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PubMed1996

Prevalence of HPV DNA in cervical lesions in patients from Ecuador and Japan.

Cervical cancer is about 6 times more frequent in Ecuador than in Japan. We investigated the association between infection by the human papillomavirus (HPV) and the genesis of cervical cancer in specimens of lesions of the cervical epithelium obtained from patients in Ecuador and Japan. We also examined the results of HPV DNA detection and typing by the polymerase chain reaction (PCR) performed under the same technical conditions in areas with differing rates of cervical cancer. Purified tissue DNA from paraffin-embedded samples was amplified by PCR with universal and type-specific primers. HPV DNA was detected in 8 (20%) of 40 normal cervical epithelial samples from Ecuadorian patients, 19 (45%) of 42 low-grade squamous intraepithelial lesions (LSIL), 16 (50%) of 32 high-grade squamous intraepithelial lesions (HSIL), and 38 (81%) of 47 invasive squamous cell carcinomas (SCC) compared with 3 (10%) of 30 normal cervical specimens from Japanese patients, 107 (51%) of 210 HSILs, and 45 (71%) of 63 SCCs. The prevalence of HPV types 16 and 18 rose significantly with increasing histological grade (p < 0.05). The prevalence of HPV DNA decreased with increasing age in both Ecuadorian and Japanese patients. The detection rate and type-specific distribution of HPV DNA were not correlated with geographic location. Findings suggest that risk factors associated with poverty and underdevelopment may influence the prevalence of HPV infection and the sequence of events after HPV infection culminating in cervical cancer. These factors may help to explain the differing geographic distribution of this disease.

Adult↗

PubMed1988

The selection and training of primary health care workers in Ecuador: issues and alternatives for public policy.

This article employs quantitative analysis to evaluate the effectiveness of the community health worker (CHW) training program used by the Ministry of Public Health in Ecuador. The study first assesses CHW knowledge in the areas of prevention, maternal-child health, first aid, and treatment of common illnesses. The analysis reveals that CHWs retained less than 50 percent of what they learned one year after graduation. Demographic factors accounted for some variance in performance. Higher levels of community organization were associated with improved CHW knowledge. The presence of a health committee was also an important factor. The second phase of the study was designed to assess the community impact of the program. Surprisingly, neither the demographic characteristics of the health worker nor his or her level of competence affected the impact of the program on the community, as measured by patient satisfaction, utilization indices, and adoption of preventive health behaviors. It was the characteristics of the beneficiaries themselves that accounted for the variance in community impact. These results yield some important implications for public health policy in Ecuador.

Community Health Workers↗

PubMedDate not supplied

Advanced life support in obstetrics in Ecuador: teaching the teachers.

The advanced life support in obstetrics (ALSO) course is designed to help maternity care providers prepare for obstetrical emergencies. A team of 12 US physicians and a medical interpreter recently taught the ALSO course in Ecuador, with the goal of addressing Ecuador's high maternal and infant mortality rates. To have a greater impact, a teach-the-teacher model was used so that Ecuadorian physicians can now hold their own ALSO courses. In the process of implementing the courses, valuable lessons were learned which can be applied to future ALSO courses in developing countries and in the United States.

Ecuador↗

PubMed2006

[Iron, oxygen and placental development in the etiology of preeclampsia. Effects of high altitude in Ecuador].

Preeclampsia is the second cause of maternal death in Ecuador. The etiology of this condition is probably a placental alteration, although the details are not well known. The development of the placenta is closely related to the availability of oxygen. A defect in the differentiation of trophoblastic cells due to a faulty sensitization to changes in oxygen pressure, could be the cause of the alteration in placental development. The role of iron and local environmental conditions of a susceptible population, should be considered in the study of the etiology of preeclampsia. In the Andrean area of Ecuador, the high incidence of preeclampsia could be explained by the high prevalence of anemia and high altitude. However more studies are required to establish a close link between the environmental conditions of this area and the imperfect placental development.

Altitude↗

PubMed1983

First record of Angiostrongylus costaricensis Morera and Céspedes, 1971 in Ecuador.

Third-stage metastrongyle larvae were recovered from slugs (Vaginulus sp.) collected in Santa Lucia, Ecuador, a town about 40 miles north of Guayaquil. Some of the larvae were inoculated into laboratory-bred cotton rats and adults of Angiostrongylus costaricensis were later recovered. This is the first report of this parasite in Ecuador.

