Institute Of Statistics And Census Research Articles

Cesarean sections and sociodemographic disparities in Ecuador: A nationwide study from hospital registries between 2015 and 2022.

This study aimed to analyze sociodemographic factors associated with cesarean sections (c-sections) in Ecuador. Data were extracted from the Ecuadorian National Institute of Statistics and Censuses (INEC). Multivariate binary and multinomial logistic regression analyses were performed to assess sociodemographic factors associated with c-sections overall and with each type of c-section (elective or emergency c-section). This study included 1 118 842 in-hospital deliveries during 2015-2022 in Ecuador, of which 41.3% were c-sections. This exceeds the recommended levels of medical justified c-sections. Those who were older than 20-29 years showed a higher probability for c-sections overall. Regarding ethnicity, Montubios had 57% higher probability for c-sectioned with an adjusted odds ratio (aOR) of 1.57 and a 95% confidence interval (CI) of 1.45-1.71; while indigenous, black, and white individuals exhibited 73%, 29%, and 21% lower probabilities, respectively. However, this varied according to specific type of c-sections: black individuals had 11% higher probability of elective c-section but 44% lower probability of emergency c-section. Deliveries in private healthcare facilities exhibited significantly higher probabilities of c-sections overall (aOR 15.38, 95% CI 15.20-15.56). Higher probability of emergency c-section was also observed during 2020-2022. Cesarean sections in Ecuador still exceed the recommended levels of medically justified c-sections, highlighting the importance of adopting an approach to childbirth that reduces unnecessary interventions. These results suggest an important role of sociodemographic factors, which aligns with the reported need for multicomponent and locally tailored strategies for addressing c-section overuse. The increase in c-sections during the COVID-19 pandemic (2020-2022) might suggest the influence of external health crises on maternal healthcare.

A nationwide epidemiological and geodemographic analysis of lymphatic filariasis in Ecuador: a neglected and often forgotten disease in Ecuador.

Lymphatic filariasis (LF) is a neglected parasitic disease transmitted by mosquitoes and affecting the lymphatic system. The aim of this study was to analyze the epidemiological and sociodemographic characteristics of patients with LF during the last 11 years of available data in Ecuador. A 11-year nationwide analysis of hospital admission and in-hospital mortality based on the National Institute of Statistics and Census (INEC) data was conducted in Ecuador from 2011 to 2021. The International Classification of Diseases 10th Revision (ICD-10) code for filariasis (ICD: B74) was used to retrieve information on severe LF as a proxy for incidence among 221 Ecuadorian cities. A total of 26 hospital admissions and 3 deaths due to LF were registered. The highest mortality rate was found in populations over 80 years. Men accounted for 62.5% (n = 17) of total number of cases with an average incidence rate of 1.7 cases per/1,000,000, while females accounted for 34.6% (n = 9), representing 1 case per/1,000,000 woman. Cities located at lower altitude (459/1,000,000) reported higher incidence rates than those located at higher altitudes (7.4/1,000,000). This is the first study on LF in Ecuador. Although, Ecuador is not considered endemic for LF, we found evidence of the presence of this disease in recent years. The implementation and improvement of an adequate integrated epidemiological surveillance system will allow early identification of cases and therefore their respective treatment.

Uma análise concorrente de sobrevida de risco dos fatores sociodemográficos da mortalidade intra-hospitalar por COVID-19 no Equador

This study aimed to analyze the effect of sociodemographic characteristics on COVID-19 in-hospital mortality in Ecuador from March 1 to December 31, 2020. This retrospective longitudinal study was performed with data from publicly accessible registries of the Ecuadorian National Institute of Statistics and Censuses (INEC). Data underwent a competing risk analysis with estimates of the cumulative incidence function (CIF). The effect of covariates on CIFs was estimated using the Fine-Gray model and results were expressed as adjusted subdistribution hazard ratios (SHR). The analysis included 30,991 confirmed COVID-19 patients with a mean age of 56.57±18.53 years; 60.7% (n = 18,816) were men and 39.3% (n = 12,175) were women. Being of advanced age, especially older than or equal to 75 years (SHR = 17.97; 95%CI: 13.08-24.69), being a man (SHR = 1.29; 95%CI: 1.22-1.36), living in rural areas (SHR = 1.18; 95%CI: 1.10-1.26), and receiving care in a public health center (SHR = 1.64; 95%CI: 1.51-1.78) were factors that increased the incidence of death from COVID-19, while living at an elevation higher than 2,500 meters above sea level (SHR = 0.69; 95%CI: 0.66-0.73) decreased this incidence. Since the incidence of death for individuals living in rural areas and who received medical care from the public sector was higher, income and poverty are important factors in the final outcome of this disease.

