Predictors of maternal knowledge on early childhood development in highly marginalized communities in Mexico: Implications for public policy.

INTRODUCTION: Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0-38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development. METHODS: We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0-38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge. RESULTS: The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs. CONCLUSION: Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.

Equivalencia translingüística y consistencia interna del Rapid Estimate Adult Literacy in Dentistry 99 (REALD-99) en población mexicana / Transliguistic Equivalence and Internal Consistency of the Rapid Estimate Adult Literacy in Dentistry 99 (REALD-99) applied to Mexican Population

Objetivo: Determinar la equivalencia lingüística al español y la consistencia interna del Rapid Estimate of Adult Literacy in Dentistry 99 (REALD-99) en población mexicana. Métodos: la equivalencia del REALD-99 se hizo mediante la metodología traducción-retraducción por expertos en la traducción de la lengua inglesa y se validó su contenido por parte de cinco odontólogos generales. El instrumento se aplicó a una muestra de 995 personas de 15 a 54 años que solicitaron atención odontológica por primera vez. La participación de los individuos fue voluntaria y el consentimiento se hizo por escrito. Se analizaron variables epidemiológicas y se determinó la consistencia interna del instrumento con la prueba del Alfa de Cronbach. Resultados: se identificaron dos palabras con traducción idéntica y tres sin aplicación en el contexto odontológico local. La edad promedio de los participantes fue de 30 años (DE ±11); el 62 % fueron mujeres. La aplicación del instrumento tuvo un promedio de 87 aciertos (DE ±9.2) con un tiempo promedio de aplicación de 2.24 minutos. El alfa de Cronbach fue de 0.91 con las 99 palabras. Conclusiones: el instrumento es intercambiable y equivalente con una consistencia interna similar al obtenido en otros países; sin embargo, los resultados son una aproximación a la habilidad de lectura, pues no garantiza la comprensión, conocimiento y la operatividad de todas las palabras; además, no explica las complejas habilidades involucradas en la alfabetización en salud.

Objective: To determine the linguistic equivalence in the Spanish language and the internal consistency of the Rapid Estimate of Adult Literacy in Dentistry 99 (REALD-99) applied to a sample group of Mexican people. Method: The equivalence of the REALD-99 was performed by expert translators of the English language by means of translation-retranslation; its content was validated by fve bachelors of dentistry. The instrument was applied to a sample group of 995 people between 15 and 54 years old who requested dental care for the frst time. The people participated voluntarily, and their consent was given in writing. Epidemiological variables were analyzed, and the internal consistency of the instrument was determined with the Cronbach's Alpha test. Results: Two words with identical translation and three without application in the local dental context were identifed. The average age of the participants was 30 years old (SD ±11); 62% were women. The application of the instrument was 87 correct answers (SD ±9.2) on average and the application time was a median of 2.24 minutes. Cronbach's alpha was 0.91 with the 99 words. Conclusions: The instrument is interchangeable and equivalent with an internal consistency similar to that obtained in other countries. However, the results are an approximation to the reading ability and do not guarantee the knowledge, comprehension, or operability of related vocabulary and neither they explain the complex skills involved in health literacy.

'[The pediatrician] said that maybe my milk, instead of doing good, no longer helped': the ecology of infant formula in rural communities in Central Mexico.

OBJECTIVE: As Mexico continues to develop, an epidemiological and nutritional transition has led to an increase in infant formula use in its rural and indigenous communities. Our objective was to determine the social and cultural factors that influence the use of formula in such populations in Central Mexico. DESIGN: Qualitative study using a data collection instrument based on the socio-ecological framework. SETTING: Two rural and indigenous communities in Central Mexico. PARTICIPANTS: Mothers, fathers, grandparents and healthcare providers. RESULTS: Breast-feeding was favoured in both communities; however, several cultural traditions hindered exclusive breast-feeding. As these communities became more developed, emerging ideas of modernity led to negative connotations about breast-feeding and many mothers began to view formula as a complement for breast-feeding. Formula was seen as a convenient solution for breast pain, insufficient milk and body image. Healthcare providers promoted the use of formula through their own beliefs, information, communication and conflicts of interest with formula industry representatives. The recent social and economic changes in these communities combined with the increased advertising and availability of breast milk substitutes have facilitated the preference for formula. CONCLUSIONS: Women in rural, indigenous communities in Central Mexico are increasingly using formula. Efforts at the policy and institutional levels are needed to protect mothers and their children from the detrimental consequences of unregulated formula promotion and the formula culture that it brings with it.

