BackgroundRapid urbanization, increase in food availability, and changes in diet and lifestyle patterns have been changing nutritional profiles in developing nations. We aimed to describe nutritional changes in children under 5 years and women of reproductive age in Peru, during a 15-year period of rapid economic development and social policy enhancement.Materials and MethodsTrend analyses of anthropometric measures in children of preschool age and women between 15–49 years, using the Peruvian National Demographic and Family Health Surveys (DHS) from 1996 to 2011. WHO growth curves were used to define stunting, underweight, wasting and overweight in children <5y. We employed the WHO BMI-age standardized curves for teenagers between 15–19y. In women >19 years, body mass index (BMI) was analyzed both categorically and as a continuous variable. To statistically analyze the trends, we used regression models: Linear and Poisson for continuous and binary outcomes, respectively.ResultsWe analyzed data from 123 642 women and 64 135 children, from 1996 to 2011. Decreases over time were evidenced for underweight (p<0.001), wasting (p<0.001), and stunting (p<0.001) in children under 5y. This effect was particularly noted in urban settings. Overweight levels in children reduced (p<0.001), however this reduction stopped, in urban settings, since 2005 (∼12%). Anemia decreased in children and women (p<0.001); with higher reduction in urban (↓43%) than in rural children (↓24%). BMI in women aged 15–19 years increased (p<0.001) across time, with noticeable BMI-curve shift in women older than 30 years. Moreover, obesity doubled during this period in women more than 19y.ConclusionNutrition transition in Peru shows different patterns for urban and rural populations. Public policies should emphasize targeting both malnutrition conditions—undernutrition/stunting, overweight/obesity and anemia—considering age and place of residence in rapid developing societies like Peru.

Historically in developing countries, the prevalence of obesity has been greater in more advantaged socioeconomic groups. However, in recent years the association between socioeconomic status (SES) and obesity has changed and varies depending on the country’s development stage. This study examines the relationship between SES and obesity using two indicators of SES: education or possession assets. Using the cross-sectional 2008 National Demographic and Family Health Survey of Peru (ENDES 2008) we investigated this relationship in women aged 15 to 49 years living in rural and urban settings. Descriptive, linear and logistic regressions analyses were conducted accounting for the multi-staged nature of the sampling design. The overall prevalence of obesity in this study was 14.1% (95%CI: 13.3–14.8); 8.4% (95%CI: 7.5–9.3) in rural areas and 16.2% (95%CI: 15.2–17-2) in urban areas. Wealthier women were more likely to be obese, and this association was stronger in rural areas. Conversely, more educated women were less likely to be obese, especially in urban areas. The distribution of obesity in Peruvian women is strongly related to socioeconomic position, and differs whether measured as possession assets or by level of education. These findings could have important implications for policy development in Peru.

After more than four months of the COVID-19 pandemics with genomic information of SARS-CoV-2 around the globe, there are more than 1000 complete genomes of this virus. We used 691 genomes from the GISAID database. Several studies have been reporting mutations and hotspots according to the viral evolution. Our work intends to show and compare positions that have variants in 30 complete viral genomes from South American countries. We classified strains according to point alterations and portray the source where strains came into this region. Most viruses entered to South America from Europe, followed by Oceania. Only Chilean isolates demonstrated a relationship to Asian isolates. Some changes in South American genomes are near to specific domains related to replication or S protein. Our work contributes to global understanding of which sort of strains are spreading throughout South American countries, and the differences among them according to the first isolates introduced in this region.

Background Whilst migration and urbanization have been linked with higher obesity rates, especially in low-resource settings, prospective information about the magnitude of these effects is lacking. We estimated the risk of obesity and central obesity among rural subjects, rural-to-urban migrants, and urban subjects. Methods Prospective data from the PERU MIGRANT Study were analysed. Baseline data were collected in 2007-08 and participants re-contacted in 2012-13. At follow-up, outcomes were obesity and central obesity measured by body mass index (BMI) and waist circumference. At baseline, the primary exposure was demographic group: rural, rural-to-urban migrant, and urban. Other exposures included an assets index and educational attainment. Cumulative incidence, incidence ratio (IR), and 95% confidence intervals (95% CI) for obesity and central obesity were estimated with Poisson regression models. Results At baseline, mean age (±SD) was 47.9 (±12.0) years, and 53.0% were females. Rural subjects comprised 20.2% of the total sample, while 59.7% were rural-to-urban migrants and 20.1% were urban dwellers. A total of 3,598 and 2,174 person-years were analysed for obesity and central obesity outcomes, respectively. At baseline, the prevalence of obesity and central obesity was 20.0% and 52.5%. In multivariable models, migrant and urban groups had an 8- to 9.5-fold higher IR of obesity compared to the rural group (IR migrants 8.19, 95% CI 2.72-24.67; IR urban 9.51, 95% CI 2.74-33.01). For central obesity, there was a higher IR only among the migrant group (IR 1.95; 95% CI 1.22-3.13). Assets index was associated with a higher IR of central obesity (IR top vs. bottom tertile 1.45, 95% CI 1.03-2.06). Conclusion Peruvian urban individuals and rural-to-urban migrants show a higher incidence of obesity compared to their rural counterparts. Given the ongoing urbanization occurring in middle-income countries, the rapid development of increased obesity risk by rural-to-urban migrants suggests that measures to reduce obesity should be a priority for this group.

Supplemental Digital Content is available in the text.

Urbanization is a hazardous process because it affects health population due to changes in diet and physical activity patterns. This study aimed to determine the effect of migration on the incidence of hypertension. Participants of the PERU MIGRANT study, i.e. rural, urban, and rural-to-urban migrants were re-evaluated after five years from baseline. The outcome was incidence of hypertension; and the exposures were study group and other well-known risk factors. Incidence rates, relative risks (RR), and population attributable fractions were calculated. At baseline, 201 (20.4%), 589 (59.5%), and 199 (20.1%) were rural, rural-to-urban migrant and urban subjects, respectively. Overall mean age was 47.9 (SD±12.0) years, and 522 (52.9%) were females. Hypertension prevalence at baseline was 16.0% (95% CI 13.7%–18.3%), being more common in urban group; whereas pre-hypertension was more prevalent in rural participants (p<0.001). Follow-up rate at 5 years was 94%, 895 participants were re-assessed and 33 (3.3%) deaths were recorded. Overall incidence of hypertension was 1.73 (95%CI 1.36–2.20) per 100 person-years. In multivariable model and compared to the urban group, rural group had a greater risk of developing hypertension (RR=3.58; 95%CI 1.42–9.06). Population attributable fractions showed high waist circumference as the leading risk factor for the hypertension development in rural (19.1%), migrant (27.9%), and urban (45.8%) participants. Subjects from rural settings are at higher risk to develop hypertension relative to rural-urban migrant or urban groups. Central obesity was the leading risk factor for hypertension incidence in the three population groups.

RESUMENEl servicio rural y urbano marginal en salud (SERUMS) es una actividad que realizan solo los profesionales de la salud al Estado peruano, ya que constituye un requisito obligatorio para optar por la segunda especialidad o para trabajar en un centro de salud público, y obtener becas del gobierno para futura capacitación. Los escasos cambios legales en el reglamento de este programa social y el enfoque de "servicio" restringido a los profesionales de salud conllevan a que esta política sea discriminatoria e inconstitucional por atentar contra el derecho a la educación y al trabajo. No hay evidencia científica que sustente la utilidad y efectividad de este programa, tanto en la calidad de servicio y mejora de indicadores sanitarios, como en la adecuada distribución y retención de profesionales de salud. Sugerimos abolir el requisito de obligatoriedad y replantear una estrategia política que ayude a atraer y retener a los profesionales de la salud en zonas vulnerables del Perú. Palabras clave: Recursos humanos; Distribución de médicos; Trabajadores rurales; Salud pública; Políticas; Perú (fuente: DeCS BIREME). MANDATORY REQUIREMENT OF SOCIAL HEALTH SERVICE IN PERU:DISCRIMINATORY AND UNCONSTITUTIONAL RESUMENThe rural and urban-edge health service (SERUMS) is an activity that only health professionals perform for the Peruvian government, as it is a mandatory requirement to qualify for a second specialty or to work in public hospitals and public health care facilities, and obtain government scholarships for future training. The few legal changes in the rules of this social program and the focus of "service" restricted to health professionals lead to a perception of this policy as discriminatory and unconstitutional because it violates the right to education and work. There is no scientific evidence that supports the usefulness and effectiveness of this program in terms of quality of service and health indicator improvement, as well as in adequate distribution and retention of health professionals. We suggest to abolish the compulsory requirement and to reformulate a political strategy to help attract and retain health professionals in vulnerable areas of Peru.

IntroductionThe rise in noncommunicable diseases and their risk factors in developing countries may have changed or intensified the effect of parity on obesity. We aimed to assess this association in Peruvian women using data from a nationally representative survey.MethodsWe used data from Peru’s Demographic and Health Survey, 2012. Parity was defined as the number of children ever born to a woman. We defined overweight as having a body mass index (BMI, kg/m2) of 25.0 to 29.9 and obesity as a BMI ≥30.0. Generalized linear models were used to evaluate the association between parity and BMI and BMI categories, by area of residence and age, adjusting for confounders.ResultsData from 16,082 women were analyzed. Mean parity was 2.25 (95% confidence interval [CI], 2.17–2.33) among rural women and 1.40 (95% CI, 1.36–1.43) among urban women. Mean BMI was 26.0 (standard deviation, 4.6). We found evidence of an association between parity and BMI, particularly in younger women; BMI was up to 4 units higher in rural areas and 2 units higher in urban areas. An association between parity and BMI categories was observed in rural areas as a gradient, being highest in younger women.ConclusionWe found a positive association between parity and overweight/obesity. This relationship was stronger in rural areas and among younger mothers.