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Background: We aimed to examine the national and subnational prevalence of vulnerable newborn phenotypes in Peru, 2012-2021. Methods: Newborn phenotypes were defined using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight [LBW], non-LBW) using the Peruvian National Birth Registry as six (by excluding birthweight) and ten newborn phenotypes (using all three outcomes). Small phenotypes (with at least one classification of PT, SGA, or LBW) were further considered. Using individual-level data, we stratified the phenotypes by maternal educational level, maternal age, healthcare insurance, altitude of residence, and geographic region (Coast, Andes, and Amazon). Findings: The prevalence of the five vulnerable newborn phenotypes for the study period was LGA+T (15.2%), AGA+PT (5.2%), SGA+T (4.6%), LGA+PT (0.8%), and SGA+PT (0.7%). The Coast had a higher prevalence of newborns with large phenotypes (19.4%) and the Highlands a higher prevalence of newborns with small phenotypes (12.5%). Mothers with poor socioeconomic status, extreme ages and living at high altitude had a higher prevalence of newborns with small phenotypes, and mothers who were wealthier, more educated, and older had a higher prevalence of infants with large phenotypes. Interpretation: Our findings cautiously suggest that socioeconomic and geographic disparities may play a crucial role in shaping vulnerable newborn phenotypes at national and subnational level in Peru. Further studies using longitudinal data are needed to corroborate our findings and to identify individual-level risk factors. Funding: Ter Meulen Grant from the KNAW Medical Sciences Fund of the Royal Netherlands Academy of Arts and Sciences (KNAWWF/1085/TMB406, KNAWWF/1327/TMB202116), Fogarty Program (D43TW011502).
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BACKGROUND: Future demographic changes will increase the number of people living with non-communicable diseases. We projected the number of people with type 2 diabetes mellitus (T2DM) in 2035 and 2050 at the global and country levels. METHODS: We pooled T2DM prevalence estimates from the Global Burden of Disease Study and population estimates from the United Nations for 188 countries. We computed the absolute number of people with T2DM in 2020 and predicted the future number in 2035 and 2050 under four scenarios for the T2DM prevalence: 1) It held constant, 2) It increased by 50%, 3) It decreased by 10%, and 4) It followed 1990-2019 country-specific past trends. RESULTS: The global number of people with T2DM was 445 million in 2020, and it is projected to increase in 2050 to 730 million if prevalence remains unchanged, 1,095 million if prevalence increases by 50%, 657 million if prevalence decreases by 10%, and 1,153 million if prevalence follows country-specific 1990-2019 past trends. Under all scenarios, Sub-Saharan Africa and lowincome countries had the highest relative increase in the number of people with T2DM. The share of people with T2DM aged <60 years is expected to drop from 5 out of 10 in 2020 to 4 out of 10 people in 2050 under all scenarios. CONCLUSIONS: There will be a massive growth in the number of people living with T2DM, and low-income countries and countries in Sub-Saharan Africa will be the most affected. Health systems must be strengthened to ensure optimal care for the future population with T2DM.
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SUMMARY Objective: To quantify the frequency of psychiatric disorders in the outpatient setting in Peru, from 2018 to 2021. Methods: Observational cross-sectional study using outpatient morbidity data from Perú's National Superintendence of Health. Psychiatric diagnoses were identified using ICD-10 codes. The frequency of major psychiatric disorder groups is described by demographic variables. Monthly trends, as well as the number of outpatient visits per 10,000 population at the subnational level, are also presented. Results: Between 2018-2021, psychiatric disorders accounted for 3,142,685 outpatient visits (2.3% of all) in Peru. Across working age groups, anxiety and depressive disorders comprised approximately 6 out of 10 psychiatric outpatient visits in women, and 4 out of 10 in men. Monthly trends showed two peaks in the absolute number of psychiatric outpatient visits during the pre-pandemic period: April-May and September. Provinces in the Highlands had the lowest outpatient visits per 10,000 population. Conclusions: Psychiatric disorders represent a small fraction of the outpatient visits in Peru, with anxiety and depressive disorders as the most frequent. National strategies targeting outpatients with psychiatric disorders should consider demographic differences, monthly trends, and the impact of the COVID-19 pandemic.
