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Objective. To assess the effectiveness of a comprehensive blood pressure (BP) control program on improving lifestyle indicators, BP levels, and laboratory examination results among people living in low-income urban areas of Peru. Methods. A prospective before-and-after study design was applied to 1 271 participants with hypertension or pre-hypertension. The intervention was implemented for 2 years, from May 2015 -- April 2017, in three health centers in Lima (2 in Comas and 1 in Callao). The changes in participants over the study period were compared. All participants were provided with individualized consultations, group health education sessions, regular group meetings to improve self-management, and text messages providing health education. Paired t- and chi-square tests were used to determine the significance of the changes in indicators before and after the intervention. Results. Lifestyle behaviors, such as weight and blood pressure monitoring, reduced salt consumption, increased fruit and vegetable consumption, and stress control improved during the intervention (P < 0.001). The EuroQol-Five Dimension Scale showed improvement (P < 0.001) and body mass index, waist circumference, and systolic and diastolic BPs of the participants significantly decreased (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) and triglyceride decreased (P < 0.01) and high-density lipoprotein cholesterol (HDL-C) increased. The estimated glomerular filtration rate (eGFR) increased after the program (P < 0.001). Conclusions. This comprehensive BP control program was effective in improving lifestyle indicators, BP levels, and laboratory results among people living in a low-income urban area of Peru. Increasing opportunities for BP measurement, systematic management of hypertensive patients, and community-based prevention and education programs are paramount to hypertension detection, prevention, and control. [ABSTRACT FROM AUTHOR]

Objective. Analyze malnutrition and anemia trends in Peruvian children under 5 years of age and their association with determinants in the 2000-2011 period. Methods. Nutritional indicators for children under 5 years of age from the 2011 Demographic and Family Health Survey (ENDES), and their evolution based on data from the 2000, 2005, and 2008 ENDES, were analyzed. Chronic malnutrition (CM) (height/age ≤ 2 SD), acute malnutrition (AM), (height/weight ≤ 2 SD), and anemia trends were estimated. Associations were found with factors such as sex, age, area of residence (urban or rural), region of residence, mother's education, wealth quintile, availability of public water system, sewer availability, altitude, presence of other children in household, birth order, presence of diarrhea in previous 15 days, and presence of cough in previous 15 days. Results. AM, CM, and anemia in Peruvian children under 5 years of age decreased from 2000-2011. This reduction was not uniform for the three conditions, with decreases of 1.1% to 0.4% recorded for AM, 31.6% to 19.6% for CM, and 50.4% to 30.7% for anemia. Although the factors analyzed were related to the prevalence of these three illnesses, calculation of the adjusted odds ratios showed significant differences for CM (mother's education, Sierra region, altitude greater than 2 500 m above sea level, presence of two or more children in household, and being the third or successive child) and anemia (child sex [higher in males], children under 2 years of age, Resto de costa region and Selva region, altitude greater than 2 500 m above sea level, availability of public water system, sewer availability, presence of two or more children in household, and presence of diarrhea within 15 days prior to the survey). For AM, differences were observed according to some factors but they were not significant in the adjusted model. Conclusions. In the 2000-2011 period, Peru achieved reduction of its CM, AM, and anemia rates. AM rates decreased to almost one-third, with overall figures remaining fairly low, and affecting to a greater extent highly localized areas and groups of the country. However, the current rates of chronic malnutrition and anemia continue to be very high, which represents a true challenge for public policy, as occurs in other countries of the region. In order to overcome this challenge it will be necessary to change the approach, no longer conceiving of child malnutrition exclusively as a nutritional problem and instead placing greater emphasis on the related determinants. Finally, comprehensive and integrated initiatives should be encouraged and strengthened in the poorest communities. [ABSTRACT FROM AUTHOR]

Objective. To estimate the prevalence of blindness and visual impairment among adults in Peru and to determine their causes, to evaluate the coverage and quality of the cataract surgical services and to investigate the barriers that inhibit access to these services. Methods. A cross-sectional population study with two-stage random cluster sampling of individuals of = 50 years old, representative of the entire country, using the standard methodology of the Rapid Assessment of Avoidable Blindness. Visual acuity was assessed and the condition of the lens and posterior pole examined by direct ophthalmoscopy. Cataract surgical coverage was calculated. Its quality, as well as the causes of visual acuity < 20/60 and the barriers to accessing surgical treatment were assessed. Results. A total of 4 849 people were examined. Blindness prevalence was 2.0% (confidence interval of 95%: 1.5-2.5%). The main causes of blindness were cataract (58.0%), glaucoma (13.7%) and age-related macular degeneration (11.5%). Uncorrected refraction errors were the principal cause of moderate visual impairment (67.2%). Cataract surgical coverage was 66.9%. 60.5% of the eyes operated for cataracts achieved a visual acuity = 20/60 with available correction. The main barriers to cataract surgery were the high cost (25.9%) and people being unaware that treatment was possible (23.8%). Conclusions. The prevalence of blindness and visual impairment in Peru is similar to that of other Latin American countries. Given the low cataract surgical coverage and the aging of the population, access to the services could be improved by increasing the population education on eye health and the response capacity of the ophthalmological and cataract surgical services, and by reducing the costs of the latter. [ABSTRACT FROM AUTHOR]

