The obesogenic environment around elementary schools: food and beverage marketing to children in two Mexican cities.

BACKGROUND: Unhealthy environments and food advertisements are major determinants of childhood obesity. Recent regulation has banned unhealthy foods from schools in Mexico. However, currently there is no regulation limiting exposure to food marketing around schools. Thus, our objective was to analyze the characteristics of food advertising practices around 60 elementary schools in two cities and to evaluate compliance with the Pan American Health Organization (PAHO) recommendations and the local food industry self-regulatory marketing code. METHODS: Data were collected during the period of October 2012 to March 2013. A random sample of elementary schools was selected from two Mexican cities. Using geographic information systems, we drew a 100-m-diameter buffer around each school. Trained personnel obtained photographs to assess the locations and types of food advertisements. Our results were stratified by school type and by indicators of compliance with the PAHO and industry recommendations. We developed a multivariate negative binomial regression model to determine factors predicting the number of advertisements around schools. RESULTS: The number of advertisements was significantly higher around public schools than around private schools (6.5 ± 5.6 vs. 2.4 ± 3.5, p < 0.05). Printed posters were the most common type of marketing medium (97%), showing mostly sugar-sweetened beverages, sweet breads, candies, and bottled water. Promotions, such as special prices or gifts, were included on 30% of printed posters. Food advertising practices were often in compliance with industry recommendations (83%) but not with those from the PAHO (32%) (p < 0.001). CONCLUSION: Our results support the importance of monitoring the obesogenic environment and identifying policy tools to protect children from food marketing not only inside schools but also around them, particularly in lower income communities.

Assessment of environmental health children's population living in environmental injustice scenarios.

We conducted a cross sectional study, involving 145 children randomly selected from three different socioeconomic locations. We selected social, environment and health indicators and measured the prevalence and prevalence odds ratios. Children from the brick producing site (segregation index 5), are exposed to high levels of multiple toxic agents, and showed the highest morbidity rates and malnutrition, anemia, dental fluorosis, and the lowest IQ, followed by children from municipal garbage dump (segregation index 4), where we detected the highest prevalence of dermatological and enteric diseases. Children from the Central Zone (segregation index 2) showed the lowest rates of malnutrition and higher IQ than the other two groups. A unified vision of social, health and environmental indicators opens the possibility of novel intervention programs and a legal framework that specifically protect children against environmental exposures.

Resetting our priorities in environmental health: an example from the South-North partnership in Lake Chapala, Mexico.

Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet. Our own data has indicated that 27% of women of childbearing age have elevated hair mercury levels, and multivariable analysis indicated that frequent consumption of carp (i.e., once a week or more) was associated with significantly higher hair mercury concentrations. In this paper we describe a range of environmental health research projects. Our main priorities are to build the necessary capacities to identify sources of water pollution, enhance early detection of environmental hazardous exposures, and deliver feasible health protection measures targeting children and pregnant women. Our projects are led by the Children's Environmental Health Specialty Unit nested in the University of Guadalajara, in collaboration with the Department of Environmental Health of Harvard School of Public Health and Department of Pediatrics of the New York School of Medicine. Our partnership focuses on translation of knowledge, building capacity, advocacy and accountability. Communication will be enhanced among women's advocacy coalitions and the Ministries of Environment and Health. We see this initiative as an important pilot program with potential to be strengthened and replicated regionally and internationally.

A qualitative analysis of environmental policy and children's health in Mexico.

