ISSN 3028-8940

JULY-DECEMBER 2025;2(2):67-78

RIGINAL ARTICLE https://doi.org/10.36097/rgcs.v2i2.3190

San Gregorio de Portoviejo University | Ecuador 67

Childhood malnutrition in patients aged 0 to 9 years attending the Miraflores Health

Center in Ecuador

Desnutrición infantil en pacientes de 0 a 9 años de edad que acuden al Centro de Salud Miraflores en

Ecuador

Daniel J. Alarcón

* , Daniel A. Briones

, Isaac E. Intriago

Mario A. García

, Lissette B. Villavicencio

Carrera de Medicina, Universidad San Gregorio de Portoviejo, Manabí, Ecuador.

Unidad Educativa Cristo Rey, Portoviejo, Manabí, Ecuador.

*Corresponding author

Reception: 11-05-2025 Acceptance: 30-06-2025 Publication: 31-07-2025

ABSTRACT

Child malnutrition is a public health issue that affects children's growth and development, particularly in vulnerable

communities. This study aimed to analyze nutritional conditions and associated factors in children aged 0 to 9 years

attending the Miraflores Health Center in Manabí, Ecuador. A cross-sectional, descriptive, and observational study

was conducted from May to September 2024 with a non-probabilistic convenience sample of 52 caregivers. Data

collection involved structured surveys and an interview with healthcare personnel. Findings revealed poor dietary

quality among children, characterized by high intake of carbohydrates and dairy products, and low consumption of

fruits and vegetables. Most caregivers also showed limited knowledge of child nutrition. These results underscore the

need to strengthen educational and community-based interventions that promote healthy eating practices from early

childhood.

Keywords: child malnutrition, child nutrition, nutritional education, public health.

RESUMEN

La desnutrición infantil es un problema de salud pública que afecta el crecimiento y desarrollo de los niños,

especialmente en comunidades vulnerables. El objetivo de este estudio fue analizar las condiciones nutricionales y los

factores asociados en niños de 0 a 9 años que asisten al Centro de Salud Miraflores, en Manabí, Ecuador. Se llevó a

cabo una investigación transversal, descriptiva y observacional entre mayo y septiembre de 2024, con una muestra no

probabilística por conveniencia de 52 cuidadores. Se aplicaron encuestas estructuradas y una entrevista a personal

sanitario. Los resultados evidenciaron deficiencias en la calidad de la alimentación infantil, marcada por un consumo

elevado de carbohidratos y lácteos, junto a una baja ingesta de frutas y verduras. Asimismo, se detectó un nivel

limitado de conocimiento nutricional en la mayoría de los cuidadores. Estos hallazgos ponen de manifiesto la

necesidad de fortalecer las intervenciones educativas y comunitarias que promuevan prácticas alimentarias saludables

desde las primeras etapas de vida.

Palabras clave: desnutrición infantil, alimentación infantil, educación nutricional, salud pública.

Cite as: Alarcón, D. J., Briones, D. A., Intriago, I. E., García, M. A., & Villavicencio, L. B. (2025). Childhood malnutrition in

patients aged 0 to 9 years attending the Miraflores Health Center in Ecuador. Revista Gregoriana de Ciencias de la Salud, 2(2),

67-78. https://doi.org/10.36097/rgcs.v2i2.3190

Childhood malnutrition in patients aged 0 to 9 years attending the Miraflores Health Center in Ecuador

Alarcón, Briones, Intriago, García, & Villavicencio

68 San Gregorio de Portoviejo University | Ecuador

INTRODUCTION

Childhood malnutrition constitutes one of the main challenges to global public health,

severely affecting children's physical, cognitive, and social development. According to the World

Health Organization (2024), nearly 45% of deaths in children under five are related to nutritional

disorders. This problem is predominantly concentrated in developing countries, where factors such

as poverty, food insecurity, and limited access to health services exacerbate its impact.

Childhood malnutrition remains a critical problem in Latin America, significantly affecting

child growth and development. In the region, the prevalence of chronic malnutrition varies widely

across countries, with some nations showing alarming rates exceeding 40% in vulnerable

populations. Factors contributing to this problem include food insecurity, limited access to health

services, lack of nutrition education, and socioeconomic inequalities. Recent studies have

identified that, despite public health policy efforts, malnutrition continues to disproportionately

affect indigenous and rural communities, where access to adequate food is more limited (Durán et

al., 2022).

