Adolescent use of outpatient health services in Mexico: their health needs and associated factors.

OBJECTIVE: To estimate adolescent use of outpatient services, identifying their health needs and associated socioeconomic factors. MATERIALS AND METHODS: Using data from Ensanut 2018-2019, adolescents (ages 10-19) with health needs and those receiving care from health personnel (users) were identified. Needs were analyzed by sex and socioeconomic status (SES). Logistic models were used to assess the factors associated with the use of health care and choice of provider. RESULTS: 6% of adolescents reported health needs, of whom 64% used outpatient services. Respiratory and gastrointestinal infections were the principal health needs prompting use of services overall. However, by SES, motivations centered on pregnancy for the poor and accidental injuries for the wealthy. One in three adolescents with health needs, particularly the poorest, received no care. Living with a partner and having health insurance were the main predictors of use. Greater schooling among household heads and higher SES correlated with the use of private services. CONCLUSIONS: Despite being aware of their health needs, adolescents are the group that uses health services the least in Mexico. Promoting preventative and timely treatment for this population would encourage youths to seek care more often.

Setbacks in the quest for universal health coverage in Mexico: polarised politics, policy upheaval, and pandemic disruption.

2023 marks the 20-year anniversary of the creation of Mexico's System of Social Protection for Health and the Seguro Popular, a model for the global quest to achieve universal health coverage through health system reform. We analyse the success and challenges after 2012, the consequences of reform ageing, and the unique coincidence of systemic reorganisation during the COVID-19 pandemic to identify strategies for health system disaster preparedness. We document that population health and financial protection improved as the Seguro Popular aged, despite erosion of the budget and absent needed reforms. The Seguro Popular closed in January, 2020, and Mexico embarked on a complex, extensive health system reorganisation. We posit that dismantling the Seguro Popular while trying to establish a new programme in 2020-21 made the Mexican health system more vulnerable in the worst pandemic period and shows the precariousness of evidence-based policy making to political polarisation and populism. Reforms should be designed to be flexible yet insulated from political volatility and constructed and managed to be structurally permeable and adaptable to new evidence to face changing health needs. Simultaneously, health systems should be grounded to withstand systemic shocks of politics and natural disasters.

Socioeconomic Inequalities in Alcohol and Tobacco Consumption: A National Ecological Study in Mexican Adolescents.

Alcohol and cigarettes are the psychoactive substances that adolescents use most frequently. When both addictions are combined, they carry the worst burden of disease globally. The objective of this study was to identify whether socioeconomic factors correlate with alcohol and tobacco consumption in Mexican adolescents aged 10 years or more and to establish the relationship in the consumption between the two substances. This ecological study utilized data describing alcohol and tobacco consumption among adolescents aged 10-16 years (n = 48,837 ≈ N = 11,621,100). Having ever consumed any alcohol-containing beverage constituted alcohol consumption. Smoking a cigarette within 30 days constituted cigarette consumption. For both variables, the state-level percentages reported in the survey were used. Diverse socioeconomic variables were collected from official sources. Data on the prevalence of tobacco use and alcohol consumption were entered into an Excel database estimated for each of the states of the Mexican Republic, as well as the socioeconomic variables. We performed the analysis using Stata 14. Consumption prevalence was 15.0% for alcohol and 4.2% for tobacco. Alcohol consumption was not correlated with any studied socioeconomic variable (p > 0.05). The prevalence of tobacco consumption among elementary school students correlated (p < 0.05) with the portion of the population living in private dwellings without sewage, drainage, or sanitation (r = 0.3853). The prevalence of tobacco consumption among middle-school adolescents correlated with the portion of the employed population that earned up to two minimum wages (r = 0.3960), the percentage in poverty by income 2008 (r = 0.4754) and 2010 (r = 0.4531), and the percentage in extreme poverty by income 2008 (r = 0.4612) and 2010 (r = 0.4291). Positive correlations were found between tobacco consumption and alcohol consumption among both elementary (r = 0.5762, p=0.0006) and middle-school children (r = 0.7016, p=0.0000). These results suggest that certain socioeconomic factors correlate with tobacco consumption but not alcohol consumption. A correlation between alcohol consumption and tobacco consumption was observed. The results can be used for developing interventions in adolescents.

Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity.

The aim of this study was to estimate the prevalence of health needs and use of outpatient services for indigenous (IP) and non-indigenous (NIP) populations aged ≥15 years, and to explore the associated factors and types of need. A cross-sectional study was conducted based on the 2018-19 National Health and Nutrition Survey. The population aged ≥15 years who had health needs and used outpatient services was identified. Logistic models were developed to explore the factors underlying the use of outpatient services. For both populations, being a woman increased the likelihood of using health services, and having health insurance was the most important variable in explaining the use of public health services. Compared to the NIP, a lower proportion of IP reported health needs during the month prior to the survey (12.8% vs. 14.7%); a higher proportion refrained from using outpatient services (19.6% vs. 12.6%); and a slightly higher proportion used public health services (56% vs. 55.4%). For the NIP, older age and belonging to a household that had received cash transfers from a social program, had few members, a high socioeconomic level, and a head with no educational lag, all increased the likelihood of using public health services. It is crucial to implement strategies that both increase the use of public health services by the IP and incorporate health-insurance coverage as a universal right.

How do diverse low-income and middle-income countries implement primary healthcare team integration to support the delivery of comprehensive primary health care? A mixed-methods study protocol from India, Mexico and Uganda.

INTRODUCTION: Attainment of universal health coverage is feasible via strengthened primary health systems that are comprehensive, accessible, people-centred, continuous and coordinated. Having an adequately trained, motivated and equipped primary healthcare workforce is central to the provision of comprehensive primary healthcare (CPHC). This study aims to understand PHC team integration, composition and organisation in the delivery of CPHC in India, Mexico and Uganda. METHODS AND ANALYSIS: A parallel, mixed-methods study (integration of quantitative and qualitative results) will be conducted to gain an understanding of PHC teams. Methods include: (1) Policy review on PHC team composition, organisation and expected comprehensiveness of PHC services, (2) PHC facility review using the WHO Service Availability and Readiness Assessment, and (3) PHC key informant interviews. Data will be collected from 20, 10 and 10 PHCs in India, Mexico and Uganda, respectively, and analysed using descriptive methods and thematic analysis approach. Outcomes will include an in-depth understanding of the health policies for PHC as well as understanding PHC team composition, organisation and the delivery of comprehensive PHC. ETHICS AND DISSEMINATION: Approvals have been sought from the Institutional Ethics Committee of The George Institute for Global Health, India for the Indian sites, School of Medicine Research Ethics Committee at Makerere University for the sites in Uganda and the Research, Ethics and Biosecurity Committees of the Mexican National Institute of Public Health for the sites in Mexico. Results will be shared through presentations with governments, publications in peer-reviewed journals and presentations at conferences.

Continuum of care for maternal, newborn and child health: Evidence from a national survey in Mexico.

OBJECTIVE: To compare coverage of maternal, newborn and child health (MNCH) continuum of care between women who had experienced adolescent maternity (AM) and those who had not. METHODS: Using a Mexican probabilistic survey representative at the national level (ENSANUT 2018-19), we developed a cross-sectional analysis of 1,768 women aged 12 to 49 years who had a child within five years before the interview. We used modified Poisson models to estimate prevalence ratios (PRs) and independent and conditional coverage levels based on the probability estimates yielded by these models at different stages of maternal-newborn care process. RESULTS: PRs for the MNCH continuum of care were approximately 40% lower for women who had experienced AM compared to those who had not (95%CI:0.35, 1.14). The coverage for the MNCH continuum of care was only 7.4% [95%CI: 3.5, 11.2] and 11.7% [95%CI: 9.3, 14.1] in women who had/not experienced AM, respectively. CONCLUSIONS: The provision of a continuum of care for mothers and their children can be achieved through a combination of well-defined policies and strategies that improve health care practices and services throughout the life cycle. It is necessary to expand the coverage and quality of care, which will provide the opportunity to shift the focus from vertical programs to integrated continuous care. Policy makers must implement interventions that are consistent with specific problems of population and health-care providers. Our analysis highlights the deficiencies in the care process, making this study a useful reference for countries with similar characteristics.

