Association between Disability and Unmet Food Needs in the Venezuelan Migrant and Refugee Population: Analysis of a Population-Based Survey, 2022.

In Peru, Venezuelan migrants and refugees have been exposed to food shortages before their emigration. This problem could have worse outcomes in vulnerable populations (such as people with disabilities); however, the literature on the basic needs of this population is still scarce. The objective was to determine the association between the presence of disability and the unmet need for access to food in the household of the Venezuelan migrant and refugee population residing in Peru. A cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru (ENPOVE 2022). The outcome variable was unmet need for food, while the independent variable was the presence of disability. Poisson log generalized linear regression models (crude and adjusted for potential confounding variables) were fitted to evaluate the association between the variables of interest, reporting prevalence ratios (PR) and 95% confidence intervals (CIs). A total of 7739 migrants and refugees from Venezuela were included. The proportion of unmet need for access to food in the household was 45.2%, while the proportion of disability was 2.1%. People with disabilities were found to be more likely to have an unmet need for access to food at home (adjusted PR [aPR]: 1.25; 95% CI: 1.08-1.46; p = 0.003). According to our findings, almost half of Venezuelan households were found to have an unmet need for access to food. In addition, Venezuelan migrants and refugees with disabilities were more likely to have an unmet need for this basic need.

Changes in the Prevalence of Overweight and Obesity among Peruvian Children under Five Years before and during the COVID-19 Pandemic: Findings from a Nationwide Population-Based Study.

This study aimed to identify changes in the prevalence of childhood (children under five years of age) overweight and obesity in Peru as a whole and at the departmental level, before and during the coronavirus disease (COVID-19) pandemic. We performed a secondary data analysis of two Demographic and Family Health Surveys (2019 and 2021) in Peru. The outcome was childhood overweight and obesity, defined as a weight-for-height score greater than 2 standard deviations. Poisson log generalized linear regression models adjusted for sex and/or age in months of the child were fitted to obtain the prevalence ratios of the changes in childhood overweight and obesity from 2019 to 2021. The analysis included 41,533 (2019: 20,414; 2021: 21,119) participants. The prevalence of childhood overweight and obesity was 6.4% in 2019 and 7.8% in 2021. Female children, aged 2, 3 and 4 years, and mothers who self-identified as non-native, had secondary and higher education, belonged to the middle and richer wealth quintile and resided in an urban area, in a village, in a small city and in the coastal region showed the largest increases in the prevalence of childhood overweight and obesity in 2021 compared to 2019. The departments of Pasco, Apurímac, Junín, Cusco, Lambayeque and La Libertad presented the largest increases in the prevalence of these nutritional disorders. During the pandemic, an increase in the prevalence of childhood overweight and obesity was observed, with demographic and socioeconomic factors accounting for the largest increases in the prevalence rates. A restructuring of overweight and obesity control strategies is required to curb this steady increase.

Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru.

OBJECTIVES: To investigate the prevalence, associated factors and socioeconomic inequalities in chronic disease relapses (CDR) during 2020 in Peru. METHODS: A secondary analysis was made of the National Household Survey on Living Conditions and Poverty (ENAHO) 2020. Participants older than 18 years who suffered from a chronic disease and with information about the occurrence of a CDR in the last 4 weeks prior to the survey were included. Adjusted prevalence ratios (aPRs) were estimated to determine the associated factors. Socioeconomic inequality in CDR was estimated using concentration curves (CC) and the Erreygers concentration index (ECI). RESULTS: Data from 38,662 participants were analyzed; the prevalence of CDR in the last 4 weeks prior to the survey was 16.5% (95% CI: 15.8-17.2). Being female (aPR 1.29; 95% CI: 1.21-1.37), with regards to being male; being 30-39 (aPR 1.22; 95% CI: 1.05-1.42), 40-49 (aPR 1.29; 95% CI: 1.12-1.48), 50-59 (aPR 1.60; 95% CI: 1.41-1.82), and 60 years or older (aPR 1.80; 95% CI: 1.58-2.04), compared to 18-29; reaching up to primary (aPR 1.18; 95% CI: 1.07-1.31), or secondary education (aPR 1.13; 95% CI: 1.02-1.24), in contrast to tertiary education; presenting some physical, psychological or cognitive limitation (aPR 1.33; 95% CI: 1.21-1.46), with respect to experiencing no limitations; and being affiliated to a health insurance (aPR 1.18; CI 95%: 1.09-1.29), opposed to not having health insurance; were associated with a higher probability of CDR. Residing in the natural region of the coastal area (aPR 0.83; 95% CI: 0.74-0.92) was associated with a lower probability of relapse compared to residing in the jungle area. In people with limitations and residents of the jungle areas, the prevalence of CDR was concentrated in those with higher per capita spending. CONCLUSIONS: Approximately 1 in 6 Peruvians with chronic diseases had a relapse within the last 4 weeks prior to the survey of 2020 and certain geographic and sociodemographic factors were found to be associated with CDR. It was also found that a higher concentration of CDR was observed in the population with the highest per capita spending with some limitations, as well as in residents of the jungle, implying the need for appropriate policy interventions that address CDR with a special focus on these populations.

