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1
Freire, Wilma B., William F. Waters, Gabriela Rivas-Mariño, and Philippe Belmont. "The double burden of chronic malnutrition and overweight and obesity in Ecuadorian mothers and children, 1986–2012." Nutrition and Health 24, no. 3 (June 17, 2018): 163–70. http://dx.doi.org/10.1177/0260106018782826.
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Background: The simultaneous presence of undernutrition and over-nutrition represents a paradox in global public health and is of increasing concern in Ecuador, where chronic malnutrition and overweight and obesity occur in the context of demographic and epidemiologic transitions. Two overlapping trends are present in Ecuador; while levels of stunting have decreased slowly in the past three decades, increasing proportions of children <5 years and women of reproductive age suffer from overweight and obesity. Aim: To analyze stunting and overweight and obesity in children <5 and their mothers aged from 15 to 49 years in the context of demographic and household characteristics between 1986 and 2012. Methods: This study compares data from nationally-representative surveys conducted in Ecuador in 1986, 2004, and 2012, each of which collected information on children <5 and mothers aged 15–49 years. Results: The prevalence of chronic malnutrition in children <5 decreased at different rates among Ecuadorians who differ in terms of residence, socioeconomic status, and mothers’ level of education, while overweight and obesity increased dramatically in the same period. Conclusion: Chronic malnutrition in children <5 and overweight in children <5 and mothers 15–49 years represent a double burden of malnutrition in Ecuador. The phenomena differ in their effects, and, while the prevalence of stunting is declining in Ecuador as it is in many parts of the world, the problem of overweight and obesity has emerged in dramatic fashion, and currently represents an extraordinary challenge to public health.
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Ortiz-Prado, Esteban, Anna M. Stewart-Ibarra, Dario Ramirez, Estefania Espin, and Abigail Morrison. "Artificial Infant Formula Consumption and Breastfeeding Trends in Ecuador, A Population-Based Analysis from 2007 to 2014." Global Journal of Health Science 8, no. 11 (March 23, 2016): 184. http://dx.doi.org/10.5539/gjhs.v8n11p184.
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<p><strong>OBJECTIVE:</strong> The aim of this study was to analyze trends in infant breastfeeding and artificial infant milk consumption in Ecuador from 2007 to 2014.</p><p><strong>METHODS: </strong>This descriptive observational study includes all the available data collected and adapted from the National Health and Nutrition Survey of Ecuador, ENSANUT, the Ecuadorian National Institute of Census and Statistics, the national report of the International Marketing Services and data from Enfarma EP. Descriptive and inferential statistics were used to determine sociodemographic distribution and temporal trends.</p><p><strong>RESULTS: </strong>In Ecuador 54% of children initiate breastfeeding during the first hour of life, and 43% of children aged five months are breastfed exclusively. 76% of children under one month of age and 60% of children under six months consume artificial infant formula. Over the last 8 years infant formula consumption has tripled in Ecuador reaching 59.6 million units sold at a cost of $530,100,000 USD from 2007 to 2014.</p><p><strong>CONCLUSIONS:</strong><em> </em>Breastfeeding practices in Ecuador are not complying with WHO recommendations and infant milk formulas consumption has risen significantly since 2007, despite active campaigns by the public health sector to educate women as to the benefits of breastfeeding.</p>
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Levav, M., A. F. Mirsky, P. M. Schantz, S. Castro, and M. E. Cruz. "Parasitic infection in malnourished school children: effects on behaviour and EEG." Parasitology 110, no. 1 (January 1995): 103–11. http://dx.doi.org/10.1017/s0031182000081105.
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This paper describes a study of 194 children (aged 9–13) from a mountain village in Ecuador who were infected with one or more species of intestinal helminth or protozoan parasite. In addition to parasite load, the assessment consisted of a battery of psychological and neuropsychological tests, an EEG examination, measures of iodine level, presence of goitre and level of nutrition. We found that, in general, parasite infection, as measured at the baseline level, was not associated with cognitive impairment. The intensity of infection withA. lumbricoides, however, was correlated with the level of verbal ability and with inhibition-control aspects of cognitive behaviour. Multivariate analysis with level of nutrition, EEG status and parasite burden showed a consistent main effect of the degree of nutrition on neuropsychological performance, particularly the language, problem solving and inhibition-control dimensions.
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Sempértegui, Estrella, Vallejo, Tapia, Herrera, Moscoso, Cerón, Griffiths, and Hamer. "Selenium Serum Concentrations in Malnourished Ecuadorian Children: A Case-Control Study." International Journal for Vitamin and Nutrition Research 73, no. 3 (May 1, 2003): 181–86. http://dx.doi.org/10.1024/0300-9831.73.3.181.
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Little is known about the selenium status of children living in the Andean regions of South America, which commonly have volcanic soil with low selenium content. Human selenium deficiency has been hypothesized to have a negative impact on immune function and to increase the risk of infection. The objective of this study was to evaluate the serum selenium concentrations of severely malnourished children living in urban and rural Andean Ecuador, and to compare them to a control group of normally nourished children from the same communities. Forty-three children, aged six to 36 months, with marasmus or kwashiorkor and 30 control children were enrolled from July to November 1993 in Quito, Ecuador. Serum selenium concentrations were lower in the children with marasmus (0.91 ± 0.28 muM/L, n = 21) and kwashiorkor (0.37 ± 0.15 muM/L, n = 22) than in those who were normally nourished (1.77 ± 0.75 muM/L, n = 30; p < 0.001 for each difference). The serum selenium concentrations in children with kwashiorkor were significantly lower than those in children with marasmus (p < 0.001). All 22 of the children with kwashiorkor, 15 of the 21 children with marasmus, and five of the 30 normal children had serum levels < 1.08 muM/L (8.5 mug/dL) (chi2 = 38.4, p < 0.00000001). In the Andean regions of Ecuador, selenium deficiency is prevalent in children with protein and caloric deficiency. Furthermore, 17% of Ecuadorian children with normal weight-for age-Z score are selenium-deficient.
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Waters, William F., Carlos Andres Gallegos, Celia Karp, Chessa Lutter, Christine Stewart, and Lora Iannotti. "Cracking the Egg Potential: Traditional Knowledge, Attitudes, and Practices in a Food-Based Nutrition Intervention in Highland Ecuador." Food and Nutrition Bulletin 39, no. 2 (March 20, 2018): 206–18. http://dx.doi.org/10.1177/0379572118763182.
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Background: Food-based interventions can reduce the prevalence of undernutrition and improve household food security, but nutritious and accessible foods may be underutilized. In Ecuador, eggs are inexpensive and widely available, but while they are a valuable source of essential nutrients for infants and young children, medical advice and community-based information have limited their inclusion in infants' diets. Objective: A qualitative component was conducted to understand local perceptions, knowledge, and practices to complement a randomized control trial that studied the effect of introducing eggs on nutritional status and growth in infants from 6 to 9 months in rural communities in the highland province of Cotopaxi, Ecuador. Methods: The qualitative inquiry consisted of key informant interviews, focus group discussions (FGDs), and structured observations in order to understand perceptions, knowledge, and practices related to household egg consumption and to the introduction of eggs in infants’ diets. Results: The two principal findings were that: (i) eggs are an available and culturally acceptable food source although they are not always a part of the diet; and (ii) perceptions and practices related to household consumption and the introduction of eggs into the diet of infants are shaped by local knowledge and practices, which are shaped by biomedical information and advice provided by public health professionals. Conclusion: Through an effective food-based intervention that includes qualitative research and a social marketing component, the behaviors of mothers and other caregivers can be modified, enabling children to realize the nutritional advantages of early introduction of eggs into their diet.
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Chapnick, Melissa, Jenna Diaz, Arianna Boshara, Jennifer Powers, David Gibson, Carlos Andres Gallegos-Riofrío, Christine Stewart, Chessa Lutter, William Waters, and Lora Iannotti. "Eggs Introduced Early in Complementary Feeding and Egg Specific IgE Antibodies: A Randomized Controlled Trial in Ecuador." Current Developments in Nutrition 5, Supplement_2 (June 2021): 730. http://dx.doi.org/10.1093/cdn/nzab046_027.
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Abstract Objectives The purpose of the study was to assess the safety of using eggs as a nutritional intervention for stunting in infants living in a rural indigenous community in Ecuador and to further understand the prevalence of egg allergy in this population. Methods The Lulun Project was a randomized controlled trial conducted in a rural indigenous population in Ecuador. Infants age 6–9 months were recruited and randomly assigned to the intervention (1 egg/day; n = 80) or control (no intervention, n = 83) group. At baseline and end line, enumerators collected anthropometric, dietary intake, morbidity, and sociodemographic data along with blood samples. Symptoms of allergies were assessed, including rash, congestion, coughing or wheezing, and diarrhea. Children in the intervention group were monitored by the study team for allergy symptoms during consumption of the first study egg. All children were monitored for illness and allergy symptoms throughout the study. We used ELISA assays to determine serum anti-ovomucoid and ovalbumin IgE levels, a validated approach to identify “risk of” egg allergy. Results 131 of the children had a sufficient serum sample to be analyzed for IgE levels. Ovomucoid levels were <0.35 kUA/L in all children. 57 paired samples were available, 1 of 51 in the control and 2 of 56 in the intervention group developed increased responses to ovalbumin during the study (0.51−1.04 kUA/L). For unpaired endline samples (n = 51), 3 of 25 in the control group and 2 of 26 in the egg group had increased ovalbumin responses (0.6–1.36 kUA/L). No child was removed from the study due to a reaction to eggs. Conclusions These findings support the use of eggs as a safe option to improve growth and reduce stunting in this community in Ecuador. Our study's findings are in alignment with current guidelines that recommend introducing eggs early in the complementary feeding period, and the evidence that doing so does not increase the risk of developing an egg allergy. Funding Sources The Mathile Institute for Human Nutrition, The Bill and Melinda Gates Foundation, and the Washington University in St. Louis Institute for Public Health Summer Research Program funded this study.
