The double burden of malnutrition in Ecuador: the current situation and possible interventions
In our blog, we want to provide more information about the double burden of malnutrition in South America. We also want to highlight different countries to give an insight into the specific situation of the double burden of malnutrition of South American countries. This blogpost will highlight the situation in Ecuador and some interventions the government has already taken in tackling the double burden of malnutrition, as was requested by some readers.
Country overview and health system
Ecuador is located in the northwest of South America, bordering Colombia, Peru, and the Pacific Ocean. The country covers nearly 100,000 square kilometers and has a population of 17.4 million people. Most of Ecuador has historically been part of the Inca empire until it was gradually brought under Spanish rule from 1534. Still, the majority of the population speaks Spanish with a smaller portion speaking indigenous languages. Ecuador is a large exporter of minerals, fish, and agricultural products, making its economy reliant on the primary sector.
The Ecuadorian health system consists of a private and public part. In recent years, universal health coverage and health insurance have been on the rise, making health care more accessible. Renovations in primary care, like a continuation of care in the sector and implementation of integrated programs at the community level, have made it a more sustainable gateway to further health care whilst also strengthening its role in retaining unnecessary care from hospitals and specialized centers. It still, however, has to adapt to the increasing burden of chronic care due to an increase in non-communicable disease, which is to some extent attributable to the double burden of malnutrition. Action for this includes addressing and promoting healthy habits. Lastly, maternal- and childcare is still falling behind, as is, for instance, seen in higher burdens of malnutrition there.
The double burden of malnutrition on different levels
At a population level, as has been discussed in the blogpost on health consequences in Ecuador, the double burden of malnutrition is significant with rates of 23.9% for stunting in children <5 years of age and 70% of the population being overweight/obese (OW/OB). These numbers become less abstract when taken into account that 13.1% of households with an OW/OB mother have at least one stunted child <5 years of age. Similar numbers are found for children with micronutrient deficiency. Lastly, the double burden can even occur within one individual, with about 10% of OW/OB children being micronutrient deficient and 2.8% being stunted. For adult women with OW/OB, about 20% is micronutrient deficient. All these statistics show that interventions meant to tackle the double burden of malnutrition should not solely focus on each aspect as a single entity but rather suggest an integrated approach.
Intervention for the double burden of malnutrition
Ecuador has been taking steps in tackling undernutrition for a while by setting up feeding programs for children and pregnant women, promoting breastfeeding, and micronutrient supplement provision. This is all overlooked by the ‘Sistema Integral de Alimentación y Nutrición’, tasked with monitoring and implementing undernutrition policies. However, interventions addressing the burden of OW/OB are quite new. The Ecuadorian government has recently implemented new policies, aiming to ultimately eradicate stunting and reduce childhood OB/OW to less than 25% by 2025. The section on OW/OB states that this is to be pursued through physical activity and healthy food programs in schools, taxes on high-sugar food and drink, and a traffic light labeling system putting foods in healthy to unhealthy categories. Though ambitious, it is a good start and shows that the government is willing to step up and tackle the problem of the double burden of malnutrition and its public health consequences. Interventions tailored to OW/OB adults could be integrated into the primary care system and its community ties, for instance by promoting exercise in groups and supplying information on healthy food, as is already happening in schools. Research conducted in focus groups in Ecuador has found that most people already recognize the importance of a healthy diet. However, easy accessibility to processed food, perceptions of food safety, financial security, and self-control were identified as factors inhibiting the transition to a healthier diet. These factors, distinctive for Ecuador, should be taken into account when creating policies for tackling OW/OB in adults and children. When combined with policies already set in place for undernutrition and micronutrient deficiency, it is hoped that the double burden of malnutrition will pose a lesser risk for the health of the Ecuadorian population in the future.
