their parents in the farming activities. Also, these children walk to and from school, walk to and from obtaining wate r, and play outside. Therefore, sunlight exposure is abundant is this ar ea and could be another explan ation for the low incidence of stunting in this population. Livestock Impacts on Childrens Health Livestock are a major component in agriculture in developi ng countries and produce much more than food. Livestock and th eir products provide direct cash income; they are a living bank for farmers and are critical to agricultural inte nsification via provision of power and manure for fertilizer and fuel. In addition, livestock pr ovide other functions to the livelihood of their keepers. They are a food supply that can provid e milk, butter, cheese, eggs and meat. Animalbased foods are high in protein and are an impor tant source of energy, minerals and vitamins (Tangka 2000). Livestock directly and indirec tly affects the nutritional status of children in developing countries. The nutritional status of children w ith low consumption of dairy products can be improved with ruminant animal product intake. Th e nutritional status of children may easily be

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18 improved from dairy animals if all the milk produ ced is not sold. There is a misconception that dietary treatments of growth-reta rded children are a waste, since the damage has already been done and cannot be improved upon. Although height is not as responsive as weight to nutritional interventions, there is evidence of rapid response of linear growth during a short period of treatment of malnourished children. Restoration of normal height is possible, up to the age of about 10. It has been found that the majority of th e cases that have reported gains in height have been based on the use of milk or soya-based supplements. For childre n in boarding schools in Papua New Guinea, their growth response was propor tional to the amount of milk in their dietary supplement (Tangka 2000). Ownership of livestock and livestock technol ogies can give househol ds more opportunities to improve the nutritional status of their childre n. There is much literature on the effects of animal products (especially milk) and the owne rship of ruminant livestock on the nutritional status of children in developing countries. Ther e are examples from Ecuador, Nepal, Uganda and Rwanda of the correlation betw een dairy animals and child nutr ition. In a study conducted in rural coastal Ecuador, access to market foods, as measured by per capita food spending and livestock ownership, mostly cows, showed the st rongest correlation with childrens nutritional status (H/A, W/A). Children from farm families owning livestock were less likely to be growth retarded than children of farm ers without livestock. A study fr om a rural community in Nepal found that households with a milk-producing bu ffalo had less chance of having a severely stunted child than households with out lactating buffalo. Ownershi p of a cow was found to be a significant predicator of H/A (long-term) nutritional status in children in south-western Uganda. A study from rural Rwanda found that children betw een the ages of two and five years old from households with dairy animals (cattle and goats) were significantly taller than children from

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19 households without these animals. The presence of well-nourished childr en in households with ruminant livestock is probably due to the ava ilability and consumption of high quality protein and calories from dairy products (Tangka 2000). Further correlation between liv estock ownership and its imp act on child nutrition has been found in a study in five Latin American countries One study showed that milk intake is associated with better growth in children during the critical developmental stage from 12 to 36 months of age (Staal 2004). A study conduc ted in Managua, Nicaragua showed that the proportion of children stunted was lower for thos e who drank milk on previous day than those who did not. In Brazil, it was found that the c onsumption of milk incr eased height-for-age Zscore standard deviation units when selected other factors were cont rolled for (Nicholson 2003). The role of milk consumption, both goat and co w, was found in Ethiopia to increase child growth in households raising liv estock. Studies in such dispar ate locations such as China, Jamaica and Mexico found that children who cons umed cows milk or other dairy products obtained significantly greater leng ths or heights. In school-age -children, where milk and other dairy product are low, the additi on of milk to the diet was f ound to increase linear growth and reduce stunting. These results were observed in Malaysia and in Japan using school feeding programs. In both studies, rapid growth in he ight was noted (Neumann 1 999). In the Dominican Republic, South Korea, Colombia, Indonesia an d Province of Sudan, milk consumption was found to have a positive associ ation with childrens nutri tional status (Tangka 2000). Dairy Cows and Child Nutrition in Kenya Several studies have been conducted on dairy co w ownership and child nutritional status in Kenya. In Kenya, nearly one-third of children showed evidence of chronic malnutrition in the mid 1990s. A major cause of malnut rition in Kenya is inadequate di etary intake, both in terms of quantity and quality. Animal-source foods, includ ing dairy products, are an excellent source of

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20 essential micronutrients and highquality protein. However, it is unclear whether actual ownership of dairy cattle brings nutritional benefits to the childre n within a household. A more recent study attempted to shed light on this issue (Staal 2004). The study was carried out in Coast and Cent ral Provinces of Kenya. The project was carried out by the Smallholder Dairy Project a nd the Department for International Development of the United Kingdom. Household surveys we re given to cattle-ow ing households and noncattle-owning households to examine the imp acts of dairy cow ownership on the nutritional status of pre-school children. The surveys in cluded anthropometric measurements (including height and weight) of all house hold children under the age of five. It was found that children from cattle-owing households had a higher height-f or-age, indicating lower levels of stunting (Staal 2004). The benefits brought to the households and chil dren were many. There is an increase in the amount of milk available for household cons umption. The sale of milk can increase household cash income, which can then be used to purchase further nutrient s. Also, the use of cattle manure may increase food crop yields (Staal 2004). An additional study in Embu, Kenya by the Global Livestock Collaborative Research Support Program has shown that supplementation with animal-source foods had positive effects on Kenyan schoolchildrens growth and cogniti ve performance. The effect of milk supplementation was second highest next to meat supplementation (Staal 2004). One further study conducted in Kenya analyzed dairy cow ow nership and child nutrition. This study was done in the coastal and highla nd areas of Kenya. For the coastal sample, ownership of cattle had a statically significant po sitive effect on the mean height-for-age for the children of this area. For the highland sample, the cattle ownership has positive effects on

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21 height-for-age as well. Cattle ownership does no t have a significant impact on mean weight-forheight for either region. Theref ore, cattle ownership has a la rge impact on longer-term child nutritional status (growth) but little or no impact on short-te rm nutritional status (Nicholson 2003). Body Size: Adaptation and Function Economist David Seckler proposed the small bu t healthy hypothesis. A child who is short but not thin is small but healthy. Reynaldo Martorell in Body Size, Adaptation and Function, argues against this hypothesis. A majo r criterion for judging childs health is whether the child is growing as expected. Failure to grow is an indication that something is wrong. Growth retardation is widely re cognized as a response to a limite d nutrient supply at the cellular level. The maintenance of basic metabolic func tions takes precedence and resources are diverted away from growth and phys ical activity (Martorell 1999). Poverty affects growth as poverty affects nu trition and infection. The components of poverty will always lead to low dietary intake s and/or infection whic h result in decreased nutrient availability at the cellular level which then gives rise to growth retardation. The diets of these children are generally lacki ng in both quantity and quality. Nu trient metabolism is directly affected by infections which lead to poor nutrient metabolism and nutrient uti lization. Therefore, the basic cause of stunting is poverty and the e ffects on size are mediated through poor diets and infection (Martorell 1999). In the case of Latin America, moderate li near growth retardation is observed, whereas wasting is rare. At severe levels of deficien cy, linear growth ceases altogether and it becomes necessary for the body to use its tis sues reserves. These reserves serve as an energy and nutrient source to maintain vital functions. However, in less severe stages, normal mass to length

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22 dimensions will be maintained. Dietary deficits are coped with by slowing down in growth and decreasing physical act ivity (Martorell 1999). Peru and Santo Domingo Peru is located in western South America, bordering the South Pacific Ocean, between Chile and Ecuador (VirtualPeru.Net 2004). It has a population of about 27,562,000 million people (UNICEF Peru 2006). The country is divided into 24 departments, and the constitutional district of Calla o. The capital of the republic is Lima. The official languages are Spanish and Quechua, but a recognized regional language is Aymara (VirtualPeru.Net 2004). Research was conducted in Santo Domingo, a providence of Can ete (Figure 1-1). Figure 1-1: Can ete, Peru Location. (Canete Government 2007) The Study: Santo Domingo, Peru Caete is a 24,000 ha valley on th e west coast of Peru, one of the driest deserts in the world. The land is highly parceled; there are ab out 5,000 farms and 80% of them are in hands of small landholders (10 ha or less). Usually, sm all farms are family-centered households, where

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23 the main source of labor comes from family members and the farm and the house are highly interrelated (Cabrera 2002). The site of this research was in the area of Santo Domingo, Can ete, Peru. Santo Domingo is located in the lower populated area of Herby Alto, in the district of San Vicente, providence of Can ete, in the department of Lima-Peru. There are a total of 54 families in this community in a total population of 152,379 valley residents (Cabre ra 2000). Twenty-seven families and their children under the age of six were studied. Dairy production is the main activity for the inhabitants in Santo Domingo. In the community of Santo Domingo, none of th e households have water or electricity in the home. Sanitation conditions ar e low and diets for the people of this community is limited. However, out of the children studied in this an alysis there was low prevalence of stunting. Of participant children, 93% of child ren were in normal range for their height and age. Of nonparticipant children, 81% were in normal range for their height and age. This low prevalence of stunting in this community is bei ng attributed to the presence of animal foods in the diet of the children. These foods include meats, eggs and m ilk. In addition, the low prevalence is also being attributed to other factors such as location of residence, nu mber of times water is obtained, mothers care and household size. Research Problem and Objectives The overall purpose of this study was to conduct a cross-sectional st udy in Santo Domingo, Caete, Peru. A portion of the inhabitants of Sant o Domingo are participants of a dairy program aimed to assist dairy farmers. This program is sponsored by the Universidad de La Molina. The research seeks to establish a ba seline anthropometric assessment (height, weight, age) for undersix child growth status of child ren whose parents are participants of a regional dairy project, compared to those children whose parents are not participants in the dairy project. In addition,

