For the first time in Mexico, a special number of the Boletín Médico del Hospital Infantil de México (BMHIM) is dedicated to the theme of early childhood development (ECD). Why should this theme be emphasized?
Hospitals and specialists, both in pediatrics and child neurology, tend to focus more on curing diseases rather than on addressing an issue such as ECD whose concept is, in essence, multifactorial, promotional and preventive and must be addressed from the perspective of the healthy child, especially at the primary healthcare level.1-3
It is worth noting that ECD appeared in Mexico for the first time in the National Development Plan 2013-2018.4 Nowadays, the intersectoral and integral role is recognized in the actions of social protection, health, education and sectors that deal with the creation of conditions favoring ECD and it has been established in the recently enacted General Law on the Rights of Children and Adolescents.5.
The conceptual framework of the model of Promotion and Care of Child Development (PRADI) presented by O’Shea-Cuevas et al.6 provides an ecological approach to child development within a rights framework. It places the family as the most immediate context to health and child development, making it the focus of interventions. The importance of the health sector is emphasized. It is the closest public service for the family and children from the time of pregnancy, childbirth, puerperium and early life. It is also where vaccination and nutritional programs are implemented and morbidity prevalence assistance is provided, among other actions.
In this issue of BMHIM, different screening tests available in Mexico are analyzed critically and objectively, based on validation studies and their properties such as sensitivity and specificity.7 On the Child Development Evaluation (CDE) screening test8 designed and validated in Mexico in 2011,9-11, an analysis of the quality of training of human resources for the implementation of this test12 and the monitoring for its correct application in the field13 is done, which is essential to ensure the quality of the measurements, referrals and interventions. As a result, there are two population-based studies regarding the implementation of the CDE presented in this issue. In one study, the usefulness of the field test is confirmed with a low false positive rate (6.5-6.8%) in children previously identified with developmental delay,14 and the other study presents interesting findings in the population who are beneficiaries of the PROSPERA Program: the significant increase in the prevalence of an abnormal result in the CDE as the age increases (9.9% in <1 year and 20.8% in 4-year-old children) and differences by gender and location (urban vs. rural) in the affected development areas.15 These findings raise new questions as well as the need to strengthen actions in all types of locations.
Undoubtedly, in the near future we will be reading in this Journal, which has been a landmark for Latin America, studies showing the results of public policies and interventions implemented, lessons learned from carrying out local initiatives at the national level, monitoring intervention levels in ECD, local management, cultural relevance, gender equality and other substantive elements for human development.
Both the HIMFG team as well as regional teams involved are part of a novel process of high technical and scientific level. This team has managed to place an integrative view of the different knowledge and skills necessary to address ECD16 and have advocated in various technical and political areas of the country (a critical issue because the will of the government is a requirement).
It begins from the validation of a screening instrument and culminates with a public policy of high social value and with great potential for growth, including a system of short-, medium-, and long-term social protection and strategies. The challenges of sustainability and impact are an incentive to advance steadily.
Funding
No external funding was received for carrying out this study.
Conflict of interest
The author declares that there are no conflicts of interest.
E-mail:helia.molina@usach.cl