Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019

"Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru’s healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8–70.3) to 80.3 (77.2–83.2) years. This increase was driven by the decline in under-5 mortality (−80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5–10.1) and reached 7.5 million (6.1–9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Herramientas De Calidad-IN92-201002

Este curso busca desarrollar competencias en la herramientas y los métodos de calidad de modo que puedan ser aplicados en empresas manufactureras y de servicios; en forma independiente o integrados en un modelo de gestión de la calidad. Se brinda fundamentos y filosofías de la calidad herramientas estadísticas para la calidad y metodologías para la mejora de proceso y proyectos

Planeamiento Y Control Tactico De Operaciones-IN58-200902

El curso proporciona fundamentos sólidos para que el futuro ingeniero industrial reconozca analice determine e implemente sistemas de operación y control de la producción al interior de una empresa proporcionando conocimientos en manejo de sistemas de inventarios planeamiento de recursos y de materiales técnicas de manejo y programación de producción

Herramientas De Calidad-IN92-201001

Este curso busca desarrollar competencias en la herramientas y los métodos de calidad de modo que puedan ser aplicados en empresas manufactureras y de servicios; en forma independiente o integrados en un modelo de gestión de la calidad.Se brinda fundamentos y filosofías de la calidad herramientas estadísticas para la calidad y metodologías para la mejora de proceso y proyectos

Planeamiento Y Control Tactico De Operaciones-IN58-200902

El curso proporciona fundamentos sólidos para que el futuro ingeniero industrial reconozca analice determine e implemente sistemas de operación y control de la producción al interior de una empresa proporcionando conocimientos en manejo de sistemas de inventarios planeamiento de recursos y de materiales técnicas de manejo y programación de producción

Herramientas De Calidad-IN92-200701

Este curso busca desarrollar competencias en la herramientas y los métodos de calidad de modo que puedan ser aplicados en empresas productivas y de servicios; en forma independiente o integrados en un modelo de gestión de la calidad.Se brinda fundamentos y filosofías de la calidad herramientas estadísticas para la calidad y metodologías para la mejora de proceso y proyectos

Planeamiento Y Control Tactico De Operaciones-IN58-200701

El curso proporciona fundamentos sólidos para que el futuro ingeniero industrial reconozca analice determine e implemente sistemas de operación y control de la producción al interior de una empresa proporcionando conocimientos en manejo de sistemas de inventarios planeamiento de recursos y de materiales técnicas de manejo de producción y técnicas de programación de producción

Planeamiento Y Control Tactico De Operaciones-IN58-201400

El curso proporciona fundamentos sólidos para que el futuro ingeniero industrial reconozca analice determine e implemente sistemas de operación y control de la producción al interior de una empresa proporcionando conocimientos en manejo de sistemas de inventarios planeamiento de recursos y de materiales técnicas de manejo y programación de producción

Planeamiento Y Control Tactico De Operaciones-IN58-200701

El curso proporciona fundamentos sólidos para que el futuro ingeniero industrial reconozca analice determine e implemente sistemas de operación y control de la producción al interior de una empresa proporcionando conocimientos en manejo de sistemas de inventarios planeamiento de recursos y de materiales técnicas de manejo de producción y técnicas de programación de producción