publications

2022

1. Saude Publica

   Exposure to domestic violence and bullying victimization among Peruvian adolescents

   Lazo-Legrand, Maria Fernanda, Palomino-Torres, Rodrigo, Chacon-Torrico, Horacio, Garayar-Peceros, Humberto, and Alarco, J Jhonnel

   Cadernos de Saude Publica 2022

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   With the aim of evaluating the association between exposure to violence at home and bullying victimization among Peruvian adolescents aged 12 to 17 years, during 2019, a cross-sectional study of secondary data analysis of the 2019 Peruvian National Survey on Social Relations (ENARES) was carried out. The independent variable was exposure to violence at home, and the dependent variable was bullying victimization, which included psychological and physical bullying. Potential confounding variables were also included. Multinomial logistic regression models were used, and relative risk ratios (RRR) with 95% confidence intervals (95%CI) were estimated. The complex sampling of the ENARES 2019 was considered in all calculations. Data from 1,569 Peruvian adolescents were included. Thirty-eight point one percent were exposed to violence at home, while 37.9% were victims of psychological bullying only, 3.4% of physical bullying only, and 22.4% of both types of bullying. Adolescents who were always or almost always exposed to violence at home were 4.8 times more likely to be victims of bullying (RRR = 4.80; 95%CI: 2.44-9.42), adjusted for multiple confounding variables. In Peru, the Peruvian adolescents aged 12 to 17 years who were exposed to violence at home were more likely to be victims of bullying at school. These results should draw the attention of public policies decision-makers toward children’s protection.

2. Thesis

   Identifying drivers of spatial-temporal heterogeneity in COVID-19 outcomes during the 2020-2021 outbreaks in Peru

   Chacon-Torrico, Horacio

   2022

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   According to the World Health Organization, it has been estimated that Peru had the highest per capita excess mortality rate for the 2020-2021 period among all countries in the world. Understanding the drivers of heterogeneity in the COVID-19 response is relevant from a public and global health perspective, as it could inform policymakers what interventions contribute to mitigating the outbreaks. To understand what province-level covariates determined better or worst outcomes in the Peruvian setting, we used vital registration data to fit time-varying mortality rates for the 196 provinces in Peru during the 2020-2021 period. Then, extracting transmission and disease features, we tested the relationship of those features with province-level covariates. We identified three main drivers of the variability of COVID-19 outcome, namely the overall wealth of the province by means of the human development index, the demographic structure, and the internal migration. The results showed potential drivers of the epidemic in Peru and acted as an example of a failed COVID-19 response as a valuable and tragic lesson for Global Health.

3. Hunger Environ

   COVID-19 and Food Insecurity in Latin America and the Caribbean

   Hernández-Vásquez, Akram, Visconti-Lopez, Fabriccio J, Chacón-Torrico, Horacio, and Azañedo, Diego

   Journal of Hunger & Environmental Nutrition 2022

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   The objective was to determine the prevalence of household food insecurity (FI) in Latin America and the Caribbean (LAC) during the COVID-19 pandemic. Secondary analysis was performed using the waves 1 to 3 of the 2020 COVID-19 High Frequency Phone Surveys in 13 LAC countries. The countries with the highest FI in the first wave were Honduras (60.3%), Peru (58.1%) and Ecuador (57.9%). Likewise, the countries with the greatest differences in the prevalence of FI between the first and last waves in percentage points (PP) were Peru (−29), Guatemala (−27.7) and Bolivia (−21.8). LAC countries face a great burden of FI.

4. Environ Res

   Gender differences in the factors associated with alcohol binge drinking: a population-based analysis in a Latin American country

   Hernández-Vásquez, Akram, Chacón-Torrico, Horacio, Vargas-Fernández, Rodrigo, Grendas, Leandro Nicolás, and Bendezu-Quispe, Guido

