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Item type:Publication, Learning from Perú: Why a Macroeconomic Star Failed Tragically and Unequally on COVID-19 Outcomes(Elsevier BV, 2023-12-20)Peru’s macroeconomic success and moderate health security rating paradoxically combined with amongst the highest levels of reported COVID-19 mortality globally, and significant inequality in pandemic health outcomes. A thematic analysis of evidence from desk review of online publications and databases was used to examine determinants of this outcome for national and global policy dialogue on pandemic preparedness, prevention and protection. The paradox relates to a concentration of risk and vulnerability in low income, urban households, associated with differentials in social conditions, and in a failure to address deficits in primary care and community systems, or in social protection of vulnerable households. Deeper causes in the political economy, state-society relations and the interests driving policy choices underlie the inequity in the immediate drivers. Neoliberal policy choices generated socio-economic insecurity and informality, which with state underinvestment in social protection and primary health care during early pandemic waves generated a society with elevated risk, disaffected by the state and surviving largely outside formal rule systems. Pandemic responses need to connect with such realities, invest in social conditions and local health systems, (re)connect people to public services and social protection, and regenerate public trust to tackle drivers of and prevent excessive, inequitable pandemic-related mortality. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Persistent inequalities in adolescent motherhood in Peru (1981–2017): From wide approaches to intercategorical mapping(Elsevier BV, 2026-06-01)Adolescent motherhood in Peru has declined over the past four decades; however, pronounced socioeconomic disparities persist. Drawing on microdata from the 1981, 1993, 2007, and 2017 population censuses-which contain sample sizes more than two orders of magnitude larger than those of Demographic and Health Surveys (DHS)-this study examines the long-run evolution of inequalities in adolescent motherhood. We employ relative risk measures, concentration indices, and their decompositions. We also apply a descriptive intercategorical approach that identifies small, multiply disadvantaged groups, a methodology feasible only with large amounts of data, such as census microdata. National prevalence decreased from 15.4% in 1993 to 11.5% in 2017; nonetheless, the risk ratio between adolescents in the poorest and richest wealth quintiles remained strikingly high. The concentration index (CI) declined between 1981 and 2007; however, this trend reversed after 2007. Decomposition analysis shows that between 1981 and 2007, the main factor statistically contributing to inequality was education level, accounting for approximately one-third of the total CI. Finally, the intercategorical mapping reveals that in 2017, three groups jointly defined by wealth, education, ethnicity, region, and rurality continued to face adolescent motherhood rates of 43%, levels that have remained virtually unchanged since 1993. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Effects of Peru's National School Feeding Program (Qali Warma) on Overweight and Obesity Among Children Aged 36–59 Months(Multidisciplinary Digital Publishing Institute (MDPI), 2026-06-01)Background: School feeding programs aim to improve child nutrition, and they may influence weight outcomes insofar as program modalities and household responses alter children's total energy intake. This is especially relevant in countries facing the double burden of malnutrition, where undernutrition and micronutrient deficiencies coexist with rising overweight and obesity. This study estimates the effect of Peru's former National School Feeding Program on obesity and excess weight among children aged 36 to 59 months under a selection-on-observables identification strategy and assesses whether impacts differ across operational modalities, particularly breakfast-only versus breakfast plus lunch and ready-to-eat rations versus foods delivered for preparation. Methods: We use repeated cross-sectional microdata from the Demographic and Health Survey (ENDES) pooled over 2014 to 2018 and link them to administrative information. The sample includes 18,959 children aged 36 to 59 months. To improve comparability, we estimate propensity score weights targeting the average treatment effect on the treated (ATT) using a machine learning generalized boosted model (GBM), and assess covariate balance using standardized mean differences and Kolmogorov–Smirnov statistics. Identification assumes conditional independence given observed covariates and overlap (common support). Main estimates rely on weighted probit models with fixed effects, progressively adding exposure duration, modality indicators, and controls. Distributional effects are examined using quantile regression on the continuous weight-for-height z-score. Results: Without differentiating modalities, beneficiary status is not associated with a statistically significant change in obesity, while pooled baseline estimates indicate a statistically significant higher probability of excess weight. Modality-specific results show that obesity declines only when Qali Warma is delivered as breakfast plus lunch through products to be prepared (approximately −1.0 percentage point in parsimonious models and −0.4 percentage points after controls). Evidence for excess weight is directionally consistent by modality but less conclusive once controls are included. Conclusions: Qali Warma's effects on early-childhood weight outcomes depend on implementation modality. Evaluations of school feeding programs should incorporate operational heterogeneity, particularly during program redesign.2