Análisis de costoefectividad de la oximetría de pulso como prueba de detección de las cardiopatías congénitas críticas en México.

OBJETIVO: Realizar un análisis de costoefectividad de la oximetría de pulso como prueba de detección neonatal de las cardiopatías congénitas críticas (CCC) en México. Material y métodos. Se realizó un estudio de evaluación económica desde la perspectiva de los proveedores de servicios de salud. A través de un árbol de decisiones se comparó la examinación física versus la examinación física junto con la prueba de oxi-metría de pulso (POP). RESULTADOS: Por cada 10 000 recién nacidos, la alternativa con la POP detectó 32 casos adicionales de CCC, con una razón de costoefectividad incremental de 1 219 USD y una probabilidad de costoefectividad mayor a 90% con una disposición a pagar de 25 000 USD por cada detección temprana. Conclusión. La costoefectividad de la POP, como tamiz neonatal cardiaco, es mayor en México que en países de altos ingresos, y representa una inversión costoefectiva para ganar años de vida en la población infantil de México.

Strategies to improve the medical device life cycle in Mexico.

OBJECTIVE: To analyze the role of stakeholders to three alternative strategies to improve processes and practices regarding the regulation, assessment, and management of orthopaedic medical devices in Mexico. MATERIALS AND METHODS: The study was based on document analysis and 17 structured interviews with multiple key actors within the Mexican health system to inform a stakeholder analysis aiming at assessing the political feasibility of these strategies. RESULTS: Central level government agencies, those with a relation to quality of care, were identified as most relevant stakeholders to influence the adaption and application of the strategies. Major barriers identified are financial and human resources, and organisational culture towards reform. CONCLUSIONS: Discussed strategies are political feasible. However, solving identified barriers is crucial to achieve changes directed to improve outputs and outcomes of medical device life cycle and positively influence the quality of health care and the health system's performance.

ATTITUDES OF ORTHOPEDIC SPECIALISTS TOWARD EFFECTS OF MEDICAL DEVICE PURCHASING.

OBJECTIVES: The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes. METHODS: We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico. RESULTS: We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments. CONCLUSIONS: To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.

[Teenagers' access to contraception in Mexico City]. / El acceso a métodos anticonceptivos en adolescentes de la Ciudad de México.

OBJECTIVE:: To study and understand the phenomenon of access to contraceptive methods in Mexican teenages, through the use of the Levesque model, which allows for the observation of both the system and the system and the user´s participation in the access process. MATERIALS AND METHODS:: A qualitative study was conducted with focus groups technique in a middle and high school of Mexico City. RESULTS:: The perception of ability to access to health care is limited, teenagers do not know the mechanisms of care or supply of contraceptive methods. Prejudices of service providers provoke a negative reaction. The family is a source of information for adolescents to make decisions. CONCLUSIONS:: The model allowed the assessment of access to contraceptive methods in teenagers. It were identified different aspects that act as barriers to access and may inform health care providers about this population in their sexual and reproductive health.

[Empowerment and social support for patients with chronic kidney disease: case study in Michoacán, MexicoEmpoderamento e apoio social de pacientes com nefropatia crônica: estudo de caso em Michoacán, México]. / Empoderamiento y apoyo social en pacientes con enfermedad renal crónica: estudio de caso en Michoacán, México.

OBJECTIVE: Identify the degree of empowerment and the characteristics of the social support for individuals with chronic kidney disease (CKD). METHODS: Cross-sectional study of people with chronic kidney disease living in the municipality of Hidalgo, Michoacán, Mexico, who belong to the Association of Kidney Patients, Civil Association. The study examined the sociodemographic profile and personal characteristics associated with the disease, the degree of empowerment, the degree of social support, and family functioning. RESULTS: Close to 90% of the sample receives sufficient social support, while 40% of the participants belong to semi-cohesive or cohesive families The overall empowerment score was 117.5 ± 14.3; community empowerment was higher in the older group (P < 0.05). Positive social interaction is the social support component most strongly correlated with the degree of empowerment (r = 0.333; P < 0.01). CONCLUSIONS: Empowerment is determined by, and is a determinant of, social support and has facilitated access to renal replacement therapy in this community.

