Nutritional Follow-Up in Indigenous Children Under Five Years in Colombia

1. Introduction

Malnutrition and its impact on early childhood development (ECD) are a priority for public health due to their effects on survival, neurodevelopment, future productivity, and social equity. Malnutrition and its implications extend beyond medical landscape, becoming a cross-cutting area of interest for societies and governments. Therefore, the Sustainable Development Goals emphasize the global commitment to combat malnutrition and reduce its impact on child development (Goal 2) [1,2].

ECD encompasses the period from gestation through the first 6–8 years of life. This stage is critical for the acquisition of physical, cognitive, emotional, and social skills that determine well-being across the life course, with implications at both individual and societal levels [3,4]. Approximately 80% of key developmental milestones occur during this period, and the brain reaches nearly 90% of its structural and functional development. Consequently, this period is particularly sensitive to adverse exposures such as food insecurity, recurrent infections, and psychosocial stress.

To achieve optimal development, the World Health Organization (WHO) and UNICEF promoted the “nurturing care” concept, which integrates the following components: good health, adequate nutrition, safety and protection, responsive caregiving, and opportunities for early learning [4,5,6,7]. However, these elements alone are insufficient. A supportive social and economic environment, which may either enhance or constrain child development, is required [4,5,8,9]. The impact of these social determinants is substantial: worldwide, an estimated 200 million children under five fail to reach their developmental potential due to poverty, food insecurity, limited access to healthcare, and inadequate early stimulation [10].

In Colombia, several populations experience similar conditions of deprivation and social vulnerability. Among them are Indigenous communities, particularly the Wayúu population in La Guajira. This community faces structural challenges that increase the risk of malnutrition and developmental disorders, including persistent poverty, chronic food insecurity, lack of access to drinking water and basic sanitation, residence in geographically dispersed rural areas with limited accessibility, cultural and language barriers to healthcare access, low educational attainment, structural discrimination, and limited local institutional capacity [11,12,13,14]. Additionally, the Wayúu population is affected by climate change, subsistence-based economies, migration, and fragile social protection systems, all of which further compromise access to adequate nutrition. These conditions create a detrimental environment that directly impacts child nutrition and development, perpetuating an intergenerational cycle of inequality and poor health outcomes [3,8,11,15,16].

Child development is intrinsically linked to nutritional status [4,6,17], which in turn varies according to socioeconomic and environmental conditions [3,8,14]. Consequently, it is essential to establish global reference standards defining optimal growth. The WHO Child Growth Standards represent a methodological milestone, derived from multicenter cohorts of healthy children raised under optimal conditions, describing how children should grow rather than how they grow in specific contexts [18,19]. These standards enable early detection of deviations and guide both clinical and population-level interventions, including in vulnerable populations such as the Wayúu, distinguishing between normal constitutional variation and growth alterations secondary to deprivation. They are critical tools for identifying nutritional risk, monitoring interventions, and evaluating recovery and developmental outcomes [10,18,20,21].

Given the impact of nutrition and social determinants on child development [8,17], and the vulnerability of populations such as the Wayúu [11,13], multiple governmental strategies have been implemented to reduce disparities. These include strengthening institutional presence, generating local data, implementing culturally sensitive primary care programs, integrating nutrition, health, education, and social protection, and promoting community empowerment to develop sustainable and culturally appropriate policies [2,22].

At the national level, the Colombian government established the Health Research Fund (FIS), administered by the Ministry of Science, Technology, and Innovation, to finance health research projects [23,24]. Through this mechanism, resources were allocated to the National Institute of Health (INS) to develop the project: “Community intervention for the prevention of maternal and perinatal morbidity and mortality under a sexual and reproductive health approach, and assessment of growth and development in Wayúu children in a region of La Guajira” (in Spanish, “Intervención comunitaria para la prevención de la morbimortalidad materna y perinatal bajo el enfoque de salud sexual y reproductiva; y valoración del crecimiento y desarrollo en niños y niñas del pueblo Wayúu de una región de La Guajira”). This project includes multiple phases, beginning with the characterization of population and nutritional status as a foundation for understanding structural vulnerabilities and guiding interventions.

Therefore, we aimed to identify growth and developmental patterns in a cohort of Wayúu children in La Guajira, Colombia, within a national governmental initiative to reduce child morbidity and mortality and strengthen ECD in vulnerable populations.

