Establishing performance standards for child development: learnings from the ECDI2030

BACKGROUND

Standards of early childhood development (ECD) are needed to determine whether children living in different contexts are developmentally on track. The Early Childhood Development Index 2030 (ECDI2030) is a population-level measure intended to be used in household surveys to collect globally comparable data on one of the indicators chosen to monitor progress toward target 4.2 of the Sustainable Development Goals: The proportion of children aged 24-59 months who are developmentally on track in health, learning and psychosocial well-being.

METHODS

To define performance cut-scores for the ECDI2030 we followed a criterion-referenced standard setting exercise using the modified Angoff method. The exercise gauged the expectations from 15 global experts in ECD and was informed by representative population data collected in Mexico and the State of Palestine. The final calibrated age-specific performance cut-scores were applied to these data to estimate the proportion of children developmentally on track, disaggregated by background characteristics, including the child's sex and attendance to early childhood education.

RESULTS

Through a process of standard setting, we generated robust performance standards for the ECDI2030 by establishing five age-specific cut-scores to identify children as developmentally on track.

CONCLUSIONS

This paper demonstrated how the standard setting methodology, typically applied to measures in the health and education fields, could be applied to a measure of child development. By creating robust criterion-referenced standards, we have been able to ensure that the cut-scores related to age for the ECDI2030 are based on performance standards set by global experts in the ECD field for defining on and off track development.

Lead Exposure Can Affect Early Childhood Development and Could Be Aggravated by Stunted Growth: Perspectives from Mexico

BACKGROUND

Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities.

METHODS

Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth.

RESULTS

Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (β: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (β: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (β: -0.15, 95% CI: -0.36, 0.06).

CONCLUSIONS

Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.

Continuum of care for maternal, newborn and child health: Evidence from a national survey in Mexico

OBJECTIVE

To compare coverage of maternal, newborn and child health (MNCH) continuum of care between women who had experienced adolescent maternity (AM) and those who had not.

METHODS

Using a Mexican probabilistic survey representative at the national level (ENSANUT 2018-19), we developed a cross-sectional analysis of 1,768 women aged 12 to 49 years who had a child within five years before the interview. We used modified Poisson models to estimate prevalence ratios (PRs) and independent and conditional coverage levels based on the probability estimates yielded by these models at different stages of maternal-newborn care process.

RESULTS

PRs for the MNCH continuum of care were approximately 40% lower for women who had experienced AM compared to those who had not (95%CI:0.35, 1.14). The coverage for the MNCH continuum of care was only 7.4% [95%CI: 3.5, 11.2] and 11.7% [95%CI: 9.3, 14.1] in women who had/not experienced AM, respectively.

CONCLUSIONS

The provision of a continuum of care for mothers and their children can be achieved through a combination of well-defined policies and strategies that improve health care practices and services throughout the life cycle. It is necessary to expand the coverage and quality of care, which will provide the opportunity to shift the focus from vertical programs to integrated continuous care. Policy makers must implement interventions that are consistent with specific problems of population and health-care providers. Our analysis highlights the deficiencies in the care process, making this study a useful reference for countries with similar characteristics.

Early childhood development and urban environment in Mexico

BACKGROUND

Childhood is considered the most important phase of human development; within it the period from birth to 5 years of age is particularly critical, given the speed at which changes occur. The context where children live can influence early childhood developmnent (ECD) by providing or limiting opportunities to learn, play and establish social interactions. This study explored the associations between characteristics of the urban environment and ECD in 2,194 children aged 36 to 59 months living in urban municipalities in Mexico.

METHODS

We obtained ECD information from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the Early Childhood Development Index. The urban environment was evaluated at the municipal level, considering variables from five environment domains: physical, social, service, socioeconomic, and governance. Multilevel logistic models were fitted to assess the association between urban environment characteristics and the inadequacy of ECD in general and by specific development domains: learning, socio-emotional, physical, and alpha-numeric.

RESULTS

Inadequate ECD was inversely associated with the availability of libraries (OR = 0.55, 95% CI: 0.43, 0.72), and positively associated with population density (OR = 1.01, 95% CI: 1.01-1.02). For the specific ECD domains, inadequate socio-emotional development was inversely associated with the availability of libraries (OR = 0.66, 95% CI: 0.51, 0.85). Inadequate literacy-numeracy knowledge was associated inversely with the availability of daycare centers (OR = 0.56, 95% CI: 0.32, 0.97), and directly associated with the number of hospitals and clinics (OR = 1.87, 95% CI: 1.29, 2.72). Finally, the marginalization index was positively associated with inadequacy in the learning domain (OR = 1.80, 95% CI: 1.06, 3.03).

