Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana / Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima

RESUMEN Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

ABSTRACT We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

Prevalence and Determinants of Adequate Compliance with Antenatal Care in Peru / Prevalência e determinantes da conformidade adequada à atenção pré-natal no Peru

Abstract Objective To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors. Methods An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model. Results A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC. Conclusion Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.

Resumo Objetivo Determinar a adequação do cumprimento dos cuidados pré-natais (CPN) por mulheres grávidas no Peru e identificar os fatores associados. Métodos Foi realizado um estudo analítico transversal dos dados da Pesquisa Demográfica e de Saúde da Família Peruana de 2019 (Encuesta Demográfica y de Salud Familiar, ENDES, em espanhol). A variável dependente foi conformidade adequada coma CPN (fornecida por profissionais de saúde qualificados; primeira visita CPN durante o primeiro trimestre de gravidez; seis ou mais visitas CPN durante a gravidez; visitas CPN com conteúdo apropriado) por mulheres de 15 a 49 anos em seu último parto nos cinco anos anteriores à pesquisa. Os índices de prevalência bruta e ajustada e seus intervalos de confiança de 95% foram calculados usando um modelo de regressão log-binomial. Resultados Foi analisado um total de 18.386 mulheres, das quais 35,0% cumpriram adequadamente o CPN. A menor proporção de conformidade foi encontrada com o conteúdo de ANC (42,6%). Fatores sociodemográficos e aqueles relacionados à gravidez, como estar na faixa etária de 20 a 34 anos e 35 a 49 anos, ter educação secundária ou superior, pertencer a um quintil de riqueza da população que não a mais pobre, ser da região da selva, não ser de etnia nativa, ter um segundo ou terceiro gravidez, e tendo uma gravidez desejada, aumentou a probabilidade de apresentar conformidade adequada com CPN. Conclusão Apenas 3 em cada 10 mulheres no Peru mostraram conformidade adequada com o CPN. O cumprimento do conteúdo do CPN deve ser melhorado, e estratégias devem ser desenvolvidas para aumentar a proporção de cumprimento adequado com o CPN.

Exceso de mortalidad en Lima Metropolitana durante la pandemia de COVID-19: comparación a nivel distrital / Excess mortality in Metropolitan Lima during the COVID-19 pandemic: a district level comparison

OBJECTIVE: To compare excess mortality by district quintiles according to the Human Development Index (HDI) in Metropolitan Lima, the capital of Peru, and analyze the socioeconomic factors associated with excess mortality within the context of COVID-19. METHODS: Retrospective cross-sectional analysis of the mortality records from non-violent causes registered in the National Death Information System in the 50 districts of Metropolitan Lima of the first 24 weeks of the years 2019 and 2020. Descriptive analysis was performed using contingency tables and time series graphs by sex, age group, and quintile of the district of residence according to the HDI. Negative binomial regression analysis was performed to identify possible explanatory factors for excess mortality. RESULTS: An excess of 20 093 non-violent deaths and 2,979 confirmed deaths from COVID-19 were registered in Metropolitan Lima during the study period. The increase was observed primarily in men and adults aged 60 and over. Residents in the districts belonging to the fifth quintile, according to HDI, presented, in most cases, the lowest rates. Multivariate analysis revealed that a higher HDI level (p = 0.009) and a higher proportion of inhabitants living in extreme poverty (p = 0.014) decreased the excess mortality. CONCLUSION: Excess of non-violent deaths in Metropolitan Lima is higher in the quintiles with the lowest HDI, in men, and the age group from 60 to more years of age. The study of social and economic health determinants in Peru is crucial for the design of measures to be taken by the government against the COVID-19 pandemic.

OBJETIVO: Comparar el exceso de muertes según quintiles distritales del Índice de Desarrollo Humano (IDH) en Lima Metropolitana, capital de Perú, y analizar los factores socioeconómicos asociados con el exceso de muertes en el contexto de la COVID-19. MÉTODOS: Estudio transversal retrospectivo de los registros de mortalidad por causas no violentas registrados en el Sistema Informático Nacional de Defunciones de los 50 distritos de Lima Metropolitana durante las primeras 24 semanas de los años 2019 y 2020. Se realizó un análisis descriptivo mediante tablas de contingencia y gráficos de series de tiempo por sexo, grupo de edad y quintil del distrito de residencia según el IDH. Se realizó un análisis de regresión binomial negativa para identificar posibles factores asociados con el exceso de muertes. RESULTADOS: Un exceso de 20 093 muertes no violentas y 2.979 muertes confirmadas por COVID-19 se registraron en Lima Metropolitana durante el período de estudio. El exceso de mortalidad se observó especialmente en hombres y adultos de 60 años o más. Los distritos pertenecientes al quintil 5 según el IDH presentan, en la mayoría de los casos, las tasas más bajas de exceso de muertes. El análisis multivariado halló que el IDH (p = 0.009) y el porcentaje de habitantes en pobreza extrema (p = 0.014) disminuyen la tasa de exceso de muertes en Lima Metropolitana. CONCLUSIONES: El exceso de muertes no violentas en Lima Metropolitana es mayor en los quintiles con el IDH más bajo, en los hombres y en el grupo de edad de 60 a más años. El estudio de los determinantes sociales y económicos de la salud en Perú es fundamental para el diseño de las medidas que debe tomar el gobierno contra la pandemia de COVID-19.

