Publications
163 results found
Carrillo-Larco RM, Castillo-Cara M, Lovón-Melgarejo J, 2022, Government plans in the 2016 and 2021 Peruvian presidential elections: A natural language processing analysis of the health chapters, Wellcome Open Research, Vol: 6, Pages: 177-177
<ns4:p><ns4:bold>Background:</ns4:bold> While clinical medicine has exploded, electronic health records for Natural Language Processing (NLP) analyses, public health, and health policy research have not yet adopted these algorithms. We aimed to dissect the health chapters of the government plans of the 2016 and 2021 Peruvian presidential elections, and to compare different NLP algorithms.</ns4:p><ns4:p> <ns4:bold>Methods:</ns4:bold> From the government plans (18 in 2016; 19 in 2021) we extracted each sentence from the health chapters. We used five NLP algorithms to extract keywords and phrases from each plan: Term Frequency–Inverse Document Frequency (TF-IDF), Latent Dirichlet Allocation (LDA), TextRank, Keywords Bidirectional Encoder Representations from Transformers (KeyBERT), and Rapid Automatic Keywords Extraction (Rake).</ns4:p><ns4:p> <ns4:bold>Results:</ns4:bold> In 2016 we analysed 630 sentences, whereas in 2021 there were 1,685 sentences. The TF-IDF algorithm showed that in 2016, 22 terms appeared with a frequency of 0.05 or greater, while in 2021 27 terms met this criterion. The LDA algorithm defined two groups. The first included terms related to things the population would receive (e.g., ’insurance’), while the second included terms about the health system (e.g., ’capacity’). In 2021, most of the government plans belonged to the second group. The TextRank analysis provided keywords showing that ’universal health coverage’ appeared frequently in 2016, while in 2021 keywords about the COVID-19 pandemic were often found. The KeyBERT algorithm provided keywords based on the context of the text. These keywords identified some underlying characteristics of the political party (e.g., political spectrum such as left-wing). The Rake algorithm delivered phrases, in which we found ’universal health coverage’ in 2016 and 2021.</ns4:p><ns4:
Guzman-Vilca WC, Castillo-Cara M, Carrillo Larco RM, 2022, Development, validation and application of a machine learning model to estimate salt consumption in 54 countries, eLife, Vol: 11, Pages: 1-38, ISSN: 2050-084X
Global targets to reduce salt intake have been proposed but their monitoring is challenged by the lack of population-based data on salt consumption. We developed a machine learning (ML) model to predict salt consumption at the population level based on simple predictors and applied this model to national surveys in 54 countries. We used 21 surveys with spot urine samples for the ML model derivation and validation; we developed a supervised ML regression model based on: sex, age, weight, height, systolic and diastolic blood pressure. We applied the ML model to 54 new surveys to quantify the mean salt consumption in the population. The pooled dataset in which we developed the ML model included 49,776 people. Overall, there were no substantial differences between the observed and ML-predicted mean salt intake (p<0.001). The pooled dataset where we applied the ML model included 166,677 people; the predicted mean salt consumption ranged from 6.8 g/day (95% CI: 6.8-6.8 g/day) in Eritrea to 10.0 g/day (95% CI: 9.9-10.0 g/day) in American Samoa. The countries with the highest predicted mean salt intake were in Western Pacific. The lowest predicted intake was found in Africa. The country-specific predicted mean salt intake was within reasonable difference from the best available evidence. A ML model based on readily available predictors estimated daily salt consumption with good accuracy. This model could be used to predict mean salt consumption in the general population where urine samples are not available.
Ruiz Alejos A, Carrillo Larco RM, Bernabe-Ortiz A, 2021, Prevalence and incidence of arterial hypertension in Peru: a systematic review and meta-analysis, Rev Peru Med Exp Salud Publica, Vol: 38, Pages: 521-529
OBJECTIVE: . To determine the prevalence and incidence of arterial hypertension, as well as the prevalence of previous diagnosis of arterial hypertension (self-reported) among the adult population of Peru. MATERIALS AND METHODS.: Systematic review and meta-analysis of epidemiological studies available in LILACS, EMBASE, MEDLINE and Global Health. Studies were included if they followed a random sampling approach in adult population. Screening and assessment of manuscripts was carried out independently by two researchers. A random-effects meta-analysis was conducted to quantify the overall prevalence and incidence of hypertension. The Newcastle-Ottawa scale was used to assess the risk of bias in the manuscripts. RESULTS.: A total of 903 papers were screened, and only 15 were included in the estimation of hypertension prevalence, 8 in the assessment of previous hypertension diagnosis, and 4 for incidence estimations. The pooled prevalence of hypertension was 22.0% (95% CI: 20.0% - 25.0%; I2=99.2%). This estimate was lower in national studies [20.0% (95% CI: 17.0% - 22.0%; I2=99.4%] than in sub-national studies [24.0% (95% CI: 17.0% - 30.0%; I2=99.2%]. The pooled prevalence of previous hypertension diagnosis was 51.0% (95% CI: 43.0% - 59.0%; I2=99.9%). The pooled incidence of hypertension was 4.2 (95% CI: 2.0 - 6.4; I2=98.6%) per 100 person-years. The included studies did not present high risk of bias. CONCLUSIONS.: Our findings show that one in five Peruvians has hypertension, and that four new cases appear per 100 persons per year; in addition, only half of the subjects with hypertension are previously diagnosed.
