Food Intake and the Significance of Feeding in Qom Children of Northern Argentina.

BACKGROUND: As part of the ubiquitous nutritional transition indigenous are experiencing, the typical diet of most indigenous communities is being substituted by one with high-fat and high-energy-density foods. Domestic feeding transmits cultural factors through meaning and symbolism influential in food, preparation, and meal experiences, which in turn influence children's eating habits differently among social groups. OBJECTIVES: The aims of this study were to explore the food consumption patterns of Qom preschoolers and to describe cultural domains about the significance of feeding in this indigenous population in northern Argentina. METHODS: This cross-sectional and mixed-methods study was conducted in 2016-2017 and focused on 160 preschoolers and their mothers in the village of Namqom. It used a closed questionnaire, three 24-h recalls, and free listing techniques. RESULTS: Qom preschoolers had a high prevalence of excess weight (25%) and stunting (16%). Mothers reported only 38 food items consumed by preschoolers. Almost all of the children (96%) consumed white bread, whereas 89% consumed milk, 87.5% sweet cookies, 84.7% some sort of stew, 72% fried dough, and 63.1% soup. In addition, it was found that preschoolers consumed neither fresh and varied vegetables, nor available fruits. They did not consume fresh fish and other meats, either. Caregivers related the term "feeding" with "having to eat," which might be associated with the context of poverty in which they live. Caregivers also mentioned "eating right" to get healthy or grow up strong. CONCLUSIONS: The present study revealed a relatively elevated consumption of high-energy but nutritionally poor food, and malnutrition, which reflects the impacts of poverty. We found that the cultural domain of food is linked to survival and depletion ideas.

The developmental origins of risk and time preferences across diverse societies.

Risk and time preferences have often been viewed as reflecting inherent traits such as impatience and self-control. Here, we offer an alternative perspective, arguing that they are flexible and environmentally informed. In Study 1, we investigated risk and time preferences among children in the United States, India, and Argentina, as well as forager-horticulturalist Shuar children in Amazonian Ecuador. We find striking cross-cultural differences in behavior: children in India, the United States, and Argentina are more risk-seeking and future-oriented, whereas Shuar children are more risk-averse and exhibit more heterogeneous time preferences, on average preferring more today choices. To explore 1 of the socioecological forces that may be shaping these preferences, in Study 2, we compared the behavior of more and less market-integrated Shuar children, finding that those in market-integrated regions are more future-oriented and risk-seeking. These findings indicate that cross-cultural differences in risk and time preferences can be traced into childhood and may be influenced by the local environment. More broadly, our results contribute to a growing understanding of plasticity and variation in the development of behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Perceptions of the healthiest body in a market-integrating indigenous population in Argentina: Fat idealization and gendered generational differences.

OBJECTIVES: Market integration seems to induce gender-specific generational change in health-related perceptions of body size. We predicted that among the Qom of Argentina, younger women would perceive comparatively thinner bodies as healthiest, demonstrating thin-idealizing body norms, and older women would retain culturally rooted perceptions of heavier bodies as healthiest. As traditional and globalized body size ideals are different for men, we predicted that men would perceive normal bodies as healthiest and would not exhibit generational differences. METHODS: We asked Qom adults (n = 273) residing in Namqom, Argentina to choose the healthiest body size from the Stunkard Figure Rating Scale (FRS). We performed multiple linear regression with age, gender, and body mass index (BMI) predicting healthy-body perception score. RESULTS: A majority of women chose overweight bodies as healthiest. As predicted, older women preferred heavier bodies compared to their younger peers; this generational effect was stronger among women clinically defined as underweight (BMI ≤19.99 kg/m2 ), and "normal" weight (20.00 kg/m2 ≤ BMI ≤24.99 kg/m2 ), as compared to women clinically defined as overweight (25.00 kg/m2 ≤ BMI ≤29.99 kg/m2 ) or obese (≥30.00 kg/m2 ). Men exhibited no generational effects and largely perceived bodies corresponding to a "normal" BMI as healthiest. CONCLUSIONS: Among Qom women, there is evidence for the adoption of the idealization of thinness as healthy alongside traditional perceptions that fat bodies are healthy.