Cepillado dental y niveles de flúor en pastas dentales usadas por niños peruanos menores de 12 años / Tooth brushing and fluoride levels in toothpaste used by peruvian children under 12 years old

RESUMEN Análisis secundario de los datos de 41 330 niños de uno a 11 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se reportó la frecuencia de cepillado y el uso de pasta dental según el nivel de flúor (no cepillado, adecuado, inadecuado, no mostró/no usa pasta, e ilegible), según variables socioeconómicas y geográficas. Un 7,8% de los niños evaluados no se cepillaba los dientes, se evidenció diferencias porcentuales significativas (p <0,001) en el uso de pasta dental con concentración inadecuada de flúor entre las categorías extremas de las variables edad (12,3%), uso de servicios odontológicos (7,7%), nivel educativo del responsable (20,4%), índice de riqueza (17,8%), dominio geográfico (11,3%) y área de residencia (9,1%). Un porcentaje considerable de niños peruanos no se cepilla los dientes; además, un gran número de niños que se cepillan emplean pastas dentales con contenidos de flúor sin efecto preventivo.

ABSTRACT Secondary analysis of data on 41,330 children aged one to 11 from the Demographic and Family Health Survey (ENDES) carried out in 2018. The frequency of brushing and the use of toothpaste were reported according to the level of fluoride (no brushing, adequate, inadequate, did not show/did not use toothpaste, and illegible), according to socioeconomic and geographical variables. The evaluation showed that 7.8% of children did not brush their teeth; there were significant percentage differences (p <0.001) in the use of toothpaste with inadequate fluoride concentration between the extreme categories of the variables: age (12.3%), use of dental services (7.7%), educational level of the person responsible (20.4%), wealth index (17.8%), geographical domain (11.3%), and area of residence (9.1%). A considerable percentage of Peruvian children do not brush their teeth; in addition, a large number of children who brush use toothpastes with a fluoride content that has no preventive effect.

¿Qué representa cambiar el umbral diagnóstico de la hipertensión arterial? Guías ACC/AHA 2017 y su aplicación en Perú / Changes in the prevalence of hypertension in Peru using the new guideline of the American College of Cardiology

Introduction and Objective: There is little evidence in Latin America about the impact of the ACC/AHA 2017 guideline. Taking as reference the JNC 7 guideline, the objective of our study is to estimate changes in the prevalence of arterial hypertension (HBP) according to socio-demographic characteristics and geographic regions, applying the criteria of the new ACC / AHA guide 2017. Methods: Cross-sectional study of the Demographic and Family Health Survey conducted in Peru in 2017. Standardized weighted hypertension prevalence's were estimated for the WHO population according to both guidelines, and absolute differences with 95% CI. Results: We included 30,682 people aged 18 years and over, with an average age of 42.3 years, 51.1% women. The standardized prevalence of HBP for 2017 according to JNC 7 was 14.4% (95% CI: 13.8-15.1) and according to ACC / AHA 2017 it was 32.9% (95% CI: 32.0-33.7), so the prevalence increase is 18.5 percentage points, being higher in males than females (24.2 vs 12.9 respectively). In people with obesity and / or who consume tobacco, the increases were higher (24.3 and 24.1 percentage points respectively). In the regions of Tacna, Ica and Metropolitan Lima, the increase, in comparison with the JNC 7 guidelines, overcome the national average (22.4, 20.7 and 20.4, percentage points, respectively). Conclusions: Considering the context of a Latin American country and knowing the epidemiology of hypertension in Peru, the potential adoption of the ACC/AHA 2017 guidelines for the prevention, detection, evaluation, and management of hypertension should be accompanied by an evaluation of the impact at the individual, system and social level.

Gasto de bolsillo en salud en adultos mayores peruanos: análisis de la encuesta nacional de hogares sobre condiciones de vida y pobreza 2017 / Health-related out-of-pocket expenses in older peruvian adults: analysis of the national household survey on living conditions and poverty 2017

RESUMEN Objetivos. Estimar el gasto de bolsillo en salud (GBS) e identificar sus factores asociados en adultos mayores peruanos. Materiales y métodos. Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2017. Se consideró como adulto mayor a todo individuo de 60 y más años y el GBS como variable principal de estudio. Se estimaron razones de prevalencia (RP) y razones de prevalencia ajustada (RPa) para cada uno de los factores asociados a GBS. Las medias del GBS fueron estimadas mediante un modelo lineal generalizado con distribución gamma y función de enlace log. Todos los intervalos de confianza (95 %) de los estimadores fueron calculados mediante bootstrapping con el método basado en la normal. Resultados. Se incluyeron 18 386 adultos mayores, de los cuales en el 56,5 % se reportó GBS. La media y mediana del GBS es de 140,8 (USD 43,2) y 34,5 (USD 10,6) soles, respectivamente. Factores como procedencia urbana, mayor nivel de educación, padecer enfermedades crónicas y mayores gastos per cápita aumentan hasta 1,6 veces la probabilidad de GBS. En los afiliados al Seguro Integral de Salud (SIS) se reduce el GBS en 63,0 soles (USD 19,3) comparado con aquellos sin ningún seguro de salud. Conclusiones. Seis de cada diez adultos mayores peruanos reportó GBS para atender su salud. Esto genera inequidad en el acceso a los servicios de salud, principalmente para los grupos socialmente vulnerables. Se sugiere investigar el impacto económico de los seguros sanitarios y el abordaje preventivo-promocional de las enfermedades crónicas, en aras de reducir el GBS y mejorar la eficiencia del sistema de salud peruano.

