Prevalence of congenital malformations and deformities of the osteomuscular system in live newborns in Mexico, 2008-2017.

BACKGROUND: From 2009 to 2010 in Mexico. CMDOMS prevalence was 27.4/10,000 births. The first places were congenital deformation of the feet with a prevalence of 8.0 and congenital deformation of the hip with 6.7/10,000 births. OBJECTIVE: To estimate for Mexico the national prevalence of CMDOMS in live births, by state and municipality, as well as to analyze spatial distribution by these same territorial delimitations. METHOD: A database of 20,175,422 newborns (NB) alive from 2008 to 2017 was integrated. Percentages and prevalence were calculated at the national level, federal entities and municipalities, with confidence intervals at 95%. Maps were made and prevalence was stratified. RESULTS: The congenital malformation prevalence rate was 77.8/10,000 NB. CMDOMS were in first place with 40.8% and a prevalence of 31.8/10,000 NB. Prevalence by federal entity presented a range of 8.0-75.8/10,000 NB, were stratified by states and municipalities for presentation on maps. CONCLUSION: In Mexico for the years 2008-2017 an increase in CMDOMS prevalence was observed globally and in particular of some specific causes.

ANTECEDENTES: En México, de 2009 a 2010, la prevalencia de las malformaciones y deformidades congénitas del sistema osteomuscular (MDCSOM) fue de 27.4 por 10,000 nacimientos. Los primeros lugares los ocuparon la deformación congénita de los pies, con una prevalencia de 8.0, y la deformación congénita de la cadera, con 6.7 por 10,000 nacimientos. OBJETIVO: Estimar para México la prevalencia nacional de MDCSOM en nacidos vivos (NV), por entidad federativa y municipio, y analizar su distribución espacial por esas mismas delimitaciones territoriales. MÉTODO: Se integró una base de datos de 20,175,422 NV en 2008-2017. Se calcularon porcentajes y prevalencias por ámbito nacional, entidades federativas y municipios, con intervalos de confianza al 95%. Se elaboraron mapas y se estratificaron las prevalencias. RESULTADOS: La tasa de prevalencia de malformaciones congénitas fue de 77.8 por 10,000 NV. Se ubicaron en el primer lugar las MDCSOM, con un 40.8% y una prevalencia de 31.8 por 10,000 NV. Las prevalencias por entidad federativa presentaron un rango de 8.0 a 75.8 por 10,000 NV; se estratificaron por estados y municipios para su presentación en mapas. CONCLUSIÓN: En México, para los años 2008-2017, se observa un incremento en las prevalencias de las MDCSOM en forma global y en particular por algunas causas específicas.

Demand for obstetric care and density of health resources for childbearing age Mexican women.

INTRODUCTION: In Mexico, there is an increase recorded in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. OBJECTIVE: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). METHOD: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. RESULTS: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the "very high" stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality. CONCLUSIONS: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.

INTRODUCCIÓN: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. OBJETIVO: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). MÉTODO: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. RESULTADOS: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato "muy alto", en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. CONCLUSIONES: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.

Demanda de atención obstétrica y densidad de recursos en salud para mujeres mexicanas en edad fértil / Demand for obstetric care and density of health resources for childbearing age Mexican women

Resumen Introducción: México registra aumento de las cesáreas e inequidad y desigualdad en la distribución de recursos para la atención obstétrica. Objetivo: Identificar las entidades y municipios en México que concentran la demanda de atención obstétrica y tasas de cesáreas y su relación con los recursos en salud y mujeres en edad fértil (MEF). Método: Se registraron los nacimientos del periodo 2008-2017, agrupados en cinco estratos municipales, y los recursos en salud y MEF de 2017. Resultados: La tasa nacional de cesáreas 2008-2017 fue de 45.3/100 nacimientos; 95 y 97 % de los nacimientos y cesáreas se concentraron en el estrato “muy alto” (470 municipios), en el cual se utilizó 80 % o más de los recursos en salud y destacó la sobreutilización. La densidad de recursos en salud destinados a las MEF reflejó inequidad y desigualdad. Conclusiones: La alta concentración de la demanda obstétrica y oferta de los recursos en salud pudiera conllevar mayor recurrencia a la cesárea. En las políticas de reducción de cesáreas es necesario considerar la organización y administración adecuadas de los recursos en salud.

