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Summary The COVID-19 pandemic has raised concern about the possibility and effects of mother–infant transmission of SARS-CoV-2 through breastfeeding and close contact. The insufficient available evidence has resulted in differing recommendations by health professional associations and national health authorities. We present an approach for deciding public health policy on infant feeding and mother–infant contact in the context of COVID-19, or for future emerging viruses, that balances the risks that are associated with viral infection against child survival, lifelong health, and development, and also maternal health. Using the Lives Saved Tool, we used available data to show how different public health approaches might affect infant mortality. Based on existing evidence, including population and survival estimates, the number of infant deaths in low-income and middle-income countries due to COVID-19 (2020–21) might range between 1800 and 2800. By contrast, if mothers with confirmed SARS-CoV-2 infection are recommended to separate from their newborn babies and avoid or stop breastfeeding, additional deaths among infants would range between 188 000 and 273 000.

BackgroundStandardised measures on experience of care are essential to understanding the care women and newborns receive and to designing appropriate interventions and responses. This review builds on ongoing work in the realm of maternity care and complements it by reviewing existing tools and measures to assess experience of and satisfaction with the care of the newborn.MethodsWe conducted a scoping review of published literature to identify measures and tools of experience (physiological or indirect) and satisfaction with newborn care. We systematically searched five bibliographic databases from 1 January 2010 through 1 December 2022 and contacted professional networks. Using a predefined evidence template, we extracted data on the studies and the tools’ characteristics. We mapped the tools and measures against the WHO quality of care frameworks to identify the most frequent measured domains of care and to highlight existing gaps.ResultWe identified 18 292 records of which 72 were eligible. An innovative finding of this review is the inclusion of newborn perspectives through behavioural responses, physiological signals, pain profiles as well as other non-verbal cues as markers of newborn experience. Domains related to parental participation and decision-making, ensuring continuity of care and receiving coordinated care, were the most measured across the included tools.ConclusionComprehensive and validated instruments measuring all aspects of care are needed. Developing a robust theoretical ground will be fundamental to the design and utilisation of standardised tools and measures.Protocol registration detailsThis review was registered and published on protocol.io (dx.doi.org/10.17504/protocols.io.bvk7n4zn).

INTRODUCTION: Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient preference trial [PRPPT]) for a trial comparing planned delivery mode in low-risk women. METHODS: A cross-sectional survey of low-risk, nulliparous pregnant women (N=416) and healthcare providers (N=168) providing prenatal care and/or labor/delivery services was conducted in Argentina (2 public, 2 private hospitals). Proportion of pregnant women and providers willing to participate in each design and reasons for not participating were determined. RESULTS: Few women (85%). Believing randomization unacceptable (RCT, PRPPT) and desiring choice of delivery mode (RCT) were women’s reasons for not participating. For providers, commonly cited reasons for not participating included unacceptability of performing CS without medical indication, difficulty obtaining informed consent, discomfort enrolling patients (all designs), and violating women’s right to choose (RCT). CONCLUSIONS FOR PRACTICE: Important limitations were found for each trial design evaluated. The necessity of stronger evidence regarding delivery mode in low-risk women suggests consideration of additional designs, such as a rigorously designed cohort study or an RCT within an obstetric population with equivocal CS indications.

Background Armed conflict has significant impacts on individuals and families living in conflict-affected settings globally. Scholars working to prevent violence within families have hypothesised that experiencing armed conflict leads to an increase in family violence and mental health problems. In this review, we assessed the prevalence of family violence in conflict settings, its association with the mental health of survivors, moderating factors, and the importance of gender relations. Methods Following PRISMA guidelines, we systematically reviewed quantitative and qualitative studies that assessed the prevalence of family violence and the association between family violence and mental health problems, within conflict settings (PROSPERO reference CRD42018114443). Results We identified 2605 records, from which 174 full text articles were screened. Twenty-nine studies that reported family violence during or up to 10 years after conflict were eligible for inclusion. Twenty one studies were quantitative, measuring prevalence and association between family violence and mental health problems. The studies were generally of high quality and all reported high prevalence of violence. The prevalence of violence against women was mostly in the range of 30–40%, the highest reported prevalence of physical abuse being 78.9% in Bosnia and Herzegovina. For violence against children, over three-quarters had ever experienced violence, the highest prevalence being 95.6% in Sri Lanka. Associations were found with a number of mental health problems, particularly post-traumatic stress disorder. The risk varied in different locations. Eight qualitative studies showed how men’s experience of conflict, including financial stresses, contributes to their perpetration of family violence. Conclusions Family violence was common in conflict settings and was associated with mental health outcomes, but the studies were too heterogenous to determine whether prevalence or risk was greater than in non-conflict settings. The review highlights an urgent need for more robust data on perpetrators, forms of family violence, and mental health outcomes in conflict-affected settings in order to help understand the magnitude of the problem and identify potential solutions to address it.

