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OBJECTIVE: Launching priority actions demand a comprehensive appraisal of the size effect that risk factors have on the burden of overweight and obesity. This study aimed to estimate the incidence of overweight and obesity among children and adolescents, with special emphasis on the role of specific risk factors. MATERIALS AND METHODS: Secondary analysis of data from the younger cohort of the Young Lives Study in Peru (2002-2017). The outcomes were: overweight and obesity, defined by the World Health Organization standards; whereas the exposures included caesarean birth, physical activity levels, sodas and sugar-sweetened beverages consumption, snacks consumption, and maternal body mass index (BMI). We used multilevel Poisson regression models, considering the repetitive nature of data, to estimate incidence rate ratios (IRRs) and population attributable fractions (PAFs). RESULTS: A total of 2052 children, mean age 1 (SD 0.4) year, and 50% girls, were enrolled at baseline. After 14 (SD 0.5) years of follow-up, the incidence of overweight and obesity were 7.9 (95% CI 7.6-8.2) and 2.2 (95% CI 2.0-2.4) per 100 person-year, respectively. Maternal BMI (IRRs 3.51; PAF 31.8%), low physical activity (IRR 1.64; PAF 27.4%), caesarean birth (IRR 1.63; PAF 11.4%), almost daily snack consumption (IRR 1.60; PAF 32.1%), and almost daily consumption of sweetened beverages (IRR 1.47; PAF 26.0%) increased the risk of developing obesity. CONCLUSIONS: This study provides evidence on the risk of overweight and obesity attributable to diet habits, physical activity and the obesogenic niche among children and adolescents in Peru, which may guide the implementation of evidence-based interventions.

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Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services. The science and technology infrastructure has also evolved, although the need for substantial investments remains if advancing science is to be a national priority. Climate change will also bring significant challenges to population health given Peru's geographical and microclimates diversity. Looking back over the 200-years of independence, we present a summary of key advances in selected health-related fields, thus serving as the basis for reflections on pending agendas and future challenges, in order to look forward to ensuring the future health and wellbeing of the Peruvian population. Resumen translated abstract: El Perú cumple 200 años de independencia en 2021. Durante estos dos siglos de vida independiente, junto con periodos sociales y políticos turbulentos, incluyendo un conflicto armado interno, hiperinflación y la inestabilidad política de los últimos 40 años, el Perú ha experimentado importantes cambios en su perfil epidemiológico con repercusiones directas en la salud de la población. En las últimas décadas, los indicadores de salud materno-infantil y de las enfermedades transmisibles muestran mejoría importante, pero el país se enfrenta de manera simultánea a una carga cada vez mayor de enfermedades no transmisibles y de salud mental. En cuanto a los sistemas de salud pública, se han realizado esfuerzos por aumentar la cobertura y calidad de la atención de salud en todo el país, apostándose en particular por mejorar la atención primaria. La ciencia y tecnología relacionadas con la salud también han mejorado, aunque si se quiere que la ciencia sea una prioridad nacional, son necesarias inversiones sustanciales. El cambio climático traerá importantes desafíos para la salud de la población, dada la diversidad geográfica y de microclimas del país. Para conmemorar los 200 años de vida independiente del Perú, presentamos un resumen de avances clave en diversas áreas y temas relacionados con la salud. Este repaso sirve como base para reflexionar sobre agendas y desafíos pendientes y futuros, con el fin de asegurar la salud y el bienestar de la población peruana en las próximas décadas.

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The high level of Venezuelan migration is a great challenge for Peru due to the healthcare needs of immigrants. Worryingly, children under the age of five are the most vulnerable. In order to know the nutritional status of this group in migratory transit to Peru, a descriptive study was carried out with two rounds of data collection (August 2018 and March 2019) at the Binational Border Healthcare Center in Tumbes. In each round, nutritional status, morbidity and food characteristics were determined for 322 and 619 Venezuelan children under the age of five, as well as any health and nutrition actions implemented upon their entry into Peru. For each round, acute malnutrition affected 3.2% and 3.0%; chronic malnutrition 16.5% and 17.9%; anemia 34.8% and 25.0%; cough or shortness of breath was present in 31.3% and 17.6%; diarrhea in 16.6% and 9.9%. Nearly seven out of ten children under the age of two breastfed the day before. During the migratory journey and for each round, 58.3% and 47.0% of children under two years of age increased their frequency of breastfeeding, the minimum meal frequency (MMF) was met only by 13.9% and 18.0%. While the timely reaction in terms of healthcare and nutrition facing the inflow of migrant population is a good first step, the health system needs to generate the conditions so that health services can provide coverage with adequate quality to the entire population residing in the national territory, under the premise that the right to health is for everybody without any type of exclusion.

