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1. Child health and living at high altitude

Author

Niermeyer, S., Andrade Mollinedo, P., and Huicho, L.

Subjects
Altitudes -- Health aspects, Altitudes -- Research, Children -- Health aspects, Children -- Environmental aspects, Children -- Research, Children -- Diseases, Children -- Distribution, Children -- Reports, Company distribution practices
Published
2009

2. The international Perinatal Outcomes in the Pandemic (iPOP) study:protocol [version 1; peer review: awaiting peer review]

Author

Stock, SJ, Zoega, H, Brockway, M, Mulholland, RH, Miller, JE, Been, JV, Wood, R, Abok, II, Alshaikh, B, Ayede, AI, Bacchini, F, Bhutta, ZA, Brew, BK, Brook, J, Calvert, C, Campbell-Yeo, M, Chan, D, Chirombo, J, Connor, KL, Daly, M, Einarsdóttir, K, Fantasia, I, Franklin, M, Fraser, A, Håberg, SE, Hui, L, Huicho, L, Magnus, MC, Morris, AD, Nagy-Bonnard, L, Nassar, N, Nyadanu, SD, Iyabode Olabisi, D, Palmer, KR, Pedersen, Lars Henning, Pereira, G, Racine-Poon, A, Ranger, M, Rihs, T, Saner, C, Sheikh, A, Swift, EM, Tooke, L, Urquia, ML, Whitehead, C, Yilgwan, C, Rodriguez, N, Burgner, D, and Azad, MB more...

Published
2021
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3. The international Perinatal Outcomes in the Pandemic (iPOP) study: Protocol

Author

Stock, SJ, Zoega, H ; https://orcid.org/0000-0003-0761-9028, Brockway, M, Mulholland, RH, Miller, JE, Been, JV, Wood, R, Abok, II, Alshaikh, B, Ayede, AI, Bacchini, F, Bhutta, ZA, Brew, BK, Brook, J, Calvert, C, Campbell-Yeo, M, Chan, D, Chirombo, J, Connor, KL, Daly, M, Einarsdóttir, K, Fantasia, I, Franklin, M, Fraser, A, Håberg, SE, Hui, L, Huicho, L, Magnus, MC, Morris, AD, Nagy-Bonnard, L, Nassar, N, Nyadanu, SD, Iyabode Olabisi, D, Palmer, KR, Pedersen, LH, Pereira, G, Racine-Poon, A, Ranger, M, Rihs, T, Saner, C, Sheikh, A, Swift, EM, Tooke, L, Urquia, ML, Whitehead, C, Yilgwan, C, Rodriguez, N, Burgner, D, Azad, MB, Haasdyk, Bronwyn Brew ; https://orcid.org/0000-0002-9885-8261, Stock, SJ, Zoega, H ; https://orcid.org/0000-0003-0761-9028, Brockway, M, Mulholland, RH, Miller, JE, Been, JV, Wood, R, Abok, II, Alshaikh, B, Ayede, AI, Bacchini, F, Bhutta, ZA, Brew, BK, Brook, J, Calvert, C, Campbell-Yeo, M, Chan, D, Chirombo, J, Connor, KL, Daly, M, Einarsdóttir, K, Fantasia, I, Franklin, M, Fraser, A, Håberg, SE, Hui, L, Huicho, L, Magnus, MC, Morris, AD, Nagy-Bonnard, L, Nassar, N, Nyadanu, SD, Iyabode Olabisi, D, Palmer, KR, Pedersen, LH, Pereira, G, Racine-Poon, A, Ranger, M, Rihs, T, Saner, C, Sheikh, A, Swift, EM, Tooke, L, Urquia, ML, Whitehead, C, Yilgwan, C, Rodriguez, N, Burgner, D, Azad, MB, and Haasdyk, Bronwyn Brew ; https://orcid.org/0000-0002-9885-8261 more...

Abstract

Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in the Pandemic (iPOP) Study, we will seize the unique opportunity offered by the COVID-19 pandemic to answer urgent questions about perinatal health. In the first two study phases, we will use population-based aggregate data and standardized outcome definitions to: 1) Determine rates of preterm birth, low birth weight, and stillbirth and describe changes during lockdowns; and assess if these changes are consistent globally, or differ by region and income setting, 2) Determine if the magnitude of changes in adverse perinatal outcomes during lockdown are modified by regional differences in COVID-19 infection rates, lockdown stringency, adherence to lockdown measures, air quality, or other social and economic markers, obtained from publicly available datasets. We will undertake an interrupted time series analysis covering births from January 2015 through July 2020. The iPOP Study will involve at least 121 researchers in 37 countries, including obstetricians, neonatologists, epidemiologists, public health researchers, environmental scientists, and policymakers. We will leverage the most disruptive and widespread 'natural experiment' of our lifetime to make rapid discoveries about preterm birth. Whether the COVID-19 pandemic is worsening or unexpectedly improving perinatal outcomes, our research will provide cr more...

Published
2021

4. Are health interventions implemented where they are most needed? District uptake of the Integrated Management of Childhood Illness strategy in Brazil, Peru and the United Republic of Tanzania

Author

Victora, C.G., Huicho, L., Amaral, J.J., Armstrong-Schellenberg, J., Manzi, F., Mason, E., and Scherpbier, R.

