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In Latin America, approximately 70 million individuals live with a disability. Although global evidence suggests that people with disabilities are one of the poorest groups and present lower employment rates, the evidence for Latin America is still weak. This article aims to contribute to the literature by estimating and analysing the levels of employment opportunity for persons with disabilities in six countries in Latin America (Chile, Bolivia, Mexico, Peru, Colombia, and Costa Rica). Using household survey data, we measure inequality of opportunities using the Paes de Barros approach and compare the probability distributions of being employed for people with disabilities according to different individual characteristics. This research makes several contributions to the literature. First, it analyses and compares the characteristics of persons with disabilities in six countries of the region. Second, it is the first paper in the region that computes and compares the levels of employment opportunities for persons with disabilities, using the Human Opportunity Index. Third, it analyses which are the main aspects contributing to the levels of employment opportunities for persons with disabilities in each of the countries. The main results of the study reveal that people with disabilities face high levels of inequality of employment opportunity compared with people without disabilities in the six countries. Peru shows the lowest disadvantage, with higher coverage of opportunities for people with disabilities. Colombia and Costa Rica were the countries where this group presents the largest disadvantages to be employed. In addition, women with disabilities and people with disabilities living in rural areas have a lower probability of being employed compared with people without disabilities. These findings reveal that policies in the region aiming to include this group in the labour market have not been effective, and there is a necessity to guarantee the proper labour inclusion of this group. [ABSTRACT FROM AUTHOR]

Community mobilisation is recognised as an important strategy to shift inequitable gender norms and ensure an enabling environment to prevent gender-based violence (GBV). Yet there is a need to better understand the factors that facilitate effective community activism in particular contexts. Although fundamental to the success of mobilisation programmes, there is also limited appreciation of the experiences and agency of engaged community activists. This paper draws on qualitative evaluations from two community mobilisation GBV prevention programmes: the Gender Violence in the Amazon of Peru (GAP) Project and the Indashyikirwa programme in Rwanda. In Peru, participatory data was collected, in addition to baseline and endline interviews with 8 activists. In Rwanda, baseline and endline interviews and observations were conducted with 12 activists, and interviews were conducted with 8 staff members. The data was thematically analysed, and a comparative case study approach was applied to both data sets. The comparative study identified similar programmatic aspects that could hinder or enable activist's engagement and development, and how these are embedded within contextual social and structural factors. We discuss these insights in reference to the current emphasis in public health on individualistic programming, with insufficient attention to how wider environments influence violence prevention programming. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exposure to PM2.5 arising from solid fuel combustion is estimated to result in ~2.3 million premature deaths and 91 million lost disability-adjusted life years annually. Interventions attempting to mitigate this burden have had limited success in reducing exposures to levels thought to provide substantive health benefits. OBJECTIVES: This paper reports exposure reductions achieved by a liquified petroleum gas (LPG) stove and fuel intervention for pregnant mothers in the Household Air Pollution Intervention Network (HAPIN) randomized controlled trial. METHODS: The HAPIN trial included 3,195 households primarily using biomass for cooking in Guatemala, India, Peru, and Rwanda. Twenty-four-hour exposures to PM2.5, carbon monoxide (CO), and black carbon (BC) were measured for pregnant women once before randomization into control (푛=1,605) and LPG (푛=1,590) arms and twice thereafter (aligned with trimester). Changes in exposure were estimated by directly comparing exposures between intervention and control arms and by using linear mixed-effect models to estimate the impact of the intervention on exposure levels. RESULTS: Median postrandomization exposures of particulate matter (PM) with aerodynamic diameter =2.5 μm (PM2.5) in the intervention arm were lower by 66% at the first (71.5 vs. 24.1 μg/m³), and second follow-up visits (69.5 vs. 23.7 μg/m³) compared to controls. BC exposures were lower in the intervention arm by 72% (9.7 vs. 2.7 μg/m³) and 70% (9.6 vs. 2.8 μg/m³) at the first and second follow-up visits, respectively, and carbon monoxide exposure was 82% lower at both visits (1.1 vs. 0.2 ppm) in comparison with controls. Exposure reductions were consistent over time and were similar across research locations. DISCUSSION: Postintervention PM2.5 exposures in the intervention arm were at the lower end of what has been reported for LPG and other clean fuel interventions, with 69% of PM2.5 samples falling below the World Health Organization Annual Interim Target 1 of 35 μg/m³. This study indicates that an LPG intervention can reduce PM2.5 exposures to levels at or below WHO targets. [ABSTRACT FROM AUTHOR]

