Developmental dysplasia of the hip (DDH) is a preventable condition when detected early through ultrasound screening. Although universal and free DDH screening is available in Turkey, adherence to screening programs may differ between population groups. This study aimed to investigate factors associated with missed opportunities for DDH ultrasound screening among Turkish and refugee infants. This single-center, hospital-based retrospective cohort study was conducted between August 10, 2020, and September 30, 2022. The main cohort included 9020 infants (5466 Turkish and 3554 refugee). A nested sub-cohort was formed comprising infants who had not undergone DDH screening at our institution. Parents of infants in the sub-cohort (120 Turkish and 80 refugee infants) were interviewed via structured telephone calls to determine reasons for missed screening. Univariate and multivariate generalized linear models were used to identify factors associated with missed screening opportunities. The rate of missed DDH screening was 15.8% among Turkish infants and 40.0% among refugee infants. The most common reason for nonattendance was lack of awareness of the screening program, reported by 47.4% of Turkish and 84.4% of refugee parents. In univariate analyses, maternal nationality, parental education level, birth order, and delayed or skipped vaccination were associated with missed screening. In the multivariate model, refugee status remained the only independent predictor of missed screening (adjusted relative risk: 2.41; P = .010). Despite unrestricted and free access to healthcare services in Turkey, refugee infants were more than twice as likely to miss DDH screening compared with Turkish infants. Missed screening was primarily driven by lack of awareness rather than structural barriers. Targeted educational interventions and culturally tailored strategies are needed to improve screening adherence among refugee populations.
Pekince et al. (Fri,) studied this question.