The spatio-temporal dynamics of infant mortality in Ecuador from 2010 to 2019

The infant mortality rate (IMR) is still a key indicator in a middle-income country such as Ecuador where a slightly increase up to 11.75 deaths per thousand life births has been observed in 2019. The purpose of this study is to propose and apply a prioritization method that combines clusters detection (Local Indicators of Spatial Association, LISA) and a monotonic statistic depicting time trend over 10 years (Mann–Kendall) at municipal level. Annual national databases (2010 to 2019) of live births and general deaths are downloaded from National Institute of Statistics and Censuses (INEC). The results allow identifying a slight increase in the IMR at the national level from 9.85‰ in 2014 to 11.75‰ in 2019, neonatal mortality accounted for 60% of the IMR in the last year. The LISA analysis allowed observing that the high-high clusters are mainly concentrated in the central highlands. At the local level, Piñas, Cuenca, Ibarra and Babahoyo registered the highest growth trends (0.7,1). The combination of techniques made it possible to identify eight priority counties, half of them pertaining to the highlands region, two to the coastal region and two to the Amazon region. To keep infant mortality at a low level is necessary to prioritize critical areas where public allocation of funds should be concentrated and formulation of policies.

Use of Fuels in the Productivity of Ecuadorian Companies: Assessment of Their Impact on Climate Change

This article aims to analyze the relationship between fuel consumption (gasoline, diesel, and Liquid Petroleum Gas (LPG) and total production in Ecuadorian companies that use some fuel in their processes, in addition to quantifying the CO2 emissions generated by these fuels in 2019. For this purpose, a correlational study of these variables (Pearson’s correlation coefficient) has been made, using statistical data from the ENESEM 2019 Structural Enterprise Survey, prepared by the National Institute of Statistics and Census (INEC). The results show that the relationship between the consumption of Extra gasoline and Ecopais with total production is not significant, while it is in the case of consumption of Super gasoline, Diesel, and LPG. As for CO2 emissions, it is observed that the largest generator is diesel, with almost 4.5 megatons per year, second to gasoline, with a little less than 2 megatons, and finally is LPG, with less than 0.5 megatons. In conclusion, LPG fuel, whose association with total production is the most significant, is the least polluting and in total these business sectors generate almost 7 megatons of CO2 per year of the total 40 megatons generated by the country.

A population-based study of preeclampsia and eclampsia in Ecuador: ethnic, geographical and altitudes differences

BackgroundIn Ecuador eclampsia and preeclampsia were identified as the third cause of maternal death. Like other Latin-American countries, Ecuador has human settlements living from 0 to more than 4000 m of altitude and comprising a wide ethnic-diversity across all these altitude changes. These characteristics offer the possibility to study a wide variety of possible risk factors for preeclampsia and eclampsia.MethodsWe conducted a population-based retrospective study of all deliveries in Ecuador from 2015 through 2017. The main variables analyzed were: altitude, ethnic self-identification, geographic location, and maternal age. The data comes from the Ecuadorian National Institute of Statistics and Census (INEC) and the Ecuadorian Ministry of Health. Data information regarding maternal parity and socioeconomic status was not available from official records. Logistic regression analysis was used to study the relationship between preeclampsia and eclampsia with the variable of interest. Geospatial statistical analysis was done to identify statistically significant spatial clusters of preeclampsia and eclampsia cases.ResultsThe incidence of preeclampsia was estimated between 5.11 (5.05–5.18) and 6.23 (6.16–6.30), and 0.25 (0.23–0.26) for eclampsia. Native American have a lower incidence regarding preeclampsia compared to other ethnic groups. High altitude has a significant odds ratio (OR = 2.31, 1.93–2.78) of preeclampsia. Montubio residing in middle altitude (1500–3500 m) have the highest risk of preeclampsia (OR = 18.13, 9.53–34.50). Afro-Ecuadorians also have an increased risk of preeclampsia associated with altitude (OR = 2.36, 1.78–3.14). Ethnicity was not identified as a risk factor for eclampsia. Early and older maternal age was associated with an increased risk of preeclampsia and eclampsia. Women living more than 20 km from the obstetric unit have an OR = 2.61 (2.32–2.95, p-value< 0.01) and OR = 1.87 (1.82–1.92, p-value< 0.01) of developing eclampsia and preeclampsia respectively.ConclusionsPreeclampsia is widespread across low and high-altitude areas, while eclampsia is mostly located at lower altitudes. Montubios living at middle or high altitudes represents the ethnic group with a higher risk of preeclampsia. No ethnic effect was identified as a potential risk factor for eclampsia. Moreover, in eclampsia the associated risk of young women seems to be higher than in preeclampsia.