Increasing participation in family decision making is an integral part of adolescent development. This paper uses longitudinal data from four low and middle income countries—Ethiopia, India, Peru and Vietnam—to assess the relationship between young people's involvement in schooling decision making and schooling outcomes. In the pooled sample, compared to young adults who indicate to have no say in educational choices at age 19, adolescents who make these decisions unilaterally or jointly with parents are on average 17%–23% more likely to drop out by age 22. The effects are, however, heterogenous across countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE: This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS: We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter =2.5 ηm (PM2.5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS: This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. [ABSTRACT FROM AUTHOR]

Objectives: To explore the reasons for discontinuation of the last contraceptive method used in women with a current unintended pregnancy.Study Design: We conducted a retrospective analysis using contraceptive calendar data from Demographic and Health Surveys from 36 low- and middle-income countries from 2005 through 2014. The prevalence of contraception utilization and the contribution of each reason for contraceptive discontinuation was calculated, at country level as well as for the pooled dataset, for 10,901 women aged 15-49 before the current unintended pregnancies.Results: Unintended pregnancies ranged from 5.5% of all pregnancies in the Kyrgyz Republic to 60.0% in Colombia and Peru. In Central Asian and in six African countries, over 80% of women with a current unintended pregnancy had not used any contraceptives in the previous five years. Use of long-acting modern methods remained consistently low across all countries. Among women who last used a traditional method, 83.8% discontinued due to failure. Among women who last used a long-acting modern method, 40.2% discontinued because of side effects.Conclusions: Our findings confirm that more than 65.0% of women with an unintended pregnancy in 36 low and middle-income countries were either non-users or using traditional methods. An additional 31.2% were using short-acting modern methods. Long-acting methods would have prevented the overwhelming majority of unintended pregnancies.Implications: This paper shows the need for the health system to support use of suitable methods, reduce switching failure and identify early when women are having concerns about the method they are using. [ABSTRACT FROM AUTHOR]

The successful implementation of comprehensive sexuality education (CSE) programmes in schools depends on the development and implementation of strong policy in support of CSE. This paper offers a comparative analysis of the policy environment governing school-based CSE in four low- and middle-income countries at different stages of programme implementation: Ghana, Peru, Kenya and Guatemala. Based on an analysis of current policy and legal frameworks, key informant interviews and recent regional reviews, the analysis focuses on seven policy-related levers that contribute to successful school-based sexuality education programmes. The levers cover policy development trends; current policy and legal frameworks for sexuality education; international commitments affecting CSE policies; the various actors involved in shaping CSE; and the partnerships and coalitions of actors that influence CSE policy. Our analysis shows that all four countries benefit from a policy environment that, if properly leveraged, could lead to a stronger implementation of CSE in schools. However, each faces several key challenges that must be addressed to ensure the health and wellbeing of their young people. Latin American and African countries show notable differences in the development and evolution of their CSE policy environments, providing valuable insights for programme development and implementation. [ABSTRACT FROM AUTHOR]