Carrillo-Larco RM, Castillo-Cara M, Lovón-Melgarejo J, 2021, Government plans in the 2016 and 2021 Peruvian presidential elections: A natural language processing analysis of the health chapters, Wellcome Open Research, Vol: 6, Pages: 177-177
<ns3:p><ns3:bold>Background:</ns3:bold>While clinical medicine has exploded, electronic health records for Natural Language Processing (NLP) analyses, public health, and health policy research have not yet adopted these algorithms. We aimed to dissect the health chapters of the government plans of the 2016 and 2021 Peruvian presidential elections, and to compare different NLP algorithms.</ns3:p><ns3:p><ns3:bold>Methods:</ns3:bold>From the government plans (18 in 2016; 19 in 2021) we extracted each sentence from the health chapters. We used five NLP algorithms to extract keywords and phrases from each plan: Term Frequency–Inverse Document Frequency (TF-IDF), Latent Dirichlet Allocation (LDA), TextRank, Keywords Bidirectional Encoder Representations from Transformers (KeyBERT), and Rapid Automatic Keywords Extraction (Rake).</ns3:p><ns3:p><ns3:bold>Results:</ns3:bold>In 2016 we analysed 630 sentences, whereas in 2021 there were 1,685 sentences. The TF-IDF algorithm showed that in 2016, 22 terms appeared with a frequency of 0.05 or greater, while in 2021 27 terms met this criterion. The LDA algorithm defined two groups. The first included terms related to things the population would receive (e.g., ’insurance’), while the second included terms about the health system (e.g., ’capacity’). In 2021, most of the government plans belonged to the second group. The TextRank analysis provided keywords showing that ’universal health coverage’ appeared frequently in 2016, while in 2021 keywords about the COVID-19 pandemic were often found. The KeyBERT algorithm provided keywords based on the context of the text. These keywords identified some underlying characteristics of the political party (e.g., political spectrum such as left-wing). The Rake algorithm delivered phrases, in which we found ’universal health coverage’ in 2016 and 2021.</ns3:p><ns3:p>
Carrillo Larco R, Anza-Ramirez C, Saal-Zapata G, et al., 2021, Type 2 diabetes mellitus and antibiotic-resistant infections: A Systematic Review and meta-analysis, Journal of Epidemiology and Community Health, Vol: 76, Pages: 75-84, ISSN: 0143-005X
Background: Type 2 diabetes mellitus (T2DM) has been associated with infectious diseases; however, whether T2DM is associated with bacterial-resistant infections has not been thoroughly studied. We ascertained whether people with T2DM were more likely to experience resistant infections in comparison to T2DM-free individuals. Methods: Systematic review and random-effects meta-analysis. The search was conducted in Medline, Embase, and Global Health. We selected observational studies in which the outcome was resistant infections (any site), and the exposure was T2DM. We studied adult subjects who could have been selected from population-or hospital-based studies. I-squared was the metric of heterogeneity. We used the Newcastle-Ottawa risk of bias scale. Results: The search retrieved 3,370 reports, 97 were studied in detail and 61 (449,247 subjects) were selected. Studies were mostly cross-sectional or case-control; several infection sites were studied, but mostly urinary tract and respiratory infections. The random-effects meta-analysis revealed that people with T2DM were two-fold more likely to have urinary tract (OR= 2.42; 95% CI: 1.83-3.20; I-squared 19.1%) or respiratory (OR= 2.35; 95% CI: 1.49-3.69; I-squared 58.1%) resistant infections. Although evidence for other infection sites was heterogeneous, they consistently suggested that T2DM was 66associated with resistant infections. Conclusions: Compelling evidence suggests that people with T2DM are more likely to experience antibiotic-resistant urinary tract and respiratory infections. The evidence for other infection sites was less conclusive but pointed to the same overall conclusion. These results could guide empirical treatment for patients with T2DM and infections.
