Understanding childhood malnutrition in a Maya village in Guatemala: A syndemic perspective

This dissertation examines the social, political ecological, economic and cultural context of childhood malnutrition in a Maya village in the western highlands of Guatemala. Considering childhood malnutrition to be the result of a combination of ecological factors, including human political, economic, and cultural systems and biotic and abiotic environmental factors, I use the UNICEF conceptual framework for understanding childhood malnutrition to structure an ethnographic analysis of the situation in the village of Santa Cruz la Laguna. ^ This dissertation also specifically examines a juncture of this framework, the relationship between maternal education and child care behaviors and nutrition status. The results show that maternal education was not strongly correlated with improved child nutrition status, nor did it significantly change the way women in Santa Cruz fed their children. These results may be explained with reference to the high incidences of stunting (70%) and underweight (32%) among children between six and 36 months and the ethnographic data which indicates high exposure to multiple interacting factors that lead to malnutrition and poor quality of education. Maternal education, however, was strongly correlated with the ways that mothers accessed advice about their children\u27s health. ^ In the field site, impoverished economic conditions and geographic isolation contributed to food insecurity and flawed infrastructure for environmental sanitation increased residents\u27 exposure to pathogens. Poor soil quality and small land holdings reduced possibilities for household food production by means of subsistence agriculture, gardening, and animal husbandry and also forced reliance on purchased food. Within households, common care practices including late introduction of complementary foods, laissez-faire feeding style for infants and toddlers, high intake of sugars and avoidance of fat resulted in developmentally inappropriate and insufficient diets for children in the vulnerable 6-36 month age range. Household food storage and hygiene practices also presented ample opportunity for cross-contamination and food borne illness. The complex set of interactions between economic factors, social dynamics, and local child care and feeding practices, led me to the realization that addressing childhood malnutrition can best be approached from a syndemics orientation. I argue that this orientation can build on existing knowledge regarding the determinants of childhood malnutrition and be used to promote and guide publicly owned, systemic changes that provide both short-term, stop-gap solutions and long-term, sustainable solutions to preventing childhood malnutrition and its related malefic effects.