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Item type:Publication, Influenza vaccination hesitancy in five countries of South America. Confidence, complacency and convenience as determinants of immunization rates(Public Library of Science, 2020-12-01)INTRODUCTION: Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status. METHODS: An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken. RESULTS: Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries. CONCLUSIONS: Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Social predictors of food insecurity during the stay-at-home order due to the COVID-19 pandemic in Peru. Results from a cross-sectional web-based survey(Cold Spring Harbor Laboratory, 2021-02-08)Stay-at-home orders and social distancing have been implemented as the primary tools to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, this approach has indirectly lead to the unemployment of 2·3 million Peruvians, in Lima, Perú alone. As a result, the risk of food insecurity may have increased, especially in low-income families who rely on a daily wage. This study estimates the prevalence of moderate or severe food insecurity (MSFI) and identifies the associated factors that explain this outcome during the stay-at-home order. METHODS: A cross-sectional web-based survey, with non-probabilistic sampling, was conducted between May 18 and June 30, 2020, during the stay-at-home order in Peru. We used social media advertisements on Facebook to reach 18-59-year-olds living in Peru. MSFI was assessed using the Food Insecurity Experience Scale (FIES). Rasch model methodology requirements were considered, and factors associated with MSFI were selected using stepwise forward selection. A Poisson generalized linear model (Poisson GLM), with log link function, was employed to estimate adjusted prevalence ratios (aPR). FINDINGS: This analysis is based on 1846 replies. The prevalence of MSFI was 23·2%, and FIES proved to be an acceptable instrument with reliability 0·72 and infit 0·8-1·3. People more likely to experience MSFI were those with low income (less than 255 US$/month) in the pre-pandemic period (aPR 3·77; 95%CI, 1·98-7·16), those whose income was significantly reduced during the pandemic period (aPR 2·27; 95%CI, 1·55-3·31), and those whose savings ran out in less than 21 days (aPR 1·86; 95%CI, 1·43-2·42). Likewise, heads of households (aPR 1·20; 95%CI, 1·00-1·44) and those with probable SARS-CoV2 cases as relatives (aPR 1·29; 95%CI, 1·05-1·58) were at an increased risk of MSFI. Additionally, those who perceived losing weight during the pandemic (aPR 1·21; 95%CI, 1·01-1·45), and increases in processed foods prices (aPR 1·31; 95%CI, 1·08-1·59), and eating less minimally processed food (aPR 1·82; 95%CI, 1·48-2·24) were more likely to experience MSFI. INTERPRETATION: People most at risk of MSFI were those in a critical economic situation before and during the pandemic. Social protection policies should be reinforced to prevent or mitigate these adverse effects. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Water insecurity, self-reported physical health, and objective measures of biological health in the Peruvian Amazon(John Wiley and Sons Inc, 2022-12-01)Objectives: This study examines the associations between water insecurity, self-reported physical health, and objective measures of biological health among 225 Awajún adults (107 women; 118 men) living in the Peruvian Amazon, a “water-abundant” region. Methods: A survey, which included multiple measures of self-reported physical health, and objective measures of biological health such as blood pressure and nutritional and immune biomarkers. Results: Greater water insecurity was associated with multiple measures of self-reported physical health, including higher incidence of reported diarrhea, nausea, back pain, headaches, chest pain, fatigue, dizziness, overall poor perceived health, and “being sick.” These symptoms align with the physical strain associated with water acquisition and with drinking contaminated water. A significant association between higher water insecurity and lower systolic blood pressure emerged, which may be linked to dehydration. None of the other biomarkers, including those for nutrition, infection, and stress were significantly associated with water insecurity scores. Conclusions: These analyses add to the growing body of research examining the associations between water insecurity and health. Biocultural anthropologists are well-positioned to continue probing these connections. Future research will investigate relationships between measures of water insecurity and biomarkers for gastrointestinal infection and inflammation in water-scarce and water-abundant contexts. