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Effects of applied educational strategies
on nutritional status and child
development: A case of Riobamba
schools
Efectos de estrategias educativas aplicadas en el estado
nutricional y desarrollo infantil: Un caso de las
escuelas de Riobamba
Cecilia Alejandra García Ríos
*
David Antonio Ureña Lara
*
Diego Hernán Miranda Barros
*
Valeria Estefania Garcia Rios
*
Abstract
This paper presents a study on the nutritional status of children in a
group of schools in Riobamba, and is part of the results of the project
"Program in prevention, promotion and rehabilitation in nutrition,
health with participation of school-age children, families and
community based on local experiences and technologies of positive
deviation of the Canton Riobamba". Using advanced statistical
methodologies and R software to analyze the data. The results show
variability in the growth and physical development of children, with
height and weight measurements that reflect a diversity in these
Medical Surgeon - Specialist in Pediatrics
Coordinator of the Linking project for the medical career Escuela
Superior Politécnica de Chimborazo -
Research Professor Universidad Nacional de Chimborazo
cecilia.garcia@espoch.edu.ec https://orcid.org/0000-0001-5179-
0303
Magister in Teaching English as a Foreign Language, Bachelor of
Science in Education English Language Teacher, Bachelor of
Business Administration, Med and Linguistics Research Group.
Faculty of Public Health, Escuela Superior Politécnica de
Chimborazo. david.urenia@espoch.edu.ec
https://orcid.org/0000-0002-1482-0312
General Physician - Specialist in Pediatrics - Hospital Provincia
General Docente Riobamba Docente Escuela Superior Politécnica de
Chimborazo diegoh.miranda@espoch.edu.ec
https://orcid.org/0000-0003-2116-5069
General practitioner, Master's degree in clinical patient safety
management and quality of care, health care external researcher
valegarcia.0205@yahoo.es https://orcid.org/ 0000-0002-5722-5759
Article
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characteristics. In addition, an average increase in Body Mass Index
for Age was observed, suggesting changes in weight relative to
height. However, the z-score for Height-for-Age decreased, which
may indicate slower than expected growth in height.
Keywords: Nutrition, infancy, Riobamba, growth, hemoglobin
Resumen
El presente documento presenta un estudio sobre el estado
nutricional de los niños en un grupo de escuelas de Riobamba, y es
parte de los resultados del proyecto “Programa en prevención,
promoción y rehabilitación en nutrición, salud con participación de
niños y niñas en edad escolar, familias y comunidad basado en
experiencias y tecnologías locales de desviación positiva del Cantón
Riobamba”. Utilizando metodologías estadísticas avanzadas y el
software R para analizar los datos. Los resultados muestran
variabilidad en el crecimiento y desarrollo físico de los niños, con
mediciones de talla y peso que reflejan una diversidad en estas
características. Además, se observó un incremento promedio en el
Índice de Masa Corporal para la Edad, sugiriendo cambios en el peso
relativo a la altura. Sin embargo, el z-score de la Talla para la Edad
disminuyó, lo que podría indicar un crecimiento en estatura más
lento de lo esperado.
Palabras clave: Nutrición, infancia, Riobamba, crecimiento,
hemoglobina
Introduction
Chronic child undernutrition is a public health problem that affects
the physical and cognitive development of children, limiting their
potential to achieve a full and productive life (Black et al., 2008). In
Ecuador, this problem has been the focus of governmental and
international attention, given its prevalence and long-term
consequences for society. Chronic undernutrition manifests mainly
as stunting and is associated with factors such as insufficient food
intake, nutritional quality of the diet, and unfavorable health and
socioeconomic conditions (Cuascota & Navas, 2020; Vega, Meza,
Solórzano, & Macías, 2022).
The Nutrition Action Strategy is an example of public policy that
seeks to improve the nutritional situation in Ecuador, especially in
children under five years of age. This strategy includes components
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such as access to healthy food through the implementation of home
gardens and the combination of health and education services
(López, 2022). At the national level, 12 thousand home gardens have
been implemented, which has contributed to a reduction in the
prevalence of chronic malnutrition from 26% in 2010 to 22% in
2012.
Malnutrition manifests itself in various forms, including chronic
malnutrition, acute malnutrition, overweight and obesity, and can be
present in the entire population, mainly in rural areas (Candela,
2020). Among the direct causes of malnutrition are inadequate food
consumption and lack of essential micronutrients for the body.
Chronic malnutrition is related to the conditions of the mother's
pregnancy and the care of the child from birth (FAO & Pan
American Health Organization [PAHO], 2017).
In Latin America and the Caribbean, initiatives have been generated
to combat hunger and malnutrition, highlighting the commitment of
CELAC and the Framework Law on the Right to Food, Food
Security and Food Sovereignty. Ecuador, despite its efforts, still
faces challenges in reducing chronic malnutrition, especially among
the indigenous population and in rural areas (Secretaría Nacional de
Planificación y Desarrollo [SENPLADES], 2013).
