Guatemalan Families Research Articles

A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala.

Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children's Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.

P044 Nutrition-Sensitive Agriculture Project Increased Bean Consumption and Improved Protein Quality of Rural Guatemalan Families

<h3>Objective</h3> To assess impact of nutrition-sensitive agricultural project on intake of beans and improved quality protein of indigenous women and their families in the Guatemalan highlands. <h3>Use of Theory</h3> Nutrition lessons were designed based on the Social Ecological Model taking into account the indigenous highland cultures and local foods grown. They were delivered across geographically dispersed communities in households using wood-burning stoves and no refrigeration. <h3>Target Audience</h3> Indigenous women and their families living in remote rural highland communities. <h3>Description</h3> Five-pound bags of improved bean seed varieties were provided to rural families coupled with training to grow them. Five group lessons with videos and activities were developed to address nutrition topics taught by cross-trained nutrition, health and agricultural extension educators: preventing chronic malnutrition; enhancing protein quality; nutrient needs in pregnancy and lactation; feeding the child 6-11 months; and feeding the child 1-3 years. Because these rural families rarely eat animal protein and had reduced bean consumption, protein complementarity was stressed. Previous assessments demonstrated that their diets were composed primarily of corn and other carbohydrates. <h3>Evaluation</h3> This was addressed two ways: by comparing the household intake of beans both before and after receiving the lessons; and using the Most Significant Change technique for qualitative assessment. <h3>Results</h3> The timeframe for the intervention was six months. Five hundred and seventy one households from 93 communities reported eating beans 1.5 x/week before receiving the bean seed and training and 2.8 x/week afterwards. Analysis of variance (ANOVA) for HH intakes showed statistically significant increases. Qualitative measurements 12 months after the intervention confirmed increased bean consumption across the study area. <h3>Conclusions</h3> This nutrition-sensitive food-based approach when coupled with seed distribution, agricultural and nutrition education resulted in an increased consumption of beans, which when combined with corn and other cereals, improved protein quality intake of women and their families in rural indigenous households. <h3>Funding</h3> USAID

Representación social y construcción identitaria juvenil en el colectivo Hakib’al, del pueblo transfronterizo maya chuj

The research revolves around the construction of the social representation that is made of the “being young” within the Hakib'al collective, whose members, from Guatemalan families of the Mayan-Chuj people who were refugees, have had to migrate for academic reasons. In Mexico, their ethnic identity has been negatively affected by the disrespectful naturalization process of their discriminatory culture, policies and dynamics, which, as a group, they seek to confront through their cultural reivindication. Analyzing these representations, with a methodological triangulation contrasted with their cultural knowledge, an intention to extend their youthful condition is first distinguished, which breaks their conceptualization as a mere transition stage; that his dominant representation of “being a good young” reaches his entire being chuj and that the main transformation, product of his participation in the group and the completion of his studies, takes place among women.

The forgotten parent: a qualitative study of indigenous Guatemalan fathers' perspectives on atypical child development

BackgroundLittle is known about the role Latino fathers have in rearing children with atypical development. Despite the positive effects of father involvement being well studied in other populations, Latino fathers have been historically overlooked in family research. The purpose of this study was to understand the experiences of indigenous Guatemalan fathers of children with atypical development, particularly their understanding of their child's needs and their role in addressing those needs. MethodsUsing Kleinman's semi-structured Explanatory Model (EM) questions, I interviewed self-identified parents of children with atypical development to investigate their perceptions of their child's development and also their role in child rearing. Interviews also included questions about gender roles in child rearing and a brief demographic survey. Participant families were recruited from rural communities in the Department of Sololá, Guatemala. Interviews were analysed using ethnographic methods. FindingsBetween Nov 2 and Nov 10, 2018, 24 mother-father pairs were interviewed in 48 interviews. The results of the interviews indicated that, despite a rigid view of each parent's responsibilities (father as the breadwinner and mother as the caretaker), parents would abandon traditional familial gender roles if it were in the best interest of their child. Further, designated familial gender roles did not predetermine the types of concern parents experienced about their child with atypical development. For example, although a Guatemalan father may believe his main familial responsibility is to meet the financial needs of his family, his main paternal concerns may not only be financial in nature. InterpretationAt a functional level, Guatemalan families will adapt their parenting roles and responsibilities for the benefit their children with atypical development. These findings act as an opposing perspective to other published work on machismo, a concept often used to describe the Hispanic male-female hierarchy. These results suggest that the concept of machismo may be a western concept that is far too generalising for the indigenous couple rearing a child with atypical development. As such, Latino men remain an understudied and potentially underutilised member of the family, especially in high-stress homes where a child with atypical development is being cared for. Ways to increase their involvement in child rearing should be considered by researchers and policy makers. FundingCollege of Latin American Studies pre-dissertation field research grant.

