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ABSTRACT: To analyze the process of seeking tuberculosis care and this process's impact on treatment adherence in the Mexican state of Chiapas, given that the two primary factors in successful tuberculosis (TB) control programs are early diagnosis and adherence to TB treatment.
We conducted a qualitative study using group interviews with 11 groups of patients in three of the nine socioeconomic regions of the state of the Chiapas (Altos, Centro, and Fronteriza).
The patients applied a variety of approaches in seeking care. The patients reported considerable delays in diagnosis due to problems that the patients themselves had and because of shortcomings in the care they received from the formal health care system. The treatment options that they followed were the result of their perceptions of the causes of TB and of the variety of traditional medical practices accepted in their communities.
The lack of knowledge about TB encourages people to consider various alternatives for their care. Tuberculosis control in Chiapas requires an optimal utilization of the health services that exist in the state as well as a program of health education. TB control in Chiapas must take into account the social, cultural, and economic reality of the population.
Revista Panamericana de Salud Pública 06/2001; 9(5):285-93. · 0.85 Impact Factor
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ABSTRACT: To identify the frequency of drug resistant tuberculosis and to determine risk factors for its development in five health districts in the State of Chiapas, Mexico.
A cross-sectional study. EMPLACEMENT: Primary care.
Patients with pulmonary tuberculosis diagnosed between September 1 and December 31, 1995. Each patient responded to a questionnaire regarding epidemiological, diagnostic and treatment variables. Sputa were cultured, drug sensitivities and typing of micobacteria were obtained.
There were 142 cases of pulmonary tuberculosis confirmed by acid fast smear. The frequency of resistant M. tuberculosis in 61 positive cultures was 24.2%. Of these, 33.3% was resistant to one drug and 66.7% at two or more drugs. Resistance to isoniazide and rifampicin together was present in 66.7% of the cases. The most frequent resistance, 86.7%, was to isoniazide. A history of multitreatments, either completed or not, resulted in a risk factor 6.48 times greater for drug resistance and patients with a history of abandoning treatment presented an increased risk factor of 5.71.
Drug resistant tuberculosis y a serious problem in Chiapas that requires urgent attention if future control of the disease is to be maintained. The frequency of resistant tuberculosis is high, 24.2%, and the risk factors identified indicate a worsening of the situation with the accumulation of patients inadequeately treated without follow up until cure.
Atención Primaria 10/1999; 24(4):209-14. · 0.63 Impact Factor
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ABSTRACT: To evaluate the usefulness of the Shortened Directly Observed Treatment (DOT,S) applied to the Tuberculosis Control Program in Chiapas, Mexico.
The efficacy and efficiency of treatment was evaluated in a cohort of pulmonary tuberculosis patients confirmed by baciloscopy, who were subjected to treatment under one of three different regimes, self-administered, supervised and DOT,S from January to June 1996.
Efficacy was 90.9%, 97.7% and 100% for self-administered, supervised and DOT,S treatment, respectively. Efficiency was 68.1%, 77.6% and 88.5% in the same order.
For public health ends, the DOT,S proved to be the most efficient in the control of tuberculosis, since healing rates were increased and this reduces sources of disease transmission.
Salud publica de Mexico 40(3):272-5. · 0.94 Impact Factor
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ABSTRACT: The purpose of this investigation, which utilized a single-blind study with placebo, was to evaluate the peripheral leukocyte count in onchocerciasis patients treated with ivermectin. Eighty-three male patients between the ages of 12 and 60, all with moderate or severe onchocerciasis infections (but otherwise in general good health), were selected from three villages from the southern onchocerciasis endemic area of Chiapas, Mexico. All onchocerciasis patients were randomly assigned to either the ivermectin group or a placebo group in a three to one ratio, respectively. Sixty-two patients from the ivermectin group received five single oral doses of ivermectin between 150 and 220 mcg/kg (one every six months), and placebo pills of identical appearance were given to 21 patients from the placebo group. Physical, ophthalmological, and laboratory exams were performed on all patients in this study. Skin and ocular microfilaria were stimulated in all patients. Results have indicated that ivermectin induced a decrease in the total number of peripheral leukocytes to the extent of about 300 to 500 cells after each drug intake. In the majority of the cases, the reduction was due to a decrease in the total number of eosinophils; the number of neutrophils, lymphocytes, and monocytes remained at the same level after treatment. These results strongly suggest that the eosinophilia observed in the prestudy of those individuals with onchocerciasis could have induced leukocytosis (the eosinophilia decreasing significantly after administering ivermectin).