Subjects
Management, Research, Company business management, Public health -- Management -- Research, Child health services -- Research -- Management
Abstract

Voir page 799 le resume en francais. En la pagina 800 figura un resumen en espanol. Introduction There is ample literature on how the availability and quality of health care [...], Objective To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. Methods We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. Findings In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. Conclusion Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most. more...

Published
2006

5. Oxygen saturation and heart rate in healthy school children and adolescents living at high altitude

Author

Huicho, L., Pawson, I.G., Leon-Velarde, F., Rivera-Ch., M., Pacheco, A., Muro, M., and Silva, J.

Subjects
Andean Region -- Research, South American native peoples -- South America, Altitude, Influence of -- Physiological aspects, Oxygen in the body -- Research, Quechuas -- Physiological aspects, Heart beat -- Environmental aspects, Biological sciences
Abstract

Percent oxygen saturation of hemoglobin and heart rate have been studied in three groups of children living at high altitude in the Peruvian Andes. The group with the greatest proportion of Quechua ancestry had the highest oxygen saturation and the lowest heart rate. more...

Published
2001

10. Enabling reproductive, maternal, neonatal and child health interventions: Time trends and driving factors of health expenditure in the successful story of Peru

Author

Huicho, L., Huayanay-Espinoza, C.A., Hernández-Peña, P., Niño de Guzman, J., Rivera-Ch, M., Huicho, L., Huayanay-Espinoza, C.A., Hernández-Peña, P., Niño de Guzman, J., and Rivera-Ch, M.

Abstract

We compared expenditure trends for reproductive, maternal, neonatal and child health (RMNCH) with trends in RMNCH service coverage in Peru. We used National Health Accounts data to report on total health expenditure by source; the Countdown database for trends in external funding to RMNCH, and Ministry of Finance data for trends in domestic funding to RMNCH. We undertook over 170 interviews and group discussions to explore factors explaining expenditure trends. We describe trends in total health expenditure and RMNCH expenditure in constant 2012 US$ between 1995 and 2012. We estimated expenditure to coverage ratios. There was a substantial increase in domestic health expenditure over the period. However, domestic health expenditure as share of total government spending and GDP remained stable. Out-of-pocket health spending (OOPS) as a share of total health expenditure remained above 35%, and increased in real terms. Expenditure on reproductive health per woman of reproductive age varied from US$ 1.0 in 2002 to US$ 6.3 in 2012. Expenditure on maternal and neonatal health per pregnant woman increased from US$ 34 in 2000 to US$ 512 in 2012, and per capita expenditure on under-five children increased from US$ 5.6 in 2000 to US$ 148.6 in 2012. Increased expenditure on RMNCH reflects a greater political support for RMNCH, along with greater emphasis on social assistance, family planning, and health reforms targeting poor areas, and a recent emphasis on antipoverty and crosscutting equitable policies and programmes focused on nutrition and maternal and neonatal mortality. Increasing domestic RMNCH expenditure likely enabled Peru to achieve substantial health gains. Peru can provide useful lessons to other countries struggling to achieve sustained gains in RMNCH by relying on their own health financing. more...

Published
2018

11. Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study

Author

Huicho, L., Hernández-Peña, P., Huayanay-Espinoza, C.A., Segura, E.R., Niño de Guzman, J., Flores-Cordova, G., Rivera-Ch, M., Friedman, H.S., Berman, P., Huicho, L., Hernández-Peña, P., Huayanay-Espinoza, C.A., Segura, E.R., Niño de Guzman, J., Flores-Cordova, G., Rivera-Ch, M., Friedman, H.S., and Berman, P. more...

Abstract

Background Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches. more...

Published
2018

13. Remaining missed opportunities of child survival in Peru:Modelling mortality impact of universal and equitable coverage of proven interventions

Author

Tam, Y., Huicho, L., Huayanay-Espinoza, C.A., and Restrepo-Méndez, M.C.

Subjects
parasitic diseases
Abstract

BackgroundPeru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru.MethodsWe used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban–rural residence.ResultsOur analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade.ConclusionsAlthough Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030. more...

Published
2016
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14. Countdown to 2015 country case studies: What have we learned about processes and progress towards MDGs 4 and 5?

Author

Moucheraud, C, Owen, H, Singh, NS, Ng, CK, Requejo, J, Lawn, JE, Berman, P, Salehi, A, Hong, Z, Ronsmans, C, Yanqiu, G, Kebede, H, Mann, C, Ruducha, J, Tadesse, M, Ngugi, A, Keats, E, Macharia, W, Ravishankar, N, Tole, J, Bryce, J, Colbourn, T, Daelmans, B, Kanyuka, M, Nsona, H, Askeer, N, Bhutta, Z, Bhatti, Z, Rizvi, A, De Guzman, JN, Huicho, L, Victora, C, Afnan-Holmes, H, John, T, Magoma, M, and Msemo, G more...

Subjects
Child health, Coverage, Health systems, Health finance, parasitic diseases, Neonatal health, Reproductive health, Maternal health, Equity, Accountability, Millennium Development Goals
Abstract

© 2016 The Author(s). Background: Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Methods: Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). Results: The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns - which require higher-level health workers, more infrastructure, and increased community engagement - showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. Conclusions: These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts. more...