Carrillo Larco R, 2021, Aggregation and combination of cardiovascular risk factors and their association with 10-year all-cause mortality: The PERU MIGRANT Study, BMC Cardiovascular Disorders, Vol: 21, Pages: 1-9, ISSN: 1471-2261
ObjectiveTo estimate the association between the aggregation and pair-wise combination of selected cardiovascular risk factors (CVRF) and 10-year all-cause mortality.MethodsSecondary data analysis of the PERU MIGRANT study, a prospective population-based cohort. Ten-year all-cause mortality was determined for participants originally enrolled in the PERU MIGRANT Study (baseline in 2007) through the National Registry of Identification and Civil Status. The CVRF included hypertension, type 2 diabetes mellitus, hypercholesterolemia, and overweight/obesity. Exposures were composed of both the aggregation of the selected CVRF (one, two, and three or more CVRF) and pair-wise combinations of CVRF. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI).FindingsOf the 989 participants evaluated at baseline, 976 (98.8%) had information about vital status at 10 years of follow-up (9992.63 person-years), and 63 deaths were recorded. In the multivariable model, adjusting for sociodemographic and lifestyle variables, participants with two CVRF (HR: 2.48, 95% CI: 1.03–5.99), and those with three or more CVRF (HR: 3.93, 95% CI: 1.21–12.74) had higher all-cause mortality risk, compared to those without any CVRF. The pair-wise combinations associated with the highest risk of all-cause mortality, compared to those without such comorbidities, were hypertension with type 2 diabetes (HR: 11.67, 95% CI: 3.67–37.10), and hypertension with overweight/obesity (HR: 2.76, 95% CI: 1.18–6.71).ConclusionsThe aggregation of two or more CVRF and the combination of hypertension with type 2 diabetes or overweight/obesity were associated with an increased risk of 10-year all-cause mortality. These risk profiles will inform primary and secondary prevention strategies to delay mortality from cardiovascular risk factors.
Bernabe-Ortiz A, Carrillo Larco R, 2021, Second-hand smoking, hypertension and cardiovascular risk: findings from Peru, BMC Cardiovascular Disorders, Vol: 21, ISSN: 1471-2261
Background:Second-hand smoking has not been detailedly studied in Peru, where smoking is prohibited in all indoor workplaces, public places, and public transportation. Second-hand smoke exposure may occur at home or any other places. This study aimed to estimate the prevalence of second-hand smoking and assess its association with hypertension and cardiovascular risk in Peru.Materials and methods:Secondary analysis of a nationally-representative population-based survey including individuals aged 18–59 years. There were two outcomes: hypertension and 10-year cardiovascular risk using the Framingham and the 2019 World Health Organization (WHO) risk scores. The exposure was self-reported second-hand smoking during the 7 days before the survey. The association between second-hand smoking and hypertension was quantified with Poisson models reporting prevalence ratio (PR) and 95% confidence interval (95% CI); the association between second-hand smoking and cardiovascular risk was quantified with linear regressions reporting coefficients and their 95% CI.Results:Data from 897 individuals, mean age: 38.2 (SD: 11.8) years, and 499 (55.7%) females, were analyzed, with 8.7% subjects reporting second-hand smoking at home and 8.3% at work or any other place. Thus, 144 (15.5%; 95% CI: 12.8%-18.6%) subjects reported any second-hand smoking. In multivariable model second-hand smoking was associated with hypertension (PR = 2.42; 95% CI: 1.25–4.67), and with 1.2% higher Framingham cardiovascular risk, and 0.2% higher 2019 WHO risk score.Conclusions:There is an association between second-hand smoking and hypertension as well as with cardiovascular risk, and 15% of adults reported second-hand smoke exposure overall with half of them exposed at home. There is a need to guarantee smoking-free places to reduce cardiovascular risk.
Carrillo-Larco RM, Stern D, Hambleton IR, et al., 2021, Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies, The Lancet Regional Health - Americas, Vol: 4, Pages: 1-12, ISSN: 2667-193X
BackgroundEstimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown.MethodsWe pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor.ResultsOur RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana.InterpretationRRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries.FundingWellcome Trust (214185/Z/18/Z)
Carrillo-Larco RM, Castillo-Cara M, Lovón-Melgarejo J, 2021, Government plans in the 2016 and 2021 Peruvian presidential elections: A natural language processing analysis of the health chapters, Wellcome Open Research, Vol: 6, Pages: 177-177
<ns4:p><ns4:bold>Background:</ns4:bold>While clinical medicine has exploded, electronic health records for Natural Language Processing (NLP) analyses, public health, and health policy research have not yet adopted these algorithms. We aimed to dissect the health chapters of the government plans of the 2016 and 2021 Peruvian presidential elections, and to compare different NLP algorithms.</ns4:p><ns4:p><ns4:bold>Methods:</ns4:bold>From the government plans (18 in 2016; 19 in 2021) we extracted each sentence from the health chapters. We used five NLP algorithms to extract keywords and phrases from each plan: Term Frequency–Inverse Document Frequency (TF-IDF), Latent Dirichlet Allocation (LDA), TextRank, Keywords Bidirectional Encoder Representations from Transformers (KeyBERT), and Rapid Automatic Keywords Extraction (Rake).