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o disminuci&#243;n o terminaci&#243;n del contenido de ox&#237;geno en el ambiente&#44; entre otras&#46; Est&#225;n agrupadas en los c&#243;digos W65-W84 de la Clasificaci&#243;n Internacional de Enfermedades 10&#46;&#170; edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mientras que los ahogamientos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">4</span></a> han sido clasificados en un grupo espec&#237;fico&#44; &#171;ahogamiento y sumersi&#243;n accidentales&#187; &#40;W65-W74&#41;&#44; las dem&#225;s condiciones son clasificadas de forma gen&#233;rica como &#171;otros accidentes que obstruyen la respiraci&#243;n&#187; &#40;W75-W84&#41;&#46; Esto ha hecho que estas &#250;ltimas pasen desapercibidas en las estad&#237;sticas de salud&#46; Estudios de la Carga Global de Enfermedad agrupan estas condiciones en la categor&#237;a &#171;lesiones no intencionales no clasificadas en otro lugar&#187;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">5</span></a>&#44; 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Las clasificaciones actuales han propiciado que un n&#250;mero importante de asfixias pasen desapercibidas por las autoridades de salud nacionales e internacionales&#44; y por tanto&#44; pocos pa&#237;ses han avanzado en una pol&#237;tica de salud basada en la evidencia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En 1991&#44; un estudio pionero document&#243; que las asfixias constitu&#237;an la segunda causa de lesiones no intencionales<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">10</span></a>&#46; La Secretar&#237;a de Salud reconoci&#243;&#44; 25 a&#241;os despu&#233;s&#44; que las asfixias segu&#237;an siendo la segunda causa en el pa&#237;s&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">2</span></a> Por ello&#44; en 2015&#44; el Secretariado T&#233;cnico del Consejo Nacional para la Prevenci&#243;n de Accidentes &#40;STCONAPRA&#41; impuls&#243; acciones espec&#237;ficas para prevenir asfixias como parte del <span class="elsevierStyleItalic">Programa de acci&#243;n espec&#237;fico&#58; prevenci&#243;n de accidentes en grupos vulnerables 2013-2018</span><a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Poco se sabe sobre la epidemiolog&#237;a de este problema de salud p&#250;blica en t&#233;rminos de la carga que genera para la salud p&#250;blica y las principales causas de asfixia en el pa&#237;s&#44; d&#243;nde y a qu&#233; hora ocurren&#44; cu&#225;les son los factores de riesgo y el grado de exposici&#243;n de la poblaci&#243;n mexicana a ellos&#46; As&#237;&#44; el objetivo del presente trabajo es caracterizar la epidemiolog&#237;a actual de las asfixias no intencionales en M&#233;xico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todo</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se analizaron los ahogamientos y otras asfixias empleando distintas fuentes secundarias de informaci&#243;n a escala nacional&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Bases de datos de mortalidad para el periodo 1999-2017<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a>&#44; consideradas por la Organizaci&#243;n Mundial de la Salud de las mejores en el mundo<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">13</span></a>&#44; que contienen informaci&#243;n sobre edad&#44; sexo&#44; lugar de ocurrencia&#44; causa b&#225;sica&#44; fecha y hora en que ocurri&#243; la defunci&#243;n&#46; Con estas &#250;ltimas se realiz&#243; un an&#225;lisis temporal sin incluir las defunciones ocurridas en a&#241;os distintos al del registro&#59; el an&#225;lisis del horario de ocurrencia incluy&#243; solo las personas que no recibieron atenci&#243;n m&#233;dica con el fin de evitar una inadecuada interpretaci&#243;n de los datos&#46; Por sus implicaciones en pol&#237;tica p&#250;blica&#44; se incluy&#243; el an&#225;lisis de ahogamientos en poblaci&#243;n menor de 5 a&#241;os y de otras asfixias en poblaci&#243;n menor de 1 a&#241;o&#46; Para facilitar comparaciones en el tiempo&#44; las tasas totales y por sexo se estandarizaron con el m&#233;todo directo tomando como referencia la distribuci&#243;n poblacional de 2017&#46; 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Previa autorizaci&#243;n&#44; se emple&#243; una lista de chequeo con 155 reactivos para identificar riesgos de lesiones no intencionales&#46; Personal previamente capacitado&#44; luego de registrar la informaci&#243;n&#44; brind&#243; consejer&#237;a espec&#237;fica a las personas responsables del hogar o de la guarder&#237;a con el fin de eliminar o mitigar los riesgos identificados&#46; Algunos resultados agregados ya han sido presentados previamente<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Estimaciones oficiales de la poblaci&#243;n mexicana del Consejo Nacional de Poblaci&#243;n&#44; para calcular las tasas de mortalidad<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">20</span></a>&#46;</p></li></ul></p><p id="par0235" class="elsevierStylePara elsevierViewall">En el Ap&#233;ndice <span class="elsevierStyleItalic">online</span>&#44; se encuentra informaci&#243;n adicional&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El an&#225;lisis se realiz&#243; con el programa estad&#237;stico STATA-14&#46;2&#174;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Asfixias fatales</span><p