title: Improvement of child survival in Mexico: the diagonal approach.
abstract: Public health interventions aimed at children in Mexico have placed the country among the seven countries on track to achieve the goal of child mortality reduction by 2015. We analysed census data, mortality registries, the nominal registry of children, national nutrition surveys, and explored temporal association and biological plausibility to explain the reduction of child, infant, and neonatal mortality rates. During the past 25 years, child mortality rates declined from 64 to 23 per 1000 livebirths. A dramatic decline in diarrhoea mortality rates was recorded. Polio, diphtheria, and measles were eliminated. Nutritional status of children improved significantly for wasting, stunting, and underweight. A selection of highly cost-effective interventions bridging clinics and homes, what we called the diagonal approach, were central to this progress. Although a causal link to the reduction of child mortality was not possible to establish, we saw evidence of temporal association and biological plausibility to the high level of coverage of public health interventions, as well as significant association to the investments in women education, social protection, water, and sanitation. Leadership and continuity of public health policies, along with investments on institutions and human resources strengthening, were also among the reasons for these achievements.
authors.affiliation: Coordinación General de los Institutos Nacionales de Salud, Calle Periférico Sur 4118, 1er. Piso Edif. Zafiro 1, Col. Jardines del Pedregal, Mexico, DF CP 1900, Mexico. jsepulveda@insp.mx
authors.forename: Jaime
authors.initials: J
authors.lastname: Sepúlveda
authors.forename: Flavia
authors.initials: F
authors.lastname: Bustreo
authors.forename: Roberto
authors.initials: R
authors.lastname: Tapia
authors.forename: Juan
authors.initials: J
authors.lastname: Rivera
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.forename: Gustavo
authors.initials: G
authors.lastname: Oláiz
authors.forename: Virgilio
authors.initials: V
authors.lastname: Partida
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-García
authors.forename: José Luis
authors.initials: JL
authors.lastname: Valdespino
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D005440:Fluid Therapy / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008457:Measles / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009752:Nutritional Status; D011203:Poverty; D015995:Prevalence; D011634:Public Health / Q000639:trends*; D019282:Wasting Syndrome / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy