The Legacy of President Lázaro Cárdenas for Health Care Reform in Today's Mexico.

Mexican President Andrés Manuel López Obrador's historic election victory in 2018 marked a sharp break from past decades of neoliberal socioeconomic policies. López Obrador campaigned on the promise of deep reform, with health care high on his agenda. The public health care sector had been decimated by decades of budget cuts, eroding workers' morale and patients' confidence, and crippling all aspects of the system. This article looks back to the creation of the nation's public health care system in the early twentieth century during the administration of President Lázaro Cárdenas (1934-1940). This "universal" system was designed to implement a central social justice goal of the Mexican Revolution of health care for all. The program rested on two pillars: providing care to the nation's vast, impoverished rural population and actively engaging communities in their own health care. Our objective is to critically assess the two presidents' health care initiatives within the distinct historical contexts of their administrations.

Sociodemographic factors associated with the success or failure of anti-tuberculosis treatment in the Chiapas Highlands, Mexico, 2019-2022.

OBJECTIVE: To estimate the incidence rate of tuberculosis (TB) in the Highlands (Tsotsil-Tseltal) region of Chiapas and to analyze sociodemographic factors that might influence the success of anti-TB treatment from the period of January 2019 to June 2022. METHODS: Retrospective study in which the TB databases of the National Epidemiological Surveillance System (SINAVE) were analyzed. TB incidence rates were calculated based on the number of registered TB cases and estimated annual populations. The success-failure of anti-TB treatment was analyzed according to sociodemographic indicators, degree of concentration of indigenous population of the municipality of residence and admission to SINAVE. RESULTS: Two hundred thirty-three cases were analyzed. The variables associated to a lower success rate of treatment against TB were: living in a municipality with high-very high concentration of indigenous population, being indigenous, having a primary school education or lower, and agricultural occupation. The number of TB diagnosed from 2020-2022 and the incidence rates from 2020-2021 decreased significantly compared to 2019. CONCLUSIONS: It is necessary to strengthen the follow-up of TB cases in the region, mainly in areas with high-very high indigenous concentration, in people with low levels of education and engaged in agricultural work.

Genetic Diversity of Mycobacterium tuberculosis Isolates From an Amerindian Population in Chiapas, México.

This is the first report of the genetic diversity of the Mycobacterium tuberculosis complex isolates found in a Mexican-Amerindian setting. In this study, we analyzed isolates collected from the Highlands region of Chiapas, Mexico, by using spoligotyping and whole-genome sequencing analyses. Seventy-three M. tuberculosis isolates were analyzed initially by spoligotyping; no new spoligotypes were identified. Nineteen percent of the isolates were identified as SIT53 (T1) (n = 14), followed by SIT42 (14%, n = 10, LAM9) and SIT119 (11%; n = 8, X1). SIT53, SIT42, and orphan isolates (16.4%, n = 12) constituted about 50% of the isolates studied and were subjected to whole-genome sequencing (WGS) analysis. Most SIT53 (10/12) isolates belonged to the Euro-American sub-lineage 4.8. Most SIT42 isolates (4/7) as .well as most orphan isolates (5/8) belonged to the lineage 4.3.3 LAM group. By comparing the single-nucleotide polymorphism (SNP) patterns of the SIT53 isolates, we found one clone (<7 SNPs) and four clustered isolates (<15 SNPs). In isolates from the SIT42 and orphan groups, we did not find any clones or clusters. This work demonstrates the success of sub-lineage 4.8 to predominate in Mexico and confirms the dominion of sub-lineage 4.3.3 in Central and South America.

Geographical distribution and international collaboration of Latin American and Caribbean scientific publications on tuberculosis in Pubmed. / Distribución geográfica y colaboración internacional de las publicaciones científicas latinoamericanas y del Caribe sobre tuberculosis en PubMed.

