Preventive Health Care For Young Children In Bulgaria

Abstract

Introduction: The 2000 reform created new conditions for the development of child health care. Children's consultation is now mainly the activity of GPs, providing also the opportunity for a specialist paediatrician. Children's development is monitored under the Child Health Programme Vaccinations are carried out by the child's GP without the involvement of a paediatrician.

Aim: To evaluate preventive care for young children through the eyes of mothers

Material and methods: A survey was conducted between November 2019 and June 2021 among mothers of young children to assess their relationship with the health service regarding their children's health. Mothers were selected on a nested basis from three districts in southern Bulgaria - Stara Zagora, Burgas and Kardzhali. 250 mothers were invited, of which 202 responded (80.8% response rate). A 35-question questionnaire was used to conduct the survey in the same nests in 2014 (242 mothers). The two surveys are conventionally designated I-14, conducted in 2014, and I-21, conducted in 2019-2021. A comparison was made between I-14 and I-21 as two independent samples.SPSS v. 25.0 software was used for statistical processing and data analysis.

Results and Discussion: According to the mothers, 88.12% of the children were followed up in child consultation and 11.88% were not covered.

Regarding the distribution of responses by "education", "ethnicity" and "residence", the results were as follows: by "education" p<0.012; by "ethnicity" p<0.008 and by "residence" p<0.014. The comparative analysis reveals that the number of children not covered by the children's consultation increased 3.6 times during the study period. GPs had the highest proportion of 61.69% in child monitoring compared to paediatricians 31.84%.

Conclusion: There is inequity in access to pediatricians in preventive care in early childhood. There is a trend towards a decrease in the relative proportion of specialist care. Nurse involvement, both alone and in a team with a doctor, is minimised.