Risk of tuberculosis in public transport sector workers, Lima, Peru.

SETTING: Delays from symptom onset to the diagnosis and treatment of smear-positive pulmonary tuberculosis (TB) produces possible new cases in persons in close contact with TB cases, especially in confined spaces such as overcrowded public transport, which puts other users and transport workers at risk. OBJECTIVE: To estimate TB incidence rates in patients of a health micro-network, and the percentage of transport sector workers among TB and multidrug-resistant TB (MDR-TB) patients. DESIGN: Crude and indirect standardised incidence rates of TB were calculated from an exhaustive analysis of all clinical histories of incident patients in a health micro-network between 1 January 2007 and 30 June 2008. The percentage of transport sector workers and the association between MDR-TB and working in the transport sector were analysed. RESULTS: Standardised incidence rates for transport sector workers are 2.7-4.5 times higher than those in the total working-age male and global population of the micro-network studied. The association between TB and transport occupation and MDR-TB and transport occupation is high (respectively OR 3.06, 95%CI 2.2-4.2 and OR 3.14, 95%CI 1.1-9.1). CONCLUSION: These results indicate that the use of informal public transport is a risk factor for TB infection and an occupational risk in countries with characteristics similar to those in Peru.

Multidrug-resistant pulmonary tuberculosis in Los Altos, Selva and Norte regions, Chiapas, Mexico.

OBJECTIVES: To analyse the proportion of multidrug-resistant tuberculosis (MDR-TB) in cultures performed during the period 2000-2002 in Los Altos, Selva and Norte regions, Chiapas, Mexico, and to analyse MDR-TB in terms of clinical and sociodemographic indicators. METHODS: Cross-sectional study of patients with pulmonary tuberculosis (PTB) from the above regions. Drug susceptibility testing results from two research projects were analysed, as were those of routine sputum samples sent in by health personnel for processing (n = 114). MDR-TB was analysed in terms of the various variables of interest using bivariate tests of association and logistic regression. RESULTS: The proportion of primary MDR-TB was 4.6% (2 of 43), that of secondary MDR-TB was 29.2% (7/24), while among those whose history of treatment was unknown the proportion was 14.3% (3/21). According to the logistic regression model, the variables most highly associated with MDR-TB were as follows: having received anti-tuberculosis treatment previously, cough of >3 years' duration and not being indigenous. CONCLUSIONS: The high proportion of MDR cases found in the regions studied shows that it is necessary to significantly improve the control and surveillance of PTB.

The GnRH analogue triptorelin confers ovarian radio-protection to adult female rats.

There is a controversy regarding the effects of the analogues of the gonadotrophin-releasing hormone (GnRH) in radiotherapy. This has led us to study the possible radio-protection of the ovarian function of a GnRH agonist analogue (GnRHa), triptorelin, in adult, female rats (Rattus norvegicus sp.). The effects of the X-irradiation on the oocytes of ovarian primordial follicles, with and without GnRHa treatment, were compared, directly in the female rats (F(0)) with reproductive parameters, and in the somatic cells of the resulting foetuses (F(1)) with cytogenetical parameters. In order to do this, the ovaries and uteri from 82 females were extracted for the reproductive analysis and 236 foetuses were obtained for cytogenetical analysis. The cytogenetical study was based on the data from 22,151 metaphases analysed. The cytogenetical parameters analysed to assess the existence of chromosomal instability were the number of aberrant metaphases (2234) and the number (2854) and type of structural chromosomal aberrations, including gaps and breaks. Concerning the reproductive analysis of the ovaries and the uteri, the parameters analysed were the number of corpora lutea, implantations, implantation losses and foetuses. Triptorelin confers radio-protection of the ovaries in front of chromosomal instability, which is different, with respect to the single and fractioned dose. The cytogenetical analysis shows a general decrease in most of the parameters of the triptorelin-treated groups, with respect to their controls, and some of these differences were considered to be statistically significant. The reproductive analysis indicates that there is also radio-protection by the agonist, although minor to the cytogenetical one. Only some of the analysed parameters show a statistically significant decrease in the triptorelin-treated groups.

Scanning electron microscopy of legs of two species of sucking lice (Anoplura: Phthiraptera).

