[Impact of delivery care type on perinatal mortality in Tapachula, Chiapas, southern border of Mexico]. / Efectos del tipo de atención del parto en la mortalidad perinatal en Tapachula, Chiapas, frontera sur de México.

PURPOSE: To know and to explain the effects of the obstetrical assistance on the rate of perinatal mortality in a municipality of the state of Chiapas, Mexico which is distinguished by having a marginal rural zone, another one presenting an important agroindustrial and fishery development and the urban area. DESIGN: Transversal, epidemiological study. Some localities representing the three different geopolitic areas of the municipality were selected by probabilistic sampling. Field work was done from october 1996 to march 1997. PARTICIPANTS: Information was obtained by a probabilistic sampling survey of 1,382 pregnancies occurring from 1987 to 1996 in 670 women whose age range was between 15 to 49 years old. The unit of analysis was the set of alive newborns as well as dead newborns (stillbirth) from the 28th week of the gestation period until the first week of extrauterin life. RESULTS: The analysis showed a rate of perinatal mortality of 36.2 per 1000 alive newborns, the percentage of birth assistance by a midwife is of 40 percent while assistance by a relative of the pregnant, her husband or herself is that of 3.8%. The higher risks of increasing the mortality rate were found to be during the gestation period prior to or up to the 7th month (OR = 23.0, p < 0.05), for the lack of prenatal control (OR = 3.44, p < 0.05) and when birth assistance is provided by the woman's husband or a relative (OR = 3.31, p < 0.01). CONCLUSION: Empirical midwives are currently assisting up to the 43% of the pregnancies as far as prenatal control is concerned while they assist up to 40% of the actual deliveries, the later varying when moving to the core of the municipality. Statistically important differences in the rate of perinatal mortality were not found regardless of the type of assistance received prior to and during the actual delivery, by a midwife or a physician.

Efectos del tipo de atención del parto en la mortalidad perinatal en Tapachula, Chiapas, Frontera sur de México / The effects of birth assistance on the rate of perinatal mortality in tapachula, chiapas, south mexican border

Objetivo. Conocer la relación entre el tipo de atención de parto y mortalidad perinatal en el municipio de Tapachula, que se caracteriza por ser la región agropecuaria más importante de la frontera sur de México. Diseño. Estudio epidemiológico de corte transversal. La unidad de observación fue la familia y en ella las mujeres en edad fértil (15-49 años). Se consideró como muerte perinatal aquella defunción u óbito fetal que ocurrió entre la semana 28 de gestación y los 7 días de vida extrauterina; la información fue obtenida mediante historias de embarazos de octubre de 1996 a marzo de 1997. Participantes. Se recolectó información de 673 mujeres que registraron 1.382 embarazos de 1987 a 1996. Resultados. La tasa de mortalidad perinatal se calculó en 36,2 por mil embarazos y/o nacidos vivos, el porcentaje de partos atendidos por médico fue del 56,2 por ciento, por parteras del 40 por ciento y por algún familiar del 3,8 por ciento; la atención del parto en instituciones del sector salud fue del 55,5 por ciento y un 88,8 por ciento de los mismos recibió control de embarazo o prenatal. Se observó un gradiente de protección en la atención del parto médico/familiar RM, 0,30 (0,33-0,69); partera/familiar, RM, 0,16 (0,07-0,39), y de riesgo médico/partera, 1,84 (0,94-3,57). La falta de control prenatal no/sí fue un importante factor de riesgo, RM, 3,45 (1,93-6,17). Conclusiones. La falta de control prenatal es un determinante importante de la mortalidad perinatal. La atención del parto médico/partera no mostró diferencias significativas, por lo que en nuestros países se debe seguir apoyando (AU)

Efecto de las prácticas anticonceptivas sobre la fecundidad en la región fronteriza de Chiapas, México / The effect of contraception on fertillity in the border region of Chiapas, México

Objetivo. Estimar el efecto de las prácticas anticonceptivas sobre la fecundidad en la región fronteriza de Chiapas, México. Material y métodos. Durante 1994 se realizó un estudio epidemiológico de corte transversal en una muestra representativa de 1 560 mujeres no indígenas de 15 a 49 años en la región fronteriza de Chiapas. Se estimaron la prevalencia de uso de métodos anticinceptivos y las tasas globales de fecundidad (TGF) por tamaño de la localidad de residencia (rurales, intermedias y urbanas). Se comparó la TGF entre las mujeres nunca usuarias y alguna vez usuarias de métodos anticonceptivos. Resultados. La TGF estimada para la región fue de 3.67 y varió de 4.14 para áreas rurales a 3.36 para áreas urbanas. No se observaron diferencias en la TGF (3.74 y 3.88) ni el promedio de hijos nacidos vivos (3.47 y 3.48) entre usuarios alguna vez y nunca usuarias de métodos anticonceptivos. Conclusiones. El mayor efecto de las prácticas anticonceptivas en la fecundidad se observó en áreas rurales. El uso tardió de métodos anticonceptivos, así como la edad de unión más temprana entre las usuarias son factores que influyen para dar por resultado un escaso efecto en la fecundidad