BACKGROUND: Since Mexico's joining the North American Free Trade Agreement (NAFTA) and the Organization for Economic Cooperation and Development (OECD) in 1994, it has witnessed rapid industrialization. A byproduct of this industrialization is increasing population exposure to environmental pollutants, of which some have been associated with childhood disease. We therefore identified and assessed the adequacy of existing international and Mexican governance instruments and policy tools to protect children from environmental hazards. METHODS: We first systematically reviewed PubMed, the Mexican legal code and the websites of the United Nations, World Health Organization, NAFTA and OECD as of July 2007 to identify the relevant governance instruments, and analyzed the approach these instruments took to preventing childhood diseases of environmental origin. Secondly, we interviewed a purposive sample of high-level government officials, researchers and non-governmental organization representatives, to identify their opinions and attitudes towards children's environmental health and potential barriers to child-specific protective legislation and implementation. RESULTS: We identified only one policy tool describing specific measures to reduce developmental neurotoxicity and other children's health effects from lead. Other governance instruments mention children's unique vulnerability to ozone, particulate matter and carbon monoxide, but do not provide further details. Most interviewees were aware of Mexican environmental policy tools addressing children's health needs, but agreed that, with few exceptions, environmental policies do not address the specific health needs of children and pregnant women. Interviewees also cited state centralization of power, communication barriers and political resistance as reasons for the absence of a strong regulatory platform. CONCLUSIONS: The Mexican government has not sufficiently accounted for children's unique vulnerability to environmental contaminants. If regulation and legislation are not updated and implemented to protect children, increases in preventable exposures to toxic chemicals in the environment may ensue.

Methylmercury exposure in a subsistence fishing community in Lake Chapala, Mexico: an ecological approach.

BACKGROUND: Elevated concentrations of mercury have been documented in fish in Lake Chapala in central Mexico, an area that is home to a large subsistence fishing community. However, neither the extent of human mercury exposure nor its sources and routes have been elucidated. METHODS: Total mercury concentrations were measured in samples of fish from Lake Chapala; in sections of sediment cores from the delta of Rio Lerma, the major tributary to the lake; and in a series of suspended-particle samples collected at sites from the mouth of the Lerma to mid-Lake. A cross-sectional survey of 92 women ranging in age from 18-45 years was conducted in three communities along the Lake to investigate the relationship between fish consumption and hair mercury concentrations among women of child-bearing age. RESULTS: Highest concentrations of mercury in fish samples were found in carp (mean 0.87 ppm). Sediment data suggest a pattern of moderate ongoing contamination. Analyses of particles filtered from the water column showed highest concentrations of mercury near the mouth of the Lerma. In the human study, 27.2% of women had >1 ppm hair mercury. On multivariable analysis, carp consumption and consumption of fish purchased or captured from Lake Chapala were both associated with significantly higher mean hair mercury concentrations. CONCLUSIONS: Our preliminary data indicate that, despite a moderate level of contamination in recent sediments and suspended particulate matter, carp in Lake Chapala contain mercury concentrations of concern for local fish consumers. Consumption of carp appears to contribute significantly to body burden in this population. Further studies of the consequences of prenatal exposure for child neurodevelopment are being initiated.

Development of the pediatric environmental health specialty unit network in North America.

Training in environmental health in general, and pediatric environmental health in particular, is inadequate. The Agency for Toxic Substances and Disease Registry began to develop pediatric environmental health specialty units (PEHSUs) after noting the dearth of practitioners who could evaluate and manage children with exposures to environmental health hazards. The Environmental Protection Agency subsequently joined in providing support for what has developed into a network of 13 PEHSUs in North America. PEHSUs provide services to families, act as consultants to clinicians and public agencies, develop educational materials, and respond to natural disasters, including hurricanes and wildfires. PEHSUs are relatively easy to organize and should be replicable internationally.

Water privatization, water source, and pediatric diarrhea in Bolivia: epidemiologic analysis of a social experiment.

Water and sanitation services are fundamental to the prevention of pediatric diarrhea. To enhance both access to water and investment, some argue for the privatization of municipal water networks. Water networks in multiple Bolivian cities were privatized in the 1990s, but contracts ended following popular protests citing poor access. A population-based retrospective cohort study was conducted in two Bolivian cities. Data were collected on family water utilization and sanitation practices and on the prevalence of diarrhea among 596 children. Drinking from an outdoor water source (OR, 2.08; 95%CI, 1.25-3.44) and shorter in-home water boiling times (OR, 1.99; 95%CI, 1.19-3.34) were associated with prevalence of diarrhea. Increased prevalence was also observed for children from families using private versus public water services, using off-network water from cistern trucks, or not treating their water in-home. Results suggest that water source, water provider, and in-home water treatment are important predictors of pediatric diarrhea.

