Assessment of the quality of the vital registration system for under-5 mortality in Yucatan, Mexico.

INTRODUCTION: Vital registration is an important element in health information systems which can inform policy and strengthen health systems. Mexico has a well-functioning vital registration system; however, there is still room for improvement, especially for deaths of children under 5. This study assesses the quality of the vital registration system in capturing deaths and evaluates the quality of cause of death certification in under-5 deaths in Yucatan, Mexico. METHODS: We collected information on under-5 deaths that occurred in 2015 and 2016 in Yucatan, Mexico. We calculated the Vital Statistics Performance Index (VSPI) to have a general assessment of the vital registration performance. We examined the agreement between vital registration records and medical records at the individual and population levels using the chance-corrected concordance (CCC) and cause-specific mortality fraction (CSMF) accuracy as quality metrics. RESULTS: We identified 966 records from the vital registry for all under-5 deaths, and 390 were linked to medical records of deaths occurring at public hospitals. The Yucatan vital registration system captured 94.8% of the expected under-5 deaths, with an overall VSPI score of 87.2%. Concordance between underlying cause of death listed in the vital registry and the cause determined by the medical record review varied substantially across causes, with a mean overall chance-corrected concordance across causes of 6.9% for neonates and 46.9% for children. Children had the highest concordance for digestive diseases, and neonates had the highest concordance for meningitis/sepsis. At the population level, the CSMF accuracy for identifying the underlying cause listed was 35.3% for neonates and 67.7% for children. CONCLUSIONS: Although the vital registration system has overall good performance, there are still problems in information about causes of death for children under 5 that are related mostly to certification of the causes of death. The accuracy of information can vary substantially across age groups and causes, with causes reported for neonates being generally less reliable than those for older children. Results highlight the need to implement strategies to improve the certification of causes of death in this population.

Factors associated with delays in the search for care in under-5 deaths in Yucatán, Mexico.

OBJECTIVE: We examined delays during the search for care and associations with mother, child, or health services characteristics, and with symptoms reported prior to death. MATERIALS AND METHODS: Cross-sectional study compris-ing household interviews with 252 caregivers of children under-5 who died in the state of Yucatán, Mexico, during 2015-2016. We evaluated the three main delays: 1) time to identify symptoms and start search for care, 2) transport time to health facility, and 3) wait time at health facility. RESULTS: Children faced important delays including a mean time to start the search for care of 4.1 days. The mean transport time to the first facility was longer for children enrolled in Seguro Popular and there were longer wait times at public facilities, especially among children who also experienced longer travel time. CONCLUSIONS: Providing resources to enable caregiv-ers to access health services in a timely manner may reduce delays in seeking care.

[Effect of a community-based intervention to improve the knowledge on the warning signs of maternal complications among Mayan women from Yucatan randomized controlled trial]. / Efecto de una intervención comunitaria para mejorar conocimientos sobre signos de alarma de complicaciones maternas en mujeres mayas de Yucatán, ensayo controlado, aleatorizado.

OBJECTIVE: To evaluate a community-based intervention aimed to improve women's knowledge on alarm signs for preeclampsia-eclampsia, obstetrical hemorrhage, and puerperal sepsis, in Mayan pregnant women in the state of Yucatan, Mexico, in 2008, using participatory methodology. MATERIAL AND METHODS: Community-based randomized controlled trial, with experimental (n = 28) and control (n = 28) groups. Participatory strategies with translators of Mayan language were used. Analysis of differences in differences was carried out to evaluate the effect of intervention. RESULTS: The intervention increased knowledge on alarm signs for preeclampsia-eclampsia in 42.9% (p = 0.012), obstetrical hemorrhage in 32.1% (p = 0.071) and puerperal sepsis in 25.0% (p = 0.659). Control group increased 32.1% (p = 0.033) knowledge on alarm signs for puerperal sepsis. Overall effect of intervention was 33.3% (p = 0.007). CONCLUSIONS: The community-based intervention improved overall knowledge of women on alarm signs and specific knowledge on alarm signs for preeclampsia-eclampsia. It is necessary to spread this methodology, so that a greater number of women of the community will also be benefitted with the intervention.

[Medical-social characteristics of maternal deaths in a Mayan community of Yucatan, Mexico]. / Características médico-sociales de las muertes maternas en una comunidad maya de Yucatán, México.