CONCLUSIONS

Some aspects of the urban environment associated with ECD, suggest that intervening in the urban context could improve overall child development. Investment in resources oriented to improve socio-emotional development and literacy (such as libraries and daycare), could foster ECD in Mexico.

Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality

Suicide was the second‑leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge.

METHODS

We conducted a prospective longitudinal study of suicidality at twelve points (four assessment occasions) for 286 suicidal youth presenting to a pediatric ER, most suffering from BPD, with 36 suicide ratings from baseline to 2-, 6- and 48-month follow-up evaluations. We examined the trajectory and predictors of persisting suicidality.

RESULTS

Suicidality rapidly decreased within 2 months post-ER-discharge, subsequently remaining low throughout 48 months. Baseline functioning, female sex, stressful life events and BPD impulsiveness were most predictive of persisting suicidality at 48-month follow-up.

CONCLUSION

Most suicidal youth, many meeting BPD criteria, no longer feel suicidal 2 months after ER discharge. Management of participants' baseline poor functioning stressful life events and the impulsiveness component of BPD specifically in females could impact suicidality 4 years later, and guide treatment options. The absence of the BPD cognitive and affective subscales as predictors of suicidality at 4-year follow-up may reflect treatment received. Further investigation of treatment effects is warranted and under way.

Impact of adverse childhood experiences on cardiovascular disease risk factors in adulthood among Mexican women

BACKGROUND

Childhood adversities are prevalent worldwide and might affect adult cardiovascular health. However, in middle-income countries such as Mexico, research on the impact of childhood adversities on cardiovascular disease (CVD) in adulthood is lacking.

OBJECTIVE

To evaluate the prevalence of adverse childhood experiences (ACEs) and their association with risk factors for CVD in adult Mexican women.

PARTICIPANTS AND SETTING

The study population comprised 9853 women from the Mexican Teachers´ Cohort.

METHODS

Participants responded to an online questionnaire including a 10-item instrument on ACEs and questions on CVD risk factors, between 2014 and 2017. Multivariate logistic regression models were used to evaluate the association between ACEs and adult behavioral and medical CVD risk factors.

RESULTS

About 61% of participants reported at least one ACE and 14% reported four or more. After multivariable adjustment, women who reported ≥4 ACEs had 58% (95%CI 1.37, 1.81) higher odds of having ever smoked and 17% (95%CI 0.69, 0.99) lower odds of being physically active, compared with women who reported no ACEs. Women who reported ≥4 ACEs also had higher odds of hypertension (OR = 1.19; 95%CI 1.00, 1.43), diabetes (OR = 1.49; 95%CI 1.13, 1.96), high cholesterol (OR = 1.49; 95%CI 1.26, 1.75), and obesity (OR = 1.37; 95%CI 1.19, 1.57). In addition, individual ACE components were independently associated with several CVD risk factors.

CONCLUSION

ACEs are common and associated with CVD risk factors in adult Mexican women.

[Maternal and child healthcare and adolescent maternity in under 100 000 inhabitants communities]

OBJECTIVE

To compare the coverage of continuous ma- ternal healthcare and early childhood care in women with and without adolescent motherhood (AM) who live in under-100 000-inhabitants communities.

MATERIALS AND METHODS

Cross-sectional analysis of Ensanut 100k 2018 of 767 women aged 12 to 49 years living in under-100 000-in- habitants communities who had their last birth two years before the survey.

RESULTS

Women with AM have lower continuous coverage of maternal care than those without AM (8.1 and 19.6%, respectively). Infant care coverage with adequate content was lower than 30%, and there were no differences between the groups.

CONCLUSIONS

It is necessary to strengthen actions focused on this group of women in order to reduce the gaps in coverage and improve maternal and child health.

[Context and results of early childhood development in 12 to 59 months old children living in Mexico]

OBJECTIVE

To evaluate early childhood development (ECD) and its determinants in 12 to 59 months old children residents of communities <100 000 inhabitants.

MATERIALS AND METHODS

The Encuesta Nacional de Salud y Nutrición of communities <100 000 inhabitants (Ensanut 100k) evaluated language level, access to ECD care services and standardized indicators of the eight quality of the development environment. We report indicator prevalence and standardized language scores according to variables of interest.

RESULTS

20.7% of children attended eight wellchild care visits within the first year of life, 13.0% received an ECD assessment, 75.0% receive support for learning, 23.4% have books and 57.7% experiment violent discipline. Improved language levels are associate with socioeconomic capacities, maternal education, preschool attendance, support for learning and household books. Children exposed to more protective factors present a language level 1.5 standard deviations higher than their peers exposed to more risk factors.

CONCLUSIONS

There is a need to increase the coverage of ECD care services and to improve early development opportunities within households.

