Child marriage and perinatal health in Ecuador, 2015-2020. / Casamiento infantil y salud perinatal en Ecuador, 2015-2020.

This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.

Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

Casamiento infantil y salud perinatal en Ecuador, 2015-2020 / Child marriage and perinatal health in Ecuador, 2015-2020

RESUMEN Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

ABSTRACT This study sought to estimate the prevalence and distribution of newborns to mothers under age 18 in Ecuador and the association between perinatal indicators and maternal marital status. Newborn records obtained from Ecuador's Instituto Nacional de Estadísticas y Censos (INEC) between 2015 and 2020 were used to assess the joint association between maternal age groups (10-15, 16-17, 18-19, and 20-24 years) and marital status (married, common-law, and single) with low birthweight, preterm birth, and inadequate prenatal care. The prevalence of newborns to mothers under age 18 was 9.3% overall, but declined over the study period, drastically among married mothers. The association between marital status and perinatal indicators depended on maternal age. The more favorable outcomes observed among married mothers aged 20-24 years (compared to their single counterparts) weaken or disappear among mothers under age 18. Mothers in stable unions exhibited outcomes in between those of married and single mothers.

Associations between child and adolescent marriage and reproductive outcomes in Brazil, Ecuador, the United States and Canada.

BACKGROUND: Although marriage is associated with favourable reproductive outcomes among adult women, it is not known whether the marriage advantage applies to girls (< 18 years). The contribution of girl child marriage (< 18 years) to perinatal health is understudied in the Americas. METHODS: National singleton birth registrations were used to estimate the prevalence of girl child marriage among mothers in Brazil (2011-2018, N = 23,117,661), Ecuador (2014-2018, N = 1,519,168), the USA (2014-2018, N = 18,618,283) and Canada (2008-2018, N = 3,907,610). The joint associations between marital status and maternal age groups (< 18, 18-19 and 20-24 years) with preterm birth (< 37 weeks), small-for-gestational age (SGA < 10 percentile) and repeat birth were assessed with logistic regression. RESULTS: The proportion of births to < 18-year-old mothers was 9.9% in Ecuador, 8.9% in Brazil, 1.5% in the United States and 0.9% in Canada, and marriage prevalence among < 18-year-old mothers was 3.0%, 4.8%, 3.7% and 1.7%, respectively. In fully-adjusted models, marriage was associated with lower odds of preterm birth and SGA among 20-24-year-old mothers in the four countries. Compared to unmarried 20-24-year-old women, married and unmarried < 18-year-old girls had higher odds of preterm birth in the four countries, and slightly higher odds of SGA in Brazil and Ecuador but not in the USA and Canada. In comparisons within age groups, the odds of repeat birth among < 18-year-old married mothers exceeded that of their unmarried counterparts in Ecuador [AOR: 1.99, 95%CI: 1.82, 2.18], the USA [AOR: 2.96, 95%CI: 2.79, 3.14], and Canada [AOR: 2.17, 95%CI: 1.67, 2.82], although minimally in Brazil [AOR: 1.09, 95%CI: 1.07, 1.11]. CONCLUSIONS: The prevalence of births to < 18-year-old mothers varies considerably in the Americas. Girl child marriage was differentially associated with perinatal health indicators across countries, suggesting context-specific mechanisms.

[Administrative data linkage and its usefulness in public health: the case of EcuadorVinculação de dados administrativos e sua utilização em saúde pública: o caso do Equador]. / Vinculación de datos administrativos y su utilidad en salud pública: el caso de Ecuador.

The objective of this article is to describe the characteristics of addressing the linkage of administrative databases and the uses of such linkages in public health research, and also to discuss the opportunities and challenges for implementation in Ecuador. The linkage of databases makes it possible to integrate a person's data that may be scattered across different subsectors such as health, education, justice, immigration, and social programs. It also facilitates research that can inform more efficient management of social and health programs and policies. The main advantages of using linked databases are: diversity of data, population coverage, stability over time, and lower cost in comparison to primary data collection. Despite the availability of tools to process, link, and analyze large data sets, there has been minimal use of this approach in Latin American countries. Ecuador is well positioned to implement this approach, due to compulsory use of a unique ID in health services delivery, which permits linkages with other national information systems. However, the country faces several cultural, technical, ethical, legal, and political challenges. To take advantage of its potential, Ecuador needs to develop a data governance strategy that includes standards for data access and data use, as well as mechanisms for data control and quality, greater investment in professional training in data use both within and beyond the health sector, and collaborations between government entities, universities, and civil society organizations.

