Socioeconomic inequalities in the use of medical consultation services in Peru, 2019.

BACKGROUND: Socioeconomic inequalities in the population influence access to health services and constitute a challenge for health systems, especially in low- and middle-income countries. In Peru, an increase in the use of medical services has been estimated; however, the study of inequalities in the use of medical services is limited. Therefore, the objective of this research was to analyze and decompose socioeconomic inequalities in the use of medical consultation services in Peru. METHODS: A cross-sectional analytical study was conducted using data from the National Household Survey 2019. The outcome variable was the use of a consultation attended by a physician in the last 4 weeks in persons who presented symptom or discomfort, illness, relapse of chronic disease and/or accident. Concentration curves and Erreygers concentration indices were used to determine socioeconomic inequalities, and a generalized linear regression model was used for the decomposition analysis of inequalities. RESULTS: A total of 52,715 persons were included in the study. The frequency of medical consultation was 25.4% (95% confidence interval: 24.8 - 26.1%). In the inequality analysis, it was found that the use of medical consultations was concentrated among the wealthiest individuals. The main contributing factors were having another type of health insurance (social health insurance [EsSalud], private health insurance, health provider, the Armed Forces, and the Police), residing in an urban area, belonging to the richest wealth quintile, having a chronic disease, and residing in the highlands of Peru. CONCLUSIONS: Based on our findings, government institutions seeking to achieve equitable access to health services should consider the main factors contributing to this inequality in the formulation of strategies to lessen the negative impact of inadequate disease control in the population.

Measuring Socioeconomic Inequalities in HIV Testing During Antenatal Care: A Peruvian National Survey.

Although several Latin American countries have 70% antenatal care coverage, the proportion of human immunodeficiency virus (HIV) testing of Peruvian pregnant women and the socioeconomic inequalities of this preventive measure are unknown. This study aimed to determine socioeconomic inequalities and quantify the contribution of contextual and compositional factors on HIV testing during prenatal care in Peru. A cross-sectional study of the 2021 Demographic and Family Health Survey data was conducted. The outcome variable was HIV testing of pregnant women during prenatal care. An analysis of inequalities was performed including the determination of concentration curves and a decomposition analysis of concentration indices. Of a total of 17521 women aged 15 to 49 years, 91.4% had been tested for HIV during prenatal care. The concentration curves showed that prenatal HIV testing was concentrated among richer women, while the decomposition analysis determined that the main contributors to inequality were having a higher education, residing in an urban area, and in the highlands, belonging to the wealthy quintile, and being exposed to television and newspapers. Strategies focused on improving access, promotion and restructuring of prevention of mother-to-child transmission measures should be prioritized.

Association Between the Autonomy of Peruvian Women and the Choice of the Place of Delivery: Analysis of a National Survey, 2019.

OBJECTIVES: To determine the association between Peruvian women's autonomy and place of delivery. METHODS: An analytical cross-sectional study of secondary data from the Demographic and Family Health Survey 2019 was carried out. The dependent variable was institutionalized childbirth, and the independent variable was women's autonomy. Likewise, the association between women's autonomy and institutionalized childbirth was evaluated using Poisson family generalized linear models with logarithmic link function, and crude (PR) and adjusted prevalence ratios (aPR) with their respective 95% confidence interval (CI) were estimated. RESULTS: The analysis included 15,334 women aged 15-49 years. It was found that a high proportion of women had a low level of autonomy (42.6%; 95% CI: 41.5-43.7), while 92.1% (95% CI: 91.3-92.9) had institutionalized childbirth. Moderate (PR: 1.10; 95% CI: 1.08-1.12) and high (PR: 1.13; 95% CI: 1.12-1.15) levels of women's autonomy were found to be associated with institutionalized childbirth, and the same association was found in the adjusted analysis. CONCLUSION: Being a woman with a higher level of autonomy was related to a higher prevalence of institutionalized childbirth. Therefore, as decision-making is a multifactorial characteristic, it is necessary to study in depth the determinants of non-institutionalized childbirth in women with less autonomy.

Physical abuse in childhood and intimate partner violence in Peruvian women: A population-based survey, 2019.