Ecuador is no stranger to this problem: the prevalence of chronic malnutrition in children

under five reaches 23.2%, with rural and peri-urban areas being the most affected due to adverse

socioeconomic conditions and difficulties in accessing nutritious food and drinking water

(Balladares et al., 2023).

The community of Miraflores, situated in a peri-urban area of Manabí province, serves as

a microcosm of this problem. With a population of approximately 3,573 people, 625 of whom are

children between the ages of 0 and 9, this community faces limitations in health infrastructure,

access to basic services, and economic resources, which contribute to the development of

childhood malnutrition. Although specific epidemiological data for Miraflores are not available,

the social and economic characteristics of the region suggest that the prevalence of malnutrition

could be comparable to or even higher than the national average.

Regarding the consequences of malnutrition, it is essential to highlight that during

childhood and preschool age, there may be a delay in growth and psychomotor development, as

well as an increased risk of morbidity with long-term adverse effects. These effects may include a

decrease in the capacity to perform physical work and in intellectual performance in school age,

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San Gregorio de Portoviejo University | Ecuador 69

adolescence, and adulthood, which can affect the individual's ability to generate income,

perpetuating the cycle of poverty and inequality in vulnerable communities (Cortez & Pérez,

2023).

In this context, it is essential to generate scientific evidence to characterize the nutritional

status of children in Miraflores, identify associated risk factors, and design effective intervention

strategies. The objective of this study was to analyze nutritional conditions and associated factors

in children aged 0 to 9 years attending the Miraflores Health Center in Manabí, Ecuador.

METHODOLOGY

This study employed a quantitative, cross-sectional, descriptive, and observational design.

The purpose of this study was to determine the prevalence of childhood malnutrition and explore

associated factors in the community of Miraflores, located in the 24 de Mayo canton, Manabí

province, Ecuador. The research was conducted between May and September 2024.

The target population consisted of 625 children aged 0 to 9 years who attended the

Miraflores Health Center during the study period. Non-probability convenience sampling was

employed for sample selection, resulting in a final sample size of 52 participants, determined by

the availability and informed consent of caregivers.

The following inclusion criteria were established: (i) children aged 0 to 9 years whose legal

caregivers voluntarily agreed to participate by signing an informed consent form; and (ii)

permanent residence in the community of Miraflores. The exclusion criteria were: (i) children with

serious chronic illnesses or metabolic conditions that influenced their nutritional status; (ii) those

receiving specialized nutritional treatment; and (iii) caregivers who did not adequately complete

the data collection instrument. Forms with incomplete or inconsistent information were considered

for elimination.

Data collection was conducted through structured surveys addressed to the children's

caregivers, designed to identify eating habits, meal frequency, food groups consumed,

breastfeeding practices, and level of knowledge about child nutrition. Experts in public health and

child nutrition previously validated the surveys. Additionally, a semi-structured interview was

conducted with a Primary Health Care Technician (TAPS) from the 24 de Mayo Health Center to

complement the epidemiological information on malnutrition in the community.

The data were coded and organized into analytical matrices using Microsoft Excel. The

Childhood malnutrition in patients aged 0 to 9 years attending the Miraflores Health Center in Ecuador

Alarcón, Briones, Intriago, García, & Villavicencio

70 San Gregorio de Portoviejo University | Ecuador

statistical analysis was descriptive, calculating absolute and relative frequencies. The results were

presented in tables and graphs for ease of interpretation. No inferential tests were applied due to

the exploratory nature and small sample size.

This study was conducted in compliance with the ethical principles established in the

Declaration of Helsinki. The confidentiality, anonymity, and voluntary participation of participants

were guaranteed at all times. Participation was preceded by the signing of an informed consent

form by the children's legal guardians.

RESULTS AND DISCUSSION

Table 1 shows the proportion of children with and without malnutrition in this community.

To obtain the prevalence of this data, an interview was conducted with the Primary Health Care

Technician (TAPS) at the 24 de Mayo Health Center. The table shows the absolute frequency and

percentage of children with and without malnutrition. Of a total of 625 children evaluated, 12 cases

of childhood malnutrition were identified, equivalent to 1.9% of the study population. In contrast,

613 children (98.1%) showed no signs of malnutrition.