id="par0065" class="elsevierStylePara elsevierViewall">De 1999 a 2017 fallecieron 100&#46;834 personas por alg&#250;n tipo de asfixia&#44; con un promedio de 5307 defunciones por a&#241;o&#46; Los ahogamientos constituyeron el 44&#44;66&#37; del total de las asfixias y afectan principalmente a varones &#40;77&#44;18&#37; del total de las defunciones&#41;&#46; Por grupo de edad&#44; la poblaci&#243;n infantil represent&#243; el 30&#44;80&#37; del total de defunciones&#44; aunque la mayor parte de ellas se concentr&#243; en el grupo de menores de 1 a&#241;o &#40;17&#44;77&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Los ahogamientos &#40;45&#46;034&#41; se concentraron en hombres &#40;84&#44;53&#37;&#41;&#44; adolescentes &#40;20&#44;45&#37;&#41; y poblaci&#243;n infantil &#40;18&#44;69&#37;&#41;&#46; Las otras asfixias &#40;55&#46;800&#41; tambi&#233;n afectaron m&#225;s a los hombres &#40;71&#44;24&#37;&#41;&#44; pero se concentraron en poblaci&#243;n infantil &#40;40&#44;57&#37;&#41;&#44; principalmente en los menores de 1 a&#241;o &#40;31&#44;30&#37;&#41;&#44; y adulta mayor &#40;15&#44;09&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La tendencia de los ahogamientos mostr&#243; una reducci&#243;n importante durante el periodo de estudio en ambos sexos y en todos los grupos de edad&#59; la tasa m&#225;s alta se observ&#243; en hombres de 80 y m&#225;s a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las otras asfixias mostraron dos tendencias distintas&#58; decreciente de 1999 a 2008 y creciente de 2008 a 2016&#46; Esto se ve influido por la tendencia en los menores de 1 a&#241;o&#44; pues en los dem&#225;s grupos de edad se observa una tendencia decreciente en el periodo analizado&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">El tipo de ahogamiento m&#225;s frecuente en la poblaci&#243;n general fue &#171;mientras se est&#225; en aguas naturales&#187; &#40;W69&#59; 25&#44;53&#37;&#41;&#44; seguido de &#171;otros ahogamientos y sumersiones especificados&#187;&#44; en los que se incluyen dep&#243;sitos de agua como aljibes&#44; tinacos o baldes de agua &#40;W73&#59; 14&#44;50&#37;&#41;&#44; y &#171;posterior a ca&#237;da en aguas naturales&#187; &#40;W70&#59; 6&#44;28&#37;&#41;&#46; Un n&#250;mero importante de ahogamientos son clasificados como &#171;no especificados&#187; &#40;W74&#59; 51&#44;44&#37;&#41;&#46; En los menores de 5 a&#241;os&#44; los c&#243;digos m&#225;s frecuentes fueron el W73 &#40;32&#44;74&#37;&#41; y el W74 &#40;54&#44;73&#37;&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">De las otras asfixias&#44; las principales causas en el total de la poblaci&#243;n fueron &#171;inhalaci&#243;n de contenidos g&#225;stricos&#187; &#40;W78&#59; 24&#44;64&#37;&#41;&#44; &#171;inhalaci&#243;n e ingesti&#243;n de alimento que causa obstrucci&#243;n de las v&#237;as respiratorias&#187; &#40;W79&#59; 12&#44;91&#37;&#41; y &#171;otros estrangulamientos y ahorcamientos accidentales&#187; &#40;W76&#59; 10&#44;92&#37;&#41;&#46; La obstrucci&#243;n de la respiraci&#243;n no especificada &#40;W84&#41; represent&#243; el 45&#44;09&#37; de los casos&#46; En los menores de 1 a&#241;o&#44; los c&#243;digos m&#225;s importantes fueron W84&#44; W78 y W79&#44; con el 58&#44;31&#37;&#44; el 25&#44;39&#37; y el 13&#44;24&#37;&#44; respectivamente&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La clasificaci&#243;n del lugar donde ocurrieron las asfixias mejor&#243; durante el periodo de estudio&#58; los ahogamientos con lugar no especificado disminuyeron del 27&#37; al 6&#37; de 1999 a 2017&#44; y en las otras asfixias del 55&#37; al 32&#37;&#46; Los ahogamientos en todas las edades ocurrieron con m&#225;s frecuencia en &#171;otro lugar especificado&#187; &#40;incluye arroyos&#44; canales&#44; ci&#233;negas&#44; estanques o piscinas&#44; lagos&#44; mares&#44; playas&#44; puertos y r&#237;os&#41;&#44; en la v&#237;a p&#250;blica y en la vivienda&#46; M&#225;s de la mitad de los ahogamientos fatales en menores de 5 a&#241;os ocurrieron en la vivienda&#46; Las otras asfixias ocurrieron principalmente en la vivienda&#44; en la v&#237;a p&#250;blica y en &#171;otros lugares especificados&#187;&#44; entre los que se incluyen&#44; adem&#225;s de los antes mencionados&#44; campamentos&#44; estacionamientos&#44; parques p&#250;blicos o de diversiones&#44; y zool&#243;gicos&#44; entre otros&#46; El porcentaje de casos en los que no se especific&#243; el lugar donde ocurri&#243; el deceso es ligeramente mayor en los menores de 1 a&#241;o &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Pr&#225;cticamente una tercera parte de los ahogamientos ocurrieron en abril&#44; julio y agosto&#46; En abril hubo pr&#225;cticamente tres por cada ahogamiento que se presenta en diciembre&#46; Casi una tercera parte de las otras asfixias se concentran de diciembre a febrero&#46; En enero hubo un 51&#44;91&#37; m&#225;s casos que en agosto &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a> A&#41;&#46; En menos del 3&#37; no se registr&#243; el mes en que ocurri&#243; la asfixia&#46; En domingo ocurre el mayor n&#250;mero de asfixias fatales&#44; en particular de los ahogamientos&#44; de los que hay pr&#225;cticamente dos veces m&#225;s casos ese d&#237;a que de martes a jueves&#46; En alrededor del 3&#37; de los casos no se registr&#243; el d&#237;a de la semana &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a> B&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Los ahogamientos en menores de 5 a&#241;os no muestran una distribuci&#243;n tan clara por mes del a&#241;o ni por d&#237;a de la semana&#46; Las otras asfixias en los menores de 1 a&#241;o tambi&#233;n se concentran de diciembre a febrero&#59; en diciembre ocurren pr&#225;cticamente tres casos por cada uno que ocurre en abril &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Salvo un pico que se observa a las 0<span class="elsevierStyleHsp" style=""></span>h&#44; los ahogamientos en la poblaci&#243;n total tienden a presentarse durante el d&#237;a&#46; La frecuencia de ahogamientos aumenta a partir de las 7<span class="elsevierStyleHsp" style=""></span>h&#44; llega a su pico m&#225;ximo a las 16<span class="elsevierStyleHsp" style=""></span>h y entonces comienza a descender&#46; A las 16<span class="elsevierStyleHsp" style=""></span>h ocurren 9&#44;76 ahogamientos m&#225;s que a las 5<span class="elsevierStyleHsp" style=""></span>h&#44; cuando se observa la menor frecuencia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">C</span>&#41;&#46; En el 12&#44;80&#37; de los ahogamientos no se registr&#243; el horario&#46; En los menores de 5 a&#241;os&#44; la distribuci&#243;n de la frecuencia es similar&#58; hay 40&#44;22 defunciones m&#225;s durante el pico m&#225;ximo&#44; observado tambi&#233;n a las 16<span class="elsevierStyleHsp" style=""></span>h&#44; en comparaci&#243;n con la hora con menor frecuencia observada &#40;4<span class="elsevierStyleHsp" style=""></span>h&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La mayor frecuencia de las otras asfixias se presenta entre las 4 y las 6<span class="elsevierStyleHsp" style=""></span>h en todos los grupos de edad &#40;m&#225;s evidente en los menores de 1 a&#241;o&#41;&#46; La <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a><span class="elsevierStyleHsp" style=""></span>C muestra que la frecuencia de otras asfixias aumenta a partir de las 2<span class="elsevierStyleHsp" style=""></span>h&#44; llega a su pico m&#225;ximo a las 5<span class="elsevierStyleHsp" style=""></span>h y desciende a menos de la mitad a las 9<span class="elsevierStyleHsp" style=""></span>h&#46; A las 5<span class="elsevierStyleHsp" style=""></span>h hubo 9&#44;53 asfixias m&#225;s que a las 21<span class="elsevierStyleHsp" style=""></span>h&#44; hora con menor frecuencia de otras asfixias en los menores de 1 a&#241;o&#46; En el 11&#44;39&#37; de las otras asfixias no se registr&#243; el horario&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Asfixias no fatales</span><p id="par0115" class="elsevierStylePara elsevierViewall">Seg&#250;n la ENSA-2000&#44; 24&#46;048 personas sufrieron una asfixia no fatal durante el a&#241;o previo a la encuesta&#44; lo que se traduce en una incidencia acumulada de 25&#44;05 por cada 100&#46;000 habitantes &#40;intervalo de confianza del 95&#37; &#91;IC95&#37;&#93;&#58; 12&#44;39-50&#44;63&#41;&#46; Esta cifra ascendi&#243; a 34&#46;818 personas seg&#250;n la ENSANut-2006 &#40;incidencia de 33&#44;80 por 100&#46;000&#59; IC95&#37;&#58; 15&#44;28-74&#44;76&#41;&#46; Para el a&#241;o 2012&#44; el n&#250;mero de personas aument&#243; a 53&#46;065 &#40;incidencia de 46&#44;11&#59; IC95&#37;&#58; 26&#44;02-81&#44;71&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La distribuci&#243;n por grupo de edad y sexo se presenta en la <a class="elsevierStyleCrossRef" href="#fig0020">figura 4</a>&#46; Se observa que las asfixias ocurren con m&#225;s frecuencia en poblaci&#243;n masculina&#44; infantil y adolescente&#46; En los hombres&#44; las asfixias aumentaron entre los a&#241;os 2000 y 2012 en todas las edades&#44; excepto en los adultos mayores&#59; en las mujeres&#44; disminuyeron en poblaci&#243;n infantil&#44; pero aumentaron en las de 20 a 59 a&#241;os y no hubo casos en las adultas mayores&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Ocurrieron en el hogar el 56&#44;51&#37; &#40;IC95&#37;&#58; 21&#44;76-85&#44;86&#41;&#44; el 37&#44;38&#37; &#40;IC95&#37;&#58; 6&#44;48-83&#44;72&#41; y el 53&#44;81&#37; &#40;IC95&#37;&#58; 14&#44;34-89&#44;01&#41; de las asfixias durante los a&#241;os 2000&#44; 2006 y 2012&#44; respectivamente&#46; Durante el a&#241;o 2000&#44; 15&#46;316 &#40;63&#44;59&#37;&#41; personas que sufrieron una asfixia no fatal acudieron al m&#233;dico o a una unidad m&#233;dica de salud para su atenci&#243;n&#44; y este n&#250;mero aument&#243; a 25&#46;286 &#40;72&#44;62&#37;&#41; en 2006 y a 37&#46;970 &#40;71&#44;55&#37;&#41; en 2012&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">De las personas de 10 y m&#225;s a&#241;os de edad que sufrieron una asfixia no fatal durante el a&#241;o 2000&#44; el 6&#44;08&#37; refirieron estar bajo el influjo del alcohol y el 8&#44;97&#37; bajo el influjo de otra droga&#46; Durante el a&#241;o 2006&#44; ning&#250;n adolescente refiri&#243; estar bajo el influjo del alcohol o de otra droga&#46; El porcentaje de autorreporte de alcohol en el momento de la asfixia ascendi&#243; al 3&#44;31&#37; en 2012&#44; sin que se reportaran casos que manifestaran el uso de otra droga&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El porcentaje de personas que tuvieron una asfixia no fatal y manifestaron haber presentado una consecuencia permanente en su estado de salud fue del 7&#44;94&#37; en 