Background Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. Methods We used data from a prospective cohort of 213 children aged 5–17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). Results During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72–1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14–0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04–0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90–1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10–1.58, P = 0.003). Conclusions In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.

A new method using a magnetic nanoparticle-based colorimetric biosensing assay (NCBA) was compared with sputum smear microscopy (SSM) for the detection of pulmonary tuberculosis (PTB) in sputum samples. Studies were made to compare the NCBA against SSM using sputum samples collected from PTB patients prior to receiving treatment. Experiments were also conducted to determine the appropriate concentration of glycan-functionalized magnetic nanoparticles (GMNP) used in the NCBA and to evaluate the optimal digestion/decontamination solution to increase the extraction, concentration and detection of acid-fast bacilli (AFB). The optimized NCBA consisted of a 1:1 mixture of 0.4% NaOH and 4% N-acetyl-L-cysteine (NALC) to homogenize the sputum sample. Additionally, 10 mg/mL of GMNP was added to isolate and concentrate the AFB. All TB positive sputum samples were identified with an increased AFB count of 47% compared to SSM, demonstrating GMNP’s ability to extract and concentrate AFB. Results showed that NCBA increased AFB count compared to SSM, improving the grade from “1+” (in SSM) to “2+”. Extending the finding to paucibacillary cases, there is the likelihood of a “scant” grade to become “1+”. The assay uses a simple magnet and only costs $0.10/test. NCBA has great potential application in TB control programs.

BackgroundThe increasing proportion of women in the medical profession is a worldwide phenomenon often called the “feminization of medicine.” However, it is understudied in low and middle-income countries, particularly in Latin America.MethodsUsing a qualitative, descriptive design, we explored the influence of gender and other factors on physician career decision-making and experiences, including medical specialty and public vs. private practice, in Quito, Ecuador, through in-depth, semi-structured interviews (n = 31) in 2014. Theoretical sampling was used to obtain approximately equal numbers of women and men and a range of medical specialties and practice settings; data saturation was used to determine sample size. Transcripts were analyzed using content coding procedures to mark quotations related to major topics and sub-themes included in the interview guide and inductive (grounded theory) approaches to identify new themes and sub-themes.ResultsGendered norms regarding women’s primary role in childrearing, along with social class or economic resources, strongly influenced physicians’ choice of medical specialty and practice settings. Women physicians, especially surgeons, have had to “pay the price” socially, often remaining single and/or childless, or ending up divorced; in addition, both women and men face limited opportunities for medical residency training in Ecuador, thus specialty is determined by economic resources and “opportunity.” Women physicians often experience discrimination from patients, nurses, and, sometimes, other physicians, which has limited their mobility and ability to operate independently and in the private sector. The public sector, where patients cannot “choose” their doctors, offers women more opportunities for professional success and advancement, and the regular hours enable organizing work and family responsibilities. However, the public sector has generally much less flexibility than the private sector, making it more difficult to balance work and family responsibilities.ConclusionWomen may outnumber men in medicine in Ecuador and across many parts of the world, but a number of structural issues-economic, social, and cultural-must be addressed for women to establish themselves in a wide variety of medical specialties and practice settings and for countries to realize the benefit of the investments being made to train and employ them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1917-1) contains supplementary material, which is available to authorized users.

BackgroundAlthough asthma has emerged as an important public health problem over recent decades in Latin America, there are limited published data on national hospital admission and mortality rates for asthma from countries in the region.ObjectiveTo analyse trends in asthma hospitalisation and mortality rates in Ecuador over a 19-year period from 2000 to 2018.MethodsHospital discharge and death certificates listing asthma, as defined in the International Classification of Diseases 10th Revision codes (J45 and J46), were used to analyse time trends in rates of hospital admissions and mortality for asthma. The data were obtained from the Ecuadorian National Institute of Statistics and Census. Crude and age-standardised rates were estimated for the entire population. Additionally, specific rates by sex, age and region were estimated. We used joinpoint analysis to identify national trends.ResultDuring 2000–2018, a total of 58 250 hospitalisations and 1328 deaths due to asthma were identified. The average annual rates for hospitalisation and mortality attributed to asthma were estimated to be 21 (95% CI 19.3 to 22.8) and 5.2 (95% CI 4.4 to 6.0) per 100 000 population, respectively, over this period. Asthma hospital admissions decreased from 28 to 13.7 per 100 000 population between 2000 and 2018, and asthma mortality decreased from 0.8 to 0.3 per 100 000 population over the same period. Based on jointpoint analysis, two temporal trends were identified for hospital admissions. Between 2000 and 2011, hospital admissions decreased 0.8% per year and between 2011 and 2018 decreased 6.6% per year (p<0.05). On average, hospitalisation rates decreased 3.1% per year (p<0.05) over the entire study period. Mortality rate decreased 5.6% per year (p<0.05) over the 19-year period. Hospitalisation rates were higher among females, those aged 5 to 19 years and those living in the Coast region.ConclusionsOur analysis shows a temporal trend of reduction in rates of hospitalisations and deaths attributed to asthma between 2000 and 2018 in Ecuador, consistent with similar trends elsewhere in the Latin American region. Health registration systems in Latin America need to be improved to provide reliable data for future between and within country comparisons of trends in asthma hospitalisations and deaths.

