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Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model

Author

Listed:
  • Michel Juarez

    (Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala)

  • Carlos Dionicio

    (Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala)

  • Neftali Sacuj

    (Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala)

  • Waleska Lopez

    (Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala)

  • Ann C. Miller

    (Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA)

  • Peter Rohloff

    (Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala
    Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA)

Abstract

Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package.

Suggested Citation

  • Michel Juarez & Carlos Dionicio & Neftali Sacuj & Waleska Lopez & Ann C. Miller & Peter Rohloff, 2021. "Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model," IJERPH, MDPI, vol. 18(2), pages 1-13, January.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:2:p:773-:d:482325
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    References listed on IDEAS

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    1. Samantha Y Rowe & David H Peters & Kathleen A Holloway & John Chalker & Dennis Ross-Degnan & Alexander K Rowe, 2019. "A systematic review of the effectiveness of strategies to improve health care provider performance in low- and middle-income countries: Methods and descriptive results," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-29, May.
    2. Santiago Lopez-Ridaura & Luis Barba-Escoto & Cristian Reyna & Jon Hellin & Bruno Gerard & Mark Wijk, 2019. "Food security and agriculture in the Western Highlands of Guatemala," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 11(4), pages 817-833, August.
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