Improving nutrition should start from pregnancy planning, during gestation and the first years of life, to enhance children’s development and opportunities to thrive.
According to information from the National Health and Nutrition Survey (Ensanut) of 2018, 23% of children under the age of five suffer from chronic childhood malnutrition (DCI), a figure that rises to 27.2% among infants up to two years of age. Also, 11% of babies with low birth weight are registered (Unicef, 2021).
On the other hand, Overweight and obesity in boys and girls aged 5 to 11 years is 35.4% with a higher prevalence in urban areas, according to the 2018 ENSANUT. In Ecuador we see at the same time two faces of malnutrition, which are malnutrition and overweight. This despite the more than ten programs related to health and nutrition that have been implemented without offering improvements.
Among the immediate determinants for malnutrition are lack of access to food, inappropriate eating practices, lack of water and sanitation, and lack of access to quality health services. At this level there are opportunities to work with communities at the individual and collective level to transform and empower on good eating habits.
Then, if we look for the structural determinants of the DCI, we will see that poverty and inequality, climate change, sociocultural and political contexts are originally the areas to intervene from public policy and the role of the state and society. All this configures a situational state of the DCI that allows a comprehensive approach to the problem.
Malnutrition and being overweight
The UNICEF Glossary of Terms on Malnutrition defines Childhood Chronic Malnutrition (DCI) as a pathological state resulting from a diet deficient in one or more essential nutrients or poor assimilation of food. It causes a delay in height for age and is usually associated with situations of poverty, causing consequences during learning and subsequent productive performance and causing a higher prevalence of diseases such as diabetes and cardiovascular diseases.
It is important to understand that DCI is a consequence of malnutrition. According to the World Health Organization (WHO), this term refers to the deficiency, excesses and imbalances in a person’s caloric and nutrient intake. Both chronic malnutrition, overweight and obesity are conditions that come from poor nutrition.
The consequences of malnutrition begin in childhood, however it is important to take into account that adult men and women and adolescents are also exposed to poor nutrition and its consequences.
Within these groups, pregnant women require special attention, since the overall health of the unborn baby depends on the nutritional status of the mother. It should be emphasized that pregnancy, and especially the first three months of gestation, are key to combat both malnutrition and overweight.
Malnutrition must be combated from the planning stage of pregnancy
The Intersectoral Strategic Plan for the Prevention and Reduction of Chronic Childhood Malnutrition prepared in this year 2021, indicates that 17 out of 100 mothers of girls and boys under 2 years of age did not attend the 5 minimum recommended controls during pregnancy.
Likewise, 20 out of every 100 mothers with children under 2 years of age diagnosed with ICD did not attend the 5 minimum recommended check-ups during pregnancy. On the other hand, many health services do not take into account the nutritional status of the mother during pregnancy. Finally, of the total number of children born in 2018, 8.9% registered low birth weight, that is, less than 2,500 grams according to the latest Ensanut report. However, the statistics of the Unicef’s Child Nutrition Report 2021 , point to 11.1% of children in Ecuador with low birth weight.
Thus, the importance of improving nutrition during pregnancy and the first years of life is highlighted. It is important to emphasize that good nutrition in pregnancy depends on the nutritional status of the mother and also the father, so it is important to maintain healthy habits permanently, with emphasis on the planning stage of pregnancy to be able to detect early certain deficiencies that may be corrected.
The WHO in its Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (2014) emphasizes that a sufficient supply of nutrients, from the first stages of life, “is decisive for a good physical and mental development and to enjoy in good health for a long time ”.
This document explains that low body mass indexes and short stature in women, which are highly prevalent in low-income countries, can cause poor fetal development, increasing the risk of complications during pregnancy. Some of them are preterm birth, low birth weight that is less than 2.5 kg; insufficient weight – 2.5 to 3 kg; intrauterine growth restriction.
In the cases of women who begin pregnancy with a body mass index greater than 30 kg / m2 (Body mass index, weight in kilograms is divided by the square of height in meters kg / m 2 ), the risk of complications such as hypertension and diabetes is increased during pregnancy and childbirth. For the newborn, there are risks of metabolic disorders such as hypoglycemia, hypocalcemia; shortness of breath; Low Apgar and death of the baby after birth. In adult life, there is a greater tendency to cardiovascular diseases, diabetes and obesity.