Actitudes y prácticas ante la búsqueda de atención odontológica en personas de la ciudad de México. Estudio cualitativo / Attitudes and practices toward dental health care searching among people of méxico city. qualitative study / Atitudes e práticas na busca por atendimento odontológico entre pessoas da Cidade do México. Estudo qualitativo

Antecedentes: La salud bucal es afectada por caries y enfermedad periodontal; ambas progresivas, irreversibles y cuyos efectos son acumulables con el tiempo. Sin embargo, son evitables cuando existen medidas preventivas y se busca la atención oportuna. Objetivo: Identificar las actitudes y prácticas que tienen las personas ante la búsqueda de atención odontológica. Métodos: Estudio cualitativo que identificó desde la subjetividad de los participantes, la experiencia y significado de la prevención y atención odontológicas; efectuado en 7 grupos focales con personas entre 18 y 60 años de edad. La muestra se definió por saturación teórica. Se diseñó y aplicó una guía semiestructurada para indagar sobre: Alternativas empleadas, búsqueda de atención, uso de los sistemas de salud y, experiencia de atención y salud bucal. Resultados: Se identificaron elementos que denotan ausencia de prevención. El dolor es referido como la principal manifestación de un problema y si éste es controlado, la búsqueda de atención se detiene. El sangrado de encía no es considerado relevante. Los procedimientos alternativos empleados antes de solicitar atención profesional son: automedicación, remedios caseros, consulta a empleados de farmacia y la internet. La búsqueda de atención se detuvo por: falta de tiempo y dinero, experiencias negativas previas (miedo, ansiedad), apatía, desidia y la pobre calidad de atención percibida en los servicios de salud. Conclusión: La falta de prevención está determinada por factores relacionados con el individuo y con el sistema de salud. La búsqueda de atención se hace con fines curativos o para reducir el daño resultante de consecuencias complejas y costosas en el tratamiento.

Background: Oral health is affected by caries and periodontal disease; both are progressive and irreversible, and the effects are cumulative with the passing of time. However, such effects are avoidable when preventive measures are taken along with timely care. Purpose: To identify the variables related to the absence of prevention and delay of dental care. Methods: Qualitative study conducted on seven focal groups of people between 18 and 60 years of age, to identify the experience and meaning of prevention and dental care. The sample was defined by theoretical saturation. A semi-structured guide was designed and applied to inquire about: options used, seeking care, use of health systems, and experience in the oral health care. Results: Absence of prevention was identified: feeling pain is the primary symptom of a problem; but if it is controlled, the search for care stops. Gingival bleeding is not considered as relevant. The alternative procedures used before requesting professional attention are self-medication, home remedies, consultation with pharmacy employees, or the internet. In such cases the search for dental care stopped by lack of time and money, negative experiences (fear or anxiety), apathy, indifference, and a poor-quality perception of health services. Conclusion: Lack of prevention is determined by factors related to the individual and the health system. A subsequent search for care with therapeutic purposes or damage limitation entails complex and costly consequences in treatments.

