Poor water quality and food insecurity in Ecuador: Disparities in exposure and associations with young child feeding practices.

Background: Reliable access to adequate food and safe drinking water is essential for child health and development, but food insecurity and water quality issues are common globally. Understanding how these factors are associated with child feeding practices is critical for identifying strategies to mitigate their potential negative impacts.

Objective: To estimate exposure to poor water quality and food insecurity among young children in Ecuador and examine their associations with child feeding practices.

Design: Secondary analysis of a cross-sectional, nationally representative survey of households with children aged 0-23 months, conducted from July 2022 - July 2023 by the Ecuadorian National Institute of Statistics and Censuses.

Participants/setting: Households in Ecuador with children younger than 2 years (n=6,985).

Main outcome measures: Exclusive breastfeeding to 6 months (maternal recall), commercial milk formula use (reported consumption in the prior 24 hours), and meeting minimum dietary diversity (reported consumption of ≥5 of 8 WHO-designated food groups). Key exposures were drinking water risk (E. coli concentration measured at the point of use) and food insecurity (assessed using a subset of items from the Latin American and Caribbean Food Security Scale).

Statistical analyses performed: Poisson regressions adjusting for confounders and design effects estimated the relative prevalence of each outcome across key exposures, by child age (0-5, 6-11, and 12-23 months).

Results: Nationally, 25.3% of households with young children had high-to-very-high drinking water risk and 37.9% of children experienced moderate-to-severe food insecurity. Households with very-high-risk drinking water had a higher prevalence of exclusive breastfeeding and lower prevalence of commercial milk formula use compared to those with low-risk drinking water. Greater food insecurity was associated with lower exclusive breastfeeding, less commercial milk formula use, and fewer children meeting minimum dietary diversity.

Conclusions: Integrated policies and programs addressing water safety and food insecurity have the potential to improve child nutritional well-being.