Health In Peru Research Articles

Social, Cultural and Economic Analysis of Post-Pandemic Public Health (COVID-19) in the Case of Peru: an Evaluation of Approaches to Promote Health and Well-Being Within the Framework of the SDG

Objective: To examine the social, cultural, and economic consequences of the pandemic on public health in Peru, recognizing challenges and possibilities to strengthen the system, given that the pandemic aggravated existing inequalities, disproportionately impacting vulnerable groups, such as rural communities and individuals living in poverty, an evaluation of approaches to promote health and well-being within the framework of the SDG. Theoretical framework: This research analyzes the way in which the pandemic has impacted several aspects of public health in the country, in a post-COVID-19 pandemic scenario that showed and aggravated the already existing weaknesses in the Peruvian health system, marked by its fragmentation and restrictions in infrastructure and human resources. Method: A qualitative approach based on a documentary review and critical analysis was used for the development of the research. Research implications: Lack of access to high-quality health services and unfavorable living conditions contributed to an increase in COVID-19 incidence and mortality in these groups. In cultural terms, distrust of the official health system and inclination towards traditional medicines impacted the community reaction to the virus. In economic terms, the pandemic severely impacted the middle class, decreasing its magnitude from 43.6% in 2019 to 24% in 2020, canceling out a decade of economic progress. Results and discussion: The infodemic, or excess of information, including rumors and misinformation, made it difficult to implement effective public health strategies. In addition to job losses and reduced incomes, they restrict access to health services, intensifying pre-existing inequalities. Originality/Value: To enhance public health in Peru after the pandemic, it is crucial to address social inequalities.

Addressing Maternal Perinatal Mortality: State Responsibility in Primary Health Care in Perú

Using data from the Comprehensive Health Insurance, this study examined Primary Health Care (PHC) and disparities in maternal-perinatal health in Peru. Its primary goal was to assess how PHC affected the decline in high and persistent maternal and perinatal mortality. The investigation also encompassed regional inequities and unequal access to health services. The study used a technique that integrated a qualitative approach, a review of scientific literature, and data analysis. It made clear how crucial it is to address inequality characteristics such as sociocultural accessibility, geographic, and economic in order to enhance care in the nation. The findings demonstrate the necessity of resolving these disparities in order to improve prenatal and maternal care. The present study offers a robust basis for subsequent inquiries and the development of evidence-based health policies. The Ministerio de la Mujer y Poblaciones Vulnerables (2021) recommended changes in health policy, which this study supports in order to enhance the health of vulnerable people and reduce inequities in access to maternal-perinatal care. The study also highlights the critical necessity of PHC in Peru. Its primary contributions are to deepen our understanding of disparities in obstetric treatment and to set the stage for future studies and national health policy.

Effectiveness of a training program in implement comprehensive care with focus on family and community health in Peru

For more than a decade, efforts have been made to implement a Comprehensive Health Care MTodel Based on Family and Community, now updated as a Comprehensive Health Care Model. Objective: determine the effectiveness of a diploma developed with the pedagogy of problematization, to implement the Comprehensive Health Care Model. Method: Retrospective, analytical study on the effectiveness of the diploma “Training Program in Family and Community Health (PROFAM)” developed for basic health teams in the Apurímac, Ayacucho, Huancavelica and Loreto regions in 2012 in Peru. Results: Basic health teams were trained in 38 health establishments, the difference between the baseline and final line results of the evaluated standards shows an association with p-value (< 0.05) in the evaluated services of the regions. Ayacucho, Huancavelica, and Loreto. Conclusion: The in-person diploma with problematization pedagogy positively influenced the implementation of the Comprehensive Health Care Model based on Family and Community, the same cannot be assured in the Apurímac region.