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Weigel, M. Margaret, Rodrigo X. Armijos, Marcia Racines, and William Cevallos. "Food Insecurity Is Associated with Undernutrition but Not Overnutrition in Ecuadorian Women from Low-Income Urban Neighborhoods." Journal of Environmental and Public Health 2016 (2016): 1–15. http://dx.doi.org/10.1155/2016/8149459.
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Household food insecurity (HFI) is becoming an increasingly important issue in Latin America and other regions undergoing rapid urbanization and nutrition transition. The survey investigated the association of HFI with the nutritional status of 794 adult women living in households with children in low-income neighborhoods in Quito, Ecuador. Data were collected on sociodemographic characteristics, household food security status, and nutritional status indicators (dietary intake, anthropometry, and blood hemoglobin). Data were analyzed using multivariate methods. The findings identified revealed a high HFI prevalence (81%) among the urban households that was associated with lowerper capitaincome and maternal education; long-term neighborhood residency appeared protective. HFI was associated with lower dietary quality and diversity and an increased likelihood of anemia and short stature but not increased high-calorie food intake or generalized or abdominal obesity. Although significant progress has been made in recent years, low dietary diversity, anemia, and growth stunting/short stature in the Ecuadorian maternal-child population continue to be major public health challenges. The study findings suggest that improving urban food security may help to improve these nutritional outcomes. They also underscore the need for food security policies and targeted interventions for urban households and systematic surveillance to assess their impact.
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Ramírez-Luzuriaga, María J., Philippe Belmont, William F. Waters, and Wilma B. Freire. "Malnutrition inequalities in Ecuador: differences by wealth, education level and ethnicity." Public Health Nutrition 23, S1 (September 27, 2019): s59—s67. http://dx.doi.org/10.1017/s1368980019002751.
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AbstractObjective:To describe and quantify the magnitude and distribution of stunting, wasting, anaemia, overweight and obesity by wealth, level of education and ethnicity in Ecuador.Design:We used nationally representative data from the 2012 Ecuadorian National Health and Nutrition Survey. We used the Multidimensional Poverty Index (MPI) as a proxy of wealth. The MPI identifies deprivations across three dimensions (health, education and standard of living). We defined education by years of schooling and ethnicity as a social construct, based on shared social, cultural and historical experiences, using Ecuadorian census categories.Setting:Urban and rural Ecuador, including the Amazon rainforest and the Galapagos Islands.Participants:Children aged <5 years (n 8580), adolescent women aged 11–19 years (n 4043) and adult women aged 20–49 years (n 15 203).Results:Among children <5 years, stunting and anaemia disproportionately affected low-wealth, low-education and indigenous groups. Among adolescent and adult women, higher rates of stunting, overweight and obesity were observed in the low-education and low-wealth groups. Stunting and short stature rates were higher in indigenous women, whereas overweight and obesity rates were higher in Afro-Ecuadorian women.Conclusions:Malnutrition differs significantly across sociodemographic groups, disproportionately affecting those in the low wealth tertile and ethnic minorities. Rates of stunting remain high compared with other countries in the region with similar economic development. The effective implementation of double-duty actions with the potential to impact both sides of the double burden is urgently required.
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Garrido, David Israel. "Response to: Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador: Correspondence." Journal of Nepal Paediatric Society 40, no. 1 (August 10, 2020): 64–66. http://dx.doi.org/10.3126/jnps.v40i1.29062.
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Dear editor,
This letter is in response to Chaudhary, Shrestha, and Pathak, who highlighted various aspects of our previous manuscript "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador." I want to respond to each point referred to in a similar extension as used by the authors.
We agreed on the fact that it is prompt to conclude in nutritional deficiencies as a risk factor to suffer pneumonia in Ecuadorian children that is why we express this conclusion as a possibility. Nevertheless, as evidenced in the meta-analysis presented by Jackson et al., the Odds Ratio (OR) meta-estimate for under nutrition as a risk factor for acute lower respiratory infections was 4.5 (95% CI 2.1-9.5)1. To add, in the same paper, the OR meta-estimate for anaemia, vitamin D deficiency, and zinc supplementation, was 3.9 (95% CI 2.4-6.3), 7.3 (95% CI 2.5 to 21.5), and 0.5 (95% CI 0.3 to 0.9), respectively 1.
Moreover, in a study conducted in Malawi including 9 533 children, severe malnutrition and moderate malnutrition were associated not only with a pneumonia risk but with an increased risk of inpatient mortality, with Odds Ratios (OR) of 4.63 (3.08, 6.97) and 1.73 (1.21, 2.48) respectively. Therefore, there is supporting evidence globally of the suggested risk 2.
I am glad that the authors in the letter bring to the table a discussion of pneumonia diagnosis. In our study, the evaluation of pneumonia started with the clinical assessment including parameters with an acceptable sensitivity (Sen%) or specificity (Spe%), such as; fever on examination (Sen% 47, Spe% 68), history of fever (Sen% 92, Spe% 21), tachypnoea (Sen% 13, Spe% 95), rhonchi (Sen% 26, Spe% 98), crackles (Sen% 43, Spe% 73), wheezing (Sen% 4, Spe% 98) (3). However, as referred to in the original paper, the evaluation was not limited to these factors "Hypoxemia, defined as a sustained saturation of peripheral oxygen (SpO2) <90 %, was used as criteria for hospitalization, along with criteria for respiratory distress, which includes: tachypnoea, dyspnoea, retractions (suprasternal, intercostal, or subcostal), grunting, nasal flaring, apnoea and altered mental status. Furthermore, CBC, acute-phase reactants and chest radiography were performed" (4). Nonetheless, I should remark two factors; firstly, pneumonia severity assessment is based on clinical parameters as presented in the New South Wales Government guideline (5). So, minimizing the utility of the clinical evaluation may be a mistake, especially in institutions without prompt access to the radiologic test. Secondly, even we knew that the patients included in this study were evaluated in other differential diagnoses like bronchiolitis, asthma or cardiac diseases which can mimic pneumonia, this was a cross-sectional study using retrospective data collection.
Regarding the exclusion criteria, concomitant conditions that could affect anthropometric measurements include any congenital disease, which compromises a normal growth independently of the nutritional intake (Examples; Down syndrome, achondroplasia). Conditions that could affect the haemoglobin measurement or other parameters in the complete blood count include haematological, infectious or any disease which physiopathology may influence the interpretation of these results in the context of our study (Examples; Sickle cell disease, thalassemia, haemolytic anaemia, solid tumour cancers, haematological neoplasm, paludism), and conditions that could predispose to pneumonia include diseases which may produce an increased risk of infections (Examples; haematological neoplasm, inherited and acquired immunodeficiencies, immunosuppressive therapy)
It is true that without specific evaluation of iron profile is not possible to establish with a high certainty iron deficiency. However, in our study are some relevant considerations; we excluded patients with a current diagnosis of other types of anaemia (haemolytic anaemia), chronic inflammatory conditions, cancer, and haematological neoplasms. All these factors reduce the possible causes of anaemia, and in the light that nutritional anaemia is the most frequent type in Latin America, it is reasonable to think that iron deficiency may be the leading cause in our patients. When we think about microcytic anaemia, as this was the most frequent type in our study, and as we excluded thalassemia, chronic inflammatory disease, and was no evidence of lead poisoning or newly diagnosed thalassemia in our patients, the possibility of iron deficiency increases. Although, at the end of our paper, we recommend the use of iron profile in new studies. I should highlight that we did not report cases of macrocytic anaemia.
The question regarding the use of nutritional supplements is interesting, especially considering that in Ecuador, the governmental normative of micronutrients supplementation with the product "Chis Paz" consider children between 6 and 24 months of age. In our study, there was no possibility to know if the patients receive any supplementation. But, it would be useful to include this variable in prospective studies.
Subclinical infections and iron deficiency anaemia have been described extensively in subclinical malaria, in other types of subclinical infections and even acute infections, there are still debate.
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Smith, Janette L., N. Paul Johnston, Kirk A. Dearden, Dennis L. Eggett, and Alison K. Campbell. "The Impact of Altitude and Diet on Anemia in School-Aged Children in Lago San Pablo, Ecuador." ICAN: Infant, Child, & Adolescent Nutrition 2, no. 5 (October 2010): 288–93. http://dx.doi.org/10.1177/1941406410383013.
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Montenegro-Bethancourt, Gabriela, Taylor Wallace, Peter Rohloff, Elizabeth Yakes Jimenez, Gabriela Proaño, George McCabe, and Alison Steiber. "The Saqmolo’ Project: Protocol for a Randomized Controlled Trial Examining the Impact of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala." Current Developments in Nutrition 5, Supplement_2 (June 2021): 162. http://dx.doi.org/10.1093/cdn/nzab035_070.