Mortality Trend of Hodgkin Lymphoma in Ecuador from 2000 to 2019

Introduction. Globally, the incidence of Hodgkin lymphoma (HL) increased from 1990 to 2017, presenting two incidence peaks regarding age, at 20–39 years, and 60 years or more. However, there is limited information about the mortality of this disease in the Ecuadorian population. This study aims to present the mortality trend of HL in Ecuador from 2000 to 2019. Methods. We performed an observational study, reporting the crude death rates by HL in the Ecuadorian population from 2000 to 2019, and its mortality trend analysis. Data were extracted from governmental databases published by the Ecuadorian National Institute of Statistics and Census (INEC). Results. From 2000 to 2019, INEC registered 862 deaths of patients with HL. From them, 355 (41.18%) were female, and 699 (81.09%) resided in urban areas, with an average age of 54.61 years. During the period studied, the mortality rates by HL in Ecuador presented a significant increasing trend (p=0.037), in which 2019 and 2018 were the years with the highest death rate (0.38 by 100,000 inhabitants), whereas 2001 and 2007 had the lowest death rate (0.20 by 100,000 inhabitants). Regarding age, we found a bimodal distribution of cases with two peaks in the 2nd and 7th decades of life. Conclusion. In this study, we found the highest mortality rate of HL in 2018 and 2019, with a significant increasing trend since 2000. Regarding age, we found two highest mortality peaks, which correspond to the 2nd and 7th decades of life, similar to other studies in the region.

La tasa de Mortalidad General del Ecuador del INEC subestima erróneamente al Cáncer

Introducción: La aplicación del sistema de clasificación 6-61 para obtener la tasa mortalidad dentro de las estadísticas del Instituto Nacional de Estadísticas y Censos (INEC) tiene un sesgo de contabilidad en las diferentes patologías: en casos particulares incluye categorías y subcategorías de las enfermedades oncológicas y en otros casos excluye a las categorías y solo se contabiliza la subcategoría, por este motivo, se planteó el presente estudio de bases de datos (BD) para obtener la verdadera tasa de mortalidad incluyendo las categorías excluidas.&#x0D; Metodología: El presente estudio es una revisión de BD de mortalidad en el Ecuador. El periodo analizado enero 1990 – diciembre 2016, usando las BD de mortalidad en el Ecuador disponible en el sitio web del INEC. Se sumaron las categorías a las enfermedades oncológicas excluidas, según el CIE-10 que le INEC no consideró como enfermedad oncológica.&#x0D; Resultados: La mortalidad en el Ecuador de las enfermedades oncológicas, presentada como porcentaje acumulado de 10.25% en el año 1990 y tiene un incremento progresivo hasta un 14.8% en el año 2016, lo que constituye la primera causa de muerte en todos los años del estudio.&#x0D; Conclusiones: El cáncer es la primera causa de muerte, no sólo debido al aporte de determinadas provincias, sino un fenómeno más amplio, posiblemente en todo el territorio del Ecuador, lo cual se asocia posiblemente a un cambio epidemiológico que corresponde a la modernidad.

Gastroschisis in Hospital del IESS “Manuel Ygnacio Ygnacio”. Case Report and Literature Reviview

