Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders.

A 42-year-old indigenous Maya man presented to a non-profit clinic in rural Guatemala with signs, symptoms and laboratory values consistent with uncontrolled diabetes. Despite appropriate treatment, approximately 18 months after presentation, he was found to have irreversible end-stage renal disease (ESRD) of uncertain aetiology. He was referred to the national public nephrology clinic and subsequently initiated home-based continuous ambulatory peritoneal dialysis. With primary care provided by the non-profit clinic, his clinical status improved on dialysis, but socioeconomic and psychological challenges persisted for the patient and his family. This case shows how care for people with ESRD in low- and middle-income countries requires scaling up renal replacement therapy and ensuring access to primary care, mental healthcare and social work services.

Four 1-N-aminohydroxy-alkyl derivatives of kanamycin A were prepared and their in vitro activities against aminoglycoside-sensitive and aminoglycoside-resistant organisms were compared with amikacin.1-N-[(S)-4-Amino-2-hydroxybutyl] kanamycin A (Fig. 1, compound 2, code no. UK-18,892) was equipotent to amikacin in all these tests and in mouse protection studies.A, has been reported1) to be highly active against both kanamycin-sensitive and kanamycin-resistant bacteria.In contrast, several other 1-N-acyl derivatives of kanamycin A have been shown to possess low antibacterial activity.21 We undertook a program of 1-N-alkyl modifications of kanamycin A to investigate structure-activity relationships in this area, and this paper describes the synthesis and antibacterial properties of some of the compounds produced. Materials and MethodsKanamycin A-1-N-Alkylated Derivatives 1-N-(S)-w-Amino-2-hydroxyalkyl derivatives of kanamycin A were prepared by diborane reduction of the corresponding 1-N-acyl derivatives, using the trifluoroacetate salts to improve solubility. The 1-N-acyl derivative (150 mg) was converted to its trifluoroacetate salt by dissolving in anhydrous trifluoroacetic acid followed by evaporation under reduced pressure. The resulting salt was dissolved in dry tetrahydrofuran (5 ml) and treated portionwise with a 1 M solution of diborane in tetrahydrofuran (20 ml), under a nitrogen atmosphere. After 6 hours at 50°C the reaction mixture was cooled and excess diborane was destroyed by the addition of a small amount of water. After evaporation under reduced pressure, the residue was taken up in water (10 ml), adjusted to pH 12 with 0.1 N sodium hydroxide solution and then to pH 5 using 2 N hydrochloric acid. The resulting solution was chromatographed on a column of Amberlite CG-50 ion-exchange resin (50 ml), in the ammonium ion form, eluting with dilute ammonia solution (linear increase, 0.1 to 1 M). Fractions containing the product were combined and evaporated under reduced pressure to yield the product as an amorphous solid (Table 1). The requisite 1-N-acyl compounds were synthesized by the method of NAITO et al.2,The structures of the products prepared in the present study have been confirmed by 13C-n.m.r. and/or mass spectral data. Microanalyses of the products reported are in agreement with the expected formulae calculated as the carbonate salts.Micro-organisms The bacteria designated 'aminoglycoside-sensitive' were pathogenic strains well adapted to growth under laboratory conditions. The aminoglycoside-resistant organisms were bacteria with proven inactivating mechanisms and were obtained from Prof. J. DAVIES, University of Wisconsin.M.I.C. Determinations Minimum inhibitory concentrations (M.I.C.) of the compounds were determined by a standard dilution method in Diagnostic Sensitivity Test Agar (DSTA-Oxoid). Serial dilutions (in 2-fold steps) of the compounds were prepared in the agar plates over the required concentration range and, after the

Development discourse has focused on gendered dimensions of poverty, demonstrating how parastatal poverty alleviation programs target women as aid recipients while devaluing their productive and reproductive work. However, seldom analyzed is how privatization of social services and proliferation of non-governmental organizations (NGOs) have impacted women. We explore this in a Guatemalan community. Methods: Over seven months, ethnographic research was conducted in a rural Guatemalan community. Fifty structured interviews were conducted with local women identified through snowball sampling. These interviews explored resource access, daily responsibilities, and interactions with NGOs, and a household poverty estimation using the Quick Poverty Scorecard. From this initial group, 12 women were invited to participate in longer interviews to explore past interactions with NGOs, gendered household duties and responsibilities, and how each woman allocated her time. Five semi-structured interviews were conducted with local NGO personnel, and content analysis was performed of the websites of 15 local NGOs. All transcripts, field notes, and website text were coded by hand using ground theory. Results: In this community, women shouldered the burden to provide for their families in times of scarcity, which they did partly through interactions with NGOs. Although these local NGOs discursively commit to 'alternative' development approaches, on the ground they reproduce elements of a gendered neoliberal subjectivity akin to parastatal programs. NGOs additionally configure aid disbursement as gift giving, requiring beneficiaries to assume affective postures of gratitude, and facilitating intrusion into women's lives. Conclusions: Small NGOs in rural Guatemala govern beneficiaries, particularly women, with a dual subjectivity, simultaneously enforcing participatory labour and conceptualizing aid as a gift, and these relationships are neither participatory nor empowering for the women involved. Contribution to the work Design: I did the preliminary literature reviews and designed the interview schedules with support from Anne Kraemer Díaz. Execution: I identified key informants and recruited research participants, in partnership with a local spiritual healer and church leader, as well as a local feminist association. I performed interviews and home visits with help from these individuals who served as research assistants and interpreters. During these interviews and participation observation with NGOs, I kept detailed field notes. I transcribed half of the interviews in Kaqchikel and translated them to English. To transcribe and translate the other half of the interviews, I hired an assistant. Throughout the execution of the study, Anne Kraemer Díaz provided support and answered questions regarding qualitative research methods.