Every woman and newborn has the right to high-quality health care, with evidence-based practices delivered in a humane, supportive environment. This quality of care should encompass clinical care as well as the experience of care of women, newborns, parents and their families, such as the rights to privacy, confidentiality, dignity, and consent. With increasing evidence showing the impact that the experience of care has on health outcomes and future care-seeking behaviors, it is necessary to understand, measure, and address the experience of care as a key driver of adverse health outcomes and a component of the right to health, equity and dignity. Building on ongoing work measuring experience of care and satisfaction of women with maternity care7, we seek to identify tools and indicators that have been developed and used to measure various domains of experience of care as related to newborns. We will conduct a scoping review to identify all available research literature on the measurements of experience of newborn care and satisfaction with newborn care and extract a comprehensive list tools and indicators used to assess experience of newborn care and satisfaction with newborn care during the postnatal period.

Background Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. Methods and findings This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Conclusions Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. Trial registration The study is not a clinical trial., Author summary Why was this study done? Estimates of severe direct maternal morbidity are largely based on hospital-based studies with inconsistent definitions and varying selection criteria. Limited data are available from South Asia and sub-Saharan Africa, the 2 regions with the highest maternal and newborn morbidity and mortality, where a larger proportion of births occur at home. What did the researchers do and find? We collected data on maternal morbidities from a cohort of women in the community in multiple sites in sub-Saharan Africa and in South Asia. Out of a cohort of >114,000 women, we found that about 1 in 3 women suffer a maternal morbidity, which was notably higher than the previously reported data. We found that the prevalence of preeclampsia and eclampsia was about 1%, which was lower than previously reported. About 11% of women reported having prolonged or obstructed labour, which was somewhat higher than published estimates. The burden of pregnancy-related infection in postpartum period was higher in South Asia than in sub-Saharan Africa. This is the first study, to our knowledge, to describe the burden of antepartum haemorrhage and late antepartum infection and to clearly demonstrate the association of direct maternal morbidity with adverse pregnancy outcomes. What do these findings mean? Higher burden of direct maternal morbidity and its association with adverse outcomes highlights the need for improving health of women and mothers, including promotion of preconception health and nutrition, and high-quality antepartum, intrapartum and postpartum care.

Background Inflammatory bowel disease (IBD) is the name given to two inflammatory diseases of the colon and/or small intestine: Crohn disease (CD) and ulcerative colitis (UC). There is no information summarizing the complete body of evidence about IBD in developing regions, including Latin America. Objectives To estimate the burden of IBD in Latin America. Methods We conducted a systematic review searching published and unpublished studies on major international and regional databases from January 2000 to September 2015. Outcomes considered were incidence, prevalence, mortality, hospitalization attributable, treatment patterns, comparative effectiveness, patient-reported outcomes, and adherence to treatment. Pairs of reviewers independently selected, extracted, and assessed the risk of bias of the studies. Discrepancies were solved by consensus. Results We retrieved 3445 references, finally including 25 studies. Only 19% of the observational studies had a low risk of bias for participant selection and 60% were based on registries. The incidence ranged from 0.74 to 6.76/100,000 person-years for UC and from 0.24 to 3.5/100,000 person-years for CD. The prevalence rate ranged from 0.99 to 44.3/100,000 inhabitants for UC and 0.24 to 16.7/100,000 inhabitants for CD. Mortality rates ranged from 0.60 to 1.02 for UC and from 0.23 to 0.40 for CD. Patient-reported outcomes showed a decrease in quality of life associated with depression and anxiety and correlated with the time of diagnosis. The most frequently used medication in the studies was mesalazine. Conclusions The burden of IBD in Latin America seems to be important, but there is a considerable gap of high-quality evidence in the region.