</ns4:p><ns4:p><ns4:bold>Results:</ns4:bold>In 2016 we analysed 630 sentences, whereas in 2021 there were 1,685 sentences. The TF-IDF algorithm showed that in 2016, nine terms appeared with a frequency of 0.10 or greater, while in 2021 43 terms met this criterion. The LDA algorithm defined two groups. The first included terms related to things the population would receive (e.g., ’insurance’), while the second included terms about the health system (e.g., ’capacity’). In 2021, most of the government plans belonged to the second group. The TextRank analysis provided keywords showing that ’universal health coverage’ appeared frequently in 2016, while in 2021 keywords about the COVID-19 pandemic were often found. The KeyBERT algorithm provided keywords based on the context of the text. These keywords identified some underlying characteristics of the political party (e.g., political spectrum such as left-wing). The Rake algorithm delivered phrases, in which we found ’universal health coverage’ in 2016 and 2021.</ns4:p><ns4:p&g
Carrillo Larco R, 2021, Blood pressure and 10-year all-cause mortality: Findings fromthe PERU MIGRANT Study, F1000Research, Vol: 10, Pages: 1-12, ISSN: 2046-1402
BackgroundThe long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines.MethodsData analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated.ResultsA total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension.ConclusionsBlood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of
Guzman-Vilca WC, Vascones-Roman FF, Quispe-Villegas GA, et al., 2021, High body-mass index and mortality from cardiometabolic diseases in Peru: a comparative risk assessment analysis, Wellcome Open Research, Vol: 6, Pages: 289-289
<ns3:p><ns3:bold>Background: </ns3:bold>High body-mass index (BMI) is a major contributor to the global burden of cardiometabolic diseases (CMD) like type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). We aimed to quantify the mortality burden associated with high BMI in Peru to inform policies and set priorities.</ns3:p><ns3:p> <ns3:bold>Methods: </ns3:bold>We computed population attributable fractions (PAF) combining BMI prevalence estimates from the Peruvian Demographic and Health Survey and relative risks between high BMI and CMD mortality from the GBD 2019 Study. PAFs were multiplied by the CMD deaths recorded in the national death registry to obtain the absolute number of CMD deaths attributable to high BMI in each region, sex and five-year age group.</ns3:p><ns3:p> <ns3:bold>Results:</ns3:bold> In 2018, the absolute number of T2DM deaths attributable to high BMI in Peru was 1,376 (50.3%) in men and 1,663 (56.0%) in women; the absolute number of CVD deaths related to high BMI was 1,665 in men (23.6%) and 1,551 (24.7%) in women. Most CMD deaths related to high BMI were attributable to obesity class 1 and overweight. Regions with the highest proportions of CMD deaths related to high BMI were in the Amazon (Madre de Dios, Ucayali) and the Coast (Tacna, Moquegua); conversely, regions with the lowest proportions were in the Highlands (Huancavelica, Apurimac).</ns3:p><ns3:p> <ns3:bold>Conclusions: </ns3:bold>High BMI is a major contributor to the CMD mortality burden in Peru, with high variability across regions. Health policies need to be strengthened to reduce BMI at the population level, which may have a subsequent reduction in the associated CMD mortality.</ns3:p>
Bernabé-Ortiz A, Carrillo-Larco RM, 2021, Incidence rate of stroke in Peru., Revista Peruana de Medicina Experimental y Salud Publica, Vol: 38, Pages: 399-405, ISSN: 1726-4634
OBJECTIVE: To determine the incidence of stroke, overall and by sub-types, in Peru between 2017 and 2018. MATERIALS AND METHODS: Analysis of hospital morbidity data obtained from SUSALUD (open data). Using the ICD-10 codes, the following were studied: subarachnoid hemorrhage (I60), atraumatic intracerebral hemorrhage (I61), cerebral infarction (I63), and unspecified stroke (I64). The crude and age-standardized incidence was calculated according to the population of the World Health Organization and using the national projected population number of people according to year, age and sex as the denominator. RESULTS: In 2017, a total of 10,570 stroke cases were recorded, whereas, in 2018, there were 12,835 cases. Ischemic events were more frequent in both years. Regardless of stroke subtype and year, men were more affected than women. In the 35+ year-old population, an increase in the crude incidence of total stroke was observed between 2017 and 2018, from 80.9 to 96.7 per 100,000 person-years. The age-standardized incidence showed the same trend, but in a greater magnitude: from 93.9 to 109.8 per 100,000 person-years. Ischemic stroke was the one that increased the most, with an age-standardized rate in people aged 35+ years of 35.2 in 2017 and 46.3 per 100,000 person-years in 2018. CONCLUSIONS: The incidence of stroke is high in Peru. Ischemic cases are the most frequent and they disproportionately affect men. Our results suggest the need for a surveillance system to robustly quantify the incidence of these cases and understand their determinants.
Carrillo-Larco RM, Guzman-Vilca WC, Bernabe-Ortiz A, 2021, Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru, Lancet Regional Health - Americas, Vol: 1, ISSN: 2667-193X
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).
Carrillo Larco RM, Cajachagua-Torres KN, Guzman-Vilca WC, et al., 2021, National and subnational trends of birthweight in Peru: Pooled analysis of 2,927,761 births between 2012 and 2019 from the national birth registry, Lancet Regional Health - Americas, Vol: 1, Pages: None-None, ISSN: 2667-193X
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).