   International journal of environmental research and public health 2022

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   Alcohol consumption is a public health problem in Peru, fostered by traditional practices, where promoting social interaction in celebrations, facilitating field work as a source of energy and warmth, and achieving objectives in certain labor negotiations, play an important role. However, research on the risk factors of binge drinking according to gender is limited. The study aim was to determine the factors associated with binge drinking in the Peruvian adult population by gender. An analytical study of secondary data from the 2018 Peruvian Demographic and Family Health Survey was conducted. The dependent variable was binge drinking in the last 30 days. Adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables with binge drinking. A total of 32,020 adults were included. Binge drinking was found in 22.4%. Men (32.6%; 95% confidence interval [CI]: 31.4–33.8) presented a higher consumption pattern compared to women (12.8%; 95% CI: 12.0–13.6). For both genders, differences were found in binge drinking according to sociodemographic characteristics (age and wealth quintile was associated in both genders while the educational level was associated only for men, and ethnic self-identification and marital status for women) and health- characteristics related (health insurance, smoking in the last 30 days, overweight and obesity were associated in both genders). Several factors are associated with binge drinking according to gender in the Peruvian population, including age and education level among men, as well as marital status and ethnic self-identification among women.

2021

1. SSM Pop Health

   Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys

   Hernández-Vásquez, Akram, Chacon-Torrico, Horacio, and Bendezu-Quispe, Guido

   SSM - Population Health, 2021

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   Objective The objective of this study was to determine the prevalence of home birth in low-middle income countries (LMIC) according to geographic area and sociodemographic characteristics between 2000 and 2019. Methods A meta-analysis was carried out using the most recent demographic and health surveys as a data source (total countries: 67). A random-effects meta-analysis was obtained to calculate pooled prevalence estimates of home birth for all the countries included and by geographic region of the world. Likewise, a subgroup analysis was performed to estimate the prevalence of home birth according to the sociodemographic factors considered for this study. Results The global prevalence of home birth was 28% (95% CI: 0.24–0.33), with the lowest prevalence in the region of Europe & Central Asia (5%, 95% CI: 0.03–0.07) and the highest in East Asia & Pacific region (38%, 95% CI: 0.26–0.51). Twelve countries had proportions of home births greater than 50% (seven belonged to the Sub-Saharan Africa region). The countries with the highest proportion of home births were Chad (78%), Ethiopia (73%), and Niger and Yemen (70% each). Concerning the wealth index, in general, the richest quintile (quintile 5) presented the lowest proportion of home births. In contrast, the poorest (quintile 1) generally had the highest prevalence of home births. Regarding educational level, women without education presented the highest proportions of home births in general. In relation to the area of residence, in almost all the countries studied, women in rural areas generally had a higher proportion of home births than those in urban areas. Conclusions Home births occurred in approximately 3 out of 10 women in LMIC. There are also differences in the proportion of home births according to socioeconomic factors such as educational level, wealth index, and rurality.

2. Birth

   Geographic and socioeconomic inequalities in cesarean birth rates in Peru: A comparison between 2009 and 2018

   Hernandez-Vasquez, Akram, Chacon-Torrico, Horacio, and Bendezu-Quispe, Guido

   Birth, 2021

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   Background: There is a global concern about the high rates of cesarean birth (CB). This study aimed to investigate the geographic and socioeconomic inequalities in CB rates in the Peruvian population. Methods: We conducted a population-based study using the Peruvian Demographic and Family Health Surveys (ENDES, the Spanish acronym for Encuesta Demográfica y de Salud Familiar) between 2009 and 2018. ENDES reported data from births registered in the five years preceding survey execution. For the years 2009 (n = 10 289) and 2018 (n = 23 077), we calculated the weighted rates of CB among variables such as natural geographic domain (Coast, Andean, or Amazon), area of residence (rural or urban), wealth index quintile (quintile 1 is poorest, and quintile 5 is richest), and educational level. To assess inequalities, we calculated the concentration index (CIs), the slope index of inequality (SII), and the relative index of inequality (RII). Results: The CB rates by year were 21.4% (95% confidence interval [CI]: 20.0-22.9) in 2009 and 34.5% (95% CI: 33.4-35.5) in 2018. Women living in urban and coastal regions and with a higher education level had the highest CB rates. All the CIs were positive, reflecting a prowealthy inequality in CB rates, and both SII and RII were positive, indicating a gap between the use of cesarean in women in the higher wealth quintile compared with those in the lower quintile. Conclusions: Cesarean birth rates have increased by 60% during the last decade in Peru. The richest wealth quintiles had the highest CB rates during the study years, which were well above global recommendations.