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Abstract Objectives Studies in Ecuador and Malawi have demonstrated mixed effects of interventions involving daily complementary feeding of eggs on child growth. For example, in Malawi, the egg intervention had no overall effect on child development. There is a need to test the effects of egg interventions on child growth and development in other settings with high prevalence of stunting and in the context of other nutritional interventions. The Saqmolo’ (i.e.,“egg” in the Mayan language, Kaqchiquel) study aims to evaluate the impact of adding 1 egg per day to local standard nutrition care (LSNC) on child development, in rural Maya infants from Guatemala. Methods In a community-based, individually randomized, controlled comparative effectiveness trial among rural indigenous Maya children (n = 1200), starting at 6–9 months at baseline, we will compare the impact of adding one egg per day to LSNC with LSNC alone. LSNC includes: growth monitoring, medical care, deworming medication, multiple micronutrient powders for point of use food fortification, and individualized complementary and responsive feeding education for caregivers. Intervention and control groups will be visited once per month during 6-months and adherence will be monitored during the visits and through phone calls for the first 2 months in both groups at the same frequency. The primary outcome is differences in child global development (measured by Caregiver Reported Child Development Instruments –CREDI-and the Guide for Monitoring Child Development GMCD); secondary outcomes include: growth (z-scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality (using the World Health Organization's infant and young child feeding indicators). Results N/A (submitting study protocol abstract). Conclusions This study will provide new evidence on the potential effect of increased egg accessibility in high prevalence stunting areas along with integrated nutrition care on child development. The results may help to inform public health decision-making regarding resource allocation for effective nutrition interventions during the complementary feeding period in Guatemala. Funding Sources This work was supported by the Academy of Nutrition and Dietetics Foundation via an investigator-initiated research grant from the Egg Nutrition Center.
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Weigel, M. Margaret, and Rodrigo X. Armijos. "Household Food Insecurity and Psychosocial Dysfunction in Ecuadorian Elementary Schoolchildren." International Journal of Pediatrics 2018 (August 13, 2018): 1–7. http://dx.doi.org/10.1155/2018/6067283.
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Household food insecurity (HFI) is a major global public health and pediatric concern due to its reported association with adverse child nutrition, growth, and health outcomes. Psychosocial dysfunction is a major cause of childhood disability. US and Canadian studies have linked HFI to poorer overall psychosocial dysfunction and specific dysfunction types in school-aged children, i.e., internalizing, externalizing, and attention behaviors. However, it is uncertain whether prior findings are generalizable to low- and middle-income country (LMIC) settings. We conducted a cross-sectional study to explore the association of HFI with psychosocial dysfunction in 6-12-year-old public elementary schoolchildren (n=279) residing in low-income neighborhoods in Quito, Ecuador. Maternal caregivers were interviewed to obtain data on child psychosocial dysfunction (Pediatric Symptom Checklist, PSC), food security (Household Food Security Survey Module), and maternal mental health (SF-36 Mental Composite Summary). Capillary blood samples were obtained from child participants to measure hemoglobin levels. The data were analyzed using general linear models with adjustment for covariates. The results revealed that HFI was associated with significantly higher overall average PSC scores (p=0.002) and with internalizing (p=0.001) and externalizing (p=0.03) but not attention subscale scores. However, anemia was independently associated with PSC attention subscale scores (p=0.015). This is the first study to report on the relationship between HFI and psychosocial dysfunction in school-aged children in a LMIC setting. It highlights the importance of improving policies and programs protecting vulnerable households from HFI. In addition to improving health and nutrition, such improvements could potentially reduce the burden of child psychosocial dysfunction.
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Uruchima, Jessica, Gwenyth Lee, Andrew Jones, Nancy Castro Morillo, Andrea Anchundia Ortega, Karen Levy, and Joseph NS Eisenberg. "Risk Factors for Infant Feeding Practices Along a Rural-Urban Gradient in Coastal Esmeraldas Province, Ecuador." Current Developments in Nutrition 5, Supplement_2 (June 2021): 824. http://dx.doi.org/10.1093/cdn/nzab046_121.
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Abstract Objectives We describe infant and young child feeding (IYCF) practices along a rural-urban gradient in the primarily Afro-Ecuadorian province of Esmeraldas, Ecuador, an often-overlooked population. Methods Mother-child dyads from 10 communities were enrolled in the ‘Gut microbiome, enteric infections, and child growth across a rural-urban gradient’ (EcoMID) birth cohort study. Surveys to assess IYCF practices, and potential risk factors for poorer IYCF practices such as problems breastfeeding and food insecurity, were completed 1 week after the child's birth and every 3 months thereafter until the child reached 9 months of age. Fisher exact tests were used to compare the prevalence of recommended IYCF practices between sites, and between risk factors Results We collected data between May 2019 and January 2021 from 115 children: 30 in the urban city of Esmeraldas (U), and 85 in intermediate and rural communities (R). Greater food insecurity was seen in the rural site (44.0% R vs 23.3% U, p = 0.05). Both sites had a similar prevalence of breastfeeding within an hour of birth (73.3% R vs 73.3% U, p = 1.00), and problems breastfeeding at 1 week (64.3% R vs 63.3% U, p = 1.00). Compared to food secure (FS) households, infants from food insecure (FIS) households tended to have a lower prevalence of breastfeeding within an hour of birth (79.7% FS vs 61.9% FIS, p = 0.05). Reported problems breastfeeding at 1 week were associated with lower odds of solid or semi-solid foods consumed in the past 24 hours (OR: 0.29, p = 0.03) and lower odds of meeting the recommended minimum meal frequency (OR:0.23, p < 0.01) at 9 months. Conclusions Food insecurity may negatively impact early initiation of breastfeeding among both rural and urban families in Esmeraldas, and problems breastfeeding may negatively impact IYCF practices. Addressing these factors may be useful in promote optimal infant feeding in the region. Funding Sources This work is supported by the National Institutes of Health.
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Herrera-Cuenca, Marianella, Agatha Previdelli, Berthold Koletzko, Pablo Hernandez, Maritza Landaeta-Jimenez, Yaritza Sifontes, Georgina Gómez, et al. "Childbearing Age Women Characteristics in Latin America. Building Evidence Bases for Early Prevention. Results from the ELANS Study." Nutrients 13, no. 1 (December 25, 2020): 45. http://dx.doi.org/10.3390/nu13010045.
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Latin American (LA) women have been exposed to demographic and epidemiologic changes that have transformed their lifestyle, with increasing sedentary and unhealthy eating behaviors. We aimed to identify characteristics of LA women to inform public policies that would benefit these women and their future children. The Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples in eight Latin American countries (n = 9218) with a standardized protocol to investigate dietary intake, anthropometric variables, physical activity, and socioeconomic characteristics. Here we included the subsample of all 3254 women of childbearing age (15 to <45 years). The majority of ELANS women had a low socioeconomic status (53.5%), had a basic education level (56.4%), had a mostly sedentary lifestyle (61.1%), and were overweight or obese (58.7%). According to the logistic multiple regression model, living in Peru and Ecuador predicts twice the risk of being obese, and an increased neck circumference is associated with a 12-fold increased obesity risk. An increased obesity risk was also predicted by age <19 years (Relative Risk (RR) 19.8) and adequate consumption of vitamin D (RR 2.12) and iron (RR 1.3). In conclusion, the identification of these risk predictors of obesity among Latin American women may facilitate targeted prevention strategies focusing on high-risk groups to promote the long-term health of women and their children.
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Haugh, Carolyn, Suzanna Attia, Sumeer Brar, Nicole Robertson, George III Fuchs, Aric Schadler, and Aurelia Radulescu. "Cardiometabolic Risk Factors in South American Children: A Systematic Review and Meta-Analysis." Current Developments in Nutrition 5, Supplement_2 (June 2021): 757. http://dx.doi.org/10.1093/cdn/nzab046_054.
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Abstract Objectives We aimed to quantify the burden of cardiometabolic risk factors (CMRF) in South American children. Methods We included primary quantitative white and gray literature in any language reporting after 1999 on the prevalence of glucose intolerance, obesity, hypertension and/or dyslipidemia in South Americans aged 2–21 years old. Studies were excluded for lack of available data, population with additional comorbidity, and/or CMRF criteria not defined. We searched PubMed, the Latin American and Caribbean Health Sciences Literature, and Google Scholar and performed reference handsearching. We assigned data quality via Effective Public Healthcare Panacea Project Quality Assessment Tool for Quantitative Studies modified for selection bias and data collection. We analyzed CMRF by available sociodemographic variables. Results Included studies (68 of 1,179; n = 115,674 children aged 2–19 years) came from 8 countries (Argentina, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru and Venezuela). CMRF definitions ranged widely. By any definition, 33.41% (n = 4,480/13,408) had low HDL cholesterol, 25.33% (n = 3,396/13,408) had elevated triglycerides, 13.92% (n = 2,900/20,830) had elevated waist circumference, 10.38% (n = 3,909/37,646) were obese by any definition, 10.49% (n = 858/9,672) had elevated blood pressure (BP), and 5.62% (n = 1,015/15,270) had glucose intolerance. By International Diabetes Federation definitions, 33.39% (n = 3,495/10,466) had HDL ≤ 40 mg/dL (16/22 studies); 23.45% (n = 909/3,876) had triglycerides ≥ 150 mg/dL (6/22 studies); 8.84% (n = 1,373/15,533) had waist circumference ≥ 90% for age, gender and height (20/30 studies); 6.10% (n = 733/12,010) had fasting glucose ≥ 100 mg/dL (17/21 studies) and 14.04% (n = 404/2,877) had systolic BP ≥ 130 mmHg (4/4 studies). CMRF varied by country, study setting (rural, urban or mixed), and indigenous population. Overall, Brazil had the highest prevalence of glucose intolerance and elevated BP; Chile had the highest prevalence of obesity and low HDL. Obesity was more prevalent in rural settings (7/65 studies); urban settings (19/28) had increased dyslipidemia. Conclusions South American children experience a high prevalence of CMRF and need further characterization of the sociomedical determinants of their risk. Funding Sources None.
