Background The indigenous child population in Ecuador has a high prevalence of stunting. There is limited evidence of the association between breastfeeding, feeding practices, and stunting in indigenous children. This study aimed to analyze the prevalence of breastfeeding and complementary feeding practices and explore their association with stunting in Ecuadorian indigenous children under two years of age. Methods Cross-sectional study of secondary data analysis using the 2012 Ecuador National Health and Nutrition Study, in 625 children aged 0–23 months (48,069 expanded sample), representative for the indigenous population. Breastfeeding and complementary feeding indicators were analyzed by age groups. Timely initiation of breastfeeding (within one hour after birth), exclusive breastfeeding (infants under six months who received only breast milk for the previous day), and other indicators were measured. Chi-square test or Fisher's exact test and logistic regression for complex samples were used to explore association with demographic and socioeconomic factors and stunting. Results Twenty-six-point eight percent of the children were stunted. Stunting occurred mainly in children with rural residence, on poor households, and where there were four or more children. Most of the children had a timely initiation of breastfeeding (69.5% for 0–12 months and 75.5% for 13–23 months) and exclusive breastfeeding up to six months (78.2%). Among children between 6–12 months of age, 99.3% continued to be breastfed. In children from ages 6 to 12 months, 32.5% received food with adequate dietary diversity. Lower percentages of complementary feeding occurred in the poorest, adolescent mothers or those with less education. Children who did not receive the minimum frequency of meals for their age had higher odds of stunting (OR 3.28; 95% CI 1.3, 8.27). Children from age 19 to 23 months who consumed foods rich in iron showed lower probabilities of stunting (OR 0.04; 95% CI 0.00, 0.51). Conclusions Breastfeeding practices reached a prevalence of 70% or more, without being associated with stunting. Complementary feeding practices showed differences by socioeconomic condition. Not reaching the minimum meal frequency between 6 and 12 months of age was associated with stunting. Plans and strategies are necessary to promote adequate feeding and breastfeeding practices in the indigenous population.

Objectives Chronic malnutrition and anemia are prevalent in developing countries. This research aimed to determine the prevalence of chronic malnutrition and anemia and their associated factors in children under five using a multi-causal model in a rural community in the coast of Ecuador. Methods The study included 314 children under 5 years old who were residents of San Isidro, Ecuador. Indicators of chronic malnutrition and anemia were identified. Mothers/caregivers were surveyed on socioeconomic and environmental conditions, feeding and care practices, access to health services and biological characteristics. Bivariate and multivariable Poisson regression were performed. Results The prevalence was 12.42% (n = 39) for chronic malnutrition and 16.98% (n = 54) for anemia. There was a significant and independent association between chronic malnutrition and family income less than $80 USD per month (Prevalence Ratio [PR] = 2.74, 95% CI 1.04, 7.20), maternal height less than 150 cm (PR 3.00, 95% CI 1.69, 5.32) and residence in a household with more than 4 children (PR 3.05, 95% CI 1.48, 6.29). Anemia was 2.57 times higher (95% CI 1.17, 5.65) in children with more than two episodes of diarrhea in the last 6 months. Prenatal care (5 to 8 visits) provided a protective effect for anemia (PR 0.48, 95% CI 0.27, 0.89). Conclusions for Practice Findings support the need for comprehensive interventions targeted toward chronic malnutrition and anemia in children from rural coastal communities. Improvement of socioeconomic conditions, family planning, prenatal care and reduction of diarrheal diseases should be prioritized.

Introducción: El capital social (CS) incluye varios componentes de la organización social, que podrían mejorar la situación de salud. Existe poca información sobre su asociación con la Desnutrición Crónica (DC). Metodología: El presente estudio transversal analítico fue realizado en los cantones de Riobamba, Alausí, Guamote, Guano y Colta en el periodo 2018-2019. Con una muestra probabilística mediante encuestas a madres/cuidadores se determinó el CS, determinantes de la salud, y mediciones antropométricas. El análisis de datos se realizó mediante regresión bivariada y multivariada, con cálculo de Odds e intervalos de confianza al 95 %, se consideró significativo un valor de p menor a 0.05, se utilizó el software SPSS versión 25.0. Resultados: Se estudiaron 1228 niños, el 50.5% (n = 620) hombres y 49.5% (n= 680) mujeres. Con DC el 52.6% (n = 326) de los hombres y el 46.7% (n = 284) de las mujeres. Los hijos cuyos padres no han escuchado hablar sobre desnutrición infantil presentaron un OR 1.46 (IC95%=1.13-1.9) para el desarrollo de DC. Esta asociación se mantuvo significativa después del ajuste por sexo, edad del niño/a, número de hijos e ingresos económicos. Conclusiones: La asociación entre el CS y la DC en la población indígena menor de 5 años de la provincia de Chimborazo se observó en la falta de información sobre nutrición infantil.