Pretarsal, tarsal and tibial structures of the forelegs, midlegs and hindlegs of Pediculus humanus of humans and of Haematopinus apri Goureau, 1866 (Phthiraptera), a parasite of feral hogs, were studied using light microscopy and scanning electron microscopy. Details of the tibial thumb-like process (tl) with the spine of the thumb (spn), tarsal apophysis (ta) and the coupled finger-like process (cfl) can be observed in the leg photomicrograph of both species. A frontal view of the leg in open position shows the articulation of the claw: the structures of an open-closed system, a tooth row (te), rack-system (rs) and two telescopic columns (tc) which are present near the base of the claw in both species. In H. apri, we observed a pad-like structure, the flap-like tibial lobe (fl) on the ventral surface on the tarsus, the euplantulae, with several sensilla basiconica, which is present in each leg.

Ectoparasites of the endangered Iberian lynx Lynx pardinus and sympatric wild and domestic carnivores in Spain.

Ectoparasites can cause important skin disorders in animals and can also transmit pathogens. The Iberian lynx Lynx pardinus has been stated to be the most endangered felid in the world and such vector-borne pathogens may threaten its survival. We surveyed 98 wild carnivores (26 Iberian lynxes, 34 red foxes Vulpes vulpes, 24 Egyptian mongooses Herpestes ichneumon, 11 common genets Genetta genetta, two Eurasian badgers Meles meles, one polecat Mustela putorius) and 75 domestic but free-ranging carnivores (46 cats Felis catus, 29 dogs Canis familiaris) from June 2004 to June 2006 in the two areas where the last lynx metapopulations survive: Sierra Morena and Doñana (Andalusia, southern Spain). A total of 65% of lynxes were parasitized (50% by ticks, 19% by fleas, 4% by lice, 31% by hippoboscid flies), as were 75% of foxes (58%, 60%, 0%, 19%), 71% of mongooses (50%, 4%, 46%, 0%), 54% of genets (18%, 36%, 0%, 0%), 30% of cats (22%, 14%, 0%, 2%), and 7% of dogs (surveyed only for ticks). Both badgers presented ticks, fleas and lice. Five species of ixodid ticks (Rhipicephalus pusillus Gil Collado, Rhipicephalus turanicus Pomerantzev and Matikashvili, Ixodes ricinus (Linnaeus), Ixodes hexagonus Leach and Ixodes ventalloi Gil Collado; and Hyalomma sp.), four species of fleas (Ctenocephalides canis Curtis, Pulex irritans Linnaeus, Spilopsyllus cuniculi (Dale), Xenopsylla cunicularis Smit), three species of chewing lice (Felicola (Felicola) inequalis (Piaget), Trichodectes (Trichodectes) melis (Fabricius), and Felicola (Lorisicola) isidoroi Pérez and Palma), and one species of hippoboscid fly (Hippobosca longipennis (Fabricius)) were found. We did not detect any cases of mange. Hippobosca longipennis is a new record for Spanish wildlife, and all the flea species are new records for the Iberian lynx. Fleas were more frequent on lynxes and foxes in winter than in spring. Rhipicephalus spp. were more frequent on cats in spring than in any other season. These and other epidemiological findings are discussed with respect to the conservation of the Iberian lynx.

Isolation, characterization, and evaluation of metallothionein in renal transplant patients.

The plasma metallothionein concentration was studied in renal transplant patients. These patients are submitted to an attack of free radicals catalyzed by metals such as copper, zinc, cadmium, and others. The function of metallothionein is to bind toxic metals inhibiting the attack of free radicals and oxidative stress that patients receiving renal transplants are submitted to. This is the reason for studying this protein in this work. The metalloprotein was separated from the plasma by thermoprecipitation and molecular exclusion chromatography with Sephadex G-75 followed by anionic-ionic exchange chromatographic purification with a CINa gradient. Identification was done by SDS electrophoresis in acrylamide gel with markers and commercial protein. Finally, determinations were made by atomic absorption, silver saturation method. In this work, determinations were made in the plasma of 11 patients before and 48 h and 1 and 2 weeks after renal transplantation. The same study was carried out in parallel in a control group of 11 blood donors. The results obtained show the existence in the plasma of metallothionein, with lower concentrations in patients than in controls (19 +/- 1.2 mg vs. 12 +/- 1.2 mg). The levels were lowest in the patient group analyzed 48 h after having received the transplant (6.34 mg) and had recovered slightly one and two weeks later.

Study of the activity of glutathione-peroxidase, glutathione-transferase, and glutathione-reductase in renal transplants.

