Ecuador: Investigation Around Newborn Deaths Continues

This post is part of our special coverage Global Development 2011.

According to Ecuador's latest census, more than 14 million people live in the country, but there is still no consensus on the national infant mortality rate. According to figures from UNICEF in 2009, the rate was 11 in 1,000, but the Index Mundi displays a value of 20.9 per 1,000 live births.

Recent incidents have called attention to health care practices in neonatal units in Ecuadorian public hospitals, triggering an investigation into newborn deaths in the country.

Simple and affordable interventions can save newborn lives. Image by Gates Foundation on Flickr (CC BY-NC-ND 2.0).

Simple and affordable interventions can save newborn lives. Image by Gates Foundation on Flickr (CC BY-NC-ND 2.0).

Health care gaps

Although in the last decade funds for health care have increased in the state budget from US $74.4 million to $1.244 million, not counting the $406 million granted [es] after a health emergency was declared in Ecuador over the last three months.

Newspaper La Hora [es] explains why Ecuadorians worry about their newborns having to enter an intensive care unit, especially in the light of complaints at hospitals in the provinces of Guayaquil, Loja and Santo Domingo de los Táchilas. These are not the only hospitals with problems however; there are gaps in other health care facilities, as the newspaper describes:

La crisis en las áreas de Neonatologia no son de hoy, en los hospitales Napoleón Davila, de Chone, y Teófilo Davila, de Machala también se registraron muertes en años anteriores. En mayo de 2006, en Chone, fallecieron 26 neonatos. En Machala, en julio de 2005, un informe de la Direccion de Salud de El Oro señaló; la muerte de 89 recién nacidos.

The crisis in neonatal care is not new: Napoleon Davila hospital, Chone, and Teofilo Davila hospital, Machala, also reported newborn deaths in previous years. In May 2006, in Chone, 26 infants died. In Machala, in July 2005, a report by the Directorate of Health of El Oro reported the death of 89 newborns.

So far, these cases are still under investigation. Ecuadorian Health Minister David Chiriboga [es] and a High Level Technical Committee are in charge of directing the enquiry.

For now only directors at the Gustavo Dominguez hospital and a provincial director of health, both in the Santo Domingo de los Tsáchilas province, have been removed for a “lack of vision” in their care for infants; photos were revealed of babies in the province being placed in bathtubs and on cardboard sheets in the absence of any cribs, by Guayaquil newspaper El Universo.

President Correa has expressed doubts [es] about the photos’ veracity, but Twitter users seem to believe the images are real. Journalist Alexis Moncayo (@alexismoncayo) tweets that he cannot believe the show President Correa displays with the newborns laying on cardboard.

But Daniela Pareja (@Cuinita) from Guayaquil thinks it is the health minister's fault, not Correa's: “what a beautiful country Ecuador is”, she tweets sarcastically.

Diosdado Anchundia (@miramelindo35) says he now knows where his taxes are going: towards a “new piece of cardboard on which newborns can stay warm”.

In the Loja province, reports have indicated that the bacterium Enterobacter cloacae found in soap was the possible cause of the 26 infant deaths registered at the Isidro Ayora hospital since November 2010 [es]. In Francisco Icaza Bustamante hospital in Guayaquil, the bacterium Serratia marcescens has been the reported cause of newborn deaths.

The vice minister of Public Health and the Isidro Ayora hospital's director have both resigned [es].

Whose responsibility?

But on Twitter, Ecuadorian journalist Mónica Mendoza (@moniquemendoza) is concerned about the level of responsibilities:

@moniquemendoza: Por qué si #Correa responsabiliza al Ministerio de Salud por mala atención a#neonatos, solo sale viceministra y no el ministro Chiriboga?

@moniquemendoza: If #Correa has issued responsibilities to his Health Minister for the poor attention to #newborns, why it is only the Vice Minister who leaves and not [Health] Minister Chiriboga?

MetroEcuador [es] reports current data on infant mortality: “The rates of frequency of infection in neonatal units are between 15 and 30 percent. About 140 babies die each year in public hospitals in Ecuador.”

But both the Health Minister David Chiriboga and the Minister of Social Development Coordination, Jeannette Sanchez, have tried to defend themselves:

En lo referente a la muerte de neonatos en diferentes ciudades del país, indicó que, a nivel mundial, se estima que entre el 5 y el 10 por ciento de pacientes ingresado a cualquier hospital adquiere infecciones intrahospitalarias. De este porcentaje, 25% ocurre en cuidados intensivos. Las infecciones neonatales son un problema global y no particular del Ecuador, presentes incluso en hospitales de países desarrollados y conocidos por su excelente atención en salud. Los neonatos son más vulnerables a infecciones ya que su sistema inmunológico no acaba de madurar.

Regarding the death of infants in different cities in the country, [Minister David Chiriboga] indicated that it is estimated that globally, between 5 and 10 percent of patients admitted to any hospital acquire hospital infections. Of this figure, 25 percent occur in the intensive care unit. Neonatal infections are a global problem and not just one that occurs in Ecuador, it is present even in hospitals in developed countries known for their excellent health care. Infants are more vulnerable to infections because their immune system is not completely mature.

New reports [es] show newborn deaths are decreasing. In 2008 the rate of neonatal deaths from 21 hospitals in Ecuador was 7.38 percent; in 2009 this figure dropped to 6.9 percent, and in 2010 it decreased to 5.69 percent.

Blogger Henry Raad predicts this issue will not be solved any time soon. He says the problem with public health is a matter of pragmatism; Ecuadorians need to stop relying so heavily on the SENPLADES [es] (Ministry of Planning and National Development) because the Ecuadorian health system is not self-sustaining [es].

Martin Pallares, on the other hand, believes that it is necessary to evaluate the government's public investment. He says that only the stubborn can deny that the scale of public works undertaken by the current Ecuadorian administration has been enormous. But are these public works really doing any good?, he asks in his blog Desde la Tranquera [es].

This post is part of our special coverage Global Development 2011.

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