How to do Interventions in Early Nutrition with Your Bare Hands: An Example in Guatemala Michele Monroy-Valle

Note: for non-commercial purposes only

Evidence based nutrition interventions

Glasgow R, Vinson C, Chambers D, coll. National Institutes of Health Approaches to Dissemination and Implementation Science: Current and Future Directions. American Journal of Public Health Vol 102:7, 2012

foreign Must foreign, some local, few and focused sample, published in English

foreign and translated (not adapted)to Spanish

Lots of workshop and meetings happen trying people to “accept” the intervention

outcomes? few and focused, but surveillance is very strict and well done

Bottlenecks of early nutrition interventions in low resource settings

Early Nutrition Interventions

Limited Disaggregated

Not achieving right for health

Very limited resources and

funding

Lack of local evidence and culturally

adapted interventions

Violent and inequity context

Limited Research or implementing research resources

Research funding of all EU funding programmes managed by the European Commission and the EU - Updated 2014-2020. • 34 funds for Developing countries • 12 are for Latin America • 4 for Central America • 2 are “related” to Health • DEVELOPMENT COOPERATION –

– CIVIL SOCIETY ORGANISATIONS AND LOCAL AUTHORITIES – GLOBAL PUBLIC GOODS AND CHALLENGES

http://www.welcomeurope.com/european-subsidies-region-Developing+countries.html

Source: WHO|Global Health Expenditure Database http://apps.who.int/nha/database/ViewData/Indicators/en

Limited implementing resources

Lack of evidence • Must of the evidence is produced in Africa by

high income country researchers. • Little LAC evidence, useful but mainly

produced in middle income countries.

Violent and inequity context • Very high violent environment: to mothers, to child, to

communities, to community health personnel and researchers – By 2007 37.3% of households were victimized in Guatemala City

• Physicians highly trained in hospital and specialty settings but lack of training in primary healthcare or research. – In LAC 18 countries and one territory offer Master (161courses) or PhD

(46, 32 in Brazil) programs in Epidemiology or Public Health

• All Health Personnel contractual terms are not permanent, payment is not regular and there is not a carrier ladder.

Encuestas de Victimización y Percepción de Inseguridad del Programa de Seguridad Ciudadana y Prevención de la Violencia del PNUD Guatemala

How interventions are done? FOCUS!, What do focus really means?

Women and Children

Pregnant and under 2

(1000 days)

Poor settings

Poor settings with access

Only households

that are willing to

acquire the intervention Adapted: Estrada G, Oppening lecture from Masters in Public Health Epidemiology.

Rafael Landivar University Guatemala.

Sacrifice Early Nutrition!

Scattering!

Guatemala´s Nutrition Surveillance system for children <5 (2009)

immunization acute malnutrition treatment breastfeeding

promotion

micronutrient supplementation

food fortification Diarrheal attention

Respiratory infections attention

Decision timely action ALL INTERVENTIONS

ALL CHILDREN ALL PLACES

"package" nutritional status

assessment.

parent tools CHW tools

eSystem tools

monthly data in 22 country’s departments

Sanitation Developmental milestones Id & location

Vaccination Timely action

monthly weight, length

Feeding guidelines

Chronic malnutrition

Micronutrient & complementary

feeding supplementation

Weight for age

CHW tools Register information

and education

Early nutrition interventions in low resources settings …With passion & common sense!

Acknowledgements • Guatemala´s Health Ministry • PAHO/WHO Guatemala office • WFP Guatemala office • San Carlos University of Guatemala, Chemical Sciences

Faculty • Rafael Landivar University, Health Sciences Faculty • Early Nutrition Academy and the event organisers