Objetive.To estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. Materials and methods. In 1994 an epidemiological cross-sectional study was carried out on a representative sample of 1 560 non-indigenous women between ages 15 and 49 in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TER) were obtained and stratified by rural, intermediate and urban communities. TER were compared between women who had never used contraceptives and those who had used them. Results. The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. Conclusions. The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users.

[The effect of contraception on fertility in the border region of Chiapas, Mexico]. / Effecto de las prácticas anticonceptivas sobre la fecundidad en la región fronteriza de Chiapas, México.

OBJECTIVE: To estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. MATERIALS AND METHODS: In 1994 an epidemiological cross-sectional study was carried out on a representative sample of 1,560 non-indigenous women between ages 15 and 49 in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TFR) were obtained and stratified by rural, intermediate and urban communities. TFR were compared between women who had never used contraceptives and those who had used them. RESULTS: The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. CONCLUSIONS: The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users.

PIP: The objective of this study was to estimate the effect of contraception on fertility in the border region of Chiapas, Mexico. In 1994, an epidemiological cross-sectional study was carried out on a representative sample of 1560 nonindigenous women between the ages of 15 and 49 years in the border region of Chiapas. The prevalence of contraception practices and the total fertility rates (TFR) were obtained and stratified by rural, intermediate, and urban communities. TFR were compared between women who had never used contraceptives and those who had used them. The estimated TFR was 3.67 and varied from 4.14 in rural areas to 3.36 in urban areas. There were no differences in the TFR (3.74 and 3.88) nor in the average live births (3.47 and 3.48) between women who had never used contraceptives and those who had used them. The major effect of contraception on fertility was observed in rural areas. Factors which influence the small impact of contraception on fertility include the late use of these methods and the early age of first union among users. (author's)

Cholesterol levels and prevalence of hypercholesterolemia in a Mexican adult population.

In Mexico, the incidence and prevalence of coronary heart disease (CHD) has increased over the past three decades and has become the leading cause of death in the country. Hypercholesterolemia is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to determine the mean total cholesterol values and the prevalence of hypercholesterolemia, an epidemiologic survey was carried out in a representative national population sample that included men and women aged 1 to 98 years. In this report, we present the findings in all individuals older than 20 years (n = 33,558). Considering the country as a whole, the mean serum total cholesterol (TC) was 4.80 +/- 1.16 mmol/l, the prevalence of borderline hypercholesterolemia (TC between 5.17 and 6.20 mmol/l) was 22.8% and the prevalence of high risk hypercholesterolemia (TC > or = 6.20 mmol/l) was 10.6%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 4.43 +/- 1.05 mmol/l in the south to 5.48 +/- 1.36 mmol/l in the north. The prevalence of high risk hypercholesterolemia was as high as 24.8% in Baja California Norte and as low as 4.0% in the state of Guerrero. These large differences in mean TC values are probably diet related and reinforce the need to carry out prospective and intervention trials related to CHD and its risk factors.

[Factors related to drug use by adolescents in urban areas of Mexico]. / Factores asociados al consumo de drogas en adolescentes de áreas urbanas de México.

This is a retrospective study on teenagers from 14 to 17 years of age based on data from the National Survey on Drug Addiction conducted in 1988. The aim of this study was to discover the factors linked to drug consumption among Mexican urban teenagers. This paper reports prevalence rates (PR), raw and adjusted by gender as well as Cornfield's intervals (CI) of 95 per cent. For women, factors linked to drug use were: alcohol consumption (PR6.5, CI:1.5-28.3); father drug user (PR 3.2, CI:1.1-9.5). For men, factors linked to drug use were: age (PR 3.2; CI: 1.5-7.4); non religious practice (PR 2.7, CI: 1.2-6.4); acquaintances who are users of marihuana, cocaine or heroine-opium (PR 12.2, 6.6 and 7.0 respectively); and if the father, a brother or another relative are drug users (PR 4.1, 7.1 and 3.5 respectively). These findings show important gender differences in drug consumption patterns and linked factors. This paper brings out useful information for a complete understanding of this problem in Mexico.

Cholesterol levels and prevalence of hypercholesterolemia in Mexican children and teenagers.