BACKGROUND "Kangaroo mother care," a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (

IntroductionGlobally, a substantial number of women experience abusive and disrespectful care from health providers during childbirth. As evidence mounts on the nature and frequency of disrespect and abuse (D&A), little is known about the consequences of a negative experience of care on health and well-being of women and newborns. This review summarises available evidence on the associations of D&A of mother and newborns during childbirth and the immediate postnatal period (understood as the first 24 hours from birth) with maternal and neonatal postnatal care (PNC) utilisation, newborn feeding practices, newborn weight gain and maternal mental health.MethodsWe conducted a systematic review of all published qualitative, quantitative and mixed-methods studies on D&A and its postnatal consequences across all countries. Pubmed, Embase, Web of Science, LILACS and Scopus were searched using predetermined search terms. Quantitative and qualitative data were analysed and presented separately. Thematic analysis was used to synthesise the qualitative evidence.ResultsA total of 4 quantitative, 1 mixed-methods and 16 qualitative studies were included. Quantitative studies suggested associations between several domains of D&A and use of PNC as well as maternal mental health. Different definitions of exposure meant formal meta-analysis was not possible. Three main themes emerged from the qualitative findings associated with PNC utilisation: (1) women’s direct experiences; (2) women’s expectations and (3) women’s agency.ConclusionThis review is the first to examine the postnatal effect of D&A of women and newborns during childbirth. We highlight gaps in research that could help improve health outcomes and protect women and newborns during childbirth. Understanding the health and access consequences of a negative birth experience can help progress the respectful care agenda.

ObjectivesTo investigate associations and potential pathways between women’s lifetime exposure to traumatic events and their recent experiences of intimate partner violence (IPV).SettingSouth African informal settlements near Durban.Participants677 women, living in informal settlements, aged 18–30 years, currently out of school or formal employment.Primary and secondary outcome measuresSelf-reported experiences of IPV in the past 12 months and exposure to traumatic neighbourhood events (including witnessing murder, being robbed or kidnapped, witnessing and experiencing rape).ResultsExposure to traumatic events was common among the 677 women surveyed. Over 70% had experienced at least one in their lifetime; one quarter (24%) had experienced 3 or more different events. Women exposed to any traumatic event had a 43% increase in the odds of experiencing IPV in comparison to those with no exposure (aOR 1.43, p≤0.000). Exposure to non-partner rape is more strongly associated with IPV than any other traumatic experience. Pathways from exposure to traumatic events and non-partner rape to recent IPV experience are mediated by a latent variable of poor mental health. Food insecurity is associated with all forms of traumatic experience, and is also indirectly associated with IPV through views by women that are unsupportive of gender equality.ConclusionsWomen living in South African informal settlements who witness or experience traumatic events were likely to experience IPV, and this increases when women were exposed to multiple types of events. Our model suggests that experiencing traumatic events, and non-partner rape in particular, has negative effects on women’s mental health in ways that may increase their vulnerability to IPV. IPV prevention interventions should consider the broader impacts of women’s exposure to neighbourhood violence and severe poverty on IPV risk in settings where these are endemic.Trial registration numberNCT03022370; post-results.

IntroductionViolence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk.MethodsFor this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women’s self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW.ResultsOur search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country’s high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms.ConclusionAvailable evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive.PROSPERO registration numberThe review is registered with PROSPERO (CRD42020190147).

Background Violence against women and girls (VAWG) is a public health problem and one of the most prevalent human rights violations in the world. Recently practitioners and researchers have taken an interest in community participation as a strategy for preventing VAWG. Despite the recent enthusiasm however, there has been little articulation of how participation in VAWG prevention programmes mobilises communities to challenge social norms and prevent VAWG. Objectives In an attempt to help address this gap, this article seeks to answer two research questions: (1) How does participation theoretically mobilise communities to prevent VAWG, and (2) how do nominally participatory programmes make use of these theoretical concepts in their (explicit or implicit) theories of change? Methods To answer the first question, we draw on two well-recognised theories of participation and community mobilisation – Rifkin and Pridmore’s continuum of participation and Freire’s steps towards achieving critical consciousness – to clarify theoretical assumptions about how participation can mobilise community to reduce VAWG. To answer our second research question, we present the results from a review of primary prevention programmes that seek to reduce VAWG through community participation. Our analysis examines the explicit and implicit theories of change for these prevention programmes against the assumptions outlined from the theoretical literature. Results Our results help to better articulate realistic goals for community mobilisation and outline a theoretical basis for how participation as part of programming can effectively mobilise communities to reduce violence. Conclusion We argue that, in order to be both effective and sustainable, the role of external agents in introducing programmes needs to be secondary to the ownership and empowerment of communities in designing and delivering their own strategies for VAWG prevention.