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24 the study provides a rapid ethnographic assessment of development indicators at the household level that includes household item s and number of livestock owned. An objective of this study is to determine the nutritional impact of this dairy project and the impact of animal-based foods on child health. It is hypothesized that animal produc ts are a daily part of th ese childrens diet and especially for the children of the participant fa milies, therefore the incidence of underweight and wasted children will be low but stunted children will be high. The general objectives of this research are to : (1) enhance the understanding of the benefits or lack thereof of agricultural change for hous ehold nutrition; (2) enhance the knowledge about family livestock ownership and the effects on child nutrition; and (3) examine the nutritional effects of milk and sun exposure on childrens health. Methodology This field study combined anthropometric data along with an assessment of the development indicators of the household. The study involved 1) measurement of height and weight of children under six, whose parents are participants of th e dairy project, compared to children whose parents are not participants in the dairy project and 2) conduct a survey of development indicators at the house hold level. Nutritional anthr opometrics parameters such as weight-for-age (W/A), height-fo r-age (H/A) and weight-for-height (W/H) were used as bases for assessing malnutrition and evaluating the eff ects of dietary treatment in the children. Conclusion Malnutrition in Peru is presen t in the form of stunting and in some cases underweight and wasted children. Research has been conducte d in several countries around the world that supports the theory that an animal-based diet impr oves the health status of children. This theory was applied to my research conducted in Sant o Domingo, Peru; a small dairy community with limited resources. My studys overall purpose wa s to conduct a cross-sectional study between

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25 families who are part of a dairy project compared to those who are not. Anthropometric data along with a development indicator survey was performed at each study household to assess the health status of the ch ildren in Santo Domingo.

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26 CHAPTER 2 BACKGROUND: PERU, SANTO DOMINGO AND DAIRY FARMING Santo Domingo, Caete, Peru: A Milk Producing Region Limas Milk Situation Like other developing countries, Peru has experienced strong urban growth during the last few decades. In 2000, 72% of its 25 million inhabita nts lived in cities. Metropolitan Lima alone makes up 30% of Perus total population. Urba n consumer preferences are significant in determining domestic agricultura l production, not only in terms of what is produced, but also how and where it is produced. The proximity be tween the production region and the market thus becomes particularly meaningful for milk, a bul ky, perishable product with a high market value (Bernet 2000). Milk producers on the coast of Lima (such as in Caete and Sa nto Domingo) currently have favorable market conditions, as milk prices are much higher than in other regions of the country. Increased competitions among local mi lk buyers, who are confronted with unused processing capacities, are unable to meet demand fr om their "local" market in the city of Lima (Bernet 2000). Caete and Santo Domingo Santo Domingo is a province of Can ete. Caete is a valley in the central coast of Peru within the department of Lima (Cabrera 1999). It is located 62.14 miles south of the city of Lima (Gomez 2002). The valley is irrigated by the Caete River wa ter. The weather is desertlike; there is little rain. Th e temperature varies from 53.6 F in the winter to 89.6 F in the summer, with an average of 64.4 F (Cabrera 1999). Average prec ipitation is 2mm/year (Gomez 2002). There are approximately 150,000 people livi ng in Caete; 41,000 of them constitute the rural population (Cabrera 1999).

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27 Santo Domingo is an annex of Caete. Da iry production is th e main activity for inhabitants of Santo Domingo. The community borders past the Caete River therefore vegetation growth stops where the river ends. There are no businesses to purchase household items, feed for the animals, food or to obtain medical care. It is a community of limited resources with no running water, electricity or sewage system in any of the homes. This community differs greatly from the bustle of Caete Caete is filled with local businesses such as a bakery, post office, library, eateries and pharmacies. There is the local open market for the purchase of clothing, household it ems and food. There is also the local hospital and private doctor offices. Caete also contains a bus st ation that operates buses to and from different locations in Peru, especially to and from Li ma. Homes and businesses have indoor plumbing and electricity. The differences between Caete and Santo Domingo are of the basic needs for survival which Santo Domingos inhabita nts and community does not possess. Arequipa and Cajamarca Since the 1940s, Arequipa and Cajamarca have been the largest milk producers in the country (Bernet 2000). Arequipa is about 700 miles from Can ete and the second largest city in Peru (Peru Traveler 2006). Ca jamarca is around 433 miles from Can ete (Globe Feed 2006). It is located in the northern highlands of Peru. Both cities are well-known for their fine cheeses and dairy products (British Council Peru 2007). Lima has also remained an important milk -producing region. The reason is its own vast market and the fact that the other two milk ar eas have high transportatio n costs for perishable and bulky dairy products taken to th e Lima market. The fact that Lima City, with its more than seven million inhabitants, has continued to grow at more than six percent annually in recent years explains its expanding demand for fresh dairy products. Comprisi ng more than 80% of national consumption for industriall y processed dairy products, Lima is considered "the market"

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28 for the milk processing industry. Consequently, as a production region, Lima has the advantage in that its market is next door. It is this geographic advantage that has led to the recent establishment of additional milk processing plants by different companies in peri-urban Lima (Bernet 2000) (Figure 2-1). Figure 2-1: Cajamar ca, Arequipa and Can ete Locations Relative to Lima. (Shunya 2007) Health in Santo Domingo, Can ete, Peru None of the homes of the families studied have access to electricity. Families do not have in-home access to adequate water for human or an imal consumption. All water is obtained two to three times a week from the puquio (natural ground water reservoir) using donkeys and at times horses for the 20-30 minute walk. The water obtained is kept in rese rvoirs constructed in each household. The water obtained is for hu man and animal use (Figure 2-2). Can ete Arequipa Cajamarca

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29 Figure 2-2: Sa nto Domingo, Can ete, Peru. (Author 2005) Medical personal of Santo Domingo include s one doctor, one nurse, two nursing technicians, and one obstetricia n. Demand for medical services in the area does not meet the supply of medical staff. The main problems that affect the population of Santo Domingo include respiratory infections and diarrh ea infections. Sharp watery di arrhea infections occur mainly during the summer months. In addition, there is multi-resistant tuberculosis (TB), malnutrition and parasites (Gomez 2004). Population and Health Statistics Basic Indicators Use of anthropometry requires two essential ite ms: an anthropometric indicator and a cutoff point. The indicator, often called an anth ropometric index, is a measurement or a combination of measurements made in the field, such as weight and height, or the combination

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30 of measurements with additional data, such as ag e. Different indices refl ect different components of nutritional status. The inde x weight-for-height indicates thinness, and because acutely undernourished persons generally lose body weight but not height weight-for-height decreases with acute undernutrition. Young children with chronic undernutrition may not be thinner than normal children, but may have retarded growth in height. Chronic undernutrition may not be severe enough to cause weight lo ss, but does interfere with norm al linear growth. As a result, height-for-age is decreased, and children become stunted. Weight-for-age reflects both acute and chronic undernutrition because both thin ch ildren and stunted ch ildren are underweight (Woodruff 2000). There are several indicators used to evalua te the condition of children. Basic indicators and body size indicators are used in this study. Basic indicato rs used are total population, life expectancy at birth, under-5 mort ality rate, infant mortality rate annual number of births and annual number of under-5 deaths (Table 2-1). Some definitions are necessary for clarity: Under-five mortality rate (U5MR) probability of dying between birth and exactly five years of age expressed per 1,000 li ve births (UNICEF Peru 2006). Infant mortality rate (IMR) probability of dying between birth and exactly one year of age expressed per 1,000 live births (UNICEF Peru 2006). Life expectancy at birththe number of years newborn children would live if subject to the mortality risks prevailing for the cross-section of population at the time of their birth (UNICEF Peru 2006). Statistics from five countries are used to compare to Peru which are Argentina, Bolivia, Colombia, Costa Rica and Mexic o. The following are notable:

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31 Costa Rica has the best basic indicators for its population. Out of the five countries analyzed, it had the lowest total numbers for under-f ive mortality rate of 13, infant mortality rate of 11 and annual number of under-5 deaths at 1,0 00. Costa Rica has the highest life expectancy at 78 years in 2004. Bolivia has the highest basic indicators for its population. It had the highest number for under-five mortality rate of 69, infa nt mortality rate of 54 and annual number of under-5 deaths at 18,000. Bolivians have the lowest life expectancy at 64 years in 2004. Infant mortality is used to compare the h ealth and well-being of populations across and within countries. In the deve loping world, about half of newbor n deaths were from infection, tetanus and diarrhea (G reen 2006). Perus basic indicator fo r U5MR is 29. It is a country still developing and in need of better health care and state involvement Although not a true indicator of nutritional status, infant mortality rates do gi ve some insight into the living conditions of children in a community. There have been subs tantial improvements in most Latin American countries, but there still exist disparities among th em. Costa Rica, for example, has the infant mortality rate of a developed country, while Bo livia still has unacceptabl y high figures (Bartell 2001). The under-five mortality rank is a critical indicator of the we ll-being of children (UNICEF Peru 2006). Five diseases pneumonia, diarrhea, malaria, measles and AIDS account for half of all deaths in children under five. Most of these lives could be saved by expanding low-cost prevention and treatment measures. These include exclusive breastfeeding of infants, antibiotics for acute respiratory infections oral re-hydration for diarrhea, immunization, and the use of insecticide-treated mosquito nets and appropriate drugs for malaria. Ensuring proper nutrition is also part of prevention, because malnutrition in creases the risk of dying from these diseases

