ISSN 3028-8940 JULY-DECEMBER 2026;3(2):139-149 ORIGINAL ARTICLE https://doi.org/10.36097/rgcs.v3i2.3247 San Gregorio de Portoviejo University | Ecuador 139 Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross- sectional study on the mixed burden of disease and access barriers Diagnóstico situacional de salud en la parroquia rural de Noboa, Ecuador: estudio descriptivo transversal sobre la carga mixta de enfermedades y barreras de acceso María R. Delgado 1, * • Jorge A. Fernández 2 • Nelson A. Cedeño 3 • María A. Rivadeneira 4 1 Carrera de Medicina, Universidad San Gregorio de Portoviejo, Manabí, Ecuador. 2 Universidad UTE, campus Manabí, Montecristi, Manabí, Ecuador. 3 Hospital General Miguel Hilario Alcívar, Bahía de Caráquez, Manabí, Ecuador. 4 Ministerio de Salud Pública, Centro de Salud Olmedo, Manabí, Ecuador. *Corresponding author Reception: 28-04-2026 Acceptance: 30-06-2026 Publication: 31-07-2026 ABSTRACT This study aimed to comprehensively characterize the health situation of Noboa parish, Manabí, Ecuador, during 2024. An observational, descriptive, cross-sectional study was conducted with 90 inhabitants selected through non- probabilistic convenience sampling, using a structured questionnaire and reviewing local health facility records. Descriptive statistics were applied for analysis. A total of 28 communicable disease cases were identified, with coronavirus (34.5%) and dengue (27.6%) predominating; among non-communicable chronic conditions (11 cases), arterial hypertension (27.3%) and diabetes mellitus (18.2%) were most frequent. Over half of the population (55.6%) lacked access to prevention programs, while alcohol consumption (38.9%) and a history of tobacco use (33.3%) were reported. Problem prioritization ranked acute respiratory infections in children and geographical access barriers as leading health issues. Noboa parish faces a mixed burden of communicable and chronic diseases, compounded by behavioral risk factors and limited preventive access, underscoring the need to strengthen primary care through health education, epidemiological surveillance, and expanded preventive coverage. Keywords: health situation diagnosis, rural health, communicable diseases, noncommunicable diseases, primary health care. RESUMEN El objetivo de este trabajo fue caracterizar integralmente la situación de salud de la parroquia Noboa, Manabí, Ecuador, durante 2024. Se realizó un estudio observacional, descriptivo y transversal con 90 habitantes seleccionados por muestreo no probabilístico por conveniencia, aplicando un cuestionario estructurado y revisando registros del centro de salud local. El análisis se efectuó mediante estadística descriptiva. Se identificaron 28 casos de enfermedades transmisibles, predominando coronavirus (34,5 %) y dengue (27,6 %); entre las crónicas no transmisibles (11 casos), destacaron hipertensión arterial (27,3 %) y diabetes mellitus (18,2 %). El 55,6 % carecía de acceso a programas de prevención, y se reportó consumo de alcohol (38,9 %) y antecedente de tabaquismo (33,3 %). La jerarquización de problemas priorizó las enfermedades respiratorias agudas en niños y las barreras geográficas de acceso. La parroquia Noboa presenta una carga mixta de enfermedades transmisibles y crónicas, agravada por factores de riesgo conductuales y el limitado acceso a la prevención, lo que exige fortalecer el primer nivel de atención mediante educación sanitaria, vigilancia epidemiológica y ampliación de la cobertura preventiva. Palabras clave: diagnóstico de la situación de salud, salud rural, enfermedades transmisibles, enfermedades no transmisibles, atención primaria de salud. Cite as: Delgado, M. R., Fernández, J. A., Cedeño, N. A., & Rivadeneira, M. A. (2026). Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross-sectional study on the mixed burden of disease and access barriers. Revista Gregoriana de Ciencias de la Salud, 3(2), 139-149. https://doi.org/10.36097/rgcs.v3i2.3247 © Author(s) 2026

Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross-sectional study on the mixed burden of disease and access barriers Delgado, Fernández, Zambrano, & Rivadeneira 140 San Gregorio de Portoviejo University | Ecuador INTRODUCTION Assessing the health situation is central to understanding the health conditions of a population and guiding the planning of primary care actions. This approach integrates social, environmental, occupational, and organizational aspects that shape the health-disease process, offering a structured view of the community context in which health interventions are carried out (Ghaderi et al., 2023). Situational diagnosis is particularly relevant in rural communities, where limitations in infrastructure, service access, and the availability of human health resources often persist. International literature emphasizes that knowledge of the local environment and its associated risks is essential for clinical and community decision-making, as it enables the prioritization of needs and the design of intervention strategies tailored to the local reality (Khamraev et al., 2021). The working and organizational conditions of health personnel directly influence the quality of care provided to the population. Previous studies have shown that exposure to workplace violence, excessive workloads, and lack of institutional support impair the performance of healthcare staff, particularly in high-demand, resource-limited settings (Kumari et al., 2022). These factors also take a toll on workers' mental health, which can, in turn, compromise the continuity and effectiveness of the health services offered to the community (García-Iglesias et al., 2023). Furthermore, health situation analysis must consider populations in conditions of greater social vulnerability. Evidence indicates that factors such as social exclusion, stigma, and structural barriers shape both access to and quality of healthcare, reinforcing the need for comprehensive diagnoses that can identify existing inequities within the territory (Pantoja et al., 2025). In this context, the use of technological tools for data collection and analysis has gained increasing relevance in public health and community studies. The application of monitoring systems and communication technologies facilitates the timely collection of data on health and environmental conditions, thereby strengthening evaluation and planning processes across diverse population settings (Bonilla et al., 2023). The present study aimed to conduct a comprehensive situational health diagnosis in a rural parish of Manabí province, Ecuador, during 2024, to describe sociodemographic conditions, the

Revista Gregoriana de Ciencias de la Salud. Bi-annual peer-reviewed publication. ISSN 3028-8940 / July-December 2026;3(2):139-149 San Gregorio de Portoviejo University | Ecuador 141 main health problems, and the factors influencing access to health services. The information generated is intended to serve as a foundation for planning community-based actions and strengthening primary health care at the local level (Ghaderi et al., 2023). METHODOLOGY A descriptive cross-sectional study was conducted to characterize the health situation of the rural parish of Noboa, located in the 24 de Mayo canton (Manabí, Ecuador), over the period from April to September 2024. This design was selected as it allowed for the description of sociodemographic conditions, the leading health problems, and the factors influencing access to health services at a single, well-defined point in time. The study population comprised residents of Noboa parish. Individuals of both sexes and across all age groups were eligible for inclusion if they had resided in the community for at least six months and provided voluntary consent to participate. A total of 90 participants were included, selected through non-probabilistic convenience sampling based on their availability and accessibility during the fieldwork phase. Records with incomplete or inconsistent data were excluded from the final analysis to ensure data quality and reliability. The study variables encompassed a broad range of dimensions. Sociodemographic characteristics included age, sex, educational level, and occupation. Additionally, housing conditions and access to basic sanitation services were assessed, along with healthcare service utilization and self-reported morbidity. Time of residence in the community and age group were treated as control variables to adjust for potential confounding effects in the descriptive analysis. Data were collected using a structured questionnaire specifically designed for situational health diagnosis, which was administered to all participants. This primary instrument was complemented by a systematic review of clinical and epidemiological records available at the local health facility, allowing for cross-verification of self-reported conditions and identification of notifiable communicable and non-communicable diseases. All questionnaires were applied through face-to-face interviews, conducted after participants had signed written informed consent forms. Simultaneously, institutional morbidity and mortality registries were reviewed to capture the main health events reported in the parish during the study period. The gathered information was subsequently coded, organized, and entered

Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross-sectional study on the mixed burden of disease and access barriers Delgado, Fernández, Zambrano, & Rivadeneira 142 San Gregorio de Portoviejo University | Ecuador into a database for systematic handling. Data analysis relied exclusively on descriptive statistics, including absolute frequencies, relative percentages, and summary measures appropriate to each variable type (e.g., means or medians for quantitative variables, and proportions for categorical data). The results were structured into tables and graphs to facilitate clear interpretation and visualization of the community's health profile, supporting the subsequent prioritization of health problems. The study strictly adhered to the ethical principles outlined in the Declaration of Helsinki for research involving human subjects. Participation was entirely voluntary, and all participants were informed of their right to withdraw from the study at any time without consequence. Informed consent was obtained from every participant before their inclusion. Confidentiality and anonymity of all collected data were rigorously guaranteed, with personal identifiers removed during the coding process. Information was used exclusively for academic and research purposes. Furthermore, the study received formal authorization from the corresponding local health authority before fieldwork commenced, ensuring institutional oversight and compliance with local research regulations. RESULTS AND DISCUSSION The results of the comprehensive situational health assessment of the Noboa parish reveal the presence of communicable diseases, chronic non-communicable diseases, and risk factors affecting the population during 2024. The findings are presented in tables that allow for the identification of the main health problems and guide the prioritization of community interventions. Table 1 shows the distribution of communicable disease cases identified in the Noboa parish. Coronavirus was the most prevalent disease, representing 34.48% of registered cases, followed by dengue fever at 27.59%. These diseases reflect the persistence of respiratory and vector-borne infectious risks in the community. Malaria accounted for 10.34%, while leptospirosis and conjunctivitis each reached 6.90%. Other pathologies, such as acute respiratory infections (ARI), HIV, and typhoid fever, had lower incidences, each representing 3.45%.

Revista Gregoriana de Ciencias de la Salud. Bi-annual peer-reviewed publication. ISSN 3028-8940 / July-December 2026;3(2):139-149 San Gregorio de Portoviejo University | Ecuador 143 Table 1. Distribution of communicable diseases in the Noboa parish, 2024 Disease Number of cases Incidence (%) Coronavirus 10 34.48 Dengue 8 27.59 Malaria 3 10.34 Leptospirosis 2 6.9 Conjunctivitis 2 6.9 Infections respiratory acute 1 3.45 HIV 1 3.45 Typhoid 1 3.45 Total 28 100 The presence of infectious diseases coincides with what has been described in the literature regarding communities with structural limitations and exposure to environmental and social factors that favor the transmission of infectious agents, especially in rural contexts (García-Iglesias et al., 2021). Table 2 shows the distribution of the identified chronic non-communicable diseases. Hypertension was the most frequent pathology, with an incidence of 27.27%, followed by diabetes, bronchial asthma, and osteoarthritis, each with 18.18%. Cancer and kidney failure represented 9.09% each. Table 2. Distribution of chronic non-communicable diseases in the Noboa parish, 2024 Disease Number of cases Incidence (%) Blood pressure 3 27.27 Diabetes mellitus 2 18,18 Bronchial asthma 2 18,18 Osteoarthritis 2 18,18 Cancer 1 9.09 Kidney failure 1 9.09 Total 11 100 These results are consistent with studies describing a growing burden of chronic diseases in rural populations, associated with lifestyle, family history, and limited access to preventive programs (García-Iglesias et al., 2021).

Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross-sectional study on the mixed burden of disease and access barriers Delgado, Fernández, Zambrano, & Rivadeneira 144 San Gregorio de Portoviejo University | Ecuador The high prevalence of non-communicable chronic diseases identified in the community, particularly hypertension and diabetes mellitus, highlights the importance of considering lifestyle and dietary factors as determinants of population health. In this regard, diet quality, the nutritional composition of consumed foods, and the energy density of traditional dishes can influence metabolic risk and the development of chronic conditions. Studies conducted in the Ecuadorian population have demonstrated the relevance of evaluating the energy density and nutritional characteristics of typical local dishes as part of a comprehensive analysis of dietary habits and their relationship to health (Alvarado et al., 2021). In addition to factors associated with energy intake, the functional quality of the diet is a relevant component in the prevention of chronic diseases. The total antioxidant capacity of food and diet can contribute to the body's redox balance, due to the action of bioactive compounds capable of modulating processes related to oxidative stress and inflammation—mechanisms implicated in various metabolic diseases. Previous research has highlighted the importance of estimating the antioxidant quality of the diet as a tool for assessing the relationship between diet and health status in different population groups (Forbes-Hernández et al., 2020; Forbes-Hernández et al., 2021). In addition to the overall quality of the diet, adequate hydration is an essential component for maintaining physiological balance and promoting bodily performance. In this regard, isotonic drinks represent a formulated alternative to contribute to the replenishment of water and electrolytes, especially in situations of increased fluid and mineral losses associated with physical activity or conditions of high physiological demand. Ruiz and García (2022) pointed out that the formulation of these beverages should consider the appropriate concentration of carbohydrates and minerals to optimize their effect on the recovery of water and electrolyte balance, highlighting the importance of analyzing their consumption within a comprehensive approach to nutrition and the promotion of healthy lifestyles. Table 3 presents the main risk indicators reported by the population. It was observed that 33.33% of respondents did not report any chronic diseases, while diabetes (22.22%) and hypertension (16.67%) were the most frequently mentioned conditions. Regarding harmful habits, 33.33% reported having smoked at some point, and 38.89% consumed alcohol occasionally or

Revista Gregoriana de Ciencias de la Salud. Bi-annual peer-reviewed publication. ISSN 3028-8940 / July-December 2026;3(2):139-149 San Gregorio de Portoviejo University | Ecuador 145 frequently. Furthermore, 55.56% indicated a lack of access to health prevention programs, which limits early detection and disease control. Table 3. Risk indicators and access to prevention programs in the Noboa parish, 2024 Indicator Frequency Percentage (%) Diabetes 20 22,22 Hypertension 15 16.67 Asthma 10 11,11 Heart disease 5 5.56 Others 10 11,11 No disease chronicle 30 33.33 Current smoker 10 11,11 Smoker in the past 20 22,22 Frequent alcohol consumption 15 16.67 Occasional alcohol consumption 20 22,22 Access to prevention programs (Yes) 40 44.44 Access to prevention programs (No) 50 55.56 The presence of these factors is related to evidence indicating the influence of stress, unhealthy habits, and limited access to preventive services on the physical and mental health of populations (Craven et al., 2022). From a holistic perspective, community health promotion must also consider the interaction between diet, gut microbiota, and physical and mental well-being. Current evidence indicates that the gut microbiota participates in metabolic, immunological, and neurobiological processes, so alterations in its composition can be associated with different health conditions. In this context, incorporating preventive strategies aimed at improving dietary habits and promoting healthy lifestyles could contribute to a multidimensional approach to chronic diseases in rural communities (Barcia et al., 2024). Table 4 presents the ranking of the main problems identified, considering vulnerability, severity, and frequency. The most pressing problem was the increase in acute respiratory illnesses in children, with a total score of 42, followed by the increase in childhood febrile illnesses and difficulty accessing health centers, both with 41 points. These results align with the literature highlighting how social, environmental, and structural determinants influence the emergence and persistence of priority health problems, especially in rural communities with limited access to services (Corchero-Falcón et al., 2023; García-Iglesias et al., 2021).

Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross-sectional study on the mixed burden of disease and access barriers Delgado, Fernández, Zambrano, & Rivadeneira 146 San Gregorio de Portoviejo University | Ecuador Table 4. Ranking of the main health problems in the Noboa parish, 2024 Problem Vulnerability Gravity Frequency Total Acute respiratory illnesses in children 14 14 14 42 Diseases in febrile children 14 14 13 41 Difficulty accessing health centers 14 13 14 41 Increase in dengue cases 14 13 13 40 Prevalence of diabetes mellitus 13 13 13 39 Diseases diarrheal acute 13 12 13 38 The situational analysis of the Noboa parish reveals a coexistence of communicable and chronic diseases, as well as risk factors, requiring a comprehensive approach. Prioritizing these problems allows for the guidance of actions focused on health promotion, disease prevention, and strengthening primary healthcare. CONCLUSIONS Noboa parish faces a complex health situation, characterized by a relevant dual burden of communicable diseases —mainly coronavirus and dengue— and non-communicable chronic conditions, with arterial hypertension and diabetes mellitus being the most prevalent. This scenario is further exacerbated by a high prevalence of harmful habits such as alcohol consumption and tobacco use, limited coverage of prevention programs (55.6% without access), and geographical and organizational barriers to accessing healthcare services, all of which increase community vulnerability and hinder timely disease control. The prioritization of problems ranks acute respiratory and febrile illnesses in children, the increasing number of dengue cases, and restricted healthcare access as the top priorities, demanding a coordinated response from the primary care level. We recommend implementing community-based strategies for health education, vector and environmental control, and expanding the availability of preventive programs. Future research should further investigate the social determinants of health in this setting and evaluate the impact of the interventions carried out in this parish. CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.

Revista Gregoriana de Ciencias de la Salud. Bi-annual peer-reviewed publication. ISSN 3028-8940 / July-December 2026;3(2):139-149 San Gregorio de Portoviejo University | Ecuador 147 AUTHOR CONTRIBUTIONS Conceptualization: María R. Delgado and Jorge A. Fernández. Data curation: Jorge A. Fernández and Nelson A. Cedeño. Formal analysis: María R. Delgado, Jorge A. Fernández, and Nelson A. Cedeño. Investigation: María R. Delgado, Jorge A. Fernández, Nelson A. Cedeño, and María A. Rivadeneira. Methodology: María R. Delgado and María A. Rivadeneira. Resources: María R. Delgado, Jorge A. Fernández, and Nelson A. Cedeño. Software: María A. Rivadeneira. Supervision: María R. Delgado and Jorge A. Fernández. Validation: Nelson A. Cedeño. Visualization: María R. Delgado and Nelson A. Cedeño. Writing – original draft: María R. Delgado, Jorge A. Fernández, Nelson A. Cedeño, and María A. Rivadeneira. Writing – review & editing: María R. Delgado. REFERENCES Alvarado, J. M., Zambrano, J. I., & García, M. A. (2021). Densidad energética nutricional de platos típicos manabitas. QhaliKay, 5(3), 66-74. https://doi.org/10.33936/qkrcs.v5i3.3911 Barcia, A. A., García, M. A., & Tejedor, R. (2024). Microbiota intestinal, probióticos y su relación con el trastorno depresivo mayor: Una revisión bibliográfica. Revista San Gregorio, (58), 111-118. https://doi.org/10.36097/rsan.v1i58.2756 Bonilla, V., Campoverde, B., & Yoo, S. G. (2023). A systematic literature review of LoRaWAN: Sensors and applications. Sensors, 23(20), 8440. https://doi.org/10.3390/s23208440 Corchero-Falcón, M. D. R., Gómez-Salgado, J., García-Iglesias, J. J., Camacho-Vega, J. C., Fagundo-Rivera, J., & Carrasco-González, A. M. (2023). Risk factors for working pregnant women and potential adverse consequences of exposure: A systematic review. International Journal of Public Health, 68, 1605655. https://doi.org/10.3389/ijph.2023.1605655 Craven, J., McCartney, D., Desbrow, B., Sabapathy, S., Bellinger, P., Roberts, L., & Irwin, C. (2022). Effects of acute sleep loss on physical performance: A systematic and meta- analytical review. Sports Medicine, 52(11), 2669-2690. https://doi.org/10.1007/s40279- 022-01706-y Forbes-Hernández, T. Y., Betancourt, G., Bilbao, T., Rodríguez, D., & García, M. A. (2021). Estimación de la calidad antioxidante de la dieta de estudiantes universitarios mexicanos. QhaliKay, 5(2), 30-41. https://doi.org/10.33936/qkrcs.v5i2.3494

