Poor regulation, desperation, and misinformation, a countrywide analysis of self-medication and prescription patterns in Ecuador during the COVID-19 pandemic.

BACKGROUND: The rapid spread of the SARS-CoV-2 virus during the early phase of the pandemic led to an unprecedented global health crisis. Various factors have influenced self-medication practices among the general population and unsubstantiated prescribing practices among healthcare professionals. OBJECTIVE: This study aimed to describe trends in the purchase and sale of medicines during the COVID-19 pandemic period (2020-2022) in Ecuador, by comparing them with pre-pandemic periods. METHODS: In this study, a cross-sectional design was employed to conduct a comprehensive analysis of 28 pharmacological groups, categorized according to the Anatomical Therapeutic Chemical Classification (ATC). Utilizing an integrated drug consumption database, the study examined physician prescribing data, medicine usage, and spending levels in Ecuador during the COVID-19 pandemic. The analysis involved computing absolute differences in monthly resolution, calculating excessive expenditure in comparison to previous yearly averages, and using Defined Daily Dose (DDD) methodology for internationally comparable results. Furthermore, a correlation analysis was performed to investigate potential associations between prescribed and consumed medicines and the number of new cases and deaths. RESULTS: In Ecuador, the average yearly expenditure among these groups prior to the pandemic (2017-2019) amounted to $150,646,206 USD, whereas during 2020 and 2021, the same groups represented a total expenditure of $228,327,210, reflecting a significant increase. The excess expenditure during this period reached 51.4%, equivalent to $77,681,004 USD. Notably, 13% of this expenditure consisted of Over the Counter (OTC) Medicines. The study also identified a remarkable surge in sales of ivermectin, which increased by 2,057%, and hydroxychloroquine, which increased by 171%, as measured by DDD. CONCLUSIONS: This study highlights the substantial consumption of medicines by the population in Ecuador during the pandemic. It is concerning that many medications were sold without proven therapeutic indications, indicating that misinformation and desperation may have led to improper prescribing by physicians and patients resorting to ineffective drugs. Moreover, since the sale of these therapeutic drugs requires a prescription, poor regulation, and a lack of control within pharmacies likely contributed to such practices.

COVID-19 diagnosis using clinical markers and multiple explainable artificial intelligence approaches: A case study from Ecuador.

The COVID-19 pandemic erupted at the beginning of 2020 and proved fatal, causing many casualties worldwide. Immediate and precise screening of affected patients is critical for disease control. COVID-19 is often confused with various other respiratory disorders since the symptoms are similar. As of today, the reverse transcription-polymerase chain reaction (RT-PCR) test is utilized for diagnosing COVID-19. However, this approach is sometimes prone to producing erroneous and false negative results. Hence, finding a reliable diagnostic method that can validate the RT-PCR test results is crucial. Artificial intelligence (AI) and machine learning (ML) applications in COVID-19 diagnosis has proven to be beneficial. Hence, clinical markers have been utilized for COVID-19 diagnosis with the help of several classifiers in this study. Further, five different explainable artificial intelligence techniques have been utilized to interpret the predictions. Among all the algorithms, the k-nearest neighbor obtained the best performance with an accuracy, precision, recall and f1-score of 84%, 85%, 84% and 84%. According to this study, the combination of clinical markers such as eosinophils, lymphocytes, red blood cells and leukocytes was significant in differentiating COVID-19. The classifiers can be utilized synchronously with the standard RT-PCR procedure making diagnosis more reliable and efficient.

Leveraging the COVID-19 pandemic as a natural experiment to assess changes in antibiotic use and antibiotic-resistant E. coli carriage in semi-rural Ecuador.

