Effects of Malnutrition

Text by Emily Rempel
Images as noted

Throughout March, Pop Wuj is spotlighting our Nutrition Program and its mission to create lifelong opportunities for Guatemalans via treatment of early childhood malnutrition.

• Find more posts in this series our blog and our Facebook
• Read more about our fundraising campaign
• Donate to the Nutrition Program via Foundation Todos Juntos

¡Gracias por su apoyo! Thank you for your support!


If you were to ask one of our many doctors or medical students about the impacts of malnutrition, you would likely receive a flood of information about z-scores, development markers, and a whole slew of acronyms that, if you’re like me, you’d have to Google. I, obviously, am not a doctor, nor a medical student, nor have I even taken a single science class in the last four years. So consider the following a layperson’s explanation of the short-term and long-term impacts of malnutrition, with a bit of a human rights flair.

In 2015 the international community adopted a set of goals aimed at ending poverty, protecting the planet, and ensuring prosperity for all as part of a new sustainable development agenda. These goals are called the Sustainable Development Goals, or more colloquially, the Global Goals.

Image from UN News Centre

#2 of the Global Goals is: Zero Hunger. By 2030, we have committed to ending hunger, achieving food security and improved nutrition, and promoting sustainable agriculture.

Image from GlobalGoals.org

Why is this so important?

Globally, 1 in 9 people in the world today are undernourished.[i] Nearly half (45%) of deaths in children under 5 are due to poor nutrition.[ii] Guatemala has one of the highest rates of chronic malnutrition in the world (at 47%) and the highest rate of child stunting (low height for age) in the Americas, estimated at 47% at birth, 53% at three months of age, and 56% at six months.[iii] Those most severely affected by chronic malnutrition in Guatemala are indigenous women and children. Mary, our Environmental Projects Coordinator, talked about why these numbers are so high and why they affect whom they affect in her latest blog post. Now we’re going to talk about what these numbers and effects mean.

In the short-term:

Many of the short-term effects of malnutrition are obvious and visible; namely, stunting (low height for age), wasting (low weight for height), and children who are underweight (low weight for age).^[iv] It has also been identified as a major cause of reduced head circumference.^[v] One of the greatest immediate threats caused by malnutrition is its impact on the immune system. Malnourishment can greatly compromise a child's immune system, making them more susceptible to infectious diseases. This is particularly troubling in the communities in which we work, where there are often poor sanitary practices and increased exposure to animal feces, unclean water, and other forms of contamination. There is a reciprocal relationship between malnutrition and infections, which is compounded by poverty: malnutrition increases susceptibility to infections while, at the same time, infections worsen malnutrition by decreasing appetite and increasing demand for nutrients.^[vi] For a child experiencing malnutrition, bouts of diarrhea or vomiting can quickly lead to dehydration and rapidly worsen their health.^[vii] Additionally, malnutrition coupled with infections or parasites can interfere with the body's ability to absorb nutrients, thus further contributing to poor growth.^[viii] In these situations, child mortality is a very real threat.

Conceptual framework on the relationship between malnutrition, infections and poverty. 

doi:10.1371/journal.pone.0105017

In the long term:

Malnutrition remains a significant barrier to sustainable development as it creates a trap from which people cannot easily escape. Its effects are cyclical and permeate through almost all aspects of a person's life. During the first 1000 days of a child’s life, while rapid development is occurring, malnutrition can mean poor outcomes in health, cognitive development, and educational and economic attainment later in life.^[ix] Malnutrition has been shown to increase the likelihood of heart disease, diabetes, kidney damage, and anemia into adulthood.^[x] Another related consequence of malnutrition, coupled with a weakened immune system, is a lowered capacity to work. Decreased economic productivity, compounded by existing barriers to dignified and fair work, perpetuates poverty. Child malnutrition during the vital years of brain development can cause permanent delays in motor, cognitive, and emotional development. It may also lead to conditions such as cerebral palsy, language and communications disorders, behavioural disorders like ADHD, autism spectrum disorder, learning disabilities and dyslexia.^[xi] Of course, the negative impacts of delays in brain development are coupled with external barriers to education, leading to lower scholastic achievement and higher drop-out rates.