Published
2016
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15. Relationship of ovarian hormones to hypoxemia in women residents of 4,300 m

Author

LEON-VELARDE, F., RIVERA-CHIRA, M., TAPIA, R., HUICHO, L., and MONGE-C, C.

Subjects
Hypoxia -- Physiological aspects, Women -- Health aspects, Postmenopausal women -- Health aspects, Menstrual cycle -- Physiological aspects, Polycythemia -- Physiological aspects, Biological sciences
Abstract

Relationship of ovarian hormones to hypoxemia in women residents of 4,300 m. Am J Physiol Regulatory Integrative Comp Physiol 280: R488-R493, 2001.--Prevalence of excessive erythrocytosis, the main sign of chronic mountain sickness (CMS), is greater in postmenopausal Andean women than in premenopausal women. It is uncertain whether this greater prevalence is related to the decline in female hormones and ventilatory function after the occurrence of the menopause. To study this, we compared the physiological variables involved in the physiopathology of CMS [end-tidal [CO.sub.2] ([MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII], Torr) and end-tidal [O.sub.2] ([MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII], Torr), arterial oxygen saturation ([MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII], %), and Hb concentration (g/dl)] and progesterone and estradiol levels between postmenopausal and premenopausal women, both in the luteal and follicular phases. Women residing in Cerro de Pasco (n = 33; 4,300 m) aged 26-62 yr were studied. Postmenopausal women compared with premenopausal women in the luteal phase had lower [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] (48 [+ or -] 4 vs. 53 [+ or -] 2 Torr, P = 0.005) and [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] levels (82 [+ or -] 12 vs. 88 [+ or -] 12%, P [is less than] 0.005) and higher [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] (34 [+ or -] 2 vs. 29 [+ or -] 3 Torr, P = 0.005) and Hb concentration (19 [+ or -] 1 vs. 14 [+ or -] 2 g/dl, P [is less than] 0.005). In addition, plasma progesterone was negatively correlated with [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] and positively correlated with [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] and [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII]. No clear relationship was found among the cycle phases between estradiol and the variables studied. In conclusion, our results reveal that, before menopause, there is better oxygenation and lower Hb levels in women long residing at altitude, and this is associated with higher levels of progesterone in the luteal phase of the cycle. menopause; chronic mountain sickness; end-tidal oxygen pressure; end-tidal carbon dioxide pressure; polycythemia; oxygen saturation more...

Published
2001

16. Child health and nutrition in Peru within an antipoverty political agenda: a Countdown to 2015 country case study

Author

Huicho, L., Segura, E.R., Huayanay-Espinoza, C.A., Niño de Guzman, J., Restrepo-Méndez, M.C., Tam, Y., Barros, A.J.D., Victora, C.G., Peru Countdown Country Case Study Working Group, Huicho, L., Segura, E.R., Huayanay-Espinoza, C.A., Niño de Guzman, J., Restrepo-Méndez, M.C., Tam, Y., Barros, A.J.D., Victora, C.G., and Peru Countdown Country Case Study Working Group more...

Abstract

Background Peru is an upper-middle-income country with wide social and regional disparities. In recent years, sustained multisectoral antipoverty programmes involving governments, political parties, and civil society have included explicit health and nutrition goals and spending increased sharply. We did a country case study with the aim of documenting Peru's progress in reproductive, maternal, neonatal, and child health from 2000–13, and explored the potential determinants. Methods We examined the outcomes of health interventions coverage, under-5 mortality, neonatal mortality, and prevalence of under-5 stunting. We obtained data from interviews with key informants, a literature review of published and unpublished data, national censuses, and governmental reports. We obtained information on social determinants of health, including economic growth, poverty, unmet basic needs, urbanisation, women's education, water supply, fertility rates, and child nutrition from the annual national households surveys and the Peruvian Demographic and Health Surveys. We obtained national mortality data from the Interagency Group for Child Mortality Estimation, and calculated subnational rates from 11 surveys. Analyses were stratified by region, wealth quintiles, and urban or rural residence. We calculated coverage indicators for the years 2000–13, and we used the Lives Saved Tool (LiST) to estimate the effect of changes in intervention coverage and in nutritional status on mortality. Findings From 2000 to 2013, under-5 mortality fell by 58% from 39·8 deaths per 1000 livebirths to 16·7. LiST, which was used to predict the decline in mortality arising from changes in fertility rates, water and sanitation, undernutrition, and coverage of indicators of reproductive, maternal, neonatal, and child health predicted that the under-5 mortality rate would fall from 39·8 to 28·4 per 1000 livebirths, accounting for 49·2% of the reported reduction. Neonatal mortality fell by 5 more...

Published
2016

17. Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

Author

Mann, C., Ng, C., Akseer, N., Bhutta, Z.A., Borghi, J., Colbourn, T., Hernández-Peña, P., Huicho, L., Malik, M.A., Martinez-Alvarez, M., Munthali, S., Salehi, A.S., Tadesse, M., Yassin, M., Berman, P., Mann, C., Ng, C., Akseer, N., Bhutta, Z.A., Borghi, J., Colbourn, T., Hernández-Peña, P., Huicho, L., Malik, M.A., Martinez-Alvarez, M., Munthali, S., Salehi, A.S., Tadesse, M., Yassin, M., and Berman, P. more...