What Drives Abdominal Obesity in Peru? A Multilevel Analysis Approach Using a Nationally Representative Survey.

Abdominal obesity (AO) is a serious public health threat due to its increasing prevalence and effect on the development of various non-communicable diseases. A multilevel analysis of the 2019 Demographic and Family Health Survey (ENDES in Spanish) using the Latin American Diabetes Association (ALAD in Spanish) cut-off points was carried out to evaluate the individual and contextual factors associated with AO in Peru. A total of 30,585 individuals 18 years and older were included in the analysis. The prevalence of AO among Peruvians in 2019 was 56.5%. Individuals of older age (aOR 4.64; 95% CI: 3.95-5.45), women (aOR 2.74; 95% CI: 2.33-3.23), individuals with a higher wealth index (aOR 2.81; 95% CI: 2.40-3.30) and having only secondary education (aOR 1.45; 95% CI: 1.21-1.75) showed increased odds of presenting AO compared to their peers. At a contextual level, only the Human Development Index (aOR 1.59; 95% CI: 1.17-2.16) was associated with the development of AO. A high Human Development Index is the contextual factor most associated with AO. It is necessary to formulate and implement new public health policies focused on these associated factors in order to reduce the prevalence of OA and prevent the excessive burden of associated noncommunicable diseases.

Prevalence and Factors Associated with Gaming Disorder in Latin America and the Caribbean: A Systematic Review.

We aimed to determine the prevalence and factors associated with gaming disorder (GD) in the population of Latin America and the Caribbean (LAC). A systematic review was performed (PROSPERO protocol registration: CRD42021230565). We included studies that identified participants with GD and/or factors associated with this condition, reported the prevalence of GD, or contained data that assisted in its estimation, were published after 2013 (the year of inclusion of GD in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders) and were carried out in a population residing in an LAC country. Evaluation of the quality of the studies was carried out using the Joanna Briggs Institute Critical appraisal checklist tool. A qualitative synthesis of the data was performed. Of the total of 1567 records identified, 25 passed the full-text review phase, and 6 met the selection criteria. These studies were published between 2018 and 2021 and had a cross-sectional design (three in Brazil, one in Ecuador, Mexico, and the other was multi-country, including a LAC country [Peru]). The prevalence of GD ranged from 1.1% to 38.2%. The three studies in Brazil had the highest figures of GD prevalence (20.4-38.2%). Four studies evaluated factors associated with GD. Characteristics regarding the game (type), pattern of use (hours played), as well as gender (higher in men), tobacco and alcohol consumption, poor interpersonal relationships, and the presence of mental disorders were found to be associated with GD in LAC. Evidence on the prevalence and factors associated with GD in LAC is limited. Studies on GD in LAC evaluate different population subgroups, describing a wide prevalence of this condition (present in up to 38 out of 100 evaluated). Characteristics such as the type and hours of use of the games, sociodemographic data, lifestyles, interpersonal relationships, and the presence of mental disorders increase the probability of presenting GD.

Factors Associated with Food Insecurity in Latin America and the Caribbean Countries: A Cross-Sectional Analysis of 13 Countries.

It is estimated that Latin America and the Caribbean (LAC) is the region with the second highest figures for food insecurity (FI) globally, with a prevalence of 40.9% in the entire region. This cross-sectional study analyzes the household factors associated with FI across 13 LAC countries. We used data from the first round of high-frequency phone surveys, conducted by the World Bank. Approximately 4 out of 10 people in LAC experienced FI during the first phase of the COVID-19 pandemic. FI was positively associated with the number of individuals aged from 5 to 18 years, the number of men, the illness, accident, or death of an income-earning household member, and health expenditure due to COVID-19 or other illnesses, as well as the increase in food prices, reduced family income, and job loss by a member of the household. On the other hand, households located in capital cities and those with more bedrooms were less likely to have experienced FI. The design of social policies must focus on the economic deficiencies experienced by the LAC population, with unemployment, reduced income, and high food costs being the main factors that must be addressed to ensure adequate nutrition.

