The effectiveness of routine health examinations at 2, 6, 9 and 12 months of age: experiences based on data from a Swedish county.
OBJECTIVE
The aim of this study was to elucidate the role of health surveillance for infants during the first year of life in detecting severe health problems. Two central questions were addressed: (1) what health problems were detected by routine health examinations at the Child Health Centre at the 2-, 6- and 12-month check-ups by a physician and at the 9-month check-up by a nurse; and (2) to what extent did the health examinations contribute to early identification of children with following key abnormalities: congenital heart disease, congenital dislocation of the hip, abnormalities as registered at the habilitation centre and severe hearing impairments? MATERIAL AND INCLUSION CRITERIA: The study population included all children in Uppsala county, born January 1995 to October 1996, who had participated in at least one of the four health check-ups. There were 3107-3487 children in the respective check-ups.


METHODS
Data from a county health register as well as child health records and information regarding referrals were analysed to categorize the health problems by type, severity and action taken. Data on children with key abnormalities were obtained from specialist units.


RESULTS
The rate of suspected new health problems varied between 1.9% and 2.8% at the respective check-ups. Of the new problems detected by the physician, 21%-36% were false-positive, 34%-44% were minor and 10%-15% were moderate. Only two severe health problems were detected among all the children during the four check-ups. Of all key abnormalities, 20% were detected by way of child health surveillance during the first year of life.


CONCLUSIONS
Severe health problems and key abnormalities in infants were detected only to a limited extent through routine health examinations at 2, 6, 9 and 12 months of age. The minor and moderate problems detected justify a health surveillance programme, but the organization and content of the programme could be reconsidered.
Department of Women's and Children's Health, Section for Paediatrics, Uppsala University, Childrens' Hospital, Uppsala, Sweden. margaretha.magnusson@pediatrik.uu.se
M
M
Magnusson
K
K
Persson
C
C
Sundelin
D002662:Child Health Services / Q000458:organization & administration*; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000517:prevention & control*; D002658:Developmental Disabilities / Q000453:epidemiology / Q000517:prevention & control*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D010808:Physical Examination; D011159:Population Surveillance / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology