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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.

Objective: To determine the factors associated and measure the socioeconomic inequalities in people with undiagnosed hypertension in Peru., Materials and Methods: An observational, cross-sectional, analytical study was performed using data from the 2019 Demographic and Family Health Survey (ENDES, acronym in Spanish) database. The dependent variable was the presence of undiagnosed hypertension (mean systolic blood pressure ≥140 mmHg and/or mean diastolic blood pressure ≥90 mmHg in the two blood pressure measurements and with no prior diagnosis of hypertension by a health care professional). Adjusted prevalence ratios were estimated to determine the factors associated with undiagnosed hypertension. The socioeconomic inequality in undiagnosed hypertension was estimated using concentration curves and the Erreygers concentration index., Results: 67.2% of 3697 persons with hypertension had not been diagnosed. Non-diagnosis of hypertension was more prevalent in men who were residents of the Coast and in inhabitants residing at more than 3000 m above sea level. Being 50 years of age or older, having health insurance, being obese and having diabetes mellitus were associated with a lower prevalence of undiagnosed hypertension. Inequality of the non-diagnosis of hypertension was found to be concentrated in the poorest population., Conclusions: At least one out of every two adult Peruvians with hypertension have not been diagnosed with this condition. Socioeconomic inequality was found, as well as socio-demographic and health-related factors associated with undiagnosed hypertension. Our findings identify some population subgroups in which interventions for screening and treatment of hypertension should be prioritized in order to reduce both inequalities and complications of hypertension among the most vulnerable., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: ST-segment elevation myocardial infarction (STEMI), is an important cause of morbidity and mortality worldwide, and myocardial reperfusion, when adequate, reduces the complications of this entity. The aim of the study was to describe the clinical and treatment characteristics of STEMI in Peru and the relationship of successful reperfusion with in-hospital adverse events., Materials and Methods: Prospective, multicenter cohort of STEMI patients attended during 2020 in public hospitals in Peru. We evaluated the clinical, therapeutic characteristics and in-hospital adverse events, also the relationship between successful reperfusion and adverse events., Results: A total of 374 patients were included, 69.5% in Lima and Callao. Fibrinolysis was used in 37% of cases (pharmacoinvasive 26% and fibrinolysis alone 11%), primary angioplasty with < 12 hours of evolution in 20%, late angioplasty in 9% and 34% did not access adequate reperfusion therapies, mainly due to late presentation. Ischemia time was longer in patients with primary angioplasty compared to fibrinolysis (median 7.7 hours (RIQ 5-10) and 4 hours (RIQ 2.3-5.5) respectively). Mortality was 8.5%, the incidence of post-infarction heart failure was 27.8% and of cardiogenic shock 11.5%. Successful reperfusion was associated with lower cardiovascular mortality (RR:0.28; 95%CI: 0.12-0.66, p=0.003) and lower incidence of heart failure during hospitalization (RR: 0.61; 95%CI: 0.43-0.85, p=0.004)., Conclusions: Fibrinolysis continues to be the most frequent reperfusion therapy in public hospitals in Peru. Shorter ischemia-to-reperfusion time was associated with reperfusion success, and in turn with fewer in-hospital adverse events.

Background: Higher rates of maternal complications and deaths have been described in home births. However, few local studies have evaluated factors associated with home births in Peru. The study aims to determine the prevalence and factors associated with home birth in the Peruvian population., Methods: A population-based analytical cross-sectional study was conducted using pooled data from the 2015-2017 Peruvian Demographic and Health Surveys. A logistic regression model was performed to calculate crude and adjusted odds ratios (aOR) for the association between sociodemographic and mother-related factors and home births., Results: Seven out of every 100 births were home births. Living in a rural area (aOR = 3.10; 95% CI: 2.52-3.81), having a primary or secondary educational level, belonging to a medium or low wealth tertile, being from the rest of the Coast, Andean or Amazon regions, the second or greater number of birth order and considering the distance to the health center as problematic (aOR: 1.32; 95% CI: 1.17-1.48) were found to be associated with a higher probability of home births. Contrarily, being in the age groups of 25-34 and 35-39 years old, having a multiple pregnancy and giving birth to a medium (aOR: 0.88; 95% CI: 0.78-1.00) or large-sized newborn (aOR = 0.81; 95% CI: 0.72-0.93) were associated with a lower probability of presenting home births., Conclusions: Sociodemographic factors are associated with home births in Peru. Further study of these factors is required to develop strategies specific to the needs of the population of childbearing age., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors.)