Os objetivos deste artigo são descrever as características do método de vinculação de bancos de dados administrativos e sua utilização em pesquisa em saúde pública e examinar o potencial e os desafios para sua implementação no Equador. A vinculação de bancos de dados possibilita integrar dados de uma mesma pessoa dispersos em subsetores diversos como saúde, educação, justiça, imigração e programas sociais e realizar pesquisas para subsidiar a gestão mais eficiente de programas e políticas sociais e de saúde. Entre as principais vantagens de utilizar bancos de dados vinculados estão diversidade dos dados, cobertura populacional, estabilidade temporal e custo menor em comparação à coleta de dados primários. Apesar de existirem ferramentas para processar, vincular e analisar grandes conjuntos de dados, a utilização deste método é mínima nos países da América Latina. O Equador possui um grande potencial para beneficiar-se com este método devido à obrigatoriedade do uso de um identificador único na prestação de serviços de saúde, o que permite a vinculação com outros sistemas de informação nacionais, mas enfrenta uma série de desafios técnicos, éticos-legais, culturais e políticos. Para aproveitá-lo, o país precisa elaborar uma estratégia de governança de dados contendo um conjunto de normas para o acesso e a utilização simultâneos com mecanismos de controle e qualidade dos dados, maior investimento em formação profissional no uso dos dados dentro e fora da área da saúde e colaboração entre entidades governamentais, universidades e organizações da sociedade civil.

Vinculación de datos administrativos y su utilidad en salud pública: el caso de Ecuador / Administrative data linkage and its usefulness in public health: the case of Ecuador / Vinculação de dados administrativos e sua utilização em saúde pública: o caso do Equador

RESUMEN Los objetivos de este artículo son describir las características del abordaje de vinculación de bases de datos administrativos y sus usos en investigación en salud pública, y discutir las potencialidades y retos para su implementación en Ecuador. La vinculación de bases de datos permite integrar datos de una misma persona dispersos en distintos subsectores como salud, educación, justicia, inmigración y programas sociales, y posibilita investigaciones que informen una gestión más eficiente de programas y políticas sociales y de salud. Las principales ventajas del uso de bases de datos relacionadas son la diversidad de datos, la cobertura poblacional, la estabilidad temporal y el costo menor en comparación con la recolección de datos primarios. A pesar de la disponibilidad de herramientas para procesar, vincular y analizar grandes conjuntos de datos, el uso de este abordaje es mínimo en los países de América Latina. Ecuador tiene un alto potencial para explotar este abordaje, debido a la obligatoriedad del uso de un identificador único en la prestación de servicios de salud, que permite la vinculación con otros sistemas de información nacionales. Sin embargo, enfrenta una serie de retos técnicos, ético-legales, culturales y políticos. Para aprovechar su potencial, Ecuador necesita desarrollar una estrategia de gobernanza de datos que incluya normativas de acceso y uso de los datos, de manera simultánea con mecanismos de control y calidad de los datos, una mayor inversión en formación profesional en el uso de los datos dentro y fuera del sector salud, y colaboraciones entre entidades gubernamentales, universidades y organizaciones de la sociedad civil.

ABSTRACT The objective of this article is to describe the characteristics of addressing the linkage of administrative databases and the uses of such linkages in public health research, and also to discuss the opportunities and challenges for implementation in Ecuador. The linkage of databases makes it possible to integrate a person's data that may be scattered across different subsectors such as health, education, justice, immigration, and social programs. It also facilitates research that can inform more efficient management of social and health programs and policies. The main advantages of using linked databases are: diversity of data, population coverage, stability over time, and lower cost in comparison to primary data collection. Despite the availability of tools to process, link, and analyze large data sets, there has been minimal use of this approach in Latin American countries. Ecuador is well positioned to implement this approach, due to compulsory use of a unique ID in health services delivery, which permits linkages with other national information systems. However, the country faces several cultural, technical, ethical, legal, and political challenges. To take advantage of its potential, Ecuador needs to develop a data governance strategy that includes standards for data access and data use, as well as mechanisms for data control and quality, greater investment in professional training in data use both within and beyond the health sector, and collaborations between government entities, universities, and civil society organizations.