La elevada migración venezolana ha mostrado ser un gran desafío para el Perú debido a las necesidades de atención que requieren los inmigrantes. De modo preocupante, los menores de cinco años son quienes se encuentran más vulnerables. A fin de conocer el estado nutricional de este grupo en tránsito migratorio al Perú, se realizó un estudio descriptivo con dos rondas de recolección de datos (agosto de 2018 y marzo de 2019) en el Centro Binacional de Atención Fronteriza de Tumbes. En cada ronda, a 322 y 619 niños venezolanos menores de cinco años se determinó su estado nutricional, morbilidad y características de la alimentación, así como las acciones de salud y nutrición implementadas al momento de su ingreso al Perú. Para cada ronda, la desnutrición aguda afectó al 3,2% y 3,0%, la desnutrición crónica al 16,5% y 17,9%, la anemia al 34,8% y 25,0%, la tos o dificultad para respirar estuvo presente en el 31,3% y 17,6%, las diarreas en el 16,6% y 9,9%. Cerca de siete de cada diez niños menores de dos años lactó el día previo. Durante el viaje migratorio y para cada ronda, el 58,3% y 47,0% de los niños menores de dos años aumentó la frecuencia de lactadas, la frecuencia mínima de alimentación (FMA) fueron alcanzadas sólo por el 13,9% y 18,0%. La reacción oportuna de atención en salud y nutrición frente al ingreso de la población migrante es un buen primer paso, el sistema de salud necesita generar las condiciones para que los servicios de salud puedan brindar la cobertura con la calidad adecuada a toda la población que reside en el territorio nacional, bajo el enfoque de que el derecho a la salud corresponde a todas las personas sin ningún tipo de exclusión.

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RESUMEN La elevada migración venezolana ha mostrado ser un gran desafío para el Perú debido a las necesidades de atención que requieren los inmigrantes. De modo preocupante, los menores de cinco años son quienes se encuentran más vulnerables. A fin de conocer el estado nutricional de este grupo en tránsito migratorio al Perú, se realizó un estudio descriptivo con dos rondas de recolección de datos (agosto de 2018 y marzo de 2019) en el Centro Binacional de Atención Fronteriza de Tumbes. En cada ronda, a 322 y 619 niños venezolanos menores de cinco años se determinó su estado nutricional, morbilidad y características de la alimentación, así como las acciones de salud y nutrición implementadas al momento de su ingreso al Perú. Para cada ronda, la desnutrición aguda afectó al 3,2% y 3,0%, la desnutrición crónica al 16,5% y 17,9%, la anemia al 34,8% y 25,0%, la tos o dificultad para respirar estuvo presente en el 31,3% y 17,6%, las diarreas en el 16,6% y 9,9%. Cerca de siete de cada diez niños menores de dos años lactó el día previo. Durante el viaje migratorio y para cada ronda, el 58,3% y 47,0% de los niños menores de dos años aumentó la frecuencia de lactadas, la frecuencia mínima de alimentación (FMA) fueron alcanzadas sólo por el 13,9% y 18,0%. La reacción oportuna de atención en salud y nutrición frente al ingreso de la población migrante es un buen primer paso, el sistema de salud necesita generar las condiciones para que los servicios de salud puedan brindar la cobertura con la calidad adecuada a toda la población que reside en el territorio nacional, bajo el enfoque de que el derecho a la salud corresponde a todas las personas sin ningún tipo de exclusión.