Assessing the roles of temperature, precipitation, and ENSO in dengue re-emergence on the Texas-Mexico border region.

OBJECTIVE: The goal of this study was to assess linkages between microclimate and longer-term ENSO-related weather forcing on the week-to-week changes in dengue prevalence in Matamoros, Tamaulipas, Mexico, over a recent decade of dengue observations. MATERIAL AND METHODS: An auto-regressive model to evaluate the role of climatic factors (sea-surface temperature) and weather (maximum temperature, minimum temperature, precipitation) on dengue incidence over the period 1995-2005, was developed by conducting time-series analysis. RESULTS: Dengue incidence increased by 2.6% (95% CI: 0.2-5.1) one week after every 1 degree Celsius increase in weekly maximum temperature and increased 1.9% (95% CI: -0.1-3.9) two weeks after every 1 cm increase in weekly precipitation. Every 1 masculineC increase in sea surface temperatures (El Niño region 3.4 ) was followed by a 19.4% (95% CI: -4.7-43.5) increase in dengue incidence (18 weeks later). CONCLUSIONS: Climate and weather factors play a small but significant role in dengue transmission in Matamoros, Mexico. This study may provide baseline information for identifying potential longer-term effects of global climate change on dengue expected in the coming decades. To our knowledge, this is the first study to investigate the potential associations between climate and weather events and dengue incidence in this geographical area.

Neuroprotective Effect of IRL-1620, an Endothelin B Receptor Agonist, on a Pediatric Rat Model of Middle Cerebral Artery Occlusion.

Objective: The purpose of this study was to determine the potential neuroprotective effect of endothelin B (ETB) receptor agonist IRL-1620 treatment in a pediatric model of ischemic stroke. Design: A prospective, animal model study. Setting: An experimental laboratory. Subjects: Three-month-old male Wistar Han rats. Interventions: The rats underwent permanent middle cerebral artery occlusion (MCAO). At 2, 4, and 6 h post MCAO, they were treated with saline, IRL-1620 (5 µg/kg, IV), and/or ETB antagonist BQ788 (1 mg/kg, IV). Measurements and Main Results: The rats were evaluated over the course of 7 days for neurological and motor deficit, cerebral blood flow (CBF), and infarct volume. Young rats treated with IRL-1620 following MCAO improved significantly in neurological and motor assessments as compared to the vehicle-treated group, as measured by neurological score (P = 0.00188), grip test (P < 0.0001), and foot-fault error (P = 0.0075). CBF in the infarcted hemisphere decreased by 45-50% in all groups immediately following MCAO. After 7 days, CBF in the infarcted hemisphere of the IRL-1620 group increased significantly (P = 0.0007) when compared to the vehicle-treated group (+2.3 ± 23.3 vs. -45.4 ± 10.2%). Additionally, infarct volume was significantly reduced in IRL-1620-treated rats as compared to vehicle-treated rats (P = 0.0035, 41.4 ± 35.4 vs. 115.4 ± 40.9 mm3). Treatment with BQ788 blocked the effects of IRL-1620. Conclusions: IRL-1620 significantly reduced neurological and motor deficit as well as infarct volume while increasing CBF in a pediatric rat model of cerebral ischemia. These results indicate that selective ETB receptor stimulation may provide a novel therapeutic strategy in the treatment of pediatric ischemic stroke as has been demonstrated in adult ischemic stroke.

Dengue fever seroprevalence and risk factors, Texas-Mexico border, 2004.

Reported autochthonous dengue fever transmission in the United States has been limited to 5 south Texas border counties since 1980. We conducted a cross-sectional serosurvey in Brownsville, Texas, and Matamoros, Tamaulipas, Mexico (n = 600), in 2004 to assess dengue seroprevalence. Recent dengue infection was detected in 2% (95% confidence interval [CI] 0.5%-3.5%) and 7.3% (95% CI 4.3%-10.3%) of residents in Brownsville and Matamoros, respectively. Past infection was detected in 40% (95% CI 34%-45%) of Brownsville residents and 78% (95% CI 74%-83%) of Matamoros residents. For recent infection, only weekly family income

Rapid assessment procedures in environmental sanitation research: a case study from the northern border of Mexico.