Abstract

Background Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies. Methods This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data. Results Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20–64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005–2010) for RMNH expenditures (2005–2010) and 165 % for CH expenditures (2005–2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements. Conclusions Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growin more...

Published
2016

18. Genotypic and Phenotypic Characterization of Enterotoxigenic Escherichia coli Strains Isolated from Peruvian Children

Author

Rivera, F. P., Ochoa, T. J., Maves, R. C., Bernal, M., Medina, A. M., Meza, R., Barletta, F., Mercado, E., Ecker, L., Gil, A. I., Hall, E. R., Huicho, L., Lanata, C. F., Rivera, F. P., Ochoa, T. J., Maves, R. C., Bernal, M., Medina, A. M., Meza, R., Barletta, F., Mercado, E., Ecker, L., Gil, A. I., Hall, E. R., Huicho, L., and Lanata, C. F. more...

Abstract

Enterotoxigenic Escherichia coli (ETEC) is a major cause of childhood diarrhea. The present study sought to determine the prevalence and distribution of toxin types, colonization factors (CFs), and antimicrobial susceptibility of ETEC strains isolated from Peruvian children. We analyzed ETEC strains isolated from Peruvian children between 2 and 24 months of age in a passive surveillance study. Five E. coli colonies per patient were studied by multiplex real-time PCR to identify ETEC virulence factors. ETEC-associated toxins were confirmed using a GM1-based enzyme-linked immunosorbent assay. Confirmed strains were tested for CFs by dot blot assay using 21 monoclonal antibodies. We analyzed 1,129 samples from children with diarrhea and 744 control children and found ETEC in 5.3% and 4.3%, respectively. ETEC was more frequently isolated from children >12 months of age than from children <12 months of age (P < 0.001). Fifty-two percent of ETEC isolates from children with diarrhea and 72% of isolates from controls were heat-labile enterotoxin (LT) positive and heat-stable enterotoxin (ST) negative; 25% and 19%, respectively, were LT negative and ST positive; and 23% and 9%, respectively, were LT positive and ST positive. CFs were identified in 64% of diarrheal samples and 37% of control samples (P < 0.05). The most common CFs were CS6 (14% and 7%, respectively), CS12 (12% and 4%, respectively), and CS1 (9% and 4%, respectively). ST-producing ETEC strains caused more severe diarrhea than non-ST-producing ETEC strains. The strains were most frequently resistant to ampicillin (71%) and co-trimoxazole (61%). ETEC was thus found to be more prevalent in older infants. LT was the most common toxin type; 64% of strains had an identified CF. These data are relevant in estimating the burden of disease due to ETEC and the potential coverage of children in Peru by investigational vaccines., Revisión por pares more...

Published
2014

19. An Insight into the Relationships between Hepcidin, Anemia, Infections and Inflammatory Cytokines in Pediatric Refugees: A Cross-Sectional Study

Author

Huicho, L, Cherian, S, Forbes, DA, Cook, AG, Sanfilippo, FM, Kemna, EH, Swinkels, DW, Burgner, DP, Huicho, L, Cherian, S, Forbes, DA, Cook, AG, Sanfilippo, FM, Kemna, EH, Swinkels, DW, and Burgner, DP more...

Abstract

BACKGROUND: Hepcidin, a key regulator of iron homeostasis, is increased in response to inflammation and some infections, but the in vivo role of hepcidin, particularly in children with iron deficiency anemia (IDA) is unclear. We investigated the relationships between hepcidin, cytokines and iron status in a pediatric population with a high prevalence of both anemia and co-morbid infections. METHODOLOGY/PRINCIPAL FINDINGS: African refugee children <16 years were consecutively recruited at the initial post-resettlement health check with 181 children meeting inclusion criteria. Data on hematological parameters, cytokine levels and co-morbid infections (Helicobacter pylori, helminth and malaria) were obtained and urinary hepcidin assays performed. The primary outcome measure was urinary hepcidin levels in children with and without iron deficiency (ID) and/or ID anaemia (IDA). The secondary outcome measures included were the relationship between co-morbid infections and (i) ID and IDA, (ii) urinary hepcidin levels and (iii) cytokine levels. IDA was present in 25/181 (13.8%). Children with IDA had significantly lower hepcidin levels (IDA median hepcidin 0.14 nmol/mmol Cr (interquartile range 0.05-0.061) versus non-IDA 2.96 nmol/mmol Cr, (IQR 0.95-6.72), p<0.001). Hemoglobin, log-ferritin, iron, mean cell volume (MCV) and transferrin saturation were positively associated with log-hepcidin levels (log-ferritin beta coefficient (beta): 1.30, 95% CI 1.02 to 1.57) and transferrin was inversely associated (beta: -0.12, 95% CI -0.15 to -0.08). Cytokine levels (including IL-6) and co-morbid infections were not associated with IDA or hepcidin levels. CONCLUSIONS/SIGNIFICANCE: This is the largest pediatric study of the in vivo associations between hepcidin, iron status and cytokines. Gastro-intestinal infections (H. pylori and helminths) did not elevate urinary hepcidin or IL-6 levels in refugee children, nor were they associated with IDA. Longitudinal and mechanistic studies of ID more...

