Understanding and addressing the double burden of malnutrition at the household level in Guatemala
PhD summary
Background:
In Guatemala, changes over time in the total prevalence of double burden of malnutrition (DBM), including its multiple combinations (i.e., the coexistence of obesity and anaemia within a household), and its associated main determinants and drivers at the household level remain unclear.
Hypotheses and objectives:
It is hypothesised that in Guatemala while some combinations of DBM might be decreasing, other under-studied combinations of DBM might be increasing. Also, it is hypothesised that those departments (geopolitical territorial divisions) in Guatemala presenting the highest prevalence of DBM at the household level coincide with higher rates of food insecurity and unhealthy food environments, and lower nutrition literacy and socioeconomic status when compared to healthy households. Therefore, this research aims to 1) understand the burden and actions for the DBM in Latin America to contextualize the DBM in Guatemala, 2) quantify the evolution of the household prevalence of DBM in Guatemala, and identify its main associated determinants and drivers, and 3) inform the feasibility and effectiveness of potential strategies to tackle the DBM at the household level.
Methodology:
To achieve this overall aim, this PhD proposes the following activities. 1) A systematic review and meta-analysis will be carried out to map out the evidence in Latin America concerning the DBM to estimate the pooled prevalence of DBM and to critically appraise the evidence evaluating modifiable drivers and implemented strategies for the DBM. 2) A secondary data analysis using Guatemalan women-children data from four nationally representative surveys will be used to estimate the household prevalence of DBM over time (1998 - 2015) and identify the department with the highest prevalence of DBM. 3) The department with the highest prevalence of DBM at the household level, will be further studied through a mixed methods case-control study that aims to quantify the total household burden of DBM including understudied household members (father/men and adolescents) and investigate thoroughly distinctive DBM determinants and drivers between cases and controls from the perspective of nutrition literacy, food security, unhealthy food environments and socio-economic and demographic characteristics. 4) A modelling exercise will be carried out to project the impact and effectiveness of a comprehensive strategy to reduce the household prevalence of the DBM using population-based data and input from previously implemented interventions.
Impact:
The proposed research will build up a solid and evidence-based foundation and framework to inform public health strategies to efficiently combat the DBM in Guatemala, thereby contributing to improving the nutritional status, overall health and well-being of Guatemalan households.