We have launched a new intervention to aggressively intervene with home visits for severely malnourished children.
As usual, we weigh and measure all the children under five years of age in our communities. We then chart the children’s growth on World Health Organization curves for height and weight. When a child’s growth appears alarming, we then try to figure out what’s going on and how to fix it.
Remember, stunting is diagnosed when a child is short for their age. When you see stunted children, they look like healthy, plump little kids until you realize that they are really short and look about 6 months younger than they should appear. Guatemala has one of the highest rates of stunting in world and the highest rate in the Western Hemisphere.
Does it Matter is someone is a bit shorter?
You may think, “Does it matter if someone is a bit shorter?” Well, after fifty years of follow-up, the INCAP Nutrition Study has found that, as they grow up, children who were stunted have decreased school performance, reduced cognitive skills, higher probability of living in poverty, and some significantly worse health-related outcomes such as number of pregnancies in women. Think of this: A child whose height improves by one standard deviation at age three (e.g., going from from the 0.1 percentile to the 2.5 percentile) will earn on average 20% more money per year as an adult and will be 10% less likely to be poor.
The New Intervention: In Home, One-on-One education and Food Supplementation
In this new intervention, we identify the kids under age two that are “severely falling off their growth curves.” We then make a visit to their homes, speak with their family, and conduct a medical work-up. We work to rule out things like hypothyroidism, congenital diseases, and parasites, and if children do have these–or any other–conditions we treat them. We send them for laboratory testing, imaging, and even surgery if they need it. We also give the child deworming medication and vitamins. We also focus heavily on one-on-one education with the family and mother on how to provide the best food and nutrition for their child.
We are particularly sensitive to the time when the child turns six months old, as this is the window when complementary foods should be given in addition to breastfeeding. Due to both economic considerations and education, many mothers delay the onset of complementary feeding or give foods that are very low in nutrients. Often, we see that children are growing just fine until they reach 6 months of age, at which point they basically stop growing.
In the “small picture,” the intervention is exciting because we think we can really influence the individual children in our care. We will evaluate this new program as we move forward and report back to you.
Our Harvard medical student David working with the program says, “I must also confess that I love visiting these children. They are so fragile, so small, so innocent. They have so much more living to do, but their future is at stake. Thankfully, we have some tools to help. I can’t think of anything that could be more worthwhile.”
Thank you friends for your amazing support. Together, we are saving lives and creating better futures!
Dear friends, as I've written to you frequently over the last few years, we've been working hard to complement the core activities of this program, which include medical care and nutritional supplementation, with additional educational and support activities for mothers and fathers of young children.
Although education can't solve all problems, it is an important part of a comprehensive solution. For example, in a report we recently published (see the link below), we discovered that many parents struggled to understand the manifestations of chronic malnutrition in their children and, therefore, tended to present late for medical evaluation. Similarly, although most parents understood the need to feed their toddlers complementary foods starting at 6 months of age, they were less likely to appreciate the importance of meal frequency and a diverse range of food groups for their children's health.
Therefore, this year, our health promotion staff have launched an exciting range of new educational activities, which include dynamic small group classes and also individualized home visits. We've seen really positive changes in health behaviors and knowledge as a result. For example, when we tested parents knowledge before and after their participation, we discovered that, before participation, only 45% of parents felt well prepared to care for children with an episode of acute diarrhea. After participation, that number increased to 71%. As another example, before participation, only 52% of parents had a good sense of how frequently a young child should consume solid foods; after participation, this number increased to 81%.
Most importantly, our staff have been conducting followup evaluations of dietary quality in the children of participants. We are seeing that, after participations, children are consuming more food and more diverse foods as a result of their parents' new knowledge!
In conjunction with our ongoing medical care programs, growth monitoring, and nutritional supplement, we are really excited to see the additional accrued benefit of education to our communities as these programs continue to unfold this year.
This is just a really quick note to let you know about two things.
First, as I talked about in our last project report, data from some of our communities is in and very encouraging, showing 50% reductions in rates of malnutrition. To follow up on this, I wanted to let you know that we've just released the final report of our study of factors associated with malnutrition. We are using the data in this study to make small changes to our programs, especially in the area of parent education, in order to achieve even better results. If you are interested, you can read the entire report at this link here.
Furthermore, I wanted to let you know that Global Giving is having a Matching Funds Campaign on June 12. Because we are a "Superstar" ranked organization, this means that all donations to any of our projects on June 12 will be matched 50%! You can see the list of all of our current projects here. Pass the link on to your friends and colleagues!
Thanks as always for your amazing support and interest in our work.
I've spent the last few weeks in front of a computer looking at child growth data. It may sound boring, but actually it has been pretty exciting to have the time to do these interim analyses of our community nutrition programs.
These programs, as many of you who have supported our work over the years know, are comprehensive. They provide medical checkups to young children, in addition to regular treatment for parasites and anemia and the provision of nutritional supplements. Recently, in the last year or so, we've also been working hard to improve our educational support of parents as they learn how best to support their children in the first few critical years of life.
Our primary endpoint is trying to reduce rates of stunting, or chronic malnutrition, in young children. This is the primary form of malnutrition in rural Guatemala, which leads to lifelong disability through short stature and impaired intellectual development.
And the good news is that our programs are working. For example, in one set of community data that I was analyzing last week, the rates of severe stunting have decreased more than 50%. At the same time, the rates of children who are underweight have decreased more than 60%. These sorts of demonstrable improvements in child health give us hope for the future!
A central part of the community-based nutritional education that we are doing this year are classes on nutrition for women with young children. The idea is to provide women with up-to-date nutritional information, and to give them a forum to ask questions, clarify misconceptions, and support each other’s efforts to improve the health of their families.
WK core staff and I have spent much of the last three weeks meeting with community liaisons in the 8 communities in which we will be rolling out these classes. Because stunting (being very short for one’s age) affects as much as 100% of children in some of the communities that we are beginning to work with, many women are very excited to learn more about what they can do to help their children grow to their potential.
Last week, we inaugurated this limb of the nutrition education program with our first class in in one of our partner communities. Twenty-two women, from first-time mothers to seasoned grandmothers, laughed along as our staff led them through an explanation of how microbes cause disease, correct hand washing technique, the best way to store food without refrigeration, and low-cost methods to purify water.
Although there are many organizations in Guatemala that are working on nutrition, one unique aspect of our program is that whenever possible we use the first language of the community in our programming. The women in this community, for example, speak a mixture of Kaqchikel and K’iche. Our staff gave this class in Kaqchikel, and the women participated in either Kaqchikel or K’iche (or both!). Many women emphasized how much they appreciated being able to take part in a class where they could speak comfortably in their own language. Doing these classes in first languages meant that all women–not just the ones that felt the most comfortable speaking Spanish–were able to understand the materials and offer their own questions and ideas to the group.
We are looking forward to being able to bring these women classes in maternal nutrition, breastfeeding, complementary feeding, and nutrient deficiencies in the months to come!
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