Maternal and congenital syphilis in Indigenous Peoples: a scoping review of the worldwide literature.

BACKGROUND: Syphilis is among the most common sexually transmitted infections worldwide. When it occurs during pregnancy, it can seriously affect the fetus and newborn`s health. The scarcity of studies on maternal and congenital syphilis in Indigenous Peoples remains an obstacle to its control in these populations. This study aimed to explore the breadth of the literature, map updated evidence, and identify knowledge gaps on maternal and congenital syphilis in Indigenous Peoples worldwide. METHODS: We conducted a Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews. In March 2021, we collected data through a priority search on PubMed, Web of Science, Embase, and SciELO. RESULTS: The strategy yielded 24 studies for analysis. Data in the articles were collected from 1989 to 2020, half from 2015 onwards. Studies were in Oceania and the Americas, mainly in South America (66.7%), particularly in Brazil (50.0%). The topics assessed were Data quality related to maternal and congenital syphilis (20.8%); Diagnosis, provision, access, and use of health services (62.5%); Disease frequency and health inequities (54.2%); Determinants of maternal syphilis and congenital syphilis (20.8%); and Outcomes of maternal and congenital syphilis in the fetus (20.8%). The results show that the available literature on maternal and congenital syphilis is sparse and concentrated in some geographic areas; the frequency of these diseases in Indigenous Peoples varies but is generally higher than in the non-indigenous counterparts; the quality of surveillance data and health information systems is poor; multiple healthcare barriers exist; and the diversity of terms to identify Indigenous Peoples is a challenge to mapping scientific outputs on Indigenous Peoples' health. CONCLUSIONS: Maternal and congenital syphilis in Indigenous Peoples is a double-neglected condition and research in this area should be given the priority and encouragement it deserves globally. Reliable data and improving access to health care are needed to reduce the burden of syphilis and correctly inform policies and health services response to mitigate ethnic-racial inequalities in maternal and congenital syphilis.

The impact of arthritis on the physical function of a rural Maya-Yucateco community and factors associated with its prevalence: a cross sectional, community-based study.

This study aims to evaluate the impact of arthritis on the physical function of people living in a Maya-Yucateco rural community and to assess the association of known modifiable risk factors with the prevalence of overall arthritis and its main types (osteoarthritis and rheumatoid arthritis). Using a cross-sectional, community-based census design, data collected from the adult population (≥18 years) of the Municipality of Chankom, Yucatán, México, were analyzed (n = 1523). Participants' physical function was assessed using a culturized version of the health assessment questionnaire disability index. Social, physical, and behavioral factors linked to overall arthritis, osteoarthritis, and rheumatoid arthritis, were assessed through the "Community-Oriented-Program-for-the-Control-of-Rheumatic-Diseases [COPCORD]" questionnaire. A physiatrist and a rheumatologist confirmed all osteoarthritis and rheumatoid arthritis cases using the American College of Rheumatology criteria. Arthritis was confirmed in 169 cases (22 %, 95 % confidence interval (CI) 19-25) of those assessed for musculoskeletal symptoms (n = 779): osteoarthritis = 144, rheumatoid arthritis = 17, and non-specific arthritis = 8. Arthritis was associated with a higher prevalence of disability after controlling for age, gender, and number of comorbidities (odds ratio = 4.0, 95 % CI 3.0-6.0). Higher level of wealth was associated with lower arthritis prevalence (odds ratio = 0.9, 95% CI 0.8-0.9). Higher body mass index was associated with higher hip and/or knee osteoarthritis prevalence (odds ratio = 1.1, 95 % CI 1.03-1.1). Arthritis is highly associated with disability in the Mayan people living in Chankom. The prevalence of arthritis in Chankom is associated with social factors, such as people's level of wealth, while the prevalence of low-extremity osteoarthritis is associated with people's body mass index.

Low prevalence of HTLV-II in Mayan Indians in the Yucatan Peninsula, Mexico.

