Spatiotemporal trends of neglected tropical disease hospitalizations in Ecuador over 25-years from 2000 to 2024.

BACKGROUND

The World Health Organization identifies 21 neglected tropical diseases (NTDs) affecting millions globally. While their population burden is well recognised, less is known about the long-term trends in severe NTD-related morbidity requiring hospitalization. We analysed national trends and geographic patterns of hospitalizations attributed to NTDs in Ecuador between 2000 and 2024.

METHODS

We analysed hospital discharge data from Ecuador's national registry over a 25-year period. Age-standardized hospitalization rates were estimated, and temporal trends were assessed using Joinpoint regression for the 5 most frequent NTDs. Standardized morbidity ratios (SMRs) 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 were attributed to NTDs, representing 0.7% of all hospitalizations. The five most frequent NTDs accounted for 97.1% of hospitalizations: dengue and chikungunya (62.4%), snakebite envenoming (20.1%), soil-transmitted helminthiases (8.7%), taeniasis and cysticercosis (3.9%), and scabies and other ectoparasitoses (2.0%). Only 0.4% of hospitalizations resulted in death. Hospitalizations were more frequent in males (54%) and younger populations (median 19 years, Q1 9 - Q3 37). Overall hospitalizations rates increased over time, driven primarily by arboviral infections, while non-arboviral NTDs showed declining trends: 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 was consistently greater in Coastal and Amazon provinces, with shifts over time across regions, although taeniasis and cysticercosis morbidity remained greatest in southern Andean Provinces.

CONCLUSION

Over 25 years in Ecuador, hospitalizations attributed to several non-arboviral NTDs declined, while arboviral infections increasingly contributed to severe NTD-related morbidity. These findings reflect trends in the most severe clinical manifestations requiring inpatient care and highlight persistent geographic inequalities, particularly in the Amazon region. Strengthening surveillance, prevention, and equitable access to timely diagnosis and care will be essential to reduce severe NTD morbidity and support progress towards national and global NTD elimination and control targets.