3. Heliyon

   Factors associated with home births in Peru 2015–2017: A cross-sectional population-based study

   Hernandez-Vasquez, Akram, Chacon-Torrico, Horacio, Vargas-Fernandez, Rodrigo, and Bendezu-Quispe, Guido

   Heliyon, 2021

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   Background Higher rates of maternal complications and deaths have been described in home births. However, few local studies have evaluated factors associated with home births in Peru. The study aims to determine the prevalence and factors associated with home birth in the Peruvian population. Methods A population-based analytical cross-sectional study was conducted using pooled data from the 2015–2017 Peruvian Demographic and Health Surveys. A logistic regression model was performed to calculate crude and adjusted odds ratios (aOR) for the association between sociodemographic and mother-related factors and home births. Results Seven out of every 100 births were home births. Living in a rural area (aOR = 3.10; 95% CI: 2.52–3.81), having a primary or secondary educational level, belonging to a medium or low wealth tertile, being from the rest of the Coast, Andean or Amazon regions, the second or greater number of birth order and considering the distance to the health center as problematic (aOR: 1.32; 95% CI: 1.17–1.48) were found to be associated with a higher probability of home births. Contrarily, being in the age groups of 25–34 and 35–39 years old, having a multiple pregnancy and giving birth to a medium (aOR: 0.88; 95% CI: 0.78–1.00) or large-sized newborn (aOR = 0.81; 95% CI: 0.72–0.93) were associated with a lower probability of presenting home births. Conclusions Sociodemographic factors are associated with home births in Peru. Further study of these factors is required to develop strategies specific to the needs of the population of childbearing age.

2020

1. Reprod Healthc

   Differences in the prevalence of cesarean section and associated factors in private and public healthcare systems in Peru

   Hernandez-Vasquez, Akram, Chacon-Torrico, Horacio, and Bendezu-Quispe, Guido

   Sexual & Reproductive Healthcare 2020

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   Background Cesarean section rates have been steadily increasing worldwide. Private health facilities are reported as being a major contributor to this rising rate in Latin America. Aim To assess the prevalence and determinants of cesarean section rates among public and private health facilities in Peru. Methods We performed a cross-sectional analytical study pooling the data of 52,215 women between 15 and 49 years of age from the 2015–2017 Peruvian Demographic and Family Health Survey (ENDES) database. Sociodemographic and pregnancy-related variables were used to construct adjusted logistic regression models for the indication of cesarean section. Findings The prevalence of cesarean births was 73.0% (95%CI: 71.1–74.9) and 30.3% (95% CI: 29.6–31.0) in private and public health facilities, respectively. In private facilities, living in an urban area, having a higher educational level, being in the age group of 35–49 years, and having multiple pregnancies increased the probability of a cesarean section. In public health facilities, living in an urban area, having a higher wealth quintile, higher education level, older maternal age, birth order, newborn size and gender, type of pregnancy, language, and maternal height were all factors associated with cesarean section. Conclusion The prevalence of cesarean section found in the present study was above the value recommended by the WHO (10%) for both public and private facilities. It is necessary to address the indiscriminate rise in the use of cesarean sections, developing strategies according to the type of health facility.

2. IJPVM

   Metrics of Ideal Cardiovascular Health are Unequally Distributed between Peruvian Men and Women: Analysis of a National Population-Based Survey in 2017

   Hernandez-Vasquez, Akram, Chacon-Torrico, Horacio, Vargas-Fernandez, Rodrigo, Bendezu-Quispe, Guido, and Santero, Marilina

   International Journal of Preventive Medicine, 2020

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   Background: To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex. Methods: An observational, cross-sectional study was conducted in 26,175 individuals aged 18–65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic-related inequality in health variables. Results: Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women (P < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: −0.0817; men: −0.2699). Conclusions: Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low- and middle-income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs.