Mercury, lead and cadmium content in tuna and its effect on public health in Peru: Systematic review

Introduction: in Peru, publications indicate that the content of mercury (Hg), lead (Pb), and cadmium (Cd) in tuna exceeds the allowable maximum limits, leading to progressive health damage. Thus, communicating this threat is necessary.Objective: to ascertain the presence of Hg, Pb, and Cd in tuna intended for direct human consumption and its implications for public health in Peru.Methods: a systematic review was conducted following the PRISMA 2020 Statement. Information was retrieved from databases including Scopus, Latindex, Science Direct, and Google Scholar. Twelve articles were selected for analysis, following inclusion and exclusion processes.Results: there is a prevalence (41,66 %) of studies focusing on Hg concentration, while Pb and Cd were equally represented (16,67 % each). Regarding Peru, the presence of metals was reported in 29 % of the studies, indicating a higher tendency towards Hg consumption compared to Pb and Cd. However, the ingestion of any of these metals poses a significant risk to public health consumers.Conclusions: Tuna, a species that incorporates heavy metals into its edible muscular tissue, is predominantly monitored for mercury (Hg), lead (Pb), and cadmium (Cd) due to their toxicity and bioaccumulation characteristics, making them particularly hazardous to public health, especially in Peru. Thus, continuous monitoring is recommended

A bibliometric analysis of 47-years of research on public health in Peru

<b>Objectives</b>: To measure Peruvian scientific production on public health in Scopus database.<br /> <b>Methods</b>: Bibliometric study using advanced Scopus web search engine (https://www.scopus.com/search/<br /> form.uri?display=advanced). The inclusion criteria were the publications of articles related to public health between 1973 and 2020. The equation was used as a strategy: TITLE-ABS-CLAVE (“public health”) AND AFFILCOUNTRY (Peru) AND (EXCLUDE (PUBYEAR, 2021) OR EXCLUDE (PUBYEAR, 2020)). SCImago journal & country rank was used to determine the impact factor (h-index) and the quartile of the journals identified. The analysis included in SPSS v24.0 included years of publication, institutions, h-index, list of authors with the most publications, publication types, and journals.<br /> <b>Results</b>: 903 articles published by 7.5±12.5 authors were included, showing that 74.5% were original articles written mainly in English (77.7%). The publications for the year 1973 and 2019 were 3 (0.3%) and 98 (10.9%), respectively. In addition, it was shown that the most productive institutions were the Universidad Peruana Cayetano Heredia (42.9%) and the Universidad Nacional Mayor de San Marcos (13.1%). The journal with the highest number of Peruvian publications was Revista Peruana de Medicina Experimental y Salud Pública (RPMESP) [Peruvian Journal of Experimental Medicine and Public Health (PJEMPH)] (17.5%) and PLoS ONE (2.88%).<br /> <b>Conclusions</b>: The present study showed in the magazines with the highest number of citations and therefore greater visualization, where Peruvian publications in this area were published, with this the future readers can take these magazines into consideration so that their publications have a greater visualization. In addition to this, the study shows the largest institutions that have a great impact on Peruvian publications in public health in Scopus, this invites researchers to analyze the research methodologies that these institutions follow in order to disclose them for reproduction in new entities interested in research.

Integrating Telehealth for Strengthening Health Systems in the Context of the COVID-19 Pandemic: A Perspective from Peru.

The COVID-19 pandemic forced the government to rapidly modify its legal framework to adopt telemedicine and promote the implementation of telehealth services to meet the healthcare needs of patients in Peru. In this paper, we aim to review the main changes to the regulatory framework and describe selected initiatives to promote the telehealth framework that emerged in Peru during the COVID-19 pandemic. In addition, we discuss the challenges to integrate telehealth services for strengthening health systems in Peru. The Peruvian telehealth regulatory framework began in 2005, and in subsequent years, laws and regulations were established that sought to progressively implement a national telehealth network. However, mainly local initiatives were deployed. In this sense, significant challenges remain to be addressed, such as infrastructure in healthcare centers, including high-speed Internet connectivity; infostructure of health-information systems, including interoperability with electronic medical records; monitoring and evaluation of the national agenda for the health sector in 2020-2025; expanding the healthcare workforce in terms of digital health; and developing the capacities of healthcare users on health literacy, including digital aspects. In addition, there is enormous potential for telemedicine as a key strategy to deal with the COVID-19 pandemic and to improve access to rural and hard-to-reach areas and populations. There is thus an urgent need to effectively implement an integrated national telehealth system to address sociocultural issues and strengthen the competencies of human resources in telehealth and digital health in Peru.

