Introduction

The social programs with a focus on food are strategies for the nutritional development of the population (^{Ruel and Alderman, 2013}). Each one addresses particular problems; however, the primordial objective is food security (^{Godfray et al., 2010}). Their creation takes place because of various reasons: to control or reduce an increasing problem, to fulfill a public policy, to evidence public spending, among others (^{Miller et al., 2012}; ^{Mishra et al., 2013}). The reason why these programs are created defines the impact on the target population, as well as the methodology employed for the design and implementation of the program.

In the methodological process of a social program, the stage of planning is the phase that contributes most to the final impact (^{Alberich et al., 2014}; ^{González et al., 2014}); therefore, if there are problems during this initial phase, the probabilities of having low effectiveness of the program increase. Among the problems caused by bad planning, there are: reduced and ill-assigned supports, design problems, lack of geographic focalization, confusion of objectives, multiplicity and superposition of programs (^{Barquera et al., 2001}; ^{Alcázar, 2007}); as consequence, the country’s economy where this type of ill-designed programs are implemented is affected negatively (^{De la Cruz, 2013}). This marks the need for the design and planning of programs that increase their effectiveness at the time of their implementation (^{Rivera-Dommarco et al., 2013}).

The knowledge of the food culture of a region can be a key element in the planning and effectiveness (^{Vilaplana, 2011}) of the social programs designed to improve the nutrition of the target population, since through its knowledge errors in execution during the application of the program can be prevented and its effectiveness could increase. The food culture is understood as the uses (luxury, pleasure), traditions (religion), customs (social status, social interaction), and symbolic elaboration of foods (^{Marín et al., 2004}; ^{Vilaplana, 2011}), and where the productive cycle of the foods from the context in particular also has an influence. The food culture can be understood through a situational diagnosis, which is a basic stage in the planning of strategies or programs (^{Quintero et al., 2014}), since it clarifies regional problems and allows discerning possible solutions.

Currently there are many food programs in México, whose planning is based on factors different from the food culture and local resources. Examples of these programs are microcredits (^{Medina and Florido, 2010}), provided to the majority of people without specific characteristics; the national Prospera program, which provides uniform and conditioned monetary resources (^{DOF, 2013}); the National Program “México sin Hambre” 2014-2018 is based on social participation, interinstitutional and intergovernmental, and territorial coordination, productive approach, innovation and coverage strategy (^{DOF, 2014}); in addition, other programs that are included in the Crusade against Hunger (Cruzada contra el Hambre, designed and implemented to promote food security) are the Oportunidades Human Development Program (Programa de Desarrollo Humano Oportunidades, PDHO, 2002-2014), the Food Support Program (Programa de Apoyo Alimentario, PAL, 2003 to date), the Milk Social Supply Program (Programa de Abasto Social de Leche, PASL, 1944 to date), and the Rural Supply Program (Programa de Abasto Rural, PAR, 1980 to date), which only consider age, vulnerability, income and number of inhabitants (^{SEDESOL, 2012}).

These are some of the outstanding programs in the country in terms of coverage; however, it has been proven that they do not attain the results expected in every case. ^{Gutiérrez et al. (2012)} report in the ENSANUT 2012 a decrease of child malnutrition; nevertheless, at the regional level Oportunidades achieved “a very limited impact” on the decrease of malnutrition (^{García-Parra et al., 2015}). In another case, ^{Gertler (2004)} observed a positive effect in the health of children from seven states of the Mexican Republic; however, there is no evidence of whether the cause of this effect was the monetary benefit or the change in behavior of the beneficiaries. The increase of food poverty has also been observed despite the Oportunidades program (^{Bracamontes et al., 2014}).

Even when there is little information about the evaluation of food programs, what is true is that malnutrition prevails; according to the last Survey on Health and Nutrition 2012 there is a national prevalence in children younger than five of low weight (2.8%), small size (13.6%) and emaciation (1.6%) (^{Gutiérrez et al., 2012}). The information available about the planning and design of the programs which support the increase in its effectiveness is insufficient and inadequate; likewise, there is a very limited number of strategies and programs that prioritize the regional characteristics and the food culture. For this reason, it is necessary to generate information about the importance of the food culture in the implementation of a social program that promotes food security.

