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.

Estudio de variabilidad geográfica de las hospitalizaciones potencialmente evitables en México durante tres quinquenios.

INTRODUCCIÓN: Las enfermedades que motivan hospitalización potencialmente evitable tienen la característica de ser sensibles a la prevención, diagnóstico y control ambulatorio en atención primaria a la salud. OBJETIVOS: Identificar la tendencia nacional de la hospitalización potencialmente evitable entre 2001 y 2015 y analizar el patrón geográfico a nivel municipal y priorizar municipios. MÉTODO: Se usaron los egresos hospitalarios de la Secretaría de Salud. Se calcularon tasas de prevalencia nacionales y razones municipales, estandarizadas por edad y sexo. Se emplearon estadísticos de variabilidad para analizar y elaborar mapas. RESULTADOS: De los egresos hospitalarios, 10.39, 9.81 y 9.26 % se clasificaron como hospitalizaciones potencialmente evitables para cada periodo quinquenal. La tasa nacional se incrementó en el lapso estudiado: de 36.27 a 47.24 por 10 000 habitantes. La diabetes mellitus, las gastroenteritis y otras enfermedades de las vías respiratorias inferiores fueron las causas de mayor frecuencia. Los patrones geográficos en los tres periodos fueron semejantes. Se identificaron 487 municipios prioritarios, 174 con alto uso y 313 con sobreuso hospitalario, que concentraron 35.83 % de las hospitalizaciones evitables, 8.58 y 27.25 %, respectivamente. CONCLUSIONES: En México existe amplia variabilidad geográfica de la hospitalización potencialmente evitable con un patrón casi inmutable. INTRODUCTION: Diseases that motivate potentially preventable hospitalization (PH) have the characteristic of being sensitive to prevention, diagnosis and control on an outpatient basis in primary care. OBJECTIVES: To identify the national trend of potentially avoidable hospitalization between 2001 and 2015; to analyze its geographical pattern at the municipal level and prioritize municipalities. METHOD: Hospital discharge records from the Ministry of Health were used. National prevalence rates and municipal PH ratios, standardized by age and gender, were calculated. Variability statistics were used to analyze and generate maps. RESULTS: Among all hospital discharges, 10.39%, 9.81% and 9.26% were classified as PH for each period. The national PH rate did increase in the studied period: from 36.27 to 47.24 per 10,000 population. Diabetes mellitus, gastroenteritis and other diseases of the lower respiratory tract were the most common causes. Geographic patterns of PH were similar for the three periods. A total of 487 priority municipalities were identified, 174 with hospital high use and 313 with overuse, 35.83 % were avoidable hospitalizations, 8.58% and 27.25%, respectively. CONCLUSIONS: In Mexico there is wide geographical variability in PH, with an almost unchanging geographical pattern.

[Percentage of births and fertility rates in adolescents in Mexico (2008-2012): stratification and priorization of municipalities with high risk]. / Porcentaje de nacimientos y tasas de fecundidad en adolescentes de México (2008-2012): estratificación y priorización de municipios con alto riesgo.

BACKGROUND: Mexico in 2008 was designed as the first place of adolescent pregnancy at the Organization for Economic Cooperation and Development, with specific fertility rate (SFR) for 15-1 9years of age of 64.2/1,000 woman at the same age. OBJECTIVE: Estimate of percentage births and SFR in adolescent population at national, state and municipal level in Mexico in 2008-2012 at the total group of adolescents 10 to 1 9 years old and by subgroups of 10-14 and 15 tol 9 years old, identifying the priority municipalities with adolescence pregnancies. MATERIAL AND METHOD: Data bases of certificates of live birth and fetal death with gestational age of 22-45 weeks were joined in 2008-2012. RESULTS: A data base of 1 0'585,032 births in 2008-2012 was obtained, 98.9% were live births and 1.1% was stillbirths. The SFR nationwide for the period 2008-2012 were of the order of 3.l for the group of 10-1 4years, 75.3 for 15-19, 39.6 for the total group of 10-19 years and 66.1 for 20 to 49 years per 1000 women for the same age. CONCLUSION: In the last decade it has increased teen pregnancy as well as the percentage of births and the fertility rate in this age group, worrying situation for the high risk of biological, psychological and social damage that pregnancy early.

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.

[Birth defects mortality in five-year-old minors of age, Mexico, 1998-2006]. / Mortalidad por defectos al nacimiento en menores de 5 años de edad en México de 1998 a 2006.