Intimate partner violence (IPV) is a global health problem and a violation of individual rights. The objective of this study was to assess the association between physical child abuse and current IPV in women of childbearing age in Peru. An analytical cross-sectional analysis of the data from the 2019 Demographic and Family Health Survey was carried out. IPV was constituted by emotional, physical and sexual violence, while physical child abuse was constructed from variables related to physical punishment that women of childbearing age experienced during childhood. Poisson's family generalized linear models were used for the crude and adjusted analyses to determine the association between physical child abuse and IPV. Data from a total of 21,518 women of childbearing age were included. 67.1% of women experienced physical abuse in childhood, while 57.7% experienced intimate partner violence. After adjusting for the characteristics of the woman, the partner or husband, marriage or relationship and the home, it was observed that having experienced physical abuse during childhood increased the probability of experiencing emotional (adjusted prevalence ratio [aPR] 1.15; 95% confidence interval [CI]: 1.09-1.21), physical (aPR 1.33; 95% CI: 1.20-1.47), sexual (aPR 1.57; 95% CI: 1.26-1.96) and any type of violence (aPR 1.15; 95% CI: 1.09-1.21) in adulthood. In conclusion, physical abuse during childhood is a public health issue in Peru. This study shows that women aged 15 to 49 who experienced physical abuse in childhood are more likely to experience intimate partner violence.

Prevalence of hepatitis C virus infection in patients with end-stage renal disease in Latin America and the Caribbean: a systematic review and meta-analysis.

AIM: To estimate the prevalence of hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) undergoing hemodialysis in Latin America and the Caribbean (LAC). MATERIALS AND METHODS: Observational studies published in Spanish, Portuguese, and English language by November 25, 2021, in PubMed, Embase, Web of Science, Scopus, SciELO, and LILACS were selected by two reviewers according to predefined eligibility criteria. Study quality was assessed using the US National Heart, Lung and Blood Institute tool for observational cohort and cross-sectional studies. A meta-analysis of proportions was performed using a random-effects model based on the DerSimonian and Laird method, using R. PROSPERO N°: CRD42018107403. RESULTS: A total of 20 studies were included in the narrative synthesis (15 from Brazil, two from Cuba, two from Argentina, and one from Peru). Only 17 studies were included in the meta-analysis (13 from Brazil, two from Argentina, one from Cuba, and one from Peru). The overall prevalence of HCV in ESRD patients undergoing hemodialysis in LAC was 11.3% (95% confidence interval [CI]: 8.9% - 13.9%; I2: 99 %). In Brazil and Argentina, the prevalence was 6% and 26.1%, respectively. Prevalence after excluding poor-quality studies was 10.7%. CONCLUSION: The prevalence of HCV in ESRD patients undergoing hemodialysis in LAC was 11.3%. The implementation of infection control measures in hemodialysis centers in LAC is required. It is also necessary to increase the number of studies on the subject in the ESRD population in most LAC countries.

Socio-economic inequalities in the consumption of fruits and vegetables in Peru between 2014 and 2019.

OBJECTIVE: To estimate the prevalence and socio-economic inequalities in adequate consumption of fruits and vegetables in Peru between 2014 and 2019. DESIGN: Analytical cross-sectional study. The outcome variable was adequate consumption of fruits and vegetables, defined as the consumption of five or more servings of fruits and vegetables per d (yes/no). We used concentration curves and Erreygers concentration index to describe socio-economic inequalities and a microeconometric approach to determine the contribution of each variable to inequality. SETTING: Peru. PARTICIPANTS: Data from Peruvians aged 18 years or older collected by the Demographic and Family Health Survey. RESULTS: The prevalence of adequate fruit and vegetable consumption did not change between 2014 (10·7 %; 95 % CI (10·0, 11·4)) and 2019 (11 %; 95 % CI (10·4, 11·7)). We found socio-economic inequalities in the adequate consumption of fruits and vegetables, with wealthier individuals having a higher prevalence of adequate consumption compared to poorer individuals in 2014 (19·2 % v. 3·5 %) and 2019 (18·6 % v. 4·7 %). The decomposition analysis found that education, urban areas and being wealthy were the main factors associated with socio-economic inequality in adequate fruit and vegetable consumption, being structural problems of society. CONCLUSION: Despite the current regulations on healthy eating in Peru, adequate consumption of fruits and vegetables remains low, and there are socio-economic inequalities between the poorest and wealthiest individuals. Our findings suggest that more efforts are needed to increase the intake and assess the disparities in adequate fruit and vegetable consumption.

