Dengue hospitalizations and in-hospital mortality changes in trend in Ecuador: a nationwide study from 2015 to 2022.

OBJECTIVE: This study aimed to analyze dengue hospitalizations and in-hospital mortality trends in Ecuador, along with sociodemographic factors influencing adverse outcomes. METHODS: This study included 31,616 dengue hospitalizations in Ecuador during 2015-2022, of which 115 (0.36%) died. Data were extracted from national hospital registries. Age adjusted rates were calculated, and for the analysis of changes in trend, a Joinpoint regression was performed. Multivariate binary and multinomial logistic regressions were performed for assessing sociodemographic factors influencing dengue adverse outcomes. RESULTS: During 2015-2022, the mean age adjusted dengue hospitalization rate was 22.3 per 100,000 inhabitants with 49.41% annual decrease during 2015-2017 and 31.73% annual increase during 2017-2022 with higher rates in 2020 with 31.61, 2021 with 34.42, and 2022 with 25.81. The mean dengue in-hospital mortality rate was 0.08, mortality rates did not show significant changes during 2015-2022. Higher probability of death was observed in ages ≥50 years and ethnic minorities. People living in rural areas exhibited a 64% higher risk for complicated dengue hospitalization. CONCLUSIONS: It was observed as an important accomplishment in Ecuador's ongoing efforts to improve healthcare regarding dengue. 0.36% of dengue hospitalizations ended in death which is below the recommended 1%. The increase in dengue hospitalizations in Ecuador during recent years remains a concern. The COVID-19 pandemic might have influenced dengue prevention and vector control to be neglected leading to an increase in cases.

Spatio-temporal evaluation of air pollution using ground-based and satellite data during COVID-19 in Ecuador.

The concentration of gases in the atmosphere is a topic of growing concern due to its effects on health, ecosystems etc. Its monitoring is commonly carried out through ground stations which offer high precision and temporal resolution. However, in countries with few stations, such as Ecuador, these data fail to adequately describe the spatial variability of pollutant concentrations. Remote sensing data have great potential to solve this complication. This study evaluates the spatiotemporal distribution of nitrogen dioxide (NO2) and ozone (O3) concentrations in Quito and Cuenca, using data obtained from ground-based and Sentinel-5 Precursor mission sources during the years 2019 and 2020. Moreover, a Linear Regression Model (LRM) was employed to analyze the correlation between ground-based and satellite datasets, revealing positive associations for O3 (R2 = 0.83, RMSE = 0.18) and NO2 (R2 = 0.83, RMSE = 0.25) in Quito; and O3 (R2 = 0.74, RMSE = 0.23) and NO2, (R2 = 0.73, RMSE = 0.23) for Cuenca. The agreement between ground-based and satellite datasets was analyzed by employing the intra-class correlation coefficient (ICC), reflecting good agreement between them (ICC ≥0.57); and using Bland and Altman coefficients, which showed low bias and that more than 95% of the differences are within the limits of agreement. Furthermore, the study investigated the impact of COVID-19 pandemic-related restrictions, such as social distancing and isolation, on atmospheric conditions. This was categorized into three periods for 2019 and 2020: before (from January 1st to March 15th), during (from March 16th to May 17th), and after (from March 18th to December 31st). A 51% decrease in NO2 concentrations was recorded for Cuenca, while Quito experienced a 14.7% decrease. The tropospheric column decreased by 27.3% in Cuenca and 15.1% in Quito. O3 showed an increasing trend, with tropospheric concentrations rising by 0.42% and 0.11% for Cuenca and Quito respectively, while the concentration in Cuenca decreased by 14.4%. Quito experienced an increase of 10.5%. Finally, the reduction of chemical species in the atmosphere as a consequence of mobility restrictions is highlighted. This study compared satellite and ground station data for NO2 and O3 concentrations. Despite differing units preventing data validation, it verified the Sentinel-5P satellite's effectiveness in anomaly detection. Our research's value lies in its applicability to developing countries, which may lack extensive monitoring networks, demonstrating the potential use of satellite technology in urban planning.

Exceso de mortalidad durante la pandemia de COVID-19 en Ecuador. Análisis espacio temporal del exceso de mortalidad durante la pandemia de COVID-19 en Ecuador / Excess Mortality during the COVID- 19 Pandemic in Ecuador. Spatiotemporal Analysis of Excess Mortality During the Covid-19 Pandemic in Ecuador

Introducción: La pandemia de COVID-19 causó una elevada mortalidad en el mundo y en el Ecuador. Esta investigación se propuso analizar el exceso de mortalidad debido a la pandemia de COVID-19 en Ecuador. Método: Estudio observacional, longitudinal, cuantitativo y descriptivo. Clasificado como estudio ecológico en el campo de la epidemiología. Este estudio se centra en la medición del exceso de mortalidad durante los años 2020, 2021 y 2022, tomando como período base el promedio de defunciones ocurridas en el intervalo de 2015 a 2019. Resultados: Ecuador, en el período de enero 2020 a octubre 2022, acumuló un exceso total de muertes de 98.915. En el año 2020, el exceso de mortalidad fue mayor a 46.374, siendo el mes de abril el valor más alto de 15.484. En el año 2021, el exceso de muertes fue de 35.859, siendo abril el mes con mayor exceso de 7.330. Y el año 2022 el exceso de mortalidad fue de 16.682, el mes con mayor exceso fue enero con 4.204. Conclusión: Se evidenció un subregistro de defunciones, así como variaciones temporales y geográficas en el exceso de mortalidad. La provincia con mayor número de fallecidos y exceso de mortalidad fue Guayas seguida de Pichincha. Los resultados proporcionan un análisis del panorama durante la emergencia sanitaria, destacando la importancia de evaluar la capacidad de respuesta de los sistemas de salud en momentos de crisis y la necesidad imperativa de implementar medidas correctivas para el futuro.