Costos de atención del cáncer de mama en el Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México / Health-care costs of breast cancer at the Institute of Social Security and Services for Government Workers in Mexico

Resumen: Objetivo: Calcular los costos del tratamiento habitual y normativo del cáncer de mama (CaMa) en el Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). Material y métodos: Se utilizó la metodología de procesos, desde la perspectiva del prestador. Se identificaron los recursos utilizados durante un año de tratamiento a través de cuestionarios en línea aplicados a oncólogos (tratamiento habitual) de diferentes hospitales y a partir de la revisión de guías clínicas (tratamiento normativo). Resultados: El costo anual habitual fue de $113.6 millones de dólares. Los costos en hospitales regionales y generales para el estadio I son 1.23 y 1.12 mayores al de alta especialidad. Los costos en los estadios 0-II son mayores al normativo por mayor uso de consultas y quimioterapia. Conclusiones: El costo anual del CaMa representó 3.8% del presupuesto del ISSSTE en 2017. Incrementar la eficiencia de los recursos destinados a su tratamiento requeriría mejorar la adherencia a las guías clínicas y la detección temprana.

Abstract: Objective: To estimate the cost of common versus normative practice in the treatment of breast cancer (BrCa) at the Mexican Institute of Social Security and Services for Government Workers (ISSSTE). Materials and methods: A process approach from the perspective of providers. We identified the resources utilized during one year of treatment through online questionnaires administered to oncologists in various hospitals (common treatment) as well as by conducting a clinical guidelines review (normative treatment). Results: The cost of common treatment was USD113.6 million annually. For stage I cases, it proved 1.23 and 1.12 times higher in regional and general as opposed to highly specialized hospitals. For stages 0-II cases, it was higher than normative treatment owing to greater use of consultations and chemotherapy. Conclusions: BrCa accounts for 3.8% of the ISSSTE budget in 2017. Achieving greater efficiency in the use of resources allocated for BrCa treatment requires stricter adherence to clinical guidelines as well as early detection.

Health-care costs of breast cancer at the Institute of Social Security and Services for Government Workers in Mexico / Costos de atención del cáncer de mama en el Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México.

Objective: To estimate the cost of common versus normative practice in the treatment of breast cancer (BrCa) at the Mexican Institute of Social Security and Services for Government Workers (ISSSTE). Materials and methods: A process approach from the perspective of providers. We identified the resources utilized during one year of treatment through online questionnaires administered to oncologists in various hospitals (common treatment) as well as by conducting a clinical guidelines review (normative treatment). Results: The cost of common treatment was USD113.6 million annually. For stage I cases, it proved 1.23 and 1.12 times higher in regional and general as opposed to highly specialized hospitals. For stages 0-II cases, it was higher than normative treatment owing to greater use of consultations and chemotherapy. Conclusions: BrCa accounts for 3.8% of the ISSSTE budget in 2017. Achieving greater efficiency in the use of resources allocated for BrCa treatment requires stricter adherence to clinical guidelines as well as early detection.

Self-Reported Dental Caries by Mexican Elementary and Middle-School Schoolchildren in the Context of Socioeconomic Indicators: A National Ecological Study.

The objective of the present research was to quantify the association between dental caries self-report and socioeconomic indicators in Mexican children. An ecological study included a self-report of dental caries in schoolchildren enrolled in public elementary and middle schools derived from the National School Health Survey. A total of 73,560 schoolchildren (representing 19,745,366 students) aged 5 to 16 years were included. Socioeconomic variables included were scales depicting physical characteristics of housing, purchasing power, etc. used in national surveys in Mexico to measure deprivation, poverty, and income inequality in official data. Data were analyzed in Stata using Spearman's correlation test. For the most part, no association (p > 0.05) was found between caries self-report, socioeconomic variables, or the Gini index. However, caries self-report in elementary schoolchildren and total (elementary + middle-school) schoolchildren groups was positively correlated (p < 0.05) with two poverty variables: extreme poverty by income (value of personal food purchases per month) and poverty by income (value of personal food and non-food purchases per month). National data for dental caries self-report were associated-at the ecological level-with a few socioeconomic indicators but not with most of the usual and customary indicators used in national surveys in Mexico.

