Child Development Evaluation Test analysis by field improves detection of developmental problems in children

Background: The Child Development Evaluation (CDE) Test is a screening instrument for developmental problems. In the validation study, a sensitivity of 81% and a specificity of 61% were reported, considering a cut-off value for both a total development quotient (TDQ) of 90. Given that the TDQ is obtained by calculation of the five evaluated fields in the Battelle Development Inventory, 2nd edition (BDI-2), it may occur that a child is classified as a false positive (TDQ ≥90) and may have a developmental delay in at least one of the fields (true positive). The objective of this work was to evaluate if the properties of the CDE Test are different when analyzing each field for the probability of a developmental delay. Methods: The information obtained for the study from the validation (Rizzoli-Córdoba, 2013) was analyzed. In the CDE Test, a true positive was considered when the result was yellow or red. A developmental delay was considered per domain with a scale score <80 in the BDI-2. The results were analyzed based on the correlation of what was evaluated between the CDE Test and the BDI-2. Results: For 438 children of 1- to 60-months of age, sensitivity (S) and specificity (Sp) per field were as follows: a) Motor: S=84.3% and Sp=87%; b) Communication: S=79.5% and Sp=79.4%; c) Personal-Social: S=86.9% and Sp=85%; d) Adaptive: S=91.7% and Sp=85.1%; and e) Cognitive: S=83.6% and Sp=88.8%. Conclusions: When analyzing each field separately, better scores for the CDE are observed compared with those reported for the TDQ in both sensitivity and specificity.

Childhood anemia in Mexico: A public health problem at all socioeconomic levels

Background: In Mexico, prevalence of anemia in children <5 years of age (preschool) is high at all socioeconomic levels. We undertook this study to analyze the socioeconomic determinants of the prevalence of anemia in preschool children and to explore the reasons why the prevalence is high, even in wealthier households. Methods: We used the National Survey of Health and Nutrition (ENSANUT) 2012 and calculated logistic regression models, considering as explanatory variables socioeconomic characteristics of children and mothers, among others. Models were estimated for all preschoolers and for each tercil of socioeconomic status. Results: The national prevalence of anemia in preschool children is 23.3%; in the lowest tertile it is 26.4%, whereas in the highest tertile it is 20.2%. Variables related to increased risk of anemia in the highest tertile are male children (OR: 1.24), those <2 years of age (OR: 2.31), stunting (OR: 2.01), and mother as the head of the household (OR: 2.06). Conclusions: Although anemia prevalence is higher at poorer socioeconomic levels, it remains high at all socioeconomic levels. Therefore, a general strategy is required to reduce the rate of childhood anemia rather than only the targeted efforts followed so far. Further research is needed.

Design of the 2009 evaluation of the Medical Insurance for a New Generation program.

OBJECTIVE: To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG). MATERIALS AND METHODS: The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) children's health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey. CONCLUSION: The results should serve as baseline data of the health status of SMNG children and the current staus of the program.

Family healthcare expenditure on children affiliated to the Medical Insurance for a New Generation.

OBJECTIVE: To analyze household health expenditures on children who are beneficiaries of the Medical Insurance for a New Generation (SMNG), program created in 2007 to cover healthcare costs of children without social security born after December 1st, 2006. MATERIALS AND METHODS: Using the SMNG National Survey, out-the-pocket and catastrophic spending on child health were calculated using several definitions. Results are presented by socioeconomic level, rural and urban areas and for Oportunidades beneficiaries. RESULTS: About 63.3% of households spent an average annual amount of 3320 Mexican pesos (MEX$) on healthcare for beneficiary children. Between 4.3 and 11.6% of households experienced catastrophic spending, depending on the definition adopted. Due to economic trouble, 15.5% of households postponed and 10.0% cancelled medical care for their child. CONCLUSIONS: Even though children are affiliated to the SMNG, the economic burden associated with attending their health is still an issue for families.

Lessons learned from the first evaluation of the Medical Insurance for a New Generation: bridging research and policy.

