1. Community Based Education Strategy Totonicapán, Guatemala Irma Chavarria de Maza

2. 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

3. 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 %

4. Exclusive Breastfeeding in Guatemala

5. 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)

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.” Breastfeeding peer counseling: from efficacy through scale-up. Chapman DJ, Morel K, Anderson AK, Damio G, Pérez-Escamilla R Chapman DJMorel KAnderson AKDamio GPérez-Escamilla R J Hum Lact.J Hum Lact. 2010 Aug;26(3):314-26; Arch Pediatr Adolesc Med. 2004 Sep;158(9):897-902.Arch Pediatr Adolesc Med. The lancet.Vol 378 July 30, 2011

7. 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

8. MOH structure to provide basic health services for an area “Jurisdicción” of 10,000 people with integrated atention for women and children

9. Community Based Education Strategy Formation of Peer Counselors and mother-to-mother support groups to improve infant and children nutrition

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 structure to provide basic health services for an area “Jurisdicción” of 10,000 people with integrated atention for women and children

14. 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

15. 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

16. Peer Conselors’ activities Mother-to-mother support groups Individual counseling Home visits

17. Peer Counselor and mother-to-mother support network 1.San Andrés Xecul 2.San Cristóbal Totonicapán 3.San Bartolo Aguas Calientes 4.San Francisco el Alto 5.Santa María Chiquimula 6.Santa Lucía la Reforma 7.Momostenango 8.Totonicapán 225 Peer Counselor trained as “Madres Consejeras”

18. 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.

19. Training of PCs

20. Demonstration of preparation of local complementary foods

21. Mother-to-mother support groups and participants Joint Program, Totonicapán Month# Support GroupsParticipants January33761 February431009 March571257 April751719 May671560 June741741 July751676 August681668 September641619 Total55613010

22. Educators accompany PCs in the formation of their support groups

23. 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

24. Momostenango San Cristóbal Totonicapán Totonicapán Santa Lucía la Reforma

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

26. Children of Totonicapán

27. 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 Chiquimula Totonicapán