addressing childhood malnourishment in zacapa, guatemala

ADDRESSING CHILDHOOD
MALNOURISHMENT IN
ZACAPA, GUATEMALA
Daniel Erhardt
Public Health Symposium
11 November 2009
OVERVIEW
Introduction/Background
| Methods
| Findings
| Study Limitations
| Study Strengths
| Conclusions/Future Steps
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Gualán, Zacapa, Guatemala, C.A.
Map from http://www.nationsonline.org/oneworld/map/guatemala-political-map.htm
BACKGROUND
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The Problem:
Guatemala – Highest rates of chronic malnutrition in
Latin America
y Almost half of children under 5 malnourished
y Ranks sixth in the world in malnutrition rates
y
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Hearts in Motion
Non-profit NGO, working in Guatemala since 1990
y Provides care and medical treatment to families and
communities
y Opened Nutrition Center for malnourished children,
January 2009
y
PROJECT ACTIVITIES
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
|
SAMPLE QUESTIONS
22 questions covering four general topic areas:
Contact/General Information
1.
How much money do you make on a monthly basis?
What expenses do you pay each month?
Questions relating to nutrition/food availability
2.
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
3.
Is the community able to support you?
Do you have extended family who can help to care for your children?
Observation questions – HIM Staff
4.
What is the size and condition of the house/state of the neighborhood?
5.
How close is the nearest fresh produce vendor?
FINDINGS
Common themes: insights from one-time visits of 5 families
| Average # living in each household
7
| Tortilla, beans and coffee as major source of nutrition 5 families
| Access to clean water inadequate
3 families
| Families working with limited budget
~$25/week
| 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
STRENGTHS
|
Family life viewed in-depth
y
|
Offers systematic approach to analysis of home setting
Allows for planning of future individualized family
interventions
y
Think Upstream!
Open format of home visits allowed patient participation
| Strengthened relationships between family and Nutrition
Center
|
LIMITATIONS
Resource-intensive process
| Problems of self-report
| Sensitivity of information collected
| Small sample size
| Questionnaire contents may be subjective
| Home visits conducted without lay CHWs
|
y
Language, cultural barriers
LESSONS LEARNED
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
greatly enhanced
| Created a useful product for use by the NGO
|
y
Developed systems-level processes thinking
NEXT STEPS
Remember the “F” word!
| Importance of assessing what the community needs
| Make family situational analyses more systematic
| Develop proactive approaches toward aiding families
|
Allocating resources
y Nutrition education
y Counseling services
y
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Partnerships with other community organizations,
government
ACKNOWLEDGEMENTS
Karen Scheeringa-Parra
| 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
|
REFERENCES
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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:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=636329 [Accessed
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:
http://www.who.int/nutrition/publications/malnutrition/en/index.html
[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].
QUESTIONS?