[Seeking tuberculosis care in Chiapas, Mexico]. / La búsqueda de atención para la tuberculosis en Chiapas, México.

OBJECTIVE: To analyze the process of seeking tuberculosis care and this process's impact on treatment adherence in the Mexican state of Chiapas, given that the two primary factors in successful tuberculosis (TB) control programs are early diagnosis and adherence to TB treatment. METHODS: We conducted a qualitative study using group interviews with 11 groups of patients in three of the nine socioeconomic regions of the state of the Chiapas (Altos, Centro, and Fronteriza). RESULTS: The patients applied a variety of approaches in seeking care. The patients reported considerable delays in diagnosis due to problems that the patients themselves had and because of shortcomings in the care they received from the formal health care system. The treatment options that they followed were the result of their perceptions of the causes of TB and of the variety of traditional medical practices accepted in their communities. CONCLUSIONS: The lack of knowledge about TB encourages people to consider various alternatives for their care. Tuberculosis control in Chiapas requires an optimal utilization of the health services that exist in the state as well as a program of health education. TB control in Chiapas must take into account the social, cultural, and economic reality of the population.

[Perceptions and practices related with tuberculosis and treatment compliance in Chiapas, Mexico]. / Percepciones y prácticas relacionadas con la tuberculosis y la adherencia al tratamiento en Chiapas, México.

OBJECTIVE: To identify health perceptions and practices and non-adherence to therapy among tuberculosis patients. MATERIAL AND METHODS: Qualitative research work consisting of 11 group interviews with 62 tuberculosis patients during 1997-1998 in the Central, Highlands, and Border Regions of Chiapas, Mexico. RESULTS: Perceived causes of tuberculosis included contagion via food utensils, excess work, malnutrition, and cold, as well as other causes unrelated to person-to-person contagion. The resulting incapability to work resulted in an economic crisis for both the patients and their family members. As a result of the social stigma imposed by the disease, patients perceived a negative impact on their personal life, family, work, and community. CONCLUSIONS: Lack of knowledge regarding tuberculosis is an important factor in the selection of and adherence to different care alternatives. Inadequate care provided by health services, including an unsatisfactory physician-patient relationship, resulted in diagnostic delay and non-adherence to therapy. Education programs to promote basic knowledge regarding tuberculosis and its treatment are necessary in this region.

[Shortened directly observed treatment of pulmonary tuberculosis]. / Tratamiento acortado estrictamente supervisado para tuberculosis pulmonar.

OBJECTIVE: To evaluate the usefulness of the Shortened Directly Observed Treatment (DOT,S) applied to the Tuberculosis Control Program in Chiapas, Mexico. MATERIAL AND METHODS: The efficacy and efficiency of treatment was evaluated in a cohort of pulmonary tuberculosis patients confirmed by baciloscopy, who were subjected to treatment under one of three different regimes, self-administered, supervised and DOT,S from January to June 1996. RESULTS: Efficacy was 90.9%, 97.7% and 100% for self-administered, supervised and DOT,S treatment, respectively. Efficiency was 68.1%, 77.6% and 88.5% in the same order. CONCLUSIONS: For public health ends, the DOT,S proved to be the most efficient in the control of tuberculosis, since healing rates were increased and this reduces sources of disease transmission.