Impact of health care services, sanitation and education on mortality rates of children under five years of age.

Objective. To analyze differences of the impact of health care services, sa nitation and literacy on the mortality rates of children under five years o f age, in Mo Mexican states with marked socioeconomic differences: Chiapas and Nuevo Leon. Material and methods. The study design was ecologic; based on a retrospective analysis of data published by the Health Ministry (Secre tarla de Salud), National Institute of Statistics, Geography and informatic s (Instituto Nacional de Estadistica, Geografia e Informatica) and the Nati onal Population Council (Consejo Nacional de Poblacion), on the tendencies of mortality among children under five years and on the changes of selected indicators corresponding to the period 1990-1997. Study design: ecologic s tudy. This was based on a retrospective analysts of data published by Secre taria de Salud, Institute Nacional de Estadistica e Informatica and Consejo Nacional de Poblacion, about the tendencies of mortality among children un der five years, and about the changes of selected indicators. The analysis was carried out in the period comprised between 1990-1997. For both states the registered variations were calculated and the trends were determined th rough analysis of simple linear regression; the independent variable corres ponded to the study years. Partial correlation analysis between the various mortality vends studies and between and the selected indicators,were calcu lated. Results. During the studied period there was a steady decline of chi ldren mortality, which was more marked in Chiapas. In both entities, this d ecrease was closely related to the decline in mortality due to acute diarrh ea, and also correlated with a descent in measles and acute respiratory inf ections. in Chiapas,the indicators which correlated more significantly with this decline in mortality were vaccination coverage and literacy. in Nuevo Leon, the indicators with greater correlation were the increase in the num ber of nurses, of lodgings with piped water and vaccination coverage. Concl usions. During the analyzed period, the mortality rate of children under fi ve years of age decreased in the states of Chiapas and Nuevo Leon. To susta in or accelerate the decline in childhood mortality it is mandatory to cont inue with the currently implemented programs, and in Chiapas, and similar s tates, to increase the available infrastructure to provide health care.