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1.

Norma técnica de salud: Gestión integral y manejo de residuos sólidos en establecimientos de salud, servicios médicos de apoyo y centros de investigación/ Technical health standard: Integral management and solid waste management in health establishments, medical support services and research centers

Perú. Ministerio de Salud; Dirección General de Salud Ambiental e Inocuidad Alimentaria; Ministerio del Ambiente
;
| Idioma(s): Español
Contribuir a brindar seguridad al personal, pacientes y visitantes de los establecimientos de salud (EESS), servicios médicos de apoyo (SMA) y centros de Investigación (CI), públicos, privados y mixtos a nivel nacional, a fin de prevenir, controlar y minimizar los riesgos sanitarios, ocupacionales y ambientales por la gestión y manejo inadecuado de sus residuos sólidos que generan, así como disminuir el impacto negativo a la salud pública y al ambiente que éstos producen.
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2.

IgG subclass responses to excreted-secreted antigens of Plasmodium falciparum in a low-transmission malaria area of the Peruvian Amazon.

Saavedra-Langer, Rafael; Marapara, Jorge; Valle-Campos, Andree; Durand, Salomón; Vásquez-Chasnamote, Maria E; Silva, Hermann; Pinedo-Cancino, Viviana
| Idioma(s): Inglés
BACKGROUND: Malaria in Peru is concentrated in the Amazon region, especially in Loreto, and transmission is focused in rural and peri-urban communities. The government has approved a malaria elimination plan with a community approach and seeks to reduce the risk of transmission through preventive interventions, but asymptomatic and low-parasite-density infections are challenges for disease control and elimination. IgG antibodies play a critical role in combating infection through their ability to reduce parasitaemia and clinical symptoms. In particular, IgG subclasses have important roles in controlling malaria disease and may provide new insight into the development of malaria control strategies and understanding of malaria transmission. Through the use of excreted-secreted antigens from Plasmodium falciparum, were evaluated the responses of the four IgG subclasses in symptomatic and asymptomatic malarial infections. RESULTS: Higher levels of whole IgG were observed in asymptomatic carriers (P < 0.05). IgG3 and IgG1 were the most prevalent subclasses and did not show differences in their antibody levels in either type of carrier. All symptomatic carriers were positive for IgG4, and the presence of IgG3 and IgG2 were correlated with protection against parasitaemia. IgG2 showed lower prevalence and antibody titers in comparison to other subclasses. CONCLUSIONS: This is the first study that characterizes the IgG subclass response in the Peruvian Amazon, and these results show that even in populations from regions with low malaria transmission, a certain degree of naturally acquired immunity can develop when the right antibody subclasses are produced. This provides important insight into the potential mechanisms regulating protective immunity.
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3.

Bioética y justicia ambiental en la salud de los pobladores andinos de Perú/ Bioethics and environmental justice in the health of the Andean residents of Peru/ Bioética e justiça ambiental na saúde dos habitantes andinos do Peru

Alcantara Zapata, Diana E.; Mazzei Pimental, Marinella
| Idioma(s): Español
Resumen Este artículo intenta plasmar el panorama bioético-ambiental de la salud del poblador que habita en la sierra peruana, remarcando la inequidad en el acceso a los servicios de salud que existe en esta región y reflexionando sobre las posibles causas contextuales, históricas y actuales que han originado diferencias entre el poblador andino del incanato y el poblador andino actual, el cambio de cosmovisón sobre el ambiente y los recursos, el deterioro del enfoque de justicia, solidaridad, bienestar y respeto hacia el ser humano y la naturaleza. Además, se describe la salud desde el escenario histórico de esta región, donde la salud pública tiene y tendrá como desafío la aplicación de programas que respondan a las necesidades específicas de esta población, con un enfoque dirigido hacia lo ambiental. Abstract This article attempts to capture the bioethical-environmental panorama of the health in the residents who live on the Peruvian highlands, highlighting the inequity in access to health services that exist in this region and reflecting on the possible historical and current contextual causes that have originated differences between Inca-Andean settler and modern-Andean settler. The change in the view of the world about the environment and natural resources, the decline of justice approach, loss of solidarity, welfare, and respect to human being and nature. Besides, we describe health from a historical scenario of this region, where Public health has and will have as a challenge the application of programs that respond to the specific needs of this population, with a focus on the environment. Resumo Este artigo tenta capturar o panorama bioético-ambiental da saúde dos habitantes que vivem nas ser as peruanas, destacando a desigualdade no acesso aos serviços de saúde que existe nesta região e refletindo sobre as possíveis causas contextuais, históricas e atuais que têm originado diferenças entre o habitante andino do Incanato e a atual população andina, a mudança de cosmovisão sobre o meio ambiente e os recursos, a deterioração da abordagem de justiça, solidariedade, bem-estar e respeito pelos seres humanos e a natureza. Além disso, a saúde é descrita a partir do cenário histórico desta região, onde a saúde pública tem e terá como desafio a aplicação de programas que respondam às necessidades específicas dessa população, com uma abordagem dirigida para o meio ambiente.
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4.

