Table 1.
Sociodemographic characteristics and hospital stay characteristics of hospital discharges of all 21 neglected tropical diseases (NTDs) and the 14 endemic NTDs in Ecuador between 2000 and 2024.
Table 2.
Joinpoint trends in age-standardized hospitalization rates (per 100,000 population) for all 21 neglected tropical diseases (NTDs) and the 5 most frequent endemic NTDs in Ecuador between 2000 and 2024.
Fig 1.
Temporal trends in age-standardized hospitalization rates for endemic neglected tropical diseases (NTDs) in Ecuador, 2000–2024.
Annual age-standardized hospitalization rates (per 100,000 population) are shown for major endemic NTD groups. Rates were calculated using the direct method based on the WHO standard population. The figure illustrates the relative contribution of arboviral and non-arboviral NTDs to overall hospitalization burden over time. Dengue and chikungunya, Snakebite envenoming, soil-transmitted helminths, Taeniasis and cysticercosis, Scabies and other ectoparasitoses, and Other NTDs—including Chagas disease, echinococcosis, leishmaniasis, leprosy, onchocerciasis, yaws, foodborne trematodiases, mycetoma, chromoblastomycosis and other deep mycoses, and rabies.
Fig 2.
Joinpoint regression analysis of age-standardized hospitalization rates for neglected tropical diseases (NTDs) in Ecuador, 2000–2024.
Panels show annual age-standardized hospitalization rates (per 100,000 population) and fitted joinpoint regression models for (A) all NTDs and (B–F) the five most frequent endemic NTDs: dengue/chikungunya, snakebite envenoming, soil-transmitted helminthiases, taeniasis/cysticercosis, and scabies/ectoparasitoses. Points represent observed rates and lines represent fitted log-linear regression segments. Joinpoints indicate statistically significant changes in trend. Segment-specific annual percentage changes (APCs) describe the direction and magnitude of trends within each period, and statistical significance was defined as P < 0.05. Rates were calculated using the WHO standard population.
Fig 3.
Monthly variation and seasonality of hospitalizations for dengue/chikungunya and snakebite in Ecuador, 2000–2024.
Panels A and B show monthly hospitalization counts for dengue/chikungunya and snakebite, respectively, presented at five-year intervals. Panels C and D show the corresponding seasonality indices. The seasonality index was calculated separately for each five-year interval as the ratio of the mean number of hospitalizations in each calendar month to the overall mean monthly count within that interval. Values >1 indicate above-average activity, values <1 indicate below-average activity, and a value of 1 indicates that the monthly frequency equals the annual average. These plots illustrate consistent seasonal patterns, with higher hospitalization activity during wetter months.
Fig 4.
Age- and sex-specific crude hospitalization rates for endemic neglected tropical diseases (NTDs) in Ecuador in 2000 and 2024.
Crude hospitalization rates (per 100,000 population) are shown by age group and sex for (A) 2000 and (B) 2024. M = male, F = female. Data are presented for the five most frequent endemic NTDs (Dengue and chikungunya; Snakebite envenoming; Soil-transmitted helminths; Taeniasis and cysticercosis; Scabies and other ectoparasitoses) and a grouped category of other endemic NTDs (including Chagas disease, echinococcosis, leishmaniasis, leprosy, onchocerciasis, yaws, foodborne trematodiases, mycetoma, chromoblastomycosis and other deep mycoses, and rabies). These distributions illustrate changes over time in the demographic profile of severe NTD-related morbidity requiring hospitalization. Hospitalization rates stratified by sex and age group for each province were calculated using population projections in 2000 and 2024 from INEC [36].
Fig 5.
Age- and sex-specific crude hospitalization rates for non-arboviral endemic neglected tropical diseases (NTDs) in Ecuador in 2000 and 2024.
Crude hospitalization rates (per 100,000 population) are shown by age group and sex for (A) 2000 and (B) 2024. Data are presented for the most frequent non-arboviral NTDs, including snakebite envenoming, soil-transmitted helminthiases, taeniasis/cysticercosis, scabies/ectoparasitoses, and a grouped category of other endemic NTDs (including Chagas disease, echinococcosis, leishmaniasis, leprosy, onchocerciasis, yaws, foodborne trematodiases, mycetoma, chromoblastomycosis and other deep mycoses, and rabies). The figure highlights age- and sex-specific differences in hospitalization patterns for non-arboviral NTDs over time.
Fig 6.
Spatial distribution of standardised morbidity ratios (SMRs) for five most frequent NTDs in Ecuador by province for censuds years of 2001, 2010, and 2022.
SMRs were calculated using indirect standardization as the ratio of observed to expected hospitalizations, adjusted for age and sex. Values >1 indicate higher-than-expected morbidity and values <1 indicate lower-than-expected morbidity. Maps for the three census years, show (A) dengue/chikungunya, (B) snakebite envenoming, (C) soil-transmitted helminthiases, (D) taeniasis/cysticercosis, and (E) scabies/ectoparasitoses. Base map: Natural Earth (public domain) [38]. Maps were generated in R version 4.5.0 using the sf, rnaturalearth, ggplot2, and ggspatial packages. For visualization purposes, the Galápagos Islands were repositioned relative to mainland Ecuador to improve figure clarity.