Contributing Factors to Child Stunting in Guatemala: A Systems Analysis Focused on Enteric Disease Transmission and Mycotoxin Exposure

Child stunting -- low height-for-age -- is a United Nation's indicator for chronic malnutrition that has been linked to both acute and chronic health problems. Data from Guatemala suggests for children under five years of age, 49% are classified as stunted. This dissertation tests the following hypotheses, among children in Guatemala 1) environmental enteric dysfunction (EED) is correlated with height-for-age, 2) aflatoxin B (AFB) exposure is correlated with height-for-age, and 3) AFB exposure is correlated with EED. A network analysis was conducted on data from the US Agency for International Development (USAID) collected in 2012 to identify trends in a height-for-age model and an EED model. These results were then combined with a literature review, field observations, and informal interviews to hypothesize two structural equation models (SEM). Additionally, a third SEM was hypothesized for the AFB exposure model. The models were tested with data collected by the San Vicente Health Center in Totonicapan in October 2016 and February 2017. Finally, five geographic specific SEMs were built with the USAID 2012 data and tested with USAID 2013 data. Results of the hypotheses include 1) mixed findings on a correlation between EED and child height-for-age, 2) a confirmed correlation between AFB exposure and child height-for-age, and 3) no correlation between AFB exposure and EED. Furthermore, improved prenatal health and improved sanitary child play areas were correlated with child height-for-age. For the EED model improved water treatment was correlated with reduced EED. Finally, improved maize purchase habits, post-harvest practices, and maize storage were correlated with a decrease in AFB symptoms. Field practitioners and policy makers must account for local and regional suitability for interventions and policies on child health.