2000&#44; del 0&#37; en 2006 y del 26&#44;21&#37; en 2012&#46; Finalmente&#44; seg&#250;n la ENSA-2000&#44; quienes sufrieron una asfixia no fatal perdieron en promedio 15&#44;02 d&#237;as &#40;IC95&#37;&#58; 10&#44;78-19&#44;26&#41; por su lesi&#243;n&#44; lo que se traduce en 12&#46;217&#46;033 d&#237;as perdidos en M&#233;xico&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Exposici&#243;n a riesgos ambientales</span><p id="par0140" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se presentan los niveles de exposici&#243;n a riesgos ambientales explorados en los hogares y las guarder&#237;as&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">Las asfixias son un problema prioritario de salud p&#250;blica en M&#233;xico&#58; ocasionan importantes da&#241;os a la salud de la poblaci&#243;n&#59; son causa importante de discapacidad potencialmente prevenible&#59; tienen un importante costo econ&#243;mico y social&#59; afectan de forma diferenciada a la poblaci&#243;n&#44; destacando la vulnerabilidad de la poblaci&#243;n infantil&#44; adolescente y adulta mayor frente a estos eventos&#59; existe la preocupaci&#243;n institucional de dar frente a estos eventos&#59; y es una prioridad internacional establecida en el Objetivo de Desarrollo Sostenible &#40;ODS&#41; 3&#46;2&#44; que busca poner fin a las muertes evitables de los menores de 5 a&#241;os&#46; Todos ellos son elementos considerados para priorizar problemas de salud<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Si M&#233;xico pretende cumplir el ODS-3&#46;2<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a>&#44; debe priorizar el trabajo en prevenci&#243;n de asfixias en los menores de 5 a&#241;os&#44; pues es una de las principales causas de muerte&#46; Aunque se ha avanzado&#44; el fortalecimiento de la respuesta social frente a este enemigo oculto de la salud p&#250;blica debe consolidarse en el futuro&#46; Para ello es importante asignar los recursos necesarios&#44; pues lo que invierte la Secretar&#237;a de Salud est&#225; por debajo de la magnitud del problema<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a>&#46; Deber&#237;a hacerse visible este problema readecuando la lista mexicana de las principales causas para dar seguimiento a todas las causas de asfixia como una entidad espec&#237;fica&#44; lo que se justifica por la carga que imponen en la salud p&#250;blica&#46; El pa&#237;s debe avanzar en el fortalecimiento de la calidad de la informaci&#243;n disponible para caracterizar mejor los mecanismos que causan las asfixias&#46; Esto permitir&#225; elaborar estrategias espec&#237;ficas dirigidas a personas cuidadoras de poblaci&#243;n infantil y adulta mayor&#46; Mientras se fortalecen los sistemas de informaci&#243;n sobre mortalidad&#44; podr&#237;an implementarse sistemas de vigilancia epidemiol&#243;gica hospitalarios&#44; &#250;tiles para identificar la distribuci&#243;n epidemiol&#243;gica de las lesiones y entender mejor sus factores de riesgo<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La presencia de alcohol y de otras drogas documentada en este trabajo est&#225; en consonancia con la evidencia del Sistema de Vigilancia Epidemiol&#243;gica de las Adicciones<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a>&#44; que muestra que con frecuencia est&#225;n presentes en las defunciones y en las personas lesionadas que acuden a los servicios de urgencias para su atenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a>&#46; Es importante que futuros estudios eval&#250;en el papel del consumo de alcohol y de otras drogas en la ocurrencia de este tipo de lesiones&#44; apoyando con ello los esfuerzos en torno al ODS-3&#46;5 para prevenir el consumo nocivo de alcohol<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Pocos estudios han analizado la dimensi&#243;n temporal en la ocurrencia de las asfixias fatales&#46; Estos resultados permiten observar que los ahogamientos ocurren en periodos vacacionales&#44; cuando hay mayor exposici&#243;n a cuerpos de agua naturales&#44; y en domingo&#44; cuando se incrementa la afluencia a sitios recreativos como playas&#44; albercas&#44; r&#237;os&#44; etc&#46; Dado que los ahogamientos en los menores de 5 a&#241;os ocurren m&#225;s en el hogar&#44; la distribuci&#243;n por mes y d&#237;a de la semana es m&#225;s homog&#233;nea<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Las otras asfixias en los menores de 1 a&#241;o se concentraron en los meses fr&#237;os&#44; a diferencia de lo observado en un estudio previo<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">27</span></a>&#46; Un mecanismo que podr&#237;a estar implicado es el exceso de cobijamiento&#44; pues las asfixias ocurren mayormente de noche&#46; El pico que se observa a las 6<span class="elsevierStyleHsp" style=""></span>h podr&#237;a estar relacionado con la alimentaci&#243;n&#44; o con la hora en que despiertan sus cuidadores y se percatan de la asfixia&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La poblaci&#243;n infantil no cuenta con los conocimientos&#44; las habilidades ni la concentraci&#243;n necesarios para enfrentar un ambiente inseguro construido por y para personas adultas&#46; Se desarrollan en entornos donde dependen en gran medida de sus cuidadores&#44; pues tienen poco o nada de control sobre ellos<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">28</span></a>&#46; Esto