Boletin de la Oficina Sanitaria Panamericana. Pan American Sanitary Bureau最新文献

Two notification systems were compared to estimate maternal death underreporting for 1988 in eight public maternity clinics of Rio de Janeiro. The death rates obtained were compared with the corrected maternal death rate (13.9 per 10,000 live births), which represented all deaths validated by either system. The system based on hospital discharge records yielded a maternal death-rate of 11.6 per 10,000 live births, or 16% underreporting when compared with the corrected death rate. Error was due to system failure in processing the discharge forms, and also to the transfer of patients to nonmonitored hospitals. The system based on death certificates, including "presumed" maternal deaths, presented a rate of 6.6 per 10,000 live births, with 52% underreporting in relation to the corrected rate. The official death rate, based on maternal deaths as declared in death certificates, underreported by 60% compared to the corrected death rate. When the two systems were compared with each other, the one based on death certificates showed 62% underreporting in relation to that based on hospital discharge forms. In order to minimize underreporting of maternal deaths and to broaden the knowledge on circumstances relating to those deaths, it is suggested (a) that a perinatal information system be introduced in all obstetric service units, and (b) to monitor the final outcome of patients transferred to tertiary units.

The purpose of this work was to describe the diet of children under 18 months of age and its relationship to nutritional status. For this purpose, in 1993 a prevalence study was carried out on children who received care from the National Health Services System of Chile. The Chilean public health system provides care to 75% of children under 6 years of age and especially to children of families in the lower strata of income distribution in the country. Participants in the study were 9330 children under 18 months old who were randomly selected from 102 of the 320 urban clinics throughout the country. The type of food these infants had received the day prior to the interview (breast milk exclusively, breast milk plus solid food, formula exclusively, formula plus solid food) and their nutritional status relative to the standards of the National Center for Health Statistics (United States of America) and of WHO were determined. Children with z values for weight-for-age between -1.0 and -2.0 standard deviations were considered at risk for malnutrition, and those with z values under 2 standard deviations were classified as malnourished. The prevalences of exclusive breast-feeding at the first, third, and sixth months of life were 86.5%, 66.7%, and 25.3%, respectively. Some 12.1% of the participants showed low weight for age; 30.7%, low height for age; and 35.7%, overweight. The magnitude of weight-for-age deficiency was 1.2 to 5 times greater among children who were fed milk substitutes than among those who received breast milk. Breast-feeding also had a positive effect on height. These results confirm the benefits of exclusive breast-feeding until 6 months of age, the need to supplement the child's diet with solid food after that age, and the breast-feeding's protective effect on the nutritional status of children of all the ages studied.

In 1992, a training program for traditional birth attendants (TBAs) was initiated in Quetzaltenango, Guatemala, in order to improve the identification and treatment of neonatal disorders and high-risk pregnancies. This program was evaluated by comparing the pattern of hospital referrals by TBAs before and after the training. The study design consisted of a community intervention evaluated by means of several cross-sectional surveys. Comparisons were made between a group of TBAs who had received the training (intervention group) and another group of TBAs from nearby communities who had not received the training (control group). The outcome variables included the TBAs' ability to correctly identify obstetric complications, the point in time at which they sent mothers to the hospital, and perinatal mortality among the children whose mothers were referred to the hospital. Of the 854 women eligible, 845 participated in the study. Following the training program, there was a 200% increase in the number of mothers referred to the hospital by the TBAs. There was also improvement in the ability of the TBAs in the intervention group to refer women with obstetric complications to the hospital, although the effect of the program appeared to have been minimal on both that ability and the reduction of perinatal mortality. Nevertheless, the latter effect should be more precisely determined, since a decrease in perinatal mortality was observed in both the intervention and control groups, with no statistically significant difference.