Birth mode and infectious morbidity risks in Qom children of Argentina.

OBJECTIVES: Cesarean delivery may increase childhood infectious morbidity risks via altered birth exposures and subsequent immune, microbial, and epigenetic development. Many Latin American indigenous populations experience dual burdens of infectious and chronic diseases, and are particularly vulnerable to rising rates of cesarean delivery and associated adverse outcomes. The Qom/Toba are an indigenous population in Argentina experiencing rapid lifestyle transitions. We hypothesized that cesarean delivery would be associated with increased risk of infectious symptoms in Qom children after adjusting for gestational and nutritional factors. METHODS: We conducted a secondary analysis of birth records and monthly anthropometric and illness data collected previously from 90 Qom children (aged 1-55 months). We tested for additive effects of birth mode on risk of gastrointestinal (GI) and respiratory illness (RI) in mixed-effects logistic regression models adjusting for child weight-for-age (WAZ), weaning, and gestational and maternal age. RESULTS: Cesarean deliveries accounted for 46% of births and were associated with maternal age < 20 and ≥ 30 years, gestational age < 39 weeks, and prenatal complications. GI and RI risks were reduced in association with cesarean delivery, greater WAZ, weaning, maternal age ≥ 30 years, and gestational age < 39 weeks. CONCLUSIONS: The relationship between cesarean delivery and reduced infectious risks may reflect statistical confounding with relatively rapid postnatal growth and greater adiposity. Postnatal growth trajectories may be important mediators of long-term morbidity risks associated with cesarean delivery. The frequency of cesarean deliveries among the Qom remains concerning given traditionally high rates of fertility and adolescent pregnancy.

Talla, peso e índice de masa corporal en niños y niñas wichí de Formosa, Argentina / Height, weight and body mass index of Wichí children from Formosa, Argentina

Este trabajo presenta datos antropométricos descriptivos de 194 niños y niñas (0-18 años) de una población wichí de la provincia de Formosa, Argentina. El objetivo fue documentar el crecimiento y el estado nutricional de este pueblo originario. Se tomaron datos de peso, talla e índice de masa corporal y se calcularon los respectivos puntajes Z utilizando referencias nacionales e internacionales. La mayoría de los parámetros analizados caen dentro de los rangos de la normalidad. Sin embargo, es preocupante la presencia de un porcentaje significativo de niñas y niños con sobrepeso, lo cual indicaría que esta población se encuentra atravesando un proceso de occidentalización que promueve el consumo de alimentos procesados hipercalóricos y una menor actividad física.

This study provides the descriptive, anthropometric data of 194 children (aged 0-18 years) from a Wichi population located in the province of Formosa, Argentina. The objective of this study was to document growth and nutritional status in this indigenous people. Weight, height, and body mass index data were collected and the corresponding Z-scores were estimated using national and international reference standards. Most analyzed parameters were within the normal range. However, it is concerning that a significant percentage of children are overweight, which may indicate that this population is going through a process of westernization that promotes the consumption of high-calorie, highly-processed foods and a lower level of physical activity.

Height, weight and body mass index of Wichí children from Formosa, Argentina. / Talla, peso e índice de masa corporal en niños y niñas wichí de Formosa, Argentina.

This study provides the descriptive, anthropometric data of 194 children (aged 0-18 years) from a Wichi population located in the province of Formosa, Argentina. The objective of this study was to document growth and nutritional status in this indigenous people. Weight, height, and body mass index data were collected and the corresponding Z-scores were estimated using national and international reference standards. Most analyzed parameters were within the normal range. However, it is concerning that a significant percentage of children are overweight, which may indicate that this population is going through a process of westernization that promotes the consumption of high-calorie, highly-processed foods and a lower level of physical activity.