BACKGROUND: Gastroschisis is an anomaly in which abdominal organs are exposed outside the abdominal wall. The global average prevalence is 1.36 for each 10 000 newborns. In Ecuador, according to the National Institute of Statistics and Censuses (INEC), there is evidence of an increase in the number of hospital discharges with this diagnosis, reaching 52 in 2010, 85 in 2012, and 112 patients in 2015. The aim of this publication is to describe this pathology and expose the importance of prenatal diagnosis to plan prompt surgical intervention for the newborn after birth. CASE REPORT: newborn from a 16-year-old primigravid mother, with no other prenatal history, four ultrasounds were performed during pregnancy in a private health facility, which reported no alterations. At 37.4 weeks of pregnancy, the newborn was delivered by eutocic birth, showing gastroschisis. The patient underwent laparotomy and peritoneostomy at 24 hours of age, delayed closure was scheduled. EVOLUTION: the newborn received comprehensive care in the neonatal intensive care unit. Delayed closure was performed eight days later. He remained hospitalized for 22 days, he received parenteral nutrition and started trophic feeding at 15 days of age; first-line antibiotic therapy was initiated, however due to torpid evolution, he required a change to a broad-spectrum antibiotic. CONCLUSION: gastroschisis can be detected in ultrasound from the twelve week of pregnancy to minimize complications and program the surgical procedure immediately after birth.

The Spatial Externalities of Tourism Activities in Poverty Reduction

Poverty is one of the main indicators of economic development worldwide, in such a way that one of the Sustainable Development Goals is to eradicate poverty in all its forms worldwide. The objective of this research was to examine the effect of the gross value added (GVA) of tourism on poverty in the 198 contiguous Ecuadorian cantons. The methodology used was the application of a set of spatial econometric models to capture the regional effect of tourism on poverty. Data were obtained from the Central Bank of Ecuador and the National Survey of Employment, Unemployment and Under-Employment of the National Institute of Statistics and Census (INEC). The results show that tourism activities and regional poverty are negatively related; thus, a 1% increase in tourism-related economic activity decreases the regional poverty of the canton itself by 4.31%, and that of neighboring cantons by between 0.7% and 2.4%. The inclusion of the control variables shows that schooling and the mestizo population contribute to reducing the canton’s poverty, since the regions with a high GVA of tourism have high levels of schooling and a mestizo population. Thus, regional poverty increases when the level of schooling increases in neighboring cantons. On the other hand, in cantons with a high Mestizo population, compared to the African-American population, the poverty of the canton and its neighboring regions decreases. Public policy measures which aim at reducing poverty must take into account spatial spills from tourist activity in the cantons.

Integrating water-quality analysis in national household surveys: water and sanitation sector learnings of Ecuador

To respond to the global Sustainable Development Goals framework, Ecuador through the National Institute of Statistics and Censuses (INEC) has been strengthening its monitoring system since 2016, specifically on SDG 6.1 and 6.2. The World Bank Group, UNICEF Ecuador Country Office and WHO/UNICEF Joint Monitoring Programme provided initial support. Additional parameters were included in household surveys, including a water sample analysis to detect presence or absence of E. coli bacteria, and the SDG indicators were adapted to the national context. Ecuador collected water-quality data in two national household surveys in 2016 and 2019, including water quality at household's point of consumption for the 2019 survey. This opens opportunities to extend the analysis beyond access to safely managed drinking water services, toward comparison of water quality between source and point of consumption, and analyzing correlations with other parameters, such as handwashing with soap, water treatment, and safe storage and open defecation. This article describes the principal findings of the extended analysis carried out by INEC, as well as the opportunities to present the results for sector advocacy and decision-making purposes. This study concludes that alignment of the national monitoring systems to the SDG 6.1 framework provided strong evidence that water quality is the principal bottleneck in the water sector in Ecuador. Water-quality testing at the point of consumption was evidenced, as well as the importance of household water treatment and possible effects of other hygiene practices like handwashing with soap and open defecation on water quality at the point of consumption.

A Nationwide Study of Incidence and Mortality Due to Traumatic Brain Injury in Ecuador (2004–2016)

