Multidimensional poverty and the co-occurrence of undernutrition and intestinal parasitic infections in Ecuadorian infants: a geospatial analysis.

Objective: This study investigated the relationship between multidimensional poverty and the co-occurrence of undernutrition and intestinal parasitic infections among children under five in Ecuador. Materials and methods: Using the 2021 national outpatient Ecuadorian registry, we assessed the co-occurrence of undernutrition and intestinal parasitic infection incidences at the municipal-level through spatial analysis. We applied spatial autocorrelation to identify geographic co-occurrence clusters of high-high and low-low incidence rates. Subsequently, we compared the proportions of multidimensional poverty between the high-high and low-low co-occurrence clusters. Results: A spatial correlation was observed between the incidence of undernutrition (14.57 per 1,000 child-years) and intestinal parasitic infections (34.07 per 1,000 child-years) (Bivariate Moran's Index = 0.19, p < 0.001). High-high incidence clusters for both conditions were concentrated in the Amazon region. The median multidimensional poverty in these high-high incidence clusters was 72.62% (IQR: 62.08-82.44%), which was nearly twice as high as in low-low incidence clusters (38.15%; IQR: 38.15-38.93%). Conclusion: Our findings suggest that undernutrition and intestinal parasitic infections in children under 5 years of age tend to co-cluster, and their joint occurrence serves as an indicator of social inequity. High-high incidence clusters were concentrated in the nation's poorest regions, particularly the Amazon. To overcome this double burden, public-health measures must go beyond biomedical interventions and address its underlying social and structural determinants.