The Question of Sanctuary: The Adorers of the Blood of Christ and the U.S. Sanctuary Movement, 1983–1996

In December 1985, the Adorers of the Blood of Christ (ASCs) welcomed a Guatemalan family into sanctuary at their Ruma, Illinois, convent. Declaring their home as a sanctuary for Central American refugees who were denied asylum by the United States was the culmination of a selfguided and months-long process of discernment and education. The ASCs arrived at this decision after considering their order's tradition of providing refuge to Jews fleeing Nazi violence and after hearing calls for solidarity from Central American activists. Their position as women religious—that is, outside patriarchal church structures—gave them the flexibility to declare sanctuary when many Catholic churches and dioceses were reluctant. The ASCs' engagement with sanctuary challenges the common understanding that the movement originated at the U.S.-Mexico border with Protestants providing assistance to migrants denied asylum.

Fluid illness

In response to the rising rate of end-stage renal disease (ESRD) in Guatemala, the public health system established a national community-based dialysis program to enable people living in rural areas to complete treatment in their homes. Here we explore how this newly available, life-prolonging technology has altered local worlds by transforming ESRD from an acute, life-ending illness into a managed chronic condition with an uncertain trajectory. Through case studies, we describe how living with dialysis influences family relations and caregiving in rural Guatemala. We find that dialysis interacts with an insufficient health care system, one that avoids life-ending complications but does not sufficiently manage life-altering symptoms. In addition, the need to care for people with ESRD for an uncertain amount of time may disrupt and strain family-based caregiving networks. Amid this meager health and social welfare infrastructure, life on dialysis exacerbates the chronic insecurity and structural inequality of life in postwar Guatemala. As both life and illness are prolonged through dialysis, the unceasing demands of the treatment and illness strain the webs of obligation and care that Guatemalan families and communities have developed to adapt to their decentralized and fragmented public health care system.

Recreational Physical Activity Experiences Among Guatemalan Families With Children With Visual Impairments.

Nationwide research indicates that children with visual impairment have limited participation in recreational and sport activities than their peers. This is due in part to the lack of recreational opportunities and facilities, as well as a lack of awareness by parents of how and where their children can participate. The purpose of the current study was to explore the experiences of Latino families of children with visual impairments living in Guatemala regarding physical recreation. Participants were Latino parents (N = 13) who have children with visual impairments recruited from a sport camp. Qualitative data were gathered through one-on-one interviews that were transcribed and analyzed through a constant comparative analysis. Participating Latino families who resided in Guatemala City participated at least once a month in low budget recreational activities with their children with visual impairments. Activities were mostly done in local surroundings and led mainly by their mother. Benefits identified by the participants related to relaxation, socialization, and sense of independence, with minimal mention of health related benefits. There is a need to disseminate information to the Latino community with children with visual impairments regarding the multiple benefits that arise from being involved in recreational physical activities.

Contextual Adaptation of Family Group Conferencing Model: Early Evidence from Guatemala

Guatemala has faced a disproportionate number of children placed outside their families through unethical intercountry adoptions or into large residential settings, jeopardising child and family rights. In response, an international team conducted a pilot training in Guatemala on family group conferencing (FGC) as a means of maintaining children in their homes or with their kin. The training participants were child welfare professionals from government and non-government organisations as well as academics. The training included pre-post assessment of the participants' grasp of key FGC practices and focus groups on the suitability of the model in a low-wealth country with very limited child welfare resources. In general, participants began and ended with a relatively elevated understanding of basic FGC concepts. The focus groups assisted with interpreting these assessment results. According to focus group participants, FGC is culturally compatible with the country's indigenous Mayan traditions and easily implementable with Guatemalan families. The participants recommended the routine and multi-sectoral incorporation of the model including by the judiciary and the attorney general's office tasked with the ultimate child welfare decision making. Implications include the institutionalisation of the FGC model through national policy, further training for practitioners and research on the model's efficacy in Guatemala.

