Epidemiology of Tropical Neglected Diseases in Ecuador in the Last 20 Years

Spatial clusters, temporal behavior, and risk factors analysis of rabies in livestock in Ecuador

Rabies, a globally distributed and highly lethal zoonotic neglected tropical disease, has a significant impact in South America. In Ecuador, animal rabies cases are primarily linked to livestock, and hematophagous bats play a crucial role in disease transmission. This study aims to identify temporal trends, spatial patterns, and risk factors for animal rabies in Ecuador between 2014 and 2019. Epidemiological survey reports from the official Animal Rabies Surveillance Program of the Phyto and Zoosanitary Regulation and Control Agency of Ecuador (AGROCALIDAD) were used. The Animal Rabies Surveillance Program from AGROCALIDAD consists of an official passive surveillance program that receives reports from farmers or individuals (both trained or untrained) who have observed animals with neurological clinical signs and lesions compatible with bat bites, or who have seen or captured bats on their farms or houses. Once this report is made, AGROCALIDAD personnel is sent for field inspection, having to confirm the suspicion of rabies based on farm conditions and compatibility of signs. AGROCALIDAD personnel collect samples from all suspicious animals, which are further processed and analyzed using the Direct Fluorescent Antibody (DFA) test for rabies confirmatory diagnosis. In this case, study data comprised 846 bovine farms (with intra-farm sample sizes ranging from 1 to 16 samples) located in different ecoregions of Ecuador; out of these, 397 (46.93%) farms tested positive for animal rabies, revealing six statistically significant spatial clusters. Among these clusters, three high-risk areas were identified in the southeast of Ecuador. Seasonality was confirmed by the Ljung-Box test for both the number of cases (p < 0.001) and the positivity rate (p < 0.001). The Pacific Coastal lowlands and Sierra regions showed a lower risk of positivity compared to Amazonia (OR = 0.529; 95% CI = 0.318 - 0.883; p = 0.015 and OR = 0.633; 95% CI = 0.410 - 0.977; p = 0.039, respectively). The breeding of non-bovine animal species demonstrated a lower risk of positivity to animal rabies when compared to bovine (OR = 0.145; 95% CI = 0.062 - 0.339; p < 0.001). Similarly, older animals exhibited a lower risk (OR = 0.974; 95% CI = 0.967 - 0.981; p < 0.001). Rainfall during the rainy season was also found to decrease the risk of positivity to animal rabies (OR = 0.996; 95% CI = 0.995 - 0.998; p < 0.001). This study underscores the significance of strengthening the national surveillance program for the prevention and control of animal rabies in Ecuador and other countries facing similar epidemiological, social, and geographical circumstances.

Leptospirosis in horses: Sentinels for a neglected zoonosis? A systematic review

Background and Aim

Leptospirosis is considered a neglected tropical zoonosis in low-income countries due to surveillance system limitations and non-specificity of symptoms. Humans become infected through direct contact with carrier animals or indirectly through Leptospira-contaminated environments. Conventionally, equines have been considered an uncommon source of leptospirosis, but recent publications in Latin America suggest that their role in the maintenance and dispersion of the bacteria could be more relevant than expected, as horses are susceptible to a wide variety of zoonotic Leptospira spp. from domestic and wild animals with which they share the environment. A systematic review of the published literature was conducted to compile the available information on Leptospira spp. in Ecuador, with a special focus on equine leptospirosis, to better understand the epidemiology of the bacterium and identify possible knowledge gaps.

Materials and Methods

A systematic review of the published literature was conducted in PubMed, SciELO and Web of Science databases to compile the available information on Leptospira spp. in Ecuador, with a special focus on equine leptospirosis, to better understand the epidemiology of the bacterium. We used a combination of the terms (Leptospira OR Leptospirosis) AND Ecuador, without restrictions on language or publication date.

Results

Our literature review reveals that published scientific information is very scarce. Eighteen full-text original scientific articles related to Leptospira or leptospirosis cases in Ecuador were included in the systematic review. Most of the studies reported data obtained from one of the four regions (Coast), and specifically from only one of the 24 Provinces of Ecuador (Manabí), which evidence a large information bias at the geographical level. Furthermore, only the studies focused on humans included clinical signs of leptospirosis and there is only one study that analyzes the presence of Leptospira spp. in water or soil as a risk factor for pathogen transmission. Finally, only one study investigated Leptospira in horses.