Este trabajo presenta datos antropométricos descriptivos de 194 niños y niñas (0-18 años) de una población wichí de la provincia de Formosa, Argentina. El objetivo fue documentar el crecimiento y el estado nutricional de este pueblo originario. Se tomaron datos de peso, talla e índice de masa corporal y se calcularon los respectivos puntajes Z utilizando referencias nacionales e internacionales. La mayoría de los parámetros analizados caen dentro de los rangos de la normalidad. Sin embargo, es preocupante la presencia de un porcentaje significativo de niñas y niños con sobrepeso, lo cual indicaría que esta población se encuentra atravesando un proceso de occidentalización que promueve el consumo de alimentos procesados hipercalóricos y una menor actividad física.

Aged Black-and-Gold Howler Monkey Female (Alouatta caraya): A Sign of Reproductive Senescence?

Reproductive senescence patterns have been scarcely studied in Neotropical primates. The few studies available on the hormonal profiles of aging female monkeys indicate that the decline of ovarian function in nonhuman primates may resemble the hormonal events associated with the perimenopause in women. In this study, we explore a reproductive hormone profile of an aged black-and-gold howler monkey female (Alouatta caraya) from a wild population in northeastern Argentina and compare this profile with that of a cycling female in the same population. As part of a larger study, we recorded sociosexual behaviors in adult and subadult females belonging to two groups, and we collected urine (n = 877) to determine the sex hormone profile of each female. These samples were analyzed using enzyme immunoassays for estrone conjugates and pregnanediol-3-glucuronide (PdG). We found differences in mean values of PdG between the younger (cycling) and the older female. These hormone values were lower in the older female, and she did not show any signs of cyclicity for either reproductive hormone. Our results show that the aging female in this wild population shows signs of ovarian senescence, indicated by low, acyclic levels of progesterone metabolites.

Growth patterns among indigenous Qom children of the Argentine Gran Chaco.

OBJECTIVES: This study describes and compares the growth strategies of rural (Western) and peri-urban (Eastern) Qom indigenous children from Argentina. METHODS: Height and weight were cross-sectionally assessed in Western (n = 263) and Eastern Qom (n = 512) individuals aged 0-18.9 years. Height-for-age (HAZ), weight-for-age (WAZ), and BMI-for-age (BMIZ) z-scores were calculated with an LMS software. Results were organized into four age categories: infancy, childhood, juvenility, and adolescence. Between-group comparisons of HAZ, WAZ, and BMIZ were carried out by age and sex categories and compared with Student's t or Mann Whitney tests. Nutritional status was classified based on BMIZ following WHO recommendations and was compared with x2 tests. RESULTS: In both groups, height and weight followed the typical human growth curve. Mean HAZ scores in both groups were within two standard deviations from the international reference, and increased from infancy to juvenility. WAZ and BMIZ scores were high during infancy and showed a general declining trend with age. Overall, Western Qom had higher HAZ scores. WAZ and BMIZ score comparisons showed only a handful of statistically significant differences, which, along with the analysis of BMI categories, indicated an association between peri-urban environments and a higher prevalence of overweight and obese individuals (P < 0.01). CONCLUSION: Among the Qom, low HAZ and high WAZ scores during the early years of development allow for the attainment of a relatively high adult stature. Their adaptive life-history strategy seems to be to divert energy toward body mass during early development, and catch-up with linear growth at a later stage of development. Am. J. Hum. Biol. 28:895-904, 2016. © 2016Wiley Periodicals, Inc.

Impact of Universal Health Coverage on Child Growth and Nutrition in Argentina.

OBJECTIVES: To estimate trends of undernutrition (stunting and underweight) among children younger than 5 years covered by the universal health coverage programs Plan Nacer and Programa Sumar. METHODS: From 2005 to 2013, Plan Nacer and Programa Sumar collected high-quality information on birth and visit dates, age (in days), gender, weight (in kg), and height (in cm) for 1.4 million children in 6386 health centers (13 million records) with broad coverage of vulnerable populations in Argentina. RESULTS: The prevalence of stunting and underweight decreased 45.0% (from 20.6% to 11.3%) and 38.0% (from 4.0% to 2.5%), respectively, with differences between rural versus urban areas, gender, regions, age, and seasons. CONCLUSIONS: Undernutrition prevalence substantially decreased in 2 programs in Argentina as a result of universal health coverage.

