Meanings and Practices of Swaddling (qillpu) in Infant Care in Andean Communities

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for this article that addresses an interesting topic as well as the growing conflict between traditional practices and western medical considerations that is translatable to many other parts of the world. 

Since I'm a specialist of neither the Latin American world nor childcare practices, my comments will be reduced to the methodology and scientific quality of this article. From this point of view, I believe that this article is not mature enough to be published.

The topic as such is interesting and tackles important issues. The collected data also seems valuable, providing interesting insights into indigenous perceptions of this practice and reactions to criticism by allopatic practitioners. But the reflection and structure are highly insufficient. 

The only parts of the article that contain a sound scientific structure with an easy-to-follow line of thought are the abstract and the discussion in point 4. All that comes in between reads like a piling up of ideas that are improperly articulated, come back and forth with plenty of repetition and redundancy, beating around the bush and paraphrasing the same ideas without a proper linking to each other. There are plenty of different directions of analysis that would all for themselves be worthy of developing in this article, but as of now, they are not used in a constructive and logical way.

I also felt quite puzzled about the use of quotes that are often too general to be of any value for the author's argument, some even remote from the topic at hand, and others simply unfitting. None of these quotes are properly introduced, which prevents them from providing a constructive add-on to the text. There is also a frequent paraphrasing of the quote as sole comment, which is obviously not satisfactory. I suspect that improper translation from Spanish to English might also contribute to obscuring their meaning.

I also noticed in several interview quotes an improper presentation of original text vs translation - this should definitely be corrected.

I have added plenty of comments in the text itself. See doc. 

 

 

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Needs to be improved. Many sentences/word choice obscure, with improper formulations. Connections between sentences not easy to make out.

Author Response

We sincerely appreciate the observations provided; the comments throughout the text were very encouraging and helpful for its improvement. The material has been fully revised in accordance with the suggestions received; however, some passages have been retained because we consider them important and well-founded, as outlined below.

48–50: The chumpi is also used by adults to help maintain an upright body posture; moreover, it comes in different sizes depending on its use.

54–56: The objective of the research is explicitly stated in this section.

143–144: The qillpu consists of wrapping the body while bringing both hands together; peasants often say that “the hands must be tied,” meaning that they remain close to the body before proceeding with the wrapping.

149–154: The quotation is correct, and the Quechua language is retained, since in Peru and in other parts of Latin America it is an official and commonly used language. There are interviews conducted entirely in Quechua, and illiteracy among adults still persists, which further justifies preserving the original form.

214–218: The quotation is necessary because local people refer to Quechua as runasimi and request to be addressed in their own language, which is fundamentally oral and does not have a standardized written tradition.

223–225: We consider this point important due to the existing fear of health professionals, who have historically been accused of failing to modernize child-care practices in rural contexts.

251–253: This aspect is relevant because the practice of wrapping newborns is of precolonial origin.

311–312: An initial stage of interculturality is indicated here, since in Peru there is a strong emphasis on this approach, beyond its purely theoretical formulation.

319: It is associated with good luck; in Andean culture, this is interpreted as an indicator of good health.

330–332: The quotation is correct.

344–346: This point is necessary because nurses attempt to explain to mothers, from the perspective of contemporary science, how a healthy child develops, drawing—at least at the theoretical level—on the most advanced scientific knowledge.

Reviewer 2 Report

Comments and Suggestions for Authors

Introduction

The introduction establishes an ethnographic research entry point by presenting qillpu as an enduring infant care method which exists in the Andean highlands of Ayacucho and that which defines the practice through specific time limits between birth and the first year of life. The text establishes the Andean method of childrearing as a communal practice while showing how urban migration maintains traditional practices of caregiving through which health practices transfer between different social environments. The section needs to develop a clearer understanding of its research problem and specific academic contributions because it serves as the opening section for a journal article which studies how social factors impact health and well-being. The narrative presents an immediate transition from describing customs and high-altitude growth issues and the protective reasons for chumpi to an objective statement. The study investigates two research areas which exist between Andean Indigenous childcare literature and its explanation of meanings risk embodiment and institutional encounters whereas the study applies a medical anthropology and intercultural health governance and social representations and embodied relational care models as its research framework.

The study of "tensions" between biomedicine and ancestral wisdom because families who practice both systems can choose to follow medical guidance according to their ancestral knowledge brings value to the research but suffers from lack of specific details which need to be displayed through three particular elements because both relationship conflicts and authority disputes between mothers and grandmothers and clinicians need to be established and the parties need to negotiate three essential conflicts which include developmental standards and abuse definitions and risk assessment methods. The Introduction includes material which does not relate to the main topic which is presented through the adult use/clothing testimony because it needs to be rewritten to support the argument which connects to the symbolic economies of textiles and protection or it should be moved to another section. The research questions need to be stated clearly through an explanation of all research objectives while the study requires definition of essential terms which include conventional medicine modernity and comprehensive care strategy. The research study will benefit from these improvements because they will help to establish better connections between the theoretical framework and the forthcoming "intercultural dialogue" section which will explore ancestral knowledge and biomedical methods.

2. Materials and Methods

The Materials and Methods chapter presents a suitable ethnographic research method which includes two natural research settings (weekly markets and "Mothers' Clubs") and combines these with in-depth interviews and participant observation to study the cultural understanding and daily activities of qillpu through local perspectives. The research design description needs better definition because it shows three important gaps which include missing details about sample size and recruitment methods and selection criteria and participant demographics which include mothers' age and parity and community of residence and language dominance and the collection methods and time spent on interviews and observations and the procedures used to choose field sites. The study states its use of interpretive analysis yet fails to explain its execution by not showing whether the coding process followed inductive or deductive methods and how the researchers developed and improved categories and the research materials used along with the methods of researcher discussions and negative case evaluations.