The objective of this study was to provide an alternative in the design and the planning of social programs with a focus on food that contributes to increasing their effectiveness. In the information presented in this study, the population’s food culture, productive activities and local resources were taken as key elements. The municipality of study has certain characteristics that can be similar to other zones; therefore, this innovating alternative can also be implemented in other areas. The ultimate purpose is to contribute to the increase of positive impact of new nutritional programs or strategies in rural areas³.

Methods

Location and characteristics of the study region

The research was performed in the municipality of Tochimilco, in the state of Puebla, México, specifically in three localities that belong to the amaranth producing zone (Amaranthus hypochondriacus L.). Tochimilco is located in the center-west of the state of Puebla, between parallels 18° 50’ and 19° 02’ N and the meridians 97° 18’ and 97° 27’ W. It neighbors with the state of Morelos and the municipalities of San Nicolás de los Ranchos, Atlixco and Tianguismanalco (Figure 1) (^{SEDESOL, 2011}). This municipality has a total surface of 233.45 km² and has 17, 028 inhabitants (^{INEGI, 2010}). Within this region, altitudes range from 1800 to 5500 masl. Of the surface, 44% is used for agriculture and only 3% is urban. Of the vegetation, 43% is pine forest in its majority and pine-oak in a lower percentage (^{SEDESOL, 2011}).

Figure 1 Location of the communities of study. 

The main economic activity is agriculture. It occupies the second place at the national level in amaranth production, only after Cuapiaxtla, municipality in the state of Tlaxcala. In 2014 the municipality’s production was 1095 t and its average yield was one t ha^-1 (^{SIAP, 2014}).

The municipality is made up of 24 localities, of which three are urban and 21 rural. The study was carried out in three communities, classified, according to ^{SEDESOL (2013)}, as two rural ones and one urban: Santiago Tochimizolco (C1), San Miguel Tecuanipa (C2) and La Magdalena Yancuitlalpan (C3), respectively. The population is 747 inhabitants in C1, 1378 in C2, and 2210 in C3. Magdalena Yancuitlalpan is classified by ^{SEDESOL (2013)} as an urban zone; however, it has characteristics, such as the predominantly agricultural land use, which make it be considered as rural population (^{Estrada, 1992}). The three localities have a high degree of marginalization and medium social backwardness (^{SEDESOL, 2013}). According to CONAPO (2010) and CONEVAL (2010) it refers to the lack of opportunities for development and to social scarcities (aspects of education, housing and services) that the localities have.

Results and Discussion

Through the semi-structured survey, characteristic features of the population of the female heads of family from the three communities were identified. In general quite similar mean values are seen between communities. In Table 1 the general characteristics of the population which was surveyed are presented. The population that participated, in average, is in the stage of young adult, with high school studies, and currently devoted to household chores; therefore, around 100 % are responsible for the diet of their family nucleus. In terms of the economy, most of the families receive a monthly income of less than $1000.00 MX pesos, from paid work activities, although the family income is complemented by government backing obtained through different programs; likewise, it can be seen that there are families that obtain higher income. The families from the three communities are of low resources and low academic training compared to the state mean, which is 8.5 years. It is possible to highlight that the social characteristics are highly similar among the survey respondents of the three communities.