Conclusion

Since sentinel species can provide useful data on infectious diseases when epidemiologic al information is lacking, and horses could be considered excellent sentinel species to reveal circulating serovars, we propose developing a nationwide surveillance system using horses. This cost-effective epidemiological survey method provides a baseline for implementing specific prevention and control programs in Ecuador and neighboring developing countries.

A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis-Molecular Diagnosis and Identification

Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques-antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp. The genus Histoplasma capsulatum comprises three varieties: var. capsulatum, var. duboissi, and var. farciminosum, which cannot be distinguished using conventional techniques. An infant from a tropical region of Ecuador was hospitalized for fever, bloody diarrhea, and anemia persisting for two months. Upon admission, he received antibiotics and immunosuppressants. Histopathological examination of the lymph nodes, intestines, and bone marrow aspirate reported the presence of Leishmania-like amastigotes, and treatment was initiated with meglumine antimoniate and conventional amphotericin B. However, subsequent analysis of samples using PCR and DNA sequencing identified H. capsulatum var. capsulatum but not Leishmania. Despite fluconazole and amphotericin B, the infant succumbed to the disease. The delay in clinical and laboratory diagnosis of histoplasmosis and the use of nonspecific and ineffective drugs such as fluconazole led to disease dissemination and, ultimately, death. Implementing molecular diagnosis and antigen tests in laboratories located in endemic regions and reference hospitals is crucial.

Temporal assessment of entomological surveillance of Trypanosoma cruzi vectors in an endemic area of northeastern Brazil

Entomological surveillance is essential for the control of triatomines and the prevention of Trypanosoma cruzi infection in humans and domestic animals. Thus, the objective of this study was to evaluate entomological indicators and triatomine control during the period from 2005 to 2015 in an endemic area in the state of Rio Grande do Norte, Brazil. This observational and retrospective study was developed based on data analysis related to active entomological surveillance activities and chemical control of infested housing units (HU) in the Agreste mesoregion of the state of Rio Grande do Norte, Brazil, in the period between 2005 to 2015. The quantitative analysis of housing units surveyed for entomological indicators was performed by linear regression of random effects (p < 0.05). The effect of the number of HU surveyed on the entomological indicators was analyzed by fitting a linear random effects regression model and an increasing intradomiciliary colonization rate was significant. In the period evaluated 92,156 housing units were investigated and the presence of triatomines was reported in 4,639 (5.0%). A total of 4,653 specimens of triatomines were captured and the species recorded were Triatoma pseudomaculata (n = 1,775), Triatoma brasiliensis (n = 1,569), Rhodnius nasutus (n = 741) and Panstrongylus lutzi (n = 568), with an index of natural infection by T. cruzi of 2.2%. Only 53.1% of the infested HU were subjected to chemical control. Moreover, there was a decrease in the total number of HU surveyed over time associated with an increase in the index of intradomiciliary colonization (p = 0.004). These data demonstrated that entomological surveillance and control of vectors in the Agreste mesoregion of the state has been discontinued, emphasizing the need for more effective public policies to effectively control the vectors, in order to avoid the exposure of humans and domestic animals to the risk of T. cruzi infection.

Identifying Barriers and Facilitators for Home Reconstruction for Prevention of Chagas Disease: An Interview Study in Rural Loja Province, Ecuador

BACKGROUND

Chagas disease (CD) is a tropical parasitic disease spread by triatomine bugs, which are bugs that tend to infest precarious housing in rural and impoverished areas. Reducing exposure to the bugs, and thus the parasite they can carry, is essential to preventing CD in these areas. One promising long-term sustainable solution is to reconstruct precarious houses. Implementing home reconstruction requires an understanding of how householders construct barriers and facilitators they might encounter when considering whether to rebuild their homes.

METHODS

To understand barriers and facilitators to home reconstruction, we performed in-depth qualitative interviews with 33 residents of Canton Calvas, Loja, Ecuador, a high-risk endemic region. Thematic analysis was used to identify these barriers and facilitators.

RESULTS

The thematic analysis identified three facilitators (project facilitators, social facilitators, and economic facilitators) and two major barriers (low personal economy and extensive deterioration of existing homes).

CONCLUSIONS

The study findings provide important loci for assisting community members and for agents of change in home reconstruction projects to prevent CD. Specifically, the project and social facilitators suggest that collective community efforts (minga) are more likely to support home reconstruction intentions than individualist efforts, while the barriers suggest that addressing structural issues of economy and affordability are necessary.