This is what I remember about Guatemala

This is what I carry with me when I write. First, one of my earliest childhood memories. I am four or five years old, a native Angeleno visiting his father’s hometown, Gualan, on the Motagua River. I have spent a day splashing in the shallow water, in a river that’s a protagonist in family sagas as yet unknown to me. I’ve waded among river stones and boulders, and I have taken ill. Night falls and I am lain out by my father on a concrete slab. Pungent ointments are applied to my skin by a medicine woman. A large group of relatives stands around me, whispering words in Spanish, while a bulb hovers over me with an electric glow. I am feverish, sweating, in a kind of waking dream, far from home, far from Los Angeles and the bungalow courtyard I call home – and I am closer than I can ever be to the place where my story begins. And then I return to Los Angeles, to the solitude of my life as an only-child of the only Guatemalan family I know, in a city of abundance in which there are no chatty uncles or grandparents or untamed rivers. Later, I am 11 or 12, visiting the home of my maternal grandfather, in Guatemala City’s Zona 7, in the Colonia 6 de octubre. The Spanish that’s been on my tongue from the time I could speak, first learned in Hollywood apartments from my parents, has begun to die. I am a North American proto-adolescent in a Guatemalan body. In Guatemala City, amid the concrete cubes, the narrow streets, the unpaved avenues, I feel bigger. I do things that make me look odd and eccentric to the people around me. For example, I plant myself alone in my grandfather’s tiny

Follow‐up association studies of chromosome region 9q and nonsyndromic cleft lip/palate

Cleft lip/palate comprises a large fraction of all human birth defects, and is notable for its significant lifelong morbidity and complex etiology. Several studies have shown that genetic factors appear to play a significant role in the etiology of cleft lip/palate. Human chromosomal region 9q21 has been suggested in previous reports to contain putative cleft loci. Moreover, a specific region (9q22.3-34.1) was suggested to present a approximately 45% probability of harboring a cleft susceptibility gene. Fine mapping of 50 SNPs across the 9q22.3-34.11 region was performed to test for association with cleft lip/palate in families from United States, Spain, Turkey, Guatemala, and China. We performed family-based analyses and found evidence of association of cleft lip/palate with STOM (rs306796) in Guatemalan families (P = 0.004) and in all multiplex families pooled together (P = 0.002). This same SNP also showed borderline association in the US families (P = 0.04). Under a nominal value of 0.05, other SNPs also showed association with cleft lip/palate and cleft subgroups. SNPs in STOM and PTCH genes and nearby FOXE1 were further associated with cleft phenotypes in Guatemalan and Chinese families. Gene prioritization analysis revealed PTCH and STOM ranking among the top fourteen candidates for cleft lip/palate among 339 genes present in the region. Our results support the hypothesis that the 9q22.32-34.1 region harbors cleft susceptibility genes. Additional studies with other populations should focus on these loci to further investigate the participation of these genes in human clefting.

Humanizing access to modern contraceptive methods in national hospitals in Guatemala, Central America

Background The overall situation in Guatemala, Central America, regarding programs caring for women's reproductive health has been lagging behind for some decades. Since the year 2000, 56% of Guatemalan families have lived below the poverty line. Guatemala has one of the highest fertility rates (lifetime births per woman) in Latin America and the Caribbean countries, comparable to those observed in less developed countries in Africa. Considering the lack of sex education, poor access to effective contraceptive methods and issues of unwanted pregnancy, Guatemalan women engage in illegal and unsafe abortions, which often causes harm and sometimes death. A key strategy designed to improve women's health is through free and informed access to contraceptive methods that are effective and accepted by Guatemalan women. Study Design From July 1, 2003, to December 31, 2006, specially hired trained facilitators visited 22 public hospitals for 1 week to train corresponding physician staff in postabortion counseling, enabling them to assist patients to select and use an effective contraceptive method. To monitor the progress achieved, the trained facilitators returned 4 weeks later. The main purpose of the training was to focus in strengthening the understanding and technical capacity of the hospital staff to implement postabortion contraceptive counseling and to enable women to obtain an effective contraceptive method prior to hospital discharge. Results Out of 22 hospitals, 21 managed to improve their record for counseling patients admitted for postabortion complications, from 31% to 96%. Furthermore, the percentage of women being discharged from the hospital with an effective contraceptive method rose from 20% to 64% from 2003 to 2006. Conclusion The successful results obtained during this study to meet postabortion demands by Guatemalan women point out to the urgent need for the government to expand this initiative within the national health system, including health centers nationwide. This is one of the worldwide recommendations previously made by the World Health Organization.