Factors associated with the consumption of table salt with inadequate iodine concentrations: a population analysis at a Peruvian household level.

OBJECTIVE: Iodine deficiency is a public health problem, especially in Peru, where it affects women of childbearing age and school-age children. The objective of the study was to conduct a household-level analysis of the factors associated with the consumption of table salt with inadequate amounts of iodine in Peru. DESIGN: Analytical cross-sectional study using Peruvian household-level data from the Demographic and Family Health Survey. Table salt iodine concentrations were considered as the dependent variable ('inadequate' with iodine levels <30 PPM and 'adequate' with levels ≥30 PPM). The association between iodine concentrations in salt and independent variables was evaluated using crude and adjusted log-binomial regression models. SETTING: Peru. PARTICIPANTS: A total of 25 007 households were included. RESULTS: In Peru, 21·8 % households had inadequate table salt iodine concentrations. Belonging to the poorer and poorest wealth index, living in the Highlands natural region, and living with women of childbearing age with native mother tongue were identified as factors associated with inadequate iodine concentrations in table salt. CONCLUSIONS: There is an urgent need to ensure that table salt with adequate iodine concentrations is available for poor populations, residents of the Highlands and households with ethnic presence. Likewise, it is necessary to promote good storage practices, greater regulation/law enforcement and better monitoring of the companies that manufacture or sell this product. Furthermore, the population needs to be informed of the disorders associated with iodine deficiency.

Cut-off points of anthropometric markers associated with hypertension and diabetes in Peru: Demographic and Health Survey 2018.

OBJECTIVE: To determine the optimal anthropometric cut-off points for predicting the likelihood ratios of hypertension and diabetes in the Peruvian population. DESIGN: A cross-sectional study was performed to establish cut-off values for body mass index (BMI), waist circumference (WC), waist:height ratio (WHtR) and Conicity index (C-index) associated with increased risk of hypertension and diabetes. Youden's index (YIndex), area under the curve (AUC), sensitivity and specificity were calculated. SETTING: Peruvian households. PARTICIPANTS: Peruvian population over the age of 18 years. RESULTS: A total of 31 553 subjects were included, 57 % being women. Among the women, 53·06 % belonged to the 25- to 44-year-old age group [mean age: 41·66 in men and 40·02 in women]. The mean BMI, WHtR and C-index values were higher in women 27·49, 0·61, 1·30, respectively, while the mean WC value was higher in men 92·12 cm (sd ± 11·28). The best predictors of hypertension in men were the WHtR (AUC = 0·64) and the C-index (AUC = 0·64) with an optimal cut-off point of 0·57 (YIndex = 0·284) and 1·301 (YIndex = 0·284), respectively. Women showed an AUC of 0·63 and 0·61 in the WHtR and C-index, respectively, with an optimal cut-off of 0·61 (YIndex = 0·236) and 1·323 (YIndex = 0·225). The best predictor for diabetes was the C-index: with an AUC = 0·67 and an optimal cut-off of 1·337 (YIndex = 0·346) for men and an AUC = 0·66 and optimal cut-off of 1·313 (YIndex = 0·319) for women. CONCLUSIONS: Our findings show that in Peruvian adults, the WHtR and the C-index have the strongest association with hypertension in both sexes. Likewise, the C-index had the strongest association with diabetes.

Rural and urban disparities in oral hygiene practices among Peruvian children aged less than 12 years: Demographic and Family Health Survey 2018.

