Planeamiento estratégico del mango en la región Lambayeque

El sector agroexportador ha registrado en los últimos años una importante tendencia de crecimiento, debido principalmente al aumento de la demanda a nivel mundial como resultado de nuevas preferencias de consumo, las mismas que generan grandes oportunidades de negocio para el Perú y en particular en la región Lambayeque. Un ejemplo de ello es que en el año 2011 los principales mercados demandaron alimentos sanos, naturales y de calidad, como es el caso de las frutas y vegetales. El mango ha sido reconocido como uno de los frutos tropicales más valorados a nivel mundial, lo cual se refleja en el crecimiento de su demanda. En el mismo sentido, el Perú ha tenido un crecimiento progresivo de la superficie cultivada y el nivel de exportaciones de este fruto, siendo la Región Piura el principal exponente de este crecimiento. Cabe destacar que el Perú cuenta con ventajas competitivas y comparativas para el desarrollo del sector del mango, tales como la ventana comercial, la variedad de climas y su mayor nivel de productividad, factores que permiten ofrecer un producto de calidad, aunque no se ha podido tomar ventaja de estas fortalezas puesto que existe una importante atomización de la agricultura en general, así como el poco nivel de asociatividad entre los productores. Destaca el hecho de que un porcentaje mayor al 90% de la exportación de mango en Perú se comercializa a los mercados de Europa y EEUU, donde se compite con importantes exportadores como México y Brasil, lo cual merma los precios del mango a nivel internacional. Para contrarrestar esto se presentan nuevos mercados con mejores condiciones comerciales a los cuales se puede atender. La región Lambayeque posee características geográficas y climáticas que propician la agricultura como una de las principales actividades productivas que impulsarían la creación de empleo directo e indirecto; sin embargo, estas potencialidades no han generado un nivel de desarrollo en la misma magnitud en la Región Piura a nivel nacional o bien como México y Brasil a nivel internacional. La presente tesis desarrolla el Plan Estratégico para el mango en la región Lambayeque. Representa una valiosa herramienta de gestión donde se han identificado los factores críticos para el desarrollo del mango, los cuales se encuentran relacionados a un incremento de las exportaciones, un estricto control fitosanitario, mejoras tecnológicas, un óptimo desarrollo para la etapa de cosecha, cultivo y comercialización del mango, una mejora en la asociatividad de los productores e integración de toda la cadena, incluyendo la participación del gobierno regional y entidades gubernamentales relacionadas. Para lo cual, se establecen objetivos a largo plazo y estrategias que se deben implementar para alcanzar el futuro deseado.The agro-export sector is experiencing in recent years a significant growth trend, mainly due to increased global demand as a result of new consumer preferences that generate great business opportunities for Peru, particularly in the Lambayeque region. In 2011, the most important markets are demanding food that is healthy, natural and of good quality, such as fruits and vegetables. The mango is being recognized as one of the most valuable tropical fruits worldwide, this is reflected in its growing demand. In the same fashion, Peru has had a progressive growth of the cultivated area and the level of exports, with the Piura region being the main example of this growth. Moreover, Peru has competitive and comparative advantages for the development of the mango sector, such as the commercial opening, the variety of climates, and its higher level of productivity that allows it to offer a quality product, however, it has not been able to take advantage of these strengths due to a significant fragmentation of the agriculture in general, as well as a low level of collaboration among producers. It should be noted that a percentage greater than 90% of the mango exports from Peru is sold to markets in Europe and the U.S., where it competes with major exporters like Mexico and Brazil, which decreases mango prices worldwide. To counter this, new markets are being introduced with better trading conditions that can be fulfilled. The Lambayeque region has geographical and climatic characteristics very conducive to making agriculture one of the main production activities that promote the creation of direct and indirect employment, however, these capabilities have not generated a stage of development in the same magnitude as Piura, nationally, or Mexico and Brazil, internationally. This thesis develops the Strategic Plan for the mango in the Lambayeque region, and is a valuable management tool where the critical factors for the development of mango are identified, which are related to increased exports, strict phytosanitary control, technological improvements, optimal development of the harvest phase, cultivation and marketing of mango, improved partnerships among producers, and integration of the entire chain, including the participation of the regional government and the related government entities. To do this, we establish long-term goals and strategies that shall be implemented to achieve the desired future.Tesi

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030