As mentioned several times throughout this blog post, it's vital to remember that barriers to health and education already exist for many indigenous communities, outside of the challenges associated to malnutrition. We see an urbanization of services, systemic discrimination, limited funding, and corruption. These barriers are compounded by malnutrition, and vice-versa. It's all cyclical. For example, research shows us that child malnutrition rates are higher for children whose parents have low education levels.^[xii] Unsurprisingly, the correlation is even stronger with maternal education levels, given mothers are generally the ones responsible for feeding their children. Again, we usually see low education levels paired with high poverty levels, creating a virtually impermeable trap of malnutrition. Furthering the link between maternal health and child health, malnourished women are more likely to have low birth-weight babies, thus perpetuating the problem across generations.^[xiii]

In our projects we see parents who were themselves malnourished as children, who did not receive an education, who are working in low-paying, labour-intensive jobs, who struggle with poverty every day. The next generation thus grows up in the same circumstances, with the same limits to opportunity, with likely the same outcomes. That's why at Pop Wuj we take a holistic approach in serving these communities. We provide nutritional support for children to aid in physical and mental development. Then later on in these children's lives, we provide scholarships to further support their education. Our medical clinics offer ongoing care, from childhood into adulthood, which may otherwise be inaccessible. In this way, we strive to help families break cycles of poverty and malnutrition.

A Nutrition Program participant checks out the goings-on at the project during her checkup in La Victoria
Photo by Emily Rempel

We have 17 Global Goals that we are attempting to reach by the year 2030 and we will not get there unless we take a holistic approach to development. Without action on health and nutrition, not only won’t we achieve goals 2 (Zero Hunger) and 3 (Good Health and Well-Being) but we also won’t meet many of the other Goals, from education and gender equality to environmental sustainability and peace and justice. Please, stand in solidarity with our grassroots efforts against child malnutrition. As Mary mentioned, though our organization may not be able to singlehandedly realize Zero Hunger in Guatemala, we can help make it a reality for some.

------
Sources:

[i] UN.org, “Sustainable Development Goals,” http://www.un.org/sustainabledevelopment/hunger/

[ii] UN.org, “Sustainable Development Goals,” http://www.un.org/sustainabledevelopment/hunger/

[iii] Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., & Wise, P. H. (2016). Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of 
       Age. Plos ONE, 11(11), 9

[iv] Oruamabo, Raphael S. (2015). Child Malnutrition and the Millennium Development Goals: much haste but less speed?. Arch of Dis Child, 100, 19-22.

[v] Dhopeshwarker, Govind A. (1983). Effects of Malnutrition on Brain Development. Nutrition and Brain Develop. Springer, US: 49-83
[vi] Rytter, M. H., Kolte, L., Briend, A., Friis, H., & Christensen, V. B. (2014). The Immune System in Children with Malnutrition—A Systematic Review. Plos 
      ONE, 9(8), 1-19. doi:10.1371/journal.pone.0105017

[vii] Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., & Wise, P. H. (2016). Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of 
       Age. Plos ONE, 11(11), 9

[viii] Nelson, C. A., Bos, K., Gunnar, M. R., & Sonuga-Barke, E. S. (2011). V. THE NEUROBIOLOGICAL TOLL OF EARLY HUMAN 
       DEPRIVATION. Monographs Of The Society For Research In Child Development, 76(4), 127-146. doi:10.1111/j.1540-5834.2011.00630.x

[ix] Danaei, G., Andrews, K. G., Sudfeld, C. R., Fink, G., McCoy, D. C., Peet, E., & ... Fawzi, W. W. (2016). Risk Factors for Childhood Stunting in 137 
         Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels. Plos Medicine, 13(10), 1-18.
[x] PBS.org, "Widespread Childhood Malnutrition is a Paradox in Agriculturally Rich Guatemala," http://www.pbs.org/newshour/bb/widespread-childhood-
       malnutrition-paradox-agriculturally-rich-guatemala/  
[xi] Cattopadhyay, N., Saumitra, M. (2016). Developmental Outcome in Children with Malnutrition. J Nepal Paediatr Soc, 36(2), 170-177.

