Maternal mortality regionalization and trend in Mexico (1937-1995)

BACKGROUND: The objectives were to establish regions by level of maternal mortality in order to evaluate its trend from 1937-1995 and to analyze characteristics of cases which occurred from 1990-1995. METHODS: Regionalization of the country by maternal mortality level was carried out using Poisson regression. Level and mortality trends were analyzed globally and compared by regions using Poisson and linear regression. Characteristics of cases were analyzed from 1990-1995 using proportions and X2 test. RESULTS: Four well-differentiated and independent regions were established. Low and medium maternal mortality rate regions were found in northern and northwestern Mexico. High and very high maternal mortality regions were found in the South and the Southeast of the country. Even when maternal mortality had descended, the speed of the descent has decreased and in the last few years, maternal mortality has increased. The quality of health care is a challenge for regions with low mortality rates, while the problem of accessibility is present in those with very high mortality rates. CONCLUSION: The employment of this regionalization approach in maternal mortality analysis would be useful to determine specific problems for each region. The establishment of programs according to this analysis could contribute to decrease in maternal mortality cases in Mexico.

[Evaluation of Mexican biomedical journals]. / La evaluación de las revistas biomédicas mexicanas.

We present the evaluation procedures of Biomedical Journals, performed by the Journal Committee of the Centro Nacional de Información y Documentación sobre Salud (CENIDS) for the preparation of CR-ROM ARTEMISA 2 (Edited health information articles in Mexico), which contains a database of the complete text of articles appearing in the journals of the highest quality published in Mexico.

[Private medicine in Mexico: the results of the National Census of Private Hospital Units]. / La medicina privada en México: resultados del Censo Nacional de Unidades Hospitalarias Privadas.

A census of private health establishments was carried out by the Secretary of Health, in order to quantify its resources and to describe their geographical distribution. The census, conducted in 1994, was limited to private units which offered hospitalization services, and the reference period was the previous year. Results showed that there are 2,723 private hospitalization units in Mexico, and nearly a half of the units are concentrated in the Federal District, and the states of Mexico, Guanajuato, Michoacán, Baja California and Veracruz. The number of private hospitalization beds registered in the country are 33,937, these figures indicate that private medicine is the main hospital care provider in the national health system. Similar results were obtained regarding other material and human resources. It is important to stress the need for further research regarding the role of private medicine in Mexico, including aspects related to the quality of the services being provided.

[Basic aspects of public health surveillance for the 90s]. / Aspectos básicos de la vigilancia en salud pública para los años noventa.

In this paper we propose a wider scope for public health surveillance in order to incorporate demographic and health systems monitoring along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes--not a sector of activity or a type of health service--but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we stress the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available--let alone any knowledge about how to treat persons for the major diseases that affected them. Later on, and largely as the result of impressive advances in biomedical knowledge, surveillance activities tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the newer proposals tend to recapture part of the spirit and scope of earlier definitions, prompted perhaps by such thoughtful historic parallels as the newly emerging health problems for which we have no clear-cut solution. If one element has to be stressed to promote the objectives of health surveillance today, it is the need to anticipate health outcomes and not just respond to them. This, in turn, requires an increased attention to the surveillance of risk factors, and a greater understanding of the complex causal relationships that those factors--including behavioral, lifestyle, and environmental ones--with adverse health outcomes and disability. Needless to say that, the first and foremost aim of health care--and of modern surveillance--is to promote the well-being of individuals by improving their health.

[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.

[An evaluation of the Mexico-BID Health Services Improvement Program, 1991]. / Evaluación del Programa de Mejoramiento de Servicios de Salud México-BID, 1991.

The evaluation of the program for enhancing health services showed advances in the building and provision of equipment for the health units, as well as development of additional operative capability until 1991. One of the main characteristics of the evaluation process, was the utilization of the local and state information systems, which allow the selective use of indicators in order to identify the advances of the program of expanded coverage and enhance of the quality of care and its direct relationship with the organization of health services. The present research constitutes a good example of the development of programmes funded by multilateral organizations.

[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.

Key issues in public health surveillance for the 1990s.