Multimorbidity analysis and hospitalizations for diabetes before and after lockdown due to the COVID-19 pandemic in Peru.

COVID-19 has disrupted the treatment of non-communicable diseases (NCDs). This study conducted a multimorbidity analysis and evaluated hospital admissions and death rates among diabetic patients before and after the implementation of lockdown due to the COVID-19 pandemic in Peru. Data from the Ministry of Health (MINSA) of Peru from January 2017 to December 2020 was used. Hospital death, discharge and the percentage of death/hospital admissions were defined as outcomes of interest. We performed an interrupted time series analysis to assess the aggregate change in the outcomes of interest before and after mandatory lockdown in response to the COVID-19 pandemic in Peru (n = 65,935). Additionally, a network analysis was performed to evaluate the frequency of occurrence of hospital admissions before and after the mandatory lockdown according to demographic characteristics. The average monthly hospital admissions among diabetic patients in Peru decreased by 29% after the implementation of the lockdown. The largest reduction was observed in women (-41%) and for patients 60 years or older (-35%). Furthermore, there was a 92% increase in the average number of monthly deaths. The largest percentage change occurred in men (+113%) and in the group of 40-59 years (+144%). After the implementation of lockdown in Peru, hospital admissions among diabetic patients significantly decreased while in-hospital mortality slightly increased. Our findings shed light on the limitations of the Peruvian health system and the importance of ensuring continued care of NCDs as part of the response strategy during times of crisis.

Mouthrinses and SARS-CoV-2 viral load in saliva: a living systematic review.

Objective To conduct a living systematic review of the clinical evidence about the effect of different mouthrinses on the viral load of SARS-CoV-2 in the saliva of infected patients.Methods This study was reported using the PRISMA guidelines. An electronic search was conducted in seven databases and preprint repositories. We included human clinical trials that evaluated the effect of mouthrinses with antiseptic substances on the viral load of SARS-CoV-2 in the saliva of children or adults, who tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (RT-PCR). The risk of bias was assessed using the ROBINS-I tool. PROSPERO registration number: CRD42021240561.Results Five studies were included (n = 66 participants). Study participants underwent oral rinses with hydrogen peroxide (H2O2) at 1%, povidone-iodine (PI) at 0.5% or 1%, chlorhexidine gluconate (CHX) at 0.2% or 0.12%, cetylpyridinium chloride (CPC) at 0.075%, and Linolasept. Only one study included a control group with sterile water. Three of the studies identified a reduction in viral load in saliva after the use of mouthrinses with PI (up to three hours), CHX (up to four hours), or Linolasept mouthwash (up to six hours). One study reported a statistically significant reduction after the use of mouthrinses with CPC or PI vs water (up to six hours) and one study reported a non-significant reduction in viral load after the use of H2O2 rinses.Conclusions According to the present systematic review, the effect of mouthrinses on SARS-CoV-2 viral load in the saliva of COVID-19 patients remains uncertain. Evidence from well-designed randomised clinical trials is required for further and more objective evaluation of this effect.

Seroprevalence and lethality by SARS-CoV-2 in indigenous populations of Latin America and the Caribbean: a systematic review.

BACKGROUND: Latin America and the Caribbean (LAC) has presented some of the highest numbers of cases and deaths due to COVID-19 in the world. Even though indigenous communities represent 8% of the total population in this region, the impact of COVID-19 on this historically vulnerable population has only been briefly explored. Thus, this study aimed to estimate the seroprevalence and lethality attributable to SARS-CoV-2 in the indigenous population of LAC. METHODS: A systematic review was conducted utilizing multiple databases (registry PROSPERO: CRD42020207862). Studies published in English, Spanish or Portuguese were selected between December 1st, 2019, and April 14th, 2021. The evaluation of the quality of the study was carried out utilizing the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A qualitative synthesis of the data analyzed was conducted following the MOOSE and PRISMA declarations. RESULTS: Fifteen studies met the inclusion criteria. Eleven studies were carried out in a Brazilian population, three in a Mexican population, and one in a Colombian population. Four studies reported data about the seroprevalence of SARS-CoV-2 in indigenous populations of Brazil (range: 4.2-81.65%). Twelve studies reported lethality in indigenous people (eight in Brazil, three in Mexico, and one in Colombia). In Brazil, a lethality of 53.30% was described in a hospital setting and between 1.83% and 4.03% in community studies. In Mexico, the lethality of COVID-19 ranged between 16.5% and 19.9%. Meanwhile, in Colombia, a lethality of 3.41% was reported. Most studies were deemed to be of good quality. CONCLUSIONS: Despite COVID-19 affecting indigenous populations of LAC, there is limited evidence of the seroprevalence and lethality of the infection by SARS-CoV-2 in this population. Future investigations should ensure standardized methods that allow comparability among studies and ensure the precision of the results obtained.

