Inequalities in COVID-19 vaccination coverage in Peru: An ecological study.

Objective: To assess the correlation between COVID-19 vaccination coverage and the Human Development Index (HDI) at the provincial level in Peru. Study design: Ecological study. Methods: We conducted a cross-sectional ecological study based on secondary data analysis. Coverages of the first, second, and third doses of the vaccine against COVID-19 and the HDI were evaluated. The magnitude of the correlations was assessed using Spearman's rank correlation coefficients with their corresponding bootstrapped 95% confidence intervals (95% CI). Scatter plots were also constructed. Results: A total of 196 provinces were included. There was a moderate correlation between the first dose of the COVID-19 vaccine and the HDI (r = 0.3807 [95% CI 0.2585-0.5030], p < 0.0001). The same direction was found for the second (r = 0.4064 [95% CI 0.2853-0.5276], p < 0.0001) and third dose (r = 0.4435 [95% CI 0.3201-0.5669], p < 0.0001). Conclusions: A positive correlation was found between COVID-19 vaccination coverage and the HDI, suggesting the presence of inequalities in access to vaccines. Individualised strategies are needed in lower HDI regions to tackle inequalities.

Spatial and socioeconomic inequalities in the access to safe drinking water in Peruvian households.

Access to safe drinking water has increased in Peru over the last decades, from 47% (2008) to 52% (2018). Nevertheless, such access would differ according to socioeconomic and regional factors. Thus, this study aimed to assess the socioeconomic inequality in the access to safe drinking water and identify its spatial distribution. We conducted a cross-sectional study based on the secondary data analysis of the 2021 Peruvian Demographic and Health Survey. Access to safe drinking water was a dummy variable categorised as safe if the residual chlorine concentration was ≥0.5 mg/L. Nationwide, 29.22% of households had access to safe drinking water. A pro-rich inequality in access to safe drinking water was observed. The spatial distribution was clustered. Significant hotspots were found in the south and centre of the country; however, cold spots were found in most areas. SaTScan analysis identified 32 and 63 significant clusters at high and low risks of having access to safe drinking water, respectively. In conclusion, approximately one out of four Peruvian households has access to safe drinking water, which was mostly concentrated among the wealthier households. Intra- and interdepartmental inequalities in access to safe drinking water were found, with several high-risk clusters.

Factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru: A population-based cross-sectional study.

BACKGROUND: Ensuring broad COVID-19 vaccination coverage among migrants is a global public health concern. Thus, our study aimed to assess the factors associated with not receiving the primary series and booster dose of the COVID-19 vaccine among Venezuelan migrants in Peru. METHODS: This was a cross-sectional study based on secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. Our population included Venezuelan migrants and refugees over 18 years old living in Peru with complete information for the variables of interest. Two outcome variables were assessed: not receiving the primary series and not receiving the booster dose of the COVID-19 vaccine. Crude and adjusted prevalences were calculated with 95% confidence intervals. RESULTS: A total of 7,727 Venezuelan adults were included in our study, of whom 6,511 completed the primary series. The overall COVID-19 vaccination coverage of the primary series was 84.17%, whilst the coverage of the booster dose was 28.06%. Being younger, uninsured, illegally-staying, and having a low educational level were associated with both outcomes. CONCLUSION: Several sociodemographic and migration-related variables were associated with both outcomes. Governmental policies prioritizing vaccination among Venezuelan migrants are needed to ensure broad coverage in this vulnerable group.

Inequalities in infant vaccination coverage during the COVID-19 pandemic: A population-based study in Peru.

OBJECTIVE: To identify the associated factors and assess the inequalities of full vaccination coverage (FVC) among Peruvian infants aged 12-23 months during the COVID-19 pandemic in a nationally representative sample. METHODS: We carried out a population-based cross-sectional study based on a secondary data analysis using the 2021 Peruvian Demographic Health Survey (DHS) in infants aged 12 to 23 months. The sampling design was probabilistic, multistage, stratified, and independent at both departmental and area of residence levels. FVC was defined according to the WHO definition. We performed generalized linear models (GLM) Poisson family log link function to estimate crude (aPR) and adjusted prevalence ratios (aPR). Also, for inequality assessment, we calculated the concentration curve (CC), concentration index (CI), and Erreygers normalized concentration index (ECI). RESULTS: We included 4,189 infants in our analysis. Nationwide, the prevalence of FVC was 66.19% (95% CI: 64.33-68). Being younger, having a mother with no education or primary education, belonging to a large family, having no access to mass media, having had six or fewer ANC visits, and having a mother whose age was under 20 at first delivery were inversely associated with FVC. Meanwhile, living in the Highlands or on the rest of the coast, and living in rural areas were directly associated with FVC. We found a pro-rich inequality in FVC based on wealth-ranked households (CI: 0.0066; ECI: 0.0175). CONCLUSION: FVC has dropped among Peruvian infants aged between 12 and 23 months. There were several factors associated with FVC. It was more concentrated among the better-off infants, although in low magnitude.

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population.

PURPOSE: Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed. FINDINGS: Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91-5.03), hypertension (aPR 7.20; 95% CI: 6.28-8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62-2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes. ORIGINALITY/VALUE: The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.

Spatial distribution, determinants and trends of full vaccination coverage in children aged 12-59 months in Peru: A subanalysis of the Peruvian Demographic and Health Survey.

OBJECTIVE: To assess the spatial distribution, trends and determinants of crude full vaccination coverage (FVC) in children aged 12-59 months between 2010 and 2019 in Peru. DESIGN, SETTING AND ANALYSIS: A cross-sectional study based on the secondary data analysis of the 2010 and 2019 Peruvian Demographic and Health Surveys (DHSs) was conducted. Logit based multivariate decomposition analysis was employed to identify factors contributing to differences in FVC between 2010 and 2019. The spatial distribution of FVC in 2019 was evaluated through spatial autocorrelation (Global Moran's I), ordinary kriging interpolation (Gaussian process regression) and Bernoulli-based purely spatial scan statistic. OUTCOME MEASURE: FVC, as crude coverage, was defined as having completely received BCG; three doses of diphtheria, pertussis, and tetanus, and polio vaccines; and measles vaccine by 12 months of age. PARTICIPANTS: A total of 5 751 and 14 144 children aged 12-59 months from 2010 and 2019 DHSs, respectively, were included. RESULTS: FVC increased from 53.62% (95% CI 51.75% to 55.49%) in 2010 to 75.86% (95% CI 74.84% to 76.85%) in 2019. Most of the increase (70.39%) was attributable to differences in coefficients effects. Family size, visit of health workers in the last 12 months, age of the mother at first delivery, place of delivery and antenatal care follow-up were all significantly associated with the increase. The trend of FVC was non-linear and increased by 2.22% annually between 2010 and 2019. FVC distribution was heterogeneous at intradepartmental and interdepartmental level. Seven high-risk clusters of incomplete coverage were identified. CONCLUSIONS: Although FVC has increased in Peru, it still remains below the recommended threshold. The increase of FVC was mainly attributed to the change in the effects of the characteristics of the population. There was high heterogeneity across Peruvian regions with the presence of high-risk clusters. Interventions must be redirected to reduce these geographical disparities.