The contribution of specific non-communicable diseases to the achievement of the Sustainable Development Goal 3.4 in Peru

Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study

BACKGROUND

During the last two decades, Caesarean section rates (C-sections), overweight and obesity rates increased in rural Peru. We examined the association between pre-pregnancy body mass index (BMI) and C-section in the province of San Marcos, Northern Andes-Peru.

METHODS

This is a prospective cohort study. Participants were women receiving antenatal care in public health establishments from February 2020 to January 2022, who were recruited and interviewed during pregnancy or shortly after childbirth. They answered a questionnaire, underwent a physical examination and gave access to their antenatal care card information. BMI was calculated using maternal height, measured by the study team and self-reported pre-pregnancy weight measured at the first antenatal care visit. For 348/965 (36%) women, weight information was completed using self-reported data collected during the cohort baseline. Information about birth was obtained from the health centre's pregnancy surveillance system. Regression models were used to assess associations between C-section and BMI. Covariates that changed BMI estimates by at least 5% were included in the multivariable model.

RESULTS

This study found that 121/965 (12.5%) women gave birth by C-section. Out of 495 women with pre-pregnancy normal weight, 46 (9.3%) had C-sections. Among the 335 women with pre-pregnancy overweight, 53 (15.5%) underwent C-sections, while 23 (18.5%) of the 124 with pre-pregnancy obesity had C-sections. After adjusting for age, parity, altitude, food and participation in a cash transfer programme pre-pregnancy overweight and obesity increased the odds of C-section by more than 80% (aOR 1.82; 95% CI 1.16-2.87 and aOR 1.85; 95% CI 1.02-3.38) compared to women with a normal BMI.

CONCLUSIONS

High pre-pregnancy BMI is associated with an increased odds of having a C-section. Furthermore, our results suggest that high BMI is a major risk factor for C-section in this population. The effect of obesity on C-section was partially mediated by the development of preeclampsia, suggesting that C-sections are being performed due to medical reasons.

Co-creation process of an intervention to implement a multiparameter point-of-care testing device in a primary healthcare setting for non-communicable diseases in Peru

BACKGROUND

Point-of-care testing (POCT) devices are diagnostic tools that can provide quick and accurate results within minutes, making them suitable for diagnosing non-communicable diseases (NCDs). However, these devices are not widely implemented in healthcare systems and for this reason is relevant to understand the implementation process.

AIM

To describe the process and define a strategy to implement a multiparameter POCT device for diagnosing and managing NCDs in one region of Peru.

METHODS

A descriptive and non-experimental study, using the participatory methodologies of co-creation process. It was conducted in one region of Peru (Tumbes) to design an intervention for implementing a multiparameter POCT device. Two co-creation sessions were conducted involving five groups: community members, primary healthcare workers, these groups in both rural and urban settings, and regional decision-makers. These sessions included activities to understand patient journeys in receiving care for NCDs, identify facilitators and barriers to POCT devices usage, and define an implementation strategy for POCT devices in both rural and urban settings of Tumbes. The research team analysed the data and summarized key topics for discussion after each session.

RESULTS

A total of 78 participants were enrolled across the five groups. Among community members: 22.2% had only diabetes, 24.1% had only hypertension, and 18.5% had both diagnoses. In the patient journey, community members mentioned that it took at least three days to receive a diagnosis and treatment for an NCD. Most of the participants agreed that the POCT devices would be beneficial for their communities, but they also identified some concerns. The strategy for POCT devices implementation included healthcare workers training, POCT devices must be placed in the laboratory area and must be able to perform tests for glucose, glycated haemoglobin, cholesterol, and creatinine. Advertising about POCT devices should be displayed at the healthcare centres and the municipality using billboards and flyers.

CONCLUSIONS

The co-creation process was useful to develop strategies for the implementation of multiparameter POCT devices for NCDs, involving the participation of different groups of stakeholders guided by moderators in both, rural and urban, settings in Peru.

