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Conclusions for policies and action programmes
The analyses conducted to determine seasonal fluctuations in family energy and protein intakes and the potential implications of these fluctuations for children's intakes and nutritional status indicated that seasons exerted an important effect only on the incidence of morbidity events in the study population. Similar effects were not observed in families' and children's energy and protein intake patterns or, as reflected by anthropometric measurements, in the nutritional status of children. In the absence of important seasonal effects on consumption patterns and nutritional status, we do not make any specific recommendations for policy and action programmes on the basis of this study. Instead, on the basis of the six-year involvement of the INCAP professional staff in the study area as well as on that of information gathered in similar environments in its member countries for decades, we propose interventions that will improve the living conditions and nutritional status of these population groups, not on a seasonal but on a permanent basis.
We do not propose that the activities we describe as action programmes should be implemented at once as a package. They are potential interventions that have been implemented by INCAP in the plantations described in this study and/or by governments in Guatemala or other countries. If a gradient of feasibility needs to be established, it is expected that medical care, improvements in environmental sanitation conditions, food distribution schemes, and nurseries for children under five may be more feasible than housing schemes, development of other labour opportunities, and land rental. However, none of these action programmes should be regarded as an intervention whose implementation is not realistic, even in the present Guatemalan political, economical, and social context.
Governments should not exclude, as has been the case for decades in Guatemala, coffee plantation communities from their ongoing programmes. Governments have regarded the delivery of health, educational, and other social government services to these population groups as the sole responsibility of plantation owners. It is more important that governments, and not only the owners of plantations, assume the costs and responsibilities for implementing programmes aimed at increasing the purchasing power of families and/or at reducing the incidence and prevalence of disease.
Furthermore, the compliance of the owners of plantations with the approved minimum wage scales, the social security system regulations, and other benefits for labourers, as dictated by existing laws, should be better monitored and enforced by the Ministry of Labour and Social Security. The following activities should be permanent interventions aimed at improving the living conditions of population groups residing on coffee plantations.
Environmental Sanitation
Water supplies are heavily contaminated and most families defecate in the open fields. As demonstrated by INCAP [3, 18], the cost of improving water supplies is not high and can be done jointly by government, communities, and owners of the plantations.
Minimum Wages Adjustments and Enforcement
Revision and adjustments of wage scales every two years are necessary, as well as the enforcement by the Ministry of Labour and Social Security of legislation on minimum wages and other social benefits.
Co-operative Shops
Groups organized by the farm administration could run this service, which will lower the cost of foods and other goods at present sold at high prices in local shops.
Land Rental
Some labourers have expressed their desire to cultivate nearby plots of land if it is available, and would be likely to use the land for the production of corn. This land could be uncultivated plots in the plantations.
Food Distribution Programmes
The period from April to July may be the best time for seasonal food-aid programmes, as prices of corn and other foods in the local market, as well as morbidity events, reach a peak then. The programme would have two positive consequences, increasing family food availability and at the same time motivating families to take their children to the clinic for periodic check-ups.
Development of Other Labour Opportunities
If properly trained, women can carry out some jobs during the non-harvest season, at home or inside the plantation. More work for women, however, could be detrimental to child care and nutrition.
Extension of School Services
The schools operating in most plantations only provide the first three years of education to the children living there. No high schools exist within an hour's walking distance from most plantations. Upper primary grades and high-school services should be made available to those communities, within reasonable distances, by the Ministry of Education.
Nurseries for Children under Five
These services can be organized and operated during the harvest season when children may suffer from a lack of maternal care as most women are working on the harvest. Mothers have less opportunity to feed their children properly, having neither the time nor the most appropriate kinds of food. Mothers also have less time to take children to a clinic if they become ill during the harvest. Fully breast-fed children present fewer feeding problems, as they are carried by mothers to the fields where they are fed on demand. However, further analyses of the implications of including breast-fed children in these nurseries should weigh the positive effects (better care and access to food and health services) against potentially detrimental ones (negative effects on breast-feeding practices).
A Medical Care Programme
The availability of an effective medical care programme will have important effects on the health and nutritional status of these population groups. The programme should be organized and implemented by the Ministry of Health with support (economic or other) from the social security system, the owners of the plantations, and organized groups within the communities.
Housing
There is a problem of overcrowding in the housing areas within the plantation. The land and the buildings belong to the owner of the plantation. Thus, there is insufficient motivation by labourers to invest in improvements in housing conditions. Legal matters need to be resolved before a housing scheme programme for families can be organized and implemented.
Recommendations for further research
Future research, related to seasonal effects on consumption patterns, morbidity, and nutritional status of children, will continue, with further analyses using data collected on all 11 coffee plantations which form the Patulul Project. It is expected that larger sample sizes will be available to assess the same hypotheses and objectives addressed in the present article. We do not mean to imply that somewhat different results are expected in the analyses to be conducted with the entire data set from 11 plantations; rather, findings concerning seasonal effects on the nutritional status of children residing in coffee plantations will be more conclusive.
Children's morbidity data for the second year of life will also be incorporated into future analyses, as will anthropometric measurements and morbidity information from mothers. Furthermore, information from the intervention phase (1979 to 1981) will be added to the data bank and analysed accordingly. With larger sample sizes it will be possible to study seasonal effects on family, maternal, and children's consumption patterns, as well as children's growth, in groups of children followed longitudinally and matched by age group, though they will differ in terms of nutritional status in the first period of analysis (1 November 1977 to 30 January 1978). The latter analytical approach is important because seasonal effects, not identified in the whole group of children (those with adequate and those with non-adequate nutritional status), may differ according to the initial nutritional status of children. If such seasonal differences between groups of children do exist, it is important to accommodate them in the design of programmes to be implemented in these communities.
The lack of consistent seasonal effects, either positive or negative, on family, mothers' and children's energy, on protein intakes, and on the nutritional status of children living on coffee plantations should not discourage further research on the subject in other population groups in Central America. In other population groups seasonal events may play an important role in determining malnutrition and poor health. However, INCAP has longitudinal data derived from a nine-year follow-up study (41969-1977) of four subsistence agricultural villages located in eastern Guatemala. The kind and periodicity of data in the eastern Guatemala study are very similar to those described for the Patulul Project.
Finally, and included in other research priorities to be pursued by INCAP in 1985 and 1986, the potential impact of public service programmes on consumption patterns and nutritional and health status will be studied. The programmes will be those related to government efforts to improve the purchasing power of families (wage increases, subsidies for basic staples, supplementary feeding schemes) and access to and utilization of effective primary health-care services. In conclusion, further research will be geared to provide additional information on the potential impacts (food, nutritional, and others) of seasonal events, but it will also document the food and nutritional impacts of policy options aimed at reducing the factors causing poverty and malnutrition in rural areas of Central America and Panama.
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