addressing childhood malnourishment in zacapa, guatemala
Public Health Symposium
11 November 2009
| Study Limitations
| Study Strengths
| Conclusions/Future Steps
Gualán, Zacapa, Guatemala, C.A.
Map from http://www.nationsonline.org/oneworld/map/guatemala-political-map.htm
Guatemala – Highest rates of chronic malnutrition in
y Almost half of children under 5 malnourished
y Ranks sixth in the world in malnutrition rates
Hearts in Motion
Non-profit NGO, working in Guatemala since 1990
y Provides care and medical treatment to families and
y Opened Nutrition Center for malnourished children,
Literature review (research on Guatemala; malnutrition)
| Drafting of nutrition education program plan
| Situational analysis of organization/families
| Creation of standards for quality care
| Qualitative analysis of children’s family environment
| Compiled results in patient cases
22 questions covering four general topic areas:
How much money do you make on a monthly basis?
What expenses do you pay each month?
Questions relating to nutrition/food availability
What are the staple foods in the house?
Where do you get your water (is it clean)?
Questions regarding ability to care for the child
Is the community able to support you?
Do you have extended family who can help to care for your children?
Observation questions – HIM Staff
What is the size and condition of the house/state of the neighborhood?
How close is the nearest fresh produce vendor?
Common themes: insights from one-time visits of 5 families
| Average # living in each household
| Tortilla, beans and coffee as major source of nutrition 5 families
| Access to clean water inadequate
| Families working with limited budget
| Community members interdependent
| Opportunities for growth:
• Implementing fruit/vegetable gardens
•Nutrition education for families
•Establishing chicken coops
•Cutting the cable!
• 2 families
• 4 families
• 3 families
• 1 family
Family life viewed in-depth
Offers systematic approach to analysis of home setting
Allows for planning of future individualized family
Open format of home visits allowed patient participation
| Strengthened relationships between family and Nutrition
| Problems of self-report
| Sensitivity of information collected
| Small sample size
| Questionnaire contents may be subjective
| Home visits conducted without lay CHWs
Language, cultural barriers
Greatly enhanced language skills, cultural
sensitivity, cultural humility
| Gained insight into social/cultural determinants of
health in a foreign country
| Professionalism, leadership, problem-solving skills
| Created a useful product for use by the NGO
Developed systems-level processes thinking
Remember the “F” word!
| Importance of assessing what the community needs
| Make family situational analyses more systematic
| Develop proactive approaches toward aiding families
y Nutrition education
y Counseling services
Partnerships with other community organizations,
| Hearts in Motion staff and volunteers
| Families of Nutrition Center children
| Charles Brokopp, DrPH
| Lori Diprete Brown, MSPH
| Patrick Remington, MD/MPH
| Barbara Duerst, RN/MPH
| Susan Zahner, RN/DrPH
| UW-Madison MPH Faculty
World Bank. Malnutrition causes heavy economic losses, contributes to
half of all child deaths, but can be prevented. 2009. Available at:
http://www.worldbank.org/gt [Accessed March 10, 2009].
Marini A, Gragnolati M. Malnutrition and Poverty in Guatemala. SSRN
eLibrary. 2003. Available at:
March 11, 2009].
Guatemala rates of malnutrition. World Food Programme: Fighting
hunger worldwide. 2009. Available at:
http://www.wfp.org/countries/guatemala [Accessed February 26, 2009].
WHO | Severe malnutrition. Available at:
[Accessed March 1, 2009].
UNICEF. Official summary, the state of the world’s children.
2009. Available at: http://www.unicef.org/sowc09/docs/SOWC09FullReport-EN.pdf [Accessed March 3, 2009].
Hearts in Motion Organization (HIM). Available at:
http://www.heartsinmotion.org [Accessed October 3, 2009].