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Lalangui K, Cotera-Mantilla M, Sánchez-Murillo M, Carrera-Alvarez A, Duque-Cuasapaz M, Quentin E. Space-time distribution of intestinal infectious diseases and their association with socioeconomic variables in Ecuador. Front Public Health 2024; 12:1412362. [PMID: 39050603 PMCID: PMC11266005 DOI: 10.3389/fpubh.2024.1412362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Background Intestinal infectious diseases are a global concern in terms of morbidity, and they are closely linked to socioeconomic variables such as quality of life, weather and access to healthcare services. Despite progress in spatial analysis tools and geographic information systems in epidemiology, studies in Ecuador that evaluate temporal trends, specific geographic groups, and their correlation with socioeconomic variables are lacking. The absence of such information makes it challenging to formulate public health policies. This study sought to identify the spatial and temporal patterns of these diseases in Ecuador, along with their correlation with socioeconomic variables. Methods In Ecuador, the study was carried out in a continental territory, focusing on data related to intestinal infectious diseases collected from the National Institute of Statistics and Census (Instituto Nacional de Estadística y Censos) during the period from 2014 to 2019. This study involved spatial and temporal analyses using tools such as the global Moran's index and Local Indicators of Spatial Association to identify spatial clustering patterns and autocorrelation. Additionally, correlations between morbidity rates and socioeconomic variables were examined. Results During the investigated period, Ecuador registered 209,668 cases of these diseases. Notable variations in case numbers were identified, with a 9.2% increase in 2019 compared to the previous year. The most impacted group was children under 5 years old, and the highest rates were centered in the southern and southwestern regions of the country, with Limón Indanza and Chunchi being the cantons with the highest rates, notably showing a significant increase in Limón Indanza. Additionally, there were significant correlations between morbidity rates and socioeconomic variables, school dropout rates, low birth weight, and access to water services. Conclusion This study emphasizes the importance of considering socioeconomic variables when addressing these diseases in Ecuador. Understanding these correlations and geospatial trends can guide the development of health policies and specific intervention programs to reduce the incidence in identified high-risk areas. More specific research is needed to understand the underlying causes of variability in morbidity and develop effective prevention strategies.
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Affiliation(s)
- Karina Lalangui
- Centro de Investigación EpiSIG, Instituto Nacional de Investigación en Salud Pública, Quito, Ecuador
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Max Cotera-Mantilla
- Centro de Investigación EpiSIG, Instituto Nacional de Investigación en Salud Pública, Quito, Ecuador
| | - Marco Sánchez-Murillo
- Centro de Investigación EpiSIG, Instituto Nacional de Investigación en Salud Pública, Quito, Ecuador
| | - Alex Carrera-Alvarez
- Centro de Investigación EpiSIG, Instituto Nacional de Investigación en Salud Pública, Quito, Ecuador
| | - Mónica Duque-Cuasapaz
- Centro de Investigación EpiSIG, Instituto Nacional de Investigación en Salud Pública, Quito, Ecuador
| | - Emmanuelle Quentin
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
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Chakraborty R, Armijos RX, Beidelman ET, Rosenberg M, Margaret Weigel M. Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years. MATERNAL & CHILD NUTRITION 2024:e13683. [PMID: 38873704 DOI: 10.1111/mcn.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/22/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Rodrigo X Armijos
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
| | - Erika T Beidelman
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
| | - M Margaret Weigel
- Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Global Environmental Health Research Laboratory, Indiana University-Bloomington School of Public Health, Bloomington, Indiana, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, Indiana, USA
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, USA
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Thomson P, Pearson AL, Kumpel E, Guzmán DB, Workman CL, Fuente D, Wutich A, Stoler J. Water Supply Interruptions Are Associated with More Frequent Stressful Behaviors and Emotions but Mitigated by Predictability: A Multisite Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:7010-7019. [PMID: 38598435 DOI: 10.1021/acs.est.3c08443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Water supply interruptions contribute to household water insecurity. Unpredictable interruptions may particularly exacerbate water insecurity, as uncertainty limits households' ability to optimize water collection and storage or to modify other coping behaviors. This study used regression models of survey data from 2873 households across 10 sites in 9 middle-income countries to assess whether water supply interruptions and the predictability of interruptions were related to composite indicators of stressful behaviors and emotional distress. More frequent water service interruptions were associated with more frequent emotional distress (β = 0.49, SE = 0.05, P < 0.001) and stressful behaviors (β = 0.39, SE = 0.06, P < 0.001). Among households that experienced interruptions, predictability mitigated these respective relationships by approximately 25 and 50%. Where the provision of continuous water supplies is challenged by climate change, population growth, and poor management, water service providers may be able to mitigate some psychosocial consequences of intermittency through scheduled intermittency and communication about water supply interruptions. Service providers unable to supply continuous water should optimize intermittent water delivery to reduce negative impacts on users, and global monitoring regimes should account for intermittency and predictability in post-2030 water service metrics to better reflect household water insecurity experiences.
