[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.

[Obstacles to overcome in the control of pulmonary tuberculosis in the border region of Chiapas, Mexico]. / Retos a superar en el control de la tuberculosis pulmonar en la región fronteriza de Chiapas, México.

OBJECTIVE: To improve the control of the pulmonary tuberculosis in the Border Region of Chiapas, Mexico. DESIGN: Academic researchers, health development workers from the nongovernmental sector and government health authorities met in a workshop to analyze recent experiences with tuberculosis. RESULTS: Among the important issues addressed were: with regard to official health services, the lack of resources, particularly medication, organizational problems which result in poor or absent communication within and among different health entities, the under diagnosis of cases and the lack of sufficient index of suspicion for tuberculosis among health personnel. With regard to the population at risk, there are profound socio-cultural barriers which include a lack of confidence in the quality of government health care centers and little attention given to chronic cough. Poorest, indigenous and more remote people have less access to care and are more likely to have advanced tuberculosis before seeking treatment if at all. New strategies proposed were to integrate communication efforts in tuberculosis control among all the involved health services, including private physicians, identify those patients at greatest risk, improve diagnostic skills of health providers, develop education campaigns in rural areas. CONCLUSIONS: Certain factors which impede better TB control seem amenable to change, others, such as severe poverty, particularly among peasants and indigeneous people, as well as the current political disruption, will require much broader intersectorial interventions.

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)

[Risk factors for antitubercular drug resistance in Chiapas, Mexico]. / Factores de riesgo para resistencia a drogas antifímicas en Chiapas, México.

OBJECTIVES: To determine risk factors for antibiotic resistance in patients with pulmonary tuberculosis in four Health Jurisdictions of the state of Chiapas. MATERIAL AND METHODS: A case-control study was carried out in patients diagnosed by acid fast smear during 1992. A questionnaire was applied which included variables related to the diagnosis, treatment and follow-up of the patients. Sputum samples were collected for culture and sensitivity tests. A case of drug-resistant pulmonary tuberculosis was defined as the presence of culture colonies showing resistance to one or more drugs. The control group was patients with negative smears and cultures or positive cultures for M. tuberculosis sensitive to the specific drugs. RESULTS: Of the total of 18 individuals reported to have positive cultures, 13 (72.2%) were resistant to one or more drugs. Resistance to two or more drugs was found in 10 of them of which three were resistant to five antituberculosis drugs. The most frequent resistance was to isoniazid (77%). Risk factors for resistance encountered in this patient population were monotherapy (OR = 34.2), abandonment of treatment (OR = 6.86), a prolonged period of illness (OR = 6.40), delay in diagnosis and a history of prior therapy (OR = 28.3). CONCLUSIONS: The high proportion of patients resistant to antituberculosis therapy poses a public health problem and is a clear consequence of the problems arising from inadequate treatment.