Guides for a Brighter Tomorrow

Noticing the nutrition problems in her country, Tania Emilia Reyes Rivas determined that she would help solve the frustrating cycle of malnutrition and lack of sanitation that has spanned generations for many Guatemalan families.

Noticing the nutrition problems in her country, Tania Emilia Reyes Rivas determined that she would help solve the frustrating cycle of malnutrition and lack of sanitation that has spanned generations for many Guatemalan families. As a nutrition student at the University of San Carlos, Reyes elected to complete her practical work with the Ezra Taft Benson Agriculture and Food Institute in the communities of Salitrón, Chancó, and Corral de Piedra. As indicated in the diagnostic study completed by the Benson Institute, children and pregnant or nursing women suffer most from nutritional deficiencies. Their relatively high nutritional requirements, as well as socioeconomic imbalances, generally lead to inferior nutrition among women and children.

In her thesis project, Reyes focused on preschool children and pregnant and nursing women in the communities. Her objectives were to evaluate the food and nutrition situation for the individuals in this category and then to develop a proposal for improvement programs, based on the needs exposed in the study.

Reyes proceeded in a methodical fashion in order to design effective programs. She created a five-step protocol for establishing improvement plans. The first step of this process was to perform a diagnostic study focusing on the women and the children. She included 22 women and 74 children in this study and recorded information on their food availability and consumption habits. She met with each person and recorded information about his or her living and sanitary conditions, economic level, and educational situation. This information provided Reyes with the background information necessary for designing programs. Reyes then used a previously designed survey instrument to determine the foods that the families regularly consume. The last part of the study was to measure the weight and height of the women and the children of the communities in order to detect chronic and current malnutrition.

The second phase of Reyes' project was to present the results of her diagnostic study to the members of the community. Reyes met with the community members to review the diagnostic results; together they determined which areas held priority for improvement attention. This allowed family members to understand the need for improvement and to make decisions regarding the programs that they would participate in implementing.

With the information that she obtained from the diagnostic and from the meetings in the communities, Reyes began to draft plans for improvement programs. In this step, she took special care to design programs that would not only satisfy the needs of the community members but that could be feasibly carried out using the resources available to them.

After formulating the program proposals, Reyes presented them for feedback and discussion. She first discussed them with her thesis adviser, then presented them in the community and to the Benson Institute for their comments and suggestions. After receiving feedback from the various parties, she adjusted the plan accordingly. This step maximized the likelihood of the programs' success by fitting the needs of the community members and other groups involved.

The fifth and final step of Reyes' procedure was to present her final proposals based on the information that she had gained from the diagnostic study and adjusted to fit the needs and resources of the communities. The proposals were submitted to the community members and to the Benson Institute for their subsequent execution.

Diagnostic findings

Based on the findings from the weight and height measurements, as well as the food consumption surveys, Reyes discovered that many of the women and the children have an inadequate caloric intake. For example, 35 percent of the children that she measured showed some degree of malnutrition, and 69 percent showed evidence that growth stunting had occurred during their childhood. As for the women, those who were pregnant appeared to have gained sufficient weight to support their pregnancy; however, among women that were nursing, 35 percent showed symptoms of mild malnutrition, based on weight and height data.

Although many of the women and the children involved in this study appeared to be of adequate weight, this does not necessarily indicate that they were properly nourished. In order to further understand the nutritive adequacy of the average diet, Reyes used diet surveys. The results indicated that only 19 percent of the children and 9 percent of the pregnant or lactating women obtain sufficient calories in their diet. Furthermore, their diet lacks adequate high quality protein and fat. This situation mainly results from the fact that the diet of the community members is largely restricted to what the family can produce.

Table 1. Improvement programs proposed by Tania Emilia Reyes Rivas
Program	Objectives	Participants	Description
Cultivation and consumption of soybeans	To encourage the cultivation and consumption of soybeans among community members as a rich source of high-quality protein	Nutritionist, Agriculture Technician, Community Residents	In an effort to encourage the consumption of soybeans this program will consist of two phases; demonstrating agricultural methods for successfully cultivating soybeans, thus encouraging consumption.
Family Gardens	To promote the development of family vegetable gardens to provide a wider variety of nutrient-rich crops	Nutritionist, Agriculture Technician, Community Residents	Families will be provided with instruction and assistance in cultivating a garden at their home. Also, they will learn about the nutritional importance of the crops that they cultivate.
Food and Nutrition Education	To involve community residents in an extended program aimed at increasing their knowledge about the theory and practice of nutrition	Nutritionist, Community Residents (especially mothers)	Mothers will participate in regularly scheduled classes in which Benson Institute staff members will teach them basic concepts of nutrition, as well as specific methods of improving nutrition in their families. They will devote time to special nutritional needs during sickness, pregnancy, and while nursing. Staff members will also teach methods of food preparation and preservation.
Health Education	To teach basic methods of health and hygiene in order to maximize the benefits of improved nutrition	Nutritionist, Nurse, Community Leaders, Community Residents	The nurse and the nutritionist will determine lesson topics based on the needs of the community. They will teach one topic each month for six-month period.
Nutrition Monitoring	To monitor the nutritional state of young children, pregnant women, and nursing mothers	Nutritionist, Benson Institute Staff, Community Residents	The growth and development of those people most susceptible to the ill effects of malnutrition will be closely monitored. The Benson Institute staff will measure the weight and height of children, pregnant women, and nursing mothers at three month intervals; mother will be taught how to evaluate the progress of their children; special attention will be offered to individual needs.