OBJETIVO: Identificar o nível de empoderamento e apoio social de pacientes com nefropatia crônica. MÉTODOS: Estudo transversal realizado com pacientes com nefropatia crônica residentes no município de Fidalgo, Michoacán, México, que participavam de uma associação civil de pacientes renais crônicos (Asociación de Enfermos del Riñón). Foram investigados aspectos pessoais e sociodemográficos dos pacientes associados à doença, nível de empoderamento e apoio social e funcionamento familiar. RESULTADOS: Cerca de 90% da amostra estudada dispõem de uma rede de apoio social satisfatória e 40% pertencem a famílias com boa coesão ou coesão média. A pontuação global de empoderamento foi de 117,5 ± 14,3 e o empoderamento comunitário foi maior no grupo com idade mais avançada (P < 0,05). Interação social positiva é o componente da rede de apoio social com correlação mais forte com o nível de empoderamento (r = 0,333; P < 0,01). CONCLUSÕES: O empoderamento é determinado pela rede de apoio social, sendo também um determinante deste apoio, e facilita o acesso à terapia renal substitutiva nesta comunidade.

Effects of procurement practices on quality of medical device or service received: a qualitative study comparing countries.

BACKGROUND: We know little about how procurement of a high-risk medical device (HRMD) affects clinical practice and outcomes. In health systems in high-income countries, and specifically those that maintain a national arthroplasty registry, procurement decisions are frequently guided by long-term clinical results, with the goal of ensuring at least standard quality of HRMDs. But in countries like Mexico, decision-making is often dominated by lowest acquisition price. We set out to study the impact of procurement for orthopaedic HRMDs on clinical procedures and outcomes. METHODS: We based our qualitative study on 59 in-depth interviews with stakeholders from Mexico, Switzerland, Germany, and UK: orthopaedic specialists, government officials, other experts, and social security system managers or administrators. We took a healthcare delivery approach to capturing and comparing factors that affected the regulations of HRMDs and procurement processes, and to understanding connections between procurement and clinical practice. RESULTS: Our findings demonstrate for procurement processes that the three European countries compared to Mexico don't have similar concerns with regards to their procurement processes. Deficiencies of procurement regulations and practices identified from representatives in Mexico were almost absent in European countries. We identified three areas of deficiency: 1) HRMD regulations based on insufficiently robust clinical evidence (mainly noted by European countries); 2) Follow-up on Health Technology Assessments is inadequate (noted by Mexico) and methodology not always good enough (noted by European countries); and, 3) Lowest-acquisition price often guides procurement decisions and thus may not align with needs of clinical procedures (noted by Mexico and some European countries). CONCLUSIONS: Procurement processes for orthopaedic HRMDs may have an impact on clinical procedures and outcomes. A favourable approach is one where orthopaedic specialists are parties to the procurement process, and post-market surveillance data informs decision-making. Actors in the procurement process can improve their impact on clinical procedures and outcomes by developing specific strategies that better align the needs of both, procurement and clinical procedures.

How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?

BACKGROUND: In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico. METHODS: We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation. RESULTS: The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed. CONCLUSIONS: The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we recommend that the procurement mechanism should integrate knowledge from clinical procedures adequately in their decision-making. Without strong guidance, organisational changes, and support by technological solutions to improve the generation and management of knowledge, procurement processes for orthopaedic high-risk medical devices will remain sub-optimal.

[Evaluation of Mexican 'Sicalidad' health quality program]. / Evaluación de la implementación del programa Sicalidad en México.

OBJECTIVE: To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. MATERIALS AND METHODS: The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. RESULTS: The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. CONCLUSION: In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.

Safety and efficacy comparison of minocycline microgranules vs lymecycline in the treatment of mild to moderate acne: randomized, evaluator-blinded, parallel, and prospective clinical trial for 8 weeks.