OBJECTIVE: To analyze mortality due to birth defects from 1998-2006. To select municipalities with high mortality among children under 5 years of age. MATERIAL AND METHODS: The source of information was mortality records from vital statistics collected by SSA/INEGI. We used the 2005 Municipal Geostatistical Framework by INEGI and SIGEPI for the spatial analysis. The selection criteria were municipalities with 80% and over of deaths due to birth defects. RESULTS: Deaths diminished 8% during 1998-2006 and rates decreased 20%. A total of 42.57% - 48% of deaths are due to circulatory system defects and 13.69% - 19.39% are due to the nervous system; the former rose 4% and the latter fell 32%. Eighty percent or more occur in children under 5 years and the rate in this group fell 8.63%. A total of 1 025 (41.82%) municipalities are priorities, 104 (10.14%) are high and 102 (9.95%) are very high priorities, where 66% of deaths occur among children under 5 years old. DISCUSSION: The interventions to decrease mortality due to birth defects should be directed towards one-year-old children (75%) and towards 8.4% of the municipalities that are a very high priority, since they represent 66% of the deaths.

Mortalidad por defectos al nacimiento en menores de 5 años de edad en México de 1998 a 2006 / Birth defects mortality in five-year-old minors of age, Mexico, 1998-2006

OBJETIVOS: Analizar la mortalidad por defectos al nacimiento (DAN) entre 1998 y 2006. Seleccionar los municipios con alta mortalidad en < 5 años de edad. MATERIAL Y MÉTODOS: Las fuentes de información fueron los registros de mortalidad de las estadísticas vitales de SSA/INEGI. Se utilizó el Marco Geoestadístico Municipal 2005 del INEGI y el SIGEPI para el análisis espacial. Los criterios de selección fueron los municipios con percentiles de 80 y mayores de las defunciones por DAN. RESULTADOS: Los decesos disminuyeron 8 por ciento en el periodo de 1998 a 2006 y las tasas 20 por ciento. Una proporción de 42.57 a 48 por ciento de las muertes se debe a defectos del sistema circulatorio y 13.69 a 19.39 por ciento del sistema nervioso; las primeras se incrementaron 4 por ciento y las segundas descendieron 32 por ciento. Hasta 80 por ciento o más ocurre en < 5 años y la tasa en este grupo decreció 8.63 por ciento. Un número de 1 025 (41.82 por ciento) municipios es prioritario, 104 (10.14 por ciento) de alta y 102 (9.95 por ciento) de muy alta prioridad. En ellos se produce 66 por ciento de las muertes en < 5 años. DISCUSIÓN: Las intervenciones para reducir la mortalidad por DAN deben focalizarse en los menores de 1 año (75 por ciento) y en 8.4 por ciento de los municipios con muy alta prioridad, ya que concentran 66 por ciento de los decesos.

OBJECTIVE: To analyze mortality due to birth defects from 1998-2006. To select municipalities with high mortality among children under 5 years of age. MATERIAL AND METHODS: The source of information was mortality records from vital statistics collected by SSA/INEGI. We used the 2005 Municipal Geostatistical Framework by INEGI and SIGEPI for the spatial analysis. The selection criteria were municipalities with 80 percent and over of deaths due to birth defects. RESULTS: Deaths diminished 8 percent during 1998-2006 and rates decreased 20 percent. A total of 42.57 percent - 48 percent of deaths are due to circulatory system defects and 13.69 percent - 19.39 percent are due to the nervous system; the former rose 4 percent and the latter fell 32 percent. Eighty percent or more occur in children under 5 years and the rate in this group fell 8.63 percent. A total of 1 025 (41.82 percent) municipalities are priorities, 104 (10.14 percent) are high and 102 (9.95 percent) are very high priorities, where 66 percent of deaths occur among children under 5 years old. DISCUSSION: The interventions to decrease mortality due to birth defects should be directed towards one-year-old children (75 percent) and towards 8.4 percent of the municipalities that are a very high priority, since they represent 66 percent of the deaths.

[Maternal mortality decrease at IMSS, 2000-2005. As a result of specific actions or by chance?]. / El descenso de la mortalidad materna en el IMSS, 2000-2005. ¿Azar o resultado de acciones específicas?

OBJECTIVE: to assessment the epidemiological characteristics and evolution of maternal hospital deaths at Instituto Mexicano del Seguro Social (IMSS) on the years 2000-2005 and to analyze a possible relation with a specific program to reduce it, starting in 2001. METHODS: we collected and studied data about 253 and 144 hospital maternal deaths between 2000 and 2005, respectively. We compared rates, causes, type of obstetrical death, age, parity, history of prenatal care and preventability at admission in hospitals were the women died. Data about live births in were obtained from the official Information Medical System of IMSS. The analysis was made with descriptive statistical measures and values of chi(2). RESULTS: the maternal mortality rate fell by 30.8 %, as result of a decline from 39 per 100,000 live births in 2000, to 27 in 2005; the proportion of direct obstetric deaths showed a reduction from 77.1 to 66.7 %; all the specific-age mortality rates felt too, but with some variability. Preeclampsia-eclampsia, hemorrhages and abortion were responsible for more of 50 % of total deaths in both years compared. We did not observe significant changes in other variables. CONCLUSIONS: the reduction in general rate of hospital maternal mortality, in percentage of direct obstetric causes of death and specific-age rates were chronologically coincidental with the development of a program to increase opportunity and quality of obstetric care at the whole institution. The results let us think there is a possible cause-effect relation. It is imperative to conduct a more long-term observation to confirm this epidemiological phenomenon.