Access to Electric Light Is Associated with Shorter Sleep Duration in a Traditionally Hunter-Gatherer Community.

Access to electric light might have shifted the ancestral timing and duration of human sleep. To test this hypothesis, we studied two communities of the historically hunter-gatherer indigenous Toba/Qom in the Argentinean Chaco. These communities share the same ethnic and sociocultural background, but one has free access to electricity while the other relies exclusively on natural light. We fitted participants in each community with wrist activity data loggers to assess their sleep-wake cycles during one week in the summer and one week in the winter. During the summer, participants with access to electricity had a tendency to a shorter daily sleep bout (43 ± 21 min) than those living under natural light conditions. This difference was due to a later daily bedtime and sleep onset in the community with electricity, but a similar sleep offset and rise time in both communities. In the winter, participants without access to electricity slept longer (56 ± 17 min) than those with access to electricity, and this was also related to earlier bedtimes and sleep onsets than participants in the community with electricity. In both communities, daily sleep duration was longer during the winter than during the summer. Our field study supports the notion that access to inexpensive sources of artificial light and the ability to create artificially lit environments must have been key factors in reducing sleep in industrialized human societies.

Illness in breastfeeding infants relates to concentration of lactoferrin and secretory Immunoglobulin A in mother's milk.

BACKGROUND AND OBJECTIVES: This study aims to better understand the relationship between immune compounds in human milk and infant health. We hypothesized that the concentration of immune compounds in milk would relate to infant illness symptoms according to two possible theoretical paradigms. In the 'protective' paradigm, high concentrations of immune compounds prevent infant illness. The converse, the 'responsive' framework, posits that concentrations of immune compounds are elevated in response to infection. METHODOLOGY: Milk samples (n = 110) and illness data were collected among the Toba of Argentina from 30 mother-infant dyads. Samples were assayed for two immune proteins, lactoferrin and secretory immunoglobulin A (sIgA). Generalized estimating equations were used to assess the relationship between immune composition of milk and symptoms of illness in infants. RESULTS: Lactoferrin was positively associated with symptoms of illness in infants (odds ratios >1), both in the month preceding the sample collection and the subsequent month. sIgA was negatively associated with symptoms (odds ratios <1) in the preceding and subsequent months, an association which was particularly strong for gastrointestinal symptoms. CONCLUSIONS AND IMPLICATIONS: The two compounds investigated in our study had opposite relationships with symptoms of illness; the positive relationship between lactoferrin and illness lends support to our 'responsive' paradigm, and the negative relationship between sIgA and symptoms of illness was consistent with our 'protective' framework. That elevated lactoferrin is restricted to periods of illness suggests that there may be a cost to mother or infant associated with persistently elevated lactoferrin that is not incurred with elevated sIgA.

Indigenous populations in transition: an evaluation of metabolic syndrome and its associated factors among the Toba of northern Argentina.

BACKGROUND: The health problems associated with rapidly changing lifestyles in indigenous populations, e.g. cardiovascular disease, are becoming a public health concern. AIM: The objective of this study was to evaluate the prevalence of metabolic syndrome and analyse the metabolic conditions that define this syndrome, in an indigenous Toba community of northern Argentina. SUBJECTS AND METHODS: A total of 275 adults participated in this study. Anthropometric (BMI, body fat percentage, waist circumference) and clinical measures (blood pressure, cholesterol, glucose and triglycerides) were taken. Pearson and logistic regressions were used in the statistical analysis of risk factors for metabolic syndrome by sex and by reproductive status in women. RESULTS: The overall prevalence of metabolic syndrome was 38%. Nearly a third (31%) of the population was overweight and 45% obese. Men had significantly higher blood pressure and levels of triglycerides than women, while women had higher percentages of body fat. BMI was significantly associated with most of the risk factors for metabolic syndrome. Menopausal women had a higher prevalence of metabolic syndrome than women of reproductive age. CONCLUSION: Metabolic syndrome was highly prevalent in this indigenous community, which places them at an increased risk for cardiovascular disease.