ABSTRACT The high level of Venezuelan migration is a great challenge for Peru due to the healthcare needs of immigrants. Worryingly, children under the age of five are the most vulnerable. In order to know the nutritional status of this group in migratory transit to Peru, a descriptive study was carried out with two rounds of data collection (August 2018 and March 2019) at the Binational Border Healthcare Center in Tumbes. In each round, nutritional status, morbidity and food characteristics were determined for 322 and 619 Venezuelan children under the age of five, as well as any health and nutrition actions implemented upon their entry into Peru. For each round, acute malnutrition affected 3.2% and 3.0%; chronic malnutrition 16.5% and 17.9%; anemia 34.8% and 25.0%; cough or shortness of breath was present in 31.3% and 17.6%; diarrhea in 16.6% and 9.9%. Nearly seven out of ten children under the age of two breastfed the day before. During the migratory journey and for each round, 58.3% and 47.0% of children under two years of age increased their frequency of breastfeeding, the minimum meal frequency (MMF) was met only by 13.9% and 18.0%. While the timely reaction in terms of healthcare and nutrition facing the inflow of migrant population is a good first step, the health system needs to generate the conditions so that health services can provide coverage with adequate quality to the entire population residing in the national territory, under the premise that the right to health is for everybody without any type of exclusion.

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BACKGROUND: Most analyses of gaps in human resources for health (HRH) do not consider training and the transition of graduates into the labour market. This study aims to explore the labour market for Peru's recent medical, nursing, and midwifery graduates as well as their transition into employment in the Ministry of Health's (MOH) system. METHODS: Data from four different datasets, covering 2007-2013, was used to characterize the patterns of recently trained physicians, nurses, midwives, and postgraduate-trained physicians that enter employment in the MOH system, and scenario analyses were used to describe how this rate of entry needs to adapt in order to fill current HRH shortages. RESULTS: HRH graduates have been increasing from 2007 to 2011, but the proportions that enter employment in the MOH system 2 years later range from 8 to 45% and less than 10% of newly trained medical specialists. Scenario analyses indicate that the gap for physicians and nurses will be met in 2027 and 2024, respectively, while midwives in 2017. However, if the number of HRH graduates entering the MOH system doubles, these gaps could be filled as early as 2020 for physicians and 2019 for nurses. In this latter scenario, the MOH system would still only utilize 56% of newly qualified physicians, 74% of nurses, and 66% of midwives available in the labour market. CONCLUSION: At 2013 training rates, Peru has the number of physicians, nurses, and midwives it needs to address HRH shortages and meet estimated HRH gaps in the national MOH system during the next decade. However, a significant number of newly qualified health professionals do not work for the MOH system within 2 years of graduation. These analyses highlight the importance of building adequate incentive structures to improve the entry and retention of HRH into the public sector.

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BACKGROUND: Vaccination against seasonal influenza in health workers is recommended but coverage is variable. This study aimed to determine coverage of influenza vaccination among health workers in Lima, Peru in 2010; explore barriers and enabling elements for vaccination; and suggest strategies to improve coverage. METHODS: Qualitative interviews informed the development of a survey instrument that consisted of open and close-ended questions. Sub-analyses were done by occupational group and results were calculated as percentages for each possible response with confidence intervals of 95%. RESULTS: Coverage of the influenza vaccination was 77.2%. Vaccinated staff were less likely to have permanent contracts (p=0.0150) and vaccination coverage was lower in physicians (p=0.0001). Over 90% cited protection of themselves, families and patients as reasons for vaccination and 48% mentioned peer encouragement. Fear of adverse events (47%) and organizational barriers (>30%) were reasons for non-vaccination. To improve coverage, highest priority was given to strategies providing more information. CONCLUSIONS: Key factors in driving health worker vaccination include desire for protection and peer encouragement. Perceptual barriers based on a misunderstanding of the epidemiology of influenza and vaccination could be overcome by targeted education and information. Organizational barriers require attention to how vaccination is implemented within health facilities.

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BACKGROUND: Rapid postnatal weight gain is associated with risk of overweight and obesity, but it's unclear whether this holds in populations exposed to concurrent obesogenic risk factors and for children who have been extensively breastfed. This study investigates whether an increase in weight for age from birth to 1 year (infancy) and from 1 to 5 years (early childhood) predicts overweight and obesity, and waist circumference at 8 years, using data from a longitudinal cohort study in Peru. METHODS: Generalized estimating equations (GEE) models were constructed for overweight and obesity, obesity alone and waist circumference at 8 years versus rapid weight gain in infancy, and early childhood including adjusted models to account for confounders. RESULTS: Rapid weight gain in both periods was associated with double the risk of overweight and obesity, obesity alone at 8 years and increased waist circumference even after controlling for maternal BMI and education level, sex of child, height-for-age at 8 years, consumption of "fast food" and number of days of active exercise. The association was significant, with some differences, for children in both rural and urban environments. CONCLUSIONS: Rapid weight gain in infancy and in early childhood in Peru is associated with overweight and obesity at age 8 years even when considering other determinants of childhood obesity.