The first evaluation of the Medical Insurance for a New Generation program (SMNG) was conducted in 2009. A mixed-method approach was used to obtain a comprehensive picture of SMNG members and the program itself. The evaluation comprised: 1) Program design; 2) Social and health conditions of its members; 3); Evaluation of SMNG's performance by measuring coverage, productivity and efficiency; 4) Families health expenditures. The lessons learned for the program are that SMNG is focused on a vulnerable segment of the population with pervasive unmet health needs; prevalence of malnutrition, anemia and other conditions remains high. Further efforts are necessary to deploy the program where it is most needed, particularly in rural areas; most of its members are urban dwellers. However, more needs to be done to educate members about the importance of preventive care and to build the capability of health providers to provide high quality care. Families are still experiencing hardship to provide medical care to their children, so additional efforts are needed to decrease out-of-pocket and catastrophic expenditures. The lessons learned for the evaluation allow concluding that this first evaluation set the groundwork for better-targeted subsequent interventions and evaluations aimed at showing the impact of SMNG to bridge existing gaps in equity, access, coverage, and health status of Mexican children.

Estudio de caso: estimación de los costos de la quimioterapia aplicando el protocolo completo en niños con leucemia linfoblástica aguda o con linfoma de Hodgkin / Estimation of chemotherapy costs applying the full protocol of children with acute lymphoblastic leukemia or Hodgkin's lymphoma: case study

Introducción. De todos los tipos de cáncer, la leucemia linfoblástica aguda (LLA) constituye el tipo de cáncer más común en la edad pediátrica; los linfomas ocupan el tercer lugar. El costo de los tratamientos de LLA y de linfomas de Hodgkin (LH) en niños es elevado. El objetivo de este trabajo fue calcular los costos estimados de los protocolos que utiliza el Hospital Infantil de México Federico Gómez (HIMFG) y los costos unitarios totales de los medicamentos para LLA en todas sus etapas y tipos de riesgo y para LH en sus diferentes estadificaciones. Métodos. Los cálculos se realizaron con una metodología específica utilizando los protocolos in extenso para LLA y LH, en las diferentes etapas y estadios, para un niño con peso de 20 kg y talla de 115 cm y otro con peso de 30 kg y talla de 135 cm en el HIMFG. Resultados. El costo total unitario en LLA de riesgo estándar fue de 71,655.00 MXN (~$5,430 USD) para el niño de 20 kg y de 95,825.90 MXN (~$7,260 USD) para el de 30 kg. En LH el costo del estadio IB-IIB fue de 39,342.16 MXN (~$3,000 USD) para el niño de 20 kg y de 52,620.14 MXN (~$4,000 USD) para el de 30 kg, y en el estadio III-IV correspondió a 41,469.46 MXN (~$3,150 USD) y 55,465.39 MXN (~$4,200.00), respectivamente. Conclusiones. Hubieron diferencias y ventajas del protocolo del HIMFG en LLA con respecto a otro protocolo. La comparación de los costos con otros países mostró resultados parecidos cuando solamente se evaluaron los costos unitarios.

Introduction. Of all types of cancer, acute lymphoblastic leukemia (ALL) constitutes the most common type of cancer during the pediatric age. Lymphomas occupy third place. Treatment costs of ALL and Hodgkin lymphoma (HL) in children are high. The aim of the study was to calculate total unit costs of drugs in cancer children with ALL and HL using the current protocols in the Hospital Infantil de Mexico Federico Gomez (HIMFG). The costs were estimated by risk stratification for ALL patients and according to tumor stage for HL. Methods. Calculations were performed using a specific methodology and using the complete protocols of ALL and HL in the different strata for a child weighing 20 kg with a height of 115 cm and 30 kg with a height of 135 cm. Results. The total unit cost in standard-risk ALL was 71,655.00 MXN (~$5,430 USD at the time of publication) in the patient weighing 20 kg and 95,825.90 MXN (~$7,250 USD) for the patient weighing 30 kg. In HL, the cost of stage IB-IIB was 39,342.16 MXN (~$3,000 USD) in the child weighing 20 kg and 52,620.14 MXN (~$4,000 USD) in the child weighing 30 kg. Costs for treating patient in stages III-IV corresponded to 41,469.46 MXN (~$3,150 USD) and 55,465.39 MXN (~$4,200.00), respectively. Conclusions. There were both differences and advantages in the HIMFG protocol for ALL. Comparing costs with costs in other countries showed similar results when only the unit costs were evaluated.