Carrillo-Larco RM, Guzman-Vilca WC, Bernabe-Ortiz A, 2021, Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020, The Lancet Regional Health - Americas, Vol: 1, ISSN: 2667-193X
Background: While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach. Following the risk-based approach, we described the proportion of eligible people receiving antihypertensive medication in Peru. Methods: Analysis of six (2015-2020) national health surveys. Absolute cardiovascular risk was computed with the 2019 WHO cardiovascular risk charts and based on local guidelines. Antihypertensive treatment allocation based on the absolute cardiovascular risk was defined using the Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings and the HEARTS guidelines by the WHO; we also followed the recommendations by local guidelines. Results: There were 120,059 people. Overall, according to the local guidelines the 17.9% of the population would be eligible for antihypertensive medication while this estimate was 8.1% based on the WHO guidelines. At the national level, depending on the guidelines, we observed a steady trend of eligible people receiving antihypertension medication (e.g., men, local guidelines), a decreasing trend (e.g., men, <60, local guidelines) or an increasing trend (e.g., men, ≥60, local guidelines). At the sub-national level, seventeen regions showed an increasing antihypertensive treatment rate based on the local guidelines; when based on the WHO guidelines, eleven regions showed a decreasing rate. Conclusions: Peru needs to define a tool for surveillance of absolute cardiovascular risk and to monitor antihypertensive treatment allocation among high-risk people. Funding: Wellcome Trust (214185/Z/18/Z).
Bernabe-Ortiz A, Carrillo Larco R, 2021, Multimorbidity and disability among Venezuelan migrants: a population-based survey in Peru, Journal of Immigrant and Minority Health, Vol: 24, Pages: 1206-1213, ISSN: 1096-4045
Background: The political and economic crisis in Venezuela has originated an unprecedented migration. As of November 2020, 1.04 million Venezuelans have moved to Peru. Understanding their health profile is needed to identify their needs, provide care and secure resources without affecting the healthcare of nationals. We quantified the burden of multimorbidity and disability in the Venezuelan population in Peru. Methods: We analyzed the 2018 Survey of Venezuelan Population Living in Peru; population-based with random sampling survey in six cities in Peru. Participants were asked about the presence of 12 chronic conditions (self-reported); this information was grouped into 0, 1 and ≥2 conditions (i.e., multimorbidity). Disability was also ascertained with a self-reported questionnaire adapted from the short version of the Washington Group on Disability Statistics. Socioeconomic variables were analyzed as potential determinants. Variables were described with frequencies and 95% confidence interval (95% CI), compared with Chi2 test, and association estimates were derived with a Poisson regression reporting prevalence ratio and 95% CI. Results accounted for the complex survey design. Results: The analysis included 7,554 migrants, mean age 31.8 (SD: 10.2), 46.6% were women, 31.7% migrated alone and 5.6% had refugee status. The prevalence of multimorbidity was 0.6% (95% CI: 0.4%-0.9%), and was often present in women (p<0.001), people ≥50 years (p<0.001) and those without recent job (p<0.001). The prevalence of disability was 2.0% (95% CI: 1.5%-2.7%), and was common among people ≥50 years (p<0.001) and those without recent job (p<0.001). Migration alone and refugee status were not associated with multimorbidity or disability. Conclusion: The self-reported prevalence of multimorbidity and disability in Venezuelan migrants in Peru was low, and were not strongly influenced by migration status. While these results could suggest a healthy migrant effect
Carrillo-Larco RM, Guzman-Vilca WC, Bernabe-Ortiz A, 2021, Who is getting screened for diabetes according to body mass index and waist circumference categories in Peru? a pooled analysis of national surveys between 2015 and 2019, PLoS One, Vol: 16, ISSN: 1932-6203
BACKGROUND: At the population level we would expect that people with obesity undergo diabetes screening tests more often than people with overweight and much more often than people with normal weight. We described the trends of diabetes screening according to body mass index (BMI) and waist circumference (WC) in Peru. METHODS: Pooled analysis of health national surveys (2015-2019); men and women aged 35-70 years. We used relative frequencies to study: among those who have had a glucose test in the last year, how many there were in each BMI and WC category. We fitted a Poisson model to study whether people with high BMI or WC were more likely to have had a glucose test. RESULTS: People with overweight (PR = 1.34; 95% CI: 1.29-1.38), obesity (PR = 1.57; 95% CI: 1.51-1.63) and central obesity (PR = 1.63; 95% CI: 1.35-1.96) were more likely to have had a glucose test. At the sub-national level, there was one (of twenty-five) region in which men with obesity were more often screened for diabetes than men with overweight and much more than men with normal weight. There were seven regions in which women with obesity were the most often screened for diabetes. CONCLUSIONS: Consistent with a risk-based prevention approach, people with obesity would be screened for diabetes more often than those with overweight and those with normal weight. This ideal profile was only observed in few regions. Diabetes screening strategies should be strengthened and homogenised, so that they reach those at high risk of diabetes.
