Anemia in Early Childhood and Associated Factors in Ecuador: An Analysis From a Health Social Determinants Model

Anemia is a problem highly prevalent in children associated with multiple factors. This study aims to identify factors associated with anemia in children under 5 years of age in Ecuador, based on the social determinants of health model. A secondary database study was conducted with information from 18,688 children aged 6-59 months included in the National Survey of Child Malnutrition 2022-2023. Anemia was defined by hemoglobin levels adjusted for age and height at sea level. Bivariate and multivariable Poisson regression for complex samples were used to calculate prevalence ratios with 95% confidence intervals. Anemia was found in 46.4% (95% CI 44.5-48.4) of children aged 6-23 months and 39.8% (95% CI 38.2-41.5) of those aged 24-59 months. For the 6-23-month age group, the prevalence of anemia was higher in the lowest economic quintiles 1 and 2 (PR 1.26; 95% CI 1.05-1.51; PR 1.31; 95% CI 1.09-1.56), in those with latrines compared with toilets (PR 1.37; 95% CI 1.05-1.77), in children of adolescent or younger mothers (PR 1.29; 95% CI 1.08-1.53; PR 1.19; 95% CI 1.08-1.31), and in those with recent infectious diseases (PR 1.13; 95% CI 1.03-1.24). For the 24- to 59-month-old group, the prevalence of anemia was higher in males than in females (PR 1.10, 95% CI 1.03-1.18), in indigenous people and Afro-Ecuadorians compared to mestizos or whites (PR 1.11, 95% CI 1.01-1.23; PR 1.35, 95% CI 1.19-1.53). Children of mothers with no education or only primary education had a 15% higher prevalence of anemia (PR 1.15, 95% CI 1.03-1.29) compared with children of mothers with a university education. In conclusion, gaps were found by gender, ethnicity, and socioeconomic status associated with the prevalence of anemia in children. A comprehensive approach is needed to reduce the prevalence of anemia in childhood.