Wuqu' Kawoq

Wuqu' Kawoq's mission is to address the barriers to excellent health care that the majority of Guatemala's indigenous Maya population face, including principally the lack of access to health care in their own languages. As such, Wuqu' Kawoq develops primary care and health programs within a larger context of community vitality, family stability,and Mayan language revitalization.
Feb 14, 2012

Nutrient Supplements for Children!

Dear Friends, I recently wrote a piece on "New Nutrition Supplements for Children" for an online global health clearinghouse website. Since one of those "New Nutrition Supplements" is Plumpy'doz, the distribution of which you have been supporting in Guatemala with your contributions to this Globalgiving Project, I thought you might like to read some excerpts (see below!). Also, check out the pictures I am uploading here of Plumpy'doz distributions and the links below to some videos of the same. As always thanks for your support!

 

Lipid based nutrient supplements (LNS) are perhaps one of the most exciting, and potentially transformative emerging technologies for the treatment of chronic malnutrition. LNS preparations are called ‘lipid-based’ because, unlike older nutritional formulations, they derive a much larger percentage of their calories from fats (typically from peanuts, milk, and vegetable oils). They also generally contain a full complement of vitamins and micronutrients. Because they are fat-based, these micronutrients may be more easily absorbed by the body (they are not bound up by plant phytates which are abundant in grain-based nutritional supplements). They also provide essential fatty acids, whose importance for promoting healthy growth and brain development is more and more appreciated today.
Most people have heard of at least one type of LNS product, Plumpydoz®, which has revolutionized the treatment of severe acute malnutrition in many countries throughout the world. Plumpydoz® is classified as a therapeutic food, meaning that it is extremely dense in calories and is essentially meant to be used in a situation where aggressive ‘refeeding’ is necessary. Since the product has a long shelf life, does not require mixing or cooking, and is tasty, it has produced a paradigm shift in the treatment of severe malnutrition. Previously, most cases of severe malnutrition needed to be hospitalized, often simply because the mixing and preparation of refeeding solutions was complex and required special tools and training. Plumpydoz® uncomplicates this process, which means that refeeding can happen in the home and in rural communities.

What many people do not know, however, is that new research has led to the development of a range of other LNS products, which are lower in calories while still providing a full complement of micronutrients. These products include some which provide a medium amount of calories (Plumpydoz® is one example) and some that provide a small amount of calories (Nutributter® is an example). These are very welcome developments, because they could potentially be used in development settings where chronic malnutrition, rather than acute malnutrition, is the norm. Chronic malnutrition, is generally a smoldering illness which affects a child over months to years and, until now, we haven’t really had any very effective tools for dealing with it. Using Plumpynut® for treating chronic malnutrition would be sort of like using a fire hose to put out a candle.

This isn’t to say that the ‘candle’ of chronic malnutrition is something to sniff at. There are many more children in the world with chronic malnutrition than with acute malnutrition. Whereas acute malnutrition puts a child at immediate and obvious risk of death, chronic malnutrition consumes their biological and social potential in a slow, insidious way. Chronically malnourished children are shorter than their peers. They have more frequent episodes of diarrhea and respiratory illness. They have slower intellectual development and lower IQs. They are less likely to complete school. As adults, and are more likely to be unemployed or to have low paying jobs. Perhaps most horrifying of all, chronic malnutrition as a child greatly increases the risk of obesity, hypertension, and diabetes in adulthood – directly contributing to the rising epidemic of these disease in the developing world.

Exactly how to combat chronic malnutrition with LNS formulations is not entirely worked out yet. There are some positive studies; for example, this study showed that the rates of severe chronic malnutrition could be reduced by supplementation with a Nutributter® like product in children in Malawi. However, the factors which influence and maintain chronic stunting vary significantly from environment to environment. For example, in Malawi chronic malnutrition is greatly influenced by seasonal food insecurity and cyclical droughts; in this type of setting, it is common for there also to be a lot of acute malnutrition. On the other hand, in Guatemala (which has the highest rates of chronic malnutrition in the Western hemisphere), there is no seasonality to malnutrition patterns; here, malnutrition is clearly related more to endemic racism and lack of access to basic medical care and only more obliquely to food production patterns and food insecurity. In short, what might work in one context to treat (or prevent) chronic malnutrition might not work somewhere else.