Prevalence and factors associated with non-use of health services in the Peruvian population with COVID-19 symptomatology: a secondary analysis of the 2020 National Household Survey.

OBJECTIVES: The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19). METHODS: A secondary analysis of the 2020 National Household Survey (ENAHO) was carried out. Participants over 18 years of age with any COVID-19 symptom (fever, cough, sensation of shortness of breath) in the last 4 weeks who did not visit health services were defined as exhibiting NUHS. Adjusted prevalence ratios (aPRs) were estimated to determine the factors associated with NUHS. RESULTS: Data from 1,856 participants were analyzed; the prevalence of NUHS was 52.2% (95% confidence interval [CI], 48.0 to 56.5). Living in urban areas of the jungle (aPR, 1.61; 95% CI, 1.32 to 1.98; p<0.001) and rural areas of the jungle (aPR, 1.48; 95% CI, 1.15 to 1.90; p=0.002) was associated with a higher probability of NUHS than living in urban coastal areas. The factors associated with a lower probability of NUHS were being 50-59 years old (aPR, 0.72; 95% CI, 0.58 to 0.90) and 60 years and over (aPR, 0.74; 95% CI, 0.59 to 0.95), having a secondary educational level (aPR, 0.67; 95% CI, 0.48 to 0.93) or superior educational level (aPR, 0.67; 95% CI, 0.48 to 0.96), and having health insurance (aPR, 0.79; 95% CI, 0.68 to 0.92). CONCLUSIONS: More than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms.

Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population.

BACKGROUND: Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. METHODS: This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were (i) the proportion of individuals who incurred OOP expenditures and (ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. RESULTS: ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (P=.916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (P=.073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. CONCLUSION: The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.

The urgency of ensuring equitable and improved access to oral health care during the Coronavirus Disease 2019 pandemic: The case of Peru.

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Chlorine dioxide and chlorine derivatives for the prevention or treatment of COVID-19: a systematic review. / Dióxido de cloro y derivados del cloro para prevenir o tratar la COVID-19: revisión sistemática.

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

OBJETIVOS: Realizar una revisión sistemática acerca de la efectividad y seguridad del uso de dióxido de cloro y derivados del cloro, en la prevención o el tratamiento de la COVID-19. MATERIALES Y MÉTODOS: Se siguieron las pautas internacionales de elaboración de revisiones sistemáticas de PRISMA y el Manual Cochrane para revisiones sistemáticas de intervenciones. La estrategia de búsqueda la desarrolló un bibliotecario y la revisaron dos de los autores. Se complementó la búsqueda electrónica con una búsqueda manual. Se incluyeron ensayos clínicos aleatorizados, estudios cuasiexperimentales, estudios de cohorte, estudios de casos y controles, estudios de corte transversal y reportes de casos; y se excluyeron estudios in vitro o realizados en animales. Dos revisores, de forma independiente, seleccionaron los estudios según los criterios de elegibilidad definidos, usando el aplicativo web Rayyan, en caso de discordancia se hizo partícipe a un tercer revisor. El protocolo de la revisión sistemática se registró en PROSPERO (CRD42020200641). RESULTADOS: No se identificó ningún estudio publicado ni en proceso de publicación que haya evaluado el uso del dióxido de cloro o derivados del cloro, administrado por vía inhalatoria, oral o parenteral en humanos, como agente preventivo o terapéutico de la COVID-19 o en infecciones por otros coronavirus. Solo se identificó el registro de un único estudio catalogado como observacional que hasta ahora no tiene resultados. CONCLUSIONES: A la fecha, no existe evidencia científica que apoye el uso del dióxido de cloro o derivados del cloro para prevenir o tratar la COVID-19.