Maternal and neonatal variables associated with premature birth and low birth weight in a tertiary hospital in Ecuador.

OBJECTIVE: To explore the maternal and neonatal factors associated with premature birth and low birth weight in an Ecuadorian tertiary hospital. DESIGN: Cross-sectional study. SETTING: The Calderón General Teaching Hospital (CGTH). Maternal and delivery characteristics were obtained from medical records. PARTICIPANTS: All live births from April 2017 to October 2020 were considered as the source population. FINDINGS: The study included 13,407 reported births. The proportion of low birth weight neonates was 12.4%. The frequencies of neonates with gestational ages of less than 34 and from 34 to 37 weeks were 1.8% and 8.8%, respectively. According to INTERGROWTH-21st standards, 14% and 5.5% of the neonates were classified as small- (<10th centile) and large-for-gestational-age (>90th centile), respectively. A higher proportion of low birth weight was observed among newborns of illiterate mothers, younger mothers, and with gestational hypertension. The proportion of small-for-gestational-age infants was lower among younger mothers, while large-for-gestational-age infants were more frequent among older mothers. Maternal obesity (proportion ratio [PR] 2.80, 95%CI 1.69 - 4.64), and gestational diabetes (PR 3.24, 95%CI 2.12 - 4.96) were associated with an increased percentage of large-for-gestational-age births. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The proportion of low birth weight in Calderón General Teaching Hospital is large compared to those found in studies conducted in Latin America, and the preterm birth rate is close to that estimated in less developed countries. Despite the advances in maternal and child health observed in Ecuador, the present study shows that interventions are still needed in this population.

Intercultural Childbirth: Impact on the Maternal Health of the Ecuadorian Kichwa and Mestizo People of the Otavalo Region.

OBJECTIVE: Considering the increased frequency of maternal deaths reported from 2001 to 2005 for Indigenous and mestizo women from the Ecuadorian rural area of Otavalo, where the Kichwa people has lived for centuries, the objective of the present article is to describe how the efforts of the local health community and hospital workers together with a propitious political environment facilitated the implementation of intercultural childbirth, which is a strategy that respects the Andean childbirth worldview. METHODS: We evaluated a 3-year follow-up (2014-16) of the maternal mortality and the childbirth features (4,213 deliveries). RESULTS: Although the Western-style (lying down position) childbirth was adopted by 80.6% of the pregnant women, 19.4% of both mestizo and Indigenous women adopted the intercultural delivery (squatting and kneeling positions). Both intercultural (42.2%) and Western-style (57.8%) childbirths were similarly adopted by Kichwa women, whereas Western-style childbirth predominated among mestizo women (94.0%). After the implementation of the intercultural strategy in 2008, a dramatic decrease of maternal deaths has been observed until now in both rural and urban Otavalo regions. CONCLUSION: This scenario reveals that the intermingling of cultures and respect for childbirth traditions have decreased maternal mortality in this World Health Organization-awarded program.

OBJETIVO: Considerando a crescente frequência de mortes maternas notificadas de 2001 a 2005 entre mulheres indígenas e mestiças da área rural equatoriana de Otavalo, onde o povo Kichwa vive há séculos, o objetivo deste artigo é descrever como os esforços da comunidade local de saúde e dos trabalhadores hospitalares, juntamente com um ambiente político propício, facilitaram a implementação do parto intercultural, que é uma estratégia que respeita a visão de mundo do parto andino. MéTODOS: Foram avaliadas as características da mortalidade materna e do parto (4.213 partos) por um período de 3 anos (2014­16) RESULTADOS: Embora o parto no estilo ocidental (posição deitada) tenha sido adotado por 80,6% das gestantes, 19,4% das mestiças e indígenas adotaram o parto intercultural (posições de agachamento e ajoelhamento). Os partos interculturais (42,2%) e ocidentais (57,8%) foram adotados de maneira semelhante pelas mulheres Kichwa, enquanto o parto ocidental predominou entre as mestiças (94,0%). Após a implementação da estratégia intercultural em 2008, foi observada uma redução drástica de mortes maternas nas regiões rurais e urbanas de Otavalo. CONCLUSãO: Esse cenário revela que a mistura de culturas e o respeito às tradições do parto diminuíram a mortalidade materna neste programa premiado pela Organização Mundial de Saúde.

Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador.

INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo's Kichwa population may have contributed to the observed clinical response to CAP treatment.

Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador

Abstract INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo's Kichwa population may have contributed to the observed clinical response to CAP treatment.