Worldwide, iron deficiency anemia affects 33% of women of childbearing age and 40% of pregnant women according to WHO data as of 2020. According to these estimates, each year 13 million children are born affected by intrauterine growth retardation and some 20 million underweight, that is, weighing less than what would correspond to their age. (PAHO / WHO Comprehensive Application Plan on Maternal, Infant, and Young Child Nutrition , 2014).
In Ecuador, anemia affects 23.9% of women of reproductive age and 32.8% of pregnant women, according to the World Nutrition Report 2020 , in its section for the Andean subregion.
Prevention of child malnutrition
The prevention of this condition must start from the planning of the pregnancy, so the optimal nutritional status of the couple and especially the mother, is key to taking care of their health and that of the baby. Medical check-ups before and follow-up during pregnancy play a fundamental role in the fight against the consequences of malnutrition.
Since Ecuador is the second country in the Andean region with the highest rate of adolescent pregnancy, according to data from the National Institute of Statistics and Censuses (INEC), it records that 148 adolescents between the ages of 15 and 19 gave birth daily in 2017. (Socioeconomic consequences of adolescent pregnancy in Ecuador, Unicef-UNFPA, 2020), attention should focus on the health status of adolescent mothers.
These pregnancies are considered risky and in many cases do not include adequate planning and nutrition of the father and mother. In addition, adolescents are in a growth stage, so the mother’s nutritional deficiencies will directly impact the fetus. This, above all, can be a problem in adolescent mothers who live in poverty, with problems of access to food, or when due to social pressures the pregnancy is hidden and timely medical attention is not sought.
This is a situation that reflects the vicious cycles of poverty and malnutrition. From the Waal Foundation (FdW), we intervene in educational, awareness and empowerment processes in groups of professionals, community leaders, adolescents and men and women of reproductive age in order to promote reflection on the importance of planning pregnancy and promoting habits healthy.
We promote care during pregnancy and the beginning of immediate and exclusive breastfeeding during the first six months of life, to continue with the supply of nutrients to the baby, avoiding malnutrition in childhood. For this reason, we insist that adequate nutrition in pregnancy and lactation are essential to allow, in addition, the infant’s potential to be expressed, preventing diseases and deficiencies and strengthening its proper development.
The monitoring of nutrition in childhood is also key, with the priority care strategy in the first 1000 days of life, since this will allow for early interventions and timely corrections in the case of diagnosing child malnutrition.
In recent days, the Waal Foundation (FdW) together with Asociación Vivir, CARE, ChildFund, ESQUEL, Plan International, Redni Ecuador and World Vision presented “Alliance for Child Nutrition in Ecuador” (APNIE). This initiative arises from civil society to contribute to the eradication of Chronic Child Malnutrition (DCI) in Ecuador and in this way ensure a comprehensive and healthy development from the beginning of life, in compliance with the national goals and Objectives of Sustainable Development (ODS).
During the presentation of this proposal, it was emphasized that the fight against malnutrition needs an approach to the root causes at the macro-economic, political and cultural levels, with special attention to the geographic areas and population groups most affected. The geneticist and mediator of the FdW, Juan Eli Galarza, indicated that “adequate nutrition in pregnancy and lactation of the mother and child is key to allow the genetic potential of the individual to be expressed, strengthening each of their organs and allowing adequate development and growth ”.
From the Alliance for Child Nutrition in Ecuador, a call is made to all public and private organizations, international cooperation agencies and local and national authorities to join forces to combat DCI and work from different areas of experience for girls and most vulnerable children in the country
SOURCES
National Health and Nutrition Survey (Ensanut) , MSP, 2018
Child Nutrition Report 2021 , Unicef
Unicef Glossary of Terms on Malnutrition.
Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition , WHO, 2014.
Intersectoral Strategic Plan for the Prevention and Reduction of Chronic Child Malnutrition , Technical Secretariat Ecuador grows without Malnutrition, 2021.
Global Nutrition Report, 2020,
Socioeconomic consequences of adolescent pregnancy in Ecuador , Unicef-UNFPA, 2020
