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In the Amazon Region of Peru, occupational activities are important drivers of human mobility and may increase the individual risk of being infected while contributing to increasing malaria community-level transmission. Even though out-of-village working activities and other mobility patterns have been identified as determinants of malaria transmission, no studies have quantified the effect of out-of-village working activities on recent malaria exposure and proposed plausible intervention scenarios. Using two population-based cross-sectional studies in the Loreto Department in Peru, and the parametric g-formula method, we simulated various hypothetical scenarios intervening in out-of-village working activities to reflect their potential health benefits. This study estimated that the standardized mean outcome (malaria seroprevalence) in the unexposed population (no out-of-village workers) was 44.6% (95% CI: 41.7%–47.5%) and 66.7% (95% CI: 61.6%–71.8%) in the exposed population resulting in a risk difference of 22.1% (95% CI: 16.3%–27.9%). However, heterogeneous patterns in the effects of interest were observed between peri-urban and rural areas (Cochran's Q test = 15.5, p < 0.001). Heterogeneous patterns were also observed in scenarios of increased prevalence of out-of-village working activities and restriction scenarios by gender (male vs. female) and age (18 and under vs. 19 and older) that inform possible occupational interventions targetting population subgroups. The findings of this study support the hypothesis that targeting out-of-village workers will considerably benefit current malaria elimination strategies in the Amazon Region. Particularly, males and adult populations that carried out out-of-village working activities in rural areas contribute the most to the malaria seropositivity (recent exposure to the parasite) in the Peruvian Amazon. [ABSTRACT FROM AUTHOR]

This study aims to quantify changes in outdoor (ambient) air pollution exposure from different migration patterns within Peru and quantify its effect on premature mortality. Data on ambient fine particulate matter (PM2.5) was obtained from the National Aeronautics and Space Administration (NASA). Census data was used to calculate rates of within-country migration at the district level. We calculated differences in PM2.5 exposure between "current" (2016–2017) and "origin" (2012) districts for each migration patterns. Using an exposure-response relationship for PM2.5 extracted from a meta-analysis, and mortality rates from the Peruvian Ministry of Health, we quantified premature mortality attributable to each migration pattern. Changes in outdoor PM2.5 exposure were observed between 2012 and 2016 with highest levels of PM2.5 in the Department of Lima. A strong spatial autocorrelation of outdoor PM2.5 values (Moran's I = 0.847, p-value=0.001) was observed. In Greater Lima, rural-to-urban and urban-to-urban migrants experienced 10-fold increases in outdoor PM2.5 exposure in comparison with non-migrants. Changes in outdoor PM2.5 exposure due to migration drove 137.1 (95%CI: 93.2, 179.4) premature deaths related to air pollution, with rural-urban producing the highest risk of mortality from exposure to higher levels of ambient air pollution. Our results demonstrate that the rural-urban and urban-urban migrant groups have higher rates of air pollution-related deaths. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via a link at the top of the paper. [ABSTRACT FROM AUTHOR]

Access to safe water and basic sanitation and hygiene facilities (WASH) are important for childhood health globally. However, inequalities in WASH access persist, and local governments need to better understand the potential impact of scaling up WASH services on childhood health. Using 2011 Peru Demographic and Health Survey data as a case study, we applied a modified substitution estimator approach to assess the impact of scaling up access (20-100%) to WASH on diarrhea prevalence among children < 5 years. The modified substitution estimator approach can help identify population subgroups or areas where WASH interventions and sustained implementation could be most beneficial and reduce existing disparities. Using findings from a recent meta-analysis and computing bootstrapped estimates and 95% CIs, we examined inequalities in the effect of WASH on self-reported diarrhea by urbanicity, maternal education level, household wealth, and district of residence. Increasing access (100% change) to improved water sources, sanitation, and hygiene facilities reduced population-level prevalence of childhood diarrhea by 8.2% (95% CI: 4.1, 12.3), 5.5% (95% CI: 0.7, 9.8), and 5.2% (95% CI: 2.2, 8.1), respectively. In stratified analyses, increased access to improved water sources and hygiene facilities was associated with decreased prevalence of diarrhea, with the largest reduction in rural areas and households with lower maternal education and lower wealth. Our findings suggest targeted WASH implementation in Peru is needed in rural areas and among lower socioeconomic-status households. In addition, even low levels of change in overall WASH access may decrease diarrhea prevalence.