Objective: Traumatic brain injury (TBI) is a public health problem worldwide. Information regarding TBI from low- and middle-income countries is scarce. The objectives of this study are to determine the incidence, mortality and geodemographic distribution of TBI in Ecuador. Methods: A population-based analytical study from 2004 to 2016 was conducted in Ecuador. Men and women with a diagnosis of TBI from all ages (0–110 years) were included. Data was obtained from official hospital-discharges records and retrieved from the National Institute of Statistics and Census (INEC) Database. We analyzed data by region, province and canton with a monthly resolution. The incidence, mortality, case fatality rates and the risk of developing TBI within the population were calculated based on the last 13 years of available data. Results: A total of 124,576 hospital admissions and 5,264 deaths due to TBI were registered in Ecuador from 2004 to 2016. The overall TBI-related hospital admission rate was 70.68 per 100,000. The sex- and age-specific rate was 90.1 per 100,000 for men and 64.1 per 100,000 for women. Mestizos’ population has the highest adjusted incidence rate of 195.6 per 100,000, followed by the indigenous with 61.4 per 100,000 and Afro-Americans with 14.2 per 100,000. The overall annual mortality rate during the study ranged from 2.11 to 3.35 per 100,000. Case fatality rates were significantly higher in older populations, becoming fatal in up to 27% of men >90 years/old and in 15% of women older than 90 years/old. Conclusion: This is the first recorded epidemiological study of the socio-demographic distribution of TBI in Ecuador to date. The study found that young men were almost 4 times more likely to be hospitalized due to TBI than women of this age. Fatalities due to TBI were less likely to occur among younger age groups, increasing significantly among the elderly population. The national incidence rate of TBI has been decreasing since 2011, which coincides with the introduction of stricter alcohol regulation, suggesting that this measure might have played a role in this reduction.

Análisis estadístico de tablas de contingencia y chi cuadrado para medir el flujo migratorio en el Ecuador en el 2018

El objetivo de este trabajo es determinar las causas para que las personas migren a otros países, debido a la falta de soluciones que su país de origen le niega convirtiéndose en un fenómeno de constante crecimiento, abriendo paso a problemas de sobrepoblación de los países de destino así como la falta de oportunidades de trabajo de los habitantes de esos países, para dar solución a las variables que causa la migración se ha tomado una base de datos correspondiente al Instituto Nacional de Estadísticas y Censos (INEC), con un total de 7`000.000 de registros, la cual se obtuvo una muestra de 1`000.000 de registros que será analizada a través de tablas de contingencias y determinar la dependencia lineal de las variables. Se utilizo el estadístico de chi cuadrado con pruebas de hipótesis. Dando como resultado que 62% personas extranjeras entraron y salieron del país, a comparación de 38% propios del país que también decidieron salir por motivo de residencia.

Trends and Spatial Patterns of Suicide Among Adolescent in Ecuador, 1997-2016.

Background:Suicide is a global public health problem, ranking among the top 20 leading causes of mortality.Objective:The aim of the present study is two-fold. Firstly, it describes the temporal trends of suicide in adolescents from 1997 to 2016 in Ecuador, allowing us to identify critical periods. Secondly, it analyzes the spatiotemporal clusters of high mortality rates and the spatial distribution due to suicide in the country, from 2011 to 2016.Methods:This is an ecological study; we included all death certificates of suicide among adolescents in the 10 - 19 age groups both sex, from the National Institute of Statistics and Census (INEC) database in Ecuador from 1997 to 2016. In order to assess the trend of suicide rates, we obtained Annual Percentage Changes (APCs) and average Annual Percent Changes (AAPCs) through Joinpoint regression analysis. Space-time scan statistics were used to identify high-risk clusters, and the spatial autocorrelation was evaluated through global Moran index.Results:Suicides at a national level increased from 165 deaths in 1997 to 286 deaths in 2016; rates increased from 12.7 to 23.3 per 100,000 population along with a significant increase of the trend at the national level (AAPC=3.7%; 95% CI: 2.1 to 5.2). We identified two significant spatial clusters for a high occurrence of suicide: the primary most likely cluster included 83 cantons (Risk Relative=2.28) while the second most likely cluster included 20 cantons (Risk Relative=1.74). The Global Moran I index for the study period showed a positive spatial autocorrelation (0.27; p = 0.001).Conclusion:Suicide rates in adolescents significantly increased over the 20-year study period; the spatial analysis indicates the presence of high occurrence clusters in the Amazon and Southern Highlands regions of the country. This growing phenomenon may be a reflection of the lack of policies and strategies focused on the adolescent’s mental health at a national level, added to factors such as family dysfunction, school failure, vulnerable ethnic groups, and immigration patterns.