OBJECTIVE: The objective of the study was to describe the geographical coverage of Latin American and Caribbean scientific publications on tuberculosis and its international collaboration. MATERIALS AND METHODS: The records were retrieved from the PubMed database (2009-2018), limiting the search to Latin American and Caribbean countries. Articles were analyzed in several categories, such as the total number, countries, institutions, authors, collaborations, and citations. The software UCINET and VOSviewer were used. RESULTS: 2,495 items were recovered, 4.2% of world production. More than half of the research came from Brazil (52.5%), Mexico (16.6%) and Peru (10.5%). 97.6% of the production is co-authored, with a rate of international collaboration of 24.5%. The countries with the highest production in international collaboration are Brazil (39.1%), Peru (26.8%) and Mexico (16%); they are also the countries with the best OutDegree, OutCloseness and Betweenness. The United States (11.9%), United Kingdom (5.8%), France (2.1%), Spain and Switzerland (1.7%), South Africa (1.7%) and Italy (1.6%) are the main collaborators with Latin America. CONCLUSION: Brazil, together with Peru and Mexico, is the undisputed leader in Latin American and Caribbean tuberculosis production, due to the volume of articles and its position in the collaborative network. The eradication of tuberculosis requires continuing research in international collaboration, to carry out more effective health policies on tuberculosis.

OBJETIVO: Describir la cobertura geográfica de las publicaciones científicas de América Latina y el Caribe sobre tuberculosis y su colaboración internacional. MATERIALES Y MÉTODOS: Los registros fueron recuperados de la base de datos bibliográfica PubMed (2009-2018), limitando la búsqueda a países latinoamericanos y del Caribe. Los artículos se analizaron en varias categorías, como número total, países participantes, instituciones, autores, colaboraciones y citas. Se utilizó el software UCINET y VOSviewer para representar las redes de colaboración. RESULTADOS: Se recuperaron 2495 artículos, 4,2% de la producción mundial. Más de la mitad de las investigaciones proceden de Brasil (52,5%), México (16,6%) y Perú (10,5%). El 97,6% de la producción presenta coautoría, con una tasa de colaboración internacional del 24,5%. Los países con mayor producción en colaboración internacional son Brasil (39,1%), Perú (26,8%) y México (16%), además son los que presentan mejor centralidad, cercanía e intermediación. Estados Unidos (11,9%), Reino Unido (5,8%), Francia (2,1%), España y Suiza (1,7%), Sudáfrica (1,7%) e Italia (1,6%), son los principales colaboradores con Latinoamérica. CONCLUSIÓN: Brasil, junto a Perú y México, es líder de la producción científica sobre tuberculosis en Latinoamérica y el Caribe, por el volumen de artículos y su posición en la red de colaboración. La erradicación de la tuberculosis pasa por continuar investigando en colaboración internacional, y así llevar a cabo políticas de salud más efectivas en tuberculosis.

Distribución geográfica y colaboración internacional de las publicaciones científicas latinoamericanas y del Caribe sobre tuberculosis en PubMed / Geographical distribution and international collaboration of Latin American and Caribbean scientific publications on tuberculosis in Pubmed

RESUMEN Objetivo: Describir la cobertura geográfica de las publicaciones científicas de América Latina y el Caribe sobre tuberculosis y su colaboración internacional. Materiales y métodos: Los registros fueron recuperados de la base de datos bibliográfica PubMed (2009-2018), limitando la búsqueda a países latinoamericanos y del Caribe. Los artículos se analizaron en varias categorías, como número total, países participantes, instituciones, autores, colaboraciones y citas. Se utilizó el software UCINET y VOSviewer para representar las redes de colaboración. Resultados: Se recuperaron 2495 artículos, 4,2% de la producción mundial. Más de la mitad de las investigaciones proceden de Brasil (52,5%), México (16,6%) y Perú (10,5%). El 97,6% de la producción presenta coautoría, con una tasa de colaboración internacional del 24,5%. Los países con mayor producción en colaboración internacional son Brasil (39,1%), Perú (26,8%) y México (16%), además son los que presentan mejor centralidad, cercanía e intermediación. Estados Unidos (11,9%), Reino Unido (5,8%), Francia (2,1%), España y Suiza (1,7%), Sudáfrica (1,7%) e Italia (1,6%), son los principales colaboradores con Latinoamérica. Conclusión: Brasil, junto a Perú y México, es líder de la producción científica sobre tuberculosis en Latinoamérica y el Caribe, por el volumen de artículos y su posición en la red de colaboración. La erradicación de la tuberculosis pasa por continuar investigando en colaboración internacional, y así llevar a cabo políticas de salud más efectivas en tuberculosis.