Angiostrongylus↗

PubMed1983

Identification of hitherto unrecognized arboviruses from Ecuador: members of serogroups B, C, Bunyamwera, Patois, and Minatitlan.

Three hundred seventy-nine virus isolates were obtained from mosquitoes collected and sentinel hamsters exposed in coastal Ecuador from 1974 to 1978. These included four alphaviruses [Venezuelan equine encephalitis 1B (1), Venezuelan equine encephalitis 1D (35), western equine encephalitis (1) and eastern equine encephalitis (4)]; two flaviviruses [St. Louis encephalitis (3) and Naranjal (6)]; 11 bunyaviruses [Maguari (243), Playas (3), Vinces (33), Turlock (2), Abras (5), Babahoyo (3), Acara (2), Guajara (3), San Juan (6), Pueblo Viejo (3), 18 unspecified Gamboa serogroup viruses, Palestina (7)]; and one vesiculovirus (vesicular stomatitis New Jersey). All but Venezuelan equine encephalitis virus were new to Ecuador, and Naranjal (serogroup B), Playas (Bunyamwera serogroup), Vinces (serogroup C), Abras and Babahoyo (Patois serogroup), San Juan and Pueblo Viejo (Gamboa serogroup) and Palestina (Minatitlan serogroup) are newly recognized viruses. These isolates have enabled us to 1) expand our knowledge of the geographic distribution of recognized viruses, 2) expand our knowledge of the members of certain serogroups and 3) establish two new serogroups (Gamboa and Minatitlan).

Alphavirus↗

PubMed1991

Abdominal sparganosis in Ecuador: a case report.

Sparganosis, infection with plerocercoids of the pseudophyllidean tapeworm Spirometra, rarely has been described in Ecuador. We report the details of a human case of sparganosis identified serendipitously in the course of an abdominal hernia repair. The parasite was found moving freely upon the external oblique fascia adjacent to the site of a direct abdominal hernia. The organism was recovered intact, photographed while alive and preserved for subsequent detailed morphological studies. The presumed route of entry into this patient was percutaneous, after application of a poultice of snake flesh to the site of a painful abdominal hernia. The literature on sparganosis in South America is reviewed. This is the second case of human sparganosis reported from Ecuador.

Abdominal Muscles↗

PubMed1997

Short report: screening for Trypanosoma cruzi in the blood supply by the Red Cross blood bank in Quito, Ecuador.

The status of Chagas' disease in Ecuador is not clear. In response to reports suggesting the possibility of transfusion-associated transmission of Chagas' disease in the blood bank in Quito, the Ecuadorian Red Cross in collaboration with the Instituto Nacional de Higiene, Zona Norte and the Tropical Disease Institute of Ohio University implemented a pilot Chagas' disease screening of the donated blood in the Quito blood bank. The results of the screening showed a low incidence of seropositivity among the donors (0.01% in 1994, 0.04% in 1995, and 0.02% in 1996) to the Quito blood bank and a higher seropositivity in samples donated to smaller blood banks (0.4% in 1994, 0.28% in 1995, and 0.13% in 1996) located in areas considered endemic, as well as from at least two areas previously considered nonendemic for Chagas' disease. This report highlights the need for a comprehensive evaluation of the prevalence and distribution of Chagas' disease in Ecuador.

Animals↗

PubMed1999

Genetic analysis of leishmania parasites in Ecuador: are Leishmania (Viannia) panamensis and Leishmania (V.) Guyanensis distinct taxa?

In the course of an epidemiologic survey in Ecuador, the following collection of Leishmania stocks was isolated: 28 from patients with clinical signs of leishmaniasis, 2 from sloths, 1 from a dog, and 4 from sand flies. For genetic characterization of these stocks, multilocus enzyme electrophoresis (MLEE) and random amplified polymorphic DNA (RAPD) were used. Twenty six of the 35 stocks were identified as either Leishmania (V.) panamensis or L. (V.) guyanensis, 2 stocks were identified as L. (V.) braziliensis, the 2 stocks from sloths showed specific genotypes, and 5 stocks were characterized as hybrids between L. (V.) braziliensis and L. (V.) guyanensis. These data show that genetic diversity of Leishmania in Ecuador is high and that L. (V.) panamensis/guyanensis is the dominant group in this country. The genetic analysis questioned the distinctness between the two species L.(V.) panamensis and L. (V.) guyanensis, since MLEE and RAPD data did not indicate that L. (V.) panamensis and L. (V.) guyanensis correspond to distinct monophyletic lines. Population genetic analysis performed on the L. (V.) panamensis/guyanensis group favors the hypothesis of a basically clonal population structure.

