Sánchez, José Daniel
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Sánchez, José Daniel
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Qutio

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The Knowledge‐Attitude Paradox in Analgesic Self‐Medication Among University Students in Ecuador: A Cross‐Sectional Study and Predictive Modeling Analysis

2025 , Argote, Sonia , Ashel Páez , Doménica Bucheli , Camila Rovayo , Daniel Freire , Pablo Pila , Sánchez, José Daniel

Objective: To evaluate the prevalence and determinants of analgesic self-medication among university students in Ecuador, with a focus on the interplay between pharmacological knowledge and personal attitudes. Methods: A cross-sectional analytical study was conducted with 422 students at Universidad Tecnologica Indoamerica (April–August 2025), selected via stratified random sampling. A validated, structured questionnaire assessed knowledge, attitudes, and practices. Multivariable logistic regression and random forest algorithms were employed to identify key predictors and their relative importance. Results: The prevalence of analgesic self-medication was exceptionally high at 87.5%. Random forest analysis identified attitude as the primary predictor of this behavior (relative importance = 0.252), followed by academic year and pharmacological knowledge. A significant “knowledge–attitude paradox” was observed, wherein health sciences students, despite possessing superior pharmacological knowledge, exhibited the highest rates of self-medication. The predictive model demonstrated excellent discrimination (AUC = 0.81). Conclusion: The high prevalence of self-medication, a finding consistent with emerging international data, necessitates a fundamental paradigm shift in public health interventions. Educational strategies must evolve beyond simple information dissemination to incorporate behavioral science principles aimed at modifying attitudes and risk perceptions, particularly during the formative early years of university education

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A Narrative Review of Human Papillomavirus (HPV) Vaccination in Ecuador: A Crisis of Inequity and an Evidence-Based Roadmap for Elimination

2025 , Sánchez, José Daniel , Loaiza Martinez, Daniela , Carlos Santillan

Background: Human Papillomavirus (HPV) remains the leading cause of cervical cancer in Ecuador, which suffers from systemic programmatic failures that undermine the global elimination strategy. Crisis: Ecuador’s HPV vaccination coverage (35.6% first dose; 17.3% complete) is the lowest in Latin America, starkly contrasting with the WHO’s 90% target for cervical cancer elimination (Pan American Health Organization 2025). Structural inequities, a profound genotypic mismatch with the circulating quadrivalent vaccine (HPV 58/31/52 prevalence), and fragmented implementation perpetuate this public health crisis (Jose Ortiz Segarra et al. Infectious Disease Reports, 15(3):267–278 2023). Key Findings: Our analysis reveals that the nation’s health-center-based model fails to reach vulnerable populations, a problem exacerbated by critical cold chain deficiencies in 30% of facilities. In contrast, regional successes, such as Peru’s school-based programs (94% coverage) and Colombia’s strategic adoption of the nonavalent vaccine, offer a clear roadmap for reform (Pan American Health Organization 2025, María Ines Sarmiento-Medina et al. PLOS ONE, 19(2):e0297579 2024). Recommendations: We propose an evidence-based 5-point plan to overhaul Ecuador’s strategy: a targeted nonavalent vaccine pilot, immediate adoption of a single-dose schedule, culturally adapted self-sampling programs, phased-in gender-neutral vaccination, and urgent investment in cold chain infrastructure

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