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Revista Panamericana de Salud Pública

On-line version ISSN 1680-5348Print version ISSN 1020-4989


MUNOZ, Georgina et al. Ecosystem approach to promoting appropriate antibiotic use for children in indigenous communities in Ecuador. Rev Panam Salud Publica [online]. 2011, vol.30, n.6, pp.566-573. ISSN 1680-5348.

OBJECTIVE: To collect baseline data on infectious diseases and antibiotic use in two Andean indigenous communities in Ecuador in order to determine the feasibility and acceptability of applying an ecosystem approach to address associated problems. METHODS: In visits  to  65  households  with  children  under  age  5  years,  environmental risk  factors  for  infectious  diseases  were  evaluated  through  rapid  assessment.  Caregivers' knowledge,  attitudes,  and  practices  related  to  antibiotic  use  were  determined  through  a knowledge,  practices,  and  coverage  survey;  antibiotic  use  was  gleaned  from  inspection  of medicine  chests;  and  overall  health  of  the  91  children  (including  nutritional  status)  was assessed. A workshop was held to share results and to craft a multicomponent intervention using an ecohealth framework. RESULTS: Numerous environmental risk factors were identified, especially related to water and sanitation. Knowledge, attitudes, and practices revealed use of traditional and Western medicines and serious knowledge gaps. Antibiotics were present in 60.9% of households in Correuco and 46.8% in La Posta; malnutrition rates were 22.2% in Correuco and 26.1% in La Posta; diarrheic episodes were experienced in the previous month by 26.7% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 50.0% and 47.1% of cases, respectively; and acute respiratory infections were incurred by 28.9% of children in Correuco and 47.8% in La Posta, with antibiotics prescribed in 53.8% and 50.0% of cases, respectively. CONCLUSIONS: Environmental,  social,  and  cultural  factors  must  be  addressed  to  prevent antibiotic resistance in addition to training health personnel. An ecosystem approach is well-suited for this goal.

Keywords : Drug  resistance,  microbial; antibacterial  agents; drug  prescriptions; indigenous population; child, preschool; intervention studies; Ecuador.

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