ABSTRACT
OBJECTIVE: To study the association between maternal working conditions and low birth-weight in Mexico City. MATERIAL AND METHODS: Interviews of 2623 workers who gave birth in Mexico City hospitals during 1992 were analyzed. Information on the main biologic and social factors associated to low birth-weight was registered. Occupational stress was determined with the instrument designed by Karasek. Logistic regression models to evaluate the relationship between working conditions and low birth-weight were used, controlling by confounding variables. RESULTS: Low birth-weight was more frequent in workers with working periods of more than 50 h/week (OR = 1.6; 95% CI = 1.17, 2.28) and with problems at work (OR = 1.5; 95% CI = 1.0, 2.25). Lack of tangible social support was identified as a risk factor for low birth-weight (OR = 1.7; 95% CI = 1.20, 2.33). Preventive working measures such as changes in tasks, shortening of working hours and leaves of absence due to illness did not show a beneficial effects on birth-weight, except for the maternity leave of absence. Mothers with no right to this had a 2.2 higher probability of giving birth to low weight children (95% CI = 1.66, 2.93). CONCLUSIONS: These results emphasize the importance of identifying the occupational risk factors during pregnancy.
Subject(s)
Infant, Low Birth Weight , Women, Working , Adult , Female , Humans , Infant, Newborn , Logistic Models , Mexico , Occupations , Parental Leave , Pregnancy , Risk Factors , Social Support , Stress, Physiological/etiologyABSTRACT
In Mexico, traditional birth attendants (TBAs) are an essential resource for health care, especially in small rural communities where they attend approximately 45% of all deliveries. Both rural and urban women seek care with the TBAs because, amongst other things, they share the same cultural codes. In this study, qualitative and quantitative methods were used to analyze the concepts, resources and process of care during birth in rural areas of the state of Morelos. Results show that the socio-economic characteristics of the TBAs are similar to those of the patients, that they share the same precarious living conditions, and the resources to which they have access for providing care during births. When choosing a TBA as a health care provider, both the economic aspect and the importance of a shared symbolism come into play. We observed advantages in some of the traditional practices which should be incorporated into the medical system, for example protection through the massage of the perineum at the moment of expulsion. Nevertheless, there are inadequacies for which the implementation of training programs is fundamental, before articulate primary care programs using the TBAs can be promoted.
Subject(s)
Health Knowledge, Attitudes, Practice , Midwifery/methods , Pregnancy , Women's Health Services/standards , Female , Humans , Labor, Obstetric , Mexico , Midwifery/standards , Population Surveillance , Primary Health Care/organization & administration , Rural Health , Socioeconomic Factors , Women's Health Services/organization & administrationABSTRACT
This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72,720 households, collected data on 8,401 live births and 209 infant deaths occurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1,000 live births (95% confidence limits = 1.7, 4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2+ doses of tetanus toxoid was 70% (95% confidence limits = 52, 100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk populations.