2. Materials and Methods

2.1. Study Design

This study is part of a governmental initiative that employed a mixed-methods approach, incorporating a qualitative component with a phenomenological and participatory action framework, and a quantitative component with a prospective cohort design.

This article presents the results of the quantitative analysis of the growth and development cohort of Wayúu children in La Guajira over an 8-month follow-up period (August 12, 2024, to March 28, 2025).

2.2. Study Population and Sample

We used a non-probabilistic sampling method (convenience sampling) to include study participants under five years from 27 communities in the municipality of Manaure, La Guajira, Colombia. In total, 398 children were included, representing:

• 0.41% of the total population in La Guajira within this age range [25,26,27]
• 3.38% of the population of the municipality of Manaure according to the 2018 census [26]
• 3.75% of children under 4 years in the dispersed rural population of Manaure
• 3.51% of the total Indigenous population under 4 years [25,27,28]

All participants belong to the Wayúu ethnic group, in a region where 93.6% of the population self-identifies as Indigenous. The study area covers 1,643 km² with a population density of 45 inhabitants/km² [29,30](Figure 1).

2.3. Inclusion and Exclusion Criteria

All children under five years (0 to 4 years) residing in the selected communities at the time of the community intervention were included. No exclusion criteria or recruitment restrictions were applied. Participants were evaluated in the presence of their legal guardians, and informed consent was obtained prior to data collection.

2.4. Variables and Data Collection

Anthropometric data were collected by a team of pediatricians using calibrated measurement instruments (stadiometer, scale, and Mid-Upper Arm Circumference [MUAC] tape) during clinical evaluations. Data were recorded in paper-based medical records and posteriorly were uploaded in a digital data collection form. Collected variables included sociodemographic characteristics and anthropometric measurements, classified according to standard definitions.

2.5. Statistical Analysis

A descriptive analysis of demographic and anthropometric variables was performed including all study participants’ data. A bivariate analysis was conducted to compare anthropometric indicators by sex. A subgroup of participants was follow-up and their changes were compared over time. Data storage and preliminary processing were performed using Microsoft Excel. Statistical analysis was conducted using SPSS version 21.

3. Results

A total of 398 children were included in the study: 216 boys and 182 girls, corresponding to a male-to-female ratio of 1.16 and a proportion of 54.3% male participants (Table 1). The median age was 2.65 years (IQR: 1.47–3.57) among boys and 2.76 years (IQR: 1.48–3.77) among girls, consistent with the sex distribution reported in the most recent departmental census.

Overall, age distribution was non-normal, with a median of 2.70 years (IQR: 1.48–3.67; range: 3.25 months to 5.05 years). The majority of participants (98.2%) were older infants and children aged between 6 months and 5 years, while only 1.8% were younger infants. Age distribution was similar across sexes (Figure 2).

Follow-up was achieved in 6.03% of cases (n = 24), and 12 children changed communities during the study period.

3.1. Baseline Nutritional Status

At the initial evaluation, more than 90% of participants presented at least one form of nutritional alteration. Except for 10 cases, all children exhibited some degree of developmental delay or established malnutrition.

The most prevalent condition was stunting (height-for-age deficit), affecting 60.1% of participants, followed by underweight (weight-for-age deficit) at 23.1%. In contrast, the prevalence of acute malnutrition (wasting) was low, at 3.5% according to weight-for-height and 2% according to MUAC.

These findings suggest a pattern of symmetrical growth impairment, which also affected head circumference, with nearly half of the children (46.48%) classified as having microcephaly (Table 2).

Overall, 92.46% of participants had at least one nutritional alteration, and 89.95% had some form of malnutrition or developmental delay.

In the follow-up subgroup (n = 24), there was a slight increase in the proportion of children with malnutrition or developmental delay (from 83.33% to 91.67%).

A heterogeneous pattern of change was observed:

• 75% of children showed changes in nutritional indicators
• 41.67% experienced worsening in at least one indicator

There was a predominance of increased risk of acute malnutrition and neurological risk (Figure 3).

Within-subject analysis showed:

• A statistically significant increase in nutritional risk between visits (83.33% vs. 91.67%, p = 0.02)
• No statistically significant change in neurological risk (25% vs. 50%, p = 0.61)

Graphical analysis (Figure 4) demonstrated a progressive negative trend in anthropometric indicators over time, with worsening z-scores for both weight-for-age and height-for-age as follow-up time increased.

