Projecting the Impact of Nutrition Policy to Improve Child Stunting: A Case Study in Guatemala Using the Lives Saved Tool

BACKGROUND: Child stunting is a critical global health issue. Guatemala has one of the world's highest levels of stunting despite the sustained commitment to international nutrition policy best practices endorsed by the Scaling Up Nutrition (SUN) movement. Our objective was to use Guatemala as a case study to project the impact of a recently published national nutrition policy, the Great Crusade, that is consistent with SUN principles. METHODS: We used the Lives Saved Tool (LiST) to project the impact of scaling-up of nutrition interventions proposed in the Great Crusade and recommended by SUN. Our outcomes were changes in stunting prevalence, number of stunting cases averted, and number of cases averted by intervention in children under 5 years of age from 2020 to 2030. We considered 4 scenarios: (1) intervention coverage continues based on historical trends, (2) coverage targets in the Great Crusade are achieved, (3) coverage targets in the Great Crusade are achieved with reduced fertility risk, and (4) coverage reaches an aspirational level. RESULTS: All scenarios led to modest reductions in stunting prevalence. In 2024, stunting prevalence was estimated to change by −0.1% (95% confidence interval [CI]= 0.0%,−0.2%) if historical trends continue, −1.1% (95% CI=−0.8%,−1.5%) in the Great Crusade scenario, and −2.2% (95% CI=−1.6%,−3.0%) in the aspirational scenario. In 2030, we projected a stunting prevalence of −0.4% (95% CI=−0.2%,−0.8%) and −3.7% (95% CI=−2.8%,−5.1%) in the historical trends and aspirational scenario, respectively. Complementary feeding, sanitation, and breastfeeding were the highest-impact interventions across models. CONCLUSIONS: Targeted reductions in child stunting prevalence in Guatemala are unlikely to be achieved solely based on increases in intervention coverage. Our results show the limitations of current paradigms recommended by the international nutrition community. Policies and strategies are needed to address the broader structural drivers of stunting.