Urbanization, migration, and indigenous health in Peru.

We compare demographic, socioeconomic, and anthropometric characteristics and blood pressure (BP), between rural and urban Peruvian indigenous women. These are preliminary results from a project on urbanization, migration, and health. Data were collected cross-sectionally (2019) and compared between a rural (n = 92) and an urban (n = 93) community. Height: μ = 148.3 ± 5.0 cm (range = 137-162), weight: μ = 62.0 ± 11.5 (range = 37.5-108.7), median waist circumference = 89.0 (IQR = 15.8, range = 64.0-126.0), BMI = 28.3 (IQR = 6.2, range = 16.7-40.0), with no significant rural-urban differences. Systolic but not diastolic BP was significantly higher in urban versus rural women (median = 110, IQR = 18, range = 80-170 vs. median = 120, IQR = 10, range = 90-170, p = .002 and median = 70, IQR = 17, range = 50-100 vs. median = 70, IQR = 10, range = 60-100, p = .354), respectively. Despite major lifestyle differences, there were no anthropometric differences between rural and urban women. Higher systolic BP in urban women may reflect social/economic stressors rather than dietary factors.

The Peruvian Alzheimer Disease Initiative (PeADI): An international effort model to increase diversity in AD research (S15.002)

<h3>Objective:</h3> We have developed an international collaborative research initiative to ascertain a Peruvian cohort for AD and other related dementias for genetic studies of Amerindian individuals. <h3>Background:</h3> Peru is one of the five largest countries in Latin America and harboring a high Amerindian ancestry component in this population. The Latin American population, including Peruvians, are underrepresented in research studies of AD. <h3>Design/Methods:</h3> PeADI was developed to recruit and enroll Peruvian adults aged 65 and older to a comprehensive genetic AD study. Individuals will get whole genome sequencing and plasma biomarkers. Participants included cases with AD and ADRD, healthy controls as well as multiplex AD families. Since 2019, we have established a multisource ascertainment approach including recruitment at main hospitals, outreach community activities and more recently due to the COVID19 pandemic remote recruitment and home visits in Lima, the capital city. Our recruitment has expanded to three regions from the Andes highlands (Puno, Huancayo, Cusco) and one region from the southern coast (Tacna). All participants are enrolled using a standard clinical and cognitive protocol administered by neurologists and neuropsychologists. <h3>Results:</h3> As of September 2022, we have enrolled 132 AD and other dementia cases, 292 controls and 6 multiplex AD families. While the majority of participants was recruited in Lima,45% controls and 7% of cases have been recruited in regions outside Lima. We have confirmed a significant association between APOE and AD in Peruvian Population higher than we have observed in non-Hispanics. In addition to ascertainment activities, we are working closely with the respective sites to develop a network and resources for AD research across Peru. To date, we have developed local research capacities within each region, including training opportunities for investigators, coordinators and lab technicians, and basic equipment for all regions. <h3>Conclusions:</h3> PeADI study shows the importance of equitable international north-south cooperation and local network cooperation to increase representation of understudied admixed populations to help us understand Amerindian ancestry in drug target discovery. <b>Disclosure:</b> Dr. Illanes-Manrique has nothing to disclose. Dr. Mena has nothing to disclose. Karina Milla-Neyra has nothing to disclose. Larry D. Adams has nothing to disclose. Dr. Mejia has nothing to disclose. Ms. Rios Pinto has received personal compensation in the range of $500-$4,999 for serving as a PSYCHOLOGIST with DOMINGO OLAVEGOYA HOSPITAL. The institution of Prof. Isasi has received research support from NIH. Dr. MEDINA has nothing to disclose. The institution of Dr. Beecham has received research support from NIH. The institution of an immediate family member of Dr. Beecham has received research support from NIH. Dr. Cornejo-Herrera has nothing to disclose. Dr. Vance has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for neurology genetics. Dr. Ochoa has nothing to disclose. The institution of Dr. Suarez has received research support from Alzheimer’s Association. Michael L. Cuccaro has nothing to disclose. Dr. Sarapura-Castro has nothing to disclose. Miss Cubas-Montecino has received research support from Fundacion San Marcos. Miss Cubas-Montecino has received personal compensation in the range of $500-$4,999 for serving as a Lab Technician with Fundacion San Marcos. The institution of Dr. Cornejo Olivas has received research support from CONCYTEC-PROCIENCIA PERU. Dr. Cornejo Olivas has a non-compensated relationship as a Board member at Rare Disorders Burou (CCI-MINSA) with Ministry of Health in Peru that is relevant to AAN interests or activities. Dr. Pericak-Vance has nothing to disclose.

Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study.

The COVID-19 pandemic heavily impacted many low- and middle-income countries (LMICs), such as Peru, overwhelming their health systems. Rapid antigen detection self-tests for SARS-CoV-2, the virus that causes COVID-19, have been proposed as a portable, safe, affordable, and easy-to-perform approach to improve early detection and surveillance of SARS-CoV-2 in resource-constrained populations where there are gaps in access to health care. This study aims to explore decision makers' values and attitudes around SARS-CoV-2 self-testing. In 2021, we conducted a qualitative study in 2 areas of Peru (urban Lima and rural Valle del Mantaro). Purposive sampling was used to identify representatives of civil society groups (RSCs), health care workers (HCWs), and potential implementers (PIs) to act as informants whose voices would provide a proxy for the public's attitudes around self-testing. In total, 30 informants participated in individual, semistructured interviews (SSIs) and 29 informants participated in 5 focus group discussions (FGDs). Self-tests were considered to represent an approach to increase access to testing that both the rural and urban public in Peru would accept. Results showed that the public would prefer saliva-based self-tests and would prefer to access them in their community pharmacies. In addition, information about how to perform a self-test should be clear for each population subgroup in Peru. The tests should be of high quality and low cost. Health-informed communication strategies must also accompany any introduction of self-testing. In Peru, decision makers consider that the public would be willing to accept SARS-CoV-2 self-tests if they are accurate, safe to use, easily available, and affordable. Adequate information about the self-tests' features and instructions, as well as about postuse access to counseling and care, must be made available through the Ministry of Health in Peru.

Chronic hepatitis C in hemodialysis patients: Prevalence and liver fibrosis impact in the National Center for Renal Health in Peru

Hepatitis C (HCV) remains a serious public health problem in high-risk persons such as patients on chronic hemodialysis. We aimed to estimate the serological prevalence of HCV, the HCV viral load and genotype, and liver fibrosis stage among patients on chronic hemodialysis at the National Renal Health Center in Lima, Peru. From June 2019 to March 2021, all patients who received chronic hemodialysis were invited to participate. Subjects who provided written informed consent were enrolled. Patients with HCV-positive serology underwent determination of HCV viral load. Samples from subjects with detectable viral load, underwent determination of HCV genotype. Then, HCV infected subjects underwent determination of liver fibrosis using transitional elastography (Fibroscan 402): Metavir score: F0–F1: 2.5–7.5 kPa, F2: 7.6–9.5 Kpa, F3: 9.6–12 Kpa, F4 (Cirrhosis): 12.1–75 Kpa. Of the 303 subjects invited to participate, 174 (57.4%) subjects gave their written consent. Mean age was 52 years (range 22–91) and 116 (66.6%) were male. HCV serology was positive in 35.1% of patients (61/174); however, the prevalence of positive serology with detectable viral load was 20.11% (35/174). Genotype 1a was the most prevalent (85%). The majority (83.6%) of subjects with detectable viral load had values lower than 800.000 IU/mL. Twenty-nine of those 35 subjects underwent elastography evaluation, and 13 (44.8%) of them were found to have stage F2–F4 fibrosis. The prevalence of HCV at the largest reference center for hemodialysis in Lima remains high, with GT1a predominance, viral load usually below 800,000 IU/mL and significant liver fibrosis.

