Access barriers to health care for Latino children.

BACKGROUND: Latinos will soon be the largest minority group in the United States, but too little is known about major access barriers to health care for this group and whether these barriers result in adverse consequences. OBJECTIVE: To identify important access barriers to health care for Latino children, as cited by parents. DESIGN: Cross-sectional survey of parents of all 203 children coming to the pediatric Latino clinic at an innercity hospital. Questions focused on barriers to health care experienced prior to receiving care at the Latino clinic. RESULTS: Parental ethnicity included Dominican (36%), Puerto Rican (34%), Central American (13%), and South American (11%). Only 42% of parents were American citizens, whereas 36% had green cards, and 13% had no documentation. Eight percent of parents and 65% of the children were born in the United States. Parents rated their ability to speak English as follows: very well/well, 27%; not very well, 46%; and not at all, 26%. The median annual household income was $11,000; 40% of parents never graduated from high school, and 49% headed single-parent households. Forty-three percent of the children were uninsured. A sick child was routinely brought to hospital clinics by 56% of parents, to the emergency department by 21%, and to neighborhood health centers by 21%. When asked to name the single greatest barrier to health care for their children, parents cited language problems (26%), long waiting time at the physician's office (15%), no medical insurance (13%), and difficulty paying medical bills (7%). When parents were asked if a particular barrier had ever caused them not to bring their children in, transportation was cited by 21%; not being able to afford health care, 18%; excessive waiting time in the clinic, 17%; no health insurance, 16%; and lack of cultural understanding by staff, 11%. Some parents who spoke little or no English reported that medical staff not speaking Spanish had led to adverse health consequences for their children, including poor medical care (8%), misdiagnosis (6%), and prescription of inappropriate medications (5%). Multivariate analyses of selected health outcomes using 7 independent variables showed that low family income was significantly associated with greater odds of a child's having suboptimal health status (odds ratio, 1.5; 95% confidence interval, 1.04-2.2) and an increased number of physician visits in the past year (P<.04), but reduced odds (odds ratio, 0.6; 95% confidence interval, 0.4-0.9) of the child's being brought to the emergency department for a routine sick visit. Children whose parents had resided in the United States for fewer than 8 years were at reduced odds (odds ratio, 0.5; 95% confidence interval, 0.2-0.9) for having spent a day or more in bed for illness in the past year. CONCLUSIONS: Parents identified language problems, cultural differences, poverty, lack of health insurance, transportation difficulties, and long waiting times as the major access barriers to health care for Latino children. Language problems can result in adverse health consequences for some children, including poor medical care, misdiagnosis, and inappropriate medication and hospitalization. Low family income is an important independent risk factor among Latino children for suboptimal health and high utilization of health services.

Using clinical signs to diagnose anaemia in African children.

Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of the conjunctiva, tongue, palm or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate a anaemia (haemoglobin concentration, 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anaemia (haemoglobin concentration, < 5 g/dl). Even without laboratory support, which is often unavailable in rural Africa, clinical findings can identify the majority of children with anaemia.

PIP: Anemia is a serious and common problem among young children in Sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, a study was conducted to evaluate the ability of health workers to use clinical findings to identify children with anemia. The study was conducted in the outpatient departments of Mangochi District Hospital and Nkhoma Hospital, serving predominately rural areas. A systematic sample was recruited by approaching the parent of every 4th sick child brought to the clinic for under-5-year-olds in Mangochi between April 17 and May 28, 1993, and every 2nd and 3rd sick child brought to the pediatric clinic in Nkhoma between April 28 and June 5, 1993. Of these, 1104 (97%) underwent a physical examination of the conjunctiva, tongue, palm, and nail bed, and a blood test was taken to determine haemoglobin concentration. The median age of the enrolled children was 13 months (range, 1 month to 60 months); 580 (53%) were boys, and 590 (53%) were seen at Mangochi District Hospital. The mean hemoglobin concentration of enrolled patients was 8.8 g/dl (range, 2.1-17.1 g/dl). 82% were anemic according to the World Health Organization definition; 35% had moderate anemia; and 5% had severe anemia. Pallor of the conjunctiva, tongue, palm, or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate anemia (hemoglobin concentration, 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anemia (hemoglobin concentration, 5 g/dl). Probable pallor at any anatomical site was 70% sensitive, 68% specific, and had a 54% positive predictive value in diagnosing a hemoglobin concentration of 8 g/dl. Multiple linear regression models predicting haemoglobin levels showed that children with definite pallor had significantly lower hemoglobin concentrations than children with probable pallor, and those with probable pallor had significantly lower concentrations than those without pallor (p 0.05 for each comparison). Laboratory support is often unavailable in rural Africa, thus clinical findings can identify the majority of children with anemia.