Abstract Introduction: In Mexico, there is an increase in the number of C-sections, as well as inequity and inequality in the distribution of resources for obstetric care. Objective: To identify the states and municipalities in Mexico that concentrate the demand for obstetric care and the C-section rates and their relationship with health resources and women of childbearing age (WCBA). Method: Births of the 2008-2017 period were recorded, grouped into five municipal strata, as well as 2017 health resources and WCBA. Results: The 2008-2017 national rate of C-sections was 45.3/100 births; 95 and 97 % of births and C-sections were concentrated in the “very high” stratum, where 80 % or more of health resources were used, with overuse standing out. The density of health resources assigned to WCBAs reflected inequity and inequality Conclusions: The high concentration of obstetric demand and health resources supply could entail a higher recurrence of C-sections. Policies for C-section reduction should consider proper organization and administration of health resources.

Prevalencia del síndrome de Down en México utilizando los certificados de nacimiento vivo y de muerte fetal durante el periodo 2008-2011 / Prevalence of Down syndrome using certificates of live births and fetal deaths in México 2008-2011

Introducción: El síndrome de Down (SD) o trisomía 21 es la causa genética más frecuente de retraso mental. Clínicamente presenta una serie de características bien definidas. Se ha asociado la edad materna avanzada con la presencia de SD. Métodos: Se conjuntaron las bases de datos de los certificados de nacimientos vivos y de muerte fetal. Se seleccionaron los códigos con base en la Clasificación Internacional de Enfermedades décima revisión (CIE-10) del capítulo XVII: <

Background: Down syndrome (DS) or trisomy 21 is the most common genetic cause of mental retardation with the clinical presentation of a series of well-defined characteristics. Advanced maternal age has been associated with DS. Methods: The databases of all the certificates of live births and fetal deaths in Mexico were combined. Codes based on the International Classification of Diseases 10th Revision (ICD-10) in Chapter XVII "Congenital malformations, deformations and chromosomal abnormalities" were selected. Results: A database of 8,250,375 births during the period 2008-2011 was constructed: 99.2% were live births with 0.8% of fetal deaths and 3,076 cases diagnosed with DS. Conclusions: The importance of this report is to initiate an epidemiological surveillance of newborn cases of DS nationwide and by state using census information systems available in the country since 2008. An increased risk has been observed for having a child with DS since the mother is ≥ 35 years, as has been reported in other studies.

[Prevalence of Down syndrome using certificates of live births and fetal deaths in México 2008-2011]. / Prevalencia del síndrome de Down en México utilizando los certificados de nacimiento vivo y de muerte fetal durante el periodo 2008-2011.

BACKGROUND: Down syndrome (DS) or trisomy 21 is the most common genetic cause of mental retardation with the clinical presentation of a series of well-defined characteristics. Advanced maternal age has been associated with DS. METHODS: The databases of all the certificates of live births and fetal deaths in Mexico were combined. Codes based on the International Classification of Diseases 10th Revision (ICD-10) in Chapter XVII "Congenital malformations, deformations and chromosomal abnormalities" were selected. RESULTS: A database of 8,250,375 births during the period 2008-2011 was constructed: 99.2% were live births with 0.8% of fetal deaths and 3,076 cases diagnosed with DS. CONCLUSIONS: The importance of this report is to initiate an epidemiological surveillance of newborn cases of DS nationwide and by state using census information systems available in the country since 2008. An increased risk has been observed for having a child with DS since the mother is ≥ 35 years, as has been reported in other studies.

Prevalencia de malformaciones congénitas registradas en el certificado de nacimiento y de muerte fetal: México, 2009-2010 / Prevalence of congenital malformations recorded on the birth certificate and fetal death, Mexico, 2009 to 2010

Introducción. Las malformaciones congénitas son causas importantes de mortalidad infantil, enfermedad crónica y discapacidad en muchos países. La frecuencia esperada es de 2 a 3% en nacidos vivos y de 15 a 20% en muertes fetales. En México, en 2010, la mortalidad infantil ocupó el segundo lugar, con una tasa de 336.3/100,000 nacimientos. El objetivo de este trabajo fue estimar la prevalencia de malformaciones congénitas en México al nacimiento y las principales causas registradas en los certificados de nacimiento y muerte fetal para el período 2009-2010. Métodos. Se conjuntaron las bases de datos del certificado de nacimiento de nacido vivos y del de muerte fetal. Resultados. La población total fue de 4'123,531 registros, 99.3% nacidos vivos y 0.7% muertes fetales. Se registró un total de 30,491 casos de malformaciones congénitas en 91.7% nacidos vivos y 8.3% muertes fetales. La prevalencia fue de 73.9/10,000 nacimientos. Conclusiones. La tasa de prevalencia fue más baja que la esperada. Se requieren programas de validación y capacitación para fortalecer estos sistemas de registro.