ABSTRACT Objective: The objective of the study was to describe the geographical coverage of Latin American and Caribbean scientific publications on tuberculosis and its international collaboration. Materials and methods: The records were retrieved from the PubMed database (2009-2018), limiting the search to Latin American and Caribbean countries. Articles were analyzed in several categories, such as the total number, countries, institutions, authors, collaborations, and citations. The software UCINET and VOSviewer were used. Results: 2,495 items were recovered, 4.2% of world production. More than half of the research came from Brazil (52.5%), Mexico (16.6%) and Peru (10.5%). 97.6% of the production is co-authored, with a rate of international collaboration of 24.5%. The countries with the highest production in international collaboration are Brazil (39.1%), Peru (26.8%) and Mexico (16%); they are also the countries with the best OutDegree, OutCloseness and Betweenness. The United States (11.9%), United Kingdom (5.8%), France (2.1%), Spain and Switzerland (1.7%), South Africa (1.7%) and Italy (1.6%) are the main collaborators with Latin America. Conclusion: Brazil, together with Peru and Mexico, is the undisputed leader in Latin American and Caribbean tuberculosis production, due to the volume of articles and its position in the collaborative network. The eradication of tuberculosis requires continuing research in international collaboration, to carry out more effective health policies on tuberculosis.

Distribución geográfica y colaboración internacional de las publicaciones científicas latinoamericanas y del Caribe sobre tuberculosis en PubMed / Geographical distribution and international collaboration of Latin American and Caribbean scientific publications on tuberculosis in Pubmed

RESUMEN Objetivo: Describir la cobertura geográfica de las publicaciones científicas de América Latina y el Caribe sobre tuberculosis y su colaboración internacional. Materiales y métodos: Los registros fueron recuperados de la base de datos bibliográfica PubMed (2009-2018), limitando la búsqueda a países latinoamericanos y del Caribe. Los artículos se analizaron en varias categorías, como número total, países participantes, instituciones, autores, colaboraciones y citas. Se utilizó el software UCINET y VOSviewer para representar las redes de colaboración. Resultados: Se recuperaron 2495 artículos, 4,2% de la producción mundial. Más de la mitad de las investigaciones proceden de Brasil (52,5%), México (16,6%) y Perú (10,5%). El 97,6% de la producción presenta coautoría, con una tasa de colaboración internacional del 24,5%. Los países con mayor producción en colaboración internacional son Brasil (39,1%), Perú (26,8%) y México (16%), además son los que presentan mejor centralidad, cercanía e intermediación. Estados Unidos (11,9%), Reino Unido (5,8%), Francia (2,1%), España y Suiza (1,7%), Sudáfrica (1,7%) e Italia (1,6%), son los principales colaboradores con Latinoamérica. Conclusión: Brasil, junto a Perú y México, es líder de la producción científica sobre tuberculosis en Latinoamérica y el Caribe, por el volumen de artículos y su posición en la red de colaboración. La erradicación de la tuberculosis pasa por continuar investigando en colaboración internacional, y así llevar a cabo políticas de salud más efectivas en tuberculosis.

ABSTRACT Objective: The objective of the study was to describe the geographical coverage of Latin American and Caribbean scientific publications on tuberculosis and its international collaboration. Materials and methods: The records were retrieved from the PubMed database (2009-2018), limiting the search to Latin American and Caribbean countries. Articles were analyzed in several categories, such as the total number, countries, institutions, authors, collaborations, and citations. The software UCINET and VOSviewer were used. Results: 2,495 items were recovered, 4.2% of world production. More than half of the research came from Brazil (52.5%), Mexico (16.6%) and Peru (10.5%). 97.6% of the production is co-authored, with a rate of international collaboration of 24.5%. The countries with the highest production in international collaboration are Brazil (39.1%), Peru (26.8%) and Mexico (16%); they are also the countries with the best OutDegree, OutCloseness and Betweenness. The United States (11.9%), United Kingdom (5.8%), France (2.1%), Spain and Switzerland (1.7%), South Africa (1.7%) and Italy (1.6%) are the main collaborators with Latin America. Conclusion: Brazil, together with Peru and Mexico, is the undisputed leader in Latin American and Caribbean tuberculosis production, due to the volume of articles and its position in the collaborative network. The eradication of tuberculosis requires continuing research in international collaboration, to carry out more effective health policies on tuberculosis.

