Kim Proffit and Ashley Jensen with Dr. Vickie Johnsen, Nursing
Background
Malnutrition is a significant problem in Guatemala. Malnutrition, and its related diseases, are part of most diagnoses of children in the hospital regardless of the reason for admission. Ruel, Habicht, Rasmussen & Martorell (1996, p. 671) report the severity of the problem, “Guatemala has one of the highest prevalences of stunting in the world.” In 2001 UNICEF reported that 29% of Guatemalan children under 5 years of age were underweight, 46% were stunted and 3% were wasting. Even in countries suffering with severe malnutrition, Zeitlin, Ghassemi, and Mansour, (1990) suggest that some children who live in poverty and have severely restricted diets are healthy and well nourished whereas others are not.
Aims
This study was performed in an attempt to determine the attitudes, beliefs, and behaviors of mothers who live in poverty in Guatemala and yet, are applying appropriate nutritional, and hygiene practices into their culture and lifestyle, resulting in well-nourished children. The results of this study will provide insight into factors that promote the integration of improved nutritional practices into Guatemalan mothers’ lifestyles; thus, resulting in a better state of health and nutrition for their children, and the population as a whole.
Methods
Guatemalan mothers of low socioeconomic status who implement healthy and nutritious behaviors were chosen for participation in this study. The mothers to be interviewed were identified through key informants. The researchers performed an in-depth interview in Spanish with the mothers. The interviews were conducted until data saturation occurred. The most prominent themes extracted from the interviews are discussed below.
Education
Lack of formal education is not necessarily correlated with lack of nutritional knowledge or with the lack of proper nutritional practices. However, every mother had gained nutritional knowledge from some source. Nutritional education came from church groups, medical advice from a doctor, on-the-job training at restaurants, books, or even formal nutrition classes. The nutritional knowledge of these mothers was vastly superior to the nutritional knowledge of the average Guatemalan mother.
Economic Situation
The total monthly income of the families ranged from 1,200 to 6,000 quetzales ($155.00- $777.00). However, in cases of extreme poverty (less than 1,000 quetzales per month, or $129.00), it seemed as if the possibility for proper hygiene and nutrition was unattainable. Many of the mothers interviewed did feel that it was possible to provide healthy food even in poverty, but they also recognized that great efforts would be required to plan meals. The mothers agreed that most families spend their money unwisely, and that improved education could help them to make wiser use of their money.
Familial Relationships
Another common thread that was evident in every interview was the existence of strong familial relationships. All the women interviewed were married and seemed to have loving relationships with their spouses. It was a striking finding that those families with the best nutritional health also had the closest family relationships, including the children. In a society where large families are common; it was interesting to note that the majority of families we interviewed were smaller by choice. These mothers would rather focus on quality care for a few children. Every mother viewed her children as the most precious possessions she owned. For every mother interviewed, raising and taking care of children became the top priority.
Religion
The women interviewed came from differing religious backgrounds. Regardless of religious affiliation, all the women have a strong belief in God. Their belief in God gave the families hope and purpose. Several mothers expressed the idea that God had blessed them with healthy and beautiful children and therefore they felt a great responsibility to do all they could to take care of them.
Delayed Gratification
The families who are able to provide proper nutrition all seemed to have a sense of delayed gratification uncommon in the general population. This perspective enabled the families to sacrifice and work hard now, knowing that in the end it would be worth it.
Implications
Malnutrition continues to be a significant problem in Guatemala; however, this study proves that educational interventions can break the cycle. Primary health care is a low cost way of disseminating nutritional knowledge, and the first step to changing behavior is providing knowledge. It is essential that more Guatemalan mothers learn the causes of malnutrition and the methods needed to prevent it. Teaching plans need to be specific to Guatemala. They need to take into consideration the Guatemalan diet, values, traditions and financial situations. It seems that at this time, PHC is the most cost effective way to improve the overall health of the Guatemalan people.
References
- Ruel, M. T., Habicht, J. P., Rasmussen, K. M., & Martorell, R. (1996). Screening for nutritional interventions: the risk or the differential-benefit approach? American Journal of Clinical Nutrition, 63: 671-677.
- United Nations Children’s Fund (UNICEF), (n.d.). Information statistics: Guatemala. Retrieved 5/8/2001 from the World Wide Web: http://www.unicef.org/statis/
- Zeitlin, M., Ghassemi, H., & Mansour, M. (1990). Positive deviance in child nutrition. Tokyo: United Nations University.