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Akila D, Oluwasegun A, Bose K, Omotoso O, Adefila A, Mwaikambo L. Improving the Quality of Adolescent and Youth-Friendly Health Services Through Integrated Supportive Supervision in Four Nigerian States. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200169. [PMID: 38621816 PMCID: PMC11111107 DOI: 10.9745/ghsp-d-22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/06/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND Although the unique sexual and reproductive health needs of adolescents and youth (AY) are widely recognized, the challenge remains how to integrate adolescent- and youth-friendly health services (AYFHS) effectively within a systems-based approach that is both feasible and scalable. This article provides preliminary evidence from 4 Nigerian states that sought to overcome this challenge by implementing capacity-strengthening approaches centered around a shortened quality assurance (QA) tool that has become part of the state health system's routine supportive supervision process and follow-up quality improvement (QI) activities. METHODS A shortened QA tool was administered to assess and track the performance of 130 high-volume health facilities across 5 domains to serve its AY population with quality contraceptive services. Facility-based providers (N=198) received training on adolescent and youth sexual and reproductive health, AYFHS, and long-acting reversible contraceptive methods. To corroborate checklist findings, we conducted exit interviews with 754 clients (aged 15-24 years) who accessed contraceptive services from the facilities that met the World Health Organization's minimum standards for quality AYFHS. RESULTS In the 4 states, the QA tool was applied at baseline and 2 rounds, accompanied by QI capacity strengthening after each round. At baseline, only 12% of the 130 facilities in the 4 states scored met the minimum quality standards for AYFHS. After 2 rounds, 88% of the facilities met the minimum standards. AY client volume increased over this same period. All 4 states showed great improvements; however, the achievements varied by state. The exit interview feedback supported client satisfaction with the services provided to AY. CONCLUSION Integrating QA followed by QI within Nigeria's family planning supportive supervision system is not only feasible but also impacts the quality of AYFHS and contraceptive uptake by clients aged 15-24 years.
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Affiliation(s)
- Dorcas Akila
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria.
| | - Akinola Oluwasegun
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Krishna Bose
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Olukunle Omotoso
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Adewale Adefila
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Lisa Mwaikambo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
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Llanes-Díaz N, Bojórquez-Chapela I, Odgers-Ortiz O. [Provision of sexual and reproductive health services to Central American migrants in TijuanaOferta de serviços de saúde sexual e reprodutiva para migrantes da América Central em Tijuana]. Rev Panam Salud Publica 2023; 47:e56. [PMID: 36895679 PMCID: PMC9989548 DOI: 10.26633/rpsp.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Objective To characterize the sexual and reproductive health (SRH) services on offer to the Central American migrant population residing in shelters in Tijuana, Mexico, and identify barriers and facilitators of access to these services by this population, from the provider perspective. Methods An observational, mixed, cross-sectional study was conducted. Different information collection techniques-consisting of 16 semi-structured interviews with civil-society providers of SRH services to the migrant population, as well as direct observation in 10 shelters in Tijuana-were employed and triangulated. A two-stage, open, selective coding process was carried out. Content analysis was then performed, using an interpretive approach based on five dimensions: approachability, acceptability, availability, affordability, and appropriateness. Results The provision of SRH services is composed of four elements: target population, nature of providing organization (religious or secular), services offered, and venue of care. The main barriers to access involve irregular migrant status, the low priority given to SRH services, and the discrepancy between user preferences and the services offered. Among facilitating elements, lay/secular orientation of providers and inter-institutional coordination stood out. Conclusions The provision of SRH services by civil society organizations is wide-ranging and heterogeneous. It ranges from strictly medical attention to other services that affect SRH indirectly, with a view to providing comprehensive care. This represents an opportunity in terms of aspects to facilitate access.
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Affiliation(s)
- Nathaly Llanes-Díaz
- El Colegio de MéxicoCiudad de MéxicoMéxicoEl Colegio de México, Ciudad de México, México.
| | | | - Olga Odgers-Ortiz
- El Colegio de MéxicoCiudad de MéxicoMéxicoEl Colegio de México, Ciudad de México, México.