The aim of this work was to study the temporare variation of oxidative stress in the plasma and erythrocytes (CR) of renal transplant patients We determined total glutathione (GST), as well as oxidized (GSSG) and reduced (GSH) fractions and the activity of glutathione peroxidase (G-px), glutathione reductase (G-red) and glutathione transferase (GSt). Determinations were performed 48 hours before transplant as well as 1 and 2 weeks after the renal transplant. The results showed a high "oxidative stress" rate, resulting from the equilibrium between the production of free radicals and the activity of antioxidants, the former being higher proportionally. Immediately after the transplant, there was an increase in oxidative stress, which resulted in an increased G-red, a marked decrease in plasma and in erythrocyte G-px (CR9 and an abrupt drop both in GST levels in plasma and in GSG (as well as in the [GSH]/[GSSG] relationship). Thereafter there was a significant improvement in the activity of antioxidant enzymes, but without normalization; the total glutathione levels and the activity of various enzymes approached the average values of the control group.

[Oxidative stress, hemo-incompatibility and complications of long-term dialysis]. / Stress oxydant, hémo-incompatibilité et complications de la dialyse au long cours.

Oxidative stress which results from an imbalance between oxidant production and antioxidant defense mechanisms is now a well recognized pathogenesis factor that could be implicated in the hemodialysis (HD)-related pathology. This review focuses on: 1) factors that may be responsible for oxidative stress in HD patients (hemoincompatibility of the dialysis system--hemoreactivity of the membrane and trace amounts of endotoxins- and uremia per se); 2) implication of such phenomenon in long term complications including anemia, amyloidosis, accelerated atherosclerosis and malnutrition and finally and 3) prevention ways consisting in improving the hemocompatibility of the dialysis system and supplementing the deficiency patients with antioxidants.

Antioxidant enzyme determination and a study of lipid peroxidation in renal transplantation.

The aim of this study was to evaluate the antioxidant enzymes, catalase (CAT) and superoxide dismutase (SOD), in renal transplant patients and at the same time to report on the degree of lipid peroxidation observed in these patients. In order to do so we measured erythrocyte malondialdehyde (MDA), a product of lipid peroxidation. These measurements were made at different times: before the transplant, 48 h after the transplant, a week after the transplant and two weeks after the transplant. The values reported were compared with a control group. The results showed that there was a higher MDA level in the transplant group than in the control group one week after the transplant. In addition, two weeks after the transplant, the activities of CAT and SOD were higher in the transplant group than in the control group.

[Primary health care and hospitalizations in ambulatory care sensitive conditions in Catalonia]. / La Atención Primaria de Salud y las hospitalizaciones por Ambulatory Care Sensitive Conditions en Cataluña.

BACKGROUND: Ambulatory Care Sensitive Conditions (ACSC) are a set of selected codes of hospital discharge diagnosis intended to measure avoidable hospitalizations. Primary Health Care Services may avoid the hospitalizations due to ACSC by applying any of the following interventions, that are characteristics of this level of care: a) primary prevention; b) secondary prevention, and c) tertiary prevention and rehabilitation. METHODS: Observational, cross-sectional pilot study on 248,174 hospital discharges, from a population of 2,248,704 inhabitants in 161 Basic Health Care Units (BHCU), recorded in the minimum basic set of hospital discharge data in Catalonia during 1996. The complete list of diagnostic codes of ACSC, identified in the literature search, has been used. Crude and age-standardised hospitalisation rates have been estimated. Standardised hospitalisation ratio (SHR) has been computed to compare hospitalisation rates between BHCU. To analyse the effect of variables associated with high ACSC admission rates, multivariate analysis has been carried out by means of Poisson's regression. RESULTS: Hospitalisation due to ACSC account for 13% of all hospitalizations and 16% of hospital stay days. Acute and chronic diseases of the lower respiratory tract are the first cause of hospitalisation at any age group (< 5, 15-64 and > or = 65 years). The most common diagnostic groups, for all ages are respiratory disorders (acute and chronic diseases of the lower respiratory tract and pneumonia) and urinary tract conditions (pyelonephritis/urinary tract infection). The so-called self-limited health problems (ear, nose and throat mild infections/infections of the upper respiratory tract, febrile convulsions in children and gastroenteritis) account for more than 10% of all hospitalizations by ACSC, 45% of which occur in children. The overall crude hospitalisation rate by ACSC is 146.9/10,000 inhabitants (range: 12.4/10,000-239.9/10,000). SHR ranges from 0.01 to 1.85. CONCLUSIONS: "Hospital admissions due to ACSC" is a valid indicator to assess global performance of Primary Health Care and it identifies a part of hospital activity that is amenable to be cared for at Primary Health Care level and therefore potentially avoidable.