Objective: To describe the calcium concentration of tap and bottled waters from Argentina and to estimate the contribution of drinking water to calcium recommendations. Results: Calcium concentrations provided by water authorities ranged from 6 to 105 mg/L. The mean calcium level of samples analysed at the Laboratorio de Ingeniería Sanitaria, National University of La Plata was 15.8 (SD ± 13.2) mg/L and at the Bone Biology Laboratory of the National University of Rosario was 13.1 (± 10.0) mg/L. Calcium values of samples from supply systems and private wells was similar. Most bottled waters had calcium levels well below 50 mg/L. The intake of one litre of drinking water from Argentina could represent in average between 1.2 and 8.0% of the calcium daily values for an adult., Centro de Investigaciones del Medioambiente

Argentina passed a law for humanized birth in 2004 and another law against obstetric violence in 2009, both of which stipulate the rights of women to achieve respectful maternity care. Clinicians and women might still be unaware of these laws, however. In this article, we discuss the case of a fourth-year medical student who, while visiting Argentina from the United States for his obstetric rotation, witnesses an act of obstetric violence. We show that the student's situation can be understood as one of moral distress and argue that, in this specific instance, it would be appropriate for the student to intervene by providing supportive care to the patient. However, we suggest that medical schools have an obligation to better prepare students for rotations conducted abroad.

The AMANHI Biobank cohort is a large cohort of pregnant women and their babies in sub-Saharan Africa and South Asia aimed at studying the interactions between genes and a wide range of varying environmental exposures on key pregnancy and birth outcomes. The cohort is well characterized for clinical, epidemiological and socio-economic information with harmonized data collection across all sites. The samples were collected and stored following standard operating procedures and provide an excellent opportunity for biological characterization. The cohort includes a total of 10 001 women enrolled between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan and Pemba Island-Tanzania, who have given birth to 9938 babies. Follow-up included three to four visits during pregnancy: at baseline, at 24–28 weeks, at 32–36 weeks and after 37 completed weeks of gestational age to collect routine epidemiological data and biological samples, and two additional visits after birth: between 1 and 6 days after birth and the second one between 42 and 60 days of age, in which the newborn’s samples were taken. The data set comprises a wide range of phenotypical data and environmental measures, biological samples, as well as a multiplicity of outcomes from the mother, the fetus and the neonate. The AMANHI biobank data is available at the Department for Maternal, Newborn, Child and Adolescent Health, and Ageing at the World Health Organization, which is the coordination centre of the study. Queries regarding the data and potential collaborations can be sent to Dr Rajiv Bahl (bahlr@who.int).

Background: Randomised controlled trials (RCTs) are widely used for establishing evidence of the effectiveness of interventions, yet public health interventions are often complex, posing specific challenges for RCTs. While there is increasing recognition that qualitative methods can and should be integrated into RCTs, few frameworks and practical guidance highlight which qualitative methods should be integrated and for what purposes. As a result, qualitative methods are often poorly or haphazardly integrated into existing trials and researchers rely heavily on standard interviews and focus group discussions. To improve current practice, we propose a framework for innovative qualitative research methods that can help address the challenges of RCTs for complex public health interventions. Methods: We used a stepped approach to develop a practical framework for researchers, which included: (1) a systematic review of the innovative qualitative methods mentioned in the health literature, (2) in-depth interviews with 23 academics from different methodological backgrounds working on RCTs of public health interventions in 11 different countries, and (3) framework development and group consensus-building process. Results: The findings are presented according to the CONSORT Statement categories for ease of use. The main challenges of RCTs for public health interventions are identified alongside each of the CONSORT categories and potential innovative qualitative methods that overcome each challenge are listed as part of a Framework for the Integration of Innovative Qualitative Methods into RCTs of Complex Health Interventions. Innovative qualitative methods raised in the interviews and discussed in detail include: rapid ethnographic appraisals, document analysis, diary methods, interactive voice responses and SMS, community mapping, spiral walks, public randomisation, pair interviews, visual participatory analysis, among others. Conclusions: The findings of this study point to the usefulness of observational and participatory methods for trials of complex public health interventions, offering a novel contribution to the broader literature about the need for mixed methods approaches. Integrating a diverse toolkit of qualitative methods can enable appropriate adjustments during RCTs, which in turn create more sustainable and effective interventions. However, this will require a cultural shift including the adoption of method-neutral research approaches, transdisciplinary collaborations, and a shift in publishing regimes.