In addition to studying the dietary and nutrition conditions of the communities, Reyes recorded data about their scholastic experience. Despite the limited schooling opportunities for the adults in the area, Reyes found that 62 percent of the women surveyed could read while 57 percent could write. When plotting this data against nutritional data, Reyes found that there was a statistically significant correlation between a mother's level of schooling and the adequate nutrition of her preschool children. Reyes collected literacy data so that she could design programs that would accommodate everyone in the communities.

Priorities

Reyes presented the diagnostic results to her adviser, the Benson Institute, and community members. Together they established priorities for improvement based on the severity of the problem and the practicability of establishing an effective program to overcome that problem. This research group defined five priorities and listed them as follows:

1. Increase the availability of high-quality protein through the cultivation and consumption of soybeans.

2. Increase the family production of high-vitamin vegetables.

3. Use nutrition and health education to maximize the benefits of the food consumed.

4. Monitor those populations that are at high risk for malnutrition.

5. Promote the participation of community members in projects of improvement.

After establishing these high-priority areas of improvement, Reyes began to design programs that would satisfy the requirements outlined.

Programs

In designing the improvement programs, Reyes defined certain roles that would provide the community residents with guidance as the programs were implemented. She also defined the objectives and described each project, as displayed in Table 1.

Because the people in Salitrón, Chancó, and Corral de Piedra consume inadequate levels of high-quality protein, Reyes designed a program aimed at increasing the availability and consumption of soybeans, a good protein source. In addition, her plan provides for teaching the people about the benefits of consuming soybeans, so that they are more likely to integrate them into their diet. Her plan calls for a nutritionist to teach about the positive effects of soybean consumption, as well as an agricultural technician to teach the people how to cultivate soybeans.

In response to the objective of helping the families to produce high-vitamin vegetables, Reyes outlined a plan for family gardens. This plan provides for an increased availability of micro nutrients, such as vitamin A, which is available in green, leafy vegetables. As with the soybean project, a nutritionist would educate the families on the nutritional benefits of various vegetables and an agriculturalist would help the family to establish and maintain their gardens.

Because the mothers of the families control so much of the food intake of the family members, Reyes considered it important to train the mothers specifically about the nutritional needs of their families. She planned for a series of classes in which mothers would learn how to prepare nutritious meals for their family. In addition, the classes would include a special focus on the increased nutritional needs during pregnancy and lactation, as well as during illness. Some of the topics suggested by Reyes were nutrition during diarrhea and respiratory illness; deficiencies in vitamin A, iron, and iodine; and effective use of the resources available in the home. Furthermore, the mothers would learn how to safely preserve and store food. In her plan, Reyes would make use of the literacy of many of the mothers, providing them with pamphlets and other educational materials; the mothers who are unable to read would use picture guides.

Designed to work in a similar fashion as the nutrition education program, Reyes also designed a sanitation and hygiene education series. This program, like the one previously mentioned, would consist of six monthly courses to be taught mainly to the mothers in the communities. The courses would focus on correct methods of sanitation and on reasons for maintaining a hygienic home. This focus would allow the mothers to better understand the connection between sanitation and the health of their family.

Finally, Reyes included a project of nutritional monitoring in order to provide continual care for those at high risk for malnutrition and to evaluate her other programs. This monitoring would be carried out through weight, height, and age measurements that would reflect an individual's nutritional progress in response to the other programs. In addition, it would alert the nutritionist of any severe cases of malnutrition that call for medical attention or special nutritional attendance. In Reyes' plan, a nutritionist, assisted by Benson Institute staff and volunteers from the community, would collect measurements on the women and children every three months. These data would be plotted on growth charts, providing information to the nutritionist and to the community members.

Conclusion

In their 1998 State of the World' Children report, UNICEF urges that "there is a need for more research programs that affect the hardest-to-reach people, and for determining the effectiveness of feasible interventions, for example, how to increase the consumption of green leafy vegetables" (UNICEF, 1998). Tania Emilia Reyes Rivas' thesis project is an example of how Benson Institute scholars accomplish the type of research for which UNICEF calls. Reyes took care to plan programs that involve the community members from the start. This not only fosters interested involvement, but it also helps community members to gain lasting knowledge, allowing them to detect and solve problems on their own.

The improvement programs suggested by Reyes have already been initiated in some form. Efforts have begun to integrate soybeans into the regular diet of the community members. Benson Institute staff and Brigham Young University interns have undertaken to teach sanitation and nutrition in the communities, and to keep continual weight and height measurements for the children. The success of these programs is largely due to the careful methodology used in planning them. The outcome is a better education for a nutrition student and a better life for the people of Salitrón, Chancó, and Corral de Piedra.

Works Cited

UNICEF (1998). Spotlight on vitamin A. State of world’s children (Online). Available: http: gopher.unicef.org: 70/00/.cefdata/.sowc98/spt0.3.txt [1998, December 1].

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