Background: Child stunting is a critical global health issue. Guatemala has one of the world's highest levels of stunting despite sustained commitment to international nutrition policy best-practices endorsed by the Scaling Up Nutrition movement (SUN). Our objective was to use Guatemala as a case study by projecting 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 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 five years of age from 2020-2030. We considered four 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{per thousand} (95{per thousand} CI 0.0{per thousand} to -0.2{per thousand}) if historical trends continue, -1.1{per thousand} (95{per thousand} CI -0.8{per thousand} to -1.5{per thousand}) in the Great Crusade scenario, and -2.2{per thousand} (95{per thousand} CI -1.6{per thousand} to -3.0{per thousand}) in the aspirational scenario. In 2030, we projected a stunting prevalence of -0.4{per thousand} (95{per thousand} CI -0.2{per thousand} to -0.8{per thousand}) and -3.7{per thousand} (95{per thousand} CI -2.8{per thousand} to -5.1{per thousand}) in the historical trends and aspirational scenario, respectively. Complementary feeding, sanitation, and breastfeeding were the most impactful 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 that address the broader structural drivers of stunting.
Projecting the impact of nutrition policy to improve child stunting: A case study in Guatemala using the Lives Saved Tool