OBJECTIVE: To describe clinical and sociodemographic characteristics of maternal deaths occurred from 1997 to 2001, so as the access and availability of services of health, in the municipality of Chemax, Yucatan, Mexico. MATERIAL AND METHODS: Acts and certificates of death of women born in the municipality of Chemax were reviewed. The maternal deaths were classified in direct and indirect obstetrical deaths, according to criteria of the International Statistical Classification of Diseases and Related Health Problems (tenth revision). The knowledge of the women on risks in the pregnancy, childbirth and the postpartum period was explored indirectly in the relatives, as well as perceptions of these last ones on the death. The time passed between the search of aid and the attention was calculated. RESULTS: Nine cases of maternal deaths were registered during 1997-2001 period, two of which were findings of the study. The principal cause was the obstetric hemorrhage. The 9 women spoke Mayan an 5 understood in addition the Spanish. The women did not know the obstetrical risks. The perceptions of the relatives on the deaths were bound to myths, lack of information and medical attention. The minimum time of transfer for the attention of the childbirth was of 10 minutes and the maximum of 2 hours. For the attention of the complications, eigth women were transferred to a hospital outside their locality. CONCLUSIONS: The hemorrhage postpartum was the leading cause of maternal death in Chemax. Sociodemographic factors and of access to the health services, characterized to the maternal deaths in this community. Something similar could be happening in other communities very marginalized of Yucatan.

Factors associated with delays in the search for care in under-5 deaths in Yucatán, Mexico / Factores asociados con demoras en la búsqueda de atención en muertes de menores de cinco años en Yucatán, México

Abstract: Objective: We examined delays during the search for care and associations with mother, child, or health services characteristics, and with symptoms reported prior to death. Materials and methods: Cross-sectional study comprising household interviews with 252 caregivers of children under-5 who died in the state of Yucatán, Mexico, during 2015-2016. We evaluated the three main delays: 1) time to identify symptoms and start search for care, 2) transport time to health facility, and 3) wait time at health facility. Results: Children faced important delays including a mean time to start the search for care of 4.1 days. The mean transport time to the first facility was longer for children enrolled in Seguro Popular and there were longer wait times at public facilities, especially among children who also experienced longer travel time Conclusions: Providing resources to enable caregivers to access health services in a timely manner may reduce delays in seeking care.

Resumen: Objetivo: Analizar las demoras en la búsqueda de atención y su asociación con características de la madre, del niño y los servicios de salud, así como con los síntomas reportados antes de la defunción. Material y métodos: Diseño transversal con entrevistas a 252 cuidadores que se encargaron de niños menores de cinco años que fallecieron en el estado de Yucatán, México, durante 2015-2016. Se evaluaron tres demoras: 1) tiempo en identificar la complicación e iniciar el proceso de búsqueda; 2) tiempo de transporte; y 3) tiempo de espera en la unidad de salud. Resultados: Los niños enfrentaron demoras importantes en la búsqueda de atención. La media de tiempo para iniciar la búsqueda de atención fue de 4.1 días. La media de tiempo de transporte a la primera unidad de atención fue mayor para niños inscritos en el Seguro Popular y hubo tiempos de espera más largos en unidades de salud del sector público, especialmente entre niños que tuvieron tiempos de transporte largos. Conclusión: Proporcionar recursos que permitan a los cuidadores acceder a los servicios de salud de manera oportuna puede reducir las demoras en la búsqueda de atención.

Detection of unusual strains of RV in patients with acute diarrhoea in Mexico.

BACKGROUND: Group A rotaviruses are a major cause of acute gastroenteritis in infants. Human strains with a short RNA pattern generally exhibit subgroup I, G2, P1B[4] specificity, those with a long RNA pattern show subgroup II, G1, G3 or G4, P1A[8] specificity. The presence of strains with unusual specificities has been reported worldwide over the last decade. OBJECTIVE: To determine antigenic diversity among rotaviruses isolated from patients with diarrhoea. STUDY DESIGN: A laboratory-based survey study was carried out with faecal samples from patients with acute gastroenteritis form January to April 2000. To classify the samples PAGE and ELISA with specific antibodies to serotype G and P and RT-PCR were carried out. RESULTS: Twenty one specimens from patients with dehydrating diarrhoea had unusual specifies. Nine specimens had unusual combination of long pattern and subgroup I. Twelve specimens with short pattern belong to G1 serotype. As far as the serotypes and genotypes concern 11 samples were P1A, P[4] and one specimen was P1A, P[9]. CONCLUSIONS: These results demonstrated the unexpected presence of unusual strains of rotavirus in Mexico. Detection of strains with both human and animal characteristics may indicate interspecies transmission of RV between humans and animals.