Infection with HTLV-II is endemic in Amerindians, with prevalence ranging from 0.89% - 33%. To determine the prevalence of HTLV-II among indigenous Mayans in the Yucatan Peninsula of Mexico, 440 indigenous Mayans were recruited, all native to and residents of one of six Mayan communities in the Yucatan Peninsula, (Xohuayan n=144, Yaxachen n=101, Kanxoc n=84, Xocen n=40, Nabalan n=46 and X'calot n=25) between May, 1992 and June, 1993. All of the above are pre-Hispanic settlements located in tropical forest with no immigrations for over 50 years. Of the 440 indigenous Mayans, only one woman from the X'calot tribe (0.23%) was shown to be infected with HTLV-II. A high percentage of indeterminate results was found (22/439, 5%), three of which were accounted for by the husband and two children of the positive female case. PCR analysis followed by specific restriction digestion demonstrated the virus to be of the HTLV-IIb subtype, similar to that described in the Guaymi Indians from Panama. The presence of HTLV-II in the Mayan ethnos, and in other Amerindian populations supports the idea that HTLV-II is an ancestral virus in America and that it has been sustained in "closed" communities.

PIP: Although not consistently associated with any specific disease, infection with HTLV-II is nonetheless endemic among Amerindians, with a prevalence of 0.89-33%. Findings are presented from a study conducted to determine the prevalence of HTLV-II among indigenous Mayans in the Yucatan Peninsula of Mexico. 440 indigenous Mayans were recruited, all native to and residents of 1 of 6 Mayan communities in the Yucatan Peninsula between May 1992 and June 1993. All participants were drawn from pre-Hispanic settlements located in tropical forest without immigration for more than 50 years. Of the 440 subjects, only 1 woman from the X'calot tribe (0.23%) was found to be infected with HTLV-II. However, 22 of the remaining 439 (5%) results were indeterminate, of which 3 were accounted for by the husband and 2 children of the positive female case. Polymerase chain reaction analysis determined the virus to be of HTLV-IIb subtype, similar to that described among the Guaymi Indians of Panama. These findings support the argument that HTLV-II is an ancestral virus in America and that it has been sustained in closed communities.

Early growth faltering of rural Mesoamerindian breast-fed infants.

Early growth faltering has been described in breast-fed infants 4-6 months of age from less-developed communities. The timing and magnitude of growth faltering, however, depends on the appropriateness or comparability of the reference used to evaluate growth performance. In this paper we compared the growth performance of a group of rural Mesoamerindian breast-fed infants from birth through 6 months of age to that of a reference group of breast-fed infants reared under favourable nutritional and environment conditions in the United States. The validity of this assessment is based upon the comparability of infant feeding mode. Mean weights and lengths and corresponding weight-for-age and length-for-age percentiles and z-scores were significantly lower among the Mesoamerindian (Otomi Indian) infants (p = 0.001). Mean weight-for-length percentiles and z-scores did not differ between groups. Weight gain (g/day) was significantly lower among the Otomi infants throughout the entire 6 months (p = 0.001). Length velocities of the Otomi infants were lower than reference infants at 3-6 months (p = 0.001). The growth pattern of the Otomi infants differed from that of the reference group: decreases in growth velocities and weight-for-age and length-for-age z-scores were significantly more precipitous for the Otomi infants between 4 and 6 months of age (p = 0.001). We conclude that growth faltering was evident among the Otomi infants between 4 and 6 months of age, relative to a reference growth of breast-fed infants.

PIP: During 1986-89, for the first 6 months of life biweekly measurements were taken of the weight and length of 114 breast fed, healthy Mesoamerindian (Otomi) infants living in rural Capulhuac, Mexico, and their mothers were asked about infant feeding. Results were compared with a reference sample of 45 predominantly breast fed infants from Houston, Texas. The Otomi infants had birth weights and lengths lower than the National Center for Health Statistics (NCHS) medians, perhaps due to suboptimal gestational weight gains. They had significantly lower growth velocities (i.e., weight gain/day throughout entire 6 months and length gain/month for 3-6 months) than the reference infants (p = 0.001). They also had significantly lower NCHS percentiles and NCHS z-scores for weight-for-age and length-for-age than the Texas infants (p = 0.001). For example, at 6 months, the weight and length velocities of the Otomi were about 70% of the reference infants. The mean weight-for-length percentiles and z-scores were not significantly different between the 2 groups, however. Between 4 and 6 months of age, the decreases in growth velocities and NCHS weight-for-age and NCHS length-for-age z-scores of the Otomi infants were much more steep than those for the reference group (p = 0.001); for example, the decrease in weight-for-age was 0.44 for Otomi infants compared to 0.29 for the reference group, and the decrease in length-for-age was 0.43 and 0.18, respectively. In conclusion, the Otomi Indian breast fed infants experienced growth faltering between 4 and 6 months.