The National Health and Nutrition Survey (ENSANUT 2012)
reveals that chronic malnutrition is more prevalent in indigenous
children and low-income families. In addition, anemia affects
approximately one in four children aged 0 to 5 years in the country.
Breastfeeding, a key practice for child nutrition, has declined in
recent decades, underscoring the need for targeted interventions
(Encuesta Nacional de Salud y Nutrición [ENSANUT], 2012).
The Nutrition Action Strategy was implemented in nine provinces
and 30 cantons, with a focus on improving the nutritional situation
of children under five, nursing mothers and pregnant women. The
components of the strategy include access to basic services, health
and nutrition, healthy food, education and community participation.
The intervention modality involves the formation of concertation
committees, problem analysis, concertation between supply and
demand, establishment of commitments and implementation of
concerted action plans (Secretaría Nacional de Planificación y
Desarrollo [SENPLADES], 2013).
The results of the Strategy show significant progress in access to
healthy food and in the reduction of chronic malnutrition. However,
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challenges remain related to equity in access to services and the need
to address structural factors that contribute to undernutrition.
In this context, it is crucial to understand the relationship between
food security and child nutrition. Food security implies not only the
availability of food, but also access to and appropriate use of food
for optimal nutrition. Interventions that promote food security, such
as home gardens and school feeding programs, can have a positive
impact on child nutrition by providing sustainable sources of
nutritious food.
In addition, it is important to consider the role of education and
awareness in promoting healthy eating practices and preventing
undernutrition. Nutrition education campaigns and training
programs for parents and caregivers can improve knowledge about
child nutrition and encourage healthy eating behaviors (Naranjo,
Alcívar, Rodríguez, & Betancourt, 2020).
Collaboration between different sectors and levels of government is
critical to effectively address chronic malnutrition. Coordination
between the ministries of health, education, agriculture and social
development, as well as the participation of local governments and
community organizations, is essential to implement comprehensive
and sustainable interventions (Vega Játiva, Meza Cruz, Solórzano
José Elías, & Macías Enrique Javier, 2020).
Finally, research and continuous monitoring are key to assessing the
impact of interventions and adjusting strategies as needed.
Collecting and analyzing data on the nutritional status of children
and the determinants of undernutrition will identify areas for
improvement and target efforts to the most vulnerable populations.
Under this perspective, the present research focuses on determining
linear growth (height/age), nutritional status (BMI age) and
nutritional risk caused by micronutrient deficiencies and parasitosis
in the school population, with the objective of contributing to the
reduction of these problems. Through the analysis of strategies
implemented in Ecuador, we seek to provide a comprehensive view
of the efforts made and lessons learned in the fight against chronic
child undernutrition.
Materials and methods
In the methodological phase of the study, a detailed statistical
analysis of the data collected was performed. R statistical software,
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which is widely recognized for its robustness and capacity to handle
large data sets, was used to perform all the analysis operations. It
was ensured that all values were numerical and missing data were
handled appropriately, applying imputation methods where
necessary to maintain statistical integrity.
Descriptive statistical tests were applied to evaluate central
tendencies and data dispersion, including mean, median and standard
deviation. For comparisons between baseline and follow-up
measurements, Student's t-test for related samples was used to
identify significant differences in the means of the variables of
interest. This made it possible to determine whether the changes
observed between the two measurements were statistically
significant.
In addition, z-scores for height and BMI-for-age were calculated
using the World Health Organization growth charts as a reference,
thus allowing a standardized assessment of children's growth and
nutritional status.
For the coproparasite variable, a qualitative and quantitative analysis
was performed. The results for "presence" or "absence" of parasites
were coded and the chi-square test was used to determine whether
there was a significant decrease or increase in the prevalence of
parasitosis between the two measurements. Interpretation of
hemoglobin results was done in the context of clinical guidelines for
identifying anemia and other conditions related to nutritional
deficiencies.
Results
Table 1. Statistical characteristics of height, weight and hemoglobin
level measurements.
Variable
Most
frequent
value
Media
Standard
deviation
Minimum
Maximum
Unique
values
Size
130 cm
(49 times)
N/A
N/A
N/A
N/A
155
Weight
22 kg (16
times)
N/A
N/A
N/A
N/A
330
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Uncorrected
hemoglobin
N/A
13.94
g/dL
1.23 g/dL
9.10 g/dL
21.40 g/dL
N/A
Corrected
hemoglobin
N/A
12.45
g/dL
1.24 g/dL
7.60 g/dL
19.90 g/dL
N/A
Source: linkage project, 2023
Table 1 summarizes the statistical characteristics of height, weight
and hemoglobin level measurements in a school population. There
were 870 measurements of both height and weight. The most
common height was 130 cm, observed in 49 students, while the most
common weight was 22 kg, recorded in 16 students. This suggests
that a significant number of children in the sample had these
measurements. In addition, 155 different values for height and 330
different values for weight were recorded, indicating variability in
the physical growth and development of the children.