Background: Traditional knowledge (TK) has enabled communities to adapt to changes in life conditions over centuries. However, this local context is being dramatically affected by recent changes through globalization and modernization of societies. In this paper we seek to identify socio-economic factors that are related to the knowledge and use of two palm species in mestizo and indigenous communities in the Amazonian of Peru and Bolivia. Both species are known in the region under the main vernacular name of Asaí, and are source of two highly commercialized resources: palm-hearts and fruits. Euterpe precatoria Mart. is native to the region whereas E. oleracea Mart. is being introduced for the use of both resources. Methods: We compare TK about the two Euterpe species in both countries in relation to 14 socioeconomic factors in seven use categories. We performed a Multivariate analysis of variance (MANOVA) to elucidate the influence of each socioeconomic factor on the overall palm knowledge or on individual use categories. Results: In the two countries, we found that mestizos, speaking only Spanish, and migrants in the same ecoregion, knew more uses in all use categories for E. precatoria than for E. oleracea, even in use categories such as Medicinal and veterinary and Construction, for which indigenous participants had more uses in case of other species. In Peru, the use of E. precatoria was higher among participants with greater wealth, which could be related to the commercial importance that both the fruits and the palm-hearts have had in the markets of the region. In contrast, in Bolivia, although some income generation from Euterpe sp. was observed, the use of E. precatoria was much more homogeneously distributed. The use of E. oleracea in Bolivia is recent, and although its most important uses are related to the consumption of fruits and palm-hearts (Human food), it is now being slowly used for Medicinal and Construction purposes, similar to E. precatoria. Conclusions: The use of each of the species forms part of divergent strategies in people's livelihoods. We show that integration into a market economy does not necessarily erode TK, but can rather stimulate knowledge acquisition and transmission of knowledge, and helps to understand the role and potential of these products to contribute to the livelihoods of households. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the characteristics of Peruvian research studies on mental disorders (MD) published in SciELO-Peru during 2006-2011. Methods: A bibliometric study was conducted that included scientific papers on MD published in medical and psychological indexed journals in SciELO during 2006-2011. Articles with at least one Peruvian author whose main or secondary objectives were any MD were included. Main variables that were analyzed included kind of MD studied, author's affiliation, references and financing sources. Results: A total of 686 papers were identified in six journals, in 51 (7.4%) of these papers a MD was the main objective. Depression, substance abuse and sleeping disorders were the main topics covered. Major financing institutions were Universidad Peruana Cayetano Heredia and Universidad Nacional Mayor de San Marcos. Seven studies (13.7%) received financial support. Conclusions: Few Peruvian publications on MD were identified. [ABSTRACT FROM AUTHOR]

Chachapoya societies that lived on the forested eastern slopes of the Andes in northern Peru between A.D. 1000 and 1450 remain largely absent from broader narratives of the Andean Late Intermediate period {LIP). This paper argues that environmentally deterministic frameworks and lingering Inka biases have led scholars to problematically isolate Chachapoyans from their highland contemporaries. This work reviews three aspects of Chachapoya built environments--settlement patterning, internal organization, and architectural style--in order to provide a baseline for comparison with other regions. Chachapoyas shared a pattern of hilltop settlement locations with nearly all of the highlands, which suggests that its inhabitants faced the same shared factors that prompted changes in settlement organization on a massive scale in this region during the LIP. At the same time, comparison of Chachapoya built environments with others of the northern, central, and southern highlands highlights the considerable diversity within and between regions. This demonstrates that Chachapoyas is best interpreted as simply one of many regions that were characterized by distinctive spatialities and architectural forms. These reflected locally specific cultural practices and social institutions. Including Chachapoyas and other regions of the Eastern Andes in accounts of the LIP underscores the diversity and dynamism that characterized this period of significant change in Andean history. [ABSTRACT FROM AUTHOR]