Prácticas alimentarias y actividad física en adultos de una población Toba de la provincia de Formosa, Argentina / Feeding practices and physical activity among adults of a Toba population in the province of Formosa, Argentina

Introducción y objetivo: Los pueblos originarios del Gran Chaco han sido en su gran mayoría cazadores-recolectores-pescadores. En la actualidad, estos pueblos están atravesando una rápida transición hacia una economía de mercado. Este estudio es parte de un proyecto que evalúa la prevalencia de riesgos de enfermedades cardiovasculares en una población Toba periurbana de la ciudad de Formosa. El objetivo de este estudio fue describir las prácticas alimentarias y el nivel de actividad física de la población. Material y Métodos: Se realizó un estudio descriptivo simple, de diseño transversal entre marzo y diciembre del 2010. Se seleccionaron al azar 275 individuos mayores de 20 años de edad (141 mujeres y 134 hombres). Se obtuvieron datos de prácticas alimentarias y de nivel de actividad física habitual. Se respetaron las normas bioéticas correspondientes. Resultados: Los resultados indican que la alimentación es monótona, a base de guisos y tortas fritas, rica en grasas y mate cebado o tereré, con pocas verduras, frutas y lácteos. El consumo de bebidas alcohólicas es significativamente superior en hombres que en mujeres. El sedentarismo es marcado en ambos sexos,pero los hombres exhiben un nivel de actividad física mayor que las mujeres.Conclusión: El tipo de alimentación hipercalórica y los bajos niveles de actividad física actuales contribuyen a crear un ambiente obesogénico, lo que hace pronosticar un panorama desalentador respecto a los riesgos de enfermedades cardiovasculares en esta población.

Prácticas alimentarias y actividad física en adultos de una población Toba de la provincia de Formosa, Argentina / Feeding practices and physical activity among adults of a Toba population in the province of Formosa, Argentina

Introducción y objetivo: Los pueblos originarios del Gran Chaco han sido en su gran mayoría cazadores-recolectores-pescadores. En la actualidad, estos pueblos están atravesando una rápida transición hacia una economía de mercado. Este estudio es parte de un proyecto que evalúa la prevalencia de riesgos de enfermedades cardiovasculares en una población Toba periurbana de la ciudad de Formosa. El objetivo de este estudio fue describir las prácticas alimentarias y el nivel de actividad física de la población. Material y Métodos: Se realizó un estudio descriptivo simple, de diseño transversal entre marzo y diciembre del 2010. Se seleccionaron al azar 275 individuos mayores de 20 años de edad (141 mujeres y 134 hombres). Se obtuvieron datos de prácticas alimentarias y de nivel de actividad física habitual. Se respetaron las normas bioéticas correspondientes. Resultados: Los resultados indican que la alimentación es monótona, a base de guisos y tortas fritas, rica en grasas y mate cebado o tereré, con pocas verduras, frutas y lácteos. El consumo de bebidas alcohólicas es significativamente superior en hombres que en mujeres. El sedentarismo es marcado en ambos sexos,pero los hombres exhiben un nivel de actividad física mayor que las mujeres.Conclusión: El tipo de alimentación hipercalórica y los bajos niveles de actividad física actuales contribuyen a crear un ambiente obesogénico, lo que hace pronosticar un panorama desalentador respecto a los riesgos de enfermedades cardiovasculares en esta población. (AU)

Women's health in urban Mali: social predictors and health itineraries.

