Fadya Orozco

Background: Breastfeeding counseling is a key intervention to promote optimal infant feeding, particularly when delivered individually and in person. Its effectiveness depends on the quality of healthcare training, which remains variable. In Ecuador, public services primarily rely on group-based strategies with limited access to individualized support, reinforcing inequalities given the high cost of private services. This study describes an intervention co-developed with the local health system to strengthen provider capacity and implement an individualized counseling model in a rural setting. Methods: This practice-based case study was conducted in two phases between 2023 and 2024. In Phase I, 32 primary-level healthcare professionals participated in an 80-hour training program combining theoretical and practical components focused on technical skills, communication, and supportive counseling. Focus group discussions informed curriculum adjustments and explored changes in perceptions and competencies. In Phase II, a breastfeeding counseling room was established and staffed by ten trained healthcare professionals. Standardized digital records were used to document user characteristics and consultation topics. Data were analyzed descriptively using Stata and thematically using MAXQDA. Results: Ten of 32 providers (31%) completed the training. A total of 305 counseling sessions were conducted with 247 women, most of whom were lactating (76.5%), aged 18–29 years (68%), and residing in the local catchment area (87.9%). The most frequent consultation topics included breastfeeding technique, nipple pain, perceived low milk supply, and milk expression and storage. Sessions averaged 36 min. Users included adolescents and women with varying levels of maternal experience, highlighting diverse counseling needs. The intervention emphasized individualized, empathetic, and context-sensitive support. Conclusions: The intervention was feasible within a public primary healthcare setting and addressed key gaps in access to individualized breastfeeding support. It demonstrated the relevance of combining technical and relational competencies in counseling and the importance of integrating such services within existing health systems. These findings provide practical insights for the implementation of similar models in resource-constrained settings. Clinical trial number: Not applicable.

Background: Ethylenebisdithiocarbamates, widely used in floriculture, degrade into ethylenethiourea (ETU), a teratogen. The SEMILLA study investigates prenatal ETU exposure and infant health in Ecuador’s flower-growing region. This analysis examines whether prenatal ETU metabolite levels differ by work sector and whether maternal urinary ETU increases with longer work hours. Methods: Participants (agricultural workers, non-agricultural workers, and non-workers) provided baseline urine samples, which were processed and stored for ETU analysis. Surveys captured ETU exposure predictors. Regression models assessed associations between work sector, weekly work hours, and urinary ETU levels (specific gravity-corrected), controlling for key covariates. Results: The sample includes 111 agricultural workers (92% floriculture), 149 non-agricultural workers, and 149 non-workers. At baseline, maternal age averaged 27 years (SD = 5.8) and gestational age 15 weeks (SD = 3.2). Urinary ETU_SG levels were elevated across the sample (geometric mean: 3.38 µg/L). Agricultural workers had significantly higher ETU_SG levels than others (5.61 vs. 3.07 and 2.57 µg/L; p < 0.001). Among agricultural workers, ETU_SG levels increased with weekly hours (B = 0.288, p = 0.001). Conclusions: Agricultural work strongly predicts higher prenatal ETU exposure, with evidence of a dose–response relationship. Research on prenatal fungicide exposure and infant health among pregnant workers is limited. Findings highlight the need for targeted interventions to protect pregnant workers and infant health.

Retention in birth cohort studies varies globally, with rates of over 80% in high-income countries and 30%-75% in low- and middle-income settings due to socioeconomic vulnerability, geographic dispersion, and infrastructural barriers. Despite the importance of participant retention, evidence on structured tracking systems contextualized to these settings remains limited. This paper describes the design, adaptations, and outcomes of a participant tracking system developed for the Study of Environmental Exposure of Mothers and Infants Impacted by Large-Scale Agriculture, a community-based birth cohort that enrolled 409 pregnant participants in a floriculture-intensive rural area of Ecuador. In this setting, retention was challenged by informal employment, variable phone access, and high mobility. The tracking system was implemented from pregnancy through 18 months postpartum, including two final follow-up waves conducted at 12 and 18 months. It comprised a predefined follow-up schedule, a team with defined roles, a real-time digital planner for recording contact attempts, participation status, and activity completion, and a five-tier participation classification. Tracking was conducted through office visits, phone calls, and home visits. Flexible protocols and targeted outreach addressed pandemic-related disruptions and irregular work schedules. Overall retention was 77%, with 84% and 75% at 12 and 18 months, respectively. Partial refusals (27%) were primarily linked to mobility and work demands, while 94 participants fully discontinued. Home visits enabled completion for 154 participants, with an 88% success rate. This experience illustrates how context-adapted tracking systems can sustain high retention in rural settings, offering a scalable model to inform global health research in underserved populations.