Background. Congenital malformations are a main cause of infant death, chronic illness and disability in several countries. The expected frequency is ~2-3% in live newborns and ~15-20% in stillbirths. In 2010 in Mexico, infant mortality ranked in second place with a rate of 336.3/100,000 births. In order to estimate prevalence and main causes of congenital malformations in live births and stillbirths, national base registries of newborns and stillbirths were evaluated for 2009-2010. Methods. Databases of neonatal live births and fetal deaths were combined. Results. From a total population of 4,123,531 certificates, 99.3% were live born and there were 0.7% fetal deaths. Congenital malformations were registered in 30,491 cases, 91.7% of live newborns and 8.3% of fetal deaths with a prevalence rate of congenital malformations of 73.9/10,000. Conclusions. The reported prevalence was lower than expected. It is necessary to enforce registry systems through system validation and training of personnel.

[Urbanization, megalopolization and mortality from birth defects in children under five years of age in Mexico]. / Urbanización, megalopolización y mortalidad por defectos al nacimiento en menores de cinco años en México.

OBJECTIVES: To identify the spatial-geographical relationship between local priority birth defect (BD) mortality in children under five years of age with demographic and economic variables representing megalopolization: urban localities,municipalities with larger populations and population density, and units and total gross output of agriculture, manufacturing and transportation. MATERIAL AND METHODS: Thematic maps were produced in the form of polygons and point to their juxtaposition and analysis of spatial correspondence. RESULTS: Priority municipality concentrations: 98.6% of the localities of 50,000 to 99,999, 100% of the cities of 100,000 inhabitants or more; 84.3% of the total population; the activity and productivity of agricultural (62.7 and 82.2%), manufacturing (83.4 and 96.9%) and of transport (92.2 and 96.8%). CONCLUSIONS: Priority municipalities concur with those where the processes of urbanization and megalopolization have a more intense effect. There is scientific evidence in the medical literature on the relationship between megalopolization,pollution, and BD. It is proposed that more should be found out about this relationship in Mexico.

Mortalidad por defectos en el cierre del tubo neural en menores de 5 años de edad en México de 1998 a 2006

Objetivos. Analizar la mortalidad por defectos en el cierre del tubo neural (DTN) en niños menores de 5 años de edad, en México de 1998 a 2006 en municipios prioritarios y compararla con la relativa a defectos al nacimiento (DAN). Material y métodos. Las fuentes de datos fueron la Secretaría de Salud y el Instituto Nacional de Estadística, Geografía e Informática. Se utilizó el análisis espacial para la selección de municipios y los criterios se basaron en percentiles. Resultados. Las defunciones por DTN representaron entre 39.63 y 56.91 por ciento de los defectos del sistema nervioso y disminuyeron 53 por ciento. La tasa descendió 59 por ciento. De las muertes, entre 86 y 93 por ciento correspondieron a menores de 5 años. La tasa en menores de 1 año descendió 51 por ciento; en los de 1 a 4 años, 60 por ciento. 205 municipios resultaron de alta prioridad, concentrando 63.23 por ciento de fallecimientos. El índice Kappa entre municipios prioritarios DAN/DTN fue 0.75. Conclusión. En los municipios seleccionados se deben enfatizar las acciones contra los DTN.

Objectives. To analyze mortality due to neural-tube defects (NTD) in children under 5 years of age, 1998-2006 and select priority municipalities and compare them to those selected for birth defects (BD). Materials and Methods. Sources of data were the Secretary of Health and the National Institute of Statistics and Geography. Spatial analysis was used to select municipalities and criteria were based on percentiles. Results. Deaths due to NTD represented 39.63 percent - 56.91 percent of nervous system defects and decreased 53 percent; the rate decreased 59 percent. Regarding deaths, 86-93 percent occurred in children under 5 years of age. The rate for children under 1 year of age decreased 51 percent, and 60 percent for 1-4 years of age. A total of 205 municipalities resulted in being high priority, where 63.23 percent of deaths were concentrated. The Kappa index between BD/NTD priority municipalities was 0.75. Conclusion. Actions against NTD should be emphasized in the selected municipalities.

[Neural-Tube Defects mortality in children under 5 years of age in Mexico, 1998 to 2006]. / Mortalidad por defectos en el cierre del tubo neural en menores de 5 años de edad en México de 1998 a 2006.