Social and marital factors may influence women's health outcomes. This is of particular relevance in sub-Saharan Africa, where women's health indicators lag behind the rest of the world. Our study examines the impact of social mediators of women's health during key events (pregnancy and illness) in urban Mali. In this cross-sectional study, we interviewed 324 women aged 15-80, living in Bamako, the capital city, in 1999. We used mixed quantitative and qualitative methods to obtain detailed histories of pregnancy and illness during specific time periods preceding the survey. We examined the role of marital factors (polygyny, widowhood), social factors (sources of support and scales derived for social network and social power), and household wealth on women's therapeutic itineraries. We compared the sociodemographic characteristics of our sample with those of the 2001 Mali Demographic and Health Survey and used their data on contraception to enrich analyses. We found that most pregnant women delivered in a health center and most women sought medical care during an illness event. Household wealth influenced illness reporting, and financial concerns were obstacles to medical care. Polygyny was associated with lower prevalence of contraceptive use, lower social power, as well as with less support received during pregnancy from women's husbands and in-laws. Widowhood appeared to increase susceptibility to illness, while decreasing resort to biomedical care. Our social composite scores highlighted differences in healthcare utilization in an urban setting with near-uniform access to biomedical care. We validate the utility of locally-derived composite scores, which may provide a deeper understanding into the social mediation of health outcomes for women.

Hormonal monitoring of reproductive status in monogamous wild female owl monkeys (Aotus azarai) of the Argentinean Chaco.

The Neotropical owl monkeys (Aotus spp.) are a good model for evaluating the hypothesis that monogamy may arise if female reproductive cycles limit the mating potential of males. To evaluate this hypothesis, we first needed to assess the feasibility of using fecal sampling for monitoring the reproductive status of females. We collected fecal samples (n = 242, from 7 females) from wild adult Aotus azarai females in the Gran Chaco forests of Argentina during 3 years. Fecal estrone-1-glucuronide (E(1)C) and pregnenadiol-3-glucuronide (PdG) tended to rise in parallel during the luteal phase. The average cycle length was 22 ± 3 days (n = 5 females, 10 cycles). We identified 2 conceptive cycles and characterized the E(1)C and PdG profiles of 2 pregnancies. This report is the first of its kind on wild female owl monkeys. Despite the difficulties in sample collection and processing in the field and providing a species-specific validation in the laboratory, we show that fecal samples from A. azarai can be used for monitoring female reproductive status and function.

Coca-colonization and hybridization of diets among the Tz'utujil Maya.

Biomedical health professionals express increasing concern that rising consumption of soft drinks and processed foods in Mayan and Latin American eating patterns may lead to detrimental nutritional and health consequences. Scholars debate whether the pervading presence of Coca-Cola and Pepsi in developing countries represents "Coca-Colonization," synonymous with cultural imperialism, or cultural hybridization. Using mixed qualitative and quantitative research methods, including participant observation and semi-structured interviews, this study explores the development of Coca-Colonization and cultural hybridization among the Tz'utujil Maya of Santiago Atitlán, Guatemala. By specifically examining biomedical perspectives, cycles of conquest, the political economy, religion, celebrations, and the physical environment through the lens of soft drinks, this study finds that Coca-Colonization and cultural hybridization are complementary rather than mutually exclusive processes that contribute to dietary transitions, economic development, and differential health beliefs related to soft drink consumption.

Criticisms of chlorination: social determinants of drinking water beliefs and practices among the Tz'utujil Maya.

OBJECTIVE: To explore social determinants of drinking water beliefs and practices among the Tz'utujil Maya of Santiago Atitlán, Guatemala, through analysis of demographics, socioeconomic status, memory of historical events, sensory experience, and water attitudes. METHODS: Parallel mixed (qualitative and quantitative) methods, including participant observation, in-depth interviews based on a purposive sample, and 201 semi-structured interviews based on a regional quota sample, were used to collect data from March 2007 to August 2008. Data analysis included the use of grounded theory methodology and Pearson's chi-square test for independence. RESULTS: Qualitative results based on grounded theory highlighted how memory of the Guatemalan Civil War and Hurricane Stan, attitudes about Lake Atitlán water, and the taste and smell of chlorine influenced Tz'utujil Maya drinking water beliefs. Quantitative survey results revealed that differences in ethnicity, literacy, years of schooling, distrust of the water supply during the Civil War and Hurricane Stan, and current beliefs about Lake Atitlán and tap water quality were associated with significantly different water self-treatment practices. CONCLUSIONS: In accordance with social determinants of health paradigms, demographic, socioeconomic, social, cultural, political, and historical factors continue to be significant determinants of water-related health. Public health water interventions must address inequalities related to these underlying factors in order to achieve maximum effectiveness.

