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Improving household air, drinking water and hygiene in rural Peru: a community-randomized-controlled trial of an integrated environmental home-based intervention package to improve child health.

Hartinger, S M; Lanata, C F; Hattendorf, J; Verastegui, H; Gil, A I; Wolf, J; Mäusezahl, D
| Idioma(s): Inglés
Background: Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality, which can be prevented by simple low-cost interventions. Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously. Methods: We conducted a community-randomized-controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package, consisting of improved solid-fuel stoves, kitchen sinks, solar disinfection of drinking water and hygiene promotion, reduces lower respiratory infections, diarrhoeal disease and improves growth in children younger than 36 months. The attention control group received an early child stimulation programme. Results: We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up. Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm. This corresponds to a relative rate of 0.78 [95% confidence interval (CI): 0.58-1.05] for diarrhoea incidence and an odds ratio of 0.71 (95% CI: 0.47-1.06) for diarrhoea prevalence. No effects on acute lower respiratory infections or children's growth rates were observed. Conclusions: Combined home-based environmental interventions slightly reduced childhood diarrhoea, but the confidence interval included unity. Effects on growth and respiratory outcomes were not observed, despite high user compliance of the interventions. The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions.
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Implications of raising cigarette excise taxes in Peru/ Efectos de aumentar los impuestos indirectos sobre tabaco en el Perú

Gonzalez-Rozada, Martin; Ramos-Carbajales, Alejandro
| Idioma(s): Inglés
Objective. To assess how raising cigarette excise taxes in Peru might impact cigarette consumption, and to determine if higher taxes would be regressive. Methods. Total demand price elasticity was estimated by income groups using two datasets: quarterly time-series data from 1993 – 2012 and data from a cross-sectional survey of income and expenses conducted in 2008 – 2009 . A functional form of the cigarette demand in Peru was specified using the quarterly data set, and the demand price elasticity was estimated for the short and long run. Using the second data set and Deaton methodology, the implementation of elasticity estimation and by groups’ elasticity was done in a two-step procedure. Results. Demand price elasticity was -0.7, implying that a 10% price increase via a new tax would reduce consumption by 7%. Demand price elasticity estimations by income group suggested that poorer families are not more price sensitive than richer ones, which implies that increasing cigarette taxes could be regressive. Conclusions. Increasing cigarette taxes is the most efficient policy for inducing a reduction in smoking. However, in the case of Peru, an increase in cigarette taxes could be regressive. Objetivo. Examinar los efectos que podría tener un aumento de los impuestos indirectos sobre el tabaco en el Perú sobre el consumo de cigarrillos y determinar si el alza de los impuestos tendría un efecto regresivo. Métodos. La elasticidad de la demanda total en función del precio se determinó, por grupos de ingreso, a partir de dos conjuntos de datos: datos trimestrales de series cronológicas para el período de 1993 al 2012 y datos obtenidos en una encuesta transversal de ingresos y gastos para el período del 2008 al 2009. El tipo de función matemática que capta la demanda de cigarrillos en el Perú se determinó a partir de los datos trimestrales; la elasticidad de la demanda en función del precio se calculó tanto para el corto como para el largo plazo. El segundo conjunto de datos y el método de Deaton se usaron para calcular en dos pasos la elasticidad y la elasticidad por grupos. Resultados. La elasticidad de la demanda en función del precio fue de -0,7. Esto implica que un aumento de precio de 10% por efecto de un impuesto nuevo reduciría el consumo en 7%. Los cálculos de la elasticidad de la demanda en función del precio por grupos de ingreso revelaron que las familias más pobres no reaccionan más a los cambios de precio que las familias más prósperas, o sea, que un aumento de los impuestos sobre el tabaco podría tener un efecto regresivo. Conclusiones. El aumento de los impuestos sobre el tabaco es la política más eficiente para reducir el tabaquismo. Sin embargo, en el caso del Perú dicho aumento podría tener consecuencias regresivas.
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Visual health screening by schoolteachers in remote communities of Peru: implementation research.

