Survey of drug resistance of Mycobacterium tuberculosis in 3 Mexican states, 1997.

BACKGROUND: Drug resistance threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Mexico. OBJECTIVE: To obtain population-based data on Mycobacterium tuberculosis drug resistance in Mexico. METHODS: To obtain drug resistance data, we conducted a population-based study of TB cases in the states of Baja California, Sinaloa, and Oaxaca, Mexico. We performed cultures and drug susceptibility testing on M tuberculosis isolates from patients with newly diagnosed, smear-positive TB from April 1 to October 31, 1997. RESULTS: Mycobacterium tuberculosis was isolated from 460 (75%) of the 614 patients. Levels of resistance in new and retreatment TB cases to 1 or more of the 3 current first-line drugs used in Mexico (isoniazid, rifampin, and pyrazinamide) were 12.9% and 50.5%, respectively; the corresponding levels of multi-drug-resistant TB were 2.4% and 22.4%. Retreatment cases were significantly more likely than new cases to have isolates resistant to 1 or more of the 3 first-line drugs (relative risk [RR], 3.9; 95% confidence interval [CI], 2.8-5.5), to have isoniazid resistance (RR, 3.6; 95% CI, 2.5-5.2), and to have multi-drug-resistant TB (RR, 9.4; 95% CI, 4.3-20.2). CONCLUSIONS: This population-based study of M tuberculosis demonstrates moderately high levels of drug resistance. Important issues to consider in the national strategy to prevent M tuberculosis resistance in Mexico include consideration of the most appropriate initial therapy in patients with TB, the treatment of patients with multiple drug resistance, and surveillance or periodic surveys of resistance among new TB patients to monitor drug resistance trends.

[The inequality of health services for the uninsured population in Mexico]. / Inequidad de los servicios de salud a población abierta en México.

In order to assess the coverage of health services for non-insured population receiving health care from the Ministry of Health (SSA), a cross-sectional study was developed. With official statistics of SSA and data from the XI General Census of Population and Housing (1990), ratios of coverage and mortality rates in hospitals were assessed. The data were processed through simple analysis. In addition, states were stratified by groups according to poverty indicators obtained through a factorial analysis with the method of multiple components. The results showed that a polarized health economy for the non-insured population in Mexico is the cause of complex difficulties in the health care provision. The low financial resources affect the distribution of health care services in the states. Seventy-six per cent of the non-insured population is concentrated in those states with the highest levels of poverty, with a potential coverage of only 34.2 per cent and just 63.4 per cent of potential population use. The coverage of health care services in the states with lower poverty indicators is 1.9 times that of the states with higher poverty indicators. It was also observed that hospital mortality rate among children less than one year old was 1.7 times higher in poor regions. In general, the health services coverage is low. Therefore, it is necessary to expand the access to health care and improve the quality of services as well as life conditions of the population in the states with the highest poverty indicators. If this occurs, it will be possible to close the gap in order to build a better National Health System.

[An evaluation of the Mexico-BID Health Services Improvement Program, 1991]. / Evaluación del Programa de Mejoramiento de Servicios de Salud México-BID, 1991.

The evaluation of the program for enhancing health services showed advances in the building and provision of equipment for the health units, as well as development of additional operative capability until 1991. One of the main characteristics of the evaluation process, was the utilization of the local and state information systems, which allow the selective use of indicators in order to identify the advances of the program of expanded coverage and enhance of the quality of care and its direct relationship with the organization of health services. The present research constitutes a good example of the development of programmes funded by multilateral organizations.

[Trends in health services research in Mexico, 1984-1991]. / Tendencias de investigación en servicios de salud en México, 1984-1991.

Health services research is a basic tool for the development of the National Health System. This paper presents the results of a national survey on research projects carried out in Mexican health institutions, as well as in universities and research centers, from 1984 to 1991.

[Epidemiologic overview of measles in Mexico: current situation and perspectives]. / Panorama epidemiológico del sarampión en México: situación actual y perspectivas.

It has been recognized that due to immunization campaigns and specific treatment of medical complications, has resulted in a reduced measles mortality in México as in others countries. However, during the last few years the number of measles cases in México has shown an increasing trend over previous years due to two larges epidemics, in 1985 and 1989. As a vaccine preventable disease, the number of measles cases has shown an important decline in mortality as compared with mortality in the general population. From the total deaths in children under five years the measles deaths have been reduced from a level of 2.8% in 1969 to a level of 1.6% in 1985. The more recent mortality data available shows that 597 deaths caused by measles were registered in 1986, for a mortality rate of 0.75 per 100,000 inhabitants. At higher rate was observed in the age groups less than 1 year with a mortality rate of 5.9 per 100,000 inhabitants compared with 4.2 in the group from 1 to 4 years. The morbidity epidemiologic surveillance system among governmental health services reported a total of 20,076 cases in 1989, with an incidence rate of 23.8 cases per 100,000 inhabitants and a estimated mortality rate of 6.6%. This recent emergence of the measles activity in México is part of a pandemic that is affecting several countries around the world. The impact of these cases on an increased demand of medical care as well as its clinical complications, outcome and mortality, makes measles a high priority problem in México.