Apendicitis en menores de cinco años en el Hospital Provincial General Docente de Riobamba / Appendicitis in children under five years old of age in the Hospital Provincial General Docente de Riobamba

La apendicitis en menores de cinco años es rara y un reto diagnóstico. El diagnóstico de apendicitis se ve limitado por la anamnesis y la poca colaboración del examen físico en este grupo etario de pacientes. El objetivo del presente trabajo fue revisar la casuística de apendicitis en menores de cinco años en el Hospital Provincial General Docente de Riobamba (HPGDR) entre el 2012 y el 2016. Con este objetivo se realizó un estudio retrospectivo, de corte transversal en niños operados de apendicitis. En el total de los casos se analizaron los síntomas, signos, pruebas de laboratorio, exámenes histopatológicos y de imagen. El porcentaje de apendicitis en menores de 5 años fue de 11 casos (3 %) de un total de 412 casos de apendicitis operadas en menores de 15 años. En el 100% de los casos (n = 11) el dolor abdominal difuso fue el síntoma más frecuente; además se evidenció leucocitos en 10 casos (91 %). Nueve de los 11 casos (82 %) fueron apendicitis complicadas (grado III y IV) y dos (18 %) no complicadas. La mayor estancia hospitalaria fue de 13 días y en ninguno de los casos se requirió una nueva intervención. El diagnóstico y tratamiento oportuno de apendicitis en menores de cinco años sigue siendo un reto. Es importante mantener un alto grado de sospecha en el caso de de que el diagnóstico sea incierto.

Appendicitis in children younger than five years is old is a diagnostic challenge. Diagnosis of appendicitis is limited by the anamnesis and little cooperation during physical examination of pediatric patients. The objective of the present work was to check the casuistry of appendicitis among children younger than five years old in the Hospital Provincial General Docente de Riobamba (HPGDR) between 2012 to 2016. In this way, we carried out a cross­sectional, retrospective study in all children diagnosed with appendicitis (11 cases in total). In all cases we analyzed symptoms, signs, histopathological and imaging studies. The percentage of appendicitis in children under five years old corresponded to 3 % (n = 11) of a total of 412 cases of appendicitis that required surgery in children younger than 15 years old. In 100 % of the cases (n = 11) diffuse abdominal pain was the most frequent symptom; additionally leukocytosis was noted in 91 % of the cases (n = 10). Nine of the 11 cases (82 %) were complicated appendicitis (grade III and IV) and two (18 %) were not complicated. The longest patients stay lasted 13 days and none of the cases required a a new intervention. The diagnosis and opportune treatment of this pathology in children younger than five years old continues to be a challenge. It is important to maintain a high degree of suspicion in case of uncertain diagnosis.

Conocimiento sobre alimentación saludable y factores biosociales de madres con niños menores de 5 años / Knowledge about healthy eating and biosocial factors of mothers with children under 5 years of age

Fundamento: que las madres adquieran conocimiento sobre la alimentación saludable, es indispensable para el crecimiento y desarrollo de los niños. Las buenas prácticas alimentarias se realizan correctamente si es que se tiene un alto nivel de conocimientos acerca de alimentación saludable. Objetivo: Determinar la relación entre conocimiento sobre alimentación saludable y los factores biosociales en madres de menores de 5 años. Metodología: Se realizo un estudio descriptivo, correlacional, transversal en el universo de madres de la comunidad San Pedro de Ayacón (41), del 1 de enero al 30 de junio del 2016. Se utilizó la entrevista para la recolección de datos y como instrumento un cuestionario que permitió determinar el nivel de conocimientos en alimentación saludable. El análisis de datos se llevó a cabo con el programa llamado SPSS, e incluyó la prueba de Fisher para identificar la relación y diferencia significativa entre variables. Resultados: El grupo predominante fue de 20 a 29 años 53,7%, agricultura 63,4 %, mujeres con relación de pareja 87,8, con nivel de instrucción primaria completa 48,8%, madres con uno a dos hijos 56,1 %. Predominó el nivel de conocimiento no satisfactorio sobre alimentación saludable 73,2 %. Se encontró relación estadísticamente significativa entre el conocimiento y la variable ocupación (p=0.004). Conclusiones: Se observa que el conocimiento sobre alimentación saludable en las madres es no satisfactorio; además es importante resaltar que existe relación significativa entre el conocimiento y la ocupación de las madres, el diseño de la estrategia educativa es un aporte muy interesante a las madres para elevar su conocimiento.