In this paper, we have proposed a wider scope for public health surveillance in order to incorporate demographic and health-system monitoring, along with activities conventionally associated with epidemiologic surveillance. This new conception stems, in turn, from a revised definition of public health, which describes, not a sector of activity or a type of health service, but a level of aggregation based on the population at large. In our review of the ideas that lead to the institutionalization of health surveillance, we have stressed the broad concepts developed by such pioneers as Graunt and Petty. Their original concepts emerged from their active concerns for the public's health at a time when no scientific theory of contagion was available, let alone any knowledge about how to treat persons for the major diseases. Later on, largely as the result of impressive advances in biomedical knowledge, public health surveillance tended to specialize and to concentrate predominantly on disease outbreaks and on salient adverse health conditions. Health surveillance became closely associated with epidemiologic surveillance, which in turn became associated with the ability to respond promptly to adverse health outcomes. Recently, we have witnessed a gradual broadening of both the concepts and the practice of health surveillance. Paradoxically, the new currents tend to recapture some of the spirit and scope of the early definitions, prompted perhaps by grave historical parallels--we face newly emerging health problems for which we have no clear-cut solutions. If one element needs to be stressed to promote the objectives of health surveillance today, it is that we need the ability to anticipate health outcomes and not just respond to them. This, in turn, requires that we give more weight to the surveillance of risk factors and that we increase our understanding of the complex causal interrelationships that link exposure to risk factors--including behavioral, life-style, and environmental ones--with adverse health conditions and disability. Needless to say, the first and foremost aim of health care--and modern surveillance is one of the tools needed to achieve this aim--is to promote the well-being of individuals while improving their health.

[Malnutrition as a multiple cause of death]. / El análisis de la desnutrición como causa múltiple de muerte.

With the purpose of describing the role of malnutrition at death time, an analysis of multiple causes of death in children under five years-old was performed on deaths which occurred during April and May 1985 in Mexico City. A proportional mortality analysis was done taking in consideration all the causes listed on the death certificate, not only the underlying causes. The number of deaths associated to malnutrition was greater by multiple cause than by underlying cause (OR = 7.9, 95% CI 5.0-12.7, p = 0.00000). The importance of considering multiple causes of death, mainly when there are frequent diseases which are some times recorded as underlying cause of death, is also discussed.

[Epidemiologic overview of measles in Mexico: current situation and perspectives]. / Panorama epidemiológico del sarampión en México: situación actual y perspectivas.

It has been recognized that due to immunization campaigns and specific treatment of medical complications, has resulted in a reduced measles mortality in México as in others countries. However, during the last few years the number of measles cases in México has shown an increasing trend over previous years due to two larges epidemics, in 1985 and 1989. As a vaccine preventable disease, the number of measles cases has shown an important decline in mortality as compared with mortality in the general population. From the total deaths in children under five years the measles deaths have been reduced from a level of 2.8% in 1969 to a level of 1.6% in 1985. The more recent mortality data available shows that 597 deaths caused by measles were registered in 1986, for a mortality rate of 0.75 per 100,000 inhabitants. At higher rate was observed in the age groups less than 1 year with a mortality rate of 5.9 per 100,000 inhabitants compared with 4.2 in the group from 1 to 4 years. The morbidity epidemiologic surveillance system among governmental health services reported a total of 20,076 cases in 1989, with an incidence rate of 23.8 cases per 100,000 inhabitants and a estimated mortality rate of 6.6%. This recent emergence of the measles activity in México is part of a pandemic that is affecting several countries around the world. The impact of these cases on an increased demand of medical care as well as its clinical complications, outcome and mortality, makes measles a high priority problem in México.

[Years of potential life lost: their usefulness in the analysis of mortality in Mexico]. / Años de vida potencial perdidos: su utilidad en el análisis de la mortalidad en México.

The evolution of the epidemiology of mortality in developing countries requires the use of indicators additional to cause specific mortality rates. This paper presents the leading causes of potential years of life lost in Mexico in 1983, by sex. Methodologic discussion focused on age limits and relative numbers. The indicator proved useful to assess the impact of infectious diseases, accidents and homicides as causes of premature death. It was also useful to identify years of potential life lost attributable to specific age and sex groups. The use of years of potential life lost provides valuable information to epidemiologic mortality analysis.