Contents -- Acknowledgments -- Acronyms and Abbreviations -- Executive Summary -- 1. Introduction -- 2. A Profile of Malnutrition in Ecuador -- Data Sources -- The Prevalence of Malnutrition in Ecuador -- 3. Causes of Chronic Malnutrition in Ecuador -- The Causes of Nutritional Failure -- Statistical Evidence from the ENDEMAIN Survey -- Behavior that Affects Nutritional Outcomes in Ecuador: Qualitative and Quantitative Evidence -- 4. Issues Facing Ecuador's Nutrition Programs -- Review of the Main Nutrition-related Programs in Ecuador -- Spending on Nutrition-related Programs -- Accountability at the Program Level -- Program Coverage, Targeting, and Benefit Incidence -- 5. Recommendations for the Development of a Goal-based National Nutrition Strategy -- Appendixes -- A. Ecuador Malnutrition Rates Using the New Reference Growth Charts -- B. Indicators -- C. Model and Methodology -- Bibliography -- LIST OF TABLES -- 1. Under-5 Nutrition Trends in Ecuador, 1986-2004 -- 2. Nutrition Outcomes in Ecuador and Similar Countries -- 3. The Prevalence of Under-5 Child Malnutrition in Ecuador -- 4. Distribution of Stunted and Severely Stunted Under-5s in Ecuador -- 5. Child Anemia Prevalence -- 6. Correlation of Anemia and Stunting in Low-income Households -- 7. Parameter Estimates of Reduced Form Models for Height-for-Age Z-score -- 8. Reduction in the Stunting Rate (%) Expected to Result from Increased Consumption -- 9. Projected Percentage Change in the Stunting Rate Due to Increasing the Proportion of Mothers Able to Recognize a Low-birth -- 10. Proportion of Stunted Children by Mother's Ethnicity and Segment's Altitude -- 11. The Correlation between Household Composition and Nutritional Outcomes -- 12. Maternal Weight Sufficiency in Ecuador -- 13. Stunting and Overweight in Adult Women.

14. Prevalence of Child Stunting in Households with Overweight Mothers -- 15. Proportion of Stunted Children by Whether Their Mother Had Breast-feeding Counseling -- 16. Proportion of Stunted Children by Number and Type of Prenatal Controls -- 17. Proportion of Stunted Children by Place of Birth Attendance -- 18. Proportion of Stunted Children by Whether they were Weighed at Birth, and by Sufficiency of Weight at Birth -- 19. Proportion of Stunted Children by Attendance at Postnatal Clinics and Type of Facility Used -- 20. Proportion of Children Who Are Stunted, by their Exposure to Diarrhea and Acute Respiratory Infections -- 21. Proportion of Children Who Are Stunted, by Immunization Status -- 22. Average Per Capita Annual Household Food Consumption Expenditure by Child's Nutritional Status -- 23. Share in Total Food Consumption of Different Types of Food -- 24. Health Ministry Staff and Facilities, 1996-2004 -- 25. Health Ministry Service Production, 1996-2004 -- 26. Coverage of Maternal and Child Consultations by Health Ministry Facilities -- 27. Public Health Ministry Budget, 2000-05 -- 28. Coverage and Outcomes of Weight-for-Age Monitoring through the SISVAN System -- 29. Recommended Micronutrient Interventions and Indicative Costs, by Priority Intervention and Target Groups -- 30. Cereal Fortification: Recommended International Standards -- 31. International Comparison of Wheat Fortification Standards -- 32. Expenditure Trends on Main Nutrition-related Programs, 2003-05 -- 33. Cost per Beneficiary and Overhead Margin for Nutrition-related Programs, 2005 -- 34. Overlap between Nutrition-related Programs at Household Level -- 35. Beneficiaries and Coverage Rates of the Main Nutrition-related Programs in Ecuador -- 36. Benefit Incidence of Nutrition-related Programs in Ecuador.

A.1. Comparison of Malnutrition Based on the Old and the New Reference Growth Curve -- B.1. Cutoff Points for BMI, Adults -- B.2. Prevalence Levels of Malnutrition among Adults -- C.1. Observations by Type of Questionnaire -- C.2. Parameter Estimates of Reduced Form Models for Height-for-Age Z-score -- C.3. Parameter Estimates of Reduced Form Models for HAZ with Different Definitions of Consumption -- LIST OF FIGURES -- 1. Distribution of Height-for-Age, Weight-for-Age, and Weight-for-Height z-scores in Ecuador, 2004 -- 2. Projected Reduction in Stunting on Historic Trends and Rate Needed to Achieve Goal -- 3. Trends in Main Nutritional Outcomes, 1986-2004 -- 4. Stunting in Ecuador Compared with Other Latin American Countries -- 5. Relationship of Stunting to Per Capita GDP in Selected Latin American Countries -- 6. Spatial Distribution of Stunting in Ecuador -- 7. Mean Height-for-Age z-Scores, by Child's Age -- 8. Mean Weight-for-Height z-Scores by Child's Age -- 9. Mean Weight-for-Age z-Scores, by Child's Age -- 10. Quintile Distribution of Stunting Rates at Provincial Level -- 11. Stunting Rates by Province and Region -- 12. Impact on the Distribution of Height-for-Age z-Scores in Ecuador of Applying the New WHO Reference Curve -- 13. Causes of Stunting at Community, Household, and Individual Level -- 14. Height-for-Age z-Scores for Under-5s in Ecuador, as a Function of Altitude -- 15. Proportion of Indigenous People, by Province -- 16. The Relationship between Under-5 Stunting and the Share of the Indigenous Population in Selected Latin American Countries -- 17. The Relationship between Mothers' Height and Child's Height in Ecuador -- 18. Density Function of Weight at Birth for Stunted and Non-stunted Under-5s -- 19. Food Consumption in Relation to Household Expenditure -- 20. Health and Nutrition Spending in Relation to GDP, Selected Countries.

21. Child Stunting and Health and Nutrition Spending in Selected Countries -- 22. A Well-stocked Medicine Cabinet-Including Nutritional Supplements-Supplied by the LMG at the Alluriquín Rural Health Subc -- 23. Coverage of SISVAN Growth Monitoring System, 1996-2004 -- 24. Children's Height is Often Measured at the Health Post-But This Information is Not Processed in SISVAN -- 25. A Child Growth Chart Illustrating a Typical Trend -- 26. A Wall Chart at the Semitas de Aliso ORI Group in Cotopaxi Illustrates the Program's Costs, a Total of 50 per Child/Mont -- 27. A Young Mother Collects the PANN2000 Mi papilla for Her Child at the Rural Health Subcenter at Alluriquín, Pichincha -- 28. The MIS Officer at ORI's Regional Operations Center for Cotapaxi in Latacunga using the "Matraca" Information System -- 29. Cumulative Distribution Curves for Nutrition-related Programs -- 30. Success Stories Reducing Malnutrition -- A.1. Comparison of Child Malnutrition Based on the Old and the New Reference Growth Curve -- LIST OF BOXES -- 1. The Linkages of Altitude to Stunting -- 2. International Evidence on the Growth Potential of Indigenous Children -- 3. Why Do Many Stunted Children Have Overweight Mothers? -- 4. Breast-feeding: The Lessons of International Experience -- 5. Supernatural Origin or Effects of Disease -- 6. Attitudes toward Family Size in Rural Areas of Pichincha Province -- 7. The Role of Traditional Midwives -- 8. Return of the Placenta -- 9. Dietary Restrictions After Childbirth -- 10. Community-based Child Development Programs-The AIN-C Program in Honduras -- 11. School Feeding-The International Experience -- 12. Nutrition Success Stories.