Background: that mothers acquire knowledge about healthy eating is essential for the growth and development of children. Good food practices are done correctly if you have a high level of knowledge about healthy eating. Objective: To determine the relationship between knowledge about healthy eating and biosocial factors in mothers under 5 years of age. Methodology: A descriptive, correlational, cross-sectional study was carried out in the universe of mothers from the community of San Pedro de Ayacón (41), from January 1 to June 30, 2016. The interview was used for data collection and as an instrument A questionnaire that allowed to determine the level of knowledge in healthy eating. The data analysis was carried out with the program called SPSS, and included the Fisher test to identify the relationship and significant difference between variables. Results: The predominant group was between 20 and 29 years of age, 53.7%, agriculture 63.4%,women with a relative 87.8, with primary level of education 48.8%, mothers with one or two children 56, 1 %. The level of unsatisfactory knowledge about healthy eating prevailed 73.2%. A statistically significant relationship was found between knowledge and occupational variable (p = 0.004). Conclusions: It is observed that knowledge about healthy eating in mothers is unsatisfactory; It is important to emphasize that there is a significant relationship between knowledge and occupation of mothers, the design of educational strategy is a very interesting contribution to mothers to raise their knowledge

Avaliação da qualidade do sistema de Informação de registro de óbitos hospitalares (SIS-ROH), hospital central da beira / Moçambique assessment of the quality of the information system of hospital death registration (SIS-ROH), beira central hospital, mozambique

As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planejamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade continua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e regsitrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SISROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédiacódigo); 3 variáveis apresentaram completitude ruim relativas à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineria dos dados pode identificar essas lacunas e subsidiar seu aprimoramento.

The mortality information is useful to assess the health status of a population. Reliable mortality data produced by a national health information system is an important tool for health planning. In many countries, especially developing countries, the mortality information system is still precarious. Despite efforts in Mozambique to improve mortality statistics, challenges still prevail in terms of information technology, technical capacity and human resources and statistical production. The SIS-ROH is an electronic system of national-level hospital deaths registration, implemented in 2008 and has a coverage of only 4% of all annual deaths in the country. Despite being a national system, it currently works in some health units (US), including Beira Central Hospital (HCB). Given the importance of this system to monitor the mortality pattern of HCB and, in general, the city of Beira, this study evaluates the quality of SIS-ROH HCB. It is a descriptive study on the completeness, coverage, compliance and consistency of the SIS-ROH data and examined a sample of 822 HCB deaths Certificates (COs) of fetal and children under 5 years of age. We find the use of two different models of CO (former and current model) for the registration of deaths related to the year 2013. We observed excellent completeness for most SIS-ROH variables. Of the 25 variables of COs there was the following situation: 9 had very bad completeness, which were relating to the identification of the deceased (type of death and age) on the V block in the mother's data, where must be filled in case of stillbirths and children under 1 year of age (education, usual occupation, number of living children taken and killed, gestational age) and on the conditions and causes of death (autopsy and intermediate-code causes); 3 variables had bad completeness concerning the identification of the deceased (NID) and on the conditions and causes of death (intermediate cause - description and basic cause - code); 9 showed regular completeness concerning the identification of the deceased (date of birth and age) on the V block (mother's age, type of pregnancy, mode of delivery, weight of the fetus / baby birth, death of the fetus / baby compared to delivery) and on the conditions and causes of death (direct cause code, basic cause description); 2 showed good completeness concerning the identification of the deceased (sex and race / color) and, finally, 2 showed excellent completeness concerning the place of occurrence of death (date of admission and date of death or the disappearance corpse). The SIS-ROH had coverage below 50% calculated on mortality data estimated by the National Survey of Causes of Death (INCAM). Some SIS-ROH variables and COS showed inconsistencies. There was a lack of agreement to direct cause between SIS-ROH and COs.

Avaliação da qualidade do sistema de Informação de registro de óbitos hospitalares (SIS-ROH), hospital central da beira / Moçambique assessment of the quality of the information system of hospital death registration (SIS-ROH), beira central hospital, mozambique

As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planeamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade contínua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e registrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SIS-ROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédia-código); 3 variáveis apresentaram completitude ruim relativa à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica ­ descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineira dos dados pode identificar essas lacunas e subsidiar seu aprimoramento.