fue evidente a partir del an&#225;lisis de riesgos en el interior de los hogares y de las guarder&#237;as&#44; y corrobora la evidencia previa<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">25</span></a>&#46; Dado que a esas edades los ni&#241;os y las ni&#241;as pasan mucho tiempo en esos espacios&#44; debe impulsarse m&#225;s trabajo de concienciaci&#243;n individual y comunitaria sobre cu&#225;les son los riesgos y las pr&#225;cticas preventivas en torno a este problema&#46; Que los lactantes duerman con los padres o en posici&#243;n diferente a boca arriba incrementa el riesgo de otras asfixias en los menores de 1 a&#241;o&#59; promover la lactancia materna y el colecho<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">29</span></a> no debe ser a costa de incrementar su riesgo de asfixias no intencionales<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">30</span></a>&#46; La alimentaci&#243;n inadecuada o sin supervisi&#243;n podr&#237;a ser otro riesgo a&#250;n no cuantificado&#44; al ser la inhalaci&#243;n de contenido g&#225;strico o de alimentos la principal causa de asfixias en los menores de 1 a&#241;o&#46; Estos riesgos pueden ser eliminados con facilidad y a un costo relativamente bajo&#44; pero para ello es importante promover una cultura de la seguridad que sea sensible a las caracter&#237;sticas y las necesidades de estas poblaciones vulnerables&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Es importante mencionar que los datos aqu&#237; presentados podr&#237;an subestimar la magnitud del problema&#44; pues las defunciones de &#171;intenci&#243;n no determinada&#187; o por &#171;otros accidentes&#187; podr&#237;an ser tambi&#233;n asfixias no intencionales&#46; El efecto que estos &#171;c&#243;digos basura&#187; tienen en cuanto a la subestimaci&#243;n de la magnitud real de otro tipo de lesiones ha sido documentado en M&#233;xico<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">31</span></a>&#44; por lo que tambi&#233;n en el tema de las asfixias deber&#237;a evaluarse<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">32</span></a>&#46; Otra v&#237;a de subestimaci&#243;n son las defunciones clasificadas como &#171;s&#237;ndrome de muerte s&#250;bita infantil&#187;&#44; muchas de las cuales podr&#237;an ser asfixias<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">27</span></a>&#59; en M&#233;xico&#44; durante 2017 hubo 549 defunciones en menores de 1 a&#241;o por esta causa&#46; Sin embargo&#44; las defunciones podr&#237;an ser menos por las lesiones intencionales clasificadas en c&#243;digos no intencionales para evitar el seguimiento judicial&#44; en particular cuando el agresor es un familiar directo del lesionado<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a>&#46; No haber analizado la informaci&#243;n de quienes fallecieron despu&#233;s de recibir atenci&#243;n m&#233;dica &#40;44&#44;2&#37; del total&#41; podr&#237;a sesgar nuestros resultados&#46; Tambi&#233;n los hallazgos de las encuestas nacionales podr&#237;an estar subestimados por el sesgo de memoria asociado a este tipo de aproximaciones<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">34</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Las asfixias no intencionales son un problema de salud p&#250;blica en M&#233;xico que ha pasado desapercibido en las estad&#237;sticas nacionales&#46; En virtud de que afectan de manera importante a los menores de 5 a&#241;os&#44; su prevenci&#243;n contribuir&#225; al cumplimiento del ODS-3&#46;2&#46; Fortalecer la estrategia en curso con mayores recursos financieros dirigidos a todas las entidades federativas y tomando en consideraci&#243;n las recomendaciones en la materia<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">30&#44;35</span></a> es la v&#237;a &#243;ptima para avanzar&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Editora responsable del art&#237;culo</span><p id="par0190" class="elsevierStylePara elsevierViewall">Laura I&#46; Gonz&#225;lez Zapata&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Declaraci&#243;n de transparencia</span><p id="par0195" class="elsevierStylePara elsevierViewall">El autor principal &#40;garante responsable del manuscrito&#41; afirma que este manuscrito es un reporte honesto&#44; preciso y transparente del estudio que se remite a <span class="elsevierStyleSmallCaps">Gaceta Sanitaria&#44;</span> que no se han omitido aspectos importantes del estudio&#44; y que las discrepancias del estudio seg&#250;n lo previsto &#40;y&#44; si son relevantes&#44; registradas&#41; se han explicado&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Contribuciones de autor&#237;a</span><p id="par0200" class="elsevierStylePara elsevierViewall">R&#46; P&#233;rez-N&#250;&#241;ez y J&#46;D&#46; Vera-L&#243;pez concibieron el estudio y compilaron la informaci&#243;n&#46; R&#46; P&#233;rez-N&#250;&#241;ez realiz&#243; el an&#225;lisis preliminar y redact&#243; la primera versi&#243;n del documento&#46; Ambos autores analizaron e interpretaron los datos&#44; revisaron cr&#237;ticamente las versiones previas del documento y aprobaron su versi&#243;n final&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Agradecimientos</span><p id="par0205" class="elsevierStylePara elsevierViewall">Agradecemos a todas las personas que recabaron informaci&#243;n sobre la seguridad