Domestic networks contribute to the diversity and composition of live wildlife trafficked in urban markets in Peru

Amazonian countries have historically sourced the international wildlife trade. However, little is known about their domestic trade, which is often overlooked in estimates of trafficking. Peruvian law prohibits the unauthorized trade and possession of wildlife, but illegal sales are common in urban markets. To describe the dynamics, diversity, and composition of this illegal trade, we surveyed live wildlife for sale in urban markets in 16 Peruvian departments from 2007 to 2012. We identified the main hotspots of market trafficking, detected 193 species being sold alive, and estimate that 0.35–1.25 million animals were trafficked in this period. Iquitos, Lima, Pucallpa, and Tumbes were the most active and diverse trafficking nodes. Amazonian cities trafficked mostly local species, whereas in other cities the proportion of local species varied significantly (39–67%). Species dissimilarity across cities was high and correlated with their distance along trafficking routes. To assess if the market-based trade was representative of the national trade, we compared species richness in markets with that of country-wide confiscations. At least 430 species were confiscated in Peru between 2001 and 2019, but only 50% of species overlapped with markets in the same cities and period of our surveys. Our data suggest that urban markets are connected in a structured network that provides consumers with a diverse selection of species from across the country. Authorities should consider organizational aspects of trafficking networks to ensure success. Failure to eradicate wildlife trafficking in markets constitutes a serious threat to wildlife conservation and One Health in Peru and beyond.

Building Caregiver Resiliency in Global Health: Embodying the Catholic Social Tradition in the Face of COVID-19

For international healthcare NGOs, the impact of the COVID-19 pandemic has been significant. Healthcare workers in both LMICs and high-income countries have described the impact of the pandemic as traumatic. This article focuses on one initiative designed to address this impact: CMMB’s Building Resiliency program. This article provides an overview of the structure and content of program, situating it within the landscape of global mental healthcare disparities and caregiver trauma. Designed to address caregiver mental health in Peru, Haiti, Kenya, South Sudan, and Zambia, the program sought to offset global mental healthcare disparities by bringing needed psycho-social-spiritual support to CMMB staff. It was intentionally shaped by the commitments of Catholic social thought—particularly to the well-being, dignity, and integral human development of CMMB staff members, to envisaging new forms of solidarity, and to prioritizing subsidiarity and participation. Theories of post-traumatic growth provided the theoretical framework for three remotely delivered seminar series, which made space for staff members to share their stories with their colleagues, to build community, to foster creativity and hope, and to intentionally integrate faith and spirituality into both personal self-care as well as the common life of the organization. Thus, this was designed equally to build the organizational resiliency that is the fruit of Catholic social thought. For attending to caregivers’ mental health and well-being is crucial not only for the success of medical missions but for embodying and witnessing the Catholic commitment to the human dignity and the integral development of those who do the work of our organizations.

Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017

BackgroundPeru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children’s growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration.MethodsUsing data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p].ResultsIn 1991–2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (− 1.0 vs − 1.2; p < 0.001) and WAZ (− 0.3 vs − 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration.ConclusionsMigration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.

