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Background Preventing infantile anaemia and ensuring optimal growth and development during early childhood, particularly in resource-constrained settings, represent an ongoing public health challenge. Current responses are aligned to treatment-based solutions, instead of determining the roles of its inter-related causes. This project aims to assess and understand the complex interplay of eco-bio-social-political factors that determine infantile anaemia to inform policy, research design and prevention practices. Methods This is a longitudinal birth cohort study including four components: (1) biological, will assess known blood markers of iron homeostasis and anaemia and stool microbiota to identify and genetically analyse the participants' flora; (2) ecological, will assess and map pollutants in air, water and soil and evaluate features of nutrition and perceived food security; (3) social, which will use different qualitative research methodologies to explore key stakeholders and informants' perceptions related to nutritional, environmental and anaemia topics, participant observations and a participatory approach and (4) a political analysis, to identify and assess the impact of policies, guidelines and programmes at all levels for infantile anaemia in the three regions. Finally, we will also explore the role of social determinants and demographic variables longitudinally for all study participants. This project aims to contribute to the evidence of the inter-related causal factors of infantile anaemia, addressing the complexity of influencing factors from diverse methodological angles. We will assess infantile anaemia in three regions of Peru, including newborns and their mothers as participants, from childbirth until their first year of age. Ethics and dissemination Ethical approval was obtained from the Institutional Research Ethics Committee of the Instituto Nacional de Salud del Niño (Lima, Peru), CIEI-043-2019. An additional opinion has been granted by the Ethical Committee of Queen Mary University of London (London, UK). Dissemination across stakeholders is taking part as a continues part of the research process. © Funding This project is supported by the Medical Research Council—MRC grant number MR/S024654/1 and by the Fondo Nacional de Desarrollo Científico, Tecnológico y de Innovación Tecnológica—FONDECYT, grant number 033-2019. AJP is funded by the Wellcome Trust (108065/Z/15/Z).

Systematic and persistent discrimination against Indigenous Peoples translates into differential health outcomes when analysed through ethnicity and/or mother tongue.1 In Peru, morbidity and mortality rates among Indigenous Peoples for COVID-19 appear to confirm this.2 The COVID-19 pandemic has highlighted the historical structural violence against Indigenous Peoples that currently takes a disproportionate toll in the Peruvian Amazon. This equally applies to Indigenous Andean Peoples and Afro Peruvians. Indigenous Peoples in voluntary isolation and those in initial contact are at highest health risk in this pandemic as they have no previous immunity against common infectious diseases, and lack access to public healthcare services. The Peruvian government introduced a state of emergency early on, but it did not work as theoretically expected because of the deeply rooted inequalities in Peru. Public policies focused on reducing health inequities affecting Indigenous Peoples in peri-urban Amazonian contexts are urgently needed.3 Essentially, Indigenous Peoples (through their legitimate representatives) ought to be incorporated in the planning, monitoring, implementation and evaluation of those public policies to ensure sustainability, equity and inclusion in the short, medium and long run. It is also urgently necessary to rethink Peru’s health system to ensure it has an intercultural approach, designed for and with Indigenous Peoples in terms of prevention, treatment and access during and beyond the pandemic. An intercultural approach to healthcare implies that health services not only respects indigenous medical practices but promotes and enables joint and complementary interactions between biomedical and indigenous medical approaches to prevent and treat healthcare problems.4 In the last 15 years, Peru has produced more than 10 official documents on intercultural health, but very little of this has turned into practice. The problem is not the lack of an approach, as such, but the incapacity to turn it into practice. Transforming the current …

This paper examines the relationship between children's theoretical knowledge of wild food plants in relation to sociocultural group, sex, and age in the context of social and environmental change. Theoretical knowledge was assessed by evaluating the composition of the cultural domain of “wild food plants,” naming ability, and cognitive salience. Freelistings were conducted with 57 Indigenous Shipibo-Konibo children and 57 mestizo children in Ucayali, one of the regions with the highest deforestation rates in the Peruvian Amazon. A total of 120 plants were listed by all children, with 72 listed by Indigenous and 95 by mestizo children. Most species listed as wild food plants have been classified as domesticated species by scientists. The main factor affecting variation in children's theoretical knowledge was sociocultural group. Mestizo children included more introduced crops in their lists, whereas, for Indigenous children, the most salient species were those that required specific abilities or knowledge to be consumed. Older children presented statistically significant longer lists than younger children, but there were no statistical differences in list length in relation to sex. We conclude by discussing the definition of “wild” versus domesticated plants and the effect of socioecological change on children's ethnobotanical knowledge as the landscape transforms in the forest-agriculture interface.

This study aims to improve the health of rural Amazonian communities through the development and application of a participatory ecosystem approach to human health assessment. In the study area marked seasonal fluctuations dictate food availability, water quality and disease outbreak. Determining the causal linkages between ecosystem variables, resource use and health required a variety of forms of inquiry at multiple scales with local participation. Landscape spatial mapping of resource use demonstrated the diversity of the ecological resources upon which communities depend. Household surveys detailed family and individual consumption and production patterns. Anthropometric measurements, parasite loading, water quality and anemia levels were used as indicators of health status. This was complemented with an ethnographic and participatory health assessment that provided the foundation for developing community action plans addressing health issues. Discussion is focused on three attributes of an ecosystem approach; (a) methodological pluralism, (b) cross-scale interactions and (c) participatory action research.