Antecedentes: A saúde bucal é afetada por cáries e doença periodontal; ambos são progressivos e irreversíveis, e os efeitos são cumulativos com o passar do tempo. No entanto, tais efeitos são evitáveis quando medidas preventivas são tomadas junto com o atendimento oportuno. Objetivo: Identificar as variáveis relacionadas à ausência de prevenção e demora no atendimento odontológico. Métodos: Estudo qualitativo, realizado em sete grupos focais de pessoas entre 18 e 60 anos, para identificar a experiência e o significado da prevenção e tratamento odontológico. A amostra foi definida por saturação teórica. Um roteiro semiestruturado foi elaborado e aplicado para indagar sobre: opções utilizadas, busca de assistência, uso de sistemas de saúde e experiência na atenção à saúde bucal. Resultados: Ausência de prevenção foi identificada: sentir dor é o principal sintoma de um problema; mas se for controlada, a busca por cuidados pára. O sangramento gengival não é considerado relevante. Os procedimentos alternativos utilizados antes de solicitar atenção profissional são: automedicação, remédios caseiros, consulta a funcionários de farmácia ou internet. Nesses casos, a busca por atendimento odontológico foi interrompida por falta de tempo e dinheiro, experiências negativas (medo ou ansiedade), apatia, indiferença e percepção de baixa qualidade dos serviços de saúde. Conclusão: A falta de prevenção é determinada por fatores relacionados ao indivíduo e ao sistema de saúde. Uma busca subsequente de cuidados com fins terapêuticos ou limitação de danos acarreta conseqüências complexas e onerosas nos tratamentos.

Impacto de la salud bucal en la calidad de vida de adultos mayores demandantes de atención dental / Impact of oral health into the quality of life in geriatric patients requiring dental care

Antecedentes: las enfermedades crónico-degenerativas y las patologías orales, como la caries y las periodontopatías, son frecuentes en los adultos mayores. Estas repercuten en su bienestar físico, psicológico y social. Objetivo: estimar el impacto de la salud bucal en la calidad de vida de los adultos mayores. Método: se realizó un estudio de corte transversal en 150 adultos mayores entre los 60 y 85 años de edad, quienes asistían a consulta dental en una Delegación Política de la Ciudad de México. La información se obtuvo mediante el registro de los impactos bucodentales durante los últimos seis meses, a través del Perfil de Impacto de Salud Oral (OHIP-14, por su sigla en inglés), y la salud bucodental, con el índice de dientes cariados, perdidos y obturados (CPOD). Resultados: se identificó un impacto positivo en las preguntas relacionadas con la preocupación por problemas con los dientes y boca (87,3%), molestias al comer (64%), dolor bucal (60,7%) e interrupción de la alimentación (56%). Menor impacto tuvieron las preguntas sobre incapacidad total para realizar actividades diarias (14,7%) y dificultad para realizar actividades diarias (13,3%). El CPOD fue de 14,1; el componente cariado, 3,96; los dientes perdidos, 5,95; y los dientes obturados, 4,19. La correlación entre el índice OHIP-14 y el CPOD fue positiva aunque débil (r=0,26; p=0,001). Conclusión: el estado bucodental influye en la calidad de vida de los adultos mayores y afecta particularmente la realización de sus actividades cotidianas.

Background: Chronic degenerative diseases and oral pathologies such as dental caries and periodontal diseases are frequent in the aged. They impact their physical, psychological, and social wellbeing. Aim: Estimate the impact of oral health status into the quality of life of older people. Method: This was a cross-sectional study. The sample consisted of 150 60-to-85-year-old patients attending a dental health care facility in Mexico City. Data were collected in a 6-month period through the Oral Health Impact Profile index (OHIP-14) and the Decayed, Missing and Filled Teeth Index (DMFT). Results: There was a positive impact regarding questions concerning teeth and mouth problems (87.3%), difficulty to eat (64%), oral pain (60.7%), and eating incapability (56%). There was a lower impact in questions related to total disability to perform daily activities (14.7%) and difficulty to perform daily activities (13.3%). The DMFT index was 14.10; the decayed component was 3.96, missing teeth 5.95, and the teeth with fillings 4.19. The correlation between OHIP-14 and DMFT indexes was positive although weak (r=0.26, p=0.001). Conclusion: Dental health status has a direct impact on the quality of life of aged, particularly affecting their daily life activities.