A wide gap exists between current evidence-based standards and current levels of provider competence.

Objective. To assess the impact that a mother-to-mother support program operated by La Leche League Guatemala had on early initiation of breast-feeding and on exclusive breast-feeding in peri-urban GuatemalaBreast-feeding, infant nutrition, social support, health education, health promotion.

Exclusive breastfeeding was promoted through the first 6 months of life using prenatal lectures, monthly support and education, peer encouragement, home visits, growth monitoring, and assistance in returning to exclusive breastfeeding. Exclusive breastfeeding increased significantly in the service area after the program started, while morbidity decreased significantly and nutritional status remained about the same among clinic attenders. This result shows that, at least in the study conditions, programs to achieve exclusive breastfeeding can be both feasible and desirable.

This is an effective, relatively low-cost program that substantially improved case management of diarrhea in Guatemala, in particular the quality of assessment and classification. However, many health workers who completed the course are still not performing to standard, so additional work is needed to resolve this problem.

Timeliness can be studied in developing countries. Its objective measurement is a first step towards improving this component of care.