Introduction: The COVID-19 pandemic caused a significant mortality in the world and in Ecuador. This research aimed to analyze the excess mortality due to the COVID-19 pandemic in Ecuador. Method: An observational, longitudinal, quantitative and descriptive study, classified as an ecological study in the field of epidemiology. This study focuses on measuring excess mortality during the years 2020, 2021 and 2022, using the average number of deaths that occurred in the period from 2015 to 2019 as the baseline. Results: From January 2020 to October 2022, Ecuador accumulated a total excess of deaths of 98,915. In 2020, the excess mortality was higher at 46,374, with the highest value occurring in April at 15,484. In 2021, the excess deaths amounted to 35,859, with April having the highest excess of 7,330. In 2022, the excess mortality was 16,682, with January recording the highest excess at 4,204. Conclusion: Evidence of underreporting of deaths, as well as temporal and geographi-cal variations in excess mortality, was observed. The province with the highest number of deaths and excess mortality was Guayas, followed by Pichincha. The results provide an analysis of the situation during the health emergency, emphasizing the importance of evaluating the healthcare system's capacity to respond during times of crisis and the imperative need to implement corrective measures for the future.

Surveillance of COVID-19 vaccines: A comprehensive analysis of the first immunization drive in Ecuador.

The initial phase of the COVID-19 vaccination in Ecuador occurred between April and November 2021. Initially, it focused on priority populations, including health professionals and other front-line workers. During this period, there was limited knowledge about the vaccine's adverse effects. A non-probability, observational study was conducted among university staff in Guayaquil, Ecuador, who received the AstraZeneca vaccine (n = 423) between April and November 2021. This study aimed to compare the acute adverse reactions by doses and to report the incidence of long-term adverse reactions within the AstraZeneca group. As a result, comparing acute adverse reactions between doses, the odds ratio for local pain, headache, muscle pain, fever, and chills are statistically higher after the first dose than the second dose. Survival curves indicated these symptoms appeared mainly within the first 6 h post-vaccination. This is the first pharmacovigilance study from Ecuador that analyzes survival probabilities for the AstraZeneca vaccine's adverse effects.

A proposed analytical approach to estimate excess daily mortality rates in Ecuador.

Background: The COVID-19 pandemic has proved deadly all over the globe; however, one of the most lethal outbreaks occurred in Ecuador. Aims: This study aims to highlight the pandemic's impact on the most affected countries worldwide in terms of excess deaths per capita and per day. Methods: An ecological study of all-cause mortality recorded in Ecuador was performed. To calculate the excess deaths relative to the historical average for the same dates in 2017, 2018, and 2019, we developed a bootstrap method based on the central tendency measure of mean. A Poisson fitting analysis was used to identify trends on officially recorded all-cause deaths and COVID-19 deaths. A bootstrapping technique was used to emulate the sampling distribution of our expected deaths estimator µâŒ¢deaths by simulating the data generation and model fitting processes daily since the first confirmed case. Results: In Ecuador, during 2020, 115,070 deaths were reported and 42,453 were cataloged as excess mortality when compared to 2017-2019 period. Ecuador is the country with the highest recorded excess mortality in the world within the shortest timespan. In one single day, Ecuador recorded 1,120 deaths (6/100,000), which represents an additional 408% of the expected fatalities. Conclusion: Adjusting for population size and time, the hardest-hit country due to the COVID-19 pandemic was Ecuador. The mortality excess rate shows that the SARS-CoV-2 virus spread rapidly in Ecuador, especially in the coastal region. Our results and the proposed new methodology could help to address the real situation of the number of deaths during the initial phase of pandemics.

Maternal mortality and COVID-19: A nationwide ecological analysis from Ecuador.

BACKGROUND: During the COVID-19 pandemic, distinct population subsets, including pregnant women, have been differentially affected. While over 90% of COVID-19-infected pregnant women experience a benign course, a subset demonstrates marked clinical exacerbation. Symptomatic pregnant individuals, in particular, present a heightened risk of severe disease in comparison to their non-pregnant counterparts. OBJECTIVE: The objective of this study is to systematically evaluate the epidemiological characteristics of COVID-19 in pregnant women, assess related maternal mortalities, ascertain the case fatality rate, and delineate associated risk factors. DESIGN: This is a comprehensive population-based ecological study. METHODOLOGY: A population-based study was conducted to investigate the epidemiological patterns of COVID-19-associated morbidity and mortality in pregnant women in Ecuador from 27 February 2020 to 14 May 2021. RESULTS: A total of 3274 positive COVID-19 cases were identified among pregnant women, with 22 official fatalities, yielding a case fatality rate of 0.67%. The majority of cases were of Mestizo ethnicity (92.66%); however, the highest case fatality rate was noted among indigenous pregnant women (case fatality rate = 1.25%), those aged between 40 and 44 years (case fatality rate = 2.68%), and those with a history of comorbidities (2.08%). Pregnant women residing at lower altitudes (<2500 m) exhibited a higher incidence rate (0.20/100,000) compared to those at higher altitudes (>2500 m), which stood at 0.17/100,000. CONCLUSION: The COVID-19 pandemic has profoundly impacted pregnant women in Ecuador during the first 14 months, particularly those with comorbidities, older age, and of indigenous ethnicity. These factors have heightened their vulnerability and susceptibility to severe COVID-19 infection and subsequent mortality. This underscores the urgency for comprehensive protective measures, including prioritization for vaccination. Further studies are needed to inform tailored prevention strategies and therapeutic interventions for these high-risk groups.