Aim of the Study and Ethnopharmacological relevance This paper presents the first ethnobotanical survey conducted among the Achuar (Jivaro), indigenous people living in Amazonian Ecuador and Peru. The aims of this study are: (a) to present and discuss Achuar medicinal plant knowledge in the context of the epidemiology of this population (b) to compare the use of Achuar medicinal plants with the uses reported among the Shuar Jivaro and other Amazonian peoples. Materials and methods The author conducted field research in 9 indigenous villages in the region of Morona Santiago and Pastaza in Ecuador. Semi-structured interviews on local illnesses and herbal remedies were carried out with 82 informants and plant specimens were collected and later identified in Quito. A literature research was conducted on the medicinal species reported by Achuar people during this study. Results The most reported medicinal plants are species used by the Achuar to treat diarrhoea, parasites infection, fractures, wounds, and snakebites. Informants reported the use of 134 medicinal species for a total of 733 recorded use-reports. Of these 134 species, 44 are reported at least 3 times for one or more specific disease condition for a total of 56 uses. These species are considered a core kit of medicinal plants of the Achuar of Ecuador. Most of these medicinal species are widely used in the Amazon rainforest and in many other parts of Latin America. Conclusion The author documented a core kit of 44 medicinal plants used among the Achuar of Ecuador and found that this core set of medicinal plants reflects local epidemiological concerns and the pharmacopoeias of the Shuar and other Amazonian groups. These findings suggest that inter-group diffusion of medicinal plant knowledge had a prominent role in the acquisition of current Achuar knowledge of medicinal plants. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Up until now, the plant pharmacopoeia of the Chayahuita, an ethnic group from the Peruvian Amazon, has been poorly defined. This paper details the uses of medicinal plants within this community, as recorded in two villages of the Paranapura basin, Soledad and Atahualpa de Conchiyacu. This study aimed to describe the basis of the Chayahuita traditional medical system, to document part of the medicinal plant corpus, and to compare it with data from other Amazonian ethnic groups. Material and methods: Methodology was based (i) on field prospection with 26 informants (ethnobotanical walks methodology), (ii) semi-structured interviews including 93 people (49 men and 44 women) focused on the most recent health problem experienced and on the therapeutic options chosen, (iii) individual or group thematic discussions relating to disease and treatments, (iv) 6-months of participants'' observations between May 2007 and May 2008. At the end of the project in May 2008 a workshop was organized to cross-check the data with the help of 12 of the most interested informants. Results: Six hundred and seventeen voucher specimens were collected, corresponding to 303 different species, from which 274 (belonging to 83 families) are documented here. Altogether 492 recipes were recorded, corresponding to a global figure of 541 therapeutic uses and a total of 664 use reports. The main therapeutic uses are related to dermatological problems (103 uses; 19%), gastro-intestinal complaints (69 uses; 13%) and malaria/fevers (52 uses; 10%). Diseases are analysed according to Chayahuita concepts, and for each disease the species having a high frequency of citation are listed, and the most frequently used remedies are described. Whenever possible, comparisons with other Amazonian groups have been drawn. Conclusion: Chayahuita nosology and medical ethnobotany appear to draw their inspiration from a common panamazonian root. Despite the fact that a certain number of medicinal plants are shared with other nearby groups, there seem to be specific uses for some species, thus highlighting the originality of the Chayahuita pharmacopoeia. Presently there is a certain disinterest in the most traditional area of the Chayahuita medical ways, and the role of the penutu (shaman) seems to be less highly-valued than in the past. Nonetheless, the use of medicinal plants in phytotherapeutic treatment is very much a living, shared knowledge. [Copyright &y& Elsevier]

Background: It is commonly assumed that indigenous medical systems remain strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions. Methodology: Open-ended interviews and free listing exercises were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification of households' therapeutic strategies and use of remedies was carried out by means of content analysis of interview transcriptions and inductive interference. Furthermore, a quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories was performed. Results: Our findings indicate that the health-seeking behavior of the Andean households in this study is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexists with biomedical healthcare that is both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses. Conclusions: The take-home lesson for health policy-makers from this study is that the main obstacle to use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions. [ABSTRACT FROM AUTHOR]

The adjustment of the information obtained from household surveys to make the figures compatible with National Accounts is a non-standard and potentially questionable practice given that it alters the structure of income distribution. This paper analyzes the sensitivity of inequality and poverty indicators to the adjustments made by ECLAC so as to enable a consistency between what is reported by the CASEN survey and the National Accounts figures in Chile. The results reveal that this leads to important changes in the top-end of the distribution and to an overestimation in the main inequality indicators in Chile. Chile looks more unequal in international relative terms due to this adjustment. [ABSTRACT FROM AUTHOR]

