Lancet regional health. Americas · 2026
Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey.
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Chis Ster Irina, Alvarez-Mena Pablo, Zurita-Loma Daniel, Gualan Monsermin, Rojeab-Bravo Batul, Cooper Philip J, Romero-Sandoval Natalia, Unit on the Social and Environmental Determinants of Health Inequalities (SEDHI)
Аннотация
BACKGROUND: The triple burden of malnutrition (TBM)- the coexistence of undernutrition, overweight, and micronutrient deficiencies such as anaemia-is a growing public health challenge in low- and middle-income countries. Amid Ecuador's rapid nutrition transition, we examined the prevalence of TBM and its components among preschool children and assessed inequalities by sociodemographic characteristics and poverty.
METHODS: We analysed nationally representative data from the 2022-23 National Survey on Child Undernutrition among children aged 0-59 months. Nutritional outcomes were defined using WHO standards. Weighted bi-probit, logistic and ordinal logistic regression models were used to examine associations between malnutrition and child, maternal, household characteristics and poverty indicators, adjusting for demographic factors.
FINDINGS: Stunting or wasting affected 17.1% (95% CI: 17.2-19.1) of children under 5 (n = 1,293,325), initially higher in boys, then shifting to girls by age three, with the highest prevalence among Indigenous children. Overweight prevalence was 4.9% (95% CI: 4.5-5.4), higher in boys, and highest among White children aged 18-53 months. Coexistence of undernutrition and overweight affected 0.6% (95% CI 0.5-0.7) or ∼7760 children, primarily boys under three. Among children aged 6-59 months (n = 1,172,450), severe anaemia affected 14.8% (95% CI 13.9-15.7) and 0.33% (95% CI 0.24-0.40; n = 3869) experienced TBM, disproportionately among socially disadvantaged Indigenous and Afro-Ecuadorian boys under three.
INTERPRETATION: Childhood malnutrition in Ecuador exhibits overlapping, socially patterned, and spatially clustered burdens, concentrated in early childhood. Addressing TBM requires integrated, early, equity-focused "triple-duty" targeted strategies that concurrently tackle undernutrition, overweight, and anaemia as interconnected manifestations of structural inequities.
FUNDING: This research was funded by the NIHR (grant NIHR134801) using UK international development funding from the UK Government to support global health research.
METHODS: We analysed nationally representative data from the 2022-23 National Survey on Child Undernutrition among children aged 0-59 months. Nutritional outcomes were defined using WHO standards. Weighted bi-probit, logistic and ordinal logistic regression models were used to examine associations between malnutrition and child, maternal, household characteristics and poverty indicators, adjusting for demographic factors.
FINDINGS: Stunting or wasting affected 17.1% (95% CI: 17.2-19.1) of children under 5 (n = 1,293,325), initially higher in boys, then shifting to girls by age three, with the highest prevalence among Indigenous children. Overweight prevalence was 4.9% (95% CI: 4.5-5.4), higher in boys, and highest among White children aged 18-53 months. Coexistence of undernutrition and overweight affected 0.6% (95% CI 0.5-0.7) or ∼7760 children, primarily boys under three. Among children aged 6-59 months (n = 1,172,450), severe anaemia affected 14.8% (95% CI 13.9-15.7) and 0.33% (95% CI 0.24-0.40; n = 3869) experienced TBM, disproportionately among socially disadvantaged Indigenous and Afro-Ecuadorian boys under three.
INTERPRETATION: Childhood malnutrition in Ecuador exhibits overlapping, socially patterned, and spatially clustered burdens, concentrated in early childhood. Addressing TBM requires integrated, early, equity-focused "triple-duty" targeted strategies that concurrently tackle undernutrition, overweight, and anaemia as interconnected manifestations of structural inequities.
FUNDING: This research was funded by the NIHR (grant NIHR134801) using UK international development funding from the UK Government to support global health research.