Referrals and Determinant Factors of a National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old

Abstract

In this extensive study examining the health of 7184 school children aged 3 to 12 in 27 Lebanese schools, screenings involved medical evaluation and interviews, complemented by phone interviews with 3880 parents. Notably, one in two students received a medical referral, revealing prevalent issues such as dental cavities (33%), under-vaccination (25%), undetected vision problems (13%), abnormal growth (6%), underweight (27%), and overweight (33%). Additional concerns encompassed abnormal vital signs (3%), abuse signs (0.6%), infectious skin lesions (1.6%), scoliosis (1.7%), abnormal auscultation (heart 1.1%, lungs 1.2%), ear problems (3.3%), precocious puberty (0.7%), and neurologic signs (0.6%). Mental health challenges affected 20–25% of students. Public schools and Beirut exhibited higher referral rates, with girls, older children, overweight students, those lacking regular pediatrician visits, and children of self-employed or less educated parents facing elevated referral rates. In contrast, children of healthcare workers experienced fewer referrals. Against this backdrop, the study emphasizes the imperative for targeted health initiatives, particularly in marginalized areas and for socioeconomically disadvantaged students. Priority areas include dental care, weight issues, mental health, vaccination compliance, and addressing vision problems to enhance learning outcomes.

A National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old: Concordance Level between Parents’ Reports and Medical Visit Findings about Physical and Mental Health

“…This result confirms the accuracy of our findings', as the low kappa accurately reflects the actual discordance between medical findings and parental reports. Importantly, its fair prevalence of 26% [27] in our population supports the reliability of using the kappa in this context.…”

“…However, for items categorized as very extreme and extreme mismatch, the observed very low kappa values align with our expectations, as these low values signify "no" to "slight" agreement, with the latter indicating and supporting the high mismatch percentages. The reliability of the kappa in this context is supported by the presence of these diseases or concerns in a fair percentage within our population [27]. For example, consider the item "sadness and stress", which is classified as very extreme mismatch.…”

“…This could elucidate the observed low kappa values for items categorized as mild and moderate mismatch, despite having high agreement. This discrepancy may be attributed to the low prevalence of certain conditions, for instance, infectious skin lesions were only reported in 1.6% of children and posture problems in 2.2% of children (as reported in the first article of our research project by Habchy et al [27]). Due to the limited occurrence of these items, the reliability of the kappa in accurately reflecting agreement is reduced, highlighting the significance of taking prevalence into account when interpreting kappa values.…”