RESUMO Os objetivos deste artigo são descrever as características do método de vinculação de bancos de dados administrativos e sua utilização em pesquisa em saúde pública e examinar o potencial e os desafios para sua implementação no Equador. A vinculação de bancos de dados possibilita integrar dados de uma mesma pessoa dispersos em subsetores diversos como saúde, educação, justiça, imigração e programas sociais e realizar pesquisas para subsidiar a gestão mais eficiente de programas e políticas sociais e de saúde. Entre as principais vantagens de utilizar bancos de dados vinculados estão diversidade dos dados, cobertura populacional, estabilidade temporal e custo menor em comparação à coleta de dados primários. Apesar de existirem ferramentas para processar, vincular e analisar grandes conjuntos de dados, a utilização deste método é mínima nos países da América Latina. O Equador possui um grande potencial para beneficiar-se com este método devido à obrigatoriedade do uso de um identificador único na prestação de serviços de saúde, o que permite a vinculação com outros sistemas de informação nacionais, mas enfrenta uma série de desafios técnicos, éticos-legais, culturais e políticos. Para aproveitá-lo, o país precisa elaborar uma estratégia de governança de dados contendo um conjunto de normas para o acesso e a utilização simultâneos com mecanismos de controle e qualidade dos dados, maior investimento em formação profissional no uso dos dados dentro e fora da área da saúde e colaboração entre entidades governamentais, universidades e organizações da sociedade civil.

Agricultural Food Production Diversity and Dietary Diversity among Female Small Holder Farmers in a Region of the Ecuadorian Andes Experiencing Nutrition Transition.

Some rural areas of Ecuador, including the Imbabura Province of the Andes Highlands, are experiencing a double burden of malnutrition where micronutrient deficiencies persist at the same time obesity is increasing as many traditional home-grown foods are being replaced with more commercially prepared convenience foods. Thus, the relationships among agricultural food production diversity (FPD), dietary diversity (DD), and household food insecurity (HFI) of the rural small holder farmers need further study. Therefore, we examined these associations in small holder farmers residing in this Province in the Andes Highlands (elevation > 2500 m). Non-pregnant maternal home managers (n = 558, x age = 44.1, SD = 16.5 y) were interviewed regarding the number of different agricultural food crops cultivated and domestic animals raised in their family farm plots. DD was determined using the Minimum Dietary Diversity for Women Score (MDD-W) based on the number of 10 different food groups consumed, and household food insecurity (HFI) was determined using the 8-item Household Food Insecurity Experience Scale. The women reported consuming an average of 53% of their total food from what they cultivated or raised. Women with higher DD [MMD-W score ≥ 5 food groups (79% of total sample)] were on farms that cultivated a greater variety of crops (x = 8.7 vs. 6.7), raised more animals (x = 17.9 vs. 12.7, p < 0.05), and reported lower HFI and significantly higher intakes of energy, protein, iron, zinc, and vitamin A (all p < 0.05). Multiple regression analyses demonstrated that FPD was only modestly related to DD, which together with years of education, per capita family income, and HFI accounted for 26% of DD variance. In rural areas of the Imbabura Province, small holder farmers still rely heavily on consumption of self-cultivated foods, but greater diversity of crops grown in family farm plots is only weakly associated with greater DD and lower HFI among the female caretakers.

Nutrition and physical activity transitions in the Ecuadorian Andes: Differences among urban and rural-dwelling women.