Background Despite the multiple initiatives implemented to reduce stunting in Ecuador, it continues to be a public health problem with a significant prevalence. One of the most affected groups is the rural indigenous population. This study aimed to analyze the prevalence of chronic malnutrition in indigenous children under 5 years of age and its association with health determinants, focusing on one of the territories with the highest prevalence of stunting. Methods A cross-sectional study in 1,204 Kichwa indigenous children under the age of five, residing in rural areas of the counties with the highest presence of indigenous in the province of Chimborazo-Ecuador. A questionnaire on health determinants was applied and anthropometric measurements were taken on the child and the mother. Stunting was determined by the height-for-age z-score of less than 2 standard deviations, according to the World Health Organization´s parameters. Data were analyzed using bivariate and multivariate Poisson regression. Results 51.6% (n = 646) of the children are stunted. Height-for-age z-scores were significantly better for girls, children under 12 months, families without overcrowding, and families with higher family income. The variables that were significantly and independently associated with stunting were: overcrowding (PR 1.20, 95% CI 1–1.44), the mother required that the father give her money to buy medicine (PR 1.33, 95% CI 1.04–1.71), the father did not give her money to support herself in the last 12 months (1.58, 95% CI 1.15–2.17), mother’s height less than 150 cm (PR 1.42, 95% CI 1.19–1.69) and the child was very small at birth (PR 1.75, 95% CI 1.22–2.5). Conclusion One out of every two rural indigenous children included in this study is stunted. The high prevalence of stunting in the indigenous and rural population is multicausal, and requires an intersectoral and multidisciplinary approach. This study identified three fundamental elements on which public policy could focus: (a) reduce overcrowding conditions, improving economic income in the rural sector (for example, through the strengthening of agriculture), (b) provide prenatal care and comprehensive postnatal care, and (c) promote strategies aimed at strengthening the empowerment of women.

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Introduction: Social capital is considered an important determinant of health and overall wellbeing; however, to the best of the authors' knowledge, literature relating social capital to malnutrition in developing countries is still relatively small. This article examines the relationships between social capital and chronic malnutrition and anemia in a population of rural coastal children in Ecuador. Methods: A cross-sectional study in two groups of 246 and 282 children under 5 years and their families was performed. Anemia and chronic malnutrition were analyzed as outcome variables. Variables about social capital were identified on the basis of the Social Capital Assessment Tool of the World Bank. Bivariate and multivariate logistic regression analyses were conducted. Results: The prevalences of anemia and chronic malnutrition in the children were 15.0% and 12.8%, respectively. At the multivariate analysis, the variable 'mother has borrowed money' had an inverse association with chronic malnutrition (prevalence ratio (PR) 0.43, 95% confidence interval (CI) 0.20-0.90). Receiving and providing help after the earthquake of 2016 was significantly associated with a lower prevalence of chronic malnutrition (PR 0.52, 95%CI 0.28-0.97), but not with anemia. However, a mother being part of a community organization was associated with a 1.90 times higher prevalence of anemia (95%CI 1.04-3.48) in children than mothers who were not part of a community organization. Conclusion:The relationship between maternal social capital and the nutritional status of their children in rural communities seems to be positively related. However, a mother's participation in community organizations increases the prevalence of anemia in the children. These mixed results highlight the need for further studies focused on the different types of social capital and how they impact on health in deprived areas.

Introduction We hypothesize that high altitudes could have an adverse effect on neonatal health outcomes, especially among at-risk neonates. The current study aims to assess the association between higher altitudes on survival time among at-risk neonates. Methods Retrospective survival analysis. Setting: Ecuadorian neonates who died at ≤28 days of life. Patients: We analyzed the nationwide dataset of neonatal deaths from the Surveillance System of Neonatal Mortality of the Ministry of Public Health of Ecuador, registered from 126 public and private health care facilities, between January 2014 to September 2017. Main outcome measures: We retrospectively reviewed 3016 patients. We performed a survival analysis by setting the survival time in days as the primary outcome and fixed and mixed-effects Cox proportional hazards models to estimate hazard ratios (HR) for each altitude stratum of each one of the health care facilities in which those neonates were attended, adjusting by individual variables (i.e., birth weight, gestational age at birth, Apgar scale at 5 minutes, and comorbidities); and contextual variables (i.e., administrative planning areas, type of health care facility, and level of care). Results Altitudes of health care facilities ranging from 80 to <2500 m, 2500 to <2750m, and ≥2750 m were associated respectively with 20% (95% CI: 1% to 44%), 32% (95% CI:<1% to 79%) and 37% (95% CI: 8% to 75%) increased HR; compared with altitudes at <80 m. Conclusion Higher altitudes are independently associated with shorter survival time, as measured by days among at-risk neonates. Altitude should be considered when assessing the risk of having negative health outcomes during neonatal period.

IntroductionThere is evidence that demonstrates lower incidence rates of cardiometabolic factors at the highlands. There are no studies which correlate the altitude with formally calculated cardiovascular risk by a meter-by-meter approach. Under the hypothesis that cardiovascular risk is inversely associated with altitude, this study was aimed to assess such association.Materials and methodsCross sectional study using data from the Ecuadorian National Health Survey of 2012. We analyzed available information of adults of ≥ 40 to 60 years old who have sociodemographic, anthropometric, cardiovascular risk factors, and laboratory biomarkers that were included in the survey. We assessed the independent association between altitude of the housing in which survey participants lived at, on a meter-by-meter approach, and cardiovascular health risk at ten years, formally calculated by Framingham equations.ResultsLinear regression model showed that participants had 0.0005 % less probability of developing cardiovascular disease at 10 years per each increase in a meter in the altitude that participants live at (p<0.001), adjusted for sex, age, ethnicity, educational level, availability of social security, immigrants in family, area, income quintile, overcrowding (≥ 7 inhabitants in the house), any alcohol consumption, history of hypertension, body mass index, hematocrit, and triglycerides.ConclusionFrom a public health perspective, altitude at which individuals live is an important health determinant of cardiovascular risk. Specifically, per each increase of 1000 m in the altitude that people live at, there is a reduction of almost half a percentual point in the cardiovascular risk at 10 years.