[Trends in vaccination coverage among children aged 12-23 and 24-35 months in Mexico. Ensanut 2012 and Ensanut 100]

OBJECTIVE

To evaluate and compare vaccination coverage among children aged 12-23 and 24-35 months living in localities with less than 100 000 inhabitants in Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 and Ensanut 100k (2018).

MATERIALS AND METHODS

Estimate of coverage with both surveys.

RESULTS

Between 2012 and 2018, according to proof and self-report, the coverage of the basic scheme was maintained in children aged 12-23 (51.6 vs. 60.2%) and 24-35 months (51.4 vs. 50.0%). Similarly, only with proof (53.9 vs. 51.3% and 52.8 vs. 44.2%). In children aged 24-35 months, the coverage of the reinforced basic scheme reinforcements with probative document and self-report (30.9 vs. 34.0%) and only with reinforcements (30.2 vs. 27.8%) was maintained. Coverage with second and third doses of hepatitis B in both age groups decreased; additionally, first dose of measlesmumps-rubella vaccine (SRP, in Spanish) and third dose of Pentavalent in children aged 24-35 months.

CONCLUSIONS

Coverages were maintained by schemes, despite reductions in hepatitis B, pentavalent and SRP.

Factors associated with pregnancy and motherhood among Mexican women aged 15-24

Adolescent pregnancy is associated with poor health and socioeconomic factors. The adolescent pregnancy rate in Mexico is the highest among the Organization for Economic Co-operation and Development (OECD) countries. We aimed to explore the factors associated with pregnancies and births in adolescent and young adult women. Using the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM), we examined two dichotomous outcomes: "ever pregnant" and "being a mother" in women from 15 to 19 years and from 20 to 24 years without pregnancies during adolescence. We conducted bivariate analysis for each age group and used general linear models (GLM) to assess the association between the outcome variables and selected socioeconomic variables. Among adolescents, school attendance and tertiary education significantly decreased the likelihood of ever having been pregnant or being mothers, while being married/cohabiting increased the likelihood. Older age at first intercourse was negatively associated with ever having been pregnant. For adult women, in addition to school attendance, tertiary education, and being married/cohabiting, the region of residence also showed a significant association with ever having been pregnant. Similar socioeconomic factors were associated with pregnancy and motherhood between adolescents and young adults. However, it was found that delaying sexual debut could reduce the adolescent pregnancy rate. Our results highlight the importance of attending school and attaining tertiary education in reducing adolescent fertility rates.

Severe functional difficulties and disabilities in children and adolescents and the Sustainable Development Goals

OBJECTIVE

To report prevalence of severe child functional difficulties and disability (CFD) in a nationally representative sample of 2 to 17 year-old children in Mexico and describe the inequities faced by children with CFD in relation to a set of Sustainable Development Goals (SDG)-related outcomes.

MATERIALS AND METHODS

Using data from the National Survey of Children and Women (ENIM 2015) we estimate prevalence with 95% confidence intervals for the selected indicators. We use chi-square test and confidence intervals inspection to report significant differences between children with and without CFD.

RESULTS

8% of children present at least one CFD. CFD is associated with higher prevalence of underweight and child labor and lower prevalence of adequate early child development. Conclusion. Children with CFD present worst outcomes and require targeted efforts to ensure they meet health and wellbeing targets in the frame of the SDGs.

Child labor and severe functioning difficulties and disability in Mexican children and adolescents 5-17 years of age

OBJECTIVE

To describe the characteristics of Mexican children and adolescents 5-17 years with severe functioning difficulties and disability and explore their participation in child labor.

MATERIALS AND METHODS

Using data from the National Survey of Boys, Girls and Women in Mexico 2015 we estimated prevalence of functioning difficulties and disability and used logistic regression to explore the association between this condition and child labor.

RESULTS

While 11.2% of Mexicans 5-17 years-old has severe functioning difficulties or disability, 13.4% work. The functioning difficulty and disability domains with the highest prevalence are experiencing anxiety (5.4%) and depression (1.5%) daily. Children and adolescents with severe functioning difficulties and disability are 70% more likely to do child labor [OR=1.7, 95%CI:1.2,2.4]. Educational lag doubles the likelihood of doing child labor [OR=2.2, 95%CI:1.5,3.3].

CONCLUSIONS

Guaranteeing educational opportunities and respect for the rights of children with severe functioning difficulties and disability is essential to achieve development of their full potential.

The development and testing of a module on child functioning for identifying children with disabilities on surveys. III: Field testing

BACKGROUND

A module on child functioning developed by UNICEF and the Washington Group on Disability Statistics (WG) for use in censuses and surveys reflects current thinking around disability measurement and is intended to produce internationally comparable data. The Child Functioning Module (CFM) was developed in response to limitations of the Ten Question Screening Instrument (TQSI) for use in surveys and builds on the WG Short Set (WG-SS) of questions that was designed to capture disability in censuses, particularly among the adult population.

