Combating Malnutrition in Guatemala through the Distribution and Use of Sprinkles A UNICEF Proposal, June 2009 Introduction reached. They’re barely surviving, and Malnourished children are not just their children are being swept up in a hungry children. They also lack critical vicious cycle that needs to be broken. With vitamins and nutrients, leaving them 13 million inhabitants, Guatemala is the more vulnerable to common childhood most heavily populated country in Central Photo Cover illnesses, less likely to recover from America. More than half of the Guatemalan Guatemala: A brother and disease, and stunted physically. population lives in poverty, and around 16 sister from the Quiché Malnutrition contributes to more than percent live in extreme poverty. According indigenous group lean half of all child deaths worldwide. As to UNICEF data from 2007, Guatemala against each other in the village of Concepción. © such, malnutrition remains one the has the highest percentage of chronically UNICEF/NYHQ1993-1868/ world’s most serious health problems. malnourished girls and boys in Latin Franck Charton America, and the fourth highest in the Though the effects of malnutrition are world. Half of the country’s children suffer dangerous to all children, those falling from chronic malnutrition. victim to the condition during the first two years of their lives face the most The situation is even worse for indigenous threatening consequences. Malnutrition families who mainly live in rural areas. in infants and toddlers causes lower Close to half of Guatemala’s population intelligence and reduced physical capacity. are members of indigenous groups that If children don’t have the best start in life speak 22 different languages. Though one during this critical period, the impacts out of two Guatemalan children suffers of malnutrition are irreversible. The from chronic malnutrition nationally, devastating effects of malnutrition have malnutrition can impact 80 percent of societal impacts as well. Communities children living in indigenous communities. that struggle with malnutrition are far The problem commonly manifests itself in more likely to witness reductions in significantly stunted growth and lowered productivity, slowed economic growth, IQ scores. and a perpetuation of poverty. The Micronutrient deficiencies are so ultimate result is that chronic malnutrition widespread among Guatemala’s children creates a vicious cycle of poverty that that the prevalence of anemia is nearly has the potential to pass from generation 40 percent. The prevalence of vitamin A to generation. deficiency is almost 20 percent among Right now, impoverished families in Guatemalan children under the age of Guatemala are in desperate need of help. five. Although no data on the prevalence Only a small portion of them are being of zinc deficiency is available, it has also been identified as a public health problem. Zinc has recently been identified as a key Percentage of Children under 5 with element in infantile growth, which accounts Stunted Growth Due to Malnutrition—2007 in part for Guatemala’s high prevalence of stunting and the recurrence of infectious 0 10 20 30 40 50 diseases. Guatemala Moreover, increasing food prices Peru worldwide have raised Guatemalans’ Bolivia cost of living, further compounding the problem. The poorest of the poor are the Haiti most vulnerable. Faced with rising food Ecuador prices, families adopt different strategies to adapt. For instance, many families are Mexico cutting down on more expensive foods Dominican with higher nutritional value and reducing Republic the quantity of the food they consume.

2 Combating Malnutrition in Guatemala through the Distribution and Use of Sprinkles This situation will lead to an increased young children and other vulnerable prevalence of chronic malnutrition, groups at risk. a deterioration of public health and UNICEF distributes Sprinkles around the conditions of poverty from which it is world. In practice, UNICEF has learned that difficult to escape. the use of Sprinkles in Guatemala carries Sprinkles: A Simple, several tangible advantages. Here are just Cost-Effective Intervention a few: UNICEF knows that the majority of deaths • Their micronutrient content fulfills the daily caused by malnutrition and disease are dietary recommendations for children from avoidable through the use of simple, cost- 6 months to 5 years of age. effective, and time-proven interventions. One of UNICEF’s principal strategies for • Sprinkles can provide the daily dose of reducing micronutrient deficiencies is micronutrients to each child regardless of food fortification programs for specific the quantity of complementary food that vulnerable groups. With your support, is fed. UNICEF aims to improve the nutritional • There are little to no changes to the taste, status of Guatemalan children from six color or texture of the food to which months to three years of age. To do so, Sprinkles are added. UNICEF will be utilizing Sprinkles (known as Chispitas in Latin American countries). The • The packets are easy to use and introduction of Sprinkles is an innovation in convenient. No special measuring utensils home fortification that addresses vitamin or handling is required and they can be and mineral deficiencies. This unique given at any mealtime during the day. delivery system provides micronutrients to • One does not have to be literate to learn vulnerable populations by enabling families how to use them. to fortify many different semi-solid foods in the home. Their standard preparation • The use of Sprinkles does not require any contains iron, vitamin A, vitamin C, zinc and change in food practices as it can be mixed folic acid. with homemade foods.

