Rodriguez-Vargas PUBH7900 PROJECT PDF

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COURSE DETAILS
Course Code: PUBH7900 Course Name: Project
Course Coordinator: Assignment No: 1
Assignment Due Date: 26/06/2019
STUDENT CONTACT DETAILS

Student ID Number: 45013814 Student Name: Anita Esther Rodriguez Vargas
Address: McConaghy St 67A, Mitchelton Email address:
a.rodriguezvargas25@uqconnect.edu.au
Telephone: 0416426759 Program you are enrolled in: Master of Public Health
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TO ACCOMPANY INDIVIDUAL STUDENT ASSIGNMENT
I declare that I have read the UQ Academic Integrity and Plagiarism policy including the
approved use of plagiarism detection software, the consequences of plagiarism and the
principles associated with preventing plagiarism. * (http://ppl.app.uq.edu.au/content/3.60.04-
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I declare that the material contained in this assignment is my own work and that where I have
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Signed: Anita Esther Rodriguez Vargas Date: 26/06/2019
Due Date: 26/06/2019 Submitted date: 26/06/2019

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Rodriguez A. PUBH7900 1
THE UNIVERSITY OF QUEENSLAND
School of Public Health
READINESS TO SUBMIT FOR EXAMINATION
PROJECT or DISSERTATION REPORT
JOINT DECLARATION
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Student Name: Anita Esther Rodriguez Vargas
Student Number: 45013814
Program: Master of Public Health
This submission is for examination of (please tick):  Project (260 hrs)  Dissertation (520 hrs)
Project/Dissertation Title: What are Peruvian health professionals expected to advise regarding
maternal and child nutrition? A content analysis of national nutrition guidelines
If the report includes a draft manuscript for peer-reviewed publication, please indicate below that
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of a Project or Dissertation
Student: Anita Esther Rodriguez Vargas

Signed:
Date: 26/06/19
Principal Supervisor: Britta Wigginton

Signed:
Date: 18/06/19
Rodriguez A. PUBH7900
WHAT ARE PERUVIAN HEALTH PROFESSIONALS
EXPECTED TO ADVISE REGARDING MATERNAL
AND CHILD NUTRITION?
A CONTENT ANALYSIS OF NATIONAL
NUTRITION GUIDELINES
This report is submitted in partial requirement for the award of

the Master of Public Health at the University of Queensland
Anita Esther Rodriguez Vargas
Rodriguez A. PUBH7900
Intended Audience:
Dr Zulema Tomás Gonzáles
Minister of Health
General Salaverry 801, Jesús María 15072, Perú
26 June 2019
Dear Minister,
In my capacity as a Master of Public Health student at The University of

Queensland, supported by a scholarship from the Peruvian Government, I have led the
design and analysis of a content analysis of the Peruvian Guidelines for Maternal and
Child Nutrition. The aim of my research is to explore the coverage and depth of Peru’s
national nutrition guidelines and consider their consistency with a supporting tailored
document (entitled: “Document for participatory cooking demonstration of food
preparation for maternal and child populations”) each document aimed at health
professionals. As a trained dietician, this research is born out of my passion to contribute
to the health and nutrition status of maternal and child populations in Peru, both
considered vulnerable to nutritional deficiencies.
My master’s thesis (enclosed) provides recommendations to take into

consideration when the Ministry undertakes an update to these documents. This update
would be an integral part of providing up-to-date comprehensive and evidence-based
nutrition education to pregnant women, lactating women and parents of children under
the age of three years.
Sincerely,
Anita Esther Rodríguez Vargas
Abstract
Nutrition education for maternal and child populations in Peru is framed by the national
nutrition guidelines, because mothers and children are the most vulnerable groups to
malnutrition. The purpose of this study was to analyse the content of the Guidelines for
Maternal and Child Nutrition (GMCN) and the tailored document referencing these
guidelines (entitled: the “Document for participatory cooking demonstration of food
preparation for maternal and child populations”). The first author designed and led a
conventional content analysis to explore the depth and coverage of the content area,
followed by a directed content analysis that explored the consistency of the tailored
document with the guidelines. The content areas included: nutrition guidelines for
breastfeeding, for pregnant and lactating women, and for children 6–24 months old. Our
analysis found that the GMCN prioritised exclusive breastfeeding versus breast milk
substitutes, focusing on a nutrient-based approach that did not distinguish between
nutrient sources. The guidelines also focused on energy needs, and critical micronutrients,
emphasising animal products as irreplaceable foods for pregnant and lactating women,
and for children. The guidelines were not considerate of minority populations such as
vegetarians/vegans, and had an incomplete approach when presenting food-sources
available across the regions of Peru. The tailored document had a food-approach but
failed to differentiate healthier food-sources. The tailored document was mostly
consistent with the GMCN, with the few inconsistencies identified centred around the
6–8 month age group, leading to a confusing message being delivered to the target
population concerning this group. This study provides recommendations for an update to
these documents, which would improve nutrition education for maternal and child
populations in Peru.
Statement of originality
I declare that the work presented in this thesis is, to the best of my knowledge and belief,
original and my own work as acknowledged in the text, and that the material has not been
submitted, either in whole or in part, for a degree at this or any other university.
I acknowledge that I have led the study design, the collection and translation of the two
data sources (from Spanish to English), and the analysis and writing of this thesis. My
supervisor offered feedback on the design of the study, supported the design of the content
analysis and early interpretations of the data, and contributed to editing drafts of the
thesis, including a final full draft.
Signed:
Anita Esther Rodríguez Vargas
Acknowledgments
This research was supported by funding from the Peruvian National Program of
Scholarships and Educational Credit (PRONABEC).
I would like to express my sincere gratitude to my supervisor, Dr. Britta Wigginton for
her constant and invaluable guidance and motivation throughout this project and
throughout my master’s degree.
I am also grateful to Peter Kelu, for his commitment and for the countless hours spent
proofreading this project. I am thankful to my parents and siblings in Peru, for their
constant encouragement and love that motivated me along this entire journey working on
my master’s. I am also forever indebted to my friends Leticia, Arini, Novi, Geoffrey,
Carolyn, Andrew and Sally for all their care and support.
List of contents
Abstract ............................................................................................................................. 2
Statement of originality .................................................................................................... 3
Acknowledgments ............................................................................................................ 4
List of contents ................................................................................................................. 5
List of tables ..................................................................................................................... 6
List of acronyms and abbreviations .................................................................................. 7
Glossary of non-English language words ......................................................................... 8
Introduction, scope and literature review ......................................................................... 9
Methodology................................................................................................................... 12
Data collection and translation ................................................................................... 12
Data analysis ............................................................................................................... 14
Results ............................................................................................................................ 18
Conventional analysis of GMCN ............................................................................... 18
Nutrition Guidelines for breastfeeding ................................................................... 18
Nutrition Guidelines for pregnant and lactating women ........................................ 21
Nutrition Guidelines for children aged 6 to 24 months .......................................... 24
Directed content analysis of the tailored document.................................................... 27
Consistency of the content area: nutrition guidelines for pregnant and lactating
women in the GMCN and tailored document ......................................................... 28
Consistency of the content area: nutrition guidelines for children aged 6 to 24

months in the GMCN and the tailored document ................................................... 31
Discussion....................................................................................................................... 35
Conclusions and Recommendations ............................................................................... 43
References ...................................................................................................................... 45
List of tables
Table 1 Example of six-stage coding process ................................................................ 16

Table 2. Content coverage specific to breastfeeding ...................................................... 20
Table 3 Content coverage of nutrition guidelines for pregnant and lactating women ... 22
Table 4 Content coverage of nutrition guidelines for children aged 6 to 24 months ..... 25
Table 5 . Consistency of the content area of nutrition guidelines for pregnant and lactating
women in GMCN and tailored document for participatory cooking demonstrations of
food preparation for maternal and child populations...................................................... 28
Table 6 Consistency of the content area of nutrition guidelines for children aged 6 to 24
months in GMCN and tailored document for participatory cooking demonstrations of
food preparation for maternal and child populations...................................................... 33
List of acronyms and abbreviations
WHO: World Health Organization

GMCN: Guidelines for Maternal and Child Nutrition
UNICEF: The United Nations Children's Fund
HIV: Human Immunodeficiency Virus
Glossary of non-English language words
Sangrecita: Peruvian cuisine dish of chicken blood, seasoned with garlic, onion, chili
pepper, herbs and prepared with potato or cassava.
Introduction, scope and literature review
Early childhood malnutrition increases childhood mortality, as well as irreversibly

affecting the physical, immunological and cognitive development of the child leading to
a reduction in their general productivity during adulthood.1,2 Similarly, nutrient
deficiencies in pregnant women have been shown to significantly increase the risk of
maternal deaths,3,4 along with increased risk of failed pregnancy, birth defects, premature
birth, low birth weight, and childhood mortality, while also impacting the cognitive
development of children.5 Despite an influx of global programs to reduce poverty, which
is a key contributing factor to malnutrition, child and maternal malnutrition persist as a
public health priority in developing countries.6
Peru has made some significant achievements in improving maternal and child health
over the past few years, including a reduction in infant mortality.7-9 For example, the
proportion of exclusive breastfeeding is now one of the highest in South America.10
According to the information provided by the Demographic and Family Health Survey
2018, at the national level, the proportion of children being exclusively breastfed in Peru
was 66.4%.11 Over the past decade, however, chronic malnutrition rates have risen
significantly in children under the age of five.12 Among Peruvian children, anaemia and
infant chronic malnutrition are ongoing nutritional issues.13 More than 40% of those aged
6–35 months presented with anaemia in the National Survey of Demographics and Family
Health collected in 2018, with approximately 12% of those under the age of five affected
by chronic malnutrition.11 In the same study, anaemia had affected nearly 30% of
pregnant women and 23% of lactating women.14 As this is the most recent national data,
these figures indicate that the risk of child malnourishment in Peru still persists.
Another problem affecting childhood and maternal populations in Peru is obesity,

especially in urban areas.15,16 Maternal obesity* is associated with a greater risk of
premature death, cardiovascular disease, gestational diabetes, as well as complications
during pregnancy, delivery and puerperium, anaemia, and breastfeeding problems17,18.
Moreover, children from obese mothers are at greater risk of future obesity, hypertension,
cardiovascular disease and diabetes.17 Studies showed that over 60% of women start their
[*Maternal obesity in pregnant women, defined according to the amount of weight gain after initial classification by
body mass index (BMI) before pregnancy]
pregnancy already overweight or obese,19,20 as these are common problems in women of
childbearing age. Despite this, over half the pregnant women in Peru present inadequate
weight gain during pregnancy, with over 20% presenting excessive weight gain.19
Postpartum weight retention also affects women in Peru, due to several factors such as:
nutritional status before pregnancy, weight gain during pregnancy, and food intake or
physical activity.21 Postpartum weight retention also increases the overweight and obesity
rates among childbearing women in Peru.18,21 As highlighted above, maternal obesity may
impact their children, in fact, 9% of Peruvian children under the age of five presented as
overweight or obese in 2014, a trend that is increasing.22 Childhood obesity can cause
serious consequences in physical, social and emotional wellbeing,23 with these outcomes
persisting into adulthood.24
Out of the strategies that can be used for improving maternal and child health outcomes,
such as nutrient supplementation, antimalarials, and supportive interventions, among
others,25 nutrition education and counselling for pregnant and lactating women stands out
because it guides pregnant women toward an improved lifestyle with a more nutritious
diet.26 Scholars have recommended that specific nutrition education that is targeted at
improving child and maternal health should be carried out during both pregnancy and the
post-natal period, accompanied by integrated interventions such as psychological
stimulation and infection control.27,28 Nutrition education interventions have also been
shown to positively impact changes in eating habits, enhancing the diet and health
outcomes in low-income populations.29,30 A similar study in Brazil has demonstrated that
when health professionals who offer nutrition counselling are adequately trained in the
national guidelines, an improvement is seen in the feeding practices of mothers receiving
such counselling. Improvements in the areas of breastfeeding, avoidance of bottle
feeding, having an understanding of the variety of choices available within each food
group, and having a proper frequency of meals.31 Therefore, nutrition education provided
by health professionals has been found to play a valuable role in reducing the risk of
anaemia, improving both birth and gestational weight, and the diminution of preterm
delivery rates.28 In the Peruvian context, nutritional education and counselling as offered
by health professionals in peri-urban areas, has been shown to reduce stunting in children
under the age of 18 months.32 The study was conducted in a poor peri-urban area, which
raises issues about the generalisability of the research to the entire Peruvian population.32
Despite this, the study offers promise in terms of the impact on nutrition education in the
country.
In order to guide health professionals in conducting appropriate education and