Diagnóstico clínico integral de adultos mayores atendidos en Perú

Introducción: Los adultos mayores constituyen el grupo poblacional más vulnerable y el menos favorecido por los sistemas de salud, transitan por un proceso de involución progresiva que puede repercutir en su salud; por tanto, se torna relevante el diagnóstico clínico oportuno y adecuado para identificar eventuales alteraciones. Objetivo: Establecer el diagnóstico clínico integral según sexo y edad de adultos mayores atendidos a nivel nacional en el Perú. Materiales y métodos: Se realizó un estudio descriptivo, transversal y retrospectivo, durante marzo y abril del 2021, en 60698 adultos mayores atendidos en todos los departamentos del Perú. La valoración física, funcional, mental y social de los adultos mayores se realizó mediante la Historia Clínica de Atención Integral de Salud del Adulto Mayor y se interpretó con su guía técnica. Se describieron frecuencias absolutas, relativas, intervalos de confianza para proporciones al 95% y el chi cuadrado de homogeneidad. Resultados: El 49,4% de adultos mayores estaban enfermos, de los cuales el 50,8% fueron mujeres y el 47,4% varones, el 50,0% tenían de 60 a 69 años, el 50,6% de 70 a 79 años y el 46,1% de 80 a más años. Se encontraron diferencias estadísticamente significativas entre el diagnóstico clínico integral por sexo y edad (p = 0,000). Discusión: Independientemente del número de participantes en todos los contextos estudiados, al menos una enfermedad crónica coexiste medianamente en los adultos mayores, sin ser determinante el lugar donde viven, pues el proceso de envejecimiento solo puede ser distinto en su velocidad de progresión y en las condiciones en que se presenta. Conclusión: Los adultos mayores en su mayoría estaban enfermos, fueron mujeres y tenían de 70 a 79 años, las diferencias por sexo y edad en el diagnóstico clínico integral fueron significativas. Las intervenciones en etapas previas contribuirían de manera importante en un envejecimiento saludable. Como citar este artículo: Asenjo-Alarcón José Ander. Diagnóstico clínico integral de adultos mayores atendidos en Perú. Revista Cuidarte. 2022;13(2): e2485. http://dx.doi.org/10.15649/cuidarte.2485

[Prediction of significant coronary lesions by SPECT myocardial perfusion. Results from a national reference hospital in Lima-Peru]

Objective

To determine the discriminative capacity of myocardial perfusion with single photon emission tomography (SPECT) to predict coronary obstructions by coronary angiography. To determine mortality and major cardiovascular events at follow-up.

Materials and methods

. Retrospective observational study with clinical follow-up in patients undergoing SPECT and then coronary angiography. We excluded patients with myocardial infarction and percutaneous and/or surgical revascularization in the previous 6 months.

Results

105 cases were included in the study. The most commonly used SPECT protocol was pharmacological (70%). Patients with perfusion defect ≥10% of total ventricular mass (TVM) had significant coronary lesions (SCL) in 88% of cases (sensitivity 87.5% and specificity 83%). On the other hand, having ischemia ≥10% of the TVM was associated with 80% SCL (sensitivity: 72%, specificity: 65%). Clinical follow-up at 48 months evidenced that a perfusion defect ≥ 10% was predictive of major cardiovascular events (MACE) in both univariate (HR=5.3; 95%CI 1.2 - 22.2; p=0.022) and multivariate (HR= 6.1; 95%CI 1.3 - 26.9; p= 0.017) analyses.

Conclusions

. Having a perfusion defect ≥10% of the MVT in the SPECT study predicted with high probability and sensitivity the existence of SCL (>80%); moreover, this group had higher MACE at follow-up.

Peru - Progress in health and sciences in 200 years of independence

Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services. The science and technology infrastructure has also evolved, although the need for substantial investments remains if advancing science is to be a national priority. Climate change will also bring significant challenges to population health given Peru's geographical and microclimates diversity. Looking back over the 200-years of independence, we present a summary of key advances in selected health-related fields, thus serving as the basis for reflections on pending agendas and future challenges, in order to look forward to ensuring the future health and wellbeing of the Peruvian population.

Resumen translated abstract

El Perú cumple 200 años de independencia en 2021. Durante estos dos siglos de vida independiente, junto con periodos sociales y políticos turbulentos, incluyendo un conflicto armado interno, hiperinflación y la inestabilidad política de los últimos 40 años, el Perú ha experimentado importantes cambios en su perfil epidemiológico con repercusiones directas en la salud de la población. En las últimas décadas, los indicadores de salud materno-infantil y de las enfermedades transmisibles muestran mejoría importante, pero el país se enfrenta de manera simultánea a una carga cada vez mayor de enfermedades no transmisibles y de salud mental. En cuanto a los sistemas de salud pública, se han realizado esfuerzos por aumentar la cobertura y calidad de la atención de salud en todo el país, apostándose en particular por mejorar la atención primaria. La ciencia y tecnología relacionadas con la salud también han mejorado, aunque si se quiere que la ciencia sea una prioridad nacional, son necesarias inversiones sustanciales. El cambio climático traerá importantes desafíos para la salud de la población, dada la diversidad geográfica y de microclimas del país. Para conmemorar los 200 años de vida independiente del Perú, presentamos un resumen de avances clave en diversas áreas y temas relacionados con la salud. Este repaso sirve como base para reflexionar sobre agendas y desafíos pendientes y futuros, con el fin de asegurar la salud y el bienestar de la población peruana en las próximas décadas.