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Update on Chagas' disease in Mexico.

Chagas' disease, caused by the protozoan parasite Trypanosoma cruzi, represents a major public health problem in most of the American continent. As transmission of the parasite is being interrupted in most of South America, the disease remains endemic in various areas of Mexico. We review here some of the information gathered in recent years. Seroprevalence of T. cruzi infection in humans remains relatively high in some areas, and there has been a general increase in the number of chronic cases reported to health authorities in recent years. In fact, chronic chagasic cardiomyopathy appears to be affecting a large number of patients with heart disease, but many cases may be misreported because of the unspecific nature of the clinical symptoms. Epidemiological monitoring of vector and reservoir populations, as well as of human cases is helping focus on endemic areas, but a better coordination and development of these efforts is still needed. Recent studies of parasite biology are in agreement with previous work showing the great diversity of parasite characteristics, and support the need for a regional approach to this zoonosis. Strong and continuing support from health and academic authorities is thus still needed to further improve our understanding of Chagas' disease in Mexico and implement efficient control programs.

Acute Disease↗

Identity and experience: a study of selected female physicians in five provincial states of Mexico.

The aim of this paper is to analyse the identity(ies) and experiences of a selected group of female physicians in five provincial states of Mexico. In the last 30 years the number of female physicians in Mexico has grown considerably and yet little is known about these women. Data for this work were drawn from two in-depth interviews with 99 female physicians during 1995-1996. In addition, physicians were asked to complete a personal diary to illustrate the nature of their daily experiences over a three-month period; the gap between the two interviews. Analysis reveals female physician identity is shaped by Mexican health care service structures, personal characteristics and goals, and career development choices and opportunities. Association with particular spaces and places influences female physician career development and identity. The multiple identities of these professional women and their lived experiences can result in various pressures and tensions in family and career life. As a result these women make choices about career development; some reassess their career goals given their family and household circumstances and thus their career development may appear to be constrained. The paper concludes by suggesting that changes in Mexican health institutions and the science of medicine may lead to changes in female physician identity.

Career Mobility↗

Hookworm infection and anemia in adult women in rural Chiapas, Mexico.

OBJECTIVE: To describe associations between anemia and hookworm (Necator americanus) infection in hospitalized women in rural Chiapas, Mexico. MATERIAL AND METHODS: We retrospectively reviewed the hospital records of 68 anemic women (defined as having a hemoglobin level < 10 mg/dl) or with intestinal parasitism, identified through hospital discharge and transfusion records for the calendar year 1999. The medical charts of 86 cases were located, 18 of which were not confirmed as anemia cases. The hospital is located in Altamirano, Chiapas. Characteristics of subjects were compared using Student's t-test (for continuous variables) and the chi 2 test (for categorical variables). A p-value < or = 0.01 was used for statistical significance. Chart review and data analysis took place during the year 2000. RESULTS: Fifty percent of women who had stool examinations were infected with N. americanus. Necator often coexisted with other potential causes of anemia, such as pregnancy and hemorrhage. Hemoglobin levels in hookworm-infected women (mean 4.1 g/dl) were significantly lower than in uninfected women (mean 7.0 gm/dl), and Necator prevalence was significantly higher in the anemic women (50%) than in the overall hospital population (1.9%). CONCLUSIONS: Anemic women should be offered stool testing where Necator is present, and should be considered for antihelminthic treatment even if pregnant. Further investigation is recommended among women in Chiapas, and probably elsewhere in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Adult↗

Frequency of antibodies against the hepatitis C virus in patients with hepatic cirrhosis in Yucatan, Mexico.

OBJECTIVE: To report the prevalence of antibodies against the hepatitis C virus (anti-HCV) in a group of patients with hepatic cirrhosis (HC). MATERIAL AND METHODS: A prospective transversal and descriptive study was carried out from March 1998 to May 1999. Study subjects were 153 patients; 117 (76%) male and 36 (24%) female, diagnosed with HC. They were attended at the General Hospital Agustin O'Horan and at Regional Research Center Doctor Hideyo Noguchi, in Merida, Yucatan, Mexico. A clinical-epidemiologic questionnaire completed by interview was used for data collection. Anti-HCV were detected using a 2nd generation enzyme-linked immunosorbent assay (ELISA-2). To confirm diagnosis, a second generation recombining immunoblot assay (RIBA-2) was used. Hepatitis B surface antigen (HbsAg) and antibodies against the hepatitis B core antigen (anti-HBc) were determined using ELISA. The presence of anti-HCV was related to the epidemiologic variables of study subjects. The prevalence of anti-HCV was obtained and the frequency of the characteristics obtained by interview were compared among the positive and negative patients through the chi 2 test and the Fisher's exact test, as needed. RESULTS: Among patients with HC (35/117 (30%) male and 14/36 (39%) female), 32% were positive to anti-HCV. Alcoholism was present in all seroreactive males and absent in all positive females (p < 0.001). Data obtained through an interview were not associated with seropositivity. Anti-HBc was found in 16% of patients positive to anti-HCV and in 12% of seronegatives (p = 0.69). CONCLUSIONS: The prevalence found was greater than previous reports in the general population in the Yucatan Peninsula (1.3%). The high prevalence of anti-HCV in these patients suggests that HC is more frequently associated with HCV in Yucatan, Mexico than hepatitis B. Alcoholism probably acts as a cofactor for the development of HC in males.

