title: Ecosystem approach to promoting appropriate antibiotic use for children in indigenous communities in Ecuador.
abstract: 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.
authors.affiliation: División de Pediatría, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
authors.forename: Georgina
authors.initials: G
authors.lastname: Muñoz
authors.forename: Lorena
authors.initials: L
authors.lastname: Mota
authors.forename: William R
authors.initials: WR
authors.lastname: Bowie
authors.forename: Arturo
authors.initials: A
authors.lastname: Quizhpe
authors.forename: Elena
authors.initials: E
authors.lastname: Orrego
authors.forename: Jerry M
authors.initials: JM
authors.lastname: Spiegel
authors.forename: Annalee
authors.initials: A
authors.lastname: Yassi
mesh_terms: D000886:Anthropometry; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002170:Canada; D017028:Caregivers / Q000523:psychology; D002669:Child Welfare; D002675:Child, Preschool; D003469:Culture; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000706:statistics & numerical data; D017753:Ecosystem; D004484:Ecuador / Q000453:epidemiology; D005191:Family Characteristics; D007722:Health Knowledge, Attitudes, Practice; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D006920:Hygiene; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007223:Infant; D007391:International Cooperation; D044342:Malnutrition / Q000208:ethnology; D010865:Pilot Projects; D044382:Population Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D012423:Rural Health
chemical_list: D000900:Anti-Bacterial Agents