Children in Guatemala Suffering from Malnutrition

Kaitlyn Pearson, Taylor Good and Jhade Gray

Background Information of GuatemalaGeographic Location: Guatemala is a small country in Central America, and shares shorelines with two major bodies of water.

Boundaries: The country is laid out over 42,042 square miles, with a total of 205 miles of coastline and contains the volcanic highlands of the Sierra Madre, which are almost a mile high. Guatemala is also bordered by Mexico, Belize, the Caribbean Sea, Honduras, El Salvador and the Pacific Ocean on the west.

Weather: The winter season takes place from May to November and is about 70° F; summer season spans November to May and the temperature averages about 80° F.

Population: There are an estimated 12 million people living in Guatemala with about 50 percent of them living in urban cities.

(Anderson, 2019)

Background Information Continued

Capital City: Guatemala City

Gender ratio: 51.3% females vs. 48.7% males.

Income/poverty level: 53% of the population lives below poverty line

Education level: Typically finish school in 6th grade, some finish high school.

Cultural Health beliefs: If you are admitted to the hospital, you will die.

Health disparities: Access to primary care clinics & malnutrition among children

(The Borgen Project, 2017)

The Community: Patanatic, Guatemala-3.5 hour bus ride from Guatemala City

-Located near Lake Atitlan

-Speak Spanish, English, K’iche’ and other indigenous languages

-Poverty is very prevalent here, with over half below the poverty line

-Education completed is typically up until 6th grade, few individuals move onto middle school and high

school.

-Primary care clinic located inside the town on a steep hill.

-Community is divided into 6 zones

(Guatemala, 2019)

Health Issue

After looking at the data for malnutrition in Guatemala, and seeing it firsthand through our clinics, we identified our population and health concern to be malnutrition in Guatemalan children under the age of 5.

Children at risk:-Little to no education-Living at or below poverty line-Indigenous populations-Rural communities-Multiple children in the family

(Guatemala, 2019)

Epidemiological Data

Top 5 health issues Incidence and prevalence Mortality Co-morbidities

United states Data 1. Heart Disease2. Cancer3. Accidents4. Chronic Lower

Respiratory Disease5. Stroke

(CDC)

1. 28.1 million2. 22.9 million3. Not indicated on CDC4. 8.6 million5. 795, 000

(CDC)

1. 610,0002. 598, 0383. 161, 3744. 154, 5965. 142, 142

(CDC)

-Renal insufficiency leading to renal failure, COPD, sleep apnea, and anemia. (CDC)

International country-Guatemala

1. Lower Respiratory Disease

2. Interpersonal Violence

3. Cancer4. Ischemic Heart

Disease5. Diabetes (CDC

Not indicated on CDC. 1. 14%

2. 11%

3. 11%

4. 8%

5. 5%

(CDC)

-Weight loss, renal insufficiency, other infections of the respiratory system. (CDC)

Community data-Patanatic 1. Malnutrition2. Infections from

contaminated water3. Upper Respiratory

Infections4. Diarrhea5. Dental Decay

(Jorge)

Unknown for this population.(Jorge)

Unknown for this population.(Jorge)

-Weight loss, diarrhea, vomiting, loss of teeth. (Jorge)

At Risk Population: Patanatic Children

Age of population: Children of 5 years of age or under

Reason this community group might come together: Families typically have on average 3 kids, making

malnutrition a huge concern for the community.

The effects of malnutrition in Guatemala are devastating and leave children prone to becoming

susceptible to other health issues such as diarrhea, gastrointestinal diseases, and bacterial infections.

No gender differences were noted in this population.

(Guatemala, 2019)

Health Issue-The primary health issue that guided our team was the negative impact of malnutrition on children, and

how this issue is so prevalent amongst Guatemalan children in school.

-Malnutrition was determined as a problem within the Patanatic community because a majority of

children were below average on their growth chart in both categories of height and BMI. The data

gathered to make this determination was utilized from the Patanatic clinic’s health record of each

individual child within the community.

-Our team chose the Healthy People 2020 objective: NSW-12: eliminate very low food security among children. We chose this specific objective because addressing the nutritional needs of children by utilizing

prevention techniques, as well as implementing interventions such as a well balanced nutritional diet will

decrease the rates of malnutrition.

-The health issue of malnutrition amongst children can also be linked to Sustainable Developmental Goal 2: end hunger, achieve food security and improved nutrition and promote sustainable agriculture.

Why is a health promotion plan needed?-According to UNICEF, malnutrition affects 4 out of 10 children under 5 years of age. (UNICEF, 2017).

-Stunting affects the height of these individuals due to malnourishment and affects a large number of Guatemalans. (Guatemala)

-Families know eating fruits and vegetables are important, as well as drinking lots of water throughout the day. The community is aware that stunting is commonly caused by malnutrition, however some areas have harder access to food with higher calorie and nutritional content.

-During primary care clinics held at school and in the communities, nurses, teachers, and workers assessed family’s access to food and clean water. We looked at growth & height charts to compare the child to “normal” developmental growth.

-Educating parents and children alike, making sure to teach on their educational level will be very helpful in taking care of this issue. Finding an environment that is quiet, provides enough space, and accessible to the surrounding community in order to promote learning about the subject will also be very beneficial to our population.

Interventions -This population is at high risk for malnutrition because young children require a well-balanced nutritional intake in order to properly develop both physically and cognitively. Guatemalan children do not have the appropriate

quantity or quality of dietary resources available to them, and therefore are not receiving the appropriate amount of nutrients, as we witnessed abroad.

-Current interventions we were able to see while there include parental education about children’s dietary needs, snack programs in place by the school that assist in feeding children and also a vitamin program in place which

help children obtain the necessary nutrients. These interventions align with our HP2020 objective, eliminate very low food security among children.