Tuberculosis Care in Mexico's Chiapas Highlands Region: A Right to Health Analysis.

This article analyzes the fulfillment of the four essential and interrelated elements of availability, accessibility, acceptability, and quality (AAAQ) presented in General Comment 14 of the United Nations Committee on Economic, Social and Cultural Rights. We examined the ways that AAAQ criteria are met in tuberculosis (TB) care by evaluating a sample of 33 primary health care units (PHCUs) in 10 municipalities of the Chiapas Highlands region of Mexico. We collected information about 56 people with TB who were treated in those PHCUs, the structural conditions of the health facilities, and data about all health care workers in the PHCUs (n=423). Our results show that there is great variability in how AAAQ criteria are met among the PHCUs and in the way that TB care programs are delivered. Resource shortages and infrastructure characteristics hinder the fulfillment of AAAQ elements despite the commitment made by Mexico to guarantee the right to health as outlined in General Comment 14.

Peer victimization at school and associated factors in Campeche, Mexico / Victimización por pares en la escuela y factores asociados en Campeche, México

Abstract Objectives: to estimate the prevalence ofpeer victimization (VI-P) and to identify factors associated to it. Methods: a cross sectional study based on a state-representativesample; 2555 students from primary and secondary schools of Campeche, in the academic year 2015-2016 participated. They were interviewed face to face. VI-P was analyzed by sex, age and various school-related aspects with prevalence rate and 95% confidence interval. The analysis of interactions among the studied factors was carried out using a hierarchical log-lineal model. With the significant terms,a multiviarite analysis using a logistic model was performed. Based on this model, maximum and minimum predictive values for VI-P were calculated by odds inverse transformation. Results: the global prevalence of VI-P was 60.4% (CI95%= 58.6-62.3). The prevalence of violence physical, psycho-emotional, patrimonial, and sexual, were 28.8, 52.9, 26.5, and 8.7%, respectively. Students in the first year, who were male, had classes scheduled in the evening, attended a public school and resided in a municipality of high/highest margination index, had the highest probability (75.3%) of suffering VI-P. Conclusions: given the high levels of VI-P found, and its possible effects, it is necessary implement truly effective measures to prevent it.

Resumen Objetivos: estimar la prevalencia de la victimización por pares (VI-P) e identificar factores asociados. Métodos: se realizó un estudio transversal en una muestra representativa de las escuelas del estado de Campeche; se entrevistaron 2555 estudiantes de primaria y secundaria del ciclo escolar 2015-2016. Los alumnos fueron entrevistados cara a cara. Se analizó la tasa de prevalencia de VI-P según sexo, edad y varios aspectos relacionados con la escuela, con un intervalo de confianza de 95%. Las interacciones entre los factores estudiados se analizaron mediante un modelo jerárquico log-linear saturado. A partir de los términos que resultaron significativos, se realizó un análisis multivariado mediante un modelo logístico. Con base en este modelo, se calcularon los valores predictivos máximo y mínimo para la VI-P mediante la transformación inversa de probabilidades. Resultados: la prevalencia global de VI-P fue 60.4% (CI95%= 58.6-62.3). Las prevalencias de violencia física, psicoemocional, patrimonial y sexual fueron: 28.8, 52.9, 26.5 y 8.7%, respectivamente. Los estudiantes de primer grado, hombres, del turno vespertino, que asisten a una escuela pública, y de municipios con alto/muy alto índice de marginación, tuvieron la mayor prevalencia de VI-P (75.3%). Conclusiones: dados los altos niveles de VI-P encontrados, y considerando sus posibles efectos, es necesario implementar medidas realmente efectivas para prevenir este tipo de violencia.

Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética / Tuberculosis in Latin America and the Caribbean: Reflections from Bioethics / Tuberculose na América Latina e no Caribe: reflexões da bioética

Resumen El objetivo de este artículo es analizar las condiciones de acceso a servicios de salud de las personas con tuberculosis en América Latina y el Caribe (ALC), reflexionando desde la bioética sobre los aspectos de salud pública implicados. Se realizó una revisión documental del contexto de la tuberculosis en ALC con base en datos epidemiológicos. Los resultados se analizaron a partir de su relación con los determinantes sociales de la salud, los principios éticos que pautan la práctica médica y la responsabilidad social de los actores de salud. La tuberculosis es un problema de salud pública acuciante en la región, debido a su impacto familiar, comunitario, social, económico y sanitario, que afecta principalmente a personas y poblaciones vulneradas. En ALC la tuberculosis constituye un serio problema ético y de salud pública que causa un significativo número de muertes, discapacidad e incremento de la pobreza. La comprensión de su responsabilidad social por parte de los actores de salud es imperativa para cumplir con el derecho a servicios de salud de calidad, que aseguren un diagnóstico oportuno y un tratamiento completo de la enfermedad, y que guarden los principios de justicia, no discriminación y dignidad de los/las enfermos/as, para lo cual es importante que las estrategias nacionales de control de la tuberculosis incluyan cambios en los determinantes sociales de la enfermedad, así como el respeto de la etnia, cultura, lengua e identidad de los pacientes.

Abstract The objective of this article is to analyze the conditions of access to health services by people with tuberculosis in Latin America and the Caribbean (LAC), reflecting on the public health aspects involved from a bioethical perspective. A literature review of the context of tuberculosis in LAC based on epidemiological data was performed. The results were analyzed from its relationship with the social determinants of health and the ethical principles that guide medical practice. Tuberculosis is a pressing public health problem in the region because of its family, social, economic and health impact. It mainly affects vulnerable individuals and populations. Health services violate ethical principles. Tuberculosis is a serious ethics and public health problem in the region that causes death, disability and increased poverty. It is imperative to ensure the right to health services and to understand the individual and public health consequences of non-adherence to treatment. It is important that national tuberculosis control strategies include principles of dignity and non-discrimination of the sick, changes in the social determinants of the disease, and respect for the ethnicity, language culture and identity of patients.

Resumo O objetivo deste artigo é analisar as condições de acesso aos serviços de saúde para pessoas com tuberculose na América Latina e no Caribe (ALC), refletindo a partir da bioética sobre os aspectos de saúde pública envolvidos. Uma revisão documental do contexto da tuberculose na ALC foi realizada com base em dados epidemiológicos. Os resultados foram analisados com base em sua relação com os determinantes sociais da saúde, os princípios éticos que norteiam a prática médica e a responsabilidade social dos atores da saúde. A tuberculose é um problema urgente de saúde pública na região, devido ao seu impacto familiar, comunitário, social, econômico e sanitário, que afeta principalmente pessoas e populações vulneráveis. Na ALC, a tuberculose é um grave problema ético e de saúde pública que causa um número significativo de mortes, deficiências e aumento da pobreza. É imperativo que os agentes de saúde compreendam a sua responsabilidade social para que, dessa forma, seja possível garantir o direito a serviços de saúde de qualidade, que assegurem o diagnóstico oportuno e o tratamento completo da doença, e que defendam os princípios de justiça, não-discriminação e a dignidade dos/das pacientes, para a qual é importante que as estratégias nacionais de controle da tuberculose incluam mudanças nos determinantes sociais da doença, bem como o respeito à etnia, cultura, língua e identidade dos pacientes.

Soil transmitted helminthiasis in indigenous groups. A community cross sectional study in the Amazonian southern border region of Ecuador.

