Impact of health insurance on the use of oral health services in the Peruvian population 2015-2019.

BACKGROUND: The high treatment cost of oral diseases is a barrier for accessing oral health services (OHS), particularly in low-income countries. Therefore, this study aimed to evaluate the impact of health insurance on the use of OHS in the Peruvian population from 2015 to 2019. METHODS: We conducted a prospective, longitudinal study of secondary data using the National Household Survey (ENAHO) 2015-2019 panel databases, which collected information from the same participants during each of the five years. The dependent variable was the use of OHS in the three months prior to the survey (yes/no). The independent variable was health insurance affiliation (four years or less/all five years). Both were measured by survey questions. Generalized estimating equation (GEE) Poisson regression models with robust standard errors were used to estimate the relative risk (RR) associated with use of OHS. RESULTS: We included 4064 individuals distributed in 1847 households, who responded to the survey during each of the five years. The adjusted GEE model showed that those who had health insurance during all five years without interruption were more likely to attend OHS than those who had insurance for four years or less (adjusted relative risk [aRR]: 1.30; 95%CI: 1.13-1.50). In addition, we carried out a sensitivity analysis by recategorizing the independent variable into three categories (never/some years/ all five years), which also showed (aRR: 1.45; 95%CI: 1.11-1.89) that participants with health insurance during all five years were more likely to have used OHS than those who never had insurance. CONCLUSION: Therefore, in the Peruvian context, health insurance affiliation was associated with greater use of OHS. The panel data used derives from a subsample of consecutive nationally representative samples, which may have led to a loss of representativeness. Furthermore, the data was collected between 2015 and 2019, prior to the onset of the COVID-19 pandemic, and insurance conditions may have changed.

Nutritional status and effective verbal communication in Peruvian children: A secondary analysis of the 2019 Demographic and Health Survey.

BACKGROUND: To estimate the impact of stunting on the development of effective verbal communication (EVC) in children aged 24 to 36 months. METHODS: We conducted a retrospective, quasi-experimental study design using data from 4452 children between 24 and 36 months of age available in the Early Childhood Development (ECD) section of the Demographic and Family Health Survey (ENDES) 2019 survey. Achievement of EVC was considered as the dependent variable. After propensity score matching analysis, a total 601 children were included in the exposed (children with stunting) and 3848 in the unexposed group (children without stunting). The psmatch2 Stata software command was used to estimate the impact of stunting on EVC with a level of 5% for significance. RESULTS: The EVC indicator was achieved by 57.4% of the children between 24 and 36 months of age evaluated, while the prevalence of stunting in this population was 14%. The evaluation of impact showed that the group exposed to stunting was 8% less likely to show EVC compared to the unexposed group (ATT -0.08; 95% CI -0.106 to -0.054; p<0.001). CONCLUSIONS: The presence of stunting was found to have a significant impact on the propensity to show EVC in Peruvian children between 24 and 36 months of age. Strengthening of strategies for reducing malnutrition in vulnerable areas, as well as those directly affecting EVC is a priority for diminishing gaps in the achievement of this indicator in our country.