Published
2008

20. Genotypic and Phenotypic Characterization of Enterotoxigenic Escherichia coli Strains Isolated from Peruvian Children

Author

Rivera, F. P., primary, Ochoa, T. J., additional, Maves, R. C., additional, Bernal, M., additional, Medina, A. M., additional, Meza, R., additional, Barletta, F., additional, Mercado, E., additional, Ecker, L., additional, Gil, A. I., additional, Hall, E. R., additional, Huicho, L., additional, and Lanata, C. F., additional more...

Published
2010
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24. Clinical and Bacteriologic Efficacy of Amoxycillin b.d. (45 mg/kg/day)VersusAmoxycillin t.d.s (40 mg/kg/day) in Children with Group A b-hemolytic Streptococcal Tonsillopharyngitis

Author

AGUILAR, A., primary, TINOCO, J., additional, MACIAS, M., additional, HUICHO, L., additional, LEVY, J., additional, TRUJILLO, H., additional, LOPEZ, P., additional, PEREIRA, M., additional, MAQBOOL, S., additional, BHUTTA, Z.A., additional, SACY, R.A., additional, and DEACON, S., additional more...

Published
2000
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32. Genotypic and Phenotypic Characterization of Enterotoxigenic Escherichia coliStrains Isolated from Peruvian Children

Author

Rivera, F. P., Ochoa, T. J., Maves, R. C., Bernal, M., Medina, A. M., Meza, R., Barletta, F., Mercado, E., Ecker, L., Gil, A. I., Hall, E. R., Huicho, L., and Lanata, C. F.

Abstract

ABSTRACTEnterotoxigenic Escherichia coli(ETEC) is a major cause of childhood diarrhea. The present study sought to determine the prevalence and distribution of toxin types, colonization factors (CFs), and antimicrobial susceptibility of ETEC strains isolated from Peruvian children. We analyzed ETEC strains isolated from Peruvian children between 2 and 24 months of age in a passive surveillance study. Five E. colicolonies per patient were studied by multiplex real-time PCR to identify ETEC virulence factors. ETEC-associated toxins were confirmed using a GM1-based enzyme-linked immunosorbent assay. Confirmed strains were tested for CFs by dot blot assay using 21 monoclonal antibodies. We analyzed 1,129 samples from children with diarrhea and 744 control children and found ETEC in 5.3% and 4.3%, respectively. ETEC was more frequently isolated from children >12 months of age than from children <12 months of age (P< 0.001). Fifty-two percent of ETEC isolates from children with diarrhea and 72% of isolates from controls were heat-labile enterotoxin (LT) positive and heat-stable enterotoxin (ST) negative; 25% and 19%, respectively, were LT negative and ST positive; and 23% and 9%, respectively, were LT positive and ST positive. CFs were identified in 64% of diarrheal samples and 37% of control samples (P< 0.05). The most common CFs were CS6 (14% and 7%, respectively), CS12 (12% and 4%, respectively), and CS1 (9% and 4%, respectively). ST-producing ETEC strains caused more severe diarrhea than non-ST-producing ETEC strains. The strains were most frequently resistant to ampicillin (71%) and co-trimoxazole (61%). ETEC was thus found to be more prevalent in older infants. LT was the most common toxin type; 64% of strains had an identified CF. These data are relevant in estimating the burden of disease due to ETEC and the potential coverage of children in Peru by investigational vaccines. more...

Published
2010
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33. Inhibitory effect of an α1-adrenergic antagonist on erythropoiesis in normoxic or hypoxic miceantagonist on erythropoiesis in normoxic or hypoxic mice

Author

Izaguirre, V., Vargas, M., León-Velarde, F., Huicho, L., Monge, C., Barcelò, A., Alippi, R., and Bozzini, C.

Abstract

Summary: The present study was undertaken to assess the effect of prazosin, a selective postsynaptic α1-adrenergic receptor blocking agent, on normoxic and hypoxic mice, in order to evaluate experimentally its use in the treatment of the excessive erythrocytosis that characterizes chronic mountain sickness. The drug, injected intraperitoneally to adult mice at a dose of 400 μg/kg per day, induced a significant depression of the rate or eryhtropoiesis, as measured by red blood cell59iron uptake, with a decrease in the hematocrit from the 3rd day. The drug also inhibited the oxygen-dependent secretion of erythropoietin (estimated by the plasma immunoreactive hormone concentration) in hypoxemic mice when injected between 0 and 2 h after initiation of the hypoxic stimulation. When injected daily into mice exposed to intermittent hypobaric hypoxia, prazosin limited the degree of polycythemia or induced a sustained decrease in the hematocrit when polycythemia was already present due to previous exposure. It is postulated that the drug, by reducing the peripheral vascular resistance seen during hypoxia, could increase renal blood flow, thus improving the renal oxygen supply and partially restoring the imbalance between gas supply and demand, which drives erythropoietin formation. more...