3.3. Sex and Age Associations

No statistically significant differences were observed in nutritional alterations by sex. However, both underweight (global malnutrition) and stunting (chronic malnutrition) showed statistically significant associations with age. Children aged 2 to 4 years were more likely to present low weight or short stature for age, whereas younger infants were more likely to have normal anthropometric indicators. These findings are consistent with a direct correlation between increasing age and worsening nutritional status (Table 3).

4. Discussion

This analysis provides a characterization of the nutritional status of Wayúu children under five years of age in the municipality of Manaure, La Guajira. The findings reveal a critical public health situation, with prevalences of underweight (weight-for-age) and stunting (height-for-age) that are substantially higher than both national estimates and those reported in other high-risk populations, including Indigenous groups in Colombia. Although the prevalence of acute malnutrition (wasting) was lower, it remains approximately twice that reported in the most recent national nutritional survey [31].

Notably, these nutritional alterations were significantly associated with age, with higher prevalence observed among children older than two years. This pattern may be related to the cessation of breastfeeding and increased exposure to food insecurity and limited access to resources within their socioeconomic context [32,33,34,35]. The predominance of chronic malnutrition reflects a pattern of symmetrical growth impairment, characterized by generalized reduced body size and, in many cases, involvement of head circumference. This pattern is not fully captured by weight-for-height indicators or the conventional diagnosis of acute malnutrition, which benefits from standardized national treatment protocols [36]. In contrast, chronic malnutrition represents a distinct and potentially more severe public health challenge.

Recovery from chronic malnutrition or symmetrical growth delay is more difficult to achieve, and its consequences are more profound and long-lasting. These include detrimental effects on neurodevelopment, immune function, and overall functional capacity, with impacts that may persist into adulthood and old age [37,38,39]. Effective intervention requires not only addressing biological and individual-level factors, such as low birth weight, chronic infections (e.g., parasitic diseases), and familial short stature, all of which are present in this population and have been described in similar settings [40,41] —but also tackling the broader structural determinants.

In addition to the previously described socioeconomic factors [32,33,34,35], this population faces severe limitations in access to essential resources, which may exacerbate or perpetuate these biological risks. Evidence from national surveys on multidimensional poverty and nutritional status [25,31,42] indicates that both the municipality of Manaure and the department of La Guajira have some of the highest levels of food insecurity, limited access to basic services (including potable water, sanitation, and electricity), and lower per capita income compared to national averages. These conditions are well-established risk factors for chronic malnutrition [32,33,34,35] and act not only as causal drivers but also as reinforcing mechanisms that sustain biological vulnerabilities over time, ultimately contributing to a persistent cycle of poverty–malnutrition–poverty [32,33,34,35,40].

The longitudinal analysis, although limited to a small subgroup, reinforces these findings. The persistence of stunting and underweight, along with the progression toward worsening anthropometric indicators over time, suggests a pattern of growth stagnation rather than recovery. This dynamic is particularly concerning, as it indicates that affected children are not achieving catch-up growth, thereby increasing the likelihood of long-term adverse outcomes. Additionally, the high degree of internal migration between communities poses a significant challenge for continuity of care and follow-up, which must be considered in the design of future interventions.

While the study is primarily descriptive, it highlights the urgent need for sustained and comprehensive interventions in this population. Such strategies should not focus solely on short-term correction of specific anthropometric indicators but rather adopt a holistic and multisectoral approach aimed at addressing both the immediate and underlying determinants of malnutrition. This includes improving access to adequate nutrition, strengthening health services, enhancing ECD programs, and addressing structural inequities that disproportionately affect Indigenous communities.

The main limitations of this study include its observational design, which precludes causal inference between nutritional outcomes and the evaluated social, economic, and demographic factors. Additionally, follow-up of the cohort was limited due to geographic barriers and the semi-nomadic lifestyle of the population, which may have introduced selection bias in the longitudinal analysis.

Finally, while the findings may be generalizable to Indigenous communities in the Guajira Peninsula, they may not be directly extrapolated to other Indigenous or rural populations in Colombia with different sociocultural and geographic contexts.

5. Conclusions

Wayúu children in La Guajira, Colombia, exhibit a shift in nutritional patterns from predominantly acute malnutrition toward chronic, symmetrical growth impairment, necessitating a reorientation of prevention and control strategies for childhood malnutrition. Childhood malnutrition in this population results from the interaction between biological factors and structural socioeconomic determinants, which together exacerbate and perpetuate nutritional deficits over time.