Mixed‐methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala

Abstract

Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders.

Exploring mechanisms of food insecurity in indigenous agricultural communities in Guatemala: a mixed methods study

“…In our own recent work, we have shown how these effects extend even to communities with high rates of local land ownership and food production [16]. At the same time, this endemic food insecurity coexists with a rapid increase in the country-wide availability and market penetration of highly-processed or pre-packaged snack foods [17,18].…”

“…Forty-five percent of the 230 families in Xejuyu' have an income of less than $2 USD/ day, and nearly 60 % of children under 5 years of age suffer from chronic malnutrition [16,19]. The nearest large town is Tecpán, located approximately 1 h away by public bus transport.…”

“…From within a food security paradigm, our and others' previous work in rural Guatemala has primarily examined one food security dimension, that of utilization, documenting deficiencies in local nutrition or sanitation knowledge and practice [12,15,16]. Here, we extend our food security analysis by systematically investigating two additional dimensions, food availability and food access.…”

“…At the same time, this endemic food insecurity coexists with a rapid increase in the country-wide availability and market penetration of highly-processed or pre-packaged snack foods [17,18]. In a recent study we conducted in an indigenous Maya farming village, Xejuyu' , 1 less than 3 % of children under five years of age met World Health Organization standards for dietary diversity and meal frequency [15,16], subjective perceptions of food insecurity were common, and the majority of households regularly consumed processed and pre-packaged snack foods. This was despite the fact that a majority of the population owned agricultural land and dedicated significant efforts to food production.…”

Complementary feeding practices: determinants of dietary diversity and meal frequency among children aged 6–23 months in Southern Benin

“…Five groups of potential explanatory variables were identified from the literature (Fein, Labiner-Wolfe, Scanlon, & Grummer-Strwan, 2008;Upul, Sanjeeva, Hiranya, Indika, & Michael, 2012;Khanal et al, 2013;Melkam, Molla, Zelalem, & Azeb, 2013;Brown et al, 2014;Issaka et al, 2015a, b).…”