The mortality information is useful to assess the health status of a population. Reliable mortality data produced by a national health information system is an important tool for health planning. In many countries, especially developing countries, the mortality information system is still precarious. Despite efforts in Mozambique to improve mortality statistics, challenges still prevail in terms of information technology, technical capacity and human resources and statistical production. The SIS-ROH is an electronic system of national-level hospital deaths registration, implemented in 2008 and has a coverage of only 4% of all annual deaths in the country. Despite being a national system, it currently works in some health units (US), including Beira Central Hospital (HCB). Given the importance of this system to monitor the mortality pattern of HCB and, in general, the city of Beira, this study evaluates the quality of SIS-ROH HCB. It is a descriptive study on the completeness, coverage, compliance and consistency of the SIS-ROH data and examined a sample of 822 HCB deaths Certificates (COs) of fetal and children under 5 years of age. We find the use of two different models of CO (former and current model) for the registration of deaths related to the year 2013. We observed excellent completeness for most SIS-ROH variables. Of the 25 variables of COs there was the following situation: 9 had very bad completeness, which were relating to the identification of the deceased (type of death and age) on the V block in the mother's data, where must be filled in case of stillbirths and children under 1 year of age (education, usual occupation, number of living children taken and killed, gestational age) and on the conditions and causes of death (autopsy and intermediate-code causes); 3 variables had bad completeness concerning the identification of the deceased (NID) and on the conditions and causes of death (intermediate cause - description and basic cause - code); 9 showed regular completeness concerning the identification of the deceased (date of birth and age) on the V block (mother's age, type of pregnancy, mode of delivery, weight of the fetus / baby birth, death of the fetus / baby compared to delivery) and on the conditions and causes of death (direct cause code, basic cause description); 2 showed good completeness concerning the identification of the deceased (sex and race / color) and, finally, 2 showed excellent completeness concerning the place of occurrence of death (date of admission and date of death or the disappearance corpse). The SIS-ROH had coverage below 50% calculated on mortality data estimated by the National Survey of Causes of Death (INCAM). Some SIS-ROH variables and COS showed inconsistencies. There was a lack of agreement to direct cause between SIS-ROH and COs.

Algunos aspectos clínico-epidemiológicos y manejo de la otitis media aguda en menores de 5 años / Some clinical-epidemiological features and the management of acute otitis media in children aged less than 5

Introducción: La otitis media aguda es la infección respiratoria aguda alta complicada, más común en pediatría en los niños menores de 5 años, y una de las causas de asistencia frecuente a la consulta.Objetivo: Describir algunos aspectos clínico- epidemiológicos de la otitis media aguda y su manejo.Métodos: Trabajo descriptivo, prospectivo y longitudinal con 120 niños menores de 5 años ingresados por el diagnóstico de otitis media aguda, en el Hospital Docente Pediátrico del Cerro, en el periodo comprendido entre el 1 de enero del 2006 y el 31 de diciembre del 2007. En la etapa de recolección de la información se revisaron las historias clínicas de los pacientes para medir las variables clínicas y del uso de medicamentos, y se entrevistó a los padres para el trabajo con alguna variable que no estuviese en la historia clínica pediátrica.Resultados: De los pacientes 72 (60 porciento) eran menores de un año, 76 (63,3 porciento) pertenecen al sexo masculino, 96 (80 porciento) presentaron como antecedentes patológicos personales infecciones respiratorias repetidas y 92 (76,6 porciento) antecedentes patológicos familiares de otitis media aguda, 82 (68,3 porciento) tenían fumadores en la vivienda, 78 (65 porciento) tuvieron un destete precoz, 76 (63,3 porciento) usaban algún tipo de pacificador. Se realizó otoscopia al 100 porciento de los pacientes y 88 (73 porciento) tuvo un inapropiado o inadecuado uso de antibióticos.Conclusiones: Predominó la edad menor de un año, el sexo masculino, niños con cuadros de infecciones respiratorias a repetición y antecedentes familiares de otitis media aguda, que convivían con fumadores, los que presentaron destete precoz antes de los seis meses de edad y que usaban algún tipo de pacificador. La otoscopia como medio diagnóstico fue positiva en la totalidad de los pacientes y existió con frecuencia uso inapropiado o inadecuado de antibióticos