INTRODUCTION: The adoption of adequate oral hygiene practices is important for the maintenance of good oral health in children. Rural-urban differences in the achievement of this important issue in Peru remain unknown. The objective of this study was to assess rural-urban differences in the proportion of adequate oral hygiene practices in Peruvian children aged less than 12 years, as well as associated sociodemographic factors. METHODS: This was a cross-sectional study of the 2018 Peruvian Demographic and Family Health Survey. Data from 41 330 children aged 1-11 years and their caregivers with complete information on oral hygiene practices were included in the study. Crude and adjusted prevalence ratios and 95% confidence intervals were estimated as measures of association between adequate oral hygiene practices (defined as toothbrushing two or more times a day, having a toothbrush for individual use and changing toothbrushes every 3 months) and sociodemographic variables. RESULTS: The prevalence of adequate oral hygiene practices was 38.3% in the rural area and 57.3% in urban areas. The greatest rural-urban disparities for adequate oral hygiene practices were observed in the age group of 6-11 years (43.4% v 64.1%), those in families in which the head of the household had no formal education (28.1% v 47.3%) or primary education (36.8% v 53.0%), those who had used dental services in the previous 6 months (46.4% v 64.4%) and those residing in the highlands (31.5% v 48.2%). All independent variables were significantly associated with adequate oral hygiene practices in rural areas, except for the jungle region variable and the richest wealth index. CONCLUSION: Four out of ten Peruvian children living in rural areas perform adequate oral hygiene practices compared to six out of ten children in urban areas. Furthermore, inequalities in the adoption of oral hygiene practices favor urban children according to sociodemographic factors. Strengthening of oral health promotion strategies is urgently needed in order to decrease inequalities in the adoption of adequate oral hygiene in children living in rural areas of Peru and countries with similar sociodemographic characteristics.

Dynamics of depressive symptoms and within-country migration among Peruvian women.

INTRODUCTION: Peru has experienced a significant internal migration from rural to urban areas in recent years. This study estimates the prevalence of depressive symptoms in Peruvian women of childbearing age and their probability of having these symptoms according to the condition of internal migration. METHODS: Data from the 2014-2018 Demographic and Family Health Survey (ENDES) was used. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Adjusted odds ratios and the marginal effects were estimated to assess associated factors and the probability of having depressive symptoms in relation to internal migration status, respectively. RESULTS: The prevalence of depressive symptoms (PHQ-9≥10 points) decreased from 2014 to 2018, as did the prevalence of these symptoms for all the internal migration status. There was a positive relationship between the post-migration residence time and the probability of having depressive symptoms. Furthermore, compared to women in rural areas who never migrated, all of the other migrant statuses were associated with an increased probability of depressive symptoms. Other factors such as being the head of the household, being married/cohabiting or separated/divorced/widowed, smoking, alcohol consumption, diabetes, having an impairment and living at levels of altitude greater than 500 m were associated with a higher probability of having depressive symptoms. CONCLUSION: Despite a reduction in the overall burden of depressive symptoms, the migrant subgroup population has a higher probability of presenting these symptoms. Mental health strategies for migrant women are a priority in Peru.

Trends in mortality due to gastrointestinal diseases attributed to alcohol use in Peru from 2003 to 2016.

OBJECTIVE: To assess and identify changes in the temporal trend in mortality from alcohol-attributable gastrointestinal diseases and their disease burden based on years of life lost (YLL) in Peru. MATERIALS AND METHODS: An ecological study of the death records of the Ministry of Health of Peru was conducted from 2003-2016. A gastrointestinal death attributable to alcohol was considered if the basic, intermediate, or final cause of death included ICD-10 codes: K70, K700-4, K709, K292, K852, and K860. Crude and age-adjusted mortality rates were calculated for the general population aged 15 or older and by sex, and YLL. Joinpoint regression analysis was performed to evaluate trends in mortality. RESULTS: There were 11 148 deaths by alcohol-attributable gastrointestinal diseases, being more frequent in males (74.89%), in adults aged 45 years and above (83.67%), living in urban area (69.87%) and the Andes region (60.0%), and in subjects with liver disease (85.98%). Adjusted mortality rates varied from 6.21 (95% CI: 5.78-6.63) in 2003 to 3.95 (95% CI: 3.67-4.22) in 2016. The trend of mortality decreased in the general population (APC: -6.17, 95% CI: -9.9 to -2.2, p=0.007) during the period 2008-2016. Deaths from the causes studied generated 224 545 YLL. CONCLUSIONS: A declining trend was found in gastrointestinal deaths attributable to alcohol in the period 2008-2016. The highest mortality occurred in males, individuals aged 45 years and above, living in urban areas and the Andes region.

Non-vaccination Against COVID-19 Among Venezuelan Refugees and Migrants Adults in Peru: A Cross-sectional Study, 2022.

