Community BasedEducation Strategy

Totonicapán, Guatemala

Irma Chavarria de Maza

Content

• Statistics• Analysis of the nutritional problem in Guatemala• Causes and conditionals of chronic malnutrition• Interventions• Scaling Up Nutrition (SUN)• MOH interventions• Community Education Strategy in Totonicapán

90 % of all stunted children live in only 36 countries in the world

Guatemala, fourth place worldwide and first in Latin America

Totonicapán 82 %El Quiché 72 %Sololá 72 %Huehue 70 %

National Average 49.8 %

Exclusive Breastfeeding in Guatemala

• 44 % of Guatemalan children have stopped being breastfed exclusively before two months of age (DHS/ENSMI 2008/09)

• 49.6 % of children under 6 months are breastfed exclusively according with WHO indicator (DHS/ENSMI 2008/09)

• Studies carried out in the highlands of Guatemala and applying a different methodology than WHO have found prevalences of EBF even lower. (Ilse van Beusekom, Marieke Vossenaar, Gabriela Montenegro-Bethancourt, Colleen M Doak, Noel W Solomons)

Evidence of the impact of the strategies for behavior change in the duration of EBF

• Mother to mother support (Peer Counseling) individual or in groups:

Increase the rates of initiation, duration and exclusive breastfeeding

Reduces the incidence of diarrhea Increases the amenorrhea by lactation

“Mother-to-mother support groups are effective and can be brought to scale in both developed and developing countries as part of maternal and child health programs well coordinated for the promotion of breastfeeding.”

Breastfeeding peer counseling: from efficacy through scale-up. Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R

J Hum Lact. 2010 Aug;26(3):314-26; Arch Pediatr Adolesc Med. 2004 Sep;158(9):897-902.

The lancet.Vol 378 July 30, 2011

Iniciative of 1,000 days

9 months of pregnancy

24 first months Months of life

Only time to prevent chronic malnutrition. The window of opportunity.

1000 children are born daily in Guatemala and unless nutritional interventions are strengthen, it

won’t be possible to prevent malnutrition.

1,000 days

1 lInstitucional Facilitador

10 Comunity

Facilitators

1 Ambulatory physician

1 HP/Peer Counselor is responsible

for 1 sector of 20 to 30 families

67 Health Promoters

2 Educadors

1 Supervisor Field worker/4

“jurisdicciones”

MOH structure to provide basic health services for an area “Jurisdicción” of 10,000 people with integrated atention for women

and children

Community Based Education StrategyFormation of Peer Counselors and mother-to-mother

support groups to improve infant and children nutrition

General Objective

Contribute to the reduction of stunting in children under the age of 36 months through a community based education strategy for vulnerable groups, children, pregnant women and nursing mothers.

Specific objectives

• Exclusive breastfeeding, • Initiation and appropriate complementary

feeding at six months,• Continued breastfeeding up to two years and

beyond, • Strengthen feeding practices for the family,

pregnant women and nursing mothers.

Definition of the strategy

• It is an educational intervention based on the community and women's participation, aimed at changing practices of feeding and care of children under 3 years of age.

1 lInstitucional Facilitador

10 Comunity

Facilitators

1 Ambulatory physician

1 HP/Peer Counselor is responsible

for 1 sector of 20 to 30 families

67 Health Promoters

2 Educadors

1 Supervisor Field worker/4

“jurisdicciones”

MOH structure to provide basic health services for an area “Jurisdicción” of 10,000 people with integrated atention for women

and children

Community Educator

Profile• Teacher• Local language speaker • Resident from the

project area• Availability to travel to

the communities.

Responsibilities• Identifify possible Peer

Counselors through community meetings.

• Meet monthly with the Peer Counselors for training and support

• Monitor and support the activities of the Peer Counselors in each community

Who are the Peer Conselors?

• Local volunteer women• Ideally mothers • Accepted and selected by

her community• Support from her partner

and family• Wishes to learn and share • Good comunication skills• Willing and able to receive

the complete training• Ideally literate

Peer Conselors’ activities

Mother-to-mother support groups

Individual counseling

Home visits

Peer Counselor and mother-to-mother support network

1. San Andrés Xecul2. San Cristóbal Totonicapán3. San Bartolo Aguas

Calientes4. San Francisco el Alto5. Santa María Chiquimula6. Santa Lucía la Reforma7. Momostenango8. Totonicapán

225 Peer Counselor trained as “Madres Consejeras”

Topics for training PCs

• The reality of my community• Malnutrition, chronic and acute• Mother-to-mother support group methodology • Communication skills• Exclusive breastfeeding • Introduction of complementary feeding , continued breastfeeding

and demonstrations of the preparation of nutritive baby local foods• Feeding and recovery of a sick child• Basic information for feeding and recovery of a malnurished child

treated at the community based on the “Guide for nutritional recovery, in my house I have a good recovery”.

• Promotion of MOH basic health package. PCs also learn how to review the MOH health card for children under five years.

Training of PCs

Demonstration of preparation of local complementary foods

Mother-to-mother support groups and participants

Joint Program, TotonicapánMonth # Support Groups Participants

January 33 761

February 43 1009

March 57 1257

April 75 1719

May 67 1560

June 74 1741

July 75 1676

August 68 1668September 64 1619

Total 556 13010

Educators accompany PCs in the formation of their support groups

PCs package of materials

• Diploma as “Madre Consejera”

• Identification Card as a PC

• Plastic identification to hang on the wall

• Bag

District events to give recognition to PCs by local authorities

Momostenango

San Cristóbal Totonicapán

Totonicapán

Santa Lucía la Reforma

Santa María Chiquimula

San Andrés Xecul

San Francisco El Alto San Bartolo Aguas Calientes

Children of Totonicapán

• The involvement of the community, especially of women, in infant feeding and care, is a cost effective strategy that assures practice and behavioral change to prevent malnutrition.

Doña Izabel, Don Santos y familia Paraje La Balacera, Santa María ChiquimulaTotonicapán