Background: This study aims to evaluate trends of DBM in Peru over the last 20 years., Methods: Using individual-level data collected in nationally representative household surveys from Peru between 1996 and 2017, we analysed trends in the prevalence and patterning of the DBM. We classified the nutritional status of children and their mothers as undernourished (either underweight, stunted or wasted for children), normal, overweight or obese. Children classified as experiencing the DBM were those undernourished and living with an overweight or obese mother. We also fitted logistic regression models to evaluate the probability of children having an overweight/obese mother across subgroups of socioeconomic status, place of residence and education., Results: The overall percentage of children experiencing the DBM in 2016 was 7%, and constitutes ~203,600 children (90% of whom were stunted). Between 1996 and 2016, undernourished children have seen the largest relative increase in the risk of having an overweight mother (31% vs. 37%) or obese mother (6% vs. 17%); however, due to the substantial decrease in the absolute number of undernourished children, the DBM has not grown. Moreover, all children, irrespective of their own nutritional status, are now more likely to live with an overweight or obese mother, a consistent pattern across wealth, location and education subgroups, and all regions of Peru., Conclusions: DBM prevalence in Peru has decreased, although the number of DBM cases is estimated to be above 200,000. In addition, all children are now more likely to live with overweight or obese mothers. The basic pattern has shifted from one of undernourished children whose mothers have a 'normal' BMI, to one where now most children have a 'normal' or healthy anthropometric status, but whose mothers are overweight or obese. This suggest that Peru is on the cusp of a major public health challenge requiring significant action.

Objective: To identify environmental factors present in areas with high density of road traffic accidents (RTA) in Leon, Nicaragua., Methods: The analysis included all accidents recorded by the Police Department in León City, from January to June 2017. All crashes were georeferenced, and data were collected from the environment elements within a perimeter of 20 meters from the site in which accidents occurred with a pre-tested data collection instrument. We specified a Poisson regression model to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) to determine environmental factors associated with the event incidence. For the identification areas with high, medium, and low occurrences of crashes, kernel density around points in which RTA occurred were estimated., Results: Out of 667 recorded crashes, 90% involved men aged 15-40, and motorcycle accidents represented 60% of injuries or deaths. Environmental factors that were positively associated with RTA included good road conditions (adjusted IRR = 1.36, 95%CI 1.13 - 1.63) and the existence of bicycle lanes (adjusted IRR = 1.64, 95%CI 1.29 - 2.10). Environmental characteristics associated with higher speeds and heavier accidents can increase their incidence., Conclusion: We found that high-foot-traffic commercial or touristic centers are three areas with high density of crashes. Local authorities can use these findings to promote road safety measures in high-incidence areas in León City.

Background: To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex., Methods: An observational, cross-sectional study was conducted in 26,175 individuals aged 18-65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic-related inequality in health variables., Results: Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women ( P < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: -0.0817; men: -0.2699)., Conclusions: Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low- and middle-income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 International Journal of Preventive Medicine.)

Objectives: To systematically review the effectiveness and safety of chlorine dioxide solution and chlorine derivatives used in the prevention or treatment of COVID-19., Methods: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and follows the guidelines provided in the Cochrane Handbook for Systematic Reviews of Interventions. A librarian developed and executed the search strategy; it was further reviewed by two of the authors and complemented by manual search. Randomized clinical trials, quasi-experimental studies, cohort studies, case-control studies, cross-sectional studies, and case reports were included; in vitro or animal studies were excluded. Abstract and full-text screening according to pre-defined eligibility criteria were performed by two reviewers independently using web application Rayyan QCRI. Disagreements on study selection were resolved by a third reviewer. The systematic review protocol was registered in PROSPERO (CRD42020200641)., Results: Neither published nor pre-print studies evaluating the use of chlorine dioxide or derivatives on SARS-CoV-2 infection were identified. The only finding was an unpublished observational study registry which has no results released yet., Conclusions: To date, there are no scientific evidence to uphold the use of chlorine dioxide or derivatives as preventive or therapeutic agents against COVID-19.