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32 (Child Info 2006). Perus U5MR is 29. As with infant mortality rate, Peru is nowhere near Costa Rica in terms of health car e and reducing childhood diseases, but Perus infant mortality is not as serious as Bolivias. Table 2-1 Basic Indicators La tin America Countries (2004) Total Population (thousands) Under-5 mortality rate Infant mortality rate Annual no. of births (thousands) Annual no. of under-5 deaths (thousands) Life expectancy at birth (years) Argentina 38372 18 16 685 12 75 Bolivia 9009 69 54 265 18 64 Colombia 44915 21 18 970 20 73 Costa Rica 4253 13 11 79 1 78 Mexico 105699 28 23 2201 62 75 Peru 27562 29 24 627 18 70 Source: UNICEF State of the World's Children 2006 Body Size Indicators Another indictor used is body size. Body si ze indicators used are underweight: moderate and severe; underweight: severe; wasting: modera te and severe; and stunting: moderate and severe (Table 2-2). Body size is generally the best indicator of physical well-being in children, because inadequate food intake, poor nutritional qua lity of the diet, and va rious infections affect growth. The most common measure of undernutrition in children ar e weight and height either individually or comb ined (Martorell 1995). Definitions are necessary for clarity:

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33 Underweight: moderate and severebelow minu s two standard deviations from median weight for age of referen ce population (UNICEF Peru 2006). Underweight: severebelow minus three standard deviations from median weight for age of reference population (UNICEF Peru 2006). Wasting: moderate and severebelow minus tw o standard deviations from median height for age of reference population (UNICEF Peru 2006). Stunting: moderate and severe below minus two standard deviations from median height for age of reference population (UNICEF Peru 2006). The same five countries statis tics are used to compare to Perus. The results are: Argentine and Costa Rica have the lowest occu rrence of underweight: moderate and severe for children under five at five percent. Bolivia has the highest at eight percent. Costa Rica has the lowest occurrence of underw eight: severe at zero percent, while all the other countries had an indi cator of one percent. Bolivia, Colombia and Peru all had the lowest indicator for wasting: moderate and severe at one percent. The highest was at three percent for Argentina. Costa Rica had the lowest indicator for stunti ng: moderate and severe at six percent. Bolivia had the highest occurrence at 27%.

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34 Table 2-2 Body Size Indicators La tin America Countries (2004) Percent of under-fives (1996-2004) suffering from: Underweight Wasting Stunting Moderate and severe Severe Moderate and severe Moderate and severe Argentina 5 1 3 12 Bolivia 8 1 1 27 Colombia 7 1 1 14 Costa Rica 5 0 2 6 Mexico 8 1 2 18 Peru 7 1 1 25 Source: UNICEF State of the World's Children 2006 Weight-for-Age Weight-for-age reflects body mass relative to chronological age. Weight-for-age is also a good indicator of the nutritional state of a child. Weight increases or decreases more rapidly than height. The metrics used for this inde x are overweight, normal, and undernourished. A child is classified as overweight if s/he is in the range of +2 or greater standard deviations (SD). Normal range is from -2 to +2 SD and unde rnourished is under -2 SD (Reyes, 2005). Low weight-for-age is described as lightness or underweight. While high weight-for-age is described as heaviness (WHO 1995).

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35 The underweight indicator for Peru was on av erage the same as other Latin American countries. Low weight-for-age is not as severe a problem in Peru as it is in other regions of the world, e.g. Sub-Saran Africa. The prevalen ce in 1990 for underweight children was eight percent in South America (Martorell 1995). Th e share of underweight children actually increased from 28.8 to 31.1 % between 1990 to 1995 in this region of Africa (Smith 1999). Weight-for-Height Low weight-for-height and high weight-for-heigh t are two growth indi cators for children. Wasting or thinness usually indicates a recent and severe process of weight loss. This is usually associated with acute starvation an d/or severe disease. It is also possible that wasting is the result of a chronic unfavorable condition. The prevalence of wasting is usually below five percent even in poor countries. Low weight-fo r-height shows a peak in the second year of life (WHO 1997). Any child with low weight for th eir height is undernourished (Reyes 2005). At the opposite end of the spectrum is high weight-for-height. Overweight is the preferred term to describe high weight-for-hei ght. There is a strong correlation between high weight-for-height and obesity. However, grea ter lean body mass can also contribute to high weight-for-height. On a populati on wide basis, high weight-for-hei ght can be considered as an adequate indicator of obesity (WHO 1997). The weight-for-height indicator for Peru (1) was on average the same compared to other Latin American countries. Wasting is not a seve re problem found in Latin American countries as compared to countries in Asia. High levels of wasting are found in Asia, probably due to lower energy intakes than in Latin America (Martorell 1995). Height-for-Age Children with very low height for their age are termed as stunted Low height-for -age is the result of reduced skeletal gr owth (Keller 1991). High levels of stunting are aociated with

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36 poor socioeconomic conditions and increased risk of frequent and early exposure to adverse conditions such as illness and/or inappropriate feeding practices. Pr evalence starts to rise at the age of about three months; the process of st unting slows down at around three years of age (WHO 1997). Latin American children are often faced w ith chronic but moderate deficiencies of nutrients. They may respond by growing less in he ight without altering we ight-for-height rations (Martorell 1995). In Latin Ameri ca, there is high prevalence of chronic malnutrition expressed as stunting. Stunting is always more prevalent in ru ral populations than in urban ones (Bartell 2001). Perus stunting indica tor at 25% is the second highest behind Bolivias at 27%. Stunting is a health problem concern for Peru. This research is based on a dairy project in the area of Santo Do mingo, Peru directed by Dr. Carlos Gomez Bravo, an animal nutritionist professor at the Universidad Nacional Agraria La Molina in Lima. Fifty-four families in this area are involved in dairy farming as their principal source of income. A sample of 18 small dairy farmers were selected for the project based on the number of dairy catt le owned; however 17 resulted in participating in the project. These farmers had Holstein genotype dairy cows a nd have been established in the area for the last 10 years (Gomez 2005). Phases of the Project Rapid Participatory Rural Appraisal Phases (October 2002-Septemenber 2003) Phase I of this dairy project c onsisted of a survey of total pr oducers in the area (three field visits) followed by selection of producers (two fi eld visits) invited to a participatory workshop and follow up project activities (Gomez 2005).

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37 Phase II encompassed a meeting with the farmers on their site with the purpose to have a participatory workshop where they expressed th e situation of their pr oduction systems (Gomez 2005). The workshop was carried out in the Universidad Nacional Agraria La Molinas nearby research facility in October 2002. The university in 1999 established a nearby research site in Santo Domingo nearby to the farmers of this area. This research site cons ists of a dairy unit of about 100 cows for the purposes of teaching, re search and extension purposes. The Kellogg Foundation funded an extension proj ect which has supported initial activities with dairy farmers of Santo Domingo. In addition, students are invo lved in various development activities (Gomez 2002). In this workshop, 20 small farmers participated. The workshop went as follows: Presentation was made to the participants. Participants were divi ded into four groups. Each group was given paper, pencils and a ny other needed materials to draw and present their dairy production system. Each group presented and expl ained their production system. After the presentation of each group, it was established that the negative factor affecting these farmers production systems were forage availability, livestock management technical deficiencies, lack of water supply and health and reproductive problems. Eighteen farmers of the 20 were in agreement with the work plan presented. The field activities were finalized and included training in organiza tion and basic r ecord keeping. Two graduate students also visited the resear ch site twice a month, for 12 months. Data were collected on milk production, herd dynamics, the feed system, reproduction, health and social economic aspects.

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38 Phase III consisted of a meeting held in January 2003 as a follow up participatory workshop. Any project advances were evaluated and any adjustments that were needed were noted (Gomez 2005) Intervention Phase (October 2003-September 2004) During October and December of 2003, field vi sits were conducted to prepare for the intervention phase of this project. Four farmers began using c oncentrated feed that was prepared at a nearby commercial feed mill. These four farmers were indicated on the appropriate quantity and handling of the concentrated feed during the months of January-March 2004. By July 2004, a total of nine farmers were purchasing the c oncentrated feed and by the end of the month, 11 families were utilizing the feed. Bulletins we re also prepared and distributed among the participants of the project (Gomez 2005). During this phase, the number of lactating and dry cows in each herd was compared to the previous year and the numbers stayed about the same. Artificial insemi nation use remained the same, although no specific activity was conducted in order to change this issue. Farmers did however express a high interest in its implemen tation. In addition, there was no significance difference in the price of milk received from the buyer for milk sold by the farmers. Milk production also remained fairly the same and the costs of inputs (Gomez 2005). Dairy Production System The production systems of the participants of th is project were estab lished at low potential levels. The participants of this project were established to ha ve a large number of bulls and growing males which limits total milk producti on and consumption of resources (Gomez 2005). Weight on the dairy cattle was 20-40% below exp ected body condition and was at an inadequate level for all. Farmers did not maintain records on lactation length, calving intervals or lactating

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39 and dry cattle. In addition, no r ecords on calf mortality, parasites and any other health problems affecting the herds were kept (Gomez 2002). Families whose property is located closer to th e water channel own more cattle than those whose property is located farther away from the channel. Hand milking was observed in all of the units. There is no use of artificial insemina tion (AI) and each family owns their own bull for reproduction purposes or shares one with th e neighbor (Gomez 2002). General difficulty was observed in the availability of appropriate bulls for service. Success of pregnancy is a problem for the herds of Santo Domingo. During an eval uation conducted in May of 2003, the number of cows in the sample was 112 and during the period of evaluation (245 days) 21 calvings occurred. The result is a 19% natality rate. Rectal pa lpation was conducted and only eight percent of the cows were pregnant. The main problem is lack of ovarian activity due to low body condition in the dairy cattle (Gomez 2005) In addition, the feed provided to theses herds were of poor quality and limited quantity. Poor quality forage was being fed such as sweet potato foliage and corn stover. Some households were feeding supplementary concentrat es to their cattle but it was of very limited amount. Also, there is limited av ailability of a consta nt water supply available to these cattle (Gomez 2002). Most of the income supporting the families in Santo Domino comes from the selling of milk. There is no data to show where money earned from income received goes however the percentages of the expenses related to dair y farming was obtained. Expenses related to maintaining dairy herds are broken down as su ch: 48% for forage expenses, 28% manual labor, 22% concentrate purchases and one percent each for facilities and other expenses.