Published
1994
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34. The use of isotonic sodium chloride in the early treatment of cholera diarrhea: the Peruvian experience

Author

Vargas, M., Huicho, L., Salcedo, V., and Monge, E.

Abstract

Due to the limited supply in Peru of polyelectrolitic solutions recommended for the initial treatment of cholera diarrhea, a massive amount of isotonic sodium chloride solution was used during the recent cholera epidemic. This treatment proved adequate based on the low mortality rate, which compared favorably with international mortality rate reports. A preliminary observation of six adult Peruvian patients hospitalized with hypovolemic shock and metabolic acidosis secondary to cholera diarrhea showed remission of hypovolemic manifestations and significant improvement of serum bicarbonate, pCO2, and base excess after rapid intravenous infusion of a solution of isotonic sodium chloride. This intravenous solution seems adequate as the initial intravenous fluid for patients with severe cholera, as a logical alternative to currently recommended polyelectrolitic solutions containing bicarbonate or lactate. more...

Published
1993
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35. Cyclospora cayetanensis associated with watery diarrhoea in Peruvian patients

Author

Rito Zerpa, Uchima, N., and Huicho, L.

Subjects
Adult, Diarrhea, Male, Adolescent, Coccidiosis, Feces, Ducks, Eucoccidiida, Water Supply, Peru, Animals, Humans, Female, Intestinal Diseases, Parasitic, Child
Abstract

Acid-fast, coccidian-like bodies (Cyclospora cayetanensis) were identified over the last 18 months in the stools of seven Peruvian patients suffering from diarrhoea. The follow-up of two patients revealed a watery, self-limited diarrhoea, which lasted for up to four weeks. The organism was simultaneously identified in the diarrhoeal stools of three members of the same family who drank unchlorinated canal water and in the stools of a duck bred by this family. The organism was not found in the faecal samples of 50 healthy subjects and 10 ducks bred by families without known diarrhoea cases. These findings, albeit preliminary, may be suggesting that besides consumption of untreated water, additional modes of transmission such as contact with domestic animals may be important in this disease. Further studies are needed to assess whether this disease behaves as a zoonotic condition and to ascertain the relative importance of symptom-free subjects in person-to-person transmission of the organism. more...

44. Impact of the COVID-19 pandemic on small vulnerable newborns: an interrupted time series analysis in Peru and Brazil.

Author

Cajachagua-Torres KN, Xavier MO, Quezada-Pinedo HG, Huayanay-Espinoza CA, Oviedo Rios AG, Amouzou A, Maïga A, Akseer N, Matijasevich A, and Huicho L

Subjects
Humans, Infant, Newborn, Brazil epidemiology, Peru epidemiology, Female, Pregnancy, Premature Birth epidemiology, Infant, Premature, Pandemics, SARS-CoV-2, COVID-19 epidemiology, Infant, Small for Gestational Age, Interrupted Time Series Analysis, Infant, Low Birth Weight
Abstract

Background: We examined COVID-19's impact on the number of small vulnerable newborns (SVN) at national and regional levels in Peru and Brazil., Methods: Using national birth registries, we examined monthly numbers of preterm (PT), low birthweight (LBW), and small for gestational age (SGA) newborns. We analysed COVID-19's impact on SVN using two interrupted time series models. We estimated SVN's expected numbers in the absence of the pandemic using mixed-effects regressions and calculated percent changes by comparing these estimates to observed during the pandemic. Incidence rate ratios (IRR) were estimated using Poisson regression., Results: In Peru, the average percent changes in PT, LBW, and SGA births were -17%, -11%, and -3% in 2020, and -10%, -4%, and +2% in 2021, respectively. The IRR of PT and LBW declined throughout the pandemic, while SGA IRR increased in August 2020-November 2020 and May 2021-December 2021. The Coast region experienced the greatest drop in PT, LBW, and SGA IRR in 2020, followed by a slight increase in 2021, whereas the Highlands and Amazon regions had increased LBW and SGA IRR. In Brazil, the percent changes in PT, LBW, and SGA births were +1%, -3%, and -8% in 2020, and +1%, 0%, and -1% in 2021, respectively. Most PT, LBW, and SGA IRRs decreased during the pandemic, except in the Northeast and Southeast regions, where PT increased in 2020. All regions experienced declines in LBW and SGA in 2020, with the Central-West and South regions showing the greatest LBW declines and Central-West region the highest SGA decrease., Conclusions: No significant worsening of neonatal outcomes were observed during the COVID-19 pandemic. In Peru, PT and LBW births declined, while SGA increased from August 2020. In Brazil, PT births slightly increased, while LBW and SGA births declined in 2020, remaining stable in 2021., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and relationships: LH and CHE received honoraria from the Countdown to 20230 Women´s, Children´s & Adolescents´ Health for conducting this study., (Copyright © 2025 by the Journal of Global Health. All rights reserved.) more...

Published
2025
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45. Impact of COVID-19 on the utilisation of maternal and child health services in Peru at national and subnational levels: An interrupted time series analysis.