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Motherly Care: The Impacts of Exiting a Childcare Program on Child and Maternal Health(Pontificia Universidad Católica del Perú, 2026-01-01)We investigate the unintended impacts of exiting Peru's Cuna Más public childcare program on child and maternal health. With increased public childcare use in developing countries, understanding the effects of program exit is critical. We use Cuna Más' strict age-based graduation rule to identify causal impacts, leveraging comprehensive data from the Demographic and Family Health Survey for the period 2015-2019. Our results suggest that mothers prioritize their children's health over their own upon program exit. While maternal mental health shows a notable decline, children's health remains unaffected. These results have important policy implications, highlighting the need for post-program transitional support to mitigate hidden costs for mothers and enhance the positive outcomes children gain during program participation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Defining drivers of human papillomavirus (HPV) vaccine uptake in migrant populations globally and strategies and interventions to improve coverage: a systematic review(2025-02-02)Background The Cervical Cancer Elimination Initiative by the World Health Organization (WHO) has set a target of 90% human papillomavirus (HPV) vaccination coverage among girls by age 15 by 2030 to dramatically reduce deaths from cervical and other HPV-related cancers. However, progress has been slow, with only 27% global coverage in 2023. Migrants are considered an under-immunised group globally for many vaccine-preventable diseases, with data showing that they may experience a high burden of HPV infection and widespread HPV under-immunisation. Better understanding of the factors influencing the ability of these communities to get vaccinated for HPV is important. We aimed to systematically synthesise evidence on drivers of HPV vaccination uptake in migrants, and explored recommended approaches, strategies, and best practices to promote uptake in these communities. Methods We searched seven databases (e.g., Medline, Global Health) and websites (WHO, IOM, Google Scholar) for literature on drivers of HPV vaccination uptake among migrants globally, published between January 2006 and December 2024 in any language. Data on influencing factors for HPV vaccination uptake in migrants were extracted for an integrated approach to synthesising findings, and recommended strategies to improve it were compiled. We conducted a hybrid thematic analysis using the WHO BeSD model and assessed risk of bias with Joanna Briggs Institute checklists. PROSPERO protocol: CRD42023401694. Findings We identified 1,806 database records and 1,756 records from websites, ultimately including 117 studies with 5,638,836 participants across 16 countries and one territory (including 933,187 first- and second-generation migrants, mostly defined as foreign-born in high-income countries). Factors negatively influencing vaccine uptake included concerns about vaccine safety, cultural beliefs, uncertainty about HPV vaccines/infection, low knowledge of HPV/HPV vaccine, gender/sex, inter-generational and family dynamics, exposure to negative information, and lack of recommendations from healthcare providers. Practical barriers included limited information on services, language issues combined with a lack of skilled interpreters, logistical challenges, and the high cost of the vaccine. Enablers mainly included positive perceptions and trust in the vaccine and healthcare providers, realistic expectations from parents regarding the sexual activity of adolescents, a sense of responsibility, as well as recommendations from healthcare providers and support from social networks. Other positive predictors of vaccine uptake included being female, and having a history of vaccine-preventable diseases or abnormal Pap test results. Findings highlighted that free-of-charge and school-based schemes were effective in increasing uptake, while mandatory or optional schemes were less popular. Key recommended approaches included culturally sensitive messaging and tailored communication for different target groups (e.g., parents/caregivers, adolescents), with an emphasis on strength framing. Deploying trusted mediators (e.g., peer school health promoters, religious champions, community health workers) and implementing practical solutions to address missed opportunities (e.g., bundling HPV vaccination with other services) and for mobile migrants (e.g., eHealth) were also emphasised. Additionally, strong provider recommendations and reducing access barriers through measures including walk-in, mobile, and outreach services were recommended, alongside addressing broader cross-cutting issues, such as strengthening vaccine monitoring systems. Interpretation This review showed that migrants worldwide face complex individual, family/social, and provider/system-level barriers to HPV vaccination, resulting in missed opportunities for protection. In many low- and middle-income countries (LMICs), the vaccine is either unavailable or has to be paid for. Achieving global commitments for universal and equitable immunisation across the life-course, making progress toward cervical cancer elimination, requires addressing these barriers through multi-pronged strategies. This includes combining effective health communication to build trust and address negative perceptions, along with efforts to eliminate physical barriers to vaccine access. Given the lack of data from LMICs, future research must urgently explore specific drivers of HPV vaccination among migrants in these regions where they are more concentrated and access to the HPV vaccine is limited, as well as develop solutions to system-level problems. Collaborative efforts with migrant communities are essential to co-develop effective, tailored delivery models that meet their unique needs. Funding This research was funded by the NIHR (NIHR300072), the Academy of Medical Sciences (SBF005\1111), and the Medical Research Council (MRC/N013638/1).1