[Maternal mortality at the Mexican Institute of Social Security, from 1991 to 2005. A period of changes]. / Mortalidad materna en el IMSS, 1991-2005. Un periodo de cambios.

OBJECTIVE: to describe and analyze the levels, tendency, causes and preventability of maternal mortality occurred at hospitals of the Mexican Institute of Social Security (IMSS) in the period 1991-2005, in order to identify possible strategies and activities to get a faster reduction of this problem. MATERIAL AND METHODS: 3553 maternal deaths registered in medical units of IMSS between 1991 and 2005. This period was divided in two: from 1991 to 1997 and from 1998 to 2005, for comparison purposes. The analysis was made based on the conclusions reached by the Institutional Committees of Maternal Mortality Studies and the classification and codification according to the criteria of the 9th and 10th revisions of the International Disease Classification. The information on live births was obtained from the institutional information system named "Population and Services". RESULTS: in the fifteen-year studied period, the maternal mortality rate in hospitals decreased from 45.3 to 27 for every 100,000 live births (40.4%). The main causes of maternal death (preeclampsia-eclampsia, obstetrical hemorrhages, pulmonary tromboembolism) did not show any important changes in percentage values, even when the direct obstetric and specific rates for causes did show a reduction. By age groups, the highest maternal mortality rate was registered for women older than 35; the lowest one corresponded to adolescents. More than the third part of cases was considered as potentially preventable at admission in medical units. CONCLUSIONS: we identified that maternal mortality at IMSS hospitals tended to decrease in the analyzed period, particularly faster in the last 6 years. This was attributed to a better quality of medical care and timeliness in the use of medical services by population.

[Maternal mortality in the IMSS: an analysis from the perspective of mortality and lethality]. / Mortalidad materna en el IMSS: un análisis desde la perspectiva de la morbilidad y la letalidad.

OBJECTIVE: To assess the incidence of hospital maternal mortality in the population covered by the Mexican Institute of Social Security (IMSS) from 2000 to 2003, utilizing the rates of the main causes of morbidity and lethality, in order to gain a better understanding of this epidemiological picture. METHODS: We collected information from 3,357,346 hospital deliveries and 832 maternal deaths that occurred in the medical units of the IMSS during the above-mentioned years. For the specific analysis of mortality, morbidity and lethality, deliveries and deaths with diagnoses of mild preeclampsia, severe preeclampsia, eclampsia, placenta previa, postpartum hemorrhage, chorioamnionitis and puerperal sepsis were selected, based on the criteria of International Diseases Classification, Tenth Revision. For statistical differences we used the chi(2). RESULTS: Maternal mortality registered a reduction of 25.1% (39 x 100,000 live births in 2000 and 29.2% in 2003). Morbidity increased by 6.6%. Morbidity and lethality caused by preeclampsia, obstetrical hemorrhages and puerperal sepsis (56.7% of the total deaths) showed a significant decrease in most cases. Specific morbidity showed no changes. CONCLUSIONS: We observed a decrease in the rate of hospital maternal mortality during the years of the study, linked to a reduction in lethality of these three main causes. This epidemiological picture may demonstrate the optimal quality in obstetrical care, because no reported changes in morbidity levels were registered.

[Maternal mortality at the Mexican Institute of Social Security (IMSS). Initial results from a reduction intervention strategy]. / Mortalidad materna en el IMSS. Resultados iniciales de una intervención para su reducción.

OBJECTIVE: To analyze the preliminary results of a medical manager intervention to improve the quality of medical care during pregnancy, delivery and puerperium, on the maternal mortality rates in population covered by the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: We selected the 14 administrative delegations of IMSS that showed the highest rates and absolute numbers of maternal deaths in the years 1999 to 2001. Within this group, the manager medical staff developed activities for medical training of family physicians and gynecologists, to improve medical resources, to achieve a better coordination among medical services, to adequate reference of obstetrical complications to higher-level hospitals, and for monitoring of maternal mortality committees operation. The other 23 IMSS administrative delegations were used as controls. RESULTS: Maternal mortality rates fell down from 40.7 to 28.2 per 100,000 live births among the delegations included in the strategy (mean reduction 30.7%). Among the control delegations maternal mortality rate fell down 1.5% only (32.3 to 31.8 per 100,000 live births). A similar phenomenon was observed for the absolute number of maternal deaths, with a reduction of 36.7% and 8.4%, respectively. CONCLUSIONS: The improving intervention was associated with a noticeable reduction in the maternal mortality rate. It is necessary a long-term observation to confirm a cause-effect relationship.