Spatiotemporal trends of neglected tropical disease hospitalizations in Ecuador over 25-years from 2000 to 2024
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Background
World Health Organization has identified 21 neglected tropical diseases (NTDs) affecting millions globally, for control or elimination. We analysed time trends and geographic distribution of hospitalizations attributed to NTDs between 2000 and 2024 in Ecuador.
Methods
We estimated hospitalization rates over the 25-year period using hospital discharge data from Ecuadorian national statistics. Time trends Joinpoint regression analysis was done for the 5 most frequent NTDs. Standardized morbidity ratios were estimated for these NTDs for census years (2001, 2010 and 2022) to explore relative changes in hospitalization rates over time and by geography.
Results
A total of 179,439 hospital discharges attributed to NTDs were recorded nationally in Ecuador. The five most frequent NTDs accounted for 97.1% of hospitalizations and included arboviral infections, dengue and chikungunya (62% of hospitalizations), snakebite envenoming (20%), soil-transmitted helminthiases (9%), taeniasis and cysticercosis (4%), and scabies and other ectoparasitoses (2%). Only 0.4% of hospitalizations resulted in death. NTD hospitalizations were more frequent in males (54%) with a median age of 19 years (Q 1 9 – Q 3 37). Although hospitalization rates for all NTDs increased over time, there was a downward trend in non-arboviral NTDs that was significant for snakebite (from 2014, annual percent change -7.81%, 95% CI -11.27, -5.69, P=0.006), soil-transmitted helminths (from 2000, -5.62%, 95% CI -6.56, -4.68, P<0.001), and taeniasis and cysticercosis (from 2003, -10.42%, 95% CI -14.50, -9.68, P=0.002). Relative morbidity caused by NTDs tended to be much greater in Coastal and Amazon provinces, shifting over time particularly to the Amazon region, although taeniasis and cysticercosis morbidity remained greatest in southern Andean Provinces.
Conclusion
Hospitalization rates for non-arboviral NTDs have declined over the past 25 years in Ecuador. Populations in the Amazon region remain the most affected by NTD morbidity, highlighting the need for enhanced and appropriately targeted efforts to control and eliminate NTDs.
Author Summary
Neglected tropical diseases (NTDs) are a group of diseases affecting millions worldwide, especially in poor and marginalized populations in tropical and subtropical regions of low and middle-income countries. This study analysed hospital records over a 25-year period (2000-2024) in Ecuador—a country where 40% of the population lives in poverty, where there is considerable geoclimatic diversity but where 80% of territory has a tropical or subtropical climate—to determine how hospitalisations due to NTDs have changed over this period and which regions of the country are most affected. Most hospitalisations (97%) were caused by five diseases: the arbovirus infections, dengue and chikungunya; snakebite; intestinal worms; pork tapeworm infections; and scabies. Children and adolescents and those living in the Amazon region suffered most from severe disease caused by NTDs. Over time, hospitalisations from most NTDs declined although those caused by dengue and chikungunya increased. These findings highlight an urgent need to strengthen health education, disease prevention, surveillance, and access to timely diagnosis and treatment tailored to each of these NTDs, especially in the Amazon region of the country. These data help inform the country’s progress meeting its targets for NTD control and elimination by 2030 as outlined in Sustainable Development Goal 3.3.