Social inequality and children's growth in Guatemala.

This paper is an investigation of the effects of social inequality in Guatemala on children's health and nutritional status as measured by attained height. Guatemala remains a highly stratified and poor society. We examine the association of land distribution, land tenure, occupation, and other aspects of family social and economic status with children's height between the ages of three months and 36 months, using data from a cross-sectional survey. An important consequence of the poverty and poor living conditions of the majority of the Guatemalan population is substantial deficits in children's growth. Our results suggest that children's growth is affected by ethnicity, their father's occupation, land distribution in the area where they live, and maternal education. Substantial growth deficits are observed among children living at altitudes above 1500 metres; we hypothesize that this is because, in Guatemala, higher altitude is associated with land scarcity, poorer agricultural conditions, and greater remoteness from transport networks and other public services.

PIP: Population researchers used data from the 1987 National Survey of Maternal and Child Health, 1981 census of population and housing, and the 1979 agricultural census to examine the relationship between land distribution, land tenure, occupation, and other characteristics of family socioeconomic status with children's growth between the ages of 3 months to 36 months in Guatemala. 57.8% of the children were stunted. 71.9% of the children lived in rural areas characterized as poor and in inferior living conditions. Characteristics influencing children's growth included ethnicity (indigenous children shorter than ladinos), father's occupation (agriculture or unskilled occupations had a negative effect on growth), land distribution (the smaller the farm, the greater the deficit in height), and maternal education. Children living at altitudes greater than 1500 meters were shorter than those living at elevations less than 1500 meters (p 0.05). Land scarcity, poorer agricultural conditions, and greater distance from transport networks and other public services were likely responsible for the association between altitude and growth. Indigenous populations were more likely to live at higher elevations than ladinos, partly because, over the last 200 years, ladinos appropriated the more productive, accessible, and desirable lands at moderate elevations. Father's occupation, land ownership, housing quality, possession of consumer goods, residency, and size of farms in area accounted for about 24% of the variation in height-for-age. These findings show that poverty and poor living conditions for most of the population adversely affect children's growth.

A comment on the "sixteenth-century population decline in the Basin of Mexico: a systems simulation" by Thomas M. Whitmore.

PIP: The author comments on an article by Thomas M. Whitmore, entitled "Sixteenth-century population decline in the Basin of Mexico: a systems simulation", which appeared in the Fall 1991 issue of the Latin American Population History Bulletin.^ieng

[Infant mortality in the indigenous population: backwardness and contrasts]. / La mortalidad infantil en la poblacion indigena: atraso y contrastes.

PIP: Some 6.4 million speakers of indigenous languages were enumerated in the 1990 Mexican census. The same census provided the basis for an indirect estimate of infant mortality using data on the numbers of live born and surviving children. Municipios with 40% or more of the population speaking an indigenous language were studied. The overall estimated infant mortality rate for indigenous municipios was 55.1/1000 live births, the equivalent of the Mexican infant mortality rate around 1982. Mexico's national infant mortality rate in 1990 was 34.8/1000. Great contrasts were found in indigenous infant mortality rates. Campeche, Quintana Roo, and Yucatan, the states of the Mayan region, had a low rate of 35.09/1000, very close to the national average. Infant mortality levels were relatively low in the indigenous populations of Hidalgo, the state of Mexico, and Michoacan, with rates of 44 to 48. Chiapas, Oaxaca, Puebla, Durango, Guerrero, and San Luis Potosi had rates of 55 to 65. The highest rates were in states with few indigenous municipios, including Chihuahua, Jalisco, and Nayarit. The Huichol of Jalisco had the highest rate at 100.01/1000. Infant mortality levels were found to be correlated in different degrees with socioeconomic indicators. The highest infant mortality rates were in the indigenous regions with the poorest socioeconomic conditions.^ieng

[The migration of indigenous mixtecans. Population mobility and preservation of identities]. / La migracion de indigenas mixtecos. Movilidad poblacional y preservacion de identidades.