OBJECTIVES: The nutrition and physical activity transitions, characterized by increased consumption of high energy density foods and more sedentary lifestyles, are associated with increased obesity and hypertension in Ecuador. These transitions have been characterized primarily in urban areas, which may neglect variation in specific rural areas of Ecuador. Therefore we examined the extent of the differences in dietary and activity patterns, obesity prevalence, and blood pressure (BP) in urban and rural-dwelling women in the Ecuadorian central highlands. METHODS: Urban-dwelling women (UW, n = 198, mean age = 44 years) from three areas of a city of 250,000 residents and rural women (RW; n = 202, mean age = 47 years) from three remote communities in the same province (Chimborazo) were randomly selected and surveyed for dietary and activity practices, BP, and anthropometrics. RESULTS: Ninety percent of UW reported obtaining their food primarily from markets while 65% of RW women obtained their food primarily from their own cultivation. Cookies, cakes, candies, ice cream, and French fries were consumed more frequently by UW. RW reported lower consumption of beef, poultry, and chicken, as well as fruits, milk, and white rice. UW compared to RW women spent less time walking and in strenuous work activities. Obesity (BMI > 30 kg/m2 ) (UW = 18.7% vs RW = 9.2%) and hypertension (UW = 15.7%, RW= 3.0%) were more common in UW. Average systolic and diastolic BP was significantly higher in UW. CONCLUSIONS: The nutrition and physical activity transitions appear more evident in urban- compared to rural-dwelling women, and are associated with more obesity and higher BP.

Awareness, Comprehension, and Use of Newly-Mandated Nutrition Labels Among Mestiza and Indigenous Ecuadorian Women in the Central Andes Region of Ecuador.

BACKGROUND: In 2014, Ecuador became the first country in Latin America to adopt the nutritional traffic light labeling system as a public policy aimed at guiding informed food choices. OBJECTIVE: To describe the differences in comprehension and use of the new nutrition label in 2 different ethnic populations residing in a limited resource area of central Ecuador. METHODS: A total of 394 women (18-75 years, 54.8% indigenous and 45.2% mixed-race mestizas) were randomly selected in the Chimborazo Province and were requested by a questionnaire to provide information regarding their awareness and comprehension of the traffic light nutritional labeling system and personal use of the food label in food selection. RESULTS: Indigenous women had a high percentage who lacked any formal education (43.5%) and a greater proportion were not aware of the labeling system when compared with the mestizas (84.3% vs 46%; P = .001). In both groups, the main reason for not reading labels was lack of understanding of its meaning (50% indigenous vs 32.7% mestiza; P < .05). The reported use of the labeling system for food choices was low-on average, 32% of the mestizas and 5% of the indigenous women reported using nutrition label information to guide their purchase and consumption of packaged food items. CONCLUSION: The use of nutritional labeling is low in both mestiza and indigenous Ecuadorians, although higher among the mestizas. Among the indigenous women, mostly likely owing to less education, limited nutrition-related health knowledge, and higher risk for food insecurity, the utility of the new traffic light food label is limited.

[Social capital and health information in the context of small scale farmers' livelihoods]. / Capital social e información para la salud en el contexto del modo de vida de agricultores de pequeña escala.

The study explores the relationship between social capital and health information among small-scale farmers in the context of their livelihoods. Having such information could promote the use of agriculture practices with fewer health impacts by reducing farmers' exposure to highly toxic pesticides. We implemented a longitudinal study design with measurements in July 2007 (T1) and February 2010 (T2), within 12 agricultural communities in Ecuador (n=208 farmers). The dependent variables were based on information regarding agricultural production practices, among them: integrated pest management (IPM) and pesticide toxicity. Independent variables included participation in organizations and social cohesion, among other aspects of social capital. Results suggest that health information is disseminated through structures of social capital, depending on its value of use in the context of the mode of production in which small scale agriculture is developed.

Capital social e información para la salud en el contexto del modo de vida de agricultores de pequeña escala / Social capital and health information in the context of small scale farmers' livelihoods

El estudio explora la relación entre el capital social y la información para la salud en agricultores de pequeña escala, en el contexto de su modo de vida. Tener información al respecto promovería la adopción de prácticas agrícolas con menos impacto en su salud debido a la reducción del uso de pesticidas de alta toxicidad. La investigación se desarrolló a través de un diseño longitudinal de medidas repetidas, en julio de 2007 (T1) y febrero de 2010 (T2), en 12 comunidades agrícolas de Ecuador (n=208). La información respecto a las prácticas de producción agrícola, entre ellas, el manejo integrado de plagas, y la toxicidad de los pesticidas constituyeron las variables dependientes. La participación en organizaciones, y la cohesión social, entre otros aspectos del capital social fueron tratados en el análisis como variables independientes. Los hallazgos sugieren que la información para la salud es transmitida por las estructuras del capital social en dependencia de su valor de uso en el marco del modo de producción agrícola.

