Community factors associated with stunting, overweight and food insecurity: a community-based mixed-method study in four Andean indigenous communities in Ecuador

BMJ Open. 2018 Jul 6;8(7):e020760. doi: 10.1136/bmjopen-2017-020760.


Objectives: We 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.

Design: We 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.

Setting: The 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.

Participants: Anthropometric 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 measures: Primary outcomes were stunting, overweight, food insecurity and their relationship with demographics, dietary habits and agricultural habits.

Results: Of 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.

Conclusion: Many indigenous communities face tumultuous cultural, nutritional and epidemiological transitions. Community-based interventions on factors identified here could mitigate negative health outcomes.

Keywords: community child health; epidemiology; feeding behavior; life style; nutrition; pediatric obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Agricultural Irrigation
  • Animals
  • Body Height
  • Body Weight
  • Chenopodium quinoa
  • Child
  • Child, Preschool
  • Community-Based Participatory Research
  • Diet
  • Ecuador / epidemiology
  • Feeding Behavior
  • Female
  • Focus Groups
  • Food Supply / statistics & numerical data*
  • Growth Disorders / ethnology*
  • Humans
  • Income
  • Infant
  • Literacy
  • Livestock
  • Male
  • Overweight / ethnology*
  • Population Groups
  • Residence Characteristics*
  • Surveys and Questionnaires

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