Mendoza-Quispe D, Hernández-Vásquez A, Miranda J, et al., 2021, Urbanization in Peru is inversely associated with double burden of malnutrition: pooled analysis of 92,841 mother-child pairs, Obesity, Vol: 29, Pages: 1363-1374, ISSN: 1071-7323
Objective: This study assessed the relationship between urbanization and the double burden of malnutrition (DBM) in Peru. Methods: Cross-sectional analysis of the Demographic and Health Survey (2009-2016). A DBM ‘case’ comprised a child with undernutrition and their mother with overweight/obesity. For urbanization, we used three indicators: an eight-category variable based on district-level population density (inhabitants/km2); a dichotomous urban/rural variable; and place of residence (countryside, towns, small cities, or capital/large cities). Results: The prevalence of DBM was lower in urban than in rural areas (prevalence ratio [PR]0.70; 95% confidence interval [CI] 0.65–0.75); and compared to the countryside, the DBM was less prevalent in towns (PR 0.75; 95% CI 0.69-0.82), small cities (PR 0.73; 95% CI 0.67-0.79) and capital/large cities (PR 0.53; 95% CI 0.46-0.61). Using population density, the adjusted prevalence of DBM was 9.7%(95% CI 9.4-10.1)in low-density settings(1-500 inhabitants/km2), 5.9% (95% CI 4.9-6.8)in mid-urbanized settings (1,001-2,500inhabitants/km2), 5.8% (95% CI 4.5-7.1)in more densely populated settings(7,501-10,000inhabitants/km2), and 5.5% (95% CI 4.1-7.0) in high-density settings (>15,000 inhabitants/km2). Conclusions: The prevalence of DBM is higher in the least urbanized settings such as rural and peri-urban areas, particularly those under 2,500 inhabitants/km2.
Huaquía-Díaz AM, Chalán-Dávila TS, Carrillo Larco R, et al., 2021, Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis, BMJ Open, Vol: 11, ISSN: 2044-6055
Objective To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC).Design Systematic review and meta-analysis.Data sources MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020.Eligibility criteria for selecting studies The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population.Data extraction and synthesis Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued.Results From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I2: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I2: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I2: 99.9%); this raised to 52% (95% CI: 33% to 70%; I2: 99.9%) for reports including self-reported and objective diagnosis.Conclusions Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported.
Carrillo-Larco RM, Castillo-Cara M, Lovón-Melgarejo J, 2021, Government plans in the 2016 and 2021 Peruvian presidential elections: A natural language processing analysis of the health chapters, Wellcome Open Research, Vol: 6, Pages: 177-177
<ns4:p><ns4:bold>Background:</ns4:bold>While clinical medicine has exploded, electronic health records for Natural Language Processing (NLP) analyses, public health, and health policy research have not yet adopted these algorithms. We aimed to dissect the health chapters of the government plans of the 2016 and 2021 Peruvian presidential elections, and to compare different NLP algorithms.</ns4:p><ns4:p><ns4:bold>Methods:</ns4:bold>From the government plans (18 in 2016; 19 in 2021) we extracted each sentence from the health chapters. We used five NLP algorithms to extract keywords and phrases from each plan: Term Frequency–Inverse Document Frequency (TF-IDF), Latent Dirichlet Allocation (LDA), TextRank, Keywords Bidirectional Encoder Representations from Transformers (KeyBERT), and Rapid Automatic Keywords Extraction (Rake).</ns4:p><ns4:p><ns4:bold>Results:</ns4:bold>In 2016 we analysed 630 sentences, whereas in 2021 there were 1,685 sentences. The TF-IDF algorithm showed that in 2016, nine terms appeared with a frequency of 0.10 or greater, while in 2021 43 terms met this criterion. The LDA algorithm defined two groups. The first included terms related to things the population would receive (e.g., ’insurance’), while the second included terms about the health system (e.g., ’capacity’). In 2021, most of the government plans belonged to the second group. The TextRank analysis provided keywords showing that ’universal health coverage’ appeared frequently in 2016, while in 2021 keywords about the COVID-19 pandemic were often found. The KeyBERT algorithm provided keywords based on the context of the text. These keywords identified some underlying characteristics of the political party (e.g., political spectrum such as left-wing). The Rake algorithm delivered phrases, in which we found ’universal health coverage’ in 2016 and 2021.</ns4:p><ns4:p&g
Carrillo Larco R, 2021, Short-term trends in the prevalence, awareness, treatment, and control of arterial hypertension in Peru, Journal of Human Hypertension, Vol: 35, Pages: 462-471, ISSN: 0950-9240
The prevalence of hypertension has been declining in low- and middle-income countries (LMIC), particularly in Latin America and the Caribbean. However, we have not identified studies that evaluate trends for awareness, treatment, and control of hypertension in LMIC. We aimed to describe the trends in the prevalence, awareness, treatment, and control of hypertension in Peru. A cross-sectional analysis was conducted using secondary data (4 years) of the Demographic and Health Survey of Peru (ENDES, Spanish acronym), which is conducted annually and is representative at the country level. The age-standardized prevalence was estimated using the World Health Organization population as the reference population. The trend over time was evaluated with the score test for trend of odds. A total of 109,401 participants were included. In Peru, from 2015 to 2018, the age-standardized prevalence of hypertension increased (p < 0.001), while the proportion of people with disease awareness (p < 0.001) and controlled hypertension decreased (p = 0.01). During that same period, the proportion of people with treatment for hypertension did not vary over time (p = 0.13). In 2018, the age-standardized prevalence of hypertension was 20.6%, and the proportion of people with disease awareness, treatment, and control of arterial hypertension was 43.5%, 20.6%, 5.3%, respectively. People with low socioeconomic status and people living in rural areas have the lowest proportion of awareness, treatment, and control of hypertension.