OBJECTIVE

This paper documents the testing of the module and summarizes its results, including a description of prevalence levels across countries using different cut-offs, and comparisons with prevalence levels obtained using the TQSI and the WG-SS.

METHODS

Field tests were conducted in Samoa as part of the 2014 Demographic and Health Survey and in Mexico as part of the 2015 National Survey of Boys, Girls and Women. The module was also implemented in Serbia as part of a dedicated survey conducted in the province of Vojvodina, in February 2016.

RESULTS

Using the recommended cut-offcut-off, the percentage of children reported as having functional difficulty ranges from 1.1% in Serbia to 2% in Mexico among children aged 2-4 years, and from 3.2% in Samoa to 11.2% in Mexico among children aged 5-17 years. Across all three countries, the prevalence of functional difficulty was highest in the socio-emotional domains. A comparison of the prevalence levels obtained using the WG-SS and the CFM shows that, except for the question on cognition/learning, the WG-SS and the CFM are relatively close for children aged 5-17 years for the domains that are included in both question sets, but the WG-SS excludes many children identified by the CFM in other domains. The comparison between the TQSI and the CFM shows that, while the prevalence estimates are similar for seeing and hearing, significant differences affect other domains, particularly cognition/learning and communication.

CONCLUSIONS

The CFM addresses a full range of functional domains that are important for child development. The module represents an improvement on the TQSI in that it allows for scaled responses to determine the degree of difficulty, and so can separate out many potential false positives. The module is also preferred over the WG-SS for collecting data on children, first, because most of the questions in the WG-SS are not suitable for children under the age of 5 years, and second, because the WG-SS leaves out important functional domains for children aged 5-17 years, namely those related to developmental disabilities and behavioural issues.

[Comprehensive sexual education in Mexico: an analysis of coverage, comprehensiveness and continuity of contents in Mexican public and private schools]

Objective:

To analyze coverage of comprehensive sex education (CSE) in high schools in Mexico and describe whether it is comprehensive, homogeneous and has continuity based on student reports of exposure to topics in three dimensions: reproductive and sexual health, self-efficacy and rights and relations.

Materials and methods:

Within a probabilistic, cross-sectional survey with stratified, cluster sampling, a nationally representative sample of 3 824 adolescents attending 45 public and private high-schools in urban and rural areas completed questionnaires on CSE.

Results:

The proportion of adolescents reporting having received sex education from school personnel varies depending on topics and grade level. Topics most frequently covered are those related to sexual and reproductive health while rights and relations are least frequently dealt with. Most sex education topics are covered during junior high school and much less frequently in elementary or high school.

Conclusions:

CSE needs to be comprehensive and homogenous in terms of content, ensure inclusion of priority topics, meet national and international recommendations, ensure continuity and adapt contents to student age through all education levels.

Sexual and reproductive health outcomes are positively associated with comprehensive sexual education exposure in Mexican high-school students

Objectives

To describe the comprehensive sex education (CSE) coverage and to evaluate a set of indicators related to knowledge, attitudes, and practices associated with the seven components of the CSE framework among Mexican high-school students.

Methods

We conducted a cross-sectional survey of a nationally representative sample of students in public and private high schools in Mexico. Questions about CSE coverage and about knowledge, attitudes, and practices related to sexual health were included. We present descriptive statistics for demographic characteristics, exposure to CSE, and sexual health outcomes. We fitted a series of multivariate logistic regression models to examine the association between each CSE component exposure and sexual health outcomes, adjusting for age and sex.

Results

There were significant associations between being exposed to each CSE components and the related sexual health outcomes. The strongest one was for identifying effective contraceptives among those exposed to the Sexual and Reproductive Health component (SRH) (OR 4.10; 95%CI[2.93,5.75]). Also, students exposed to the relationships component had 20% higher odds of affirming they could convince their partner to use condoms (OR 1.20; 95%CI[1.05,1.36]).

Conclusions

This paper provides evidence of the potential beneficial effects of CSE on attitudes, knowledge, and behaviors regarding sexual and reproductive health among adolescents. In addition, it identifies areas that should be strengthened to increase the positive impact of CSE.

Perceptions of adolescent 'simulated clients' on barriers to seeking contraceptive services in health centers and pharmacies in Mexico

OBJECTIVE

To examine adolescent simulated clients' perceived barriers to quality care as they sought information on contraceptives in public-sector healthcare facilities and pharmacies in Mexico.