Leptospirosis in Ecuador: Current Status and Future Prospects

The location of Ecuador-an equatorial nation-favors the multiplication and dispersal of the Leptospira genus both on the Pacific Coast and in the Amazon tropical ecoregions. Nevertheless, leptospirosis epidemiology has not been fully addressed, even though the disease has been recognized as a significant public health problem in the country. The purpose of this literature review is to update knowledge on the epidemiology and geographical distribution of Leptospira spp. and leptospirosis in Ecuador to target future research and develop a national control strategy. A retrospective literature search using five international, regional, and national databases on Leptospira and leptospirosis including humans, animals, and environmental isolations of the bacteria and the disease incidence in Ecuador published between 1919 and 2022 (103 years) with no restriction on language or publication date was performed. We found and analyzed 47 publications including 22 of humans, 19 of animals, and two of the environments; three of these covered more than one of these topics, and one covered all three (i.e., One Health). Most (60%) of the studies were conducted in the Coastal ecoregion. Twenty-four (51%) were published in international journals, and 27 (57%) were in Spanish. A total of 7342 human and 6314 other animal cases were studied. Leptospirosis was a frequent cause of acute undifferentiated febrile illness in the Coast and Amazon and was associated with rainfall. All three major clusters of Leptospira-pathogenic, intermediate, and saprophytic-were identified from both healthy and febrile humans, the environment, and animals; moreover, nine species and 29 serovars were recorded over the three Ecuadorian ecoregions. Leptospira infections were diagnosed in livestock, companion, and wild animals from the Amazon and the Coast regions along with sea lions from the Galápagos Islands. Microscopic-agglutination test was the diagnostic tool most widely used. Three reviews covering national data on outpatients and inpatients determined the varied annual incidence and mortality rate, with males being more commonly affected. No human cases have been reported in the Galápagos Islands. Genomic sequences of three pathogenic Leptospira were reported. No studies on clinical ground, antibiotic resistance, or treatment were reported, nor were control programs or clinical-practice guidelines found. The published literature demonstrated that leptospirosis was and still is an endemic disease with active transmission in the four geoclimatic regions of Ecuador including the Galápagos Islands. Animal infections, distributed in mainland and insular Ecuador, pose a significant health risk for humans. Nationwide epidemiological surveys-encouraging more research on the fauna and environment with appropriate sampling design on risk factors for human and animal leptospirosis, Leptospira genotyping, increased laboratory capability, and readily available official data-are required to improve our understanding of transmission patterns and to develop effective national intervention strategies with the intention of applying One Health approaches.

Severe Chagas disease in Ecuador: a countrywide geodemographic epidemiological analysis from 2011 to 2021

Background

Chagas disease is a neglected and often forgotten tropical disease caused by the Trypanosoma cruzi. This parasite can be transmitted through the direct contact of human skin with feces and urine of the triatomine insect. According to the World Health Organization (WHO), an estimated 6-7 million people are infected worldwide, killing at least 14,000 every year. The disease has been reported in 20 of the 24 provinces of Ecuador, with El Oro, Guayas, and Loja being the most affected.

Methodology

We analyzed the morbidity and mortality rates of severe Chagas disease in Ecuador on a nationwide, population-based level. Hospitalization cases and deaths were also examined based on altitude, including low (< 2,500 m) and high (> 2,500 m) altitudes, according to the International Society. Data was retrieved from the National Institute of Statistics and Census hospital admissions and in-hospital mortality databases from 2011 to 2021.

Results

A total of 118 patients have been hospitalized in Ecuador since 2011 due to Chagas disease. The overall in-hospital mortality rate was 69.4% (N = 82). Men have a higher incidence rate (4.8/1,000,000) than women, although women have a significantly higher mortality rate than men (6.9/1,000,000).

Conclusion

Chagas disease is a severe parasitic condition that primarily affects rural and poorer areas of Ecuador. Men are more likely to be infected due to differences in work and sociocultural activities. Using average elevation data, we conducted a geodemographic analysis to assess incidence rates by altitude. Our findings indicate that the disease is more common at low and moderate altitudes, but recent increases in cases at higher altitudes suggest that environmental changes, such as global warming, could be driving the proliferation of disease-carrying vectors in previously unaffected areas.

