Risk factors associated with chronic childhood malnutrition in children under two years of age in Ecuador. Systematic review (2018-2024)

Abstract

Introduction: Chronic malnutrition in children under two years of age in Ecuador constitutes a public health emergency with serious implications for physical, cognitive, and social development. Despite government efforts, the country maintains one of the highest rates in Latin America. This systematic review aimed to analyze the main factors associated with chronic malnutrition in this vulnerable population during the period 2018–2024. Objective: A systematic review was conducted following PRISMA guidelines in PubMed, SciELO, Scopus, LILACS, and Google Scholar. The PICO strategy was applied: Population (children under two years of age), Intervention/Exposure (social determinants/programs), Comparison (vulnerable contexts), Outcome (prevalence of chronic malnutrition). Quality was assessed using AMSTAR-2. Thirteen articles were included. Results: The main factors associated with chronic malnutrition in children under two years of age were: low maternal education, extreme poverty, adolescent pregnancy, lack of access to basic services, inadequate prenatal care, inadequate complementary feeding, and belonging to indigenous groups. The Andean provinces and rural areas showed a higher prevalence, exceeding 35% in some cases. Discussion: Malnutrition in children under two years of age reflects profound structural inequalities. Early intervention in the first 1,000 days of life, including exclusive breastfeeding, nutritional supplementation, and targeted policies, is essential to reduce its prevalence. Conclusion: A sustained, territorially contextualized, multisectoral approach is required.