BACKGROUND: Rural communities in the Amazonian southern border of Ecuador have benefited from governmental social programmes over the past 9 years, which have addressed, among other things, diseases associated with poverty, such as soil transmitted helminth infections. The aim of this study was to explore the prevalence of geohelminth infection and several factors associated with it in these communities. METHODS: This was a cross sectional study in two indigenous communities of the Amazonian southern border of Ecuador. The data were analysed at both the household and individual levels. RESULTS: At the individual level, the prevalence of geohelminth infection reached 46.9% (95% CI 39.5% to 54.2%), with no differences in terms of gender, age, temporary migration movements or previous chemoprophylaxis. In 72.9% of households, one or more members were infected. Receiving subsidies and overcrowding were associated with the presence of helminths. CONCLUSIONS: The prevalence of geohelminth infection was high. Our study suggests that it is necessary to conduct studies focusing on communities, and not simply on captive groups, such as schoolchildren, with the object of proposing more suitable and effective strategies to control this problem.

Conformance contrast testing between rates of pulmonary tuberculosis in Ecuadorian border areas.

OBJECTIVE: To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. MATERIALS AND METHODS: Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. RESULTS: The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). CONCLUSION: It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.

Conformance contrast testing between rates of pulmonary tuberculosis in Ecuadorian border areas / Pruebas de contraste de conformidad en tasas de tuberculosis pulmonar en zonas fronterizas de Ecuador

Objective. To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. Materials and methods. Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. Results. The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). Conclusion. It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.

Objetivo. Determinar las tasas de sintomáticos respiratorios y de incidencia de tuberculosis pulmonar en dos zonas fronterizas de Ecuador, y contrastarlas con cifras oficiales. Material y métodos. Encuesta transversal aplicada en comunidades fronterizas Sur Oriental (FSO) y Sur Andina (FSA) a 1 598 y 2 419 mayores de 15 años, respectivamente. A los sintomáticos respiratorios se les realizó una baciloscopía en esputo. Las tasas y razón de momios se compararon frente a cifras oficiales mediante contraste de verosimilitudes. Resultados. Las tasas de sintomáticos respiratorios (7.7 y 5.9% en FSO y FSA, respectivamente) y de tuberculosis pulmonar (incidencia acumulada 125 y 140 por 100 000 habitantes, respectivamente) discrepan de las cifras oficiales (0.98 y 0.99% de sintomáticos respiratorios, respectivamente; y, 38.23 por 10(5) habitantes para tuberculosis pulmonar en Ecuador) (p<0.001). Conclusión. Fortalecer la búsqueda de sintomáticos respiratorios y la vigilancia epidemiológica de la tuberculosis pulmonar en áreas fronterizas.

Anti-tuberculosis treatment defaulting: an analysis of perceptions and interactions in Chiapas, Mexico.

OBJECTIVE: To analyze the perceptions and interactions of the actors involved in anti-tuberculosis treatment, and to explore their influence in treatment defaulting in Los Altos region of Chiapas, Mexico. MATERIAL AND METHODS: From November 2002 to August 2003, in-depth interviews were administered to patients with PTB, patients' family members, institutional physicians, community health coordinators, and traditional medicine practitioners. RESULTS: We found different perceptions about PTB between patients and their families and among health personnel, as well as communication barriers between actors. Defaulting is considered to be mainly due to the treatment's adverse effects. CONCLUSIONS: It is necessary to conduct research and interventions in the studied area with the aim of changing perceptions, improving sensitization, quality and suitability of management of patients with PTB in a multicultural context, and promoting collaboration between institutional and traditional medicine.

Anti-tuberculosis treatment defaulting: an analysis of perceptions and interactions in Chiapas, Mexico / Abandono del tratamiento antituberculosis: un análisis de percepciones e interacciones en Chiapas, México

OBJECTIVE: To analyze the perceptions and interactions of the actors involved in anti-tuberculosis treatment, and to explore their influence in treatment defaulting in Los Altos region of Chiapas, Mexico. MATERIAL AND METHODS: From November 2002 to August 2003, in-depth interviews were administered to patients with PTB, patients' family members, institutional physicians, community health coordinators, and traditional medicine practitioners. RESULTS: We found different perceptions about PTB between patients and their families and among health personnel, as well as communication barriers between actors. Defaulting is considered to be mainly due to the treatment's adverse effects. CONCLUSIONS: It is necessary to conduct research and interventions in the studied area with the aim of changing perceptions, improving sensitization, quality and suitability of management of patients with PTB in a multicultural context, and promoting collaboration between institutional and traditional medicine.

