Community Based Education Strategy

1. CommunityBasedEducationStrategy Totonicapán, Guatemala Irma Chavarria de Maza

2. Content Statistics Analysis of thenutritionalproblem in Guatemala Causes and conditionals of chronicmalnutrition Interventions Scaling Up Nutrition (SUN) MOH interventions CommunityEducationStrategy in Totonicapán

3. 90 % of allstuntedchildrenlive in only 36 countries in theworld Totonicapán 82 % El Quiché 72 % Sololá 72 % Huehue 70 % NationalAverage 49.8 % Guatemala, fourth place worldwide and first in Latin America

4. Exclusive Breastfeedingin Guatemala

5. 44 % of Guatemalanchildrenhavestoppedbeingbreastfedexclusivelybeforetwomonths of age (DHS/ENSMI 2008/09) • 49.6 % of childrenunder6 months are breastfedexclusivelyaccordingwithWHO indicator (DHS/ENSMI 2008/09) • Studiescarriedout in thehighlands of Guatemala and applying a differentmethodologythan WHO havefoundprevalences of EBF evenlower. (Ilsevan Beusekom, MariekeVossenaar, Gabriela Montenegro-Bethancourt, Colleen M Doak, Noel W Solomons)

6. 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.” Thelancet.Vol378 July 30, 2011 Breastfeeding peer counseling: from efficacy through scale-up. Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R J HumLact. 2010 Aug;26(3):314-26; Arch PediatrAdolesc Med. 2004 Sep;158(9):897-902.

7. Iniciative of 1,000 days Only time topreventchronicmalnutrition. Thewindow of opportunity. 9 months of pregnancy 24 firstmonths Months of life 1,000 days 1000 children are borndaily in Guatemala and unlessnutritionalinterventions are strengthen, itwon’t be possibletopreventmalnutrition.

8. MOH structuretoprovidebasichealthservicesforanarea “Jurisdicción” of 10,000 peoplewithintegratedatentionforwomen and children 1 Ambulatoryphysician 1 lInstitucional Facilitador 1 Supervisor Field worker/4 “jurisdicciones” • 10 Comunity Facilitators 2 Educadors 67 HealthPromoters 1 HP/Peer Counselorisresponsible for1 sector of 20 to30 families

9. CommunityBasedEducationStrategy Formation of Peer Counselors and mother-to-mothersupportgroupstoimproveinfant and childrennutrition

10. 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.

11. 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.

12. 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.

13. MOH structuretoprovidebasichealthservicesforanarea “Jurisdicción” of 10,000 peoplewithintegratedatentionforwomen and children 1 Ambulatoryphysician 1 lInstitucional Facilitador 1 Supervisor Field worker/4 “jurisdicciones” • 10 Comunity Facilitators 2 Educadors 67 HealthPromoters 1 HP/Peer Counselorisresponsible for1 sector of 20 to30 families

14. CommunityEducator Profile • Teacher • Local language speaker • Residentfromtheprojectarea • Availabilitytotraveltothecommunities. Responsibilities • Identififypossible Peer Counselorsthroughcommunitymeetings. • Meetmonthlywiththe Peer Counselorsfor training and support • Monitor and supporttheactivities of the Peer Counselors in eachcommunity

15. Who are the Peer Conselors? • Local volunteer women • Ideally mothers • Accepted and selectedbyhercommunity • Supportfromherpartner and family • Wishestolearn and share • Goodcomunicationskills • Willing and abletoreceivethe complete training • Ideallyliterate

16. Peer Conselors’ activities Individual counseling Mother-to-mothersupportgroups Home visits

17. Peer Counselor and mother-to-mothersupportnetwork San Andrés Xecul San Cristóbal Totonicapán San Bartolo Aguas Calientes San Francisco el Alto Santa María Chiquimula Santa Lucía la Reforma Momostenango Totonicapán 225 Peer Counselor trained as “Madres Consejeras”

18. Topicsfor training PCs • Thereality of mycommunity • Malnutrition, chronic and acute • Mother-to-mothersupportgroupmethodology • Communicationskills • Exclusive breastfeeding • Introduction of complementaryfeeding , continuedbreastfeeding and demonstrations of thepreparation of nutritivebaby local foods • Feeding and recovery of a sickchild • Basic informationforfeeding and recovery of a malnurishedchildtreated at thecommunitybasedonthe “Guide fornutritionalrecovery, in myhouse I have a goodrecovery”. • Promotion of MOH basichealthpackage. PCsalsolearnhowtoreviewthe MOH healthcardforchildrenunderfiveyears.

19. Training of PCs

20. Demonstration of preparation of local complementaryfoods

22. EducatorsaccompanyPCs in theformation of theirsupportgroups

23. PCspackage of materials • Diploma as “Madre Consejera” • IdentificationCard as a PC • Plasticidentificationtohangonthewall • Bag District events to give recognition to PCs by local authorities

24. Momostenango San Cristóbal Totonicapán Totonicapán Santa Lucía la Reforma

25. Santa María Chiquimula San Andrés Xecul San Francisco El Alto San Bartolo Aguas Calientes

26. Children of Totonicapán

27. Theinvolvement of thecommunity, especially of women, in infantfeeding and care, is a costeffectivestrategythatassurespractice and behavioralchangetopreventmalnutrition. Doña Izabel, Don Santos y familia Paraje La Balacera, Santa María Chiquimula Totonicapán