Salud publica de Mexico 33(2):112-23. · 0.94 Impact Factor
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ABSTRACT: To identify health perceptions and practices and non-adherence to therapy among tuberculosis patients.
Qualitative research work consisting of 11 group interviews with 62 tuberculosis patients during 1997-1998 in the Central, Highlands, and Border Regions of Chiapas, Mexico.
Perceived causes of tuberculosis included contagion via food utensils, excess work, malnutrition, and cold, as well as other causes unrelated to person-to-person contagion. The resulting incapability to work resulted in an economic crisis for both the patients and their family members. As a result of the social stigma imposed by the disease, patients perceived a negative impact on their personal life, family, work, and community.
Lack of knowledge regarding tuberculosis is an important factor in the selection of and adherence to different care alternatives. Inadequate care provided by health services, including an unsatisfactory physician-patient relationship, resulted in diagnostic delay and non-adherence to therapy. Education programs to promote basic knowledge regarding tuberculosis and its treatment are necessary in this region.
Salud publica de Mexico 42(6):520-8. · 0.94 Impact Factor
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ABSTRACT: To determine risk factors for antibiotic resistance in patients with pulmonary tuberculosis in four Health Jurisdictions of the state of Chiapas.
A case-control study was carried out in patients diagnosed by acid fast smear during 1992. A questionnaire was applied which included variables related to the diagnosis, treatment and follow-up of the patients. Sputum samples were collected for culture and sensitivity tests. A case of drug-resistant pulmonary tuberculosis was defined as the presence of culture colonies showing resistance to one or more drugs. The control group was patients with negative smears and cultures or positive cultures for M. tuberculosis sensitive to the specific drugs.
Of the total of 18 individuals reported to have positive cultures, 13 (72.2%) were resistant to one or more drugs. Resistance to two or more drugs was found in 10 of them of which three were resistant to five antituberculosis drugs. The most frequent resistance was to isoniazid (77%). Risk factors for resistance encountered in this patient population were monotherapy (OR = 34.2), abandonment of treatment (OR = 6.86), a prolonged period of illness (OR = 6.40), delay in diagnosis and a history of prior therapy (OR = 28.3).
The high proportion of patients resistant to antituberculosis therapy poses a public health problem and is a clear consequence of the problems arising from inadequate treatment.
Salud publica de Mexico 37(5):408-16. · 0.94 Impact Factor
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ABSTRACT: The objective of this work is to evaluate the palpation sensitivity of onchocercomata for the diagnosis of onchocerciasis in individuals residents of the locality of Nueva Costa Rica, Mapastepec, in the south endemic area of the state of Chiapas, Mexico. Every one of the 243 individuals who voluntarily participate in this study was interrogated and physical examined for the detection of nodules. The positivity and the worm burden to the Onchocerca volvulus infections was estimated by the presence of one or more microfilariae in any of the for skin snips taken from both suprascapular and gluteal regions, and by the mean of the Dmf/mg of each skin snip. From the total number of individual studied, 131 (53.9%) were positives to microfilariae and 37 (15.2%) to onchocercomata. Only 23 (17.6%) of the microfilariae positive individuals carried nodules. The distribution of positive individuals to nodules in relation to age, was similar in all the age groups. In relation to the intensity of the infection was found that, the mean of the Dmf/mg of all individuals was 6.67, there was not significant differences (p greater than 0.001) between males and females; being the Dmf/mg of 6.35 and 6.99, respectively. The age group between 21 and 30 years old showed the higher mean of Dmf/mg than the rest of the groups (p greater than 0.001). However, there was a high microfilariae positivity in the oldest groups than in the young. The prevalence for onchocerciasis in this locality, estimated by the positivity to either microfilariae or nodules, was 59.9 per cent. It is concluded that, the onchocercomata detection sensitivity for the diagnosis of onchocerciasis was very low, probably due to the nodulectomy activity of the onchocerciasis control program, which has been operating since 1930 and therefore, there are an important number of individuals positive to microfilariae without detectable nodules.
Salud publica de Mexico 32(6):658-64. · 0.94 Impact Factor