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Huiracocha-Tutiven, Lourdes, Adriana Orellana-Paucar, Victoria Abril-Ulloa, Mirian Huiracocha-Tutiven, Gicela Palacios-Santana, and Stuart Blume. "Child Development and Nutritional Status in Ecuador." Global Pediatric Health 6 (January 2019): 2333794X1882194. http://dx.doi.org/10.1177/2333794x18821946.
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We assessed the development, nutritional status, and complementary feeding of 12- to 23-month-old children from Cuenca, Ecuador in 2013. Ecuador, an upper-middle-income country, developed a child policy in accordance with World Health Organization (WHO) guidelines. We collected cross-sectional survey data. Child development was assessed using the Integrated Management of Childhood Illness Guide–2011. The nutritional status was defined with WHO Child Growth Standards−2006. We investigated nutrient density, WHO Infant and Young Child Feeding Indicators, and nutrient supplementation intake of the complementary feeding. In all, 11.7% of children had “possible developmental delay,” stunting was identified in 29.4% of the children, and 25.3% faced overnutrition (overweight risk/overweight/obesity). The complementary feeding composition can be summarized as having adequate fat, high energy (MJ/day) and protein, and low iron and zinc. Children with “possible developmental delay” received less iron ( P < .05) than children with normal development. Overall, 30.4% of children had minimum dietary diversity. A total of 47.7% of children received nutrient supplementation. This epidemiological profile of infants remains a challenge for Ecuador’s health programs.
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Radosevich, Ainelen, Francisca de Castro Mendes, Rodrigo Villegas, Gustavo Mora-Garcia, and Vanessa Garcia-Larsen. "Awareness, Understanding and Use of the ‘Traffic Light’ Food Labelling Policy and Educational Level in Ecuador – Findings from the National Nutrition Survey 2018." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1731. http://dx.doi.org/10.1093/cdn/nzaa064_021.
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Abstract Objectives To examine the association between awareness, understanding and use of the traffic light food labelling policy (TLFL) and educational level in children and adults from Ecuador. Methods Data from the National Health and Nutrition Survey (ENSANUT) 2018 (40,938 participants aged 10y–98y) was used. Awareness, understanding and use of TLFL were ascertained with the questions ‘do you know/have you seen the TLFL in foods? [yes/no]’; ‘do you understand the TLFL in foods’ [yes/no]; and ‘do you consider that the TLFL helps you with food purchase decisions? (a little or nothing [reference]/some/a lot)’, respectively. Education was categorized as illiterate [reference]; primary school [incomplete/complete]; high school [incomplete/complete]; and higher education. Age, sex, residence (rural/urban), income, poverty index (unsatisfied basic needs) were included as potential confounders. Adjusted multivariable regressions were used to investigate the association of TLFL and education (reported as odds ratios [OR] and 95% confidence intervals [95%CI]), using sampling weights, and Akaike's Information Criterion to select the most optimal models. Results 31,028 participants (79%) reported to be aware of the TLFL, of whom 88% said they understood. Amongst the latter, only 21% reported to use TLFL when purchasing foods. Increasing education was associated with increased odds of awareness and understanding of TLFL (p-values: 0.004, 0.005, respectively) but not with its use. Compared to the lowest education, those with the highest educational level had the highest odds of being aware of and understanding the TLFL, OR 1.54 (95% CI 1.48; 1.61) and OR 1.28 (95% CI 1.19;1.39), respectively. Conclusions Whilst awareness and understanding of TLFL is relatively high in the Ecuadorian population, its use remains low. These findings highlight the need to strengthen public health policies that increase the use of food labelling as reference to make healthier decisions about food purchase, particularly amongst individuals from more vulnerable educational and socio-economic background. Funding Sources AR is funded by an MPH Fellowship and FDCM by a Grant for Research, both awarded by the Fulbright Commission; GMG is funded by COLCIENCIAS (Fondo para Investigacion en Salud -FIS-).
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Arsenault, J. E., S. E. Wuehler, D. L. de Romaña, M. E. Penny, F. Sempértegui, and K. H. Brown. "The time of day and the interval since previous meal are associated with plasma zinc concentrations and affect estimated risk of zinc deficiency in young children in Peru and Ecuador." European Journal of Clinical Nutrition 65, no. 2 (October 27, 2010): 184–90. http://dx.doi.org/10.1038/ejcn.2010.234.
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Orozco, Fadya, Donald C. Cole, Verónica Muñoz, Ana Altamirano, Susitha Wanigaratne, Patricio Espinosa, and Fabian Muñoz. "Relationships among Production Systems, Preschool Nutritional Status, and Pesticide-Related Toxicity in Seven Ecuadorian Communities: A Multi-Case Study Approach." Food and Nutrition Bulletin 28, no. 2_suppl2 (June 2007): S247—S257. http://dx.doi.org/10.1177/15648265070282s204.
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Background Among small Andean potato farmers, greater pesticide use and better linkage to markets are promoted as ways to improve farm outputs and incomes. The health of household members is assumed to improve with higher incomes, although evidence to support such an assumption remains scarce. Objective Using a multidisciplinary approach, we sought to characterize agricultural systems producing potatoes and to assess relationships between these characteristics and farm household health indicators. Methods We included seven communities linked to a regional agricultural potato production platform (socio-organizational “space” for potato commercialization) in Chimborazo, Ecuador. The unit of analysis was the community, each of which was classified according to its level of intensity of potato production as more intensive, intermediate, or less intensive. Data on crop management, household food intake, child anthropometry, and impacts of pesticide use on adult health were collected by survey. Results The net income from potato production was similar in communities with more intensive and intermediate production systems and lower in those with less intensive systems. However, deficits in protein intake were more common among children in communities with more intensive systems (63%) than among those in communities with intermediate (53%) and less intensive (37%) systems. Deficits in thiamin and riboflavin intake were more prevalent in communities with more and less intensive systems than in those with intermediate systems. In contrast, the prevalence of moderate chronic malnutrition, as measured by height-for-age, was greater among children in communities with less intensive systems (27%) than among those in communities with intermediate (5%) and more intensive (7%) systems. Across all intensities, frequent use of highly hazardous pesticides was associated with adverse health effects. Conclusions Agricultural development programs need to work more cross-sectorally to realize the potential health benefits associated with intensification of production.
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Katuli, S., Z. S. Natto, L. Beeson, and Z. R. Cordero-MacIntyre. "Nutritional Status of Highland and Lowland Children in Ecuador." Journal of Tropical Pediatrics 59, no. 1 (July 2, 2012): 3–9. http://dx.doi.org/10.1093/tropej/fms032.
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Antén, José-Ignacio. "The Impact of Remittances on Nutritional Status of Children in Ecuador." International Migration Review 44, no. 2 (June 2010): 269–99. http://dx.doi.org/10.1111/j.1747-7379.2010.00806.x.
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Garrido Salazar, David Israel, Michelle Fuseau, Santiago Moises Garrido, Gina Vivas, and Miguel Gutiérrez. "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador." Journal of Nepal Paediatric Society 38, no. 2 (January 11, 2019): 102–9. http://dx.doi.org/10.3126/jnps.v38i2.20193.
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Introduction: Anaemia and pneumonia are frequent diseases which affect children. However, these two conditions could coexist. The aim of this study is presenting the prevalence of anemia among Ecuadorian children diagnosed with pneumonia, hospitalized in a tertiary hospital.
Material and Methods: An observational and cross-sectional study conducted through a secondary source in that 80 children, between six months and 15 years of age were included. All the patients involved were admitted to the paediatric department presenting pneumonia. The medical evaluation included anthropometric measurements and complete blood count. Risk associations were evaluated using odds ratio.
Results: Anaemia was found in 21.25% of the whole group. Nonetheless, the children under three years of age were more affected by this condition (18.75%). Low mean corpuscular volume and high red cells distribution width were more frequent than anaemia itself; 38.75% and 28.75%, respectively. Additionally, the prevalence of anaemia in children under 36 months was higher than the patients with over three years, with a significant risk of anaemia in the first group (OR 13.04; CI 95% 11.48-14.61; p<0.05) and low haematocrit (OR 14.64; CI 95% 12.53-16.75; p<0.05). This was also seen in low mean corpuscular volume (OR 3.23; CI 95% 2.3-4.17; p<0.05), high red cells distribution width (OR 2.77; CI 95% 1.76-3.78; p<0.05), and mean corpuscular haemoglobin (OR 8.48; CI 95% 7.14-9.82; p<0.01).
Conclusions: Anaemia is a frequent condition in paediatric pneumonia, particularly during the first three years of life. Therefore, anaemia or nutritional deficiencies could be a risk factor for respiratory diseases.
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ROBALINO FLORES, Ximena del Rocío, Aida Mercedes BALLADARES SALTOS, Marcela Esther GUERENDIAIN MARGNI, and Fátima MORALES MARÍN. "Anthropometric and hematological tests to diagnose nutritional deficiencies in schoolchildren of indigenous communities living in the Andean region of Ecuador." Revista de Nutrição 30, no. 6 (December 2017): 723–33. http://dx.doi.org/10.1590/1678-98652017000600005.
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ABSTRACT Objective To carry out the anthropometric and biometric-hematological assessments in schoolchildren of the Andean region of Ecuador, in order to improve the diagnosis of nutritional deficiencies. Methods The study has been carried out in the San Juan School (Chimborazo, Ecuador), located at 3,240m of altitude, to 36 children of 5 and 6 years old. Anthropometric analyses (weight, height and body mass index), and hematocrit and hemoglobin concentrations were measured. The hemoglobin measurement was evaluated considering the normal value and the one adapted to the altitude of the area. Results The schoolchildren showed high prevalence of stunting (44%). The values of hematocrit (.=0.001) and hemoglobin (.=0.003) were higher in girls. It should be highlighted that using the normal value of hemoglobin, anemia was not detected. However almost a fifth of the schoolchildren studied were diagnosed with anemia when we applied the correction factors adapted to the altitude. Conclusion The use of correction factors adapted to the altitude is considered essential to do the hematology test in populations that live in high altitude in order to avoid a false diagnosis. Moreover, it is necessary to establish the environmental factors related to the stunted growth of this population of the Andean region.