Latorre-Arteaga, Sergio; Gil-González, Diana; Bascarán, Covadonga; Núñez, Richard Hurtado; Morales, María Del Carmen Peral; Orihuela, Guillermo Carrillo
| Idioma(s): Inglés
OBJECTIVE: To describe the adaptation and scaling-up of an intervention to improve the visual health of children in the Apurimac region, Peru. METHODS: In a pilot screening programme in 2009-2010, 26 schoolteachers were trained to detect and refer visual acuity problems in schoolchildren in one district in Apurimac. To scale-up the intervention, lessons learnt from the pilot were used to design strategies for: (i) strengthening multisector partnerships; (ii) promoting the engagement and participation of teachers and (iii) increasing children's attendance at referral eye clinics. Implementation began in February 2015 in two out of eight provinces of Apurimac, including hard-to-reach communities. We made an observational study of the processes and outcomes of adapting and scaling-up the intervention. Qualitative and quantitative analyses were made of data collected from March 2015 to January 2016 from programme documents, routine reports and structured evaluation questionnaires completed by teachers. FINDINGS: Partnerships were expanded after sharing the results of the pilot phase. Training was completed by 355 teachers and directors in both provinces, belonging to 315 schools distributed in 24 districts. Teachers' appraisal of the training achieved high positive scores. Outreach eye clinics and subsidies for glasses were provided for poorer families. Data from six districts showed that attendance at the eye clinic increased from 66% (45/68 children referred) in the pilot phase to 92% (237/259) in the implementation phase. CONCLUSION: Adaptation to the local context allowed the scaling-up of an intervention to improve visual health in children and enhanced the equity of the programme.
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Biomonitoring Human Exposure to Household Air Pollution and Association with Self-reported Health Symptoms - A Stove Intervention Study in Peru.

Li, Zheng; Commodore, Adwoa; Hartinger, Stella; Lewin, Michael; Sjödin, Andreas; Pittman, Erin; Trinidad, Debra; Hubbard, Kendra; Lanata, Claudio F; Gil, Ana I; Mäusezahl, Daniel; Naeher, Luke P
| Idioma(s): Inglés
BACKGROUND: Household air pollution (HAP) from indoor biomass stoves contains harmful pollutants, such as polycyclic aromatic hydrocarbons (PAHs), and is a leading risk factor for global disease burden. We used biomonitoring to assess HAP exposure and association with self-reported symptoms in 334 non-smoking Peruvian women to evaluate the efficacy of a stove intervention program. METHODS: We conducted a cross-sectional study within the framework of a community randomized control trial. Using urinary PAH metabolites (OH-PAHs) as the exposure biomarkers, we investigated whether the intervention group (n=155, with new chimney-equipped stoves) were less exposed to HAP compared to the control group (n=179, with mostly open-fire stoves). We also estimated associations between the exposure biomarkers, risk factors, and self-reported health symptoms, such as recent eye conditions, respiratory conditions, and headache. RESULTS: We observed reduced headache and ocular symptoms in the intervention group than the control group. Urinary 2-naphthol, a suggested biomarker for inhalation PAH exposure, was significantly lower in the intervention group (GM with 95% CI: 13.4 [12.3, 14.6] µg/g creatinine) compared to control group (16.5 [15.0, 18.0] µg/g creatinine). Stove type and/or 2-naphthol was associated with a number of self-reported symptoms, such as red eye (adjusted OR with 95% CI: 3.80 [1.32, 10.9]) in the past 48h. CONCLUSIONS: Even with the improved stoves, the biomarker concentrations in this study far exceeded those of the general populations and were higher than a no-observed-genotoxic-effect-level, indicating high exposure and a potential for increased cancer risk in the population.
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Salud mental y estrés por aculturación en inmigrantes sudamericanos en el norte de Chile./ [Mental health and stress by acculturation in immigrants from South America in northern Chile].

Urzúa M, Alfonso; Heredia B, Osvaldo; Caqueo-Urízar, Alejandra
| Idioma(s): Español
BACKGROUND: Coping with changes brought about by immigration and social circumstances that often characterize this process may cause mental health problems. AIM: To analyze the relationship between acculturation stress and mental health symptoms in South American immigrants residing in Antofagasta, Chile. MATERIAL AND METHODS: The OQ questionnaire, which assesses mental health and the acculturation stress questionnaire from Ruiz, were answered by 431 immigrants (53.8% Colombian and 46.2% Peruvian) aged between 18 and 65 years old. RESULTS: The major source of acculturation stress was distance from origin, followed by difficulties in social relationships and perceived discrimination and rejection. About 50% of respondents had elevated levels of discomfort in their life, with mental health problems derived from their adjustment to social roles and relationships. There was a high correlation between acculturation stress levels and severity of mental health symptoms. CONCLUSIONS: Immigrants are exposed to high levels of stress resulting in a negative impact on their mental health.
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Características clínico y sociodemográficas de los pacientes de un centro de rehabilitación para las adicciones./ Características clínico y sociodemográficas de los pacientes de un centro de rehabilitación para las adicciones./ Clinical and socio-demographic characteristics of patients at a rehabilitation center for chemical dependency.

