Abstractobjective To describe the current situation of Chagas disease in Ecuador and to evaluate the impact of vector control for the period 2004-2014.methods Since 2004, the Ministry of Public Health has formalized activities for the surveillance and control of Chagas disease and we analyzed here available records.results More than 200 000 houses were surveyed, and 2.6% were found to be infested (95% CI: 2.6-2.7), and more than 51 000 houses were sprayed with residual insecticide, with important yearly variations. A total of 915 cases of T. cruzi infection were registered. The Amazon region is emerging as a high priority area, where nearly half of T. cruzi infection cases originate. The costal region and the southern highland valleys remain important high-risk area. Vector control efforts over the past 10 years have been effective in the coastal region, where T. dimidiata predominates, and resulted in important reductions in house infestation indices in many areas, even reaching negligible levels in some parishes.conclusion Vector efforts need to be sustained and expanded for the elimination of T. dimidiata to be feasible. Novel vector control interventions need to be designed to reduce intrusion by several triatomine species present in the Amazon region and southern Ecuador. Strong political commitment is needed to sustain current achievements and improve the national coverage of these programmes.

Background Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Between 1996 and 2007 Ecuador went through one of the greatest political and socio-economic crises in Latin America, a product of neo-liberal economic growth strategies. Between 2007 and 2012 it regained political stability, promoted redistributive policies, and initiated greater social spending. To understand the possible influence on the political and economic context, we analyzed the coverage and inequalities in five Reproductive, Maternal, and Child Health (RMNCH) and two water and sanitation interventions using survey data from a broad time window (1994–2012), at a national and subnational level. Methods The series cross-sectional study used data from four representative national health surveys (1994, 1999, 2004 and 2012). Coverage of RMNCH and sanitary interventions were stratified by wealth quintiles (as a measure of the socio-economic level), urban-rural residence and the coverage for each province was mapped. Mean difference, Theil index and Variance-weighted least squares regression were calculated to indicate subnational and temporal changes. Results From 1994 to 2004, Ecuador evidenced large inequalities whose reduction becomes more evident in 2012. Coverage in RMNCH health service-related interventions showed a rather unequal distribution among the socioeconomic status and across provinces in 1994 and 2004, compared to 2012. Sanitary interventions on the contrary, showed the most unequal interventions, and failed to improve or even worsened in several provinces. While there is a temporary improvement also at the subnational level, in 2012 several provinces maintain low levels of coverage. Conclusions The remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries. Territorial heterogeneity and great inequalities specially related with sanitation interventions persists. It is necessary to obtain high quality information with sharper geographic desegregation that allows to identify and understand local changes over time. This would help to prioritize intervention strategies, introduce multisectoral policies and investments that support local governments.

Objetivo: analizar determinantes sociodemográficos relacionados con IRAg y calcular un índice de priorización en los cantones del Ecuador para identificar áreas vulnerables para transmisión COVID-19. Diseño: Estudio observacional ecológico descriptivo. Emplazamiento: 224 cantones del Ecuador con fuentes de datos secundarios de información hospitalaria. Participantes: La unidad de medida fueron 224 cantones del Ecuador, en las cuales se analizó tasas de morbilidad y letalidad por IRAg con datos de egresos hospitalarios (2016-2018). Mediciones principales: Se estructuraron 8 variables sociodemográficos y se aplicaron pruebas correlacionales (modelo de regresión múltiple). El índice de priorización considera criterios de eficiencia, eficacia, tamaño de efecto y equidad; usando la suma para cada indicador, se calculó el puntaje de priorización. Resultados: Factores asociados con morbilidad por IRAg fueron: escolaridad, urbanización y densidad poblacional; para mortalidad fueron: escolaridad y etnia (indígena) IRR:1.09 (IC95%:1.06-1.15), IRR:1.024 (IC95%:1.02-1.03) respectivamente. Con letalidad se asociaron los cantones con población mayor de 60 años (IRR:1.049 IC95%:1.03-1.07). Se obtuvo 86 cantones de alta prioridad, mayoritariamente localizados en la región sierra centro y la provincia de Morona Santiago. Conclusiones: Morbilidad y mortalidad por IRA grave en Ecuador se asociaron a factores sociales y demográficos. Los ejercicios de priorización que consideran estos factores permiten identificar territorios vulnerables durante la propagación de enfermedades respiratorias. Determinantes sociales propias de cada territorio deben sumarse a factores individuales conocidos, para analizar riesgo y vulnerabilidad por COVID.

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