Leptospirosis: Morbidity, mortality, and spatial distribution of hospitalized cases in Ecuador. A nationwide study 2000-2020

Background

In Ecuador, leptospirosis surveillance involves a mandatory notification of all cases and a hospitalization for severe illness. Morbidity and mortality are, nevertheless, underestimated and contribute directly to the status of leptospirosis as a neglected disease. Leptospira spp. is zoonotic in Ecuador with established endemic transmission in the Tropics. Here, we review retrospective national data within the country to aid in control strategies.

Methodology/Principal findings

In a population-based nationwide study, we analysed morbidity, mortality, and spatial distribution on confirmed hospital-discharged leptospirosis cases from 2000–2020 from a publicly accesible National Database, including males and females of all ages. We computed data for the 24 provinces across the four-geoclimatic regions of Ecuador based on seasonal and monthly variations and calculated rates according to age and sex. The spatial distribution was estimated at the level of ecoregions, provinces, and cantons. A total of 2,584 hospitalizations were recorded over all three continental regions in 22 provinces, except Carchi province and the Galapagos Islands. The annual incidence varied from 0.27 to 2.45 cases per 100,000 inhabitants with ages ranging from 1 to 98 years-old and an overall male/female ratio of 1.92:1. Most hospitalizations and deaths occurred in males ages 25–34 years. We registered 79 fatalities (3.06%); the highest mortality rate was 0.05 per 100,000 inhabitants. More cases clustered in the tropical cantons of central and north of the Coast and in the southern Amazon when compared to the Andes.

Conclusions and significance

Our findings evidence leptospirosis endemicity and pinpoint the highest incidence within resource-poor tropical settings. The highest incidence occurred in males of adult age, with those also exhibiting the highest mortality. The national incidence rate was stable, but peaks occurred intermittently during the rainy seasons. Thus, strategies aimed at leptospirosis monitoring and control involving the application of preventive measures should consider this season and the aforementioned high-risk groups.

Leptospirosis is a neglected tropical disease poorly characterized in Latin American countries like Ecuador. Although this zoonotic disease is considered by the Epidemiology Department of the Ministry of Public Health to be of mandatory notification, an updated document on the patterns of morbidity and mortality or a control strategy do not yet exist. In the present study, we carried out a retrospective analysis of Ecuadorian national data (INEC) on hospitalized cases and deaths from 2000 through 2020 to estimate the trends of morbidity and mortality, and the spatial distribution of this disease throughout its four geoclimatic regions (Pacific coastal, Andes, Amazon, and the Galapagos Islands). The INEC recorded only hospitalized cases, meaning those with severe illness. The spatial distribution was estimated at the ecoregion, province, and canton levels. With a total number of 2,584 hospitalizations, an annual incidence ranging from 0.27 to 2.45 cases per 100,000 inhabitants, and a fatality rate of 3.06% during the period of study. Our findings evidence the endemicity of leptospirosis, particularly within the neglected tropical settings in the Ecuadorian Coast and Amazon regions. Despite the wide geographic distribution of leptospirosis and its severity in terms of incidence, morbidity, and mortality, leptospirosis is not yet considered a “tool-ready” disease for control/elimination and research initiatives.

Analysis of laboratory and serological test results in patients with acute brucellosis during follow-up

BACKGROUND

The laboratory test results and serum-specific antibodies of patients with acute brucellosis initial infection were followed up and analyzed.

METHODS

70 patients in Hohhot City, Inner Mongolia Autonomous Region, with acute brucellosis were followed up for 360 days. Serum samples were collected at 0, 15, 30, 60, 90, 180, and 360 days after diagnosis and analyzed by Rose Bengal plate test (RBPT), colloidal gold test paper (GICA), and test tube agglutination test (SAT). The serum-specific antibodies IgG and IgM were detected.

RESULTS

RBPT results: False negative (-) gradually increased with the extension of the course of disease, with the largest change in 30-60 days after diagnosis, and the constituent ratio increased by 12.9%. GICA results: The false negative increased with the course of disease, and the constituent ratio of false negative was 20.0% after 180 days of diagnosis. SAT results: 1:100 positive showed a ladder like decrease with the increase in the course of disease, and the largest decrease was 90-180 days, with a decrease of 34.3% in the constituent ratio. 360 days after diagnosis, the constituent ratio of positive was only 14.3%. During the follow-up period, the IgG average value fluctuated and the average IgM value decreased.