STUDY DESIGN

We used a qualitative research design and conducted semi-structured interviews with eight young women who posed as simulated clients at health centers and pharmacies in Mexico City. Grounded Theory was used to analyze the transcripts.

RESULTS

Barriers to receiving information about contraceptives included healthcare professionals who gave administrative pretexts to avoid providing services. Simulated clients also felt judged by healthcare professionals and reported a lack of simple, understandable and pertinent information. Healthcare professionals did not ensure clients understood and had no further questions about using contraceptives, which resulted in clients' poor perceived self-efficacy, as well as a lack of confidence in the healthcare system to help them.

CONCLUSIONS

When healthcare professionals fail to provide services according to the World Health Organization's five basic criteria of adolescent friendly care, adolescents perceive important barriers in their access to contraceptive methods. Quality of sexual health care in Mexico would benefit from efforts to improve healthcare professionals' knowledge, attitudes and skills related to adolescent friendly service delivery.

Adolescent Access to Information on Contraceptives: A Mystery Client Study in Mexico

PURPOSE

We aimed to evaluate adolescent access to contraceptive information and quality of care in a sample of primary care clinics and pharmacies in Mexico and their association with health facility and adolescent characteristics.

METHODS

We selected a random sample of pharmacies (n = 434) and public-sector, primary care clinics (n = 327) in Mexico City to be visited by young women posing as "mystery clients" looking for contraception or emergency contraception. Access to contraception information was measured as the percent of times that women received the information they requested. To assess quality of care, we built an "adolescent-friendly services" (AFS) score based on the World Health Organization framework. Regression models were fitted to evaluate the associations between outcomes and health facility and client characteristics.

RESULTS

Twenty percent of women did not receive the information they requested. Clients seeking emergency contraception information had higher odds of obtaining it than clients seeking information on contraception (odds ratio 3.08 95% confidence interval 2.03, 4.67). AFS scores were low, although higher in clinics than in pharmacies (5/9 in clinics vs. 3/9 in pharmacies). Younger age and indigenous appearance were associated with lower quality as measured by the AFS score.

CONCLUSIONS

Access to information about contraception in pharmacies and clinics is high, but efforts must be made to provide 100% coverage to adolescents. The quality of contraception services in pharmacies and clinics is poor and nonequitable, favoring older and nonindigenous adolescents. Clinics and pharmacies must strive to comply with international AFS guidelines.

[Contraception in Mexican adolescents in upper secondary schools: use and unmet needs]

OBJECTIVE

To describe sexual behavior and contraceptive use in adolescent students.

MATERIALS AND METHODS

National representative survey in upper secondary schools in Mexico 2014. Logistic regressions identify the factors associated with contraceptive use and unmet needs for contraception (UNC).

RESULTS

For male adolescents, non-contraceptive use in the last sexual relation is associated with non-contraceptive use in the sexual debut (OR=11.5; IC95%:5.6,23.4) and not recognizing effective contraceptive methods (OR=2.4;IC95%:1.04,5.5). For female adolescents, non-contraceptive use is associated with non-contraceptive use in sexual debut (OR=4.5;IC95%:2.3,8.4) and low self-efficacy towards condom use and negotiation (OR=3.1; IC95%:1.1,8.2). UNC were associated with insecure attitudes towards condom use and negotiation (OR=3.5;IC95%:1.3,9.4), non-contraceptive use in sexual debut (OR=9.0;IC95%:2.5,32.4) and use of alcohol or drugs during sexual relations (OR=3.0;IC95%:1.1,8.1).

CONCLUSIONS

Strategies to ensure contraceptive use from sexual debut onwards are required, promoting self-efficacy and safe sex practices among adolescents.

Population profiles associated with severe functional difficulties and disability among 5-17 years-old children in México

OBJECTIVES

To report the prevalence of severe functional difficulties and disability (SFD) in a nationally representative sample of children ages 5 to 17 in Mexico, to identify factors associated with SFD, and population profiles predictive of SFD.

MATERIALS AND METHODS

Using data from the National Survey on Children and Women we estimated prevalence and 95% confidence intervals of SFD and risk factors. We fitted bivariate and multivariate logistic regression models. We then examined which combinations of the sociodemographic factors best predicted SFD.

RESULTS

The prevalence of SFD was 11.2%. The most prevalent SFD were on the socioemotional dimension (8.3%). The associated risk factors in the three dimensions were: living in a poor household, being a boy, having a mother with basic education or less, and non-indigenous background or living in an urban area.

CONCLUSIONS

Identifying groups of the population at higher risk for SFD provides useful information for targeted intervention implementation.

