Developing a health information system for a chronic malnutrition program in San Juan and San Pablo La Laguna, Guatemala: A Special Studies Project Público

Abstract

Chronic or recurrent undernutrition results in lower linear growth achieved for age, also known as stunting. Globally, there are about 155 million stunted children. Within Latin America and the Caribbean, the highest national prevalence of stunting is found in Guatemala where about half of all children nationally, and up to 90% of children in certain municipalities are stunted. ODIM is a small NGO that aims to prevent and treat chronic malnutrition in two rural towns of Guatemala, through its program “Mamá y Yo Saludable” (“Healthy Mommy and Me” or MYS). Currently, MYS employs evidence-based approaches in its health education and community outreach, but its data collection and management systems prohibit rigorous analysis. Effective data use will inform future decision making, MYS programmatic efforts, and evaluate its past efforts and positive impact created. Thus, there is a need for accessible and effective knowledge management systems that allow for efficient data entry, review, and analysis. The purpose of this project is to provide ODIM with an accessible database system that allows for the longitudinal monitoring of its participants, and an accompanying data management protocol that delineates all steps related to data collection, entry, management, quality control, and initial steps for analysis. With successful implementation of the database and protocol, ODIM will be able to effectively evaluate the MYS program and quantify its impact on the reduction of chronic malnutrition.

Table of Contents

Chapter 1: Introduction…………………………………………………………………………………….

1

The problem of chronic malnutrition…………………………………………………………………………

1

Figure 1: Map of Guatemala………………………………………………………………………………….

1

Figure 2: Map of Lake Atitlan, in the department of Sololá………………………………………………….

1

ODIM’s “Mamá y Yo Saludable” program…………………………………………………………………..

2

Figure 3: MYS program participation schematic……………………………………………………………..

3

Data demand, use, and quality………………………………………………………………………………..

4

ODIM’s data management challenges………………………………………………………………………..

6

Motivations and purpose……………………………………………………………………………………...

6

Definition of terms…………………………………………………………………………………………….

8

Chapter 2: Comprehensive Review of the Literature……………………………………………………..

9

Background of chronic malnutrition in Guatemala…………………………………………………………...

9

Causes of malnutrition………………………………………………………………………………………...

11

Figure 4: Causes of child malnutrition………………………………………………………………………...

12

The window of 1,000 days……………………………………………………………………………………..

12

Figure 5: Context and causes of stunted growth and development……………………………………………

13

The evidence base that supports MYS’ approach……………………………………………………………..

13

Past and current interventions………………………………………………………………………………...

15

Figure 6: Multi-sectorial nutrition conceptual framework…………………………………………………….

16

Table 1: Select chronic malnutrition programs in Guatemala…………………………………………………

17

Stunting and its measurement……………………………………………………………………………….....

18

Current recommendations on data systems……………………………………………………………………

18

Chapter 3: Project Content/Methods………………………………………………………………………..

19

Original dataflow………………………………………………………………………………………………

19

Proposed dataflow……………………………………………………………………………………………..

20

Figure 7: Original and proposed dataflows…………………………………………………………………….

21

Development of data collection tools…………………………………………………………………………..

21

Cleaning of existing data………………………………………………………………………………………

22

Access database development………………………………………………………………………………….

22

Data management protocol development………………………………………………………………………

23

Chapter 4: Discussion, Implications, and Limitations……………………………………………………...

25

Discussion……………………………………………………………………………………………………....

25

Implications for chronic malnutrition in Guatemala…………………………………………………………..

26

Limitations……………………………………………………………………………………………………...

26

References……………………………………………………………………………………………………..

28

Appendix A: Proposed data collection forms……………………………………………………………….

32

Appendix B: Data management protocol……………………………………………………………………

36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Information Science Health Sciences, Nutrition
Palabra Clave	Health information systems Knowledge management Chronic malnutrition
Committee Chair / Thesis Advisor	Roger Rochat, Emory University Johnathan A. Edwards, Emory University
Partnering Agencies	Community-based non-profit organization (e.g., AID Atlanta)

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