OBJECTIVES: The purpose of this study was to determine factors associated with non-vaccination against coronavirus disease 2019 (COVID-19) among the Venezuelan immigrant population residing in Peru. METHODS: A cross-sectional study was conducted using data obtained from the Second Survey of the Venezuelan Population Residing in Peru in 2022. The dependent variable was vaccination status against COVID-19. The independent variables included socio-demographic, economic, and migratory characteristics of the included population. Crude and adjusted generalized linear Poisson-family models were used to calculate prevalence ratios with 95% confidence intervals (CIs). RESULTS: A total of 7739 Venezuelan migrants aged 18 years or older were included. The proportion of non-vaccination against COVID-19 was 5.7%. Regarding associated factors, unemployment (adjusted prevalence ratio [aPR], 1.31; 95% CI, 1.04 to 1.65) was linked to an increased likelihood of not being vaccinated against COVID-19. In contrast, women (aPR, 0.76; 95% CI, 0.61 to 0.95), possessing a migration permit (aPR, 0.41; 95% CI, 0.31 to 0.54), and having health insurance (aPR, 0.47; 95% CI, 0.27 to 0.81) were associated with a decreased likelihood of being unvaccinated. CONCLUSIONS: The primary governmental and non-governmental institutions responsible for supporting and protecting the Venezuelan migrant and refugee population should improve vaccination access by issuing migration permits and providing health insurance.

Geographic and Socioeconomic Determinants of Full Coverage COVID-19 Vaccination in Peru: Findings from a National Population-Based Study.

Despite the fact that vaccination coverage against COVID-19 has made great progress in Peru, there is still a quarter of the population that has not been fully vaccinated. This study aims to determine the factors associated with complete vaccination in Peruvian adults. An analysis of the National Household Survey 2022 in Peru was performed. Prevalence ratios with their 95% confidence intervals (95% CI) were estimated to assess the factors associated with vaccination with three or more doses of the COVID-19 vaccine. A total of 58,471 participants were included in the study and 75.8% of the surveyed population were found to have received full vaccination. Significant differences in complete coverage were observed according to sex, age, educational level, ethnicity, poverty status, and geographic location. In the adjusted analysis, individuals aged 60 years or older, those with higher educational attainment, the non-poor, and those living in urban areas were more likely to be fully vaccinated. Native individuals and people who live in households without media are less likely to be fully covered. These results highlight the importance of considering demographic and socioeconomic factors when analyzing COVID-19 vaccination coverage. Additional strategies are needed to address vaccination gaps and ensure better vaccination coverage.

Binge drinking and suicidal ideation in Peruvian adolescents: Evidence from a pooled cross-sectional survey.

BACKGROUND: Binge drinking and suicidal ideation are public health problems that have consequences on the well-being of Peruvian adolescents. This study aimed to evaluate the relationship between binge drinking and suicidal ideation in Peruvian adolescents. METHODS: A secondary data analysis of the health questionnaire of the Demographic and Family Health Surveys from 2013 to 2019 was performed. The outcome variable was suicidal ideation in the last 14 days, assessed with one of the Patient Health Questionnaire (PHQ-9) questions, while the independent variable was binge drinking in the last 30 days. Generalized linear models of the Poisson family with logarithmic link (crude and adjusted) were used to assess the association of interest. RESULTS: Data from a total of 11,609 participants were analyzed. The pooled prevalence of suicidal ideation was 8.5 % (95 % confidence interval [CI]: 7.8-9.2), and that of binge drinking was 5.8 % (95 % CI: 5.2-6.5). An association was found between binge drinking and suicidal ideation in the adjusted analysis (adjusted prevalence ratio: 2.95; 95 % CI: 1.69-3.09). LIMITATIONS: The cross-sectional design of the study does not allow for establishing a causal relationship. CONCLUSIONS: Between 2013 and 2019, nine out of every 100 Peruvian adolescents had suicidal ideation, and six out of every 100 adolescents had binge drinking. An association was found between both risk behaviors in Peruvian adolescents.

Altitude and Its Association with Low Birth Weight among Children of 151,873 Peruvian Women: A Pooled Analysis of a Nationally Representative Survey.

The aim of this study was to determine the relationship between the altitude of residence and the low birth weight (LBW) of the children of pregnant Peruvian women using a nationally representative database. An analysis of individual-level data from the last 13 years (from 2009 to 2021) of the Demographic and Family Health Survey was performed. The outcome variable was LBW, defined as birth weight less than 2500 g, while the independent variable was the altitude of residence in meters above sea level (masl). To estimate the association between the two variables, the crude and adjusted generalized linear model of the Poisson family with a log link was used along with crude and adjusted prevalence ratios, which were estimated with their respective 95% confidence interval. A total of 151,873 women aged 15-49 years were included between 2009 and 2021. The pooled proportion of LBW was 7.0%. As the main finding, the children of mothers residing at an altitude from 2500 to 3499 masl and ≥3500 masl had a higher probability of LBW. It was found that the children of mothers residing at an altitude above 2500 masl were more likely to have LBW. Our results will help to strengthen the cultural practice of maternal health care and increase its coverage in women residing in high-altitude regions.

Escherichia coli Contamination of Water for Human Consumption and Its Associated Factors in Peru: A Cross-Sectional Study.

The objective of the study was to determine the factors associated with the presence of Escherichia coli contamination in water supplies for human consumption in Peru. A secondary analysis of the Food and Nutrition Surveillance by Life Stages survey (VIANEV) of 2017-2018 was performed. The presence of E. coli contamination in the water samples for human consumption of the households evaluated was defined as a dependent variable. A supply was considered contaminated when there was at least 1 colony-forming unit of E. coli in 100 mL of water for human consumption. Data from 886 participants were analyzed. It was found that 25.2% of household water supply sources for human consumption had E. coli at the time of sampling. Water reservoirs such as buckets or other containers (adjusted prevalence ratio [aPR]: 1.15; 95% confidence interval [CI]: 1.18-1.93), households belonging to a poor wealth quintile (aPR: 1.82; 95% CI: 1.01-3.25), residing in a rural area (aPR: 1.36; 95% CI: 1.01-1.83), and having a low human development index (aPR: 2.12; 95% CI: 1.15-3.91) were more likely to contain E. coli in water supplies for human consumption. However, households with chlorine concentrations of 0.5 mg/L or more in water (aPR: 0.20; 95% CI: 0.11-0.33) and with household members with a higher education (aPR: 0.67; 95% CI: 0.45-0.99) were less likely to contain E. coli in drinking-water supplies. From 2017 to 2018, one in four Peruvians had contamination by E. coli in the water supply to their homes, which was associated with sociodemographic factors, management, and water treatment.

Determinants, inequalities, and spatial patterns of diarrhea in the Peruvian under-five population: findings from nationally representative survey data.

Objective: To determine the associated factors, decompose the socioeconomic inequalities, and analyze the spatial distribution of childhood diarrhea in Peru. Methods: A cross-sectional analytical study was conducted using data from the National Demographic and Family Health Survey 2021. The dependent variable was the presence of diarrhea in the last two weeks. Three types of analysis were performed: (i) to evaluate the associated factors, generalized linear models of the Poisson family with logarithmic link were applied and prevalence ratios with their 95% confidence intervals were reported; (ii) for the analysis of inequalities, a decomposition of the Erreygers concentration index was performed using a generalized linear model; and (ii) a spatial autocorrelation analysis, hot spot analysis and cluster and outlier analysis were performed. Results: A total of 18,871 children under 5 years of age were included. The prevalence of diarrhea in this population was 10.0%. Determinants such as being aged 0-23 months, being male, belonging to the poorest, poorer and rich wealth index, and residing in the Highlands and Jungle increased the probability of presenting diarrhea. In the decomposition analysis, diarrhea had a pro-poor orientation, with the greatest contributors were age 0-23 months, belonging to the poorest and poorer wealth indexes, and residing in the Highlands and Jungle. Spatial analysis showed that the highest concentrations and occurrence of this event were observed in departments of the Highlands and Jungle. Conclusion: Government institutions seeking to reduce the numbers and burden of childhood diarrhea should focus their strategies on promoting hygiene measures and improving access to water and sanitation services, especially in poor populations living in the Peruvian Highlands and Jungle.

Women's Autonomy and Anemia in Children under Five Years of Age: A Peruvian Population-Based Survey.

