Travel Time to Health Facilities as a Marker of Geographical Accessibility Across Heterogeneous Land Coverage in Peru

Carrasco-Escobar, Gabriel; Manrique, Edgar; Tello-Lizarraga, Kelly; Miranda, J. Jaime

doi:10.3389/fpubh.2020.00498

Cited by 50 publications

(48 citation statements)

References 40 publications

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“…For example, those working in healthcare could secure adequate antenatal care, those working with poor or vulnerable populations could secure access to what mothers need for a healthy pregnancy (e.g., diet, education, and prevention of acute diseases), and those working in transportation could secure safe routes and means to access timely antenatal and maternal healthcare, particularly in rural settings. [49] The equiplots also showed that the birthweight indicators would be worse for mothers aged <19 years; this observation agrees with the literature on the subject. [ 50 , 51 ] Regarding low birthweight prevalence, the youngest mothers were closely followed by those aged 36+ years, which has also been documented before.…”

Section: Discussionsupporting

confidence: 87%

National and subnational trends of birthweight in Peru: Pooled analysis of 2,927,761 births between 2012 and 2019 from the national birth registry

Carrillo‐Larco

Cajachagua-Torres

Guzman‐Vilca

et al. 2021

The Lancet Regional Health - Americas

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Summary Background National and subnational characterization of birthweight profiles lacks in low- and middle-income countries, yet these are needed for monitoring the progress of national and global nutritional targets. We aimed to describe birthweight indicators at the national and subnational levels in Peru (2012-2019), and by selected correlates. Methods We studied mean birthweight (g), low birthweight (<2,500 g) and small for gestational age (according to international growth curves) prevalences. We analysed the national birth registry and summarized the three birthweight indicators at the national, regional, and province level, also by geographic area (Coast, Highlands, and Amazon). With individual-level data from the mother, we described the birthweight indicators by age, educational level and healthcare provider. Following an ecological approach (province level), we described the birthweight indicators by human development index (HDI), altitude above sea level, proportion of the population living in poverty and proportion of rural population. Findings Mean birthweight was always the lowest in the Highlands (2,954 g in 2019) yet the highest in the Coast (3,516 g in 2019). The same was observed for low birthweight and small for gestational age. In regions with Coast and Highlands, the birthweight indicators worsen from the Coast to the Highlands; the largest absolute difference in mean birthweight between Coast and Highlands in the same region was 367 g. All birthweight indicators were the worst in mothers with none/initial education, while they improved with higher HDI. Interpretation This analysis suggests that interventions are needed at the province level, given the large differences observed between Coast and Highlands even in the same region. Funding Wellcome Trust (214185/Z/18/Z)

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Section: Discussionsupporting

confidence: 87%

National and subnational trends of birthweight in Peru: Pooled analysis of 2,927,761 births between 2012 and 2019 from the national birth registry

Carrillo‐Larco

Cajachagua-Torres

Guzman‐Vilca

et al. 2021

The Lancet Regional Health - Americas

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“…Health authorities should also improve structural barriers. For example, if commuting to the healthcare centre is a barrier to seek care and receive treatment [14] , other options must be considered like tele-medicine along with remote devices [15] , and community visits.…”

Section: Discussionmentioning

confidence: 99%

Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru

Carrillo‐Larco

Guzman‐Vilca

Bernabé‐Ortiz

2021

The Lancet Regional Health - Americas

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Background While we have good evidence about the hypertension care cascade, we do not know the mean blood pressure (BP) in these groups. We described the mean BP in four groups based on the hypertension care cascade at the national and sub-national levels in Peru. Methods Descriptive analysis of six national health surveys. Blood pressure was measured twice and the second record herein analysed. We defined four groups: i) people with self-reported hypertension diagnosis receiving antihypertensive medication; ii) people with self-reported hypertension diagnosis not receiving antihypertensive medication; iii) people unaware they have hypertension with blood pressure ≥140 or 90 mmHg; and iv) otherwise healthy people. Findings There were 125,066 people; mean age was 49.8 years and there were more women (51.7%). At the national level, in men and women and throughout the study period, we observed that the mean systolic BP (SBP) was the highest in people unaware they have hypertension; the mean SBP was similar between those with and without antihypertension medication, yet slightly higher in the former group. At the sub-national level, even though the mean SBP in the unaware group was usually the highest, there were some regions and years in which the mean SBP was the highest in the untreated and treated groups. Interpretation These results complement the hypertension care cascade with a clinically relevant parameter: mean BP. The results point where policies may be needed to secure effective interventions to control hypertension in Peru, suggesting that improving early diagnosis and treatment coverage could be priorities. Funding Wellcome Trust (214185/Z/18/Z).