Photo Right • Sprinkles can be easily incorporated into the busy rhythm of everyday life. Guatemala: A boy eats his meal at a community • The packets are lightweight and thus are center in Chiquimula simple to store, transport and distribute. Department. © UNICEF/ Sprinkles have a long shelf-life, even in hot NYHQ2007-2763/Claudio Versiani conditions (2 years). • The packaging of Sprinkles is attractive and thus is easily accepted. • The use of Sprinkles has been embraced Sprinkles are packets (like small packets of by Guatemala’s National Strategy for the sugar) containing a blend of micronutrients Reduction of Chronic Malnutrition which in powder form, which are easily sprinkled will ensure sustainability over the long onto foods prepared in the home. Any term. homemade food can be instantly fortified • The low cost of Sprinkles is in line with by adding Sprinkles. Coating of the iron UNICEF’s low-cost, effective strategies. prevents changes to the taste, color or texture of the food to which Sprinkles are In sum, the use of Sprinkles is a simple, added. Sprinkles were developed by the low-cost intervention that is highly Sprinkles Global Health Initiative to prevent effective. Just $25 can provide seven and treat micronutrient deficiencies among Guatemalan children with the vitamins

3 Combating Malnutrition in Guatemala through the Distribution and Use of Sprinkles Photo Right Guatemala: Maria Alejandra Raxon Homez weighs a toddler in a sling scale at a neighborhood center in Canton Cerro Partido. © UNICEF/ NYHQ2007-2765/Claudio Versiani

and minerals they need for an entire year. to prevent anemia due to iron deficiency; Your support will allow a child to receive a to avoid growth retardation due to zinc total of 120 packets of Sprinkles a year – 60 deficiency; to prevent gastrointestinal packets every six months. Parents are infections related to vitamin A deficiency. instructed to give their children one packet Your support will not only allow UNICEF a day for 60 days and they’re nutritional to provide Sprinkles to health centers, needs will be covered for six months. Then but it will also allow UNICEF to provide they have to repeat. That’s all it takes. adequate counseling to mothers or child care providers in order to administer Conclusion Sprinkles in the recommended manner and The number of preventable child deaths frequency. During the medical consultation can be reduced with the implementation or in the home visit, health providers have of effective health care and nutrition the opportunity to teach mothers how programs—and UNICEF is the organization to prepare Sprinkles adequately in order best equipped to provide these initiatives. to preserve its efficiency. This is also Malnutrition requires both short-term and an opportunity in which it is possible to long-term solutions. UNICEF is offering counsel mothers on other aspects of child both. UNICEF aims to provide communities care, including hygiene, breastfeeding, with the tools and knowledge to sustain complementary feeding and the use of their own healthcare and nutrition available health services. programs. UNICEF-assisted health centers reflect this mission, delivering services UNICEF will also supervise and improve while also training families and community data on micronutrient supplementation health workers on the best possible health coverage by establishing a Monitoring and practices. Supervision Plan in order to guarantee follow up on the fulfillment of micronutrient With your support, UNICEF will provide supplementation with Sprinkles in children Sprinkles to 35,000 Guatemalan children six months to three years of age. Based on across 17 municipalities. Through the information gathered, UNICEF will be Sprinkles supplementation, UNICEF aims

4 Combating Malnutrition in Guatemala through the Distribution and Use of Sprinkles possibility and peace, a day when every child has a childhood, a day when every child lives. With your support, UNICEF can make a world of difference in the lives of 35,000 Guatemalan children, their families, and their communities. Thank you for your interest in UNICEF’s lifesaving programs in Guatemala. Budget The total estimated cost for this project is $175,000. If we are successful at raising these funds, UNICEF will be able to conduct the following activities: • Purchase and distribute 4,200,000 packets Photo Right of Sprinkles to 35,000 children over the course of a year at local health centers. Three packets of Sprinkles. © U.S. Fund for UNICEF • Train over 300 health providers at local health centers. able to ascertain if the proposed goals • Monitor and supervise all activities have been reached. related to the distribution of Sprinkles. Your support will also allow UNICEF to • Provide local health centers with develop a manual that could be useful in equipment necessary to monitor other countries interested in implementing the growth of children. the Sprinkles strategy for micronutrient supplementation. UNICEF proposes to • Develop and publish a manual that will produce this manual and distribute it be shared within Guatemala and among throughout the country as well as in neighboring countries wishing to replicate other countries of the region. the success of the program. UNICEF, and the growing number of people To donate directly to the like you who support us, believe in a day Sprinkles Program please visit when every child can grow up healthy and www.unicefusa.org/donate/ung educated with hearts and minds full of

We are deeply grateful to our donors for their emergency help in times of crisis. With your help, incredible generosity and personal involvement we can reach a day when zero children die of U.S. Fund for UNICEF in UNICEF’s growing child survival mission. Every preventable causes. 125 Maiden Lane contribution, great or small, means a lifeline for Believe in the possibility of zero. New York, NY 10038 children and their families—clean water, vital health 1.800.4UNICEF care, better nutrition, opportunities for education, Casey Rotter, Development Officer www.unicefusa.org protection from abuses and exploitation, and Tel: 212.880.9164 • e-mail: [email protected]

5 Combating Malnutrition in Guatemala through the Distribution and Use of Sprinkles