BACKGROUND: Minocycline and lymecycline are used in the treatment of acne, but there is not enough evidence to support superior efficacy of one of them. METHODS: 170 participants from 14 to 34 years old with mild to moderate facial acne vulgaris were recruited. 84 had 100 mg of minocycline in a single daily dose for 8 weeks and 86 had 300 mg of lymecycline in a single daily dose for 8 weeks. Participants were evaluated at baseline, week 4 and week 8. RESULTS: 65 minocycline and 60 lymecycline patients were evaluable. The last observation carried forward for the count of non-inflammatory lesions changed from 37.5 ± 17.8 to 37.7 ± 17.8 in the minocycline group and from 36.9 ± 15.5 to 33.4 ± 19.3 in the lymecycline group (no significant changes); corresponding changes in inflammatory lesions were from 19.4 ± 12.4 to 12.2 ± 10.0 in the minocycline group and from 20.1 ± 11.3 to 12.6 ± 8.4 in lymecycline group (P< 0.05 comparing baseline vs. final in both groups). Porphyrin counts varied from 899.5 ± 613.9 to 233.5 ± 219.5 in the minocycline group and from 956.9 ± 661.8 to 411.8 ± 411.5 in the lymecycline group (P<0.05 between the groups at study end). 36 (42.9%) patients receiving minocycline suffered 55 adverse events (22 of them gastrointestinal), while 28 (33.3%) lymecycline patients had 37 adverse events (15 of them gastrointestinal). One patient in the lymecycline group withdrew the study due to gastritis, and one more patient in the same group experienced eosinophilia. CONCLUSIONS: There were no differences between the groups in non-inflammatory and inflammatory lesion counts, and in the safety profile. Treatment with minocycline induced statistically significant decrease in facial porphyrin counts compared to the group treated with lymecycline (ClinicalTrials.gov number, NCT00988026).

Comparison of the Influence of Oxygen Groups Introduced by Graphene Oxide on the Activity of Carbon Felt in Vanadium and Anthraquinone Flow Batteries.

An increasing number of studies focus on organic flow batteries (OFBs) as possible substitutes for the vanadium flow battery (VFB), featuring anthraquinone derivatives, such as anthraquinone-2,7-disulfonic acid (2,7-AQDS). VFBs have been postulated as a promising energy storage technology. However, the fluctuating cost of vanadium minerals and risky supply chains have hampered their implementation, while OFBs could be prepared from renewable raw materials. A critical component of flow batteries is the electrode material, which can determine the power density and energy efficiency. Yet, and in contrast to VFBs, studies on electrodes tailored for OFBs are scarce. Hence, in this work, we propose the modification of commercial carbon felts with reduced graphene oxide (rGO) and poly(ethylene glycol) for the 2,7-AQDS redox couple and to preliminarily assess its effects on the efficiency of a 2,7-AQDS/ferrocyanide flow battery. Results are compared to those of a VFB to evaluate if the benefits of the modification are transferable to OFBs. The modification of carbon felts with surface oxygen groups introduced by the presence of rGO enhanced both its hydrophilicity and surface area, favoring the catalytic activity toward VFB and OFB reactions. The results are promising, given the improved behavior of the modified electrodes. Parallels are established between the electrodes of both FB technologies.

A novel membrane-based process to concentrate nutrients from sidestreams of an Urban Wastewater Treatment Plant through captured carbon dioxide from biogas.

Among the challenges that wastewater treatment plants face in the path towards sustainability, reducing CO2 emissions and decrease the amount of waste highlight. Within these wastes, those that can cause eutrophication, such as nutrients (nitrogen and phosphorous) are of great concern. Herein we study a novel process to concentrate nutrients via membrane technology. In particular, we propose the use of forward osmosis, applying the carbonated solvent which contains the CO2 captured from the biogas stream as draw solution. This carbonated solvent has a high potential osmotic pressure, which can be used in forward osmosis to concentrate the nutrients stream. To this end, we present the results of an experimental plan specifically designed and performed to evaluate two main parameters: (1) nutrients concentration; and (2) water recovery. The process designed involves pH adjustment, membrane filtration to separate solids, pH reduction and forward osmosis concentration of nutrients. With this process, concentrations factor for nutrients in between 2 and 2.5 and water recovery of approximately 50 % with water flux of 7 to 8 L/(m2h) can be achieved.

An Environmental-friendly Procedure Based on Deep Eutectic Solvent for Extraction and Determination of Toxic Elements in Fish Species from Different Regions of Iraq.