The study explores the relationship between social capital and health information among small-scale farmers in the context of their livelihoods. Having such information could promote the use of agriculture practices with fewer health impacts by reducing farmers' exposure to highly toxic pesticides. We implemented a longitudinal study design with measurements in July 2007 (T1) and February 2010 (T2), within 12 agricultural communities in Ecuador (n=208 farmers). The dependent variables were based on information regarding agricultural production practices, among them: integrated pest management (IPM) and pesticide toxicity. Independent variables included participation in organizations and social cohesion, among other aspects of social capital. Results suggest that health information is disseminated through structures of social capital, depending on its value of use in the context of the mode of production in which small scale agriculture is developed.

Organisational participation and health among smallholder farmers: a longitudinal study in a Latin American context.

OBJECTIVE: To understand the impact of social organisation affiliation and farmers' agricultural production practices on farmer health. Organisations facilitate the acquisition and exchange of forms of social capital which can influence the adoption of practices with potential health impacts. In countries such as Ecuador, smallholder agriculture is practised by socially vulnerable populations. Agricultural production often involves the use of extremely hazardous pesticides, while practices that reduce the use of chemicals through integrated pest management (IPM) remain uncommon. DESIGN: Longitudinal study (2007-2010). SETTING: 12 Ecuadorian communities, previously part of a participatory action research study. PARTICIPANTS: 208 small-scale farmers. Inclusion criteria were: age between 18 and 65 years, literate and resident in the community for the previous 3 years. PRIMARY OUTCOMES: The differential effects of the membership in social organisations (as an effect modifier), on the relationship between the implementation of IPM practices (main independent variable) and farmers' health, measured by neurocognitive performance scores (better higher value; dependent variable). RESULTS: Among organisational participants, the coefficient of association between the implementation of IPM practices for the category good/very good (vs no use) and neurocognitive performance, when farmers were involved in organisations, was negative and moderate (ß=-0.17, SE 0.21) though not significant (p>0.1); for the category little/moderate use, the coefficient was positive (ß=0.34, SE 0.19) and significant. Among those who did not participate in organisations, both little/moderate use and good/very good use of IPM practices were associated with an increase in neurocognitive performance. CONCLUSIONS: The effect of agricultural production practices on farmers' health, transmitted through organisations, can be differentiated. Organisations as structures of social capital seem to be functional in the social reproduction process of the communities studied. Results highlight the need to redirect the analysis of social capital to a more integrated study of social determination of health.

Community and household socioeconomic factors associated with pesticide-using, small farm household members' health: a multi-level, longitudinal analysis.

BACKGROUND: Longitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador. METHODS: We profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables. RESULTS: 376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: ß (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers. CONCLUSIONS: The important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC.

Health promotion outcomes associated with a community-based program to reduce pesticide-related risks among small farm households.

A range of determinants at multiple socio-ecological levels operate in small farm households' use and handling of hazardous pesticides, suggesting the need for integrated health and agriculture promotion approaches. The aim is to assess changes in health promotion outcomes relevant to highly hazardous pesticide use associated with a multi-component community program. A longitudinal evaluation design using mixed methods was employed in 18 agricultural communities in Ecuador. Over a 7-month period, health education and agricultural interventions focused upon: health risks associated with hazardous pesticides, more adequate use and handling of pesticides, and better crop management techniques. Data collection included field forms, focus groups, structured observations and repeat surveys. In the qualitative analysis, communities were compared by extent of leadership and involvement with the interventions. For the quantitative analysis, hypothesized paths were constructed including factors relevant to pesticide-related practices and use. Testing involved gender-role stratified (household and crop manager) multivariable regression models. Information on pesticide health impacts and the pesticide use and handling, shared in focus groups, showed substantial improvement, as a result of health promotion activities though people were still observed to engage in risky practices in the field. In path models, community leadership and intervention intensity lead to changes in the household managers' pesticide-related knowledge and practices and to reduction in farm use of hazardous pesticides (both significant, p < 0.05). Integrated, community programs can promote pesticide-related risk reduction among small farm households. Changing practices in the use and management of pesticides among crop managers appears limited by deeper structural and cultural factors.