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40 Constraints for Gomezs Project Success Dairy producers of Santo Domi ngo were restricted to recei ve financial support and the herd size was a constraint for improvements. With possible interven tion of this project, improvements were possible. Possible interventions were the introduction of quality feed and an adequate supply to the cows. This would assi st in the undernutrition of the cows in this community. Also, reproductive management needs to be revised in order to tackle the problem of the large number of non-lactat ing dry cows. Therefore, this project planned to impact these farmers and their herds by an in crease in total milk production due to greater milk production per cow and more cows per herd (Gomez 2002). Goals of Gomez Dairy Project The main goal of the project was to improve dairying in the Caete region. The project began in 2002 and operated until the end of 2005. The objectives of the project were to: (1) identify the priorities, constrai nts and opportunities of selected dairy farmers in the Caete region; (2) determine the important limiting fact ors; (3) develop interv ention strategies and assess the economic impact of the project; and (4) develop me thodologies for recording and demonstrating the economic impact of the project (Gomez 2002). The objectives of Gomezs project inter-related to my objectives for my research. Both projects aimed to assess the economic impact of the dairy project to this community. As Gomez looked to identify issues that f ace the dairy farmers, I searched to identify the nutritional issues of this community that could be affected by the limited resources and production of the dairy farmers. My Research on Santo Domingo Dairy Farmers The dairy farmers who are part of the Gomez dairy project are labe led as participant families for this study. These farmers were sele cted for this program based on the number of

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41 dairy cattle they owned. The dairy farmers who did not have the number of dairy cattle to meet the requirements of the program are labeled as non-participant families for this study. All of participant families rely on dairy farming as their main source of income. Eighty-two percent of non-participant families rely on dairy farming as th eir main source of income. The 18% of those families who do not rely on dairy farming rely on other sources of income such as working on others farm land. The price of milk during my study was twenty-five cents ( 0.83 centimos/litro ) per liter of milk. An average of 20 liters of milk per day is sold per family. Therefore, families are living off an average of $5.15 per day. The population studied lives in the rural area of Santo Domingo. Of seventeen families involved in a dairy project mon itored by Gomez eleven had children six or under. One family refused to participate in the study. Thus only 10 fa milies were studied. All children (15 in total) under age six in these 10 families were subjects. They were measured for weight and height, and surveys were administered to each mother of the household. The date of bi rth and sex were also recorded of each measured child. An additional 17 non-participant families with similar income, education levels and those who had children under the age of six years old were selected randomly. All non-participants owned dairy cattle and dairy farming was the main source of income for the majority. All 26 children under age six in these families were measured for their weight and height. Date of birth and sex were also recorded. The majority of t hose living in Santo Domi ngo live in adobe made homes. Conclusion Even though Peru over the past several decades has had an improvement in child health, there is still a high incidence of stunting. Perus wasting a nd underweight indicators are low

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42 even when compared to other Latin American c ountries. However, Perus stunting indicator is high therefore my study assumed a high incide nce in the children of Santo Domingo. Santo Domingo has a population that has lim ited access to basic necessities such as electricity and water. It is a population wher e the majority of the families depend on dairy farming as their main source of income. The Gomez project implemented a dairy project to involve eligible dairy farmers to participate in this project and provide services. My study was conducted based on the Gomez project and involved a small sample of the children and families of this area.

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43 CHAPTER 3 METHODS Data Collection and Design The study involved: (1) measuring the height and weight of child ren under six, whose parents are participants of a dairy project compar ed to parents who are not participants in the dairy project and (2) conducting a survey of development and w ealth indicators at the household (HH) level. Anthropometric and vaccine data for the ch ildren in Santo Domingo was collected from the la posta (basic clinic facility administered by the Ministry of Health which is located in Herby Alto). All communicati on was conducted in Spanish. I introduced myself as a graduate student fr om the University of Florida and explained what I was researching and read them their ri ghts if they chose to participate in my study (through the informed consent form). I then ob tained a signature from the parent who was present. Formal compensation was not specifie d in the informed consent process or proposal, but customary gifts included photos, candy and cl othes for the children, fruit, bread and clothing detergent. Indicators of Development The survey administered for this study was for wealth indicators (Indicator 2006). The survey asked about household capital, including the availability of water, electricity and sewage in the home. The health impacts of having thes e utilities in the home were hypothesized to be very important. Water and sanitation improve childs health and nu trition by decreasing exposure to pathogens, thereby reducing diarrhea and improvements in anthropometric indices in children and reductions in total mortality (Pinst rup-Andersen 1995). Key cr iteria included in the survey included:

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44 Household capital ownership TV Iron Number of beds Stove Vehicle (car/truck) Refrigerator Sewing machine Radio Bicycle Tractor Amenity Ownership Electricity Water in house Outhouse Income Income from farm Income off farm from source other than farm The other method used was a survey on the in dicators of development. This allows collecting both social and agro-economic data. This survey asked a bout key indicators of development which are used as a way to measure the effects of project in tervention, such as the dairy project (Spring 1995). Mother and fathers age, education and o ccupation were obtained. Mothers age and education are important to know. Women are th e main providers of nutrients and informal health care to their children and other member s of their household (Pinstrup-Andersen 1995). Mothers education has a substantial effect on the childs health and mortality rate even after controlling for major lifetime events and ec onomic status. Previous studies have shown the effect mothers education has on child health. A study done in Uganda on 720 children showed a higher prevalence of stunting among children of non-educated mothers. When all socio-

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45 economic indicators were simultaneously adjusted for in conditional regression analysis, it left mothers education the only i ndependent predictor of stunti ng. Children of non-educated mothers are significantly more likel y to be stunted compared to t hose of mothers educated above primary school (Wamani 2004). A study done in Peru equated improving wome ns education to improving a communitys healthcare facility, water supply and sewage system. The study found that over 25 % of children were stunted and chroni cally malnourished. These childre n were from rural community homes where the average schooling for mothers is four years compared to urban mothers with nine years of schooling. This implies that a moth ers educational level di rectly affects a childs nutritional status. In areas with many educated mothers, the entire communitys health improves because the mothers share health ad vice and information (Escobal 2005). In the present works, the diet of the children was also investigated to see if animal-source foods are consumed in the home. Nutritional status of children may be easily improved from dairy animals if all the milk produ ced is not sold. Alt hough height is not as responsive as weight to nutritional interventions, there is evidence of rapid response of linear growth during a short period of treatment of malnourishe d children. Restoration of normal height is possible, up to the age of about 10. It was found that the majority of the cases that have re ported gains in height have been based on the use of milk or soya-b ased supplements. For example, children in boarding schools in Papua New Guinea, their growth response was proportional to the amount of milk in their supplement (Tangka 2000). Limitations of the Research It is important to mention the possible caveats of this research project. No geographic region is identical throughout. However, in this community, the households were almost identical. Higher nutritional status or food consumption may be a reflection of preexisting social

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46 economic status (SES) or independent (or actual proceeding) participa tion. Conversely a decrease in nutritional status a nd food consumption can reflect th e result of the project. The research was conducted during the cold climate time for the coast. Anthropometric data could be somehow affected but it should not be a significant factor. In addition, there was only one project in progr ess in this community at the time of this study. Santo Domingo is a small community and in a remote location that there has been little study done on this community. The sample taken for this research was a small sample and a limited amount of data was collected. The variables analyzed were household nutrition (foods such as milk, animal-sources, vegetables, etc.) and growth indices of children. Independe nt variables were project participation or not, parents educ ation and income. Child health und er five is a sensitive marker of household and community health, a goal of the project; however due to the limited number of children under five years of age children unde r six years of age were also included. Conclusion Anthropometric data and household indictor data was obtained from 27 families and 41 children in Santo Domingo. Anthropometric data was conducted on children less than six years of age. Development and wealth indicators were used to analyze the ho useholds of the children studied. Indicators collected in cluded household and farm wealth capital. Based on the small sample obtained there are limitations to my study. A ll data contained was u tilized to analyze the health situation of the children of Santo Domingo.

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47 CHAPTER 4 RESEARCH DATA Underweight Indicator: Moderate and Severe Table 4-1 provides a comparison between Peru, Latin America (LA), Santo Domingo Participants, and Santo Domingo N on-Participants for the underwei ght indicator: moderate and severe. As mentioned in Chapter 2, a child is considered a moderate and severe case when below -2 standard deviations from median weig ht for age of the reference population. As the table displays, the Santo Domi ngo study groups had zero percent of under-fives suffering from moderate and severe underweight compared to th e rest of Latin America and Peru who each are at seven percent for this category (UNICEF Peru 2006). Underweight Indicator: Severe A child suffering under the underweight category is below -3 standard deviations for their median weight for age of reference p opulation (UNICEF Peru 2006) (Table 4-1). Table 4-1 Underweight Indicators Percentage of under-fives suffering from: Underweight Moderate and severe Severe *Peru (1996-2004) 7%1% *LA and Caribbean (1996-2004) 7%1% **Santo Doming Participants (2007) 0%0% **Santo Domingo Non-Participants (2007) 0%4% Source: *UNICEF State of the World's Children 2006 **Author 2005

