Innovation Summary:
Our program also innovates the financing of child nutrition programs by raising direct care costs for the program through crowdfunding. The primary barrier to personalized, intensive approaches to nutrition is cost but through crowdfunding, we can demonstrate that it is possible to overcome this barrier. We will conduct extensive evaluations of the efficiency of the financing mechanism and of donor engagement with the program, in order to document the approach for other organizations to use in the future.
Gallery
Impact
Expected Impact:
- 322 children will receive nutrition services (in both intervention and control arms)
- The mean height for age Z score will improve by 0.2 standard deviations Direct costs of~625 CAD per child funded by crowdfunding
Guatemala has one of the highest rates of stunting in the world. We’re excited to be taking seriously the problem of individualized, intensive treatment for severely stunted children. We’re excited to be the first in Guatemala to measure developmental outcomes in stunted children, bringing together the fields of child nutrition and early child development in a culturally appropriate way
--Peter Rohloff, Project Lead
Innovation
Guatemala has one of the highest rates of stunting in the world [1], often more than 75% of all children under 5 [2]. Stunting is not just a disorder of linear growth but also affects neurological and psychoemotional development [3]. Furthermore, most stunting interventions have been developed in countries which much lower rates of stunting and focus only on prevention. In addition to improving prevention, Guatemala badly needs treatment-focused programs for children who are already severely stunted.
Our program includes micronutrient supplementation, food support for the most food-insecure families, growth monitoring, and extensive individualized counselling of caregivers about improving dietary diversity, caloric density, and minimum meal frequency. We will compare this intervention to our standard care approach to child stunting, which follows national policy guidelines and includes growth monitoring and micronutrient supplementation.
Children in the standard care arm of the program will also benefit, since we will guarantee the supply chain for their supplements. Lack of supply chain assurances has made public versions of this intervention less effective. Our program will finance direct costs of the intervention through internet-based crowdfunding. This mechanism of financing will allow for higher-cost interventions to achieve sustainability.
Our program innovates several “firsts” in Guatemala and in pediatric nutrition: (1) The first program to systematically measure developmental outcomes in a Guatemalan population; (2) The first intensive nutrition program to our knowledge globally to use crowdfunding as a core financing mechanism; (3) The first attempt in the region to provide customized, personalized in-home care for severely stunted children.
Collaboration
Funders:
- Saving Brains Partners
Key Partners:
- Wuqu’ Kawoq | Maya Health Alliance – Guatemala
- Universidad del Valle de Guatemala – Guatemala
- Watsi – USA
Implementation
Expected Drivers:
- Successful recruitment of sufficient participants
- Successful engagement of parents, community leaders, and other stakeholders
- Skill of cultural ambassadors/interpreters in administration and interpretation of developmental tests
- Successful funding of direct costs through crowdfunding
- Interdisciplinary team collaboration
Expected Challenges:
- Cultural variables between indigenous Guatemalan participants and the research team
- Challenges of researching in a non-written indigenous language
Evaluation Methods
This study is a two-arm randomized controlled trial. Key outcomes include Height-for-age Z score and items from the Bayley Scales of Infant Development III. Additionally, we will measure baseline and endline 24 hour dietary recalls to permit the calculation of minimal meal frequency, minimal dietary diversity, and minimal acceptable diet. The baseline/endline survey also includes elements from the HOME survey adapted to assess parenting practice around early child stimulation.
Impact of Innovation
322 children will be enrolled in the trial, 161 in each arm. In the intervention arm, 215 caregivers will receive individualized nutrition education. Our primary estimated impact will be change in Height for Age Z score between the two arms – hypothesizing a change of at least 0.2 SD. We also anticipate positive changes in Bayley developmental indices between the two arms of 0.5 SD.
Cost:
Estimated direct costs of ~625 CAD per child
References
- Black RE, Victora GG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382:427-51.
- Ministerio de Salud Pública y Asistencia Social (MSPAS). (2009). V Encuesta Nacional de Salud Materno Infantil 2008–2009. MSPAS: Guatemala City.
- Dewey, KG, Begum K. (2011). Long-term consequences of stunting in early life. Maternal & Child Nutrition, S3, 5-18.
- WHO Multicentre Growth Reference Study Group. (2006). WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization.
- World Health Organization (WHO) (2008) Indicators for Assessing Infant and Young Child Feeding Practices: Conclusions of a Consensus Meeting Held 6–8 November 2007 in Washington D.C., USA. WHO: Geneva, Switzerland
- Schreiner M, Woller G. A simple poverty scorecard for guatemala.
- Hamadani J, Tofail F, Hilaly A, Huda S, Engle P, Grantham S. (2010).Use of Family Care Indicators and Their Relationship with Child Development in Bangladesh. Journal of Health, Population and Nutrition, 28(1): 23-33
- Bayley, N. (2006). Bayley Scales of Infant and Toddler Development–Third Edition. San Antonio, TX: Harcourt Assessment.
Resources
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Research
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WHO Multicentre Growth Reference Study Group. (2006). WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization.
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Food and Nutrition Technical Assistance III Project (FANTA) (2013) Summary Report: Development of Evidence-Based Dietary Recommendations for Children, Pregnant Women, and Lactating Women Living in the Western Highlands in Guatemala. FHI360/FANTA: Washington DC.
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Instruments and Batteries:
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Baseline/endline survey guide (developed by project team but includes many elements from other studies [4-7]). Includes Height and Weight for Age Z scores, Poverty Score, HOME indicators, 24 hr. dietary recall
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Bayley Scales of Infant and Toddler Development–Third Edition. Subindices include gross motor, fine motor, cognitive, language, and sociobehavioral [8].
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