Mortality in a rural population in Mexico and its relation to the use of medical services before death

A survey was conducted to determine the relationship between causes of death and medical or nonmedical services utilized immediately before death in the rural community of Emiliano Zapata Tlaxcala Mexico. The community had a health center staffed by a doctor and nurse from outside the community and a local norse auxiliary as well as 4 midwives and a store selling patent remedies. Other professional medical services were available in Apizaco Tlaxcala 45 km distant. E. Zapata is an agricultural community located in the eastern sierra of Tlaxcala at an altitude of over 3000 meters. It has twice daily public transport services to Apizaco. 44.7% of consultations at the health center in 1980-81 were for infections and parasitic conditions compared to 38.4% in the rest of the state. The interviews were conducted with housewives in March 1980 and covered the entire period from 1975-79. The data were grouped by year according to the type of attention sought in the 3 months and 24 hours preceding death and the information was related to 3 main variables: educational level occupation of head of household and probable cause of death. 310 families with 1595 members were included in study of which 88 had had deaths during the study period. 75 families had 1 death and 13 had 2. 83.3% of the deaths occurred at home 13.0% in the health center and the rest at other medical facilities. In the 3 months and 24 hours preceding death respectively 30 and 27 persons sought help at the medical center 17 and 29 from a private physician 7 and 44 from an empiric practitioner and 47 and 1 did not seek help. Medical help was sought within 3 months of death for 24 of the 66 persons under 15 and 23 of the 35 persons over 15. All 10 aged 15-44 sought medical help but only 21 of the 57 aged under 1 year received help. Only 12 of those under 1 year old had help within 24 hours of death. 12 of the 169 births attended by physicians were followed by death in the 1st year compared to 45 of the 346 attended by midwives. The mortality rates for those whose births were attended by physicians and not attended by physicians respectively were 29.6 and 57.8 for deaths under 7 days 41.4 and 83.8 for deaths under 28 days and 71.0 and 130.1 for deaths under 1 year. Differences in medical help sought by education were not significant. In the 3 months preceding death only 34.3% of help for families of day-laborers was provided by physicians with the rest provided by healers. Among members of families belonging to ejidos 62.5% received medical attention. Almost 80% of deaths attended by physicians but only 40% attended by healers could be classified according to the International Classification of Diseases.