ABSTRACT
BACKGROUND: Type 2 Diabetes (T2DM) prevalence is increasing in low- and middle-income countries along with high levels of obesity which vary according to socioeconomic and contextual characteristics. We aim to estimate the prevalence of T2DM and obesity in men and women in a hard-to-reach rural area in northern Ecuador considering socio-demographic characteristics. METHODS: Cross-sectional descriptive study based on a population-based survey in the Eloy Alfaro health district of Esmeraldas between October 2020 and January 2022. We collected sociodemographic information and risk factors for non-communicable diseases with an adapted version of the STEPS survey, performed oral glucose tolerance tests, biochemistry and took physical measurements. We estimated the prevalence of T2DM, obesity, and calculated Odds Ratios (OR) with confidence intervals by logistic regression in Stata v.15. RESULTS: The overall prevalence of T2DM was 6.8% (CI95%: 4.9-8.7), markedly higher among women compared to men (10.4%, CI95% 7.3-13.4%, compared 2.0%, CI95% 0.4-3.7% respectively). The risk of having T2DM in women was 5 times higher than in men adjusting for age, ethnicity, employment, household earnings and obesity (OR: 5.03; 95%CI: 1.68-15.01). Regarding age, the risk of T2DM increased by 6% per year (adjusted OR: 1.06; 95%CI: 1.03-1.08). Obesity prevalence was 30.8% (CI95%: 27.3-34.3), in women was nearly three times higher than in men (43.2% CI95%: 38.2-48.2, compared to 14.7% prevalence, CI95%: 10.6-18.8). Indigenous women had a lower prevalence of obesity compared with the Afro-Ecuadorian women (OR: 0.05; 95%CI: 0.02-0.18) after adjusting for age, employment status, household earnings and setting. CONCLUSION: We found alarming differences between the prevalence of T2DM and obesity in women and men that may be explained by gender roles, exacerbated in the rural context. Health promotion measures with a gender perspective should be adapted according to the characteristics of isolated rural contexts.
Subject(s)
Diabetes Mellitus, Type 2 , Male , Humans , Female , Diabetes Mellitus, Type 2/epidemiology , Ecuador/epidemiology , Cross-Sectional Studies , Prevalence , Obesity/epidemiologyABSTRACT
Challenges remain for policy adoption and implementation to tackle the unprecedented and relentless increase in obesity, diabetes and other non-communicable diseases (NCDs), especially in low- and middle-income countries. The aim of this mixed-methods study is to analyse the contextual relevance and applicability to low-resource settings of a sample of evidence-based healthy public policies, using local knowledge, perceptions and pertinent epidemiological data. Firstly, we will identify and prioritise policies that have the potential to reduce the burden of diabetes in low-resource settings with a scoping review and modified Delphi method. In parallel, we will undertake two cross-sectional population surveys on diabetes risk and morbidity in two low-resource settings in Ecuador. Patients, community members, health workers and policy makers will analyse the contextual relevance and applicability of the policy actions and discuss their potential for the reduction in inequities in diabetes risk and morbidity in their population. This study tackles one of the greatest challenges in global health today: how to drive the implementation of population-wide preventative measures to fight NCDs in low resource settings. The findings will demonstrate how local knowledge, perceptions and pertinent epidemiological data can be used to analyse the contextual relevance and applicability of potential policy actions.
