Diagnostic: Assessing the Food and Nutrition Situation in Rural Guatemala

A nutritional assessment of rural Guatemala with recommendations.

According to UNICEF’s 1998 Progress of Nations report, malnutrition causes half of children’s deaths worldwide. While such statistics elicit mental pictures of frail children on the brink of starvation, perhaps the more disturbing news is that most of the malnutrition-related deaths occur in children with only moderate or mild malnutrition. In Guatemala, for example, while malnutrition contributes to 48 percent of deaths in children under age five, 83 percent of these deaths occur in children whose level of malnutrition is considered moderate or mild.

Figure 1

Because of its devastating effects, malnutrition has been dubbed “the silent killer.” Its morbidity is attributable to its exacerbation of otherwise minor health problems. Malnutrition most often joins forces with common infectious diseases to create a deadly combination. Ironically, both -malnutrition and illness can be combated by modest control of hygiene and dietary conditions. For this reason, the Ezra Taft Benson Agriculture and Food Institute has allocated much of its human and material resources to overcoming the ravages of this sinister pair.

While the causes of malnutrition vary, the Benson Institute has attempted to address those that would be most affected by preventive efforts. Based on a balance of frequency, social importance, and possibility of prevention, Bengoa (1973) suggests that we should focus on the following issues. First, we should address protein-caloric malnutrition, which has a high index of frequency and mortality. This type of deficiency can cause irreversible physical and mental damage, and it has the most severe consequences among the types of malnutrition. The second area of concern is anemia. Left unchecked, this easily preventable condition increases mortality, causes sickness, and reduces work capacity. Third, vitamin A deficiency often causes vision problems associated with conjunctivitis (inflammation of the eyelid membrane). Finally, a lack of iodine is easily overcome but can cause frequent endemic goiters if not prevented.

With this background information, Benson Institute researchers set out to understand the relative severity of these and other nutritional problems within their work area in eastern Guatemala. Focusing on needs involving nutrition and disease prevention, they performed diagnostic studies to assess the situation among the people in this rural area. This diagnostic serves as the basis for continuing improvement programs and research projects.

The Area of Study

The communities of Salitrón, Chancó, and Corral de Piedra are located in the southeastern Guatemalan department of Chiquimula (see map, Figure 2). The uneven terrain rests at approximately 900 meters (2950 feet) above sea-level, and the rocky soil makes large-scale agriculture difficult. Combined, the three communities consist of a total of 196 families, which have an average of six members each.

The families in the communities have access to fresh water, though it is of questionable potability. In Salitrón, water is available at most individual homes, while in Chancó and Corral de Piedra, the residents must manually transport it from a central location. Each of the communities offers public schooling for the primary grades. Between the three communities, these schools enroll a total of 192 students in grades one through six. Of students enrolled in school, 75 percent of their fathers and 72 percent of their mothers have had no schooling; of those parents who have attended school, only 8 percent progressed beyond the first grade. These figures explain why the weight of Guatemala’s 54 percent illiteracy rate is represented in rural communities, such as Salitrón, Chancó, and Corral de Piedra.

Figure 2. Schematic map of Guatemala, and rural communities

The Benson Institute strives to improve the living conditions for individuals in these communities. By focusing on their nutrition and health, the Institute hopes to help them improve their food security, disease prevention, and self-sufficiency. In addition, they will learn to use the resources that they already have more effectively through proper nutrition, hygiene, and home management.

The Research

The Benson Institute’s focus on preventing health and nutrition problems has led them to investigate the causes and nature of such problems in the communities of Salitrón, Chancó, and Corral de Piedra. The Benson Institute’s coordinator for Guatemala, Dr. Malaquías Flores, along with Benson Institute employees and scholars Lorena Romero, Dora Roque, and Maricruz Escobar, performed a diagnostic investigation on the nutritional and health situation of these communities. The research team used a number of tools to answer the following questions:

1. What is the nutritional state of children under the age of five?

2. What is the common diet in the area, and how does it meet the nutritional needs of the people?

3. What are the preventable situations compromising health, hygiene, and food availability?

The answers to these questions will help in designing useful research projects and effective improvement programs.

Nutritional State of Children

In order to diagnose the nutritional status of the young children, the research team recorded weight and height measurements for each child in the sample group. Using age, weight, and height data, nutritionists obtain a broad understanding of the child’s current and historical nutritional state by making the following comparisons:

Weight/Age

These measurements allow nutritional comparisons between children within a small area or on a global scale. Those who fall below the standard are considered to be “underweight” UNICEF reports that underweight children are two to eight times more likely to die within a year than those whose weight meets standards for their age (1998).

Weight/Height

These comparisons indicate a child’s current nutritional state. Those who are underweight for their height are considered to be “wasted.” Wasting is often attributable to reduced dietary intake, illness, or both, resulting in a loss of muscle mass and body fat (UNICEF, 1998). Wasting is reversible if circumstances are improved before permanent damage results.