[Prevalence and associated factors of moderncontraceptive methods use among adolescents,2012 and 2018]. / Prevalencias y factores asociados con el uso de métodos anticonceptivos modernos en adolescentes, 2012 y 2018.

OBJECTIVE: To analyze the prevalence of modern contracep-tive methods (CM) use in adolescents aged 12 to 19 years in 2012 and 2018-19, and the factors associated with consistent use of modern CM. MATERIALS AND METHODS: Using the Health and Nutrition National Surveys 2012 and 2018-19 we calculated the outcome variables: long-acting reversible con-traceptives (LARC) use, dual protection and consistent use of CM. We estimated prevalence by sex and adjusted logistic models with consistent use (which is understood as CM use in the first and last sexual relationship) as a dependent variable. RESULTS: LARC use in last intercourse increased between surveys (4.1 to 6.3%). For women, being older, not having been pregnant, and school attendance increased the likelihood of consistent use. For men, school attendance increases the likelihood while cohabiting, early sexual initiation and having smoked more than 100 cigarettes reduces it. CONCLUSIONS: It is necessary to promote access and consistent use of MC, based on respect for sexual and reproductive rights.

OBJETIVO: Analizar la prevalencia de uso de métodos anticonceptivos (MAC) modernos en adolescentes de 12 a19 años en 2012 y 2018-19, y factores asociados con su uso consistente. MATERIAL Y MÉTODOS: A partir de las Encuestas Nacionales de Salud y Nutrición 2012 y 2018-19, se construyeron variables de interés: uso de anticonceptivos reversibles de acción prolongada (ARAP), protección dual y uso consistente de MAC. Se calcularon prevalencias y modelos logísticos para uso consistente de MAC. RESULTADOS: El uso de ARAP en la última relación se incrementó entre encuestas (4.1 a 6.3%). Tener mayor edad, no embarazo y asistencia escolar incrementaron la posibilidad de uso consistente en mujeres; en hombres, la asistencia escolar la incrementó, y vivir en unión, inicio temprano de vida sexual y consumir >100 cigarrillos la disminuyeron. CONCLUSIONES: Es necesario fomentar el acceso y uso de MAC de manera consistente, basado en el respeto a los derechos sexuales y reproductivos.

Government Expenditure on Maternal Health and Family Planning Services for Adolescents in Mexico, 2003-2015.

The purpose of this study was to assess whether government policies to expand the coverage of maternal health and family planning (MHFP) services were benefiting the adolescents in need. To this end, we estimated government MHFP expenditure for 10- to 19-year-old adolescents without social security (SS) coverage between 2003 and 2015. We evaluated its evolution and distribution nationally and sub-nationally by level of marginalization, as well as its relationship with demand indicators. Using Jointpoint regressions, we estimated the average annual percent change (AAPC) nationally and among states. Expenditure for adolescents without SS coverage registered 15% for AAPC for the period 2003-2011 and was stable for the remaining years, with 88% of spending allocated to maternal health. Growth in MHFP expenditure reduced the ratio of spending by 13% among groups of states with greater/lesser marginalization; nonetheless, the poorest states continued to show the lowest levels of expenditure. Although adolescents without SS coverage benefited from greater MHFP expenditure as a consequence of health policies directed at achieving universal health coverage, gaps persisted in its distribution among states, since those with similar demand indicators exhibited different levels of expenditure. Further actions are required to improve resource allocation to disadvantaged states and to reinforce the use of FP services by adolescents.

Ecological study on needs and cost of treatment for dental caries in schoolchildren aged 6, 12, and 15 years: Data from a national survey in Mexico.