Subject(s)
Clinical Studies as Topic/methods , Diabetes Mellitus/therapy , Cost of Illness , Cross-Sectional Studies , Ecuador , Humans , Morbidity , Risk AssessmentABSTRACT
Contexto: Se aborda desde la contextualización del Modelo de Atención Integral en Salud, Familiar, Comunitario e Intercultural (MAIS-FCI), la respuesta planificada en oferta de programas de posgrado de la FCM de la UCE, de acuerdo a las necesidades del Sistema Nacional de Salud (SNS), anclada al Sistema de Educación Superior y su marco legal. Objetivo: analizar el comportamiento histórico de los programas de posgrado en la Facultad de Ciencias Médicas de la Universidad Central del Ecuador, que relaciona los aspectos relativos a la pertinencia nacional e internacional, desde un contexto legal y fáctico que incluye los hitos cronológicos de la institucionalización académica de la formación y la titulación así como su fortalecimiento y proyección. Métodos: estudio documental, descriptivo, observacional, cuantitativo y cualitativo. Resultados: la Facultad de Ciencias Médicas de la Universidad Central fue creada en 1693. En el año de 1972 nace el primer programa de especialidad médica en Ginecología y Obstetricia, como respuesta a la alta prevalencia de la morbimortalidad materno-infantil; luego Medicina Interna en 1973, Pediatría en 1974, Ortopedia y Traumatología en 1975. La institucionalidad de los posgrados se ancla al Departamento de Graduados (1972-1986), Escuela de Graduados (1987-1997) e Instituto Superior de Posgrados (1998-2017). Desde su creación se han ofertado 31 programas en especializaciones médicas, 8 programas de especialización en enfermería, 10 programas de maestría y 16 diplomados en salud. Discusión: la Facultad de Ciencias Médicas ha titulado a 5.307 profesionales en 65 programas académicos; ha ejecutado 505 cohortes con una duración de hasta 4 años; siendo los programas emblemáticos Medicina Interna y Gíneco-Obstetricia (31 cohortes) y Pediatría y Anestesiología (29 cohortes). Al año 2017 están en funcionamiento 24 programas de especializaciones médicas, con 715 estudiantes posgradistas y 567 docentes. A futuro y respondiendo al contexto mundial y nacional, se propone implantar un sistema de gestión de calidad, acreditar los programas de posgrado de acuerdo a la nueva normativa legal vigente e internacionalizarlos. Manteniendo las especializaciones médicas "tradicionales", se plantea impulsar la creación de nuevas especializaciones médicas, de enfermería, de obstetricia y otras del campo específico de la salud. Se fortalecerán en pertinencia los modelos educativos, pedagógicos y curriculares, para una formación profundamente humanista de los posgradistas, con calidad y excelencia académica, incluyendo la investigación científica, que genere la publicación de literatura científica. Conclusión: la formación en posgrados de la Facultad de Ciencias Médicas es histórica, protagónica y pionera en el Ecuador, para el desempeño del talento humano en el campo de la salud, lo que ha aportado en la construcción de soluciones a los problemas de la salud de la población, en contribución a ejercer el derecho a la salud en condiciones de calidad y calidez.
Context: This summary cover the Integral Comprehensive Health Care Model in the field of Family, Community and Intercultural health (MAIS-FCI), the planned response in offer of postgraduate programs of the Faculty of Medical Sciences of the UCE, according to the needs of the National Health System (SNS) and, anchored to the Higher Education System and its legal framework. Objective: to analyze the historical behavior of the postgraduate programs in the Faculty of Medical Sciences of the Central University of Ecuador, in which aspects related to national and international appropriatness are related, from a legal and factual context that includes the chronological milestones of the academic institutionalization of training and certification; as well as its strengthening and projection. Methods: bibliographic, documentary, descriptive, observational, quantitative and qualitative study. Results: the Faculty of Medical Sciences at Central University was created in 1693. In 1972, the first medical specialty program in Gynecology and Obstetrics was founded, in response to the high prevalence of maternal and child morbidity and mortality; then Internal Medicine in 1973, Pediatrics in 1974, Orthopedics and Traumatology in 1975. The postgraduate institutionalism is anchored to the Department of Graduates (1972-1986), Graduate School (1987-1997) and Higher Institute of Postgraduate Studies (1998-2017). ). Since its creation, 31 programs have been offered in medical specializations, 8 specialization programs in nursing, 10 master's programs and 16 health Diplomates. Discussion: the Faculty of Medical Sciences have graduated from 5.307 professionals in 65 academic programs; has executed 505 cohorts with a duration of up to 4 years; the emblematic programs are Internal Medicine and Gineco-Obstetrics (31 cohorts) and Pediatrics and Anesthesiology (29 cohorts). By 2017, 24 medical specialization programs are in operation, with 715 postgraduate studentsand 567 teachers. In the future and responding to the global and national context, iproposes to implement a quality managemen system, accredit graduate programs according to the new legal regulations in force, and internationalize them. Maintaining the "traditional" medical specializations, it is proposed to promote the creation of new medical specializations, of nursing, of obstetrics and others of the specific field of health. The educational, pedagogical and curricular models will be strengthened in relevance, for a profoundly humanistic formation o postgraduates, with academic quality and excellence, including scientific research that will generate the publication of scientific literature. Conclusion: the postgraduate training of the Faculty of Medical Sciences is historical, leading and a pioneerin Ecuador, for the performance of human talent in the field of health, which has contributed to the construction of solutions to health problems of the population, in contribution to exercise the right to health in conditions of quality and warmth.