La atención primaria de Salud y las hospitalizaciones por Ambulatory Care Sensitive Conditions en Cataluña / Primary Health Care and hospital admissions due to Ambulatory Care Sensitive Conditions in Catalonia

Introducción. Los Ambulatory Care Sensitive Conditions (ACSC) son los códigos de diagnóstico de alta hospitalaria que pretenden servir de medida de hospitalizaciones que se consideran potencialmente evitables. La Atención Primaria podría evitar el ingreso de los ACSC mediante alguna de las siguientes intervenciones propias de este nivel asistencial: a) prevención primaria; b) prevención secundaria, o c) prevención terciaria y rehabilitación.Material y métodos. Estudio piloto observacional transversal de 248.174 altas hospitalarias, generadas por 2.248.704 habitantes de 161 Áreas Básicas de Salud (ABS) registradas en el conjunto mínimo básico de alta hospitalaria de Cataluña del año 1996. Se ha utilizado el listado completo de códigos de diagnóstico de ACSC identificados en la literatura. Se han calculado las tasas de hospitalización bruta y estandarizada. Para comparar las tasas de hospitalización entre ABS se ha calculado la razón de hospitalización estandarizada (RHE). El efecto de las variables asociadas a las tasas de hospitalización se ha estudiado mediante la regresión de Poisson. Resultados. Las hospitalizaciones por ACSC representan el 13 por ciento del total de las hospitalizaciones y el 16 por ciento de las estancias hospitalarias. Las enfermedades agudas y crónicas de las vías respiratorias bajas son la primera causa de hospitalización para los tres grupos de edad (< 15, 15-64 y 65). Los grupos de diagnósticos más frecuentes para todas las edades son la patología respiratoria (enfermedades agudas y crónicas de las vías respiratorias bajas y neumonía) y la patología del tracto urinario (pielonefritis/infección del tracto urinario). La patología denominada autolimitada (las infecciones otorrinolaringológicas no graves/infecciones de vías respiratorias altas, las convulsiones febriles infantiles, los problemas dentales y las gastroenteritis) representa más del 10 por ciento del total de las hospitalizaciones por ACSC, el 45 por ciento de las cuales se presenta en niños. La tasa cruda de hospitalización por ACSC para el conjunto de las ABS estudiadas es de 146,9/10.000, siendo el intervalo de las tasas crudas observadas de 12,4 a 239,9/10.000. El intervalo de la RHE fue de 0,01 a 1,85. Conclusiones. Las hospitalizaciones por ACSC son un indicador que se considera válido para evaluar la capacidad de resolución global de la Atención Primaria e identifica un volumen de actividad hospitalaria susceptible de cuidados del primer nivel asistencial y, por tanto, potencialmente evitable (AU)

Pulmonary tuberculosis and associated factors in areas of high levels of poverty in Chiapas, Mexico.

OBJECTIVES: To estimate the prevalence of pulmonary tuberculosis (PTB) and factors associated with PTB in areas of high levels of poverty in Chiapas, Mexico. METHODS: In 1998 active case-finding was carried out among those aged over 14 years who had a cough of > or =15 days duration, in a convenience sample of 1894 households in 32 communities selected at random based on the level of poverty and on the level of access to health services, measured by travelling time (<1 hour, > or =1 hour) from the community to the nearest health care unit. Of the 277 identified with a productive cough, we obtained sputum samples from 228 for the purposes of detecting PTB through acid-fast smears and cultures. Mycobacteria characterization was carried out using the BACTEC method. The identification of factors associated with PTB was performed using bivariate analysis and via logistic regression models. RESULTS: A PTB rate of 276.9 per 100 000 persons aged > or =15 years was found (95% CI : 161-443). Blood in sputum was the only factor associated with PTB (none of the demographic or socioeconomic characteristics were). Of 16 positive cultures, 14 became contaminated. The two cultures characterized were Mycobacterium tuberculosis (one being multiresistant). CONCLUSION: The high prevalence of PTB detected indicates the need, both in the area studied and in others with similar conditions, to develop PTB control programmes which give priority to early diagnosis and to the provision of adequate treatment.

Rationale for antioxidant supplementation in hemodialysis patients.