This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI) undergoing hemodialysis (HD) and chronic peritoneal dialysis (CPD). There were 67 patients (40 female and 27 male) with a mean age of 14.76 ± 2.71 years, duration of illness ≥3months, 43 (64.18%) patients with CPD and 24 (35.82%) undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (n = 7), 43.28% (n = 29), and 46.27% (n = 31), respectively; all of the seven (100%) patients with high occurrence of depressive symptomatology were female (P = 0.04), and none of these (0%) had a friend to confide in (P = 0.03). Depressive symptomatology in patients with CPD was associated with a lower weekly Kt/V compared to those without depressive symptomatology (2.15 ± 0.68 versus 2.52 ± 0.65; P = 0.01). There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment. [ABSTRACT FROM AUTHOR]

During the decades of the 1950's and 1960's, several communities of Peru's central coastal area, well-known examples being Acos and Huayopampa (Chancay Valley, Huaral), converted from subsistence production systems to fruit growing, economically more profitable. This occurred in Putinza, the community discussed in this paper. Around 1955 it shifted to cultivating fruit and replaced multicropping with monoculture, articulated to the urban markets of Cañete and Lima. This research, which combines field work with a diachronic and synchronic vision and draws on comparative studies of peasant economies, seeks to explain the factors that facilitated this articulation in the early 1960's. Among the factors that influenced this process are the ecological advantages the community enjoyed, its openness to change, its relative closeness to large urban centers, the existence of roads and infrastructure, and market advantages in terms of prices and the growing consumer demand for fruit. [ABSTRACT FROM AUTHOR]

Small economies, such as the Peruvian and Chilean, are immersed in the global arena of emergent economies, so evaluating them from a home based point of view (Porter, 1990) would be limited and of little use. This fact turns Porter's national diamond framework insufficient for that purpose (Moon, Rugman and Verbeke, 1998). This paper analyzes these economies from a global view that would include local as well as foreign markets; in other words, it applies the International Competitiveness Double Diamond approach proposed by Moon, Rugman & Verbeke (1998), and Moon & Lee (2004). Information from the World Bank, the International Monetary Fund, the World Economic Forum, the Inter-American Development Bank and other sources was gathered to draw up the double diamond. The empirical analyses show that Chile is more competitive globally, while Peru is locally. To sum up, the results imply that Chile is more attractive to direct foreign investment than Peru. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that folktales in some societies are characterized by a culturally constructed underlying emotional structure, or Cultural Emotion Schema. In this paper we argue that Matsigenka illness narratives and folk stories share an underlying emotion schema, in which death and suffering result from conflicts between strong-willed individuals prompting anger and aggression. Analysis of illness narratives collected by Izquierdo in the Matsigenka community of Kamisea in the Peruvian Amazon between 1996 and 1999 reveals a common pattern in which envy and frustration lead to the belief in sorcery as the main cause of illness and death. This pattern contrasts with the typical stories of a previous generation collected by the Johnsons among the Matsigenka of Shimaa and other Matsigenka researchers, where sorcery beliefs were virtually absent. Our argument is that important changes in ecology, community, politics, and religion have led to a systematic rise in feelings of envy and frustration, and that these have increased the likelihood that sorcery accusations will occur. We explore the likelihood that such beliefs increase as egalitarian peoples become more crowded into settlements where they are likely to experience greater inequality, more competition for resources and increased societal and personal stress. [ABSTRACT FROM AUTHOR]

What is the effect of political violence on the production of coca in the Central Andes? Does U.S. military aid reduce the amount of drugs that originate from this region? What other factors help explain the production of coca? Are the effects of U.S. military aid the same across the Andean nations? This paper tests the effects of political violence and U.S. military aid in the drug producing nations of Colombia, Bolivia and Peru. Our results are consistent with existing literature that emphasizes the obstacles that governments face as they attempt to suppress markets for prohibited goods. Our comparative analysis sheds new light on the limitations of the current U.S. policy, particularly in Colombia, where political violence has strengthened the global drug trade. [ABSTRACT FROM AUTHOR]