Background The feminisation of the global health workforce presents a unique challenge for human resource policy and health sector reform which requires an explicit gender focus. Relatively little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. In this article, we use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health. Methods We performed an exploratory, time series analysis of gender disaggregated WageIndicator data. We explored global gender trends, wage gaps and wage conditions over time in selected health occupations. We analysed a sample of 25 countries over 9 years between 2006 and 2014, containing data from 970,894 individuals, with 79,633 participants working in health occupations (48,282 of which reported wage data). We reported by year, country income level and health occupation grouping. Results The health workforce is feminising, particularly in lower- and upper-middle-income countries. This was associated with a wage gap for women of 26 to 36% less than men, which increased over time. In lower- and upper-middle-income countries, an increasing proportion of women in the health workforce was associated with an increasing gender wage gap and decreasing wage conditions. The gender wage gap was pronounced in both clinical and allied health professions and over lower-middle-, upper-middle- and high-income countries, although the largest gender wage gaps were seen in allied healthcare occupations in lower-middle-income countries. Conclusion These results, if a true reflection of the global health workforce, have significant implications for health policy and planning and highlight tensions between current, purely economic, framing of health workforce dynamics and the need for more extensive gender analysis. They also highlight the value of a more nuanced approach to health workforce planning that is gender sensitive, specific to countries’ levels of development, and considers specific health occupations.

Objectives. To estimate regional prevalence and identify the spatial patterns of the degree of overweight and obesity by districts in under five years children in Peru during 2014. Materials and methods. Analysis of the information reported by the Information System Nutritional Status (SIEN) of the number of cases of overweight and obesity in children under five years recorded during 2014. Regional prevalence for overweight and obesity, and their respective confidence intervals to 95% were calculated. Moran index was used to determine patterns of grouping districts with high prevalence of overweight and/or obesity. Results. Data from 1834 districts and 2,318,980 children under five years were analyzed. 158,738 cases (6.84%; CI 95%: 6.81 to 6.87) were overweight, while 56,125 (2.42%; CI 95%: 2.40 to 2.44) obesity. The highest prevalence of overweight were identified in the regions of Tacna (13.9%), Moquegua (11.8%), Callao (10.4%), Lima (10.2%) and Ica (9.3%), and in the same regions for obesity with 5.3%; 4.3%; 4.0%; 4.0% and 3.8% respectively. The spatial analysis found grouping districts of high prevalence in 10% of all districts for both overweight and obesity, identifying 199 districts for overweight (126 urban and 73 rural), and 184 for obesity (136 urban and 48 rural). Conclusions. The highest prevalence of overweight and obesity were identified in the Peruvian coast regions. Moreover, these regions are predominantly exhibited a spatial clustering of districts with high prevalence of overweight and obesity. Objetivos. Estimar las prevalencias regionales e identificar los patrones espaciales del grado de sobrepeso y obesidad por distritos, en menores de cinco años en el Perú durante el año 2014. Materiales y métodos. Análisis de la información reportada por el Sistema de Información del Estado Nutricional (SIEN) del número de casos de sobrepeso y obesidad en menores de cinco años registrados durante el año 2014. Se calcularon prevalencias regionales para sobrepeso y obesidad y sus respectivos intervalos de confianza al 95%. El índice de Moran fue utilizado para determinar los patrones de agrupación de distritos con altas prevalencia de sobrepeso y/o obesidad. Resultados. Se analizaron datos de 1834 distritos y 2 318 980 menores de cinco años, 158 738 casos (6,84%; IC 95%: 6,81-6,87) presentaron sobrepeso, mientras que 56 125 (2,42%; IC 95%: 2,40-2,44) obesidad. Las mayores prevalencias de sobrepeso fueron identificadas en las regiones de Tacna (13,9%), Moquegua (11,8%), Callao (10,4%), Lima (10,2%) e Ica (9,3%), y en las mismas regiones para obesidad con 5,3%; 4,3%; 4,0%; 4,0% y 3,8% respectivamente. El análisis espacial encontró agrupaciones distritales de altas prevalencias en un 10% del total de distritos tanto para sobrepeso y obesidad, identificándose 199 distritos para sobrepeso (126 urbanos y 73 rurales), y 184 para obesidad (136 urbanos y 48 rurales). Conclusiones. Se identificó las mayores prevalencias de sobrepeso y obesidad en regiones de la costa peruana. Asimismo, estas regiones son las que exhibieron predominantemente una agrupación espacial de distritos con altas prevalencias de sobrepeso y obesidad.