Monitoring adherence to the international code of conduct: highly hazardous pesticides in central Andean agriculture and farmers' rights to health.

The WHO has advocated monitoring adherence to the Food and Agriculture Organization's Code of Conduct to reduce use of highly hazardous pesticides in lower and middle income countries. We re-framed Code articles in terms of farmers' rights and drew on survey data, farmer focus group results, and direct observations of agrochemical stores in Ecuador and Peru to construct indicators reflecting respect for such rights. Use of highly (Ia and Ib) and moderately (II) hazardous pesticides was common. Worse indicators were observed in places with lower education, greater poverty, and more use of indigenous languages. Limited government enforcement capacity, social irresponsibility of the pesticide industry, and lack of farmers' knowledge of the Code were all factors impeding respect for farmers' rights. Addressing the power imbalance among social actors requires informed farmer and farmworker participation in monitoring adherence and active involvement of non-governmental organizations and municipal governments.

Development of transdisciplinarity among students placed with a sustainability for health research project.

Transdisciplinary education on sustainability for health has been primarily developed in high-income countries, yet the need in countries with limited research and human resource investments remains urgent. Little empiric documentation of the facilitators and barriers to transdisciplinary learning in such countries has been described. We assessed transdisciplinary learning among students of different disciplines collaborating with an Ecuadorian sustainability for health research project. Six undergraduate students from four different disciplinary backgrounds were incorporated through work-study agreements with provincial university academic supervisors. Learning was fostered and monitored through participant observations by a field supervisor. Students' learning was evaluated through subsequent in-depth interviews and visualization methods. Academic supervisor key informant and co-investigator observations aided triangulation. Qualitative data were analyzed using indicators of transdisciplinary thinking. Principal factors facilitating transdisciplinary learning were interaction with social actors, the integration of work with other disciplines, the use of alternative research techniques and methods, and the constant support of the field supervisor. Inhibiting factors included the existence of rigid academic rules, lack of training of the academic supervisors in diverse research methods, and social pressures to implement unidisciplinary foci. At the end of their link with the project, students had developed both cognitive outcomes and attitudinal values relevant to sustainable development for health. In countries with limited investments in research and human resources development, transdisciplinary approaches with social actors and engaged researchers can sensitize new professionals training in traditional academic contexts to the ecological-social-health problems faced by poor majorities and encourage their subsequent work on sustainability for human health.

Relationships among production systems, preschool nutritional status, and pesticide-related toxicity in seven ecuadorian communities: a multi-case study approach.

BACKGROUND: Among small Andean potato farmers, greater pesticide use and better linkage to markets are promoted as ways to improve farm outputs and incomes. The health of household members is assumed to improve with higher incomes, although evidence to support such an assumption remains scarce. OBJECTIVE: Using a multidisciplinary approach, we sought to characterize agricultural systems producing potatoes and to assess relationships between these characteristics and farm household health indicators. METHODS: We included seven communities linked to a regional agricultural potato production platform (socioorganizational "space" for potato commercialization) in Chimborazo, Ecuador. The unit of analysis was the community, each of which was classified according to its level of intensity of potato production as more intensive, intermediate, or less intensive. Data on crop management, household food intake, child anthropometry, and impacts of pesticide use on adult health were collected by survey. RESULTS: The net income from potato production was similar in communities with more intensive and intermediate production systems and lower in those with less intensive systems. However, deficits in protein intake were more common among children in communities with more intensive systems (63%) than among those in communities with intermediate (53%) and less intensive (37%) systems. Deficits in thiamin and riboflavin intake were more prevalent in communities with more and less intensive systems than in those with intermediate systems. In contrast, the prevalence of moderate chronic malnutrition, as measured by height-for-age, was greater among children in communities with less intensive systems (27%) than among those in communities with intermediate (5%) and more intensive (7%) systems. Across all intensities, frequent use of highly hazardous pesticides was associated with adverse health effects. CONCLUSIONS: Agricultural development programs need to work more cross-sectorally to realize the potential health benefits associated with intensification of production.