Design of the 2009 evaluation of the Medical Insurance for a New Generation program / Diseño de la evaluación 2009 del programa Seguro Médico para una Nueva Generación

OBJECTIVE: To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG). MATERIALS AND METHODS: The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) children's health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey. CONCLUSION: The results should serve as baseline data of the health status of SMNG children and the current staus of the program.

OBJETIVO: Describir el abordaje de métodos mixtos que se utilizó para evaluar el SMNG Seguro Médico para una Nueva Generación. MATERIAL Y MÉTODOS: la evaluación integral del Programa se llevó a cabo en cuatro áreas clave: 1) el diseño del SMNG, 2) el estado de salud y las características sociodemográficas de los niños afiliados, 3) el desempeño del SMNG mediante la medición de la cobertura y de procesos clave, 4) los gastos en salud de la familia. La metodología mixta combina enfoques de investigación cuantitativa y cualitativa y la recolección y análisis de datos. La evaluación incluyó la revisión de bases de datos y de expedientes clínicos y la recolección de datos empíricos mediante entrevistas a profundidad con actores clave, una encuesta de hogares en todo el país y cuestionarios a personal de salud. CONCLUSIÓN: Los resultados sirven como referencia sobre el estado de salud de los niños afiliados al SMNG y de las condiciones actuales del programa; además permiten identificar áreas clave que pueden abordarse para mejorar la calidad, eficiencia y eficacia del SMNG.

Family healthcare expenditure on children affiliated to the Medical Insurance for a New Generation / Gasto en salud de los hogares con niños afiliados al Seguro Médico para una Nueva Generación

OBJECTIVE: To analyze household health expenditures on children who are beneficiaries of the Medical Insurance for a New Generation (SMNG), program created in 2007 to cover healthcare costs of children without social security born after December 1st, 2006. MATERIALS AND METHODS: Using the SMNG National Survey, out-the-pocket and catastrophic spending on child health were calculated using several definitions. Results are presented by socioeconomic level, rural and urban areas and for Oportunidades beneficiaries. RESULTS: About 63.3% of households spent an average annual amount of 3320 Mexican pesos (MEX$) on healthcare for beneficiary children. Between 4.3 and 11.6% of households experienced catastrophic spending, depending on the definition adopted. Due to economic trouble, 15.5% of households postponed and 10.0% cancelled medical care for their child. CONCLUSIONS: Even though children are affiliated to the SMNG, the economic burden associated with attending their health is still an issue for families.

OBJETIVO: Analizar el gasto en salud y gasto catastrófico en los niños beneficiarios del Seguro Médico para una Nueva Generación (SMNG), programa creado en 2007 para niños sin seguridad social nacidos a partir del 1o de diciembre de 2006. MATERIAL Y MÉTODOS: Con información de la Encuesta Nacional del SMNG se calculó el gasto en salud y el gasto catastrófico de los hogares de acuerdo a varias definiciones. Los resultados se presentan por nivel socioeconómico, para zonas urbanas y rurales y por pertenencia al programa Oportunidades. RESULTADOS: El 63.3% de los hogares gastaron en la salud de los niños un promedio anual de 3320 pesos. Entre el 4.3 y el 11.6% de los hogares incurrieron en gasto catastrófico, dependiendo de la definición. Debido a problemas económicos, 15.5% pospuso y 10% no realizó la atención médica del niño. CONCLUSIONES: Aún cuando los hogares están afiliados al SMNG, todavía enfrentan restricciones económicas para atender los problemas de salud del niño.