La economía popular y solidaria y las finanzas populares y solidarias en Ecuador

La Economía Popular y Solidaria (EPS) y las Finanzas Populares y Solidarias (FPS) surgen en Ecuador con la administración del gobierno conocido como de la Revolución Ciudadana (15 de enero de 2007 - 24 de mayo de 2017), a tal punto que, la EPS se halla inserta en la actual Constitución de la República del Ecuador 2008. A fin de dotarle a la EPS de su marco regulatorio, la Asamblea Nacional Constituyente en 2011 aprobó la Ley Orgánica de la Economía y Popular y Solidaria y del Sector Financiero Popular y Solidario (LOEPS); en esta consta la base legal para que se hayan creado los agentes institucionales: Corporación Nacional de Finanzas Populares y Solidarias (CONAFIPS) en 2011 y Superintendencia de Economía Popular y Solidaria (SEPS) en 2012. A más del que estaba creado Instituto Nacional de Economía Popular y Solidara (IEPS) en 2009, encargado del progreso de la EPS. La CONAFIPS es la que otorga financiamiento a las organizaciones de las FPS, y éstas a la vez, financian el desarrollo de los emprendimientos de la EPS en las parroquias urbanas y rurales del país; y la SEPS, se encarga del control de las organizaciones de la EPS y de las FPS. El objetivo de estos agentes institucionales es, velar por la sostenibilidad de los emprendimientos que se desarrollan en las parroquias urbanas y rurales del país. Sin embargo, no han logrado cumplir el fin para lo que fueron creados, debido a la forma como están organizados actualmente. Los resultados así lo demuestran sobre todo en las parroquias rurales, ya que la pobreza por Necesidades Básicas Insatisfechas (NBI) según el Instituto Nacional de Estadística y Censos (INEC) a diciembre de 2017 alcanzó el 56,1%.

Test de Sullivan. Eficacia en la detección de diabetes gestacional, en mujeres de 18 a 35 años Cantón Buena Fe, Los Ríos

La alta prevalencia de la diabetes en todo el mundo y su mayor frecuencia en las mujeres embarazadas han generado nuevos datos de la investigación sobre la relación entre los resultados de glucemia y embarazo. La diabetes gestacional se define como la intolerancia a la glucosa que se reconoce por primera vez durante el embarazo. La diabetes gestacional afecta aproximadamente al 3-6\% de las mujeres embarazadas.Es importante comprender que todas las mujeres embarazadas experimentan cambios metabólicos durante el embarazo, esto reduce su tolerancia a la glucosa. Como los niveles de glucosa en sangre aumentan durante el embarazo, su cuerpo produce más insulina. De acuerdo a estadísticas oficiales del Instituto Ecuatoriano de Estadística y Censos (INEC), la DG ocupó, en el año 2009, el sexto puesto entre las causas de morbimortalidad materno-fetal. En 2012, el sobrepeso al nacer se ubica dentro de las 10 primeras causas de morbilidad infantil en el Ecuador (Instituto Nacional de Estadística y Censos (INEC). Bases de datos 2000-2012.Por lo anteriormente expuesto este proyecto de investigación está basado en determinar la eficacia del test de Sullivan para identificar los factores riesgos maternos y fetales que se pueden producir en madres con diabetes gestacional en el cantón Buena Fe primer semestre 2015.

The remarkable geographical pattern of gastric cancer mortality in Ecuador

AimThis study was aimed to describe the gastric cancer mortality trend, and to analyze the spatial distribution of gastric cancer mortality in Ecuador, between 2004 and 2015. MethodsData were collected from the National Institute of Statistics and Census (INEC) database. Crude gastric cancer mortality rates, standardized mortality ratios (SMRs) and indirect standardized mortality rates (ISMRs) were calculated per 100,000 persons. For time trend analysis, joinpoint regression was used. The annual percentage rate change (APC) and the average annual percent change (AAPC) was computed for each province. Spatial age-adjusted analysis was used to detect high risk clusters of gastric cancer mortality, from 2010 to 2015, using Kulldorff spatial scan statistics. ResultsIn Ecuador, between 2004 and 2015, gastric cancer caused a total of 19,115 deaths: 10,679 in men and 8436 in women. When crude rates were analyzed, a significant decline was detected (AAPC: −1.8%; p<0.001). ISMR also decreased, but this change was not statistically significant (APC: −0.53%; p=0.36). From 2004 to 2007 and from 2008 to 2011 the province with the highest ISMR was Carchi; and, from 2012 to 2015, was Cotopaxi. The most likely high occurrence cluster included Bolívar, Los Ríos, Chimborazo, Tungurahua, and Cotopaxi provinces, with a relative risk of 1.34 (p<0.001). ConclusionThere is a substantial geographic variation in gastric cancer mortality rates among Ecuadorian provinces. The spatial analysis indicates the presence of high occurrence clusters throughout the Andes Mountains.