Objective. Describe the association between receipt of cervical cytology and type of health insurance in Peruvian women, and determine the role of sociodemographic and sexual health variables in this relationship. Methods. A cross-sectional study using information on a sample of 12 272 women aged 30 to 49 years from the Demographic and Family Health Survey (ENDES), Peru, 2005-2008. The dependent variable was receipt of at least one Pap smear in the last five years. The primary independent variables were type of health insurance, educational level, household socioeconomic level, ethnicity, and place of residence. Prevalence ratio, obtained from Poisson regression with robust variance, was used to measure multivariate association. Results. Among sexually active women, 62.7% had received at least one Pap test in the last five years. Percentage of women tested varied by type of health insurance. Women with public or private insurance had a greater probability of having received a Pap smear-1.27 (95% CI, 1.24-1.31) and 1.52 (95% CI, 1.46-1.58) times greater, respectively-than uninsured women. This association was primarily explained by socioeconomic status variables. In addition, women who participated the least in screening were characterized by illiteracy or only a primary education, low socioeconomic level, speaking an indigenous language, and living in a rural area. When they also lacked health insurance, the gap widened, rising to as much as one third compared to more advantaged social groups. Conclusions. Inequalities were found in receipt of Pap testing according to type of health insurance; women without insurance were least likely to be screened, implying existence of a barrier to cervical cancer screening in Peru. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the effect of sex-related alcohol expectancies (SRAE) on hazardous drinking prevalence and examine gender differences in reporting SRAE. Methods. Trained research assistants administered part of a questionnaire to 393 men and 400 women between 18 and 30 years old from a peri-urban shantytown in Lima, Peru. The remaining questions were self-administered. Two measuring instruments--one testing for hazardous drinking and one for SRAE--were used. Multivariate data analysis was performed using logistic regression. Results. Based on odds ratios adjusted for socio-demographic variables (age, marital status, education, and employment status) (n = 793), men with one or two SRAE and men with three or more SRAE were 2.3 (95% confidence interval (CI) = 1.4-3.8; p = 0.001) and 3.9 (95% CI = 2.1-7.3; p < 0.001) times more likely than men with no SRAE, respectively, to be hazardous drinkers. Reporting of SRAE was significantly higher in men versus women. Conclusion. In a shantytown in Lima, SRAE is associated with hazardous drinking among men, but not among women, and reporting of SRAE differs by gender. [ABSTRACT FROM AUTHOR]

Objective. To conduct a formative evaluation of a proposed mobile health (mHealth) program designed to educate caregivers about management of common childhood illnesses. Methods. A cluster-randomized sample (n = 220) of mothers in Cono Norte, Arequipa, Peru with at least one child under five completed an iPad-based survey. This descriptive study examined trends in mobile phone ownership and feasibility of and interest in mHealth across sociodemographic categories. Fisher's exact tests were used to evaluate associations. Univariate logistic regression models were fitted to calculate odds ratios and 95% confidence intervals. Results. Of 220 participants, 82.3% and 95.0% reported mobile phone ownership and access, respectively. Ownership was significantly associated with educational level (P = 0.031); however, even among mothers with the lowest education, ownership approached 80%. Educational level and age, respectively, were associated with the ability to open (P < 0.001; P < 0.001), read (P < 0.001; P < 0.001), write (P < 0.001; P < 0.001), and send (P = 0.006; P = 0.047) text messages. Over 85% of mothers were interested in using their mobile phones to receive health advice for their child and to seek help during illness. Regression analyses revealed that ability to use a mobile phone was positively associated with the mother's intention to participate in the mHealth program. Conclusions. The study findings confirm widespread access to mobile phones and sufficient ability to utilize text messaging within this population of caregivers. In addition to access and feasibility, high levels of interest in using mobile phones for health-related purposes suggest the potential value associated with an mHealth program designed to improve childhood illness management in this community. [ABSTRACT FROM AUTHOR]

Objective. To identify the factors associated with level of knowledge and attitudes toward research among undergraduate medical students in Peru. Methods. In this analytical cross-sectional study, a validated questionnaire on knowledge, attitudes, and practices related to research was applied to a representative sample of students at 17 Peruvian medical schools. The categorical and quantitative variables were subjected to simple two-factor analysis with adjustment for intraclass correlation. Prevalence ratios were derived on the basis of generalized linear models using bifactorial and multifactorial analysis. Results. Questionnaires from 1 554 students (51.0% women) with an average age of 20.5 ± 2.86 years were analyzed. Only 46.7% of the respondents had a good level of knowledge and 37.7% had appropriate attitudes toward research. The variables that correlated with a good level of knowledge were the respondent having completed at least four years of academic study, belonging to a research group, and having an adviser. Having appropriate attitudes toward research correlated with being a woman and having an adviser. No differences were found between the level of knowledge and attitudes of the students at the universities studied. Conclusions. In general, the level of knowledge about research was unsatisfactory and the attitudes toward it were inappropriate. In order to change this situation, it will be critical to make changes in the curriculum to ensure that students engage in research from the beginning of their academic careers and develop research skills in their final years of study. [ABSTRACT FROM AUTHOR]