Systemic barriers undermine parental education as a strategy for chronic child malnutrition prevention in Ecuador

Systemic barriers undermine parental education as a strategy for chronic child malnutrition prevention in Ecuador | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Systemic barriers undermine parental education as a strategy for chronic child malnutrition prevention in Ecuador José Daniel Sánchez Redrobán, Mario Alomía, Pablo Reyes, Sophia Garcia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7810472/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Chronic child malnutrition (CCM) remains a persistent public health challenge in Ecuador, with devastating long-term consequences for human capital development. Despite high-level government initiatives, national prevalence rates have shown minimal, statistically insignificant improvement, disproportionately affecting vulnerable populations and perpetuating cycles of poverty and inequality. Objective: This study evaluates the role of parental education in CCM prevention through a critical analysis of the interaction between caregivers' knowledge, attitudes, and practices (KAP). We identify systemic barriers that prevent the translation of nutritional knowledge into optimal feeding and childcare practices, arguing that these barriers are the primary drivers of continued high CCM rates. Methods: We conducted a comprehensive synthesis of scientific literature on the effectiveness of educational interventions and the social determinants of CCM in Latin America. This evidence was triangulated with a case analysis of preliminary data from the "Playful Learning Landscapes for Chronic Child Malnutrition Prevention" (PALDCI) Project in Ecuador, which utilized a standardized KAP survey based on FAO guidelines to assess breastfeeding-related knowledge and behaviors. Results: Ecuador's epidemiological context reveals a national CCM prevalence of 19.3% in children under two years, with profound ethnic and geographic disparities. CCM rates in indigenous children reach an alarming 32.3%. The PALDCI Project case analysis evidences a critical dissonance between intention and action: while 98% of mothers initiate breastfeeding at birth, only 2% maintain exclusive breastfeeding for the recommended six months. We identified key knowledge deficits that, according to FAO thresholds, require "urgent" intervention, such as knowledge about breastfeeding benefits for mothers (44% correct responses). Literature confirms that sociocultural, occupational, and health system barriers are key determinants of this premature abandonment. Conclusion: Parental education is a fundamental but intrinsically insufficient pillar for eradicating CCM. The success of educational interventions critically depends on the creation of a supportive ecosystem that addresses the structural barriers limiting parents' capacity to act on their knowledge. Comprehensive public policies are required to strengthen social protection, regulate the breast milk substitute industry, improve water and sanitation infrastructure, and train health personnel to close the systemic gap between parental knowledge and effective nutritional practice. chronic malnutrition parental education breastfeeding knowledge- practice gap Ecuador public health policy systemic barriers Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7810472","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547712949,"identity":"6ba68e3f-b6b7-450e-a445-6b2fd2fefebb","order_by":0,"name":"José Daniel Sánchez 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policy, systemic barriers","lastPublishedDoi":"10.21203/rs.3.rs-7810472/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7810472/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Chronic child malnutrition (CCM) remains a persistent public health challenge in Ecuador, with devastating long-term consequences for human capital development. Despite high-level government initiatives, national prevalence rates have shown minimal, statistically insignificant improvement, disproportionately affecting vulnerable populations and perpetuating cycles of poverty and inequality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjective: This study evaluates the role of parental education in CCM prevention through a critical analysis of the interaction between caregivers' knowledge, attitudes, and practices (KAP). We identify systemic barriers that prevent the translation of nutritional knowledge into optimal feeding and childcare practices, arguing that these barriers are the primary drivers of continued high CCM rates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: We conducted a comprehensive synthesis of scientific literature on the effectiveness of educational interventions and the social determinants of CCM in Latin America. This evidence was triangulated with a case analysis of preliminary data from the \"Playful Learning Landscapes for Chronic Child Malnutrition Prevention\" (PALDCI) Project in Ecuador, which utilized a standardized KAP survey based on FAO guidelines to assess breastfeeding-related knowledge and behaviors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Ecuador's epidemiological context reveals a national CCM prevalence of 19.3% in children under two years, with profound ethnic and geographic disparities. CCM rates in indigenous children reach an alarming 32.3%. The PALDCI Project case analysis evidences a critical dissonance between intention and action: while 98% of mothers initiate breastfeeding at birth, only 2% maintain exclusive breastfeeding for the recommended six months. We identified key knowledge deficits that, according to FAO thresholds, require \"urgent\" intervention, such as knowledge about breastfeeding benefits for mothers (44% correct responses). Literature confirms that sociocultural, occupational, and health system barriers are key determinants of this premature abandonment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Parental education is a fundamental but intrinsically insufficient pillar for eradicating CCM. The success of educational interventions critically depends on the creation of a supportive ecosystem that addresses the structural barriers limiting parents' capacity to act on their knowledge. Comprehensive public policies are required to strengthen social protection, regulate the breast milk substitute industry, improve water and sanitation infrastructure, and train health personnel to close the systemic gap between parental knowledge and effective nutritional practice.\u003c/p\u003e","manuscriptTitle":"Systemic barriers undermine parental education as a strategy for chronic child malnutrition prevention in Ecuador","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 10:05:28","doi":"10.21203/rs.3.rs-7810472/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f51eb136-d0e7-4e3a-a30e-7a657e42f5a8","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T13:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-21 10:05:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7810472","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7810472","identity":"rs-7810472","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}