STAMINA: Strategies to Mitigate Nutritional Risks among mothers and infants under 2 years in low income urban households in Peru during COVID-19

Peru's progress in combatting malnutrition may be reversed with the current COVID-19 pandemic which has caused disruption of maternal and infant nutrition services, closure of health centres and rising unemployment. Peru has experienced one of the highest mortality rates from COVID-19 in South America. Deteriorations in infant nutrition will lead to poorer health outcomes for the next generation. Government and community stakeholders in Peru have highlighted the unknown impacts of the pandemic on the nutrition of mothers and their infants and young children. This study will examine how the COVID-19 response is impacting on the nutritional risks of mothers and infants (aged 0-23 months) within the household setting in low-income areas of two cities, Huánuco and Lima. This information will be compared with detailed nutritional assessments conducted in the same communities immediately before the national State of Emergency due to COVID-19. To address the emerging nutritional risks, we will work with stakeholders to co-create adapted methods for the delivery of nutritional services including iron supplementation and support for exclusive and continued breastfeeding. We will identify the nutritional risks resulting from the COVID-19 pandemic by examining short, medium and longer term changes in: - exclusive breastfeeding rates for infants aged 0-6 months; continued breastfeeding for infants aged 6-23 months, and the extent to which WHO recommended complementary feeding practices are being met. - the uptake of iron supplementation in infants and young children - a national priority to combat anaemia - in the context of the disrupted health services and new delivery strategies implemented since the pandemic. - household food security, maternal psychological wellbeing, and changing quality of diet in relation to nutritional risks of undernutrition as well as overweight and obesity at the household level. - how household dietary practices adapt and respond to the ongoing pandemic. With these insights, we will co-create support systems for the design or adapted delivery of nutritional counselling, growth monitoring and iron supplementation for infants and young children using information and communication technologies or socially-distanced health services. We will work with UNICEF Peru as a project partner in order to ensure that efforts to address malnutrition target the most vulnerable groups and are tailored to the challenges experienced by urban communities which make up the majority population of Peru.