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Chantong, Sandra Patricia, Maira Janeth Monar Pazmiño, and Gloria Verónica Parreño. "“investigación en enseñanza de la carrera educación básica” Guayaquil, ecuador, 18 y 19 de agosto del 2017." South Florida Journal of Development 2, no. 4 (September 24, 2021): 6123–32. http://dx.doi.org/10.46932/sfjdv2n4-086.
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Conocedoras de la relevancia que tiene la educación infantil en la vida de los seres humanos, etapa en la que se desarrolla su inteligencia, personalidad, comportamiento social y otras potencialidades, consideramos que es importante hacer cambios en nuestra labor educativa y aplicar métodos activos de enseñanza- aprendizaje, promoviendo la participación de los estudiantes en proyectos de aula, trabajo colaborativo y a partir de la experiencia crear su propio conocimiento con la guía de los docentes. Nuestra propuesta es la visita al mercado del barrio con la finalidad de que conozcan su comunidad y de que se sientan orgullosos de su cultura y costumbres; destacar la diferencia entre la comida nutritiva y alimentos chatarra; reconocer la labor que realizan los vendedores en el mercado; resaltar valores como la honestidad y el respeto; conocer las reglas del aseo para la conservación de los alimentos y cuidado del medio ambiente. Aplicar esta estrategia activa permite utilizar de manera apropiada recursos de nuestro entorno, crear el sentido de pertenencia, mejorar el desempeño escolar, la participación creativa de los estudiantes en cada uno de los ambientes de aprendizajes y aumentar su capacidad lingüística.
Knowing the relevance of the education of children in the life of human beings, a stage in which their intelligence, personality, social behavior and other potential develops, we consider that it is important to make changes in our educational work and to apply active teaching methods - learning, promoting the participation of students in classroom projects, collaborative work and based on the experience, to create their own knowledge with the guidance of teachers. Our proposal is the visit to the market of the neighborhood in order that they know their community and that they are proud of their culture and customs; to recognize the difference between nutritious food and junk foods; Recognize the work of marketers in the market; to exalt values such as honesty and respect; to know the rules of cleanliness for food preservation and care of the environment. Applying this active strategy allows us to appropriately use resources from our environment, create a sense of belonging, improve school performance in students, creative participation of students in every learning environment and increase their language ability.
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Ponce-Castillo, Jorge, and Fabricio Gonzalez-Andrade. "Neonatal complications of newborns children born of immigrant mothers in comparison with local mothers: A view of a growing immigration to Ecuador." Research, Society and Development 10, no. 2 (February 13, 2021): e22210212644. http://dx.doi.org/10.33448/rsd-v10i2.12644.
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Background: In the last years, there has been a great migratory flow to Ecuador. Purpose: To determine if there are differences in the morbidity of children born of immigrant mothers or local mothers. Methods: epidemiological, observational, cross-sectional study, with two cohorts of patients, newborns from immigrant mothers, and local mothers. 220 individuals were analyzed. Results: 90.45% of the mothers were between 18 and 35 years old; 49.09% had a free-union marital status, 32.27% were single, 18.18% married, and 0.45 divorced, homemakers in the 75.91%, with temporarily leased housing, 89.09% live with close relatives. In 54.55%, the income was between 61 to 400 USD, 66.36% eat three meals in a day, and 70.46% of mothers had five or more prenatal controls. In 71.90% of cases, it performed prenatal controls in the facilities of the Ministry of Health in Ecuador, and it made 18.10% in their country of origin, Colombia, or Venezuela. The most common maternal risk factor was UTIs in 60.57% of mothers, followed by preeclampsia and syphilis. Conclusion: Children born from immigrant mothers have a higher number of neonatal complications. Most immigrant mothers arrive in conditions of poverty and get occasional and temporary jobs that allow them to earn an income of between 30 to 400 USD per month. This low income has a direct effect on the nutritional status of the mother and the fetus. Additionally, these mothers have a lower number of prenatal controls, of low quality, and more connate infections. The circle of immigrant poverty has direct health complications.
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Walrod, Jemie, Erica Seccareccia, Iván Sarmiento, Juan Pablo Pimentel, Shivali Misra, Juana Morales, Alison Doucet, and Neil Andersson. "Community factors associated with stunting, overweight and food insecurity: a community-based mixed-method study in four Andean indigenous communities in Ecuador." BMJ Open 8, no. 7 (July 2018): e020760. http://dx.doi.org/10.1136/bmjopen-2017-020760.
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ObjectivesWe aimed to implement participatory research to answer a question posed by four Kichwa indigenous communities in Andean Ecuador about what actionable factors are associated with childhood stunting, overweight and food insecurity among their people.DesignWe used mixed methods including household questionnaires, discussion groups with respondents of the questionnaires and anthropometric measurement of children (6 months to 12 years) from surveyed households.SettingThe study involved four Andean indigenous communities transitioning from traditional to Western lifestyles. They subsist mainly on small-scale agriculture and have a rich cultural heritage including their traditional language.ParticipantsAnthropometric data were collected from 298 children from 139 households in four communities; all households completed the questionnaire. We held five discussion groups (6–10 participants each): three composed of mothers and two of farmers.Primary and secondary outcome measuresPrimary outcomes were stunting, overweight, food insecurity and their relationship with demographics, dietary habits and agricultural habits.ResultsOf 298 children, 48.6% were stunted and 43.3% overweight for age. Stunted children were more likely to live in households that sold livestock (ORa 1.77, 95% CIa 1.06 to 2.95) and with illiterate primary caretakers (ORa 1.81, 95% CIa 1.07 to 3.06), but were less likely to live in households with irrigation (ORa 0.47, 95% CIa 0.27 to 0.81). Overweight children were more likely to be male (ORa 1.87, 95% CIa 1.02 to 3.43) and live in a household that sold livestock (ORa 2.14, 95% CIa 1.14 to 4.02). Some 67.8% of children lived in a household with food insecurity, more frequently in those earning below minimum wage (ORa 2.90, 95% CIa 1.56 to 5.41) and less frequently in those that ate quinoa in the past 24 hours (ORa 0.17, 95% CIa 0.06 to 0.48). Discussion groups identified irrigation and loss of agricultural and dietary traditions as important causes of poor childhood nutrition.ConclusionMany indigenous communities face tumultuous cultural, nutritional and epidemiological transitions. Community-based interventions on factors identified here could mitigate negative health outcomes.
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Chaudhary, Nagendra, Sandeep Shrestha, and Santosh Pathak. "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador: Correspondence." Journal of Nepal Paediatric Society 39, no. 1 (April 27, 2019): 63–64. http://dx.doi.org/10.3126/jnps.v39i1.22444.
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Dear editor,
We read with interest the article “Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador” in the recent issue of your esteemed journal and found it very useful and informative1. This article presents the prevalence of anemia in children with pneumonia. However, there are certain points we would like to comment and highlight which might bring more clarity to this issue and will be useful to the readers of JNPS.
In the abstract (conclusion section), the authors have mentioned that “anaemia or nutritional deficiencies could be a risk factor for respiratory diseases”. The authors seem to draw a conclusion on “nutritional deficiencies” as a risk factor for respiratory disease without any evidence or data provided in the results. We feel that it should better be omitted from the conclusion.
The authors have mentioned that they used physical findings such as: fever, tachypnea, breathing difficulties, rhonchi, crackles, and wheezing to diagnose pneumonia and them again have mentioned using WHO tachypnea threshold to diagnose pneumonia. It is very unlikely for all the 80 cases to have all the above listed physical findings. Diagnosis of pneumonia in children remains an important yet difficult clinical problem. WHO criteria which uses the presence of cough, fast breathing and chest indrawing to diagnose pneumonia may over-estimate the diagnosis of actual pneumonia2. Chest radiograph remains a diagnostic test of choice in hospitals3. The readers would be keen to know which diagnostic criteria the authors had used to diagnose pneumonia (either clinical or radiological?). If they had used the clinical criteria, what were the exact parameters used to diagnose pneumonia needs further clarification. The authors also need to reply the reason of not including cough and retractions in the inclusion criteria to diagnose pneumonia. The readers would also be keen to know that if any attempt was made to exclude pneumonia like illnesses e.g., bronchiolitis, asthma or cardiac diseases which can mimic pneumonia.
The authors have mentioned that diagnosis of concomitant conditions that could affect anthropometric or haemoglobin parameters, or that could predispose to pneumonia were excluded. The readers would be interested to know (a) what anthropometric parameters or hemoglobin parameters were excluded and (b) what factors predisposing to pneumonia were excluded which is missing in the material and methods.
The authors have concluded that anaemia is a frequent condition in paediatric pneumonia and could be a risk factor for respiratory diseases. The study done by the authors was a cross-sectional study which has always a chance of selection bias4. The increased prevalence of anemia in pneumonia patients could have been due to chance, we do not know. Therefore, it is very difficult to answer (in a cross-sectional study) either anemia is prevalent in children with pneumonia or not unless we have some cohort studies on the same. This should have been mentioned as one of the limitations of the study.
The readers would be interested to know regarding any iron supplements in children aged more than 3 years which might be the cause of decrease prevalence of anemia in this age group.