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OBJECTIVES: To describe the availability and demand of professional training programs for eight health science professions in Peru. Study the profiles of the physicians, nurses and midwives that these programs train and their competencies to work at the primary health care level. MATERIALS AND METHODS: Cross-sectional study using data on the volume of applicants, students and graduates of these eight professional training programs during the period 2007 - 2011. In addition, the curricula of professional training programs for physicians, nurses and midwives from public and private universities were analyzed, along with competency profiles developed by Professional Colleges and the Ministry of Health. RESULTS: Admission rates in public and private universities vary by program: 4% and 28% respectively for medical schools, and 18% and 90% for nursing. Graduation rates were estimated at approximately 43% and 53% of students entering medicine and nursing training programs respectively. Contrasting the profiles of recently graduated professionals in medicine, nursing and midwifery, with the skills required by the Ministry of Health for professionals working in primary care the first level of care, indicate that these recently graduated professionals are not necessarily or specifically trained to work in primary care. CONCLUSIONS: Demand for professional training in health sciences exists and its supply is met predominantly by private universities. Competency profiles developed by the MOH for the basic professional health team in primary care shows a clear disconnect regarding the current supply of trained professionals.

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Objetivos. Describir el mercado de formación y la disponibilidad de profesionales de ocho carreras de ciencias de la salud en Perú. Además, examinar los perfiles de los médicos, enfermeros y obstetras que se forman y sus competencias para trabajar en el primer nivel de atención. Materiales y métodos. Estudio transversal utilizando datos de volumen de postulantes, ingresantes y graduados de ocho profesiones durante el periodo de 2007û2011. También se analizaron los planes de estudio de programas de formación de médicos, enfermeros y obstetras de universidades públicas y privadas, y los perfiles de competencias elaborados por los colegios profesionales y el Ministerio de Salud (MINSA). Resultados. Las tasas de ingreso en universidades públicas y privadas varían según la carrera: 4 y 28% respectivamente para Medicina Humana, y 18 y 90% para Enfermería. Además, se estima que se gradúan aproximadamente 43 y 53% de los estudiantes que ingresan a Medicina y Enfermería, respectivamente. El análisis del perfil de los profesionales recientemente graduados en Medicina, Enfermería y Obstetricia, al ser contrastados con el perfil de competencias priorizadas para los profesionales que laboran en el primer nivel de atención elaborado por el MINSA, indican que no están necesariamente ni específicamente formados para trabajar en este nivel de atención. Conclusiones. Existe demanda de formación para profesionales de ciencias de la salud y predomina la oferta por parte de universidades privadas. Los perfiles de competencias desarrollados por el MINSA muestran un claro divorcio con respecto a la oferta actual de profesionales formados.

Objectives. To describe the availability and demand of professional training programs for eight health science professions in Peru. Study the profiles of the physicians, nurses and midwives that these programs train and their competencies to work at the primary health care level. Materials and methods. Cross-sectional study using data on the volume of applicants, students and graduates of these eight professional training programs during the period 2007 - 2011. In addition, the curricula of professional training programs for physicians, nurses and midwives from public and private universities were analyzed, along with competency profiles developed by Professional Colleges and the Ministry of Health. Results. Admission rates in public and private universities vary by program: 4% and 28% respectively for medical schools, and 18% and 90% for nursing. Graduation rates were estimated at approximately 43% and 53% of students entering medicine and nursing training programs respectively. Contrasting the profiles of recently graduated professionals in medicine, nursing and midwifery, with the skills required by the Ministry of Health for professionals working in primary care the first level of care, indicate that these recently graduated professionals are not necessarily or specifically trained to work in primary care. Conclusions. Demand for professional training in health sciences exists and its supply is met predominantly by private universities. Competency profiles developed by the MOH for the basic professional health team in primary care shows a clear disconnect regarding the current supply of trained professionals.

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