Figure 2 shows the dendogram through which three groups formed with interviewees from the three communities of study are identified. Groups 1, 2 and 3 were made up of 30, 19 and 25 survey respondents. When performing a multivariate variance analysis, significant differences were found between the groups identified (data not shown), contrasting with the descriptive analysis in which marked differences were not observed in the general characteristics. This can be because in the multivariate variance analysis groups were compared based on a higher number of variables than in the descriptive analysis. The average number of members in the family nucleus of the three communities is five people and the presence of preschool and school age minors is two to three children per family unit. According to the information obtained in the 74 surveys it was found that there are 42 children younger than 12 in Santiago Tochimizolco, 37 in San Miguel Tecuanipa, and 62 in La Magdalena Yancuitlalpan, which gives a total of 141 minors who are at risk of enduring some type of malnutrition in any of its two aspects: undernourishment or obesity. Despite it being a rural zone, the average family is not very numerous, so that the minors can be tended to with greater care in the nutritional aspect; in this sense, the female head of family is who takes on this responsibility.

*TEC: San Miguel Tecuanipa; YAN: La Magdalena Yancuitlalpan; TOCH: Santiago Tochimizolco; E: Number of survey.

Figure 2 Groups identified with the 74 families in three localities of the municipality of Tochimilco, Puebla, México. 2015. 

The group formation in the dendogram was determined basically by the variables related to amaranth production and to the frequency of weekly consumption of the foods considered in the study. Three groups were formed at a distance of 0.1 of r-square. The groups that were established according to the surface and annual production of amaranth from each family, which were classified as low, medium and high amaranth production, based on the average yield per surface unit of amaranth; the lowest was 240 kg ha^-1 and the highest 4000 kg ha^-1. Group 1 is made up of families with low amaranth production, which have been producing it 4.8 years in average, in contrast with Group 2, whose production is high and have cultivated it 7.6 in average; finally, Group 3 is of medium production. In terms of the frequency of consumption of the foods, Groups 1 and 2 present very similar averages; instead, Group 3 is more complete and balanced, since it consumes healthy foods like vegetables, fruits, dairy, cheese and amaranth, with higher frequency.

The grouping of family units, based on characteristics related to the general aspects of the families and the consumption patterns of foods, can allow a better approach directed at the moment of designing strategies of nutritional improvement for the rural populations. In addition, with the principal factors analysis it is possible to identify the most outstanding ones that influence the diet and their relation with the most important variables or indicators, on which to focus the attention of the programs for nutritional improvement.

The information analysis in this study indicates a contradiction with the literature related to the characteristics of the rural and urban zones. ^{Pineda (2012)} observed that the gaps between these translate into inequality and maintain poverty; however, in this study it was found that the three communities where the study took place, two rural and one urban, had similar results in terms of general aspects of the family units and their characteristics, which allowed the formation of family groups based on their similarities (predominantly rural livelihoods), regardless of the community where they reside and the classification, rural or urban, that they have been given; these results are similar to those by ^{Urzúa et al. (2013)}. The variations that were found within the families were not necessarily because of their zone, but rather due to other factors: characteristics of the families, such as number of children, and frequent foods in their diet. These must be taken into account in the planning of a social program. These results would justify elaborating a social program with a punctual and exclusive focus on food for the region, which in addition could be of high impact and effectiveness, not only in the municipality, but also in the amaranth producing zone of the state. However, it should be mentioned that what is advisable is to have an anthropometric diagnosis and an initial clinical one to complement the information and which can be the basis for a more punctual and prolonged follow-up.

It was found that most of the families are beneficiaries of some social program with a focus on food; the programs identified that have been implemented in the municipality were: Programa de Desarrollo Humano Oportunidades (PDHO), currently PROSPERA, Programa de Apoyo Alimentario (PAL), Programa de Abasto Rural (PAR), and Pensión para adultos mayores. It can be said that due to its degree of vulnerability the region has governmental backing, nutrition strategies, and programs with a focus on food. Therefore, the people are used to belonging to a program, to complying with the requirements and to receiving support in kind or cash. However, the need for a better design and planning is made evident when the families, despite being beneficiaries of certain food programs, have a high degree of marginalization and medium degree of social backwardness (^{SEDESOL, 2013}). Likewise, the problem of child malnutrition remains valid since, despite the government supports, low weight (8.0 %) and low size (29.7 %) prevail in the rural zone among infants (^{Gutiérrez et al., 2012}), a group of age considered as vulnerable (^{Vio et al., 2011}). In this study a considerable number of possible beneficiaries was found, since there are two to three minors in each family, which means that a social program with a focus on food that centers its attention in this age group would significantly improve the low weight and the low size in the zone, even the standard of living of the families (^{León-Corona, 2011}).

