1. Xela-Babies and Mam-Mamas

Background

“Xela-Babies” and “Mam-Mamas” represent two major field-study projects in the Quetzaltenango Province of Guatemala with separate funding and staffing streams, but with multiple of common themes and interest related to maternal health, the adequacy of lactation, the early feeding practices and the nature of complementary feeding and growth of the offspring.

The focus is on the urban experience of early-feeding, growth and illness and their interaction. The projects have a survey component with children from birth to 23 months of life, and a prospective, longitudinal component with serial measurements and interviews in the first, fourth and sixth month of life.

The Mam-Mamas Project is a research platform for addressing the dissertation hypotheses of two doctoral candidates from McGill University: Dr. Anne-Marie Chomat and Ms. Hilary Wren. It is based in seven remote hamlets in the Western Highlands among Mam-speaking families. These are areas of high rates of poor linear growth (stunting) in early life. The major objective is to investigate the impact of women’s health in late pregnancy and in the first 6 months of lactation as potential determinants of the offspring’s growth and disease resistance. It includes qualitative and quantitative interview methods and the collection of biological specimens, with a specific focus on non-invasive methods, such as determination in saliva, urine, feces and human milk. It explicitly eliminates the collection of blood. The project is conducting a survey among women in these reproductive phases, and performing a serial (longitudinal) screening of variables. The measurements include dietary intake of mothers and children, body size of both parties, the parasites and infections in the dyad, and specifically in the mothers, the nutritional quality of milk, and the social and biological markers of maternal stress (including stress hormones in saliva and milk). The project also has a “Positive Deviance” dimension, in which factors common to the families with the most successful growth and health experience in the offspring are sought as potential clues to resolving the problems in these settings. 

Final Report „The ‚Cuarenta‘: Perceptions and Practices of Maternal Care during early Postpartum period among Mayan Women from the Guatemalan Western Highlands“

Stunting at Birth

The under-five population of Guatemala has the highest rate of linear growth retardation (=stunting) in the Western Hemisphere. The reported prevalence is 54% below the “international minimum height standard”. The loss of linear growth commences shortly after birth and produces dramatic rates of stunting in affected areas by 24 months of age. As official survey samples include infants as of 6 months of age, the amount of growth loss occurring before that age has remained obscure. Combined insights from the Xela-Babies and Mam-Mamas projects have recently revealed that rates of stunting are already on the order of 31% in the first month of life.

This has multiple implications for public health. The most obvious conclusion is that directing efforts against stunting after birth is too late, and any full redress of linear growth would have to begin during pregnancy or before. This implies attention to the maternal health to resolve the child-malnutrition problem. At the same time, with the short stature of women in this population, increase in utero growth would increase the risk of obstructed labor and obligate attention to provisions for appropriate obstetrical intervention.  

Relationship of Agüitas and Morbidity

A cultural practice, widespread in Guatemala, is the administration to infants of ritual fluids consisting of herbal infusions or dilute gruels, known as agüitas (“little waters”). Since this violates the tenets of exclusive breast feeding – but does not involve provision of nutrition – this constitutes “predominant breast feeding” by WHO terminology. The findings from Xela-babies’ dietary and morbidity survey identified the fact that early introduction of agüitas was associated with a greater risk of stunting up to 24 months of age.

Results

Stunting rates still seem to be very high in Guatemala. More results will be published.

Corresponding publications

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2. Dietary Offering and Inter-Subject Variance in Day-Care Center Attendees

Background

The Secretariat for Social Projects of the First Lady of Guatemala (SOSEP) supports the formation and maintenance of Hogares Comunitarios (HC) (i.e. of day-care centers) allowing both parents of a family to work outside of the home in low-income communities. A notable feature of the SOSEP HCs is the provision of a well-planned and standardized dietary fare including a breakfast, a lunch and two snacks over 5 days per week in a 40-day (8 week) rotating official menu. This food plan applies to all HCs in the system, tending to normalize the dietary offering for all attendees across the nation, with the variation arising what is consumed in the evenings at home.  The intake of nutrients across all of the nutrients offered were quantified by the United States Department of Agriculture on-line composition tables.

With a common general dietary pattern, variability in nutritional status and health from child to child will depend upon genetic and environmental peculiarities.

It is now examined how growth, hematological status, oxidative and inflammatory processes, parasite infestations and even hydration vary across individuals in the context of a fairly common dietary experience.

Corresponding publications

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3. Supertortilla - Dietary Preferences and Eating Patterns of Reproductive-Phase Women

Background

The requirements for dietary nutrients are higher during pregnancy and breast-feeding than during non-reproductive phases of the female lifespan. Whereas some habitual dietary patterns, including those in some low-income sectors of Guatemala, may come close to providing the standard for nutrients for women, it does not have the reserve needed to supply the extra nutrients for gestation and lactation. A public health strategy would be to get women to consume more nutrients from a fortified source to cover additional reproduction-based demands.

In the Province of Quetzaltenango, CeSSIAM has two initiatives on this theme. One of these is to model a formula for maize flour for preparing maize-derived items such as tortillas and tamales that would enhance the intake of micronutrients for the needs of pregnant and nursing women.

A second focus is on interviews regarding how the maize items are prepared and how they are distributed across family members within the household and to quantify the nutrient intake in pregnant and lactating women from rural and urban settings to identify the nutrient gaps as compared to the standard, international recommended intakes. It also inquires about specific avoidances and cravings or preferences during the two physiological conditions and on food taboos, food avoidances and the cultural nuances surrounding views on equity versus hierarchy of food distribution within the household.

Corresponding publications

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Abstracts EB 2015: ID: 4337