RESUMEN Objetivo: Cuantificar la frecuencia de trastornos psiquiátricos en el ámbito ambulatorio en Perú, del 2018 al 2021. Métodos: Estudio observacional transversal utilizando información de la Superintendencia Nacional de Salud del Perú. Los diagnósticos psiquiátricos se identificaron mediante códigos de CIE-10. La frecuencia de trastornos psiquiátricos mayores se describe mediante variables demográficas. También se presentan las tendencias mensuales, así como el número de visitas ambulatorias por cada 10.000 habitantes a nivel subnacional. Resultados: Entre 2018-2021, los trastornos psiquiátricos presentaron 3.142.685 visitas ambulatorias (2,3% del total) en el Perú. En todos los grupos de edad laboral, los trastornos de ansiedad y depresión representaron aproximadamente 6 de cada 10 visitas ambulatorias psiquiátricas en mujeres y 4 de cada 10 en hombres. Las tendencias mensuales mostraron dos picos en el número absoluto de visitas ambulatorias psiquiátricas durante el período prepandémico: abril-mayo y septiembre. Las provincias de la sierra tuvieron la frecuencia más baja de visitas ambulatorias por cada 10.000 habitantes. Conclusiones: Los trastornos psiquiátricos representan una pequeña fracción de las consultas ambulatorias en el Perú, con los trastornos de ansiedad y depresivos como los más frecuentes. Estrategias nacionales en relación a pacientes ambulatorios con trastornos psiquiátricos deben considerar diferencias demográficas, tendencias mensuales y el impacto de la pandemia COVID-19.
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OBJECTIVES: The aim of this review is to map out the use of process evaluation (PE) in complex interventions that address non-communicable diseases (NCDs) and neglected tropical diseases (NTDs) to identify gaps in the design and conduct, as well as strengths, limitations and implications, of this type of research in low- and middle-income countries (LMICs). DESIGN: Scoping review of PE studies of complex interventions implemented in LMICs. Six databases were searched focused on studies published since 2008. DATA SOURCES: Embase, PubMed, EbscoHost, Web of Science (WOS), Virtual Health Library (VHL) Regional Portal and Global Index Medicus: Regional Indexes AIM (AFRO), LILACS (AMRO/PAHO), IMEMR (EMRO), IMSEAR (SEARO), WPRIM (WPRO) Global Index Regional Indexes, MEDLINE, SciELO. ELIGIBILITY CRITERIA: Studies conducted in LMICs on PEs of randomised controlled trials (RCTs) and non-RCTs published between January 2008 and January 2020. Other criteria were studies of interventions for people at risk or having physical and mental NCDs, and/or NTDs, and/or their healthcare providers and/or others related to achieve better health for these two disease groups. Studies were excluded if they were not reported in English or Spanish or Portuguese or French, not peer-reviewed articles, not empirical research and not human research. DATA EXTRACTION AND SYNTHESIS: Data extracted to be evaluated were: available evidence in the utilisation of PE in the areas of NCDs and NTDs, including frameworks and theories used; methods applied to conduct PEs; and in a subsample, the barriers and facilitators to implement complex interventions identified through the PE. Variables were extracted and categorised. The information was synthesised through quantitative analysis by reporting frequencies and percentages. Qualitative analysis was also performed to understand facilitators and barriers presented in these studies. The implications for PEs, and how the information from the PE was used by researchers or other stakeholders were also assessed in this approach. RESULTS: 303 studies were identified, 79% were for NCDs, 12% used the label 'PE', 27% described a theory or framework for the PE, and 42% used mixed methods to analyse their findings. Acceptability, barriers and facilitators to implement the interventions, experiences and perceptions, and feasibility were the outcomes most frequently evaluated as part of the PEs. Barriers and facilitators themes identified were contextual factors, health system factors, human resources, attitudes and policy factors. CONCLUSIONS: PEs in NCDs and NTDs are used in LMICs with a wide variety of methods. This review identified many PEs that were not labelled by the authors as such, as well as a limited application of PE-related theories and frameworks, and heterogeneous reporting of this type of study.
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Países em Desenvolvimento , Pessoal de Saúde , HumanosRESUMO
OBJECTIVE: To determine the agreement between the cardiovascular disease (CVD) risk predictions computed with the WHO non-laboratory-based model and laboratory-based model in a nationally representative sample of Peruvian adults. DESIGN: Cross-sectional analysis of a national health survey. METHODS: Absolute CVD risk was computed with the 2019 WHO laboratory-based and non-laboratory-based models. The risk predictions from both models were compared with Bland-Altman plots, Lin's concordance coefficient correlation (LCCC), and kappa statistics, stratified by sex, age, body mass index categories, smoking and diabetes status. RESULTS: 663 people aged 30-59 years were included in the analysis. Overall, there were no substantial differences between the mean CVD risk computed with the laboratory-based model 2.0% (95% CI 1.8% to 2.2%) and the non-laboratory-based model 2.0% (95% CI 1.8% to 2.1%). In the Bland-Altman plots, the limits of agreement were the widest among people with diabetes (-0.21; 4.37) compared with people without diabetes (-1.17; 0.95). The lowest agreement as per the LCCC was also seen in people with diabetes (0.74 (95% CI 0.63 to 0.82)), the same was observed with the kappa statistic (kappa=0.36). In general, agreement between the scores was appropriate in terms of clinical significance. CONCLUSIONS: The absolute cardiovascular predicted risk was similar between the laboratory-based and non-laboratory-based 2019 WHO cardiovascular risk models. Pending validation from longitudinal studies, the non-laboratory-based model (instead of the laboratory-based) could be used when assessing CVD risk in Peruvian population.
