IJE Advance Access originally published online on May 29, 2008
International Journal of Epidemiology 2008 37(4):786-795; doi:10.1093/ije/dyn089
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Demographic, health services and socio-economic factors associated with pulmonary tuberculosis mortality in Los Altos Region of Chiapas, Mexico
1 Health Division, El Colegio de la Frontera Sur, Chiapas, Mexico.
2 Grups de Reserca d’América I d’África Latines (GRAAL), Unitat de Bioestadística, Facultat de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain.
3 Center for Training in Ecology and Health for Campesinos (CCESC) – Right to Health Defense Group (DDS), San Cristóbal de Las Casas, Chiapas, Mexico.
4 Clinic of Tuberculosis, National Institute of Respiratory Diseases. Mexico.
* Corresponding author. Carretera Panamericana y Periférico Sur, S/N, 29290, San Cristóbal de Las Casas, Chiapas, México. E-mail: jnajera{at}ecosur.mx
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Abstract |
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Background Chiapas is one of the Mexican states having the highest rates of Pulmonary Tuberculosis (PTB), due to the numerous factors impeding its management and control (poverty, poor housing and nutrition, shortage of health resources, among others).
Objectives To analyse the PTB mortality of a cohort of patients in Los Altos Region of Chiapas, who had been diagnosed with PTB from January 1, 1998 to December 31, 2002; and, to identify demographic, socioeconomic and health services utilization factors, associated with death from PTB.
Methods Analysis of a cohort of patients aged over 14 years diagnosed with PTB in the above mentioned period (n = 431) in Los Altos region of Chiapas. The records of the Tuberculosis Programme were reviewed, and patients were located through a search attempting to locate them in their homes. Those found alive were interviewed and asked to provide sputum samples. In the case of deceased patients, a verbal autopsy was obtained from a member of their family.
Results The records of the PTB Programme in the area were incomplete and erroneous in many cases. The results of the home follow-up visits were: 208 (48%) patients located alive, five of whom were still PTB positive (three with multi-drug resistance); 145 (34%) could not be located and 78 (18%) had already died. Apparently, in at least 40 cases, the deaths were associated with PTB. Of these forty, 33 (83%) died without having received any medical care. The factors associated with dying from PTB were: 45 and over years of age (OR = 1.3; 95% CI = 0.98–1.3), 0–3 schooling years (OR = 3.3; 95% CI = 1.1–9.6), engaged in agriculture (OR = 2.2; 95% CI = 1.1–4.4), not living in main villages of their municipality (OR = 1.2; 95% CI = 1.0–1.3), living in a rural community (OR = 2.7; 95% CI = 1.1–6.8), not having been treated in DOTS (OR = 1.2; 95% CI = 1.0–1.3) and having defaulted from treatment (OR = 11.5; 95% CI = 5.3–24.8).
Conclusions The high rate of mortality due to PTB observed constitutes a serious public health problem deserving attention. There is an urgent need to evaluate and restructure the Tuberculosis Programme in the studied area.
Keywords Mexico, pulmonary tuberculosis, DOTS, mortality, poverty
Accepted 24 April 2008
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