counselling, nutrition guidelines are helpful tools that frame professional interactions and
practices, shaping their recommendations for changes in eating behaviours, especially in
such vulnerable populations as children and their mothers.33 Being aware that maternal
and child nutrition requires multisectoral and integrated actions, the Peruvian Ministry of
Health moved to establish the Guidelines for Maternal and Child Nutrition (GMCN).
These guidelines were the result of a joint effort between health institutions, universities
and professional associations, as part of their commitment to eradicate maternal and child
malnutrition in the nation.34 These guidelines represent a health promotion ‘tool’
designed to assist health professionals, and "forms part of the comprehensive healthcare
system for women of childbearing age, especially pregnant and lactating women".34 In
addition, the Ministry of Health developed additional tailored documents for health
professionals, based on the GMCN, to supplement these guidelines. One such document
is the “Document for participatory cooking demonstration of food preparation for
maternal and child populations”, which establishes the standardised methodology to
manage cooking demonstrations. It is aimed at health professionals and others who run
such workshops (in a community context) intended for pregnant women, breastfeeding
women, and parents of children under the age of three.35 However, to date, there is no
standardised tool to assess the adequacy of country-level nutrition guidelines.
There is consensus globally that nutrition education should be based on the best available
evidence36 and be adapted to the local culture and conditions where the guidelines are
implemented.37 As foundational as the guidelines are to nutrition education, they have not
been re-evaluated or analysed since their initial inception to consider their relevance to
practice in relation to current evidence. Limited human, financial, and logistic resources,
a lack of priority for research, and no clear policy for sciences and technology,38 make it
difficult to produce quality research, and even more difficult to update an already
published document in Peru. Without revisions and updates the information contained
may have become dated, and potentially superseded by more current research.
Considering this, there is a clear need to analyse these documents, given their potential to
impact maternal and child health outcomes, in the areas of malnourishment, anaemia and
emerging obesity.
Peru as a country is diverse in geography, biogenetics and culture, with multiple races,
languages, religions, customs and traditions.39 As such it presents a range of socio-
cultural conditions that influence, and in some cases limit the availability to health
services especially when these contradict their cultural practices, customs and beliefs.40
Moreover, physical conditions of the geography hinder the reach of public services to
remote areas, affecting the availability of diverse types of food and health services.12
Therefore, nutrition education interventions in Peru have the challenge of reaching all
areas and regions in a balanced way, from urban to rural populations.41,42 As the GMCN
and its tailored document are both intended for nutrition education to the heterogeneous
population in Peru (both culturally and geographically), these documents ideally need to
be consistent with one another to ensure continuity in practice. It is with this
understanding and appreciation of the cultural context that this analysis will be conducted,
with the goal of contributing to the improvement of nutritional outcomes for mothers and
children in Peru.
This study seeks to offer the first analysis of the Guidelines for Maternal and Child
Nutrition (GMCN) and tailored document. In particular, this study aims to explore the
coverage and depth of the GMCN, and the consistency between these guidelines and the
tailored document.
Methodology
Data collection and translation
The data was publicly available and accessed by the student researcher via the Peruvian
Ministry of Health website. In line with guidelines for conducting online qualitative
research, data that is publicly available and maintains individual confidentiality does not
require formal ethical clearance.43 The documents are only available in Spanish;
therefore, the current analysis is a cross-language study with the target language being
English.
Currently, there is no consensus in the recommendations of translation procedures, nor in

the timing of translation within qualitative research.44 Some researchers suggest
procedures to perform data translation should take place immediately after it is collected
to avoid significant differences between the original and translated categories and
themes.45 On the other hand, other authors advocate performing the translation after the
content analysis procedure, but only translating the categories that arise as relevant in the
data analysis, since this method is less expensive and less time consuming.46 However,
this latter approach may restrict the availability of data for the research team and interfere
in their interaction with the data, if all researchers are not fluent in the language.44
The decision of what approach to undertake for this particular study was made with an
awareness of available resources and the potential analytical implications.47 The final
decision was made in one of the regular supervisory meetings between the student
researcher and her supervisor. It was taken into account that the student researcher is a
native Spanish speaker, also fluent in English, and the supervisor is a native English
speaker. Therefore, together they decided that the translation of the data should be
conducted prior to the analysis, facilitating in-depth interactions with the data between
the student researcher and supervisor earlier in the research process. This translation
approach benefited the data analysis process, as the supervisor could be involved in the
coding and analysis, and support the student’s training in qualitative research.
Due to the fact that the student researcher is bilingual, the initial translation was carried
out by the student. This also had the added benefit of enabling the student researcher to
gain familiarity with the data ultimately facilitating the coding process. During the
translation, some words and phrases did not have an appropriate translation into English,
because they could only be understood in the context of Peruvian culture. These words
were left in the original language and explained in a footnote or translated into words
with a similar meaning in English. It was observed that some parts of the original text had
extra words or redundant words, which were simplified in the translation, however this
was done carefully to ensure the text did not lose its meaning. In addition, the text
contained some short and some very long sentences with many connectors, which made
it difficult to understand despite the student researcher being a native Spanish speaker.
Regarding technical words pertaining to the field of health and nutrition, they were cross-
referenced to check that the same terms were employed in other research studies.
Subsequently, the student researcher emailed the data to a team of two professional
Peruvian translators, for proofreading and checking, as the data is strewn with terms and
phrases that are better understood by those living in the Peruvian context. The student
researcher verified that the two translators were members of the Peruvian Professional
College of Translators, using the College website to check their Translator Registration
Numbers. This check also verified that the translators had experience translating Spanish
into English, and vice versa, and also experience with academic and research articles. The
translated data was e-mailed back and forth between the student researcher and the
translators until a final and accurate version was arrived at.
Data analysis
The student researcher and supervisor had regular meetings to discuss the research
process and suitable analytical techniques. Through these discussions, in line with the
aim of the study, the student researcher and supervisor decided on content analysis as the
chosen method of analysis, particularly drawing on the guidelines of Hsieh & Shannon.48
Qualitative content analysis is a method of research that subjectively interprets text-based
data content by a systematic process of coding and identifying themes or patterns to
classify that data.49 This method involves a series of procedures for analysing a range of
diverse data sources,50 and is therefore fitting for an analysis of national guidelines and
supplementary documents.
In their guidelines, Hsieh and Shannon describe three approaches to content analysis:
conventional, directed, and summative.48 This study first employed a conventional
content analysis, in order to analyse the content coverage and depth of the GMCN (before
being able to analyse content consistency). This type of content analysis was chosen as it
is the method most suited to situations where there is insufficient theory or previous
evidence to conduct an analysis on a given topic.48 Another name for this approach is the
conventional inductive content analysis, since it makes use of inductive coding processes,
which raise codes and categories from data analysis.49,51 Because there is no standardised
tool which acts as the model theory regarding nutrition guidelines for child and maternal
populations, inductive coding processes are required to conduct this analysis.52 The
conventional content analysis has the benefit of being able to perform a data-driven
analysis, without predetermined categories or prior assumptions regarding what is
important. Instead, categories were developed through familiarisation and the coding of
the data.
After the student researcher obtained the data from the translation process, the first step
for this conventional content analysis was reading all the data as a whole. Next, the
student researcher scrutinised the data highlighting words that depicted key concepts
mentioned throughout. Then, the data was divided into meaning units, then abbreviated
into simpler condensed meaning units (see example in Table 1). A meaning unit is a small
segment which transmit the same central connotation53 while a condensed meaning unit
is the meaning unit shortened51 to facilitate the following codes arising.
The student researcher led this first analytical process and throughout wrote reflections
and observations of the data while descriptively labelling the emerging codes. This
process formed the first coding scheme of the content analysis. These codes were
subsequently classified into different categories by the first author based on their
similarities – a category reflected a broader, higher-order descriptor that allowed the
clustering of multiple, similar codes. Further analysis of the data allowed the student
researcher to classify the categories into themes. Themes are the highest level of data
extraction and are “expressing data on an interpretative level”.54 From this, the student
researcher and supervisor engaged in discussion and through further refinement
developed a set of three content areas that sought to organise the categories of data:
nutrition guidelines for breastfeeding, nutrition guidelines for pregnant and lactating
women, nutrition guidelines for children aged 6 to 24 months.
The conventional content analysis hence involved six stages: meaning units, condensed
meaning units, initial coding, and final coding. An example of this six-stage process is
shown in Table 1.
Table 1 Example of six-stage coding process
Content Guidelines for pregnant and lactating women

area
Theme Micronutrients
Category Iron from animal sources
Final Justification of iron needs in pregnant and breastfeeding

coding women and animal sources of iron
Initial Benefits of iron Risks of iron deficit and Tailored Sources of iron from
coding in pregnant consequences recommendati animal products
women on of iron
consumption
for
breastfeeding
women.
Condensed Pregnant Anaemia is the main nutritional Breastfeeding The best sources of
meaning women require problem in pregnant women. This women have iron are found in
unit iron, because it disease can be prevented if to increase the animal products
has multiple childbearing women have an consumption especially meat,
benefits for adequate iron consumption. Anaemia of iron. poultry, sangrecita
them and their is associated with multiple maternal (Peruvian dish of
babies. and childhood negative health chicken blood), etc.
outcomes. because of their high
bioavailability iron.
Meaning During One of the main nutritional problems Moreover, The iron from all
unit pregnancy, during pregnancy is nutritional breastfeeding types of meat,
women require anaemia, which have to be prevented mothers have poultry, fish, viscera,
iron for the with adequate iron consumption in to increase the sangrecita (Peruvian
development of women of childbearing age, consumption dish of chicken
the foetus, especially during pregnancy. Iron is of this blood), etc. is
placenta, and important for preventing anaemia micronutrient considered to be of
synthesis of and it is associated with premature during this high bioavailability,
additional birth, low birthweight, increase in stage. which means it is
erythrocytes maternal mortality risk, and absorbed more easily
and for alterations in children’s behaviour. and is slightly
replenishing In addition, limited reserves of the altered before the
losses from mother during pregnancy may affect presence of
childbirth. newborn’s iron reserves. inhibiting factors of
iron absorption.
The secondary aim of this analysis was to analyse the consistency of the tailored
document entitled: "Participatory cooking demonstration of food preparation for maternal
and child populations” and GMCN. In order to assess consistency a directed content
analysis was performed. This approach is the most appropriate when there is theory or
prior research about the topic.48,49 A part of its appropriateness is that it has been used to
determine the degree to which nutrition education content has been included in tailored
nutrition documents.55 In this case, the tailored document is based on the GMCN, and so
the guidelines serve the purpose of offering a framework from which to systemically
‘check’ the data in the tailored document, as per Hsieh and Shannon’s suggestions.44 The
directed content analysis has the benefit of having a more systematised process than the
conventional approach50 as the student researched started with predetermined categories
sieving the data within these categories. This approach is also called deductive content
analysis and it is useful to compare categories when there is existing theory, or previous
categories,49 in this case the arisen categories from the GMCN.
The student researcher first read the data as a whole and identified the extent to which the
data from the tailored document included content from the initial analysis. In particular,
the data from the tailored document was read meticulously, highlighting the meaning
units which fitted in the predetermined categories selected from the GMCN. These
meaning units were coded and later categorised with the coding scheme from the GMCN.
Meaning units which could not be categorised with this coding scheme were given a new
code. It was later determined whether they signified a new category or sub category. This
later step was conducted to safeguard against the loss of additional information that is
addressed in the tailored document which is not contained in the GMCN. These new-
found categories offered extended content that the GMCN did not include, enriching the
theory presented by the GMCN. Finally, categories from both documents were paralleled
to assess consistency between the documents.
Results
Conventional analysis of GMCN
This analysis is structured around three key content areas identified in the conventional
content analysis: nutrition guidelines for breastfeeding, nutrition guidelines for pregnant
and lactating women, nutrition guidelines for children aged 6 to 24 months. To address
the question of content coverage of the guidelines, what follows is an exploration of each
content area, including its main focus and gaps.
Nutrition Guidelines for breastfeeding
Given the target audience of these guidelines, it is unsurprising that one of the major
content areas of the guidelines was breastfeeding. The student researcher identified 27
content categories specific to breastfeeding that were summarised in Table 2. In this
analysis, we noticed that the guidelines focused particularly on the promotion of exclusive
breastfeeding, at the expense of alternative infant feeding methods. This is evidenced by
26 (of the 27) categories discuss breastfeeding and one alone is related to breast-milk
substitutes as shown in Table 2. In looking closely at these 27 content categories, we
identified five main themes: the physical and emotional support, characteristics of
breastfeeding, techniques of breastfeeding, breastmilk collected by manual extraction,
and breastmilk substitutes.
As part of promoting exclusive breastfeeding, the guidelines discussed a range of factors