The coronavirus 2019 (COVID-19) pandemic has had significant impacts on health systems, population dynamics, public health awareness, and antibiotic stewardship, which could affect antibiotic resistant bacteria (ARB) emergence and transmission. In this study, we aimed to compare knowledge, attitudes, and practices (KAP) of antibiotic use and ARB carriage in Ecuadorian communities before versus after the COVID-19 pandemic began. We leveraged data collected for a repeated measures observational study of third-generation cephalosporin-resistant E. coli (3GCR-EC) carriage among children in semi-rural communities in Quito, Ecuador between July 2018 and September 2021. We included 241 households that participated in surveys and child stool sample collection in 2019, before the pandemic, and in 2021, after the pandemic began. We estimated adjusted Prevalence Ratios (aPR) and 95% Confidence Intervals (CI) using logistic and Poisson regression models. Child antibiotic use in the last 3 months declined from 17% pre-pandemic to 5% in 2021 (aPR: 0.30; 95% CI 0.15, 0.61) and 3GCR-EC carriage among children declined from 40 to 23% (aPR: 0.48; 95% CI 0.32, 0.73). Multi-drug resistance declined from 86 to 70% (aPR: 0.32; 95% CI 0.13; 0.79), the average number of antibiotic resistance genes (ARGs) per 3GCR-EC isolate declined from 9.9 to 7.8 (aPR of 0.79; 95% CI 0.65, 0.96), and the diversity of ARGs was lower in 2021. In the context of Ecuador, where COVID-19 prevention and control measures were strictly enforced after its major cities experienced some of the world's the highest mortality rates from SARS-CoV-2 infections, antibiotic use and ARB carriage declined in semi-rural communities of Quito from 2019 to 2021.

Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools.

BACKGROUND: The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience. OBJECTIVE: This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations. METHODS: The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises. RESULTS: The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used. CONCLUSIONS: Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams.

Exploring the Impact of Ecuador´s Policies on the Right to Health of Venezuelan Migrants during the Covid-19 Pandemic: A Scoping Review.

Venezuela's ongoing economic and political crisis has forced more than 6 million people to emigrate from the country since 2014. In the Andean region, Ecuador is one of the main host countries for Venezuelan migrants and refugees. During the COVID-19 pandemic, specific measures were implemented in the country to control the spread of the disease and its associated impacts. In this context, we conducted a scoping review to understand how policies implemented by the Ecuadorian government during the pandemic impacted Venezuelan migrants' right to health. The literature search focused on scientific and grey publications between 2018 and 2022 in electronic databases and institutional websites, complemented by snowball sampling and expert advice. Our thematic analysis revealed discrepancies between the rights granted to migrants in Ecuador's legal framework and their practical implementation during the pandemic, with several instances of policy and programmatic infringement. Disruption of services further complicated migrant's options for regularization. Some measures, like border closures, negatively impacted migrants' health, including increased exposure to abuse and violence. While migrants were included in the country's COVID-19 vaccination plan, they were excluded from other national aid programmes. There are indications of an increase in xenophobia and discrimination stigmatizing migrants as "disease carriers" and "resource takers", resulting in a prioritization of services for the Ecuadorian population. We found limited research on the emergent topic of migrants' vulnerability and related health system challenges. Future research should include working in border zones, consider socioeconomic factors, and further explore the poor implementation of Ecuador's legal framework towards upholding of migrants' right to health.

Estudio psicométrico del Inventario de Burnout Académico de Maslach (MBI-SS) en el contexto universitario ecuatoriano / Psychometric study of the Maslach Burnout Inventory (MBI-SS) in the Ecuadorian university context

El presente estudio instrumental examina las propiedades psicométricas del cuestionario Maslach Burnout Inventory – Student Survey (MBI-SS) en una muestra de 361 estudiantes universitarios pertenecientes a la carrera de Psicología de una universidad privada ecuatoriana con sede en Quito. La recolección de datos se efectuó de forma virtual durante la etapa de confinamiento provocada por la pandemia por COVID-19. Partiendo de una versión reducida de 14 ítems del MBI-SS, los principales resultados de proceso de validación son los siguientes: a) el modelo trifactorial (agotamiento, cinismo e ineficacia académica) presenta un ajuste satisfactorio a los datos; b) todas las subescalas del instrumento cuentan con buenos niveles de confiabilidad; c) las subescalas del MBI-SS se correlacionan negativamente con la variable satisfacción con los estudios, aportándose evidencia de validez nomológica; y d) el MBI-SS posee invarianza factorial fuerte en cuanto al sexo de los estudiantes. En conjunto, la recolección de evidencia de validez efectuada permite concluir que el MBI-SS, considerando el modelo de medición establecido, es un instrumento válido, útil y confiable para medir y evaluar el burnout académico al interior del contexto universitario ecuatoriano.(AU)