PIP: In today's world, where large numbers of people migrate for reasons that are not strictly economic, the preservation of the cultural identity of migrants has attracted scrutiny. Indigenous populations are one of the most vulnerable groups in Mexico because of their economic disadvantages and their ethnic identity. Paradoxically, however, their ethnic identity has constituted a basis for preserving their cultural identity and creating a broad network of social relations that assist them in their territorial movement. The Mixtec region of western Oaxaca, Guerrero, and Puebla is one of the poorest of Mexico, with high rates of emigration, infant mortality, and illiteracy, and villages lacking potable water and basic services such as schools and roads. Holdings of less than two hectares of impoverished and eroded lands do not provide resources to support life at even a subsistence level. Migration, a constant in Mixtec economic and social life, accelerated in the 1980s. The Mixtec have become one of the largest ethnic groups of workers in the northwest of Mexico and in California, Oregon, and Washington. Entire communities have migrated in search of work. In their continuous movement the Mixtec have conserved ties that permit their collective survival. Associating with other Mixtec allows the migrants to share food, lodgings, and information on possibilities for success in their search for work. Mixtec families living in Tijuana, for example, assist those staying temporarily in Tijuana on their way elsewhere. The migrants provide their hosts with information about their villages or on conditions elsewhere. The continual movement in search of work has led the Mixtec to establish themselves in Guadalajara, Culiacan, Hermosillo, Nogales, Tijuana, Ensenada, and elsewhere, creating parallel routes north for subsequent migrants. More than 20,000 Mixtec were estimated to be employed in California, Oregon, and Washington in 1990. The Mixtec find temporary work in agriculture but also in small cleaning and maintenance enterprises. In Mexico they work as agricultural laborers or construction workers, domestics or ambulatory vendors. Migration has become an element in the daily life of the Mixtec, who have broadened their horizons while preserving their identity.^ieng

Lactation performance of rural Mesoamerindians.

Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.

PIP: Researchers analyzed data on 30 postpartum women from the Otomi Indian community living in rural Capulhuac, Mexico to examine interrelationships among lactation performance, maternal body size/composition, and dietary intake to learn which maternal factors limit lactation and thus infant growth. Infant food supplementation was minimal. Current diet did not affect milk production or levels of energy and fat in milk. Even though the body mass index (BMI) was lower than the normal range (19.8-26 kg/sq meter) for only 2 women, 8 women had 20% body fat indicating considerable undernutrition. Women consumed a mean of 68% and 80% of energy and protein requirements. Mean energy intakes (kcal/kg/day) at 4 and 6 months postpartum were 33.8 and 35.1 respectively, compared with the recommended 51. Mean protein intakes (g/kg/day) were 0.75 and 0.84 respectively compared with the recommended 1.1 3-day intake records based on memory, estimation of portion sizes, food preparation, and food composition data led to the above energy intake results, but they may not have been accurate since a mean of 35 would not allow much physical activity. Fats and carbohydrates mainly from maize made up 17% and 76% respectively of the Otomi diet suggesting a suboptimal diet. Yet human milk production rates (885 g/day at 4 months and 869 g/day at 6 months) tended to equal or be higher than those of women of higher socioeconomic status (711-925 g/day) and other poor women (525-789 g/day). The greater the levels of maternal body fat the smaller the amount of milk women produced (p=.006). Total nitrogen, protein nitrogen, lactose, and nonprotein nitrogen levels fell within the range of that of privileged women. Fat and energy levels in the milk were lower than those of privileged women, however heavy women (p=.002) with high BMI (p=.05) and body fat (p=.004) levels tended to have high levels of energy and fat in the milk. Energy levels in milk were not linked with milk production. Neither milk production nor composition were related to dietary intake.

Lactation, nutrition and fertility and the secretion of prolactin and gonadotrophins in Mopan Mayan women.

The effect of lactation on menstrual cycles, ovulation and conception was studied in a group of non-contracepting Amerindian Mopan Mayan women. Anthropological observations of relevant events were made over a 21-month period. Blood samples were assayed to determine the plasma concentrations of prolactin, luteinising hormone, follicle stimulating hormone, human chorionic gonadotrophin, placental lactogen, oestrogen, progesterone and cortisol. The data show that: frequent and prolonged breast-feeding was associated with a marked increase in plasma prolactin concentrations to levels similar to those in lactating Gaing but higher than those in lactating Scottish women; ovulatory menstrual cycles and pregnancy occurred during frequent lactation; in lactating menstruating women there was an inverse correlation between fat weight and months post-partum. These data suggest that other factors as well as suckling account for the effects of lactation on fecundity.