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48 Wasting: Moderate and Severe The prevalence of wasting is much lower th an that of stunting or underweight. The expected prevalence in developing countries is two-three percent. The highest prevalence in the world is South Central Asia (15.4%) and West Africa (15.6%). A child is considered a moderate and severe case when they are below -2 standard deviations for median height for age of reference population (UNICEF Peru 2006). Peru as a whole was at one percent and Latin America at two percent compared to Sant o Domingo Participants and Santo Domingo NonParticipants who were both at zero percent (Table 4-2). Table 4-2 Wasting Indicators Percentage of under-fives suffering from: Wasting Moderate and severe *Peru (1996-2004) 1% *LA and Caribbean (1996-2004) 2% **Santo Domingo Participants (2007) 0% **Santo Domingo Non Participants (2007) 0% Source: *UNICEF State of the World's Children 2006 **Author 2005 Stunting: Moderate and Severe Stunting that is classified as moderate and severe is below -2 standard deviations from median height for age of reference population. For children less than five years old, a low prevalence of stunting is <20% and 20-29% is a medium prevalence. Latin America is

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49 considered as low prevalence but Peru is consider ed as medium prevalence region. Peru is still not as high as East Africa whic h is at 48% for stunting of children under five years old and the highest incidence of stunting worldwide. As for Santo Domingo, participants and non-partic ipants are considered as low prevalence; however it is substantially lower for the children of those families who participated in the dairy project. (Table 4-3). Table 4-3 Stunting Indicators Percentage of under-fives suffering from: Stunting Moderate and Severe *Peru (1996-2004) 25% *LA and Caribbean (1996-2004) 16% **Santo Domingo Participants (2007) 7% **Santo Domingo Non-Participants (2007) 19% Source: *UNICEF State of the World's Children 2006 **Author 2005 Feeding of Animal-based Foods Eighty-five percent of Santo Domingo families feed their children animal products based on the sample diet provided by all those questione d. These animal products include milk, eggs, goat, turkey, chicken, lamb and beef. For fa milies that retain m ilk produced for family consumption, there is no refrigeration therefor e what is retained is consumed daily. Of non-

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50 participating families, 70% give their children milk on a daily basis. Of participating families, 90% give their children milk on a daily basis and 60% give eggs as part of their diet. All families (participants and non-participants ) boiled the water they obtain from the puqio when used for drinking and when given to the ch ildren. In addition, despite the limited income obtained by these families, 81% take their children to the posta (clinic in Herby Alto), doctor or hospital when their children are sick. Children are fed on average three full meals per day. All of the children are taken care of by their mother and in some occasions by their mother and mothers sister. Some households retain more milk for househol d use and others sell more. This conduct has an effect on the income from milk sold (Table 4-4) (Table 4-5). Table 4-4 Participant Families: Milk Sold, In come Obtained and Number of Producing Cows Participants Range: $1.02-$15.32 Average: $5.07 HH # Liters/day of milk soldAmount sold 100 143.58 101 102.55 102 205.11 103 82.04 104 307.66 105 256.38 106 51.28 107 185.79 108 6015.32 109 41.02 Source: Author 2005

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51 Table 4-5 Non-Participant Families: Milk Sold, Income Obtain and Number of Producing Cows Non-Participants Range: $2.55-$15.32 Average: $5.62 HH # Liters/day of milk soldAmount sold 500 none-cheese onlyn/a 501 102.55 502 n/an/a 503 328.17 504 112.81 505 184.60 506 254.85 507 205.11 508 5012.77 509 6015.32 510 287.15 511 71.79 512 n/an/a 513 205.11 514 5012.77 515 348.68 516 153.83 Source: Author 2005 Milk Production and Needs Dairy cattle require several components in or der for them to produce milk. One dairy cattle can produce 6-7 gallons (2327 liters) per day of milk. Dairy cattle consume about 100 pounds of feed per day and 25-50 gallons of water per day. They require a balanced diet that consists of hay, grains, protein sources and other vitamins and mi nerals. In addition, shade and protection from the elements with bedding that is made of wood chips and sand also are required for the caring of and optimum production of milk. In areas where it is hot, sprays misters are used to fan water out to keep the ca ttle cool (Dairy Farming Today 2007). The requirements for optimum dairy cattle produ ction are limited to the farmers of Santo Domingo and their dairy cattle. Therefore, the amount of milk produced by the dairy cattle in Santo Domingo is lower due to several reasons. The majority of dair y cattle here are not

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52 provided shade or given protection from the elemen ts. In addition, they are not provided with the usual 25-50 gallons of water needed per cow per day for optimum milk production. Homes in Santo Domingo do not have water and must obta in it from an outside source twice per week. The amount of water obtained and reserved is not sufficient for each cow. The feed given to the cattle is not a mix of a balanced diet but mostly cane shavings, sweet potatoes foliage and corn cobs. This feed is obtained in exchange for labor in agricultural fields. In addition, the cattle are not provided with proper bedding other than sand or cane shavings. Therefore, these dairy producing households could produce more milk if provided with the means to obtain the above necessary tools to achieve optimum milk pr oduction. Education and payment alone will not result in optimum milk production. Santo Domingo Households Participant Families The composition of each household was not obtai ned. However, data collected does show that for participant households, th ere is a range of 4-10 members in each, with an average of six family members per household. The mothers of the children studied range in age from 18-41 years of age and fathers age between 27-46 years of age. All of mother s label their occupation as housewife and farmer. Eighty percent of father s label themselves as farmers. The range of number of rooms is one to four rooms, with an average of two rooms per household. Non-Participant Families The composition of each non-participant household was also not obtained. However, data collected does show that for non-participant households, there is a range of 2-14 members in each, with an average of six family members per household. The mothers of the children studied range in age from 19-37 years of age and fathers age between 24-40 years of age. All of mothers label their occupation as housewife and farmer. Eighty-eight pe rcent of fathers label themselves

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53 as farmers. The range of number of rooms is one to four rooms, with an average of two rooms per household. Comparing participant and non-partic ipant households, they very similar in all comparisons. Participant and Non-Participant Fa milies: Compared Case Studies Height-for-Age and Weight-for-Age In each group of participant and non-partic ipant households, there were children who surpassed the healthy range in height for age and weight for age. As previously discussed, the ranges for height-for-age is +2 or greater SD which is classified as tall, normal range is from -2 to +2 SD and stunted is under -2 SD. The range s for weight-for-age is +2 or greater SD is classified as overweight, normal ra nge is from -2 to +2 SD and undernourished is under -2 SD (Reyes 2005). The majority of the children in this commun ity are within normal ranges of health for height-for-age and weight-for-age However, there were children who resulted in figures greater than -2SD or +2 SD. Two families, one from pa rticipant and one from non-participant families, had children at extreme levels of health and were thus chosen as case studies. Table 4.6 displays the similarities and differences between these families. Participant Household Case Study A Participant A is a household typical of Sant o Domingo. The residents obtain their water from the water reserve as the rest of the comm unity. They obtain water once a week and boil the water before it is given to the children of th e household. Income of this household is obtained from the sale of milk and there is no off-farm income. There are no major or minor crops grown. Child care and food preparation is performed by the mother. Household A has limited resources. They do not own a battery operated TV or radio. There are two beds in the home and two rooms. This home is made of straw panels and does not

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54 have a roof. There is no water, electricity or outhouse access. In addition to owing dairy cattle, other livestock owned are six meat cattle, two goats, and f our calves. This households normal residence is in the upper region of Santo Domingo. The environment is harsher in the upper region therefore current residence was with the wi fes father at the time of this study. The youngest child had a respiratory in fection due to the colder clim ate compared to their usual residence. Non-Participant Household Case Study B Non-participant B is also typical of fam ilies in Santo Domingo. Water is obtained from the water reserve as the rest of the community. The residents obtain water twice a week and boil the water before it is given to the children of the household. Income of this household is obtained from the sale of milk and there is no off-farm income. There are no major or minor crops grown. The mother of this household is re sponsible for food prepara tion and child care. Household B owns a battery-operated TV and ra dio. There are four beds and two rooms. This home is made of straw and cane panels. Th ere is no water, electricity or outhouse access. In addition to owing dairy cattle, other livest ock owned are two donkeys, 10 chickens, and four ducks (Table 4-6).

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55 Table 4-6 Case Studies # in HH Material of home Lactatin g cows Milk sold (liters / day) Surplus milk # Times child fed/ day Child's diet H/A W/A W/H # Under 5 childr en Participan A 4 Straw, No Roof 6 8 Family 3 Eggs, Milk 0.37 2.23 2.26 2 Non Participan B 8 Cane, Wheat Panels 5 20 Family 3 Oatmeal Milk, Bread, Rice, Soup, Eggs -2.54 -1.62 -0.02 4 Source: Author 2005 Impact of Dairy Project Participation So what impact did the Dr. Go mez project provide from the pa rticipants perspective? The dairy project provided animal car e education, concentrat ed feed at a lower price, and faster payment of milk sold (Table 4-7). Eight of the 10 participants perceived some type of change from participating in this project. The major ity of participants perc eived changes associated with knowledge and education on how to better care for their livestock. Not one of the participants commented that the education received or purchase of feed increased their milk production. In addition, some participants commented that th ey receive faster payment of the milk they sell. Previously, payment did not come or took up to four months; however at the time of this study, payment was coming in every week. Info rmation was obtained from an employee of Fongal which was the previous dairy COLLECTIVO that was collecting and distributing the milk obtained from the Santo Domingo dair y farmers. Fongal was closed at the time when it visited. However, the informant did comment that the ad ministrator of Fongal wa s stealing money from the company therefore utilities were not being paid and were shut off. Therefore, Santo Domingo dairy farmers were not getting paid for months.

