Factors associated with stunting in children under 5 years of age in Ecuador: A cross-sectional study from the National Survey on Child Malnutrition

Abstract

Background: In Ecuador, as of 2023, the prevalence of stunting in children under 5 years is 17.5%, exceeding the Latin American average (Freire, 2014; INEC, 2023b). Stunting has extensive implications, encompassing limitations in physical growth, diminished educational achievements, cognitive challenges, and decreased productivity in the workforce, all of which have social, human, and economic repercussions. This study aims to acknowledge the risk factors of stunting in children under 5 years in Ecuador to discuss whether current public policies are addressing it or not. Methods: Secondary data were obtained from a cross-sectional representative survey called as the National Survey on Child Malnutrition (ENDI). A total of 20.758 children under 5 years were included in this study from where dependent variable stunting and independent variables were obtained, analyzing through Chi-square and bivariate logistic regression to examine the factors associated with stunting. Results: The prevalence of stunting obtained in this study is 18.1%. Children in major proportion are males, delivery in public or private facilities, with vaginal delivery representing represents the majority. The complete rotavirus vaccination scheme is 97% and the pneumococcus complete vaccination scheme is 94.9%. Mothers aged between 27 to 49 years represent 61.3% of the total, while the educational level of mothers who have attended Middle or High School represent 47.6%. During pregnancy, 89.3% of the mothers were supplemented with iron and folic acid and attended 4 to 8 visits (66.9%) during pregnancy. Households participating in this study were located in a major proportion of urban areas and presented poverty with low access to safe water and excreta disposal. The findings also revealed that children above one year are 1.94 times more likely to be stunted. Children without a complete vaccination scheme for rotavirus and pneumococcus are respectively 1.07 and 1.03 times more likely to be stunted compared to children with a complete vaccination scheme (OR= 1.07, 95% CI: 0.88-1.34), (OR= 1.04, 95% CI: 0.96-1.14). Children with mothers with no or basic education are 1.99 times more likely to be stunted, compared to mothers with higher education (OR= 1.99, 95% CI: 1.76-2.25), and women aged between 12 to 19 years are 1.17 times more likely to have children with stunting (OR= 1.17, 95% CI: 1.01-1.36). Children born at home or in other places are 1.56 times more likely to be stunted, and having a vaginal birth increases the possibility of stunting by 1.25 times. A lack of supplementation with iron and folic acid during pregnancy increases the possibility of having a stunted child by 1.16 (OR= 1.16, 95% CI: 1.04-1.31), and preterm babies are 2.16 times more likely to be stunted compared to those born on time or post-term (OR= 2.16, 95% CI: 1.91-2.46). Having fewer than 4 prenatal care visits during pregnancy increases the risk of having a stunted child by 1.16 times (OR= 1.61, 95% CI: 1.39-1.87). Conclusion: Factors like age between one to two years, mothers with no or basic education, less than 4 antenatal care visits, pre-term delivery, and no institutional delivery have shown a strong correlation with stunting. Simultaneously, child gender, having diarrhea in the last two weeks, complete vaccination scheme, mother´s age under 27 years, vaginal delivery, no micronutrient supplementation during pregnancy, safe water access, poverty, and rural area are related also in a minor magnitude in Ecuador.