Experiences and Lessons Learned in Developing and Implementing a Population-Based Nutrition and Health Surveillance System in Guatemala 2011–2021

Abstract

Background Practice-based experiences documenting development and implementation of nutrition and health surveillance systems are needed. Objectives Described processes, methods, and lessons learned from developing and implementing a population-based household nutrition and health surveillance system in Guatemala. Methods Described the phases and methods for the design and implementation of the surveillance system. Described efforts to institutionalize the system in government institutions, provided illustrative examples describing different data uses, and lessons learned. Results After initial assessments of data needs and consultations with officials in government institutions and partners in country, a population-based nutrition surveillance system prototype with complex sampling was designed and tested in five Guatemalan Highland departments in 2011. After dissemination of the prototype, government and partners expanded the content and multi-topic nutrition and health surveillance cycles were collected in 2013, 2015, 2016, 2017/18, and 2018/19 providing nationally representative data for households, women of reproductive age 15–49 years, and children 0–59 months. Each cycle, data were to be collected from 100 clusters, 30 households in each, and one woman and one child per household. Content covered around 25 health and nutrition topics, including coverage of all large-scale nutrition-specific interventions; the micronutrient content of fortifiable sugar, salt, and bread samples; anthropometry; and biomarkers to assess annually, or at least once, around 25 indicators of micronutrient status and chronic disease. Data were collected by 3–5 highly trained field teams. The design was flexible and revised each cycle allowing potential changes to questionnaires, population groups, biomarkers, survey design, or other changes. Data were used to change national guidelines for vitamin A and B12 interventions, among others, and evaluate interventions. Barriers included frequent changes of high-level government officials and heavy dependence on USA funding. Conclusions This system provides high quality data and fills critical data gaps and may serve as a useful model for others.

Prevalence of Hypertension, Diabetes, and Other Cardiovascular Disease Risk Factors in Two Indigenous Municipalities in Rural Guatemala: A Population-Representative Survey

“…Regarding hypertension in predominantly Indigenous areas of Guatemala, our prevalence of 20.3% was similar to Santiago Atitlán (hypertension prevalence of 18.3%) [ 23 ], higher than the Department of Sololá (hypertension prevalence of 12.5%) [ 22 ], and higher than a nationally representative survey of women aged 15–49 (hypertension prevalence among Indigenous subpopulation of 12.8%) [ 43 44 ]. Overall, the hypertension prevalence in our study was lower than in the STEPS survey in Guatemala City [ 49 ] and also lower than modeled national prevalence in Guatemala from the NCD Risk Factor Collaboration [ 19 ].…”

“…Second, it was notable that women had nearly double the age-adjusted prevalence of obesity as men (30.1% vs. 17.0%; Supplementary Table S1 shows all BMI categories). The DHS and other national reproductive health surveys collect anthropometric measures only among women [ 41 43 44 ], and our study is one of few to report the BMI status of Indigenous men in Guatemala [ 23 ]. We speculate that gender differences in obesity in these communities are driven by greater physical activity among men practicing intensive agricultural occupations [ 45 ].…”

National nutrition surveillance programmes in south-east Asian countries and China: a systematic scoping review

“…Past experiences in establishing and expanding nutrition surveillance programmes suggest that collaborating with a wider range of partners with similar interests, priorities and information, under the guidance of a governmental body, fosters a more sustainable nutrition surveillance. 170 …”

Trends in Micronutrient Interventions, Anemia, and Iron Deficiency among Women and Children in Guatemala, 2009–2019

“…All nonpregnant women of reproductive age (WRA), classified as females aged 15–49 y, and preschool age children (PSC), classified as children aged 0–59 mo, were eligible for inclusion (aged 6–59 mo for biomarker collection). Detailed information on the sampling methodology for each survey is reported elsewhere [ 13 ]. Briefly, these nationally representative household surveys used multistage cluster sampling designs and selected clusters with probability proportional to their number of households.…”

“…Changes in indicators and methodologies also create additional issues with comparing these data over time. To resolve these issues, the Integrated Reproductive Health and Nutrition Surveillance System (Sistema de Vigilancia Epidemiológica de Salud y Nutrición [SIVESNU]) was created [ 13 ].…”