Independent and joint associations of food and water insecurity with illness, anaemia, and malnutrition in 6–59 month old Ecuadorian children

Abstract

Household food (HFI) and water insecurity (HWI) have each been linked to poorer child health but their joint relationship is understudied. We used 2023–2024 Ecuadorian National Infant Malnutrition Survey data to examine the independent and joint associations of HFI and HWI exposure with illness, anaemia, and malnutrition in 6–59 month olds. The Food Insecurity Experience Scale measured marginal and moderate–severe HFI. Water indicators (source, availability, accessibility, microbial safety) measured HWI. We used a 4-category indicator to classify HFI only, HWI only, joint HFI/HWI, and secure food and water. Child respiratory (RI) and diarrheal illness (DI) were assessed from caregiver reports, anaemia from blood haemoglobin, and nutrition indicators from anthropometric measurements. Modified Poisson regression models estimated adjusted prevalence ratios (aPR). Joint HFI/HWI was associated with a higher RI and DI prevalence, HFI only with higher RI, stunting and overweight/obesity, and HWI only with higher overweight/obesity but lower anaemia. The age-stratified analyses linked joint HFI/HWI and HFI only to higher RI and DI in 6–23 month olds and higher RI in 24–59 month olds. Joint HFI/HWI and HWI were linked to lower anaemia. In 24–59 month olds, HFI only was associated with higher stunting and HWI only with higher overweight/obesity. Exclusion of marginal HFI in the sensitivity analysis identified child-level double malnutrition as more prevalent in 24–59 month olds from HFI only or joint HFI/HWI households. These findings suggest HFI and HWI independently and jointly influence child health and nutrition, underscoring the need for effective multisectoral policies and interventions simultaneously targeting both.