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Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial
  1. Boris Martinez1,
  2. Meghan Farley Webb1,
  3. Ana Gonzalez2,
  4. Kate Douglas1,3,
  5. Maria del Pilar Grazioso2,
  6. Peter Rohloff1,4
  1. 1 Wuqu’ Kawoq | Maya Health Alliance, Santiago Sacatepéquez, Guatemala
  2. 2 Department of Psychology, Universidad del Valle de Guatemala, Guatemala City, Guatemala
  3. 3 School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
  4. 4 Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Peter Rohloff; prohloff{at}


Objective/background Guatemala’s indigenous Maya population has one of the highest rates of childhood stunting in the world. The goal of this study was to examine the impact of an intensive, individualised approach to complementary feeding education for caregivers on feeding practices and growth over usual care.

Design An individually randomised (1:1 allocation ratio), parallel-group superiority trial, with blinding of study staff collecting outcome data.

Setting Rural Maya communities in Guatemala.

Participants 324 children aged 6–24 months with a height-for-age Z score of less than or equal to −2.5 SD were randomised, 161 to the intervention and 163 to usual care.

Interventions Community health workers conducted home visits for 6 months, providing usual care or usual care plus individualised caregiver education.

Main outcomes measures The main outcome was change in length/height-for-age Z score. Secondary outcomes were changes in complementary feeding indicators.

Results Data were analysed for 296 subjects (intervention 145, usual care 151). There was a non-significant trend to improved growth in the intervention arm (length/height-for-age Z score change difference 0.07(95% CI −0.04 to 0.18)). The intervention led to a 22% improvement in minimum dietary diversity (RR 1.22, 95% CI 1.11 to 1.35) and a 23% improvement in minimal acceptable diet (RR 1.23, 95% CI 1.08 to 1.40) over usual care.

Conclusions Complementary feeding outcomes improved in the intervention arm, and a non-significant trend towards improved linear growth was observed. Community health workers in a low-resource rural environment can implement individualised caregiver complementary feeding education with significant improvements in child dietary quality over standard approaches.

Clinical trial registration number NCT02509936.

Stage: Results

  • Stunting
  • diet quality
  • feeding practices
  • 24-diet recall
  • randomised clinical trial
  • Guatemala
  • indigenous
  • community health workers

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  • Contributors BM designed the study, acquired study data, analysed study data and drafted the manuscript. MFW, MPG and PR designed the study and critically revised the manuscript. AG acquired study data and critically revised the manuscript. KD analysed study data and critically revised the manuscript.

  • Funding This work was supported by Grand Challenges Canada, grant number SB-1726251050.

  • Competing interests This work was financially supported by a grant from Grand Challenges Canada to PR and MPG; BM, MFW and PR are current staff members and KD is a former staff member at Maya Health Alliance, the partnering healthcare organisation for this study in Guatemala.

  • Patient consent Not required.

  • Ethics approval Wuqu' Kawoq | Maya Health Alliance; Universidad del Valle de Guatemala

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Replication data set and statistical code for this study available upon publication at: doi:10.7910/DVN/1MVDY7

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