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56 Table 4-7 Dairy Project Impact Participant's Comments on Dairy Project Impact HH # What Does the Project Provide? Perceived Changes from the Project 100 Concentrated feed at a lower cost than local sellers Little change 101 Faster payment, dairy cattle management and education Faster payment, dairy cattle management and education 102 Animal care education Animal care education 103 Animal care education Animal care education 104 Guidance, education and concentrated feed Better cared of animals 105 Orientation on the care of animals Orientation on the care of animals 106 Orientation on the care of animals Better care of animals 107 Animal care education None 108 Concentrated feed, animal care education Concentrated f eed, animal care education 109 Animal care education Better under standing of how to raise cattle Source: Author 2005 In addition, participants of th e dairy project were asked what items they possessed before and after the project. All of the participant households had the same items before and after the project. The items that were questioned were the ownership of the following: battery operated TV, iron, number of beds, stove, ve hicle, refrigerator, sewing m achine, battery operated radio, bicycle and tractor. The proj ect had no effect on the purchas ing of household capital. Relation Between Milk Sold and Child Health Status Gender Division of Labor No formal data were obtained on the gender division of labor in Santo Domingo. However, when conducting the questionnaire an d obtaining the anthropometric data on the children, activities were observed. In a ddition, those being questioned would provide information on the gender division of labor (Table 4-8).

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57 Elder males or females were not observed ofte n in this community. When elders were present, the assistance each provided was obs erved through childcare, obtaining water or obtaining forage for the cattle. Children, ma le or female, were only observed accompanying their parents to obtain water from the PUQIO or if they were very young, they would accompany their mothers to obtain forage and water. Othe r than obtaining water, children were solely observed attending school and playing with other children. Adult females were those observed the most during the time of this study. Off-farm work performed was also discussed. This category does not in clude labor such as weeding, the preparation of farm land, planting or harvesting because none of the families in Santo Domingo are able to produce any crops. The environment is too dry to support any crop life. Table 4-8 Gender Division of Labor Male adult Female adult Male child Female child Male elder Female elder Agricultural Labor Milking Cleaning Cooking Child Care Obtaining Forage for Cattle Feed Cattle Obtaining Water from Outside Source Source: Author 2005 Household and Farm Capital Ownership When comparing participant and non-particip ant families to household capital ownership, similarities and some differences are found (Table 4.9).

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58 Table 4-9 Household and Farm Capital Percentage Percentage of Households with Capital Ownership TV (battery) Iron Stove Vehicle Fridge Sewing Machine Stereo (battery) Bicycle Tractor Participant 60 0 20 0 0 0 70 0 0 Non Participant 52 5 5 0 0 5 65 11 0 Source: Author 2005 The table displays household capital and the percentage of ownership. No one owns a refrigerator or vehicle. There is low ownership of irons, se wing machines and bicycles. Over than half of households, have battery operated TV and radios. One main difference is stove ownership. There are a greater num ber of participant families who ow n charcoal or wood stoves. As for farm capital, the table shows that no one owns tractors and othe r farm equipment. The only farm capital documented and visually ev ident was that of livestock and other small animals for Santo Domingo participants and non -participants (Table 4-10) (Table 4-11). Horses and burros are used for transportation of people, water, food shavings and other goods. Non-participant households have a greater va riety of livestock, as well as higher numbers of ownership.

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59Table 4-10 Participant Livestock Capital Cows Lactating Cows Pregnant Meat Cattle Lamb Horses Burros Chickens Turkeys Goats Calves Doves 100 2 3 0 3 0 2 0 0 0 0 0 101 4 0 0 5 1 3 7 0 0 0 0 102 4 0 6 0 0 2 0 2 0 0 0 103 6 0 6 0 0 0 0 0 2 4 0 104 6 1 0 0 0 4 6 0 0 0 20 105 3 3 0 7 2 2 10 0 0 9 0 106 2 0 0 2 0 2 0 0 0 2 0 107 6 0 0 7 0 0 0 0 0 3 0 108 3 3 0 0 0 0 0 0 0 8 0 109 1 2 0 0 0 0 0 0 0 6 0 Source: Author 2005 Table 4-11 Non-Participant Livestock Capital Cows Lactating Cows Pregnant Meat Cattle Lamb Burros Chickens Ducks Goats Calves Doves Pigs Parakeets Geese 500 3 0 6 6 2 12 0 45 0 0 0 0 0 501 10 0 0 1 2 0 0 2 0 0 0 0 0 502 0 0 0 0 0 0 0 0 1 0 0 0 0 503 3 0 0 0 1 0 0 0 4 0 0 0 0 504 3 3 0 0 3 0 0 0 4 0 0 0 0 505 2 0 5 0 3 2 0 0 0 0 0 0 0 506 1 4 0 0 0 4 27 0 1 0 0 0 0 507 5 3 0 0 2 10 4 0 0 0 0 0 0 508 4 0 0 2 2 5 0 0 2 0 6 0 0 509 6 0 4 2 2 0 0 0 10 0 0 0 0 510 3 5 1 0 2 8 0 0 1 0 0 0 0 511 1 0 0 0 0 4 0 1 0 0 0 0 0 512 1 0 5 0 2 4 0 0 0 0 0 0 0 513 2 0 0 0 2 1 0 1 0 0 1 0 0 514 4 0 1 0 2 0 0 0 0 0 0 0 0 515 4 0 1 0 0 0 9 0 7 3 0 2 3 516 2 2 0 0 2 0 0 0 5 0 0 0 0 Source: Author 2005

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60 Diet This research study did not investigate in depth the daily diet of this community. However, selected items were mentioned during the part of the questionnaire when asked what the children were fed during th e day. Some households mentione d what they fed their children by the meal of the day (Table 4-12). Table 4-12 Sample Diet of Santo Domingo Children Breakfast Lunch Dinner Average # Times Fed/Day Participants Breast milk, oatmeal, milk, eggs, potato Breast milk, beans, rice, salad, eggs, bread Breast milk, eggs, rice, soup, lentils, meat 3 Non Participants Oatmeal, milk, eggs, bread Beans, meat, rice, soup, potato Rice, fried foods, potato, milk, soup, 3 Source: Author 2005 Conclusion The data obtained from my study was compared to different factors th at could affect the health of children. Data was analyzed for gende r division of labor, income received per family, the impact of the Gomez project, farm capital ow nership and the diet of the children. All of these factors were analyzed and presented in detail.

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61 CHAPTER 5 RESULTS, CONCLUSIONS AND RECOMMENDATIONS Results and Conclusions Although child nutrition and its effects have been thoroughly studied, the inter-relating factors of why some children grow healthier than others are still studied throughout the world. A principal objective of this st udy was to find a link between f eeding animal products and the growth of children whose parents were part of the Gomez Dairy Project in Santo Domingo, Peru. It was assumed that participants of the dairy project would be nutriti onally healthier than nonparticipants. However, the findi ngs did not support the original hypothesis of this study and the reasons why will be discussed in this chapter. When this study began, it was hypothesized that because animal products were a daily part of the childrens diet (especially for the children of the participant families) and that the children appeared physical healthy, the incidence of underweight and wast ed children would be low but stunted children would be high. The hypothesis that the number of stunted children would be high is because of the high incidence of stunted ch ildren in Peru. It was also assumed that there would be a difference between participant and non-participant children because participant children were part of the dairy project and rece iving monetary and educational benefits. As discussed in Chapter 1, the litera ture supports the notion that ther e is a positive effect from milk and other animal products on the health of child ren worldwide. However, no differences were found between participant and non-participant fam ilies in terms of child nutrition. Family and physical environment was similar throughout the whole community including the ownership of livestock and especially dairy ca ttle. The only difference initiall y found for the participants of the project was weekly payment of milk sold (faster payment of wh at was previously received). However, faster payments were due to the Gome z researched project and this affected all of

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62 Santo Domingo dairy farmers, and therefore, all farmers received timely weekly payment for milk sold. It was believed that there would be a high num ber of stunted children because as discussed in Chapter 2 there is a high prevalence of stunting, es pecially in the rural ar eas of Peru. Peru is affected by poor socioeconomic conditions and e xposure to adverse conditions such as illness and/or inappropriate feeding pr actices. Peruvian children are often faced with chronic but moderate deficiencies of nutrients therefore they tend to be short for their age. It was assumed that the children of Santo Domingo were part of this country-wi de health problem. This study shows a low prevalence of stunt ed children for participant and non-participant children. Even with the limited sample of this study and small variation throughout the community, the children of this community were found not to be malnou rished. Anthropometric findings show that none of the children, participant or nonparticipant, were found to be underweight moderate and severe or under the wasting category. Ninety-six percent of the non-participant children were found to be healthy under the category of severe underweight and the entire gr oup of participant children was found healthy under this same cate gory. Of the participant children, 97% were non-stunted and 81% of non-participant children were non-stunted. What was different for the children who were not healthy? As discussed in Chapter 4, several case studies were presented of the children in th e undernourished category. These cases showed several factors coming into play. Thes e children were found in households with low and with no daily milk production. There is little income to purchase items for the household. In addition, these households are larger in size and of ten have more than one child under the age of five. Two families have limited amounts of milk so little is retained for family consumption; one

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63 family produced no milk at all. Also, one family only obtained water once a week compared to twice a week compared to the other households that obtained water. Therefore, it is conjectured that low milk or animal food consumption may be a factor in the undernourishment of these children; however it is not the sole cause of why they are unhealthy. It is evident that there are other factors to consider in addition to the intake of animal products. These factors are clean water availability, the numbe r of people in a household, the amount of milk reserved for the household, and for specific family members the amount of other animal and vegetable protein products consumed on a daily basis, the location of residence, the number of young children in a household, and prope r mothering skills. Families with healthy children most likely had a combination of the se factors. The many factors have an effect on child health and development. Wa ter availability can affect the amount of daily clean and fresh water a child is receiving and can prevent dehydration. The environment of Santo Domingo is dry and ther e is unlimited sun exposure. The children of this community perform the major ity of their daily activ ities outside (e.g., as walking to and from school, assisting in household or farm duties, and playing). The number of residents in a household reduces the amount of food available for each individua l of the household especially vital foods such as oatmeal, eggs, milk, legumes and rice. Any food products, including animal products that contain proteins, carbohydrates, vitamins, etc, aff ect the growth of children. The closer the residence is to the Can ete River, the closer it is to the water supply which affects feeding livestock. The further away a residence is from the river the drier and colder is the environment and limits the number of times water is obtained, as well as other activities such as washing clothes. Proper mothering skills are one more factor affecting child growth. One of the