Author

Huicho L, Huayanay-Espinoza CA, Valladares R, Oviedo-Rios AG, Ruiz-Lopez SS, Akseer N, Maïga A, Matijasevich A, and Amouzou A

Subjects
Humans, Peru epidemiology, Female, Pregnancy, Child, Maternal-Child Health Services statistics & numerical data, Patient Acceptance of Health Care statistics & numerical data, Adult, Child, Preschool, Maternal Health Services statistics & numerical data, Infant, Pandemics, COVID-19 epidemiology, Interrupted Time Series Analysis
Abstract

Background: The resilience of Peru´s health system was weakened by a political crisis that started in 2016 and was further challenged by the coronavirus 2019 (COVID-19) pandemic. We assessed the indirect impact of the pandemic on the utilisation of essential maternal and child health (MCH) services in Peru at national and subnational levels., Methods: We assessed the trends in MCH services utilisation and the percentage change from 2018 to 2021, using routine health facility data. We used an interrupted time series analysis to quantify the impact of COVID-19 on the utilisation of health services., Results: The utilisation of most maternal and child health services dropped dramatically in 2020 after the outbreak. However, we observed a quick recovery in 2021, with service utilisation fairly similar or higher to the pre-pandemic period (2018-2019). The decrease was higher in the utilisation of antenatal care visit one or more (incidence rate ratio (IRR) = 0.79; 95% CI = 0.74-0.83) and antenatal care visits four or more (IRR= 0.76; 95% = 0.74-0.79) in 2020. The IRR showed a drop of 5, 6, 9, and 13% in the utilisation of skilled birth attendances, institutional deliveries, caesarean sections and postnatal care visits within two days of childbirth, respectively in 2020 in comparison to pre-pandemic service utilisation. In 2020 the utilisation decreased in all three natural regions, with the Rainforest being the most affected. In 2021 there was a recovery in all natural regions., Conclusions: The pandemic decreased the utilisation of essential maternal and child health services in Peru. This highlights the need to preserve the resilience of a health system both at central and local levels, to face more successfully future pandemics., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and/or relationships: LH and CAH received honoraria from the Countdown to 20230 Women´s, Children´s & Adolescents´ Health for conducting this study., (Copyright © 2024 by the Journal of Global Health. All rights reserved.) more...

Published
2024
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46. Impact of COVID-19 on the utilisation of maternal health services in Bangladesh: A division-level analysis.

Author

Hossain AT, Akter E, Manna RM, Ara T, Hossain MA, Tanvir KM, Rahman MH, Sayeed A, Siddique AB, Ahamed B, Haider MS, Jabeen S, Ameen S, Shomik MS, Ahmed A, Huicho L, Matijasevich A, Maiga A, Rahman AE, Akseer N, El Arifeen S, and Amouzou A more...

Subjects
Humans, Pregnancy, Bangladesh epidemiology, Cesarean Section statistics & numerical data, Confidence Intervals, Poisson Distribution, Regression Analysis, Quarantine statistics & numerical data, Data Analysis, Prenatal Care statistics & numerical data, Parturition, Maternal Health Services classification, Maternal Health Services organization & administration, Maternal Health Services statistics & numerical data, COVID-19 epidemiology, COVID-19 prevention & control
Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic., Methods: Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019)., Results: Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery., Conclusions: The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.) more...

Published
2024
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47. Unveiling the dimension of regional disparities: Assessing the disruption of immunisation services by COVID-19 in Bangladesh.

Author

Akter E, Sayeed A, Siddique AB, Ahamed B, Manna RM, Hossain L, Tanvir KM, Sanim MAI, Rahman MH, Chowdhury S, Ara T, Hossain MA, Haider MS, Jabeen S, Ameen S, Shomik MS, Ahmed A, Huicho L, Matijasevich A, Maiga A, Rahman AE, Akseer N, El Arifeen S, Hossain AT, and Amouzou A more...

Subjects
Humans, Bangladesh epidemiology, Child, Preschool, Infant, Immunization Programs, Healthcare Disparities, Child, Vaccination statistics & numerical data, COVID-19 prevention & control, COVID-19 epidemiology, BCG Vaccine administration & dosage, Measles Vaccine administration & dosage
Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted essential health care services worldwide, including those related to immunisation. National data from Bangladesh shows that child immunisation may have been adversely affected by the pandemic but regional evidence is limited. We therefore aimed to explore the regional differences in the indirect effects of COVID-19 on child immunisation in Bangladesh., Methods: We extracted data from the District Health Information Software (DHIS2) spanning the period from January 2017 to December 2021. We examined three essential immunisation indicators: Bacille Calmette-Guérin (BCG), pentavalent third dose, and measles vaccinations. We examined both the yearly and monthly trends to explore fluctuations in the number of immunisations to pinpoint specific periods of service utilisation regression. Segmented regression with Poisson distribution was implemented given the count-based outcome. We reported incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in different regions in 2020 and 2021 compared to the reference period (2017-19)., Results: We initially observed a notable decline in vaccine administration in April 2020 compared to the pre-pandemic period of 2017-19 with a drop of approximately 53% for BCG vaccines, 55% for pentavalent third doses, and 51% for measles vaccines followed by May 2020. The second half of 2020 saw an increase in vaccination numbers. There were noticeable regional disparities, with Sylhet (IRR = 0.75; 95% CI = 0.67-0.84 for pentavalent administration, IRR = 0.79; 95% CI = 0.71-0.88 for measles administration) and Chattogram (IRR = 0.77; 95% CI = 0.72-0.83 for BCG administration) experiencing the most significant reductions in 2020. In April 2020, Dhaka also experienced the largest decline of 67% in measles vaccination. In 2021, most divisions experienced a rebound in BCG and pentavalent administration, exceeding 2019 levels, except for Chittagong, where numbers continued to decline, falling below the 2019 figure., Conclusions: Our findings highlight the impact of the COVID-19 pandemic on childhood immunisation across regions in Bangladesh. Sylhet, Chattogram, and Dhaka divisions experienced the most significant reductions in immunisation services during 2020. This underscores the importance of targeted interventions and regional strategies to mitigate the indirect effects of future challenges on essential health care services, particularly childhood immunisation, in Bangladesh., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.) more...