Height/Age

This comparison reveals the nutritional history of a child. A long history of under nutrition causes growth retardation; therefore, children who are short for their age (more than is attributable to genetic variation) are considered “stunted.” This irreversible condition results from continual malnutrition mixed with repeated episodes of illness (UNICEF, 1998).

To determine the nutritional state of the children in the three communities on a global, historical, and current basis, the researchers weighed and measured the height of each child involved in the study. This allowed them to classify the nutritional state of the children according to the standards established by the National Center for Health Statistics.

Based on these standards, the data collected from this part of the study indicate that the problem of malnutrition in these communities severely impacts the children. In Salitrón, 34 out of the 40 children (85 percent) are stunted to some degree, indicating that they have prolonged malnutrition during their short lifetimes. Fifteen of the 40 show some degree of wasting, indicating that they are underweight for their height. Slightly less severe results came from Chancó, where 80 percent of the children are stunted and 25 percent are wasting to some degree. Although most of the children in the wasting category fall within the mild range of malnutrition, they still face a high-risk of illness. Finally, in Corral de Piedra, approximately 77 percent of the children indicated histories of malnutrition, while approximately 35 percent are currently wasting.

According to the data collected during the diagnostic study, fewer children are currently malnourished than show a history of malnutrition. This suggests that malnutrition is most severe during the first few years of life. In addition to using measurement data as an indicator, we must address other factors that contribute to the current nutrition of the children. These factors include, among other things, the nutritive quality of the diet, variable food availability during the year, and the health of the children.

Adequacy of the Common Diet

The nutritional situation of a community refers to the availability, quantity, and quality of the existing food. While many factors influence the nutrition situation, this diagnostic focuses on the following: the availability of resources, local consumption habits, and the biological integration of the consumed nutrients.

Table 1. Common foods eaten in Salitron, Chanco, and Corral de Piedra
Availability	Consumed in large quantities	Consumed in small quantities
Cultivated in the communities	black beans, corn	guisguil (Sechium edule), eggs, native herbs
Purchased in the local market	rice, potatoes, coffee	sugar, salt

The Benson Institute research team employed a two-part survey to determine the foods commonly consumed by the families. They then compared the results of this survey with the recommended daily allowances provided by the United States Department of Agriculture in order to determine the nutritive value of the daily diet. The diet survey was designed to record the types and amounts of food consumed by each family member during a 24-hour period. Assisted by the Benson Institute in Guatemala and BYU professors, the researchers modeled their survey after a survey created by the polytechnical school (ESPOCH) in Riobamba, Ecuador.

Table 2. Adequacy of the common diet in Salitron, Chanco, and Corral de Piedra
Nutrient	Children Age 1 to 5	Adult Women	Pregnant Women	Nursing Women	Adult Men
Energy	68.75	130.41	114.76	106325	98.92
Protein	146.15	178.4	142.72	133.8	142.72
Vitamin A	27.03	28.26	28.26	13.09	22.61
Vitamin C	21.83	38.31	22.64	23.70	22.99
Thiamine	98.33	202.39	148.42	139.14	148.42
Riboflavin	564.67	98.13	79.73	72.90	75.04
Niacin	52.90	119.6	109.95	89.4	94.31
Iron	50.01	305.87	152.73	305.87	458.3
Calcium	69.57	192.83	160.69	158.5	192.83
Phosphorus	127.64	439.21	292.8	292.8	431.00

In collecting data, the Benson Institute personnel visited the homes of each family involved in the study and explained to the families the purpose of their visit. They interviewed the mothers about the dietary habits of the family. During this visit they would also record the weight of the food that the family would eat in a 24-hour period, both as a whole and as individual portions for each member of the family. After measuring the portions, the Benson Institute researcher would ask what the family had eaten in the last 48-hour period. They repeated these home visits for each of the 116 families included in the study.

The diagnostic study revealed that the diet of every family in the communities consists primarily of corn and beans. Complementary foods vary depending on the season and their availability in the market. Table 1 lists the most commonly eaten foods among the people. In addition to the foods indicated, they occasionally consume processed foods that are available from small stands in the communities.

In this assessment, it is important to take into account the seasonal foods that were not included in this study. For example, during part of the year, the people consume a variety of fruits and vegetables that provide them with additional nutrients. However, in this study, these foods were not considered part of the typical diet.

By measuring individual portions, the researchers were able to determine the nutritional quality of the diet for different members of the family, based on the standard set by the USRDA. Table 2 indicates the levels of macro nutrients and micro nutrients that the families in this area consume. As this table indicates, the overall protein intake is generally sufficient. Conversely, there is an inadequate consumption of vitamin A, vitamin C, and vitamin B12. Most obtain sufficient plant-derived iron in the diet, with the disconcerting exception of children. When perusing this information, one should remember that in order for the iron to be usable, it must be accompanied by other vitamins, such as vitamin C.