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Doenças Cardiovasculares , Diabetes Mellitus , Adulto , Humanos , Estudos Transversais , Doenças Cardiovasculares/epidemiologia , Peru/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Risco de Doenças Cardíacas , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Inquéritos Epidemiológicos , Organização Mundial da SaúdeRESUMO
Background: Predicted heart age (PHA) can simplify communicating the absolute cardiovascular disease (CVD) risk. Few studies have characterized PHA across multiple populations, and none has described whether people with excess PHA are eligible for preventive treatment for CVD. Methods: Pooled analysis of 41 World Health Organization (WHO) STEPS surveys conducted in 41 countries in six world regions between 2013 and 2019. PHA was calculated as per the non-laboratory Framingham risk score in adults without history of CVD. We described the differences between chronological age and PHA, the distribution of PHA, and the proportion of people with excess PHA that were eligible for antihypertensive and lipid-lowering treatment following the WHO guidelines. Logistic regression models were fitted to assess sociodemographic and health-related variables associated with PHA excess. Findings: 94,655 individuals aged 30-74 years were included. 36% of those aged 30-34 years had a PHA of 30-34 years; 9% of those aged 60-64 years had a PHA of 60-64 years. Countries in Africa had the lowest prevalence of very high PHA (i.e., PHA exceeding chronological age in ≥5 years) and countries in Western Pacific had the highest. ≥50% of the population with PHA excess (i.e., PHA exceeding chronological age in ≥1 year) was not eligible for antihypertensive nor lipid-lowering treatment. Abdominal obesity, high total cholesterol, smoking and having diabetes were associated with higher odds of having PHA excess, whereas higher education and employment were inversely associated with excess PHA. Interpretation: PHA is generally higher than chronological age in LMICs and there are regional disparities. Most people with excess PHA would not be eligible to receive preventive medication. Funding: RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z).
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Background: National and subnational C-section rates are seldom available in low- and middle-income countries to guide policies and interventions. We aimed to describe the C-section rates at the national and subnational levels in Peru (2012-2020). Methods: Based on the Peruvian national birth registry, we quantified C-section rates at the national, regional and province levels; also, by natural regions (Coast, Highlands, and Amazon). Using individual-level data from the mother, we stratified the C-section rates by educational level, healthcare insurance and provider. Ecologically, we studied the correlations between C-section rates and human development index (HDI), altitude above sea level, proportion of the population living in poverty and proportion of rural population. Findings: C-section rate in Peru decreased slightly from 2012 (39·7%) to 2020 (38·0%). A widening gap of C-section rates was observed through the study years among the Coast that showed higher rates and the other natural regions that showed lower rates. The rates in most of the 25 regions showed a flat trend, particularly in the last four years and some provinces showed a very low rate. The rates were highest in mothers with higher education and in users of private health insurance. Higher HDI, health facility located at lower altitude, lower poverty and urbanization were positively correlated with higher C-section rates. Interpretation: C-section rates in Peru are above the international recommendations. Large differences by natural region, provinces and women socioeconomic status were found. Further efforts are needed to achieve the recommended C-section rates. Funding: Academy Ter Meulen grant of the Academy Medical Sciences Fund of the Royal Netherlands Academy of Arts & Sciences (KNAWWF/1327/TMB202116), Wellcome Trust (214185/Z/18/Z), Fogarty (D43TW011502).