that are of vital importance to achieve exclusive breastfeeding. For example, as shown in
Table 2, the guidelines cite physical and emotional support with the participation of
healthcare staff, plus community and family, including the partner. It is encouraged that
this “preparation” should be undertaken both during pregnancy and during lactating
stages. As part of the recommended physical preparation, the guidelines included nipple
test, sucking stimulation and learning of the proper breastfeeding techniques. Regarding
emotional support the guidelines contained the reinforcement of the confidence of the
mother about the quality and quantity of breastmilk, the peace of mind, and increase of
self-esteem while breastfeeding. The last piece of information expressed in the guidelines
is that “women who manage to breastfeed often experience an increase of self-
confidence.” The support by the community includes the provision of adequate spaces
for breastfeeding, especially for working mothers. The guidelines also provided legal
information of maternity leave for pre and post-partum, and the lactating period for six
months. Another contribution of the community to support lactating mothers, is the
compliance by health facilities with the ten steps for successful. Some of these steps were
the recommendations of other guidelines and emphasised the support of healthcare staff
to promote exclusive breastfeeding.
Furthermore, the guidelines described the characteristics of breastfeeding that mothers

should acknowledge, focusing on the benefits of breastmilk (both colostrum and mature
breastmilk) versus other drinks for children under six months. These benefits were stated,
differentiating between healthy and sick children, both those under six months old and
those from 6 to 24 months. These guidelines enforced the need of continuing
breastfeeding when a child is sick. The only cases identified when it is recommended to
avoid breastfeeding, was where the mother has HIV. The guidelines emphasised the
importance of breastfeeding during the first hour after birth. Moreover, the frequency of
breastfeeding on demand is described with the support of sucking stimulation, and
children who sleep a lot are encouraged to be awakened. This theme also involved the
process of re-lactation in cases of mixed feeding and artificial feeding, including the
specific cases of children where this process is recommended (e.g. “children who have
stopped breastfeeding before or during a disease”). In addition, the recommended age to
continue breastfeeding is advised up to two years as a minimum, presenting the
importance of breastmilk for children over six months.
Another theme in these guidelines is techniques of breastfeeding focusing on the benefits

and description of the proper breastfeeding technique. In addition, five breastfeeding
positions were described which suits each mother’s condition. The sitting position was
described, but the tailored recommendation of the case where it would suit this position,
was not explained. The fourth theme in these guidelines explained the technique,
conservation and handling of breastmilk collected by manual extraction. In addition, the
process to feed children with this extracted breastmilk is explained. Finally, only one
theme described breastmilk substitutes, as previously acknowledged, which addressed the
compliance of the International Code of Marketing of Breast-milk Substitutes and the
Peruvian adaptation of this code. The guidelines did not explain the content of the Code
and the Peruvian norm regarding breastmilk substitutes but expressed that they aim to
“promote and protect the practice of breastfeeding.”
Table 2. Content coverage specific to breastfeeding
Category
Theme 1: Physical and emotional support
Reinforcement of confidence to breastfeed
Physical and emotional preparation for breastfeeding
Benefits for working mothers to breastfeed
10 steps of successful breastfeeding
Theme 2: Characteristics of breastfeeding
Benefits of breastmilk
Discouragement of other drinks and their risks
Frequency of breastfeeding
Sucking stimulation
Breastfeeding in children who sleep a lot
Benefits of contact between mother and child during the first hour after birth
Definition and benefits of colostrum
Benefits and frequency of breastfeeding in sick children
Process of re-lactation and cases when it is recommended
Breastfeeding in children with mothers with HIV
Recommended age to continue breastfeeding
Benefits of breastmilk after six months
Theme 3: Techniques of breastfeeding
Benefits of appropriate breastfeeding techniques
Description of the proper breastfeeding technique
Description of lying position and who will benefit with this technique
Description of sitting position
Description of watermelon position and who will benefit with this technique
Description of dancer position and who will benefit with this technique
Description of horse position and who will benefit with this technique
Theme 4: Breastfeeding collected by manual extraction
Technique of manual extraction of breastmilk and hygiene practices
Conservation of breastmilk from manual extraction
Process to feed children with breastmilk from manual extraction
Theme 5: Breastmilk substitutes
Compliance of International code of marketing of breast-milk substitutes
Nutrition Guidelines for pregnant and lactating women
The second major content area for the guidelines explored the most important nutrients
for pregnant and lactating women, risks and protective factors to be avoided or promoted
in pregnancy and lactating stages, and the role of the environment (partner, family and
community) to support women. These guidelines presented information that was mostly
for both pregnant and lactating women, and only differentiated these two groups when
the recommendations were specifically for one group or another, most often for pregnant
women. We identified four themes present within this content area of the guidelines, these
are summarised in Table 3.
The first theme captured macronutrients, which included proteins, fats, and energy needs
(that are provided by macronutrients). The emphasis of this theme was energy needs,
discussing the risks of deficiency or excess of energy, and tailored recommendations for
ensuring that both pregnant and lactating women consume enough energy. The guidelines
also specified the amount of additional energy needed by pregnant and lactating women.
Thus, the guidelines recommended additional meals to cover these extra needs. Fats were
addressed in regard to their benefits and their recommended proportion in the diet.
Examples of polyunsaturated fats were also provided. Nevertheless, the guidelines did
not offer information about other types of fats, their benefits and/or risks or their sources.
The guidelines offered no information about proteins, only briefly mentioning them
throughout the document. Information about their benefits, risks of deficit or excess, and
their sources were lacking. In addition, carbohydrates were not addressed in these
guidelines.
The following theme captured micronutrients, and we found this was widely discussed.
The information focused on vitamins and minerals found in both animal products and in
plant-based products individually. The vitamins addressed were: Vitamin A, Vitamin C,
folic acid; while the minerals addressed were: iron, zinc, calcium and iodine. Animal
products were stated to have a higher quantity of iron, folic acid, calcium and Vitamin A.
Iron and zinc from animal products were especially stated as being unbeatable for their
high-availability, as expressed as “just like iron, a daily consumption of food of animal
origin is important because it is a more bioavailable source-of-zinc food.” Almost all
micronutrients were addressing the benefits and consequences of deficiency for both
pregnant and lactating women, primarily for pregnant women. Folic acid was encouraged
for pregnant women because of their greater need of this nutrient and importance for a
higher intake at this stage. Zinc was addressed in a general context. Regarding plant-
based foods, they were highlighted as being rich in two micronutrients: Vitamin A and
Vitamin C. Animal and plant-based sources were provided for each of the vitamins and
minerals mentioned.
a, b, c
Table 3 Content coverage of nutrition guidelines for pregnant and lactating women
Theme/Category Tailored Justification Example

recommendation
Pregnant Lactating (Benefits and/or
Pregnant Lactating or
risks) sources
Theme 1: Macronutrients
Energy needs ✓ ✓ ✓ ✓ NA
Proteins need ✓ - - - -
Fats needs ✓ - ✓ ✓ ✓
Additional meals ✓ ✓ ✓ NA
Theme 2: Micronutrients
Daily consumption of animal products - - ✓ ✓ NA
Iron from animal sources ✓ ✓ ✓ - ✓
Folic acid from animal sources ✓ - ✓ - ✓
Calcium from animal sources ✓ ✓ ✓ ✓ ✓
Vitamin A from animal sources ✓ ✓ ✓ ✓ ✓
Zinc from animal sources - - ✓ - ✓
Daily consumption of fruits and ✓ ✓ ✓ ✓ ✓
vegetables
Vitamin A plant-based ✓ ✓ ✓ - ✓
Vitamin C plant-based ✓ ✓ ✓ - ✓
Ferrous sulphate supplementation ✓ ✓ ✓ ✓ ✓
Folic acid supplementation ✓ ✓ - - ✓
Vitamin A supplementation NA ✓ NA ✓ ✓
Iodised salt ✓ ✓ ✓
Theme 3: Individual behavioural factors
Fibre - - ✓ ✓ ✓
Junk food and sweets - - ✓ ✓ ✓
Coffee, tea, hot cocoa, hot chocolate ✓ ✓ ✓ - ✓
and soft drinks
Cigarettes, alcohol and drugs ✓ ✓ ✓ - NA
Nutritional assessment ✓ ✓ ✓ - NA
Weight assessment ✓ - ✓ - ✓
Stature assessment ✓ - ✓ - NA
Adolescent motherhood ✓ ✓ ✓ ✓ NA
Physical activity ✓ ✓ ✓ - ✓
Theme 4: Support of partner, family and community
Support of partner, family and ✓ ✓ ✓ ✓ ✓
community
a
“✓” indicates Yes
b
“-” indicates No
c
NA” indicates Not applicable
No other micronutrients apart from those discussed above were mentioned. The daily
requirements of these micronutrients were also not stated. This theme also addressed the
supplementation with ferrous sulphate, folic acid, Vitamin A, and consumption of iodised
salt. These micronutrients were noted as being highly needed by pregnant women and/or
lactating women, or deficient in risk populations (impoverished, or from Highlands and
Rainforest regions). The supplementation of iron with ferrous sulphate was highlighted
as compulsory for pregnant women, because “food is not enough to meet their iron
needs”. In post-partum women, those who are up to two months after delivery, it is
“necessary to prescribe ferrous sulphate supplementation, given that it is very difficult for
food intake to meet these needs”. Folic acid was also encouraged to be taken as a
supplement by pregnant women and post-partum women. The guidelines also presented
the recommended dose of supplements in pregnant women and post-partum women,
offering advice while taking ferrous sulphate, in order to increase its absorption. A single
dose of vitamin A was encouraged only for post-partum women from impoverished areas.
Iodised salt was reviewed in a general context for all Peruvian populations from
Highlands and Rainforest regions, with pregnant and lactating women.
The third theme explored individual behavioural factors, which embraced information
about protective factors (e.g. fibre, physical activity), and risk factors in pregnant and
lactating women, related to some foods (e.g. junk food, coffee), some substances (e.g.
alcohol, drugs), particular parenting contexts (e.g. adolescent motherhood) and nutritional
assessment (e.g. weight, stature). The daily requirements for fibre were not mentioned
neither were the types. In regard to smoking, the guidelines only presented the risks for
pregnant women, while smoking during breastfeeding or the effects on breastmilk56 were
not mentioned. Despite that the nutritional assessments of weight and stature were cited
as being important for both pregnant and lactating women, the guideline provides only
information about the benefits and risks of this assessment for pregnant women,
specifying the amount of weight expected to be gained during pregnancy. It was not clear
if lactating women are expected to gain, lose, or keep their weight. Furthermore, it was
not clear if short stature also had an impact in lactating women. Physical activity was
presented as a “healthy habit” in pregnant and lactating women, but its benefits were not
addressed beyond this statement. The guidelines were not clear regarding the amount and
types of exercises for these groups, presenting walking as the “safest and most advisable
exercise.” This category also warned that in the case of pregnant and lactating women
who already have heavy work, “longer rests are recommended.”
The fourth theme depicted the support of partner, family and community. The guidelines
called for the participation of the partner and the family in the emotional and physical
support, caring for pregnant and lactating women to ensure the compliance of check-ups,
proper food intake, and ensuring they receive enough physical rest as well as peace of
mind. The support by the community was not thoroughly explored in this theme but was
referenced briefly as important for increasing the women’s self-esteem.
Nutrition Guidelines for children aged 6 to 24 months
The third content area of focus for the guidelines was on the supplementary feeding of
children from six months onwards after finishing exclusive breastfeeding. The focus of
this content area was on the most important nutrients that children of this age need, the
characteristics their food should possess to ensure their nutrient needs are met, and the
role of their parents in this important mission.
We identified four themes within this final content area, these are summarised in Table 4.
The first theme concentrates on macronutrients and describes the fulfilment of the energy
gap, which is the amount of energy that should be provided by food not provided by
breastmilk. The age to start supplementary feeding in children older than six months was
explained in the hope of covering these energy needs. The only proper macronutrient
addressed was fats, and no information about proteins and carbohydrates was discussed
in the guidelines. Regarding fats, the sources presented were oil, butter and margarine,
without differentiating the type of fats and their differences, in regard to benefits and
sources. A specific recommendation of the amount of these fats was addressed for
children up to 24 months.
a, b, c
Table 4 Content coverage of nutrition guidelines for children aged 6 to 24 months
Theme/Category Justification Elaboratio Example