Machine Learning Applied to Prevention and Mental Health Care in Peru

The present research aims to develop an application that allows the early and timely detection of signs of problems in the mental health of citizens. Agile methodology was used, with its SCRUM framework developing its four steps. In addition, technological tools such as artificial intelligence, mobile appli-cations, social networks and the python programming language were used. Also using SQL Server, Android Studio and the Marvel applications, the latter for the design of the prototypes, through the method of sentiment analysis and machine learning, in order to create a mobile application that is as accurate as possible in its results. For this, several types of algorithm were evaluated, managing to select the most appropriate one since it works based on information collected through the social networks Facebook and Twitter. The result that was obtained was the application that uses machine learning to prevent and take care of mental health in Peru, thus benefiting the citizens of society.

Effects of the COVID-19 Pandemic on Mental Health in Peru: Psychological Distress.

This pandemic has been classified as a “psychological pandemic” that produces anxiety, depression, post-traumatic stress disorder, and sleep disorders. As the mental health effects of the Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, continue to unfold, there are still large knowledge gaps about the variables that predispose individuals to, or protect individuals against the disease. However, there are few publications on the effects of the COVID-19 pandemic on the mental health of citizens in Latin American countries. In this study, the effects that COVID-19 had on citizens of Peru have been described. For this, 1699 questionnaires, collected between 2 April and 2 September 2020, were analyzed. Descriptive, bivariate analysis was performed with odds ratio (OR) calculations and a data mining methodology. Sociodemographic variables (from the General Health Questionnaire), health conditions and perception, symptoms, and variables related to contact and preventive measures regarding COVID-19 were analyzed. As compared to other countries, less affectation of mental health and increased use of preventive measures were observed. It has been suggested that the country’s precarious health system and poverty rates prior to the pandemic may justify higher mortality figures in Peru than in other Latin American countries, despite prompt action for its containment and compliance with the protective measures. Psychological distress had a greater incidence in women, young people, people without a partner, and people without university studies. The most significant conditioning variables were self-perceived health status, headache or muscle pain over the past 14 days, level of studies, and age. The extensive use of preventive measures against COVID-19 is in line with the strict legislative measures taken, and this is, in turn, in line with other countries when looking at the lower effect on mental health, but contrary when focusing on the high lethality identified. The need to include the economy or availability and quality of healthcare in future studies arises, as well as the suitability to analyze the cause for differences between countries.

Prevalencia de ansiedad dental en pacientes del servicio de odontología de dos hospitales del Ministerio de Salud del Perú

Objective: To determine the level of dental anxiety in dental patients from two hospitals managed by the Ministry of Health of Peru, between August-September 2015. Material and Methods: Cross-sectional, comparative, and observational study, carried out between August and September 2015, including a total of 660 adult patients from the Dental Service of the Hospitals Regional Docente de Trujillo and Belén de Trujillo, Peru. A questionnaire based on the Modified Dental Anxiety Scale (MDAS) (Cronbach's Alpha=0.77) was applied to the participating subjects. Student's t test for independent groups and the Mann-Whitney U test were used for the analysis of the results, considering a significance level of 5%. Results: The mean total anxiety score for the population was 12.05 (SD=3.76). Females (mean=12.56) presented greater anxiety than males (mean=11.53) (p&lt;0.001), young adults (Me=12.60) presented greater anxiety than subjects in mid-adulthood (Me=11.10) (p&lt;0.001). No difference was found in terms of hospitals (p=0.386); 96.06% of the patients evaluated presented dental anxiety, 4.09% had extreme anxiety. Conclusion: The mean dental anxiety of the studied population coincides with the level of moderate anxiety. Females and young adults presented greater anxiety. No difference was found with respect to hospitals. Likewise, 96.06% of the evaluated patients presented dental anxiety, 4.09% had extreme anxiety.