The present instrumental study examines the psychometric properties of the Maslach Burnout Inventory - Student Survey (MBI-SS) in a sample of 361 undergraduate psychology students at a private Ecuadorian university, Quito campus. Data collection was carried out virtually during the confinement phase due to the COVID-19 pandemic. Based on a reduced version of 14 items of the MBI-SS, the main results of the validation process are the following: a) the three-factor model (burnout, cynicism and academic inefficacy) presents a satisfactory fit to the data; b) all subscales of the instrument have good levels of reliability; c) the subscales of the MBI-SS are negatively correlated with the variable study satisfaction, providing evidence of nomological validity; and d) the MBI-SS has strong factorial invariance regarding to the sex of the students. As a whole, the collection of validity evidence allows us to conclude that the MBI-SS, considering the established measurement model, is a valid, useful and reliable instrument to measure and evaluate academic burnout within the Ecuadorian university context.(AU)

First sequenced cases of Omicron BA.2 sublineage in Ecuador.

The largest wave of infection with SARS-CoV-2 virus in Ecuador was observed in mid-December 2021 and early January 2022, driven by B.1.1.529/BA (Omicron) variant. During the second half of March, an increase in the number of daily cases was observed and coincided with the emergence of the BA.2 variant, which we describe in the present study. The first sequenced five cases of SARS-CoV-2 21L/BA.2 in Ecuador were identified using variant specific genotyping by qPCR and confirmed by whole genome sequencing (WGS). The first sequenced Ecuadorian BA.2 isolate was obtained from a person with international travel history who became symptomatic 3 days after travelling, whereas in the other cases no travel history was recorded.

Assessment of variations in air quality in cities of Ecuador in relation to the lockdown due to the COVID-19 pandemic.

This study analyzes the effect of lockdown due to COVID-19 on the spatiotemporal variability of ozone (O3), sulfur dioxide (SO2), and nitrogen dioxide (NO2) concentrations in different provinces of continental Ecuador using satellite information from Sentinel - 5P. The statistical analysis includes data from 2018 to March 2021 and was performed based on three periods defined a priori: before, during, and after lockdown due to COVID-19, focusing on the provinces with the highest concentrations of the studied gases (hotspots). The results showed a significant decrease in NO2 concentrations during the COVID-19 lockdown period in all the study areas: the Metropolitan District of Quito (DMQ) and the provinces of Guayas and Santo Domingo de los Tsáchilas. In the period after lockdown, NO2 concentrations increased by over 20% when compared to the pre-lockdown period, which may be attributable to a shift towards private transportation due to health concerns. On the other hand, SO2 concentrations during the lockdown period showed irregular, non-significant variations; however, increases were observed in the provinces of Chimborazo, Guayas, Santa Elena, and Morona Santiago, which could be partly attributed to the eruptive activity of the Sangay volcano during 2019-2020. Conversely, O3 concentrations increased by 2-3% in the study areas; this anomalous behavior could be attributed to decreased levels of NOx, which react with ozone, reducing its concentration. Finally, satellite data validation using the corresponding data from monitoring stations in the DMQ showed correlation values of 0.9 for O3 data and 0.7 for NO2 data, while no significant correlation was found for SO2.

Development and validation of a scoring system to predict mortality in patients hospitalized with COVID-19: A retrospective cohort study in two large hospitals in Ecuador.