n of the or
guideline sources
Age to start supplementary feeding ✓ ✓ NA
Fulfilment of energy and nutrient gap ✓ ✓ NA
Fats ✓ ✓ ✓
Daily consumption of animal products ✓ ✓ ✓
Iron from animal sources ✓ - ✓
Zinc from animal sources ✓ - ✓
Vitamin A from animal sources ✓ - ✓
Calcium from animal sources ✓ - ✓
Daily consumption of fruits and vegetables ✓ ✓ ✓
Vitamin A from plant sources ✓ - ✓
Vitamin C from plant sources ✓ - ✓
Ferrous sulphate supplementation ✓ ✓ ✓
Vitamin A supplementation ✓ ✓ ✓
Iodine needs ✓ ✓ ✓
Theme 3: Parenteral influence on children eating
Types of style of caregivers and influence on ✓ ✓ ✓
nutrient consumption
Appropriate way to feed a child (interactive style) ✓ ✓ ✓
according to principles of psychosocial care
Hygiene practices in food handling ✓ ✓ ✓
Theme 4: Characteristics of children's food
Consistency of food ✓ ✓ ✓
Number of meals per day according to age ✓ ✓ ✓
Amount of food per meal according to age ✓ ✓ ✓
Incorporation of new foods - ✓ ✓
a “✓” indicates Yes
b “-” indicates No
c NA” indicates Not applicable
The second theme was about micronutrients according to animal products and plant-
based products. Animal products were claimed to have iron, zinc, vitamin A and calcium.
These micronutrients were widely explained to be present in animal products. Eggs and
fish were encouraged to be consumed by children with only a warning for cases of
temporary restrictions in families with strong allergic backgrounds. Vitamins A and C
were addressed in plant-food sources, presenting their benefits, but other elements present
in these foods, such as fibre were not addressed. In addition, these guidelines also
presented information about ferrous sulphate supplementation for children at risk of
anaemia, discussing the dose and process of giving this supplement to the child. Likewise,
vitamin A supplementation as well as iodine were encouraged in risk areas.
The following theme was parental influence on children eating, which included
information about three types of caregivers. Effects of each type were explained but there
was a lack of information about the consequences of the “allow-to-do” style, the most
common in Peruvian culture. It was assumed that this style could lead to
undernourishment from insufficient energy consumption or a deficiency of specific
macronutrients or micronutrients; however, this was not clarified. The guidelines focused
on the impact that parents have on the nutritional status of the child when they decide
what approach to take while feeding their children. Particularly, the appropriate way to
feed children is discussed with specific advice with the application of principles of
psychosocial care (e.g. eye contact, patience, attentiveness to signs of appetite and satiety,
experiencing different textures and flavours of food). Moreover, recommendations of
hygiene practices in food handling were addressed.
The last theme of these guidelines addressed the characteristics of children’s food. This
theme divided these characteristics according to the age of the child in four groups:
children six months old, children 7–8 months, children 9–11 months, and children 12–24
months. Consistency, number of meals per day, and amount of food per meal were
extensively explained in the guidelines. These were focused on the fulfilment of energy
needs more than on covering nutrient needs. Consistency was explained with the aim to
meet energy density of food, and specifically tailored recommendations for each age were
addressed. The number of meals and amount of food per meal were explained, because
of the child’s gastric capacity. In addition, information about the incorporation of new
foods and the procedure to achieve this was explained. The characteristics of food, not
only for healthy children, but for children during infectious diseases was also developed
by the guidelines. Alternatives were not addressed for when children do not comply with
the quantity of food recommended by the guidelines.
Directed content analysis of the tailored document
We addressed the question of consistency between the guidelines and the tailored
document using predetermined categories from the conventional analysis of GMCN. The
tailored document contained content from two of the three content areas of the GMCN:
nutrition guidelines for pregnant and lactating women, and guidelines for children aged
6 to 24 months. Based on our analysis, the categories and themes in these latter two
content areas, in both the GMCN and the tailored document, were considered sufficiently
consistent. Breastfeeding, however, was missing from the tailored document.
We noticed that the tailored document addressed the information in a more practical way
for the target population, giving specific and concrete recommendations, while the
GMCN focused more on the details relevant to health professionals (e.g. doses of nutrient
supplementation, justification of the guidelines). This is due to the fact that the GMCN
was written specifically for health professionals, while the tailored document was
intended more for health professionals, but also for other staff who performs cooking
demonstrations on a community level, also targeting pregnant and lactating women, and
parents of children under three years old.
The tailored document includes the GMCN as one of its sources, containing only the most
vital information for the addressed populations. Therefore, to ensure good nutrition in
both mother and child, the information is summarised, written in the simplest way
possible, only addressing the most important messages for pregnant women, lactating
women, and parent of a child under the age of three. In what follows, we offer a more
detailed look at these two content areas, noting the discrepancies and similarities,
ultimately to address its consistency with the categories from the GMCN.
Consistency of the content area: nutrition guidelines for pregnant and lactating
women in the GMCN and tailored document
Table 5 . Consistency of the content area of nutrition guidelines for pregnant and lactating women in
GMCN and tailored document for participatory cooking demonstrations of food preparation for maternal
and child populations.
Themes/Category Addressed in tailored document

Energy needs ✗
Proteins need ✗
Fats needs ✓
Additional meals ✓
Daily consumption of animal products ✓
Iron from animal sources ✓
Folic acid from animal sources ✗
Calcium from animal sources ✗
Vitamin A from animal sources ✗
Zinc from animal sources ✗
Daily consumption of fruits and vegetables ✓
Vitamin A plant-based ✗
Vitamin C plant-based ✗
Ferrous sulphate supplementation ✓
Folic acid supplementation ✗
Vitamin A supplementation ✗
Iodised salt ✓
Theme 3: Individual behavioural factors
Fibre ✗
Junk food and sweets ✗
Coffee, tea, hot cocoa, hot chocolate and soft drinks ✗
Cigarettes, alcohol and drugs ✗
Nutritional assessment ✗
Weight assessment ✗
Stature assessment ✗
Adolescent motherhood ✗
Physical activity ✗
Theme 4: Support of partner, family and community
Support of partner, family and community for ✗
promoting the care of pregnant and lactating women
Upon thorough examination, the first content area of the tailored document that was
consistent with the GMCN, was nutrition guidelines for pregnant and lactating women.
While the focus in the GMCN was mostly nutrient-based, the content area nutrition
guidelines for pregnant and lactating women in the tailored document included mostly
concrete recommendations in the quantity and type of food that the target population
should consume. Looking at the tailored document, in this same content area, two of the
four themes from the GMCN were similarly addressed, namely macronutrients and
micronutrients.
Meanwhile individual behavioural factors and support of partner, family and community
were not mentioned. From the 27 predetermined categories in the GMCN, the tailored
document included only seven in the content area nutrition guidelines for pregnant and
lactating women, as shown in Table 5. In the tailored document, the only pre-existing
categories that were addressed from the GMCN, as shown in Table 5, included: fats
needs, additional meals, daily consumption of animal products, iron from animal sources,
daily consumption of fruits and vegetables, ferrous sulphate supplementation, and the
recommendation of iodised salt. The 20 predetermined categories missing in the tailored
document are also presented in Table 5. It is important to highlight that the tailored
document included additional information that was not addressed in the GMCN neither
reflected in Table 5, because the deductive content analysis included no new categories.
Only predetermined categories were included to assess consistency between these two
documents.
In regard to the theme macronutrients, the categories that were addressed in the tailored
document were fats needs and additional meals. The need for fats was only addressed
briefly, while teaching how to make a model meal for pregnant and lactating women.
Thus, the only fat addressed in the tailored document was vegetable oil, without any
justification for its use or addressing the risks of using it excessively or inadequately. No
other fats or their sources were addressed in this document, but a specific
recommendation was given for the quantity of vegetable oil, which had not been
addressed in the GMCN. Regarding additional meals, the information was consistent with
the tailored recommendations for pregnant and lactating women but was stated without
justification. As shown in Table 5, the only actual macronutrient addressed in both
GMCN and the tailored document was fats. The tailored document addressed sources of
carbohydrates and proteins indirectly, by including foods such as rice, legumes, and
animal products, in the model meal for pregnant and lactating women. Nevertheless,
because of its food-based approach, the tailored document conveys a simple message to
the target populations, without mentioning the names of any specific macronutrient.
Regarding the second theme micronutrients, the categories addressed in the tailored
document were: daily consumption of animal products, daily consumption of fruits and
vegetables, iron from animal sources, ferrous sulphate supplementation, and the
recommendation for iodised salt. Focusing on these over other categories is a result of the
foremost food-based approach of the tailored document, while the GMCN has a mostly
nutrient-based approach. The daily consumption of animal products was addressed in the
tailored document, with a specific recommendation for the quantity of animal products
required by pregnant and lactating women, which was not addressed in the GMCN. Both
documents acknowledged low iron intake as the primary cause of anaemia among
pregnant and lactating women, recommending a daily consumption of animal products to
combat this, due to their high iron content. Furthermore, the need of iron supplementation
with ferrous sulphate or multi-micronutrients was highlighted in both documents, the only
variation being that the GMCN also addressed specific doses and the steps necessary for
administering this supplementation.
The importance of having a daily consumption of vegetables and fruits was also stated in
both documents, highlighting their vitamin and mineral content, with the GMCN also
including the relationship between their colour and the specific subset of vitamins they
contain. The need of iodised salt was addressed in the tailored document, while teaching
how to make a model meal for pregnant and lactating women, which included iodised
salt. The GMCN highlighted the need of iodised salt in the diet of Andean and Amazon
populations, while the tailored document speaks in a national context without mentioning
specific regions. This point in the tailored document may have been influenced by the
current availability of iodised salt throughout all regions of Peru, as there is a national
law that prohibits the manufacture and distribution of salt without iodine.57 The GMCN
also presented justification for the importance of iodine and the reasons why the
mentioned populations could present this deficiency, points not addressed by the tailored
document. Both documents agreed conceptually across the categories they had in
common, but differed in the quantity of information presented in each category.
The new categories that arose from the directed content analysis in this content area, were
food consistency, quantity of food per meal, and the consumption of legumes. The first
two of these categories could have been intended for the purpose of targeting energy
needs, which was one of the pre-existing categories. However, energy needs as a category
was not mentioned in the tailored document, which contained more pragmatic and
concrete recommendations in place of the largely theoretical approach seen in the GMCN.
Regarding consumption of legumes, this new category was entirely omitted in the
GMCN, but was one of the key messages in the tailored document.
Consistency of the content area: nutrition guidelines for children aged 6 to 24 months
in the GMCN and the tailored document
The second content area in the tailored document from the GMCN, was nutrition
guidelines for children aged 6 to 24 months. The guidelines addressed information for
children aged 6 to 24 months, while the tailored document extended this scope to include
children up to the age of three. The student researcher together with the supervisor
decided to analyse the consistency of this content area, disregarding the discrepancy
between age groups across the documents. This decision was made after the student
researcher had taken the first steps conducting the content analysis, concluding that the
addressed information in the tailored document was similar. The directed content analysis
identified the similarities and discrepancies between the tailored document addressing
pre-existing categories from the GMCN. The tailored document included all the four
themes from the GMCN: macronutrients, micronutrients, parental influence on children
eating, and characteristics of children’s food. Within these themes, the tailored document
included twelve of the twenty-one pre-determined content categories of the GMCN,
which is considerably more than in the content area for pregnant and lactating women.
Both the categories that were included and those not included were shown in Table 6.
Regarding the first theme macronutrients, as well as in the GMCN, the only proper
macronutrient addressed was fats, which was to be included during the preparation of a
model meal for children under the age of three, in the form of vegetable oil. However, no
justification was made regarding that particular choice of fat, neither giving any
recommendations for alternative fats. Both the GMCN and the tailored document
recommended a specific quantity of vegetable oil, showing consistency across documents
in this category. The age to start supplementary feeding was assumed, as the tailored
document discusses supplementary food for children older than six months, but does not
state the why this is the right time to start feeding with foods apart from breast milk. The
gaps in macronutrients that were not addressed could be due the food-based approach of
the tailored document. This led to challenges in comparing the tailored document with
the guidelines. The tailored document addressed varieties of food groups that were not
mentioned by the GMCN, such as roots, legumes, and cereals. These foods safeguard the
implied consumption of macronutrients such as carbohydrates and proteins. For example,
carbohydrates could have been incorporated by adding foods such as potatoes and cassava
in the model meals for children under three years old.
Regarding micronutrients, the categories addressed in the tailored document were the
daily consumption of animal products, daily consumption of vegetables and fruits, iron
from animal products, ferrous sulphate supplementation, and iodine needs. The daily
consumption of animal products was discussed in both documents, because of the high
iron content in the food group, addressing its role in avoiding anaemia when present in
the diet in appropriate quantities. The tailored document also addressed the specific
amounts of animal products that children must consume daily, which was not addressed
in the GMCN. In addition, the iron supplementation of ferrous sulphate was also
emphasised in both documents, but only the GMCN presented the dose and way to
administrate this supplement to children. The recommendation for a daily consumption
of vegetables and fruits was presented in both documents, with an emphasis on the colours
of the plant foods: oranges, yellows and greens. This coincided with the sources of
Vitamin A presented in the GMCN, while no specific mention of nutrients was made in
the tailored document to make the message simpler for the target population. Iodine needs
were addressed by including iodised salt in each model meal for children. Moreover, the
GMCN emphasised the use of iodised salt in Andean and Amazon populations, whereas
the tailored document did not differentiate populations in these areas. Iodised salt is
ordinarily available in the diet of children throughout Peru,58 because the fortification of
salt with iodine has been legislated to be compulsory.59
In the theme parental influence on children eating, only hygiene practices in food
handling were presented in the tailored document, while doing a segment in the workshop
prior to the commencement of food preparation, including the correct method of washing
hands, followed by the replication of this procedure by all the participants. However,
guidance in regard to the style of parenting has a marked influence on the success of
feeding in children according to the recommendations presented. Therefore, it would be
useful to address this information as part of the workshops in the tailored document.
Table 6 Consistency of the content area of nutrition guidelines for children aged 6 to 24 months in GMCN
and tailored document for participatory cooking demonstrations of food preparation for maternal and child
populations.
Themes/Category from GMCN Addressed in tailored