Population profiles associated with severe functioning difficulties and disability among two to four years old children in Mexico

OBJECTIVE

To describe the prevalence and factors associated with severe child functioning difficulties and disability (CFD) among two to four year old children in Mexico, and estimates the probability of presenting CFD based on specific population profiles.

MATERIALS AND METHODS

The sample consists of 5 104 children who participated in the National Survey of Children and Women 2015 (ENIM). We used post-estimation exploration by computing predicted values of CFD to interpret the logistic models for discrete combinations of the independent variables.

RESULTS

CFD prevalence is 2%, which means at least 130 000 two to four year-old children are at risk of experiencing severely limited participation in an unaccommodating environment. The probability of presenting CFD is dramatically higher in specific sub-groups of the population, in particular, male children of women with low education, who live in the poorest households.

CONCLUSIONS

A significant proportion of Mexican children face important challenges due to functioning difficulties and disability. Public policies must be developed to accommodate the needs of these children and provide a proper environment for their development.

Detection and care practices for postpartum depressive symptoms in public-sector obstetric units in Mexico: Qualitative results from a resource-constrained setting

BACKGROUND

Postpartum depression (PPD) is amenable to detection and treatment, but effectively addressing it is contingent on policies, practices, and health care providers working together to address the issue. The aim of this study is to describe a sample of health care providers' existing practices in public-sector obstetric units in Mexico related to detecting and offering care to women with depressive symptomology.

METHODS

Semi-structured interviews with 40 health care providers (16 physicians, 13 nurses, three social workers, and eight psychologists) from one tertiary-level and two secondary-level, public-sector obstetric units, were conducted by members of a trained research team from May to July 2012. Qualitative data were analyzed in Spanish according to Grounded Theory, using Nvivo 10 software.

RESULTS

Lack of hospital guidelines, training, and time constraints are reasons given for not detecting PPD symptoms among women. Providers reported that their role is cursory and limited to giving women anticipatory guidance for what to expect emotionally after childbirth or providing a trusting atmosphere for women to express their feelings. Care is fragmented and inadequate, in part because of the lack of protocols that define who makes mental health referrals and where. Providers indicated PPD is important but not prioritized in health care for pregnant and postpartum women.

CONCLUSION

Critical needs in obstetric units include formal mental health care detection and care protocols during the perinatal period, strategies to address mental health needs despite short hospital stays, and training for providers on how to implement detection and care protocols and strategies.

Poor early childhood outcomes attributable to maternal depression in Mexican women

We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5 years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR = 1.77; p < .05), health problems (RR = 1.37; p < .05), acute respiratory disease (RR = 1.51; p < .05), accidents requiring child hospitalization (RR = 2.16; p < .01), and moderate or severe food insecurity (RR = 1.58; p < .001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR = 2.14; p < .05) and moderate or severe food insecurity (RR = 1.75; p < .01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.

The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder

The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions.

Risk profiles associated with postnatal depressive symptoms among women in a public sector hospital in Mexico: the role of sociodemographic and psychosocial factors

This study examined the association between postnatal depressive symptoms and a set of demographic and psychosocial factors among 604 women attending a public hospital for postnatal care in Mexico City. Specific profiles of women that would indicate an increased probability for developing postnatal depression (PND) based on discrete combinations of risk and protective factors were generated. In a logistic model, followed by the estimation of predicted probabilities, we examined the association between depressive symptomatology and psychosocial factors: low social support, unplanned pregnancies, history of depression, and exposure to moderate or severe intimate partner violence (IPV) during pregnancy. Postnatal depressive symptomatology was reported by 10.6 % of the women, as measured by scores at 12 or above on the Edinburgh Postnatal Depression Scale. The cumulative probability of presenting PND in the simultaneous presence of the psychosocial factors was 67.0 %; however, this could be reduced to 5.5 % through preventive measures that work to eliminate low social support, unplanned pregnancy, and exposure to severe IPV during pregnancy. Early identification of psychosocial risk factors, specifically low social support, unplanned pregnancies, history of depression, and exposure to violence during pregnancy, is recommended.

Factores individuales y familiares asociados con sintomatología depresiva en adolescentes de escuelas públicas de México

Objetivo. Estimar la prevalencia de sintomatología depresiva y explorar su asociación con factores individuales y familiares en estudiantes de escuelas públicas de nivel medio superior en México. Material y métodos. Estudio transversal con muestra representativa de 9 982 estudiantes de 14 a 19 años. Se estimaron modelos de regresión logística para obtener razones de momios (RM), con intervalos de confianza a 95% (IC95%). Resultados. El 27% de los estudiantes presentó sintomatología depresiva; la proporción fue mayor en mujeres (34%) que en hombres (18%). Factores asociados: sexo femenino (RM=2.25 IC95% 1.86-2.71); baja autoestima (RM=2.77 IC95% 2.41-3.19); consumo de alcohol (RM=1.72 IC95% 1.46-2.02); consumo de tabaco (RM=1.57 IC95% 1.31-1.88); consumo de drogas (RM=1.63 IC95% 1.29-2.05); violencia intrafamiliar (RM=2.05 IC95% 1.77-2.39); baja comunicación padres e hijos (RM=1.78 IC95% 1.59-2.00). Conclusiones. La sintomatología depresiva en estudiantes de nivel medio superior es un problema de salud pública en México. Se requiere la implementación de programas de intervención enfocados en el manejo de factores de riesgo asociados.

