Noción de número en niños y niñas de cinco años de una institución educativa de un distrito de Lima, 2019

El mundo está en constante evolución y crecimiento, por ello se necesita fomentar habilidades matemáticas tanto en el hogar como en la escuela para lograr un desarrollo temprano a partir de la curiosidad del niño (a) por ello la presente investigación tuvo como finalidad determinar la diferencia de Noción de Número en niños y niñas de cinco años de una Institución Educativa de un distrito de Lima, 2019; siendo este estudio cuantitativo, tipo básica, diseño descriptiva comparativa no experimental de corte transversal, cuyos resultados fueron sobresalientes en las niñas con 70,0% en el nivel logro y con 83,3% los niños en nivel proceso, siendo el mismo porcentaje de 3,3% para ambos en el nivel inicio, La diferencia de 13.3% en el nivel logro para los niños y con el 26.7% en el nivel proceso para las niñas; además se concluyó que se cumple el objetivo general: determinar la diferencia de noción de número en los niños y niñas de cinco años de una Institución Educativa mediante la prueba U- Mann Whitney, donde se evidenció que el valor de significancia hallado fue 0,000 el cual es menor a 0,05

Moving from formative research to co-creation of interventions: insights from a community health system project in Mozambique, Nepal and Peru.

Different methodological approaches for implementation research in global health focusing on how interventions are developed, implemented and evaluated are needed. In this paper, we detail the approach developed and implemented in the COmmunity HEalth System InnovatiON (COHESION) Project, a global health project aimed at strengthening health systems in Mozambique, Nepal and Peru. This project developed innovative formative research at policy, health system and community levels to gain a comprehensive understanding of the barriers, enablers, needs and lessons for the management of chronic disease using non-communicable and neglected tropical diseases as tracer conditions. After formative research, COHESION adopted a co-creation approach in the planning of interventions. The approach included two interactions with each type of stakeholder at policy, health system and community level in each country which aimed to develop interventions to improve the delivery of care of the tracer conditions. Diverse tools and methods were used in order to prioritise interventions based on support, resources and impact. Additionally, a COHESION score that assessed feasibility, sustainability and scaling up was used to select three potential interventions. Next steps for the COHESION Project are to further detail and develop the interventions propositioned through this process. Besides providing some useful tools and methods, this work also highlights the challenges and lessons learned from such an approach

Applied methods to promote sustainability and scalability of complex interventions

Hypotheses to be worked out: Research methods like co-creation and process evaluation are methods that could promote the sustainability and the scalability of complex interventions. Original research to be performed to address these hypotheses: For this PhD thesis, material and tools from two studies (COHESION and SALT) have been used in addition to a scoping review to map the research on process evaluation of complex interventions. The first and second articles of the current PhD thesis used the COHESION project to explain the steps followed for conducting a co-creation process and show lessons learned from this process. COHESION was conducted in Mozambique, Nepal and Peru. It included three formative studies (a policy analysis, health system assessment, and a community perception study), and following this research, a co-creation process was developed in three countries. The hypothesis of this study was that sustainable, gender and context appropriate interventions could be developed and integrated into primary healthcare responses through a clear understanding of barriers and enablers for diagnosis, management and care of NCDs and NTDs. The third and fourth article are the protocol and results of a scoping review which aimed to map out the use of process evaluation in complex interventions for NCDs and NTDs to identify gaps in the design and conduct, as well as strengths, limitations and implications, of this type of research in LMICs. Six databases were searched focused on studies published since 2008. The fifth article used data from the SALT project to conduct a process evaluation using the Medical Research Council framework. The SALT project was a population-wide implementation of a potassium-enriched salt substitute (75% NaCl and 25% KCl) to reduce blood pressure. A stepped-wedge, cluster randomized controlled trial was conducted in northern Peru, during the study six participating villages crossed over every 5 months from the control to the intervention phase. The intervention consisted in the introduction of a salt substitute using a social marketing campaign. Other elements of the intervention were a little spoon to incorporate the right measure of salt to the food and the “Amigas de Liz”, a group of women from the community that support the activities of the project. A qualitative study was conducted and data was collected from interviews from four out of the six villages. This data was used for this PhD thesis. The five articles for this PhD thesis are used to show the potential of co-creation and process evaluation to promote sustainability and scalability of complex interventions. Conclusions: This PhD contributes to highlight the role of two methods, co-creation and process evaluation, and their potential to promote sustainability and scalability of complex interventions. The strategic partnership built during co-creation could help to increase commitment with the implementation of the intervention and promote buy-in to promote sustainability. As for the role of process evaluation in terms of scalability, this allows for the identification of barriers and facilitators to implement an intervention that is related to certain contexts.</p

Precios, disponibilidad y asequibilidad de insulina en farmacias públicas y privadas en Perú

Measure and compare the price, availability, and affordability of insulin and metformin in public and private pharmacies in six regions of Peru

Screening for Parasitic Infection and Tuberculosis in Immunosuppressed and Pre-Immunosuppressed Patients: An Observational Study

