title: 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.
authors.affiliation: World Vision US, Federal Way, Washington, USA.
authors.forename: Kelley
authors.initials: K
authors.lastname: Brown
authors.affiliation: Edesia Inc., Providence, Rhode Island, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Henretty
authors.affiliation: School of Medicine & Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Chary
authors.affiliation: Department of Anthropology, University of Kansas, Lawrence, Kansas, USA.
authors.forename: Meghan Farley
authors.initials: MF
authors.lastname: Webb
authors.affiliation: Department of Anthropology, University of Kansas, Lawrence, Kansas, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Wehr
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Moore
authors.affiliation: Department of Anthropology, University of Florida, Gainesville, Florida, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Baird
authors.affiliation: Wuqu' Kawoq, Santiago Sacatepéquez, Guatemala.
authors.forename: Anne Kraemer
authors.initials: AK
authors.lastname: Díaz
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rohloff
mesh_terms: D001942:Breast Feeding; D015362:Child Nutrition Disorders / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003469:Culture; D004032:Diet; D005248:Feeding Methods; D005502:Food / Q000191:economics; D005523:Food Supply; D005527:Food, Fortified; D006166:Guatemala / Q000453:epidemiology; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D033183:Interdisciplinary Communication; D009753:Nutritive Value; D011203:Poverty; D012424:Rural Population
keywords: child nutrition; complementary foods; cultural issues; ethnicity; low-income countries; multidisciplinary approaches