In this study, an eco-friendly procedure was established by vortex-assisted liquid-phase microextraction based on deep eutectic solvent (VA-LPME-DES) combined with graphite furnace atomic absorption spectroscopy (GFAAS). The performance of this method was demonstrated by the extraction and analysis of lead (Pb), cadmium (Cd), and mercury (Hg) in fish samples. The hydrophobic DES is considered as a green extractant (environmentally friendly and less toxic than common organic solvents) and is a suitable alternative to common toxic organic solvents and is made of l-menthol and ethylene glycol (EG) with a molar ratio of 1:1. Under optimized conditions, the method linearity was in the ranges of 0.15-150 µg kg-1 with the coefficient of determinations (r2) higher than 0.996. Accordingly, the detection limits for Pb, Cd, and Hg were 0.05, 0.05, and 0.10 µg kg-1, respectively. The analysis of fish samples showed that the concentration of toxic elements in fish caught from the Tigris and Euphrates Rivers is much higher than the concentration of these elements in locally farmed trout fish. Also, the analysis of fish-certified reference materials with presented procedure produced results that were in good agreement with the certified values. The results showed that VA-LPME-DES is a very cheap, fast, and environmental-friendly procedure for the analysis of toxic elements in different types of fish species.

Recommendations to improve healthcare of neonates with respiratory insufficiency beneficiaries of Seguro Popular.

OBJECTIVE: To evaluate the structure and processes of care of neonatal intensive care units (NICU) providing health care to neonates with respiratory insufficiency, and financed by Seguro Popular. MATERIALS AND METHODS: A cross-sectional design was used; 21 NICU were included. Information was collected from four sources: Seguro Popular database, self-applicable interviews to medical staff, structure and processes format, and reviews of clinical charts. VARIABLES: structure, processes of care, drug supplies, training, and neonates' clinical conditions. RESULTS: The analysis of the database included 9 679 newborns. The respiratory disorders were transitory tachypnea, non-specific respiratory insufficiency, respiratory distress syndrome, (RDS) perinatal asphyxia, and meconium aspiration syndrome. 90% of NICU'S directors considered that drug supply was good, whereas only 16% of neonatologist had this opinion. 58.5% of neonates with RDS had <37 gestation weeks. 34.2% with RDS were prescribed alveolar surfactant; 51% received dosages above recommended standards. CONCLUSIONS: Recommendations to improve infrastructure and care processes are issued.

Quality of health care of the medical units that provide services for Medical Insurance for a New Generation enrollees.

OBJECTIVE: In this evaluation we assess the quality of the general and clinical structure in medical units that deliver health services for the Medical Insurance for a New Generation (SMNG) enrollees. MATERIALS AND METHODS: The study population included 82 medical units that deliver health services to enrollees of the SMNG in 15 states of Mexico, during 2009. Two indexes: the general structure index and the clinical structure index were created. RESULTS: It was found an unequal quality of the general and clinical structure in the different levels of care. The results suggest that the first level of care lacks both important general and clinical structural items. They also show on average a regular quality in the second level of care and a good quality in the third level of care medical units. CONCLUSIONS: Our results support the main conclusion of the work of Bulatao, "Improving services requires moving beyond policy reform to strengthening implementation of services".

The use of the tracer methodology to assess the quality of care for patients enrolled in Medical Insurance for a New Generation.

OBJECTIVE: To assess the quality of care provided at medical units that provide services to Medical Insurance for a New Generation (SMNG) enrollees. MATERIALS AND METHODS: The tracer methodology was used in a sample of 82 medical units selected in fifteen states of Mexico and data collected in November 2009. RESULTS: Problems were found to locate the minimal number of the 18 medical charts requested in three of the tracers. The first level of care on the average reports that the quality of the process of care is 6, in a 10 point scale. In the second level improves and the third level of care is better qualified. CONCLUSIONS: The tracer methodology has enabled us to assess the quality of care. There is room for improvement in the medical units of the state health services, to that end should be directed the efforts in the health system in Mexico.

Design of the 2009 evaluation of the Medical Insurance for a New Generation program.

OBJECTIVE: To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG). MATERIALS AND METHODS: The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) children's health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey. CONCLUSION: The results should serve as baseline data of the health status of SMNG children and the current staus of the program.

