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      Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies

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          Abstract

          Background

          The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers’ infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies.

          Methods

          Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes.

          Results

          The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother’s accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers.

          Conclusions

          Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.

          Electronic supplementary material

          The online version of this article (10.1186/s13002-018-0271-2) contains supplementary material, which is available to authorized users.

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          Most cited references47

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          Comparison of health conditions treated with traditional and biomedical health care in a Quechua community in rural Bolivia

          Background The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively. Methods A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients. Results Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options. Conclusion Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient data represents a novel approach to compare the contribution of traditional and biomedical health care to treatment of particular health conditions.
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            Resilience of Andean urban ethnobotanies: a comparison of medicinal plant use among Bolivian and Peruvian migrants in the United Kingdom and in their countries of origin.

            Analysing why and how ethnobotanical traditions 'survive' is important for a better understanding of migrants' health care behaviour. This study investigates the use of traditional medicinal plants among first generation migrants from Bolivia and Peru in London, in relation to practices among their peers in their respective home countries in order to assess changes in traditional health care among newcomer communities. A total of 98 semi-structured interviews were conducted in London (UK), Cochabamba (Bolivia) and Lima (Peru). Voucher specimens of all reported species were collected and identified. By comparing data on active plant uses and their applications, overlap and differences between health care practices before and after migration could be outlined. In London, people can rely on more biomedical alternatives and have access to less traditional herbal remedies as compared to their countries of origin. In general, Peruvians and Bolivians in London continued to use traditional medicine for common, self-limiting ailments that were also widespread in their countries of origin. The same widely used (either readily available cosmopolitan or culturally relevant) plant species appeared in the post-migration group. In general, less freshly available medicinal species were used in London and more edible, primary food species were consumed for medicinal purposes after migration. Bolivian and Peruvian migrants in London clearly proved to be resilient in their use of home-remedies when faced with the changes that come with migration. The observed ethnobotanical coping strategies are characterised by: (1) the preservation of culturally salient species (cultural key stone species); (2) a positive influence of the presence of cultural diversity (cultural edge effect), (3) a creative blending of different kinds of knowledge and resources, noticeable in an increased use of dried, processed alternatives and food species; and (4) a reliance on social networks for the exchange of plant material. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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              Public health research and lay knowledge

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                Author and article information

                Contributors
                madamonteban@gmail.com
                valeriayucravelasquez@gmail.com
                benedictayucrav@gmail.com
                Journal
                J Ethnobiol Ethnomed
                J Ethnobiol Ethnomed
                Journal of Ethnobiology and Ethnomedicine
                BioMed Central (London )
                1746-4269
                20 November 2018
                20 November 2018
                2018
                : 14
                Affiliations
                [1 ]ISNI 0000 0004 1936 738X, GRID grid.213876.9, Department of Anthropology, , University of Georgia, ; Athens, USA
                [2 ]ISNI 0000 0001 1945 2152, GRID grid.423606.5, Scientific and Technical Research Council (CONICET), ; Buenos Aires, Argentina
                [3 ]Asociación ANDES, Street Ciro Alegria H-13, Urb. Santa Monica–Wanchaq, Postal Nº 567, Cusco, Peru
                [4 ]4600 S.S. de Jujuy, Argentina
                Article
                271
                10.1186/s13002-018-0271-2
                6245876
                30458832
                3325d4b9-f9d3-46b7-a4d5-123ba2a0fab1
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                andes,infant feeding,breastfeeding,ethnomedicine,intercultural health,public health

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