For uncorrected hemoglobin, 812 valid measurements were
obtained, with a mean of 13.94 g/dL and a standard deviation of 1.23
g/dL. This reflects the average hemoglobin level in the sample and
the variability of these levels. The extreme values were 9.10 g/dL
and 21.40 g/dL, showing the range of variation in hemoglobin levels
among the students. Similarly, there were 811 valid corrected
hemoglobin measurements, with a mean of 12.45 g/dL and a
standard deviation of 1.24 g/dL, and the extreme values were 7.60
g/dL and 19.90 g/dL.
These results provide a quantitative view of the physical and health
characteristics of the school population studied. Height and weight
measurements show diversity in physical growth and development,
while hemoglobin levels provide information on the iron status and
general health of the students. The mean and standard deviation are
key indicators for understanding the central tendency and variability
of the data, and the minimum and maximum values provide insight
into the extremes in the measurements.
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Figure 1. Distribution of Z-scores of Height for age
Graph 1 reflected a centered distribution, with a mean of -1.74e-16
and a slightly positive median of 0.14. 16.37% of the schoolchildren
fell below the mean by more than one standard deviation, and
14.18% exceeded it, indicating growth generally in line with
expectations.
Figure 2. Distribution of BMI Z-scores for age.
For BMI-for-age (Figure 2) we found a mean of -3.75e-16 and a
median of -0.18, with 11.21% of the children below and 14.95%
above one standard deviation, pointing to a slight tendency toward
overweight in some cases.
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Both graphs suggest that the majority of children were within normal
ranges of growth and nutritional status. The presence of values
outside one standard deviation highlights the importance of targeted
interventions for those with significant deviations.
With respect to the coproparasitic examination they show a variety
of findings which are shown below.
Absence: 487 samples indicated the absence of parasites, which
represents the majority of the results. This is a good sign, as it
indicates that many of the children evaluated do not have parasitic
infections.
Enthamoeba coli cyst (+): 94 samples showed the presence of
entamoeba coli cysts, a parasite commonly found in the human
intestinal tract that generally does not cause disease.
Chilomastix mesnili cyst (+): 92 samples had chilomastix mesnili
cysts, another parasite that is generally considered non-pathogenic.
Enthamoeba histolytica cyst (+): 45 samples showed the presence of
entamoeba histolytica cysts, a parasite that can cause amoebic
dysentery and other health problems.
Other results: several other types of parasites were found in smaller
quantities, including giardia lamblia, which can cause diarrhea and
other gastrointestinal symptoms.
Comparative analyses between the two data sheets reveal several
trends in the health and growth measures of the school population
studied. An average increase in Body Mass Index for Age (Z BMI/E)
was observed, with an increase of 0.49 in the z-score. This suggests
that, in general, children's BMI has increased between the two
measurements, which could be indicative of changes in weight
relative to height within the period studied.
In contrast, the z-score for Height-for-Age (Z SIZE/ AGE)
experienced an average decrease of -0.56. This decline may signal
that children's growth in height has not kept pace with expected
growth compared to standardized growth patterns, or it could reflect
a particular stage of growth depending on the age of the children and
the time interval between measurements.
In terms of general health and nutrition, improvements in
hemoglobin levels were observed. Uncorrected hemoglobin showed
an average increase of 0.37 g/dL, while corrected hemoglobin
increased by an average of 0.33 g/dL. These changes indicate a
positive improvement in hemoglobin levels, suggesting a possible
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reduction in the prevalence of anemia or an improvement in the iron
status of the children.
These trends provide evidence of changes in children's nutrition and
health status. The increase in BMI may need attention to ensure that
it is within healthy ranges and to avoid risks of overweight or
obesity. Meanwhile, improvement in hemoglobin levels is a positive
indicator of possible improvements in nutrition and overall health of
the school population.
Discussion
Research has demonstrated changes in growth and nutrition
measures in the child population studied. The increase in BMI
requires continued monitoring to prevent possible negative effects
associated with overweight and obesity. The decrease in height-for-
age z-score raises questions that warrant future research to better
understand the underlying causes and possible long-term
implications for children's well-being and development.
Improvements in hemoglobin levels are encouraging and could be
the result of successful public health policies or positive changes in
nutritional behavior within the school community. These results
underscore the importance of proper nutrition and suggest that
efforts to improve the quality of children's diets can have a tangible
positive impact.
Finally, this study highlights the need for targeted interventions and
regular monitoring of growth and nutritional status in school
populations. Furthermore, it encourages the adoption of
multidisciplinary approaches that include nutrition education,
physical activity promotion and health surveillance to promote
healthy lifestyle habits from childhood onwards.
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