Provision of mental health care within primary care in Peru: A qualitative study exploring the perspectives of psychologists, primary health care providers, and patients.

Cavero, Victoria; Diez-Canseco, Francisco; Toyama, Mauricio; Flórez Salcedo, Gustavo; Ipince, Alessandra; Araya, Ricardo; Miranda, J Jaime
| Idioma(s): Inglés
This study aimed to understand the offer of mental health care at the primary care level, collecting the views of psychologists, primary health care providers (PHCPs), and patients, with a focus on health services in which patients attend regularly and who present a higher prevalence of mental disorders. A qualitative study was conducted in antenatal care, tuberculosis, HIV/AIDS, and chronic diseases services from six primary health care centers. Semi-structured interviews were conducted with psychologists, PHCPs, and patients working in or attending the selected facilities.  A total of 4 psychologists, 22 PHCPs, and 37 patients were interviewed. A high perceived need for mental health care was noted. PHCPs acknowledged the emotional impact physical health conditions have on their patients and mentioned that referral to psychologists was reserved only for serious problems. Their approach to emotional problems was providing emotional support (includes listening, talk about their patients' feelings, provide advice). PHCPs identified system-level barriers about the specialized mental health care, including a shortage of psychologists and an overwhelming demand, which results in brief consultations and lack in continuity of care. Psychologists focus their work on individual consultations; however, consultations were brief, did not follow a standardized model of care, and most patients attend only once. Psychologists also mentioned the lack of collaborative work among other healthcare providers. Despite these limitations, interviewed patients declared that they were willing to seek specialized care if advised and considered the psychologist's care provided as helpful; however, they recognized the stigmatization related to seeking mental health care. There is a perceived need of mental health care for primary care patients. To attend these needs, PHCPs provide emotional support and refer to psychology the most severe cases, while psychologists provide one-to-one consultations. Significant limitations in the care provided are discussed.
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5.

The economic burden of noncommunicable diseases and mental health conditions: results for Costa Rica, Jamaica, and Peru