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High consumption of sugar-sweetened beverages (SSB) is associated with a high risk of non-communicable diseases. Evidence of SSB consumption is needed to inform SSB-related policies, especially in countries with a high consumption, such as Peru. Using data from Peru's National Health Survey conducted in 2017-2018, the consumption of homemade and ready-to-drink SSB was estimated from a single 24 h dietary recall, accounting for socio-demographic and health-related variables. Regression models were fitted to assess which variables were linked to a high/low SSB consumption. There were 913 people and mean age was 37.7 years (95% confidence interval (CI): 36.9-38.6). Mean consumption (8 oz servings/day) of homemade SSB (1.2) doubled that of ready-to-drink SSB (0.5). The intake of homemade and ready-to-drink SSB was higher in men (1.3 and 0.7) than women (1.1 and 0.3). The intake of ready-to-drink SSB was higher in urban (0.6) compared to rural (0.2) populations. People aware of having diabetes had a lower consumption of both ready-to-drink (0.9 vs. 0.4) and homemade SSB (1.3 vs. 0.8) than those unaware of having diabetes. Male sex and living in urban locations were associated with higher ready-to-drink SSB intake. Older age was associated with a higher intake of homemade SSB. Amongst Peruvian adults, the consumption of SSB products (particularly homemade) remains high. Population-wide interventions should also aim to improve awareness of the nutritional components of homemade beverages.
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Bebidas Adoçadas com Açúcar , Adulto , Bebidas , Dieta , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , PeruRESUMO
INTRODUCTION: We quantified the proportion and the absolute number of deaths attributable to type 2 diabetes mellitus (T2DM) in Latin America and the Caribbean (LAC) using an estimation approach. RESEARCH DESIGN AND METHODS: We combined T2DM prevalence estimates from the NCD Risk Factor Collaboration, relative risks between T2DM and all-cause mortality from a meta-analysis of cohorts in LAC, and death rates from the Global Burden of Disease Study 2019. We estimated population-attributable fractions (PAFs) and computed the absolute number of attributable deaths in 1990 and 2019 by multiplying the PAFs by the total deaths in each country, year, sex, and 5-year age group. RESULTS: Between 1985 and 2014 in LAC, the proportion of all-cause mortality attributable to T2DM increased from 12.2% to 16.9% in men and from 14.5% to 19.3% in women. In 2019, the absolute number of deaths attributable to T2DM was 349 787 in men and 330 414 in women. The highest death rates (deaths per 100 000 people) in 2019 were in Saint Kitts and Nevis (325 in men, 229 in women), Guyana (313 in men, 272 in women), and Haiti (269 in men, 265 in women). CONCLUSIONS: A substantial burden of all deaths is attributed to T2DM in LAC. To decrease the mortality attributable to T2DM in LAC, policies are needed to strengthen early diagnosis and management, along with the prevention of complications.
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Diabetes Mellitus Tipo 2 , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , América Latina/epidemiologia , Masculino , Prevalência , Medição de Risco , Fatores de RiscoRESUMO
Global targets to reduce salt intake have been proposed, but their monitoring is challenged by the lack of population-based data on salt consumption. We developed a machine learning (ML) model to predict salt consumption at the population level based on simple predictors and applied this model to national surveys in 54 countries. We used 21 surveys with spot urine samples for the ML model derivation and validation; we developed a supervised ML regression model based on sex, age, weight, height, and systolic and diastolic blood pressure. We applied the ML model to 54 new surveys to quantify the mean salt consumption in the population. The pooled dataset in which we developed the ML model included 49,776 people. Overall, there were no substantial differences between the observed and ML-predicted mean salt intake (p<0.001). The pooled dataset where we applied the ML model included 166,677 people; the predicted mean salt consumption ranged from 6.8 g/day (95% CI: 6.8-6.8 g/day) in Eritrea to 10.0 g/day (95% CI: 9.9-10.0 g/day) in American Samoa. The countries with the highest predicted mean salt intake were in the Western Pacific. The lowest predicted intake was found in Africa. The country-specific predicted mean salt intake was within reasonable difference from the best available evidence. An ML model based on readily available predictors estimated daily salt consumption with good accuracy. This model could be used to predict mean salt consumption in the general population where urine samples are not available.
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Aprendizado de Máquina , Cloreto de Sódio na Dieta/urina , Pressão Sanguínea , HumanosRESUMO
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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BACKGROUND: National and subnational characterization of birthweight profiles lacks in low- and middle-income countries, yet these are needed for monitoring the progress of national and global nutritional targets. We aimed to describe birthweight indicators at the national and subnational levels in Peru (2012-2019), and by selected correlates. METHODS: We studied mean birthweight (g), low birthweight (<2,500 g) and small for gestational age (according to international growth curves) prevalences. We analysed the national birth registry and summarized the three birthweight indicators at the national, regional, and province level, also by geographic area (Coast, Highlands, and Amazon). With individual-level data from the mother, we described the birthweight indicators by age, educational level and healthcare provider. Following an ecological approach (province level), we described the birthweight indicators by human development index (HDI), altitude above sea level, proportion of the population living in poverty and proportion of rural population. FINDINGS: Mean birthweight was always the lowest in the Highlands (2,954 g in 2019) yet the highest in the Coast (3,516 g in 2019). The same was observed for low birthweight and small for gestational age. In regions with Coast and Highlands, the birthweight indicators worsen from the Coast to the Highlands; the largest absolute difference in mean birthweight between Coast and Highlands in the same region was 367 g. All birthweight indicators were the worst in mothers with none/initial education, while they improved with higher HDI. INTERPRETATION: This analysis suggests that interventions are needed at the province level, given the large differences observed between Coast and Highlands even in the same region. FUNDING: Wellcome Trust (214185/Z/18/Z).