document
Age to start supplementary feeding ✓
Fulfilment of energy and nutrient gap ✗
Fats ✓
Daily consumption of animal products ✓
Iron from animal sources ✓
Zinc from animal sources ✗
Vitamin A from animal sources ✗
Calcium from animal sources ✗
Daily consumption of fruits and vegetables ✓
Vitamin A from plant sources ✗
Vitamin C from plant sources ✗
Ferrous sulphate supplementation ✓
Vitamin A supplementation ✗
Iodine needs ✓
Theme 3: Parental influence on children eating
Types of style of caregivers and influence on nutrient consumption ✗
Appropriate way to feed a child (interactive style) according to ✗
principles of psychosocial care
Hygiene practices in food handling ✓
Theme 4: Characteristics of children's food
Consistency of food ✓
Number of meals per day according to age ✓
Amount of food per meal according to age ✓
Incorporation of new foods ✗
Finally, the last theme, the characteristics of a child’s food was primarily approached in
the tailored document with the categories: food consistency, number of meals per day
according to age, and the amount of food per meal, also according to age. In addition,
these categories were condensed in comparison to those in the GMCN. Discrepancies
were related to the information for children 6–8 months. While the tailored document
gathered children 6–8 months in a group, the GMCN presented the same age in two
groups six months and 7–8 months. This divergence provides a slight confusion in the
recommendations that, health professionals and staff who perform cooking
demonstrations, will deliver to the target population. Despite this inconsistency, the
information about the characteristics of food was comparable in a broad way. For
example, the food consistency was always addressed as being dense, regardless of being
mashed or chopped. Moreover, the recommendation in each category presented for
children older than nine months was consistent between the two documents. Only the
GMCN gave more information justifying these recommendations.
Neither the GMCN nor the tailored document addressed methods of handling situations
where children do not comply with the recommended quantity of food during each meal
or during the day. Overall both documents showed significant consistency in their
common categories, with only a few inconsistencies regarding age brackets in this content
area. Most of the pre-existing categories from the GMCN were omitted from the tailored
document, with the purpose of conveying a simpler and more concrete message for
parents of children under three years, with one new category arising in relation to the
consumption of legumes.
Discussion
This study established that the nutrition guidelines for maternal and child populations,
together with the tailored document, are focused on safeguarding the fulfilment of energy
needs, the critical nutrients to be consumed during pregnancy, lactation, and infanthood,
and the promotion of exclusive breastfeeding. This general approach in Peruvian
government documents, concerning these vulnerable groups, has the aim of reducing two
of the main public health problems in these populations, namely malnourishment and
anaemia.13 The main findings of this study are discussed, along with its strengths and
limitations, and reflexivity about position of the researcher, capturing the significance
and implications of this study.
Breastfeeding is indisputably and vastly promoted by the GMCN in Peru.34 The

importance and benefits of breastfeeding are extensively acknowledged especially in
middle and low-income countries.60 Global promotion of breastfeeding is aligned with
important organizations that vigilantly defend the rights of children, such as The United
Nations Children's Fund (UNICEF) and the World Health Organization (WHO) that also
advocate for breastfeeding.61 Neighbouring countries in the South American Region, such
as Chile, Argentina, and Colombia, among others, also promote breastfeeding extensively
through guidelines, manuals and norms.62-66 These countries address similar categories
and content areas as Peru does in its guidelines (analysed here), such as the benefits of
breastfeeding, re-lactation, manual extraction of breastmilk, and proper techniques for
breastfeeding, among others.
While breastfeeding is ideal, there is a lack of recognition in the Peruvian Guidelines for
alternatives to breastfeeding where mothers are unable. The GMCN only mentioned
compliance with the Code of Marketing of Breast-milk substitutes, established by
WHO,67 and the Peruvian adaptation of this Code, otherwise not addressing them widely.
These two Codes, both have the purpose of regulating the commercialisation of
breastmilk substitutes and feeding bottles, advocating the practice of exclusive
breastfeeding instead.67,68 The countries in the South American Region also discuss the
International Code of Marketing of Breast-milk substitutes,63-66 in a wider way63,64 along
with breastmilk substitutes,63 presenting acceptable reasons for when these options are
valid and making recommendations for best practices when prescribing them.65 In
addition, these countries guiding documents, compared to the Peruvian guidelines,
offered more alternatives for the difficulties and problems potentially experienced by the
mother or the child while breastfeeding.63,64,69
The exception presented in the Peruvian guidelines regarding the giving of breastmilk to
a child when the mother is HIV positive, is in accordance with UNICEF and WHO.70
Nevertheless, WHO also advises other acceptable reasons for avoiding breastmilk,71
which were not presented in the GMCN. The recommended age of exclusive
breastfeeding is advised to be until six months, with extended breastfeeding until two
years or beyond, which aligns with WHO recommendations.72 With the aim to increase
the possibilities for lactating women to breastfeed, the GMCN addressed the legal
benefits for working lactating mothers and “Ten steps for Successful breastfeeding”, also
published by WHO.73 Overall, the Peruvian guidelines are more restrictive, providing
recommendations for exclusive breastfeeding but not accounting for those who are unable
to breastfeed.
The nutritional focus of the content area of the nutrition guidelines for pregnant and
lactating women, and also the guidelines for children aged 6 to 24 months, was on
covering energy needs and critical nutrients during these stages. Therefore, this approach
conceptualises the consumption of food to cover energy needs, without emphasising the
macronutrient food-sources for this energy consumption. The explicit focus on energy
needs over specific macronutrients responds to the problem of inadequate weight gain by
pregnant women in Peru,74,75 and undernutrition in children.76 However, excessive weight
is another nutritional problem that affects numerous pregnant women in the country.77
There are also women that keep their weight gain after pregnancy contributing to the
increase of overweight and obesity rates among childbearing women in Peru.18,21,78
Deficiency in energy needs among children is observed in impoverished populations,79
nevertheless, the focus on covering energy needs without focusing on the role of each
macronutrient does not correspond with the other types of malnutrition also prevalent in
Peru. That is, there is a double burden of malnutrition in Peruvian children under five
years old where both chronic malnutrition and obesity are present.80-82 Thus, this approach
of focusing on energy over macronutrients, and nutrients over foods, is not completely in
line with the multiple nutritional problems in Peru.
The major approach of the guidelines was clearly a nutrient-focused approach. The
nutrient-based approach in the guidelines is a reductionist approach that is valuable for
addressing nutrient deficiencies, but there are also multiple disadvantages that could lead
to the consumption of unhealthy food.83-85 This focus on guaranteeing an adequate
nutrient intake in nutritionally vulnerable populations has been the primary approach for
government actions.86 One of the failures of this approach was the lack of some main
foods in the guidelines, which give essential nutrients in pregnant and lactating women,
such as roots, whole-grain cereals, nuts, seaweed, legumes and seeds.87 Another failure
with the nutrient-approach instead of food-based approach is that these guidelines failed
to give a clear differentiation between healthier sources of fats. Differentiating the type
of fats has a crucial impact on health outcomes during pregnancy and throughout early
childhood, because their effects on health outcomes, such as physical growth and
cognitive development of children.88-93
On the contrary, a food-based approach emphasises the consumption of whole foods

instead of processed foods, and ensures a more adequate consumption of healthy food
components, such as antioxidants, and fibre among others, while reducing foods with a
high percentage of salt, trans fats, added sugars and others harmful elements.84 The
tailored document had a food-focused approach because of its more practical
recommendations. While it is true that more food groups were addressed in the tailored
document, no differentiation of healthier food sources was presented. A food-based
approach is important to achieve a balanced diet,94 but differentiating these foods
according to their grade of processing is also important, because it is related to chronic
diseases and obesity.95 A food-based approach that considers grade of processing is
especially important in Peru due to its growing trend of obesity among women and
children. As illustrated by the fact that over 40% of energy consumption in the Peruvian
diet is based on carbohydrate food-sources, most of which are refined, such as: rice,
noodles and other packaged cereal products.96
While these mentioned foods (i.e., refined carbohydrate sources) contribute to energy
consumption, the Peruvian diet in women and children is characterised for not providing
enough micronutrients, especially iron, which is reflected in the partially nutrient-based
approach of the guidelines.97 Pregnant women in Peru have showed that they have
sufficient energy consumption; however, consumption of micronutrients such as iron,
zinc, calcium, folic acid, Vitamin A and thiamine are deficient in this population. 98 The
deficiencies of micronutrients such as iron, folic acid, calcium, and zinc are a common
denominator of deficiencies in pregnant women in low-income countries.99 The
guidelines seems to have purposefully stressed these micronutrients due to the prevalence
of their deficiency in the Peruvian population, especially in pregnant and lactating
women.98 From the micronutrients deficiencies present in Peru, anaemia is the most
recognised and addressed nutritional deficiency in pregnant women in Peru, and it is
generally associated with iron deficiency.100-102 Accordingly, the nutrition guidelines
broadly addressed the association between iron intake and anaemia, recommending
animal products as iron sources along with supplementation for achieving iron
requirements in pregnant and lactating women, and in children. However, the
recommended supplement doses of not only iron, but also of other micronutrients
mentioned in the GMCN, require updating according to current WHO
recommendations.103
The nutrition guidelines for pregnant and lactating women, and for children aged 6 to 24
months, along with the tailored document, promoted the benefits of animal products for
calcium, iron and zinc. Especially regarding iron and zinc as critical nutrients, whose
proper intake was said to be only achieved via animal sources. Therefore, the guidelines
were not adapted for vegetarian/vegan populations because “plant-based foods alone do
not meet the needs of iron, zinc and other nutrients”. However, the levels of iron and zinc
in vegetarian/vegan populations seems not to be problematic, when addressed
carefully.104,105 However, the levels of iron and zinc in vegetarian/vegan populations does
not seem to be problematic, when addressed carefully.104,106 The safety of vegetarian diets
has been demonstrated, with regard to the iron and zinc status of children107-109 and
pregnant women.110,111 A careful approach, however, is needed to address the guidelines
for these populations.112,113 With a notable 11% vegetarian/vegan population already in
Peru, and a growing trend, 29 the guidelines should have a softer and more inclusive
approach addressing plant-based sources of iron, calcium and zinc.
In regard to food-sources addressed in the guidelines for pregnant women and children
aged 6 to 24 months old, the options presented did not address regional foods in Peru.
The tailored document addressed a greater variety but also presented insufficient foods-
sources based on locality. This is a critical oversight in the Peruvian context, because the
availability of food and the dietary patterns are most certainly different across the various
geographic regions of Peru.114 Much of this can be attributed to the great diversity in
culture, languages, beliefs and traditions, from region to region.115 Furthermore,
geographic conditions affect the availability of many types of food.12 Hence, national
nutrition guidelines for such vulnerable populations should address a greater variety of
foods that are better able to reach all regions, with fairness, whether from urban or rural
populations.
Another focus of the guidelines for pregnant and lactating women is on individual
behavioural factors. This approach is framed in health behaviour theories important for
understanding the behaviours of individuals.116 However, the behavioural approach is
impractical when addressing social inequalities in the field of health, because it does not
address the social determinants of health.117 Despite this, it seems to be the most appealing
approach for governments.118-121
Understanding the community environment is also crucial when comprehending the