Adolescent↗

Nutritional status of indigenous children younger than five years of age in Mexico: results of a national probabilistic survey.

OBJECTIVE: To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children < 5 years of age at the national level, by region and by urban and rural areas, and to evaluate the degree to which the socioeconomic condition of the family predicts the differences. MATERIAL AND METHODS: A national probabilistic survey was conducted in Mexico in 1999. Indigenous families were identified as those in which at least one woman 12-49 years of age in the household spoke a native language. The prevalence of undernutrition (stunting, wasting and underweight) and anemia was compared between indigenous and non-indigenous children. Probability ratios (PR) were used to compare prevalences in indigenous and non-indigenous children adjusting for socioeconomic status (SES) of the family and for other covariates. RESULTS: The prevalences of stunting and underweight were greater in indigenous than in non-indigenous children. At the national level and in urban areas the prevalences were three times greater and in rural areas approximately 2 times greater (p < 0.05). No differences were found in the prevalence of wasting (p > 0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p < 0.05) and was between 30 and 60% greater in urban areas and in the regions studied (p < 0.05) but was not statistically significant (p > 0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly higher in indigenous children (p < 0.05). CONCLUSIONS: Indigenous children have higher probabilities of stunting and underweight than non-indigenous children. The differences are larger in urban areas and in higher socioeconomic geographic regions and are explained mostly by socioeconomic factors. The overall difference in the probability of anemia is small, is higher only in urban relative to rural areas, and is explained to a lesser degree by socioeconomic factors. Policy and programs should be designed and implemented to reduce the dramatic differences in nutritional status between indigenous and non-indigenous children in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Adolescent↗

Breast-feeding practices in Mexico: results from the Second National Nutrition Survey 1999.

OBJECTIVE: To assess breast-feeding (BF) practices and determinants of exclusive BF (EBF) < 4 and < 6 months (mo) among women and infants < 23 mo in the NNS-1999. MATERIAL AND METHODS: BF practices from the day and night before the interview were ascertained, and median duration estimated. Determinants of EBF < 4 and < 6 mo were analysed by logistic regression models for complex surveys. RESULTS: Prevalence of EBF < 4 mo was 25.7%, and of < 6 mo 20.3%. The overall rate of continued BF (second year) was 30.9%, median duration of BF 9 mo, and the national proportion of children ever breast-fed 92.3%. The probability (p) of EBF < 4 mo was determined by infant age and sex, by maternal socio-economic level (SEL) and ethnicity, and by the interaction between infant sex and SEL. The pEBF < 6 mo was determined by infant age and length, by maternal ethnicity, and employment. CONCLUSIONS: EBF rates and duration are low in Mexico and have improved only slightly in the last 20 y. Infant and maternal characteristics determine the pEBF. If improvements in infant health are a national priority, aggressive interventions to promote and protect BF are urgently needed in Mexico, as well as formal evaluation of current initiatives. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Adolescent↗

[Caesarean sections in Mexico: tendencies, levels and associated factors].

OBJECTIVE: To describe the rate of caesarean sections in Mexico in the last 10 years and evaluate its relationship with several socioeconomic variables, type of health care services, and specialists' availability. MATERIAL AND METHODS: The Ministry of Health's register of births was used as source of information. The dependent variable was the type of delivery (vaginal or caesarean). The independent variables were: gross domestic product, human development index, illiteracy percentage among women, social exclusion index and, gynecology and obstetrics specialists supply. Correlations between variables were evaluated using Pearson's parametric test and Spearman range test. A lineal multiple regression was used to model the national caesarean data of 1999. RESULTS: National caesarean percentage increased in the last 10 years at an annual rate of 1%. It was considerably higher in social security institutions and the private sector. Caesareans percentages in 1999 were slightly above 35%. The highest values were those of the private sector with 53%, followed by social security institutions, with 38.2%. The variables more strongly associated with C sections were GDP, specialists' availability and human development index. CONCLUSIONS: It seems reasonable to advocate for a widespread descent in caesarean sections in Mexico. Important declines in certain contexts have been witnessed by implementing measures such as a second opinion before any C-section, a precise definition of the reasons for using it, and the monitoring of individual caesarean percentage among hospital obstetricians.

