Lambden, Kaley

Public Health

MSPH

Guatemala

Guatemala - Project MIEL

Nutritional deficiencies and the lack of responsive learning opportunities contribute to the loss of developmental potential among more than 200 million children under 5 years of age from low-income and middle-income countries. Without adequate nutrition and responsive feeding and learning opportunities, children are at risk for poor growth, low academic performance and life-long disparities. Recent evidence has shown that in Guatemala, the prevalence of stunting for children under age 5 years exceeds 40%, the highest in the western hemisphere. There is no national preschool and first grade failure is estimated to exceed 40%. The combination of nutritional deficiencies and lack of adequate responsive feeding and learning opportunities undermines the progress of individual children, and threatens the well-being of the entire country.This project represents a collaboration with APEVIHS (Association for the Prevention and Study of HIV/AIDS, in Spanish) and The Mathile Institute for the Advancement of Human Nutrition. APEVIHS, a non-governmental organization located in western Guatemala, works with other organizations, such as the World Food Programme, to promote the health and nutritional status of children and families. They develop training programs for health workers and families (e.g., trained head of household mothers in income-generating skills to improve their families' economy). The Mathile Institute, a US foundation, has a mission to create lasting solutions that enable nutritional well-being in children throughout the world. Through the innovative efforts of APEVIHS and The Mathile Institute, a comprehensive micronutrient mix (Chispuditos) has successfully been introduced into the rural communities in Retalhuleu, Guatemala. Early data from over 1,000 stunted children (length-for-age < 1 z-score) have suggested beneficial effects of Chispuditos on children's health, growth, and development. The objective of this project (Project MIEL) is to evaluate the effects of an integrated Chispuditos, responsive feeding, and early learning intervention on the development and nutritional status (e.g. growth, diet, and micronutrient status) of infants and young children in rural Guatemala, following principles of randomized controlled trials. To address the developmental periods in which micronutrient deficiencies are highly prevalent and responsive feeding and early learning opportunities are most beneficial, the trial includes an infant phase (recruitment age 6–12 months) and a preschool phase (recruitment age 36–48 months). The hypotheses of PROJECT MIEL are: 1) exposure to Chispuditos leads to better development and nutritional status, 2) responsive feeding (exposure in infant phase) and early learning opportunities (exposure in preschool phase) lead to better development; and 3) integrated Chispuditos plus responsive feeding/early learning opportunities lead to better nutrition and development through either additive or synergistic processes.

Global Health Mentor: Kristen Hurley, PhD

People

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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November 2017

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