Malnutrition among infants is a public health problem in developing countries. Ecuador is one such South American country, in which stunting due to malnutrition affects nearly 25% of children younger than 5 years of age. In order to address this problem, the Lulun Project (lulun meaning "egg" in Kichwa, an indigenous language) was introduced in 2015 in the province of Cotopaxi, Ecuador, a region that had a high prevalence of stunting (Gallegos-Riofrio et al., 2018: Waters et al., 2018). The goal of the project was to introduce the consumption of eggs in infants 6 to 9 months of age using a social marketing strategy targeted at caregivers. The effectiveness of the project was then tested through a randomized controlled trial (RCT). The social marketing approach used six strategies: (1) gaining the trust of mothers/caregivers; (2) negating project identity and brand; (4) addressing perceptions of inequity; (5) promoting local empowerment; and (6) ensuring sustainability beyond project completion. The Ps of social marketing addressed in the project were as follows: the product for the infants in the intervention group was the consumption of one egg per day for 6 months, facilitated by their mother/caregiver. The place was five rural parishes in the province of Cotopaxi, which is located in the Andean mountains and consists of dispersed communities. The price entailed the costs associated with project activities, instruments, and physical and intellectual inputs of the project staff. The promotion included the communication plan (message design and channel selection), implementation of campaigns, and branding (establishing the project identity through a name, mascot, pymbols, and design). Finally, were made to relax the rules for were made to relax the rules for egg consumption among participants. The project (4) addressing perceptions of inequity; (5) promoting local empowerment; and (6) ensuring sustainability beyond project completion. The Ps of social marketing addressed in the project were as follows: the product for the infants in the intervention group was the consumption of one egg per day for 6 months, facilitated by their mother/caregiver. The place was five rural parishes in the province of Cotopaxi, which is located in the Andean mountains and consists of dispersed communities. The price entailed the costs associated with project activities, instruments, and physical and intellectual inputs of the project staff. The promotion included the communication plan (message design and channel selection), implementation of campaigns, and branding (establishing the project identity through a name, mascot, symbols, and design). Finally, policy changes at the local level were made to relax the rules for participants. The project demonstrated high compliance, low attrition, and policy change in infant feeding by Ecuador's Ministry of Public Health, which issued guidelines for introducing eggs early in complementary feeding. QUESTIONS FOR DISCUSSION 1. Do you think the project was successful? Why or why not? 2. Do you think this approach can be replicated elsewhere? What would be some of the barriers to implementing this approach in other areas? 3. Did the project apply the social marketing mix completely? Why or why not? 4. The project utilized a randomized controlled trial (RCT) to test the effects of the intervention. What are the pros and cons of such a design? 5. What are some challenges in working with rural mountainous communities that are dispersed in location (like the ones in this case study)? 6. What are some other complementary feeding practices that can be introduced to infants to prevent malnutrition? 7. How would you go about designing a social marketing campaign for a behavior of your choice to a target population of your choice? Gallegos-Riofrio, C. A., Waters, W. F