Bloom, David E.; Chen, Simiao; McGovern, Mark E.
| Idioma(s): Inglés
[ABSTRACT]. Objective. We extend the EPIC model of the World Health Organization (WHO) and apply it to analyze the macroeconomic impact of noncommunicable diseases (NCDs) and mental health conditions in Costa Rica, Jamaica, and Peru. Methods. The EPIC model quantifies the impact of NCDs and mental health conditions on aggregate output solely through the effect of chronic conditions on labor supply due to mortality. In contrast, the expanded EPIC-H Plus framework also incorporates reductions in effective labor supply due to morbidity and negative effects of health expenditure on output via the diversion of productive savings and reduced capital accumulation. We apply this methodology to Costa Rica, Jamaica, and Peru and estimate gross domestic product (GDP) output lost due to four leading NCDs (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) and mental health conditions in these countries from 2015 to 2030. We also estimate losses from all NCDs and mental health conditions combined. Results. Overall, our results show total losses associated with all NCDs and mental health conditions over the period 2015–2030 of US$ 81.96 billion (2015 US$) for Costa Rica, US$ 18.45 billion for Jamaica, and US$ 477.33 billion for Peru. Moderate variation exists in the magnitude of the burdens of diseases for the three countries. In Costa Rica and Peru, respiratory disease and mental health conditions are two leading contributors to lost output, while in Jamaica, cardiovascular disease alone accounts for 20.8% of the total loss, followed by cancer. Conclusions. These results indicate that the economic impact of NCDs and mental health conditions is substantial and that interventions to reduce the prevalence of chronic conditions in countries of Latin America and the Caribbean are likely to be highly cost-beneficial. [RESUMEN]. Objetivo. Ampliamos el modelo EPIC de la Organización Mundial de la Salud y lo aplicamos para analizar el impacto macroeconómico de las enfermedades no transmisibles y la enfermedad mental en Costa Rica, Jamaica y Perú. Métodos. El modelo EPIC cuantifica el impacto de las enfermedades no transmisibles y la enfermedad mental en la producción agregada únicamente a través del efecto que las enfermedades crónicas producen sobre la oferta de trabajo debido a la mortalidad que estas causan. En cambio, el marco ampliado EPIC-H Plus también incorpora reducciones en la oferta efectiva de trabajo debido a la morbilidad y los efectos negativos del gasto en salud sobre la producción a través del desvío del ahorro productivo y la reducción de la acumulación de capital. Aplicamos esta metodología a Costa Rica, Jamaica y Perú y estimamos la pérdida en términos de producto interno bruto debida a cuatro enfermedades no transmisibles (enfermedades cardiovasculares, cáncer, enfermedad respiratoria crónica y diabetes) y a la enfermedad mental en estos países desde 2015 a 2030. También estimamos las pérdidas de todas las enfermedades no transmisibles y la enfermedad mental combinadas. Resultados. En general, nuestros resultados muestran pérdidas totales asociadas con todas las enfermedades no transmisibles y la enfermedad mental durante el período 2015–2030 de USD 81,96 mil millones (en dólares de 2015) para Costa Rica, USD 18,45 mil millones para Jamaica y USD 477,33 mil millones para Perú. Existe una variación moderada en la magnitud de la carga de las enfermedades para los tres países. En Costa Rica y Perú, las afecciones respiratorias y la enfermedad mental son los dos factores principales que contribuyen a la pérdida de producción, mientras que en Jamaica la enfermedad cardiovascular sola representa el 20,8% de la pérdida total, seguida por el cáncer. Conclusiones. Estos resultados indican que el impacto económico de las enfermedades no transmisibles y la enfermedad mental es considerable y que las intervenciones para reducir la prevalencia de enfermedades crónicas en América Latina y el Caribe probablemente sean muy beneficiosas en relación al costo. [RESUMO]. Objetivo. Estendemos o modelo EPIC da Organização Mundial da Saúde e aplicamos para analisar o impacto macroeconômico das doenças não transmissíveis (DNT) e as condições de saúde mental na Costa Rica, Jamaica e Peru. Métodos. O modelo EPIC quantifica o impacto das DNT e condições de saúde mental na produção agregada unicamente através do efeito de condições crônicas na oferta de trabalho devido à mortalidade. Em contrapartida, a estrutura ampliada EPIC-H Plus também incorpora reduções na oferta de trabalho efetiva devido à morbidade e aos efeitos negativos das despesas de saúde na produção através do desvio de poupanças produtivas e redução da acumulação de capital. Aplicamos essa metodologia à Costa Rica, Jamaica e Peru e estimamos a perda de produto interno bruto devido a quatro DNT (doenças cardiovasculares, câncer, doenças respiratórias crônicas e diabetes) e condições de saúde mental nesses países de 2015 a 2030. Também estimamos as perdas de todas as DNT e condições de saúde mental combinadas. Resultados. No geral, nossos resultados mostram perdas totais associadas a todas as DNT e condições de saúde mental no período 2015–2030 de USD 81,96 bilhões (USD de 2015) para a Costa Rica, USD 18,45 bilhões para a Jamaica e USD 477,33 bilhões para o Peru. Existe variação moderada na magnitude da carga das doenças para os três países. Na Costa Rica e no Peru, as doenças respiratórias e as condições de saúde mental são dois principais contribuintes para a perda de produção, enquanto na Jamaica, a doença cardiovascular sozinha representa 20,8% da perda total, seguida de câncer. Conclusões. Esses resultados indicam que o impacto econômico das doenças não transmissíveis e as condições de saúde mental são substanciais e que as intervenções para reduzir a prevalência de condições crônicas em países da América Latina e do Caribe são benéficos em relação ao custo.
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6.

