Advancing child nutrition science in the scaling up nutrition era: a systematic scoping review of stunting research in Guatemala

Abstract

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.

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

“…An additional dimension is that attention to program adaptability and supervisory support in nutrition programs are likely major determinants of impact. Qualitative work has demonstrated how lack of clear “marching orders” for frontline actors have limited the impact of prior efforts to scale nutrition policy; furthermore, despite a large technical nutrition literature in Guatemala, evidence of best practices in program implementation are largely missing [ 4 ].…”

“…Our case study provides detailed implementation evidence for the effectiveness of augmenting supervisory (audit and feedback) support for frontline nutrition workers in rural Guatemala. This evidence is of national importance, as implementing institutions and policymakers work to improve child growth indicators and to understand what factors predict program success or failure [ 4 ]. In addition, our study articulates with a larger global literature on audit and feedback, most of which however is situated in high income settings [ 17 , 30 ].…”

“…Guatemala has the highest stunting rate in Latin America and 6th highest worldwide, and the annual rate of reduction has averaged only 0.45% over the last 20 years, despite intensive investments and efforts [ 2 , 3 , 4 ]. Repeatedly, ambitious national political milestones to reduce stunting dramatically—such as the 24% reduction proposed by the National Secretary of Food and Nutritional Security for 2006–2016—have not been met [ 5 ].…”

“…This may help to explain why, for example, even recent evidence-based packages of stunting interventions aligned with the international Scaling Up Nutrition movement priorities have failed to achieve the same impact in Guatemala as in other peer countries [ 10 ]. For example, in a recent scoping review of nutrition literature from Guatemala, lack of attention to contextual and implementation details were identified as important barriers [ 4 , 11 ]. Similarly, a qualitative review of nutrition scale-up activities highlighted how deficiencies in frontline capacity impeded implementation of central nutrition policy decisions [ 12 ].…”

Barriers and Facilitators to the Implementation of Large-Scale Nutrition Interventions in Africa: A Scoping Review

“…For example, Cordon and colleagues investigated interventions addressing the issue of stunting in Guatemala. They concluded a need for multileveled interventions that address both proximate and distal factors underlying child malnutrition, and also advocated for more comprehensive implementation science studies examining scale-up efforts (Cordon et al 2019). Similarly, Roos et al (2018) examined population-based nutrition interventions in South East Asia.…”