Onchocerciasis in Ecuador: prevalence of infection on the Ecuador-Colombia border in the Province of Esmeraldas

The prevalence of onchocerciasis infection was determined in communities on 7 rivers located in the northern area of the canton San Lorenzo, province of Esmeraldas. Diagnosis of the infection was obtained by skin biopsies and recombinant-antigen based-serology. No evidence of infection was detected in 9 communities studied along the Rio Mataje, which forms the frontier between Ecuador and Colombia, nor in 10 adjacent communities located on 5 interior rivers. Evidence for Onchocerca volvulus infection was found in 4 communities on the Rio Tululvi with the following prevalence: La Boca (3.5% by biopsy and 3.9% by serology), Guayabal (9.1% by both biopsy and serology), La Ceiva (51.5% by biopsy and 53% by serology), and Salidero (4% by biopsy and 7.7% by serology). A few individuals in these communities were seropositive for O. volvulus in the absence of detectable dermal microfilariae: these might harbor very light or prepatent infections. No clinical disease attributable to onchocerciasis was found. The infected communities will be included in the ivermectin-based National Control Program for the disease, with no evidence of the infection having extended north of the Ecuadorian-colombian border.

Limited education as a risk factor in cervical cancer

The study reported here analyzes the influence of formal education on the behavior and age at onset of carcinoma of the cervix in 2204 women in Quito, Ecuador, between 1985 and 1994. The results indicate that education had a considerable degree of influence on the behavior of this neoplasia. That is, women with primary education or less were found to have almost twice the cervical cancer incidence of those with secondary or higher education, while those who were illiterate had almost six times the incidence found among university-educated women. Overall, it seems reasonable to consider women's education a key factor in defining risk groups for cervical cancer-so much so that grouping by instructional level would make it possible to improve the effectiveness of cervical cytology-based preventive measures.

The population of the Amazon basin in 1492: a view from the Ecuadorian headwaters

"Recent archaeological, ethnohistorical and ecological evidence has begun to challenge the view that 'civilizations' failed to develop in the Amazon basin due to limitations of the tropical forest environment. As a result, estimates of the native population in 1492 have become an issue of debate. These estimates are evaluated in the light of the ethnohistorical research on the Ecuadorian headwaters. Estimates are considered by examining estimated habitat densities, the impact of Old World diseases and contemporary evidence for native cultures. The study is based on documents found in archives in Quito, Seville, Madrid and Rome. It is suggested that the population of the Amazon basin in 1492 probably exceeded 5 million but that expectations of substantially higher populations appear unfounded."

Using parity-progression ratios to estimate the effect of female sterilization on fertility

In this article, a new methodology that employs parity-progression ratios to estimate the effect of female sterilization on fertility is described, and results using data from Ecuador are compared to those obtained using a previously existing approach that classifies women by marital duration. The methods differ in how they disaggregate marital fertility and in the assumption they make about what the subsequent fertility of sterilized women would have been if they had not been sterilized. The analysis of the Ecuadoran data shows that the estimate of births averted by sterilization has diminished over time, even as sterilization prevalence has been increasing. This situation is attributed to a decline in the fertility of nonsterilized women resulting from increased use of reversible methods of contraception.

Frontier migration as a multi-stage phenomenon reflecting the interplay of macroforces and local conditions: the Ecuador Amazon

"This paper considers frontier migration to the Ecuador Amazon as a multistage phenomenon, examining the entire migration stream from its origins in highland and coastal locales of Ecuador, to intermediate stops outside and within the Amazon, to final Amazon destinations. The approach is one where models pertaining to regional development, migration, and pioneer activity are treated as complementary to one another and meshed with a qualitative knowledge of place. It is shown that frontier settlement patterns reflect the composite of these models, a maturing space-economy, and the interaction of local characteristics with exogenous circumstances representing national and international contexts."

Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment

Popular perceptions and knowledge about cutaneous leishmaniasis and its treatment were studied in an endemic area of subtropical Northwest Ecuador. Although most of the adults surveyed were familiar with the disease, the vector, and traditional treatments, many showed a lack of knowledge about transmission of the disease, ulcer healing, and conventional treatment. Gender was found to have a significant impact on disease risk, perceptions, and treatment knowledge. Males experienced a risk of contracting cutaneous leishmaniasis that was almost triple that of women. Men were also more likely to perceive that the disease seriously diminished the victim's capacity to work. Women, on the other hand, were more prone to perceive that cutaneous leishmaniasis was a serious disease that significantly decreased self-esteem. Although 80% of the subjects knew at least one method of treating the disease, women tended to know more methods than men. Most of 150 different therapies reported involved the use of indigenous plants, chemicals, acids, antibiotics, heat treatments, or petroleum by-products. Some of these treatments could have clinical value. However, only 7% of the subjects knew about pentavalent antimonials. Almost 70% of the subjects with a past or present infection history were treated solely by traditional methods; only 12% received a full course of Glucantime, while 7.5% got an incomplete course. The findings indicate that it will be important to consider the identified gaps in knowledge and gender perceptions regarding the disease and its treatment when planning future control programs.

Integrating the Lactational Amenorrhea Method into a family planning program in Ecuador

This paper reports the results of a 12-month implementation study documenting the process of integrating the Lactational Amenorrhea Method (LAM) into a multiple-method family planning service-delivery organization, the Céntro Médico de Orientación y Planificación Familiar (CEMOPLAF), in Ecuador. LAM was introduced as a family planning option in four CEMOPLAF clinics. LAM was accepted by 133 breastfeeding women during the program's first five months, representing about one-third of postpartum clients. Seventy-three percent of LAM acceptors were new to any family planning method. Follow-up interviews with a systematic sample of 67 LAM users revealed that the method was generally used correctly. Three pregnancies were reported, none by women who were following LAM as recommended. Service providers' knowledge of LAM resulted in earlier IUD insertions among breastfeeding women. Relationships with other maternal and child health organizations and programs were also established.

Onchocerciasis in Ecuador: the situation in 1989

Details are given of the prevalence rates of onchocerciasis from the most recent surveys (1989) conducted in northern Ecuador. The disease has intensified and dispersed considerably due to migration of infected individuals and the presence of a highly efficient vector. Comparison of these data with those from two previous surveys carried out in 1982/83 and 1986 and correlated with entomological findings highlight the danger of the formation of new foci of onchocerciasis in areas currently free of the disease. Recommendations are made for further entomological studies in areas either recently or likely to be affected by the disease where potential vectors are unknown or different to those registered in the Santiago focus. Ivermectin treatment with local vector control in specific areas is advocated to reduce the disease to a low level of public health importance.

[Migration and integration policies within the Andean Pact]

"After a review of the institutions belonging to the 1969 Andean Pact, migration topics within this context are analyzed, considering three main issues: labor migration,...circulation of persons, where a series of agreements tending to simplify procedures at bordersites are still not practically in force for reasons concerning internal safety, drug traffic and unemployment, and migration across borders as related to borderline integration, which was dealt with in the Macchu Picchu Summit in 1990 and in a Decision Project in 1991." The five pact countries are Bolivia, Chile, Colombia, Ecuador, and Peru. (SUMMARY IN ENG)