Animals↗

PubMed1998

Leishmania mini-exon genes for molecular epidemiology of leishmaniasis in China and Ecuador.

The mini-exon gene is unique and is tandemly repeated in the Leishmania genome. The transcribed region is highly conserved, but the non-transcribed spacer region is distinct in length and in sequence among different Leishmania species. The usefulness of PCR amplification of the Leishmania mini-exon gene was examined for molecular epidemiology of visceral and cutaneous leishmaniasis. We previously described a PCR method for amplification of the mini-exon gene and obtained positive amplification in bone marrow aspirates of patients with visceral leishmaniasis in China. In this study, we have cloned and sequenced two PCR products from the patients. The sequences of two products revealed 100% identity and showed more similarity to the mini-exon gene of L. donovani Indian strain than those of L. donovani complex in Africa and South America. We also applied this PCR method to the diagnosis of cutaneous leishmaniasis. We obtained positive PCR amplification in skin biopsy materials taken from patients with cutaneous leishmaniasis in Ecuador. Since this PCR amplification is simple and requires only a pair of primers to detect all Leishmania species distributed in Ecuador, the method may be a useful tool for the detection of parasites, not only from patients, but also from sandflies and reservoir animals in this area of endemicity.

Animals↗

PubMedDate not supplied

Anaplastic thyroid carcinoma in ecuador: analysis of prognostic factors.

The highest incidence of anaplastic thyroid carcinoma (ATC) has been reported in countries with endemic goiter, such as in Ecuador. In this country, ATC is the third most common histologic type of thyroid cancer, following papillary and follicular carcinoma. The aim of this study was to review the clinical presentation and the results of treatment of a large consecutive series of ATC patients treated at the oncological department of a general hospital in Quito, Ecuador. This is a retrospective study of 30 patients diagnosed with ATC at the Social Security Hospital, from 1982 to 1998. Symptomatic rapidly growing neck masses were generally present. All the patients had histological diagnosis of ATC. Two patients with pulmonary metastases and pleural effusion died before treatment could be instituted. Twenty-eight patients received at least one type of treatment: surgery, radiation therapy (RT), or chemotherapy (CT). The two most frequently employed therapeutic modalities were surgery followed by RT and/or CT in 14 patients and surgery alone in 9 patients. Surgery was performed in 23 patients but a complete resection was possible in only 14 patients. RT, postoperatively or alone, was given to 17 patients. Only 5 patients received doses ranging from 4,000 to 5,000 cGy and 4 patients more than 5,000 cGy. CT was administered to 17 patients. Doxorubicin alone was given to 10 patients and different combinations to the remaining patients. Local control was obtained in 8 of 14 complete resections. The prognostic value of the following parameters was studied by univariate analysis: duration of symptoms, size of the tumor, extent of glandular involvement, type of treatment, and surgical margins. A statistically longer survival was found in cases of differentiated carcinoma with areas of ATC or tumor limited to one lobe, those patients who received a complete treatment of chemotherapy, and those patients with tumors smaller than 10 cm and with duration of symptoms longer than 4 months. Longer mean survivals were seen in patients with longer duration of symptoms and smaller lesions. Five patients with focal anaplastic lesions within a differentiated thyroid carcinoma or a lesion limited to one lobe had a significant better survival (a mean of 20 months).

Adult↗

PubMedDate not supplied

The long-term health and economic benefits of DOTS implementation in Ecuador.

BACKGROUND: Between April 2001 and March 2004, the Directly Observed Therapy-Short course (DOTS) program was successfully implemented by the National Tuberculosis control program, with assistance from the Canadian Lung Association, in three provinces of Ecuador, where 52% of the population of the country reside. METHODS: Markov modelling was used to project TB-related morbidity, mortality and costs if the former TB control program (status quo) had continued or if the newly expanded DOTS program is maintained over 20 years. Extensive sensitivity analyses were used to determine the effect on projected outcomes of varying key assumptions. RESULTS: If DOTS is maintained over the next 20 years, we predict that 18,760 cases and 15,812 TB-related deaths will be prevented, resulting in societal savings of dollars 203 million and government savings of dollars 7.1 million (all costs in dollars US). These findings were robust in extensive sensitivity analyses. Given the initial investment of dollars 3 million for DOTS implementation, this would mean a cost of dollars 190 per life saved. CONCLUSIONS: Implementation of DOTS could yield very substantial public health and economic benefits for Ecuador. These results demonstrate the benefits from Canadian government support for DOTS implementation in low- and middle-income countries.