Background: To date, the factors associated with the presence of depression or depressive symptoms in the Peruvian population have not been described. This study aimed to determine the prevalence of clinically relevant depressive symptoms in the Peruvian population and its associated factors., Methods: A cross-sectional analytical study of secondary data from 2018 Demographic and Family Health Survey was conducted. The survey database includes 31,996 participants over 18 years of age. The dependent variable of the analysis was the presence of depression during the 14 days before the survey measured by the Patient Health Questionnaire (PHQ-9). Factors associated with the presence of depression were estimated with a proportional odds logistic regression model., Results: The overall prevalence of clinically relevant depressive symptoms was 6.4% (moderate and severe symptomatology in 3.9% [95% CI: 3.6-4.3] and 2.5% [95% CI: 2.2-2.7], respectively). Being a woman, belonging to the age groups of 45 to 64 years or 65 or older, living in the Andean region, and having high blood pressure or diabetes mellitus or some disability increased the probability of having clinically relevant depressive symptoms., Limitations: The use of the PHQ-9 tool to assess depressive symptomatology limits the evaluation to a period of two weeks before the survey, requiring further study for diagnosis confirmation., Conclusion: Six out of 100 Peruvians presented moderate to severe clinically relevant depressive symptoms in 2018. Strategies for depression should contemplate population subgroups , such as women and patients with chronic diseases and disabilities., Competing Interests: Declaration of Competing interests The authors declare that they have no competing interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

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&ge;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.

Background: The burden of obesity differs by socioeconomic status. We aimed to characterise the prevalence of obesity among adult men and women in Latin America and the Caribbean by socioeconomic measures and the shifting obesity burden over time., Methods: We did a cross-sectional series analysis of obesity prevalence by socioeconomic status by use of national health surveys done between 1998 and 2017 in 13 countries in Latin America and the Caribbean. We generated equiplots to display inequalities in, the primary outcome, obesity by wealth, education, and residence area. We measured obesity gaps as the difference in percentage points between the highest and lowest obesity prevalence within each socioeconomic measure, and described trends as well as changing patterns of the obesity burden over time., Findings: 479 809 adult men and women were included in the analysis. Obesity prevalence across countries has increased over time, with distinct patterns emerging by wealth and education indices. In the most recent available surveys, obesity was most prevalent among women in Mexico in 2016, and the least prevalent among women in Haiti in 2016. The largest gap between the highest and lowest obesity estimates by wealth was observed in Honduras among women (21·6 percentage point gap), and in Peru among men (22·4 percentage point gap), compared with a 3·7 percentage point gap among women in Brazil and 3·3 percentage points among men in Argentina. Urban residents consistently had a larger burden than their rural counterparts in most countries, with obesity gaps ranging from 0·1 percentage points among women in Paraguay to 15·8 percentage points among men in Peru. The trend analysis done in five countries suggests a shifting of the obesity burden across socioeconomic groups and different patterns by gender. Obesity gaps by education in Mexico have reduced over time among women, but increased among men, whereas the gap has increased among women but remains relatively constant among men in Argentina., Interpretation: The increase in obesity prevalence in the Latin American and Caribbean region has been paralleled with an unequal distribution and a shifting burden across socioeconomic groups. Anticipation of the establishment of obesity among low socioeconomic groups could provide opportunities for societal gains in primordial prevention., Funding: None., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

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.

Objectives.: To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults., Materials and Methods.: Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated., Results.: The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care., Conclusions.: Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

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.

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.

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.

Traffic accidents are an emerging problem in cities with high mobility and little urban planning. Evidence is lacking in Argentina regarding the relationship between the environment and accident occurrence; we therefore conducted a geospatial analysis and estimated the risk of accidents and their possible association with the characteristics of the physical environment in the city of Resistencia, Argentina occurring in 2012. Kernel density estimates were used for the spatial distribution of accidents and in parallel an observational, analytical study was carried out to analyze the factors associated with accident occurrence. The results show three critical areas (in the northwest, center and south of the city) with greater accident frequency. Environmental factors that were associated with the occurrence of accidents were the presence of street lighting (23% greater), the presence of a tree close to the road (47% greater), the presence of a traffic light (28% greater), and if the road was a major avenue (122% greater) and had curves (129% greater). This study shows the city of Resistencia to be in a situation of urban vulnerability due not only to its socioeconomic status but also to the unequal development compared to neighboring cities, a reality that fosters an unfavorable environment.