In Mexico, the incidence and prevalence of coronary heart disease has increased over the past three decades and has become the leading cause of death in some areas of the country. Hypercholesterolemia (HC) is a major risk factor for coronary atherosclerosis and most developed countries currently have public health strategies that attempt to reduce the level of cholesterol. In order to learn the mean total cholesterol values and the prevalence of HC, an epidemiologic survey was carried out in a representative population sample that included men and women aged 1 to 98 years, across the nation. In this report, we present the findings in children and teenagers of both sexes (n = 34369). Considering the country as a whole, the mean serum TC was 147 +/- 35 mg/dl, the prevalence of borderline hypercholesterolemia (TC between 170 and 199 mg/dl) was 14.7% and the prevalence of high risk hypercholesterolemia (TC > or = 200 mg/dl) was 6.7%. This cross sectional study demonstrated the existence of significant geographic differences in serum TC, with mean state values ranging from 133 mg/dl in the south to 164 mg/dl in the north. The prevalences of high risk hypercholesterolemia was as high as 18.2% in Baja California Norte and as low as 2.5% in the state of Morelos. These geographic differences in total cholesterol and prevalence of hypercholesterolemia were already present at one year of age and persisted throughout childhood and adolescence.

[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.

[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.

[Seroepidemiology of toxoplasmosis in Mexico]. / Seroepidemiología de la toxoplasmosis en México.

This article presents to the results of the National Seroepidemiology Survey with regard to the prevalence of toxoplasmosis in Mexico. Some theoretical aspects of the disease are discussed, and the prevalences found in earlier reports are presented. The study measured 29,279 blood samples from persons in all 32 states of Mexico, for both sexes, all ages, and socio-economic groups. The samples were processed by indirect immunofluorescence for antibody titers of 1:16 and 1:128. Positivity levels were stratified by age, sex, socioeconomic level, place of residence, education level, number of persons in the family, state, and with or without rights to care in the social security medical institutions. The results pointed to greater prevalences in the costal areas, in lower socioeconomic levels, and a high incidence in women of reproductive age. Also included are a discussion of socio-economic aspects and the potential role of the domestic cat.

[Seroepidemiology of brucellosis in Mexico]. / Seroepidemiología de la brucelosis en México.

Brucellosis is an important and widely distributed zoonosis in Mexican cattle which also affects an unknown proportion of the human population. This report presents the brucellosis antibody levels registered in the National Seroepidemiology Survey (NAS) in sera obtained from 66,982 healthy persons from one to 98 years of age and determined by the test of plaque microagglutination. Seroprevalences by states ranged from 0.24 per cent in Morelos to 13.5 per cent in the state of Mexico. The national mean was estimated to be 3.42 per cent. The analysis showed no statistical differences for brucellosis antibody levels by urban and rural residence and by density of family sleeping areas (three or more persons vs. one or two persons per bedroom). Adults between 20 and 39 years of age had greater seropositivity and children from one to nine years had the least. Women were most affected and had 48 per cent more seropositivity than men. According to the information obtained in the study, brucellosis in Mexico has the following characteristics: it is related to gender but not to occupation; affects persons in all age groups, social strata and is independent of size of the community of residence. Historically, brucellosis has been an endemic disease in Mexico. Recently an increasing incidence has been reported, and this is possibly due to a better national notification system.

[Factors related to mortality in neonatal tetanus in the rural area of Jalisco]. / Factores asociados a la mortalidad por tétanos neonatal en el área rural de Jalisco.

In this article, we report the results of a survey taken in towns with less than 2,500 inhabitants in the rural tetanigenic zone of the State of Jalisco. The purpose was to know the Infant Mortality Rate (IMR), the Neonatal Tetanus Mortality Rate (NTMR), the incidence of neonatal tetanus, and a partial register of these indicators, as well as the identification of the risk factors associated with fatalities from this disease. The sampling was multistaged with random selection of the conglomerates. The results were as follows: 75 deaths in children of less than one year of age with an IMR of 34.7 per 1,000 Live Births Registered (LBR), 40 deaths in those of less than 29 days old (Neonatal Mortality Rate of 18.5 per 1,000 LBR), eight deaths by neonatal tetanus (NTMR of 3.7 per 1,000 LBR), the estimated annual incidence rate of neonatal tetanus was 4.6 per 1,000 LBR, and the proportion of neonatal deaths due to tetanus was 20 per cent. The main factors studied which were statistically found to be significantly associated with the mortality rate from neonatal tetanus were: a maternal history of two or more prior child deaths having an Odds Ratio (OR) of seven; the existence of cramped living conditions greater than 3.5 persons per room (OR = 7.93); maternal illiteracy (OR = 7.22); and birth at the home (OR = 17.89). When the logistics model was used to control some of the misleading factors and obtain adjusted OR estimates, place of birth and the maternal history or two or more prior child deaths were found to be significant.