Criticisms of chlorination: social determinants of drinking water beliefs and practices among the Tz'utujil Maya / Críticas a la cloración: factores sociales determinantes de las creencias y prácticas con respecto al agua potable de la población Maya Tz'utujil

OBJECTIVE: To explore social determinants of drinking water beliefs and practices among the Tz'utujil Maya of Santiago Atitlán, Guatemala, through analysis of demographics, socioeconomic status, memory of historical events, sensory experience, and water attitudes. METHODS: Parallel mixed (qualitative and quantitative) methods, including participant observation, in-depth interviews based on a purposive sample, and 201 semi-structured interviews based on a regional quota sample, were used to collect data from March 2007 to August 2008. Data analysis included the use of grounded theory methodology and Pearson's chi-square test for independence. RESULTS: Qualitative results based on grounded theory highlighted how memory of the Guatemalan Civil War and Hurricane Stan, attitudes about Lake Atitlán water, and the taste and smell of chlorine influenced Tz'utujil Maya drinking water beliefs. Quantitative survey results revealed that differences in ethnicity, literacy, years of schooling, distrust of the water supply during the Civil War and Hurricane Stan, and current beliefs about Lake Atitlán and tap water quality were associated with significantly different water self-treatment practices. CONCLUSIONS: In accordance with social determinants of health paradigms, demographic, socioeconomic, social, cultural, political, and historical factors continue to be significant determinants of water-related health. Public health water interventions must address inequalities related to these underlying factors in order to achieve maximum effectiveness.

OBJETIVO: Explorar los factores sociales determinantes de las creencias y prácticas con respecto al agua potable de la población maya tz'utujil, que habita en Santiago Atitlán (Guatemala), mediante el análisis de la información demográfica, la situación socioeconómica, la memoria de hechos históricos, la experiencia sensorial y las actitudes con respecto al agua. MÉTODOS: De marzo del 2007 a agosto del 2008, se recopilaron datos por medio de métodos paralelos mixtos (tanto cualitativos como cuantitativos), como la observación de participantes, entrevistas en profundidad basadas en un muestreo intencionado y 201 entrevistas semiestructuradas basadas en un muestreo por cuota regional. En el análisis de los datos se usó el método de la teoría fundamentada o muestreo teórico y la prueba de la chi al cuadrado de Pearson para la independencia. RESULTADOS: Los resultados cualitativos basados en la teoría fundamentada pusieron de relieve que los recuerdos de la guerra civil guatemalteca y del huracán Stan, las actitudes acerca del agua del Lago Atitlán, y el gusto y el olor del cloro influían las creencias de los tz'utujiles con respecto al agua potable. Los resultados cuantitativos de la encuesta indicaron que las diferencias a raíz del grupo étnico, el alfabetismo, los años de escolaridad, la desconfianza del abastecimiento de agua durante la guerra civil y el huracán Stan, y las creencias actuales acerca de la calidad del agua del Lago Atitlán y del agua de grifo estaban asociadas con prácticas de autotratamiento del agua sumamente diferentes. CONCLUSIONES: En consonancia con el paradigma de los factores sociales determinantes de la salud, los factores demográficos, socioeconómicos, sociales, culturales, políticos e históricos siguen siendo determinantes significativos de la salud en relación con el agua. Para que puedan lograr la mayor eficacia posible, las intervenciones de salud pública con respecto al agua deben abordar las desigualdades relacionadas con estos factores fundamentales.