Objective: Peru has implemented various strategies seeking to improve nutritional indicators in children under five years old. However, high prevalence of malnutrition in some regions still remains. The aim of this study was to assess changes in regional prevalence and to determine the presence of district conglomerates with a high prevalence of chronic childhood malnutrition (CCM) in 2010 and 2016., Methods: A comparative descriptive analysis by regions and a district-level spatial analysis were conducted employing indicators reported by the Nutritional Status Information System., Results: 23.9% (561.090/2.343.806) children under five years evaluated in Peru during 2010 and 18.0% (394.049/2.193.268) evaluated during 2016 were chronic malnutrition (reduction of 5.9 percentage points). We identified a decline of 7.6 percent points in rural areas and the persistence of prevalence above 30% in only one region (Huancavelica). The spatial analysis identified clusters of districts with high prevalence in 20% (379/1834) of Peruvian districts in 2010, and 17.2% (316/1834) of those in 2016, which are mainly spread across the sierra and jungle regions. ., Conclusions: Peru has made significant progress in reducing stunting in children. Nevertheless, it still represents a health problem due to high prevalence in the sierra region, as well as expansion to jungle districts in 2016., (Licencia Creative Commons Atribución-NoComercial-SinDerivadas 3.0 Unported Licencia Creative Commons)

Objectives: To establish regional prevalences of anemia in pregnant women receiving care at public clinics in Peru in 2015 and identify high-prevalence district conglomerates., Materials and Methods: An ecological study was carried out on data from pregnant women with anemia registered on the Nutritional Status Information System (SIEN) who received care in 7703 public clinics in 2015. Regional and district prevalences of gestational anemia were calculated. District conglomerates with a high prevalence of gestational anemia were identified using the Moran Index., Results: Information was gathered from 311,521 pregnant women distributed in 1638 districts in Peru. The national prevalence of anemia was 24.2% (95% confidence interval [95% CI]: 24.0-24.3%), the rural prevalence was 30.5%, and the urban prevalence was 22.0%. The regions of Huancavelica (45.5%; 95% CI: 44.2-46.7%), Puno (42.8%; 95% CI: 41.9-43.7%), Pasco (38.5%; 95% CI: 36.9-40.0%), Cusco (36.0%; 95% CI: 35.3-36.8%), and Apurímac (32.0%; 95% CI: 30.8-33.1%) had the highest prevalences of anemia. The local Moran Index identified 202 high-priority districts (hot spots) (12.3% of total; 44 urban and 158 rural) located in Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco, and Puno containing high-prevalence district conglomerates., Conclusions: Gestational anemia in Peru has its highest prevalence rates in rural and southern mountainous areas. The district conglomerates with high prevalence rates of gestational anemia coincide with the areas of high regional prevalence.

The aim of this study was to geospatially explore the occurrence rates of car accidents involving pedestrians in Cercado de Lima (Lima District), Peru. Car accidents involving pedestrians recorded in the 2015 National Police Station Census of the National Statistics and Information Institute were described and georeferenced. Subsequently, a Kernel Density analysis was carried out to locate areas with high, medium, and low density events. Records of 171 car accidents involving pedestrians were studied: the types of vehicles involved were automobiles (56.7%) and smaller vehicles (22.8%). The highest percentage of car accidents involving pedestrians (38.6%) took place between 12:00 p.m. and 5:00 p.m. There were two densely populated areas and two areas with intermediate density for car accidents involving pedestrians, locations that were previously reported as critical due to their deficiencies and high probability of traffic accidents. The use of geographic information systems offers a quick overview of the occurrence rates of car accidents involving pedestrians to make comparisons and enable the local implementation of strategies.

The aim of this study was to estimate and analyze the evolution of mortality rates due to suicide in Peru between 2004 and 2013. National death records from the Peruvian Ministry of Health were analyzed, calculating the regional mortality rates due to suicide standardized by age. Similarly, rates grouped in 5-year periods were geospatially projected. There were 3,162 cases of suicide (67.2% men); the age range with the highest incidence was 20 to 29 years (28.7%) and 49.2% were due to poisoning. Suicide rates increased from 0.46 (95% confidence interval [CI] = 0.38-0.55) to 1.13 (95% CI = 1.01-1.25) per 100,000 people from 2004 to 2013, respectively. The highest rates of suicide were identified in Pasco, Junín, Tacna, Moquegua, and Huánuco. The suicide issue in Peru requires a comprehensive approach that entails not just identifying the areas with the highest risk, but also studying its associated factors that may explain the regional variability observed.