OBJECTIVE: To develop and validate a scoring system to predict mortality among hospitalized patients with COVID-19. METHODS: Retrospective cohort study. We analyzed 5,062 analyzed hospitalized patients with COVID-19 treated at two hospitals; one each in Quito and Guayaquil, from February to July 2020. We assessed predictors of mortality using survival analyses and Cox models. We randomly divided the database into two sets: (i) the derivation cohort (n = 2497) to identify predictors of mortality, and (ii) the validation cohort (n = 2565) to test the discriminative ability of a scoring system. After multivariate analyses, we used the final model's ß-coefficients to build the score. Statistical analyses involved the development of a Cox proportional hazards regression model, assessment of goodness of fit, discrimination, and calibration. RESULTS: There was a higher mortality risk for these factors: male sex [(hazard ratio (HR) = 1.32, 95% confidence interval (95% CI): 1.03-1.69], per each increase in a quartile of ages (HR = 1.44, 95% CI: 1.24-1.67) considering the younger group (17-44 years old) as the reference, presence of hypoxemia (HR = 1.40, 95% CI: 1.01-1.95), hypoglycemia and hospital hyperglycemia (HR = 1.99, 95% CI: 1.01-3.91, and HR = 1.27, 95% CI: 0.99-1.62, respectively) when compared with normoglycemia, an AST-ALT ratio >1 (HR = 1.55, 95% CI: 1.25-1.92), C-reactive protein level (CRP) of >10 mg/dL (HR = 1.49, 95% CI: 1.07-2.08), arterial pH <7.35 (HR = 1.39, 95% CI: 1.08-1.80) when compared with normal pH (7.35-7.45), and a white blood cell count >10 × 103 per µL (HR = 1.76, 95% CI: 1.35-2.29). We found a strong discriminative ability in the proposed score in the validation cohort [AUC of 0.876 (95% CI: 0.822-0.930)], moreover, a cutoff score ≥39 points demonstrates superior performance with a sensitivity of 93.10%, a specificity of 70.28%, and a correct classification rate of 72.66%. The LR+ (3.1328) and LR- (0.0981) values further support its efficacy in identifying high-risk patients. CONCLUSION: Male sex, increasing age, hypoxemia, hypoglycemia or hospital hyperglycemia, AST-ALT ratio >1, elevated CRP, altered arterial pH, and leucocytosis were factors significantly associated with higher mortality in hospitalized patients with COVID-19. A statistically significant Cox regression model with strong discriminatory power and good calibration was developed to predict mortality in hospitalized patients with COVID-19, highlighting its potential clinical utility.

The adoption of non-pharmaceutical interventions and the role of digital infrastructure during the COVID-19 pandemic in Colombia, Ecuador, and El Salvador.

Adherence to the non-pharmaceutical interventions (NPIs) put in place to mitigate the spreading of infectious diseases is a multifaceted problem. Several factors, including socio-demographic and socio-economic attributes, can influence the perceived susceptibility and risk which are known to affect behavior. Furthermore, the adoption of NPIs is dependent upon the barriers, real or perceived, associated with their implementation. Here, we study the determinants of NPIs adherence during the first wave of the COVID-19 Pandemic in Colombia, Ecuador, and El Salvador. Analyses are performed at the level of municipalities and include socio-economic, socio-demographic, and epidemiological indicators. Furthermore, by leveraging a unique dataset comprising tens of millions of internet Speedtest® measurements from Ookla®, we investigate the quality of the digital infrastructure as a possible barrier to adoption. We use mobility changes provided by Meta as a proxy of adherence to NPIs and find a significant correlation between mobility drops and digital infrastructure quality. The relationship remains significant after controlling for several factors. This finding suggests that municipalities with better internet connectivity were able to afford higher mobility reductions. We also find that mobility reductions were more pronounced in larger, denser, and wealthier municipalities. Supplementary Information: The online version contains supplementary material available at 10.1140/epjds/s13688-023-00395-5.

COVID-19 mortality and risk factors in patients with cancer in Ecuador: A retrospective, non-randomized, controlled study.

