Health
 Guatemala
Project #7107

Feed a Child - Reduce Malnutrition in Guatemala

by Wuqu' Kawoq
Vetted

Dear friends, 

Thanks so much for your ongoing support this year! We greatly appreciate it. 

We wish you and yours a pleasant and enjoyable holiday season. If you are still looking for an end of the year giving opportunity, don't forget that it is easy to donate to any of Wuqu' Kawoq's projects through the Global Giving interface here. In addition to regular giving options, the interface also allows you to give holiday gift cards or donate in honor of a loved one, both great options for alternative holiday giving!

As the year draws to a close, I wanted to provide a brief research update from one of the community nutrition projects that you have supported this year. This project has been providing direct nutritional supplementation and medical care for children for 18 months now. In this time, based on new data that we just collected last month, we've seen that the rates of severe stunting have fallen by more than 40%. This reduction in stunting has occurred at the community level, including even the small number of children who haven't been always so regular at taking their supplements or coming to medical checkups. This means that the positive messages about child nutrition and coming together to combat this problem are really having an effect at all levels in the community!

Also, as the year draws to a close, we are just wrapping up analysis of our focused needs assessment survey that we performed over the summer, and to which I've alluded in prior updates. This survey, they results of which I'll share with you when the analysis is complete, are really pointing us towards some new opportunities in 2013, especially focused on improving dietary diversity and support for new mothers. Look for these changes and additions to our programming in coming months!

As always, thanks for your support, and feel free to email me with any questions at peter@wuqukawoq.org. 

Links:

The focus group team
The focus group team

Dear Friends,

 Our child nutrition programs have always had three basic pillars.

 (1) The provision of nutritional supplements to children, to help prevent malnutrition and provide as a "safety net" in times of food insecurity.

(2) The provision of excellent medical care, to help identify and treat the diseases--both common and rare-- that contribution to child malnutrition.

(3) Education of caregivers and community leaders about child health and nutrition, to help provide communities with the tools they themselves need to be engaged in protecting the health of their children.

Of these three pillars, by far education is the most challenging. This may sound counter-intuitive at first. However, if you think about all the different barriers that exists to a good educational program--such as low rates of literacy, or the inherent resistance there always is to changing infant rearing practices (which are time-honored and passed down from generation to generation in every culture)--then it is becomes easier to understand why educational programs are numerous but quality educational programs (that produce real change at the community level) are few indeed. 

With this mind, I'm happy to report that Wuqu' Kawoq has just finished up the initial stages of a massive program evaluation designed to improve our nutritional education programming. To accomplish this, we assembled a highly skilled team of community health workers, anthropologists, and nutritionists, who spend most of July and August conducting dozens of focus groups and hundreds of interviews with community leaders, parents, and other stakeholders in our communities.

This evaluation was wide-ranging, designed to help us understand better what parents think about the health of their children and the causes of malnutrition. It will also give us deeper inside into dietary diversity, breastfeeding and weaning practices, and competing nutritional messages from other groups (such as companies which market infant foods).

 Right now our team is evaluating the immense amount of data that was collected during this evaluation. Within the next month or two, we will have a formal report from the team which will identify the areas where our current nutrition education programming might be deficient or not exactly in line with the needs of our communities and give us recommendations for improvement. We're very excited about this great opportunity we have to continue to improve our programs so that we can better serve the children of Guatemala!

As always, thanks so much for your continued support, and keep in touch! Feel free to drop me an email at any point at peter@wuqukawoq.org. 

Traveling to communities
Traveling to communities
Interviews in progress
Interviews in progress

Links:

Dear Friends, 

Once again I'm writing to you all to thank you for your ongoing support of our child nutrition and health projects in Guatemala. 

I thought I would take this update opportunity to reflect on something that we haven't talked about in a while. Although we talk about the need to fight the overwhelming rates of child malnutrition in Guatemala frequently, what we haven't mentioned is how poor nutrition is just one of the many health challenges that children in Guatemala face. One of these that we face in our work everyday is the lack of primary care (pediatricians). Not having pediatricians means that children do not receive the normal "well child" check ups that we take for granted in the developed world. Consequently, if a child has a serious medical condition, it may not every be picked up, since there is no one around to pick it up!

To give you an idea about how this plays out, our experience has been that about five percent of all the children we see in a new nutrition program will have a serious medical condition. Even though our "in road" to communities is the nutrition programming, we are also committed to providing comprehensive health care, and so we always do our best to help out those children who need more than just nutrition. 

One case that we are currently managing is quite typical. This is a 1 year old boy with Down's syndrome who was brought to us for the usual reason - "not growing." However, with just a quick physical examination, it was clear that something more was going on. He had a very loud heart murmur and signs of heart failure. We quickly obtained a heart ultrasound, which confirmed that he did indeed have a heart defect that was going to need surgery. Although he was certainly malnourished, the heart defect was really the major reason that he was 'not growing.' 

Fortunately, we have an excellent collaboration with a group of pediatric heart surgeons who can make this happen. Therefore, over the last few months, we have been managing the child's heart failure with medications while he recuperates nutritionally. He should have surgery within the next few weeks and go on to be a much healthier child afterwards!

Links:

Cristalina making child growth entries.
Cristalina making child growth entries.

Dear Friends, 

I am writing you again from Guatemala, where I have spent the last several days visiting our projects. This is just a short update, whose purpose is mostly to post a few pictures of our staff hard at work!

In most of the updates we have made to this project so far we have talked about the needs of the children we are serving and about the nutritional product, Plumpydoz, that we are using. However, I wanted to take a moment to celebrate the hard work of our staff, whose compassion, commitment, and dedication make our programs a success. 

Community based nutritional programs like ours require multiple levels of staff in order to run smoothly. At the most local level, we work with women's cooperatives, who coordinate most of the program logistics, such as distributing nutritional products and medications, measuring children's heights and weights, and noting down data in medical records. These women's groups are closely supported by our nursing staff, who help with triaging patients and who also lead educational sessions about nutrition and other health topics.

In the first picture, you can see Cristalina, one of our community leaders hard at work; she has just finished weighing and measuring children and she is recording their data for the medical team to review. In the second picture, you can see Herlinda, one of our nurses, together with Carolina, another community leader; they are just about to take off to make some house calls on some of our most malnourished children. 

Finally, all children in our programs receive medical attention directly from our physician staff. This is done collaboratively with our nursing staff and with the community leaders, who always know the child's individual situation very well and provide expert advice on how to achieve our nutritional goals for each child. In the final picture, you can see our nurse Herlinda together with Dr. Cesar and myself carefully reviewing the growth of a particularly complicated case, trying to figure out how best to help the child out.

Thanks for listening!

Herlinda and Carolina making house calls.
Herlinda and Carolina making house calls.
Herlinda, Cesar, and Peter discussing a case.
Herlinda, Cesar, and Peter discussing a case.

Links:

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:

 

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Organization Information

Wuqu' Kawoq

Location: Bethel, VT - USA
Website: http:/​/​www.wuqukawoq.org
Project Leader:
Anne Kraemer Diaz
Bethel, VT Guatemala
$342,007 raised of $365,000 goal
 
10,817 donations
$22,993 to go
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