Lessons learned from the first evaluation of the Medical Insurance for a New Generation: bridging research and policy / Lecciones aprendidas de la primera evaluación del Seguro Médico para una Nueva Generación

The first evaluation of the Medical Insurance for a New Generation program (SMNG) was conducted in 2009. A mixed-method approach was used to obtain a comprehensive picture of SMNG members and the program itself. The evaluation comprised: 1) Program design; 2) Social and health conditions of its members; 3); Evaluation of SMNG's performance by measuring coverage, productivity and efficiency; 4) Families health expenditures. The lessons learned for the program are that SMNG is focused on a vulnerable segment of the population with pervasive unmet health needs; prevalence of malnutrition, anemia and other conditions remains high. Further efforts are necessary to deploy the program where it is most needed, particularly in rural areas; most of its members are urban dwellers. However, more needs to be done to educate members about the importance of preventive care and to build the capability of health providers to provide high quality care. Families are still experiencing hardship to provide medical care to their children, so additional efforts are needed to decrease out-of-pocket and catastrophic expenditures. The lessons learned for the evaluation allow concluding that this first evaluation set the groundwork for better-targeted subsequent interventions and evaluations aimed at showing the impact of SMNG to bridge existing gaps in equity, access, coverage, and health status of Mexican children.

La primera evaluación del Seguro Médico para una Nueva Generación (SMNG) se llevó a cabo en 2009. La evaluación utilizó métodos mixtos para obtener una imagen completa de los miembros del SMNG y del programa. La evaluación comprendió: 1) el diseño del programa, 2) las condiciones sociales y de salud de los miembros, 3) acceso y uso de los servicios de salud, 4) la calidad de los servicios de atención ambulatoria y hospitalaria y 5) el efecto en los gastos de salud de las familias. El SMNG está enfocado a la población vulnerable con necesidades de salud no satisfechas, donde persiste la prevalencia de la desnutrición, anemia y otras enfermedades. Son necesarios esfuerzos adicionales para aumentar la cobertura del programa en zonas rurales donde la necesidad es mayor; pues la mayoría de sus miembros habitan en áreas urbanas, también es indispensable fortalecer la atención preventiva y fortalecer la capacidad de los proveedores de salud para proporcionar atención de alta calidad. Las familias todavía están experimentando dificultades para prestar atención a sus hijos, son necesarios esfuerzos adicionales para disminuir los gastos de bolsillo y catastrófico. Esta primera evaluación establece las bases para intervenciones y evaluaciones posteriores sustentadas en objetivos mejor definidos y enfocados a demostrar que SMNG está disminuyendo las brechas existentes en equidad, acceso, cobertura y estado de salud de la niñez mexicana.

Una mirada desde los servicios de salud a la nutrición de la niñez mexicana: IV Prevención de los problemas de nutrición de los niños, de rezago y emergentes / Health services perspective of the nutrition of Mexican children: IV. Prevention of shortage and emerging nutritional problems during childhood

Para contender con los problemas de la nutrición de los niños, los de rezago y emergentes, se enfatiza la importancia de que los niños pequeños sean amamantados e ingieran mayor cantidad de alimentos complementarios de origen animal. Asimismo, se recomienda utilizar el índice de masa corporal para detectar oportunamente problemas nutricios de déficit o exceso. La prevención del peso bajo al nacer requiere otorgar a la madre una atención prenatal de calidad, favorecer el acceso a los servicios de salud y una atención profesional del nacimiento. Para prevenir la anemia carencial se destaca la importancia de una correcta orientación alimentaria, eliminar los factores que ocasionan microsangrado gastrointestinal, adicionar hierro a los alimentos de consumo popular, aumentar las reservas al nacimiento y dar a los niños suplementos con sales específicas de hierro y ácido fólico. Para disminuir el retardo de la talla para la edad, que se encuentra vinculado a la deficiencia de cinc, se considera que la forma más eficaz de aportar este micro nutrimento es con suplementos que lo contengan y con alimentos de origen animal, además de productos del mar. De los problemas emergentes se menciona sólo la prevención de la obesidad por sus graves repercusiones. Ante la dificultad actual para decidir qué medidas son costo-efectivas, y ante el elevado fracaso terapéutico, se destaca la prevención como estrategia para su contención. Se enfatiza que es un problema de salud que estrictamente no es una responsabilidad médica o de los sistemas de salud, pero se proponen acciones alrededor de la ecuación del balance energético, abarcando desde la gestación a la edad escolar, en la que deben participar los individuos, los padres de familia, escuelas, maestros, productores de alimentos, publicistas y funcionarios públicos para modificar factores de riesgo como la cantidad y composición de los alimentos, además de la necesidad de eliminar el sedentarismo como forma de bienestar.