Cesarean sections and sociodemographic disparities in Ecuador: A nationwide study from hospital registries between 2015 and 2022.

OBJECTIVE: This study aimed to analyze sociodemographic factors associated with cesarean sections (c-sections) in Ecuador. METHODS: Data were extracted from the Ecuadorian National Institute of Statistics and Censuses (INEC). Multivariate binary and multinomial logistic regression analyses were performed to assess sociodemographic factors associated with c-sections overall and with each type of c-section (elective or emergency c-section). RESULTS: This study included 1 118 842 in-hospital deliveries during 2015-2022 in Ecuador, of which 41.3% were c-sections. This exceeds the recommended levels of medical justified c-sections. Those who were older than 20-29 years showed a higher probability for c-sections overall. Regarding ethnicity, Montubios had 57% higher probability for c-sectioned with an adjusted odds ratio (aOR) of 1.57 and a 95% confidence interval (CI) of 1.45-1.71; while indigenous, black, and white individuals exhibited 73%, 29%, and 21% lower probabilities, respectively. However, this varied according to specific type of c-sections: black individuals had 11% higher probability of elective c-section but 44% lower probability of emergency c-section. Deliveries in private healthcare facilities exhibited significantly higher probabilities of c-sections overall (aOR 15.38, 95% CI 15.20-15.56). Higher probability of emergency c-section was also observed during 2020-2022. CONCLUSION: Cesarean sections in Ecuador still exceed the recommended levels of medically justified c-sections, highlighting the importance of adopting an approach to childbirth that reduces unnecessary interventions. These results suggest an important role of sociodemographic factors, which aligns with the reported need for multicomponent and locally tailored strategies for addressing c-section overuse. The increase in c-sections during the COVID-19 pandemic (2020-2022) might suggest the influence of external health crises on maternal healthcare.

SARS-CoV-2 infection in brown-headed spider monkeys (Ateles fusciceps) at a wildlife rescue center on the coast of Ecuador-South America.

Human populations can be affected in unpredictable ways by the emergence and spread of zoonotic diseases. The COVID-19 (coronavirus disease of 2019) pandemic was a reminder of how devastating these events can be if left unchecked. However, once they have spread globally, the impact of these diseases when entering non-exposed wildlife populations is unknown. The current study reports the infection of brown-headed spider monkeys (Ateles fusciceps) at a wildlife rescue center in Ecuador. Four monkeys were hospitalized, and all tested positive for SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) by RT-qPCR (Quantitative Reverse Transcription PCR). Fecal samples (n = 12) from monkeys at the rescue center also tested positive; three zookeepers responsible for feeding and deworming the monkeys also tested positive, suggesting human-animal transmission. Whole genome sequencing identified most samples' omicron clade 22B BA.5 lineage. These findings highlight the threat posed by an emerging zoonotic disease in wildlife species and the importance of preventing spillover and spillback events during epidemic or pandemic events.IMPORTANCEAlthough COVID-19 (coronavirus disease of 2019) has been primarily contained in humans through widespread vaccination, the impact and incidence of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus) and its transmission and epidemiology in wildlife may need to be addressed. In some natural environments, the proximity of animals to humans is difficult to control, creating perfect scenarios where susceptible wildlife can acquire the virus from humans. In these places, it is essential to understand how transmission can occur and to develop protocols to prevent infection. This study reports the infection of brown-headed spider monkeys with SARS-CoV-2, a red-listed monkey species, at a wildlife recovery center in Ecuador. This study reports the infection of brown-headed spider monkeys with SARS-CoV-2, indicating the potential for transmission between humans and wildlife primates and the importance of preventing such events in the future.

Knowledge about methods of disinfection of dental impression among dentists from Ecuador post SARS-COV-2 pandemic.

Purpose: The aim of this study is to evaluate the understanding of the management of methods and practices of disinfection of dental impressions applied by general dentists and specialists in oral rehabilitation, post SARS-COV-2 pandemic. Introduction: The oral cavity has a favorable environment for the growth and multiplication of bacteria and viruses, serving as the gateway to viruses such as SARS CoV-2 virus. Given that patients may be hosts of this infectious disease, stricter biosecurity measures in dental offices and a better understanding of the disinfection processes of dental impressions should be considered in addition to avoiding cross-infections, which are very common in our work environment. Materials and methods: Descriptive, analytical, survey with the topic "Methods and practices of disinfection of dental impressions" that was composed of 14 questions based in OHPD (Oral Health Preventive Dentistry), n = 452 respondents who met the following inclusion criteria: general practice dentists from Ecuador who actively take dental impressions, specialists in oral rehabilitation with 5 years of experience, surveys with information of complete items, n = 270 professionals; n = 192 general dentists, dental hygienist and n = 78 oral rehabilitation specialists. Results: n = 270 professionals evaluated, with a mean of p = 0.0. At 426 responses with a p value of <0.05, 30.4 % of responses indicated ignorance in the management of dental impressions, with a standard deviation of 2.744, with significant differences between professions (p = 0.035) and higher average knowledge of sample management within specialist dentists, (Chi p = 0.410 p > 0.05). Conclusion: The understanding of the management of dental impressions among general dentists and specialists in oral rehabilitation is limited.