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Affiliation(s)
- Patrick Thomson
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, U.K
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, U.K
| | - Amber L Pearson
- CS Mott Department of Public Health, Michigan State University, Flint, Michigan 48503, United States
| | - Emily Kumpel
- Department of Civil and Environmental Engineering, University of Massachusetts Amherst, Amherst, Massachusetts 01003, United States
| | - Danice B Guzmán
- Pulte Institute of Global Development, University of Notre Dame, Notre Dame, Indiana 46556, United States
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina Greensboro, Greensboro, North Carolina 27412, United States
| | - David Fuente
- School of the Earth, Ocean and Environment, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona 85281, United States
| | - Justin Stoler
- Department of Geography and Sustainable Development, University of Miami, Coral Gables, Florida 33146, United States
- Department of Public Health Sciences, University of Miami, Miami, Florida 33136, United States
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Zambrana JV, Bustos Carrillo FA, Ojeda S, Lopez Mercado B, Latta K, Schiller A, Kuan G, Gordon A, Reingold A, Harris E. Epidemiologic Features of Acute Pediatric Diarrhea in Managua, Nicaragua, from 2011 to 2019. Am J Trop Med Hyg 2022; 106:1757-1764. [PMID: 35895434 PMCID: PMC9209918 DOI: 10.4269/ajtmh.21-0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
Diarrhea remains a leading cause of death in children in developing countries, including Nicaragua, but little is known about patterns of diarrhea occurrence in Central America over long periods of time. The purpose of this study was to determine the incidence, risk factors, long-term trends, and seasonality of diarrhea in children age 2 to 14 years in Managua, Nicaragua. From 2011 to 2019, we examined episodes of diarrhea among 6,485 children who participated in a prospective cohort study and presented for care in a primary care facility. We performed a longitudinal analysis considering time-varying variables and the intra-subject correlation of outcomes. In addition, we analyzed the weekly incidence of diarrhea, applying seasonal trend decomposition to extract secular and seasonal patterns. The overall incidence rate of diarrhea was 133.4 episodes per 1,000 person-years (95% CI, 128.3–138.7). We observed a slight increase in the incidence of diarrhea from 2011 to 2019. Younger age was the strongest predictor of the risk of diarrhea, and incidence increased with every additional hour without running water in the household per day. Diarrhea incidence in Managua was seasonal, with high peaks each year between May and July. Despite reductions in childhood mortality since 1990 in Nicaragua, diarrheal morbidity remains a major problem in Managua.
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Affiliation(s)
| | - Fausto Andres Bustos Carrillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Krista Latta
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Amy Schiller
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Arthur Reingold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California
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Bastidas-Caldes C, Ochoa J, Guerrero-Latorre L, Moyota-Tello C, Tapia W, Rey-Pérez JM, Baroja MI. Removal of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli, ST98, in Water for Human Consumption by Black Ceramic Water Filters in Low-Income Ecuadorian Highlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084736. [PMID: 35457602 PMCID: PMC9028703 DOI: 10.3390/ijerph19084736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023]
Abstract
Fecal contamination in natural water sources is a common problem in low-income countries. Several health risks are associated with unprotected water sources, such as gastrointestinal infections caused by parasites, viruses, and bacteria. Moreover, antibiotic-resistant bacteria in water sources have become an increasing problem worldwide. This study aimed to evaluate the bacterial pathogens present in water within a rural context in Ecuador, along with the efficiency of black ceramic water filters (BCWFs) as a sustainable household water treatment. We monitored five natural water sources that were used for human consumption in the highlands of Ecuador and analyzed the total coliforms and E. coli before and after BCWF installation. The results indicated a variable bacterial contamination (29–300 colony-forming units/100mL) in all unfiltered samples, and they were considered as high risk for human consumption, but after filtration, no bacteria were present. Moreover, extended-spectrum beta-lactamase-producing E. coli with blaTEM, blaCTX-M9, and blaCTX-M1 genes, and two E. coli classified in the clonal complex ST10 (ST98) were detected in two of the locations sampled; these strains can severely impact public health. The clonal complex ST10, found in the E. coli isolates, possesses the potential to spread bacteria-resistant genes to humans and animals. The results of the use of BCWFs, however, argue for the filters’ potential impact within those contexts, as the BCWFs completely removed even antibiotic-resistant contaminants from the water.
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Affiliation(s)
- Carlos Bastidas-Caldes
- One Health Research Group, Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador
- Programa de Doctorado en Salud Pública y Animal, Universidad de Extremadura, 10003 Mérida, Spain
- Correspondence: (C.B.-C.); (M.I.B.); Tel.: +593-983174949 (C.B.-C.)
| | - Juan Ochoa
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
| | - Laura Guerrero-Latorre
- Catalan Institute for Water Research (ICRA), Water Quality Area, Emili Grahit 101, 17003 Girona, Spain;
| | - Carlos Moyota-Tello
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
| | - Wilson Tapia
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
| | - Joaquín María Rey-Pérez
- Unidad de Patología Infecciosa, Facultad de Veterinaria, Universidad de Extremadura, 10003 Mérida, Spain;
| | - Maria Isabel Baroja
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
- Programa de Doctorado en Biología Molecular y Celular, Biomedicina y Biotecnología, Universidad de Extremadura, 10003 Mérida, Spain
- Correspondence: (C.B.-C.); (M.I.B.); Tel.: +593-983174949 (C.B.-C.)
