Dengue and malaria mortality in Ecuador: A population analysis of hospital deaths across 24 provinces, 2015-2023.

Background: Dengue and malaria remain critical vector-borne threats in Latin America, yet mortality surveillance at subnational levels is sparse. Ecuador, a country with diverse ecological zones and shifting transmission dynamics, lacks standardized hospital-based mortality indicators to guide targeted interventions. Objective: To analyze age-standardized hospital mortality rates for dengue and malaria across Ecuador's 24 provinces from 2015 to 2023, identifying geographic disparities, temporal trends, and surveillance gaps. Methods: We conducted a cross-sectional ecological study using anonymized hospital discharge data from the National Institute of Statistics and Censuses (INEC). Fatal dengue and malaria cases were identified using ICD-10 codes and stratified by year, age groups, and province. Standardized mortality rates per million inhabitants were calculated using population projections, and geographic and temporal patterns were visualized through heat maps and time-series plots. Results: Dengue accounted for 125 hospital deaths, with mortality concentrated in Amazonian and coastal provinces. Malaria, though markedly less frequent, resulted in five adult deaths (3 in 2019, 1 in 2021, and 1 in 2023), with Plasmodium falciparum predominating. The highest malaria mortality rate occurred in Napo (16.3 per million in 2021), underscoring the fragility of elimination gains. Both diseases revealed fragmented mortality patterns, with isolated spikes and persistent underreporting in endemic zones. Conclusion: Hospital-based mortality data expose critical gaps in Ecuador's arboviral and Plasmodium spp surveillance. While dengue shows episodic lethality across endemic provinces, malaria's sporadic fatality signals in urban, non-endemic regions highlight the need for sustained clinical vigilance and integrated mortality monitoring.