Microplastics in Ecuador: A review of environmental and health-risk assessment challenges.

Pollution from plastic debris and microplastics (MPs) is a worldwide issue. Classified as emerging contaminants, MPs have become widespread and have been found not only in terrestrial and aquatic ecosystems but also within the food chain, which affects both the environment and human health. Since the outbreak of COVID-19, the consumption of single-use plastics has drastically increased, intensifying mismanaged plastic waste in countries such as Ecuador. Therefore, the aim of this review is to 1) summarize the state of MP-related knowledge, focusing on studies conducted with environmental matrices, biota, and food, and 2) analyze the efforts by different national authorities and entities in Ecuador to control MP contamination. Results showed a limited number of studies have been done in Ecuador, which have mainly focused on the surface water of coastal areas, followed by studies on sediment and food. MPs were identified in all samples, indicating the lack of wastewater management policies, deficient management of solid wastes, and the contribution of anthropogenic activities such as artisanal fishing and aquaculture to water ecosystem pollution, which affects food webs. Moreover, studies have shown that food contamination can occur through atmospheric deposition of MPs; however, ingredients and inputs from food production, processing, and packaging, as well as food containers, contribute to MP occurrence in food. Further research is needed to develop more sensitive, precise, and reliable detection methods and assess MPs' impact on terrestrial and aquatic ecosystems, biota, and human health. In Ecuador specifically, implementing wastewater treatment plants in major cities, continuously monitoring MP coastal contamination, and establishing environmental and food safety regulations are crucial. Additionally, national authorities need to develop programs to raise public awareness of plastic use and its environmental effects, as well as MP exposure's effects on human health.

First report of fatal fungemia due Fusarium oxysporum in a patient with COVID-19 in Ecuador.

Filamentous fungal infections are an important cause of systemic infections in immunocompromised patients. Fusarium genus members potentially cause disseminated infections, especially in patients with catheters, due to the ability to adhere to these devices. We describe a case of fatal fungemia due to Fusarium oxysporum in a patient with COVID-19 in Ecuador. The genus identification was carried out with conventional techniques and species identification by molecular and phylogenetic techniques through sequencing of the ITS region.

Nationwide study of in-hospital maternal mortality in Ecuador, 2015-2022.

Objective: This study aimed to analyze estimates of in-hospital delivery-related maternal mortality and sociodemographic factors influencing this mortality in Ecuador during 2015 to 2022. Methods: Data from publicly accessible registries from the Ecuadorian National Institute of Statistics and Censuses were analyzed. Maternal mortality ratios (MMRs) were calculated, and bivariate and multivariate logistic regression models were used to obtain unadjusted and adjusted odds ratios. Results: There was an increase in in-hospital delivery-related maternal deaths in Ecuador from 2015 to 2022: MMRs increased from 3.70 maternal deaths/100 000 live births in 2015 to 32.22 in 2020 and 18.94 in 2022. Manabí province had the highest rate, at 84.85 maternal deaths/100 000 live births between 2015 and 2022. Women from ethnic minorities had a higher probability of in-hospital delivery-related mortality, with an adjusted odds ratio (AOR) of 9.59 (95% confidence interval [95% CI]: 6.98 to 13.18). More maternal deaths were also observed in private health care facilities (AOR: 1.99, 95% CI: 1.4 to 2.84). Conclusions: Efforts to reduce maternal mortality have stagnated in recent years. During the COVID-19 pandemic in 2020, an increase in maternal deaths in hospital settings was observed in Ecuador. Although the pandemic might have contributed to the stagnation of maternal mortality estimates, socioeconomic, demographic and clinical factors play key roles in the complexity of trends in maternal mortality. The results from this study emphasize the importance of addressing not only the medical aspects of care but also the social determinants of health and disparities in the health care system.

Thyroid cancer in Ecuador: A genetic variants review and a cross-sectional population-based analysis before and after COVID-19 pandemic.

Objectives: The purpose of this study is to describe the genetic variants present in the Ecuadorian population and the incidence and mortality patterns of thyroid cancer in Ecuador from 2016 to 2021. Methods: The present research constitutes a nationwide cross-sectional study encompassing all reported cases of thyroid cancer (C-73) in Ecuador from 2016 to 2021. Incidence rates were calculated based on the annual population at risk, considering factors such as ethnicity, sex, age group, and the geographic location of the incidence. All data was collected from the Hospital Discharge Statistics and the Statistical Registry of General Deaths Databases. Results: Between 2016 and 2021, a total of 20,297 hospital admissions and 921 deaths attributed to thyroid cancer were reported in Ecuador. The incidence of thyroid cancer remained relatively stable from 2016 to 2019. However, there was a notable decrease in 2020, followed by an increase in 2021. Notably, thyroid cancer prevalence rates were found to be higher in highlands regions. Moreover, two genetic variants, the BRAFV600E and KITL678F, have been identified in the Ecuadorian population. It is noteworthy that women exhibited a higher susceptibility to thyroid cancer, being five times more likely than men to develop this condition. Conclusion: Ecuador exhibits one of the highest global incidences of thyroid cancer. Consequently, describing the genetic variants and epidemiological characteristics of thyroid cancer is imperative for enhancing healthcare access and formulating evidence-based public health policies. This research contributes towards a comprehensive understanding of thyroid cancer in the Ecuadorian context, aiming to improve targeted interventions and health outcomes.

The impact of the COVID-19 pandemic on the Galapagos Islands' seafood system from consumers' perspectives.