The economic burden of noncommunicable diseases and mental health conditions: results for Costa Rica, Jamaica, and Peru/ La carga económica de las enfermedades no transmisibles y la enfermedad mental: resultados para Costa Rica, Jamaica y Perú/ A carga econômica das doenças não transmissíveis e condições de saúde mental: resultados para a Costa Rica, Jamaica e Peru

Bloom, David E.; Chen, Simiao; McGovern, Mark E.
| Idioma(s): Inglés
ABSTRACT Objective We extend the EPIC model of the World Health Organization (WHO) and apply it to analyze the macroeconomic impact of noncommunicable diseases (NCDs) and mental health conditions in Costa Rica, Jamaica, and Peru. Methods The EPIC model quantifies the impact of NCDs and mental health conditions on aggregate output solely through the effect of chronic conditions on labor supply due to mortality. In contrast, the expanded EPIC-H Plus framework also incorporates reductions in effective labor supply due to morbidity and negative effects of health expenditure on output via the diversion of productive savings and reduced capital accumulation. We apply this methodology to Costa Rica, Jamaica, and Peru and estimate gross domestic product (GDP) output lost due to four leading NCDs (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) and mental health conditions in these countries from 2015 to 2030. We also estimate losses from all NCDs and mental health conditions combined. Results Overall, our results show total losses associated with all NCDs and mental health conditions over the period 2015-2030 of US$ 81.96 billion (2015 US$) for Costa Rica, US$ 18.45 billion for Jamaica, and US$ 477.33 billion for Peru. Moderate variation exists in the magnitude of the burdens of diseases for the three countries. In Costa Rica and Peru, respiratory disease and mental health conditions are two leading contributors to lost output, while in Jamaica, cardiovascular disease alone accounts for 20.8% of the total loss, followed by cancer. Conclusions These results indicate that the economic impact of NCDs and mental health conditions is substantial and that interventions to reduce the prevalence of chronic conditions in countries of Latin America and the Caribbean are likely to be highly cost-beneficial. RESUMEN Objetivo Ampliamos el modelo EPIC de la Organización Mundial de la Salud y lo aplicamos para analizar el impacto macroeconómico de las enfermedades no transmisibles y la enfermedad mental en Costa Rica, Jamaica y Perú. Métodos El modelo EPIC cuantifica el impacto de las enfermedades no transmisibles y la enfermedad mental en la producción agregada únicamente a través del efecto que las enfermedades crónicas producen sobre la oferta de trabajo debido a la mortalidad que estas causan. En cambio, el marco ampliado EPIC-H Plus también incorpora reducciones en la oferta efectiva de trabajo debido a la morbilidad y los efectos negativos del gasto en salud sobre la producción a través del desvío del ahorro productivo y la reducción de la acumulación de capital. Aplicamos esta metodología a Costa Rica, Jamaica y Perú y estimamos la pérdida en términos de producto interno bruto debida a cuatro enfermedades no transmisibles (enfermedades cardiovasculares, cáncer, enfermedad respiratoria crónica y diabetes) y a la enfermedad mental en estos países desde 2015 a 2030. También estimamos las pérdidas de todas las enfermedades no transmisibles y la enfermedad mental combinadas. Resultados En general, nuestros resultados muestran pérdidas totales asociadas con todas las enfermedades no transmisibles y la enfermedad mental durante el período 2015-2030 de USD 81,96 mil millones (en dólares de 2015) para Costa Rica, USD 18,45 mil millones para Jamaica y USD 477,33 mil millones para Perú. Existe una variación moderada en la magnitud de la carga de las enfermedades para los tres países. En Costa Rica y Perú, las afecciones respiratorias y la enfermedad mental son los dos factores principales que contribuyen a la pérdida de producción, mientras que en Jamaica la enfermedad cardiovascular sola representa el 20,8% de la pérdida total, seguida por el cáncer. Conclusiones Estos resultados indican que el impacto económico de las enfermedades no transmisibles y la enfermedad mental es considerable y que las intervenciones para reducir la prevalencia de enfermedades crónicas en América Latina y el Caribe probablemente sean muy beneficiosas en relación al costo. RESUMO Objetivo Estendemos o modelo EPIC da Organização Mundial da Saúde e aplicamos para analisar o impacto macroeconômico das doenças não transmissíveis (DNT) e as condições de saúde mental na Costa Rica, Jamaica e Peru. Métodos O modelo EPIC quantifica o impacto das DNT e condições de saúde mental na produção agregada unicamente através do efeito de condições crônicas na oferta de trabalho devido à mortalidade. Em contrapartida, a estrutura ampliada EPIC-H Plus também incorpora reduções na oferta de trabalho efetiva devido à morbidade e aos efeitos negativos das despesas de saúde na produção através do desvio de poupanças produtivas e redução da acumulação de capital. Aplicamos essa metodologia à Costa Rica, Jamaica e Peru e estimamos a perda de produto interno bruto devido a quatro DNT (doenças cardiovasculares, câncer, doenças respiratórias crônicas e diabetes) e condições de saúde mental nesses países de 2015 a 2030. Também estimamos as perdas de todas as DNT e condições de saúde mental combinadas. Resultados No geral, nossos resultados mostram perdas totais associadas a todas as DNT e condições de saúde mental no período 2015-2030 de USD 81,96 bilhões (USD de 2015) para a Costa Rica, USD 18,45 bilhões para a Jamaica e USD 477,33 bilhões para o Peru. Existe variação moderada na magnitude da carga das doenças para os três países. Na Costa Rica e no Peru, as doenças respiratórias e as condições de saúde mental são dois principais contribuintes para a perda de produção, enquanto na Jamaica, a doença cardiovascular sozinha representa 20,8% da perda total, seguida de câncer. Conclusões Esses resultados indicam que o impacto econômico das doenças não transmissíveis e as condições de saúde mental são substanciais e que as intervenções para reduzir a prevalência de condições crônicas em países da América Latina e do Caribe são benéficos em relação ao custo.
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7.