[xii] Nagata, J. M., Gippetti, J., Wager, S., Chavez, A., & Wise, P. H. (2016). Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years 
        of Age. Plos ONE, 11(11), 9

[xiii] The World Bank, “World Development Indicators – Guatemala,” http://databank.worldbank.org/data/reports.aspx?source=2&country=GTM

Images:
UN News Centre, http://www.un.org/apps/news/story.asp?NewsID=51809#.WNAgdWQrLL8 
GlobalGoals.org, http://www.globalgoals.org/global-goals/no-hunger/ 
 Rytter MJH, Kolte L, Briend A, Friis H, Christensen VB (2014) The Immune System in Children with Malnutrition—A Systematic Review. PLoS ONE 9(8): 
        e105017. doi:10.1371/journal.pone.0105017

Causes of Malnutrition in Guatemala

Text by Mary Gramiak and photos by Emily Rempel

Throughout March, Pop Wuj is spotlighting our Nutrition Program and its mission to create lifelong opportunities for Guatemalans via treatment of early childhood malnutrition.

• Find more posts in this series our blog and our Facebook
• Read more about our fundraising campaign
• Donate to the Nutrition Program via Foundation Todos Juntos

¡Gracias por su apoyo! Thank you for your support!

A Nutrition Program participant in La Victoria plays peek-a-boo with his truck.

With one of the highest rates of chronic malnutrition in the world, and the single highest rate in the Western Hemisphere, it’s important to address not only treatment but also root causes of malnutrition issues in Guatemala. With an official population of 16.3 million, and estimates ranging closer to 18 million, Guatemala faces a chronic malnutrition rate of about 47 per cent – sixth highest in the world. Within indigenous communities these numbers reach closer to 65.9 per cent, with about 80 per cent of indigenous children suffering from stunting. While there are a multitude of issues contributing to the malnutrition issues throughout the country, some of the main contributors are environmental issues, inappropriate nutrition practices, and poverty. 

When people think about chronic malnutrition, they often picture starving children in desolate regions. However, this is a misconception which rests on the assumption that malnutrition and starvation are the same thing; when in reality, malnutrition and starvation have very distinct definitions. As opposed to starvation, malnutrition is the inadequate intake of any of the required nutrients, even if someone is receiving an adequate amount of calories throughout the day. In Guatemala the cycle of malnutrition can begin in pregnancy among women who are stunted, obese, or anemic; issues which reflect their own experiences with malnutrition throughout childhood. After birth, infants often receive breast milk which lacks appropriate nutrients, and children under five often do not receive an adequate diversity of nutrients to support their development. 

In a country such as Guatemala, with countrysides often overflowing with vegetables during the rainy season, it can be difficult to understand how malnutrition is such a prevalent problem. However, for the nearly 60 per cent of Guatemalans living in poverty, and the 23 per cent of Guatemalans living in extreme poverty, the cost of vegetables and meat is often too high. Because of this, families often are surviving off a high-calorie, starch-based diet of maize, beans, and rice. These are foods which are cheap, readily available, and can make someone feel full without having to eat a large amount. While poverty and lack of access to a diversity of nutrients accounts for a large portion of this phenomenon, a lack of education surrounding the importance of diversity within diet also contributes to the issue. 

Students in the Medical Spanish Program carry out a monthly check-up with a Nutrition Program participant and his mother in La Victoria.

Environmentally, changes in climate and reduced crop yields contribute to malnutrition in more ways than one. More than 40 per cent of the country’s labour force relies on the agriculture sector, but climate change has contributed to increased hurricanes, droughts, and decreased crop yields. Over-exploitation of natural resources through slash-and-burn agriculture, illegal deforestation, and mono-cropping are also contributing factors in decreased crop yields, presenting two issues which contribute to malnutrition in the country. The first is that the 40 per cent of the population which relies on agriculture as their primary source of income are not making as much money as they are used to, making diverse, nutrient-rich food, even more difficult to procure. The second is that the nearly 50 per cent of the country who live in rural communities, and rely either on their own crops or the crops of their neighbours for food, are producing less for themselves and for market, forcing them to spread already thin resources even further.