Este estudio buscó estimar la prevalencia y distribución de nacidos vivos de madres menores de 18 años en Ecuador y la asociación entre indicadores perinatales y estado marital materno. A partir de los registros de nacidos vivos obtenidos del Instituto Nacional de Estadísticas y Censos de Ecuador para el período 2015-2020, se estimó la asociación conjunta entre grupos de edad (10-15, 16-17, 18-19 y 20-24 años) y la situación conyugal materna (casada, unión estable y soltera), con bajo peso al nacer, parto pretérmino e inadecuada atención prenatal. La prevalencia de partos de madres menores de 18 años fue del 9,3% y declinó en el periodo de estudio, drásticamente entre las mujeres casadas. La asociación entre estado marital y las variables explicativas dependió de la edad materna. Los resultados más favorables de salud observados entre las madres casadas de 20-24 años, en comparación con las madres solteras, se debilitan o desaparecen entre las menores de edad. Las madres en uniones de hecho experimentaron resultados intermedios entre las mujeres casadas y las solteras.

Background: Longitudinal studies using multi-level models to examine health inequalities in lower and middle income countries (LMICs) are rare. We explored socio-economic gradients in health among small farm members participating in a pesticide-related health and agriculture program in highland Ecuador. Methods: We profiled 24 communities through key informant interviews, secondary data (percent of population with unsatisfied basic needs), and intervention implementation indicators. Pre (2005) and post (2007) surveys of the primary household and crop managers included common questions (education, age, and the health outcome - digit span scaled 0-10)) and pesticide-related practice questions specific to each. Household assets and pesticide use variables were shared across managers. We constructed multi-level models predicting 2007 digit span for each manager type, with staged introduction of predictor variables. Results: 376 household managers (79% of 2005 participants) and 380 crop managers (76% of 2005 participants) had complete data for analysis. The most important predictor of 2007 digit span was 2005 digit span: β (Standard Error) of 0.31(0.05) per unit for household and 0.17(0.04) for crop managers. Household asset score was next most important: 0.14(0.06) per unit for household and 0.14(0.05) for crop managers. Community percent with unsatisfied basic needs was associated with reductions in 2007 digit span: -0.04(0.01) per percent for household and -0.03(0.01) for crop managers. Conclusions: The important roles of life endowments and/or persistent neurotoxicity were exemplified by limited change in the health outcome. Gradients by household assets and community deprivation were indicative of ongoing, structural inequities within this LMIC.

The use of highly hazardous pesticides by smallholder farmers constitutes a classic trans-sectoral ‘wicked problem’. We share our program of research in potato and vegetable farming communities in the Andean highlands, working with partners from multiple sectors to confront this problem over several projects.

Agricultural development is a health determinant for small-scale farmers. This article examines the process of developing health and agricultural policy at the municipal level. Operational research was conducted in three rural, Andean municipalities in Ecuador. Policy development involved four steps: 1) proposal of a political agenda, 2) political analysis, 3) consultation, and 4) design and implementation of a political strategy. Our study of stage 2 included in-depth interviews with institutional and community leaders in each municipality. We also reviewed secondary sources and took field notes of observations made during the process. Content analysis was used for textual materials. We observed that institutional actors used a functionalist logic with respect to agricultural production processes; this – along with their individual attitudes and aptititudes – limited progress in policy development. On the other hand, social participation tended to facilitate the development of intersectoral programs. The promotion of cross-sectoral policy development fosters cross-sectoral approaches to action on the social determinants of health.