de las viviendas y las guarder&#237;as&#44; as&#237; como a los responsables estatales de prevenci&#243;n de accidentes que coordinaron dichos esfuerzos locales&#46; A las instituciones participantes&#44; se les agradecen las facilidades brindadas para este trabajo&#46; Agradecemos muy especialmente a las personas que de manera desinteresada permitieron verificar los riesgos en el interior de sus domicilios&#44; sin cuyo apoyo no podr&#237;amos aprender desde la salud p&#250;blica para mejorar las estrategias de prevenci&#243;n de lesiones no intencionales&#46; Finalmente&#44; agradecemos a la Mtra&#46; Elisa Hidalgo-Sol&#243;rzano su asesor&#237;a t&#233;cnica&#44; y a los revisores an&#243;nimos que proporcionaron comentarios y sugerencias &#250;tiles para enriquecer la versi&#243;n final de este documento&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0210" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflictos de intereses</span><p id="par0215" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracterizar la epidemiolog&#237;a de las asfixias accidentales en M&#233;xico en el periodo 1999-2017&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis secundario de bases de mortalidad&#44; tres encuestas nacionales de salud e informaci&#243;n del programa de inspecciones de seguridad de la Secretar&#237;a de Salud&#44; para caracterizar las lesiones fatales y no fatales asociadas a ahogamientos &#40;CIE-10&#58; W65-W74&#41; y otras asfixias &#40;CIE-10&#58; W75-W84&#41;&#44; y determinar el grado de exposici&#243;n a distintos riesgos en el interior de viviendas y guarder&#237;as&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se registraron 100&#46;834 defunciones&#44; el 44&#44;66&#37; por ahogamientos&#44; y el 77&#44;18&#37; eran de varones&#46; Los ahogamientos afectan a poblaci&#243;n infantil y adolescente&#44; ocurren con m&#225;s frecuencia en abril&#44; julio y agosto&#44; los domingos&#44; y en horario vespertino&#59; las otras asfixias afectan a poblaci&#243;n infantil y adulta mayor&#44; ocurren con m&#225;s frecuencia de diciembre a febrero&#44; en domingo&#44; de las 4 a las 6<span class="elsevierStyleHsp" style=""></span>h&#46; Seg&#250;n la ENSANut-2012&#44; 53&#46;065 personas sufren una asfixia no fatal al a&#241;o&#44; el 26&#44;21&#37; con consecuencias permanentes en su salud&#46; Se observaron riesgos importantes de asfixia en el 38&#37; de las guarder&#237;as y el 80&#37; de los hogares analizados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las asfixias accidentales son un problema prioritario de salud p&#250;blica que debe ser atendido urgentemente para cumplir con el objetivo de desarrollo sostenible 3&#46;2&#46; La evidencia presentada en este trabajo es un insumo que permite informar y orientar los esfuerzos al respecto&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Secondary analysis of vital registries&#44; three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings &#40;ICD-10&#58; W65-W74&#41; and other asphyxias including suffocation&#44; chocking and strangulation &#40;ICD-10&#58; W75-W84&#41;&#44; and to estimate the level of exposure to different risk factors within households and daycares&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">100&#44;834 deaths were registered&#44; 44&#46;66&#37; were drowning and 77&#46;17&#37; male&#46; Drownings mainly affect children and adolescents&#44; occur in April&#44; July and August&#44; on Sundays&#44; during the afternoon&#46; Other asphyxias affect children and the elderly more frequently&#44; occur mainly from December to February&#44; on Sundays and from 4 to 6<span class="elsevierStyleHsp" style=""></span>h&#46; According to ENSANut-2012&#44; 53&#44;065 individuals experience a non-fatal asphyxia per year&#44; 26&#46;21&#37; of them with permanent consequences in their health and wellbeing&#46; Important risks of unintentional asphyxias are present in 38&#37; of daycares and 80&#37; of households analyzed&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals&#44; in particular the 3&#46;2&#46; Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n porcentual del lugar de ocurrencia de los ahogamientos y otras asfixias en M&#233;xico durante el periodo 1999-2017&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Fuente&#58; INEGI&#46; Bases de datos de mortalidad para el periodo 1999 a 2016&#46;</p>"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n porcentual del an&#225;lisis temporal de los ahogamientos y otras asfixias en M&#233;xico en poblaci&#243;n infantil en el periodo 1999-2017&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de ahogamientos y otras asfixias no fatales en M&#233;xico documentados a trav&#233;s de las Encuestas Nacionales de Salud&#44; M&#233;xico 2000&#44; 2006 y 2012&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Fuente&#58; Elaboraci&#243;n propia a partir de los datos de las Encuestas Nacionales de Salud 2000&#44; 2006 y 2012 del Instituto Nacional de Salud P&#250;blica&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="20" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Ahogamientos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hombres</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;1 a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-4 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Tasas estandarizadas por sexo y grupo de edad&#44; empleando el m&#233;todo directo y tomando como referencia la distribuci&#243;n de la poblaci&#243;n de 2017&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Tasa de mortalidad por 100&#46;000 habitantes de los ahogamientos y otras asfixias en M&#233;xico&#44; seg&#250;n sexo y a&#241;o en que ocurri&#243; la defunci&#243;n&#44; 1999-2017</p>"
