ProPAN: Process for the Promotion of Child Feeding

Emory University, USA; Nutrition Research Institute, Peru; National Institute of Public Health, Mexico; and Pan American Health Organization, USA

October, 2003

ProPAN is a manual aimed at Ministries of Health, non-governmental organizations, and bi-lateral and international organizations interested in improving infant and young child feeding practices to prevent early childhood malnutrition. It describes a step-by-step process, which begins with the quantitative identification of nutritional and dietary problems, and also with the collection of qualitative information on why these problems occur, and ends with the design of and evaluation plan for an intervention to address the problems identified.

The key distinguishing feature of ProPAN is its comprehensiveness. It includes steps on how to collect, analyze, and integrate both quantitative and qualitative information, provides guidance on how to design an intervention, and reviews evaluation strategies. In addition, ProPAN contains software in an EPI INFO format (it will be available in this site shortly) developed specifically for the quantitative analysis of infant and young child diets. Other unique characteristics of ProPAN are as follows:

It leads to the identification of specific nutritional and dietary problems.
It allows for an understanding of the context in which these problems occur.
It presents a method for identifying, ranking and selecting practices to promote that are practical, feasible and accepted by the community and potentially effective if adopted.
It distinguishes between the practices that are to be promoted and recommended and the messages that are to be disseminated in an intervention.
It provides data collection forms in an electronic format.
It includes a module on monitoring and evaluation.
It has a focus on Latin America and the Caribbean though is likely to be suitable for other regions.
It addresses essential elements necessary to design and evaluate interventions to improve breastfeeding and complementary feeding.

The ProPAN manual consists of four modules. In Module I, quantitative and qualitative methods are applied to identify specific dietary problems, the practices that lead to these problems, and the context in which these problems occur. The quantitative methodologies that are used include a General Survey, 24-hour Dietary Recall and Market Survey. The qualitative methodologies include Opportunistic Observation, Mothers’ Semi-structured Interview and Food Attributes Exercise. A software package is provided to aid in the analysis of the dietary data required by Module I (it will be available in this site shortly); specifically, it serves to identify the key nutrient problems and the relative importance and cost of local foods as sources of these nutrients. Through Module I, users will be able to generate a list of potential practices and of foods and preparations that could be promoted to improve the feeding problems identified.

In Module II, users will be able to test the acceptability and feasibility of the potential practices and of foods and preparations identified in Module I through household behavior and recipe trials. The outcome of Module II will be the identification of feasible options for change, that is, practices that the community can and is willing to adopt and foods and recipes that it is willing to prepare and give to young children.

In Module III, guidelines are provided for the design of the intervention plan, to be crafted around the options selected in Module II. The steps recommended lead to the strategies, activities, materials, and messages that can promote the desired changes in practices.

Module IV involves the development of the monitoring and evaluation plan. It includes the design of indicators to monitor the impact of the intervention as well as the selection of appropriate evaluation designs. The grand outcome is, then, the joint implementation of the intervention plan and its monitoring and evaluation plan.