Published
2024
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49. Vulnerable newborn phenotypes in Peru: a population-based study of 3,841,531 births at national and subnational levels from 2012 to 2021.

Author

Cajachagua-Torres KN, Quezada-Pinedo HG, Guzman-Vilca WC, Tarazona-Meza C, Carrillo-Larco RM, and Huicho L

Abstract

Background: We aimed to examine the national and subnational prevalence of vulnerable newborn phenotypes in Peru, 2012-2021., Methods: Newborn phenotypes were defined using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight [LBW], non-LBW) using the Peruvian National Birth Registry as six (by excluding birthweight) and ten newborn phenotypes (using all three outcomes). Small phenotypes (with at least one classification of PT, SGA, or LBW) were further considered. Using individual-level data, we stratified the phenotypes by maternal educational level, maternal age, healthcare insurance, altitude of residence, and geographic region (Coast, Andes, and Amazon)., Findings: The prevalence of the five vulnerable newborn phenotypes for the study period was LGA+T (15.2%), AGA+PT (5.2%), SGA+T (4.6%), LGA+PT (0.8%), and SGA+PT (0.7%). The Coast had a higher prevalence of newborns with large phenotypes (19.4%) and the Highlands a higher prevalence of newborns with small phenotypes (12.5%). Mothers with poor socioeconomic status, extreme ages and living at high altitude had a higher prevalence of newborns with small phenotypes, and mothers who were wealthier, more educated, and older had a higher prevalence of infants with large phenotypes., Interpretation: Our findings cautiously suggest that socioeconomic and geographic disparities may play a crucial role in shaping vulnerable newborn phenotypes at national and subnational level in Peru. Further studies using longitudinal data are needed to corroborate our findings and to identify individual-level risk factors., Funding: Ter Meulen Grant from the KNAW Medical Sciences Fund of the Royal Netherlands Academy of Arts and Sciences (KNAWWF/1085/TMB406, KNAWWF/1327/TMB202116), Fogarty Program (D43TW011502)., Competing Interests: None., (© 2024 The Author(s).) more...

Published
2024
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50. Effect of the Mamás del Río programme on essential newborn care: a three-year before-and-after outcome evaluation of a community-based, maternal and neonatal health intervention in the Peruvian Amazon.

Author

Blas MM, Reinders S, Alva A, Neuman M, Lange I, Huicho L, and Ronsmans C

Abstract

Background: Despite remarkable progress in maternal and neonatal health, regional inequalities persist in Peru. In rural areas of Amazonian Loreto, access to quality care is difficult, home births are frequent, and neonatal mortality is high. We conducted a prospective before-and-after study to assess the effect after implementation and over time of a community-based intervention on essential newborn care (ENC)., Methods: Mamás del Río consists of tablet-enhanced educational home visits by Community health workers (CHW) to pregnant women and mothers of newborns, with supportive training on ENC of traditional birth attendants and facility staff. The study area comprised 79 rural communities of three districts in Loreto. Primary outcomes were ENC practices in home births, secondary outcomes were ENC in facility births as well as healthcare seeking, measured at baseline before and at year 2 and year 3 after intervention implementation. Community censuses included questionnaires to women aged 15-49 years with a live birth. We calculated prevalence of outcomes at each time point and estimated adjusted prevalence differences (PD) between time points using post-estimation based on logistic regression., Findings: Following implementation early 2019, 97% of communities had a trained CHW. At year 2 follow-up, 63% (322/530) of women received a CHW visit during pregnancy. Seven out of nine ENC indicators among home births improved, with largest adjusted prevalence differences in immediate skin-to-skin contact (50% [95% CI: 42-58], p < 0.0001), colostrum feeding (45% [35-54], p < 0.0001), and cord care (19% [10-28], p = 0.0001). Improvements were maintained at year 3, except for cord care. At year 2, among facility births only three ENC indicators improved, while more women gave birth in a facility. Sensitivity analyses showed ENC prevalence was similar before compared to after onset of Covid-19 lockdown., Interpretation: ENC practices in home births improved consistently and changes were sustained over time, despite the onset of the Covid-19 pandemic. A community-based approach for behaviour-change in home-based newborn care appears effective. Process evaluation of mechanisms will help to explain observed effects and understand transferability of findings., Funding: Grand Challenges Canada and Peruvian National Council of Science and Technology., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Author(s).) more...

Published
2023
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