IntroductionEver since the 1960s, Guatemala has been a principle site for global academic research on child growth and nutrition. Nevertheless, Guatemala still has one of the highest rates of child stunting in the world. Since 2012, Guatemala has had a comprehensive national policy on stunting, calling for a renewed investment in innovative, multilevel nutrition interventions and implementation science. Our objective was to perform a systematic search and scoping review of the literature on stunting in Guatemala to identify gaps in research and opportunities for responding to this unique policy opportunity.MethodsWe conducted a systematic search and scoping review on stunting in Guatemala, searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were of any design or format, published in English and Spanish from 2000 to 2018. Articles were thematically grouped by those published before (2000–2011) and after (2012–2018) the new national policy initiatives.ResultsWe identified a total of 1934 articles through database searches. After full-text review, 104 were included in the synthesis. The volume of published articles on stunting increased from a mean of 3.2 to 9.4 articles/year before and after 2012. There was a shift toward articles generating new data on priority populations, including rural indigenous Maya populations (34% vs 61%, χ2 test, p=0.01). However, the proportion of studies conducting implementation evaluations or testing new interventions was low and did not change significantly (34% vs 18%, χ2 test, p=0.07). Among 17 identified intervention studies, only 4 tested multilevel interventions, and there were no published interventions incorporating nutrition-sensitive interventions.ConclusionsA systematic search and scoping review of the literature on child stunting in Guatemala identified critical opportunities for new research in multilevel interventions, nutrition-sensitive interventions and implementation science.

Scaling-up coverage of evidence-based nutrition interventions recommended by the international community would only lead to a small improvement in child stunting in Guatemala and are unlikely to meet the ambitious national goals set for 2024 or the 2030 SDGs.n Our results support an increased focus on strategies that address the social determinants that contribute to stunting rather than a narrow focus on nutritionspecific interventions.

Background: Child stunting is a critical global health issue. Guatemala has one of the world′s highest levels of stunting despite sustained commitment to international nutrition policy best-practices endorsed by the Scaling Up Nutrition movement (SUN). Our objective was to use Guatemala as a case study by projecting the impact of a recently published national nutrition policy, the Great Crusade, that is consistent with SUN principles. Methods: We used the Lives Saved Tool (LiST) to project the scaling-up of nutrition interventions proposed in the Great Crusade and recommended by SUN. Our outcomes were changes in stunting prevalence, number of stunting cases averted, and number of cases averted by intervention in children under five years of age from 2020–2030. We considered four scenarios: (1) intervention coverage continues based on historical trends, (2) coverage targets in the Great Crusade are achieved, (3) coverage targets in the Great Crusade are achieved with reduced fertility risk, and (4) coverage reaches an aspirational level. Results: All scenarios led to modest reductions in stunting prevalence. In 2024, stunting prevalence was estimated to change by -0.1‰ (95‰ CI 0.0‰ to -0.2‰) if historical trends continue, -1.1‰ (95‰ CI -0.8‰ to -1.5‰) in the Great Crusade scenario, and -2.2‰ (95‰ CI -1.6‰ to -3.0‰) in the aspirational scenario. In 2030, we projected a stunting prevalence of -0.4‰ (95‰ CI -0.2‰ to -0.8‰) and -3.7‰ (95‰ CI -2.8‰ to -5.1‰) in the historical trends and aspirational scenario, respectively. Complementary feeding, sanitation, and breastfeeding were the most impactful interventions across models. Conclusions: Targeted reductions in child stunting prevalence in Guatemala are unlikely to be achieved solely based on increases in intervention coverage. Our results show the limitations of current paradigms recommended by the international nutrition community. Policies and strategies are needed that address the broader structural drivers of stunting.

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