Patricia Tomé

Validation of the verbal autopsy method to ascertain acute respiratory infection as cause of death.

The validity of the Verbal Autopsy (VA) in death due to acute respiratory infection (ARI), Was tested in 36 children who died by any acute infectious disease as stated by the necropsy diagnosis, at two public hospitals in Mexico City; the illness started at home. Clinical data obtained through VA were compared with diagnoses of necropsies, which were considered as “gold standard”. The presence of dyspnoea for more than one day showed sensitivity of 0.69 and Specificity of 0.74, while history of coughing showed a sensitivity of 0.61 and a specificity of 0.73. Combination of both clinical data improved specificity (0.83), but decreased sensitivity (0.54). Additional sources of diagnosis (a panel of assessors, the clinical record and the death certificate), also showed good sensitivity (0.69–0.77) and specificity (0.74–7.8). Focus on history of dyspnea and/or cough in children with an infectious syndrome should be emphasized, as a useful epidemiologic tool to determine children’s mortality due to ARI in areas where diagnosis resources are constrained.

Características asociadas al subregistro de muerte en niños del estado de Guerrero, México

Objective. To estimate the frequency of underregistered children deaths in rural areas and to identify associated characteristics. Material and methods. The study was conducted in three stages. In the first, three strata of communities were formed according to the number of inhabitants; then a representative number of villages was randomly selected from each stratum. A census was made in each village to determine the deaths occurred between June 1993 and July 1994. In the second stage, the verbal autopsy method was used with the mothers of the dead children to determine the cause of death and investigate the study variables. In the third stage, registration of death was verified through the death certificates. Results. An underregistration frequency of 68.9% was found; in communities of less than 500 inhabitants underregistration reached 73.2% and in larger communities it was 60.5%. Characteristics associated to underregistration were the lack of birth and death certificate, age younger than one month, lack of information on the concept and purpose of a Public Registration Office, distance from the Public Registration Office and to the doctor of more than 30 minutes, and community smaller than 1 000 inhabitants. Conclusions. A modification in the current organization of the death registration procedure is proposed and the use of a birth certificate designed by the National Health System.

La mortalidad por enfermedad diarreica en México: ¿problema de acceso o de calidad de atención?

Objetivo. Evaluar el proceso de atencion y el acceso a servicios de salud en menores de cinco anos fallecidos por enfermedad diarreica (ED), en cuatro estados de la Republica mexicana. Material y metodos. Se realizo un estudio transversal que incluyo defunciones ocurridas durante un ano; mediante autopsia verbal se obtuvo informacion de caracteristicas clinicas, atencion durante la enfermedad y acceso a los servicios de salud; se realizo un analisis descriptivo y comparativo de acuerdo con el tamano de la localidad. Resultados. De 553 defunciones, la mayoria ocurrio en ninos sin derecho a seguridad social o residentes en localidades rurales; la muerte en el hogar, la edad menor a un ano y la corta evolucion de la enfermedad caracterizaron a mas de la mitad de los casos. Se proporciono terapia de hidratacion oral por decision de la madre a casi 75% de los ninos; 20% recibio atencion no medica, principalmente de curanderos. La atencion medica fue otorgada en 60% de los casos; a una elevada proporcion le fue indicado algun medicamento y no se le envio a hospital ni se recomendo regresar ante la presencia de signos de alarma; la indicacion de hidratacion oral fue mayor por medicos de servicios publicos y en localidades rurales; en estas, el acceso geografico y economico fue menor. Conclusiones. Si bien se confirmo el problema de acceso a los servicios de salud, se identificaron fallas importantes en la atencion medica primaria. Se propone la creacion de unidades docente-asistenciales como una estrategia para la reduccion de la mortalidad por ED.