In the discussion section, the authors have tried to convince that anemia in the study groups was most likely due to iron deficiency. They have used hemoglobin, MCV and RDW to support the diagnosis of iron deficiency anemia. The sensitivity and specificity of MCV to diagnose IDA is 61.7% and 59.1% respectively with a positive predictive value of 70% 5 whereas using RDW as a criteria to diagnose IDA has a sensitivity of 81% and specificity of 53.4%6.
In the discussion, the authors have emphasized iron deficiency as the cause of anemia in the cases. The authors need to explain that how can they be sure that all the cases of anemia in their study was due to iron deficiency without undergoing iron profile (serum ferritin, % saturation, TIBC).
It is well known that with subclinical infection, serum iron concentrations are reduced, altering the synthesis of hemoglobin, the main indicator of anemia7. The readers would be interested to know if any attempts were made to exclude those subclinical infections from the enrolled cases with pneumonia.
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Arencibia-Moreno, Ricardo, Damaris Hernández-Gallardo, Daniel Linares-Girela, Johanna Sabrina Párraga-Acosta, José Gabriel Pilay-Chávez, and Marta Linares-Manrique. "Abdominal Obesity in Overweight Schoolchildren from Portoviejo (Ecuador). Conicity Index Cut-Points for Sustainable Health." Sustainability 13, no. 10 (May 17, 2021): 5583. http://dx.doi.org/10.3390/su13105583.
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(1) Background: Abdominal obesity describes the accumulation of visceral fat. Monitoring of abdominal obesity in children aids prognosis of atherogenic risk and prediction of the emergence of different comorbidities, many of which persist into and throughout adulthood. For this reason, it is of great diagnostic value to the sustainability of health in populations. The aim of this study was to evaluate abdominal obesity in overweight schoolchildren from Portoviejo (Ecuador) and propose conicity index cut-points for sustainable health. (2) Methods: The sample was formed by 356 schoolchildren whose BMI z-score deemed them to be overweight. Height, weight, waist circumference (wstC), various skinfolds, percent body fat, conicity index (CI) and overweight classification according to wstC were determined. (3) Results: The mean age was 6.83 ± 1.2 years, 17.4% were obese, 34.8% were overweight and 47.8% were at risk of being overweight according to their BMI z-score. The mean height was 1.29 ± 0.12 m, whilst the mean weight was 35.21 ± 11.57 kg. When classifying according to wstC, 37.9% were identified as obese, 28.1% had high-risk abdominal adiposity and 34% were normal. The average CI was 1.16 ± 0.06, whilst that of body fat was 19.34 ± 6.03, with 56.2% of individuals having body fat values lower than 20%. (4) Conclusions: The sample showed a high prevalence of central obesity. Significant agreement was not found between classifications of nutritional status according to BMI z-score and wstC.
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Fernandez Velez, Yumy, Angel Caballero Torres, and Katiuska Mederos Mollineda. "Evaluación Nutricional en preescolares atendidos en el Hospital de Manglaralto, Santa Elena / Nutritional Evaluation of pre-school children attended in Manglaralto Hospital, Santa Elena province." Ciencia Unemi 8, no. 15 (November 5, 2015): 103. http://dx.doi.org/10.29076/issn.2528-7737vol8iss15.2015pp103-108p.
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Con el objetivo de analizar los hábitos alimentarios, actividad física y estado nutricional de 514 niñas y niños en edades de 3 a 5 años, se realizó una investigación de corte transversal descriptiva, no experimental, y documental con técnicas cualitativas y cuantitativas para la descripción de los datos e informaciones encontradas, la cual permitió construir la labor técnica Se trabajó con encuestas, mensuraciones antropométricas e investigaciones bioquímicas (hemoglobina) en una muestra de la población atendida en la consulta ambulatoria del Hospital Manglaralto, provincia de Santa Elena, Ecuador, 2014. Se clasificó a los preescolares en desnutridos, normopeso, sobrepeso y obeso, además de identificar la existencia de anemia. Se buscó la asociación con los hábitos alimentarios, acceso y disponibilidad de alimentos, el nivel de cultura alimentaria y escolar, pobreza económica y educación sanitaria de las familias de los preescolares. Se encontró un 44.5% de desnutridos y 0,7% con sobrepeso, además de 81.7% con anemia. Se detectó asociación entre desnutrición y anemia en más de la tercera parte de la población estudiada, además de estar asociada la presentación de Infección Respiratoria Aguda y Enfermedad Diarreica Aguda con la desnutrición y la anemia. En la población estudiada existe correspondencia entre el estado nutricional y los determinantes estudiados. AbstractA cross-sectional descriptive piece of research was conducted in order to document the eating habits, physical activity and nutritional status of 514 children aged 3-5 years. Both Qualitative and quantitative techniques were used to describe the data and information found; surveys, anthropometric evaluations and biochemical investigations (hemoglobin) were carried out on a sample of the population treated at the outpatient clinic of Manglaralto Hospital in Santa Elena province, Ecuador during 2014. Preschool children were classified as malnourished, normal weight, overweight and obese, and the existence of anemia was also identified. The data was studied to observe associations between eating habits, access to and availability of food, the level of culture in terms of diet and education, economic poverty and health education for families of preschoolers. It was found that 44.5% of the group were malnourished, 0.7% overweight, and 81.7% suffered from anemia. An association was found between malnutrition and anemia in more than a third of the population studied, with a further association between both conditions and acute respiratory infections and diarrheal disease. In the population there is a relationship between nutritional status and determining variables studied.
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Romo, Matthew, Adriana Orellana, Lourdes Huiracocha, and Victoria Abril-Ulloa. "Demographic characteristics, nutritional status, dietary and physical activity habits, Helicobacter pylori infection, and intestinal parasitosis among children at municipal preschools in Cuenca, Ecuador." MASKANA 9, no. 1 (June 28, 2018): 41–50. http://dx.doi.org/10.18537/mskn.09.01.05.
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Miño, P., M. Balladares-Saltos, X. Robalino, and M. Guerendiain. "MON-P268: Analysis of Serum Ferritin and Iron Concentration According to Nutritional Status and Sex in Children from the Andean Region of Ecuador." Clinical Nutrition 36 (September 2017): S277. http://dx.doi.org/10.1016/s0261-5614(17)30821-x.
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Robalino, Ximena, Mercedes Balladares-Saltos, Patricia Miño, and Marcela Guerendiain. "Comparison of Hemoglobin Concentration Adjusted for Altitude and Serum Iron and Ferritin to Diagnose Anemia in Childhood in Highlands." Blood 128, no. 22 (December 2, 2016): 2459. http://dx.doi.org/10.1182/blood.v128.22.2459.2459.
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Abstract Introduction: Iron deficiency anemia in childhood is a public health problem, especially in developing countries, being one of the most prevalent nutritional disorders in Ecuador. The proper diagnosis of anemia at school age is a priority, because it is related to inadequate growth and cognitive development, low immunity and increased morbidity and mortality. In highlands, the anemia diagnosis is difficult due to hyperbaric hypoxia stimulates erythropoiesis and the low sensitivity of conventional methods. It was established that hemoglobin concentration increases with altitude, proposing that these values must be adjusted for the altitude of residence. Thus, different models were generated to correct hemoglobin. However, other authors have an opposite position, stating that the adjustment is not required. It should be noted that, unlike hemoglobin, the content of body ferritin is not affected by the elevation above sea level, therefore constitutes an alternative for the assessment of anemia in highlands. Hence, our objective was to evaluate different hematological parameters, including the hemoglobin correction, to diagnose anemia in children living in regions of high geographical altitude, in Ecuador. Methods: This study has been carried out in San Juan and Yaruquíes schools, located at 3240 and 2764 meters above sea level, respectively. It was included 140 preschool and school children, who participated in the EVANES study, aged 3 to 13 years old. The 60% were female. Serum iron and ferritin and hemoglobin and hematocrit concentrations were measured in blood. The hemoglobin was evaluated considering the uncorrected values and the concentration adjusted for the geographical altitude of each region, according to World Health Organization (WHO), Center for Disease Control (CDC; for children), Dirren (for children) and Cohen (for pregnant women) methods. Children with hemoglobin levels lower than 11.5 g/dl were considered anemic (n=18/16/18/12; WHO, CDC, Dirren et al and Cohen et al, respectively). This study was conducted in accordance to the ethical rules of the Helsinki Declaration and the current Ecuadorian law, which regulates clinical research on humans, and was approved by the Ethic Committee of the San Francisco de Quito University. Written informed consent was obtained from all schoolchildren parents or tutors. Results: The means of age, hematocrit, unadjusted hemoglobin, serum iron and ferritin were: 8.65 ± 2.16 years, 43.01 ± 2.66 %, 14.27 ± 0.90 g/dl, 14.28 ± 4.04 µmol/l and 30.95 ± 14.33 ng/ml, respectively. When the correction factors and equations were applied, the hemoglobin concentrations were 12.45 ± 0.88 g/dl (WHO), 12.54 ± 0.88 g/dl (CDC), 12.43 ± 0.88 g/dl (Dirren) and 12.73 ± 0.89 g/dl (Cohen). No differences between female and male were found in hematological parameters. According to unadjusted hemoglobin, no cases of anemia were determined. By applying the corrections, 13.5% (WHO), 12.0% (CDC), 13.5% (Dirren) and 9.0% (Cohen) of children were identified as anemic, and using serum ferritin and iron the percentages were 10.3% and 15.0%, respectively. When comparing the latters with the corrected hemoglobin, there were no differences in the frequency of anemia. However, of the 14 children assessed as anemic using ferritin, only 2 (0MS), 1 (CDC), 2 (Dirren) and 1 (Cohen) of them presented this condition applying the adjusted hemoglobin, and 11 to 16 non-anemic children were classified as anemic. On the other hand, taking into account adjusted hemoglobin, there were more cases of anemia among boys than girls (p<0.05), but considering the ferritin and iron, no differences were found between sexes. In relation to the adjusted hemoglobin (all methods), the children identified as anemic presented lower hematocrit and hemoglobin (uncorrected and adjusted) levels (p<0.001) than non-anemic. No differences were found between groups in ferritin and iron concentration. Conversely, when ferritin and iron were used to divide the children, only these parameters were different in anemic and non-anemic groups (p<0.001). Conclusions: According to our findings, the adjustment of hemoglobin concentration by geographical altitude may be an useful method to diagnose anemia in childhood at the population level but not individually. Serum ferritin is the most appropriate anemia indicator for the individual assessment in children living in highlands. Disclosures No relevant conflicts of interest to declare.
