{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:56:52Z","timestamp":1789750612715,"version":"4.0.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peru underwent marked political instability after the 2016 electoral cycle. Whether that period coincided with a change in the national trajectory of child anemia among children aged 6\u201335\u202fmonths has not been evaluated using a long national time series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of the Demographic and Family Health Survey (ENDES), 2006\u20132024 (123,600 children aged 6\u201335\u202fmonths with valid hemoglobin). We estimated weighted annual prevalences of anemia (hemoglobin &amp;lt;11.0\u202fg\/dL) and mean hemoglobin. The primary analysis used segmented interrupted time-series regression with a flexible pre-trend (knot in 2011), Prais\u2013Winsten AR(1) correction, and a prespecified cut-point in 2017. Sensitivity analyses included alternative cut-points (2016, 2018, 2020), exclusion of 2020\u20132021, an interrupted time-series model with mean hemoglobin as a continuous outcome, and composition-adjusted predicted prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anemia decreased from 56.4% (2006) to 41.4% (2011), plateaued (~43%) between 2012 and 2016, fell to 36.5% in 2021, and rebounded to 43.1% in 2023. The slope in 2006\u20132010 was \u22123.48 percentage points per year; in 2011\u20132016 it was near zero (\u22120.09\u202fpp.\/year). In 2017 we observed a favorable level change relative to the counterfactual (\u22124.4\u202fpp), followed by a positive and statistically significant change in slope (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2083\u202f=\u202f3.83; 95% CI 1.80\u20135.87;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), consistent with loss of momentum and a subsequent rebound. The interrupted time-series model of mean hemoglobin showed directionally consistent results (slope change \u22120.137\u202fg\/dL\/year;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.014).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The post-2016 period coincided with an initial decline relative to the counterfactual, followed by an adverse slope and a recent rebound. This pattern is compatible with programmatic fragility in a context of political and institutional instability, but should not be interpreted as proof of a direct causal effect of political instability itself. Anemia-control policies require mechanisms that protect operational continuity from political turnover and other concurrent health-system shocks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1880585","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:36:08Z","timestamp":1785821768000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Political instability and child anemia in Peru: a national interrupted time-series analysis, 2006\u20132024"],"prefix":"10.3389","volume":"14","author":[{"given":"V\u00edctor Juan","family":"Vera-Ponce","sequence":"first","affiliation":[{"name":"Facultad de Medicina (FAMED), Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas (UNTRM)","place":["Chachapoyas, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhosmer","family":"Ballena-Caicedo","sequence":"additional","affiliation":[{"name":"Facultad de Medicina (FAMED), Universidad Nacional Toribio Rodr\u00edguez de Mendoza de Amazonas (UNTRM)","place":["Chachapoyas, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3390\/nu11010183","article-title":"Prevalence of Anemia in children from Latin America and the Caribbean and effectiveness of nutritional interventions: systematic review and Meta\u2212analysis","volume":"11","author":"Iglesias V\u00e1zquez","year":"2019","journal-title":"Nutrients"},{"key":"ref2","article-title":"Guideline on haemoglobin cutoffs to define anaemia in individuals and populations","year":"2024"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"588","DOI":"10.17843\/rpmesp.2017.344.3281","article-title":"Anemia infantil: retos y oportunidades al 2021","volume":"34","author":"Zavaleta","year":"2017","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"100148","DOI":"10.1016\/j.lana.2021.100148","article-title":"Peru - Progress in health and sciences in 200 years of independence","volume":"7","author":"Carrillo-Larco","year":"2022","journal-title":"Lancet Reg Health Am"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"115","DOI":"10.17843\/rpmesp.2025.422.14028","article-title":"New world health organization guideline on anemia cut-off points: implications for children aged 6-35 months in