Child health surveillance. Surveillance of the child under 5.

1. General health checks should be made at the following times as outlined in these guidelines: Initial neonatal assessment 7-10 day check, 6-week check, 7-9 months: general examination with particular attention to hearing and vision, 18-24 months: check with special attention to gait, speech and understanding, 36-42 months: general examination and developmental assessment, 2. Parental concern over a child''s special senses should be carefully followed up and investigated. 3. Immunization schedules are as follows: 0-2 months: Neonatal BCG (variable depending upon local public health policy and countries of origin of local residents) 2 months: 1st diphtheria, tetanus, pertussis (DTP) and polio, Hib 3 months: 2nd DTP and polio, Hib 4 months: 3rd DTP and polio, Hib 12-18 months: MMR 4 years: Preschool DT and polio There are very few contra-indications. 4. Failure to thrive may be caused by infection, a metabolic problem or emotional factors. It is most commonly revealed by: poor weight gain over a period of time rapid weight loss. These guidelines are in two parts. The first part outlines a programme of surveillance which we hope all general practitioners will find helpful. The second part is more applicable to practices which organize their own child health clinics.     

Cooperation or conflict over child health surveillance? Views of key actors.

OBJECTIVE--To describe the views of general practitioners, health visitors, and clinical medical officers on child health surveillance, recent changes, perceptions of each other's roles, and attitudes to audit. DESIGN--Postal questionnaire survey. SETTING--Three health districts in North West Thames health region. SUBJECTS--All 602 general practitioners, 272 health visitors, and 42 clinical medical officers in these districts. MAIN MEASURES--Attitudes to and perceptions of child health surveillance and audit. Questionnaires were completed by 440 general practitioners (response rate 73%), 164 health visitors (60%), and 39 clinical medical officers (93%). RESULTS--Attitudes to child health surveillance were less positive among general practitioners than health visitors or clinical medical officers. Few respondents agreed that child health surveillance was a cost effective use of general practitioners' time (general practitioners 28%, 113/407; health visitors 28%, 40/145; clinical medical officers 39%, 15/39) and most thought that health visitors should carry out more of the doctors' examinations (68%, 262/387; 65%, 89/136; 66%, 25/38). General practitioners thought that clinical medical officers were less supportive than other relevant groups of their doing more child health surveillance. Most (72%, 105/146) health visitors thought that the 1990 contract had reduced parental choice of where to attend for child health surveillance. General practitioners were less enthusiastic than health visitors about most forms of clinical audit. CONCLUSIONS--Despite reservations about the impact of recent changes all groups were willing to explore innovative ways of delivering child health surveillance. IMPLICATIONS--There is scope for health visitors to increase their responsibilities and for more varied relationships between general practitioners and community child health doctors.     

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

Changes in the role of general practitioners in child health surveillance

Background: Changes in their Contract in 1990 gave general practitioners the opportunity to become more involved in child health surveillance. This study aimed to describe and compare child health surveillance services provided by general practitioners before and after the changes of the 1990 GP contract.Methods: A questionnaire was sent to all general practices within the Nottingham Health Authority area in 1990, and this process was repeated in 1994, ascertaining the services provided for child health surveillance. Outcome measures were: the reported provision of services, keeping of records and facilities for following up non-attenders. Also recorded were the training and qualifications of general practitioners and their attitudes towards child health surveillance.Results: Response rates were 62% in 1990 and 80% in 1994. More practices were involved in the provision of child health surveillance services in 1994, more held a baby clinic and more reported having a recall system for non-attenders. There was little change in the training or qualifications of GPs in child health between 1990 and 1994. In 1994, there was evidence of GPs meeting regularly with Health Visitors. There remained a small number of practices who were not interested in child health surveillance.Conclusion: The 1990 GP contract appears to have increased the provision of child health surveillance services by GPs and improved liaison with Health Visitors in general practice.     

Environmental public health surveillance.

A holistic and collaborative approach needs to be taken in the development of environmental public health surveillance systems. Exposure and hazard surveillance integrated with outcome-based surveillance will blend fragmented strands of data into streams of information. Adequate resources and strong leadership are essential to the creation of such surveillance systems.     

中国妇幼卫生监测信息系统的应用效果评价

目的:了解中国妇幼卫生监测数据网络直报系统(包括中国妇幼卫生监测网站)的应用效果,为进一步完善国家级妇幼卫生监测体系提供参考。方法:采用自填式问卷调查540个妇幼卫生监测机构对直报系统的使用效果、信息安全现状的意见和改进建议,按照监测机构的行政级别(省、地市和区县)和所处地区(东、中、西部)分类分析资料。结果:接受调查的单位中,认为直报系统对日常工作和决策有支持作用,能提高工作效率,降低人力成本和物资成本的单位分别占95.5%、90.1%、85.5%和84.9%;直报系统提高工作效率的作用在不同级别的单位间存在差别;降低物资成本的作用则有地区差别;降低人力成本的作用同时存在明显的地区差别和级别差别。认为系统安全性较好的单位占58.5%。结论:现有妇幼卫生监测数据直报系统对规范监测、提高工作效率有积极作用,需要增加投入,完善系统功能,提高系统的可靠性、易操作性和安全性,最终提高系统的实际应用效果。     

Public health surveillance of fatal child maltreatment: analysis of 3 state programs

