Dietary management of diarrhea (DMD) project : final report -- October 1, 1985 to December 31, 1989

The project was conducted by scientists and program planners of The Johns Hopkins University and the Academy for Educational Development and other North American institutions in collaboration with local scientists and Ministry of Health personnel in Peru and Nigeria. Preliminary research activities included rapid ethnographic assessments of infant feeding practices, local definitions of diarrheal diseases, and current practices for the management of children with these illnesses; a representative sample survey of families in selected regions of each of these countries to obtain similar types of information; structured observations and quantitative measurements of dietary intakes by young children during and after diarrheal diseases; clinical trials of locally appropriate, culturally acceptable prototype diets for the dietary management of children with diarrhea; focus groups and recipe trials to test the acceptability of recipes to be promoted; and development and pretesting of educational materials to promote the use of these recipes. Pilot communication/educational campaigns were then undertaken to promote the use of these enhanced, home available weaning diets for use during diarrhea. The impact of these interventions was also evaluated. In Peru, the pilot intervention was conducted in the highland valley of the Callejon de Huaylas. A recipe for "Sanquito," a mixture of pre-toasted wheat flour, legume flour, carrots, vegetable oil, and sugar, was promoted through mass media and face-to-face cooking demonstrations in mothers" clubs and market places. Additionally, training seminars were conducted for health and nutrition professionals in the region. In Nigeria, a recipe incorporating fermented maize or sorghum porridge enhanced with pre-toasted cowpea flour, palm oil, and sugar was developed. Mothers were also taught to prepare and incorporate germinated sorghum flour as a source of amylase to reduce the viscosity of this weaning diet. Information on the preparation of these ingredients and the final recipe was disseminated through health clinics and mother-to-mother communication channels. Evaluations of the pilot interventions in both countries indicated a very high degree of penetration of the project messages. Knowledge of the recipes and adoption were greater than predicted for this short-term pilot intervention. Suggestions for improving the educational messages and expanding the intervention design were incorporated in the evaluation reports. Important conclusions of the project were the importance of considering children"s nutritional problems from an interdisciplinary perspective and the need to work with mothers and existing institutional structures in the development and implementation of nutrition education programs. These and other key findings have been documented in numerous project reports. (Author abstract)