Oxidative stress, which results from an imbalance between reactive oxygen species (ROS) production and antioxidant defense mechanisms, is now a well recognized pathogenic process in hemodialysis (HD) patients that could be involved in dialysis-related pathologies such as accelerated atherosclerosis, amyloidosis and anemia. This review is aimed at evaluating the rationale for preventive intervention against oxidative damage during HD as well as the putative causal factors implicated in this imbalance. The antioxidant system is severely impaired in uremic patients and impairment increases with the degree of renal failure. HD further worsens this condition mainly by losses of hydrophilic unbound small molecular weight substances such as vitamin C, trace elements and enzyme regulatory compounds. Moreover, inflammatory state due to the hemo-incompatibility of the dialysis system plays a critical role in the production of oxidants contributing further to aggravate the pro-oxidant status of uremic patients. Prevention of ROS overproduction can be achieved by improvement of dialysis biocompatibility, a main component of adequate dialysis, and further complimented by antioxidant supplementation. This could be achieved either orally or via the extracorporeal circuit. Antioxidants such as vitamin E could be bound on dialyzer membranes. Alternatively, hemolipodialysis consisting of loading HD patients with vitamin C or E via an ancillary circuit made of vitamin E-rich liposomes may be used.

[Pulmonary tuberculosis and use of health services in zones of high socioeconomic marginalization in Chiapas, Mexico]. / Tuberculosis pulmonar y uso de servicios del primer nivel de atención en zonas de alta marginación socioeconómica de Chiapas, México.

OBJECTIVE: To estimate the prevalence of pulmonary tuberculosis and to analyze the utilization of health services, in coughers seeking care at primary care centers, within areas of "severe" and "very severe" poverty, in the Border Region of Chiapas, Mexico. MATERIALS AND METHODS: In 1997 an active case finding of patients with cough was carried out among all patients aged over 14 years seeking consultation (n = 2.203) in a random sample of seven primary care centers; 573 coughers were found. RESULTS: A rate of 11.1 positive pulmonary tuberculosis per hundred patients was found (95% CI = 6.6-17.2). The factors associated with positive pulmonary tuberculosis were size and poverty level of the locality of residence. Fifty-six percent of the coughers sought care for non-respiratory symptoms. CONCLUSIONS: It is necessary to improve detection and control of pulmonary tuberculosis at the primary care centers, as well as to develop a health education campaign among the general population, with the aim of increasing the demands for care among coughers and reduce the time elapsed between onset of cough and first medical care.

Tuberculosis pulmonar y uso de servicios del primer nivel de atención en zonas de alta marginación socioeconómica de Chiapas, México / Pulmonary tuberculosis and use of health services among coughers in areas of poverty in Chiapas, Mexico

Objetivo: Estimar la prevalencia de tuberculosis pulmonar, analizar factores asociados a su positividad y analizar el uso de servicios de salud en tosedores usuarios del primer nivel de atención en zonas de alta y muy alta marginación de la Región Fronteriza de Chiapas, México. Métodos: En 1997 se realizó una búsqueda activa de tosedores (n = 573), entre usuarios (n = 2.203) de una muestra aleatoria de siete unidades del primer nivel de atención, a los que se les solicitaron tres muestras de esputo para la realización de baciloscopías y cultivos. Resultados: Se encontró una tasa de positividad a tuberculosis pulmonar de 11,1 por 100 pacientes estudiados (IC 95 por ciento = 6,6-17,2). La positividad a tuberculosis pulmonar se mostró asociada al tamaño y grado de marginación de la localidad de residencia. El 56 por ciento de los tosedores acudió a consulta por síntomas no respiratorios. Conclusiones: Es necesario reforzar la detección y control de la tuberculosis pulmonar en el primer nivel de atención, así como sensibilizar y brindar educación para la salud a la población en general, con el fin de aumentar la demanda de atención a causa de la tos y reducir el tiempo entre el inicio de la tos y la búsqueda de atención (AU)

Oxidative stress in chronic renal failure.

This study focuses on the oxidative stress in patients with severe chronic renal failure who are not undergoing dialysis treatment. The erythocyte levels, creatinine clearing and plasma- and cell activities of the following enzymes were determined: glutathione peroxidase (Gpx), superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), and glutathione transferase (GT). The concentrations of non-enzyme molecules such as total glutathione in both oxidized and reduced forms, and malonyldialdehyde (MDA) were also measured. The obtained values were compared with those in healthy blood donors of comparable age and social status. The results indicate that chronic renal patients have lower glutathione levels and reduced activities of glutathione peroxidase and of glutathione reductase, while exhibiting elevated levels of malonyldialdehyde and activities of superoxide dismutase, glutathione transferase, and catalase. Finally, creatinine clearing was found to be correlated (p < 0.001) to total (oxidized and reduced) glutathione, Gpx and MDA. These observations may serve to establish a simple protocol for evaluation of renal function.