The bilingual data collection represents a strong point of research because the researchers speak Quechua and they focus on maintaining spoken language. The translation process needs more precise standards which should describe whether interviews were recorded and whether the Quechua transcription process preceded the Spanish and English translations and which methods were selected to prevent semantic loss and linguistic interference through back-translation and translator triangulation and participant verification processes that control semantic loss. This section provides insufficient ethical reporting because it notes consent at a later time yet requires short details about Quichua informed consent procedures and small community confidentiality measures and sensitive account management which includes near-suffocation episode reporting to appear in the Methods section. The section presents supplementary material without describing its contents and without showing its connection to establishing methodological trustworthiness. The section needs both active reflexivity through researcher positionality and participant relationship disclosure and their methods for managing biomedical discourses apart from personal biases and their methods to build trust through site and actor triangulation and their member checking process which will help demonstrate the study's goals for mixed cultural interpretation.

3. Results

The qillpu practice shows itself as a cultural care practice because it extends beyond its status as a technique which people have carried through generations who use it to take care of infants according to the standards of their local community. The Results show through subsections 3.1 to 3.5 that mothers and grandparents testify swaddling results in longer and more peaceful sleep while swaddling provides advantages of physical strength and balanced body development and protection against fright and cold weather. The Results demonstrate how social-health tensions create biomedical checks which include medical checkups and pediatric warnings and medical checks which lead to qillpu being treated as abuse. This discovery demonstrates how health and well-being depend on social interactions because institutions use their authority together with surveillance to control both health-related activities and personal identities. The section presents its analytical content as a combination of three elements because it contains results and literature review together with interpretive analysis. The study results, which need additional methodological support through the results section, require at least two components to achieve minimum requirements. The research needs to specify participant details together with research methods that were used to develop themes through showing the participant characteristics which include interviewee numbers and community representation and saturation assessment methods and Quechua-to-Spanish translation procedures and active search for opposing cases. The participant statements about near-suffocation risk and the practice of abuse evaluation show internal contradictions which provide useful information but need better analysis to support the main theme of conflict between care and risk assessment.

The results fail to demonstrate the analytical value of two visual elements which show how contemporary practices have changed from traditional methods. The results need to establish stronger connections between observed technique variations and reported outcomes because this will help to show medical outcomes without making direct medical claims.

4. Discussion

The discussion chapter is based on data which extends to the month of October in the year 2023. The first section of the document shows how qillpu functions as a cultural practice that determines when babies should sleep and their protection needs and their connection to past generations. The common understanding between people establishes social bonds which determine how caregivers will take care of infants who need to sleep while mothers finish their household tasks in places with limited resources that exist in highland areas. The Discussion section of the document needs improvement because it currently restates the results instead of providing deeper analytical interpretation through better theoretical frameworks which include medical anthropology of care together with embodiment and syncretic health worldviews and social determinants and structural constraints on caregiving and power/authority dynamics in clinical encounters. The community claims that modernity together with excessive freedom results in weaker and sicker children because the community makes these statements. The statements need to be treated as local moral discourse. The statements need to be treated as local moral discourse which requires comparison with relevant pediatric and sleep safety evidence together with cross-cultural research on swaddling and motor development and caregiver-infant co-regulation.

The call for "re, educating" mothers is quite normatively loaded and might unintentionally lead to the deficit/paternalistic stance being replicated; a culturally safer ending would focus more on co, created, harm, reductionoriented intercultural practice (e. g. , collaborative counseling on safe swaddling tightness, duration, temperature, positioning, and monitoring; engagement of elders and traditional birth attendants as partners; and respectful negotiation rather than abrupt prohibition).

 

Lastly, the limitation mentioned that the interviewees are "poor communicators" is at odds with a social, health journal context; it should be reinterpreted as language, translation consistency, interview format, and research/clinical surveillance power dynamics (including how participants reportedly change behavior when being observed medically) issues, along with more reflexivity on the researcher positionality and clearer direct implications for future participatory or mixed, method designs that can systematically explore both the potential benefits and the documented risks (including the near, suffocation incident noted in Results) without stigmatizing Indigenous communicative behaviors.

Author Response

We appreciate the observations and suggestions; all the material has been substantially revised, and some of the comments that were incorporated into the paragraphs are listed below.

60–65: The observation was incorporated into the introduction.

75–81: The information was added to the methodology section.

285–288: On social media, there is an abundance of information posted by individuals outside the academic sphere, who share photographs of swaddled children from Andean regions.

405–410: The conclusion has been revised and strengthened.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Some corrections and improvements have been made, but the basic issues of structure and redundancy are left totally unaddressed. I recommend reviewing the structure entirely, by using a step by step argumentation, clustering topics and data together in a logical progression, that would largely improve the scientific value of this article.

I would also recommend adding some of the information provided as answer to my questions or comments into the text in order to add more substance.

I have once more highlighted sentences where my comments have not been considered - all of these comments have to do with readability and understandability of the author's point and logic. I'm in no position to judge the quality of the content. But when an idea is not properly articulated with the rest of the text, or a sentence simply not understandable, then they impede the scientific usability of the document.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

was improved - but some more work (obscure sentences/formulations) is needed here to reach the international quality required for the Journal. 

Author Response

Thank you for the detailed observations.
All comments and suggestions have been addressed throughout the manuscript; some words and sentences were replaced as recommended in the referenced material. Incongruent author citations were corrected. An explanation was added regarding linguistic interference, as it is understood in Peru due to the combined use of Quechua and Spanish vocabulary (pp. 97-106). No additional numbering is included, as the observations were distributed throughout the manuscript, which was reviewed thoroughly, detail by detail.