Related Experiment Videos
Variation in coverage by ethnic group of neonatal (Guthrie) screening programme in south London
A Streetly1, C Grant, G Bickler
1United Medical School, Department of Public Health Medicine, St Thomas's Hospital, London.
Insights
Neonatal screening for sickle cell disease has incomplete coverage, particularly for African infants and those with mobile families. Improved monitoring systems are needed for this vital public health program.
Area of Science:
- Public Health
- Genetics
- Neonatal Care
Background:
- Neonatal screening programs are crucial for early detection of genetic disorders.
- Sickle cell disease is a significant health concern, particularly in at-risk ethnic groups.
- The Guthrie (neonatal) screening programme in Britain aims to identify various conditions at birth.
Purpose of the Study:
- To evaluate the coverage of the neonatal screening programme for sickle cell disease in Britain.
- To identify disparities in screening coverage among different ethnic groups and risk populations.
- To investigate reasons for incomplete screening coverage, including family mobility and geographic factors.
Main Methods:
- A descriptive study design was employed to assess screening programme coverage.
- Data were collected on 1727 infants born between October and December 1991 in two London health districts.
- Coverage variation was analyzed based on infant's ethnic group, family mobility, and district of residence.
Main Results:
- Overall screening coverage was 96.3%, with variations between districts.
- Infants of African ethnicity had a significantly higher odds ratio of not being tested compared to white infants.
- Family mobility around the time of birth was strongly associated with lower screening test completion rates.
Conclusions:
- The neonatal screening programme exhibits incomplete coverage, disproportionately affecting infants of African ethnicity and those from mobile families.
- Current monitoring systems for the screening programme are inadequate.
- Recommendations include establishing an improved monitoring system, similar to the national immunisation programme, to enhance screening coverage and equity.
Objectives:
To determine whether coverage of the neonatal (Guthrie) screening programme in Britain is different for groups at highest risk of sickle cell disease and to identify possible reasons for incomplete coverage.
Design:
Descriptive study of coverage of screening programme and its variation by mobility, district of residence, and ethnic group.
Subjects:
1727 infants born between 1 October and 31 December 1991.
Setting:
Former West Lambeth and Camberwell District Health Authorities, London.
Main Outcome Measure:
Proportion of infants with an identifiable screening test result.
Results:
Screening covered 1663/1727 (96.3%) infants overall (745/786 (94.8%) in West Lambeth; 918/941 (97.6%) in Camberwell). The relative odds ratio of an African infant not having been tested compared with a white infant was 3.05 (95% confidence interval 1.30 to 7.14) (2.08 (0.86 to 5.01) after adjustment for mobility and district of residence). For infants whose families moved into the districts after the birth compared with those born and resident in the districts the relative odds ratio of having been tested was 10.16 (4.85 to 21.29). The odds ratio of locally delivered infants in West Lambeth not having been tested compared with those in Camberwell was 2.12 (1.08 to 4.16) after adjustment for ethnic group.
Conclusion:
Coverage of the screening programme is incomplete and poorer in infants of African ethnic group than in white infants. Poorer coverage is also associated with mobility of the family around the time of birth. The findings have implications for using the neonatal programme for testing for sickle cell disease and other disorders. Arrangements for monitoring the existing screening programme are inadequate and an improved system should be established, similar to the scheme that monitors the immunisation programme.