Pediatr Blood Cancer 2014;61:2071–2073 BRIEF REPORT Measurement of Socio-Economic Status in Families of Children with Cancer in Guatemala M. De Pernillo, 1 S. Rivas, 1 L. Fuentes, 1 F. Antillon, 1 and R.D. Barr 2 * INTRODUCTION Poor socio-economic status (SES) in their families is an important contributing factor to the compromised survival of children with cancer in low and middle income countries (LMICs) [1]. Among the mechanisms that connect poor SES with compromised health outcomes are under-nutrition [2], treatment-related morbidity and mortality [3] (TRM), and abandonment of therapy [4]. Identification of families who are most at risk would allow the use of interventions to reverse under- nutrition [5], reduce TRM [6] and minimize abandonment of therapy [7]; all leading to a diminution of treatment failure with improved prospects for cure. Guatemala is the most populous country (total population more than 14 million) in Central America, and, with an annual per capita income of US$ 2,740 in 2010, has been categorized as low middle income by the World Bank [8]. However, it has been estimated that 15% of the population live in extreme poverty [9] and there is marked income maldistribution; the wealthiest 10% accounting for 47% of the income consumption while the poorest 19% account for only 1% [10]. Of course there is more to SES than income and a consequent need to include other important contributory elements, such as the types of housing, water supply and sanitation. To that end an instrument has been developed for the measurement of SES in the families of newly diagnosed children with cancer in Guatemala. As the original instrument is in Spanish, it should be applicable, with modest local modifications, throughout most of Latin America and Mexico. METHODS Based on clinical experience, the staff at the Unidad Nacional de Oncologı ´a Pedia ´trica (UNOP) in Guatemala City designed a 15- item instrument with five ordinal levels in each item to capture a broad array of information pertaining to SES. The 15 domains are: Income according to social 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 resource for education and available/expenditure on children’s education; source of medication in the family; expendi- ture on recreation per month. Summative scores range from 15 (high) to 75 (low/poor SES). The instrument is provided in English and Spanish in the Supplementary Material. The questionnaire was completed in a mean time of 15 minutes. Families were categorized into six groups of SES: high (score 15–20), medium high (21–25), medium (26–30), medium low (score 31–45), low (46–60), and extremely low (61–75). In order to identify the families in need of support, and to provide effective interventions, the width of the ranges of scores was skewed purposefully to accomodate those with more compromised SES. The assignment of scores was accom- plished by social workers and psychologists in interviews with families. It was intended to capture information on the families of all newly diagnosed children during the calendar year 2012 (n ¼ 406). RESULTS The information on age, sex, and disease, according to the International Classification of Childhood Cancer [11], is provided in Table I. The interviews were completed on all families. Categorization of SES yielded the following distribution: High 6 (1.5%); medium high 22 (5.4%); medium 98 (19.2%); medium low 116 (28.6%); low 145 (35.7%); extremely low 39 (9.6%). Almost 75% of the families were in the lowest three categories. Based on this categorization, a policy of social support has been enacted, focusing on meeting financial expenses and the provision of food (Table II). This template provides the framework for the distribution of resources by the social workers. 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 Oncologı ´a Pedia ´trica 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. Pediatr Blood Cancer 2014;61:2071–2073. # 2014 Wiley Periodicals, Inc. Key words: cancer; children; measurement; socio-economic status Additional supporting information may be found in the online version of this article at the publisher’s web-site. 1 National Pediatric Oncology Unit (Unidad Nacional de Oncologı ´a Pedia ´trica), Guatemala City, Guatemala; 2 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada Grant sponsor: Foundation – Help Me to Live Conflict of Interest: Nothing to report.  Correspondence to: Ronald D. Barr, Department of Pediatrics, McMaster University, Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8S 4J9. E-mail: rbarr@mcmaster.ca Received 6 December 2013; Accepted 18 March 2014  C 2014 Wiley Periodicals, Inc. DOI 10.1002/pbc.25060 Published online 19 April 2014 in Wiley Online Library (wileyonlinelibrary.com).