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          0 => array:3 [
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            "detalle" => "Tabla "
            "rol" => "short"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lugar de inspecci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de asfixia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Riesgo explorado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="12" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hogares donde residen menores de 5 a&#241;os<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2887&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ahogamientos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Los hogares almacenaban agua en tinas&#44; tambos&#44; piletas o cubetas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estos dep&#243;sitos de agua inseguros se localizaban en el mismo lugar donde jugaban las y los menores de 5 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Los hogares contaban con aljibe&#44; cisterna o pozo de agua&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lo ten&#237;an bien cerrado y contaba con bomba el&#233;ctrica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otras asfixias</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Las y los menores de 5 a&#241;os utilizan collares&#44; cadenas o les amarran el chup&#243;n al cuello&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Las y los menores de 5 a&#241;os ten&#237;an alg&#250;n juguete con cordones de &#8805;30 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Los hogares ten&#237;an cordones de cortinas o persianas a una altura &#60;1&#44;20 m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Las y los menores de 5 a&#241;os tienen chamarras o su&#233;teres con cordones o agujetas en el cuello&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Las y los menores de 5 a&#241;os juegan con juguetes con partes que pueden introducir en su boca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Las y los menores de 1 a&#241;o duermen en la cama con sus cuidadores<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Las y los menores de 1 a&#241;o duermen exclusivamente boca arriba<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hogares con al menos un riesgo de asfixias no intencionales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="8" align="left" valign="\n
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                  \t\t\t\t">Guarder&#237;as &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>184&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ahogamientos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ten&#237;an una cisterna o pozo de agua sin seguro o candado para evitar su apertura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&#44;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="7" align="left" valign="\n
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                  \t\t\t\t">Otras asfixias</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ten&#237;an una fuente o alberca sin cerca perimetral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ten&#237;an juguetes que pueden ser introducidos en la boca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">En salas con poblaci&#243;n infantil menor de 3 a&#241;os ten&#237;an juguetes con piezas sueltas o mal ensambladas que pueden producir atragantamiento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ten&#237;an juguetes con cordones de &#8805;30 cm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ten&#237;an cordones de cortinas o persianas a una altura &#60;1&#44;20 m&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hay bolsas de pl&#225;stico al alcance de la poblaci&#243;n infantil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Guarder&#237;as con al menos un riesgo de asfixias no intencionales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">62&#44;5&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estimaci&#243;n de la exposici&#243;n a distintos riesgos de asfixias no intencionales en hogares y guarder&#237;as&#44; M&#233;xico 2016-2017</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">&#191;Qu&#233; se sabe sobre el tema&#63;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Las asfixias no intencionales han sido tradicionalmente clasificadas como &#171;otros accidentes&#187; en las estad&#237;sticas nacionales e internacionales&#46; Salvo algunos estudios de casos&#44; poco se sabe sobre este problema de salud p&#250;blica en M&#233;xico&#44; en particular sobre su temporalidad y el grado de exposici&#243;n a factores de riesgo presentes en viviendas y guarder&#237;as&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">&#191;Qu&#233; a&#241;ade el estudio realizado a la literatura&#63;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Las asfixias son la segunda causa de accidentes en M&#233;xico y afectan desproporcionadamente a la poblaci&#243;n infantil&#44; que est&#225; expuesta a un importante n&#250;mero de riesgos que pasan desapercibidos para la poblaci&#243;n adulta&#46; Las caracter&#237;sticas de las asfixias en M&#233;xico&#44; incluyendo su distribuci&#243;n temporal y los factores de riesgo documentados&#44; permiten llenar brechas en el conocimiento actual&#44; as&#237; como orientar acciones concretas de prevenci&#243;n&#46;</p></span></span>"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asfixia por sofocaci&#243;n y estrangulaci&#243;n en menores de 15 a&#241;os"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Celis"
