A/HRC/44/48/Add.1 B. Children and adolescents 54. Malnutrition remains a very important national health challenge. The level of malnutrition is the second highest in Latin America and remains high among the indigenous and Afro-Ecuadorian populations, as well as in rural areas. According to information received, acute diarrhoeic infections caused by rotavirus and pneumonia have a great impact on malnutrition. Pneumonia is one of the three main causes of death in children under five years old. According to official data, 24 per cent of children under five suffered from chronic malnutrition in 2016 compared to 25.8 per cent in 2006. 25 As of 2014, among indigenous peoples that indicator was approximately 49 per cent. 26 In 2014, 15 per cent of households with children or adolescents did not have enough food and 26 per cent had problems paying for food. That indicator was 33 per cent for Afro-Ecuadorian households.27 As of 2012, 63.9 per cent of children aged between 6 and 11 months suffered from anaemia, 22 per cent of adolescents aged between 12 and 19 were overweight and 7 per cent were obese.28 The vaccination coverage is below the desired level of 95 per cent. 55. In line with the recommendations of the Committee on Economic, Social and Cultural Rights, the Special Rapporteur recommends that Ecuador should recognize the situation of malnutrition as a national priority and adopt a comprehensive policy to address it, including sufficient human and financial resources. Such financial resources should also guarantee the supply of nutrients and minerals to all children and adolescents, especially in schools (E/C.12/ECU/CO/4, para. 44 (f)). 56. The Special Rapporteur stresses that it is of the utmost importance not only to invest in preventing malnutrition, but also to guarantee the healthy holistic development of children and adolescents, with due importance given to their social, cultural and emotional development, as provided in article 6 of the Convention on the Rights of the Child, which was ratified by Ecuador in March 1990. That approach requires the concerted efforts of the health, education and social inclusion sectors, together with the network of communitybased services that protect children from violence and other harmful factors in families, schools, communities and other settings. 57. The Special Rapporteur echoes the concerns of the Committee on the Rights of the Child, noting the prevalence of several forms of violence, including physical, sexual and psychological violence, against children of all ages at home, in school and in public spaces that is inflicted by parents, teachers, partners, caregivers and/or classmates, (CRC/C/ECU/CO/5-6, para. 24 (a)). He emphasizes that according to new research, the prevention of violence and other forms of adverse childhood experiences is crucial to promote the physical and mental health of individuals throughout their life span. For that reason, the Special Rapporteur recommends increasing investment in services that prevent all forms of violence against children and supporting parents so that they have the skills to bring up children in non-violent ways. C. Lesbian, gay, bisexual and transgender persons 58. Lesbian, gay, bisexual and transgender persons face significant barriers in the full enjoyment of their right to physical and mental health. The barriers are connected to deeply entrenched discriminatory attitudes in society at large, which generate stigma, violence and abuse, including in the health system. 59. Lesbian, gay, bisexual and transgender persons have reported discrimination by health-care personnel and a lack of integral health services tailored to their needs. The of Special Rapporteur received testimonies and evidence that they face forms violence on the basis of their sexual orientation and gender identity and expression. That is particularly relevant for transgender people who require hormonal treatment, which is reportedly not available through the public health services. Information gathered during his visit allowed 25 26 27 28 See www2.congreso.gob.pe/sicr/cendocbib/con4_uibd.nsf/915B4499240864A405257B82007270FF/ $FILE/Mapa_de_Desnutricion_2009.pdf. See www.unicef.org/ecuador/informes/situación-de-la-niñez-y-adolescencia-en-el-ecuador. Ibid. See www.salud.gob.ec/encuesta-nacional-de-salud-y-nutricion-ensanut/. 13