Validating food-based recommendations to promote dietary quality for pregnant and lactating women and children under two years of age using local foods in the Western Highlands of Guatemala

Background:  Childhood stunting is a pervasive problem in the Western Highlands of Guatemala. Pregnant and lactating women (PLW) and children under two (CU2) are both at risk and in need of an adequate diet to reduce the very high prevalence of childhood stunting. We developed food-based recommendations (FBRs) based on local foods to optimize the diets of PLW and CU2.

Methods: FBRs were developed for PLW and CU2 using Optifood, a linear programming tool. Validation of FBRs involved conducting semi-structured interviews with PLW (n=19), caregivers of children aged 6-11 months (n=11) and 12-23 months (n=15), focus group discussions and key informant interviews in two regions. Foods that were promoted in specific quantities and frequency for PLW included potatoes, a thick fortified drink, vegetables, oranges and liver, and for CU2 included fortified porridge, potatoes, beans, greens, eggs, and meat. 

Results: The FBRs were acceptable but feasibility varied; PLW were able to implement three of the five FBRs; caregivers of CU2 reported that several of the FBRs were not feasible due to constraints such as cost and access to the foods themselves.

Conclusions: Efforts to promote improved dietary quality and practices through social and behavior change communication need to occur in tandem with efforts to strengthen the enabling environment to improve access to nutritious foods.