Perceptions, priorities, and project delivery problems in women's and environmental health in Peru: a qualitative study

BackgroundWomen living in low-income and-middle-income countries experience increased exposure and worse effects of environmental threats and climate change. Peru is especially susceptible to a range of environmental exposures, including high levels of pollutants, contamination associated with extractive industries, and flooding exacerbated by the ongoing climate emergency. International policies and movements are increasingly calling for a gendered approach to planetary health. However, little research has been done explicitly examining environmental threats to women's health in Peru. We aimed to understand the current Peruvian research, advocacy, and policy landscape at the environment-gender health nexus. MethodsWe did in-depth semi-structured interviews in Spanish via online Zoom video conferencing (audio only) with key informants from the Peruvian Government, academia, and non-governmental organisations to explore their perception of environmental health threats and priorities, population vulnerability factors, awareness of projects and collaborations on these topics, and the role of gender in their work. We used thematic analysis to compare priorities, gender sensitivity, and barriers and facilitators to delivering successful women's environmental health projects in the country. FindingsSince July 14, 2020, we have interviewed 16 people, with four further interviews planned to take place before the end of May, 2021. Several interviewees mentioned the detrimental role of weak institutions, multilevel corruption, and the absence of interdisciplinarity and intersectorality across programmes and research. Barriers to successful collaboration across organisations and sectors were clearly identified, including funding scandals related to extractive economies, high staff turnovers impairing long-term programme implementation, and machismo culture in both organisations and communities. By contrast, some interviewees highlighted that successful collaborations were instead built on direct relationships, reputation, trust, and transparency. Women's empowerment was also described as important for successful programme delivery, especially in female-led associations. Some interviewees emphasised the so-called invisibilisation of vulnerable groups, such as girls, teenagers, pregnant women, victims of gender-based violence, and LGBTQI people. Existing health inequalities varied by setting and cultural context and were deeply and silently exacerbated by the COVID-19 pandemic. InterpretationThese qualitative findings highlight the multiple and inter-related contextual issues faced by environmentally threatened communities in Peru, and how macrostructural barriers contribute to a paucity of sustainable, gender-oriented, environmental health projects. FundingPartially funded by the UK's Economic and Social Research Council.

Can communal systems work? The effects of communal water provision on child health in Peru

• We assess the impact of communal versus public water provision on child health in Peru. • Identification strategy based on the discontinuity in the type of provision across district sub-units. • Communal organizations result in better health outcomes in historical Inca settlements. • Long-standing effects of the Minka tradition of collective work. • Social norms and traditions are important for the success of communal projects. Communal water organizations are widespread in many areas of developing countries, where local governments lack the resources to offer a minimum quality water service. However, these organizations have their own resource limitations and they additionally face the well-known problems associated with collective action. It is therefore unclear how effectively they can provide safe water, and the evidence available thus far is mixed. This paper analyzes the communal water organizations in Peru known as Juntas Administrativas de Servicios de Saneamiento (JASS). Using detailed household survey data, we empirically assess the differential impact of the JASS vis-à-vis public systems on two water-related child health outcomes: diarrhea and low birth weight. Our identification strategy exploits the legislative changes introduced in the 2000s and the arbitrary cut-off to classify the administrative sub-units of Peruvian municipalities (districts) in order to achieve exogenous variation in the type of water provision. We find that child diarrhea and low birth weight are significantly lower for households served by JASS in the districts located in the first Inca settlements where the pre-Columbian tradition of communal work, called Minka, has survived over centuries. We also show that in those districts the JASS have better governance (existence of their own rules, higher participation and accountability and a greater ability to obtain external support). These findings confirm the hypothesis that social capital and traditions foster cooperation among community members and are in line with recent works showing the importance of historically developed institutions in building social capital. More generally, our results suggest that communal organizations are not a one-fits-all solution, but rather their success depends crucially on the existence of mechanisms for overcoming the problems associated with collective action and the active involvement of the community.

National trends of hepatocellular carcinoma mortality registered by the ministry of health in Peru, from 2005 to 2016

National trends of hepatocellular carcinoma mortality registered by the ministry of health in Peru, from 2005 to 2016

La violencia: ¿Un problema de salud mental en el Perú?

La violencia: ¿Un problema de salud mental en el Perú?