PIP: Lactation, ovulation and conception were observed as part of an anthropological study of Amerindian Mopan Mayan women from the village of San Jose Hawaii in western Belize from March 1985-January 1987. Single blood samples from each subject were immunoassayed for prolactin, LH, FSH, hCG, placental lactogen, estrogen, progesterone and cortisol. Anthropomorphic data analyzed were body mass index (BMI), fat/weight percentage, total body water and lean body weight. 117 women had at least 1 child during the study; 91 were lactating; 51 reported no menstrual cycles. 50 submitted to blood testing. Almost all infants were breast fed for 18 months or longer, up to 3 years, typically at least 6 times per day and 3 times per night. Women averaged 9 live births and 8 surviving children, with a mean birth interval of 28 months. 25 of the 29 women known to be pregnant conceived while lactating. 16 lactating women were pregnant. Their culture requires them to have 3 menses before conception to nourish the fetus, yet forbids speaking about menstrual blood: women fabricated menstrual dates, but in confidence 51 of 81 stated that they did not menstruate before the last conception. Most often menses began 12 months postpartum. Lactating women had heightened prolactin levels even if supplementing their children's diet. Thus frequent lactation delayed onset of menses, but supplementation had no effect. Most of the women were within the normal range of BMI, but 13% were below normal. In lactating menstruating women there was a significant negative correlation between fat weight and postpartum month. The data suggest that the interval to conception or menstruation was inversely correlated with fat weight. Here suckling frequency rather than prolactin levels seems to postpone fertility. In this society, with 10-12 births and 9-10 children in the completed family, the largest in the world, prolonged frequent lactation has little effect on fertility. Instead, birth trauma, maternal mortality, fetal and infant mortality, and perhaps nutrition, have more effect on completed family size.

[In the America of mountain ranges, the brief summer of Indian agrarian movements (1970-1991)]. / Dans l'Amerique des cordilleres, le bref ete des mouvements paysans indiens (1970-1991).

PIP: Important rural Indian movements appeared almost simultaneously in the early 1970s in 3 countries, Ecuador, Bolivia, and Guatemala, which had the distinction of remaining the most rural and the most Indian countries of Latin America. A similar movement with similar characteristics arose in a rural and Indian region of Colombia, a largely urban and mestizo country. Each movement constituted a particular response to the same problems in different contexts. This work provides a comparative analysis of the historical context, development, constitution, and functioning of Bolivian katarisme, the Ecuarrunari movement in Ecuador, the Regional Committee of the Indigenous of Cauca (CRIC) in Colombia, and the Committee of Peasant Unity (CUC) in Guatemala. The indigenous peasant movements were defined in relation to national-populist models of development and integration: limitations and failures of national-populism in Bolivia and to some extent also in Ecuador, marginalization of the Indian populations vis a vis modernization processes in Ecuador and Colombia, or a crisis caused by blockage of participation in the sociopolitical system in Guatemala. The movements appeared in the context of strong peasant communities left at the margin of processes of integration, but also in contexts where the social dynamics were reinforced by reforms and modernization during a long period of precarious reconstitution of communities sometimes dating back to the 1930s. Another contributing factor in some cases was the dissolution of peonage and other forms of servitude on the great estates. An Indian elite whose emergence was related to modernization of the communities is present in all the movements. It is composed of educated and partially urbanized young people who have maintained ties to the communities, of leaders trained in cooperative or union activity, of promoters of new religious currents, and others affected by change. The leaders belong to modern organizations that wish to make Indians actors in cultural, social, or political affairs at the regional or national level previously dominated by non-Indians. The peasant Indian movements are above all interested in issues of land and agrarian development, but they are not exclusively peasant. Some of the members are not agricultural workers, and their concerns exceed those of a simple peasant society. Diverse influences have been exercised on the formation and development of the movements. Progressive sectors of the Catholic Church were influential in almost all. The movements encountered opposition from class and national adversaries interested in maintaining the status quo, and also often experienced distrust, misunderstanding, or paternalistic attitudes on the part of nonpeasant organizations working for change. The future is uncertain for all of the movements, despite notable past successes for some of them.^ieng

[The indigenous population of Sierra Norte de Puebla]. / La poblacion indigena de la Sierra Norte de Puebla.