The COVID-19 pandemic's early stages severely impacted global fisheries, particularly areas heavily reliant on imported food and tourism like the Galapagos Islands, Ecuador. To contain the spread of the virus, a full lockdown was implemented. However, the collapse of the tourism industry precipitated the worst economic crisis in the history of this multiple-use marine protected area. This paper examines the impact of the pandemic's early stages on consumption patterns and seafood security in the Galapagos from consumers' perspective, drawing on online surveys conducted during the lockdown. Our findings revealed pre-existing seafood insecurity across the archipelago, further exacerbated by the pandemic on the least-populated island. Nevertheless, the seafood system displayed moderated resilience to the pandemic's socioeconomic disruptions. A variety of adaptive responses were adopted by Galapagos residents to cope with the lockdown. Consumers modified their seafood consumption habits, while fishers adapted their harvesting and marketing strategies. Such adaptive responses were shaped by the unique socioeconomic characteristics of each inhabited island and the ability of seafood suppliers to shift from a tourism- and export-oriented to a resident- and domestic-oriented market. This transition has created novel opportunities to foster a systemic transformation of the Galapagos seafood system to enhance its resilience against future crises caused by new pandemics, climate change, or other natural and anthropogenic drivers of change.

Nationwide study of in-hospital maternal mortality in Ecuador, 2015–2022

[ABSTRACT]. Objective. This study aimed to analyze estimates of in-hospital delivery-related maternal mortality and socio-demographic factors influencing this mortality in Ecuador during 2015 to 2022. Methods. Data from publicly accessible registries from the Ecuadorian National Institute of Statistics and Cen-suses were analyzed. Maternal mortality ratios (MMRs) were calculated, and bivariate and multivariate logistic regression models were used to obtain unadjusted and adjusted odds ratios. Results. There was an increase in in-hospital delivery-related maternal deaths in Ecuador from 2015 to 2022: MMRs increased from 3.70 maternal deaths/100 000 live births in 2015 to 32.22 in 2020 and 18.94 in 2022. Manabí province had the highest rate, at 84.85 maternal deaths/100 000 live births between 2015 and 2022. Women from ethnic minorities had a higher probability of in-hospital delivery-related mortality, with an adjusted odds ratio (AOR) of 9.59 (95% confidence interval [95% CI]: 6.98 to 13.18). More maternal deaths were also observed in private health care facilities (AOR: 1.99, 95% CI: 1.4 to 2.84). Conclusions. Efforts to reduce maternal mortality have stagnated in recent years. During the COVID-19 pan-demic in 2020, an increase in maternal deaths in hospital settings was observed in Ecuador. Although the pandemic might have contributed to the stagnation of maternal mortality estimates, socioeconomic, demo-graphic and clinical factors play key roles in the complexity of trends in maternal mortality. The results from this study emphasize the importance of addressing not only the medical aspects of care but also the social determinants of health and disparities in the health care system.

[RESUMEN]. Objetivo. El objetivo de este estudio fue analizar las cifras estimadas de mortalidad materna intrahospitalaria asociada al parto y los factores sociodemográficos que influyen en ella en Ecuador en el período 2015-2022. Métodos. Se analizaron datos de los registros de acceso público del Instituto Nacional de Estadística y Cen-sos de Ecuador. Se calcularon las razones de mortalidad materna (RMM) y se utilizaron modelos de regresión logística bivariados y multivariados para obtener los cocientes de posibilidades sin ajustar y ajustados. Resultados. Entre el 2015 y el 2022, se observó un aumento de las muertes maternas intrahospitalarias asociadas al parto en Ecuador: la RMM aumentó de 3,70 muertes maternas por 100 000 nacidos vivos en el 2015 a 32,22 en el 2020 y 18,94 en el 2022. En la provincia de Manabí se registró la cifra más alta, con 84,85 muertes maternas por 100 000 nacidos vivos entre el 2015 y el 2022. Las mujeres pertenecientes a minorías étnicas tuvieron una mayor probabilidad de muerte intrahospitalaria por causas relacionadas con el parto, con un cociente de posibilidades ajustado (aOR, por su sigla en inglés) de 9,59 (intervalo de confianza del 95% [IC del 95%]: 6,98 a 13,18). También se observó una mayor mortalidad materna en los establecimientos de salud privados (aOR: 1,99, IC del 95%: 1,4 a 2,84). Conclusiones. Los esfuerzos para reducir la mortalidad materna se han estancado en los últimos años. Durante la pandemia de COVID-19, se observó un aumento de las muertes maternas en el 2020 en entornos hospitalarios en Ecuador. Si bien la pandemia podría haber contribuido a que las cifras estimadas de mortal-idad materna se estancaran, los factores socioeconómicos, demográficos y clínicos desempeñan un papel clave en la complejidad de las tendencias de la mortalidad materna. Los resultados de este estudio destacan la importancia de abordar no solo los aspectos médicos de la atención, sino también los determinantes socia-les de la salud y las disparidades en el sistema de atención de salud.