-The CDC recommended interventions focused on getting adequate micronutrients (i.e. iron, zinc, vitamin A, and folate)

-Interventions include fortification of cereals and grains, monitoring and evaluation, accurate assessments, and developing surveillance systems.

-This intervention aligns with our SDG, end hunger, achieve food security and improved nutrition and promote sustainable agriculture.

Interventions Continued

-Individual: Performing accurate well child exams and addressing need for more food or nutrients.Education on proper nutrition.

-Community: Educate community on need for well child exams annually.Keep snacks and multivitamins at the clinics and work with the schools to provide children with them at

any age.

-Systems: Stakeholders advocating at a national level for nutritional programAppropriate documentation in height and growth charts.

Outcomes

Priority Outcomes 1. Decrease childhood death rates related to malnutrition

a. Primary- Growth monitoring, vaccination, vitamin A supplementation, & deworming b. Secondary- Screen children for acute malnutrition c. Tertiary- Hospitalization & treatment (rehydration/manage underlying factors/nutritional supplementation)

2. Eliminate very low food security amongst children a. Primary- Provide snacks and multivitamins at schools.b. Secondary- Check children’s height and weight at each annual physical.c. Tertiary- Hospital treatment for malnutrition.

3. Improve nutrition amongst children a. Primary- Monthly preventive doses of small nutrient supplements b. Secondary- Monitor & screen growth chart of children (BMI & height) c. Tertiary- Hospital treatment and follow up by healthcare professionals & school teachers

Priority Outcomes 1, 2, & 3 are linked to the Healthy People 2020 objective: NSW-12: eliminate very low food security among children and the and the Sustainable Developmental Goal 2: end hunger, achieve food security and improved nutrition and promote sustainable agriculture as the outcomes focus on decreasing childhood death rates caused by malnutrition by eliminating low food security and improving children’s quality & quantity of food. The primary, secondary, and tertiary interventions for each priority outcome align with the Healthy People 2020 objective and Sustainable Developmental Goal 2 because each intervention addresses prevention, screening, and treatment of malnutrition.

Health Promotion Model - The Health Promotion Model our team has adopted to guide our health promotion program plan is the

Community-based Management of Acute Malnutrition Model (CMAM)- CMAM is based on the provision of safe, effective therapeutic food for individuals to use at home rather

than expensive treatment in the hospital. CMAM works with communities to assist them in identifying specific cases of malnutrition and to promote the early presentation of malnutrition signs before individuals become very ill. CMAM also works to deliver therapeutic food through already existing structures, and assisting in resisting costs by integrating treatment of malnutrition into the health system.

- 4 key components to CMAM:- Community Mobilization - children cared for in their own community by mobilizing volunteers

- Supplementary Feeding Program-provide food rations and basic treatment for those with moderate malnutrition

- Outpatient Therapeutic Program-provide home based treatment and rehab for children with severe acute malnutrition, and monitor progress through outpatient clinics.

- Stabilization Center/Outpatient Care-provide intensive in-patient medical care to children with severe complications

- We will use CMAM in order to provide nutrition to the children of Patanatic by mobilizing our volunteers and utilizing them in the community to provide adequate nutrition, while also providing more intensive care by referring them to hospitals or the nearest clinic.

Conclusion-The chosen health issue of malnutrition amongst children in developing countries is a prevalent issue that must be addressed. Performing a community health assessment on the chosen population and health issue has helped our team better understand the social determinants of health and factors that play a role in childhood malnutrition. Our community health improvement plan has been guided by the CMAM model in hopes to adequately prevent and treat childhood malnutrition, and overall decrease childhood death rates. It was apparent that the health issue was occuring in the community of Guatemala our group visited. There were interventions in place by stakeholders of the community to try and address the issue, but we feel there is more that can be done in order to decrease childhood malnutrition rates. Certain interventions we would recommend as a team is to implement monthly screenings for children at risk for malnutrition. Another recommendation is to provide preventive nutritional supplements to children. Implementation of these interventions would include action from various stakeholders at the community and governmental level. Personal Highlight- One of the most meaningful experiences we had the opportunity to partake in was a field trip with kids from a local Guatemalan school. While on the way to the Mayan ruins, all of the kids were sharing their snacks with everyone. It was a very humbling experience because even though some of those kids could have been struggling to eat at home, they were all more than willing to share. We really appreciated the culture in that sense as we felt it was a perfect example of why we should be more grateful of what we have.Professional Highlight-Professionally speaking, this trip had a profound impact on each of us. We had to be able to think outside of the box in order to help people since there was a language barrier. This required us to engage more with the culture, and be able to recall words in order to communicate with those in the healthcare setting and even the locals.

References

Anderson, T. P., Griffith, W. J., Stansifer, C. L., & Horst, O. H. (2019, February 04). Guatemala. Retrieved from https://www.britannica.com/place/Guatemala

CDC. (2017). National Center for Health Statistics. Retrieved from: https://www.cdc.gov/nchs/fastats/copd.htm

Country Meters. (2019). Live Guatemala Population. Retrieved from: https://countrymeters.info/en/Guatemala

The Borgen Project. (2017). Current Poverty Rate in Guatemala. Retrieved from: https://borgenproject.org/exploring-poverty-rate-in-guatemala/

UNICEF. (2017). Malnutrition. Retrieved from: https://www.unicef.org/guatemala/english/overview_18012.htm

The World Factbook: GUATEMALA. (2018). Retrieved October 14, 2018, from https://www.cia.gov/library/publications/the-world-factbook/geos/gt.html

World Vision. (2017). Community-based Management of Acute Malnutrition Model. Retrieved from: https://www.wvi.org/nutrition/project-models/cmam

*observation during our experience abroad is cited by (Guatemala, 2019).