[Transforming health systems based on primary care]. / La transformación del sistema de salud con base en la atención primaria.

Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.

What Opportunities Exist for Making the Food Supply Nutrition Friendly? A Policy Space Analysis in Mexico.

BACKGROUND: As part of a global policy response for addressing malnutrition, food system actions have been proposed. Within food system interventions, policies directed to supply chains have the potential to increase the availability and affordability of a healthy diet. This qualitative study aimed to identify opportunities to integrate nutrition as a priority into the food supply policy space in Mexico. METHODS: Data were collected through analysis of 19 policy documents and 20 semi-structured stakeholder interviews. As an analytical framework, we used policy space analysis and embedded the Advocacy Coalition Framework (ACF) and the steps of the food chain of the conceptual framework of food systems for diets and nutrition. RESULTS: Policy issues relevant to nutrition were viewed differently in the economic and agricultural sectors versus the health sector. Overall, the main policy objective related to nutrition within the economic and agricultural sectors was to contribute to food security in terms of food quantity. Nutrition was an objective in itself only in the health sector, with a focus on food quality. Our policy space analysis reveals an opportunity to promote a new integrated vision with the recent creation of an intersectoral group working on the public agenda for a food system transformation. This newer integrative narrative on food systems presents an opportunity to shift the existing food security narrative from quantity towards considerations of diet quality. CONCLUSION: The political context and public agenda are favorable to pursue a food system transformation to deliver sustainable healthy diets. Mexico can provide a case study for other low- and middle-income countries (LMICs) for putting nutrition at the center of food policy, despite the ongoing constraints on achieving this.

Phosphate Ion Removal from Synthetic and Real Wastewater Using MnFe2O4 Nanoparticles: A Reusable Adsorbent.

The purpose of this study was to eliminate phosphate (P) from wastewater using MnFe2O4 nanoparticles. BET, TGA/DTG, FTIR, SEM, TEM, VSM, XRD and EDX/Map analyses were used to determine the MnFe2O4 surface properties. The specific surface area of the adsorbent was 196.56 m2/g and VSM analysis showed that the adsorbent has a ferromagnetic property. The maximum P sorption efficiency using MnFe2O4 (98.52%) was achieved at pH 6, temperature of 55 °C, P concentration of 10 mg/L, time of 60 min, and sorbent dosage of 2.5 g/L, which is a significant value. Also, the thermodynamic study indicated that the P sorption process is spontaneous and endothermic. Moreover, the utmost sorption capacity of P using MnFe2O4 was 39.48 mg/g. Besides, MnFe2O4 can be used for up to 6 reuse cycles with high sorption efficiency (>91%). Also, MnFe2O4 was able to remove phosphate, COD, and BOD5 from municipal wastewater with considerable removal efficiencies of 82.7%, 75.8%, and 77.3%, respectively.

Seroprevalence of Trypanosoma cruzi in Eight Blood Banks in Mexico.

BACKGROUND: The true prevalence of Chagas disease in Mexico is unknown. However, it has been estimated that 1.1-4 million people are infected with Trypanosoma cruzi, which represents a potential risk for transmission of the disease via contaminated blood. AIM OF THE STUDY: To determine the Chagas disease seroprevalence in donors from eight blood banks in the north of Mexico City, and the northeast of the State of Mexico. STUDY DESIGN AND METHODS: Serum samples from blood donors (n = 515,038) were tested to detect the presence of anti-Trypanosoma cruzi antibodies in eight blood banks. The serologic screening test was performed in each of the blood banks. To confirm the seropositive blood donors, only two out of the eight blood banks used a test with a different principle with the aim of identifying anti-Trypanosoma cruzi antibodies. All tests were validated by the Mexican Institute for Epidemiological Diagnosis and Reference. RESULTS: One thousand two hundred and ten blood donors were seropositive for Trypanosoma cruzi, which represents a 0.23% seroprevalence (95% CI 0.22-0.25%). Of the seropositive blood donors, 97.03 % resided in the northeast area of the State of Mexico, Mexico City, and southern part of the State of Hidalgo. CONCLUSIONS: Active transmission of Chagas disease may be occurring in non-endemic regions in the northeast of the State of Mexico.