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Vision screening in New Zealand pre-school children: Is it equitable?
Rebecca Findlay1, Lisa Hamm1, Nicola Anstice1,2
1School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.
Insights
Vision screening coverage and testability varied significantly among New Zealand preschoolers based on ethnicity, socioeconomic status, and region. Targeted equity initiatives are needed to improve outcomes for Māori, Pacific, and low-income children.
Area of Science:
- Public Health
- Ophthalmology
- Pediatrics
Background:
- The B4 School Check is a universal vision screening program for 4-5-year-old children in New Zealand.
- Understanding disparities in program reach and effectiveness is crucial for improving child health outcomes.
Purpose of the Study:
- To investigate variations in vision screening coverage and testability by ethnicity, socioeconomic status, and geographic location.
- To identify inequities in the B4 School Check program for preschool children in New Zealand.
Main Methods:
- Analysis of aggregated data from July 2011 to June 2015 from Statistics New Zealand.
- Stratification of screening attendance and visual acuity measurement data by ethnicity, socioeconomic status, and region.
- Calculation of coverage by comparing screened children to the eligible population and testability by comparing those with recorded visual acuity to those who attended screening.
Main Results:
- Overall vision screening coverage was 89.5% and testability was 97.8%.
- Significant ethnic disparities were observed: coverage was lower for Pacific (85.7%) and Māori children, and testability was lower for Māori children (96.4%) compared to European children.
- Socioeconomic and regional variations also indicated disparities, with lower coverage and testability in more deprived areas and wider ranges across regions.
Conclusions:
- The B4 School Check program exhibits significant disparities in coverage and testability, particularly affecting Māori, Pacific, and children from lower socioeconomic backgrounds.
- Equity-focused initiatives are essential to address these gaps and improve vision screening outcomes for vulnerable preschool populations.
- Further research is needed to understand the root causes of these inequities and their interactions with demographic factors.
Aim:
This study aimed to investigate the variability by ethnicity, socio-economic status and location in coverage and testability of the universal B4 School Check vision screening in children aged 4-5 years in New Zealand.
Methods:
Aggregated data from 1 July 2011 to 30 June 2015 were sourced from the Statistics New Zealand Integrated Data Infrastructure. Sourced data were attendance at vision screening and record of visual acuity measurement stratified by ethnicity, socio-economic status and region. Children who attended screening were compared with the eligible population (n = 252 279) to calculate coverage. Testability was determined by comparing the children with a recorded visual acuity measurement in each eye with those who attended screening.
Results:
Overall vision screening coverage was 89.5% and testability was 97.8%. Ethnic differences were evident for coverage (85.7% in Pacific children, 92.5% in European children) and testability (96.4% in Māori children, 98.4% in European children). Socio-economic differences were also observed for coverage (86.4% in most deprived areas, 92.4% in least deprived), testability (most deprived 96.3%, least deprived 98.7%) and by region (coverage range of 80.4-96.4% and testability range of 93.2-99.3%).
Conclusions:
Significant disparities exist in vision screening coverage and testability for New Zealand pre-school children. Equity-focused initiatives are required to improve outcomes for children from Māori and Pacific families, and those from households in lower socio-economic areas. Understanding region-specific challenges and successes could support more equitable access to vision screening between regions. Further research is required to determine sources of inequities and to investigate interactions between ethnicity, socio-economic status and location.