Imagining Social Justice amidst Guatemala’s Post-Conflict Violence

Introduction

Candidate Genes for Oral-Facial Clefts in Guatemalan Families

Nonsyndromic cleft lip +/- cleft palate (CL/P) is a complex trait of unknown etiology. Most genetic studies of CL/P define affection status in a way that ignores subtle subclinical manifestations, resulting in a potential loss of statistical power. This study investigated 10 candidate genes in 155 individuals from 25 Guatemalan CL/P families. High-resolution ultrasound images of the orbicularis oris (OO) muscle were obtained. CL/P was present in 28 family members; an additional 10 had subcutaneous OO muscle defects. Family-based association studies were performed for both narrow (CL/P only) and broad (CL/P plus OO muscle defects) definitions of affection status. PVRL1 was significantly associated under both definitions (P = 0.04, narrow; P = 0.02, broad). Association with JAG2 improved from P = 0.09 under the narrow definition to P = 0.04 under the broad definition. Broadening the oral-facial cleft phenotype to include subclinical variants may improve power in genetic studies.

Popular Culture, Violence, and Religion in Gloria's Story

One of the most vexing challenges accompanying any attempt to reconstruct the legal history of the family is deciding how much interpretive weight to assign to social factors as opposed to legal factors. “Gloria's Story” is loaded with social history, in part because it focuses on a small group of decidedly non-elite characters. It discusses non-legal matters as big as the impact of wealth concentration on the Guatemalan family and as small as the social significance of home births, as opposed to hospital births, in Quetzaltenango during the 1960s. Nonetheless, the most important factors driving the analysis are legal, not social. The article's central argument—that “modernizing” legal reforms adopted in Guatemala since the mid-nineteenth century have fortified, not weakened, adulterous concubinage—emphasizes the effects of legal change.

Intra-household food distribution among Guatemalan families in a supplementary feeding program: Behavior patterns

The present study investigated how food is distributed to various family members differing in age, sex, earning status, family role, and status as target child in families enrolled in supplementary feeding programs in urban Guatemala. Two patterns to explain intra-household food distribution patterns were hypothesized: a Contributions Rule, that individuals considered in the culture to have higher economic value would receive a higher percentage of the family's food; and a Needs Rule, in which those considered to have greater need (but not contribution) would receive a higher percentage of the family's food. The results with 45 families (230 individuals) suggested that the Contribution Rule was a better predictor of food distribution patterns in this setting than the Needs Rule. Specifically, male heads of households received a relatively higher proportion of the family's proteins, and the female heads of households received a relatively higher proportion of the family's calories, given their nutritional requirements, than other family members. There was no evidence that mothers were giving the child targeted as undernourished by the health center any more food than any other similar-aged child.

Intra-Household Food Distribution among Guatemalan Families in a Supplementary Feeding Programme: Mothers’ Perceptions

Mothers’ views on the appropriate distribution of food within a household, and the relation of these views to actual food distribution, are explored. The subjects were 45 mothers with one child enrolled in a health centre's food-supplementation programme in periurban Guatemala because of low weight for height. In the interviews, most of the mothers did not report believing that more food should be given to the targeted child. The four distribution rules mentioned were giving preference to adults or workers, giving preference to children, giving preference to males, and equality. The latter two rules were significantly associated with actual food distribution within the families: mothers who stated a male preference (N = 13) were likely to give more food to males than those who did not, and mothers who stated a preference for equality (N = 29) gave a relatively higher proportion of food to children. Recommendations for food supplementation programmes are made.