Objective: To estimate and analyze the evolution of mortality rates of gastrointestinal (GI) cancer in Peru and its regions between 2005-2014., Material and Methods: We performed a nationwide secondary analysis of Peru's Health Ministry registry of deaths during the period 2005-2014, with a focus on regional differences. Deaths registered with codes C15 to C25 (malignant neoplasms of digestive organs) from the ICD-10 were included. Calculation of age-standarized mortality rates and years of life lost (YLL) due to GI cancer per 100,000 habitants were also performed., Results: Data of 67,527 deaths from GI cancers was analyzed, 35,055 (51.91%) were women. In 2005, the number of GI cancer deaths was 6,484, for 2014, 7,532 cases were recorded. The GI cancer age-standarized mortality rates at the country level showed a decrease of 12.70% between 2005-2014. Stomach cancer presented the highest age-standarized mortality rate despite showing a downward trend in the last years, equal for gallbladder, liver and biliary tract, and esophagus cancer. Colorectal, small intestine and anus cancer show a progressive increase. In 2014, Callao (48.8), Huancavelica (48.5), La Libertad (39.6), Lambayeque (40.5) and Huanuco (38.9) had the highest rates. The three types of GI cancers with the highest rates of YLL in 2014 were stomach cancer (118.51), followed by liver and biliary tract cancer (58.68) and colorectal (44.86)., Conclusion: GI cancer mortality in Peru is high and a priority issue in regions like Huancavelica, Huanuco, Callao, La Libertad and Lambayeque. Stomach cancer remains the most frequent GI cancer, but with a downward trend in the study period.

Objective: Childhood obesity is a global problem, sociodemographic and cultural factors influence its presence. An analysis of disparities in the prevalence of childhood obesity in Peru was made by sex and region in 2015., Methods: Analysis of the information reported by the Sistema de Información del Estado Nutricional of the number of obesity cases in 2,336,791 children under five years, evaluated in public health facilities during 2015. The distribution of obesity cases was analyzed by sex and region of residence, also a spatial projection of the regional prevalence of obesity and the prevalence differences between men and women was performed., Results: Data from 2,336,791 children under five was analyzed. An obesity prevalence of 1.52% (girls: 1.3% and boys: 1.7%) was found; the highest prevalence were observed in urban areas (girls: 1.5% and boys: 1.9%) and on the Costa (girls: 1.9% and boys: 2.5%). Highest prevalence of obesity were in Tacna (girls: 3.2% y boys: 3.9%), Moquegua (girls: 2.4% y boys: 3.1%) and Callao (girls: 2.3% y boys: 2.8%)., Conclusions: Childhood obesity predominates on the coast and in urban areas of Peru particularly among boys. The regions of higher prevalence of obesity were Tacna Moquegua and Callao.

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.

Objectives.: To estimate regional prevalence and identify the spatial patterns of the degree of overweight and obesity by districts in under five years children in Peru during 2014., Materials and Methods.: Analysis of the information reported by the Information System Nutritional Status (SIEN) of the number of cases of overweight and obesity in children under five years recorded during 2014. Regional prevalence for overweight and obesity, and their respective confidence intervals to 95% were calculated. Moran index was used to determine patterns of grouping districts with high prevalence of overweight and/or obesity., Results.: Data from 1834 districts and 2,318,980 children under five years were analyzed. 158,738 cases (6.84%; CI 95%: 6.81 to 6.87) were overweight, while 56,125 (2.42%; CI 95%: 2.40 to 2.44) obesity. The highest prevalence of overweight were identified in the regions of Tacna (13.9%), Moquegua (11.8%), Callao (10.4%), Lima (10.2%) and Ica (9.3%), and in the same regions for obesity with 5.3%; 4.3%; 4.0%; 4.0% and 3.8% respectively. The spatial analysis found grouping districts of high prevalence in 10% of all districts for both overweight and obesity, identifying 199 districts for overweight (126 urban and 73 rural), and 184 for obesity (136 urban and 48 rural)., Conclusions.: The highest prevalence of overweight and obesity were identified in the Peruvian coast regions. Moreover, these regions are predominantly exhibited a spatial clustering of districts with high prevalence of overweight and obesity.

In order to determine the potential vulnerability of public health facilities in four northern regions of Peru to the possible effects of El Niño-Southern Oscillation (ENSO) phenomenon. An exploratory spatial analysis was performed using the geo-referenced points for at-risk areas based on the activation of gullies that were reported by the National Water Authority, and the location of the four regional public health facilities of the Ministry of Health. Concentric areas of influence were simulate from the points of risk towards the public health facilities using radii of 200, 1000 and 1500 meters. The Tumbes region would be the most affected with 37.2% of its health facilities being affected by floods and landslides. The I-2 and I-3 categories of health facilities appeared to be the most affected with 28.9% and 31.6% respectively. Therefore, public health facilities near the risk zones may be affected by the ENSO.

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.