origin of healthy behaviours and in providing for their support.118 A community-level
model for health behaviour change, adds to health promotion instruments a more
multilevel approach for achieving better health outcomes.122 The guidelines presented
one point about the community-level approach in the category community, partner and
family to support pregnant and lactating women. The community-level approach is
especially of interest in the Peruvian context, where multiple problems exist affecting the
emotional and physical health of pregnant and lactating women. These women gain little
or no support, or are physically and emotionally abused, especially by their partners,
123-130
leading to higher rates of depression. External support for pregnant and lactating
Peruvian women is therefore critical in order to avoid these extreme factors, and achieve
satisfactory maternal and child health outcomes, while promoting their overall health.
Another point where an individual-level approach has been used in the guidelines was
regarding parenting styles, addressed in the guidelines for children aged 6 to 24 months.
Parental influence has proved to have an impact on the eating behaviour and nutritional
status of children.131,132 However, the feeding of children depends not only on parental
influence, but also on social cultural factors, which have an impact on the availability and
accessibility of food for children.133 The guidelines and tailored document generally use
an individual-level model, because of their nature to be utilised when advising pregnant
and lactating women and parents of children. However, within their own scope, these
documents could not integrally address both individual and community levels.
The inconsistencies related to the age groups and their precise divisions in the group 6-8
months could be confusing and lead to contrary messages being sent to the population.
The standardisation of nutrition messages conveyed to the target population is crucial in
order to avoid delivering double messages. While it is true that the nutrition guidelines
should not be static in their recommendations, a clear message in nutrition education
requires standardisation to achieve a uniform nutritional message.134
The methodology used for this study has some strengths and limitations. Some issues
arose during the translation process despite being conducted in the best feasible way. We
believe that a strength of the study was in the translation conducted by the student
researcher, knowing both the context and being an expert in the field of nutrition. This
made it possible to achieve a more precise translation in regard to content. Being aware
that some words could not be translated into an equivalent in English, the student
researcher ensured that the data did not lose its meaning in the content analysis once
interpreted. As the student researcher is fluent but not native to English, the initial
translation was later complemented by professional Peruvian translators, having
experience in translation of academic papers but not experts in nutrition and health. This
approach led to a precise translation for the type of study, a content analysis.
The data for this cross-language study was first translated from Spanish to English, hence
we offer a brief point of reflection and critique of the process undertaken in this study.
Translation can often compromise the reliability of the data and therefore, explaining the
process of the translation in a transparent, detailed and systematic way, from the very
beginning of the study is imperative.135 Hence, factors to take into consideration were the
methods and quality of translation, the translator and the preservation of the
trustworthiness of the data.135 Regarding the methods and quality of the translation, the
semantic and content equivalence was not always kept, because the data had Peruvian
specific words and there were no equivalent terms in the target language.136 Also,
cohesion of the data was not completely feasible, because grammatical mistakes and
difficult sentence structure were adjusted to facilitate comprehension in the target
language.136 Congruence, or the alignment of data between the original and the target
language without loss of meaning, was challenging, due to the words having an
inseparable cultural context.137 Congruence was enhanced by the translation of the
Peruvian data being performed by Peruvian translators, in order to be consistent with the
nuances of Peruvian Spanish and the cultural context (terms only used in Peru, technical
terms or titles used by Peruvian health institutions).
Regarding the translators, some authors recommend just one translator to avoid
disagreement between translators while other authors recommend more than one
translator forming a committee that reaches an agreement on the translation.135 Because
the professional translator lives in Peru, the translation of the data was e-mailed back and
forth between the student researcher and the translators, with final consensus resting with
both parties. However, a committee of experts on linguistics, the cultural context, and the
topic and methodologies while ideal was not feasible in this instance, because of the time
and difficulty to rely on such experts. The translators’ qualifications, language
proficiency, specialisation in healthcare, are also indicated as important.135 While the
professional translators fulfilled the first two of these attributes, the student researcher
fulfilled the third, making the translation team complementary. It is unavoidable that
words would not always be conveyed accurately to another language; thus, this could
cause an unavoidable threat to the trustworthiness of the data. However, the type of study
allows a more flexible approach, because content analysis presents categories and themes
that are more about the substance of the data than the precise meaning of each word.
Therefore, the translation process was performed in the most feasible way, with the
resources available, taking into consideration the theory and research regarding cross-
language studies. However, it is unavoidable that some factors during the process could
have threatened the actual meaning of the text, affecting the later data analysis.
The methodology of content analysis allowed the researchers to answer the research
questions regarding analysis of depth, coverage and consistency of text-data, in a flexible
way. However, the methodology also raised some issues, particularly surrounding the
subjective nature of content analysis, as the researcher plays a critical role defining the
particular coding process.49 These issues could have threatened the trustworthiness of the
study,138 so a careful approach was implemented to minimise these limitations. To that
end, honest self-criticism and reflexivity were employed during the entire research, and
the process of coding was presented with as much detail as possible.
Reflexivity and stating the position of the researcher is critical in qualitative research, to
provide a better understanding of the way that past experiences, and the characteristics of
the researcher, have impacted the research.138,139 The awareness of the position of the
researcher, is especially crucial in content analysis, where subjectivity is an inevitable
factor of the methodology.140 Subjectivity is inherent in content analysis yet it should not
be considered merely an obstacle, but also a resource.141 The student researcher coming
from a Peruvian background and having previous familiarity with the analysed documents
was able to enrich and better place the study in its right context. After graduating as a
dietitian, the student researcher worked for the government health department in Peru, as
a nutrition advisor for mothers of children under five years old. With the purpose of
building a framework, the GMCN was enforced and used for all the staff of the
government health department. The student researcher confronted many issues while
using the guidelines regarding its application on practice, which she reflects on here as a
means of contextualising this analysis within her professional practice. For example,
mothers raised concerns that were not practical in everyday life such as the amount of
food for children, the number of additional meals, the enforcement of animal foods in
daily consumption, and exclusive breastfeeding, among others. While the GMCN are
standards of best practice within Peru, they were perceived by the student researcher as
not being adjustable or flexible for numerous Peruvian mothers. It is with this pre-
understanding that the student researcher was concerned about conducting a content
analysis to validate whether these initial hypotheses had substantiation.
Conclusions and Recommendations
This content analysis was aimed at analysing the coverage and depth of the GMCN
through a conventional content analysis, and the consistency of a tailored document with
respect to the GMCN via a directed content analysis. These two documents are used with
nutritional education purposes for improving nutrition outcomes in maternal and
childhood populations in Peru. The study has found that the guidelines had nutrient-based
approach with a major focus on covering energy needs, which could lead to unhealthy
eating. Meanwhile, the tailored document had a food-focused approach, with both
documents failing to differentiate degrees of food processing. These documents strongly
focused on resolving undernutrition problems, such as chronic malnutrition, anaemia, and
other micronutrient deficiencies, while over-nutrition problems such as obesity were
hardly addressed. Moreover, the guidelines did not offer as many food-sources as the
tailored document, from the different geographic regions of Peru. Furthermore, both
documents were not suited for minor groups such as vegetarians/vegans. In addition, these
documents both adopt an individual-level approach, as they are used for nutritional
education, yet fail to fully account for the broader socio-cultural context. Certain
inconsistences between these two documents regarding children in the 6–8 month age
bracket, lead to an unclear nutritional message.
In summary, the researchers recommend an update to the GMCN and the tailored
document, with information based on current evidence. A food-based approach in the
guidelines, considerate of the degrees of food processing, is recommended in order to
ensure healthier eating practices. Moreover, the guidelines should be based on current
and arising nutritional problems in maternal and childhood populations in Peru. Inclusion
of food-sources specific to different regions are also recommended. A more inclusive
approach in the discussion of animal consumption is also needed, in order to reach
vegetarian and vegan populations.
References
1. Pollitt E. Consecuencias de la desnutrición en el escolar peruano. Fondo

