Homero Martínez

The Conceptualization of Perceived Insufficient Milk Among Mexican Mothers

This study sought to provide a comprehensive picture of maternal conceptualization of Perceived Insufficient Milk (PIM) using qualitative methods (semistructured interviews, free lists, and rankings) in Mexico. Two hundred and seven first-time mothers of infants younger than 6 months and mothers-to-be who were (or intended to be) breastfeeding were interviewed in waiting areas at a hospital and a health clinic in Mexico City, Mexico, from September 2000 to January 2001. Pattern searching and triangulation of the 3 qualitative methods indicated that women viewed crying as the chief symptom of PIM. Maternal diet and liquid intake were cited as both the most salient causes and treatments for PIM. The main coping strategy in the event of PIM was formula feeding. These findings highlight the need for addressing maternal concerns in relation to PIM, especially regarding the role of crying as the initiator of the PIM cycle.

Nutritional status of indigenous children at boarding schools in northern Mexico.

Objective: To assess the nutritional status of Tarahumara children at indigenous boarding schools.Design: Cross-sectional comprehensive nutritional survey.Setting: The schools sampled were located in indigenous municipalities of the northern Mexican state of Chihuahua.Subjects: The study was carried out in 2001 among 331 children aged 6–14u2009y from a sample of five schools. Anthropometric measurements, a thyroid exam and capillary haemoglobin levels were obtained from the children. Serum concentrations of ferritin, iron, total iron-binding capacity, vitamin B12, folic acid and zinc were collected from a subsample of 100 children.Results: The prevalence of wasting and overweight (children 6–9u2009y) was 1.1 and 4.6%, respectively, and of underweight, risk of overweight and overweight (10–14u2009y) was 3.2, 5.1 and 0.6%, respectively. Stunting (6–12u2009y) was present in 22.3% of the children. The total goitre rate was 5.4%. The prevalence of anaemia was 13% (boys 11.4, girls 14.5%). Overall, 24.2% of the children were iron deficient (depletion 11.1%, deficient erythropoiesis 3%, iron deficiency anaemia 10.1%). No child had folic acid values <3u2009ng/ml, but 20.2% had low (<200u2009μg/dl) and 27.3% marginal (200–300u2009μg/dl) vitamin B12 levels, and 80.2% had low zinc concentrations (<60u2009μg/dl).Conclusions: Nutritional underweight and stunting were similar to those reported in rural localities at the national level, but overweight was less prevalent in children aged 10–14u2009y. Various micronutrient deficiencies was identified including zinc and vitamin B12, but the prevalence of iron and folic acid deficiency was lower than expected. These results suggest that Tarahumara children attending boarding schools may be the better-off children from these extremely poor and marginalized areas.Sponsorship: Swedish Agency for Research Cooperation with Developing Countries and the Mexican Social Security Institute.

Iron deficiency anemia in Tarahumara women of reproductive-age in Northern Mexico

OBJECTIVEnTo determine the prevalence of iron deficiency anemia (IDA) among Tarahumara women of reproductive age.nnnMATERIAL AND METHODSnA cross-sectional survey was conducted in a representative sample of 481 women aged 12-49 years, residents of Guachochi Municipality, Chihuahua, from June to September 1998. The hemoglobin (Hb) level was measured in capillary blood using the Hemocue technique, and the serum ferritin level in capillary serum spotted on filter paper, in a sub-sample of women. Central tendency and dispersion measures were estimated; the Chi-squared test was used to test differences in proportions and ANOVA and Bonferronis test for differences in means.nnnRESULTSnPrevalence of anemia (mean Hb +/- S.D.) was 16.1% (140 +/- 16 g/l) and 25.7% (129 +/- 12 g/l) for non-pregnant and pregnant women, respectively. Pregnant women in the 3rd trimester and those who were breast-feeding their children during the first 6 months after delivery had the highest prevalence of anemia (38.5% and 42.9%, respectively). Iron deficiency was responsible for most of the anemia found in this sample.nnnCONCLUSIONSnThis study provides relevant information for the development of intervention programs to treat and prevent IDA in this ethnic group.

Prevalencia de desnutrición en niños tarahumaras menores de cinco años en el municipio de Guachochi, Chihuahua

Objective. To determine the prevalence of malnutrition among Tarahumara children under 5 years of age in the municipality of Guachochi, Chihuahua, Mexico. Material and methods. During the summer of 1996, we interviewed a representative sample of 450 children from 62 communities, stratified by size of population. The sample represents 12.2% of the total number of Tarahumaras in the municipality. For each of three anthropometric indices (weight-forage, weight-for-height and height-for-age), we calculated the Z-score in reference to NCHS population values. Results are presented as means and standard deviations as well as prevalence of malnutrition at different cut-off-points, stratified by age, sex, and size of the community. Results. Prevalence figures of malnutrition (<-2Z) were: weightfor-age: 36.4% (mean SD± -1.66 ±1.1); weight-for-height: 3.5% (mean SD± -0.43 ±0.9); and height-for-age: 57.1% (mean SD± -2.15 ±1.3). Children aged 12-23 months were the most affected, both in weight-for-height and weight-for-age (10.3% and 52.6%, respectively). Children over one year of age presented prevalences of height-for-age <-2Z over 60%. Significant sex differences (p<0.05) were observed, favoring girls. Conclusions. Malnutrition among Tarahumara children reaches its peak during the second year of life (12-23 months old), affecting boys more than girls. This information may be useful for planning and targeting nutrition intervention programs for this underprivileged indigenous group.

Creencias y conocimientos de un grupo de médicos sobre el manejo de la alimentación del niño con diarrea aguda

Objective. To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians’ dietary management was compared with that recommended by the World Health Organization. Material and Methods. A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then crossreferred. Results. The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. Conclusions. The obtained information is in conflict with WHO’s recommendations, specially with that of sustained feeding. The English version of this paper is available at: http:// www.insp.mx/salud/index.html

Iron Nutrition in Schoolchildren of Western Mexico: The Effect of Iron Fortification

In Mexico, food fortification is used as a strategy to combat micronutrient deficiencies. However, little is known about the effects of food fortification in vulnerable populations. This study was carried out in a population of school children believed to be at risk of various micronutrient deficiencies, including iron. The study aimed at determining iron status of children, and identifying and quantifying the sources of iron intake and the presence of relevant enhancers and inhibitors of iron absorption in the diet. The iron status and dietary iron intake was assessed of schoolchildren aged 3–14 years in western Mexico. Hemoglobin, serum ferritin, and transferrin saturation percentages were used to evaluate the iron status in a school-based sample of 762 children. Dietary data were collected from 607 children using semi-quantitative food frequency questionnaires. The overall prevalence of anemia and iron deficiency was 3.7% and 4%, respectively. Iron intake ranged from 1.9 to 3.3 times the recommended daily allowance, with fortified iron accounting for 72% of the total iron intake. Although iron fortification of staples such as maize flour in Mexico for more than a decade most likely contributed to reducing the prevalence of anemia and iron deficiency, the relatively large amounts of iron consumed could eventually lead to problems related to excessive iron intake in some children. Nutritional guidelines for iron fortification in Mexico should be defined and put into practice.