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Núñez Medina G. Bayesian spatial modelling of contraception effects on fertility in Mexican municipalities in 2020. GEOSPATIAL HEALTH 2022; 17. [PMID: 35579245 DOI: 10.4081/gh.2022.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
The prevalence and use of contraceptive methods is an essential element to explain the behaviour of fertility and population growth. The objective of this study was to analyse the spatial correlation between the use of contraceptive methods in women of childbearing age and fertility levels observed in Mexico's municipalities in 2020. Data on contraceptive use are from the National Survey of Demographic Dynamics (ENADID) 2018, while fertility rates were estimated from vital statistics and population census data. Three Bayesian spatial models including fixed effects, random effects and spatial effects were employed. The models were estimated using the integral nested Laplace approximation (INLA) package available in the R language. The results reveal the existence of important regional inequalities associated with the use and prevalence of contraceptive methods, which generate marked differences in observed levels of fertility between municipalities.
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Walker K, Prata N, Lahiff M, Quintero X, Holt K. Client, provider, and visit factors associated with quality in contraceptive counseling in Mexico: an exploratory cross-sectional analysis. Reprod Health 2021; 18:244. [PMID: 34886894 PMCID: PMC8656075 DOI: 10.1186/s12978-021-01291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Monitoring clients’ experiences with contraceptive care is vital to inform quality improvement efforts and ensure fulfillment of individuals’ human rights. The Quality of Contraceptive Counseling (QCC) Scale is a previously validated scale that comprehensively measures individuals’ experiences receiving counseling in three subscales: Information Exchange, Interpersonal Relationship, and Disrespect and Abuse. We sought to better understand the correlation of client, provider, and visit factors with client-reported quality of contraceptive counseling in the public sector in two Mexican states using the QCC Scale. Methods This cross-sectional survey study used the QCC Scale total score and subscale scores as outcome variables. Explanatory variables included clients’ age, LGBTTTIQ status, relationship status, number of children, education, and occupation; providers’ gender and type of provider; and the reason for visit. Linear and logistic regression models assessed bivariate associations. Multivariable, multilevel mixed-effects models with clinic as a random effect were fit. All models used complete cases (n = 470). Results In the multilevel mixed-effects analyses, patients aged 35+ years reported worse Information Exchange (coefficient − 0.29, p = 0.01). Clients receiving care post-partum reported worse Information Exchange (coefficient − 0.25, p = 0.02) and worse total scores (coefficient − 0.15, p = 0.04) compared to clients seeking contraceptive information or methods. Clients who had 1+ children reported better Information Exchange (coefficient 0.21, p = 0.01) than those with no children. Though Disrespect and Abuse subscale scores were overall high (indicating high quality of care), we found a significant association between age and report of such negative experiences: clients in increasing age categories had increasingly higher adjusted odds of reporting no disrespect and abuse (aORs compared to the youngest group were 2.50 for those aged 19–24 years, p = 0.04; 4.53 for those 25–34 years, p = 0.01; and 6.11 for those 35+ years, p = 0.01.) Conclusions Our findings align with previous results that younger clients have lower adjusted odds of reporting high-quality services in Mexico. There is a need for continued work supporting youth-friendly services in Mexico, and efforts should aim to ensure zero tolerance for disrespectful or coercive provider behaviors, such as pressuring or scolding clients. Improvements are also needed to ensure quality in counseling for post-partum clients, those aged 35+ years, and those without children. Monitoring clients’ experiences with contraceptive care is vital to help improve service delivery and make sure individuals’ human rights are fulfilled. The Quality of Contraceptive Counseling (QCC) Scale is a survey which measures individuals’ experiences receiving counseling about contraceptives. It is grounded in principles of person-centeredness and human rights and asks directly about negative experiences. This paper describes an analysis of data collected using the QCC Scale, exploring statistical associations between the QCC Scale scores and the client, provider, and visit characteristics. The study also analyses scores from the three QCC subscales (Information Exchange, Interpersonal Relationship, and Disrespect and Abuse). The results of the analyses revealed that, though it was not commonly reported, younger clients had higher odds of reporting Disrespect and Abuse. Clients aged 35+ years reported worse Information Exchange, clients receiving care post-partum reported both worse Information Exchange and worse total scores, and clients who had 1+ children reported better Information Exchange. These findings align with previous results that younger clients have lower odds of reporting high-quality services in Mexico. There is a need for continued work supporting youth-friendly services in Mexico, and efforts should aim to reduce disrespectful or coercive provider behaviors, such as pressuring or scolding clients. Improvements are also needed to ensure quality in counseling for post-partum clients, those aged 35+ years, and those without children.