CONCLUSION

The false-negative results of RBPT, GICA, and SAT increased with the course of disease, and the false-negative rates were higher than 20% after half a year. IgM level is beneficial to the early diagnosis of brucellosis, while IgG level is helpful to the judgment of brucellosis stage.

An exploratory assessment of human and animal health concerns of smallholder farmers in rural communities of Chimborazo, Ecuador

Background

Livestock play important economic and cultural roles in smallholder communities of Ecuador, yet they also serve as potential sources of zoonotic infections. Understanding the animal and human health concerns of smallholder farmers is important in guiding strategies for improvement of the health and livelihoods of these resource-poor farmers. Therefore, the objectives of this study were to: (a) assess the health concerns of smallholder farmers; (b) explore animal and waste management practices; and (c) identify predictors of pediatric and livestock diarrhea on smallholder farms in Ecuador.

Methods

This is a cross-sectional survey of 58 smallholder farmers in three communities of Chimborazo province, Ecuador. Data were collected on household demographics, smallholding characteristics, type of animals owned, human-animal interactions, health concerns, and 30-day occurrence of human as well as animal diarrhea. Summary statistics were computed and logistic models used to investigate predictors of pediatric and animal diarrhea.

Results

All respondents reported keeping animals. Animals kept included cattle, pigs, poultry, dogs, guinea pigs, cats, sheep, horses, rabbits, donkeys, or other livestock. More than half of the respondents named diseases as their greatest personal (55.2%) or family (58.6%) health concern, while an even greater percentage (60.3%) reported physiological stress as the primary health concern for their animals. Occurrence of diarrhea in the 30 days prior to the study was reported by 12.1% of the respondents. Additionally, 15.2% and 55.2% of the households reported diarrhea among children and animals, respectively. The majority (65.5%) of the households had toilets, while the remainder had either latrines (27.6%) or no sanitation facilities (6.9%). However, only 9.1% of the smallholdings had either a toilet (3.6%) or a latrine (5.5%) onsite and yet the farmers tended to spend most of the day at the smallholdings. Potential exposures to gastrointestinal pathogens included food- or water-borne sources (93.5% of children; 91.4% of adults) and blood-borne or fecal sources (80.4% of children; 100% of adults). Although 98.3% of the respondents kept cattle, only 27.6% had animal enclosures and even fewer (15.5%) had animal waste management plans. The odds of animal diarrhea were significantly higher (Odds Ratio [OR] = 8.7; 95% Confidence Interval [1.0–75.0]; p = .049) among households that had animal waste management plans compared to those that did not. None of the variables investigated were significant predictors of pediatric diarrhea.

Conclusions

Ongoing surveillance is needed to develop estimates of diarrhea incidence among smallholder families and their livestock. The impact of different animal management strategies on the potential pathogen exposure of smallholders warrants further investigations. Improving sanitation infrastructure and animal waste management strategies is recommended.

High seroprevalence of anti-Leptospira spp. antibodies in domestic and wild mammals from a mixed use rescue center in Ecuador: Lessons for "One Health" based conservation strategies

Leptospirosis is a zoonotic disease of worldwide distribution that affects humans, domestic and wild animals. This study evaluates the frequency of anti- Leptospira spp. antibodies in companion, livestock and wild mammals from a mixed use rescue center on Guayaquil, the main city of Ecuador. Sera were collected from 23 domestic and 6 wild mammals. All animals tested were seropositive for Leptospira spp. using Microscopic Agglutination Test (MAT), most of them for multiple serovars. Leptospira interrogans serovars Canicola, Hardjo and Icterohaemorrhagiae were the most frequent ones. We conclude that the presence of domestic animals at this mixed use rescue center may cause the exposure of wild animals, considering the high frequency of Leptospira spp. seropositivity already reported for livestock and companion animals in Ecuador. This is the first serological survey for leptospirosis including wild animals rescued from illegal traffic in Ecuador and point out the urgent need of exclusive rescue and conservation units for wild species and the potential role as Leptospira spp. reservoir for wild mammals.

Spatial patterns of leptospirosis in Ecuador, 2013-2018

BACKGROUND

Leptospirosis is a zoonotic disease that is considered an important public health problem in tropical regions and the world's poorest countries.

METHODS

In this ecological study, we included cases of leptospirosis reported in Ecuador from 2013 to 2018. Spatial autocorrelation was evaluated through the global Moran I index and spatial-temporal scan statistics were used to identify high-risk clusters.