PIP: The northern sierra region of Pueblo, Mexico, contains 1496 communities in 65 municipios and covers 1/4 of the area of the state of Puebla. The topography is steep and mountainous, and the area is inaccessible. The region contains the 3 principal zones of Mesoamerica, hot lands from sea level to 700 meters above sea level, temperate zones from 700-1500 meters, and cold country from 1500-2000 meters above sea level. Most of the population resides in the temperate and cold lands, but the hot zones are economically important. Little is known of the prehistory of the area. The Totonac were believed to have been the earliest settlers. In the mid-15th century numerous Nahua groups came to the area. In the late 15th century the region fell to the Aztecs, but their dominion was cut short by the arrival of the Spanish. Spanish penetration was relatively slow because of the difficult terrain and the lack of precious metals desired by the Spanish. The introduction of coffee cultivation in the late 19th century accelerated the adoption of urban-mestizo sociocultural and commercial elements by the indigenous population. The population of the northern sierra increased from 752,656 in 1980 to 965,976 in 1990. The 1980 census reported that 259,140 persons spoke indigenous languages, including 179,677 who spoke Nahuatl, 66,020 Totonaco, and 4921 Otomi. The most important cities are located on paved roads: Teziutland, Zacatlan, Hauachinango, and Zacapoaxtla. The municipios with predominantly monolingual indigenous populations are concentrated in the most difficult to reach areas of the central sierra massif. The region is characterized by temporary and permanent emigration of the indigenous population. The main reasons for emigration are lack of land and of alternative sources of employment, and desire for education. During the months August-December, known as the time of hunger, there is seasonal migration of household heads in search of work as laborers in cane cutting, tobacco, or fruit harvesting. The local economy is based on subsistence agriculture and production of coffee, fruits, and woods for export. The most isolated and inaccessible communities have preserved traditional cultural elements the most strongly.^ieng

Maternal risk factors for low birth weight and intrauterine growth retardation in a Guatemalan population.

Hospital data on 306 mother-infant pairs in Cobán, Guatemala, were studied to assess factors responsible for low infant birth weights involving the two general kinds of intrauterine growth retardation (IUGR), these being Type I (symmetric stunting) and Type II (asymmetric stunting or wasting). The results indicate that the Type I IUGR observed arose primarily from long-term poverty, malnutrition, and chronic poor living conditions, while much of the Type II IUGR seemed attributable to maternal disorders affected by short interbirth intervals.

PIP: In 1988, researchers studies data from 306 mother-infant pairs at the Helen Losi de Laugerud regional hospital in Coban, Guatemala to determine the relationship between intrauterine growth etiology and the mothers nutritional, demographic, socioeconomic, and obstetric characteristics. Maternal education and socioeconomic status had a significant positive effect on birth weight. The relationship between maternal education and socioeconomic status, however. Maternal height, maternal triceps skinfold thickness, and maternal weight measurements revealed an association between maternal childhood nutrition status and infant birth weight (p,.0001) and an association between current maternal nutrition status and infant birth weight (p.0001). Indian mothers were more likely to have low birth weight infants than Ladino mothers (p.0001). Infants of mothers of low socioeconomic status had a lower mean birth weight than those of higher socioeconomic status, even when controlled for race (p=.034). 26.5% of all infants exhibited Type I intrauterine growth retardation (IUGR). In fact, 77% of all IUGR infants were Type I. The most significant determinants of these chronically malnourished infants were prolonged poverty, maternal malnutrition, and poor living conditions (p.05). Maternal disorders which were a result of short birth intervals significantly contributed to Type II IUGR--the acutely malnourished infants. In fact, more short intervals (42.9% vs. 21.9%). Since Type I IUGR was so prevalent in this group and chronic malnutrition and poor socioeconomic conditions render mothers susceptible to chronic infections which, in turn, impede growth of the rapidly growing fetus as they do in infants, further research on the etiology of Type I IUGR is warranted.

[Use of maternal health services in rural Mexico]. / Utilización de los servicios de salud materna en el México rural.

