[Mortality for diarrheic disease in Mexico: problem of accessibility or quality of care?].
OBJECTIVE
To evaluate the access to health services and the process of care provided to children under five years old who died from acute diarrhea (AD).


METHODS
In four states of Mexico, a cross-sectional study was carried out. Deaths from AD that occurred in the lapse of one year were included. Information about clinical characteristics of the illness, process of care and access to the health facilities were obtained through verbal autopsy. Descriptive analysis and comparison of data between rural and urban communities were performed.


RESULTS
Five-hundred and fifty three deaths were analysed. Most of the children were not enrolled in a public care health system. The main children's characteristics were the following: residence in rural communities; age less than one year; died at home or had short illness duration. Geographic and economic access barriers were identified in rural areas. Oral rehydration salts were provided as a part of household treatment in about 75% of children. 20% of them received non-medical care, specially from traditional healers. Primary medical care was provided to 60% of cases; the drawbacks of the process were related to a high rate of medication prescription, lack or referral to hospital, and lack of recommendation for a new visit in presence of alarm signs. Public physicians and those from rural communities prescribed oral rehydration therapy in a greater proportion.


CONCLUSIONS
The problem of access to health services in rural communities was confirmed. However, low quality of care provided by primary level physicians was found in both rural and urban areas. We propose the creation of clinical teaching centers to improve the quality of the process of medical care as a strategy to decrease mortality due to AD.
Unidad de Investigación Epidemiológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México.
H
H
Reyes
P
P
Tomé
G
G
Gutiérrez
L
L
Rodríguez
M
M
Orozco
H
H
Guiscafré
D002675:Child, Preschool; D000529:Complementary Therapies; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000401:mortality / Q000628:therapy; D003968:Diarrhea, Infantile / Q000401:mortality* / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006701:Home Nursing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011787:Quality of Health Care
La mortalidad por enfermedad diarreica en México: problema de acceso o de calidad de atención?