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64 households discussed in Chapter 4 where the moth er did not properly care for her children well in terms of appearance and hygiene compared with the other mothers interviewed. What are some reasons why the majority of th e children studied are h ealthier than children in the rest of Peru? Several factors could be involved. Sant o Domingo households own a variety of livestock such as cattle and chickens. This a llows for a variety in the childrens diet that can include eggs, meat and milk. The water given to the children is boiled before consumption to kill bacteria and pathogens. Children are also ex posed to sun exposure and therefore get Vitamin D. The diet fed to the children, even though limit ed, includes foods that provide carbohydrates, fat, and protein. Future Research Feeding practices during the first years of life have an important influence on the nutritional status, growth and f unction in young children (Allen 2001). Hence future studies of Santo Domingo should have additional types of data collected and use some additional methodology compared to this study. Further investigation would be to obtain a larger sample of Santo Domingo children and household members. A more detailed account of the food bought and f ood fed to the children would be recorded. Food fed to children s hould be broken down into categories such as carbohydrates, fats and proteins. In addition, the amount of wate r or other liquids given to children on a daily basis should be measured or counted. Medica l techniques could be incorporated to analyze if any of the children are de hydrated. A food intake survey could be given to each household member. Other areas of Peru without livestock could be analyzed and compared to Santo Domingo to see if the difference in health is the presence of animal produc ts in the diet. The La Molina dairy unit discussed in Chapter 2 would be a good comparison area to live at because it is located

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65 in Santo Domingo and allow for direct observati on of the households. A further study could include interviewing the elders of the community and questioning changes they have observed over time in the community. In addition, research should include fertility and natality histories of women. This study could have also analyzed different hypotheses. Other hypothesis that could have been researched is, does a greater number of livestock household make a household better off? Are children in larger household sizes wors e off nutritionally? Did participants of the dairy project negatively affected by the project? Applied Recommendations to Increase Child Nutrition Given the poor economic situation of the Santo Domingo families and their children, is it reasonable to recommend that their children conti nue to consume animal products? The answer is that this will continue for these families becau se dairying is their source of income and food. Strategies to improve and c ontinue the consumption of an imal products in Santo Domingo include: Educating the mother to target small amounts of animal products (such as liver and meat) to her young children Encouraging consumption of cheaper anim al products (e.g., eggs, fish, dried milk) Supporting home production of small an imals such as fish and birds Giving fermented rather than fresh milk beca use refrigeration is not needed (Allen 2001) It is further recommended that a community -wide dairy program/project be implemented to provide animal care education. Provide nutrition workshops to the families on the importance of feeding animal products, legumes and oatmeal. Provide hygiene workshops to teach the need of a daily and clean water supply. The children and the families of Santo Domingo even with th eir limited amount of resources have been able to provide a basic nutritional environment for their children. The

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66 recommendation of a community well or water s upply in close proximity and a safe source of water for cooking and drinking purposes should be implemented. There should be some type of sewage system for the proper management of human waste. There would even be a recommendation for the neutering/spaying of the dog population presently in Santo Domingo to reduce the risk to livestock and sp read of dog waste and diseases. Conclusion The findings of my study did not support the original hypothesis proposed. There was low incidence of stunted childre n and the children were found not to be malnourished. Animalbased foods was not the only factor affecting the health of the children of Santo Domingo; other factors were found to have an effect such as hous ehold size, mothers care, location of residence and water availability. Therefore my study gives i ndication that further res earch is needed in the community of Santo Domingo and that not only diet but environment af fects the health of children. The proper interventions and programs can support the health of all children around the world including thos e of Santo Domingo.

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67 APPENDIX A ANTHROPOMETRIC DATA SHEET Anthropometry Study of Nutrition and Health -2005 Can ete, Peru University of Florida English Translation Code: __ __ __ Date: ___________________ Hour: ____________________ Measurement by: ___________________ Name of the objective child: ___________________________________ Name of the mother: ___________________________________ Name of the father: __________________________ Sex: ____ 1. Male ____ 2. Female Date of Birth: _____ / _____ / _____ Age: ________ in months Height and Weight of the Child: Size (cm): ____ ____ ____. ____ Weight (kg): ____ ____ ____. ____ Recumbent measurement ________ (Check if YES)

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68 APPENDIX B DEVELOPMENT INDICATOR SURVEY Study of Nutrition and Health 2005 Can ete, Peru Date: _______ Code: __ __ __ University of Florida Survey of Development Indica tors (English Translation): A. HH SIZE AND COMPOSITION # in HH: ________ Relationship Age Gender Yrs Schooling Occupation *1. 2. 3. 4. 5. 6. 7. 8. B. HH CAPITAL -Do you own the following? Before Project Now 1. TV 2. Iron 3. Bed (s) 4. Stove 5. Car 6. Truck 7. Refrigerator 8. Sewing Machine 9. Stereo 10. Bicycle 11. Tractor # of rooms in the home? _____ Material home is made out of? ________________ Do you have in your home? ___ Electricity ___ Water (If answer is NO then ask next question)

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69 ___ Toilet (sewage system) If NO WATER is in the home From where is it obtained?_______________________________________________ How often is it obtained? ________________________________________________ Do you boil the water to drink? ___ Yes ___ No Is it boiled for when given to the children? ___ Yes ___ No C. INCOME Sources of income: On farm income: _____________________________________________________ ____________________________________________________________________ Off farm income: _____________________________________________________ _____________________________________________________________________ Amount of milk sold ____________________ Current price of milk sold_________________ per _______ Surplus of milk what is done with it? ______________________________________ D. PROJECT SERVICES What does the project provide to you? ___________________________________________________________________________ _______________________________________________________________ Perceived changes as a re sult of the project? ___________________________________________________________________________ ______________________________________________________________

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70 E. LAND AND CROP INFORMATION Land size: __________ Ownership of Land Status: ____________ -Major Crops Grown: ______________________________________________________ _______________________________________________________________________ -Minor Crops Grown: ______________________________________________________ ________________________________________________________________________ F. FARM CAPITAL Types of animals owned # Owned Purpose 1. 2. 3. 4. 5. 6. 7. 8. G. DIET OF CHILDREN -Basic diet of child (ren) for br eakfast, lunch and dinner? (B)_____________________ (L) __________________ (D) ______________________ -Basic diet of child (ren) when sick? _____________________________________________________________________ How often child (ren) are fed? _____________________________________________________________________ What is done with child (ren) is sick? _____________________________________________________________________

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71 Who is main caregiver to the child (ren)? _____________________________________________________________________ Who prepares their food? ______________________________________________________________________

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72 APPENDIX C ANTHROPOMETRIC DATA Table C-1. Participant Child Anthropometric Data ID # Gender HT/AGE WT/AGEWT/HT 100 F 0.29 0.700.78 101 M 0.49 1.811.93 102 F -0.53 0.470.93 103 M 0.04 1.481.79 104 M -0.20 0.240.46 105 F -1.27 -0.88-0.28 106 M -2.46 -1.070.61 107 F -0.58 -0.58-0.10 108 M -0.76 -0.320.26 109 F -0.45 -1.92-1.99 110 M 0.14 1.281.60 111 M 0.37 2.232.26 112 M 0.70 1.020.71 113 M -1.69 -1.27-0.01 114 F 0.29 -0.42-0.51

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73 Table C-2. Non-Participant Child Anthropometric Data ID # Gender HT/AGE WT/AGEWT/HT 500 M 1.63 2.21 1.2O 501 M -1.00 0.26 1.07 502 M -1.49 -1.76 -0.90 503 F -2.17 -0.81 0.67 504 M -1.84 -0.70 0.64 505 F -1.03 -0.50 0.15 506 F -0.32 -1.17 -1.22 507 F -2.48 -1.10 0.52 508 F 0.27 1.05 1.23 509 M -1.43 -0.60 0.36 510 F -1.63 -0.31 0.78 511 M 1.55 1.59 1.09 512 F -2.30 -3.29 -2.89 513 F -1.90 0.35 1.97 514 F -0.66 0.21 0.70 515 F -0.46 0.29 0.71 516 M -1.90 -0.08 1.10 517 F 0.70 2.98 3.19 518 M -1.85 -0.23 1.35 519 M -2.04 -0.31 1.04 520 F -2.54 -1.62 -0.02 521 F -1.61 -0.71 0.29 522 F -1.76 -0.67 1.05 523 M -1.59 0.06 1.51 524 M -1.38 -0.53 0.53 525 F -1.69 -1.20 -0.20

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74 APPENDIX D VITAMINS IMPORTANT FOR THE GROWTH OF CHILDREN OBTAINED FROM ANIMAL PRODUCTS Calcium In the case for children, calcium is an importa nt nutrient for growth. It is difficult for a child to even approach the average calcium requirements (around 345 mg /d) on a cereal-based diet (Neumann 1999). Milk is the major dietary source of calcium for bone growth. Calcium not only builds bones and teeth, it is utilized in essential functions all over the body. Infants undergo growth and development for many years. Disp osition of calcium into bones continues until the third year of life (Patton 2004). Vitamin D Vitamin D is also an important nutrient for chil dren. It is a requirement for the digestive absorption of calcium. Proper development and mineralization of the human skeleton requires this vitamin. The human body requires exposure to sunlight to generate vitamin D from 7dehydrocholetrol, a precursor in th e skin. It is the ultraviole t component of sunlight that accomplishes this reaction. Vitamin D produced by this means is effective in meeting the bodys needs for the vitamin. (Patton 2004). Vitamin A Vitamin A deficiency leads to high cases of b lindness and high infant and child mortality. Around 40 million children suffer from vitami n A deficiency and about 35,000 infants and young children are blinded annually. It is important for maintaini ng the structure and function of the cornea and lens and produces necessary components for night vi sion. Vitamin A also plays a role in resistance to infection through multiple functions; mechanical barriers against invasion of pathogens and maintain a role in immunity. Animal-source foods, especially milk, are an excellent source of pre-formed vitamin A (retinol) (Neumann 1999).