An Analysis of Key Aspects of the Illiterate Ecuadorian Population Aged 15 Years and Older

This article aims to provide an analysis of several aspects that comprise the profile of the Ecuadorian population aged 15 years old and over who do not know how to read and write. The approach, employed in this research study, focuses on a descriptive analysis and a multidimensional statistical analysis. Available data from the National Survey of Employment, Unemployment and Underemployment of Ecuador (ENEMDU), conducted by the National Institute of Statistics and Censuses (INEC) in 2016, was utilized as the main source of information in the study. One of the previous surveys, conducted in the country in 2006, suggested that the equivalent percentage of the illiterate population was 8.63%; therefore, these data indicate that the population under examination has decreased considerably in the last ten years. This means that a highly important enhancement in terms of literacy has occurred over this period of time in Ecuador. The study results, drawn from the descriptive analysis and the hierarchical analysis carried out as part of this research, may be key at the moment of creating policies, educational campaings and nationwide, special programs focused on helping reduce and eliminate illiteracy across the nation in the upcoming years.

Cesarean section rates in Ecuador: a 13-year comparative analysis between public and private health systems.

ABSTRACTObjective.To demonstrate the prevalence of cesearean sections (C-sections) in Ecuador and their distribution between private and public health centers.Methods.An observational population-based study was conducted of patients discharged from public and private hospitals in Ecuador after a C-section or vaginal delivery. Data were collected by the Ecuadorian National Institute of Statistics and Census (INEC) between 2001 and 2013.Results.The overall national C-section rate in the private health care system is double the rate in the public health care system. Over the 13 years of the study, C-sections accounted for 57.5% of births in the private sector, while the public sector proportion did not exceed 22.3%. Countrywide, less than 36% of C-sections were found to be clinically justified by parallel analysis of absolute or relative indications. Acute fetal distress (AFD) was more frequently reported in private centers compared to public ones (446 per 10 000 live births versus 274 per 10 000). Since 2001, the number of births by cesarean section increased by more than 50% (R2 = 0.7306, P < 0.05), with an annual growth rate of 4.03%. In Guayaquil, the largest city in Ecuador, up to 74% of live births occurred by C-section.Conclusion.National data show that C-sections are performed more frequently in Ecuador than the rate recommended by the World Health Organization, especially in the private health care system. Private centers also report higher rates of AFD, which implies that this diagnosis is either overused in private centers or underrecognized in public centers. Although several factors might be influencing these trends, no data are available to determine the relative importance of economics, practicality, and medical or personal concerns of mothers and physicians in deciding which method of delivery should be used.

Suicide attempts associated with sexual violence: Women – Ecuador

ObjectiveDetermine the incidence of suicide attempts in women exposed to sexual violence in Ecuador.MaterialsWe applied a transversal descriptive study accomplished by the National Institute of Statistics and Census (INEC). The INEC recruited Ecuadorian women from 15-years-old and ahead, the surveys were focused on this population. Eighteen thousand and eight hundred (18,800) rural and urban housings were selected all over the country, 24 provinces. Date of the survey: November 16–December 15 of 2011. The sample included 737 women of several marital status (single, married and separated woman) who reported had been victims of sexual violence.ResultsThe average age of the sample was 28-years-old. The standard deviation was 21 years, ages: 15–25 years old: 14.265 (21.6%), 25–35-years-old: 9.324 (14.1%), 35–45-years-old: 8.132 (12.3%), 45–55-years-old: 6.283 (9.5%), 55–65-years-old: 4.302 (6.5%) and &gt; 65 years old: 23.745 (35.9%). The incidence of women who had attempted suicide due to sexual violence was 73.95% (545 of 737 women surveyed). According to the marital status, the incidence was 79.3% on single, 65.5% on married and 79.0% on separated women.ConclusionThe rate of suicide attempts in Ecuadorian women undergoing situations of sexual violence is very elevated. The traumatic incident in descending order according to the classification by marital status is: single, separated and married. It was identified the population of unmarried women in our society to be the most vulnerable to develop suicidal behaviors (8 out of 10 women). However, we must keep in mind that these statistics could be even higher due to the fear and rejection to expose personal traumatic experiences in conservative societies such as the Ecuadorian. These results represent a powerful call to the Mental Health Systems. They must increase protection and follow-up programs on sexually abused women in Ecuador and other Latin-American countries.Disclosure of interestThe authors have not supplied their declaration of competing interest.