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Kanu, Florence, Andrea Sharma, O. Yaw Addo, and Parminder Suchdev. "Association Between Hemoglobin and Elevation Among School-Aged Children: A Verification of Proposed Adjustments." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1717. http://dx.doi.org/10.1093/cdn/nzaa064_007.
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Abstract Objectives Anemia is defined by hemoglobin (Hb) lower than normal based on cutoffs specific to age and sex. Hb increases with elevation as a response to lower blood oxygen, thus adjusting Hb for elevation is necessary before applying cutoffs. Recent evidence among preschool-aged children (PSC) and reproductive-aged women (WRA) suggests current World Health Organization (WHO) recommended Hb elevation adjustments need updating. We examined the Hb and elevation association among school-age children (SAC) to confirm these findings. Methods Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project data include SAC aged 5–14 years (n = 23,454; 53.5% female) with data on Hb and elevation (−6 to 3,834 meters, m) from 6 population-based surveys from 5 countries (Columbia, Ecuador, Malawi, Mexico, United Kingdom). Anemia was defined as Hb < 115 g/L for SAC < 12 years and < 120 g/L for SAC 12–14 years after elevation adjustments. Generalized linear models were used to assess the association between Hb and elevation, including controlling for inflammation-corrected iron and vitamin A deficiency. Hb adjustments for each 500 m increase in elevation from sea level are proposed and compared to current WHO recommendations and new proposed PSC and WRA adjustments. Results Hb was positively associated with elevation. There was no sex interaction, and the association was robust to model specification. The association among SAC and the resulting Hb adjustments were consistent with PSC and WRA findings, suggesting current WHO recommendations may under-adjust Hb at lower elevation (500–2500 m) and over-adjust Hb at higher elevation (>3000 m). Anemia prevalence in SAC using new elevation adjustments increased by 0.7 (UK) to 14.1 (Malawi) percentage points relative to current WHO elevation adjustments. Conclusions Results confirm current WHO recommended Hb elevation adjustments may need updating, and anemia prevalence in SAC may be higher than currently estimated. Findings will inform global guidelines on use of elevation-adjusted Hb for anemia assessment and possible need for intervention among SAC. Funding Sources Bill & Melinda Gates Foundation, Centers for Disease Control and Prevention, Eunice Kennedy Shriver National Institute of Child Health and Human Development, HarvestPlus, and United States Agency for International Development.
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Sánchez Martínez, Belkis, Vladimir Vega Falcón, Raúl González Salas, and Leinier Pablo Perón Bayolo. "DIAGNÓSTICO DEL ESTADO DE SALUD DE NIÑOS Y ADOLESCENTES EN UNIDAD EDUCATIVA DE PELILEO." Enfermería Investiga 6, no. 4 (July 3, 2021): 49. http://dx.doi.org/10.31243/ei.uta.v6i4.1205.2021.
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Introducción: El estado de salud pediátrica entre los 0 y 18 años se encuentra en un constante desarrollo, expuestos a múltiples influencias de carácter biológico, ambiental, cultural y conductual. Los cuales pueden convertirse en factores de riesgo, factores protectores o promotores de la salud. Objetivo: Diagnosticar el estado de salud en niños y adolescentes de la Unidad de Deportes y Recreación del Gobierno Autónomo Descentralizado Municipal (GADM) de Pelileo, Ecuador, para la mejora en su calidad de vida. Métodos: Estudio de tipo descriptivo, observacional, prospectivo y transversal, en un periodo de seis meses. La población de estudio constituye una muestra censal 295 alumnos, con edades entre 5 a 18 años, de ambos sexos, con el consentimiento informado de sus padres. Se calculó el Índice de Masa Corporal (IMC) y se aplicó como instrumentos la historia clínica, basada en la entrevista, la observación directa y el examen físico completo Simultáneamente, se brindaron charlas educativas personalizadas, apoyadas con la entrega de material didáctico. Resultados: De la totalidad, 215 resultaron sanos (72,88%) y 80 resultaron enfermos (27,12%), con parasitosis intestinal (35); catarro común (24); alergia (8); escabiosis (5); micosis de la piel (3); neumonías (2); faringitis (2); y amigdalitis (1). Conclusiones: El sexo predominante fue el masculino y con edades entre 5 y 10 años. Con familia de tipo nuclear. El estado nutricional normal ocupa casi la mitad de todos los estudiantes, seguidos del estado de emaciación. Las dos terceras partes fueron sano y solo un cuarto presentó alguna patología, dentro de las cuales, se encontró la parasitosis intestinal, el catarro común. Es importante la educación de la comunidad y padres de familia Palabras clave: educación en salud, adolescentes, alumnos, estado de salud, Índice de Masa Corporal. ABSTRACT Introduction: Pediatric health status between 0 and 18 years of age is in constant development, exposed to multiple biological, environmental, cultural and behavioral influences. Which can become risk factors, protective factors or promoters of health. Objective: To diagnose the health status in children and adolescents of the Sports and Recreation Unit of the Municipal Decentralized Autonomous Government (GADM) of Pelileo, Ecuador, to improve their quality of life. Methods: Descriptive, observational, prospective and cross-sectional study, in a period of six months. The study population constitutes a census sample of 295 students, aged between 5 to 18 years, of both sexes, with the informed consent of their parents. The Body Mass Index (BMI) was calculated and the clinical history was applied as instruments, based on the interview, direct observation and the complete physical examination. At the same time, personalized educational talks were given, supported by the delivery of didactic material. Results: Of the total, 215 were healthy (72.88%) and 80 were ill (27.12%), with intestinal parasites (35); common cold (24); allergy (8); scabies (5); mycosis of the skin (3); pneumonia (2); pharyngitis (2); and tonsillitis (1). Conclusions: The predominant sex was male and aged between 5 and 10 years. With nuclear type family. The normal nutritional status nearly half of all busy students, followed by the emaciated status. Two thirds were healthy and only a quarter presented some pathology, among which was intestinal parasitosis, the common cold. Community and parent education is important Keywords: health education, adolescents, students, health status, Body Mass Index.
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Katuli, Sozina Dora, Zuhair Natto, Lawrence W. Beeson, and Zaida R. Cordero-MacIntyre. "Nutrition Status of Children in Rural and Urban Areas in Ecuador." FASEB Journal 26, S1 (April 2012). http://dx.doi.org/10.1096/fasebj.26.1_supplement.814.5.
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Guevara, Daniela, Samira Reyes, Mariuxi López, Nancy Flores, Santiago Aguirre, Erika Muñoz, Marco Fornasini, and Manuel E. Baldeón. "Impact of milk based micronutrient supplementation in school children in Quito-Ecuador." Nutrición Hospitalaria, November 17, 2017. http://dx.doi.org/10.20960/nh.1353.
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Hajri, Tahar, Viviana Angamarca-Armijos, and Luis Caceres. "Prevalence of stunting and obesity in Ecuador: a systematic review." Public Health Nutrition, July 29, 2020, 1–14. http://dx.doi.org/10.1017/s1368980020002049.
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Abstract Objective: In low- and middle-income countries, undernutrition remains a major risk factor for child growth retardation. In addition, the emergence of obesity in recent years is adding another public health concern in that both stunting and obesity are associated with serious adverse health consequences. This review was designed to evaluate the prevalence of stunting and obesity in Ecuador. Design: Electronic databases were searched for articles published through February 2018 reporting the prevalence of stunting and/or obesity. Selected data were subjected to meta-analysis and pooled prevalence and their 95 percentiles (95 % CI) were calculated. Setting: Studies were identified in Medline, Web of Science, CINAHL, Cochrane Database and Ibero-America databases. Participants: Population of Ecuador. Results: Twenty-three articles were selected according to the inclusion/exclusion criteria of the study. The estimate of pooled prevalence of stunting was 23·2 % (95 % CI 23·3, 23·5) in preschoolers (age < 5 years), but was markedly higher in indigenous and rural communities. Pooled prevalence of obesity was 8·1 % (95 % CI 6·9, 9·3), 10·7 % (95 % CI 9·6, 11·7) and 10·5 % (95 % CI 9·2, 11·8) in preschoolers, school-age children (age: 5–11 years) and adolescent (age: 12–18 years), respectively. In adults (age ≥ 19 years), the rate of obesity was remarkably high as indicated by an overall estimate equal to 44·2 % (95 % CI 43·1, 45·4). Conclusions: This study underlines high levels of stunting among children and obesity among adults in Ecuador, both of which are not equally distributed among the population. The magnitude of this double burden emphasises the need for sustained and targeted interventions.
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Romo, Matthew L., and Victoria Abril-Ulloa. "Improving Nutrition Habits and Reducing Sedentary Time Among Preschool-Aged Children in Cuenca, Ecuador: A Trial of a School-Based Intervention." Preventing Chronic Disease 15 (July 26, 2018). http://dx.doi.org/10.5888/pcd15.180053.