Background Major mental disorders in prison populations have been recognised as a long-term problem with an important impact on public health. Despite this, screening activities in prisons are still weak in Latin America. We proposed to estimate the prevalence of depression and psychosis and associated factors in the largest Ecuadorian prison for male inmates. Methods Cross-sectional study with 309 prisoners chosen at random between January and February 2017, who were administered two structured questionnaires. The first examined socio-demographic and occupational characteristics prior to incarceration and presence of social support networks; the second was the Mini International Neuropsychiatric Interview version in Spanish 5.0.0. We used maximum likelihood tests and multiple logistic regression to assess associations between depression, psychosis and study factors. Results The prevalence of depression and psychosis were 50.2% (95% CI 44.6–55.8) and 25.9% (95% CI 21.0–30.8), respectively. The two conditions occurred together in 22.0% of the cases (95% CI 14.8–29.2), and depression or psychosis (D/P) was found in 54.0% (95% CI 48.4–59.6). Consuming drugs while in prison was found in 41.4% (95% CI 35.9–46.9). When age was considered among those consuming drugs, the prevalence of D/P were 72.2, 88.0, and 92.3%, respectively for the age-groups 18–29, 30–39 and 40 years or over ( p -value < 0.001). Using a multivariate model, we found that not receiving visits (AOR 3.15 95%CI 1.42–6.96) and consuming drugs while in prison (AOR 5.85 95%CI 3.06–11.16) were associated with D/P, while the age effect disappears. Inmates who stopped drug consumption in prison or who had never consumed did not present any significant differences. Conclusions Depression and psychosis in prisoners are strongly affected by the absence of visitors and by consumption of drugs in prison. Greater presence of social support networks and preventive actions targeting drug abuse would contribute to improving the mental health of prison inmates.

BackgroundRural 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.MethodsThis 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.ResultsAt 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.ConclusionsThe 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.

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following topics: human rights, the right to health, principles of health rights, patient rights, TB in several vulnerable populations (children, elderly, women, indigenous groups and migrants); and legal health reforms in Mexico and its impact in DOTS strategy. 2. Chiapas: A brief description of epidemiological TB situation In Mexico, in 2013 there were registered 21,381 cases of TB (in all its forms) with a incidence rate of 16.7 per 100,000 inhabitants [12], from which 92.3% were new cases; 81.7% were PTB; 21% were associated with DM and 5.6% with HIV/AIDS; 1.05% were drug-resistant (any forms) and 8.4% were pediatric [12]. Among the pediatric group, 68.2% were PTB and 31.8% extrapulmonary-TB [12]. Chiapas, Guerrero, Veracruz, Puebla, and Tabasco, are Mexican states which contribute every year about 5,400 new cases of PTB, and this constitutes 36% of the total national average [12]. Factors that contribute to the high prevalence of PTB in these states are: (a) internal and external migration; (b) problems with accessibility to health services and social security; (c) significant presence of indigenous populations; (d) more than 90% of their municipalities are considered with low human development index [13,14]; (e) inadequate implementation of the DOTS strategy [10]; (f) little or null access to early TB diagnosis [10]. The above-mentioned factors, related to life styles and living conditions also contribute to health inequities increasing the high prevalence of TB in Chiapas and worldwide. According to official data provided by the Mexican Ministry of Health, in 2012, Baja California, Guerrero and Tamaulipas, were states with the highest incidence rates of TB, all its forms, (54.8, 38.1 and 32.0, respectively, per 100,000 inhabitants), while Chiapas ranked eleventh place with an incidence rate of 24.4 per 100,000 in the same denominator [15]. On the other hand, Tlaxcala and the State of Mexico were ranked with the lowest incidence rates, 3.9 and 4.4 per 100,000, respectively [15]. Regarding to PTB, for the same year, the registered incidence rate for the whole country was 13.6 per 100,000 inhabitants, whereas Chiapas ranked eighth with 21.8 incidence rate for the same denominator [15]. For administrative purposes, Chiapas is divided into ten health districts or sanitary jurisdictions. For 2012, the three regions with highest registered incidence rates were Tapachula, Tonala and Pichucalco, having 59.3, 33.1 and 22.3 per 100,000 inhabitants, respectively, while San Cristobal and Comitan regions reported the lowest incidence rate with 11.7 and 12.7 per 100,000 people, respectively [16]. However, epidemiological studies carried out in the San Cristobal region 1 , also known as the Highlands region, have reported high morbidity and mortality rates which doubles the state and national figures [9,10,17-25]. Furthermore, the official epidemiological data is based on notified cases by the health sector systems, and this could lead to under-quantification of cases in great part due to under-diagnosis. In Chiapas, the ...