¿Qué se hace para no morir de hambre? Dinámicas domésticas y alimentación en la niñez en un área rural de extrema pobreza de México / What to do to avoid death by starvation? Domestic dynamics and childhood feeding practices in a rural area of extreme poverty in Mexico

OBJETIVO: Caracterizar y comparar, en términos de estructura, creencias y comportamiento en torno a la alimentación, la dinámica doméstica de hogares de niños y niñas menores de cinco años con y sin desnutrición. MATERIAL Y MÉTODOS: Estudio cualitativo con un diseño etnográfico basado en observación participante y entrevistas a profundidad a responsables del cuidado de menores e informantes clave bajo consentimiento informado verbal. El foco de observación fue el conjunto de prácticas relacionadas con el cuidado de los menores, con énfasis en las relacionadas con su alimentación, tanto al interior de los hogares como en la comunidad. Se realizaron dos estancias de campo, durante 2001, en tres comunidades rurales del Río Balsas, en el estado de Guerrero, México. RESULTADOS: Estructuras monoparentales, en etapa temprana del ciclo doméstico, generan condiciones que pueden propiciar la presencia de desnutrición de menores de cinco años. Las familias extensas representan, por su propia estructura, dinámicas domésticas más favorables. CONCLUSIONES: El problema de la desnutrición en ambientes de extrema pobreza resulta decisivamente influido por las estrategias nutricionales y las dinámicas sociales generadas en el interior de las familias.

OBJECTIVE: To describe and compare household dynamics in terms of structure, beliefs and nutrition-related behavior in the homes of malnourished and well-nourished children less than five years of age. MATERIAL AND METHODS: The authors carried out a qualitative ethnographic study using participant observation, and in depth interviews. Interviews were conducted with the child's caretaker or key informants, prior oral informed consent. Child care and childhood feeding practices at home and in the community were the focus of observations. The study included two periods of field work conducted in 2001, in three rural municipalities from the Río Balsas region, in Guerrero state, Mexico. The study's ethical and methodological aspects were approved by the National Research Commission of the Mexican Institute of Social Security. RESULTS: Households were differentially characterized by number of members, composition, type of relationship, source of income, and interactions among household members and with the community. CONCLUSION: Monoparental structures, in an early stage of the household cycle, give rise to conditions that render the child prone to malnutrition. Extended family structure represented more favorable household dynamics.

[Acceptability of dietary supplements of the national Mexican program "Oportunidades"]. / Aceptabilidad de los suplementos alimenticios del programa Oportunidades.

OBJECTIVE: To identify cultural beliefs and practices to evaluate the acceptability of dietary supplements of Oportunidades Program. MATERIAL AND METHODS: Ethnographic study with in-depth interviews (n=43)--mothers of children less than five years of age and pregnant and breasfeeding women (PBW)--, key informants (n=9); focus groups (n=8) and direct observation, in four communities from North, Central, South and Southwest of Mexico. RESULTS: The supplement was prepared in several different ways. The liquid preparation was best accepted; generally the supplement was mixed with milk. Initially, the supplement caused nausea, vomiting and diarrhea, but these symptoms disappeared with continued consumption. Acceptance was highest among PBW. CONCLUSIONS: The supplement tends to replace milk as a food product in the daily diet. There is a necessity to develop culturally specific evaluations in regions with different food intake practices. The study results should be interpreted in the context of other program components, such as health care and education.

Aceptabilidad de los suplementos alimenticios del programa Oportunidades / Acceptability of dietary supplements of the national Mexican program

OBJETIVO: Identificar usos y prácticas culturales para evaluar la aceptabilidad de los suplementos alimenticios del programa Oportunidades. MATERIAL Y MÉTODOS: Estudio etnográfico con entrevistas a profundidad (43) -madres de niños menores de cinco años y mujeres embarazadas y en periodo de lactancia (MEPL)-; informantes clave (9); grupos focales (8) y observación directa en cuatro comunidades del norte, centro, rur y sureste de México. RESULTADOS: El suplemento se prepara en distintas formas. Se consumió más en forma líquida que en solución de consistencia espesa. En las primeras ingestas causa vómito, diarrea y náuseas, pero estos malestares se superan posteriormente. Debido a la preferencia por la forma líquida, el suplemento se combina con leche. Entre las MEPL la aceptación fue generalizada. CONCLUSIONES: El suplemento tiende a sustituir a la leche como un alimento en la dieta diaria. Se recomiendan evaluaciones en regiones con prácticas alimenticias culturalmente diferentes y considerar su relación con otros componentes del programa.