Politically, indigenous peoples who are the worst hit by conditions of poverty and malnutrition have been systematically disadvantaged throughout colonization – which makes providing nutrient-rich food to their families even more difficult. Within the last century indigenous peoples have been systematically displaced due to violence, war, and resource scarcity. Throughout the thirty-year civil war which plagued the country, more than one-million primarily indigenous people were displaced from their lands, and tens of thousands more killed. While the civil war officially ended with the Peace Accords of 1996, the democratic transition began in the mid 1980s, right in the midst of the the conflict. The Peace Accords mandated resettlement of displaced populations, integrated programs for human development, sustainable infrastructure and agricultural development, modernization, and an emphasis on the rights of indigenous communities, rights of women, as well as greater social participation. While the intention of the Peace Accords was honourable, implementation has been slow and uneven. Displaced indigenous peoples were resettled onto dry, useless lands in favour of leaving the arable lands for export based crops owned by wealthy landowners or multinational corporations. These lands make agriculture and subsistence farming for individuals and families difficult, further driving malnutrition rates throughout the country. 

Malnutrition is a complex issue which can reflect conditions of poverty, systemic oppression, a lack of education, or environmental issues. Throughout Guatemala’s complex history malnutrition rates within indigenous communities have hit nearly crisis levels, costing the country USD 8.4 million everyday in lost productivity, increased hospital costs, and academic setbacks. While nutrition programs like Pop Wuj and others operate throughout the country to try and correct for some of these setbacks in children under five, fundamental change will have to come through large scale initiatives which address the underlying factors driving malnutrition throughout the country.

Within our own Nutrition Program at Pop Wuj, we work to address some of these underlying issues by providing education and resources to the participants within our program. This includes the importance of a varied diet, and low-cost ways to incorporate different nutrients into daily life. We also treat malnutrition in as many children as we can so that their families, at least, have a chance of breaking the generational cycle. No single organization can solve the deeply ingrained problem of malnutrition for all of Guatemala. But we can transform individuals, and those changes mean everything to their families.

Sources:
"Guatemala," World Food Programme.
"Our Neighbors, Ourselves: Guatemala’s Chronic Malnutrition Crosses Borders," USAID, 2011.

"Recipe for better nutrition in Guatemala: Double challenge: Chronic malnutrition still a problem even as obesity rates rise," Inter-American Development Bank.

"Widespread childhood malnutrition is a paradox in agriculturally rich Guatemala," PBS, 2014.

Stove Shopping Day

Text and photos by Mary Gramiak

It’s been an exciting couple of weeks here at Pop Wuj! After completing the interviews for the incoming stove group, and holding our group meeting the previous weeks, last Wednesday we spent the morning performing La Compra – a morning where we collect and deliver all of the necessary stove materials for the incoming group. 

With this group we have 11 women and families from the communities of Llanos del Pinal and Xecaracoj, all of whom were present to help with the Compra. For each stove there is 110 bricks, 30 cinder blocks, a stovetop, a chimney, a door, and cement, clay, and sand. 

We started by collecting and loading the bricks into the truck, about 1,210 in total. From there we all piled into the back of the truck, a squishy experience to be sure. We then picked up the necessary cinder blocks and sand and headed to the communities in order to distribute the supplies to each home. 

A community member helps unload sand in Xecaracoj

This is where the manual labour aspect of the day really jumped into overdrive. In order to unload all of the materials we set up some assembly line and unloaded the bricks four at a time, and the cinder blocks one at a time. Something which was really cool about the unloading process was the community aspect of it, where everyone worked together to achieve the same goal. It was tough though, and if I never carry another bag of cement in my life I think I would be okay with it. 

The unloading begins. 

Incoming stove recipients held unload bricks.

Something I really appreciated about the Compra was that it gave the participants of the stove program the opportunity to be more involved with the stoves they will be receiving. When the women participate in aspects of the stove building like picking up and delivering supplies it creates a relationship based on teamwork and mutual respect between the participants and the organization. 

Working with Pop Wuj has been a really cool experience because in all projects there’s an emphasis on creating collaborative relationships with the surrounding communities, and working together to develop solutions which directly meets the needs of the population without taking a domineering approach. The Compra this past week was an excellent example of the importance of including community members in all aspects of social and development projects. 