Introduction: The acute otitis media is the commonest complicated high acute respiratory infection in children aged less than 5 and one of the causes of frequent visit to consultation. Objective: To describe some clinical-epidemiological features of the acute otitis media and its management. Methods: A longitudinal, prospective and descriptive study conducted in 120 children aged less than 5 admitted due to a diagnosis of acute otitis media in the Children Teaching Hospital from Cerro municipality from January 1, 2006 to December 31, 2007. During the collection stage of information he medical records of patients were reviewed to measure the clinical variables and the drugs use and interviewing parents for the work with some variable not registered in the children medical record. Results: From the total of patients, 72 (60 percent) were less than 1 year, 76 (63.3 percent) were males, 96 (80 percent) had repeated respiratory personal infections as pathological background, and 92 (76.6 percent) with family pathological backgrounds of acute otitis media, 82 (68.3 percent) live together with smokers, 78 (65 percent) had an early weaning, 76 (63.3 percent) used some type of pacifier. The 100 percent of patients underwent otoscopy and 88 (73 percent) had an inappropriate use of antibiotics. Conclusions: There was predominance of an age less than 1 year, male sex, children with situations of repeated respiratory infections and family history of acute otitis media, living together with smokers, those with an early weaning before the six months old and using some type of pacifier. The otoscopy as a diagnostic indicator was positive in the total of patients and also, there was an inappropriate use of antibiotics

Algunos aspectos clínico-epidemiológicos y manejo de la otitis media aguda en menores de 5 años / Some clinical-epidemiological features and the management of acute otitis media in children aged less than 5

Introducción: La otitis media aguda es la infección respiratoria aguda alta complicada, más común en pediatría en los niños menores de 5 años, y una de las causas de asistencia frecuente a la consulta.Objetivo: Describir algunos aspectos clínico- epidemiológicos de la otitis media aguda y su manejo.Métodos: Trabajo descriptivo, prospectivo y longitudinal con 120 niños menores de 5 años ingresados por el diagnóstico de otitis media aguda, en el Hospital Docente Pediátrico del Cerro, en el periodo comprendido entre el 1 de enero del 2006 y el 31 de diciembre del 2007. En la etapa de recolección de la información se revisaron las historias clínicas de los pacientes para medir las variables clínicas y del uso de medicamentos, y se entrevistó a los padres para el trabajo con alguna variable que no estuviese en la historia clínica pediátrica.Resultados: De los pacientes 72 (60 porciento) eran menores de un año, 76 (63,3 porciento) pertenecen al sexo masculino, 96 (80 porciento) presentaron como antecedentes patológicos personales infecciones respiratorias repetidas y 92 (76,6 porciento) antecedentes patológicos familiares de otitis media aguda, 82 (68,3 porciento) tenían fumadores en la vivienda, 78 (65 porciento) tuvieron un destete precoz, 76 (63,3 porciento) usaban algún tipo de pacificador. Se realizó otoscopia al 100 porciento de los pacientes y 88 (73 porciento) tuvo un inapropiado o inadecuado uso de antibióticos.Conclusiones: Predominó la edad menor de un año, el sexo masculino, niños con cuadros de infecciones respiratorias a repetición y antecedentes familiares de otitis media aguda, que convivían con fumadores, los que presentaron destete precoz antes de los seis meses de edad y que usaban algún tipo de pacificador. La otoscopia como medio diagnóstico fue positiva en la totalidad de los pacientes y existió con frecuencia uso inapropiado o inadecuado de antibióticos(AU)

