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Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model
Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for f...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831302/ https://www.ncbi.nlm.nih.gov/pubmed/33477580 http://dx.doi.org/10.3390/ijerph18020773 |
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author | Juarez, Michel Dionicio, Carlos Sacuj, Neftali Lopez, Waleska Miller, Ann C. Rohloff, Peter |
author_facet | Juarez, Michel Dionicio, Carlos Sacuj, Neftali Lopez, Waleska Miller, Ann C. Rohloff, Peter |
author_sort | Juarez, Michel |
collection | PubMed |
description | Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package. |
format | Online Article Text |
id | pubmed-7831302 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-78313022021-01-26 Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model Juarez, Michel Dionicio, Carlos Sacuj, Neftali Lopez, Waleska Miller, Ann C. Rohloff, Peter Int J Environ Res Public Health Article Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package. MDPI 2021-01-18 2021-01 /pmc/articles/PMC7831302/ /pubmed/33477580 http://dx.doi.org/10.3390/ijerph18020773 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Juarez, Michel Dionicio, Carlos Sacuj, Neftali Lopez, Waleska Miller, Ann C. Rohloff, Peter Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model |
title | Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model |
title_full | Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model |
title_fullStr | Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model |
title_full_unstemmed | Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model |
title_short | Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model |
title_sort | community-based interventions to reduce child stunting in rural guatemala: a quality improvement model |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831302/ https://www.ncbi.nlm.nih.gov/pubmed/33477580 http://dx.doi.org/10.3390/ijerph18020773 |
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