Situational health diagnosis in the rural parish of Noboa, Ecuador: a descriptive cross-sectional study on the mixed burden of disease and access barriers Delgado, Fernández, Zambrano, & Rivadeneira 148 San Gregorio de Portoviejo University | Ecuador Forbes-Hernández, T. Y., Betancourt, G., Rodríguez, D., & García, M. A. (2020). Capacidad antioxidante total de la dieta vs. balance redox. QhaliKay, 4(1), 35-48. https://doi.org/10.33936/qkrcs.v4i1.2711 García-Iglesias, J. J., Gómez-Salgado, J., Apostolo, J., Rodrigues, R., Costa, E. I., Ruiz-Frutos, C., Martínez-Isasi, S., Fernández-García, D., & Vilches-Arenas, Á. (2023). Presenteeism and mental health of workers during the COVID-19 pandemic: A systematic review. Frontiers in Public Health, 11, 1224332. https://doi.org/10.3389/fpubh.2023.1224332 García-Iglesias, J. J., Gómez-Salgado, J., Fagundo-Rivera, J., & Romero-Martín, M. (2021). Factores predictores de los niveles de burnout y work engagement en médicos y enfermeras: una revisión sistemática. Revista Española de Salud Pública, 95, e1-24. https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272021000100189 Ghaderi, C., Esmaeili, R., Ebadi, A., & Amiri, M. R. (2023). Measuring situation awareness in health care providers: A systematic review of measurement properties using COSMIN methodology. Systematic Reviews, 12(1), 60. https://doi.org/10.1186/s13643-023-02220-6 Khamraev, K., Cheriyan, D., & Choi, J. (2021). A review on health risk assessment of PM in the construction industry—Current situation and future directions. Science of The Total Environment, 758, 143716. https://doi.org/10.1016/j.scitotenv.2020.143716 Kumari, A., Sarkar, S., Ranjan, P., Chopra, S., Kaur, T., Baitha, U., Chakrawarty, A., & Klanidhi, K. B. (2022). Interventions for workplace violence against health-care professionals: A systematic review. Work, 73(2), 415-427. https://doi.org/10.3233/WOR-210046 Pantoja-Maldonado, D. Z., Torrubia-Pérez, E., Casanova-Garrigós, G., & Swieszek, A. (2025). Atención a la salud de las mujeres en situación de prostitución: revisión narrativa sistematizada. Revista Española de Salud Pública, 99(1), e202502009. https://ojs.sanidad.gob.es/index.php/resp/article/view/924 Statement on the use of artificial intelligence: The authors acknowledge the use of generative artificial intelligence (AI) and AI-assisted technologies solely to improve the readability, language quality, and clarity of this manuscript. AI tools may also have been used to create or edit non- scientific graphical content, such as graphical abstracts, icons, illustrations, diagrams, or educational figures, provided that such use is transparently disclosed and does not misrepresent or fabricate research findings. AI tools were not used to generate, modify, enhance, interpret, or

Revista Gregoriana de Ciencias de la Salud. Bi-annual peer-reviewed publication. ISSN 3028-8940 / July-December 2026;3(2):139-149 San Gregorio de Portoviejo University | Ecuador 149 analyze scientific data, medical images (e.g., radiographs, computed tomography scans, magnetic resonance imaging, ultrasound images, histopathological images, microscopy images, or other diagnostic images), or any figures that constitute primary research data. The authors reviewed and edited all AI-assisted content as necessary and assume full responsibility for the accuracy, integrity, and originality of the final published work. Disclaimer / Editor's Note: All publications' statements, opinions, and data are solely those of the individual authors and contributors, not Revista Gregoriana de Ciencias de la Salud or the editors. Revista Gregoriana de Ciencias de la Salud and/or the editors disclaim all responsibility for any injury to persons or property resulting from any ideas, methods, instructions, or products referred to in the content.