2019

1. Medwave

   Use of mammography in Peruvian women: an analysis of the 2018 Demographic and health survey

   Hernandez-Vasquez, Akram, and Chacon-Torrico, Horacio

   Medwave, 2019

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2. CCIS

   Comparing Predictive Machine Learning Algorithms in Fit for Work Occupational Health Assessments

   Charapaqui-Miranda, Saul, Arapa-Apaza, Katherine, Meza-Rodriguez, Moises, and Chacon-Torrico, Horacio

   In Annual International Symposium on Information Management and Big Data 2019

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3. rpmesp

   Manipulation, Analysis, and Visualization of Data from the Demographic and Family Health Survey With the R Program

   Hernandez-Vasquez, Akram, and Chacon-Torrico, Horacio

   Revista peruana de medicina experimental y salud publica, 2019

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   The Demographic and Family Health Survey (ENDES, in Spanish) is a national population-based survey with representation at the departmental level and area of residence, constituting a source of information on the health status of the Peruvian population. In order to standardize its processing and subsequent reuse by the academic community and other stakeholders, we documented the code for the manipulation, analysis, and visualization of data from the ENDES 2017 health questionnaire, through an example on the prevalence of hypertension and obesity, using the R statistical programming environment and language. The R code is presented and detailed sequentially, as well as the theoretical support of the survey structure for the manipulation of databases, considering that the complex structure of the ENDES could be a potential barrier faced by researchers. Finally, this example can serve as a basis for generating further studies based on the ENDES that are relevant to public health decision-making.

4. epiH

   Determinants of early initiation of breastfeeding in Peru: analysis of the 2018 Demographic and Family Health Survey

   Hernandez-Vasquez, Akram, and Chacon-Torrico, Horacio

   Epidemiology and health 2019

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   OBJECTIVES Early initiation of breastfeeding (EIBF) is one of the most cost-effective strategies to reduce neonatal mortality. We sought to determine the prevalence and determinants of EIBF in Peru. METHODS We performed a cross-sectional analytical study of the 2018 Peruvian Demographic and Family Health Survey as a secondary data source. In total, 19,595 children born during the 5 years prior to the survey were included in the study. The dependent variable (EIBF status), socio-demographic variables, and pregnancy-related variables were analyzed using a multivariate logistic regression model to identify the determinants of EIBF. RESULTS The prevalence of EIBF in the study population was 49.7%. Cesarean deliveries were associated with a lower likelihood of EIBF (adjusted odds ratio [aOR], 0.06; 95% confidence interval [CI], 0.05 to 0.07) than were vaginal deliveries. Newborns born at public health centers (aOR, 1.37; 95% CI, 1.15 to 1.65) had a higher rate of EIBF than those not born at public or private health centers. Women from the jungle region (aOR, 2.51; 95% CI, 2.17 to 2.89) had higher odds of providing EIBF than those from the coast. Mothers with more than a secondary education (aOR, 0.65; 95% CI, 0.55 to 0.76) were less likely to breastfeed during the first hour of the newborn’s life than women with primary or no education. CONCLUSIONS More than half of Peruvian children do not breastfeed during the first hour after birth. The major determinants of EIBF status were the delivery mode and the region of maternal residence. Strategies are needed to promote early breastfeeding practices.

2013

1. rpmesp

   Characteristics of Violence During Teenage Pregnancy in Lima, Peru

   Contreras-Pulache, Hans, Mori-Quispe, Elizabeth, Hinostroza-Camposano, Willy D, Yancachajlla-Apaza, Maribel, Lam-Figueroa, Nelly, and Chacon-Torrico, Horacio

   Revista peruana de medicina experimental y salud publica 2013

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   Objectives. To determine the characteristics of violence seen in pregnant teenagers who were treated at the Instituto Nacional Materno Perinatal (INMP) in Lima, Peru. Materials and methods. A cross-sectional study was carried out by INMP between January and March, 2010 using a probabilistic and systematic sampling. The study unit comprises every hospitalized teenager who had just given birth and who lived in Lima. A semi-structured interview was conducted. History of violence was operationalized into: verbal violence (insults, ridicule, and humiliation), physical violence (arm pulling, hair pulling, pushes), direct aggression (slaps, kicking, burns) and sexual violence (sexual intercourse without consent). Results. 292 teenage mothers aged 16,5 ± 1 in average took part in the study. 47.9% lived with their partners and 51.4% were single. In 97.3% of the cases, they got pregnant as a result of a conserted sexual relationship, while 2.7% got pregnant as a result of rape. 90.1% of teenage mothers reported not having planned the pregnancy. Conserning history of violence: 48.1% had had verbal violence, 17.1% physical violence, 8.2% direct aggression and 6.8% sexual violence. Conclusions. Violence during teenage pregnancy is not an isolated event; actually, it is rather common in any of its forms.