OBJETIVO: Analizar percepciones e interacciones entre actores involucrados en el tratamiento antituberculosis y su influencia en el abandono del tratamiento en los Altos de Chiapas, México. MATERIAL Y MÉTODOS: De noviembre 2002 a agosto 2003, se realizaron entrevistas a profundidad a pacientes con TBP, familiares, médicos institucionales, coordinadores comunitarios de salud y médicos tradicionales. RESULTADOS: Se encontraron diferentes percepciones entre los pacientes y sus familiares, respecto a las del personal de salud, así como barreras de comunicación entre los distintos actores. Los efectos adversos del tratamiento antituberculosis, son consideradas como una de las principales causas de su abandono. CONCLUSIONES: Es necesario que en la región estudiada se realicen investigaciones e intervenciones encaminadas a: cambiar percepciones y mejorar la sensibilidad, calidad y adecuación del manejo de pacientes con TBP en contextos multiculturales, así como impulsar el trabajo conjunto entre la medicina institucional y tradicional.

Malnutrition among children younger than 5 years-old in conflict zones of Chiapas, Mexico.

We performed a cross-sectional, community-based survey, supplemented by interviews with community leaders in Chiapas, Mexico, to examine the prevalence and predictors of child malnutrition in regions affected by the Zapatista conflict. The prevalence rates of stunting, wasting, and underweight were 54.1%, 2.9%, and 20.3%, respectively, in 2666 children aged younger than 5 years. Stunting was associated with indigenous ethnicity, poverty, region of residence, and intracommunity division. The results indicate that malnutrition is a serious public health problem in the studied regions.

Pregnancy outcomes, site of delivery, and community schisms in regions affected by the armed conflict in Chiapas, Mexico.

The Zapatista armed conflict began in the state of Chiapas, Mexico, in 1994, and overlaps pre-existing local disputes about land, religion, and other issues. Related disruptions in access to and utilization of health services have been alleged to have compromised local health status, particularly in vulnerable subgroups such as indigenous women and infants. The study objective was to measure maternal and perinatal mortality ratios and utilization of pregnancy-related health services in the region affected by the Zapatista conflict, and to describe associations between these primary outcome measures, socioeconomic and demographic factors, and factors associated with inter-party and intra-community conflict. A cross-sectional, population-based survey was conducted in 46 communities in three regions. The study subjects were 1227 women, 13-49 years old, who had been pregnant during the preceding 2 years (1999-2001). Principal outcome measures were maternal and perinatal mortality, and site of delivery. Secondary analyses explored associations between primary outcomes and socioeconomic, demographic, and conflict-related factors. Most births (87.1%) occurred at home. The crude observed maternal and perinatal mortality ratios were 607/100,000 and 23.5/1000 live births, respectively. Those who died had difficulty accessing emergency obstetrical care. Both home birth and mortality were associated with descriptors of intra-community conflict. Observed maternal and perinatal mortality ratios were substantially higher than those officially reported for Mexico or Chiapas. Reduction of high reproductive mortality ratios will require attention to socioeconomic and conflict-related problems, in addition to improved access to emergency obstetrical services.

Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico.

