Knowledge and attitudes of community health workers in Ecuador regarding the prevention of chronic malnutrition in children: results of a cross-sectional exploratory study

OBJECTIVE: To explore the prior knowledge and attitudes of community health workers (CHWs) in Ecuador regarding chronic malnutrition in children (CMC) in order to identify the needs and improve their capabilities to address this issue in their communities. METHODS: A cross-sectional exploratory study with a mixed-paradigm social approach. A virtual questionnaire adapted from the Food and Agriculture Organization (FAO) Knowledge, Attitudes, and Practices (KAP) survey was administered to 111 CHWs from Ecuador's Ministry of Health, operating in communities prioritised by the state due to high rates of Chronic Malnutrition in Children (CMC). The questionnaire assessed knowledge and attitudes regarding anaemia, CMC, drinking water, breastfeeding, complementary feeding and feeding during pregnancy. Descriptive and bivariate analysis was performed using SPSS V.24.0 for the closed questions, and qualitative analysis through deductive coding using MAXQDA for the open questions of the questionnaire. RESULTS: The mean knowledge score was 6.6/9 points (SD 1.43). Significant differences were observed based on experience (p<0.05), with lower scores among CHWs with less than 1 year of experience. While 88.3% identified at least one cause of CMC, only 60.4% could identify consequences. CHWs showed greater knowledge about feeding during pregnancy and breastfeeding practices than about complementary feeding (44.14% adequate responses). CHWs reported high confidence in providing advice on CMC prevention, breastfeeding and nutrition during pregnancy, but lower confidence in using the country's dietary guidelines. Qualitative analysis revealed important barriers such as families' lack of financial resources and limited access to drinking water. CONCLUSIONS: The results demonstrate the need to improve CHWs' understanding of adequate nutrition from pregnancy to 2 years of age, and the use of the country's dietary guidelines. It is necessary to strengthen their capacity to identify CMC risk factors in communities and better understand its consequences so they can promote behavioural changes and mobilise their communities to address this issue.