Clearly, there is exciting and important work to be done. In Guatemala, we have been working at Wuqu’ Kawoq with both medium calorie and low calorie LNS products. For example, we have been using Plumpydoz® in 5 different communities for about 12 months now. In these communities, the Plumpydoz® seems generally well accepted with decent uptake and utilization. In the cohort of the most severely stunted children, height recovery also seems to be progressing nicely. Most mothers also report reductions in rates of acute illness in their children. We are conducting a prospective analysis of the growth data in these communities over the next several years, which we hope will bear out these observations. Potentially the great advantage of a medium calorie preparation is that it could provide some nutritional boost to children who are already malnourished at the start of a program, and this is the hypothesis we are exploring – that Plumpydoz®, or another product like it, can provide both prevention of malnutrition onset in the youngest children but also some recuperation in older, already-malnourished children.

Links:

Jan 26, 2012

Expanding treatment options for diabetics

Dear friends, 

Over the last few months since I last wrote a project update for our diabetes program, a lot of great things have happened!

As you know, for a number of years now we have focused on educational initiatives for our diabetic patients, coupled with intensive glucose-lowering strategies. One of the most rewarding parts of this initiative has been using glycosylated hemoglobin testing ("A1C" testing) to give us a better sense of how are patients are doing and how their medications should be adjusted. Using A1C as a target for treatment, about 50% of our patients now achieve a level of glucose control that we think is "excellent", with another 25% achieving acceptable control (of course, with the other 25% still needing some work!

Now, in the last few months, we have been working to identify other areas where we can improve care for our diabetic patients. For example, since people with diabetes have a higher-than-average risk of heart disease, blood pressure control is very important. Although we have always treated high blood pressure in our diabetics, we are now being more aggressive in treating patients with more borderline high blood pressure readings, to reduce their risk of complications even further. This has been very successful, with more than 75% of our diabetics now reaching our goal for blood pressure control.

Finally, we have begun monitoring kidney function in our patients more aggressively. Long standing diabetes does permanent damage to the kidneys, and kidney disease in diabetes is a major cause of death and complications. Knowing whether a patient has kidney disease is tricky, because it means taking blood samples, often in very rural settings, and transporting them to a central laboratory for analysis. However, thanks to several highly motivated staff members, we have been able to begin offering this service to our patients! Fortunately, only 10% of our patients have significant kidney disease; knowing this information, however, allows us to tailor our treatment for them in ways that better help to protect their kidneys.  

Well, those are the updates for now! Thanks so much for your continued support!

Links:

Jan 24, 2012

Graduating New Midwives!

Dear friends, 

There are so many updates on our midwife and women's health programs that I am not sure where to begin!

First of all, I am writing this right now in the airport on the way to Guatemala, in part to attend a graduation ceremony for the classes of midwives that we are supporting. For a number of years, we have supported a midwifery cooperative of some 100 midwives, who get together for training sessions and professional development. However, three years ago, we added a new training track especially for young women interested in getting into the profession for the first time. Over the past thre years they have participated in formal classroom and clinical activities - and they will be graduating this week! This is a major accomplishment for the cooperative, and we are proud to have played a small role. I will make sure to post some photos from the ceremony later on!

In other news, this week is also important because our women's health nursing staff are receiving training from a volunteer gynecologist visiting from the United States. Already, our women's health nurses are providing a wide range of medical services to women, including cervical cancer screening and access to birth control methods. This week, they will be learning how to insert intrauterine devices (IUDs), which will be a major boost to our family planning programs. At the same time, they will be learning to use basic laboratory technology to diagnosis common sexually transmitted infections, such as gonorrhea and chlamydia. This technology will allow them to immediately identify women infected with these disease and provide on the spot treatment. 

Finally, our women's sexual health classes continue to be a big hit. Currently, we are offering simultaneous classes in four different communities (where we also have other projects, such as child nutrition programs). In 2012, our goal is to provide these classes to at least 250 new women, and we will keep you updated on progress towards that goal!

Links:

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