El Gran Fantasma: Intercultural Challenges and Opportunities for Maternal and Child Nutrition in El Alto, Bolivia Public

Abstract

Background. This qualitative project aimed to synthesize perspectives of mothers and health service providers in El Alto, Bolivia, with regards to challenges and opportunities in maternal and child nutrition. The nutrition of mothers and children is a major public health concern in Bolivia--particularly in the rapidly growing and predominantly indigenous city of El Alto--and has received considerable attention from the Bolivian government.

Methods. In order to characterize a community-level perspective on maternal and child nutrition, a team of Emory students and Bolivian partners conducted focus group discussions with mothers (n = 4 focus groups, n = 25 mothers [age 18-43, 64% indigenous]) and interviews with health service providers (n = 10) in El Alto in 2014. Focus groups and interviews were transcribed, coded, and analyzed using an across-case descriptive thematic approach.

Results. Mothers and providers viewed infant feeding practices and family meal habits as generally poor and said that the services (e.g., nutrition consultation) provided by the formal healthcare system are inadequate for the needs of mothers and children. Mothers and providers described a struggle to reconcile cultural influences of a past life with a present life where things are not "natural" and advocated for tangible, natural, and lively nutrition education as a solution.

Discussion. Borrowing a phrase from one provider, maternal and child nutrition in El Alto is a "Great Phantom" (Gran Fantasma), elusive and stuck between worlds. But in this rapidly transitioning city, intercultural education that harmonizes historical and contemporary views of nutrition can actively transform this phantom into something new and revitalized.

Table of Contents

INTRODUCTION. 1

LITERATURE REVIEW. 4

METHODS. 18

RESULTS. 25

DISCUSSION: "THE GREAT PHANTOM". 51

RECOMMENDATIONS. 59

CONCLUSION. 66

REFERENCES. 67

APPENDIX 1: PROVIDER INTERVIEW GUIDE. 73

APPENDIX 2: FOCUS GROUP DISCUSSION GUIDE. 76

APPENDIX 3: FOCUS GROUP PARTICIPANT SURVEY. 79

APPENDIX 4: PROVIDER INTERVIEW INFORMATION SHEET. 80

APPENDIX 5: FOCUS GROUP INFORMATION SHEET. 81

APPENDIX 6: CODEBOOK FOR TRANSCRIPT ANALYSIS. 82

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	maternal child Bolivia interculturality altiplano nutrition indigenous
Committee Chair / Thesis Advisor	Andes, Karen, Emory University Leon, Juan, Emory University
Partnering Agencies	Community-based non-profit organization (e.g., AID Atlanta) University, college or educational institution (other than Emory) Hospital or other health care provider

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