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How universal are universal preschool health checks? An observational study using routine data from New Zealand's B4
Sheree Gibb1,2, Barry Milne2,3, Nichola Shackleton2,3
1Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
Insights
Preschool health screen participation varied, with Māori and Pacific children less likely to attend. Addressing disparities is crucial to ensure all children receive necessary health checks.
Area of Science:
- Child Health
- Public Health
- Health Services Research
Background:
- Universal preschool health screenings are vital for early detection of developmental and health issues.
- Understanding participation patterns in these screenings is essential for equitable service delivery.
Purpose of the Study:
- To estimate attendance rates for a universal preschool health screen (B4 School Check).
- To identify demographic and socioeconomic factors associated with non-participation in the B4 School Check.
Main Methods:
- Analysis of linked, population-level administrative data from New Zealand.
- Inclusion criteria focused on residency, survival, and engagement with health services or birth registration.
- Data spanned four years (July 2011 to June 2015) for over 250,000 eligible children.
Main Results:
- Participation rates for B4 School Check components varied, with vision and hearing tests (VHTs) at 91.8% and teacher-reported Strengths and Difficulties Questionnaire (SDQ-T) at 62.1% in 2014/2015.
- Participation rates increased over the study period.
- Māori and Pacific children, those from deprived areas, younger mothers, rented housing, larger households, poorer health status, and higher residential mobility were less likely to participate.
Conclusions:
- Non-participation patterns indicate a potential exacerbation of existing health disparities.
- Children with potentially greater needs may be less likely to access essential health screenings.
- Increased efforts from public health organizations and communities are needed to ensure equitable B4 School Check participation for all children.
Objectives:
We aimed to estimate how many children were attending a universal preschool health screen and to identify characteristics associated with non-participation.
Design:
Analysis of population-level linked administrative data.
Participants:
Children were considered eligible for a B4 School Check for a given year if:(1) they were ever resident in New Zealand (NZ),(2) lived in NZ for at least 6 months during the reference year, (3) were alive at the end of the reference year, (4) either appeared in any hospital (including emergency) admissions, community pharmaceutical dispensing or general practitioner enrolment datasets during the reference year or (5) had a registered birth in NZ. We analysed 252 273 records over 4 years, from 1 July 2011 to 30 June 2015.
Results:
We found that participation rates varied for each component of the B4 School Check (in 2014/2015 91.8% for vision and hearing tests (VHTs), 87.2% for nurse checks (including height, weight, oral health, Strengths and Difficulties Questionnaire [SDQ] and parental evaluation of development status) and 62.1% for SDQ - Teacher [SDQ-T]), but participation rates for all components increased over time. Māori and Pacific children were less likely to complete the checks than non-Māori and non-Pacific children (for VHTs: Māori: OR=0.60[95% CI 0.61 to 0.58], Pacific: OR=0.58[95% CI 0.60 to 0.56], for nurse checks: Māori: OR=0.63[95% CI 0.64 to 0.61], Pacific: OR=0.67[95% CI 0.69 to0.65] and for SDQ-T: Māori: OR=0.76[95% CI 0.78 to 0.75], Pacific: OR=0.37[95% CI 0.38 to 0.36]). Children from socioeconomically deprived areas, with younger mothers, from rented homes, residing in larger households, with worse health status and with higher rates of residential mobility were less likely to participate in the B4 School Check than other children.
Conclusion:
The patterns of non-participation suggest a reinforcing of existing disparities, whereby the children most in need are not getting the services they potentially require. There needs to be an increased effort by public health organisations, community and whānau/family to ensure that all children are tested and screened.
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