To determine the treatment needs and the care index for dental caries in the primary dentition and permanent dentition of schoolchildren and to quantify the cost of care that would represent the treatment of dental caries in Mexico.A secondary analysis of data from the First National Caries Survey was conducted, which was a cross-sectional study conducted in the 32 states of Mexico. Based on dmft (average number of decayed, extracted, and filled teeth in the primary dentition) and DMFT (average number of decayed, extracted, and filled teeth in permanent dentition) information, a treatment needs index (TNI) and a caries care index (CI) were calculated.At age 6, the TNI for the primary dentition ranged from 81.7% to 99.5% and the CI ranged from 0.5% to 17.6%. In the permanent dentition, the TNI ranged from 58.8% to 100%, and the CI ranged from 0.0% to 41.2%. At age 12, the TNI ranged from 55.4% to 93.4%, and the CI ranged from 6.5% to 43.4%. At age 15, the TNI ranged from 50.4% to 98.4%, and the CI ranged from 1.4% to 48.3%. The total cost of treatment at 6 years of age was estimated to range from a purchasing power parity (PPP) of USD $49.1 to 287.7 million in the primary dentition, and from a PPP of USD $3.7 to 24 million in the permanent dentition. For the treatment of the permanent dentition of 12-year-olds, the PPP ranged from USD $13.3 to 85.4 million. The estimated cost of treatment of the permanent dentition of the 15-year-olds ranged from a PPP of USD $10.9 to 70.3 million. The total estimated cost of caries treatment ranged from a PPP of USD $77.1 to 499.6 million, depending on the type of treatment and provider (public or private).High percentages of TNI for dental caries and low CI values were observed. The estimated costs associated with the treatment for caries have an impact because they represent a considerable percentage of the total health expenditure in Mexico.

[Provision of immediate postpartum contraceptivemethods in Mexico, 2018-19]. / Provisión de métodos anticonceptivos en el posparto inmediato en México, 2018-19.

OBJECTIVE: To identify sociodemographic and health services factors associated with receipt of immediate post-partum (IPP) contraception and the type of contraceptive method received. MATERIALS AND METHODS: We used the National Health and Nutrition Survey (Ensanut), 2018-19, which contains information on 4 548 women aged 12-49 years who gave birth. We described receipt of IPP contraception and method type and used multivariable logistic (n=4 544) and multinomial regression (n=2 903) to examine receipt of any modern method and type of method. RESULTS: 65% of women received IPP contraception. 56.8% of adolescents received long-acting reversible contraception (43.7% IUD & 13.1% implant). Being indigenous, having only one child, or receiving care in State Health Services/IMSS-Prospera or private sector facilities were associated with lower odds of receiving IPP contraception. CONCLUSIONS: We identify progress in the IPP contraception coverage among adoles-cents. Disparities persist in receipt of IPP contraception by type of health insurance.

OBJETIVO: Analizar la anticoncepción posparto (APP) y tipo de método anticonceptivo recibido según características sociodemográficas y de atención del parto de las mujeres. MATERIAL Y MÉTODOS: Se analizaron datos de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19 en4 548 mujeres de 12-49 años que tuvieron un parto. Se ajustaron modelos de regresión logística (n=4 544) y multinomial (n=2 903) con variables dependientes APP y tipo de anti-conceptivo recibido. RESULTADOS: Se encontró que 65% de las mujeres recibieron APP,y 56.8% de las adolescentes un método reversible de larga duración (43.7% DIU y 13.1% implantes). Ser indígena, tener un hijo, o recibir atención en los servicios estatales de salud/IMSS-Prospera o privadas, se asocia con menores posibilidades de APP. CONCLUSIONES: Se identificaron progresos en la cobertura de APP en las adolescentes. Persisten brechas de acuerdo con el asegura-miento en salud tanto en la recepción de APP como en el tipo de método recibido.

Prevalencias y factores asociados con el uso de métodos anticonceptivos modernos en adolescentes, 2012 y 2018 / Prevalence and associated factors of modern contraceptive methods use among adolescents, 2012 and 2018

Resumen: Objetivo: Analizar la prevalencia de uso de métodos anticonceptivos (MAC) modernos en adolescentes de 12 a19 años en 2012 y 2018-19, y factores asociados con su uso consistente. Material y métodos: A partir de las Encuestas Nacionales de Salud y Nutrición 2012 y 2018-19, se construyeron variables de interés: uso de anticonceptivos reversibles de acción prolongada (ARAP), protección dual y uso consistente de MAC. Se calcularon prevalencias y modelos logísticos para uso consistente de MAC. Resultados: El uso de ARAP en la última relación se incrementó entre encuestas (4.1 a 6.3%). Tener mayor edad, no embarazo y asistencia escolar incrementaron la posibilidad de uso consistente en mujeres; en hombres, la asistencia escolar la incrementó, y vivir en unión, inicio temprano de vida sexual y consumir >100 cigarrillos la disminuyeron. Conclusión: Es necesario fomentar el acceso y uso de MAC de manera consistente, basado en el respeto a los derechos sexuales y reproductivos.

