Sepúlveda Jaime, Bustreo Flavia, Tapia Roberto, Rivera Juan, Lozano Rafael, Olaiz Gustavo, Partida Virgilio, García-García Ma de Lourdes, Valdespino José Luis
Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
Salud Publica Mex. 2007;49 Suppl 1:S110-25.
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.
墨西哥针对儿童的公共卫生干预措施使该国跻身有望在2015年前实现降低儿童死亡率目标的七个国家之列。我们分析了人口普查数据、死亡率登记册、儿童名义登记册、全国营养调查，并探讨了时间关联和生物学合理性，以解释儿童、婴儿和新生儿死亡率的下降情况。在过去25年中，儿童死亡率从每1000例活产64例降至23例。腹泻死亡率大幅下降。脊髓灰质炎、白喉和麻疹已被消灭。儿童在消瘦、发育迟缓及体重不足方面的营养状况显著改善。一系列连接诊所和家庭的高性价比干预措施，即我们所称的对角线方法，是这一进展的核心。尽管无法确定与儿童死亡率降低之间存在因果关系，但我们看到了公共卫生干预措施高覆盖率的时间关联和生物学合理性证据，以及与妇女教育、社会保护、水和卫生设施投资之间的显著关联。公共卫生政策的领导力和连续性，以及对机构和人力资源强化的投资，也是取得这些成就的原因之一。