Díaz, José Eduardo Cruz; Gaino, Loraine Vivian; Souza, Jacqueline de
| Idioma(s): Inglés; Español
OBJECTIVE: Identify the socio-demographic and clinical characteristics of a sample of chemically dependent people undergoing treatment at a daytime ambulatory care center specialized in treating chemical dependency in Lima, Peru, and describe their dropout rates. METHOD: Quantitative, descriptive, and exploratory study based on secondary data. The instrument used was the individual notification record from the information system for the treatment demand. RESULTS: The demand was composed mostly of young, single men who were unemployed or underemployed. The most common diagnosis was dependency on cocaine-based drugs and the age of the onset of use was between 15 and 19 years. The dropout rate was 85%, and 48% remained in treatment for only one day. CONCLUSION: The results highlight important factors to be considered in the evaluation of public policies on prevention, treatment, and supply control. We recommend more inclusive and participatory public policies.
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Evolución del concepto de cambio climático y su impacto en la salud pública del Perú./ [Evolution of the climate change concept and its impact in the public health of Peru].

Sánchez Zavaleta, Carlos A
| Idioma(s): Español
The term "climate change" is not a new concept but its impact on public health is under constant review. We know that climate has already changed and will continue to change for centuries with the rise in average global temperature, and the associated rise in sea level. This fact makes mitigation efforts relevant only in the very long term and for generations of humans whose parents have not yet been born. When we talk about public health in the context of climate change, we are talking about adaptation. In the present, countries that are currently the most affected by climate change are precisely countries like Peru, without a significant carbon footprint at the global level but that are highly sensitive to the effects of climate. Without reliable climate projections, the health impact of climate change can be uncertain and complicated. Nevertheless, at the local level, every district can identify its vulnerabilities and define priorities to protect the health of its population. There are, and it can also be developed, environmental health indicators that can help monitor how well we are adapting and how prepared we are for changes in the climate. Adaptation to climate change implies improving living conditions, enhancing epidemiological surveillance systems and extending access to healthcare. The fight against the effects of climate change in public health is a fight against poverty and inequality, and that is nothing new in Peru.
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Tobacco consumption and positive mental health: an epidemiological study from a positive psychology perspective.

Bazo-Alvarez, Juan Carlos; Peralta-Alvarez, Frank; Bernabé-Ortiz, Antonio; Alvarado, Germán F; Miranda, J Jaime
| Idioma(s): Inglés
BACKGROUND: Positive mental health (PMH) is much more than the absence of mental illnesses. For example, PMH explains that to be happy or resilient can drive us to live a full life, giving us a perception of well-being and robustness against everyday problems. Moreover, PMH can help people to avoid risky behaviours like tobacco consumption (TC). Our hypothesis was that PMH is negatively associated with TC, and this association differs across rural, urban and migrant populations. METHODS: A cross-sectional study was conducted using the PERU MIGRANT Study's dataset, including rural population from the Peruvian highlands (n = 201), urban population from the capital city Lima (n = 199) and migrants who were born in highlands but had to migrated because of terrorism (n = 589). We used an adapted version of the 12-item Global Health Questionnaire to measure PMH. The outcome was TC, measured as lifetime and recent TC. Log-Poisson robust regression, performed with a Maximum Likelihood method, was used to estimate crude prevalence ratios (PR) and 95 % confidence intervals (95%CI), adjusted by sex, age, family income and education which were the confounders. The modelling procedure included the use of LR Test, Akaike information criteria (AIC) and Bayesian information criteria (BIC). RESULTS: Cumulative occurrence of tobacco use (lifetime TC) was 61.7 % in the rural group, 78 % in the urban group and 76.2 % in rural-to-urban migrants. Recent TC was 35.3 % in the rural group, 30.7 % in the urban group and 20.5 % in rural-to-urban migrants. After adjusting for confounders, there was evidence of a negative association between PMH and lifetime TC in the rural group (PR = 0.93; 95%CI: 0.87-0.99), and a positive association between PMH and recent TC in migrants (PR = 1.1; 95%CI: 1.0-1.3). CONCLUSIONS: PMH was negatively associated with TC in rural participants only. Urbans exhibited just a similar trend, while migrants exhibited the opposite one. This evidence represents the first step in the route of knowing the potential of PMH for fighting against TC. For rural populations, this study supplies new information that could support decisions about prevention programmes and psychotherapy for smoking cessation. However, more research in the topic is needed.
Resultados  1-10 de 2.126