[RESUMO]. Objetivo. O objetivo deste estudo foi analisar estimativas de mortalidade materna relacionada ao parto intra-hospitalar e os fatores sociodemográficos que influenciaram esse tipo de mortalidade no período de 2015 a 2022 no Equador. Métodos. Foram analisados dados de registros de acesso público do Instituto Nacional de Estatísticas e Cen-sos do Equador. Foram calculadas razões de mortalidade materna (RMM), com o uso de regressão logística bivariada e multivariada para obter razões de chance não ajustadas e ajustadas. Resultados. Houve um aumento nas mortes maternas relacionadas ao parto intra-hospitalar no Equador entre 2015 e 2022: as RMM aumentaram de 3,70 mortes maternas/100 mil nascidos vivos em 2015 para 32,22 em 2020 e 18,94 em 2022. A província de Manabí teve a taxa mais alta, com 84,85 mortes maternas/100 mil nascidos vivos entre 2015 e 2022. Mulheres de minorias étnicas tiveram maior probabilidade de mortalidade relacionada ao parto intra-hospitalar, com uma razão de chances ajustada (RCa) de 9,59 (intervalo de confi-ança de 95% [IC95%]: 6,98 a 13,18). Também foram observadas mais mortes maternas em estabelecimentos de saúde privados (RCa: 1,99, IC95%: 1,4 a 2,84). Conclusões. As inciativas para reduzir a mortalidade materna estagnaram nos últimos anos. Durante a pandemia de COVID-19 em 2020, foi observado um aumento nas mortes maternas em hospitais do Equa-dor. Embora a pandemia possa ter contribuído para a estagnação das estimativas de mortalidade materna, fatores socioeconômicos, demográficos e clínicos desempenharam papéis fundamentais na complexidade das tendências de mortalidade materna. Os resultados deste estudo destacam a importância de abordar não apenas os aspectos clínicos da atenção, mas também os determinantes sociais da saúde e as disparidades do sistema de saúde.

Nationwide study of in-hospital maternal mortality in Ecuador, 2015-2022 / Estudio a nivel nacional de la mortalidad materna intrahospitalaria en Ecuador, 2015-2022 / Estudo nacional sobre mortalidade materna intra-hospitalar no Equador, 2015-2022

ABSTRACT Objective. This study aimed to analyze estimates of in-hospital delivery-related maternal mortality and sociodemographic factors influencing this mortality in Ecuador during 2015 to 2022. Methods. Data from publicly accessible registries from the Ecuadorian National Institute of Statistics and Censuses were analyzed. Maternal mortality ratios (MMRs) were calculated, and bivariate and multivariate logistic regression models were used to obtain unadjusted and adjusted odds ratios. Results. There was an increase in in-hospital delivery-related maternal deaths in Ecuador from 2015 to 2022: MMRs increased from 3.70 maternal deaths/100 000 live births in 2015 to 32.22 in 2020 and 18.94 in 2022. Manabí province had the highest rate, at 84.85 maternal deaths/100 000 live births between 2015 and 2022. Women from ethnic minorities had a higher probability of in-hospital delivery-related mortality, with an adjusted odds ratio (AOR) of 9.59 (95% confidence interval [95% CI]: 6.98 to 13.18). More maternal deaths were also observed in private health care facilities (AOR: 1.99, 95% CI: 1.4 to 2.84). Conclusions. Efforts to reduce maternal mortality have stagnated in recent years. During the COVID-19 pandemic in 2020, an increase in maternal deaths in hospital settings was observed in Ecuador. Although the pandemic might have contributed to the stagnation of maternal mortality estimates, socioeconomic, demographic and clinical factors play key roles in the complexity of trends in maternal mortality. The results from this study emphasize the importance of addressing not only the medical aspects of care but also the social determinants of health and disparities in the health care system.

RESUMEN Objetivo. El objetivo de este estudio fue analizar las cifras estimadas de mortalidad materna intrahospitalaria asociada al parto y los factores sociodemográficos que influyen en ella en Ecuador en el período 2015-2022. Métodos. Se analizaron datos de los registros de acceso público del Instituto Nacional de Estadística y Censos de Ecuador. Se calcularon las razones de mortalidad materna (RMM) y se utilizaron modelos de regresión logística bivariados y multivariados para obtener los cocientes de posibilidades sin ajustar y ajustados. Resultados. Entre el 2015 y el 2022, se observó un aumento de las muertes maternas intrahospitalarias asociadas al parto en Ecuador: la RMM aumentó de 3,70 muertes maternas por 100 000 nacidos vivos en el 2015 a 32,22 en el 2020 y 18,94 en el 2022. En la provincia de Manabí se registró la cifra más alta, con 84,85 muertes maternas por 100 000 nacidos vivos entre el 2015 y el 2022. Las mujeres pertenecientes a minorías étnicas tuvieron una mayor probabilidad de muerte intrahospitalaria por causas relacionadas con el parto, con un cociente de posibilidades ajustado (aOR, por su sigla en inglés) de 9,59 (intervalo de confianza del 95% [IC del 95%]: 6,98 a 13,18). También se observó una mayor mortalidad materna en los establecimientos de salud privados (aOR: 1,99, IC del 95%: 1,4 a 2,84). Conclusiones. Los esfuerzos para reducir la mortalidad materna se han estancado en los últimos años. Durante la pandemia de COVID-19, se observó un aumento de las muertes maternas en el 2020 en entornos hospitalarios en Ecuador. Si bien la pandemia podría haber contribuido a que las cifras estimadas de mortalidad materna se estancaran, los factores socioeconómicos, demográficos y clínicos desempeñan un papel clave en la complejidad de las tendencias de la mortalidad materna. Los resultados de este estudio destacan la importancia de abordar no solo los aspectos médicos de la atención, sino también los determinantes sociales de la salud y las disparidades en el sistema de atención de salud.