BACKGROUND: There is a need to enhance the quality and sustainability of environmental health programs in Mexico. What socio-cultural factors influenced the adoption or rejection of Clean Water in Homes programs in this population? We applied rapid appraisal procedures (RAP) to evaluate these community-based programs. METHOD: Qualitative study conducted in communities along Mexico's northern border. We conducted informal dialogues, semi-structured interviews, field notes and observations. Home visits used a checklist to observe: sources of water, handwashing, as well as human waste and garbage disposal patterns. Data analysis was conducted using ATLAS.ti, which facilitated comparison and illustration of discrepancies, the elaboration of emerging issues and relationships between them. RESULTS: Community members perceived that the Clean Water program was a top-down intervention. Water is perceived as a political issue and a matter of corruption. Inequity also limits solidarity activities involved in environmental sanitation. Migration to the United States of America (US) contributes to community fragmentation, which in turn dilutes communal efforts to improve water and sanitation infrastructure. While targeting women as program "recipients", the Clean Water program did not take gendered spheres of decision-making into account. Community members and authorities discussed the main results in "assemblies", particularly addressing the needs of excluded groups. CONCLUSION: The oversight of not exploring community members' needs and priorities prior to program implementation resulted in interventions that did not address the structural (economic, infrastructure) and socio-cultural barriers faced by community members to undertake the health-promoting behaviour change, and provoked resentment.

The Toxic Food Environment Around Elementary Schools and Childhood Obesity in Mexican Cities.

INTRODUCTION: The childhood obesity epidemic is a global concern. There is limited evidence in Mexico linking the local food environment to obesity. The purpose of this study is to describe the links between the local food environment around elementary schools and schoolchildren's BMI in two Mexican cities. METHODS: Cross-sectional surveys were conducted in 60 elementary schools in two Mexican cities (i.e., Cuernavaca and Guadalajara) in 2012-2013. Anthropometric measurements on schoolchildren were collected, as well as environmental direct audits and observations in a 100-m buffer around schools. Children's BMI was evaluated according to WHO-recommended procedures. In BMI models, the explanatory variable was the number of retail food sources. These models were adjusted for child's characteristics, schools' socioeconomic background, compliance with federal guidelines concerning unhealthy foods within schools' facilities, and corresponding city. Analysis was conducted in 2014. RESULTS: The number of mobile food vendors was higher around public schools than outside private schools (p<0.05). Linear regression procedures showed a significant positive statistical association between children's BMI and the number of mobile food vendors around schools. Schoolchildren from the highest tertile of mobile food vendors showed 6.8% higher BMI units than those from the lowest tertile. Children attending schools within the highest tertile of food stores also had 4.7% higher BMI units than children from schools in the lowest tertile. CONCLUSIONS: Health policy in Mexico should target the obesogenic environment surrounding elementary schools, where children may be more exposed to unhealthy foods.

Diarrheal diseases in children from a water reclamation site in Mexico city.

This study was conducted to assess the risk of enteric diseases among children living in a water reclamation area in Mexico City. A geographic information system was used to define eligible wells and surrounding homesteads. Sixty-five water samples from five wells were tested for fecal coliform bacteria per 100 mL (FC/100 mL) during visits to 750 eligible households; caretakers only in those dwellings with children under 5 years old were interviewed throughout repeated cross-sectional surveys, conducted during 1999-2000. Data on diarrheal diseases were obtained from 761 children during the rainy season and 732 children during the dry season; their guardians also provided information on drinking water supply, sanitation, and socioeconomic variables. The presence of indicator organisms in groundwater samples pointed to fecal pollution; bacterial indicators, however, did not predict the health risk. The rates of diarrhea were 10.7% in the dry season and 11.8% in the rainy season. Children 1 year old showed the highest rate of diarrhea during the dry season [odds ratio (OR) = 2.1 with 95% confidence interval (CI), 0.99-4.71], particularly those from households perceiving unpleasant taste of tap water (OR, 1.7; 95% CI, 0.97-2.92) and consuming vegetables washed only with water (OR, 2.2; 95% CI, 1.10-4.39). Lower risk was observed in individuals enjoying full-day water supply (OR, 0.5; 95% CI, 0.27-0.86) and a flushing toilet (OR, 0.3; 95% CI, 0.16-0.67), as well as those storing water in covered receptacles (OR, 0.3; 95% CI, 0.15-0.80). Rainy season data suggested that children from households perceiving a color to their water had a higher rate of diarrhea than did those without such complaint (OR, 1.8; 95% CI, 0.93-3.67); recent consumption of food sold by street vendors was also a significant risk factor (OR, 1.6; 95% CI, 0.98-2.87). Groundwater is at risk of contamination, as indicated by the presence of FC/100 mL. The endemic pattern of diarrhea, however, reflects mostly inadequate housing, sanitation, and water-related practices. Health protection policy must be discussed.

