Center for Research in Indigenous Health, Wuqu' Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala.
Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA.
Int J Environ Res Public Health. 2021 Jan 18;18(2):773. doi: 10.3390/ijerph18020773.
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.
危地马拉农村地区的慢性儿童营养不良（发育迟缓）率是世界上最高的之一，尽管为扩大循证营养干预措施做出了相当大的努力，但进展甚微。最近的文献表明，一个限制影响的因素是对一线工作人员的监督支持不足。在这里，我们描述了在发育迟缓率较高的地区进行的基于社区的质量改进干预措施。该干预措施通过电子工作清单、绩效仪表板和一对一反馈会议为一线营养工作者提供审计和反馈支持。我们使用运行图和控制图在改进干预期间可视化绩效指标和儿童营养结果。在这个基于社区的小样本（计划开始时的 125 户家庭）中，在为期两年的改进期间，方案组件的提供（如生长监测服务和微量营养素补充）有了显著改善。儿童发育迟缓的患病率从 42.4%降至 30.6%，符合特殊原因变化的标准。平均长度/身高年龄 Z 评分从-1.77 上升至-1.47，也符合特殊原因变化的标准。总之，通过提高现有循证营养方案的保真度，将结构化绩效可视化和审计反馈组件添加到现有的基于社区的营养方案中，显著改善了儿童健康指标。