Mercury-containing industrial waste has been released into the coastal waters of the Eighth Region of Chile for around two decades. This study, carried out from 1991 to 1993, sought to measure mercury concentrations in the hair of pregnant and lactating women from villages near the coast and in the interior of the region in order to examine the relationship between the concentration of mercury and seafood consumption. The survey questionnaire used in 1991 to determine seafood consumption did not ask about the frequency of consumption of fish, shellfish, and algae but only whether the women who were pregnant or breast-feeding consumed a minimum of one fish-based meal per week. The questionnaire used in 1992 and 1993 asked about the daily and weekly consumption of seafood in general (fish, shellfish, and algae). Spectrophotometry was used to determine the total mercury concentration in samples of 100 mg of hair from 153 pregnant and lactating women in 11 fishing villages of the Eighth Region where seafood is regularly consumed. None of the women had occupational exposure to mercury. Total mercury concentration was also determined in hair samples from a control group composed of 26 pregnant and lactating women from Pinto and El Carmen, villages in the interior of the same region where seafood was rarely eaten. The arithmetic mean of the total mercury concentration in hair was 1.81 mg/kg of body weight for the study group (standard deviation [SD] 1.52) and 0.42 mg/kg for the control group (SD 0.15)--a statistically significant difference (P < 0.01). Pairwise comparisons also revealed statistically significant differences (P < 0.05) between the mean for the interior group and the means for the women in the nine villages closest to the sources of the pollution, but not between the mean for the interior group and those for women in the two villages at the extreme north and south of the study zone, who lived farthest from the contaminated waters. The total mercury concentration in hair was significantly higher in women who indicated that they ate fish seven or more times per week; in those who said they ate fish, shellfish, or algae five or more times per week; and in those who had lived 20 or more years in their village. No statistically significant differences were found when the results were analyzed by age.

This study was carried out in order to describe tuberculosis trends in Cuba and its provinces between 1979 and 1993. For this purpose, reports of new cases of all forms of tuberculosis were obtained from the National Statistics Bureau of the Ministry of Public Health. In addition, tuberculosis incidence rates and their trends between 1979 and 1992 were determined. The data were analyzed by means of simple linear and exponential regression models. Finally, the percentage reductions in incidence between 1979 and 1992 were calculated and the observed changes were described in reference to the expected values derived from the regression models. The number of new tuberculosis cases reported in Cuba decreased from 1133 (11.6 per 100,000 population) in 1979 to 633 (5.8 per 100,000) in 1992 (a 44% reduction). In 1993, 788 cases were reported (7.2 per 100,000). In almost all the provinces the incidence tended to decrease between 1979 and 1992, and the average annual number of new case notifications fell between 4.0 and 5.4%, although in some, less than 3%. In 1992, the number of new case notifications in the country was 25% higher than in 1991, and the incidence rates in all the provinces were higher than expected. The incidence in La Habana, the City of Havana, Villa Clara, Cienfuegos, Ciego de Avila, Santiago de Cuba, and Guantánamo exceeded the overall national incidence. In 1993, incidence in the country was 55.6% higher than it had been in 1991 and 24.5% higher than in 1992. Incidence rose in all provinces, and especially in the City of Havana, Matanzas, and Guantánamo. Although incidence remained below 8 cases per 100,000 population between 1992 and 1993, it rose during those years, as it did in other countries. The increase appears to be attributable to the economic crisis that affects the country and to have very little connection to human immunodeficiency virus infection.

The purpose of this study was to evaluate the ability of a panel of eight antinucleocapsid monoclonal antibodies developed in Europe to identify different strains of rabies virus isolated from a variety of animal species from diverse geographic areas in Mexico. Fifty-one virus-positive samples of brain tissue from various animal species and humans were studied. Material from these samples was used to infect mice, whose brains were later tested by indirect immunofluorescence, using the monoclonal antibodies described above. Strains of the virus that showed antigenic variations were sent to the Pasteur Institute in Paris for confirmation of the results. No mouse brain sample showed a pattern of antigenic reactivity that indicated the presence of a Lyssavirus other than the classic rabies virus. However, four antigenic variations from serotype 1 of classic rabies were found. The panel of antibodies was judged to be useful for the rapid classification of rabies virus in Mexico. It is possible that autochthonous antigenic variations are appearing among strains circulating in that country, a scenario that could explain some of the failures observed with certain vaccines. For this reason, there is a need to produce antinucleocapsid monoclonal antibodies with strains of rabies virus indigenous to the area.