Peru","volume":"42","author":"Campos-S\u00e1nchez","year":"2025","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"6936","DOI":"10.22605\/RRH6936","article-title":"Rural and urban disparities in anemia among Peruvian children aged 6-59 months: a multivariate decomposition and spatial analysis","volume":"22","author":"Al-Kassab-C\u00f3rdova","year":"2022","journal-title":"Rural Remote Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1068083","DOI":"10.3389\/fpubh.2023.1068083","article-title":"Inequalities in anemia among Peruvian children aged 6-59\u202fmonths: a decomposition analysis","volume":"11","author":"Al-Kassab-C\u00f3rdova","year":"2023","journal-title":"Front Public Health"},{"key":"ref8","article-title":"OECD reviews of health systems: Peru 2025. OECD reviews of health systems","year":"2025"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"100007","DOI":"10.1016\/j.ssmhs.2023.100007","article-title":"Learning from Per\u00fa: why a macroeconomic star failed tragically and unequally on Covid-19 outcomes","volume":"2","author":"Villar","year":"2024","journal-title":"SSM Health Syst"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"98","DOI":"10.5334\/aogh.2896","article-title":"Evaluation of Peruvian government interventions to reduce childhood anemia","volume":"86","author":"Berky","year":"2020","journal-title":"Ann Glob Health"},{"key":"ref11","first-page":"41","article-title":"El control de crecimiento y desarrollo en la reducci\u00f3n de anemia en el Per\u00fa","volume":"23","author":"Castro Mayta","year":"2023","journal-title":"RFMH Rev Fac Med Hum"},{"key":"ref12","volume-title":"Resoluci\u00f3n Ministerial N.\u00b0 250-2017-MINSA. Aprobar la NTS N.\u00b0 134-MINSA\/2017\/DGIESP, Norma T\u00e9cnica de Salud para el manejo terap\u00e9utico y preventivo de la anemia en ni\u00f1os, adolescentes, mujeres gestantes y pu\u00e9rperas","year":"2017"},{"key":"ref13","volume-title":"Decreto Supremo N.\u00b0 068-2018-PCM. Decreto Supremo que aprueba el Plan Multisectorial de Lucha contra la Anemia","year":"2018"},{"key":"ref14","volume-title":"Resoluci\u00f3n Ministerial N.\u00b0 229-2020-MINSA. Modificar el apartado 5.3.1 del subnumeral 5.3 del numeral V de la NTS N.\u00b0 134-MINSA-DGIESP","year":"2020"},{"key":"ref15","volume-title":"Resoluci\u00f3n Ministerial N.\u00b0 275-2020-MINSA. Directiva Sanitaria N.\u00b0 099-MINSA\/2020\/DGIESP: disposiciones para garantizar las prestaciones de prevenci\u00f3n y control de la anemia en el contexto del COVID-19","year":"2020"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e0005667","DOI":"10.1371\/journal.pgph.0005667","article-title":"Challenges in the medical oxygen ecosystem of Peru: a political economy analysis","volume":"5","author":"Garcia","year":"2025","journal-title":"PLOS Global Public Health"},{"key":"ref17","first-page":"1453","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume-title":"Lancet","author":"Altman","year":"2007"},{"key":"ref18","volume-title":"Ficha T\u00e9cnica: Encuesta Demogr\u00e1fica y de Salud Familiar \u2013 ENDES","year":"2024"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"324","DOI":"10.17843\/rpmesp.2024.413.13993","article-title":"How much has the prevalence of anemia in Peruvian women changed with the WHO 2024 criteria? Analysis of ENDES 2023","volume":"41","author":"Hern\u00e1ndez-V\u00e1squez","year":"2024","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"ref20","first-page":"1478","article-title":"Secondary data analysis: ethical issues and challenges","volume":"42","author":"Tripathy","year":"2013","journal-title":"Iran J Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e1681","DOI":"10.35434\/rcmhnaaa.2023.161.1681","article-title":"Trend in prevalence of anemia in children between 6 and 35 months in Peru during the period 2014-2019","volume":"16","author":"Mougenot","year":"2023","journal-title":"Rev Cuerpo Med Hosp Nac Almanzor Aguinaga Asenjo"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/nyas.14520","article-title":"Changes in hemoglobin levels with age and altitude in preschool-aged children in Peru: the assessment of two individual-based national databases","volume":"1488","author":"Gonzales","year":"2021","journal-title":"Ann N Y Acad Sci"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1880585\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:36:10Z","timestamp":1785821770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1880585\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":22,"alternative-id":["10.3389\/fpubh.2026.1880585"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1880585","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"article-number":"1880585"}}