Suchergebnisse

Intro -- Preface -- Contents -- Contributors -- Chapter 1: Introduction -- 1.1 Conclusion -- References -- Part I: Water Environment -- Chapter 2: Analysis of Water Supply and Demand Management Strategies in Overcoming Water Scarcity in Santa Cruz -- 2.1 The Island of Santa Cruz -- 2.2 Quantification of Water Demand -- 2.2.1 Research Methodology -- 2.2.2 Analyses of Results in Puerto Ayora and Bellavista -- 2.2.2.1 The Domestic Category -- 2.2.2.2 Total Demand Quantification for Domestic Sector -- 2.2.2.3 Analysis of Tourist and Laundry Category -- 2.3 Assessment of Domestic Consumption in Puerto Ayora's Intermittent Supply Network -- 2.3.1 Research Methodology -- 2.3.2 Results Based on Installed Water Meters -- 2.3.2.1 Water Consumption -- 2.3.2.2 Water Demand Patterns -- 2.3.3 Analysis of Water Demand in Pilot Zones -- 2.3.4 Analysis on Scarcity of Water in Puerto Ayora -- 2.4 Conclusions -- References -- Chapter 3: Galapagos' Water Management Evaluation Under a Changing Climate and the Current COVID-19 Pandemic -- 3.1 Introduction -- 3.2 Methods -- 3.2.1 Study Area -- 3.2.2 Study Approach -- 3.2.2.1 Multi-stakeholder Approach to Identify Proposed Actions to Address Water Needs and Priorities Under Climate Change -- 3.2.2.2 Proposed Action Evaluation Under Two Different Scenarios -- 3.3 Results -- 3.3.1 Executed Projects and Plans Addressing Climate Change and Water Management Issues in the Galapagos Islands -- 3.3.2 Agreements Among All Three Groups of Stakeholders -- 3.3.3 What Has Been Done -- 3.3.4 What Needs to Be Done -- 3.4 Discussion -- 3.4.1 Evaluation of Proposed Actions Under Climate Change Scenario -- 3.4.2 Evaluation of Proposed Actions Under Climate Change and COVID-19 Scenario -- 3.5 Conclusions -- Apppendix -- References -- Chapter 4: Water Quality and Access in Isabela: Results from a Household Water Survey -- 4.1 Introduction.

Background: Limited research is available about the impact of healthcare reforms on healthcare utilization accord‑ing to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gapbetween the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007–2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. Methods: We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difculties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes ininequalities over time. Sample weights were applied to all analyses, and 95% confdence intervals were calculated to assess statistical signifcance in the regression analysis. Results: In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically signifcant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. Conclusions: Our results showed remarkable and signifcant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specifc indicators. Further studies are also needed to identify the main barriers that contribute to UHCN among socially disadvantaged groups.

BACKGROUND: Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women's health care access. METHODS: The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time. RESULTS: Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use. CONCLUSIONS: While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.

Introduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador. Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador. Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs. Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.

Isabel Hernández,1,2 Julio Barzallo,3 Simón Beltrán,4 Alberto Castillo,5 Nelson Cevallos,6 Patricio Hernández,7 Camilo López,8 Rita Vera,9 Gabriela Yerovi,10 Alejandra Mendoza,1 Santiago Terán,1 Andres Izurieta,11 Enrique Teran11Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador; 2Facultad de Enfermería, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; 3Hospital Teofilo Dávila, Ministerio de Salud Pública, Machala, Ecuador; 4Hospital Carlos Andrade Marín, Instituto Ecuatoriano de Seguridad Social, Quito, Ecuador; 5Hospital Eugenio Espejo, Ministerio de Salud Pública, Quito, Ecuador; 6Hospital Enrique Garcés, Ministerio de Salud Pública, Quito, Ecuador; 7Hospital de Infectología Dr. José Daniel Rodríguez Maridueña, Ministerio de Salud Pública, Guayaquil, Ecuador; 8Hospital Teodoro Maldonado Carbo, Instituto Ecuatoriano de Seguridad Social, Guayaquil, Ecuador; 9Hospital Abel Gilbert Pontón, Ministerio de Salud Pública, Guayaquil, Ecuador; 10Programa Nacional para Control del VIH, Ministerio de Salud Pública, Quito, Ecuador; 11Department of Computer Engineering, College of Engineering, University of South Florida, Tampa, FL, USAIntroduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador.Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador.Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs.Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.Keywords: HIV noninfectious comorbidities, people living with HIV, HIV combined antiretroviral therapy, HIV diagnosis, HIV treatment, HIV in developing countries, HIV in Ecuador