In Peru, nearly half of children aged 6–36 months were diagnosed with anaemia in 2017. To address this disease, the Peruvian Ministry of Health implemented a national programme in 2014, distributing free micronutrient powders (MNPs) to all children of this age. However, rates of childhood anaemia remain high. The aim of this study was to explore factors at all levels of the Social‐Ecological Model that affect MNP use and adherence in Arequipa, an Andean city with childhood anaemia rates higher than the national average. We conducted in‐depth interviews with 20 health personnel and 24 caregivers and 12 focus group discussions with 105 caregivers. We identified numerous barriers, including negative side effects (constipation, vomiting, and diarrhoea), poor taste of MNP, lack of familial and peer support for its use, insufficient informational resources provided by the health system, and limited human resources that constricted health personnel abilities to implement MNP programming successfully. Facilitators identified included concern about the long‐term effects of anaemia, support from organizations external to the health system, well‐coordinated care within the health system, and provision of resources by the Ministry of Health. We found that community or organizational and societal factors were key to limited MNP use and adherence, specifically the limited time health personnel have to address caregivers' doubts during appointments and the lack of informational resources outside of these appointments. Potential policy implications could be to increase informational resources available outside of individualized counselling by strengthening existing collaborations with community organizations, increasing media coverage, and providing group counselling.

Negative experiences with health care providers or inconvenience at the time that micronutrient powder (MNP) use is initiated may discourage future MNP use. n Mental models about nutrition can shape intentions to use MNP, and having too many choices can confuse caregivers. n A single negative experience with MNP can form strong memories and discourage caregivers from giving MNP.

Background From 2014–2019, Latin America and the Caribbean had the fastest growth of moderate-to-severe food insecurity than any other region, rising from 22.9% to 31.7%. While the prevalence of food insecurity is higher among women than men in every continent, Latin America has the largest food insecurity gender gap. Factors contributing to this gender inequity include underrepresentation of women in formal employment, heightened burden of dependent care on women, and unequal compensation of labor for women vs. men. The objective of this study was to investigate the association between the gender of the head of the household, employment status of household members, and food insecurity in households with children in a low-income district of Lima, Peru. Methods This cross-sectional study was carried out in Villa El Salvador, the fifth largest district in Metropolitan Lima, Peru, where over 20% of the population lives in poverty. Data were collected on a stratified random sample (n = 329) using a household questionnaire, including a validated food security tool (HFIAS). We ran multivariate logistic regression models predicting household food insecurity, with independent variables including gender of household head, education of household head, employment of household head, household-level employment status, age, and weekly food expenses per person. Results In fully adjusted models, woman-headed households had almost thrice the odds of being food insecure compared to man-headed households. Education also had a significant effect size: a household whose household head did not complete high school was 3.4 times more likely to be food insecure than if they had some post-secondary education. Woman-headed households had a significantly higher proportion of members not formally employed, compared to man-headed households, but employment status was not associated with food insecurity. Conclusions Gender of the household head was a major contributing factor to household food insecurity in Villa el Salvador. Gender dynamics affecting opportunities for employment, education, and non-remunerated work should inform national food security policies and interventions with the goal to not only lower food insecurity, but also reduce gender inequities in food insecurity and other nutritional outcomes.

The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use – FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.

• Premise of the study: Rhizopogon kretzerae and R. salebrosus (Rhizopogonaceae) are ectomycorrhizal fungi symbiotic with pines and the mycoheterotrophic plant Pterospora andromedea (Ericaceae). Microsatellite loci will allow population genetic study of fungal hosts to P. andromedea.• Methods and Results: Shotgun pyrosequencing of R. kretzerae DNA resulted in primer development of 23 perfect microsatellite loci and screened across two populations each for R. kretzerae and R. salebrosus. Twelve loci were polymorphic in R. kretzerae populations, and 11 loci cross-amplified in R. salebrosus populations. For R. kretzerae and R. salebrosus, number of alleles was one to eight and one to nine, respectively, and observed heterozygosity ranged from 0.00–0.57 and 0.00–0.70, respectively.• Conclusions: These are the first microsatellite loci developed for any species within Rhizopogon subgenus Amylopogon. These microsatellite loci will be used in conservation genetic studies of rare to endangered eastern populations and to compare plant and fungal population genetic structure at different hierarchical levels.