L. (Anacardiaceae): Antioxidant and Antiulcer Activities of the Leaf Hexane Extract.

de Almeida, Cynthia Layse Ferreira; Brito, Samara Alves; de Santana, Temístocles Italo; Costa, Henrique Bandeira Alves; de Carvalho Júnior, Carlson Helder Reis; da Silva, Márcia Vanusa; de Almeida, Lécio Leone; Rolim, Larissa Araújo; Dos Santos, Vanda Lucia; Wanderley, Almir Gonçalves; da Silva, Teresinha Gonçalves
| Idioma(s): Inglés
is used in folk medicine to treat diarrhea and diuresis. The objective of this study was to evaluate the phytochemical profile and antioxidant and antiulcer activities of the hexane extract of the leaves of (SpHE). Phytochemical profile was evaluated via thin layer chromatography (TLC) and HPLC. SpHE was screened for antioxidant activities using DPPH, ABTS, FRAP, and phosphomolybdenum assays. To determine its antiulcer properties, animals were pretreated with injured control, lansoprazole, ranitidine, carbenoxolone, or SpHE (12.5, 25, and 50 mg/kg) and were screened; acute ulcers were induced by HCl/ethanol, absolute ethanol, and nonsteroidal anti-inflammatory drug (NSAID). TLC revealed the presence of flavonoids, whereas HPLC analysis showed the presence of caffeic acid and epigallocatechin. The phenolic compounds and assays showed antioxidant activity. After gastric ulcer induction by using HCl/ethanol, SpHE reduced the area of ulcerative lesions by 82, 91, and 88%, respectively. In ethanol, SpHE reduced the area of ulcerative lesions by 77, 93, and 92%, respectively. In the NSAID, the percentages of protection were 70, 76, and 78%, respectively. SpHE promoted the minimization of ulcers, increased the levels of reduced glutathione, and decreased tumor necrosis factor. has antioxidant and antiulcer properties.
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8.

Quantifying the burden of vampire bat rabies in Peruvian livestock.

Benavides, Julio A; Rojas Paniagua, Elizabeth; Hampson, Katie; Valderrama, William; Streicker, Daniel G
| Idioma(s): Inglés
BACKGROUND: Knowledge of infectious disease burden is necessary to appropriately allocate resources for prevention and control. In Latin America, rabies is among the most important zoonoses for human health and agriculture, but the burden of disease attributed to its main reservoir, the common vampire bat (Desmodus rotundus), remains uncertain. METHODOLOGY/PRINCIPAL FINDINGS: We used questionnaires to quantify under-reporting of livestock deaths across 40 agricultural communities with differing access to health resources and epidemiological histories of vampire bat rabies (VBR) in the regions of Apurimac, Ayacucho and Cusco in southern Peru. Farmers who believed VBR was absent from their communities were one third as likely to report livestock deaths from disease as those who believed VBR was present, and under-reporting increased with distance from reporting offices. Using generalized mixed-effect models that captured spatial autocorrelation in reporting, we project 4.6 (95% CI: 4.4-8.2) rabies cases per reported case and identify geographic areas with potentially greater VBR burden than indicated by official reports. Spatially-corrected models estimate 505-724 cattle deaths from VBR in our study area during 2014 (421-444 deaths/100,000 cattle), costing US$121,797-171,992. Cost benefit analysis favoured vaccinating all cattle over the current practice of partial vaccination or halting vaccination all together. CONCLUSIONS: Our study represents the first estimate of the burden of VBR in Latin America to incorporate data on reporting rates. We confirm the long-suspected cost of VBR to small-scale farmers and show that vaccinating livestock is a cost-effective solution to mitigate the burden of VBR. More generally, results highlight that ignoring geographic variation in access to health resources can bias estimates of disease burden and risk.
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9.

