Home birth is very common in the Peruvian Amazon. In rural areas of the Loreto region, home to indigenous populations such as the Kukama-Kukamiria, birth takes place at home constantly. This study aims to understand the preference for home births as well as childbirth and newborn care practices among Kukama-Kukamiria women in rural Loreto. Following a case study approach, sixty semi-structured, face-to-face interviews were conducted with recent mothers who experienced childbirth within one year prior to the interview, female relatives of recent mothers who had a role in childbirth, male relatives of recent mothers, community health workers, and traditional healers. We found that for women from these communities, home birth is a courageous act and an intimate (i.e. members of the community and relatives participate in it) and inexpensive practice in comparison with institutional birth. These preferences are also linked to experiences of mistreatment at health facilities, lack of cultural adaptation of birthing services, and access barriers to them. Preparations for home births included handwashing and cleaning delivery surfaces. After birth, waiting for the godparent to arrive to cut the cord can delay drying of the newborn. Discarding of colostrum, lack of skin-to-skin contact as well as a range of responses regarding immediate breastfeeding and immediate drying of the baby were also found. These findings were used to tailor the educational content of the Mamas del Rio program, where community health workers are trained to identify pregnancy early, perform home visits to pregnant women and newborns, and promote essential newborn care practices in case institutional birth is not desired or feasible. We make recommendations to improve Peru’s cultural adaptation of birthing services.

Introducción: La resistencia mediante la producción de betalactamasa de espectro extendido (BLEE) es la resistencia microbiana más común y de importancia en salud pública. Objetivos: Describir las características de las infecciones por bacterias productoras de BLEE en un hospital de referencia nacional. Diseño Estudio transversal descriptivo. Lugar: Hospital Nacional Daniel Alcides Carrión, Callao, Perú. Materiales: Registros de los cultivos de secreciones realizados en el Laboratorio de Microbiología del HNDAC en el año 2012. Métodos: Se analizó datos del paciente (edad, sexo y servicio del cual se recibió la muestra) y datos de la muestra (fecha de obtención, el tipo de muestra, el microrganismo encontrado, el antibiograma detallado y su calificación como bacteria productora de BLEE). Principales medidas de resultados: Características de las infecciones por bacterias productoras de BLEE. Resultados Se recolectó 3 149 muestras, 70,9% (2 235) fueron de mujeres; 29,4% fueron cultivos positivos para bacterias productoras de BLEE. Los servicios críticos obtuvieron la mayor prevalencia, y los meses donde se encontró mayor presencia fueron abril (34,7%) y julio (34,7%). Tanto E. coli (72,4%) como Klebsiella sp. (20%) fueron las prevalentes. No se encontró resistencia para imipinem, tanto para E. coli como para Klebsiella sp. Conclusiones La prevalencia fue similar a la de América Latina (34,6%). Se presenta más evidencias de una alta presencia en consulta externa y en mayores de 46 años; siendo así un problema de salud pública.

Objective The aim of this study was to determine the appropriateness of messages on osteoporosis in Spanish videos posted on YouTube. Methods YouTube Spanish language videos on osteoporosis were evaluated. The main variable was the presence of appropriate messages related to osteoporosis. The content was evaluated through a checklist based on available guidelines and reviewed by an expert (E.C.L.). The evaluation was performed twice independently for each video. A discussion of discordant messages was made with the expert. Other variables included were number of views, comments, “likes,” and “dislikes”; the total duration of the video; and their source (health professionals and non–health professionals). Bivariate analysis between health professionals and non–health professionals were performed using the Mann-Whitney U and the χ2 tests. Results A total of 148 videos were reviewed. The median appropriate score for all videos was 5 (p25: 3, p75: 9) (maximum possible, 29 points). Seventy-three (49%) videos had a health professional as source, 124 (83.8%) mentioned at least one message in the definition area, 99 (66.9%) in the area of diagnosis, 99 (66.9%) in the area of recommendations, 43 (29.1%) in the area of treatment, and 5 (3.4%) in follow-up. The most frequent message was “risk of fracture” (68.9%). Conclusions The content of osteoporosis information found in YouTube was generally incomplete and inaccurate. The content of these videos should include treatment and preventive strategies.

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