Cesarean Section↗

Clinical profile of dengue hemorrhagic fever cases in Mexico.

OBJECTIVE: Dengue hemorrhagic fever is a public health problem in Mexico since 1994. With four serotypes circulating the risk of epidemic dengue hemorrhagic fever is increasing. MATERIAL AND METHODS: We describe the clinical features of confirmed cases in the social security health system (IMSS) from 1995 to 2003. Clinical picture and epidemiological features were compared and a multivariate model was fitted to evaluate associations. RESULTS: Cases were divided into two groups: 438 patients with dengue fever, including 109 cases with hemorrhagic manifestations without thrombocytopenia, and 977 cases with dengue hemorrhagic fever, including 79 deaths. The main risk factors associated with mortality were hematemesis (RR 2.6; CI 95% 1.4-4.6) and melena (RR 2.2; Cl 95% 1.2-3.7). CONCLUSIONS: Our results characterize the clinical profile of dengue hemorrhagic fever cases in Mexico and identify prognostic factors to alert clinician for the prevention of a fatal evolution.

Adult↗

Obesity and overweight in IMSS female workers in Mexico City.

OBJECTIVE: To estimate the prevalence and risk factors for overweight (OW) and obesity (OB) in women working at the Mexican Social Security Institute (IMSS, per its abbreviation in Spanish) in Mexico City, using two different classification criteria. MATERIAL AND METHODS: A cross-sectional study was performed from July 1999 to September 2000. It included 588 women 20 to 65 years of age and who were working at the IMSS. The criteria used to estimate the prevalence of OW and OB were the WHO criteria and the Mexican Official Norm (NOM) for the integrated management of obesity in Mexico. RESULTS: The frequency of OB, according to WHO criteria, was 27.6% (26% adjusted) and for OW 43.2% (40.2% adjusted). According to the NOM, the levels of OB in those with short height (< 1.50 m) increased to 75% and to 52.2% for those with height > 1.50 m. Comparison of BMI between the two height groups showed no differences. The risk factor associated with OB and OW was age. Education and exercise were protective factors. CONCLUSIONS: The high prevalences detected in this particular working group highlight the importance of prevention and control of OB in health personnel because it can result in a high number of disability and premature retirement due to disease. The use of the NOM criteria for the identification of women at risk may be useful for early detection of high-risk groups.

Adult↗

[Efficacy of a rapid test to diagnose Plasmodium vivax in symptomatic patients of Chiapas, Mexico].

OBJECTIVE: To evaluate, under laboratory conditions, the sensitivity and specificity of a rapid diagnostic test (OptiMAL), based on immunoreactive strips, to detect Plasmodium vivax infection in febrile patients in Southern Chiapas, Mexico. MATERIAL AND METHODS: The presence of parasites in blood samples of 893 patients was investigated by Giemsa-stained thick blood smear microscopic examination (gold standard). A blood drop from the same sample was smeared on immunoreactive strips to investigate the presence of the parasite pLDH. Discordant results were resolved by PCR amplification of the parasite's 18S SSU rRNA, to discard infection. RESULTS: OptiMAL had an overall sensitivity of 93.3% and its specificity was 99.5%. Its positive and negative predictive values were 96.5% and 98.9%, respectively. Signal intensity in OptiMAL strips correlated well with the parasitemia density in the blood samples (r = 0.601, p = 0.0001). CONCLUSION: This rapid test had acceptable sensitivity and specificity to detect P. vivax under laboratory conditions and could be useful for malaria diagnosis in field operations in Mexico.

Adolescent↗

[Prevalence and risk factors related to sale of cigarettes to minors in stores in Mexico City].