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75 Vitamin B12 Animal-source foods are nearly the sole source of vitamin B12 for humans. In developing countries, mal-absorption of this vitamin is pres ent because due to a wide variety of infections and intestinal parasites in all ages. Vitamin B12 deficiency affects the hemalogic system, the nervous system and immune function. Vitami n B12 is found in eggs and dairy products among other animal food sources. The prevalence of B12 deficiencies in developing countries is not well documented, but is probably wi despread where consumption of animal products is low or absent. There is a need for the study of the pr evalence of vitamin B12 de ficiency in developing nations because of the serious health and neurological conseq uences for women, infants and young children (Neumann 1999).

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76 LIST OF REFERENCES Allen LH, Gillespie SR. 2001. What Works? A Review of the Efficacy and Effectiveness of Nutrition Interventions (Electronic version). United Nations Sub-Committee on Nutrition and the Asian Development Bank. Manila, Philippines: Asian Development Bank Bartell E, JODonnell A, eds. 2001. The Child in Latin America: Health, Development and Rights. Notre Dame, IN: University of Notre Dame Press Bernet T, Saenz J, Prain G. 2000. Peri-urban milk production in Peru: Assessing farmers decision-making within a changi ng market. Accessed November 2004. http://www.cipav.org.co /lrrd/lrrd12/4/bern124.htm British Council Peru. 2007. Information about Placement Cajamarca. Accessed June 2007. http://www.britishcouncil.org/it/peru-educa tion-exchanges-and-sc holarships-la-englishcajamarca.htm Cabrera V. 1999. Farm problems, solutions and extension programs for small farmers in Caete, Lima, Peru. Accessed October 2004. http://etd.fcla.edu/etd/uf /1999/amj9816/cabrera.pdf Cabrera VE, Baker M, Hildebrand PE. 2000. A Formative Evaluation of Valle Grande Rural Institute in Caete, Peru. Proceedings of the 27th Annual National Agricultural Education Research Conference. San Diego, CA Cabrera V, Hildebrand PE. 2002. Family Dynamics and Household Welfare in Caete, Peru. Agrippa-FAO 1, pp. 607-615 Can ete Government. 2007. Can ete Map. Accessed June 2007. http://www.municanete.gob.pe/mapa.html Child Info. 2006. Childinfo.org: Child Mortal ity (last updated May 2006). Progress for Children a Child Survival Report Card. Accessed October 2006. http://childinfo.org/areas/childmortality/ Cohen R. 1997. Milk: The Deadly Poison Englewood Cliffs, NJ: Argus Publishing, Inc. Green J. 2006. U.S. Has Second Worst Newbor n Death Rate in Modern World. Accessed June 2007. http://www.cnn.com/2006/HEALTH/paren ting/05/08/mothers.index/index.html Globe Feed. 2006. Distance Calcul ator Peru. Accessed June 2007. http://distancecalculator.globefee d.com/Peru_Distance_Calculator.asp Dairy Farming Today. 2007. Dairy Cattle Care. Accessed June 2007. http://www.dairyfarmingtoday.org

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77 Escobal J. 2005. Educating Women=Healthie r Children? Id21 Insights Communicating Development. Accessed October 2006. http://www.id21.org/insights/insights56/insightsiss56-art02.html Espindola E, Leon A, Martinez R, and Schejtman A. 2005. Poverty, Hunger and Food Security in Central America and Panama Santiago, Chile: United Nations Publication FAO. 2006. Nutrition Country Profiles: Peru Summary. Accessed September 2006. http://www.fao.org/ag/agn/nutrition/per-e.stm Gomez C, Salazar I, Alvarado E. 2002. Pr eliminary information on peri-urban dairy production oriented to the market in the Caete valley of Peru. Accessed October 2004. http://tarwi.lamolina.edu.pe/~c gomez/project_santo_domingo.doc Gomez, C. 2004. Health. Herby Alto, Peru. Gomez C, Salazar I, Heredia E, Saldaa I, Fe rnandez M. 2005. Report of Project: Improvement of Dairy Produce in the Can ete region of Peru. Sec ond research Co-ordination meeting: Integrated Approach for Impr oving Small Scale Market Oriented Dairy Systems. Santo Domingo, Peru Gomez C, Salazar I, Heredia E, Saldaa I, Fe rnandez M. 2005. Report of Project: Improvement of Dairy Produce in the Can ete region of Peru. Third research Co-ordination meeting: Integrated Approach for Improving Small Scal e Market Oriented Dairy Systems. Santo Domingo, Peru Indicator. 2006. Creating Indicators of Wealth Status. Accessed October 2006. http://dspace.stir.ac.uk/dsp ace/bitstream/1893/72/4/Appendix+ 3_Wealth+Indicators. PDF Kataki PK, Babu CS. 2002. Food Systems for Improved Human Nu trition: Linking Agriculture, Nutrition and Productivity Binghamton, NY: The Food Products Press Keller W. 1991. Stature and Weight as Indicators of Undernutrition. In Anthropometric Assessment of Nutritional Status pp. 113-122. New York: WileyLiss, Inc. Martorell R. 1995. Promoting Health Growth: Rationale and Benefits. In Child Growth and Nutrition in Developing Countries pp. 15-31. New York: Cornell University Press Martorell R. 1999. Body Size, Adaptation and Function. In Nutritional Anthropology: Biocultural Perspectives on Food and Nutrition pp. 39-45. San Francisco: Mayfield Publishing Miller GD, Jarvis JK, McBean LD. 2000. Handbook of Dairy Foods and Nutrition Boca Raton, FL: CRC Press LLC

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78 Neumann C, Harris DM. 1999. Contribution of Animal-source Foods in Improving Diet Quality for Children in the Developing World Washington DC: The World Bank Nicholson CF, Mwangi L, Staal SJ, Thornton PK. 2003. Dairy Cow Ownership and Child Nutritional Status in Kenya Ithaca, NY: Cornell University Patton S. 2004. Milk: Its Remarkable Contribution to Human Health and Well-Being. New Jersey: Transaction Publishers Peru Travel Adventures. 2006. Peru Culture, Peru People, Peruvian Culture. Accessed September 2006. http://www.perutraveladventures.com/people-culture.html Peru Traveler. 2006. Arequipa Tour, Arequi pa Peru Hotels and Tour Destinations. Accessed October 2006. http://www.peru-explorer.com/colca.htm Pinstrup-Andersen P, Pelletie r D, Alderman H. 1995. Child Growth and Nutrition in Developing Countries: Priorities for Action Ithaca, NY: Cornell University Reyes K. 2005. Indicators of Growth and Deve lopment. Personal Document to Author. Asuncion 8, Peru Shunya. 2007. Shunyas Site Peru Pictures. http://www.shunya.net/Pic tures/Peru/peru-map.jpg Smith LC, Haddad L. 1999. Explaining Child Malnutrition in Developing Countries: A CrossCountry Analysis Washington DC: International F ood Policy Research Institute Spring A. 1995. Agricultural Development and Gender Issues in Malawi University Press of America Staal S. 2004. Improved Child Nutrition thr ough Cattle Ownership in Kenya. UK: Smallholder Dairy (Research and De velopment) Project Research Report Stuart CD. 1998. The Changing Status of Children in Latin America: Issues in Child Health and Childrens Rights a Rapporteurs Report University of Notre Dame: The Helen Kellogg Institute for International Studies Tangka FK, Jabbar MA, Shapiro BI. 2000. Gende r Roles and Child Nutrition in Livestock Production Systems in Developing Countries : A Critical Review. Socio-economics and Policy Research Working Paper 27. Nairobi Kenya: International Livestock Research Institute UNICEF Peru. 2006. Peru. Accessed November 2004. http://www.unicef.org/infobycountry/peru.html Virtual Peru. 2004. Peru. Accessed November 2004. http://www.virtualperu.net/index.html

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79 Wamani H, Tylleskar T, Nordrenhaug A, Tuwwine J, Peterson S. 2004. Mothers Education but Not Fathers Education, House hold Assets or Land Ownership Is the Best Predicator of Child Health Inequalities in Rural Uganda. Internati onal Journal for Equity in Health Website. Accessed October 2006. http://www.equityhealth.c om/content/3/1/9/abstract/ WHO. 1995. Physical Status: The Use and Interpretation of Anthropometry Switzerland: World Health Organization WHO. 1997. WHO Global Databa se on Child Growth and Mal nutrition. Accessed March 2006. http://whqlibdoc.who.int/ hq/1997/WHO_NUT_97.4.pdf Woodruff BA, Duffield A. 2000. Assessment of Nutritional Stat us in EmergencyAffected Populations Adolescents Switzerland: Center for Disease Control and Prevention

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80 BIOGRAPHICAL SKETCH Priscilla M. Medina was bor n in Columbus, Indiana on March 22. She grew up in the small and beautiful beach town of Mexico Beach, Fl orida. She received her bachelors degree in animal science from the University of Florida, Ga inesville, Florida, in 2002. She will graduate with her masters degree in Latin American St udies with a specializa tion in anthropology from the University of Florida, Ga inesville, Florida, in 2007. Priscilla M. Medina plans after graduation to work helping families and children from Latin America. She currently resides in Gaines ville, Florida with her boyfriend Andres Vargas and German Shepard mix rescue Lima.