[Under-registry of maternal death in Merida, Yucatan, Mexico (1997-2001)]. / Subregistro de muertes maternas en Mérida, Yucatán (1997-2001).

OBJECTIVE: To analyze the subregistry of maternal deaths in Merida, Yucatan, Mexico. MATERIAL AND METHODS: The subregistry was studied using descriptive, cross-sectional and retrospective approaches. Acts and death certificates of women aged 9 to 50 years that passed away in five years (1997-2001) were reviewed. Additionally, an interview with their relatives was conducted plus a revision of clinical files and reports of autopsies. The maternal deaths were classified according to the criteria of the International Statistical Classification of Diseases and Related Health Problems (tenth revision). Maternal deaths found during the period of study were compared with those reported by the official organism in order to detect their subregistry. RESULTS: 21 cases of maternal deaths were found during the study period, from them 16 were notified officially. The subregistry of maternal deaths was 24% in the five analyzed years. CONCLUSIONS: Maternal mortality continues to be a public health problem in urban areas, like the city of Merida. It is necessary to design strategies to avoid the subregistry and allow the reduction of maternal deaths.

Clinical manifestations of the rotavirus infection and his relation with the electropherotypes and serotypes detected during 1998 and 1999 in Merida, Yucatan, Mexico.

BACKGROUND: Group A rotavirus (RV) is associated with acute infectious diarrhea (AID) in children and adults. The clinical manifestations of RV infection are classified as slight, moderate and severe and could be the results of differing rotaviral serotypes. Attempts have been made to correlate the severity of the infection with specific RV groups, subgroups (SG) serotypes and electropherotypes, but the results have been inconclusive. OBJECTIVE: To correlate the severity of the RV infection with the strains of RV isolated from the patients. STUDY DESIGN: 142 feces were collected from patients with AID caused by RV. The samples were subjected to polyacrylamide gel electrophoresis (PAGE) to determine the electrophoretic pattern and immunoenzymatic assays with monoclonal antibodies specific for serotype, SG and group. The Program EPIINFO 6.0 was used to analyze the correlation. RESULTS: The 142 RV strains isolated were from group A and long electrophoretic pattern. Respect to the symptoms were classified, 43 (30%) as slight; the RV isolates corresponding to these patients were 35 of serotype G1P1A SG II; 4 G1P1A SG I and II; 1 G1P1A SG Non I Non I; 1 G3 SG II; 1 G3 SG Non I and Non II and 1 G3 SG I and II. 89 (53%) of patients showed moderate clinical symptoms. 58 isolates of RV were G1P1A SG II; 11 G1P1A SG Non I Non II; 9 G1P1A SG I and II; 1 G1P1B SG II; 1 G4P1A SG II; 1G1 and G4 SG I and II; 6 G3 SG Non I Non II; 2 G3 SG II. The severe RV infection occurred in only 10 (7%). 8 were serotype G1P1A SG II and 2 were G1P1A SG I and II. CONCLUSION: This study demonstrated that the severity of AID has no significant statistical relationship to the specific RV strains isolated from the patients.

[Rotavirus infections in Yucatan, Mexico, in 2000]. / Infecciones por rotavirus en Yucatán, México, durante el 2000.

OBJECTIVE: To describe the cases of rotavirus infection occurred in Yucatan, Mexico, in the year 2000. MATERIAL AND METHODS: From January to May 2000, were studied 668 patients with acute infectious diarrhea and their fecal samples. A questionnaire was applied and the samples were analyzed by polyacrylamide gel electrophoresis with silver stained. Incidence rates and the frequency of clinical manifestations were calculated. RESULTS: The cases of rotavirus occurred from January to April 2000. Three hundred-thirty seven (50.45%) samples were positives. The higher incidence rate of 0.70% was observed in infants 6 to 8 months of age. Vomit, nausea and hyperthermia were the more frequent clinical manifestations. Abdominal pain and dehydration occurred in 45.9% and 41.8% of the cases respectively. CONCLUSIONS: Presentation of the cases was similar to the reported by the countries with tempered climate. The risk of becoming ill by rotavirus was greater in the children under 1 year of age. Abdominal pain requires be carefully explored. Surveillance of the cases must be carried out throughout the year.