Risk of Giardia intestinalis infection in children from an artificially recharged groundwater area in Mexico City.

The objective of this study was to assess the risk of infection with Giardia intestinalis in children living in an area with artificial groundwater recharge and potable water reuse in Mexico City. Eligible wells and surrounding homesteads were defined by using a geographic information system. Five wells were tested for G. intestinalis cysts per 400 liters of water. A total of 750 eligible households were visited during two cross-sectional surveys. Stool samples were provided by 986 children in the rainy season study and 928 children during the dry season survey for parasitologic tests. Their guardians provided information on water, sanitation, hygiene, and socioeconomic variables. The prevalence rates of G. intestinalis infection were 9.4% in the rainy season and 4.4% in the dry season. Higher rates of infection were observed in older individuals (9.5% and 10.6%) and girls had a lower risk of infection than boys (odds ratio [OR] =0.55, 95% confidence interval [CI] = 0.34, 0.88 in the rainy season and OR = 0.47, 95% CI = 0.25, 0.90 in the dry season). During the wet season survey, a health risk was detected among those storing water in unprotected receptacles (OR = 4.00, 4.69, and 5.34 for those using uncovered jars, cisterns or tanks, and buckets, respectively), and bathing outside the dwelling, i.e., using a tap (OR = 1.93, 95% CI = 1.10, 3.39). A health risk was also detected among children from households with unsafe food hygiene practices (OR =2.41, 95% CI =1.10, 5.30) and those with no hand-washing habits (OR = 2.27, 95% CI = 1.00, 5.20). Groundwater reserves are at risk of fecal pollution, as indicated by the presence of G. intestinalis cysts. However, the endemic pattern of intestinal infection reflects low standards of personal hygiene and unsafe drinking water storage and food-related practices at household level. Prevention activities must address health education and environmental protection policies.

Knowledge and practice of traditional medicine in Mexico: a survey of healthcare practitioners.

A cross-sectional study combined anthropologic (ethnographic) techniques to obtain qualitative information from decision makers and a questionnaire designed to investigate the population that used health services provided by the medical centers in Mexico. The results demonstrate that non-biomedical therapists fell into three main groups: (1) practitioners of traditional medicine; (2) practitioners of alternative medicine; and (3) faith healers. The cultural affiliations, academic backgrounds, training, and preparation of these practitioners differed markedly. They employed many strategies to finance their services, create and utilize therapist networks, and provide care to different segments of the population. The authors recommend further research on non-biomedical health care models, which are becoming more important with expanding globalization.

Limiting the consumption of sugar sweetened beverages in Mexico's obesogenic environment: a qualitative policy review and stakeholder analysis.

Mexico is building a legal framework to address its childhood obesity epidemic. Sugar sweetened beverages (SSB) in the school environment represent a major policy challenge. We addressed the following questions: What barriers inhibit political attention to SSB and childhood obesity? What political instruments, international and national, exist to guide agenda setting in Mexico? What opportunities exist for policy adoption? We conducted a systematic review of international and national legal instruments concerned with SSB consumption. We traced process, conducting interviews with key informants. Thematic analysis helped us identify barriers and opportunities for public health interventions. We found 11 national policy instruments, but detected implementation gaps and weak fiscal policies on SSB consumption in schools: limited drinking water infrastructure, SSB industry interests, and regulatory ambiguities addressing reduction of sugar in beverages. Public policy should target marketing practices and taxation. The school environment remains a promising target for policy. Access to safe drinking water must complement comprehensive and multi-sector policy approaches to reduce access to SSB.