Characterization of Salmonella enterica isolates causing bacteremia in Lima, Peru, using multiple typing methods.

Silva, Claudia; Betancor, Laura; García, Coralith; Astocondor, Lizeth; Hinostroza, Noemí; Bisio, Julieta; Rivera, Javier; Perezgasga, Lucía; Pérez Escanda, Victoria; Yim, Lucía; Jacobs, Jan; García-Del Portillo, Francisco; Chabalgoity, José A; Puente, José L
| Idioma(s): Inglés
In this study, different molecular typing tools were applied to characterize 95 Salmonella enterica blood isolates collected between 2008 and 2013 from patients at nine public hospitals in Lima, Peru. Combined results of multiplex PCR serotyping, two- and seven-loci multilocus sequence typing (MLST) schemes, serotyping, IS200 amplification and RAPD fingerprints, showed that these infections were caused by eight different serovars: Enteritidis, Typhimurium, Typhi, Choleraesuis, Dublin, Paratyphi A, Paratyphi B and Infantis. Among these, Enteritidis, Typhimurium and Typhi were the most prevalent, representing 45, 36 and 11% of the isolates, respectively. Most isolates (74%) were not resistant to ten primarily used antimicrobial drugs; however, 37% of the strains showed intermediate susceptibility to ciprofloxacin (ISC). Antimicrobial resistance integrons were carried by one Dublin (dfra1 and aadA1) and two Infantis (aadA1) isolates. The two Infantis isolates were multidrug resistant and harbored a large megaplasmid. Amplification of spvC and spvRA regions showed that all Enteritidis (n = 42), Typhimurium (n = 34), Choleraesuis (n = 3) and Dublin (n = 1) isolates carried the Salmonella virulence plasmid (pSV). We conclude that the classic serotyping method can be substituted by the multiplex PCR and, when necessary, sequencing of only one or two loci of the MLST scheme is a valuable tool to confirm the results. The effectiveness and feasibility of different typing tools is discussed.
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10.

Factores asociados a la no utilización de los servicios formales de prestación en salud en la población peruana: análisis de la encuesta nacional de hogares (ENAHO) 2015./ [Associated Factors to non-use of Formal Health Services in the Peruvian Population: Analysis of the National Household Survey (ENAHO) 2015].

Benites-Zapata, Vicente A; Lozada-Urbano, Michelle; Urrunaga-Pastor, Diego; Márquez-Bobadilla, Edith; Moncada-Mapelli, Enrique; Mezones-Holguín, Edward
| Idioma(s): Español
The aim of the study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors using the National Household Survey (ENAHO 2015). The participants were defined as NUHS if they have presented any symptoms, discomfort, illness, relapse of chronic illness or accident during the last month and did not go to the health services. 35036 participants were analyzed; the prevalence of NUHS was 53,9%. NUHS was higher in the coastal region (adjusted Prevalence Ratio [aPR]=1.24;95%CI:1.17-1.31), highlands (aPR=1.38; 95%CI: 1.31-1.46) and jungle (aPR=1.25,95%CI:1.18-1.33) compared to Lima. Likewise, there were a higher prevalence of NUHS in participants without health insurance (aPR=1.59;95%CI:1.52-1.66) and those affiliated to Ministry of Health insurance (aPR=1.16;95%CI:1.11-1.22) compared to those affiliated to Social Security. More than half of the participants suffered from NUHS, which was associated with geographical and health system conditions. It is required evidenced-informed public policies to improve this situation.
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