RT Journal Article SR Electronic T1 Projecting the Impact of Nutrition Policy to Improve Child Stunting: A Case Study in Guatemala Using the Lives Saved Tool JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 752 OP 764 DO 10.9745/GHSP-D-20-00585 VO 9 IS 4 A1 Tschida, Scott A1 Cordon, Ana A1 Asturias, Gabriela A1 Mazariegos, Mónica A1 Kroker-Lobos, María F. A1 Jackson, Bianca A1 Rohloff, Peter A1 Flood, David YR 2021 UL http://www.ghspjournal.org/content/9/4/752.abstract AB Key FindingScaling-up coverage of evidence-based nutrition interventions recommended by the international community would only lead to a small improvement in child stunting in Guatemala and are unlikely to meet the ambitious national goals set for 2024 or the 2030 SDGs.Our results support an increased focus on strategies that address the social determinants that contribute to stunting rather than a narrow focus on nutrition-specific interventions.Key ImplicationsLarge improvements in child stunting in some high-burden countries like Guatemala are unlikely to be achieved solely based on increases in nutrition intervention coverage.Multisectoral nutritional and social policies are needed to address the structural drivers of stunting.Background:Child stunting is a critical global health issue. Guatemala has one of the world's highest levels of stunting despite the sustained commitment to international nutrition policy best practices endorsed by the Scaling Up Nutrition (SUN) movement. Our objective was to use Guatemala as a case study to project the impact of a recently published national nutrition policy, the Great Crusade, that is consistent with SUN principles.Methods:We used the Lives Saved Tool (LiST) to project the impact of scaling-up of nutrition interventions proposed in the Great Crusade and recommended by SUN. Our outcomes were changes in stunting prevalence, number of stunting cases averted, and number of cases averted by intervention in children under 5 years of age from 2020 to 2030. We considered 4 scenarios: (1) intervention coverage continues based on historical trends, (2) coverage targets in the Great Crusade are achieved, (3) coverage targets in the Great Crusade are achieved with reduced fertility risk, and (4) coverage reaches an aspirational level.Results:All scenarios led to modest reductions in stunting prevalence. In 2024, stunting prevalence was estimated to change by −0.1% (95% confidence interval [CI]= 0.0%,−0.2%) if historical trends continue, −1.1% (95% CI=−0.8%,−1.5%) in the Great Crusade scenario, and −2.2% (95% CI=−1.6%,−3.0%) in the aspirational scenario. In 2030, we projected a stunting prevalence of −0.4% (95% CI=−0.2%,−0.8%) and −3.7% (95% CI=−2.8%,−5.1%) in the historical trends and aspirational scenario, respectively. Complementary feeding, sanitation, and breastfeeding were the highest-impact interventions across models.Conclusions:Targeted reductions in child stunting prevalence in Guatemala are unlikely to be achieved solely based on increases in intervention coverage. Our results show the limitations of current paradigms recommended by the international nutrition community. Policies and strategies are needed to address the broader structural drivers of stunting.