[Individual and family factors associated with depressive symptomatology in adolescents from public schools of Mexico]

OBJECTIVE

To estimate the prevalence of depressive symptoms (DS) and to explore associated individual and family factors in high-school students from public schools of Mexico.

MATERIALS AND METHODS

Cross-sectional study of a representative sample of 9 982 students aged between 14 and 19 years. Logistic regression models were used to estimate odds ratio (OR) with 95% confidence interval (CI95%).

RESULTS

27% of students presented DS, with higher proportion among women (34%) than among men (18%). Factors associated with DS were being female (OR=2.25 CI95% 1.86-2.71); low self-esteem (OR=2.77 CI95% 2.41 -3.19); consuming alcohol (OR= 1.72 CI95% 1.46-2.02), consuming tobacco (OR= 1.57 CI95% 1.31-1.88), consuming illegal drugs (OR=1.63 CI95% 1.29-2.05), domestic violence (OR=2.05 CI95% 1.77-2.39), and low communication between parents and their children (OR=1.78 CI95% 1.59-2.00).

CONCLUSIONS

Depressive symptomatology among high-school students in Mexico is a public health issue.There is a need for intervention programs aimed at tackling the associated risk factors.

[Maternal depressive symptomatology in México: National prevalence, care, and population risk profiles]

OBJECTIVE

This study estimates the prevalence of depressive symptomatology (DS) in women with children younger than five years of age, examines detection and care rates and probabilities of developing DS based on specific risk profiles.

MATERIALS AND METHODS

The sample consists of 7 187 women with children younger than five drawn from the Ensanut 2012.

RESULTS

DS prevalence is 19.91%, which means at least 4.6 million children live with mothers who experience depressive symptoms indicative of moderate to severe depression. Rates of detection (17.06%) and care (15.19%) for depression are low. DS is associated with violence (OR=2.34; IC95% 1.06-5.15), having ≥4 children, having a female baby, older age of the last child, low birth weight, food insecurity, and sexual debut <15 years old (p<0.01). Accumulated probability of DS, taking into consideration all risk factors measured, is 69.76%. It could be reduced to 13.21% through prevention efforts focused on eliminating violence, food insecurity, bias against having a female baby, and low birth weight.

CONCLUSIONS

DS is a compelling public health problem in Mexico associated with a well-defined set of risk factors that warrant attention and timely detection at various levels of care.

Discrete subgroups of adolescents diagnosed with borderline personality disorder: a latent class analysis of personality features

Research suggests that borderline personality disorder (BPD) can be diagnosed in adolescents and is marked by considerable heterogeneity. This study aimed to identify personality features characterizing adolescents with BPD and possible meaningful patterns of heterogeneity that could lead to personality subgroups. The authors analyzed data on 60 adolescents, ages 15 to 18 years, who met DSM criteria for a BPD diagnosis. The authors used latent class analysis (LCA) to identify subgroups based on the personality pattern scales from the Millon Adolescent Clinical Inventory (MACI). LCA indicated that the best-fitting solution was a two-class model, identifying two discrete subgroups of BPD adolescents that were described as internalizing and externalizing. The subgroups were then compared on clinical and sociodemographic variables, measures of personality dimensions, DSM BPD criteria, and perception of attachment styles. Adolescents with a BPD diagnosis constitute a heterogeneous group and vary meaningfully on personality features that can have clinical implications for treatment.

[Child wellbeing and development indicators in Mexico]

OBJECTIVE

To provide evidence and input for monitoring child welfare and wellbeing in Mexico.

MATERIALS AND METHODS

Adjusting for sampling design, information from ENSANUT 2012 for children <10 years was compared with national and international parameters and goals.

RESULTS

While 8.37% of infants were born with low birth weight (<2,500 g), neonatal screening was not performed on 9.4% of newborns. Of children <5 years, 78.03% were breastfed until at least four months. Among mothers of newborns, 69.5% received training in early stimulation. At the national level, 28% of children (23% in rural areas) received five medical consultations to monitor their early development. 29% of children either had a disability or were at risk of developing one.