Moving Day at the Family Support Center

Text and photos by Emily Rempel

This has been a VERY exciting couple of weeks for our Family Support Center. After a long and difficult search for a new location, we signed the papers last Monday for our new space and were ready to start making it our own. On Tuesday a group of volunteers from Pop Wuj and Pathways, an organization serving adults with developmental disabilities, headed out to the old FSC site in Llanos del Pinal. There we were met by a big group of FSC mothers and several of their children. 

Our first task was loading all of the furniture and the piles upon piles of other FSC materials up into the big moving truck. With many hands, and many trips, we loaded up the benches, cabinets, tables, and chairs. Luckily we had some Tetris experts on our team who were able to find a way to fit all of the awkward, bulky furniture into the truck.

Jeremy, Ashley, and Santos search for any remaining free spaces

On top of the furniture, we piled chairs, sacks of books, pots and pans, and a myriad of other odds and ends that all help the FSC run. By the end of it, the truck was just about overflowing. Then, once we got to our new FSC site, we had to unload it all! 

With the first truckload emptied, one group headed back to the old FSC site to pack up one more load, including a stove and a great big swing set. 

The swing set proved an interesting challenge to get into the new Center and the process was truly an impressive feat of strength and geometry.

In the end, just about all of the furniture got moved without a hitch, with the exception of one damaged cabinet. That, we can blame on the age-old problem of "too much cabinet -- not enough doorway." 

Moving our shelving units was a team effort 

By the time 5 p.m. came around, we were done! A special thanks goes out to all of our little helpers...

Emmanuel inspecting the inside of our recycling bin, making sure everything looked up to spec

One of Brenda and Ingrid's little cousins carrying our shelving unit (while teacher Santos helps just a tiny bit)

On Thursday we held a special benefit dinner for our Family Support Center, featuring some top-notch burritos (which, as co-chef, I say with absolutely no bias) and a margarita bar. At the dinner, we talked to the students a bit about what the Family Support Center is, what it offers to the community, and why it's so important. All proceeds from the night are going to be put towards our Family Support Center. 

We can't say enough how incredibly excited we are to be starting this new chapter in the life of our FSC, for it to be able to continue providing its vital services to families in Llanos del Pinal. Thanks for following this journey with us, for reading about our work, and for supporting our projects. 

Interested in helping us with this transition to a new site? Donations through Foundation Todos Juntos make a tremendous difference!

Off Come the Training Wheels

Text by Emily Rempel

As with any position of responsibility, there comes a time when the trainees must learn to fly solo. Sometimes we know exactly when our newly learned skills will be put to the test, and other times we’re surprised by a pop quiz. For Environmental Projects Coordinator Mary-Mak and I, last Tuesday was definitely a “pop quiz” kind of day.

We set out on the Safe Stove Project just like any other day, our bag of tools in hand, following the lead of our stove expert, Carmelina (who we’ve lovingly dubbed “La Reina de las Estufas,” or “Stove Queen”). We would be finishing up the third and final stage of a stove we’d been building in the home of a truly lovely couple and their sweet little baby. This particular stove project was memorable for me as it would be the first time I’d gotten to work on the same stove through all three of its stages.

We had just barely gotten started with the day’s build when our Stove Queen, Carmelina, was called away on family business. Of course, not only can Carmelina build a stove faster than anyone I’ve ever seen, but she’s also a mother.

Talk about a #LadyBoss, am I right?

Stage 1 of the stove (Photo by Emily Rempel)

And that’s when the training wheels came off, when the pop quiz was handed out, when we learned to fly solo. Now, before I indulge myself in any more dramatization, I should probably clarify that this was definitely not my, or Mary’s, first stove. I’d participated in about 5 different builds, doing every stage at least once. Mary-Mak, as our beloved Environmental Projects Coordinator, had completed her full stove building training, which you may have read about here (if not, check it out!). She had also been co-leading builds with Carmelina.

Stage 3 ft. the family's creative addition to help even out the cement (Photo by Mary Gramiak)

Nevertheless, it was still nerve-wracking to be left reliant on our own understanding of the project… especially when dealing with materials as unforgiving as cement. This would be Mary-Mak’s first time leading the project solo, and unfortunately for her, I was the only other Pop Wuj volunteer there to help. It was also only my second day as an official intern.

