Tuberculosis (TB) and Human Rights in Chiapas, Mexico

Abstract

following topics: human rights, the right to health, principles of health rights, patient rights, TB in several vulnerable populations (children, elderly, women, indigenous groups and migrants); and legal health reforms in Mexico and its impact in DOTS strategy. 2. Chiapas: A brief description of epidemiological TB situation In Mexico, in 2013 there were registered 21,381 cases of TB (in all its forms) with a incidence rate of 16.7 per 100,000 inhabitants [12], from which 92.3% were new cases; 81.7% were PTB; 21% were associated with DM and 5.6% with HIV/AIDS; 1.05% were drug-resistant (any forms) and 8.4% were pediatric [12]. Among the pediatric group, 68.2% were PTB and 31.8% extrapulmonary-TB [12]. Chiapas, Guerrero, Veracruz, Puebla, and Tabasco, are Mexican states which contribute every year about 5,400 new cases of PTB, and this constitutes 36% of the total national average [12]. Factors that contribute to the high prevalence of PTB in these states are: (a) internal and external migration; (b) problems with accessibility to health services and social security; (c) significant presence of indigenous populations; (d) more than 90% of their municipalities are considered with low human development index [13,14]; (e) inadequate implementation of the DOTS strategy [10]; (f) little or null access to early TB diagnosis [10]. The above-mentioned factors, related to life styles and living conditions also contribute to health inequities increasing the high prevalence of TB in Chiapas and worldwide. According to official data provided by the Mexican Ministry of Health, in 2012, Baja California, Guerrero and Tamaulipas, were states with the highest incidence rates of TB, all its forms, (54.8, 38.1 and 32.0, respectively, per 100,000 inhabitants), while Chiapas ranked eleventh place with an incidence rate of 24.4 per 100,000 in the same denominator [15]. On the other hand, Tlaxcala and the State of Mexico were ranked with the lowest incidence rates, 3.9 and 4.4 per 100,000, respectively [15]. Regarding to PTB, for the same year, the registered incidence rate for the whole country was 13.6 per 100,000 inhabitants, whereas Chiapas ranked eighth with 21.8 incidence rate for the same denominator [15]. For administrative purposes, Chiapas is divided into ten health districts or sanitary jurisdictions. For 2012, the three regions with highest registered incidence rates were Tapachula, Tonala and Pichucalco, having 59.3, 33.1 and 22.3 per 100,000 inhabitants, respectively, while San Cristobal and Comitan regions reported the lowest incidence rate with 11.7 and 12.7 per 100,000 people, respectively [16]. However, epidemiological studies carried out in the San Cristobal region 1 , also known as the Highlands region, have reported high morbidity and mortality rates which doubles the state and national figures [9,10,17-25]. Furthermore, the official epidemiological data is based on notified cases by the health sector systems, and this could lead to under-quantification of cases in great part due to under-diagnosis. In Chiapas, the ...

Diabetes, undernutrition, migration and indigenous communities: tuberculosis in Chiapas, Mexico

“…Finally, in our study a proportion of the TB patients (4.7%) were not followed when they defaulted treatment, and we were not able to assess other poor outcomes such as TB recurrences and relapses, which are reportedly associated with DM [13,52]. The indigenous communities in Mexico, Chiapas included, live in difficult conditions that favour TB, such as poverty and being marginalised [28,29,53]. This is consistent with the higher burden of TB among indigenous people worldwide [26].…”

“…Another plausible explanation is the possible under-reporting of TB in the municipalities with predominant indigenous presence. Several studies carried out in different regions of Chiapas, have demonstrated high levels of underdiagnosis of TB in indigenous communities [27][28][29] with only 45% of their cases being detected and reported by officials. Accordingly, another study found that being indigenous was a protective factor for MDR-TB, but their disproportionate underdiagnosis (vs. non-indigenous) is a likely source of error for this conclusion [56].…”

“…The presence of indigenous communities and migrants are relevant to TB control in Chiapas given its high indigenous presence and border location with Guatemala. Indigenous populations bear a disproportionately high burden of TB worldwide despite the underdiagnoses of TB in these communities [26][27][28][29][30]. Certain indigenous populations appear to be genetically susceptible to type-2 DM, which can further increase TB risk [31].…”

Magnetic Nanoparticle-Based Biosensing Assay Quantitatively Enhances Acid-Fast Bacilli Count in Paucibacillary Pulmonary Tuberculosis

“…Once the GMNP-AFB complex is formed, GMNPs facilitate rapid detection due to the presence of visually observable clumped red-stained bacilli which are surrounded by brown nanoparticles. This technique could be easily integrated into conventional TB control programs in any resource-limited setting and where SSM has low sensitivity performance [15,16,17,18,19,20,21,22,23]. The assay relies on the physical (magnetic) and chemical (glycan) properties of the nanoparticles to concentrate mycobacteria cells from clinical samples.…”

Health reform in Mexico: governance and potential outcomes

“…The number of poor people in Mexico has increased from 53.3 to 55.3 millons in only three years [1], and some preventable health problems as maternal mortality [32] and Tuberculosis [33], are far from being solved (Table 1). Social health institutions such as IMSS, Ministry of Health (SSA), ISSSTE and PEMEX, face a dramatic finantial crisis.…”