Bernabe-Ortiz A, Carrillo-Larco RM, Miranda JJ, 2021, Association between body mass index and blood pressure levels across socio-demographic groups and geographical settings: analysis of pooled data in Peru, PeerJ, Vol: 9, ISSN: 2167-8359
BackgroundUnderstanding the relationship between BMI and blood pressure requires assessing whether this association is similar or differs across population groups. This study aimed to assess the association between body mass index (BMI) and blood pressure levels, and how these associations vary between socioeconomic groups and geographical settings.MethodsData from the National Demographic Health Survey of Peru from 2014 to 2019 was analyzed considering the complex survey design. The outcomes were levels of systolic (SBP) and diastolic blood pressure (DBP), and the exposure was BMI. Exposure and outcomes were fitted as continuous variables in a non-linear quadratic regression model. We explored effect modification by six socioeconomic and geographical variables (sex, age, education level, socioeconomic position, study area, and altitude), fitting an interaction term between each of these variables and BMI.ResultsData from 159, 940 subjects, mean age 44.4 (SD: 17.1), 54.6% females, was analyzed. A third (34.0%) of individuals had ≥12 years of education, 24.7% were from rural areas, and 23.7% lived in areas located over 2,500 m above sea level. In the overall sample mean BMI was 27.1 (SD: 4.6) kg/m2, and mean SBP and DBP were 122.5 (SD: 17.2) and 72.3 (SD: 9.8) mmHg, respectively. In the multivariable models, greater BMI levels were associated with higher SBP (p-value < 0.001) and DBP (p-value < 0.001). There was strong evidence that sex, age, education level, and altitude were effect modifiers of the association between BMI and both SBP and DBP. In addition to these socio-demographic variables, socioeconomic position and study area were also effect modifiers of the association between BMI and DBP, but not SBP.ConclusionsThe association between BMI and levels of blood pressure is not uniform on a range of socio-demographic and geographical population groups. This characterization can inform the understanding of the epidemiology and rise of blood pressure in a
NCD Risk Factor Collaboration NCD-RisC, Iurilli N, 2021, Heterogeneous contributions of change in population distribution of body-mass index to change in obesity and underweight, eLife, Vol: 10, ISSN: 2050-084X
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
Pomati M, Mendoza-Quispe D, Anza-Ramirez C, et al., 2021, Trends and patterns of the double burden of malnutrition 1 (DBM) in Peru: A pooled analysis of 129,159 mother-child dyads, International Journal of Obesity, Vol: 45, Pages: 609-618, ISSN: 0307-0565
BackgroundThis study aims to evaluate trends of DBM in Peru over the last 20 years.MethodsUsing individual-level data collected in nationally representative household surveys from Peru between 1996 and 2017, we analysed trends in the prevalence and patterning of the DBM. We classified the nutritional status of children and their mothers as undernourished (either underweight, stunted or wasted for children), normal, overweight or obese. Children classified as experiencing the DBM were those undernourished and living with an overweight or obese mother. We also fitted logistic regression models to evaluate the probability of children having an overweight/obese mother across subgroups of socioeconomic status, place of residence and education.ResultsThe overall percentage of children experiencing the DBM in 2016 was 7%, and constitutes ~203,600 children (90% of whom were stunted). Between 1996 and 2016, undernourished children have seen the largest relative increase in the risk of having an overweight mother (31% vs. 37%) or obese mother (6% vs. 17%); however, due to the substantial decrease in the absolute number of undernourished children, the DBM has not grown. Moreover, all children, irrespective of their own nutritional status, are now more likely to live with an overweight or obese mother, a consistent pattern across wealth, location and education subgroups, and all regions of Peru.ConclusionsDBM prevalence in Peru has decreased, although the number of DBM cases is estimated to be above 200,000. In addition, all children are now more likely to live with overweight or obese mothers. The basic pattern has shifted from one of undernourished children whose mothers have a ‘normal’ BMI, to one where now most children have a ‘normal’ or healthy anthropometric status, but whose mothers are overweight or obese. This suggest that Peru is on the cusp of a major public health challenge requiring significant action.
