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Community factors associated with stunting, overweight and food insecurity: a community-based mixed-method study in four Andean indigenous communities in Ecuador
  1. Jemie Walrod1,
  2. Erica Seccareccia1,
  3. Iván Sarmiento1,
  4. Juan Pablo Pimentel1,
  5. Shivali Misra1,
  6. Juana Morales2,
  7. Alison Doucet1,
  8. Neil Andersson1
  1. 1 Department of Family Medicine, McGill University, Montreal, Canada
  2. 2 Indigenous Community of Chilcapamba, Chilcapamba, Ecuador
  1. Correspondence to Iván Sarmiento; ivan.sarmiento{at}


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.

  • nutrition
  • pediatric obesity
  • feeding behavior
  • life style
  • community child health
  • epidemiology

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  • JW and ES contributed equally.

  • Contributors ES and JW contributed equally to the project and were involved in project design, securing funding in 2014 and ethical approval in 2014. They were also responsible for data collection in the communities of Iltaqui, Morales Chupa and Arrayanes in 2014. Both authors administered the questionnaire along with the CHW and facilitated the discussion groups with the support of JM. They also drafted the original manuscript with the support of IS (Methods and Results sections) and JPP (Background and Discussion sections). IS led the statistical analysis with CIETmap and the Mantel Haenszel procedure. IS and JPP reviewed the qualitative data and edited the results section. JW, ES and IS addressed reviewers' comments. SM developed the original questionnaire in 2013 and applied for funding and ethical approval in 2013; she administered the questionnaire along with the CHW in Chilcapamba in 2013. JM was the leader of the CHW at the time of the project; she organised and assisted in data collection (2013 and 2014); she reviewed the questionnaires to ensure acceptance by communities and compatibility with local language and facilitated the discussion groups; she contributed particularly to the review of the Methods section of this manuscript and presented the results in Spanish and Kichwa to the involved communities. AD, in discussion with the CHW, initiated the study and was involved in project design and development. NA guided the data analysis and edited the manuscript.

  • Funding The study was funded by CIHR Health Professional Student Research Award, Clarke K McLeod Memorial Scholarship, Ivan Racheff Scholarship and Sir Edward W Beatty Memorial Scholarships. ES was funded by the CIHR Health Professional Student Research Award and the Clarke K McLeod Memorial Scholarship. JW was funded by the Ivan Racheff Scholarship. SM was funded by the Clarke K McLeod Memorial and Sir Edward W Beatty Memorial Scholarships. Funding was used for travel costs for the primary investigators. The authors thank the Global Health Program at McGill’s Department of Family Medicine for its contribution to the financing of this publication.

  • Disclaimer The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Internal Review Board of McGill University approved this study and its use of human subjects (IRB Study Number A04-B11-12B). We attest that we have obtained appropriate permissions and paid any required fees for use of copyright protected materials.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated during or analysed during the current study will be available upon request from the corresponding author. Before the information can be shared, the requester will need to present a plan for data analysis. Also, the requester will need to complete the procedure for ethical approval of the secondary analysis following the procedures defined by McGill University’s Institutional Review Board and the agreements with communities to ensure the protection of the participants.

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