RESUMO Objetivo. O objetivo deste estudo foi analisar estimativas de mortalidade materna relacionada ao parto intra-hospitalar e os fatores sociodemográficos que influenciaram esse tipo de mortalidade no período de 2015 a 2022 no Equador. Métodos. Foram analisados dados de registros de acesso público do Instituto Nacional de Estatísticas e Censos do Equador. Foram calculadas razões de mortalidade materna (RMM), com o uso de regressão logística bivariada e multivariada para obter razões de chance não ajustadas e ajustadas. Resultados. Houve um aumento nas mortes maternas relacionadas ao parto intra-hospitalar no Equador entre 2015 e 2022: as RMM aumentaram de 3,70 mortes maternas/100 mil nascidos vivos em 2015 para 32,22 em 2020 e 18,94 em 2022. A província de Manabí teve a taxa mais alta, com 84,85 mortes maternas/100 mil nascidos vivos entre 2015 e 2022. Mulheres de minorias étnicas tiveram maior probabilidade de mortalidade relacionada ao parto intra-hospitalar, com uma razão de chances ajustada (RCa) de 9,59 (intervalo de confiança de 95% [IC95%]: 6,98 a 13,18). Também foram observadas mais mortes maternas em estabelecimentos de saúde privados (RCa: 1,99, IC95%: 1,4 a 2,84). Conclusões. As inciativas para reduzir a mortalidade materna estagnaram nos últimos anos. Durante a pandemia de COVID-19 em 2020, foi observado um aumento nas mortes maternas em hospitais do Equador. Embora a pandemia possa ter contribuído para a estagnação das estimativas de mortalidade materna, fatores socioeconômicos, demográficos e clínicos desempenharam papéis fundamentais na complexidade das tendências de mortalidade materna. Os resultados deste estudo destacam a importância de abordar não apenas os aspectos clínicos da atenção, mas também os determinantes sociais da saúde e as disparidades do sistema de saúde.

A precision overview of genomic resistance screening in Ecuadorian isolates of Mycobacterium tuberculosis using web-based bioinformatics tools.

INTRODUCTION: Tuberculosis (TB) is among the deadliest diseases worldwide, and its impact is mainly due to the continuous emergence of resistant isolates during treatment due to the laborious process of resistance diagnosis, nonadherence to treatment and circulation of previously resistant isolates of Mycobacterium tuberculosis. In this study, we evaluated the performance and functionalities of web-based tools, including Mykrobe, TB-profiler, PhyResSE, KvarQ, and SAM-TB, for detecting resistance in 88 Ecuadorian isolates of Mycobacterium tuberculosis drug susceptibility tested previously. Statistical analysis was used to determine the correlation between genomic and phenotypic analysis. Our results showed that with the exception of KvarQ, all tools had the highest correlation with the conventional drug susceptibility test (DST) for global resistance detection (98% agreement and 0.941 Cohen's kappa), while SAM-TB, PhyResSE, TB-profiler and Mykrobe had better correlations with DST for first-line drug analysis individually. We also identified that in our study, only 50% of mutations characterized by the web-based tools in the rpoB, katG, embB, pncA, gyrA and rrs regions were canonical and included in the World Health Organization (WHO) catalogue. Our findings suggest that SAM-TB, PhyResSE, TB-profiler and Mykrobe were efficient in determining canonical resistance-related mutations, but more analysis is needed to improve second-line detection. Improving surveillance programs using whole-genome sequencing tools for first-line drugs, MDR-TB and XDR-TB is essential to understand the molecular epidemiology of TB in Ecuador. IMPORTANCE: Tuberculosis, an infectious disease caused by Mycobacterium tuberculosis, most commonly affects the lungs and is often spread through the air when infected people cough, sneeze, or spit. However, despite the existence of effective drug treatment, patient adherence, long duration of treatment, and late diagnosis have reduced the effectiveness of therapy and increased drug resistance. The increase in resistant cases, added to the impact of the COVID-19 pandemic, has highlighted the importance of implementing efficient and timely diagnostic methodologies worldwide. The significance of our research is in evaluating and identifying a more efficient and user-friendly web-based tool to characterize resistance in Mycobacterium tuberculosis by whole-genome sequencing, which will allow more routine application to improve TB strain surveillance programs locally.

Mental health, suicide risk and the important role of self-esteem in Adolescents before and during coexistence with COVID-19 in Ecuador

Introduction/Objectives: COVID-19 has had a significant emotional impact on people's lives, especially adolescents. Therefore, the aim was to assess the predictors of suicide risk during the COVID-19 pandemic in adolescents in Ecuador by means of a longitudinal study. Method: The application of a longitudinal design with two measures: before the start of the pandemic and one year afterwards. The sample consisted of 137 adolescents between 12-18 years of age. The variables analysed were mental health, the risk of suicide and self-esteem. Statistical analyses were performed using mean comparison, correlations, QCA models and mediation models. Results: The results indicated higher levels of anxiety and stress after one year of the pandemic. In addition, a higher risk of suicide following the pandemic was observed in those adolescents with higher scores in emotional symptomatology and low self-esteem. QCA models and mediation models highlighted the importance of self-esteem as a protective variable between pre-COVID-19 suicide risk and emotional symptomatology and post-COVID-19 suicide risk. Conclusions: This study highlights adolescents' level of vulnerability to the pandemic and its significant psychological impact. It is important to detect which factors function as risks and which as protection against COVID-19 in order to implement intervention programmes that target these aspects and ensure better adolescent well-being.

