Objective: To examine the relationship between high altitude and microtia in Ecuador. Methods: We evaluated the epidemiological issues of 1298 cases of microtia reported in Ecuador from 2001 to 2007. It used data arising from the Vital Statistics National Reports: Annual Survey of Admissions and Discharges in this 7 year period. The register is national and population based, run and funded by the government. Results: It reported a total of 1298 cases of microtia out of 34654 cases of congenital malformations described in the registries. The overall prevalence was 2.38/10000 admissions/discharges calculated out of 5462263 admissions. An overall percentage (of 90.22%) were admitted before 19 years of age with the most prevalent group between 5 to 9 years of age (31.90%). There was progressive increase of cases every year; from 132 cases in 2001 to 304 in 2007. Total male cases in this study were 723 (55.70%) and female cases were 575 (44.30%). Tungurahua reported the highest prevalence of 18.31/10000 births, followed by Chimborazo, Azuay, Pichincha and Cotopaxi; all of them located over 2500 meters above sea level. It found that highest prevalence was 10.21 over 2700 meters above sea level followed by 8.28 over 2800 meters above sea level; with both having a cumulative prevalence of 8.81. Conclusion: There is a higher prevalence of microtia in patients living above 2500 meters above sea level. This study was not able to establish a clear relationship between microtia and different ethnic groups.

Aim The aim of this paper is to analyze the epidemiological pattern, the occupational background and the public health problems of acute pesticide poisoning in Ecuador. This is the first report of its kind. Subjects and methods This was an observational and retrospective study performed with data from 2001 to 2007 from the National Register of Hospital Admissions/Discharges from the Instituto Nacional de Estadísticas y Censos, and also with data from the Ministry of Public Health. Ecuador does not have an official public medical poisoning registry or disease-specific registries. Results The complete register reported 44,931 cases of poisoning with an average of 6,418 cases per year and a global progressive increase of 2,123 cases in the entire period. It reported 14,145 cases of pesticide poisoning. Of these, 10,100 cases were due to the effects of the insecticides organophospate and carbamate. The number of cases by gender was 7,102 (50.21%) males and 7,043 (49.79%) females. The major age group affected was adolescents and young adults. Conclusion In Ecuador, pesticide poisoning occurs in individuals of both sexes who are between 15 to 25 years old and work in adverse conditions as agricultural farmers. The poisoning especially occurs in flower and banana plantation workers throughout the country. Seventy-one percent of the cases are due to organophosphate and carbamate poisonings, which cause death in 4% of the cases; 57% die in the first 48 h, possibly because of the acute action of AChE inhibitors. The long-term effects of pesticides are still unclear and need further research.

The typical case was an adolescent woman between 16 and 19 years with self-harm around Christmas. There was no specific treatment, but early attendance was associated with improved prognosis. Further studies are necessary to establish an adequate protocol of treatment.

Ecuador has a heterogeneous population of almost 14 million people and a complex health care system provided through provincial and national health programs by government and private hospitals. There are public health facilities at regional and territorial level. Ecuador has a small cadre of genetic professionals that provide clinical genetic services in a few private medical centers in the main cities. Prenatal screening is offered exclusively in a few individual hospitals, with variable uptake as part of prenatal care. Surveillance of the effect of prenatal screening and diagnosis on the birth prevalence of congenital anomalies is limited by gaps and variations in surveillance systems. Newborn screening programs are almost inexistent. There is broad variation in optional participation in laboratory quality assurance schemes, and there are no regulatory frameworks that are directly pertinent to genetic testing services or population genetics. Health technology assessment in Ecuador is conducted by a diverse collection of organizations, several of which have produced reports related to genetics.

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