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BACKGROUND: While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach. Following the risk-based approach, we described the proportion of eligible people receiving antihypertensive medication in Peru. METHODS: Analysis of six (2015-2020) national health surveys. Absolute cardiovascular risk was computed with the 2019 WHO cardiovascular risk charts and based on local guidelines. Antihypertensive treatment allocation based on the absolute cardiovascular risk was defined using the Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings and the HEARTS guidelines by the WHO; we also followed the recommendations by local guidelines. RESULTS: There were 120,059 people. Overall, according to the local guidelines the 17.9% of the population would be eligible for antihypertensive medication while this estimate was 8.1% based on the WHO guidelines. At the national level, depending on the guidelines, we observed a steady trend of eligible people receiving antihypertension medication (e.g., men, local guidelines), a decreasing trend (e.g., men, <60, local guidelines) or an increasing trend (e.g., men, ≥60, local guidelines). At the sub-national level, seventeen regions showed an increasing antihypertensive treatment rate based on the local guidelines; when based on the WHO guidelines, eleven regions showed a decreasing rate. CONCLUSIONS: Peru needs to define a tool for surveillance of absolute cardiovascular risk and to monitor antihypertensive treatment allocation among high-risk people. FUNDING: Wellcome Trust (214185/Z/18/Z).
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BACKGROUND: While we have good evidence about the hypertension care cascade, we do not know the mean blood pressure (BP) in these groups. We described the mean BP in four groups based on the hypertension care cascade at the national and sub-national levels in Peru. METHODS: Descriptive analysis of six national health surveys. Blood pressure was measured twice and the second record herein analysed. We defined four groups: i) people with self-reported hypertension diagnosis receiving antihypertensive medication; ii) people with self-reported hypertension diagnosis not receiving antihypertensive medication; iii) people unaware they have hypertension with blood pressure ≥140 or 90 mmHg; and iv) otherwise healthy people. FINDINGS: There were 125,066 people; mean age was 49.8 years and there were more women (51.7%). At the national level, in men and women and throughout the study period, we observed that the mean systolic BP (SBP) was the highest in people unaware they have hypertension; the mean SBP was similar between those with and without antihypertension medication, yet slightly higher in the former group. At the sub-national level, even though the mean SBP in the unaware group was usually the highest, there were some regions and years in which the mean SBP was the highest in the untreated and treated groups. INTERPRETATION: These results complement the hypertension care cascade with a clinically relevant parameter: mean BP. The results point where policies may be needed to secure effective interventions to control hypertension in Peru, suggesting that improving early diagnosis and treatment coverage could be priorities. FUNDING: Wellcome Trust (214185/Z/18/Z).
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BACKGROUND: At the population level we would expect that people with obesity undergo diabetes screening tests more often than people with overweight and much more often than people with normal weight. We described the trends of diabetes screening according to body mass index (BMI) and waist circumference (WC) in Peru. METHODS: Pooled analysis of health national surveys (2015-2019); men and women aged 35-70 years. We used relative frequencies to study: among those who have had a glucose test in the last year, how many there were in each BMI and WC category. We fitted a Poisson model to study whether people with high BMI or WC were more likely to have had a glucose test. RESULTS: People with overweight (PR = 1.34; 95% CI: 1.29-1.38), obesity (PR = 1.57; 95% CI: 1.51-1.63) and central obesity (PR = 1.63; 95% CI: 1.35-1.96) were more likely to have had a glucose test. At the sub-national level, there was one (of twenty-five) region in which men with obesity were more often screened for diabetes than men with overweight and much more than men with normal weight. There were seven regions in which women with obesity were the most often screened for diabetes. CONCLUSIONS: Consistent with a risk-based prevention approach, people with obesity would be screened for diabetes more often than those with overweight and those with normal weight. This ideal profile was only observed in few regions. Diabetes screening strategies should be strengthened and homogenised, so that they reach those at high risk of diabetes.