The 2019 coronavirus disease (COVID-19) pandemic has affected different human populations since March 2020 and challenged healthcare systems, especially in chronic non-communicable diseases such as cancer. The present study aimed to evaluate the mortality, risk factors, and symptoms of cancer patients and control subjects, diagnosed with COVID-19 and admitted to intensive care unit (ICU). This retrospective, observational, non-randomized, controlled study of patients admitted to ICU was conducted between March and August 2020 in an Ecuadorian oncology center. Patient information collected from electronic medical records included sociodemographic information, clinical history, symptoms, laboratory test results, COVID-19 treatment, and discharge status. For patients with neoplasia, diagnosis, type, and status of cancer, as well as antineoplastic treatment received over the past month was also recorded. Descriptive statistics and multiple logistic regression were used to analyze the data. Statistical analysis was performed with SPSS (version 22.0) and R (version 4.1.3). In total, 79 adult COVID-19 patients were studied (40 with cancer and 39 controls). The total mean time until COVID-19 symptoms onset was 6.2 ±â€…3.5 days (5.3 ±â€…3.2 days in the cancer group vs 7.2 ±â€…3.6 days in the control group; P = .016) but no difference was observed in reported symptoms. All patients received an antibiotic treatment, but only 70% of the cancer group had antivirals (P < .001). Cancer patients had lower hemoglobin levels than controls (10.7 ±â€…2.8 vs 13.3 ±â€…1.7 g/dL; P < .001). In terms of mortality, not statistically significance difference was reported between groups. The study showed that high ferritin (Absolute Odds Ratio of 3.9; 95% CI 1.1-14.6) and mechanical ventilation (Absolute Odds Ratio of 4.9; 95% CI 1.3-18.6) were independent COVID-19 mortality risk factors. COVID-19 infection did not represent an increased risk of mortality in cancer patients, but elevated ferritin levels and the need for mechanical ventilation were identified as mortality risk factors.

Psychosocial dysfunction of children and adolescents during the COVID-19 lockdown in Ecuador: a cross-sectional study.

OBJECTIVE: Although the risk of morbidity and mortality of children and adolescents was lower during the COVID-19 pandemic, it appears that their mental health was strongly impacted. The goal of this study is to document psychological dysfunction among children and adolescents who underwent confinement due to COVID-19 in Ecuador. DESIGN: A cross-sectional, internet-based questionnaire. SETTING: Ecuador. PARTICIPANTS: A total of 1077 caregivers of children and adolescents (4-16 years old). OUTCOME MEASURES: Caregivers responded to Pediatric Symptom Checklist-35 to assess psychosocial dysfunction. RESULTS: The prevalence of psychosocial dysfunction was 20.8%, with internalising symptoms being the most common (30.7%). The prevalence of psychosocial dysfunction was higher in children who had a poor family relationship during confinement (prevalence ratio (PR) 2.23; 95% CI 1.22 to 4.07), children who never helped with housework (PR 2.63; 95% CI 1.13 to 6.14) and those whose caregivers were worried about children's need for emotional therapy (PR 2.86; 95% CI 1.97 to 4.15). Never playing video games (PR 0.34; 95% CI 0.17 to 0.69) or playing video games infrequently (PR 0.39; 95% CI 0.20 to 0.79) was a protective factor for the psychosocial problems of children and adolescents. CONCLUSION: Our study demonstrates that children and adolescents have experienced a deterioration of mental health due to the pandemic. Family factors played an important role in the mental health of children during the lockdown. When a public crisis occurs, supportive mental health policies should be developed and implemented to promote children's psychological welfare.

Access to health services for chronic disease care during the COVID-19 pandemic in Ecuador: A qualitative analysis using a Social Determinants of Health approach.