Luckily, Mary-Mak’s training quickly kicked in, and she was able to guide us through the final stage of the stove with only a few minor speed-bumps along the way. We were also helped along significantly by Señor Sales, the husband and father of the house, who was wonderfully patient with us and managed to contain most of his laughter at our masonry struggles. He also rigged up a very effective method of smoothing and evening out our final layer of cement. All in all, it ended up being a real team effort, and was an amazing experience to be able to work so closely with the family that will be using this stove for many years to come. Through lots of broken Spanish, hand gestures, and laughter, we were able to communicate well enough to get the job done.

There’s something really special about being welcomed into someone’s home, in a space as intimate and vital as the kitchen. For food lovers like me, the kitchen can really be understood as the heart of a home. As such, it can’t be stressed enough how important it is to make sure that a kitchen is as safe, accessible, and functional as possible. To read more about the numerous health concerns associated with unsafe stoves, check out the last blog post by our Environmental Projects Coordinator. At the end of a building session, when you’re up to your elbows in clay and cement dust, it’s this knowledge that brings the most satisfaction: these stoves will undeniably have a tremendous positive impact on the everyday lives of the families who are using them.

With that last thought, I leave you with one final photo:

(Photo by Señor Sales)

The (almost) finished stove, Mary-Mak, and myself ... and the dirt-smeared, exhausted, triumphant smiles on our faces.

Talking Indoor Air Pollution

Text by Mary Gramiak and photo by Elise Lynch

One of the most exciting moments of the week before last was during a Nutrition Program meeting in Llanos del Pinal, where I was able to give a short presentation on the impacts indoor air pollution have on the lungs of women and children.

Here at Pop Wuj, we run a Safe Stove Project which upgrades cook stoves in the Llanos del Pinal region just outside of Xela. These stoves are constructed to reduce the probability of burns, reduce smoke in the kitchen, and reduce the amount of fuel needed by about half. With this presentation, we were able to continue to educate women on the impacts open fire cookstoves have on the health of themselves and their children.

Mary and Carmen talking about the impacts of indoor air pollution on health. 

Many people don't know, but indoor air pollution is one of the leading causes of premature death in the developing world, with World Health Organization estimates ranging around 4 million deaths every year. The indoor air pollution comes almost exclusively from stoves which use open fires, biomass fuels, or coal, and has profound impacts on the health of communities and individuals.

Indoor air pollution affects children the most, and can lead to low birthweight in infants, pneumonia, atypical lung development, asthma, and tuberculosis. In adults, it contributes to strokes, heart disease, respiratory illnesses, and cancer. For the community, these stoves can pollute the air and their energy inefficiency leads to rapid deforestation. On a day to day basis, the smoke from these stoves contributes to skin and eye irritation and headaches. Of the 3 billion people worldwide who cook over  these stoves, many are inhaling the equivalent of two packs of cigarettes a day. Of course, because women and children spend the most time in these environments, they are disproportionally impacted.

In the Thursday presentation I was able to talk with a group of women from Llanos del Pinal whose children participate in the malnutrition clinic about the different ways indoor air pollution effects women, children, and babies. In order to illustrate these points we filled three different size jars, small, medium, and large, with water in order to represent the different sized lungs. Then we dropped the same amount of ink into each and watched the ink spread throughout the jar. In the smallest jar, which represented the lungs of a baby, the water was pitch black while in the adult's jar the colour was significantly more diluted. This represented how the effects of indoor air pollution on babies are significantly more profound than the effects in adults. By using the visual demonstration of the jars and the ink we were able to turn a complex topic such as respiratory health into a user-friendly experience for the women involved.

A really rewarding moment from this presentation came the next day, Friday, when Carmen, Carmelina, and I went out to conduct interviews for the new group of safe stove participants. Before someone can receive a stove we conduct short interviews to identify their needs and overall profile, including number of dependents, level of education, and so on. What was special about these interviews was that we met with many women who had intended the presentation the day before. This was important because we were able to follow through with a lot of women by not only talking about the impacts of indoor air pollution, but actively offering them alternatives to their current cooking situation.

If you're interested in learning more about the impacts of indoor air pollution in the developing world there are many resources available including this fact sheet  from the United Nations.