Rural populations are changing their livelihoods as there are factors that influence the depeasantization (^{Hocsman, 2014}), a phenomenon attributable, among other causes, to migration, commerce and employment in other zones; however, this is not as evident among the population of the municipality of Tochimilco, for it was found that the prevailing livelihood in the municipality is agriculture, activity in which most of the members of the family nucleus are involved. The five most important crops were maize, bean, amaranth, avocado and broad bean. Of the survey respondents, 85 % answered that they produce maize and that the production is destined basically to auto-consumption. All (100 %) sow white maize out of custom, taste and higher probability of sale. In terms of amaranth, 78 % of the families said they produce it, in average, since eight years ago.

Although there is low, medium and high amaranth production, the differences are not great; most of the production volume obtained is for sale to intermediaries, primarily, which represents a source of economic income for most of the families. Amaranth is the third crop in importance in the municipality and it is predominantly for the family economy, since in the state of Puebla it has higher profitability than in other states ($5895.6 t^-1), according ^{Ayala et al. (2013)}. In the municipality of Tochimilco, just as in the rest of the country, maize is the main crop for the region and the basis of the family diet (^{Fernández et al., 2013}); both maize and amaranth are of high quality in the nutritional aspect, since they contribute energy and essential amino acids (^{Aguilar et al., 2015}), necessary for vital physiological activities.

Amaranth is an available resource with high nutritional quality and the combination of it with another food could be a key element for the development of a food program that contributes to family nutrition. The limiting factor is that the population does not take amaranth into account to incorporate it to its daily diet and is only considered as a desert that contributes a high content of simple carbohydrates. It was observed that 66 % of the survey respondents consume amaranth in the form of atole (beverage), alegría sweets, and pancakes, but most only do it once a month; that is, amaranth is not a part of the habitual diet of Tochimilco inhabitants. Table 2 presents the main reasons why amaranth is not part of the family diet in this municipality. The lack of information of the female heads of household is relevant, since the main reason why it is not consumed as part of the regular diet of the family in three of the communities was they did not know how to prepare it. The results showed that the lack of knowledge of traditional amaranth cooking by those in charge of the family diet, of new dishes and alternative ways of cooking it, influence the consumption of this pseudo cereal in the study region, even when it is a resource that is available locally and which, therefore, is economically accessible.

In the population group studied, the female heads of family are the ones in charge of the family diet, just as was found in previous studies (^{Restrepo and Maya, 2005}); according to the classification by ^{Kotler & Lee (2008)}, the female heads of family participated as the target audience of secondary type, since they influence the primary audience: the children. Therefore, they have a higher possibility of influencing their children’s nutrition, although they must be informed in order to be agents of change in the lifestyle. ^{Galván and Atalah (2008)} observed that the female heads of family’s schooling is highly linked to the diet of the minors, since the higher degree of studies the better knowledge they have about the diet and family health. In this study we can lean on this explanation to understand that the low use of food resources of high nutritional value such as amaranth and the prevalence of a diet deficient in vitamins, minerals, and proteins of high biological value (Figure 3) is probably linked to the low educational level of the female heads of family; it can be inferred that they are disconnected from knowledge outside of the locality and, because the studies are carried out within the municipality, the population has limitations to gain access to the information from other instances.

†Classification proposed by NOM-043-SSA2-2012.

Figure 3 Frequency of weekly consumption per food group of the families in Tochimilco, Puebla, México. 2015. 

