Patterns of the triple burden of childhood malnutrition in Ecuador by age, sex, ethnicity, and poverty: a cross-sectional population survey.

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.