Determinants of child malnutrition in rural and urban Ecuadorian highlands

Objective: To identify and compare the sociodemographic determinants of stunting, wasting and overweight among infants of urban and rural areas in the Ecuadorian highlands. Design: Cross-sectional study. Setting: Nabon (rural) and Cuenca (urban) cantons, Azuay Province, Ecuador. Subjects: A total of 703 children aged 0-24 months and their caregivers (227 rural and 476 urban) recruited during the period from June to September 2008. Results: Stunting prevalence was significantly higher in the rural area (37.4 % v. 17.7 %; P < 0.001) while wasting (7.1 %) and overweight (17.1 %) prevalence were more similar between areas. Determinants of stunting for the pooled sample were male gender (OR = 1.43; 95 % CI 1.06, 1.92; P = 0.02), preterm delivery (OR = 1.65; 95 % CI 1.14, 2.38; P = 0.008), child's age (OR = 1.04; 95 % CI 1.01, 1.07; P = 0.011), maternal education (OR = 0.95; 95 % CI 0.92, 0.99; P = 0.025) and facility-based delivery (OR = 0.57; 95 % CI 0.45, 0.74; P < 0.001). The latter was also a determinant of overweight (OR = 0.39; 95 % CI 0.25, 0.62; P < 0.001). Rural determinants of stunting were maternal height (OR = 0.004; 95 % CI 0.00004, 0.39; P = 0.018), diarrhoea prevalence (OR = 2.18; 95 % CI 1.13, 4.21; P = 0.02), socio-economic status (OR = 0.79; 95 % CI 0.64, 0.98; P = 0.030) and child's age (OR = 1.07; 95 % CI 1.02, 1.11; P = 0.005). Urban determinants were: maternal BMI for stunting (OR = 0.91; 95 % CI 0.84, 0.99; P = 0.027), cough prevalence (OR = 0.57; 95 % CI 0.34, 0.96; P = 0.036) and facility-based delivery (OR = 0.25; 95 % CI 0.09, 0.73; P = 0.011) for overweight, and hygiene for wasting (OR = 0.57; 95 % CI 0.36, 0.89; P = 0.013). Conclusions: Infant malnutrition was associated with different sociodemographic determinants between urban and rural areas in the Ecuadorian highlands, a finding which contributes to prioritize the determinants to be assessed in nutritional interventions.