Introduction: The acute otitis media is the commonest complicated high acute respiratory infection in children aged less than 5 and one of the causes of frequent visit to consultation. Objective: To describe some clinical-epidemiological features of the acute otitis media and its management. Methods: A longitudinal, prospective and descriptive study conducted in 120 children aged less than 5 admitted due to a diagnosis of acute otitis media in the Children Teaching Hospital from Cerro municipality from January 1, 2006 to December 31, 2007. During the collection stage of information he medical records of patients were reviewed to measure the clinical variables and the drugs use and interviewing parents for the work with some variable not registered in the children medical record. Results: From the total of patients, 72 (60 percent) were less than 1 year, 76 (63.3 percent) were males, 96 (80 percent) had repeated respiratory personal infections as pathological background, and 92 (76.6 percent) with family pathological backgrounds of acute otitis media, 82 (68.3 percent) live together with smokers, 78 (65 percent) had an early weaning, 76 (63.3 percent) used some type of pacifier. The 100 percent of patients underwent otoscopy and 88 (73 percent) had an inappropriate use of antibiotics. Conclusions: There was predominance of an age less than 1 year, male sex, children with situations of repeated respiratory infections and family history of acute otitis media, living together with smokers, those with an early weaning before the six months old and using some type of pacifier. The otoscopy as a diagnostic indicator was positive in the total of patients and also, there was an inappropriate use of antibiotics(AU)

Saneamiento y relación con la salud de la niñez en el contexto mundial 2004 / Sanitation as related to children`s health in the world context 2004

Se determina el efecto mundial de los diferentes tipos de cobertura de disposición de excretas, DE, definidas en el marco del concepto "Instalaciones de Saneamiento Mejoradas", ISM, de OMS y UNICEF, sobre las tasas de mortalidad en niños menores de 5 años, TM menor 5 años. Para lograrlo se recolectaron datos de cobertura de DE en 161 países del "Programa Conjunto de Monitoreo" del 2004. Las TM menor 5 años se obtuvieron del informe "Progreso para la Infancia: un balance sobre agua y saneamiento". Los datos de ISM se clasificaron en totales, ISM-total, alcantarillado, DEA, tanques sépticos y letrinas, DET y L, y sin servicio, DESS. Se aplicaron 3 métodos estadísticos: distribución de frecuencias entre los intervalos de ambas variables, la correlación simple de Pearson entre los tipos de evacuación de excretas y las TM menor 5 años y la correlación Parcial al 95 por ciento de confianza pero controlando variables. Los resultados indican que a mayor cobertura mediante ISM-total menor es la TM menor 5 años, con una correlación de menos 0.782, mientras que las coberturas con DEA tienen mayor impacto sobre la disminución de la mortalidad que cuando se realiza por DET y L. Estos resultados se ratifican con las otras pruebas estadísticas y comprueban la hipótesis.

The worldwide effect on mortality in children under five years of age (MR < 5 years ) is determined for the different types of excreta disposal (ED) coverage, as defined in the framework of "Improved Sanitation Facilities (ISF)", established by the WHO and UNICEF. To accomplish this, ED coverage data was collected from 161 countries participating in the "Joint Monitoring Programme" in 2004. The mortality rates were obtained from "Progress for Children: A Balance on Water and Sanitation". ISF data were classified as: total (total-ISF), sewage (DEA), septic tanks and latrines (DET and L), and without services (DESS). Three statistical methods were applied: frequency distribution between the intervals of both variables, Pearson´s simple correlation between the types of excreta evacuation and the MR<5 years, and partial correlation at 95% confidence but controlling the variables. Results indicate that as total coverage (total-ISF) increases, there is a lower incidence of mortality (MR < 5 years), with a correlation of –0,782; while DEA coverage has a greater impact over mortality decrease as compared to DET and L. The results are ratified with the other statistical tests and prove the hypothesis.

Diferentes factores de riesgo de accidentes en hogares de niños menores de cinco años / Different accidents risk factors in homes of children under five years of age

Se realizó un estudio descriptivo y transversal con el objetivo de identificar los factores de riesgo de accidentes en los hogares de niños menores de cinco años en cuatro consultorios del área urbana del Policlínico Universitario Santiago Rafael Echezarreta Mulkay de San José de las Lajas. Se aplicó por los autores durante los meses de enero a marzo del 2007 una encuesta en cada uno de los hogares visitados. Se utilizaron variables como edad, sexo, factores de riesgo y antecedentes de accidentes. Se clasificaron las viviendas en bajo, mediano y alto riesgo de accidentes. Se obtuvieron los siguientes resultados. En la totalidad de las viviendas se identificaron factores de riesgo de accidentes siendo los mas frecuentes, el acceso al área de la cocina, las fuentes de electricidad mal protegidas y los muebles que pueden ser tirados al piso. La mayoría de las viviendas se clasificaron con bajo riesgo de accidentes y ninguna con alto riesgo. El antecedente de accidentes se identificó en 20 niños, prevaleciendo entre ellos el sexo masculino, las caídas, las quemaduras y la introducción de cuerpos extraños. Predominaron los niños de uno y tres años, y existe una mayor posibilidad de accidentes en aquellos hogares clasificados con mediano riesgo. Se recomienda a los médicos y enfermeras de la Atención Primaria de Salud aplicar la clasificación de riesgo de accidentes para orientar las acciones de promoción y prevención de salud(AU)

