Cesarean section prevalence based on prenatal care provider, location, and wealth index: A comparative analysis in peru's healthcare systems.

BACKGROUND: Cesarean section rates are increasing and surpassing WHO guidelines. While sometimes necessary, excessive use poses risks and additional costs to pregnant women and healthcare systems. AIM: To evaluate the prevalence of cesarean section according to healthcare professionals, facility location, and the wealth index of pregnant women in each Peruvian healthcare system. METHODS: A cross-sectional study analyzed 20,870 records of women aged 12 to 49 from the Demographic and Family Health Survey (ENDES). The evaluated healthcare systems were the Ministry of Health, Social Health Insurance, Armed Forces and National Police, and private institutions. FINDINGS: The highest cesarean section prevalence was observed in women receiving prenatal care in private hospitals or clinics (69.13%) and Social Health Insurance hospitals (51.54%). Urban settings, "richest" wealth index, and medical professional involvement increased the probability of cesarean sections. Conversely, the probability of cesarean section was reduced in Ministry of Health facilities when pregnant women belonged to the "poorest" or "poorer" wealth index category and when prenatal care was provided by a midwife in a private facility. CONCLUSION: The prevalence of cesarean sections in Peru during 2021 is 33.75%, warranting evaluation of strategies to regulate their indiscriminate use in each system.

Ocorrência simultânea de uso abusivo de álcool e alimentação não saudável em adultos

Objetivo Estimar a prevalência da coocorrência do uso abusivo de álcool e alimentação não saudável em adultos brasileiros e verificar sua relação com o consumo alimentar, segundo o sexo. Métodos Estudo com dados do inquérito telefônico Vigitel, 2016. Considerou-se uso abusivo de álcool: ingestão ≥5 doses/homens e ≥4/mulheres em uma única ocasião, pelo menos uma vez no último mês. Alimentação não saudável foi caracterizada a partir de um indicador composto por oito alimentos. Foram usados os testes Qui-quadrado de Pearson e Wald, com nível de significância de 5%, e razões de chances ajustadas com regressão logística. Resultados A coocorrência dos fatores de risco (24,7% vs. 10,0%) foi superior nos homens, nos indivíduos com melhor escolaridade, sem cônjuge, com plano de saúde, nas mulheres que se declararam pretas, e foi menor nos adultos (40-59 anos) e idosos. A coocorrência associou-se com menores chances de consumo de hortaliças cruas e cozidas, frutas, suco, leite e frango (≥5 dias/semana), e com maiores chances de consumo de carne vermelha, refrigerante (≥3 dias/semana) e carnes com excesso de gordura. Conclusão Os resultados mostram os prejuízos da coocorrência do uso excessivo de álcool e alimentação inadequada sobre os padrões alimentares da população adulta.

Objective To estimate the prevalence of co-occurrence of alcohol abuse and unhealthy eating in Brazilian adults and to verify its relationship with food intake, according to sex. Methods Study with data from Vigitel telephone survey, 2016. Alcohol abuse was considered as: ingestion ≥5 doses/men and ≥4 doses/women on a single occasion, at least once in the last month. Unhealthy eating was characterized from an indicator consisting of eight foods. Pearson's chi-square and Wald tests were used, with a 5% significance level, and adjusted odds ratios with logistic regression. Results The co-occurrence of risk factors (24.7% vs. 10.0%) was higher in men, in individuals with better education, without a spouse, with health insurance, in women who declared themselves black, and was lower in adults (40-59 years) and the elderly. The co-occurrence was associated with lower odds of consumption of raw and cooked vegetables, fruits, juice, milk, and chicken (≥5 days/week) and with higher odds of consumption of red meat, soda (≥3 days/week), and meats with excess fat. Conclusion The results show the harms of the co-occurrence of excessive alcohol use and inadequate diet on the dietary patterns of the adult population.

Objetivo Estimar la prevalencia de la coocurrencia de abuso de alcohol y alimentación no saludable en adultos brasileños y verificar su relación con el consumo de alimentos según el sexo. Métodos Estudio con datos de la encuesta telefónica Vigitel, 2016. Se consideró abuso de alcohol: ingestión ≥5 dosis para hombres y ≥4 para mujeres en una única ocasión, al menos una vez en el último mes. La alimentación poco saludable se caracterizó a partir de un indicador compuesto por ocho alimentos. Se utilizaron las pruebas de chi-cuadrado de Pearson y de Wfeld, con un nivel de significación del 5% y las odds ratio (OR) ajustadas con regresión logística. Resultados La coocurrencia de factores de riesgo (24,7% vs. 10,0%) fue mayor en los hombres, en los individuos con mayor educación, sin cónyuge, con seguro médico y en las mujeres que se declararon negras, y fue menor en los adultos (40-59 años) y los ancianos. La coocurrencia se asoció con menores probabilidades de consumo de verduras crudas y cocidas, frutas, zumos, leche y pollo (≥5 días/semana) y con mayores probabilidades de consumo de carne roja, refrescos (≥3 días/semana) y carnes con exceso de grasa. Conclusión Los resultados muestran el daño de la coexistencia del consumo excesivo de alcohol y la dieta inadecuada en los patrones dietéticos de la población adulta.