Abstract
The physical growth of children under 5 years of age was studied in relation to patterns of nutrition, morbidity, and health care utilization in three remote villages of tropical Ecuador. Ageโspecific comparisons of height and weight to growth curves from reference populations (US National Child Health Survey) indicated moderate to severe stunting in the population of male and female children. Examination of heightโweight relationships as a measure of recent nutritional status provided little evidence that male children were underweight for their height. However, the observation that female children fell between the 3rd and 50th centile channels of the reference population in their heightโweight relationship suggested moderate wasting in addition to substantial stunting. Endemic parasitism and a high rate of diarrheal illnesses were detected in the study population and were likely contributing agents to the stunting observed in male and female children. No dichotomy in the incidence of diarrhea was detected between male and female children, and if the episode was mild it was typical not to treat the illness, regardless of sex. In more severe cases, female children were more frequently taken to traditional healers. However, when familial selfโtreatment or local clinics were used, male children were more likely to be the beneficiary. Thus it seems possible that this advantage, along with the cultural practice of investing more of the family's resources in male children, may be responsible for the wasting detected in young females. Tropical conditions, chronic undernutrition, compromised cellular immunity, and inadequate health care services were likely causes of the high morbidity and mortality of children under age 5. Communityโbased programs of health promotion and disease prevention appear to offer the best potential as intervention strategies in these villages.