A descriptive and transversal study was carried out with the objective of identifying the accident risk factors in the homes of children under five years in four doctor's offices of the urban area of the Santiago Rafael Echezarreta Mulkay Policlinical University at San josé de las Lajas. A survey was applied in each one of the visited homes during the months of January to March 2007 by the authors. Variables like age, sex, risk factors and antecedents of accidents were used. The houses were classified in low, medium and high risk of accidents. The following results were obtained. Accident risk factors were identified in the totality of the houses, being the most frequent the access to the area of the kitchen, unprotected power supplies and the furniture that can be thrown to the floor. Most of the houses were classified as low accident risk and none with high risk. The antecedent of accidents was identified in 20 children, prevailing among them masculine sex, falls, burns and the introduction of foreign bodies. Children of one and three years predominated, and exists a greater possibility of accidents in those homes classified as medium risk. It is recommended that doctors and nurses of primary health care apply the classification of accident risk to indicate the actions for prevention and health promotion

Factores de riesgo del huésped en las infecciones respiratorias agudas, en menores de 5 años de edad / Risk factors of the host in acute respiratory infections in children under 5 years of age

Se realizó un estudio descriptivo y retrospectivo, para analizar los factores de riesgo del huésped, en la morbilidad, por infecciones respiratorias agudas (IRA) en 112 niños menores de 5 años de edad. El trabajo se desarrolló en los consultorios del médico de la familia, del área urbana del consejo popular 1, del Policlínico Docente Universitario Luis Li Trijent, del municipio de Güines, provincia La Habana, durante el segundo semestre del 2006. Se apreció un mayor predominio de las IRA asociadas a los menores de 3 años de edad, en el sexo masculino y con poco tiempo de utilización de la lactancia materna. El peso al nacer y la malnutrición por defecto, no constituyeron factores de riesgo en este estudio. La anemia nutricional y el asma bronquial fueron las enfermedades asociadas más frecuentes. Es necesario aplicar programas de educación comunitaria de salud sobre los factores de riesgo del huésped, para la aparición de IRA, en niños menores de 5 años que garanticen su control por la familia(AU)

It was carried out a descriptive and retrospective study, to analyze the risk factors of the host, in the morbidity, due to acute respiratory infections (ARI) in 112 children under 5 years of age. The work was developed at the family doctor's offices, of the urban area of the popular council number 1 of Luis Li Trijent university teaching polyclinic in Güines, Havana, during the second half of 2006. There was a higher prevalence of ARI's associated with children under 3 years of age in male sex and with little time of breastfeeding use. The birth weight and malnutrition by default, did not constitute risk factors in this study. Nutritional anemia and bronchial asthma were the most frequent associated diseases. It is necessary to implement community education programs on health risk factors of the host, for the emergence of ARIs, in children under 5 years to ensure their control by the family

La estrategia de atención primaria en salud (APS) para Bogotá-Colombia y su relación con la disminución de inequidades de resultados en salud / Strategy of primary health care for Bogotá - Colombia and its relationship with the decrease of inequities in health results

Describir la tendencia de un conjunto de indicadores de estado de salud y analizar el comportamiento de las disparidades en salud en las localidades de Bogotá con mayor y menor desarrollo de la estrategia de Atención Primaria Integral de Salud. Metodología: El diseño corresponde al de un estudio Observacional Ecológico que describe tendencias de los indicadores de mortalidad en menores de 5 años utilizando la información oficial de las bases de datos de mortalidad, estadísticas vitales y caracterización de Salud a su Hogar. Resultados: Los hallazgos sugieren que la estrategia de Atención Primaria Integral de Salud ha podido contribuir al mejoramiento en los resultados en salud y a la reducción de las disparidades por mortalidad en menores de cinco años en la población en desventaja social de las localidades con mayor grado de cobertura de la estrategia, en el marco de una tendencia general de disminución de la mortalidad en este grupo etáreo en la ciudad.