Análisis de algunas barreras del ambiente construido para la actividad física en la Ciudad de Cuernavaca, Morelos, México / Analysis of some environmental barriers for physical activity Cuernavaca City, Morelos, México

Introducción: La actividad física (AF) es un factor de protección ante múltiples enfermedades. Las recomendaciones mundiales para la AF están bien establecidas y son difundidas en todos los escenarios posibles, pero el ambiente construido podría presentar múltiples barreras para seguir dichas recomendaciones. Objetivo: Analizar algunas barreras del ambiente construido para la actividad física por niveles de marginación en la ciudad de Cuernavaca, México. Materiales y métodos: Empleando el programa Atlas ti 5.0, se categorizaron los datos obtenidos de 170 guías de observación. Se realizó el análisis de un acervo fotográfico de 341 imágenes de 20 AGEBS de la ciudad de Cuernavaca, utilizando un análisis de imágenes fijas connotativo, denotativo y por 3 categorías (Calzadas, tránsito y espacios deportivos). Se utilizó el programa Stata 12.0 para obtener frecuencias y porcentajes. Resultados: Se identificaron deficiencias en el diseño y uso de espacios como las banquetas, falta de señalización e inseguridad de las vías públicas. Se encontró carencia de espacios para la práctica de la actividad física. Solo hay una presencia del 10% de espacios deportivos en los 20 AGEBS estudiados. Se encontró que el 82.86% de las calles está en deficiente estado. La deficiente iluminación vial, carencia de ciclovías y grafitis con porcentajes importantes también se identificaron como barreras para la AF. Discusión: En Cuernavaca las posibilidades de acceso a espacios seguros, presentan múltiples barreras y por ende esta tendencia afecta de forma negativa la salud de los habitantes de la ciudad, además que no es congruente con las recomendaciones mundiales para la actividad física. Conclusiones: La identificación y abolición de las barreras deben estar dentro las prioridades de las políticas de salud públicas y las intervenciones deben procurar dicha transformación, de esta forma se superará la tendencia de solamente informar sobre los beneficios de la actividad física que predominan en la gran mayoría de las recomendaciones e intervenciones.

Introduction: Physical activity (PA) is a factor of protection against multiple diseases. Global recommendations for PA are well established and are spread in all possible scenarios, but the built environment could present multiple barriers to follow these recommendations. Objective: To Analyze some built environment barriers for physical activity by levels of marginalization in the city of Cuernavaca, Mexico. Material and methods: Using the software Atlas ti 5.0, data from 170 observation guides and were categorized. The analysis of a photographic collection of 341 images of 20 AGEBS of Cuernavaca was performed using an analysis connotative and denotative by 3 categories (roadways, traffic and sports areas). Stata 12.0 software was used to obtain frequencies and percentages. Results: Deficiencies in the design and use of spaces such as sidewalks, lack of signage and insecurity of public roads were identified. Lack of spaces for the practice of physical activity was found. There is only one presence of 10% of sports facilities in the 20 AGEBS studied. It was found that 82.86% of the streets are in poor condition. Poor street lighting, lack of bicycle paths and graffiti with significant percentages were also identified as barriers to PA. Discussion: In Cuernavaca the possibilities of access to safe spaces for FA have multiple barriers, this negatively affects the health of the habitants of the city, and that is not consistent with global recommendations for physical activity. Conclusions: Identifying and abolishing barriers must be within the priorities of public health policies and interventions should seek this transformation, to improve the tendency to only report on benefits of physical activity prevailing in the vast majority of programs.

Policy analysis of the dengue control program in Mexico.