To determine the association between women's autonomy and the presence of childhood anemia in children under five years of age in Peru, a cross-sectional study utilizing data from the 2019 Demographic and Family Health Survey was carried out. The study employed generalized linear models with a Poisson distribution and log link function. Crude and adjusted prevalence ratios (aPR) were calculated, along with their corresponding 95% confidence intervals (CI), to assess the association of interest. A total of 15,815 women and their children under five years of age were analyzed. The prevalence of childhood anemia was 30.4% (95%CI: 29.5-31.3%), while the proportions of low, moderate and high autonomy of the mothers were 44.5%, 38.4% and 17.1%, respectively. Children under five years of age of women with a low level of autonomy were more likely to have anemia (aPR: 1.10; 95%CI: 1.00-1.21). Three out of ten children under five years of age suffer from anemia, and four out of ten mothers have a low level of autonomy. A low level of women's autonomy was associated with a higher probability of anemia in children under 5 years of age.

Association between Disability and Unmet Food Needs in the Venezuelan Migrant and Refugee Population: Analysis of a Population-Based Survey, 2022.

In Peru, Venezuelan migrants and refugees have been exposed to food shortages before their emigration. This problem could have worse outcomes in vulnerable populations (such as people with disabilities); however, the literature on the basic needs of this population is still scarce. The objective was to determine the association between the presence of disability and the unmet need for access to food in the household of the Venezuelan migrant and refugee population residing in Peru. A cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru (ENPOVE 2022). The outcome variable was unmet need for food, while the independent variable was the presence of disability. Poisson log generalized linear regression models (crude and adjusted for potential confounding variables) were fitted to evaluate the association between the variables of interest, reporting prevalence ratios (PR) and 95% confidence intervals (CIs). A total of 7739 migrants and refugees from Venezuela were included. The proportion of unmet need for access to food in the household was 45.2%, while the proportion of disability was 2.1%. People with disabilities were found to be more likely to have an unmet need for access to food at home (adjusted PR [aPR]: 1.25; 95% CI: 1.08-1.46; p = 0.003). According to our findings, almost half of Venezuelan households were found to have an unmet need for access to food. In addition, Venezuelan migrants and refugees with disabilities were more likely to have an unmet need for this basic need.

Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis.

OBJECTIVE: To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. DATA SOURCES: Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. SELECTION OF STUDIES: Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. DATA COLLECTION: Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. DATA SYNTHESIS: Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. CONCLUSION: There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

OBJETIVO: Determinar a associação entre macrossomia fetal (FM) e hemorragia pós-parto (HPP) em mulheres da América Latina e Caribe (ALC). FONTES DE DADOS: Estudos avaliando a associação entre FM e HPP (≥ 500 ml) e HPP grave (≥ 1.000 ml) até 4 de novembro de 2021, indexados no CINHAL, Scopus, Embase, Biblioteca Cochrane, MEDLINE, LILACS e SciELO. SELEçãO DE ESTUDOS: Os critérios de inclusão foram estudos de corte e caso-controle que forneceram o número de casos de HPP e FM. Os critérios de exclusão foram estudos sem informação sobre o número de casos, com uma população de mulheres que não eram da ALC; publicado em um idioma diferente do inglês, espanhol ou português e com um design diferente. COLETA DE DADOS: A extração de dados foi realizada independentemente por dois autores, as discrepâncias foram resolvidas com um terceiro autor. Os dados relativos aos casos de FM e HPP foram recuperados. SíNTESE DOS DADOS: Dos 1.044 artigos avaliados, foram incluídos 5 estudos, de 6 países diferentes: Argentina e Uruguai (multipaíses), Índias Ocidentais, Antígua e Barbuda, Guiana Francesa e Suriname. O odds ratio agrupado (OR) para FM e HPP na meta-análise (cinco estudos) foi de 2,10 (intervalo de confiança de 95% [IC]: 1,79­2,47; I2: 0%), com estimativas dentro deste IC de 95% no análise sensitiva. O OR combinado para HPP grave (3 estudos) foi de 1,61 (95% CI: 0.40­6.48; I2: 91.89%), mostrando alta heterogeneidade. CONCLUSãO: Houve associação positiva entre FM e HPP na ALC, aumentando em 2 vezes o risco da presença desse evento. A alta heterogeneidade dos estudos que mediram a HPP grave não permite tirar conclusões sobre as estimativas obtidas.