To describe the tendency of a set of health indicators and analyze the behavior of the disparities in health in the localities of Bogota with most and least development in the strategyof Comprehensive Primary Health Care. Methodology: The design of the study is Ecological Observation. It describes the tendencies of the mortality indicators for children below five years of age utilizing official information from the mortality database, vital statistics, and home health characterization. Results: the findings illustrate that the strategy of Comprehensive Primary Health Care has been able to contribute to the improvement of health results an the reduction of mortality disparities among children under 5 years of age within the socially disadvantaged population in the localities with a higher degree of coverage of the strategy, as part of a general tendency in decreasing the child mortality rate in the city.

Mortalidad en menores de cinco años mexicanos en 2004: hacia los objetivos del milenio / Mortality in Mexican children under five in 2004: towards meeting the millenium development goals

Introducción. En México, el cumplimiento de los objetivos del milenio (ODM), y en particular el número 4 relativo a la mortalidad en la infancia, tiene múltiples implicaciones. Para disminuir la mortalidad en menores de cinco años de 46 a 15.2 por 1 000 nacidos vivos (nv) se requiere realizar diversas acciones coordinadamente por todas las instituciones que componen el sistema de salud. Material y métodos. Se analizaron estimaciones del Consejo Nacional de Población (CONAPO), así como bases de datos de defunciones 1990-2002, Instituto Nacional de Estadística, Geografía e Informática (INEGI)/Secretaría de Salud y bases de datos de defunciones 2004, INEGI/Secretaría de Salud. Resultados. De acuerdo con las estimaciones del CONAPO en 1990 la mortalidad de menores de 5 años en el Distrito Federal era de 28.4 por 1 000 nv y en Chiapas la cifra ascendía a 65, es decir, 2.3 veces más riesgo de morir de los niños del sur y en 2004 la mortalidad en la infancia del Distrito Federal ha descendido a 14.4 y en Chiapas a 26.3 por 1 000 nv disminuyendo a 1.8 el diferencial de riesgo. No obstante el avance, la cifra alcanzada por Chiapas en 2004 representa un rezago con respecto a lo alcanzado por el Distrito Federal o por Nuevo León de 15 a 18 años. En la actualidad, como causas de mortalidad en menores de 5 años, predominan las afecciones perinatales, las anomalías congénitas y las lesiones accidentales.Aunque ha disminuido de manera considerable la participación de las causas infecciosas, todavía se mantienen dentro de los primeros lugares a nivel nacional. Conclusión. México es de los pocos países que se encuentra en la trayectoria adecuada de descenso de la mortalidad en la infancia. Sin embargo, existen importantes rezagos por resolver y sobre todo desafíos que atender. La compresión de la mortalidad infantil es uno de ellos, o quizás el más importante a encarar en el corto plazo.

Introduction. For Mexico, to achieve the Millennium Development Goals and particularly Goal number 4, relative to fewer than 5 mortality, has multiple implications. In order to reduce under 5 mortality from 46 to 15.2 per 1 000 live births mortality, multiple public health actions have to be undertaken in a coordinated fashion by all of the institutions that conform the National Health System. Materials and methods. Estimates by the National Population Council (CONAPO) were analyzed. The data base of registered deaths compiled by the National Institute for Geography and Health Statistics and the Ministry of Health between 1990-2002 and for 2004 were also reviewed and analyzed. Results. According to CONAPO estimates, in 1990 under 5 mortality in Mexico City (Federal District) was 28.4 per 1 000 live births, while in the State of Chiapas the rate was 65; that is 2.3 times higher risk of dying in this region of the country. In 2004 the figures for these 2 Federal entities had dropped significantly to 14.4 and 26.3 respectively, lowering the difference in risk to 1.8 for the latter, yet still leaving Chiapas in greater risk. At present, the primary causes of under 5 mortality include perinatal causes, congenital malformations, lesions and accidents. Although infectious diseases as a cause of death have been significantly reduced, at a National level, they still appear in the top causes of mortality in children under 5. Conclusion. Mexico is among the few countries in the correct or adequate path for reducing under 5 mortality. Nevertheless, there are still significant obstacles that need to be resolved and challenges to be addressed. The compression of the infant mortality and the gap among states is undoubtedly one of the most important issues to be addressed in the immediate future.