Universidad Peruana Cayetano Heredia

Healthcare provision to distinct social groups in Latin America contributes to inequities. Individuals make active choices by bypassing their coverage and intended healthcare source. After the pandemic, we sought to characterize bypassing behaviors and quantify their effects on access to essential services.

Cross-sectional data from a population-based telephone survey in Peru and Uruguay were analyzed. Participants were selected by random digit dialing. Outcomes were defined as access to preventive screenings and satisfaction of emerging health needs. Bypassing by level was defined as when participants went around primary care for the usual source of care or last preventive visit; bypassing by coverage when care was sought outside of public coverage or social security. Sociodemographic characteristics were included, and the adjusted average treatment effect was calculated.

Data from 1,255 participants in Peru and 1,237 participants in Uruguay were analyzed. Bypassing behaviors by level (32% Peru; 60% Uruguay) and coverage (29% Peru; 21% Uruguay) were more prevalent in more privileged groups, especially in Peru. System competence was low overall and varied by bypassing mode, especially in Peru. In the adjusted analysis, statistically significant differences were found in bypassing by coverage in Peru (-8% difference in unmet health needs) and by level in Uruguay (5% more unmet needs).

Provision of essential preventive services was insufficient in both countries. In Peru, bypassing could serve as a proxy measure of inequities. Reminders of preventive services could be offered to bypassers of primary care. Profound health system reforms are needed to ensure equitable access to essential services.

Poultry can act as a reservoir of Salmonella enterica serotype Infantis (S. Infantis) of clinical and epidemiological importance because it triggers foodborne disease outbreaks and presents antibiotic multiresistance. The present study aimed to determine antimicrobial resistance in S. Infantis isolates from poultry livers, litter and chicken carcasses from Lima, Peru, during 2022-2023. S. Infantis was isolated from 10.1 % (27/267), 4.7 % (4/86), and 8 % (2/25) of the bird, litter and carcass samples, respectively. All isolates showed resistance to nalidixic acid (NA). In addition, 94 %, 76 %, 70 %, 48 %, and 45 % of the isolates showed resistance to tetracycline (TET), amoxicillin (AMX), chloramphenicol (C), gentamicin (GEN) and trimethoprim/sulfamethoxazole (TS), respectively. All isolates showed susceptibility to imipinem and amoxicillin/clavulanic acid. Of the isolates, 93.9 % displayed multidrug resistance. The most frequent resistance pattern was C-AMX-NA-GEN-TET (24.2 %, n=8), determined even from carcass isolates, followed by C-AMX-NA-TET (18.2 %, n=6), and C-AMX-NA-GEN-TS-TET (12.1 %, n=4). The presence of these multidrug-resistant S. Infantis isolates is a threat to food safety and public health.