Abstract: Objective: To analyze the prevalence of modern contraceptive methods (CM) use in adolescents aged 12 to 19 years in 2012 and 2018-19, and the factors associated with consistent use of modern CM. Materials and methods: Using the Health and Nutrition National Surveys 2012 and 2018-19 we calculated the outcome variables: long-acting reversible contraceptives (LARC) use, dual protection and consistent use of CM. We estimated prevalence by sex and adjusted logistic models with consistent use (which is understood as CM use in the first and last sexual relationship) as a dependent variable. Results: LARC use in last intercourse increased between surveys (4.1 to 6.3%). For women, being older, not having been pregnant, and school attendance increased the likelihood of consistent use. For men, school attendance increases the likelihood while cohabiting, early sexual initiation and having smoked more than 100 cigarettes reduces it. Conclusion: It is necessary to promote access and consistent use of MC, based on respect for sexual and reproductive rights.

[Adolescent motherhood in under 100 000 inhabitants communities in the first decades of the millennium]. / Maternidad en la adolescencia en localidades menores de 100 000 habitantes en las primeras décadas del milenio.

OBJECTIVE: To analyze the adolescent motherhood trend and associated factors in under-100 000-inhabitants communities. MATERIALS AND METHODS: Cross-sectional analysis of 16 686 women in under-100 000-inhabitants communities in Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 and 100k 2018. We adjusted robust Poisson models with adolescent motherhood as dependent variable for women aged 12-19 and 20-24. RESULTS: Attending school and using modern contraceptives decrease adolescent motherhood prevalence in both age groups. Among adolescent girls, having a health financing scheme, and early sexual debut in the case of adults, is positively associated with adolescent motherhood. CONCLUSIONS: It is necessary to strengthen public policies seeking to modify structural factors that provide life choices, and to maintain and strengthen the actions and coverage proposed by Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) targeting this population.

OBJETIVO: Analizar en localidades menores de 100 000 habitantes la tendencia de la maternidad en la adolescencia y factores relacionados. MATERIAL Y MÉTODOS: Análisis transversal de 16 686 mujeres en localidades menores de 100 000 habitantes a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 y 100k 2018. Se ajustaron modelos Poisson robustos con variable dependiente maternidad adolescente para mujeres de 12-19 y 20-24 años. RESULTADOS: Asistir a la escuela y usar anticonceptivos modernos disminuye la prevalencia de maternidad adolescente en ambos grupos de edad. Entre las adolescentes, contar con esquema de financiamiento en salud, y el inicio de vida sexual temprano para el caso de las adultas, se asocia positivamente con maternidad adolescente. CONCLUSIONES: Es necesario fortalecer las políticas públicas para modificar factores estructurales que proporcionen opciones de vida; es preciso mantener y fortalecer las acciones y cobertura propuestas por la Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) focalizándolas en esta población.

[Maternal and child healthcare and adolescent maternity in under 100 000 inhabitants communities]. / Atención en salud materno-infantil y maternidad adolescente en localidades menores de 100 000 habitantes.

OBJECTIVE: To compare the coverage of continuous ma- ternal healthcare and early childhood care in women with and without adolescent motherhood (AM) who live in under-100 000-inhabitants communities. MATERIALS AND METHODS: Cross-sectional analysis of Ensanut 100k 2018 of 767 women aged 12 to 49 years living in under-100 000-in- habitants communities who had their last birth two years before the survey. RESULTS: Women with AM have lower continuous coverage of maternal care than those without AM (8.1 and 19.6%, respectively). Infant care coverage with adequate content was lower than 30%, and there were no differences between the groups. CONCLUSIONS: It is necessary to strengthen actions focused on this group of women in order to reduce the gaps in coverage and improve maternal and child health.

