Multidimensional poverty and the co-occurrence of undernutrition and intestinal parasitic infections in Ecuadorian infants: a geospatial analysis

Pamela Vinueza Veloz¹Andrés Fernando Vinueza Veloz²Estephany Tapia Veloz³Gabriela Tapia Veloz⁴Valeria Carpio-Arias²Maria Fernanda Vinueza Veloz^5*

• ¹Grupo de Investigación en Ciencias Veterinarias, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
• ²Research Group on Human Food and Nutrition (GIANH), Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador
• ³Department of Pharmacy, School of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, 46115 Valencia, Spain
• ⁴Area of Parasitology, Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia,, Valencia, Spain
• ⁵Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway

Objective: This study investigated the relationship between multidimensional poverty and the co-occurrence of undernutrition and intestinal parasitic infections among children under five in Ecuador. Material and Methods: Using the 2021 national outpatient Ecuadorian registry, we assessed the co-occurrence of undernutrition and intestinal parasitic infection incidences at the municipal-level through spatial analysis. We applied spatial autocorrelation to identify geographic co-occurrence clusters of high-high and low-low incidence rates. Subsequently, we compared the proportions of multidimensional poverty between the high-high and low-low co-occurrence clusters. Results: A spatial correlation was observed between the incidence of undernutrition (14.57 per 1000 child-years) and intestinal parasitic infections (34.07 per 1000 child-years) (Bivariate Moran's Index = 0.19, p < 0.001). High-high incidence clusters for both conditions were concentrated in the Amazon region. The median multidimensional poverty in these high-high incidence clusters was 72.62% (IQR: 62.08%-82.44%), which was nearly twice as high as in low-low incidence clusters (38.15%; IQR: 38.15%-38.93%). Conclusions: Our findings suggest that undernutrition and intestinal parasitic infections in children under five years of age tend to co‑ cluster, and their joint occurrence serves as an indicator of social inequity. High‑ high incidence clusters were concentrated in the nation's poorest regions, particularly the Amazon. To overcome this double burden, public‑ health measures must go beyond biomedical interventions and address its underlying social and structural determinants.