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Challenges to Water Management in Ecuador: Legal Authorization, Quality Parameters, and Socio-Political Responses. WATER 2021. [DOI: 10.3390/w13081017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ecuador has historically had a unique experience with water law, management, and policy as a result of its constitutional declaration of water access as a human right. In this paper, the legal, environmental, economic, and social aspects related to water management in Ecuador are analyzed. In doing so, the incorporation of local governance structures such as water users’ associations (WUAs) are characterized within a national model of authorization under SENAGUA, Ecuador’s former water agency, highlighting the importance of integrated management for meeting the country’s geographically and environmentally diverse needs. Additionally, the role of anthropogenic activities such as crude oil production, artisanal and small-scale gold (ASGM) mining, agriculture, sewage discharge, and domestic practices are evaluated in the context of policy implementation and environmental quality concerns. Finally, individual and community-level responses are explored, highlighting the importance of geographically specific perceptions of water rights and quality in the adoption of coping strategies. In these ways, a multi-faceted analysis of Ecuadorian water policy shaped by community-level engagement, geographic diversity, and influential economic sectors is developed. This study highlights the need for increased financial and legislative support around extractive and polluting industries such as agriculture, ASGM, and sewage treatment for long-term safety and sustainability of water access in Ecuador. Additionally, increased efforts to educate industry-specific workers, local management boards, and individuals about potential solutions to water-related challenges will help improve the efficiency of current legislation. Finally, this study underscores a need for additional research related to water quality and sustainability in Ecuador, as well as for the social, economic, and environmentally specific factors that influence water security outcomes in the country.
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Jepson WE, Stoler J, Baek J, Morán Martínez J, Uribe Salas FJ, Carrillo G. Cross-sectional study to measure household water insecurity and its health outcomes in urban Mexico. BMJ Open 2021; 11:e040825. [PMID: 33674365 PMCID: PMC7938997 DOI: 10.1136/bmjopen-2020-040825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income and low-income urban areas of Torreón, Mexico. DESIGN Cross-sectional household survey conducted in two waves (rainy and dry seasons). PARTICIPANTS 500 households selected via multistage cluster sample in selected communities. Socioeconomic status determined the selection of participant neighbourhoods; five were identified in low socioeconomic status neighbourhoods and five in low-medium socioeconomic status neighbourhoods. We examine how the context of urban water provision is related to a new cross-culturally valid Household Water Insecurity Experiences (HWISE) Scale. PRIMARY OUTCOME MEASURES The HWISE Scale, self-reported diarrhoea, dengue fever and the Perceived Stress Scale. RESULTS Water system intermittency (adjusted OR (AOR) 3.96, 95% CI 2.40 to 6.54, p<0.001), unpredictability (AOR 2.24, 95% CI 1.34 to 3.74, p=0.002) and the dry season (AOR 3.47, 95% CI 2.18 to 5.52, p<0.001) were structural correlates of the HWISE Scale. This study also found that the HWISE Scale was associated with two health outcomes, self-reported diarrhoea (AOR 1.09, 95% CI 1.03 to 1.15, p=0.002) and perceived stress (β=0.28, SE=0.07, t=4.30, p<0.001), but not self-reported dengue fever (AOR 1.02, 95% CI 0.98 to 1.06). A 3-item hygiene subscore and a 3-item water worry subscore were also both positively associated with self-reported diarrhoea and perceived stress. CONCLUSION Short-form screeners of water insecurity may be useful for assessing certain health risks by lay survey workers in settings with limited healthcare resources, particularly in lieu of more expensive microbiological tests that require specialised training and facilities.
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Affiliation(s)
- Wendy E Jepson
- Geography, Texas A&M University, College Station, Texas, USA
| | - Justin Stoler
- Geography, University of Miami, Coral Gables, Florida, USA
| | - Juha Baek
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Javier Morán Martínez
- Universidad Autónoma de Coahuila Facultad de Medicina Unidad Torreón, Torreón, Mexico
| | | | - Genny Carrillo
- Environmental and Occupational Health, Texas A&M University, College Station, Texas, USA
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Multiple burdens of malnutrition and relative remoteness in rural Ecuadorian communities. Public Health Nutr 2020; 24:4591-4602. [PMID: 33155533 DOI: 10.1017/s1368980020004462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia. DESIGN Adult anthropometry was collected through serial case-control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community. SETTING Northern coastal Ecuador. PARTICIPANTS Adults (n 1665) and children under 5 years of age (n 2618). RESULTS From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness-OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age. CONCLUSIONS The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.
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