CONCLUSIONS

Progress has been made in Mexico in terms of services promoting early child development and wellbeing but important challenges persist. National standards and a system for monitoring, screening, referring and providing care for child development and wellbeing are necessary.

[Use of contraception and family planning in adolescent and adult women in Mexico]

OBJECTIVE

To offer current evidence about age at sexual initiation and contraceptive use among adolescent and adult women of different age groups, places of residence, and marital status in Mexico.

MATERIALS AND METHODS

Data were analyzed from ENSANUT 2006 and 2012 surveys on knowledge and use of contraceptives.

RESULTS

In 2012 31.2% of 15-19 year old adolescent women had undergone sexual debut. Condom use increased from 31.8% in 2006 to 47.8% in 2012. Women in rural areas reported lower levels of contraceptive use at last sexual intercourse; 47.9% of 30-34 year-old and 53.2% of 35-49 year-old women reported not using any contraception at last sexual intercourse. A high percentage of women did not adopt contraception after the most recent obstetric event: 52% (15-19 years), 44.2% (20-29 years), 42.5% (30-34 years) and 39% (≥35 years)].

CONCLUSIONS

Equitable policies to promote contraception, particularly after a post-obstetric event, are needed.

Diverse physical growth trajectories in institutionalized Portuguese children below age 3: relation to child, family, and institutional factors

OBJECTIVE

To identify and analyze diverse longitudinal trajectories of physical growth of institutionalized children and their relation to child, family, and institutional factors.

METHODS

49 institutionalized children were studied for 9 months after admission. Weight, height, and head circumference were measured on 4 occasions, beginning at admission. Data were analyzed using latent class analysis, yielding diverse patterns of growth for each feature, and relations with child characteristics, early family risk factors, and institutional relational care were investigated.

RESULTS

For each growth feature, 4 classes emerged: "Persistently Low," "Improving," "Deteriorating," and "Persistently High." Younger age at admission was a risk factor for impaired physical growth across all domains. Physical characteristics at birth were associated with trajectories across all domains. Lower prenatal risk and better institutional relational care were associated with Improving weight over time.

CONCLUSIONS

Discussion highlights the role of children's physical features at birth, prenatal risk, and caregiver's cooperation with the child in explaining differential trajectories.

[Prevalence and factors associated with suicidal behavior among Mexican students]

OBJECTIVE

To identify the prevalence of and factors associated with suicidal ideation and intent in adolescent students in Mexico.

MATERIAL AND METHODS

A cross-sectional study was conducted with a sample of 12,424 students from public schools in 2007. We used logistic regression to obtain odds ratios (OR) with 95% confidence intervals.

RESULTS

A total of 47% of the students reported at least one suicidal ideation symptom and 9% reported an antecedent of suicidal intent. Factors associated with suicide ideation and intent include low confidence in communication with parents (OR=1.30; OR=1.54), sexual abuse (OR=1.92; OR=1.57), depressive symptoms (OR=5.36; OR=1.51), tobacco use (OR=1.30; OR=2.57), alcohol use (OR=1.60; OR=1.31) and, for women, having had sexual relations (OR=1.28; OR=1.65).

CONCLUSIONS

Roughly 50% of high school students had at least one symptom of suicidal ideation. To lessen this problem, associated factors should be considered, including consumption of addictive substances, gender, history of sexual abuse and depression.

Case report: reversible mitral regurgitation and congestive heart failure complicating thyrotoxicosis

Congestive heart failure is a relatively uncommon manifestation of thyrotoxic heart disease, and different mechanisms have been proposed. The authors present a possible explanation of congestive heart failure in some cases of thyrotoxicosis. A 39 year-old woman with Graves' disease was hypermetabolic, in atrial fibrillation, and had signs of congestive heart failure. She had a loud murmur of mitral regurgitation, clinical cardiomegaly, accentuated pulmonic sound, and peripheral edema. Propranolol reduced the heart rate to 60 beats per minute, but the loud mitral regurgitation murmur persisted. Echocardiographic and angiographic data were consistent with moderate to severe mitral regurgitation, serious enough to consider mitral valve replacement. As the patient's hyperthyroid state came under control, weight increased and the cardiac murmur resolved. After radioactive iodine treatment and the return to a eumetabolic state, an echocardiogram revealed only trace mitral regurgitation, with near normal left ventricular function and pulmonary arterial systolic pressures. These findings were confirmed by subsequent cardiac catheterization. The authors believe that mitral regurgitation, perhaps secondary to intrinsic papillary muscle dysfunction from hyperthyroidism, was the major cause of reversible congestive heart failure in this case. Valvular disease may play a more substantive role in thyrotoxic heart disease than previously recognized.