title: Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions.
abstract: Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru.
  
  
  
  We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence.
  
  
  
  Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade.
  
  
  
  Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.
authors.affiliation: Institute for International Programs and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. yvonneyotam@jhu.edu.
authors.forename: Yvonne
authors.identifier: 0000-0003-4849-5084
authors.initials: Y
authors.lastname: Tam
authors.affiliation: Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru.|Centro de Investigación en Salud Materna e Infantil, Universidad Peruana Cayetano Heredia, Lima, Peru.|School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.|Universidad Nacional Mayor de San Marcos, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Huicho
authors.affiliation: Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Huayanay-Espinoza
authors.affiliation: International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
authors.forename: María Clara
authors.initials: MC
authors.lastname: Restrepo-Méndez
mesh_terms: D002648:Child; D000067576:Child Health / Q000639:trends*; D002662:Child Health Services / Q000706:statistics & numerical data*; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D019458:Insurance Coverage; D010568:Peru; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data