Carrillo Larco R, 2021, Clusters of people with type 2 diabetes in the general population: Unsupervised machine learning approach using national surveys in Latin America and the Caribbean, BMJ Open Diabetes Research and Care, Vol: 9, Pages: e001889-e001889, ISSN: 2052-4897
Introduction We aimed to identify clusters of people withtype 2 diabetes mellitus (T2DM) and to assess whether thefrequency of these clusters was consistent across selectedcountries in Latin America and the Caribbean (LAC).Research design and methods We analyzed 13population-based national surveys in nine countries(n=8361). We used k-means to develop a clustering model;predictors were age, sex, body mass index (BMI), waistcircumference (WC), systolic/diastolic blood pressure(SBP/DBP), and T2DM family history. The training data setincluded all surveys, and the clusters were then predictedin each country-year data set. We used Euclidean distance,elbow and silhouette plots to select the optimal numberof clusters and described each cluster according to theunderlying predictors (mean and proportions).Results The optimal number of clusters was 4. Cluster0 grouped more men and those with the highest meanSBP/DBP. Cluster 1 had the highest mean BMI and WC, aswell as the largest proportion of T2DM family history. Weobserved the smallest values of all predictors in cluster 2.Cluster 3 had the highest mean age. When we reflectedthe four clusters in each country-year data set, a differentdistribution was observed. For example, cluster 3 was themost frequent in the training data set, and so it was in 7out of 13 other country-year data sets.Conclusions Using unsupervised machine learningalgorithms, it was possible to cluster people with T2DMfrom the general population in LAC; clusters showedunique profiles that could be used to identify theunderlying characteristics of the T2DM population in LAC
Espinoza López PA, Fernández Landeo KJ, Pérez Silva Mercado RR, et al., 2021, Neck circumference in Latin America and the Caribbean: A systematic review and meta-analysis [version 1; peer review: 2 approved], Wellcome Open Research, Vol: 6, ISSN: 2398-502X
Background: High neck circumference (NC) is associated with high burden diseases in Latin American and the Caribbean (LAC). NC complements established anthropometric measurements for early identification of cardio-metabolic and other illnesses. However, evidence about NC has not been systematically studied in LAC. We aimed to estimate the mean NC and the prevalence of high NC in LAC. Methods: We conducted a systematic review in MEDLINE, Embase, Global Health and LILACS. Search results were screened and studied by two reviewers independently. To assess risk of bias of individual studies, we used the Hoy et al. scale and the Newcastle-Ottawa scale. We conducted a random-effects meta-analysis. Results: In total, 182 abstracts were screened, 96 manuscripts were reviewed and 85 studies (n= 51,978) were summarized. From all the summarized studies, 14 were conducted in a sample of the general population, 23 were conducted with captive populations and 49 studies were conducted with patients. The pooled mean NC in the general population was 35.69 cm (95% IC: 34.85cm-36.53cm; I²: 99.6%). In our patient populations, the pooled mean NC in the obesity group was 42.56cm (95% CI 41.70cm-43.42cm; I²: 92.40%). Across all studied populations, there were several definitions of high NC; thus, prevalence estimates were not comparable. The prevalence of high NC ranged between 37.00% and 57.69% in the general population. The methodology to measure NC was not consistently reported. Conclusions: Mean NC in LAC appears to be in the range of estimates from other world regions. Inconsistent methods and definitions hamper cross-country comparisons and time trend analyses. There is a need for consistent and comparable definitions of NC so that it can be incorporated as a standard anthropometric indicator in surveys and epidemiological studies.
Miranda JJ, Aldridge RW, Pesantes MA, et al., 2021, Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review, Wellcome Open Research, Vol: 6
Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery. We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential to fo
Zhou B, Carrillo-Larco RM, Danaei G, et al., 2021, Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants, The Lancet, Vol: 398, Pages: 957-980, ISSN: 0140-6736
Miranda JJ, Pesantes MA, Lazo-Porras M, et al., 2021, Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review., Wellcome Open Res, Vol: 6, ISSN: 2398-502X
Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery. We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential
Pesantes MA, Lazo-Porras M, Cárdenas MK, et al., 2020, [Healthcare challenges for people with diabetes during the national state of emergency due to COVID-19 in Lima, Peru: primary healthcare recommendations], Revista Peruana de Medicina Experimental y Salud Publica, Vol: 37, Pages: 541-546, ISSN: 1726-4634
Patients diagnosed with type 2 diabetes mellitus, who then become infected with SARS-CoV-2, are at greater risk of developing complications from COVID-19, which may even lead to death. Diabetes is a chronic condition that requires continuous contact with healthcare facilities; therefore, this type of patients should have regular access to medicines, tests and appointments with healthcare personnel. In Peru, care and treatment continuity have been affected since the national state of emergency due to COVID-19 began; because many healthcare facilities suspended outpatient consultations. The strategies presented in this study were developed by different Peruvian health providers in the pandemic context to ensure care continuity for people with diabetes. This article provides recommendations to strengthen primary healthcare, because it is the first level of healthcare contact for patients with diabetes.
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