[HIV/AIDS-related stigma and discrimination: the case of health care providers in México]. / El estigma asociado al VIH/SIDA: el caso de los prestadores de servicios de salud en México.

OBJECTIVE: To analyze the social construction of stigma and discrimination processes associated with HIV/AIDS and people living with HIV/AIDS (PLHA), based on the perceptions of health care providers in three states of the Mexican Republic. MATERIAL AND METHODS: Qualitative and quantitative description. Observation at nine institutions; in-depth interviews (14) and surveys (373) directed to providers of health services. RESULTS: Seventy-five percent of providers reported having received training related to HIV/AIDS; however, notions persist as to patients being hopeless; discrimination due to the idea of risk groups; the immediate identification of living with the virus, having the syndrome and death; and specific lack of knowledge of forms of transmission. Twenty-three percent would not buy food from a PLHA and 16% think they should be banned from public services. With respect to confidentiality: 89% believe it should be maintained and 38% think that employers and administrators have the right to know about their employees' condition. Isolation, notes in clinical histories pointing to HIV, obligatory testing and delays in surgeries for PLHA were constant practices. The perception that men who have sexual relations with men and sexual workers decide their sexual practices marks the division between innocent victims and guilty ones, which determines the stigmatization and discrimination processes in health services. CONCLUSIONS: The design of strategies to decrease stigma and discrimination associated with HIV/AIDS demands the inclusion of an ethical debate about human rights and a structural focus regarding social conditions that go beyond the notion of risk behaviors.

El estigma asociado al VIH/SIDA: el caso de los prestadores de servicios de salud en México / HIV/AIDS-related stigma and discrimination: the case of health care providers in México

OBJETIVO: Analizar el estigma y la discriminación relacionados con el VIH/SIDA por parte de los prestadores de servicios de salud en tres estados de la República mexicana, con base en las percepciones que tienen sobre la infección y las personas que viven con VIH/SIDA (PVVS). MATERIAL Y MÉTODOS: Descripción cualitativa y cuantitativa. Observación en nueve instituciones; entrevistas en profundidad (14) y encuestas (373) a proveedores de servicios de salud. RESULTADOS: El 75 por ciento de los proveedores recibió capacitación relacionada con el VIH/SIDA, pese a lo cual persiste la discriminación debida a clasificaciones en grupos de riesgo; la identificación de vivir con el virus, padecer el síndrome y morir; y el desconocimiento de las vías de transmisión. El 23 por ciento no compraría comida a una PVVS y 16 por ciento sugiere prohibir su ingreso a servicios públicos. Respecto a la confidencialidad, 89 por ciento opina que debe guardarse y 38 por ciento cree que los patrones tienen derecho a conocer la condición de sus empleados. El aislamiento, registro del VIH en expedientes, pruebas obligatorias y demora en procedimientos quirúrgicos de las PVVS fueron prácticas constantes. La percepción de que los hombres que tienen sexo con otros hombres y las personas que realizan trabajo sexual deciden sus prácticas sexuales establece la división entre víctimas inocentes y culpables e influye en la estigmatización y discriminación en los servicios. CONCLUSIONES: El diseño de medidas para disminuir el estigma y la discriminación relacionados con el VIH/SIDA exige la inclusión del debate ético sobre los derechos humanos y un enfoque estructural de las condiciones sociales que rebase la noción de comportamientos de riesgo.

[What to do to avoid death by starvation? Domestic dynamics and childhood feeding practices in a rural area of extreme poverty in Mexico]. / Qué se hace para no morir de hambre? Dinámicas domésticas y alimentación en la niñez en un area rural de extrema pobreza de México.

