Abstract
Child stunting is a critical global health issue. Guatemala has one of the world's highest levels of stunting despite the sustained commitment to international nutrition policy best practices endorsed by the Scaling Up Nutrition (SUN) movement. Our objective was to use Guatemala as a case study to project the impact of a recently published national nutrition policy, the Great Crusade, that is consistent with SUN principles. We used the Lives Saved Tool (LiST) to project the impact of scaling-up of nutrition interventions proposed in the Great Crusade and recommended by SUN. Our outcomes were changes in stunting prevalence, number of stunting cases averted, and number of cases averted by intervention in children under 5 years of age from 2020 to 2030. We considered 4 scenarios: (1) intervention coverage continues based on historical trends, (2) coverage targets in the Great Crusade are achieved, (3) coverage targets in the Great Crusade are achieved with reduced fertility risk, and (4) coverage reaches an aspirational level. All scenarios led to modest reductions in stunting prevalence. In 2024, stunting prevalence was estimated to change by -0.1% (95% confidence interval [CI]= 0.0%,-0.2%) if historical trends continue, -1.1% (95% CI=-0.8%,-1.5%) in the Great Crusade scenario, and -2.2% (95% CI=-1.6%,-3.0%) in the aspirational scenario. In 2030, we projected a stunting prevalence of -0.4% (95% CI=-0.2%,-0.8%) and -3.7% (95% CI=-2.8%,-5.1%) in the historical trends and aspirational scenario, respectively. Complementary feeding, sanitation, and breastfeeding were the highest-impact interventions across models. Targeted reductions in child stunting prevalence in Guatemala are unlikely to be achieved solely based on increases in intervention coverage. Our results show the limitations of current paradigms recommended by the international nutrition community. Policies and strategies are needed to address the broader structural drivers of stunting.
Highlights
Child stunting is a critical global health issue
2020–2024 Outcomes If intervention coverage levels increase at historical levels stunting prevalence is projected to change in 2024 by À0.1%
The projected change in stunting prevalence in the Great Crusade with reduced fertility risk model is nearly identical at À1.1%
Summary
Child stunting is a critical global health issue. Guatemala has one of the world’s highest levels of stunting despite the sustained commitment to international nutrition policy best practices endorsed by the Scaling Up Nutrition (SUN) movement. Our objective was to use Guatemala as a case study to project the impact of a recently published national nutrition policy, the Great Crusade, that is consistent with SUN principles. Methods: We used the Lives Saved Tool (LiST) to project the impact of scaling-up of nutrition interventions proposed in the Great Crusade and recommended by SUN. We considered 4 scenarios: (1) intervention coverage continues based on historical trends, (2) coverage targets in the Great Crusade are achieved, (3) coverage targets in the Great Crusade are achieved with reduced fertility risk, and (4) coverage reaches an aspirational level. In 2024, stunting prevalence was estimated to change by À0.1% (95% confidence interval [CI]= 0.0%,À0.2%) if historical trends continue, À1.1% (95% CI=À0.8%,À1.5%) in the Great Crusade scenario, and À2.2% (95% CI=À1.6%,À3.0%) in the aspirational scenario. Conclusions: Targeted reductions in child stunting prevalence in Guatemala are unlikely to be achieved solely based on increases in intervention coverage. Adults who were stunted as children are at risk for lower cognitive performance, educational achievement, and economic productivity.[3,4,5] Stunting may contribute to the development of adult cardiometabolic conditions such as diabetes, obesity, and hypertension.[6,7] Sustainable Development Goal (SDG) target 2.2 aims to reduce the number of stunted children by 40% by 2025 and to eliminate all forms of malnutrition by 2030
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