It is evident that deficiencies in micro- and macro nutrients can have serious health ramifications. Effects of these deficiencies may include an increased susceptibility to infection, sight problems, anemia, and reduced energy. Children and pregnant and lactating women are at highest risk for such problems. Alarmingly, these groups have the greatest incidence of inadequate nutrition. These data indicate that the familial diet is unbalanced,creating a danger for young children, developing fetuses, and pregnant women.

Health and Hygiene Situation

According to Benson Institute research, the most common ailments in the rural communities affect the respiratory and gastric systems. Often, these illnesses can be prevented through careful practices of hygiene and nutrition. Such prevention is vital in order to reduce both illness and malnutrition. The relationship between malnutrition and sickness is discussed in UNICEF’s 1998 State of the World’s Children publication:

"The interplay between the two most significant immediate causes of malnutrition—inadequate dietary intake and illness—tends to create a vicious circle: A malnourished child, whose resistance to illness is compromised, falls ill, and malnourishment worsens. Children who enter this malnutrition-infection cycle can quickly fall into a potentially fatal spiral as one condition feeds off the other." (UNICEF, 1998)

Malnutrition lowers the body’s ability to resist infection by undermining the function of the main immune-response mechanisms. This leads to longer, more severe, and more frequent episodes of illness. For these reasons, the Benson Institute workers have taken special interest in teaching the people how to prevent those illnesses that result from poor hygiene and sanitation.

The health of the community members is an essential factor in their nutritional state and work capabilities. Disease prevention is imperative, even in the cases of seemingly minor or transitory illness such as diarrhea. Such illnesses reduce the physical and mental capacities of the individual, as well as compromising the absorption of nutrients.

While there are many serious illnesses beyond the scope of prevention through proper sanitation, the most common illnesses are easily avoided. According to the survey responses, 8 of the 116 children regularly suffer from diarrhea, while 47 of them regularly have respiratory infections. These illnesses, which diminish the mental and physical performance of the child while causing significant discomfort, can generally be prevented through proper hygiene and sanitation.

Fortunately, children in the communities of Chancó, Salitrón, and Corral de Piedra have access to immunizations through the Ministry of Public Health and Social Aid. Data collected during the diagnostic study show that each of the children under the age of five had received the immunizations recommended for that age group.

Waste Disposal

As part of their surveys, the researchers would ask family members about their methods of waste disposal. In regard to elimination of human waste, 54 percent indicated that they dispose of it in an open field, 41 percent use latrines, while only 4 percent have access to improved latrines (see Figure 2). This situation is disturbing considering the health risk of being directly exposed to human waste.

Garbage elimination methods reflect the habits pertaining to human waste disposal: 84 percent of the families surveyed responded that they dispose of garbage in an open field, while the remainder either burn or bury their trash. On the other hand, all of the families surveyed indicated that they feed food scraps to their domestic animals.

By improving sanitation practices, community members can potentially curb the ravages of many of the intestinal and respiratory diseases that plague their families.

Recommendations/Continuing Research

This diagnostic study illuminated several improvements that would be specifically useful in Salitrón, Chancó, and Corral de Piedra. These include changing waste disposal methods by building latrines and composting garbage. Next, because the children are not receiving the nutrients they need for optimal health, there should be an increased intake of macro nutrients and micro nutrients, particularly in vitamins A, B12, and C. The groups at highest risk for malnutrition include children and pregnant or nursing women.

In response to the findings of this diagnostic study, Benson Institute scholars from the University of San Carlos have designed projects that can lead to the alleviation of these problems. Several reports of these projects are reported in this issue of the Benson Institute Review.

Benson Institute scholars have deepened investigation into the nutritional quality of common foods. For example, Ana Luisa Mendez studied the vitamin A content of commonly eaten vegetables, while others measured the chemical composition of common meals. Tania Emilia Reyes proposed a nutrition program based on her research in the three communities, while Marina Lool Cuc prepared food guides for infants. One group developed soy-fortified tortillas and tested their acceptability among community members. In her studies, Gudrid Mariella Jimenez looked at the nutritional habits of the women during pregnancy and lactation.

These and other studies allow local students to further their training while serving and improving the living conditions of their own people. This type of activity is most valuable because it is self-perpetuating. As the people gain the knowledge and develop the ability to help themselves, they can prevent many common problems related to health, nutrition, and food production.

Works Cited

Bengoa, J. M. (1973). Significance of malnutrition and priorities for its prevention. In A. Berg, N. S. Scrimshaw, & D. L. Call (Eds.), Nutrition, national development, and planning (pp. 103–128). Cambridge, MA: Massachusetts Institute of Technology.

UNICEF (1998). State of the world's children (Online). Available: gopher://gopher.unicef.org:70/00/.cefdata/.sowc98/01g.txt [1998, December 1].

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