OBJECTIVE: To describe and compare household dynamics in terms of structure, beliefs and nutrition-related behavior in the homes of malnourished and well-nourished children less than five years of age. MATERIAL AND METHODS: The authors carried out a qualitative ethnographic study using participant observation, and in depth interviews. Interviews were conducted with the child's caretaker or key informants, prior oral informed consent. Child care and childhood feeding practices at home and in the community were the focus of observations. The study included two periods of field work conducted in 2001, in three rural municipalities from the Río Balsas region, in Guerrero state, Mexico. The study's ethical and methodological aspects were approved by the National Research Commission of the Mexican Institute of Social Security. RESULTS: Households were differentially characterized by number of members, composition, type of relationship, source of income, and interactions among household members and with the community. CONCLUSION: Monoparental structures, in an early stage of the household cycle, give rise to conditions that render the child prone to malnutrition. Extended family structure represented more favorable household dynamics.

La cooperación técnica internacional y los procesos de reforma del sector salud en América Latina / The international technical cooperation and the health sector reform processes

Intenta identificar asuntos específicamente relacionados con los procesos de reforma sectorial de salud, para los cuales deberían haber sido definidas nuevas orientaciones y estrategias en el marco de una suerte de ´competencia´ entre agencias internacionales para las cuales este tema es altamente sensible, destacando el papel de la investigación.(AU)

Migration and AIDS in Mexico: an overview based on recent evidence.

OBJECTIVES: Provide an overview of the relation between migration to the United States and AIDS cases in Mexico. Characterize the sexual behaviors of Mexican migrants. Describe HIV/AIDS prevention and clinical attention actions developed. METHODS: The following were analyzed: AIDS cases databases, various prevalence studies, the migrants survey, and information of the Ministries of the Interior and of Health. A documental analysis was undertaken of works published between 1992 and 2000 on migration and AIDS. RESULTS: In terms of their sexual practices, migrants in the past year had more sexual partners, tended to use a condom in their most recent relation in greater proportion, and had greater use of injected medicines and drugs. Two bi-national programs undertake epidemiological surveillance activities, while several initiatives have used innovative formats to provide prevention information to migrants. Imminent universal coverage leaves the challenge to assure quality of attention for migrants. CONCLUSIONS: Studies to evaluate the impact of international migration on distribution of infected persons will be indispensable to establish priorities in prevention and attention among migrants. More information is needed on bi-national health projects to understand the impact they may have in prevention, while continuity of the prevention initiatives must be guaranteed. Attention to migrants in bi-national contexts requires information exchange agreements on migrants living with the HIV/AIDS.

Pedestrian injuries in Mexico: a multi-method approach.

UNLABELLED: Studies of road traffic injuries should identify social determinants amenable to intervention, and should attend to the problems of individual drivers and pedestrians. This is especially true in developing nations like Mexico, where traffic fatality rates are high and interventions ineffective. OBJECTIVE: Combine qualitative and quantitative methods to analyze pedestrian injuries from motor vehicles in Mexico City, and identify their social, contextual and environmental determinants. Methods included (1). a cross-sectional analysis of mortality, producing crude and specific mortality rates and standardized mortality ratios (95% CI) by region; (2). Spatial analysis using a geographic information system to generate maps at different aggregation levels; (3). Observation with cameras to identify traffic patterns, spaces, behaviors, and patterned violations of regulations; and 4). Semi-structured in-depth interviews of pedestrians and drivers involved in an accident. RESULTS: The overall crude mortality rate was 7.14/100000, (CI 6.85-7.42), with differences by sex and region. The highest concentration of deaths was observed in 10 neighborhoods, at specific types of street environments. The high-risk environments have wide avenues with abundant vehicular traffic, where spaces supposedly reserved for pedestrians are invaded by cars and vendors. Many pedestrians have never driven a motor vehicle, few know the traffic signs, and almost all events were "hit and run" cases. CONCLUSIONS: The combination of quantitative and qualitative methods allows us to see the specific importance of some determinants of pedestrian injuries. Spatial, epidemiological, and social perspectives help point out the local accident characteristics which must be considered before defining preventive interventions.

[Identification of meeting places of sexual partners in 2 cities of the Southern Mexican borders, using the PLACE method]. / Identificación de sitios de encuentro de parejas sexuales en dos ciudades de la frontera sur de México, mediante el método PLACE.