Objectives The purpose of this study is to assess the perceived role of food assistance programs (FAPs) in the development and prevention of overweight/obesity (OW/OB) in two low-income districts of Lima, Peru and analyze how these perceptions have changed across time. Methods In 2009, we conducted focus groups with FAP beneficiaries and in-depth interviews with FAP administrators (N = 34) from three common FAPs in two low-income districts of Lima, Peru. These data captured participants’ perceptions of OW/OB and their recommendations to address them. We conducted grounded theory analysis on this dataset to identify dominant themes and structure a second round of data collection. In January-February 2021, we are conducting in-depth interviews with FAP beneficiaries and administrators from the same programs and districts (current N = 16, expected N = 36). We will conduct grounded theory analysis on the second dataset and cross-analyze the two datasets to measure differences and similarities. Results In 2009, nearly all FAP beneficiaries and half of FAP administrators identified OW/OB as a public health problem in their community. They expressed need for more nutrition education, potentially through FAPs. Most FAP administrators and some beneficiaries also recommended offering healthier food in one particular FAP (Community Kitchens). Preliminary results from 2021 reveal that nearly all FAP beneficiaries and administrators perceived OW/OB to be a problem in their community. Educational resources about OW/OB were limited and participants continued to recommend increased outreach, potentially through FAPs. Most beneficiaries of Community Kitchens cited the need for healthier food options. Conclusions From 2009 to 2021, more FAP beneficiaries and administrators perceived OW/OB to be a problem in their communities; however, resources to address this problem remained limited. Our findings suggest the need for increased nutrition education through FAPs and adjustments to foods available in specific FAPs. Funding Sources Tulane University.

Objectives To examine the association between food insecurity – the inability to acquire adequate nutritious foods due to economic constraints – and perceptions of food accessibility, quality, and variety in one's neighborhood in a low socioeconomic district of Lima, Peru. Methods A household survey was conducted among randomly selected households with at least one child <18 years of age in Villa El Salvador (Lima, Peru; N = 329). The language-validated questionnaire included questions from the Perceived Nutrition Environment Measures Survey (NEMS), which were adapted to the local setting and translated into Spanish. These NEMS questions assessed perceived accessibility, quality, and variety of foods in the neighborhood of residence on a Likert scale (e.g., 1 = completely agree to 5 = completely disagree) and were later dichotomized for analysis. The questionnaire also included the Household Food Insecurity Access Scale (HFAIS), to measure food insecurity. Multivariable logistic regression was used to assess the association between the perceived neighborhood food environment and food insecurity, adjusting for sociodemographic variables. Results About 77% of the households reported having food insecurity. Adjusting for age, gender, and education of the homemaker, food insecurity was associated with perceptions of decreased accessibility to fresh fruits and vegetables (OR = 5.05; 95% CI = 2.03–12.60) and low-fat products (OR = 2.07; 95% CI = 1.18, 3.65); low quality of fresh fruits and vegetables (OR = 3.28; 95% CI = 1.84, 5.86) and low-fat products (OR = 2.13; 95% CI = 1.22, 3.73); and a low variety of fresh fruits and vegetables (OR = 2.62; 95% CI = 1.43, 4.79) in the neighborhood. Conclusions Food insecure families living in a low-income district in Lima, Peru share negative perceptions of access, quality, and variety of food in their surrounding neighborhood. Efforts to improve the availability of affordable healthy foods in low-income neighborhoods in Lima may help ameliorate food insecurity. Funding Sources This work was supported by the National Institute on Minority Health and Health Disparities’ Minority Health and Health Disparities International Training Grant, the Fulbright U.S. Student Program, and the Carol Lavin Bernick Faculty Grant Program (Tulane University).

The objective of the present study was to assess the association between the observed and perceived food environment and food insecurity among households with children <18 years in Lima, Peru. This was a cross-sectional study including an income-stratified random sample of households (n 329) in Villa el Salvador, a low-income district in Lima, Peru. Data were collected with a household questionnaire – including the Household Food Insecurity Access Scale (HFIAS) and the University of Pennsylvania's Perceived Nutrition Environment Survey (NEMS-P) – and a neighbourhood food outlet census, including recording of food outlets’ GPS coordinates. Three-quarters of the households interviewed were food insecure. Compared with food secure households and adjusting for socio-demographic covariates, food insecure households were more likely to disagree to having easy access (OR 5⋅4; 95 % CI 2⋅1, 13⋅4), high quality (OR 3⋅1; 95 % CI 1⋅7, 5⋅5) and variety (OR 2⋅5; 95 % CI 1⋅4, 4⋅6) of fresh fruits and vegetables in their neighbourhood. About 60 % (513 out of 861) of the food outlets identified in participants’ neighbourhoods were classified as fresh, including markets, bodegas, and fruit and vegetable vendors. There was no difference in distance to fresh food outlets by household food insecurity; all households were on average within 52–62 m from a fresh food outlet (~2-min walk). Despite negative perceptions of their neighbourhood food environment, food insecure households had similar physical access to fresh food sources than their food secure counterparts. Thus, changes to the food environment may not alleviate food insecurity in urban poor areas of Peru.