PIP: Because of the spread of western health care into rural Mexican communities through primary health care programs and medical school graduates performing their year of community service, the proportion of rural Mexican women whose deliveries were attended by physicians increased from 17.7% in 1969 to 45.8% in 1981. The primary objective of this work is to identify factors involved in the utilization of the modern medical system for prenatal care and of hospital delivery in transitional rural areas. A secondary objective is to evaluate the impact of modern prenatal care and hospital delivery on perinatal and neonatal mortality. The data came from a 1981 survey by the Mexican Institute of Social Security of a nationally representative sample of 7953 fertile-aged women in 410 communities with fewer than 2500 inhabitants. The survey provided information on both utilization of health services and on medical and biological conditions that might have prompted women to seek modern medical care. This study was limited to 1579 pregnancies which arrived at term in the 13 months preceding the survey. Among dependent variables, the variable for prenatal care was a 1st prenatal visit in the 1st 5 months of pregnancy. 486 women, about 31% of the sample, had such a visit. 69% of the subsample of 1579 women had had some form of prenatal care, of whom 63% had their 1st consultation in the 1st 5 months. 36% of deliveries occurred in hospitals. There were 64 prenatal or neonatal deaths in the 1579 pregnancies, including 38 deaths in the 1st month and 26 stillbirths. The independent variables included 5 factors measuring health facilities available in the community, 3 assessing the commercial center used by the community, and 2 assessing the respondent's housing. The 2 individual factors were birth order and education. 7 factors concerned symptoms of pregnancy and 4 complications during delivery. The multivariate analysis of these factors was carried out by logistic regression. The availability of different types of health services in the community was not a significant predictor of utilization of prenatal services, but existence of a good road was associated with a 30% increase in probability of using medical services and presence in the community of persons speaking only an indigenous language was associated with a 57% decline in probability. Use of prenatal services and hospital delivery were also associated with maternal educational level and housing characteristics. The results appear to indicate the isolation, poverty, and lack of familiarity with western culture constitute important barriers to use of modern maternal health services. The analysis suggests that the policy of providing medical facilities at the community level has had little effect on the extremely disparate use of prenatal care and hospital delivery in rural Mexico.^ieng

[Use of contraceptives and fertility in Panama]. / Uso de anticonceptivos y fecundidad en Panama.

PIP: The 1984 Maternal-Child Health and Family Planning survey of Panama was the first to achieve nationwide coverage by including 2 provinces with large indigenous populations that were excluded from the 1976 Panama Fertility Survey and the 1979 Contraceptive Prevalence Survey. The 1984 survey indicated a total fertility rate 4.0 children/woman or 3.7 excluding the 2 provinces not included in the previous surveys. The total fertility rate was estimated at 4.5 in 1976 and 3.9 in 1979. In 1979, rural women had 2.5 children more than urban women, but by 1984 the difference was reduced to 1.3. Including the 2 predominantly indigenous provinces, the total fertility rates were 5.0 children for the rural population and 3.2 for the urban population. The 1984 there were wide regional variations in fertility. The total fertility rate was 6.3 in the predominantly rural and indigenous provinces, 4.3 in the predominantly rural nonindigenous provinces, and 3.2 in urban areas. 10% of women stated that their most recent birth had been unwanted. The proportion of women giving birth within the previous 2 years who stated they had breast fed their babies increased from 80% in 1979 to 93% in 1984 and the average duration of breast feeding increased from 9.5 to 10.3 months. Between 16-79, contraceptive usage among currently married women aged 20-44 years increased from 53% to 63%, with 10% increases in both rural and urban areas. Between 1979-84, the level of contraceptive usage remained about the same and even showed a slight decline in urban areas. The proportion of women sterilized increased from 32.3% in 1979 to 36.8% in 1984, the proportion using pills declined for 18.9% to 12.2%, and the proportion using IUDs increased from 3.8% to 6.4%. Changes in use of rhythm, condoms, and other methods were slight. 58.2% of currently married women aged 15-44 used a contraceptive method in 1984, with use increasing with age to over 70% among women aged 35 or more. Pills are the most used method among men aged 15-19 and 20-24, but sterilization is the most popular method for women 25 or over. Over 80% of women aged 35 or over who use a method are sterilized. Among women in union aged 15-44, 43.2 in rural indigenous provinces, 56.7% in rural nonindigenous provinces, and 63.7% in the urban province used a method. The level of use varied from 52.7% of those with less than primary educations to 65.9% of those with university educations. 75% of married, fertile women who did not want additional children stated they would be interested in sterilization, but over 1/4 of them had been denied sterilization services by physicians because they were too young or had too few children. An estimated 61,400 Panamanian women, or about 13% of women aged 15-44 years, are in need of family planning services. The unmet need for services is especially high in rural areas, among women aged 20-34, among the less educated, and in the indigenous population.^ieng