Oxidative stress and enzyme activity in ambulatory renal patients undergoing continuous peritoneal dialysis.

Some parameters indicating the possibility of oxidative stress in chronic renal failure patients (CRF) undergoing continuous ambulatory peritoneal dialysis (CAPD), are presented in this study. Oxidative stress appears to be lower than in hemodialysis patients. In a group of CRF patients and in a control group malondialdehyde (MDA) was determined as an indicator of red-blood-cell membrane lipid peroxidation. Also, the three glutathione forms, total (GST), oxidated (GSSG) and reduced (GSH) and the levels of glutathione peroxidase (GPX), the levels of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) have been measured. Significantly higher MDA values (p < .05) have been found in CRF patients when compared to controls. The three forms of glutathione and GPX are also significantly decreased in the CRF group (p < .05 and p < .001, respectively). The levels of SOD and CAT are increased with respect to the control group (p < .001).

[Delivery care in Chiapas, Mexico: who and where does provide it?]. / La atención del parto en Chiapas, México: dónde y quién los atiende?

OBJECTIVE: To identify the place and provider of delivery care; to analyse the relationship between the type of delivery care provider and prenatal care and sociodemographic factors; to identify groups with greater and lesser probability of receiving attention at health centers and to identify the reasons for not attending the health center nearest to the household. MATERIAL AND METHODS: Data on the delivery care of 297 women of La Fraylesca Region, Chiapas, were gathered using multivariate logit models to identify groups. RESULTS: From the total, 32% of childbirths occurred at health centers and 60% at home (mostly with poor sanitary conditions). Only 10% of women with less than 5 prenatal visits, school level under 3 years and whose household head was a peasant were attended by health care personnel. CONCLUSIONS: The accessibility and quality of health centers must be improved, and a programme aimed at increasing the number of deliveries that are attended by trained health care personnel should be implemented.

Catalase activity in erythrocytes from colon and gastric cancer patients. Influence of nickel, lead, mercury, and cadmium.

Catalase (CAT) is an enzyme that is involved in antioxidant defense, cell growth, and is possibly associated with tumoral processes. In this paper, the results of experiments designed to determine the influence of metallic carcinogens such as nickel (Ni), lead (Pb), mercury (Hg), and cadmium (Cd), on CAT activity are reported. CAT activity was measured in erythrocytes from three groups: a group of colon cancer patients, a group of gastric cancer patients before clinical treatment, and a control group of healthy blood donors. Concentrations of this enzyme are significantly higher than controls in the colon cancer group, but lower in gastric neoplasia. By generating highly reactive oxygenated species, Ni, Pb, Hg, and Cd alter catalase activity. Solutions of Ni, Cd, and Pb at 0.2 mM concentrations inhibit CAT activity in colon cancer, but increase it in gastric neoplasia. Hg activates CAT in colon cancer, and causes a slightly increased activity in gastric cancer. No complete deactivation of the enzyme was observed.

[Social welfare and health services in the Fraylesca Region in Chiapas: the use of prenatal care services]. / Bienestar social y servicios de salud en la Región Fraylesca de Chiapas: el uso de servicios de atención prenatal.

OBJECTIVE: To analyze the use of antenatal care services (ACS) in the Fraylesca Region of Chiapas, Mexico, and to identify groups with lower probability of receiving ACS. MATERIAL AND METHODS: In 1994, a health survey was performed on a random sample of 1,100 households, which compiled sociodemographic information and on the use of ACS during the last pregnancy within the two years previous to the study (n = 297 women from 15 to 49 years of age). The groups with lower probability of receiving adequate ACS (5 or more visits) were identified with a log-linear model. RESULTS: Forty-two percent of women received inadequate ACS (0 to 4 visits). Women with better socioeconomic status had higher probability of using ACS adequately than women with lower socioeconomic status: OR 2.47 (Cl 95% 1.12-5.44). CONCLUSIONS: Results provide evidence of the need to improve the quality of ACS, to support the traditional midwives and to improve living conditions of the population.