Canada↗

PubMed1991

[Primary health care in Ecuador: services provided by the Ministry of Health and Rural Social security Services].

The present study will examine three common premises in the field of international public health: that the primary care services offered by agencies of the Ministries of Health (MH) are less costly than those offered by Social Security institutions, that the former services are inferior to the latter, and that funds are distributed more equitably by the MH centers among their various recipient populations. The 1986 study compared the costs, quality, and equity of the services in 15 primary care centers in Ecuador--eight Ministry of Health centers and seven rural Social Security (RSS) centers--examining budgetary data from 1985 and obtaining information through a questionnaire and interviews with the personnel at those centers. Average costs were calculated by standardized accounting techniques, and it was confirmed that for several important services, especially medical consultations, these costs were much lower in the Ministry centers than in the Social Security centers. However, no differences in the cost of dental care were detected. The evaluation of quality, based on an analysis of the production structure and process, did not yield uniform results. On the one hand, the distribution of personnel and the allocation of funds for drugs and other supplies indicated that the RSS agencies provided better quality services. On the other hand, a questionnaire revealed that the MH health workers' knowledge of various principles of primary care was superior to that of the RSS workers. Upon comparing the per capita budget of the two types of entities, it was confirmed that the Ministry of Health had more equitable per capita coverage than rural Social Security. The implications of these findings for Ecuador and other developing countries are discussed and several recommendations made.

Costs and Cost Analysis↗

PubMed1989

Cost-effectiveness of routine and campaign vaccination strategies in Ecuador.

A national household coverage survey of 3697 Ecuadorean children, carried out in July 1986, provided an opportunity for a cost-effectiveness analysis of (1) routine vaccination services based in fixed facilities and (2) mass immunization campaigns. A major purpose of the campaigns was to complement the routine services and to accelerate immunization activities. Based on the coverage survey, the Program for Reduction of Maternal and Childhood Illness (PREMI) and earlier campaigns increased the proportion of children under 5 years who were fully vaccinated from 43% to 64%. In one year, the PREMI campaign was responsible for fully vaccinating 11% of children under one year, 21% of 1-2-year-old children, and 13% of all children under 5 years. The campaign also helped ensure that vaccinations were completed when children were still very young and at greatest risk. The average cost per vaccination dose (in 1985 US$ prices) was approximately $0.29 for fixed facilities and $0.83 for the PREMI campaign. Total national costs were $675,000 and $1,665,000 for routine and campaign services respectively. The cost per fully vaccinated child (FVC) was $4.39 for routine vaccination services and $8.60 for the campaign. The cost per death averted was about $1900 for routine vaccination services, $4200 for the PREMI campaign, and $3200 for the combined programme. Because of Ecuador's lower mortality rates, the costs per death averted in Ecuador from both vaccination strategies are not as low as those from studies of vaccinations in Africa. The campaigns, though less cost-effective than routine services, significantly improved the vaccination coverage of younger children who had been missed by the routine services. The costs per FVC of both the campaign and the routine services compare favourably with such programmes in other countries.

Child↗

PubMed1988

Prevalence of different types of anemia in Ecuador.

1. We present the results of a study of the prevalence of anemia and its causes in the population of Ecuador. The following parameters were used: blood cytology, reticulocyte count, serum iron, iron binding capacity, ferritin, folic acid and vitamin B 12 concentration. 2. The study was carried out on 4 groups: 426 individuals of both sexes and all ages from the rural population of the lowlands, with a warm and humid climate; 226 individuals from the highlands, with a cold and dry climate; 1000 individuals of the urban working group from the lowlands; and 1000 individuals of the urban working group from the highlands. All subjects were chosen randomly. 3. The prevalence of anemia was 31.4% in the rural group from the lowlands, 27.9% in the rural group from the highlands, 5.5% in the urban group from the lowlands, and 2.7% in the urban group from the highlands, with an overall estimated prevalence of 20.6% for the population of Ecuador as a whole. Iron deficiency was the most frequent cause of anemia (91.3%; 18.7% of the total population), followed by bone marrow failure (6%; 1.2% of the total population), hemolysis (2.2%; 0.5% of the total population), and finally megaloblastic anemia (0.5%; 0.1% of the total population). 4. Since iron deficiency with and without anemia is very frequent, we believe it is justified to establish mechanisms for food iron enrichment for liable groups such as children and pregnant women from marginal areas.