Caso de púrpura trombocitopénica autoinmune y dengue / A case of autoimmune thrombocytopenic purpura and dengue

El dengue fue detectar en Yucatán en 1979. Desde entonces, han sido reportados cerca de 17,000 casos clínicos, de los cuales 1169 fueron confirmados por la presencia de anticuerpos específicos (IgM e IgG) y/o estudios virológicos; 10 de los casos fueron clasificados como fiebre hemorrágica por dengue y cuatro fallecieron. El padecimiento es endémico en la región y se han detectado los serotipos 1, 2 y 4. Este informe describe a un paciente con púrpura trombocitopénica autoinmune crónica, quien desarrolló infección primaria por dengue con manifestaciones hemorrágicas y respondió a corticoides. Se discute la fisiopatogenia de la trombocitopenia y se analiza la utilidad del tratamiento con corticosteroides en pacientes con enfermedad autoinmune

Leptospirosis anictérica en un brote epidémico de dengue en la Península de Yucatán / Anicteric leptospirosis in a dengue epidemic in Yucatan, Mexico

Introducción. La leptospirosis es una zoonosis de amplia distribución mundial. Posee un amplio polimorfismo clínico, pero en general se presenta en tres formas distintas: subclínica, anictérica (benigna) y grave (enfermedad de Weil). En México la información que se tiene sobre leptospirosis humana de 1970 a la fecha es escasa y en su gran mayoría proviene de estudios de corte seroepidemiológico, por lo que poco se sabe sobre sus otras formas clínicas, y tal vez por ellos sólo se relacione con la forma grave. Objetivo. Demostrar que la leptospirosis no es rara en la región y que puede estarse confundiendo clínicamente con otras entidades febriles, entre ellas el dengue. Método. Se analizaron para la búsqueda de casos de leptospirosis, sueros y expedientes clínicos de 50 pacientes que fueron diagnosticados clínicamente como dengue y que resultaron negativos en las pruebas de confirmación etiológica. Se utilizó como prueba diagnóstica la de microaglutinación (MA), utilizando como antígeno Leptospira interrogans vivas de ocho serovares diferentes. Resultados. Se encontraron siete pacientes positivos a leptospirosis (14 por ciento). La sintomatología que presentaron correspondió a la descrita para la forma anictérica. Tres fueron de Yucatán y cuatro de Campeche. En el primer Estado predominó el serovar canícola y en el segundo el serovar pomona. Conclusiones. La leptospirosis es una enfermedad infecciosa presente al igual que el dengue en los estados de Yucatán y Campeche, por lo que se le debe tomar en cuenta en el diagnóstico diferencial, sobre todo en zonas geográficas en donde los dos padecimientos son endémicos

Factores de la personalidad relacionados con la participación de los médicos en un sistema de vigilancia del dengue / Personality factors and physician participation in a surveillance system for dengue control

Introducción. El conocimiento de la incidencia del dengue en una población es un factor importante para la toma de deciciones referentes a las medidas preventivas y de control de la enfermedad. Esta incidencia se puede conocer si los médicos solicitan los estudios de diagnósticos necesarios para su confirmación y si se reportan sus casos a las autoridades sanitarias. Objetivo. El presente estudio tuvo como objetivo el determinar los factores de personalidad que se asocian con la participación en el sistema de vigilancia del dengue, en un grupo de médicos generales y familiares de cuatro instituciones públicas de salud de la ciudad de Mérida. Material y Métodos. Los datos obtenidos en el presente estudio fueron analizados mediante un modelo de regresión logística. Los factores de personalidad fueron estudiados en los médicos, mediante el método de Cattell. Resultados. De los factores de personalidad, el factor F, característico de personas entusiastas, se asoció a la actitud positiva hacia la participación en el sistema de vigilancia del dengue, establecido en su sitio de trabajo