OBJETIVO: Comparar la cobertura de atención continua de salud materna y de atención en la primera infancia en mujeres con y sin maternidad en la adolescencia (MA), que habitan en localidades menores de 100 000 habitantes. MATERIAL Y MÉTODOS: Análisis transversal de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k) 2018 en 767 mujeres de 12 a 49 años residentes en localidades con menos de 100 000 habitantes que tuvieron su último hijo dos años anteriores a la encuesta. Se calcularon coberturas de atención a partir de modelos de regresión logística. RESULTADOS: Las mujeres con MA tienen menor cobertura continua en salud materna que las que no tuvieron MA (8.1 y 19.6%, respectivamente). La cobertura de atención del infante con contenido adecuado fue menor a 30% y no hubo diferencias entre los grupos. CONCLUSIONES: Es necesario fortalecer acciones focalizadas en este grupo de mujeres para reducir brechas en las coberturas y mejorar la salud materno-infantil.

[Medical care and self-care actions in people living with diabetes, according to socioeconomic level.] / Atención médica y acciones de autocuidado en personas que viven con diabetes, según nivel socioeconómico.

OBJECTIVE: To characterize medical care and self-care actions in a population with diabetes in locations smaller than 100 000 inhabitants. MATERIALS AND METHODS: With information from the Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), two logistic regression models were obtained: not performing five basic actions in the last consultation and not taking priority self-care actions. RESULTS: Having low schooling, belonging to the low economic stratum, and speaking indigenous language, increase the probability of not taking self-care actions. On the contrary, as age increases, the chances of self-care are reduced by 3%. Belonging to an indigenous household and the low tercile, increases the chances that health personnel will not perform the five basic actions during the consultation. CONCLUSIONS: It is essential that a diabetes control program be established that includes patient education and update courses for medical staff.

OBJETIVO: Caracterizar la atención médica y las acciones de autocuidado en población con diabetes, en localidades de menos de 100 000 habitantes. MATERIAL Y MÉTODOS: Con información de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), se obtuvieron dos modelos de regresión logística: no realizar las cinco acciones básicas en la última consulta médica y no realizar acciones prioritarias de autocuidado. RESULTADOS: Tener baja escolaridad, pertenecer al estrato económico bajo y hablar lengua indígena incrementan las posibilidades de no realizar acciones de autocuidado. Por el contrario, al incrementarse la edad, se disminuyen las posibilida- des de autocuidado en 3%. Pertenecer a un hogar indígena y al tercil bajo incrementan las posibilidades de que el personal de salud no realice las cinco acciones básicas durante la consulta. CONCLUSIONES: Es indispensable que se establezca un programa de control de diabetes que incluya educación a pacientes y cursos de actualización al personal médico.

Maternidad en la adolescencia en localidades menores de 100 000 habitantes en las primeras décadas del milenio / Adolescent motherhood in under 100 000 inhabitants communities in the first decades of the millennium

Resumen: Objetivo: Analizar en localidades menores de 100 000 habitantes la tendencia de la maternidad en la adolescencia y factores relacionados. Material y métodos: Análisis transversal de 16 686 mujeres en localidades menores de 100 000 habitantes a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 y 100k 2018. Se ajustaron modelos Poisson robustos con variable dependiente maternidad adolescente para mujeres de 12-19 y 20-24 años. Resultados: Asistir a la escuela y usar anticonceptivos modernos disminuye la prevalencia de maternidad adolescente en ambos grupos de edad. Entre las adolescentes, contar con esquema de financiamiento en salud, y el inicio de vida sexual temprano para el caso de las adultas, se asocia positivamente con maternidad adolescente. Conclusiones: Es necesario fortalecer las políticas públicas para modificar factores estructurales que proporcionen opciones de vida; es preciso mantener y fortalecer las acciones y cobertura propuestas por la Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) focalizándolas en esta población.

