Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Curamericas Global, Raleigh, North Carolina, USA.
Int J Equity Health. 2023 Feb 28;21(Suppl 2):197. doi: 10.1186/s12939-022-01756-8.
This is the fourth paper in our supplement on improving the health and well-being of rural indigenous Maya mothers and children in the Western Highlands of Guatemala, where the prevalence of stunting is the highest in Latin America and among the highest in the world. Reducing childhood undernutrition was one of the objectives of the Maternal and Child Health Project, 2011-2015, implemented by Curamericas/Guatemala. The implementation research portion of the Project attempted to determine if there were greater improvements in childhood nutritional status in the Project Area than in comparison areas and whether or not a dose-response effect was present in terms of a greater improvement in the Project Area with a longer duration of interventions. METHODS: The Project provided nutrition-related messages to mothers of young children, cooking sessions using locally available nutritious foods, a lipid-based nutrient supplement (Nutributter®) for a short period of time (4 months), anti-helminthic medication, and repeated growth monitoring and nutrition counseling. Measures of height and weight for calculating the prevalence of underweight, stunting, and wasting in under-2 children were analyzed and compared with the anthropometric data for children in the rural areas of the Northwestern Region and in the Western Highlands of Guatemala.
The prevalence of stunting declined in Area A from 74.5% in September 2012 to 39.5% in June 2015. Area A comprised approximately one-half of the Project Area and was the geographic area with the greatest intensity and duration of nutrition-related Project interventions. Minimal improvements in stunting were observed in the Northwestern Region, which served as a comparison area. Improvements in multiple output and outcome indicators associated with nutritional status were also observed in Areas A and B: infant and young child feeding practices, routine growth monitoring and counseling, and household practices for the prevention and treatment of diarrhea.
The Project Area in which Curamericas/Guatemala implemented the CBIO+ Approach experienced a reduction in the prevalence of stunting and other measures of undernutrition in under-2 children. Given the burden of undernutrition in Guatemala and other parts of the world, this approach merits broader application and further evaluation.
这是我们关于改善危地马拉西部高地农村土着玛雅母婴健康和福祉的增刊中的第四篇论文，该地区的发育迟缓率在拉丁美洲是最高的，也是世界上最高的之一。减少儿童营养不良是 2011-2015 年危地马拉库拉梅卡斯实施的母婴健康项目的目标之一。该项目的实施研究部分试图确定项目区儿童营养状况是否比对照区有更大改善，以及项目区干预时间较长是否存在剂量反应效应，从而使项目区有更大改善。
该项目向幼儿母亲提供与营养相关的信息，使用当地可获得的营养食品进行烹饪课程，短期（4 个月）提供基于脂质的营养补充剂（Nutributter®），驱虫药物以及反复进行生长监测和营养咨询。对计算 2 岁以下儿童体重不足、发育迟缓、消瘦患病率的身高和体重测量值进行分析，并与危地马拉西北地区和西部高地农村地区儿童的人体测量数据进行比较。
A 区的发育迟缓患病率从 2012 年 9 月的 74.5%下降到 2015 年 6 月的 39.5%。A 区约占项目区的一半，是营养相关项目干预强度和持续时间最大的地理区域。作为对照区的西北地区发育迟缓的改善情况很小。A 区和 B 区也观察到与营养状况相关的多项产出和结果指标的改善：婴儿和幼儿喂养习惯、常规生长监测和咨询以及预防和治疗腹泻的家庭实践。
在危地马拉实施 CBIO+ 方法的项目区，2 岁以下儿童发育迟缓率和其他营养不足指标有所下降。鉴于世界上许多地区的营养不良负担，这种方法值得更广泛的应用和进一步的评估。
