Nutrition Updates from the Field

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from Sarah Messmer

Nicole Henretty (a registered dietitian, nutrition graduate student from Tufts, and member of Wuqu’ Kawoq for the past year and a half) and I have been working on evaluating, expanding, and improving our nutritional programs here in Guatemala this summer. We are focused mainly in two locations: the small highland town of Paya’ and Socorro, the coastal community where I lived from July 2008 to July 2009. We have been devoting our efforts to two main goals: developing a solid nutritional education program and nutrition education materials, and trying out two new nutritional supplements, Chispitas and PlumpyDoz.

Nutrition Education Initiatives

Paya’ is a beautiful community located at the top of a mountain—reached only by a 30-minute tuktuk ride up a dirt road. Every Wednesday, we have been making this bumpy but gorgeous journey to meet with a group of mothers and midwives from Paya’ who make up the comité in charge of Paya’s child nutrition program. These women are incredible; they are enthusiastic, motivated, and excited to learn as much as possible about complementary feeding, breastfeeding, anemia, diarrhea, vitamins, and more in order to improve the health of the children of their community.




Sarah and everyone in front of the poster that Sarah made for the first nutrition class




Nicole and one of the women demonstrating the size of a baby’s stomach with balloons

Just last week, we taught the mothers how to do point-of-care anemia tests, a crucial component of our initiative to prevent and treat anemia. They were incredibly skilled and are now very comfortable using the machine, which will stay with them at the end of the summer. This week, we will be discussing parasites and diarrhea, as well as helping them to prepare a lesson plan for the following week, when they will be teaching a short class on anemia to the rest of the mothers in the community.

This inspiring comitee will also be continuing the work they have been doing for months now: measuring and weighing the children of Paya’, as well as providing food supplements to the youngest children in order to prevent and treat stunting. Now, however, they will be trying out the new hanging Salter scale, which will not only provide more accurate measurements but also never needs batteries!




Nicole helping the women to use the new scale to weight a child in Paya’




The women in Paya’ measuring the length of one of their children

Chispitas: the new tasteless iron supplement

In both Paya’ and Socorro we have begun to distribute Chispitas (known as Sprinkles in other countries) in order to prevent and treat anemia. Anemia is a significant problem in both communities (in Socorro, about 3/4 of children under 5 are anemic, whereas in Paya’ the rate is about 1/3) and can lead to poor growth and cognitive development. To address this problem, we have been giving iron drops and pills; however, children often refuse to take these medications due to the unpleasant taste and frequent stomachaches that accompany them. To remedy this problem, we have switched over to a fairly new product, Chispitas, which is a tasteless powder that can be added to foods. Since the iron is coated in lipid, the Chispitas simply dissolve and the child cannot taste the iron. In fact, some of the mothers reported that their children actually requested the Chispitas, thinking that they were a sweetener for the food. One child, who likes her Chispitas mixed with purified water, claimed that the Chispitas tasted like, “pura leche!”—or pure milk.




Child in Socorro with Chispitas




Child in Paya’ with Chispitas

Looking to the future: PlumpyDoz

In Socorro, we have been providing food supplements for nearly two years now, and we are constantly in the process of re-evaluating and improving our nutrition program. For example, we now provide supplements to all children from 6-24 months in order to focus on preventing stunting. We have been providing Incaparina, a corn-based atol that is commonly eaten throughout Guatemala, and we have seen very positive results overall. However, this supplement is prepared with a fair amount of water, which is not ideal for small children, who need more calorie- and nutrient-dense foods.

For this reason, we have been looking into other types of food supplements, such as PlumpyDoz, a peanut-butter based product designed to be used as a complementary food. Peanut butter, however, is not a commonly eaten food in Guatemala. Before importing large amounts of PlumpyDoz, we have begun a two-week acceptability trial in Socorro with 17 children from 6-18 months of age in order to see if they will actually eat it. If it goes well, we plan to try out the PlumpyDoz at full scale to see if it can produce even further improvements in child growth.




Sarah and Nicole handing out PlumpyDoz to moms in Socorro

So far, mothers and children have reacted positively to the PlumpyDoz. Although not a dietary staple like Incaparina, the children have liked the taste. Mothers have found it fairly easy to use, feeding it to their children in many forms, from mixing it with beans to giving straight spoonfuls. At the end of this week, we will be heading back to Socorro to do some more extensive follow-up interviews and analysis of the best steps to take to continually improve the program. And, of course, to spend time platicando with the moms of the community, who are our friends and partners in the project.