OBJECTIVE: To identify the meeting sites of new sexual partners in two Southern border cities in Mexico. MATERIAL AND METHODS: A descriptive epidemiologic study was carried out in May 2001, by surveying key informants in two border cities. Each reported site was visited to interview a resident subject. Subjects socializing in a subsample of sites were also interviewed. RESULTS: The key informants of the community reported 134 meeting sites in Chetumal and 111 in Ciudad Hidalgo. Both sites had scarce HIV/AIDS prevention activities. Characteristics were obtained for 89 sites in Chetumal and 42 in Ciudad Hidalgo. Almost 21% of interviewees reportedly met a new sexual partner in these sites in the past four weeks. CONCLUSIONS: Preventive actions are needed in meeting sites of new sexual partners. This method may provide information to plan for future interventions. The English version of this paper is available too at:http://www.insp.mx/salud/index.html.

Identificación de sitios de encuentro de parejas sexuales en dos ciudades de la frontera sur de México, mediante el método PLACE / Identification of meeting sites of new sexual partners in two Southern border cities in Mexico using the PLACE method

OBJETIVO: Identificar sitios de encuentro de nuevas parejas sexuales en dos ciudades de la frontera sur de México. MATERIAL Y MÉTODOS: En un estudio epidemiológico descriptivo se encuestó, en mayo de 2001, a informantes clave de la comunidad en dos ciudades fronterizas del sur de México para identificar sitios de encuentro de nuevas parejas. Se visitó cada sitio reportado y se encuestó a una persona del lugar. De una submuestra de sitios, se encuestó a personas que socializaban en los mismos. RESULTADOS: Los informantes clave de la comunidad reportaron 134 sitios en Chetumal y 111 en Ciudad Hidalgo. Se obtuvo información de las características de 89 sitios en Chetumal y 42 en Ciudad Hidalgo, ambos con escasas actividades preventivas del VIH/SIDA. Cerca de 21 por ciento de usuarios encuestados reportaron haber conocido una nueva pareja en los sitios en las últimas cuatro semanas. CONCLUSIONES: Son necesarias acciones de prevención en los sitios de encuentro de nuevas parejas sexuales. Este método puede proveer información para planificar futuras intervenciones.

La cooperación técnica internacional y las políticas de salud / The international technical cooperation and the health policies

Este artículo analiza los cambios ocurridos en la CTI atribuibles a dos procesos: los cambios en los escenarios internacionales y otros que surgen de las propias organizaciones que brindan CTI. Se toman dos procesos como casos centrales: las políticas y las reformas de salud, especialmente el papel desempeñado por la Organización Mundial de la Salud y su oficina para las Américas, la Organización Panamericana de la Salud, y sus relaciones con las agencias multilaterales. Compara los resultados de la CTI en términos de costo/efectividad y, finalmente, sugiere opciones para mejorar el proceso de CTI basadas en las consecuencias de los cambios en los escenarios internacionales, las modalidades de CTI y los valores que deben orientar la producción de la CTI

Mobile populations and HIV/AIDS in Central America and Mexico: research for action.

OBJECTIVE: To present a multi-centre study that analyses the socioeconomic, cultural and political contexts that give rise to population mobility, and its relationship to vulnerability to sexually transmitted infections (STI)/HIV/AIDS, in order to provide information that can be used to design appropriate and focused interventions. METHODS: In each of 11 transit stations (border towns, port cities, areas where mobile populations congregate) in Central America and Mexico, a household survey of the local population was conducted to analyse demographic, socioeconomic characteristics, and information known and opinions held about HIV/AIDS and mobile populations. In-depth interviews with key informants, community members and mobile populations were held to ascertain knowledge about prevention and transmission of STI/HIV/AIDS. Likewise, an ethnographic study was undertaken to identify interactions between local and mobile populations. RESULTS: The transit stations share low educational levels among the local population, few public services, repeated human rights violations, violence, poverty and corrupt authorities. Within this social context, transactional sex, sex for survival, rape and non-professional commercial sex happen in conditions that increase the risk of the transmission of STI/HIV, such as infrequent condom use. Migrant women and sex workers are particularly vulnerable in this context. A wide gap exists between information about STI/HIV transmission and reported prevention practices. CONCLUSION: Given the conditions that exist in these transit stations, interventions should be multisectoral, sustainable, and should defend the human rights of various groups, including women and people living with HIV/AIDS.