Measurement of socio‐economic status in families of children with cancer in Guatemala

Abstract

The prospects for survival of children in low and middle income countries are linked to their families socio-economic status (SES), of which income is only one component. Developing a comprehensive measure of SES is required. Informed by clinical experience, a 15-item instrument was designed in Guatemala to categorize SES by five levels in each item. Almost 75% of families attending the Unidad Nacional de Oncología Pediátrica were in the lowest three of six categories, providing a framework for stratified financial and nutritional support. The measure of SES offers an opportunity for examining associations with health outcomes throughout Latin America.

Incidence and consequences of varicella in children treated for cancer in Guatemala

“…This minimum estimate is nearly one-third the annual per capita income in Guatemala of 2740 USD, and a recent study categorized 73% of families at UNOP as below the poverty line. [17] The universal use of varicella vaccine in young children has resulted in a 70%-98% decrease in the varicella incidence in the U.S. and other countries. [26][27][28] This policy provides varicella-specific immunity to most children prior to developing a malignancy and induces herd protection, decreasing the risk of transmission to those who lack adequate immunity due to their age, lack of response, or underlying disease.…”

“…Approximately 30% of patients have advanced disease at diagnosis and 50% of those newly diagnosed with ALL are undernourished, although nutritional status improves with support during cancer therapy. [17,18] Standard practice at UNOP at the time of the study was to treat varicella only when children presented to the clinic with symptoms; varicella-zoster immune globulin for post-exposure prophylaxis is unavailable and acyclovir was not used for this purpose. Laboratorybased diagnostic tests are not used, nor do patients undergo serologic screening.…”

Nutritional status at diagnosis of cancer in children and adolescents in Guatemala and its relationship to socioeconomic disadvantage: A retrospective cohort study

“…A comprehensive 15‐item instrument with five ordinal levels in each item, developed at UNOP, was used by social workers to assess SES at diagnosis . The 15 domains are marital status; number of occupants living in the home who are employed; highest level of education of the head of the family; status of the dwelling; construction of the dwelling; mode of sanitation; means of communication; distance from/mode of transport to UNOP; family income per month; source/cost of water supply for drinking; source/cost of lighting; cost of food per month; types of resources for education and available expenditure on children's education; source of medication in the family; and expenditure on recreation per month.…”

“…The ranges of scores are not equal because the initial purpose of the instrument was to link SES with the supply of resources to meet the needs of families . For the purpose of the current study, the top three categories were combined in analyses.…”

“…The probabilities of survival and cure in LMIC are not as encouraging as in high‐income countries (HIC), for the less‐developed economies result in unstable health systems together with limited access to food, education, and new technologies otherwise available in developed economies . Malnutrition and socioeconomic disadvantages are especially prevalent in LMIC and are strongly linked to adverse outcome, as had been demonstrated specifically in Central America . In children with cancer, malnutrition is related to the disease itself, treatment‐related mortality, and economic and social deprivation.…”