Background: Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses in pregnant women and their children. In Ecuador, the coverage of seasonal influenza vaccination in pregnant women is low. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of pregnant women toward influenza vaccination in Quito-Ecuador. Methods: A cross-sectional study enrolled 842 women who delivered at three main public gynecological-obstetric units of the Metropolitan District of Quito. A questionnaire regarding demographics, antenatal care, risk conditions and knowledge, attitudes and practices related to influenza vaccination was administered. We examined factors associated with vaccination using log-binomial regression models. Results: A low vaccination rate (36.6%) against influenza was observed among pregnant women. The factorsassociated with vaccination included the recommendations from health providers (adjusted PR: 15.84; CI 95% 9.62–26.10), belief in the safety of the influenza vaccine (adjusted PR: 1.53; CI 95% 1.03–2.37) and antenatal care (adjusted PR: 1.21; CI 95% 1.01–1.47). The most common reasons for not vaccinating included the lack of recommendation from health care providers (73.9%) and lack of access to vaccine (9.0%).Conclusions: Health educational programs aimed at pregnant women and antenatal care providers have the most potential to increase influenza vaccination rates. Further studies are needed to understand the barriers of health care providers regarding influenza vaccination in Ecuador.

Background Chagas disease is endemic to the southern Andean region of Ecuador, an area with one of the highest poverty rates in the country. However, few studies have looked into the epidemiology, vectors and transmission risks in this region. In this study we describe the triatomine household infestation in Loja province, determine the rate of Trypanosoma cruzi infection in triatomines and study the risk factors associated with infestation. Methodology/Principal Findings An entomological survey found four triatomine species (Rhodnius ecuadoriensis, Triatoma carrioni, Panstrongylus chinai, and P. rufotuberculatus) infesting domiciles in 68% of the 92 rural communities examined. Nine percent of domiciles were infested, and nymphs were observed in 80% of the infested domiciles. Triatomines were found in all ecological regions below 2,200 masl. We found R. ecuadoriensis (275 to 1948 masl) and T. carrioni (831 to 2242 masl) mostly in bedrooms within the domicile, and they were abundant in chicken coops near the domicile. Established colonies of P. chinai (175 to 2003 masl) and P. rufotuberculatus (404 to 1613 masl) also were found in the domicile. Triatomine infestation was associated with surrogate poverty indicators, such as poor sanitary infrastructure (lack of latrine/toilet [w = 0.95], sewage to environment [w = 1.0]). Vegetation type was a determinant of infestation [w = 1.0] and vector control program insecticide spraying was a protective factor [w = 1.0]. Of the 754 triatomines analyzed, 11% were infected with Trypanosoma cruzi and 2% were infected with T. rangeli.

Although the central coast of the Ecuador is considered endemic for Chagas disease, few studies have focused on determining the risk of transmission in this region. In this study we describe the triatomine household infestation in Manabí province (Central Coast region), determine the rate of Trypanosoma cruzi infection and study the risk factors associated with infestation by Rhodnius ecuadoriensis.

Chagas disease is caused by Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae). It is transmitted to humans primarily through contaminated feces of blood-sucking vectors of the subfamily Triatominae, known in Ecuador as ‘chinchorros’. Some Triatominae species can adapt to domiciliary and peridomiciliary environments where T. cruzi can be transmitted to humans. Triatoma carrioni (Larrousse 1926) colonizes domestic and peridomestic habitats up to 2,242 m above sea level (masl) in southern Ecuador (Loja Province) and northern Peru. This study describes the life cycle, feeding, and defecation patterns of T. carrioni under controlled laboratory conditions using mice as hosts. Specimens were collected in Loja Province, Ecuador, and maintained in the laboratory. The life cycle was approximately 385.7 ± 110.6 d. There was a high mortality rate, 40.9% for first instars and 38.9% for fifth instars (NV). Feeding and defecation patterns for each life stage were examined by recording: insertion time of the proboscis into the host, total feeding time, time to first defecation, and weight of the bloodmeal. Total feeding time varied between 20.6 ± 11.4 min for first instars (NI) and 48.9 ± 19.0 min for adult females. The time to first defecation was variable but ranged from 9.8 ± 10.6 min for NI to 39.4 ± 24.7 min for NV during feeding. This suggests that T. carrioni has an annual life cycle and is a potential vector of T. cruzi in Loja Province.

Objectives: Chronic malnutrition and anemia are prevalent in developing countries. This research aimed to determine the prevalence of chronic malnutrition and anemia and their associated factors in children under five using a multi - causal model in a rural community in the coast of Ecuador. Methods: The study included 314 children under 5 years old who were residents of San Isidro, Ecuador. Indicators of chronic malnutrition and anemia were identified. Mothers/caregivers were surveyed on socio-economic and environmental conditions, feeding and care practices, access to health services and biological characteristics. Bivariate and multivariable Poisson regression were performed. Results: The prevalence was 12.42% (n = 39) for chronic malnutrition and 16.98% (n = 54) for anemia. There was a significant and independent association between chronic malnutrition and family income less than $80 USD per month (Prevalence Ratio [PR] = 2.74, 95% CI 1.04, 7.20), maternal height less than 150 cm (PR 3.00, 95% CI 1.69, 5.32) and residence in a household with more than 4 children (PR 3.05, 95% CI 1.48, 6.29). Anemia was 2.57 times higher (95% CI 1.17, 5.65) in children with more than two episodes of diarrhea in the last 6 months. Prenatal care (5 to 8 visits) provided a protective effect for anemia (PR 0.48, 95% CI 0.27, 0.89). Conclusions for Practice: Findings support the need for comprehensive interventions targeted toward chronic malnutrition and anemia in children from rural coastal communities. Improvement of socioeconomic conditions, family planning, prenatal care and reduction of diarrheal diseases should be prioritized.

Background: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. Methods: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. Results: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. Conclusions: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections.

Introducción: El capital social (CS) incluye varios componentes de la organización social, que podrían mejorar la situación de salud. Existe poca información sobre su asociación con la Desnutrición Crónica (DC). Metodología: El presente estudio transversal analítico fue realizado en los cantones de Riobamba, Alausí, Guamote, Guano y Colta en el periodo 2018-2019. Con una muestra probabilística mediante encuestas a madres/cuidadores se determinó el CS, determinantes de la salud, y mediciones antropométricas. El análisis de datos se realizó mediante regresión bivariada y multivariada, con cálculo de Odds e intervalos de confianza al 95 %, se consideró significativo un valor de p menor a 0.05, se utilizó el software SPSS versión 25.0. Resultados: Se estudiaron 1228 niños, el 50.5% (n = 620) hombres y 49.5% (n= 680) mujeres. Con DC el 52.6% (n = 326) de los hombres y el 46.7% (n = 284) de las mujeres. Los hijos cuyos padres no han escuchado hablar sobre desnutrición infantil presentaron un OR 1.46 (IC95%=1.13-1.9) para el desarrollo de DC. Esta asociación se mantuvo significativa después del ajuste por sexo, edad del niño/a, número de hijos e ingresos económicos. Conclusiones: La asociación entre el CS y la DC en la población indígena menor de 5 años de la provincia de Chimborazo se observó en la falta de información sobre nutrición infantil.