RESULTS

In Ecuador, the leptospirosis incidence rates decreased from 3.3 cases per 100 000 population in 2013 to 0.8 cases per 100 000 population in 2018. The global Moran I index for the study period showed a positive spatial autocorrelation (0.68; p=0.001). We identified three significant spatial-temporal clusters for a high occurrence of leptospirosis incidence located in cantons of the Coast and Amazon regions.

CONCLUSIONS

The clusters identified could be targeted by policymakers and stakeholders in order to direct surveillance and understand the dynamics of the distribution of leptospirosis in Ecuador.

Análisis de la producción científica del Ecuador e impacto de la colaboración internacional en el periodo 2006-2015

La producción científica del Ecuador en relación con otros países latinoamericanos ha sido históricamente baja, en gran parte debido a la falta de cultura científica y políticas adecuadas que promuevan la investigación, además del descuido en priorizar la investigación en las universidades. Sin embargo, en los últimos 10 años, el gobierno ha implementado diversas políticas para ayudar a remediar esta situación. Presentamos un análisis bibliométrico de la producción de la investigación ecuatoriana durante el período 2006-2015. Los resultados muestran que la producción científica de Ecuador ha aumentado 5.16 veces en los últimos años, lo que supera el crecimiento latinoamericano. Más del 80% de las publicaciones ecuatorianas incluyen colaboración internacional, principalmente con EE.UU., España, el Reino Unido, Alemania, Francia, Brasil y Colombia. Se discuten las implicaciones de política pública.

A Review of the Integrated Model of Care: An Opportunity to Respond to Extensive Palliative Care Needs in Pediatric Intensive Care Units in Under-Resourced Settings

It is estimated that 6.3 million children who die annually need pediatric palliative care (PPC) and that only about 10% of them receive the attention they need because about 98% of them live in under-resourced settings where PPC is not accessible. The consultative model and the integrated model of care (IMOC) are the most common strategies used to make PPC available to critically ill children. In the consultative model, the pediatric intensive care unit (PICU) team, the patient, or their family must request a palliative care (PC) consultation with the external PC team for a PICU patient to be evaluated for special care needs. While the consultation model has historically been more popular, issues related to specialist availability, referral timing, staff's personal biases, misconceptions about PC, and other factors may impede excellent candidates from receiving the attention they need in a timely manner. Contrastingly, in the IMOC, family-centered care, PC tasks, and/or PC are a standard part of the treatment automatically available to all patients. In the IMOC, the PICU team is trained to complete critical and PC tasks as a part of normal daily operations. This review investigates the claim that the IMOC is the best model to meet extensive PPC needs in PICUs, especially in low-resource settings; based on an extensive review of the literature, we have identified five reasons why this model may be superior. The IMOC appears to: (1) improve the delivery of PPC and pediatric critical care, (2) allow clinicians to better respond to the care needs of patients and the epidemiological realities of their settings in ways that are consistent with evidence-based recommendations, (3) facilitate the universal delivery of care to all patients with special care needs, (4) maximize available resources, and (5) build local capacity; each of these areas should be further researched to develop a model of care that enables clinicians to provide pediatric patients with the highest attainable standard of health care. The IMOC lays out a pathway to provide the world's sickest, most vulnerable children with access to PPC, a human right to which they are entitled by international legal conventions.

Soil transmitted helminthiasis in indigenous groups. A community cross sectional study in the Amazonian southern border region of Ecuador

BACKGROUND

Rural communities in the Amazonian southern border of Ecuador have benefited from governmental social programmes over the past 9 years, which have addressed, among other things, diseases associated with poverty, such as soil transmitted helminth infections. The aim of this study was to explore the prevalence of geohelminth infection and several factors associated with it in these communities.

METHODS

This was a cross sectional study in two indigenous communities of the Amazonian southern border of Ecuador. The data were analysed at both the household and individual levels.

RESULTS

At the individual level, the prevalence of geohelminth infection reached 46.9% (95% CI 39.5% to 54.2%), with no differences in terms of gender, age, temporary migration movements or previous chemoprophylaxis. In 72.9% of households, one or more members were infected. Receiving subsidies and overcrowding were associated with the presence of helminths.

CONCLUSIONS

The prevalence of geohelminth infection was high. Our study suggests that it is necessary to conduct studies focusing on communities, and not simply on captive groups, such as schoolchildren, with the object of proposing more suitable and effective strategies to control this problem.