OBJECTIVE: To analyze municipal measures implemented to control the dengue epidemic, giving priority to the functions of intersectoral coordination, policy strengthening and community participation. METHODS: The observational study was performed in Morelos, Mexico in 2007. Data collected in interviews and direct observations were submitted to contents analysis and policy mapping. Policy Maker software was used to evaluate the values assigned to the stakeholders' performance (i.e., high, medium and low criteria) and to their role (actions undertaken for surveillance, control or management). A strategic analysis of opportunities and challenges regarding public policies and dengue control was conducted. RESULTS: The legal framework indicates that the approach to the dengue epidemic should be an intersectoral response. However, the burden of activities in terms of financial and human resources tends to fall on local health services, which contrasts with the contribution of other sectors (e.g., water and sanitation) that do not recognize their responsibilities. A high degree of operational feasibility links, in terms of optimization of resources and objectives fulfillment was detected, particularly among health authorities at state, jurisdictional and municipal levels. CONCLUSIONS: A multidisciplinary approach and strengthening of policy stewardship may allow a more efficient response to dengue outbreaks, sustained by intersectoral coordination and the active participation of the affected population.

Análisis político del Programa de Control del dengue en Morelos, México / Análise política do programa de controle da dengue em Morelos, México / Policy analysis of the dengue control program in Mexico

OBJETIVO: Analisar medidas municipais implementadas para o controle da epidemia da dengue, sobretudo as de coordenação setorial, governança e participação de grupos sociais. MÉTODOS: Estudo observacional, realizado em Morelos, México, 2007. Os dados coletados em entrevistas e observações diretas foram submetidos a análise de conteúdo e mapeamento político. O software Policy Maker foi utilizado para avaliar os pesos atribuídos aos dados do desempenho (i.e., critérios alto, médio e baixo) e papel de atores (ações realizadas, sejam elas de vigilância, controle, sejam administrativas). Foi realizada análise estratégica das oportunidades e desafios no cumprimento das políticas públicas e controle da dengue. RESULTADOS: As bases jurídicas indicam que a resposta à epidemia é uma tarefa multissetorial. Porém, a resposta está centrada em atividades dos serviços da saúde, que estão forçados a dar o maior apoio financeiro e a derivar os recursos humanos necessários, em contraste com a contribuição de outros setores (e.g., água e saneamento básico), que desconhecem as suas responsabilidades. O setor da saúde apresenta alto nível de factibilidade para a vinculação intra-institucional, em termos de otimização de recursos e cumprimento de objetivos, particularmente entre autoridades de saúde nos níveis estatal, jurisdicional, municipal e local. CONCLUSÕES: A abordagem multidisciplinar e o fortalecimento das responsabilidades políticas permitirão a resposta eficaz perante a epidemia da dengue, sustentada na coordenação setorial e envolvimento ativo da população afetada.

OBJETIVO: Analizar medidas municipales implementadas para el control de la epidemia del dengue, sobretodo las de coordinación sectorial, gobernanza y participación de grupos sociales. MÉTODOS: Estudio de observación, realizado en Morelos, México, 2007. Los datos colectados en entrevistas y observaciones directas fueron sometidos a análisis de contenido y mapeo político. El software Policy Marker fue utilizado para evaluar los pesos atribuidos a los datos de desempeño (e.g. criterios alto, medio y bajo) y el papel de actores (acciones realizadas sean ellas de vigilancia, control o administrativas). Se realizó análisis estratégico de las oportunidades y desafíos en el cumplimiento de las políticas públicas y control del dengue. RESULTADOS: Las bases jurídicas indican que la respuesta a la epidemia es una tarea multisectorial. Sin embargo, la respuesta está centrada en actividades de los servicios de la salud, que están forzados a dar mayor apoyo financiero y derivar los recursos humanos necesarios, en contraste con la contribución de otros sectores (e.g. agua y saneamiento básico), que desconocen sus responsabilidades. El sector de la salud presenta alto nivel de factibilidad para la vinculación intra?institucional, en términos de optimización de recursos y cumplimiento de objetivos, particularmente entre autoridades de salud en los niveles estatal, jurisdiccional, municipal y local. CONCLUSIONES: El abordaje multidisciplinario y el fortalecimiento de las responsabilidades políticas permitirán la respuesta eficaz ante la epidemia del dengue, sustentada en la coordinación sectorial e involucramiento activo de la población afectada.