Facilitators and barriers to anemia prevention in the urban government childcare program for infants and young children in Peru.

Background: Anemia is a major public health problem in children under 2 years old in Peru and other low- and middle-income countries.

Objectives: We aimed to explore facilitators and barriers to anemia prevention through feeding strategies in the Cuna Mas day-care centers in urban Peru among infants and young children (IYC) aged 6-23 months.

Methods: Qualitative research in day-care services (n = 14) in Peru. We conducted direct observations and semi-structured interviews about consumption of animal source foods (ASF) and iron supplementation with day-care staff (technical managers, nursery caregivers and 'mother guides') and caregivers of IYC. We applied a grounded approach to data analysis.

Results: Cuna Mas staff facilitated ASF consumption by introducing small portions of iron-rich foods and serving organ meats in tasty stews. Staff also avoided giving carbohydrate-rich foods to IYC prior to giving organ meats. Staff facilitated giving daily iron supplement by using standardized and personalized strategies, such as using a timed reminder, praising and cheering a child or giving supplements whilst washing a child's hands and face. These strategies were also shared with primary caregivers to use at home. Some barriers reported by caregivers included difficulties in accessing and preparing specific ASF at home.

Conclusion: The Peruvian Cuna Mas complementary feeding program facilitated consumption of iron-rich ASF and iron supplements through a range of strategies which they then shared with caregivers for implementation at home. These institutional behavioral change initiatives could be replicated in other settings whilst considering the facilitators and barriers identified in this study.