OBJECTIVES: To analyze mortality due to neural-tube defects (NTD) in children under 5 years of age, 1998-2006 and select priority municipalities and compare them to those selected for birth defects (BD). MATERIALS AND METHODS: Sources of data were the Secretary of Health and the National Institute of Statistics and Geography. Spatial analysis was used to select municipalities and criteria were based on percentiles. RESULTS: Deaths due to NTD represented 39.63% - 56.91% of nervous system defects and decreased 53%; the rate decreased 59%. Regarding deaths, 86-93% occurred in children under 5 years of age. The rate for children under 1 year of age decreased 51%, and 60% for 1-4 years of age. A total of 205 municipalities resulted in being high priority, where 63.23% of deaths were concentrated. The Kappa index between BD/NTD priority municipalities was 0.75. CONCLUSION: Actions against NTD should be emphasized in the selected municipalities.

[Periconceptional use of folic acid in health centers from the territorial sanitary jurisdiction of Tlalpan, Mexico City]. / Uso periconcepcional de ácido fólico en centros de salud de la Jurisdicción Sanitaria de la Delegación Tlalpan.

BACKGROUND: In 1992, the United States Public Health Service, the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the United States Institute of Medicine recommended periconceptional intake of 400 microg of folic acid (FA) in order to reduce the risk of neural tube defects (NTD) by 70%. Our objective was to assess among pregnant women the periconceptional intake of FA and to assess the level of knowledge among health professionals regarding the benefits associated with FA intake as a preventive measure of NTD. METHODS: We designed a prospective and cross-sectional study to assess certain sociodemographic and reproductive health characteristics, knowledge of periconceptional intake, benefits of FA intake among pregnant women and among health workers. Descriptive statistics was employed. RESULTS: From 200 pregnant women, only 1.7% had taken 400 microg doses of periconceptional FA. Among participating health care personnel only 10.17% knew about the benefits of periconceptional intake of 400 microg of FA. CONCLUSIONS: Periconceptional intake of FA among our sample of pregnant woman was very low and knowledge of its benefits among health professionals was also scarce.

Uso periconcepcional de ácido fólico en centros de salud de la Jurisdicción Sanitaria de la Delegación Tlalpan / Periconceptional use of folic acid in health centers from the territorial sanitary jurisdiction of Tlalpan, Mexico City

Antecedentes: En 1992, el Servicio de Salud Pública, la Academia Americana de Pediatría, los Centros para Control y Prevención de Enfermedades y el Instituto de Medicina de Estados Unidos de Norteamérica, señalaron que la ingesta materna periconcepcional de 400 μg de ácido fólico (AF) reduce el riesgo de los defectos de cierre del tubo neural en alrededor de 70%. El objetivo del presente estudio fue evaluar en embarazadas la ingesta periconcepcional de AF y el conocimiento del equipo de salud del primer nivel de atención sobre el beneficio del AF para prevención de los defectos de cierre del tubo neural. Métodos: Se diseñó un estudio prospectivo y transversal para evaluar las características sociodemográficas y de salud reproductiva, así como el conocimiento del beneficio de la ingesta de AF en las mujeres embarazadas y en el equipo de salud. Se utilizó estadística descriptiva. Resultados: Entre 200 mujeres embarazadas, el 99.5% conocía que el AF previene malformaciones congénitas pero solo el 1.7% ingería 400 μg de AF en forma periconcepcional; en el equipo de salud solo 10.2% estaba al tanto de la ingesta periconcepcional de 400 μg de AF. Conclusiones: La ingesta periconcepcional de AF para prevenir defectos de cierre del tubo neural es mínima en las mujeres embarazadas de los centros de salud estudiados.

BACKGROUND: In 1992, the United States Public Health Service, the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the United States Institute of Medicine recommended periconceptional intake of 400 microg of folic acid (FA) in order to reduce the risk of neural tube defects (NTD) by 70%. Our objective was to assess among pregnant women the periconceptional intake of FA and to assess the level of knowledge among health professionals regarding the benefits associated with FA intake as a preventive measure of NTD. METHODS: We designed a prospective and cross-sectional study to assess certain sociodemographic and reproductive health characteristics, knowledge of periconceptional intake, benefits of FA intake among pregnant women and among health workers. Descriptive statistics was employed. RESULTS: From 200 pregnant women, only 1.7% had taken 400 microg doses of periconceptional FA. Among participating health care personnel only 10.17% knew about the benefits of periconceptional intake of 400 microg of FA. CONCLUSIONS: Periconceptional intake of FA among our sample of pregnant woman was very low and knowledge of its benefits among health professionals was also scarce.