Infectious diseases are significant for paediatric patients worldwide because of their morbidity and mortality, especially in low and middle-income countries such as Ecuador and many others in Latin America [2]. Pneumonia, diarrhoea, tuberculosis, malaria and human immunodeficiency virus infections are significant worldwide burdens[1]. Although these diseases have different etiological agents, they are classified as communicable diseases. And through various measures, these communicable diseases can be prevented [11]. Unfortunately, many disproportionately affect places with limited resources and overlapping health variables [1]. That presents a complex problem to address to prevent communicable diseases. Therefore, examining the burden and geographical characteristics of occurrence in each country can help focus resources and optimise prevention strategies.
As reported by the WHO [1], preschool-aged children are most affected by most of the communicable diseases analysed in this study, making them the most vulnerable group. Pneumonia is the disease with the highest burden in Ecuador. In Brazil, a cumulative incidence of 13.85 per 103 pop. was reported for pneumonia in 2015, which is expected to remain stable until 2019 [12]. In Ecuador, a cumulative incidence of 2.6 per 103 was reported in 2015, which will decrease to 1.7 per 103 by 2021. That is lower than the cumulative incidence reported in Brazil for hospital admissions for pneumonia. This decrease in pneumonia cumulative incidence in Ecuador may be related to the measures taken to control COVID-19 (social distancing, use of masks, among others) [13].
Vaccine prevention of pneumonia is an important measure to analyse. However, pneumonia in the paediatric population has a different aetiology depending on age. Pneumococcal pneumonia is a vital aetiology, especially for children five years and older, but with invasive disease especially in children under 5 years of age. After introducing pneumococcal conjugate vaccines (PCV), invasive pneumococcal disease decreased dramatically worldwide; however, new vaccines were needed due to serotype change. Ecuador and Venezuela are the only countries in Latin America that maintain the PCV10 pneumococcal vaccine, although serotype 19A (included in PCV10) appears to be the most common [14, 15].
According to the data analysed, diarrhoeal diseases of infectious origin are in second place. In the region, few countries have studied the burden of diarrhoeal diseases in the paediatric population. In Brazil, a study analysed hospitalisations by region [16]. The hospitalisation cumulative incidence for diarrhoeal diseases ranged from 2 to 10 per 105 pop 2010 [16]. In Ecuador, the highest cumulative incidence was 2.4 per 105 pop in 2015. It then dropped to 0.8 cases per 105 pop in 2020 and 2021. Before the years of the pandemic, the number of hospital admissions for diarrhoeal diseases was gradually declining. The 2.8-fold decrease since 2015 compared to cumulative incidence in 2020 and 2021 could, we hypothesise, be due to COVID-19 improved hygiene measures, social distancing and some confinement measures that reduced food intake outside the home.
Regarding prevention, rotavirus is one of the leading causes of diarrhoeal disease in children. Despite this, rotavirus vaccination coverage is low throughout the Region of the Americas and especially in Ecuador: 75% in 2020 and 60% in 2021 [17]. That could be one of the factors explaining the burden of diarrhoeal diseases. Policy decisions are also needed to improve water quality, especially in rural areas of Ecuador, especially because safe water is one of the most crucial protective factors against diarrhoeal diseases [18] Unfortunately, rural villages and some Pacific coast towns in Ecuador do not have optimal access to safe water [19].
In the case of tuberculosis, it was more likely to find specific hospital reports in the scientific bibliography than at the country level. In Brazil, tuberculosis in childhood was studied [20]. And a line of slight variation was found, starting from an average cumulative incidence of 0.4 per 105 inhabitants between 2010 and 2022 [20]. In Ecuador, TB had the highest cumulative incidence of hospitalisations in 2018, at 4.8 per 105 pop, and the lowest, at 2.4 per 105 pop. Analysis over time shows fluctuations in tuberculosis in Ecuador. However, this trend decreased in 2020 and 2021. Several factors could contribute to this, e.g., under-reporting cumulative incidence and COVID-19 measure's control [21], among others. At this point, it is important to stress that the potentially low detection cumulative incidence may be related to the difficulty in accessing microbiological diagnosis, as this is not easy and requires a specialised laboratory [22], which is not readily available in Ecuador [23].
If we look at malaria, there are two critical changes. First, the age group most affected was adolescents. And Esmeraldas was the most affected region. Unfortunately, no studies on malaria cumulative incidence in the paediatric population were found in the countries of the South American region. Overall, malaria cumulative incidence in 2015 ranged from 0.3 per 103 population in Peru to the highest in the Region in Venezuela, at 24 per 103 population [24]. In Ecuador, malaria hospitalisation cumulative incidence in the paediatric population ranged from 0.004 per 103 in 2015 to 0.007 per 103. There were ups and downs in malaria cumulative incidence, but overall, there was no control as the country was about average at the time studied. That shows how poor vector control is in the country, especially in Esmeraldas province. Therefore, it is necessary to take decisions at the local level and in public health policies, especially in the form of education about the disease, vector control with shared responsibility with the community, prevention measures such as the use of mosquito nets and repellents to avoid vector bites [24].
HIV is a double threat to children under five, as they can become infected during birth or while breastfeeding from newly diagnosed and undiagnosed mothers [25]. In adolescents, unprotected sexual debut is the main route of infection for new cases [26]. No specific studies were found that examined the incidence of HIV in the population aged 0 to 18 years in South American countries. In Ecuador, most cases were reported in preschool-aged children and the second most in adolescents. It seems that transmission from mother to child is still a problem. And there is not much difference in the cumulative burden between the school and adolescent populations. However, cumulative incidence has dropped from 0.37 per 105 population in 2015 to 0.18 in 2021.