Table 1. Prevalence of child malnutrition in the Miraflores community in Manabí, Ecuador

Prevalence of malnutrition

Absolute

frequency

Percentage

Cases of child malnutrition

1.9

Children without malnutrition

613

98.1

Total

625

100

Although the percentage of malnutrition detected is relatively low (1.9%), this figure is

still significant from a public health perspective, as malnutrition in childhood is directly linked to

growth retardation, cognitive impairment, and increased vulnerability to infectious diseases. The

Miraflores community faces socioeconomic challenges that could impact child nutrition.

The results obtained in the Miraflores community indicate that the prevalence of childhood

malnutrition is 1.9%, a considerably lower figure compared to recent studies on chronic childhood

malnutrition in Ecuador. Alcocer & Masaquiza (2024) analyzed ICD in children under 24 months

of age and found that 14 children in their sample presented indicators of chronic childhood

malnutrition, evidencing a significantly higher incidence. These cases included six boys and eight

girls with short stature or severe stature, reflecting the complexity of this problem. On the other

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San Gregorio de Portoviejo University | Ecuador 71

hand, Bonilla & Noriega (2023) showed that ICD has been a persistent problem in Ecuador since

1993, with an increase from 24.8% in 2014 to 27.2% in 2018 among children under 2 years of age.

Table 2 shows the distribution of different infant feeding methods in the Miraflores

community. Data were obtained through a survey of caregivers of children participating in the

study. 59.6% of the surveyed population (31 people) opted for a mixed feeding, combining

breastfeeding and formula. 28.8% (15 people) practiced exclusive breastfeeding, while only 11.5%

(6 people) exclusively used formula.

Table 2. Infant feeding in the first 2 years of life

Type of feeding Absolute frequency Percentage

Breastfeeding

28.8

Formula milk

11.5

Mixed feeding

59.6

Total

100

These data suggest that, although breastfeeding is valued, most mothers in the community

opt for a mixed approach. This pattern may be related to various factors, such as maternal return

to work, perceptions of insufficient breast milk, medical recommendations, and a lack of education

on exclusive breastfeeding. Exclusive breastfeeding for the first six months of life is recommended

by the WHO (2024) as it provides infants with antibodies and essential nutrients, thereby reducing

the risk of infections and diseases.

These results partially align with those obtained in the study by Montoya and Salinas

(2023), who analyzed complementary feeding and physical-psychomotor development in children

participating in the "Growing with Our Children" program. Their research revealed that 51.85%

of children received adequate complementary feeding, while 48.15% had inadequate practices.

Although their study did not specifically focus on the combination of feeding methods, their

findings reinforce the importance of an adequate start and transition in infant feeding to prevent

nutritional imbalances and malnutrition.

On the other hand, Arimijo et al. (2024) conducted a research study evaluating nutritional

education among parents and caregivers of infants at two health centers in Ecuador. They found

that before the intervention, 78.5% of parents had basic knowledge about complementary feeding,

while after nutritional education, the percentage increased to 89.1%. This data is relevant because

Childhood malnutrition in patients aged 0 to 9 years attending the Miraflores Health Center in Ecuador

Alarcón, Briones, Intriago, García, & Villavicencio

72 San Gregorio de Portoviejo University | Ecuador

it shows that caregivers' level of expertise directly impacts decisions about infant feeding. In the

case of Miraflores, the predominance of mixed feeding may be influenced by a lack of education

about the benefits of exclusive breastfeeding and a limited awareness of nutritional

recommendations.

This is important because nearly 60% of mothers in Miraflores combine breastfeeding with

formula, indicating a need to strengthen strategies that promote exclusive breastfeeding and

improve access to information about its benefits. This could be achieved through health education

programs and community support for breastfeeding mothers.

Table 3 illustrates the distribution of the number of daily meals received by children in the

Miraflores community, as perceived by their caregivers. More than half of the respondents (55.8%,

29 people) reported that their children consume three meals a day. 19.2% (10 people) mentioned

that their children receive five meals a day. On the other hand, 11.5% (6 people) indicated that

their children receive two or four meals a day, while 1.9% (1 person) reported receiving only one

meal a day.