Adolescent↗

PubMed1984

[Robles' disease (onchocerciasis). Presentation of the first confirmed case in Ecuador].

For the first time a case of "onchocercosis " was found in Ecuador. The patient is a coloured person which was examined in the Dermatology Department of the "Luis Vernaza" Hospital. The diagnosis was established on the bases of a biopsy of a thoracic nodule. The principal lesions which were established are the following: intense and generalized pigmentation of violet tones; a very accentuated ictiosiform statey specially on the trunk; hardened accematous plaques in the fore-arms; eruptions on the buttocks nodules in the region of the iliac bone and zones of vitiligo on the anterior part of the legs; linfatic nodules were also observed. Elefantiasis of the penis and scrotum. With this case we have established an endemic focus of onchocercosis in Esmeraldas, Ecuador.

Aged↗

PubMed1996

Reducing patient waiting times through quality assurance methods in La Troncal, Ecuador.

Long patient waiting time is a common problem in hospitals and urban health centers in Ecuador and elsewhere. Besides being a leading cause of patient dissatisfaction with health service quality, it is often related to short doctor-patient contact times that in turn can seriously reduce the technical quality of care. This article describes a quality improvement effort undertaken by the staff of the La Troncal Health Center in Ecuador, with the assistance of a quality assurance project of the University Research Corporation and the Ecuadorian Ministry of Health. Data on patient waiting times was collected and analyzed, and solutions were devised and implemented using quality assurance techniques. As a result, the average patient's total waiting time fell from 116 minutes per visit to 66, and his or her contact time with health center staff members increased from 11 minutes to 16. It appears that the methods and techniques applied have potential for use elsewhere, because they can be applied easily by health personnel, and their cost of implementation is relatively low.

Ambulatory Care Facilities↗

PubMed1997

Six species of Acanthobothrium (Eucestoda: Tetraphyllidea) in stingrays (Chondrichthyes: Rajiformes: Myliobatoidei) from Ecuador.

Six species of Acanthobothrium, 4 described as new, are reported in stingrays from southern Ecuador. Acanthobothrium atahualpai n. sp. in Gymnura afuerae most closely resembles Acanthobothrium fogeli and Acanthobothrium parviuncinatum by having bothridial hooks with recurved prongs and short handles. It differs from A. fogeli by having bothridial hooks 163-195 microns vs. 78-114 microns long and averaging 25 vs. 32 testes per pruglottis: it differs from A. parviuncinatum by having bothridial hooks 163-195 microns vs. 87 microns long and averaging 25 vs. 13 testes per proglottis. Acanthobothrium minusculus n. sp. in Urolophus tumbesensis most resembles Acanthobothrium campbelli and Acanthobothrium vargasi by being no more than 3 mm long and having 6-30 testes per proglottis. It can be distinguished from them by having bothridial hooks averaging 86 microns vs. 108-111 microns and 130-133 microns long, and 6-10 vs. 15-23 and 22-29 testes per proglottis, respectively. Acanthobothrium monksi n. sp. in Aetobatus narinari resembles Acanthobothrium tasajerasi from Himantura schmardae by having a prominent genital atrium and a large globose cirrus sac; it differs by averaging 21 vs. 35 testes per proglottis and having bothridial hooks averaging 150 microns vs. 165 microns long. Acanthobothrium obuncus n. sp. in Dasyatis longus resembles a group of species characterized by wider than long to square immature and mature proglottides, bothridia at least partially fused to the scolex at their posterior ends, and asymmetrical ovarian arms with aporal arms extending anteriorly to the vaginal level. It resembles Acanthobothrium americanum by averaging 73 vs. 72 testes per proglottis, but differs by having bothridial hooks averaging 120-131 microns vs. 151 microns long; it resembles Acanthobothrium chilensis by having bothridial hooks averaging 120-131 microns vs. 130 microns long, but differs by averaging 73 vs. 90 testes per proglottis. Acanthobothrium campbelli in Urotrygon chilensis and Acanthobothrium costarricense in Dasyatis longus, previously known in those hosts from the Pacific coast of Costa Rica, are reported from Ecuador for the first time.

Animals↗