The instrument Frequency of Consumption helps to discover food deficiencies and needs of the population. When applied in this study, the weekly mean consumption of foods in the population of Tochimilco was identified, specifically of preschooler and school children, shown in Figure 3. In it, the foods and dishes classified according to the food model of the Plato del Bien Comer, divulged in the Norma Oficial Mexicana 043 (NOM-043-SSA2-2012), are presented; this model classifies the foods by colors according to the recommended level of consumption. It was observed that the foods of animal origin are not part of the patterns of food consumption of the families in the municipality of Tochimilco, and, as consequence, these do not reach the recommended content of proteins and energy, which is corroborated by ^{Navarro-Meza et al. (2014)}. The beef, pork, chicken, cheese and egg intake was limited to less than three days per week and dairy to less than four times per week, which is why it is necessary to cover this deficiency present in the habitual diet of the target population. The results indicated that, on the one hand, the family diet lacks vitamins, minerals and proteins of high biological value and that, on the other hand, it is based on the consumption of complex and simple carbohydrates, and is scarce in proteins of plant origin from beans. It was determined that the group of highest consumption was the yellow one; tortilla is the most highly consumed food by the families and for this reason it becomes a key element for the implementation of a program to increase protein intake, especially essential amino acids (^{Juan et al., 2007}). Maize tortilla is the base of the daily diet, and it is consumed during many moments during the day. Because most of the population sows it, this crop becomes a locally available resource and of easy access for almost all the families in the study area.

It is necessary to highlight that the families have direct access to two crops rich in different essential amino acids, so they are a potential source of proteins of high biological value that contribute to eliminating malnutrition. The amaranth grain reaches high levels in some amino acids, compared to the ideal protein, whose values are shown in Table 3.

Likewise, through the results it was observed that fruit and beans belong to a local food culture and that they are the two foods with higher relevance after tortilla, since they are consumed three to five days per week; due to the frequency of consumption, both can be enriched with amaranth to increase their nutritional value. Adding amaranth to the fruits, in addition to being a source of fructose, would potentiate the quality of essential amino acids. If these three foods were enriched with amaranth and incorporated to the regular diet of the population in the municipality of Tochimilco, or of similar localities in the region, they would obtain the nutritional benefits of amaranth, without necessarily modifying the intake of dishes that they are used to.

When the principal factors analysis was carried out, it was found that the first three factors explained 63 % of the total variation of the data. The explicative variables are presented in Table 4. In order to establish the determination of the principal factors with the original variables, an absolute value higher than 0.4 was taken into account in the coefficients derived from this analysis (without any rotation). According to this, factor 1 was related to the weekly frequency of consumption of some of the foods available to people, as well as to the variable related to the time that it takes them to produce amaranth. Factor 2 is related to the members of the family unit, who at the same time represent the potential beneficiary population of nutritional development strategies; finally, factor 3 is related to the minors who are members of a family unit and to the weekly consumption of proteins of plant origin that are important in the region: beans.

The understanding of these factors would ease the design, dissemination and implementation of a program with a focus on food, since it would be based on the local diet culture, in which amaranth and the benefits of its consumption could be adopted as part of the regular diet of the population in the study region, especially part of the diet of the minors. Likewise, the program could be of lower cost than the current ones, in addition to being more effective, since the necessary resources would be within the community, minimizing transport costs.

Conclusions

The precise knowledge about the food culture and the consumption patterns of families of the study region are determinant to identify the factors that allow improving the nutritional health of the population; the strategies and programs may be designed according to these factors to improve their effectiveness. It was found that amaranth is consumed marginally among families of the study zone despite being an available resource and of easy access, situation that can be solved with greater information, food orientation and technological training. Likewise, the local foods with highest use - tortilla, beans and fruits - may be a vehicle for amaranth to improve the quality of nutrition in the population.

Acknowledgement

We thank the municipal, auxiliary and educational authorities of the municipality of Tochimilco and the women for the support offered, time, trust, and valuable information contributed, especially the ladies Amelia Flores, Reyna Martínez and Gabriela Pérez. We thank Lic. Juan Velázquez for elaborating Figure 1.