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Objective. The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department. Methods. The DoTT project was implemented at a Peruvian hospital and followed the World Health Organization (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient outcomes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services. Results. Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were compared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97--265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50--120 minutes) afterwards in 30 patients (p < 0.01). The median PTA was reduced from 1 483 minutes at baseline to 660 minutes after the intervention (p < 0.01). Conclusions. Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients. [ABSTRACT FROM AUTHOR]

Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities. [ABSTRACT FROM AUTHOR]

Objective. To present summary measures of socioeconomic inequalities in access barriers to health services in Colombia, El Salvador, Paraguay, and Peru. Methods. This cross-sectional study used data from nationally - representative household surveys in Colombia, El Salvador, Peru, and Paraguay to analyze income-related inequalities in barriers to seeking health services. Households that reported having a health problem (disease/accident) and not seeking professional health care were considered to be facing access barriers. The measures of inequality were the slope index of inequality and relative index of inequality. Results. Inequality trends were mixed across the four countries. All showed improvement, but large inequality gaps persisted between the highest and lowest income quintiles, despite health care reforms. Relative inequality gaps were highest in Colombia (60%), followed by Paraguay (30%), Peru (20%), and El Salvador (20%). Conclusions. The effect of national policy initiatives on equity to accessing health services should be the object of future analysis. There is also a need for research on national and regional monitoring of access barriers and explanatory factors for why people do not seek care, even when having a health problem. [ABSTRACT FROM AUTHOR]

Objective. To assess the effectiveness of a comprehensive blood pressure (BP) control program on improving lifestyle indicators, BP levels, and laboratory examination results among people living in low-income urban areas of Peru. Methods. A prospective before-and-after study design was applied to 1 271 participants with hypertension or pre-hypertension. The intervention was implemented for 2 years, from May 2015 -- April 2017, in three health centers in Lima (2 in Comas and 1 in Callao). The changes in participants over the study period were compared. All participants were provided with individualized consultations, group health education sessions, regular group meetings to improve self-management, and text messages providing health education. Paired t- and chi-square tests were used to determine the significance of the changes in indicators before and after the intervention. Results. Lifestyle behaviors, such as weight and blood pressure monitoring, reduced salt consumption, increased fruit and vegetable consumption, and stress control improved during the intervention (P < 0.001). The EuroQol-Five Dimension Scale showed improvement (P < 0.001) and body mass index, waist circumference, and systolic and diastolic BPs of the participants significantly decreased (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) and triglyceride decreased (P < 0.01) and high-density lipoprotein cholesterol (HDL-C) increased. The estimated glomerular filtration rate (eGFR) increased after the program (P < 0.001). Conclusions. This comprehensive BP control program was effective in improving lifestyle indicators, BP levels, and laboratory results among people living in a low-income urban area of Peru. Increasing opportunities for BP measurement, systematic management of hypertensive patients, and community-based prevention and education programs are paramount to hypertension detection, prevention, and control. [ABSTRACT FROM AUTHOR]

Objective. Determine the effectiveness of the Integrated Growth and Development Strategy (ECDI, Spanish acronym) of World Vision Peru on anemia, malnutrition, psychomotor development, and child care and protection in children aged <3 years living in three rural communities of Ayacucho Region, Peru. Methods. A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Anemia was measured using capillary blood and the HemoCue® analyzer, with hemoglobin values adjusted for altitude. Malnutrition was measured with anthropometric indicators for height and weight, using the World Health Organization's Anthro software. Psychomotor development was measured with the Abbreviated Test of the Ministry of Health of Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May 2013, midpoint in November 2013, and final in May 2014. In total, 283 children had two or more measurements including the final measurement, and 205 had all three measurements. Results. Multivariate analysis for repeated measures showed that ECDI had an estimated 33.1% effectiveness in reducing anemia (95% CI: 1.0%-54.7%), adjusted for age, sex, consumption of iron-rich foods, consumption of iron-absorption-enhancing foods, consumption of iron-absorption-inhibiting foods, having received iron supplementation in the last six months, and having participated in the Cuna Más Program. Conclusions. ECDI was effective in improving nutrition in children aged <36 months through anemia reduction and increased consumption of iron-absorption enhancers. Interventions that include educational and community monitoring components could be of great assistance to combating anemia in children aged <36 months in rural communities. [ABSTRACT FROM AUTHOR]

Objective. To estimate the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes and to determine any association with clinical factors. Methods. This hospital-based screening project was designed to prospectively detect the presence of DR in patients with type 2 diabetes by grading images acquired with a digital retinal camera. Results. Of 1 311 patients screened, appropriate retinal images were obtained in 1 222 subjects (93.2%). DR was detected in 282 patients (23.1%) [95% confidence interval (CI): 20.71--25.44]; 249 patients (20.4%) (95% CI: 18.1--22.6) had nonproliferative DR and 33 (2.7%) (95% CI: 1.8--3.6) had proliferative DR. In 32 patients (11.3%), DR was unilateral. The frequency of DR was the same in both sexes. Prevalence of blindness was twice as frequent in patients with DR as in those without it (9.4% and 4.6%, respectively) (P = 0.001). The frequency of DR at diagnosis was 3.5% and it increased with the duration of diabetes. DR was more frequent in patients with arterial hypertension, macrovascular or microvascular complications, and hemoglobin A1c (HbA1c) ≥ 7.0% and in those treated with insulin or sulfonylureas. It was less prevalent in those with HbA1c < 7.0%, with greater body mass index, and who had been treated with metformin. Conclusions. The prevalence of DR in these patients with type 2 diabetes was 23.1%. Nonproliferative retinopathy accounted for 77.0% of cases. Although less prevalent than in a previous report, it doubled the frequency of blindness in the people affected. A national screening DR program should be considered in order to detect this prevalent condition early and treat it in a timely fashion. [ABSTRACT FROM AUTHOR]