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“…Second, limited access to remote areas in the Amazon region prevents continuous health care access to indigenous communities, thus the malaria caseload is an underestimate. Low geographic accessibility and travel time have been found to be barriers to reaching remote health facilities ( 35 ). Third, some reports have indicated that mosquito activities such as host-seeking behavior were influenced by wind speed affecting human CO 2 dispersion, and other studies reported that the mosquito movement depends on wind direction ( 70 ).…”

Section: Discussionmentioning

confidence: 99%

“…For malaria, the diagnosis is carried out exclusively by MoH. However, health access is still deficient in indigenous and rural communities in the Peruvian Amazon, mainly due to transportation and monetary barriers ( 34 , 35 ). Approximately 83.3% of the population had informal employment since the most common economic activities are based on agriculture, fishing, and mining ( 32 ).…”

Section: Methodsmentioning

confidence: 99%

Time-Varying Effects of Meteorological Variables on Malaria Epidemiology in the Context of Interrupted Control Efforts in the Amazon Rainforest, 2000–2017

et al. 2021

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Successful malaria control interventions, mostly based on the training of health workers, distribution of insecticide-treated nets, and spraying, decrease malaria incidence; however, when these interventions are interrupted, a resurgence may occur. In the Peruvian Amazon, after discontinuing the control activities implemented by the PAMAFRO project (2006–2010)-a Global Fund-sponsored project for the strengthening of malaria control and surveillance in multiple countries in Latin America– malaria cases re-emerged dramatically. In parallel, meteorological factors determine the conditions suitable for the development, reproduction, and survival of mosquito vectors and parasites. This study hypothesized that interruption of malaria interventions may have modified the meteorological-malaria relationships over time (i.e., temporal changes in the dose-response between meteorological variables and malaria incidence). In this panel data analysis, we assessed the extent that relationships between meteorological variables and malaria changed temporally using data of monthly malaria incidence due to Plasmodium vivax or P. falciparum in Loreto, Peru (2000–2017). Generalized additive models were used to explore how the effects of meteorological variables changed in magnitude before, during, and after the PAMAFRO intervention. We found that once the PAMAFRO intervention had been interrupted, the estimated effects (dose-response) of meteorological variables on incidence rates decreased for both malaria parasite species. However, these fitted effect estimates did not reach their baseline levels (before the PAMAFRO period); variations of time-varying slopes between 0.45 and 2.07 times were observed after the PAMAFRO intervention. We also reported significant heterogeneity in the geographical distributions of malaria, parasite species, and meteorological variables. High malaria transmission occurred consistently in the northwestern provinces of Loreto Department. Since the end of the PAMAFRO period, a higher effect of precipitation and actual evapotranspiration was described on P. falciparum compared to P. vivax. The effect of temperature on malaria was greater over a shorter time (1-month lag or less), compared with precipitation and actual evapotranspiration (12-month lag). These findings demonstrate the importance of sustained malaria control efforts since interruption may enhance the links between meteorological factors and malaria. Our results also emphasize the importance of considering the time-varying effect of meteorological factors on malaria incidence to tailor control interventions, especially to better manage the current and future climate change crisis.

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Travel Time to Health Facilities as a Marker of Geographical Accessibility Across Heterogeneous Land Coverage in Peru

Cited by 50 publications

References 40 publications

National and subnational trends of birthweight in Peru: Pooled analysis of 2,927,761 births between 2012 and 2019 from the national birth registry

National and subnational trends of birthweight in Peru: Pooled analysis of 2,927,761 births between 2012 and 2019 from the national birth registry

Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru

Time-Varying Effects of Meteorological Variables on Malaria Epidemiology in the Context of Interrupted Control Efforts in the Amazon Rainforest, 2000–2017

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