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

Juarez, Michel; Dionicio, Carlos; Sacuj, Neftali; Lopez, Waleska; Miller, Ann C.; Rohloff, Peter

doi:10.3390/ijerph18020773

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

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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

Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA

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Int. J. Environ. Res. Public Health 2021, 18(2), 773; https://doi.org/10.3390/ijerph18020773

Received: 4 December 2020 / Revised: 7 January 2021 / Accepted: 14 January 2021 / Published: 18 January 2021

(This article belongs to the Special Issue Improving the Health of Rural, Minority Populations)

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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. View Full-Text

Keywords: stunting; malnutrition; health disparities; indigenous populations; rural populations; quality improvement; community health worker

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Juarez, M.; Dionicio, C.; Sacuj, N.; Lopez, W.; Miller, A.C.; Rohloff, P. Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model. Int. J. Environ. Res. Public Health 2021, 18, 773. https://doi.org/10.3390/ijerph18020773

AMA Style

Juarez M, Dionicio C, Sacuj N, Lopez W, Miller AC, Rohloff P. Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model. International Journal of Environmental Research and Public Health. 2021; 18(2):773. https://doi.org/10.3390/ijerph18020773

Chicago/Turabian Style

Juarez, Michel, Carlos Dionicio, Neftali Sacuj, Waleska Lopez, Ann C. Miller, and Peter Rohloff. 2021. "Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model" International Journal of Environmental Research and Public Health 18, no. 2: 773. https://doi.org/10.3390/ijerph18020773

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

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