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Affiliation(s)
- Kay Walker
- School of Public Health, University of California, Berkeley, CA, USA. .,School of Medicine, University of California, San Francisco, CA, USA.
| | - Ndola Prata
- School of Public Health, University of California, Berkeley, CA, USA.,Bixby Center for Population, Health and Sustainability, University of California, Berkeley, CA, USA
| | - Maureen Lahiff
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Kelsey Holt
- School of Medicine, University of California, San Francisco, CA, USA
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Darney BG, Fuentes-Rivera E, Corbin A, Saavedra-Avendano B, Schiavon R. Trends in subdermal contraceptive implant use in Mexico 2009-2018: A population-based study. Int J Gynaecol Obstet 2021; 156:284-291. [PMID: 33999446 DOI: 10.1002/ijgo.13744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe subdermal implant use in Mexico over time, by state and by age. METHODS We conducted a repeated cross-sectional study using the 2009, 2014, and 2018 waves of the National Survey of Demographic Dynamics (Encuesta Nacional de la Dinámica Demográfica [ENADID]). Our outcome was current use of contraception, by type, with a focus on the implant. We used visualizations, descriptive and bivariate statistics, and multinomial models to assess change over time, geographic patterns, method mix, and factors associated with implant use (vs intrauterine device [IUD] or other hormonal methods). RESULTS Implant use is increasing over time in Mexico, from 1.1% of women who have ever used a method in 2009 to 4.5% in 2018 (P < 0.001); the change is greatest among adolescents (2.5% in 2009 to 12.2% in 2018; P < 0.001). Change in implant use as a fraction of modern method use was heterogeneous across Mexican states. The adjusted relative likelihood of using an implant compared with IUD was 34% higher for adolescents compared with women aged 20-29 years (relative risk ratio 1.34, 95% confidence interval 1.16-1.55, P < 0.001), controlling for other variables in the model. CONCLUSION Use of subdermal implants is increasing over time in Mexico and is concentrated among adolescents. Implants have the potential to expand access to highly effective contraception in Mexico.
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Affiliation(s)
- Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health and Science University (OHSU), Portland, OR, USA.,OHSU-Portland State University School of Public Health, Portland, OR, USA.,Centro de Investigacion en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Evelyn Fuentes-Rivera
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Andrea Corbin
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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Serván-Mori E, Heredia-Pi I, García DC, Nigenda G, Sosa-Rubí SG, Seiglie JA, Lozano R. Assessing the continuum of care for maternal health in Mexico, 1994-2018. Bull World Health Organ 2021; 99:190-200. [PMID: 33716341 PMCID: PMC7941105 DOI: 10.2471/blt.20.252544] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the temporal and geographical patterns of the continuum of maternal health care in Mexico, as well as the sociodemographic characteristics that affect the likelihood of receiving this care. METHODS We conducted a pooled cross-sectional analysis using the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics, collating sociodemographic and obstetric characteristics of 93 745 women aged 12-54 years at last delivery. We defined eight variables along the antenatal-postnatal continuum, both independently and conditionally. We used a pooled fixed-effects multivariable logistic model to determine the likelihood of receiving the continuum of care for various properties. We also mapped the quintiles of adjusted state-level absolute change in continuum of care coverage during 1994-2018. FINDINGS We observed large absolute increases in the proportion of women receiving timely antenatal and postnatal care (from 48.9% to 88.2% and from 39.1% to 68.7%, respectively). In our conditional analysis, we found that the proportion of women receiving adequate antenatal care doubled over this period. We showed that having social security and a higher level of education is positively associated with receiving the continuum of care. We observed the largest relative increases in continuum of care coverage in Chiapas (181.5%) and Durango (160.6%), assigned human development index categories of low and medium, respectively. CONCLUSION Despite significant progress in coverage of the continuum of maternal health care, disparities remain. While ensuring progress towards achievement of the health-related sustainable development goal, government intervention must also target underserved populations.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Ileana Heredia-Pi
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Diego Cerecero García
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Sandra G Sosa-Rubí
- Center for Health System Research, National Institute of Public Health, Avenida Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, United States of America (USA)