This qualitative study aims to explore how the COVID-19 pandemic impacted healthcare access for patients with chronic conditions in Ecuador from the patient's perspective. We interviewed 19 patients diagnosed with arterial hypertension or type 2 diabetes in rural and urban areas of Ecuador during August and September 2020. We used the Framework Method to analyse the interview transcripts with ATLAS.Ti 8.4 and organised the ideas discussed using categories from the World Health Organization Commission on the Social Determinants of Health conceptual framework. Reorganization of health services during the pandemic meant that patients with arterial hypertension or diabetes could no longer attend face-to-face appointments for disease follow-up. System failures related to medication supply led to increased out-of-pocket payments, which, together with reduced or absent earnings, and in a context with limited social protection policies, meant that patients frequently went for prolonged periods without medication. Rural health initiatives, support from family and use of traditional medicine were reported as ways to manage their chronic condition during this time. Barriers to disease management disproportionately affected individuals with low socioeconomic positions. Stock shortages, lack of protective labour policies and limited reach of anticipatory policies for health emergencies likely worsened pre-existing health inequities in Ecuador.

A report on SARS-CoV-2 first wave in Ecuador: drug consumption dynamics.

Introduction: The first COVID-19 wave in Ecuador started in March 2020 and extended until November. Several types of drugs have been proposed as a potential treatment during this period, and some affected people have self-medicated. Method: A retrospective study was conducted with 10,175 individuals who underwent RT-PCR tests for SARS-CoV-2 from July to November 2020. We compared the number of positive and negative cases in Ecuador with symptoms and drug consumption. The Chi-square test of independence compared clinical and demographic data and PCR test results. Odds ratios analyzed drug consumption dynamics. Results: Of 10,175 cases, 570 were positive for COVID-19, while 9,605 were negative. In positive cases, there was no association between the RT-PCR result and sex, age, or comorbidities. When considering demographic data, Cotopaxi and Napo had the highest rates of positive cases (25.7% and 18.8%, respectively). Manabí, Santa Elena, and Guayas regions had fewer than 10% positive cases. The Drug consumption dynamic analysis showed that negative COVID-19 cases presented higher drug consumption than positive cases. In both groups, the most consumed medication was acetaminophen. Acetaminophen and Antihistamines had higher odds of consumption in positive PCR cases than in negative. Symptoms like fever and cough were more related to positive RT-PCR results. Conclusion: The first COVID-19 wave in Ecuador has affected the provinces differently. At a national level, the consumption of drugs has been highly associated with self-medication.

SARS-CoV-2 en pacientes de la Unidad de Cuidados Intensivos Pediátricos. Hospital de Especialidades Portoviejo, Ecuador

Introducción: el manejo del SARS-CoV-2 en pacientes pediátricos por el profesional de enfermería, debe estar regido por las directrices y protocolos que la Organización Mundial de la Salud y el Ministerio de Salud Pública han diseñado para minimizar las complicaciones y el índice de morbimotalidad que el coronavirus puede desencadenar. Objetivo: analizar el manejo del SARS-CoV-2 en pacientes de la Unidad de Cuidados Intensivos Pediátricos del Hospital de Especialidades Portoviejo, en Ecuador. Materiales y métodos: se realizó una investigación transversal, descriptiva y cuantitativa. La población estuvo constituida por 11 profesionales de enfermería y 19 pacientes pediátricos que estuvieron hospitalizados con SARS-CoV-2 y que requirieron soporte ventilatorio. Para la recolección de datos, se realizó una encuesta mediante Google Forms, con el fin de conocer los diferentes procedimientos y revisión de las historias clínicas, así como las complicaciones, tratamiento ventilatorio y egreso. Resultados: el 100 % del personal de enfermería empleó medidas contempladas en los protocolos de bioseguridad. Además de los pacientes que requirieron soporte ventilatorio, el 62,5 % presentó una insuficiencia respiratoria aguda asociada a la COVID-19, frente al 37,5 % que tuvieron una clínica de síndrome inflamatorio multisistémico. Los pediátricos fallecidos padecían de enfermedades congénitas. Conclusiones: la asistencia del personal de enfermería a los pacientes de la Unidad de Cuidados Intensivos Pediátricos, demuestra que los conocimientos adquiridos por dichos profesionales logró el restablecimiento de la salud de los menores ingresados.

