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How universal are universal preschool health checks? An observational study using routine data from New Zealand’s B4 School Check

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Authors:
Summary:

These researchers analysed data from 252,273 New Zealand children who completed a B4 School Check over 4 years, from 1 July 2011 to 30 June 2015. The study aimed to determine characteristics associated with non-participation in this universal preschool health screen. The study grouped the B4 School Check into 3 components: vision and hearing test (VHT) checks; nurse checks (height, weight, oral health, Strengths and Difficulties Questionnaire [SDQ] and parental evaluation of development status); and SDQ-Teacher check. Participation rates varied for each component of the B4 School Check (in 2014/2015, completion was highest at 91.8% for vision and hearing tests, followed by 87.2% for nurse checks and 62.1% for the SDQ-T), although participation rates for all components increased over time. The checks were less likely to be completed by Māori and Pacific children than by non-Māori and non-Pacific children (for VHTs: Māori: OR 0.60; 95% CI, 0.61 to 0.58; Pacific: 0.58; 0.60 to 0.56; for nurse checks: Māori: 0.63; 0.64 to 0.61; Pacific: 0.67; 0.69 to 0.65; and for SDQ-T: Māori: OR 0.76; 0.78 to 0.75; Pacific: 0.37; 0.38 to 0.36). Other characteristics that predicted a lower likelihood of participation in the B4 School Check included living in socioeconomically deprived areas, having younger mothers, living in rented homes and in larger households, having worse health status and living with higher rates of residential mobility, compared with children who completed the B4 School Check.

Comment:
I agree with the authors in the respect that screening is an important part of the pathway from diagnosis to management to better outcomes, and that strategies to support health services to engage whanau in B4SCs is required. However, I’d also like to see a review of those two steps beyond ‘diagnosis’, i.e. appropriate referral to investigate and manage issues. Anecdotally, parents tell me that their concerns were often raised before or at the B4SC, but not actioned until much later.
Reference: BMJ Open 2019;9:e025535
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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