Table 3. Daily feeding frequency of the infant

Daily amount of food Absolute frequency Percentage

One meal

1.9

Two meals

11.5

Three meals

55.8

Four meals

11.5

Five meals

19.2

Total

100

The fact that most children receive three meals a day is encouraging, as this allows for

adequate basic nutrition. However, variability in the number of meals may be influenced by

socioeconomic factors, caregivers' education level, and food availability. The 19.2% of children

who receive five meals suggests the inclusion of snacks, which is positive if they consist of

nutritious foods. However, the 11.5% who receive only two or four meals and the 1.9% who

consume only one meal raise concerns about potential nutritional deficiencies or food insecurity

in specific households.

These results can be compared with those of a study conducted by Alonzo et al. (2024),

who analyzed the sociocultural factors influencing chronic malnutrition in children aged 1 to 3.

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San Gregorio de Portoviejo University | Ecuador 73

Their research reported that 58.18% of the children in their study consumed three meals a day,

which coincides with the results obtained in Miraflores. However, the same survey identified that

5.45% of the children received only two meals a day, which demonstrates the persistence of

inadequate nutritional practices in specific vulnerable populations.

Limited access to a balanced diet is a key risk factor for chronic childhood malnutrition,

affecting children's physical and cognitive development. The similarity between the two studies

highlights the importance of promoting nutrition education programs for caregivers to improve the

frequency and quality of children's meals.

Table 4 presents the number of different food groups and classifications in the children's

diet within the Miraflores community. It was found that 86.5% of respondents (45 people) reported

including carbohydrates in their children's diet, which is the most commonly consumed food

group. Traditional dietary patterns may influence the predominance of carbohydrates in children's

diets in the region. According to a recent analysis of the energy density of typical Manabí dishes,

they tend to be rich in simple carbohydrates and fats, which could explain their frequency in

children's diets (Alvarado et al., 2021; Alvarado & Zambrano, 2023).

Table 4. Food groups included in the infant's diet

Food group Absolute frequency Percentage

Fruits

38.5

Vegetables

67.3

Carbohydrates

86.5

Proteins

48.1

Dairy

76.9

Processed foods

19.2

Sausages

23.1

Carbonated drinks

5.8

Dairy products are the next most common, present in 76.9% (40 people), followed by

vegetables, which are consumed by 67.3% (35 people) of the children. As for fruits, their

consumption is 38.5% (20 people). Low consumption of fruits and vegetables can affect the

antioxidant capacity of children's diets, compromising their defense mechanisms against oxidative

stress, a topic widely discussed in recent literature on redox balance in the diet (Forbes-Hernández

et al., 2020). The tendency toward diets lacking fruits and vegetables is not limited to childhood.

Childhood malnutrition in patients aged 0 to 9 years attending the Miraflores Health Center in Ecuador

Alarcón, Briones, Intriago, García, & Villavicencio

74 San Gregorio de Portoviejo University | Ecuador

Studies with young university-aged populations have demonstrated suboptimal levels of

antioxidant quality in the diet, suggesting a persistence of poor eating habits from early stages

(Forbes-Hernández et al., 2021).

Three people (5.8%) indicated that their children consume carbonated beverages. On the

other hand, 19.2% (10 people) mentioned that their children consume processed foods, while

23.1% (12 people) include sausages in their children's diet. The inclusion of sausages in children's

diets is a cause for concern due to their high sodium and saturated fat content, as well as additives

such as sodium nitrite, the use of which has been the subject of technological reformulations aimed

at improving nutritional quality and reducing health risks. Studies, such as those by García et al.

(2011), have proposed partially replacing nitrite with biopolymers, such as chitosan, showing

positive effects on product quality without compromising food safety.

These results are consistent with the study conducted by Solorzano et al. (2020), who

analyzed micronutrient intake in children aged 6 to 24 months in Ecuador. Their research revealed

that 42% of the reviewed studies reported significant deficiencies in the intake of essential

nutrients, including iron, vitamin A, and folic acid, which have a direct impact on child growth

and development. Furthermore, the study highlights the importance of increasing access to

micronutrient-rich foods, as many diets in the country lack variety and primarily focus on staple

foods with low nutritional value.

