Table 3

Summary of articles engaging implementation science themes around stunting and stunting-related interventions in Guatemala 2000–2018

StudyDesignBrief summary
Bennett30 DissertationUses the theoretical framework of a ‘syndemic’ to examine stunting in a rural Maya community. Finds that improvements in classic intervention targets, like maternal education, do not correlate well with improvements in stunting. Highlights the need to also address geographic isolation, environmental and WASH infrastructure, and inadequacy of subsistence agriculture to provide food security
Schooley and Morales32 QualitativeReviews Project Concern International use of group-based Positive Deviance approaches with indigenous families to improve child growth and nutrition. The impact of the methodology was less marked than that seen in other countries, and this was in part explained by difficulty engaging both caregivers and by men not being supportive of their wives’ participation
Fort et a 31 DissertationExamines the implementation of an innovative primary care model focused on inclusive and culturally appropriate care in a rural indigenous health district. Finds that the model improved equity in access to care, healthcare utilisation and vaccination. Both stunting and wasting remained very high, however, the authors emphasised that multisectorial social programme and not just health system strengthening are needed
Pelletier et al 35 QualitativeReviews the effectiveness of national efforts to scale up nutrition policy. Conclusions include that high-level political attention to stunting is not sufficient to achieve change, which requires sustained actions from mid-level actors and entrepreneurs and better investments in frontline organisational capacity
Chary et al 33 QualitativeExplores community and caregiver perceptions of stunting in an indigenous community. Child malnutrition is highly prevalent and therefore ‘normalised’ with low awareness that it is a significant health problem, requiring significant consensus building in order to mobilise community resources
Paz37 Mixed methodsOne of several annual assessments that aim to monitor the actions, interventions and advancements in public policy and service delivery in line with the 1000 days framework and national plans to reduce stunting. Describes deficits in infrastructure, service delivery, and knowledge, action, and practices observed in site visits with both healthcare providers and community members
Davis et al 34 QualitativeDocuments implementation barriers to community-based supplementary feeding for stunting, including misunderstandings related to messaging around exclusive breastfeeding and how these conflict with messaging around the need to provide timely complementary feeding, as well as sharing of supplements among family members, and the need to standardise messaging and therapeutic benefit communicated by staff to beneficiaries
Pulgar36 QualitativeAnalysis of the Food Insecurity and Malnutrition in Guatemala Project that aimed to evaluate food security and nutrition policies to advocate for effective policies around stunting. Primarily concludes that there is a need to strengthen national research efforts around outcomes, update technical recommendations based on newly available nutritional and food security data, and strengthen private and university sector collaborations with the government
  • WASH, Water, Sanitation and Hygiene.