OBJECTIVE: To assess the prevalence of intestinal parasitic infections among children in highly deprived areas, and its possible association with demographic and socioeconomic indicators. MATERIAL AND METHODS: From March to September 1998 in a convenience sample of 32 communities of the border region of Chiapas, Mexico, selected at random based on the level of poverty and distance from the community to the nearest health care unit (< 1 hour; 1 hour or more), one of every four households with children under 15 years of age was randomly selected to provide three stool samples from their children (n 1478). Bivariate and multivariate (generalized linear models for correlated binary data), analysis were performed. RESULTS: The global prevalence of intestinal parasitosis was 67% (95% confidence interval [CI] 64-70%). Sixty percent had multiple parasites. The prevalence of Entamoeba histolytica/E dispar was 51.2%, that of Giardia lamblia 18.3%, and that of Ascaris lumbricoides 14.5%. Multivariate analysis showed that age and speaking an indigenous language were significantly associated with the presence of E histolytical E dispar and Giardia lamblia. Source of water and lacking a refrigerator and electricity were associated with the presence of Ascaris lumbricoides. CONCLUSIONS: Measures should be taken to improve water quality, sewage disposal, and domestic hygiene. Furthermore, health programs should be established to promote breast-feeding, and education policies aimed at reinforcing the use of indigenous languages by physicians in the health services.

Intestinal parasites in children, in highly deprived areas in the border region of Chiapas, Mexico

OBJETIVO: Estimar la prevalencia de parasitosis intestinal en niños de zonas de alta marginación y su asociación con indicadores demográficos y socioeconómicos de interés. MATERIAL Y MÉTODOS: En una muestra de 1478 menores de edad, de entre 1 a 14 años, provenientes de 32 comunidades de la región fronteriza de Chiapas, México, de marzo a septiembre de 1998, se recolectaron tres muestras de heces fecales, seleccionadas aleatoriamente a partir del grado de marginación (alto y muy alto) del municipio al que pertenecen, y distancia de la unidad de salud más cercana a la comunidad (<1 hora; 1 hora o más). En una de cada cuatro viviendas con niños menores de 15 años de edad, seleccionadas aleatoriamente, se obtuvieron tres muestras de heces fecales de éstos. Se efectuaron análisis bivariados con la prueba de ji cuadrada y multivariados con modelos lineales generalizados. RESULTADOS: La prevalencia global de parasitosis fue de 67 por ciento (intervalo de confianza IC 95 por ciento 64-70 por ciento). Sesenta por ciento de los niños estaban multiparasitados. La prevalencia de Entamoeba histolytica/E dispar fue de 51.2 por ciento, de Giardia lamblia, 18.3 por ciento y de Ascaris lumbricoides, 14.5 por ciento. La mayor prevalencia de E histolytica/E dispar se asoció con la edad y hablar algún idioma indígena; la de Ascaris lumbricoides con el sitio de obtención de agua y la carencia de refrigerador y electricidad. CONCLUSIONES: Es necesario hacer intervenciones locales de salud (calidad del agua, sistemas de desagüe), programas de educación sanitaria (promoción de la lactancia materna y medidas higiénicas) y promoción del habla de idiomas indígenas entre los médicos de la región

Calidad bacteriológica del agua para consumo humano en zonas de alta marginación de Chiapas / Bacteriological quality of drinking water in areas of high levels of poverty in Chiapas, Mexico

Objetivo. Analizar la calidad bacteriológica del agua (CBA) para consumo humano y su relación con diarreas y ente-roparasitosis en niños de 1 a 14 años en comunidades de alta marginación socioeconómica de Chiapas, México. Material y métodos. En una muestra aleatoria de 99 vi-viendas de la Región Fronteriza de Chiapas, de marzo a sep-tiembre de 1998, se recolectaron muestras de agua para consumo humano, se indagó sobre diarreas en los últi-mos 15 días y se recolectaron muestras de heces de 322 niños de 1 a 14 años. La CBA se determinó mediante la téc-nica de filtración por membranas y las enteroparasitosis por el método de Faust. Se utilizó el estadístico c2 para el análisis de la CBA con relación a los diversos factores ana-lizados. Resultados. Sólo 31 POR CIENTO de las muestras de agua fue-ron aptas para consumo humano. La CBA y la presencia de diarreas referida por las madres de los menores no mostraron asociación. Los niños con mala CBA en sus viviendas mostraron mayor prevalencia de Entamoeba histolytica y ma-yor tendencia a estar parasitados. Conclusiones. Es necesario desarrollar medidas que mejoren la CBA y campañas de educación que incrementen el uso de agua hervida, su ma-nejo adecuado y el cuidado de las fuentes de abaste-cimiento comunitarias.