ArticlePLoS neglected tropical diseases2025
Neurocysticercosis in Ecuador: Spatial clustering, social determinants, and epidemiological trends (2017-2023).
Article in PLoS neglected tropical diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNeurocysticercosis (NCC) is endemic in Ecuador. This study analyzes spatial clustering of municipalities with high and low incidence rates (hot and cold spots) and its association with social determinants of health (SDH).
methodsThis ecological study used national anonymized hospitalization records (2017-2023) and outpatient registries (2021), as well as municipality-level SDH data. Data were aggregated at the municipality level. Spatial clustering was assessed using Local Indicators of Spatial Association (LISA). SDH were compared between hot and cold spots using parametric and non-parametric tests.
resultsBetween 2017 and 2023, 735 NCC cases were recorded. Annual incidence decreased from 1.01 to 0.44 per 100,000 inhabitants-year between 2017 and 2023. There was no difference in NCC incidence rates between males and females. Spatial analysis revealed clustering of municipalities with high NCC incidence rates in southern Ecuador (Moran's Index = 0.46, p < 0.001). In comparison with cold spots, hot spots exhibited higher income inequality (Gini index: 0.48 vs. 0.46; p < 0.001), higher density of Creole pigs (6,672.84 vs. 724.73 per 100,000 inhabitants; p = 0.010), but lower population density (28.00 vs. 117.20 inhabitants/km²; p < 0.001), rainfall (1,183.90 vs. 2,126.93 mm³/m²; p < 0.001), and temperature (18.47°C vs. 23.98°C; p < 0.001). Paradoxically, hot spots had higher sewerage coverage (77.00% vs. 50.70%; p = 0.010) and physician density (220.95 vs. 138.69 per 100,000; p = 0.010).
conclusionsNCC hot spots were identified in southern Ecuador, which included rural, arid and cooler municipalities reliant on traditional pig-rearing and where income distribution was more unequal. Despite available sanitary infrastructure and healthcare access, structural inequalities seem to undermine NCC control efforts in endemic regions. To disrupt NCC persistence, government strategies must prioritize systemic reforms addressing income gaps alongside targeted public health interventions.
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