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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...

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Autores principales: Juarez, Michel, Dionicio, Carlos, Sacuj, Neftali, Lopez, Waleska, Miller, Ann C., Rohloff, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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