Risk Factors for Infant Feeding Practices along a Rural-Urban Gradient in Coastal Esmeraldas Province, Ecuador

We describe infant and young child feeding (IYCF) practices along a rural-urban gradient in the primarily Afro-Ecuadorian province of Esmeraldas, Ecuador, an often-overlooked population. Mother-child dyads from 10 communities were enrolled in the ‘Gut microbiome, enteric infections, and child growth across a rural-urban gradient’ (EcoMID) birth cohort study. Surveys to assess IYCF practices, and potential risk factors for poorer IYCF practices such as problems breastfeeding and food insecurity, were completed 1 week after the child's birth and every 3 months thereafter until the child reached 9 months of age. Fisher exact tests were used to compare the prevalence of recommended IYCF practices between sites, and between risk factors We collected data between May 2019 and January 2021 from 115 children: 30 in the urban city of Esmeraldas (U), and 85 in intermediate and rural communities (R). Greater food insecurity was seen in the rural site (44.0% R vs 23.3% U, p = 0.05). Both sites had a similar prevalence of breastfeeding within an hour of birth (73.3% R vs 73.3% U, p = 1.00), and problems breastfeeding at 1 week (64.3% R vs 63.3% U, p = 1.00). Compared to food secure (FS) households, infants from food insecure (FIS) households tended to have a lower prevalence of breastfeeding within an hour of birth (79.7% FS vs 61.9% FIS, p = 0.05). Reported problems breastfeeding at 1 week were associated with lower odds of solid or semi-solid foods consumed in the past 24 hours (OR: 0.29, p = 0.03) and lower odds of meeting the recommended minimum meal frequency (OR:0.23, p < 0.01) at 9 months. Food insecurity may negatively impact early initiation of breastfeeding among both rural and urban families in Esmeraldas, and problems breastfeeding may negatively impact IYCF practices. Addressing these factors may be useful in promote optimal infant feeding in the region. This work is supported by the National Institutes of Health.