Respiratory disease mortality in New Mexico's American Indians and Hispanics.

To determine the effect of ethnic group on respiratory disease occurrence, average annual sex, ethnic, and disease specific mortality rates for the period of 1969 to 1977 were calculated for New Mexico's American Indian, Hispanic, and Anglo populations. Incidence data were available for respiratory tract cancer. This study corroborates previous findings of reduced mortality from lung cancer in American Indians of both sexes and in Hispanic males. American Indian mortality from tuberculosis and from influenza and pneumonia was high. Hispanic males and American Indians of both sexes showed low mortality rates for chronic obstructive pulmonary disease (COPD). Differing cigarette usage is the most obvious explanation for the variations in COPD and lung cancer occurrence with ethnic group.

Traditional and Western health care among the Zuni Indians of New Mexico.

PIP: The Zuni Indians of New Mexico have access to medical care provided by the Public Health Service, native healers belonging to medicine societies, and folk remedies. The Zuni regard natural causes, sorcery, disease-object intrusion and breach of taboo as the origins of illness. Case materials are presented to illustrate the pragmatic manner in which most Zuni seek medical care. Over 90% of patients with nonemergency problems see the native healers before seeking help at the hospital, and patients continue to seek different therapies until their symptoms are relieved. The interaction of Zuni and Western health practices is discussed using the examples of childbirth, epilepsy and diabetes; and reasons for the continued vitality of the traditional systems are explored. It is recommended that physicians acquaint themselves with the traditional beliefs of the people they treat in order to facilitate the acceptance of Western medicine in areas where traditional medicine is still important.^ieng

Assessment of body concepts and beliefs regarding reproductive physiology.

PIP: Instruments for depicting the way rural women experience and perceive their bodies were administered in an anthropological study in Central Mexico. Body outlines were filled in or finished by the women and concepts of reproductive physiology were shown during the drawing process which showed various degrees of knowledge or accuracy. The organs most frequently drawn were the stomach, intestines, heart, liver, uterus, and lungs. Ribs were the only bones spontaneously included. The external structures most often drawn were breasts, vagina, and umbilicus. All structures were represented as circles of varying sizes except for the intestines, which were lines, and the heart, which was a valentine. Accurate placement of internal organs was unusual. When the names used for the bodily parts were elicited, the breast had 5 different terms. Multiple names were also given to the stomach, uterus, and vagina. The heart is believed to the origin of feeling and emotion and has religious as well as physical meaning. It was often thought that from 2-10 coital incidents were needed to become pregnant since it was believed that the blood of man must mix with the blood of the woman. In this type of survey it is important that the women can identify with the basic body outline; in pretesting certain figures were rejected.^ieng

Anita: a Mayan peasant woman copes.

PIP: This is a case history of Anita, Mayan woman aged 38, who lives in the small village of Can Cun in the Yucatan, Mexico. She has had 10 pregnancies and 7 living children. She nearly died with her last birth. She has a good relationship with her children. She worked several jobs and sold illegal alcohol to put her son, Emiliano, through school. She is close with her married daughter, aged 17. She herself was married at 17. Because of previous bad pregnancies Anita would like to have no more children. Her husband, Demetrio was interested in a vasectomy but couldn't believe he would have the strength to work after the operation. He, like many Mayan men, practiced coitus interruptus and rhythm. When Anita finally went to the family planning clinic, under the auspices of the author, she chose oral contraceptives, but she never actually used them. Many Mayan women seldom get a period because they are always lactating. Some women would rather be pregnant then menstruating. The husband opposes schooling for his children because he needs them to help him work their crops of beans and corn. Sending children to school creates hardship because cash is needed for living expenses.^ieng