9
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      La mortalidad infantil por malformaciones congénitas en México: un problema de oportunidad y acceso al tratamiento Translated title: Infant mortality from congenital malformations in Mexico: an issue of opportunity and access to treatment

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          OBJETIVOS: Caracterizar el comportamiento del Sistema Nacional de Salud (SNS) de México en la tarea de reducir el número de muertes por malformaciones congénitas mediante el análisis de la tendencia de las tasas de mortalidad infantil específicas por esas afecciones. MÉTODOS: Análisis de series de tiempos de las defunciones de niños y niñas menores de 1 año entre 1980 y 2005, según las bases de datos nacionales anuales de mortalidad de la Secretaría de Salud de México. Se calcularon las tasas de mortalidad infantil específicas (TMIe) por malformaciones congénitas graves más frecuentes en México: defectos del tubo neural, hernia diafragmática congénita, exonfalos (onfalocele y gastrosquisis) y malformaciones cardíacas y del tubo digestivo, agrupadas según el grado de urgencia y de sofisticación tecnológica que demanda su tratamiento y el desenlace más frecuente. RESULTADOS: Entre 1980 y 2005, la tasa de mortalidad infantil en México descendió de 40,7 a 16,9 por 1 000 nacimientos (β = -0,86; P < 0,001); en cambio, la tasa de mortalidad específica por malformaciones congénitas creció de 2,2 a 3,5 por 1 000 nacimientos (β = 0,05; P < 0,001). La hipertrofia pilórica y la atresia anorrectal, malformaciones con buen pronóstico y tratamiento programable en unidades con equipamiento básico, fueron las únicas que mostraron una tendencia descendente en su TMIe (β = -0,01 a -0,09; P < 0,001), mientras que las que requieren tratamiento urgente en unidades especializadas mostraron TMIe crecientes (β = 0,03 a 0,05; P < 0,001). CONCLUSIONES: El desarrollo del SNS de México entre 1980 y 2005 no se ha traducido en una reducción en la mortalidad por malformaciones congénitas; esta ineficacia fue más notoria en las enfermedades cuyo tratamiento es urgente y requiere tecnología sofisticada.

          Translated abstract

          OBJECTIVES: To evaluate the role that Mexico's National Health System (Sistema Nacional de Salud-SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). METHODS: Time-series analysis of deaths of boys and girls under 1 year of age from 1980-2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for the most frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technological sophistication required for treatment, and most frequent outcome. RESULTS: From 1980-2005, the infant mortality rate in Mexico decreased from 40.7 to 16.9 per 1 000 births (β = -0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (β = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (β = -0.01 to -0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (β = 0.03 to 0.05; P < 0.001). CONCLUSIONS: The development of Mexico's SNS from 1980-2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronounced for anomalies that require immediate treatment and sophisticated technology.

          Related collections

          Most cited references53

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          The world health report 2000 - Health systems: improving performance

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence.

            Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developing-country communities has not been reported. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Clasificación estadística internacional de enfermedades y problemas relacionados con la salud

              (1995)
                Bookmark

                Author and article information

                Journal
                rpsp
                Revista Panamericana de Salud Pública
                Rev Panam Salud Publica
                Organización Panamericana de la Salud (Washington, Washington, United States )
                1020-4989
                1680-5348
                November 2008
                : 24
                : 5
                : 297-303
                Affiliations
                [01] Ciudad Obregón Sonora orgnameInstituto Mexicano del Seguro Social orgdiv1Delegación Sonora orgdiv2Coordinación de Investigación en Salud México
                [02] Hermosillo Sonora orgnameInstituto Mexicano del Seguro Social orgdiv1Unidad de Investigación Epidemiológica y en Servicios de Salud México
                Article
                S1020-49892008001100001 S1020-4989(08)02400501
                10.1590/s1020-49892008001100001
                19141171
                36a33a98-6d65-4ba3-b108-9ff7793bb818

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 05 July 2007
                : 27 May 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 7
                Product

                SciELO Public Health

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Artículos

                Infant mortality,infant mortality rate,congenital abnormalities,Mexico,Mortalidad infantil,tasa de mortalidad infantil,anomalías congénitas,México

                Comments

                Comment on this article