Introducción/Objetivos: La COVID-19 tuvo un impacto emocional en la vida de las personas, especialmente en la adolescencia. El objetivo fue evaluar los predictores de riesgo de suicidio en adolescentes en Ecuador por medio de un estudio longitudinal. Método: Se trata de un diseño longitudinal con dos medidas: antes del inicio de la pandemia y un año después. La muestra fue de 137 adolescentes entre 12 y 18 años. Las variables analizadas fueron la salud mental, el riesgo de suicidio y la autoestima. Los análisis estadísticos se realizaron mediante comparación de medias, correlaciones, modelos QCA y modelos de mediación. Resultados: Los resultados indicaron mayores niveles de ansiedad y estrés después de un año de la pandemia. Se observó un mayor riesgo de suicidio tras la pandemia en aquellos adolescentes con puntuaciones más altas en sintomatología emocional y baja autoestima. Los modelos QCA y los modelos de mediación destacaron la importancia de la autoestima como variable protectora en el riesgo postsuicidio. Conclusiones: Este estudio pone de manifiesto el nivel de vulnerabilidad de los adolescentes ante la pandemia y su importante impacto psicológico. Es importante detectar qué factores funcionan como riesgos y cuáles como protección frente al COVID-19 para implementar programas de intervención.

Nivel de conocimiento de Covid-19 entre estudiantes, docentes y personal administrativo que pertenecen a la Facultad de Odontología de la Universidad Central del Ecuador

Introducción: Covid-19, una enfermedad letal que ha provocado estragos a nivel mundial causó una pandemia, afectando a casi todos los aspectos de la vida humana, por lo cual, se debe adquirir conocimientos sobre prevención, formar actitudes y comportamientos positivos para evitar más contagios y muertes. El objetivo fue determinar el nivel de conocimiento de Covid-19 entre estudiantes, docentes y personal administrativo que pertenecen a la Facultad de Odontología de la Universidad Central del Ecuador. Métodos: estudio observacional, analítico transversal, con una muestra conformada por 275 participantes entre docentes odontólogos, personal administrativo, estudiantes de pregrado y posgrado. Previo al estudio se realizó la traducción del cuestionario: Covid-19 Awareness Among Healthcare Students and Professionals in Mumbai Metropolitan Region: A Questionnaire-Based Survey, de inglés a español, siguiendo los debidos procesos de preparación, conciliación, retrotraducción, e informe final. Una vez establecida la fiabilidad del cuestionario (consistencia interna CCI= 0,89 y Alpha de Cronbach α= 0,63) se aplicó a la muestra total previo diseño en Google Forms y enviado a través de correo electrónico. Los datos fueron analizados en el programa estadístico SPSS v. 26 mediante la prueba de Chi-Cuadrado. Resultados: el promedio establecido del valor de la mediana mostró que los estudiantes de pregrado y los profesionales con un nivel educativo de tercer nivel tuvieron un mayor nivel de conocimientos que los otros grupos (p=0,014 y 0,012) respectivamente. Conclusiones: el grupo etario de 18 a 30 años, los estudiantes de universitarios de pregrado y los profesionales con el título de tercer nivel tuvieron un mejor nivel de conocimientos sobre Covid-19.

Introduction: Covid-19, a lethal disease that has wreaked havoc worldwide caused a pandemic, affecting almost all aspects of human life, therefore, it is necessary to acquire knowledge about prevention, form positive attitudes and behaviors to avoid more contagions and deaths. The objective was to determine the level of knowledge of Covid-19 among students, teachers and administrative personnel belonging to the Faculty of Dentistry of the Central University of Ecuador. Methods: observational, cross-sectional analytical study, with a sample of 275 participants including dental teachers, administrative personnel, undergraduate and graduate students. Prior to the study, the questionnaire Covid-19 Awareness Among Healthcare Students and Professionals in Mumbai Metropolitan Region: A Questionnaire-Based Survey was translated from English into Spanish, following the due processes of preparation, reconciliation, back-translation and final report. Once the reliability of the questionnaire was established (internal consistency CCI= 0,89 and Cronbach's Alpha α= 0,63), it was applied to the total sample after being designed in Google Forms and sent via e-mail. The data were analyzed in the SPSS v. 26 statistical program using the Chi-Square test. Results: the established average of the median value showed that undergraduate students and professionals with a third level education had a higher level of knowledge than the other groups (p=0,014 and 0,012) respectively. Conclusions: the age group 18-30 years, undergraduate university students and professionals with third level degree had a better level of knowledge about Covid-19.

Unveiling the intersection: exploring obstetric violence in the Era of COVID-19 in Ecuador.

INTRODUCTION: Changes to healthcare delivery organization that have occurred to protect people from the virus COVID-19 may have led to harmful consequences to pregnant women intensifying obstetric violence. Prevalence of obstetric violence in Ecuador is high with a range between 30 and 70% approximately. METHODS: This cross-sectional study was performed with the participation of 1298 women who answered EPREVO questionnaire from June 2021 to January 2022. Obstetrics characteristics' relationship before and during COVID-19 were examined using Fisher exact test. RESULTS: From 1598 respondents, 1284 (80.4%) gave birth before March 2020 Most of the participants (73.6%; CI:73.59-73.61) experienced obstetric violence during childbirth. Vaginal examination, enemas and genital shaving, episiotomy and cesarean section decreased significantly as well as rooming with the baby during the pandemic. Half of the women did not breastfeed the baby in the first hour but there were not statistically significant differences between giving birth before or during the infection from COVID-19. CONCLUSIONS: Levels of obstetric violence in Ecuador remains high but without major differences due to the COVID-19 pandemic, however some harmful medical practices considered as obstetric violence decreased but maybe to the fear to be infected by the virus.