OBJECTIVE: To identify the prevalence of the sale of cigarette to minors in stores in Mexico City. MATERIAL AND METHODS: A cross-sectional study was done applying a questionnaire to salespersons in stores that sell cigarettes. The SCINCE 2000 from INEGI was used to select and sample two Basic Geostatistical Areas (AGEB) per Delegation and a census of stores was carried out. RESULTS: A total of 577 stores were visited, 73% sold cigarettes to minors, 58% sell loose cigarettes, only 2.6% asked the buyer's age, and 1.2% requested identification. Among the salespersons, 51% were men, 37% had secondary school studies, 57% were smokers, 42% had children underage, and 99% knew that the sale of cigarettes to minors is prohibited. The multivariate analysis established an explicative model and it was discovered that when the salesperson was male or if the cigarettes were sold individually the probability of sale was 2 and 5 times higher respectively. CONCLUSIONS: The sale of cigarettes to minors in Mexico City is not associated with the personal characteristics of the salespersons or with the stores.

Adolescent↗

Prevalence of risk factors for HIV infection among Mexican migrants and immigrants: probability survey in the North border of Mexico.

OBJECTIVE: To estimate the prevalence of risk factors for HIV infection among Mexican migrants and immigrants (MMIs) in different geographic contexts, including the sending communities in Mexico, the receiving communities in the United States (US), and the Mexican North border region. MATERIAL AND METHODS: We conducted a probability survey among MMIs traveling through key border crossing sites in the Tijuana (Baja California, Mexico)-San Diego (California, US) border region (N= 1,429). RESULTS: The survey revealed substantial rates of reported sexually transmitted infections, needle-sharing and sexual risk practices in all migration contexts. CONCLUSIONS: The estimated levels of HIV risk call for further binational research and preventive interventions in all key geographic contexts of the migration experience to identify and tackle the different personal, environmental, and structural determinants of HIV risk in each of these contexts.

Adult↗

[Mexico health care system's objectives: importance to its population and determining factors].

OBJECTIVE: To document the importance to Mexico's population of the five intrinsic objectives of Mexico's present health care system (SS) and describe some of the determinants of its evaluation; the purpose is to contribute elements for defining priorities and to support the fulfillment of said objectives. MATERIAL AND METHODS: This is a cross-sectional study to the importance for Mexican population of the five objectives of SS, considered intrinsic or final in the National Evaluation and Performance Survey. The dependent variable was the ranking given by the population surveyed to each one of the objectives, based on the question: Which SS objective do you believe is most important? The independent variables (nominal and categorical) were: state of residence, type of locality, gender, age, education, present employment, quality of present state of health, last occurrence when medical assistance was needed but not received, grade of satisfaction with the operation of the country's medical care system and satisfaction with one's own health. A univaried analysis was conducted and summarized using percentages. The chi square test was used to validate or reject the hypothesis according to whether the rank assigned by the population to the SS objectives is the same, regardless of which variables were used in the comparison. A multinomial (politomic) logistical regression model was also developed to correlate the effect of the independent variables employed in the study with the importance assigned by the population to the SS objectives. The reference category of the model was the objective of improving the health of the population. The analysis was conducted using the statistical package STATA version 7.0. RESULTS: From the population studied, 31.8% reported that the most important objective is to improve treatment within the health care system. In rural areas, 31.46% of the population thinks the most important objective is to improve health, a result related with the self-perception of one's present state of health and lack of medical care. The probability of preferring the objective of improving treatment over improving health, between the populations with average education and higher levels of education is, respectively, 10% and 16% greater than the population with no education. Among the population that works independently, 31.2% consider improving health the most important objective, a greater percentage than that reported by the population of business owners and the one consisting of public and private employees. CONCLUSIONS: In general terms, the population analyzed by this study considered the improvement of treatment within the health care system to be most important, which differs from that suggested by the PRONASA 2001-2006. It was indicated that the importance assigned to the objectives can vary according to the group analyzed, its characteristics and the influence of diverse external factors on the individual, as a result of which the null hypothsesis is rejected. Variations among the populations' evaluations occurred, in particular, between the objective of improving treatment within the health care system and that of the improvement of the population's health. The obtained results guide the steps for communication and the strengthening of the health care system in order to adjust itself to the expectations of the population and support the fulfillment of the established objectives.

Cross-Sectional Studies↗

[Violence and pregnancy in female users of Ministry of Health care services in highly deprived states in Mexico].

