Eesti eelkooliealiste laste terviseseisund ja tervisekäitumine sünnist kuni 7aastaseks saamiseni 2010. aasta sünnikohordi põhjal Eesti Haigekassa raviarvete alusel
Abstract
Eelkooliealiste laste tervist kajastavaid uuringuid on Eestis võrreldes teiste riikidega vähe tehtud. Uuringuid, mis vaatleksid eelkooliealiste laste tervist ja tervisekäitumist kogu nende eelkooliea jooksul, ei ole Eestis teadaolevalt üldse läbi viidud. Sellised uuringud on harvad ka mujal riikides. Samas pakuvad rutiinselt kogutavad registripõhised terviseandmed selleks head võimalust.Käesolevas töös analüüsiti Eesti Haigekassale perearstide, eriarstide ja hambaarstide poolt esitatud raviarveid (n=991568) kõigi 2010. aastal sündinud laste kohta (n=16417), kes Eestis perioodil 2010–2017 tervishoiuteenuseid tarbisid. Töö eesmärk oli anda raviarvete põhjal ülevaade, kui sageli ja millistel põhjustel tervishoiuteenuse osutajate poole pöörduti, kui suure osaga lastest käidi laste ennetava tervisekontrolli ajakavas ette nähtud profülaktilistes tervisekontrollides perearsti, hambaarsti ja silmaarsti juures, kui suurel osal lastest viidi immuniseerimiskavas ette nähtud vaktsineerimised lõpuni ja milline oli koolimineva lapse tervislik seisund.Töö tulemused näitavad, et raviarvete põhjal oli perearstiabiga seotud umbes 60% eelkooliealiste laste ravijuhtudest, ülejäänud 40% ravijuhtudest oli seotud eriarstiabiga. Poistel esines tüdrukutest rohkem psüühika- ja käitumishäireid ning vigastusi, tüdrukutel aga rohkem kuse-suguelundite haigusi. Perearstiabisse pöörduti kõige rohkem alla aastaste lastega, kusjuures profülaktilised tervisekontrollid moodustasid sel perioodil poole kõigist pöördumistest. Sellele vaatamata ei tehtud raviarvete põhjal perearsti poolt esimesel eluaastal suurele osale lastest ette nähtud vereanalüüsi. Koduvisiite tehti esimesel eluaastal vähem kui pooltele lastest, esines regionaalseid erinevusi nende läbiviimises. Raviarvete põhjal käidi järjepidevalt profülaktilistes tervisekontrollides väheste lastega – vaid umbes 2% lastega tehti seda ette nähtud sagedusega. Kõige rohkem oli lapsi, kellega käidi perearsti kvaliteedisüsteemis hinnatavates tervisekontrollides, aga kellel puudusid raviarvete põhjal üks või mitu profülaktilist tervisekontrolli 18. kuu, 3, 4 ja 5 aasta vanuses. Esimene hambaarsti külastus toimus hilja – veidi enne 4aastaseks saamist, hambaarstile pöördumise osas esines regionaalset erinevust. Silmaarsti poole profülaktilisele läbivaatusele pöörduti raviarvete põhjal umbes poolte lastega, samas silmade või nägemisega seotud häireid esines peaaegu viiendikul kõigist lastest. Immuniseerimiskava täitmise osas on oht, et kõiki lapsi ei vaktsineerita riikliku immuniseerimiskava kohaselt. Paljudel lastel võib olla vaktsineerimine jäänud õigeaegselt lõpule viimata – vaid ligi 40% 7aastaste laste puhul sai raviarvete alusel kindlalt väita, et neile olid kõik immuniseerimiskavas ette nähtud vaktsiinid manustatud. Kõige sagedamini puudusid raviarved IPV-DTPa teise kordusvaktsineerimise kohta (poliomüeliidi, difteeria, teetanuse ja läkaköha vastu vaktsineerimine 6–7 aasta vanuses). Kooliminevate laste peamised terviseprobleemid olid seotud allergiate, psüühika- ja käitumishäirete ning nägemishäiretega.
There has been little research on the health of pre-school children in Estonia compared to other countries. To the best of author’s knowledge, no studies have been conducted in Estonia about the health and health behaviour of pre-school children throughout their pre-school years. Such studies are rare also in other countries. At the same time, routinely collected registry-based health data provide a great opportunity to investigate children´s health.This study analysed the insurance claims submitted to Estonian Health Insurance Fund by family doctors, medical specialists and dentists (n = 991568) for all children born in 2010 (n = 16417) who used health care services in Estonia in 2010–2017. The aim of the study was to give an overview of how often and for which reasons health care providers were contacted; how many children had regular check-ups with family doctor, dentist and ophthalmologist; how many children completed the immunizations according to the national immunization schedule; and what was the health status of the children starting school.The results of the study showed that approximately 60% of treatment cases of pre-school children were related to primary healthcare. Boys had more mental and behavioural disorders and injuries, while girls had more urinary tract disorders. Primary healthcare was most often addressed with children under the age of one - during this period preventive health examinations made up half of all referrals. However, many children were not tested to detect iron deficiency anaemia in their first year of life as required. Home visits were made for less than half of the children in their first year of life and regional differences occurred. Only 2% of children had regular health checks consistently with prescribed frequency. Regular check-ups on the 18th month, 3rd, 4th and 5th year were missed most often. The first visit to the dentist took place quite late - a little before the age of 4, and regional differences were observed. Based on insurance claims, approximately half of the children had preventive ophthalmic examination, while eye and vision disorders occurred in almost one-fifth of all children.There is a risk that the immunization schedule is not completed timely for many children - only about 40% of 7-year-old children had all the vaccines according to the immunization schedule. Most often the IPV-DTPa-Hib re-vaccinations were not completed on time. The main health problems of children starting school were related to allergies, mental and behavioural disorders and vision disorders.
There has been little research on the health of pre-school children in Estonia compared to other countries. To the best of author’s knowledge, no studies have been conducted in Estonia about the health and health behaviour of pre-school children throughout their pre-school years. Such studies are rare also in other countries. At the same time, routinely collected registry-based health data provide a great opportunity to investigate children´s health.This study analysed the insurance claims submitted to Estonian Health Insurance Fund by family doctors, medical specialists and dentists (n = 991568) for all children born in 2010 (n = 16417) who used health care services in Estonia in 2010–2017. The aim of the study was to give an overview of how often and for which reasons health care providers were contacted; how many children had regular check-ups with family doctor, dentist and ophthalmologist; how many children completed the immunizations according to the national immunization schedule; and what was the health status of the children starting school.The results of the study showed that approximately 60% of treatment cases of pre-school children were related to primary healthcare. Boys had more mental and behavioural disorders and injuries, while girls had more urinary tract disorders. Primary healthcare was most often addressed with children under the age of one - during this period preventive health examinations made up half of all referrals. However, many children were not tested to detect iron deficiency anaemia in their first year of life as required. Home visits were made for less than half of the children in their first year of life and regional differences occurred. Only 2% of children had regular health checks consistently with prescribed frequency. Regular check-ups on the 18th month, 3rd, 4th and 5th year were missed most often. The first visit to the dentist took place quite late - a little before the age of 4, and regional differences were observed. Based on insurance claims, approximately half of the children had preventive ophthalmic examination, while eye and vision disorders occurred in almost one-fifth of all children.There is a risk that the immunization schedule is not completed timely for many children - only about 40% of 7-year-old children had all the vaccines according to the immunization schedule. Most often the IPV-DTPa-Hib re-vaccinations were not completed on time. The main health problems of children starting school were related to allergies, mental and behavioural disorders and vision disorders.