Objectives. We sought to describe approaches to surveillance of fatal child maltreatment and to identify options for improving case ascertainment.Methods. Three states—California, Michigan, and Rhode Island—used multiple data sources for surveillance. Potential cases were identified, operational definitions were applied, and the number of maltreatment deaths was determined.Results. These programs identified 258 maltreatment deaths in California, 192 in Michigan, and 60 in Rhode Island. Corresponding maltreatment fatality rates ranged from 2.5 per 100000 population in Michigan to 8.8 in Rhode Island. Most deaths were identified by child death review teams in Rhode Island (98%), Uniform Crime Reports in California (56%), and child welfare agency data in Michigan (44%). Compared with the total number of cases identified, child welfare agency (the official source for maltreatment reports) and death certificate data underascertain child maltreatment deaths by 55% to 76% and 80% to 90%, respectively. In all 3 states, more than 90% of cases ascertained could be identified by combining 2 data sources.Conclusions. No single data source was adequate for thorough surveillance of fatal child maltreatment, but combining just 2 sources substantially increased case ascertainment. The child death review team process may be the most promising surveillance approach.Child maltreatment causes a significant number of fatalities in the United States, and accurately determining the number of maltreatment-related deaths each year remains a challenge. With data from child protective services agencies, the National Child Abuse and Neglect Data System estimated there were nearly 1500 child abuse–related or neglect-related deaths in 2004 (2.0 per 100 000 children).1 However, child protective services data are known to underestimate maltreatment deaths for a variety of reasons including difficulties identifying, investigating, and reporting deaths to child protective services; lack of standard definitions of child maltreatment; and differing legal standards for substantiation of maltreatment.2^,3In the United States, a death certificate is the official record of death. Death certificates include a determination of the cause and manner of death and are often used to summarize the mortality burden of injuries and diseases. It is, however, well documented that these vital records underestimate the magnitude of fatal child maltreatment.3^–6 In fact, 50% to 60% of all child maltreatment deaths are not identified as such by death certificates,3^,5^,6 with 1 report estimating that 85% of deaths related to child maltreatment are recorded on the death certificate as attributable to other causes.7The combination of data from multiple sources to obtain more accurate identification of individuals with the condition under surveillance (i.e., case ascertainment) has enhanced public health surveillance of injuries and violence8^–11 and has shown promise as a method for obtaining more accurate estimates of mortality related to child maltreatment.3^,6 In September 2001, the Centers for Disease Control and Prevention (CDC) funded programs in 3 states—California, Michigan, and Rhode Island—to develop and evaluate public health surveillance of fatal child maltreatment through the use of multiple data sources for case ascertainment. We describe the approaches taken in these programs and summarize the epidemiology of fatal child maltreatment. Because underascertainment of fatal child maltreatment by both child protective services and death certificate data are well documented, we focused on the relative utility of additional data sources available for surveillance and explored various options for improving case ascertainment. Four of the authors took part in the state programs (T. M. C. and V. J. P. in Michigan, S. J. W. in California, and W. V-O. in Rhode Island). By summarizing options for surveillance based on their experiences, we hope to provide useful information to other states interested in establishing surveillance for fatal child maltreatment.     

Public health surveillance in child-care settings.

To investigate the potential contribution of public health surveillance systems to the health of children and workers in out-of-home child-care settings, we review existing public health surveillance practice in the United States. We identify issues that are of particular concern for surveillance in child-care settings. We propose a framework for developing public health surveillance systems that uses sentinel child-care sites, notifiable disease surveillance, modification of existing surveillance systems, and population surveys. Successful surveillance in these settings depends on the active participation of child-care providers, public health practitioners, and clinicians in (a) the selection of high priority diseases and injuries for surveillance; (b) the development of practical case definitions; (c) the augmentation of current surveillance systems to include disease and injury related to child care; and (d) the implementation, assessment, dissemination, and evaluation of new approaches for surveillance in child-care settings.     

Validation of the Warwick Child Health and Morbidity profile in routine child health surveillance

OBJECTIVE: To further validate a simple instrument for the measurement of parent-reported health and morbidity in infancy and childhood when used in routine child health surveillance as part of a whole year birth cohort study. Setting The socially and ethnically diverse city of Coventry. METHODS: Health visitors administered the Warwick Child Health and Morbidity profile (WCHMP), incorporated into the Parent Held Record (PHR), to the parents of infants born in 1996 and enrolled in the Coventry Cohort study as part of routine child health surveillance at 8 weeks and 8 months. Criterion validity was estimated for Hospital admission status and immunization status against health records and validity against medically plausible constructs was tested by comparing responses between domains and between the two data collection points for the whole cohort. RESULTS: Criterion validity for parental reporting of immunization status (Kappa 0.824 [95% CIs, 0.708, 0.940]) and hospital admission (Weighted Kappa 0.987 [95% CIs, 0.977, 0.997]) were high. There was a high level of concordance between parental responses to related domains and the medically plausible constructs. The proportion of parents reporting chronic illness, acute significant illness, chronic illness and accidents increased as expected between 8 weeks and 8 months. As expected, adverse outcomes at 8 weeks were associated with an increased risk of the same outcomes at 8 months. CONCLUSIONS: The WCHMP is a simple measure of parent-reported health and illness which was shown to be reliable and valid with low inter-observer variation on initial field-testing. Further validation of the WCHMP, incorporated into the PHR, in a routine child health surveillance programme demonstrates its suitability for use in infancy to collect cross-sectional and longitudinal health and morbidity data for research and service planning purposes.