ENFERMEDADES INFECCIOSAS DESATENDIDAS EN PUEBLOS OLVIDADOS. EL CASO DE LA FRONTERA SURORIENTAL DE LA AMAZONIA ECUATORIANA

Abstract

Introduction: Neglected infectious diseases disproportionately affect the most socially disadvantaged populations and promote the poverty trap. Native peoples present numerous social determinants of health and are at risk of multimorbidity due to poverty-related diseases; they also suffer structural violence and a systematic violation of human rights. However, in the Ecuadorian Amazon these populations lack disaggregated data for their prioritization within public health programs. The objective of this research was to characterize the socioeconomic and epidemiological situation of the native population that inhabits the Ecuadorian Amazonian border and to determine the presence of pulmonary tuberculosis and geohelminthiasis, and the serological memory presence of the hepatitis A virus and Leptospira._x000D_ _x000D_ Methods: This was a cross-sectional study carried out in two areas of the southeastern border of the Ecuadorian Amazon where Shuar communities live in a dispersed and remote situation and with geographic accessibility difficulties. The first phase of the research was conducted in Taisha in 2013, where 1,598 individuals participated and the second phase in Tiwintza in 2015, where 216 people participated. The individuals voluntarily participated with sputum samples for sputum smear and culture; stool samples for parasitological analysis; and, blood samples for the determination of IgG for the hepatitis A virus and Leptospira spp. In addition, sociodemographic, epidemiological and clinical variables of the diseases studied were collected for analysis at the household and individual level._x000D_ _x000D_ Results: In the first phase of the investigation, through active case finding, respiratory symptomatic subjects were recorded (7.57%, 95%CI = 6.27-8.87) and pulmonary tuberculosis diagnosis (CI = 125.16 per 100,000 inhabitants), one of them MDR, significantly higher than the officially registered (CI 39.08 per 100,000 inhab). An association was found between the presence of respiratory symptoms and living at a distance greater than 3 hours from the health services. _x000D_ In the second phase, a prevalence of soil-transmitted helminthiasis of 55.98% (95% CI = 48.49-63.27%) was found without differences by sex, age, migration or history of chemoprophylaxis. 50.85% of households had an infection and the preschool age group had a greater presence of disease (PR = 1.47, 95% CI = 1.04-2.08). In addition, a serological presence of memory was found for Leptospira of 50.23% and for the hepatitis A virus of 98.06%. All the houses in the communities used river water without treatment and lacked a wastewater system._x000D_ _x000D_ Discussion: The results of this research constitute a novel epidemiological characterization of the native communities that inhabit the southeastern border of the Ecuadorian Amazon. The high presence of the disease found generates the need to prioritize the neglected infectious diseases in the public health programs of this population and to strengthen the epidemiological surveillance system. The main limitation of this study was the collection of only one biological sample of each type per participant, due to the dispersed, precarious and remote conditions of these communities. It is essential to strengthen the active search for respiratory symptomatic subjects, the timely diagnosis of pulmonary tuberculosis, adapt chemoprophylaxis programs for soil-transmitted helminth infections and improve access to safe water and health services in these marginalized communities.

Date of Award	7 Feb 2018
Original language	Spanish
Supervisor	Natalia Cristina Romero Sandoval (Director)