Likewise, the study by Rodríguez et al. (2024) reinforces these findings, highlighting that

the lack of access to nutritious foods and the prevalence of monotonous diets in the child

population are associated with an increased risk of anemia and chronic malnutrition. In their

analysis of children treated at the Rocafuerte Health Center in Manabí, they found that diets high

in carbohydrates and low in protein and vegetables are associated with lower physical development

and a higher incidence of metabolic diseases.

Table 5 presents the level of knowledge that caregivers in the Miraflores community have

about nutritional recommendations, revealing that 37.7% of respondents (20 people) reported

being familiar with dietary recommendations for their children. In comparison, 60.4% (32 people)

indicated that they are not familiar with these guidelines.

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San Gregorio de Portoviejo University | Ecuador 75

Table 5. Nutritional knowledge of the caregiver towards the infant

Level of knowledge Absolute frequency Percentage

Aware of nutritional recommendations

37.7

Not aware of nutritional recommendations

60.4

Total

100

These critical results suggest that most caregivers lack adequate information about child

nutrition, which can negatively impact children's nutrition and development. A lack of nutrition

education can lead to poor diets, lower consumption of essential foods, and increased dependence

on ultra-processed products.

The study by Barreno-Sánchez et al. (2020) showed that children's poor nutrition is not

only due to a lack of access to healthy foods but also to inadequate nutritional education among

caregivers. This pattern is similar to what was observed in Miraflores, where a lack of knowledge

about dietary recommendations could be affecting the quality of children's nutrition.

On the other hand, the study by Montoya and Cumbicus (2024) showed that 70% of parents

had inadequate knowledge about child nutrition, which was reflected in inappropriate feeding

practices. In this context, the Miraflores community has higher levels of expertise compared to this

study; however, a considerable proportion of caregivers remain inadequately informed. The lack

of nutritional education contributes to the maintenance of poor eating habits, which in the long

term can lead to malnutrition and dietary deficiencies in children. Early nutritional deterioration

can impact the quality of life in later stages of life, as observed in older adults with a history of

chronic childhood malnutrition, where functional capacities and autonomy are compromised

(Angulo et al., 2024).

CONCLUSIONS

Although the prevalence of childhood malnutrition in the Miraflores community (1.9%)

was lower than the national average, nutritional deficiencies persist that could affect children's

long-term development. Diets were characterized by a high consumption of carbohydrates and

dairy products, in contrast to an insufficient intake of fruits and vegetables. This situation is

exacerbated by caregivers' limited knowledge of nutritional recommendations (60.4%),

highlighting the urgent need for health education interventions. A trend toward the early

introduction of mixed diets and processed foods was also identified, underscoring the importance

Childhood malnutrition in patients aged 0 to 9 years attending the Miraflores Health Center in Ecuador

Alarcón, Briones, Intriago, García, & Villavicencio

76 San Gregorio de Portoviejo University | Ecuador

of guiding eating habits appropriately from the earliest stages of life. While the results provide

valuable information for designing public policies in vulnerable contexts, the small sample size

and lack of anthropometric assessments are acknowledged as limitations. Therefore, longitudinal

studies evaluating the impact of nutrition education strategies on preventing childhood

malnutrition are recommended.

CONFLICTS OF INTEREST

The authors declare that they have no conflicts of interest.

AUTHOR CONTRIBUTIONS

Conceptualization: Daniel J. Alarcón and Daniel A. Briones. Data curation: Isaac E.

Intriago. Formal analysis: Isaac E. Intriago. Investigation: Daniel J. Alarcón, Daniel A. Briones,

Isaac E. Intriago, Mario A. García, and Lissette B. Villavicencio. Methodology: Mario A. García.

Supervision: Mario A. García and Lissette B. Villavicencio. Validation: Mario A. García and

Lissette B. Villavicencio. Visualization: Daniel J. Alarcón. Writing – original draft: Daniel J.

Alarcón, Daniel A. Briones, Isaac E. Intriago, Mario A. García, and Lissette B. Villavicencio.

Writing – review & editing: Daniel J. Alarcón, Daniel A. Briones, Isaac E. Intriago, Mario A.

García, and Lissette B. Villavicencio.

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