OBJECTIVE: To characterize intimate partner abuse and identify the main factors associated with violence in pregnancy in four highly deprived States in Mexico. MATERIAL AND METHODS: The data were taken from the National Survey on Violence against Women 2003 (ENVIM per its abbreviation in Spanish). Based on it a cross-sectional study was conducted on 1 949 women between 15 and 50 years of age, who were once pregnant and who utilized primary and secondary health care services from the Ministry of Health, Mexican Institute of Social Security, and the Institute for Social Security and Services for State Workers in Guerrero, Hidalgo, Oaxaca and Chiapas states, between November 2002 and March 2003. Logistic regression was used to assess the association between independent variables and violence during pregnancy. RESULTS: 250 women (13%) suffered a type of violence (physical, psychological, sexual or economical) during any of their pregnancies. Of these women 76 (30.40%) were battered on their abdomen. In most of these cases (91.39%) the husband was the aggressor. The variables significantly associated with violence in pregnancy were: woman's illiteracy (OR 2.2; CI 95:% .1,4.4); history of violence in childhood (OR 3.2; CI 95% 1.9, 5.4) as well as sexual abuse in her childhood (OR 2.4, CI 95% 1.3, 4.4) and her partner's daily alcohol consumption (OR 6.5; CI 95% 3.3, 12.9). CONCLUSIONS: The results show that violence during pregnancy is a regular event in the impoverished context and that its expression is more severe. These results point to the importance of continued study of the problem of violence against pregnant women in Mexico and the importance of identifying battered women in prenatal care.

Adolescent↗

Population dynamics and biting rhythm of the anthropophilic sandfly Lutzomyia cruciata (Diptera: Psychodidae) in Southeast, Mexico.

Sandflies attracted by human bait were caught in an endemic focus of localized cutaneous leishmaniasis in the state of Campeche, Mexico. Catches were carried out monthly from February 1994 to January 1995 between 18:00 and 22:00 h. Lutzomyia cruciata was the only species caught. The highest population peak of Lu. cruciata was found in March with lesser peaks in February, December 1994, and January 1995. Maximum biting rate of Lu. cruciata was found between 18:00 and 19:00 h. The host-seeking females of Lu. cruciata were directly related to levels of humidity between 88 and 100%. Low and high temperature had a negative effect upon Lu. cruciata activity. The possible role of Lu. cruciata as vector of leishmaniasis in the state of Campeche, Mexico is discussed.

Analysis of Variance↗

Infection by Trypanosoma cruzi in mammals in Yucatan, Mexico: a serological and parasitological study.

In order to determine Trypanosoma cruzi infection among mammals in Yucatan, Mexico, 372 animals, both wild and synanthropic including carnivores, marsupials and rodents were studied. Serological studies by indirect haemagglutination (IHA) were carried out to detect antibodies to T. cruzi and a parasitological study was also performed (blood smear and histopathology). Of all the animals tested 18.54% were serologically positive, with a significantly higher frequency among the wild ones (33.33%) compared to the synanthropic ones (17.79%). To determine T. cruzi in positive animals, blood was inoculated into a white mouse (webster type) to prove myocardium colonization. The serological and parasitological positivity of these animals, as well as their behavior in the environment, taken together with the socioeconomic and cultural characteristics of the population, suggest that in Yucatan, Mexico, Canis familiaris, Didelphis marsupialis and Rattus rattus act as a link with the wild cycle.

Animals↗

First case of natural infection in pigs. Review of Trypanosoma cruzi reservoirs in Mexico.

An epidemiological research project was performed in the State of Morelos including collection of samples for blood smears and culture, serological tests, and xenodiagnoses from a total of 76 domestic and peridomestic mammals. Two strains of Trypanosoma cruzi were isolated by haemocultures; one from a pig (Sus scrofa), the first case of natural infection reported in Mexico, and the other from a dog (Canis familiaris). This study summarizes current information in Mexico concerning confirmed reservoirs of T. cruzi.

Animals↗

Role of two Triatoma (Hemiptera: Reduviidae: Triatominae) species in the transmission of Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) to man in the west coast of Mexico.

From August 1997 to August 1998, 334 specimens of Triatoma longipennis and 62 of T. picturata were collected in four groups of localities placed in the zone from Guadalajara, Jalisco to Tepic, Nayarit, in the West Coast of Mexico. Most T. longipennis were collected outdoors (69.2%) while most T. picturata (58.1%) were collected indoors. All collected specimens were examined for Trypanosoma cruzi infection, which was detected on 98 (29.3%) T. longipennis and 17 (27.4%) T. picturata. This study confirms the role of T. longipennis and T. picturata as some of the main T. cruzi vectors to humans in Mexico. Habitation Infestation Rate with T. longipennis was of 0.09 and with T. picturata was of 0.03 and the predominating ecotopes were pile of blocks, chicken coops, pigsties, wall crawls and beds.

Animals↗