Reactivation of latent tuberculosis infection (LTBI) or latent parasitic infection (LPI) during drug-induced immunosuppression can have serious consequences. The Division of tropical and humanitarian medicine of the Geneva University Hospitals runs a specific consultation for parasitic screening of immunosuppressed or pre-immunosuppressed patients. We sought to determine the seroprevalence of LTBI and LPI in such patients and explore its relationship with country of origin or previous travel in a retrospective, single-centre observational study from 2016 to 2019. Demographic data, travel history, ongoing treatments and results of the parasitological (Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus multilocularis, Entamoeba histolytica and Leishmania spp.) and TB screening were collected to calculate LPI or LTBI prevalence. Risk factors for LTBI and strongyloidiasis were analysed using Poisson regression with robust variance. Among 406 eligible patients, 24/353 (6.8%) had LTBI, 8/368 (2.2%) were positive for Strongyloides stercoralis infection, 1/32 (3.1%) was positive for Entamoeba histolytica and 1/299 (0.3%) was positive for Leishmaniasis. No cases of Trypanosoma cruzi (0/274) or Echinococcus multilocularis (0/56) infection were detected. Previous travel to or originating from high-prevalence countries was a risk factor for LTBI (PR = 3.4, CI 95%: 1.4-8.2 and 4.0, CI 95%: 1.8-8.9, respectively). The prevalence of serological Strongyloidiasis in immunosuppressed patients is lower in comparison to those without immunosuppression (PR = 0.1, CI 95%: 0.01-0.8). In conclusion, screening before immunosuppression needs to be individualized, and LTBI and LPI need to be ruled out in patients who originate from or have travelled to high-prevalence countries. The sensitivity of strongyloidiasis serology is reduced following immunosuppression, so an algorithm combining different tests or presumptive treatment should be considered

Using government data to understand the use and availability of medicines for hypertension and diabetes: lessons from Peru

Background: Regular measurement of the availability and use of key medicines for non-communicable diseases allows the tracking of progress to achieve equitable access to medicines. Using a country-level public sector monitoring system for medicine supply, we aim to evaluate the availability and use of losartan 50 mg tablets and metformin 850 mg tablets between 2015 and 2020 investigating the impact of different policy changes and the COVID-19 pandemic. Methods: Data from the Peruvian National System of Medicine Supply were analyzed using an interrupted time series analysis with known and unknown structural breaks. The outcomes assessed were medicine use (monthly doses dispensed at facilities over time) and medicine availability (proportion of facilities that reported having the medicine available). Results: The use of losartan and metformin at the primary level of care had a linear increasing trend over the period of analysis. In secondary and tertiary levels of care, there were no increases but some significant level and trend changes of doses dispensed at different times between 2017 to 2019, but none were related to the change of procurement procedures. At all levels of care, the COVID-19 onset in April 2020 caused an abrupt drop in doses dispensed especially at the primary level. Regarding availability, we found an increasing linear trend in the primary level of care for both medicines. In secondary and tertiary levels of care, the availability fluctuated between 40 and 95%. The onset of the COVID-19 pandemic did not significantly impact medicine availability, except for losartan in the tertiary level of care. Conclusion: The availability and proper dispensing of first-line medicines for hypertension and diabetes is an essential factor for sustainable and equitable treatment. Health care systems need to be prepared for forecasting the increasing demand of medicines for chronic diseases, but also to maintain effective medicine supply chains during humanitarian crisis like pandemics.</p

Global Inequality in Type 1 Diabetes: a Comparison of Switzerland and Low-and Middle-Income Countries

Globally it is estimated that over 1 million children and adolescents have Type 1 diabetes with large variations in incidence between different contexts. Health systems need to provide a variety of elements to ensure appropriate diabetes care, such as service delivery; healthcare workforce; information; medical products and technologies; financing and leadership and governance. Describing these elements between Geneva, Switzerland, a high-income country with high spending on healthcare and a large density of doctors, and low- and middle-income countries this article aims to highlight the global inequality of diabetes care. Type 1 diabetes can serve as a litmus as we move towards the centenary of the discovery of insulin and beyond as there is a need for a global movement to ensure that innovation in the management of diabetes benefits the whole diabetes community and not just a select few

Management of type 1 diabetes in low‐ and middle‐income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania

Aims: To describe and compare the health system responses for type 1 diabetes in Kyrgyzstan, Mali, Peru and Tanzania. Methods: The Rapid Assessment Protocol for Insulin Access, a multi-level assessment of the health system, was implemented in Kyrgyzstan, Mali, Peru and Tanzania using document reviews, site visits and interviews to assess the delivery of care and access to insulin. Results: Despite the existence of noncommunicable or diabetes strategies and Universal Health Coverage policies including diabetes-related supplies, this has not necessarily translated into access to insulin or diabetes care for all. Insulin and related supplies were often unavailable and unaffordable. Across the four countries test strips and insulin, when paid for by the individual, represented respectively 48-82% and 25-36% of total costs. Care was mainly delivered at tertiary-level hospitals by specialists. Only Kyrgyzstan had data collection systems integrated into the Ministry of Health structure. In addition, issues with healthcare worker training and education and empowerment of people with diabetes were present in these health systems. Conclusions: People with type 1 diabetes in these countries face different barriers, including the cost of insulin and care. Given the renewed attention to diabetes on the global health agenda tailored health system responses for type 1 diabetes are needed. Insulin should be prioritized as it is the foundation of type 1 diabetes care, but other elements of care and support need to be fostered by different actors.</p