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Avila-Burgos L, Montañez-Hernández JC, Cahuana-Hurtado L, Villalobos A, Hernández-Peña P, Heredia-Pi I. Government Expenditure on Maternal Health and Family Planning Services for Adolescents in Mexico, 2003-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093097. [PMID: 32365602 PMCID: PMC7246577 DOI: 10.3390/ijerph17093097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to assess whether government policies to expand the coverage of maternal health and family planning (MHFP) services were benefiting the adolescents in need. To this end, we estimated government MHFP expenditure for 10- to 19-year-old adolescents without social security (SS) coverage between 2003 and 2015. We evaluated its evolution and distribution nationally and sub-nationally by level of marginalization, as well as its relationship with demand indicators. Using Jointpoint regressions, we estimated the average annual percent change (AAPC) nationally and among states. Expenditure for adolescents without SS coverage registered 15% for AAPC for the period 2003–2011 and was stable for the remaining years, with 88% of spending allocated to maternal health. Growth in MHFP expenditure reduced the ratio of spending by 13% among groups of states with greater/lesser marginalization; nonetheless, the poorest states continued to show the lowest levels of expenditure. Although adolescents without SS coverage benefited from greater MHFP expenditure as a consequence of health policies directed at achieving universal health coverage, gaps persisted in its distribution among states, since those with similar demand indicators exhibited different levels of expenditure. Further actions are required to improve resource allocation to disadvantaged states and to reinforce the use of FP services by adolescents.
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Affiliation(s)
- Leticia Avila-Burgos
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico; (L.A.-B.); (I.H.-P.)
| | - Julio César Montañez-Hernández
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico; (L.A.-B.); (I.H.-P.)
- Correspondence:
| | - Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15102, Peru;
| | - Aremis Villalobos
- Center for Population Health Research, The National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico;
| | - Patricia Hernández-Peña
- Netherlands Interdisciplinary Demographic Institute-KNAW, University of Groningen, 2511 CV The Hague, The Netherlands;
| | - Ileana Heredia-Pi
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca 62100, Morelos, Mexico; (L.A.-B.); (I.H.-P.)
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Abarbanell L. Mexico's Prospera Program and Indigenous Women's Reproductive Rights. QUALITATIVE HEALTH RESEARCH 2020; 30:745-759. [PMID: 31642384 DOI: 10.1177/1049732319882674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this study, I examine Indigenous women's autonomy and reproductive rights within Mexico's Prospera program. Prospera gave women living in poverty bimonthly cash stipends for complying with requirements argued to improve the health and welfare of their families, including attending regular appointments at the clinic. Although hailed as successful, Mexico's new administration recently eliminated the health care component, citing various abuses. Some policy experts argue that these claims are unfounded and have questioned how Mexico will now address the health care needs of marginalized populations. Drawing on more than 2 years of fieldwork (2012-2014) in a Mayan community in Chiapas, I present evidence of abusive practices related to reproductive health care based on direct observations and audio-recordings of clinical interactions and program operations in IMSS-Prospera. Furthermore, I show how the reproductive habitus that supported these actions was shaped by long-standing institutional habits and sociocultural factors that need to be directly addressed in present reforms.
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Affiliation(s)
- Linda Abarbanell
- San Diego State University, Imperial Valley, Calexico, California, USA
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Murillo-Zamora E, Mendoza-Cano O, Guzmán-Esquivel J, Trujillo-Hernández B, Higareda-Almaraz MA, Ahumada-López LA, Higareda-Almaraz E, García-López NA. Trends in Teen Births in Mexico Spanning 25 Years: A Need for Regionally-directed Preventive Strategies. Arch Med Res 2019; 50:142-150. [PMID: 31495391 DOI: 10.1016/j.arcmed.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/19/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016. METHODS A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models. RESULTS The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94). CONCLUSIONS Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.
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Affiliation(s)
- Efrén Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico
| | - Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Coquimatlán, Colima, Mexico.
| | - José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico; Facultad de Medicina, Universidad de Colima, Colima, Colima, Mexico
| | | | | | - Luz Angélica Ahumada-López
- Dirección, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico
| | | | - Nallely A García-López
- Departamento Clínico, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, Colima, Mexico
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