To demonstrate childhood nutritional problems, both those that are a consequence of underdevelopment (stunted and micronutrient deficiencies) and those emerging problems (overweight and obesity), we stress the importance of promoting breastfeeding along with appropriate complementary feeding. It is also recommended to measure body mass index to detect timely childhood growth deviations. To prevent low birth weight, high-quality antenatal care must be offered to mothers in accessible health facilities that are equipped to resolve pregnancy-related complications including newborn delivery by healthcare professionals. Several measures are helpful for preventing iron deficiency anemia such as increasing the iron reserves of pregnant women, retarding clamping of the umbilical cord that, in turn, increases the iron reserves of the newborn. We must eliminate risk factors for iron loss through the gastrointestinal tract and provide iron supplementation for at-risk infants. Folie acid also must be included in the supplement. Prevalence of stunting in poor communities is generally associated with zinc deficiency. Sufficient portions of animal and seafood products should be included in the daily diet, and supplements with this micronutrient should be provided in order to help prevent its deficiency. Regarding the emergent nutritional problems, we discuss the prevention of obesity due to its severe health consequences. Currently, there is no consensus about the most cost-effective interventions. In addition to the high proportion of therapeutic failures, several actions using as a model the energy balance equation from gestation to the child's age are proposed. We discuss about the amount of food and food composition as risk factors for obesity, along with the need to disregard a sedentary lifestyle. Obesity is not strictly a medical or health system responsibility but a problem shared by parents, families, schools, food producers and mass media as well as public authorities who, as social leaders, do not realize that we all are living in an obesogenic environment.

Una mirada desde los servicios de salud a la nutrición de la niñez mexicana: III. Carga económica y en salud de la obesidad en niños mexicanos. Proyecciones de largo plazo / A look from health services to the nutrition of Mexican childhood: III. Economic and health burden of Mexican childhood obesity. Long-term projections

Objetivo. Estimar la carga económica y en salud de la obesidad en niños mexicanos en un horizonte de largo plazo. Estimación de costos médicos atribuibles a la obesidad en niños mexicanos durante 2006-2050. Una cohorte hipotética de 5-11 años de edad obesa se modeló con base en prevalencia, incidencia y evolución clínica. Los costos considerados fueron por diabetes mellitus tipo 2 e hipertensión arterial. En 2015 se presentarían los primeros casos de diabetes mellitus y de hipertensión arterial. Cuando el primer grupo de niños cumpla 40 años aumentarán considerablemente las complicaciones de la obesidad. Para 2050, 67.3% de la cohorte tendría obesidad. El costo de atención a la obesidad será de $57 678 millones de pesos. La magnitud de la obesidad se reporta en niveles preocupantes en todas las edades, con costos que consumirán buena parte de los recursos del sistema de salud.

Objective. To estimate the economic and health burden of childhood obesity in Mexican population over the long term. This study estimates healthcare costs due to child obesity in Mexican children from 2006-2050. A hypothetic 5-11-year-old obese cohort based on prevalence, incidence, and clinical development data was modelled. Cost allocation considerations include type 2 diabetes mellitus and high blood pressure. The first cases of diabetes mellitus and with a risk of high blood pressure appears in the year 2015. When the first group of children is 40 years old, there is a considerable increase in obesity-related complications. A total of 67.3% of the cohort would have obesity in the year 2050. The cost of obesity care would be $57 678 million Mexican pesos. The magnitude of obesity reported is at worrisome levels in all age groups, showing costs that would consume a high percentage of the health system’s resources.