Objetivos. Estimar las prevalencias regionales e identificar los patrones espaciales del grado de sobrepeso y obesidad por distritos, en menores de cinco años en el Perú durante el año 2014. Materiales y métodos. Análisis de la información reportada por el Sistema de Información del Estado Nutricional (SIEN) del número de casos de sobrepeso y obesidad en menores de cinco años registrados durante el año 2014. Se calcularon prevalencias regionales para sobrepeso y obesidad y sus respectivos intervalos de confianza al 95%. El índice de Moran fue utilizado para determinar los patrones de agrupación de distritos con altas prevalencia de sobrepeso y/o obesidad. Resultados. Se analizaron datos de 1834 distritos y 2 318 980 menores de cinco años, 158 738 casos (6,84%; IC 95%: 6,81-6,87) presentaron sobrepeso, mientras que 56 125 (2,42%; IC 95%: 2,40-2,44) obesidad. Las mayores prevalencias de sobrepeso fueron identificadas en las regiones de Tacna (13,9%), Moquegua (11,8%), Callao (10,4%), Lima (10,2%) e Ica (9,3%), y en las mismas regiones para obesidad con 5,3%; 4,3%; 4,0%; 4,0% y 3,8% respectivamente. El análisis espacial encontró agrupaciones distritales de altas prevalencias en un 10% del total de distritos tanto para sobrepeso y obesidad, identificándose 199 distritos para sobrepeso (126 urbanos y 73 rurales), y 184 para obesidad (136 urbanos y 48 rurales). Conclusiones. Se identificó las mayores prevalencias de sobrepeso y obesidad en regiones de la costa peruana. Asimismo, estas regiones son las que exhibieron predominantemente una agrupación espacial de distritos con altas prevalencias de sobrepeso y obesidad. Objectives. To estimate regional prevalence and identify the spatial patterns of the degree of overweight and obesity bydistricts in under five years children in Peru during 2014. Materials and methods. Analysis of the information reported by the Information System Nutritional Status (SIEN) of the number of cases of overweight and obesity in children under five years recorded during 2014. Regional prevalence for overweight and obesity, and their respective confidence intervals to 95% were calculated. Moran index was used to determine patterns of grouping districts with high prevalence of overweight and/or obesity. Results. Data from 1834 districts and 2,318,980 children under five years were analyzed. 158,738 cases (6.84%; CI 95%: 6.81 to 6.87) were overweight, while 56,125 (2.42%; CI 95%: 2.40 to 2.44) obesity. The highest prevalence of overweight were identified in the regions of Tacna (13.9%), Moquegua (11.8%), Callao (10.4%), Lima (10.2%) and Ica (9.3%), and in the same regions for obesity with 5.3%; 4.3%; 4.0%; 4.0% and 3.8% respectively. The spatial analysis found grouping districts of high prevalence in 10% of all districts for both overweight and obesity, identifying 199 districts for overweight (126 urban and 73 rural), and 184 for obesity (136 urban and 48 rural). Conclusions. The highest prevalence of overweight and obesity were identified in the Peruvian coast regions. Moreover, these regions are predominantly exhibited a spatial clustering of districts with high prevalence of overweight and obesity.