community based education strategy
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Community BasedEducation Strategy
Totonicapán, Guatemala
Irma Chavarria de Maza
Content
• Statistics• Analysis of the nutritional problem in Guatemala• Causes and conditionals of chronic malnutrition• Interventions• Scaling Up Nutrition (SUN)• MOH interventions• Community Education Strategy in Totonicapán
90 % of all stunted children live in only 36 countries in the world
Guatemala, fourth place worldwide and first in Latin America
Totonicapán 82 %El Quiché 72 %Sololá 72 %Huehue 70 %
National Average 49.8 %
Exclusive Breastfeeding in Guatemala
• 44 % of Guatemalan children have stopped being breastfed exclusively before two months of age (DHS/ENSMI 2008/09)
• 49.6 % of children under 6 months are breastfed exclusively according with WHO indicator (DHS/ENSMI 2008/09)
• Studies carried out in the highlands of Guatemala and applying a different methodology than WHO have found prevalences of EBF even lower. (Ilse van Beusekom, Marieke Vossenaar, Gabriela Montenegro-Bethancourt, Colleen M Doak, Noel W Solomons)
Evidence of the impact of the strategies for behavior change in the duration of EBF
• Mother to mother support (Peer Counseling) individual or in groups:
Increase the rates of initiation, duration and exclusive breastfeeding
Reduces the incidence of diarrhea Increases the amenorrhea by lactation
“Mother-to-mother support groups are effective and can be brought to scale in both developed and developing countries as part of maternal and child health programs well coordinated for the promotion of breastfeeding.”
Breastfeeding peer counseling: from efficacy through scale-up. Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R
J Hum Lact. 2010 Aug;26(3):314-26; Arch Pediatr Adolesc Med. 2004 Sep;158(9):897-902.
The lancet.Vol 378 July 30, 2011
Iniciative of 1,000 days
9 months of pregnancy
24 first months Months of life
Only time to prevent chronic malnutrition. The window of opportunity.
1000 children are born daily in Guatemala and unless nutritional interventions are strengthen, it
won’t be possible to prevent malnutrition.
1,000 days
1 lInstitucional Facilitador
10 Comunity
Facilitators
1 Ambulatory physician
1 HP/Peer Counselor is responsible
for 1 sector of 20 to 30 families
67 Health Promoters
2 Educadors
1 Supervisor Field worker/4
“jurisdicciones”
MOH structure to provide basic health services for an area “Jurisdicción” of 10,000 people with integrated atention for women
and children
Community Based Education StrategyFormation of Peer Counselors and mother-to-mother
support groups to improve infant and children nutrition
General Objective
Contribute to the reduction of stunting in children under the age of 36 months through a community based education strategy for vulnerable groups, children, pregnant women and nursing mothers.
Specific objectives
• Exclusive breastfeeding, • Initiation and appropriate complementary
feeding at six months,• Continued breastfeeding up to two years and
beyond, • Strengthen feeding practices for the family,
pregnant women and nursing mothers.
Definition of the strategy
• It is an educational intervention based on the community and women's participation, aimed at changing practices of feeding and care of children under 3 years of age.
1 lInstitucional Facilitador
10 Comunity
Facilitators
1 Ambulatory physician
1 HP/Peer Counselor is responsible
for 1 sector of 20 to 30 families
67 Health Promoters
2 Educadors
1 Supervisor Field worker/4
“jurisdicciones”
MOH structure to provide basic health services for an area “Jurisdicción” of 10,000 people with integrated atention for women
and children
Community Educator
Profile• Teacher• Local language speaker • Resident from the
project area• Availability to travel to
the communities.
Responsibilities• Identifify possible Peer
Counselors through community meetings.
• Meet monthly with the Peer Counselors for training and support
• Monitor and support the activities of the Peer Counselors in each community
Who are the Peer Conselors?
• Local volunteer women• Ideally mothers • Accepted and selected by
her community• Support from her partner
and family• Wishes to learn and share • Good comunication skills• Willing and able to receive
the complete training• Ideally literate
Peer Conselors’ activities
Mother-to-mother support groups
Individual counseling
Home visits
Peer Counselor and mother-to-mother support network
1. San Andrés Xecul2. San Cristóbal Totonicapán3. San Bartolo Aguas
Calientes4. San Francisco el Alto5. Santa María Chiquimula6. Santa Lucía la Reforma7. Momostenango8. Totonicapán
225 Peer Counselor trained as “Madres Consejeras”
Topics for training PCs• The reality of my community• Malnutrition, chronic and acute• Mother-to-mother support group methodology • Communication skills• Exclusive breastfeeding • Introduction of complementary feeding , continued breastfeeding
and demonstrations of the preparation of nutritive baby local foods• Feeding and recovery of a sick child• Basic information for feeding and recovery of a malnurished child
treated at the community based on the “Guide for nutritional recovery, in my house I have a good recovery”.
• Promotion of MOH basic health package. PCs also learn how to review the MOH health card for children under five years.
Training of PCs
Demonstration of preparation of local complementary foods
Mother-to-mother support groups and participants
Joint Program, TotonicapánMonth # Support Groups Participants
January 33 761February 43 1009March 57 1257April 75 1719May 67 1560June 74 1741July 75 1676August 68 1668September 64 1619
Total 556 13010
Educators accompany PCs in the formation of their support groups
PCs package of materials
• Diploma as “Madre Consejera”
• Identification Card as a PC
• Plastic identification to hang on the wall
• Bag
District events to give recognition to PCs by local authorities
Momostenango
San Cristóbal Totonicapán
Totonicapán
Santa Lucía la Reforma
Santa María Chiquimula
San Andrés Xecul
San Francisco El Alto San Bartolo Aguas Calientes
Children of Totonicapán
• The involvement of the community, especially of women, in infant feeding and care, is a cost effective strategy that assures practice and behavioral change to prevent malnutrition.
Doña Izabel, Don Santos y familia Paraje La Balacera, Santa María ChiquimulaTotonicapán
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