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Ruiz OA, Ancira-Moreno M, Omaña-Guzmán I, Cordero SH, Morales ACB, Navarro CP, Méndez SB, Flores EM, Trejo A, Kaufer-Horwitz M, Cajero A, Sánchez B, Bernat C, Salgado-Amador E, Hoyos-Loya E, Mazariegos M, Manrique CM, Cruz RP, Mendoza E, Brero M, Sachse M, Armijo FC. Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders. Int J Equity Health 2024; 23:35. [PMID: 38388936 PMCID: PMC10885649 DOI: 10.1186/s12939-024-02129-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. METHODS We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. RESULTS Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. CONCLUSIONS These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.
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Grants
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
- RFP9156422 UNICEF, Mexico
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Affiliation(s)
- Omar Acosta Ruiz
- Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Monica Ancira-Moreno
- Health Department, Universidad Iberoamericana, Mexico City, Mexico.
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico.
| | - Isabel Omaña-Guzmán
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México, "Dr. Eduardo Liceaga,", Mexico City, Mexico
| | - Sonia Hernández Cordero
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | | | | | - Soraya Burrola Méndez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Eric Monterrubio Flores
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alejandra Trejo
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Martha Kaufer-Horwitz
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ariana Cajero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Belén Sánchez
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Constanza Bernat
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Elder Salgado-Amador
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Cinthya Muñoz Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Royer Pacheco Cruz
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Instituto de Nutrición, Universidad de la Sierra Sur, Oaxaca, México
| | - Elvia Mendoza
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Matthias Sachse
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
| | - Fernanda Cobo Armijo
- United Nations International Children's Emergency Fund (UNICEF), Mexico City, México
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Hoyos-Loya E, Pérez Navarro C, Burrola-Méndez S, Hernández-Cordero S, Omaña-Guzmán I, Sachse Aguilera M, Ancira-Moreno M. Barriers to promoting breastfeeding in primary health care in Mexico: a qualitative perspective. Front Nutr 2024; 10:1278280. [PMID: 38264191 PMCID: PMC10803647 DOI: 10.3389/fnut.2023.1278280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Objective This article aimed to identify the main barriers related to promoting and counseling breastfeeding (BF) at the Primary Health Care (PHC) in Mexico. Methodology A qualitative study with a phenomenological approach was carried out in 88 health centers of the Ministry of Health in the states of Chihuahua, Oaxaca, Chiapas, Veracruz, Mexico, and Yucatan. From September to November 2021, we interviewed 88 key health professionals (HPs) (physicians, nurses, nutritionists, and others) from the PHC of the Ministry of Health in Mexico and 80 parents of children under 5 years old. In addition, nine focus groups were conducted with parents and caregivers. The data obtained were triangulated with information from focus groups and semi-structured interviews. Results Of the total interviews, 43.2% (n = 38) were nurses, 29.5% (n = 26) were physicians, 19.3% (n = 17) were nutritionists, and the rest were other health professionals. In the group of users, 97.6% (n = 121) were women. We identified contextual barriers, such as the lack of well-trained health professionals and the scarcest nutrition professionals, as material resources in the health units, without mentioning the low user attendance at their control consultations. Furthermore, we identified barriers related to the orientation and promotion of breastfeeding in health units, including a lack of specific strategies, ineffective communication, and the recommendations of commercial milk formulas. Conclusion The results presented reflect the reality of Mexico in relation to BF, making it urgent to take immediate action to improve the quality of nutritional care related to the promotion and orientation of BF at the PHC.
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Affiliation(s)
- Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Isabel Omaña-Guzmán
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | | | - Mónica Ancira-Moreno
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
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Ancira-Moreno M, Omaña-Guzmán I, Bautista-Morales AC, Acosta-Ruiz O, Hernández Cordero S, Burrola-Méndez S, Vilar-Compte M, Monterrubio Flores E, Kaufer-Horwitz M, Pérez Navarro C, Muñoz-Manrique C, Mazariegos M, Trejo-Domínguez A, Sánchez Muzquiz B, Cajero A, Brero M, Sachse M, Cobo Armijo F. Development and validation of a new set of indicators to assess the quality of maternal and child nutritional care at the primary care. Front Med (Lausanne) 2022; 9:1011940. [PMID: 36569141 PMCID: PMC9769120 DOI: 10.3389/fmed.2022.1011940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC. Methods We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted. Results Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.
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Affiliation(s)
| | | | | | - Omar Acosta-Ruiz
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Sonia Hernández Cordero
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | | | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Eric Monterrubio Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Cinthya Muñoz-Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Ariana Cajero
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Matthias Sachse
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Fernanda Cobo Armijo
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
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Vilar-Compte M, Hernández-Cordero S, Ancira-Moreno M, Burrola-Méndez S, Ferre-Eguiluz I, Omaña I, Pérez Navarro C. Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. Int J Equity Health 2021; 20:110. [PMID: 33926471 PMCID: PMC8082937 DOI: 10.1186/s12939-021-01432-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. Methods A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women’s working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). Results Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. Conclusions The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers – individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers’ self-esteem and outcomes such productivity and abstentionism.
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Affiliation(s)
- Mireya Vilar-Compte
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.
| | - Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Ferre-Eguiluz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Omaña
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.,Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
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Abstract
During insulin stupor in mice, acetylcholine levels in cerebral cortex, cerebellum, brainstem, striatum, and hippocampus were unchanged from control values despite brain glucose concentrations 3-10% of normal, whereas choline levels rose 2.4-3.6-fold in all five CNS regions. Brain acetylcholine and choline levels did not change during recovery following glucose injection. The data suggest that, in hypoglycemic stupor, (1) overall rates of acetylcholine synthesis and degradation remain balanced within each of the CNS regions studied; (2) the biochemical mechanism that elevates brain choline levels is unlikely to be related only to cholinergic synaptic processes; and (3) brain choline levels need not rise for stupor to occur.
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