                            1 => "P&#46; Hern&#225;ndez"
                            2 => "Z&#46; G&#243;mez"
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                        "paginaFinal" => "506"
                        "link" => array:1 [
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              "identificador" => "bib0185"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Modelo para la prevenci&#243;n de asfixias en grupos vulnerables en M&#233;xico&#46; M&#233;xico&#44; Distrito Federal&#58; Secretar&#237;a de Salud&#47;STCONAPRA&#59; 2016&#46; 72 p&#46;"
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            2 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "3"
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                  "referenciaCompleta" => "Organizaci&#243;n Panamericana de la Salud&#46; Clasificaci&#243;n estad&#237;stica internacional de enfermedades y problemas relacionados con la salud&#46; D&#233;cima revisi&#243;n&#46; Washington&#44; DC&#58; OPS&#59; 1995&#46; 1177 p"
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            3 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new definition of drowning&#58; towards documentation and prevention of a global public health problem"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;F&#46; van Beeck"
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                    0 => array:2 [
                      "doi" => "/S0042-96862005001100015"
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                        "paginaFinal" => "856"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16302042"
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010&#58; a systematic analysis for the Global Burden of Disease Study 2010"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Lozano"
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                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(12)61728-0"
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                        "paginaFinal" => "2128"
                        "link" => array:1 [
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                      "titulo" => "The global burden of injury&#58; incidence mortality&#44; disability-adjusted life years and time trends from the Global Burden of Disease study 2013"
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                          "autores" => array:3 [
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                  "referenciaCompleta" => "GBD 2017 Causes of Death Collaborators&#46; Global&#44; regional&#44; and national age-sex-specific mortality for 282 causes of death in 195 countries and territories&#44; 1980-2017&#58; a systematic analysis for the Global Burden of Disease Study 2017&#46; Lancet&#46; 2018&#59;392&#58;1736-88&#46;"
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                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica y Geograf&#237;a&#46; Lista mexicana para la selecci&#243;n de las principales causas&#46; Ciudad de M&#233;xico&#58; INEGI &#40;M&#233;xico&#41;&#46; &#40;Consultado el 19&#47;3&#47;2019&#46;&#41; Disponible en&#58; <a target="_blank" href="http://www3.inegi.org.mx/rnm/index.php/catalog/57/download/3131">http&#58;&#47;&#47;www3&#46;inegi&#46;org&#46;mx&#47;rnm&#47;index&#46;php&#47;catalog&#47;57&#47;download&#47;3131</a>"
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                    0 => array:2 [
                      "titulo" => "Suicide presented as a leading cause of mortality&#58; uncover facts or misrepresent statistics&#63;"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Gjertsen"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Traumatismos y envenenamientos en Jalisco&#58; un estudio de la mortalidad a partir de autopsias"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Salud Publica Mex&#46;"
                        "fecha" => "1991"
                        "volumen" => "33"
                        "paginaInicial" => "77"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2047935"
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              "identificador" => "bib0230"
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            12 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#191;Es posible seguir mejorando los registros de las defunciones en M&#233;xico&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Lozano-Ascencio"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Med Mex&#46;"
                        "fecha" => "2008"
                        "volumen" => "144"
                        "paginaInicial" => "525"
                        "paginaFinal" => "533"
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