Editorial PUCP; 2002.
2. Gómez de Arriba A. El hambre ¿todavía existe? La malnutrición en el nuevo
milenio. Un reto pendiente. Revista Pediatría de Atención Primaria
2004;6(22):249-61.
3. Ticona Rendón M, Huanco Apaza D. Factores de riesgo de la mortalidad
perinatal en hospitales del Ministerio de Salud del Perú. Revista cubana de
obstetricia y ginecología. 2011;37(3):432-43. Available from:
http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-
600X2011000300017
4. Purandare CN. Maternal nutritional deficiencies and interventions. Journal of
Obstetrics and Gynaecology of India 2012;62(6):621-3.
5. Gernand AD, Schulze KJ, Stewart CP, West Jr KP, Christian P. Micronutrient
deficiencies in pregnancy worldwide: health effects and prevention. Nature
Reviews Endocrinology 2016;12(5):274.
6. Vaivada T, Gaffey MF, Das JK, Bhutta ZA. Evidence-based interventions for
improvement of maternal and child nutrition in low-income settings: what's
new? Current Opinion in Clinical Nutrition Metabolic Care 2017;20(3):204-10.
7. Instituto Nacional de Estadística e Informática. Peru: Evolución de los
Indicadores de Desarrollo del Milenio 2015. Finanzas MdEy. Lima: Instituto
Nacional de Estadística e Informática; 2017.
8. Sánchez-Abanto J. Evolución de la desnutrición crónica en menores de cinco
años en el Perú. Revista Peruana de Medicina Experimental y Salud Pública.
2012;29:402-5. Available from:
http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726-
46342012000300018
9. Sobrino M, Gutiérrez C, Cunha AJ, Dávila M, Alarcón J. Desnutrición infantil en
menores de cinco años en Perú: tendencias y factores determinantes. Revista
Panamericana de Salud Pública 2014;35:104-12.
10. UNICEF. Breastfeeding: A mother's gift, for every child. New York, USA:
UNICEF; 2018.
11. Instituto Nacional de Estadística e Informática. Informe Perú: Indicadores de
Resultados de los Programas Presupuestales, 2013-2018. Finanzas MdEy. Lima:
Instituto Nacional de Estadística e Informática; 2019.
12. Marini A, Rokx C. Dando la talla: El éxito del Perú en la lucha contra la
desnutrición crónica. . Banco Internacional de Reconstrucción y Fomento,
Banco Mundial. Washington, DC; 2017.
13. Ministerio de Salud del Perú. Plan Nacional para la Reducción y Control de la
anemia Materno Infantil y la Desnutrición Crónica Infantil en el Perú: 2017-
2021. Lima,: Ministerio de Salud; 2017.
14. Instituto Nacional de Estadística e Informática. Desnutrición crónica afectó al
12,2% de la población menor de cinco años de edad en el año 2018. 2019;
Available from: https://www.inei.gob.pe/prensa/noticias/desnutricion-cronica-
afecto-al-122-de-la-poblacion-menor-de-cinco-anos-de-edad-en-el-ano-2018-
11370/
15. Hernández-Vásquez A, Bendezú-Quispe G, Santero M, Azañedo D. Prevalencia
de obesidad en menores de cinco años en Perú según sexo y región, 2015.
Revista Española de Salud Pública. 2016 [cited May 10];90:e1-e10. Available
from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-
57272016000100414&lng=es&nrm=iso
16. Mispireta M. Determinantes del sobrepeso y la obesidad en niños en edad
escolar en Perú. Revista Peruana de Medicina Experimental y Salud Pública.
2012;29(3):361-5. Available from:
46342012000300011
17. Pacheco-Romero J. Gestación en la mujer obesa: consideraciones especiales.
In: Anales de la Facultad de Medicina: UNMSM. Facultad de Medicina; 2017. p.
207-14.
18. Minjarez-Corral M, Rincón-Gómez I, Morales-Chomina Y, Espinosa-Velasco M,
Zárate A, Hernández-Valencia M. Ganancia de peso gestacional como factor de
riesgo para desarrollar complicaciones obstétricas. Perinatología y
Reproducción Humana 2014;28(3):159-66.
19. Tarqui-Mamani C, Álvarez-Dongo D, Gómez-Guizado G. Estado nutricional y
ganancia de peso en gestantes peruanas, 2009-2010. Anales de la Facultad de
Medicina. 2014;75(2):99-105. Available from:
55832014000200002
20. Munares-García O, Gómez-Guizado G, Sánchez-Abanto J. Estado nutricional de
gestantes atendidas en servicios de salud del Ministerio de Salud, Perú 2011.
Revista Peruana de Epidemiología. 2013;17(1):01-9. Available from:
http://www.redalyc.org/articulo.oa?id=203128542003
21. Magallanes-Corimanya M, Barazorda-Huyhua MI, Roa-Meggo YJ. Índice de
masa corporal pregestacional, ganancia de peso gestacional y retención de
peso posparto. Revista Cubana de Obstetricia y Ginecología 2018;44(1):1-12.
22. Villar CM. Obesidad en el niño: factores de riesgo y estrategias para su
prevención en Perú. Revista Peruana de Medicina Experimental y Salud Pública.
2017;34:113-8. Available from:
46342017000100016 DOI: 10.17843/rpmesp.2017.341.2773
23. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood
obesity: causes and consequences. Journal of family medicine and primary care
2015;4(2):187.
24. Dietz WH. Health consequences of obesity in youth: childhood predictors of
adult disease. Pediatrics 1998;101(Suppl 2):518-25.
25. Bhutta ZA, Das JK. Interventions to address maternal and childhood
undernutrition: current evidence. In: Black RE, Singhal A, Uauy R, editors.
International Nutrition: Achieving Millennium Goals and Beyond. Basel: Karger;
2014. vol 78 p. 59-69.
26. Nielsen JN, Gittelsohn J, Anliker J, O’Brien K. Interventions to improve diet and
weight gain among pregnant adolescents and recommendations for future
research. Journal of the American Dietetic Association 2006;106(11):1825-40.
27. Dewey KG. Reducing stunting by improving maternal, infant and young child
nutrition in regions such as South Asia: evidence, challenges and opportunities.
Maternal Child Nutrition 2016;12:27-38.
28. Girard AW, Olude O. Nutrition education and counselling provided during
pregnancy: effects on maternal, neonatal and child health outcomes. Paediatric
Perinatal Epidemiology 2012;26(Suppl 1):191-204.
29. Jordan KC, Freeland-Graves JH, Klohe-Lehman DM, Cai G, Voruganti VS, Proffitt
JM, et al. A nutrition and physical activity intervention promotes weight loss
and enhances diet attitudes in low-income mothers of young children.
Nutrition Research 2008;28(1):13-20.
30. Rustad C, Smith C. Nutrition Knowledge and Associated Behavior Changes in a
Holistic, Short-term Nutrition Education Intervention with Low-income Women.
Journal of Nutrition Education and Behavior 2013;45(6):490-8.
31. Ferreira V, Sangalli C, Leffa P, Rauber F, Vitolo M. The impact of a primary
health care intervention on infant feeding practices: a cluster randomised
controlled trial in Brazil. Journal of Human Nutrition Dietetics 2019;32(1):21-30.
32. Penny ME, Creed-Kanashiro H, Robert R, Narro M, Caulfield L, Black R.
Effectiveness of an educational intervention delivered through the health
services to improve nutrition in young children: a cluster-randomised
controlled trial. The Lancet 2005;365(9474):1863-72.
33. Smith B, Smitasiri S. A framework for nutrition education programmes. FAO
Food Nutrition Paper; 1997.
34. Instituto Nacional de Salud, Centro Nacional de Alimentación y Nutrición.
Lineamientos de Nutrición Materno Infantil del Perú. Perú MdSd. Lima:
Ministerio de Salud del Perú; 2004.
35. Villar-Bernaola L, Lazaro-Serrano M. Documento técnico de Sesiones
demostrativas de preparación de alimentos para la Población Materno Infantil.
Instituto Nacional de Salud, Centro Nacional de Alimentación y Nutrición. Lima:
Ministerio de Salud del Perú; 2013.
36. World Health Organization. Evidence-informed nutrition guidelines. 2018;
Available from: https://www.who.int/nutrition/topics/guideline-
development/en/
37. Food and Agriculture Organization. Nutrition. 2018 [cited 2019 March 7];
Available from: http://www.fao.org/nutrition/education/healthy-eating-
resources/en/
38. Bermúdez García JE. Investigación científica en el Perú: factor crítico de éxito
para el desarrollo del país. 2014.
39. Degregori CI. Perú: identidad, nación y diversidad cultural. In: Territorio, cultura
e historia. Lima: Cooperación Alemana al Desarrollo/Prom Perú/Instituto de
Estudios Peruanos. Lima; 2003. p. 212-28.
40. Nureña CR. Incorporación del enfoque intercultural en el sistema de salud
peruano: la atención del parto vertical. Revista Panamericana de Salud Pública.
2009;26(4):368-76. Available from:
https://scielosp.org/pdf/rpsp/2009.v26n4/368-376
41. Lazo-Gonzales O, Alcalde-Rabanal J, Espinosa-Henao M. El sistema de salud en
Perú. Situación y desafíos. Lima: Colegio Médico del Perú,; 2016.
42. Vargas S, Penny ME. Measuring food insecurity and hunger in Peru: a
qualitative and quantitative analysis of an adapted version of the USDA’s Food
Insecurity and Hunger Module. Public Health Nutrition 2010;13(10):1488-97.
43. Roberts L. Ethical Issues in Conducting Qualitative Research in Online
Communities. 2015;12(3):314-25 DOI: 10.1080/14780887.2015.1008909
44. Santos HPO, Black AM, Sandelowski M. Timing of Translation in Cross-Language
Qualitative Research. Qualitative Health Research 2015;25(1):134-44.
45. Lopez GI, Figueroa M, Connor SE, Maliski SL. Translation Barriers in Conducting
Qualitative Research With Spanish Speakers. Qualitative Health Research
2008;18(12):1729-37.
46. Chen H-Y, Boore JR. Translation and back-translation in qualitative nursing
research: methodological review. Journal of clinical nursing 2010;19(1-2):234-9.
47. Temple B, Young A. Qualitative Research and Translation Dilemmas. Qualitative
Research 2004;4(2):161-78.
48. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis.
Qualitative health research 2005;15(9):1277-88.
49. Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced
Nursing 2008;62(1):107-15.
50. Kondracki NL, Wellman NS, Amundson DR, behavior. Content analysis: review
of methods and their applications in nutrition education. Journal of Nutrition
Education 2002;34(4):224-30.
51. Milos V, Westerlund T, Midlöv P, Strandberg EL. Swedish general practitioners’
attitudes towards treatment guidelines – a qualitative study. BMC Family
Practice 2014;15(1):199.
52. Fade SA, Swift JA. Qualitative research in nutrition and dietetics: data analysis
issues. Journal of human nutrition and dietetics : the official journal of the
British Dietetic Association 2011;24(2):106-14.
53. Graneheim UH, Lundman B. Qualitative content analysis in nursing research:
concepts, procedures and measures to achieve trustworthiness. Nurse
Education Today 2004;24(2):105-12.
54. Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. African
Journal of Emergency Medicine 2017;7(3):93-9.
55. Murray EK, Auld G, Inglis-Widrick R, Baker S. Nutrition content in a national
nutrition education program for low-income adults: content analysis and
comparison with the 2010 Dietary Guidelines for Americans. Journal of
Nutrition Education Behavior 2015;47(6):566-73. e1.
56. Napierala M, Mazela J, Merritt TA, Florek E. Tobacco smoking and
breastfeeding: Effect on the lactation process, breast milk composition and
infant development. A critical review. Environmental Research 2016;151:321-
38.
57. Pretell EA. De la investigación científica al diseño de políticas de salud: la
experiencia con la eliminación de la deficiencia de yodo en Perú. Revista
Peruana de Medicina Experimental y Salud Pública. 2017;34(3):538-43.
Available from:
https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/2861/2855
58. Miranda M, Calderón M, Riega V, Barboza del C J, Rojas C. Consumo de sal
fortificada con yodo en niños de 12 a 35 meses de edad y mujeres en edad
fértil en el Perú. Revista Peruana de Medicina Experimental y Salud Pública.
2004;21(2):82-6. Available from:
46342004000200005
59. Valdivia Zapana S, Robles Cebrián S, Ramirez Beltrán G. Vigilancia de la
fortificación de la sal para consumo humano en el Perú, periodos 2009-2010.
Boletin del Insitituto Nacional de Salud. 2012;18:5-6. Available from:
https://repositorio.ins.gob.pe/handle/INS/361
60. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al.
Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong
effect. The Lancet 2016;387(10017):475-90.
61. World Health Organization, UNICEF. Protección, promoción y apoyo de la
lactancia natural: la función especial de los servicios de maternidad. 1989.
62. Ministerio de Trabajo Empleo y Seguridad Social de Paraguay, Congreso de la
Nacion paraguaya. Promoción, Protección de la Maternidad y Apoyo a la
Lactancia Materna. 2015.
63. Ministerio de Salud de Argentina, UNICEF, Organización Panamericana de la
Salud. Consejería en Lactancia Materna. 2012.
64. Ministerio de Salud de Chile. Manual de Lactancia Materna. 2010.
65. Ministerio de Salud Pública de Uruguay. Norma Nacional de Lactancia Materna.
Programa Nacional de Salud de la Niñez. Direccion Nacional de Impresiones y
Publicaciones Oficiales; 2009.
66. Ministerio de Salud y Promoción Social de Colombia, Programa Mundial de
Alimentos. Lineamientos Técnicos para la implementacion de las salas amigas
de la familia lactante en el entorno laboral. Colombia; 2012.
67. World Health Organization. International code of marketing of breast-milk
substitutes. 1981.
68. Ministerio de Salud del Perú. La Lactancia Materna y el Cumplimiento del
Código Internacional de Comercialización de Sucedáneos de Leche Materna en
el Perú. 2011.
69. UNICEF Ecuador. Lactancia Materna. 2012.
70. World Health Organization. Transmisión del VIH a través de la lactancia:
revisión de los conocimientos actuales. 2004.
71. World Health Organization. Acceptable medical reasons for use of breast-milk
substitutes. Geneva: World Health Organization; 2009.
72. World Health Organization Staff, World Health Organization, UNICEF. Global
strategy for infant and young child feeding. World Health Organization; 2003.
73. World Health Organization. Evidence for the ten steps to successful
breastfeeding. Geneva: World Health Organization; 1998.
74. Tarqui-Mamani C, Álvarez-Dongo D, Gómez-Guizado G. Estado nutricional y
ganancia de peso en gestantes peruanas, 2009-2010. In: Anales de la Facultad
de Medicina: UNMSM. Facultad de Medicina; 2014. p. 99-105.
75. Montero Munayco JN. Estado nutricional y prácticas alimentarias durante el
embarazo en las gestantes a término atendidas en el Instituto Nacional
Materno Perinatal durante enerofebrero del 2016. 2016.
76. Domínguez-Curi CH, Aguilar-Esenarro LÁ. Requerimientos de energía para la
población peruana. Instituto Nacional de Salud, Centro de Alimentacióon y
Nutrición. Ministerio de Salud del Peru,. Lima: Ministerio de Salud del Perú;
2015.
77. Munares-García O, Gómez-Guizado G, Sánchez-Abanto J. Estado nutricional de
gestantes atendidas en servicios de salud del Ministerio de Salud, Perú 2011.
Revista Peruana de Epidemiología 2013;17(1).
78. Ramón-Arbués E, Martínez Abadía B, Martín Gómez S. Ganancia de peso
gestacional y retención de peso posparto en una cohorte de mujeres en Aragón
(España). Nutrición Hospitalaria 2017;34(5):1138-45.
79. Miranda M, Calderón M, Riega V, Barboza del C J, Rojas C. Consumo de sal
fortificada con yodo en niños de 12 a 35 meses de edad y mujeres en edad
fértil en el Perú. Revista Peruana de Medicina Experimental y Salud Pública
2004;21(2):82-6.
80. Budge S. Maternal Perceptions of Child Weight and Height and the Double
Burden of Malnutrition: Young Lives, Peru. 2015.
81. Rojas C, Calderón M, Taipe M, Bernui I, Ysla M, Riega V. Consumo de energía y
nutrientes, características socioeconómicas, pobreza y área de residencia de
niños peruanos de 12 a 35 meses de edad. Revista Peruana de Medicina
Experimental y Salud Pública 2004;21(2):98-106.
82. Tazza R, Bullón L. ¿Obesidad o desnutrición?: Problema actual de los niños
peruanos menores de 5 años. In: Anales de la Facultad de Medicina: UNMSM.
Facultad de Medicina; 2006. p. 214-23.
83. Jacobs DR, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition.
Nutrition Reviews 2007;65(10):439-50.
84. Mozaffarian D, Ludwig DS. Dietary Guidelines in the 21st Century—a Time for
Food. Journal of the American Medical Association 2010;304(6):681-2.
85. Mozaffarian D, Rosenberg I, Uauy R. History of modern nutrition science—
Implications for current research, dietary guidelines, and food policy. British
Medical Journal 2018;361:k2392.
86. Laraia BA, Siega-Riz AM, Gundersen C, Dole N. Psychosocial Factors and
Socioeconomic Indicators Are Associated with Household Food Insecurity
among Pregnant Women. The Journal of Nutrition 2006;136(1):177-82.
87. Meija L, Rezeberga D. Proper maternal nutrition during pregnancy planning and
pregnancy: a healthy start in life 2017.
88. Agostoni C, Verduci E, Massetto N, Fiori L, Radaelli G, Riva E, et al. Long term
effects of long chain polyunsaturated fats in hyperphenylalaninemic children.
2003;88(7):582-3.
89. Helland IB, Smith L, Blomén B, Saarem K, Saugstad OD, Drevon CA. Effect of
supplementing pregnant and lactating mothers with n-3 very-long-chain fatty
acids on children's IQ and body mass index at 7 years of age. Pediatrics
2008;122(2):e472-e9.
90. Innis SM. Trans fatty intakes during pregnancy, infancy and early childhood.
Atherosclerosis Supplements 2006;7(2):17-20.
91. Makrides M, Collins CT, Gibson RA. Impact of fatty acid status on growth and
neurobehavioural development in humans. Maternal Child Nutrition 2011;7:80-
8.
92. Briend A, Dewey KG, Reinhart GA. Fatty acid status in early life in low‐income
countries–overview of the situation, policy and research priorities. Maternal
child nutrition 2011;7:141-8.
93. Huffman SL, Harika RK, Eilander A, Osendarp SJ. Essential fats: how do they
affect growth and development of infants and young children in developing
countries? A literature review. Maternal child nutrition 2011;7:44-65.
94. Food and Agriculture Organization. Food-based approaches to meeting vitamin
and mineral needs. Available from:
http://www.fao.org/3/y2809e/y2809e08.htm?fbclid=IwAR32mjxK-zWRDBQ7-
lO2hVx-jjgZSoDF0Q6hsByiZg3HxxImLnHpDvPAPdE
95. Monteiro CA. Nutrition and health. The issue is not food, nor nutrients, so
much as processing. Public Health Nutrition 2009;12(5):729-31.
96. Kovalskys I, Fisberg M, Gómez G, Pareja RG, García MCY, Sanabria LYC, et al.
Energy intake and food sources of eight Latin American countries: Results from
the Latin American Study of Nutrition and Health (ELANS). Public Health
Nutrition 2018;21(14):2535-47.
97. Rojas C, Moreno C, Vara E, Bernui I, Ysla M. Consumo de energía y nutrientes,
características socioeconómicas, pobreza y área de residencia de mujeres
peruanas en edad fértil. Revista Peruana de Medicina Experimental y Salud
Pública 2004;21(4):231-9.
98. Sacco L, Caulfield L, Zavaleta N, Retamozo L. Dietary pattern and usual nutrient
intakes of Peruvian women during pregnancy. European Journal of Clinical
Nutrition 2003;57(11):1492.
99. Lee SE, Talegawkar SA, Merialdi M, Caulfield LE. Dietary intakes of women
during pregnancy in low-and middle-income countries. Public Health Nutrition
2013;16(8):1340-53.
100. Castillo A, Fersen R. Prevalencia de anemia en gestantes que acuden por signos
de alarma al servicio de emergencia del Hospital Nacional Arzobispo Loayza del
1 junio al 30 de noviembre de 2016. 2017
101. Becerra C, Gonzales GF, Villena A, De la Cruz D, Florián A. Prevalencia de
anemia en gestantes, Hospital Regional de Pucallpa, Perú. Revista
Panamericana de Salud Pública 1998;3:285-92.
102. Milman N. Fisiopatología e impacto de la deficiencia de hierro y la anemia en
las mujeres gestantes y en los recién nacidos/infantes. Revista peruana de
ginecología y obstetricia 2012;58(4):293-312.
103. World Health Organization. Intervenciones. 2019; Available from:
https://www.who.int/elena/intervention/es/
104. Saunders AV, Craig WJ, Baines SK. Zinc and vegetarian diets. The Medical
Journal of Australia 2013;199(4):S17-S21.
105. Saunders AV. Iron and vegetarian diets. The Medical Journal of Australia
2013;199(4):S11-S6.
106. Saunders AV. Iron and vegetarian diets. The Medical Journal of Australia.
[Article]. 2013;199(4):S11-S6. Available from:
https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sa
u11494_fm.pdf
107. Osei-Boadi K, Lartey A, Marquis G, Colecraft E. Dietary intakes and iron status
of vegetarian and non-vegetarian children in selected communities in Accra
and Cape Coast, Ghana. African Journal of Food, Agriculture, Nutrition
Development. 2012;12(1):5822-42. Available from:
https://www.ajol.info/index.php/ajfand/article/view/74834
108. George K, Kumar NS, Lal JJ, Sreedevi R. Anemia and nutritional status of pre-
school children in Kerala. The Indian Journal of Pediatrics 2000;67(8):575-8.
109. Gibson RS, Heath A-LM, Szymlek-Gay EA. Is iron and zinc nutrition a concern for
vegetarian infants and young children in industrialized countries? The American
Journal of Clinical Nutrition 2014;100(suppl_1):459S-68S.
110. Piccoli GB, Clari R, Vigotti F, Leone F, Attini R, Cabiddu G, et al. Vegan–
vegetarian diets in pregnancy: danger or panacea? A systematic narrative
review. BJOG: An International Journal of Obstetrics Gynaecology
2015;122(5):623-33.
111. King JC, Stein T, Doyle M. Effect of vegetarianism on the zinc status of pregnant
women. The American Journal of Clinical Nutrition 1981;34(6):1049-55.
112. Penney DS, Miller KG. Nutritional Counseling for Vegetarians During Pregnancy
and Lactation. Journal of Midwifery & Women's Health 2008;53(1):37-44.
113. Foster M, Samman S. Chapter Three - Vegetarian Diets Across the Lifecycle:
Impact on Zinc Intake and Status. In: Henry J, editor. Advances in Food and
Nutrition Research. Oxford: Academic Press; 2015. vol 74 p. 93-131.
114. Padilla Trejo A. Instituto Nacional de Estadística e Informática de Perú, editor.
Diferencias regionales en los patrones de consumo en el Perú. In: Instituto
Nacional de Estadística e Informática de Perú, editor. En: Third Meeting of the
Expert Group on Poverty Statistics (Rio Group)-LC/R. 1998-2000-p. 63-81; 2000.
115. Degregori CI. Perú: identidad, nación y diversidad cultural. In: Oliart P, editor.
Territorio, cultura e historia. Lima: Cooperación Alemana al Desarrollo/Prom
Perú/Instituto de Estudios Peruanos. Lima: Instituto de Estudios Peruanos;
2003. p. 212-28.
116. Baum F. The new public health. 4 ed. Oxford: Oxford University Press; 2015.
117. Baum F, Fisher M. Why behavioural health promotion endures despite its
failure to reduce health inequities. Sociology of Health & Illness
2014;36(2):213-25.
118. Glanz K, Rimer BK, Viswanath K. Health Behavior: Theory, Research, and
Practice. 5th ed. New York, United States: John Wiley & Sons, Incorporated;
2015.
119. Baum F. Overcoming barriers to improved research on the social determinants
of health. MEDICC review 2010;12(3):36-8.
120. Popay J, Whitehead M, Hunter DJ. Injustice is killing people on a large scale—
but what is to be done about it? Journal of Public Health 2010;32(2).
121. Lantz PM, Lichtenstein RL, Pollack HA. Health policy approaches to population
health: the limits of medicalization. Health Affairs 2007;26(5):1253-7.
122. Glanz K, Rimer BK, Viswanath K. Health Behavior: Theory, Research, and
Practice. New York, United States: John Wiley & Sons, Incorporated; 2015.
123. Escobar J, Pacora P, Custodio N, Villar W. Depresión posparto: ¿se encuentra
asociada a la violencia basada en género? In: Anales de la Facultad de
Medicina: UNMSM. Facultad de Medicina; 2009. p. 115-8.
124. Aramburú P, Arellano R, Jáuregui S, Pari L, Salazar P, Sierra O. Prevalencia y
factores asociados a depresión posparto en mujeres atendidas en
establecimientos de salud del primer nivel de atención en Lima Metropolitana,
junio 2004. Revista Peruana de Epidemiología 2008;12(3).
125. Yanac P, Vanesa L, Mercado Huachupoma YD. Factores asociados a la depresion
en gestantes del Instituto Nacional Materno Perinatal. 2012.
126. Bao-Alonso MdP, Vega-Dienstmaier JM, Saona-Ugarte P. Prevalencia de
depresión durante la gestación. Revista de Neuro-Psiquiatría 2010;73(3).
127. Luna Matos ML, Salinas Piélago J, Luna Figueroa A. Depresión mayor en
embarazadas atendidas en el Instituto Nacional Materno Perinatal de Lima,
Perú. Revista Panamericana de Salud Pública 2009;26:310-4.
128. Lam N, Contreras H, Mori E, Hinostroza W, Hinostroza R, Torrejón E, et al.
Factores psicosociales y depresión antenatal en mujeres gestantes. Estudio
multicéntrico en tres hospitales de Lima, Perú. Abril a junio de 2008. Revista
Peruana de Epidemiología 2010;14(3).
129. Mori-Quispe E, Contreras-Pulache H, Hinostroza-Camposano WD, Gil-Guevara
E, Vallejos-Matos A, Chacón-Torrico H. Relación con la pareja en madres de
neonatos con bajo peso al nacer. Revista Peruana de Epidemiología.
2013;17(1)
http://www.imbiomed.com.mx/1/1/articulos.php?method=showDetail&id_arti
culo=95534&id_seccion=3631&id_ejemplar=9334&id_revista=221
130. Saravia JC, Mejía M, Becerra S, Palomino A. Violencia física contra la mujer
durante el embarazo: prevalencia y factores asociados. Revista Peruana de
Epidemiología 2012;16(2).
131. Ventura AK, Birch LL. Does parenting affect children's eating and weight status?
International Journal of Behavioral Nutrition and Physical Activity 2008;5(1):15.
132. Scaglioni S, Salvioni M, Galimberti C. Influence of parental attitudes in the
development of children eating behaviour. British Journal of Nutrition
2008;99(S1):S22-S5.
133. Patrick H, Nicklas TA. A Review of Family and Social Determinants of Children’s
Eating Patterns and Diet Quality. Journal of the American College of Nutrition
2005;24(2):83-92.
134. Instituto Nacional de Salud, Centro de Alimentacióon y Nutrición. Consejería
Nutricional en el marco de la atención de salud materno infantil. Ministerio de
Salud. Lima: Ministerio de Salud; 2010.
135. Al‐Amer R, Ramjan L, Glew P, Darwish M, Salamonson Y. Translation of
interviews from a source language to a target language: Examining issues in
cross‐cultural health care research. Journal of Clinical Nursing 2015;24(9-
10):1151-62.
136. Esposito N. From Meaning to Meaning: The Influence of Translation Techniques
on Non-English Focus Group Research. Qualitative Health Research
2001;11(4):568-79.
137. Irvine FE, Lloyd D, Reece PJ, Allsup DM, Kakehashi BC, Ogi A, et al. Lost in
translation? Undertaking transcultural qualitative research. Nurse Researcher
2007;14(3).
138. Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative
Content Analysis: A Focus on Trustworthiness. SAGE Open
2014;4(1):2158244014522633.
139. Berger R. Now I see it, now I don’t: Researcher’s position and reflexivity in
qualitative research. Qualitative research 2015;15(2):219-34.
140. Rourke L, Anderson T, Garrison DR, Archer W. Methodological issues in the
content analysis of computer conference transcripts. International journal of
artificial intelligence in education 2001;12:8-22.
141. Braun V, Clarke V, Hayfield N, Terry G. Thematic analysis. In: Liamputtong P,
editor. Handbook of Research Methods in Health Social Sciences. Singapore:
Springer; 2019. p. 843-60.