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Verguet, Stéphane, Paulina Limasalle, Averi Chakrabarti, Arif Husain, Carmen Burbano, Lesley Drake, and Donald A. P. Bundy. "The Broader Economic Value of School Feeding Programs in Low- and Middle-Income Countries: Estimating the Multi-Sectoral Returns to Public Health, Human Capital, Social Protection, and the Local Economy." Frontiers in Public Health 8 (December 3, 2020). http://dx.doi.org/10.3389/fpubh.2020.587046.
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Introduction: Globally, there are 370 million children receiving school meals every day. Coverage is least in low-income countries, where the need is greatest and where program costs are viewed as high in comparison with the benefits to public health alone. Here we explore the policy implications of including the returns of school feeding to other sectors in an economic analysis.Methods: We develop an economic evaluation methodology to estimate the costs and benefits of school feeding programs across four sectors: health and nutrition; education; social protection; and the local agricultural economy. We then apply this multi-sectoral benefit-cost analytical framework to school feeding programs in 14 countries (Botswana, Brazil, Cape Verde, Chile, Côte d'Ivoire, Ecuador, Ghana, India, Kenya, Mali, Mexico, Namibia, Nigeria, and South Africa) for which input data are readily available.Results: Across the 14 countries, we estimate that 190 million schoolchildren benefit from school feeding programs, with total program budgets reaching USD11 billion per year. Estimated annual human capital returns are USD180 billion: USD24 billion from health and nutrition gains, and USD156 billion from education. In addition, school feeding programs offer annual social protection benefits of USD7 billion and gains to local agricultural economies worth USD23 billion.Conclusions: This multi-sectoral analysis suggests that the overall benefits of school feeding are several times greater than the returns to public health alone, and that the overall benefit-cost ratio of school feeding programs could vary between 7 and 35, with particular sensitivity to the value of local wages. The scale of the findings suggests that school feeding programs are potentially much more cost-beneficial when viewed from the perspective of their multi-sectoral returns, and that it would be worthwhile following up with more detailed analyses at the national level to enhance the precision of these estimates.
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Lee, Gwenyth O., Cynthia Gutierrez, Nancy Castro Morillo, William Cevallos, Andrew D. Jones, and Joseph NS Eisenberg. "Multiple burdens of malnutrition and relative remoteness in rural Ecuadorian communities." Public Health Nutrition, November 6, 2020, 1–12. http://dx.doi.org/10.1017/s1368980020004462.
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Abstract Objective: Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia. Design: Adult anthropometry was collected through serial case–control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community. Setting: Northern coastal Ecuador. Participants: Adults (n 1665) and children under 5 years of age (n 2618). Results: From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness–OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age. Conclusions: The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.
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Chang, Ana, Julia Finkelstein, Washington Cárdenas, Mildred Zambrano Leal, Joyce Andrade Velasquez, Juan Chang Asinc, Elizabeth Centeno Tablante, Susannah Colt, David Erickson, and Saurabh Mehta. "Malnutrition and Suspected Dengue Virus Infection in Children in Coastal Ecuador (P10-120-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz034.p10-120-19.
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Abstract Objectives To examine the burden of anemia and malnutrition in children presenting with suspected dengue virus infection, as part of our ongoing surveillance program for acute febrile illnesses in Ecuador. Methods A total of 58 children (6 months to 5 y) were recruited in 2018 as part of the surveillance program. Sociodemographic characteristics, clinical signs and symptoms, and anthropometric data were obtained using structured interviews and standardized assessments. Venous blood samples were collected, and hemoglobin was assessed via the sodium lauryl sulfate method. Suspected dengue cases were identified using the World Health Organization dengue severity classification guidelines. Anemia was defined as hemoglobin <110 g/L. Stunting, underweight, and wasting were defined based on their corresponding z-scores: height-for-age z-score (HAZ) <-2, weight-for-age z-score (WAZ) <-2, and weight-for-length z-score (WHZ) <-2, respectively. Overweight and obesity were defined as BMIZ >1 SDs, and BMIZ >2 SDs, respectively. Binomial and linear regressions were used to examine the associations of hemoglobin, anemia, and anthropometric variables with clinical variables among patients presenting with suspected dengue infection. Results Approximately 33% of children were classified as suspected dengue cases and 43% of the children were anemic (median [IQR]: 111 [103, 118] g/L). Additionally, 26% of the cohort presented a fever and the most prevalent symptoms were rash (67%), nausea (43%) and vomiting (31%). Further, 7% of the children were stunted, 3% were underweight, and 5% of children were wasted. Approximately 19% were overweight and 12% were obese. Anemia was associated with an increased likelihood of presenting a rash (P = 0.04) overall as well as within the subset of children not suspected of having dengue viral infection. There were no significant associations noted between nutritional factors and other clinical variables. Conclusions Findings suggest that the prevalence of anemia and overweight were high in children presenting with suspected dengue virus infection in coastal Ecuador. Funding Sources NIH.
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Blackmore, Ivy, Lora Iannotti, and Carolyn Lesorogol. "Nutritional and Livelihood Vulnerabilities Among Indigenous Subsistence Farming Communities in the Andes of Ecuador (P03-001-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz047.p03-001-19.
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Abstract Objectives Characterize the climatic, economic, and natural resource trends associated with nutritional and livelihood challenges for the inhabitants of three rural subsistence farming communities in the Andes of Ecuador. Methods The study utilized a mixed methods approach. In-depth interviews (n = 32), focus groups (n = 3), and structured observations (n = 10) were carried out to yield multiple perspectives on agricultural and food production practices and challenges. A quantitative household survey (n = 109) was used to collect a range of data including consumption and dietary information and anthropometric data for children under 5 years and their mothers. Height and weight measurements were collected using an Infant/Child/Adult ShorrBoard and a Seca digital scale-Model 874. A HemoCue Hb 201 + system was used to determine hemoglobin concentrations. Soil quality tests were conducted at 10 different locations and elevations using Rapitest soil testers. Results The qualitative data suggests that soil degradation linked to land overuse and changing weather patterns have led to decreasing agriculture production and economic hardship. The household survey indicates that families are extremely poor, living on .70 USD per capita per day, and rely on what they produce for the majority of their consumption. These challenges are exacerbated by a lack of support from the local government, as reported by study participants, leading many community members to migrate to cities in search of work. We argue that these trends have had a negative impact on participants’ sense of identity and the health of young children and their mothers. There was a high prevalence of stunting (59.5%), underweight (26.1%), and anemia (78%) in children under 5 years. The anemia prevalence among mothers was 30%. Conclusions Findings show the high prevalence of malnutrition among the study population is linked to agricultural and climatic challenges. The results suggest the need for a transdisciplinary agriculture focused intervention that sustainably improves food production and the populations’ resiliency to climate change. Funding Sources This study was supported by the Global Health Center of the Institute for Public Health and the Center for Dissemination and Implementation Pilot Program at Washington University in St Louis.
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Handal, Alexis J., Betsy Lozoff, Jaime Breilh, and Siobán D. Harlow. "Sociodemographic and nutritional correlates of neurobehavioral development: a study of young children in a rural region of Ecuador." Revista Panamericana de Salud Pública 21, no. 5 (May 2007). http://dx.doi.org/10.1590/s1020-49892007000400004.
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Yu, Emma Xinchun, Anne Williams, O. Yaw Addo, Parminder Suchdev, Junjue Guo, Sanober Ismaily, and Melissa Fox Young. "Association Between Water and Sanitation with Anemia in Preschool Children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project (P10-087-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz034.p10-087-19.
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Abstract Objectives We aimed to assess the associations between water source and sanitation with anemia in preschool children (age: 6–59 months) in 16 population-based surveys. Methods We analyzed data from the BRINDA project. Sixteen surveys, representing 15 countries (n = 25,214), that had measures of hemoglobin, household water source and sanitation, type of residence, and socioeconomic (SES) status were included in this analysis. Anemia was defined as altitude-adjusted hemoglobin concentration <110 g/L. Water source and sanitation were defined as improved household drinking water source and improved toilet facility, respectively. Bivariate analyses were done using Rao-Scott chi-square test (except for age, a continuous predictor using logistic regressions). Multivariable logistic regressions were conducted to examine associations between anemia and water source and sanitation, adjusting for age, sex, rural-urban location, and SES. All analyses were conducted with SAS 9.4, accounting for complex survey design. Results The prevalence of anemia ranged from 20.0% in Nicaragua to 72.1% in Kenya 2010. The prevalence of improved water source and improved sanitation ranged from 44.1% in Laos to 98.4% in Bangladesh, and from 0.1% in Kenya 2007 to 93.7% in Ecuador, respectively. Improved water source alone was protective of anemia in two surveys. Improved sanitation alone was protective of anemia in three surveys. Improved water source alone was negatively associated with anemia in one survey. Improved water source and sanitation combined was protective of anemia in 4 out of 16 surveys, specifically Afghanistan (adjusted OR = 0.55, 95% CI: 0.31–0.96), Azerbaijan (adjusted OR = 0.55, 95% CI: 0.31–0.999), Bangladesh (adjusted OR = 0.03, 95% CI: 0.002–0.28), and Laos (adjusted OR = 0.37, 95% CI: 0.17–0.80). Conclusions Improved household water source and sanitation was inversely associated with anemia in some settings. However, results were not consistent across surveys, and there may be thresholds at which water source and sanitation impacts anemia. Further research is warranted to evaluate the potential mechanisms that explain links between water source and sanitation with anemia. Funding Sources Bill & Melinda Gates Foundation.