Introduction: the management of SARS-CoV-2 in pediatric patients by nursing professionals should be governed by the guidelines and protocols that the World Health Organization and the Ministry of Public Health have designed to minimize the complications and morbimortality rate that coronavirus can trigger. Objective: to analyze the management of SARS-CoV-2 in patients of the Pediatric Intensive Care Unit of Portoviejo Specialties Hospital, in Ecuador. Materials and methods: a cross-sectional, descriptive and quantitative research was carried out. The population consisted of 11 nursing professionals and 19 pediatric patients who were hospitalized with SARS-CoV-2 and who required ventilatory support. For data collection, a survey was carried out using Google Forms, in order to know the different procedures and review of clinical histories, as well as complications, ventilatory treatment and discharge. Results: 100% of the nursing staff used measures covered by the biosecurity protocols. In addition to the patients who required ventilatory support, 62.5% presented acute respiratory failure associated to COVID-19, compared to 37.5% who had symptoms of multisystem inflammatory syndrome. The deceased pediatric patients suffered from congenital diseases. Conclusions: the assistance of the nursing staff to the patients of the Pediatric Intensive Care Unit shows that knowledge acquired by these professionals achieved the restoration of the health of the children admitted there.

La aplicación del 'Plan estratégico de preparación y respuesta frente a la COVID-19'. Estado Plurinacional de Bolivia, Colombia, Ecuador y Perú

Con el fin de reforzar la capacidad de preparación para la respuesta y la recuperación temprana frente a emergencias de salud y desastres, la Organización Panamericana de la Salud OPS revisó las orientaciones del Plan estratégico de preparación y respuesta frente a la COVID-19 y su grado de aplicación en el Estado Plurinacional de Bolivia, Colombia, Ecuador y Perú. En particular, se tuvieron en cuenta las orientaciones relativas a la respuesta médica a la COVID-19, la reorganización y la ampliación de la oferta de servicios de salud durante la pandemia, y la reanudación y la continuidad de los servicios esenciales. En esta publicación se sistematizan las experiencias y buenas prácticas detectadas durante la revisión. Se espera que contribuyan a fortalecer la planificación, la organización y la gestión con enfoque multiamenaza en los países de la Región y, en última instancia, a salvar vidas, con hincapié en los grupos de población en situación de vulnerabilidad.

The deadly impact of COVID-19 among children from Latin America: The case of Ecuador.

Background: The SARS-CoV-2 pandemic remains a critical global health concern, with older adults being the most vulnerable group. Nonetheless, it is crucial to recognize that COVID-19 has caused numerous deaths in children worldwide. Emerging evidence indicates that infants and breastfeeding children, particularly those aged below one year, face a greater risk of hospitalization and mortality than older children with COVID-19. Objective: This study aimed to describe the epidemiology of COVID-19 among children during the early phase of the pandemic in Ecuador. Methods: We conducted a country-wide population-based analysis of the epidemiology of COVID-19, using incidence and mortality data reported from Ecuador between February 15, 2020 and May 14 2021. Measurements of frequency, central tendency, dispersion, and absolute differences were calculated for all categorical and continuous variables. Results: At least 34,001 cases (23,587 confirmed cases, 5,315 probable and 5,099 suspected) and 258 COVID-19 related deaths have been reported among children in Ecuador during the first 16 months of the pandemic. The overall incidence rate was 612 cases per 100,000 children, the mortality rate was 3 per 100,000, while the case fatality rate was 0.76%. The highest risk group for infection was children and adolescents between 15 and 19 years of age; however, the highest mortality rate occurred in children under one year of age. The largest provinces, such as Pichincha, Guavas and Manabí, were the ones that reported the highest number of cases, 27%, 12.1% and 10.8%, respectively. Conclusions: This study is the first to report on COVID-19 epidemics among children in Ecuador. Our findings reveal that younger children have a lower risk of SARS-CoV-2 infection, but a higher risk of mortality compared to older children and adolescents. Additionally, we observed significant disparities in infection rates and outcomes among children living in rural areas, those with comorbidities, and those from indigenous ethnic groups.