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ASSIGNMENT COVER SHEET

Every piece of written work you submit for assessment must

STUDENT CONTACT DETAILS

Signed: Anita Esther Rodriguez Vargas Date: 26/06/2019

Due Date: 26/06/2019 Submitted date: 26/06/2019

Program Directors require the submission of a joint declaration of readiness of dissertation or

Student Name: Anita Esther Rodriguez Vargas

Student Number: 45013814

Program: Master of Public Health

Student: Anita Esther Rodriguez Vargas

Principal Supervisor: Britta Wigginton

This report is submitted in partial requirement for the award of

Anita Esther Rodriguez Vargas

In my capacity as a Master of Public Health student at The University of

My master’s thesis (enclosed) provides recommendations to take into

Anita Esther Rodríguez Vargas

Anita Esther Rodríguez Vargas

Data analysis ............................................................................................................... 14

Nutrition Guidelines for breastfeeding ................................................................... 18

Nutrition Guidelines for pregnant and lactating women ........................................ 21

Nutrition Guidelines for children aged 6 to 24 months .......................................... 24

Directed content analysis of the tailored document.................................................... 27

Consistency of the content area: nutrition guidelines for children aged 6 to 24

Table 1 Example of six-stage coding process ................................................................ 16

WHO: World Health Organization

Early childhood malnutrition increases childhood mortality, as well as irreversibly

Another problem affecting childhood and maternal populations in Peru is obesity,

In order to guide health professionals in conducting appropriate education and

Data collection and translation

Currently, there is no consensus in the recommendations of translation procedures, nor in

Table 1 Example of six-stage coding process

Content Guidelines for pregnant and lactating women

Final Justification of iron needs in pregnant and breastfeeding

Conventional analysis of GMCN

Nutrition Guidelines for breastfeeding

As part of promoting exclusive breastfeeding, the guidelines discussed a range of factors

Furthermore, the guidelines described the characteristics of breastfeeding that mothers

Another theme in these guidelines is techniques of breastfeeding focusing on the benefits

Table 2. Content coverage specific to breastfeeding

Theme/Category Tailored Justification Example

Nutrition Guidelines for children aged 6 to 24 months

Theme/Category Justification Elaboratio Example

Directed content analysis of the tailored document

Themes/Category Addressed in tailored document

Themes/Category from GMCN Addressed in tailored

Breastfeeding is indisputably and vastly promoted by the GMCN in Peru.34 The

On the contrary, a food-based approach emphasises the consumption of whole foods

Understanding the community environment is also crucial when comprehending the

Conclusions and Recommendations

1. Pollitt E. Consecuencias de la desnutrición en el escolar peruano. Fondo

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