Abstract: Objective: To analyze the adolescent motherhood trend and associated factors in under-100 000-inhabitants communities. Materials and methods: Cross-sectional analysis of 16 686 women in under-100 000-inhabitants communities inEncuesta Nacional de Salud y Nutrición(Ensanut) 2006, 2012 and 100k 2018. We adjusted robust Poisson models with adolescent motherhood as dependent variable for women aged 12-19 and 20-24. Results: Attending school and using modern contraceptives decrease adolescent motherhood prevalence in both age groups. Among adolescent girls, having a health financing scheme, and early sexual debut in the case of adults, is positively associated with adolescent motherhood. Conclusions: It is necessary to strengthen public policies seeking to modify structural factors that provide life choices, and to maintain and strengthen the actions and coverage proposed byEstrategia Nacional para la Prevención del Embarazo en Adolescentes(ENAPEA) targeting this population.

Atención en salud materno-infantil y maternidad adolescente en localidades menores de 100 000 habitantes / Maternal and child healthcare and adolescent maternity in under 100 000 inhabitants communities

Resumen: Objetivo: Comparar la cobertura de atención continua de salud materna y de atención en la primera infancia en mujeres con y sin maternidad en la adolescencia (MA), que habitan en localidades menores de 100 000 habitantes. Material y métodos: Análisis transversal de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k) 2018 en 767 mujeres de 12 a 49 años residentes en localidades con menos de 100 000 habitantes que tuvieron su último hijo dos años anteriores a la encuesta. Se calcularon coberturas de atención a partir de modelos de regresión logística. Resultados: Las mujeres con MA tienen menor cobertura continua en salud materna que las que no tuvieron MA (8.1 y 19.6%, respectivamente). La cobertura de atención del infante con contenido adecuado fue menor a 30% y no hubo diferencias entre los grupos. Conclusión: Es necesario fortalecer acciones focalizadas en este grupo de mujeres para reducir brechas en las coberturas y mejorar la salud materno-infantil.

Abstract: Objective: To compare the coverage of continuous maternal healthcare and early childhood care in women with and without adolescent motherhood (AM) who live in under-100 000-inhabitants communities. Materials and methods: Cross-sectional analysis of Ensanut 100k 2018 of 767 women aged 12 to 49 years living in under-100 000-inhabitants communities who had their last birth two years before the survey. Results: Women with AM have lower continuous coverage of maternal care than those without AM (8.1 and 19.6%, respectively). Infant care coverage with adequate content was lower than 30%, and there were no differences between the groups. Conclusions: It is necessary to strengthen actions focused on this group of women in order to reduce the gaps in coverage and improve maternal and child health.

Atención médica y acciones de autocuidado en personas que viven con diabetes, según nivel socioeconómico / Medical care and self-care actions in people living with diabetes, according to socioeconomic level

Resumen: Objetivo: Caracterizar la atención médica y las acciones de autocuidado en población con diabetes, en localidades de menos de 100 000 habitantes. Material y métodos: Con información de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), se obtuvieron dos modelos de regresión logística: no realizar las cinco acciones básicas en la última consulta médica y no realizar acciones prioritarias de autocuidado. Resultados: Tener baja escolaridad, pertenecer al estrato económico bajo y hablar lengua indígena incrementan las posibilidades de no realizar acciones de autocuidado. Por el contrario, al incrementarse la edad, se disminuyen las posibilidades de autocuidado en 3%. Pertenecer a un hogar indígena y al tercil bajo incrementan las posibilidades de que el personal de salud no realice las cinco acciones básicas durante la consulta. Conclusión: Es indispensable que se establezca un programa de control de diabetes que incluya educación a pacientes y cursos de actualización al personal médico.

Abstract: Objective: To characterize medical care and self-care actions in a population with diabetes in locations smaller than 100 000 inhabitants Materials and methods: With information from the Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), two logistic regression models were obtained: not performing five basic actions in the last consultation and not taking priority self-care actions. Results: Having low schooling, belonging to the low economic stratum, and speaking indigenous language, increase the probability of not taking self-care actions. On the contrary, as age increases, the chances of self-care are reduced by 3%. Belonging to an indigenous household and the low tercile, increases the chances that health personnel will not perform the five basic actions during the consultation. Conclusions: It is essential that a diabetes control program be established that includes patient education and update courses for medical staff