ABSTRACT Objectives . To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults. Materials and Methods. Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method. Results . Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance. Conclusions . Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.

Acceso a servicios de salud dental en menores de doce años en Perú, 2014 / Access to oral health services in children under twelve years of age in Peru, 2014

RESUMEN El objetivo del estudio fue explorar los patrones de acceso a servicios de salud dental en menores de doce años en Perú. Se revisaron datos de 25.285 niños menores de 12 años que participaron en la Encuesta Demográfica y de Salud Familiar 2014. Se realizó un análisis exploratorio espacial para proyectar las proporciones de menores con acceso a servicios de salud dental según regiones a nivel nacional, tipo de servicio de salud y lugar de residencia urbana o rural. Los resultados muestran que el 26,7% de la muestra tuvo acceso a los servicios de salud dental en los últimos seis meses. El 39,6% pertenecía al grupo etario de 0 a 4 años, el 40,6% habitaba en la zona andina y un 58,3% residía en zonas urbanas. Las regiones de Huancavelica, Apurímac, Ayacucho, Lima y Pasco tuvieron los mayores porcentajes de población que accedió a servicios de salud dental a nivel nacional. En conclusión, existe un bajo acceso a los servicios de salud dental para la población menor de 12 años en Perú. La distribución espacial del acceso a los servicios de salud dental permitiría identificar y agrupar regiones según patrones comunes de acceso para enfocar acciones en materia de salud pública.

ABSTRACT The aim of the study was to explore the patterns of dental health services access in children under twelve years of age in Peru. Data from 25,285 children under 12 years who participated in the Demographic and Family Health Survey of 2014 were reviewed. An exploratory spatial analysis was performed to project the proportions of children with access to dental health services, according to national regions, type of health service and urban or rural place of residence. The results show that of the total sample, 26.7% had access to dental health services in the last six months, 39.6% belonged to the age group 0-4 years, 40.6% lived in the Andean region and 58.3% lived in urban areas. The regions of Huancavelica, Apurimac, Ayacucho, Lima and Pasco had the highest percentages of access nationwide. In conclusion, there is low access to dental health services in the population under 12 years of age in Peru. The spatial distribution of access to dental health services allows regions to be identified and grouped according to similar access patterns, in order to better focus public health actions.

Distribución espacial de los accidentes y enfermedades relacionados con el trabajo en el Perú, 2012-2014 / Spatial distribution of accidents, incidents and diseases related to work in Peru, 2012-2014

Se analizaron geoespacialmente los accidentes, incidentes peligrosos y enfermedades ocupacionales que se reportaron a nivel regional en el Perú (2012-2014). 52 887 eventos se notificaron entre accidentes de trabajo (93%), incidentes peligrosos (5,1%), enfermedades ocupacionales (1%) y accidentes mortales (0,9%). Se evidenciaron altas tasas de accidentes mortales en Pasco, Callao, Lima, Moquegua y Arequipa. Callao y Lima son las regiones con tasas más altas de accidentes de trabajo. Las mayores tasas de incidentes peligrosos se reportaron en Arequipa, Callao, Lima, Ica y Piura. Las enfermedades ocupacionales se distribuyeron con altas tasas en Huancavelica, Ancash, Pasco, Callao y Cusco. La explotación de minas y canteras (49,2%); seguida por la industria manufacturera (23,4%); y, la construcción (8%) son las actividades económicas que concentraron elevadas tasas de enfermedades ocupacionales. Se concluye que existen altas tasas y patrones espaciales comunes de accidentabilidad en el Perú que pueden servir para enfocar intervenciones...

We analyzed geospatially accidents, incidents and diseases related to work of regional reports in Peru (2012-2014). The 52887 events were classified as work related accidents (93%), dangerous incidents (5.1%), occupational diseases (1%) and fatal accidents (0.9%). The highest rates of fatal accidents were reported in Pasco, Callao, Lima, Moquegua and Arequipa. Callao and Lima are the regions with the highest rates of occupational accidents. The highest rates of dangerous incidents were reported in Arequipa, Callao, Lima, Ica and Piura. Occupational diseases are distributed with high rates in Huancavelica, Ancash, Pasco, Callao and Cusco. The economic activities that reported most of the occupational diseases were mining and quarrying (49.2%); followed by manufacturing industry (23.4%); and construction (8%). It is concluded that there are high rates and common spatial patterns of laboral accidents in Peru that could be used by decision makers to focus interventions...