Milcent Karen, Gassama Malamine, Dufourg Marie-Noëlle, Thierry Xavier, Charles Marie-Aline, Bois Corinne
ELFE Joint Unit INED-INSERM-EFS, Paris, France.
Centre for Research in Epidemiology and Statistics (CRESS), INSERM, INRAE, Universite de Paris, Paris, France.
Front Pediatr. 2023 May 4;11:1167539. doi: 10.3389/fped.2023.1167539. eCollection 2023.
The study aims to describe the output of routine health screening performed in French nursery schools by the maternal and child health services among children aged 3-4 years and to quantify the level of early socioeconomic health disparities.
In 30 participating , data on screening for vision and hearing impairments, overweight and thinness, dental health, language, psychomotor development, and immunizations were collected for children born on specific dates in 2011 and enrolled in nursery school in 2014-2016. Information was collected on the children, their socioeconomic characteristics and on the school attended. Odds of abnormal screening results were compared for each socioeconomic factor by logistic regressions adjusted for age, sex, prematurity and bilingualism.
Among the 9,939 children screened, prevalence of disorders was 12.3% for vision, 10.9% for hearing, 10.4% for overweight, 7.3% for untreated caries, 14.2% for language and 6.6% for psychomotricity. Newly detected visual disorders were more frequent in disadvantaged areas. Children with unemployed parents were three time more likely to have untreated caries and twice as likely to present language or psychomotor impairments; 52% were referred to a health professional following screening compared to 39% of children with employed parents. Except for children in disadvantaged areas, vaccine coverage was lower among disadvantaged groups.
The prevalences of impairments, which are higher among disadvantaged children, highlight the potential preventive impact of systematic screening under the comprehensive maternal and child healthcare program. These results are important to quantify early socioeconomic inequalities in a Western country known for its generous social welfare system. A more holistic approach to child health is needed with a coherent system involving families and aligning primary care, local child health professionals, general practitioners, and specialists. Further results are needed to evaluate its impact on later child development and health.
本研究旨在描述法国托儿所中母婴健康服务机构对3至4岁儿童进行的常规健康筛查结果，并量化早期社会经济健康差距水平。
在30所参与研究的托儿所中，收集了2011年特定日期出生且于2014年至2016年入托的儿童的视力和听力障碍筛查、超重和消瘦、牙齿健康、语言、心理运动发育及免疫接种数据。收集了儿童及其社会经济特征以及所上学校的信息。通过对年龄、性别、早产和双语情况进行调整的逻辑回归，比较了各社会经济因素下筛查结果异常的几率。
在9939名接受筛查的儿童中，视力障碍患病率为12.3%，听力障碍为10.9%，超重为10.4%，未经治疗的龋齿为7.3%，语言障碍为14.2%，心理运动障碍为6.6%。新发现的视力障碍在贫困地区更为常见。父母失业的儿童患未经治疗龋齿的可能性是其他儿童的三倍，出现语言或心理运动障碍的可能性是其他儿童的两倍；筛查后，52%的此类儿童被转诊至健康专业人员处，而父母有工作 的儿童这一比例为39%。除贫困地区儿童外，弱势群体的疫苗接种率较低。
贫困儿童中障碍患病率较高，这凸显了在全面母婴保健计划下进行系统筛查的潜在预防作用。这些结果对于在一个以慷慨社会福利体系著称的西方国家量化早期社会经济不平等具有重要意义。需要采取更全面的儿童健康方法，建立一个包括家庭并整合初级保健、当地儿童健康专业人员、全科医生和专科医生的连贯体系。还需要进一步的结果来评估其对儿童后期发育和健康的影响。
